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HomeMy WebLinkAboutCity Council Meeting - Council - Agenda - 05/16/2006 i 1 i City of Kent City Council Meeting i Agenda May 16, 2006 Mayor Suzette Cooke Deborah Ranniger, Council President Councilmembers i Tim Clark Debbie Raplee Ron Harmon Les Thomas Bob O'Brien Elizabeth Watson T KENT WASHINGTON City Clerk's Office KENT CITY COUNCIL AGENDAS KENT May 16, 2006 VJ A 5 H I N G,o N Council Chambers MAYOR Suzette Cooke COUNCILMEMBERS: Deborah Ranniger, President Tim Clark Ron Harmon Bob O'Brien Debbie Raplee Les Thomas Elizabeth Watson COUNCIL WORKSHOP AGENDA 5:30 p.m. Item Description Speaker Time 1. Strategic Goals and Targets John Hodgson 40 min 2. Fees and Charges Ordinance Bob Nachlinger 20 min COUNCIL MEETING AGENDA 7:00 p.m. j 1. CALL TO ORDER/FLAG SALUTE 2. ROLL CALL 3. CHANGES TO AGENDA A. FROM COUNCIL, ADMINISTRATION, OR STAFF B. FROM THE PUBLIC— Citizens may request that an item be added to the agenda at this time. Please stand or raise your hand to be recognized by the Mayor. 4. PUBLIC COMMUNICATIONS A. Public Recognition B Community Events C. Kent Youth Board Presentation r E Economic Development Report 5. PUBLIC HEARINGS None 6. CONSENT CALENDAR A. Minutes of Previous Meeting—Approve B. Payment of Bills—Approve C. 2006 Premera Blue Cross Contract—Authorize D. 2006 Group Health Contract—Authorize E Public Records Ordinance—Adopt (Continued) COUNCIL MEETING AGENDA CONTINUED F. Affidavit of Correction for Flower Court Final Plat—Authorize G. Water Resource Inventory Area (WRIA) 8 Interlocal Agreement Extension— Authorize H. Signal Maintenance Shop Lease Agreement—Authorize 1. South Ridge Estates Bill of Sale —Accept J. South Ridge Estates Bill of Sale Addendum—Accept K. Brookside Court Bill of Sale— Accept L. Pediatric Interim Care Center Bill of Sale—Accept M. Larcher Office Building Bill of Sale—Accept N. Gray Hill Bill of Sale—Accept O. Burkhardt Heights Bill of Sale—Accept 7 OTHER BUSINESS •l " A. Aerial Fireworks Prohibition Ordinance—Adopt B. Critical Areas Ordinances 1 8. BIDS A. Service Club Ballfields Restroom and Concession Building 9. REPORTS FROM STANDING COMMITTEES, STAFF AND SPECIAL COMMITTEES 10. CONTINUED COMMUNICATIONS 11. EXECUTIVE SESSION AND AFTER EXECUTIVE SESSION A. Potential Litigation 7 B__ Property Negotiation 12. ADJOURNMENT i i NOTE- A copy of the full agenda packet is available for perusal in the City Clerk's Office and the Kent Library The Agenda Summary page and complete packet are on the City of Kent web site at www.ci.kent.wa us. An explanation of the agenda format is given on the back of this page Any person requiring a disability accommodation should contact the City Clerk's Office in advance at (253) 856-5725. For TDD relay service call the Washington Telecommunications Relay Service at1-800-833-6388. 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A) FROM COUNCIL, ADMINISTRATION, OR STAFF B) FROM THE PUBLIC PUBLIC COMMUNICATIONS A) PUBLIC RECOGNITION B) COMMUNITY EVENTS C) KENT YOUTH BOARD PRESENTATION (.aw DU D UP P NTATION i E) ECONOMIC DEVELOPMENT REPORT CONSENT CALENDAR 6. Citv Council Action. - (� Councilmember moves, Councilmember seconds to approve Conse Calendar Items A through O Discussion KA G Action 6A. Approval of Minutes. Approval of the minutes of the regular Council meeting of May 2, 2006. 6B. Approval of Rills. Approval of payment of the bills received through March 31 and paid on March 31 after auditing by the Operations Committee on May 2, 2006. Approval of checks issued for vouchers- Date Check Numbers Amount 3/31/06 Wire Transfers 2381-2395 $1,574,898 52 3/31/06 Prepays & 591510 L253,735 64 3/31/06 Regular 592219 2,333,05157 Use Tax Payable 3,281 54 $5,164,967.27 Approval of payment of the bills received through April 15 and paid on April 15 after auditing by the Operations Committee on May 2, 2006. Approval of checks issued for vouchers: Date Check Numbers Amount 4/15/06 Wire Transfers 2396-2412 $1,464,671.31 4/15/06 Regular 592220-592729 1,749,413 55 Use Tax Payable 1,636.74 $3,215,721.60 (Continued on Back) t 6B. Approval of Bills. (Continued) Approval of payment of the bills received through April 30 and paid on April 30 after auditing by the Operations Committee on May 2, 2006. Approval of checks issued for vouchers: ' Date Check Numbers Amount 4/30/06 Wire Transfers 2413-2428 $11863,608 43 4/30/06 Regular 592730-593351 6,150,318 47 Use Tax Payable 2,495.68 $8,016,422.58 Approval of checks issued for payroll for March 16 through March 31 and paid on April 5, 2006. Date Check Numbers Amount 4/5/06 Checks 289828-290098 $ 218,869.13 4/5/06 Advices 194441-195129 1,288,340 80 Total of Regular Payroll $11507,209 93 Approval of checks issued for payroll for April 1 through April 15 and paid on April 15, 2006: Date Check Numbers Amount 4/12/06 Interim Check 290099 $ 115.05 4/15/06 Checks 290100-290369 198,38612 4/15/06 Advices 195130-195818 1,264,240.92 Total of Regular Payroll $1,462,527.04 Council Agenda Item No. 6 A-B t Z�• Kent City Council Meeting K N T May 2, 2006 WASHINGTON The regular meeting of the Kent City Council was called to order at 7:00 p.m. by Mayor Cooke. Councilmembers present: Clark, Harmon, O'Brien, Ranmger, Raplee, Thomas and Watson. (CFN-198) CHANGES TO THE AGENDA A. From Council, Administration, or Staff. (CFN-198&961) Hodgson asked that the Critical Areas Ordinance be added as Other Business Item B, and it was so ordered PUBLIC COMMUNICATIONS A. 2006 Legislative Wrap Up. (CFN-198) Senator Karen Keiser gave an update on discussions and actions taken during the recent Legislative session, including medical malpractice, equal rights, pandemic flu, health care, and renewable fuel issues B. Public Recognition. (CFN-155) Mayor Cooke presented the City Clerk with a proclamation declaring April 30—May 6, 2006 as Municipal Clerks Week. The Mayor introduced Karen Kirkmeyer-Wilson of the United States Postal Service, who spoke about the Letter Carriers Food Drive Day on May 13`h, and accepted a proclamation from the Mayor. Mayor Cooke and Interim Chief Administrative Officer Hodgson displayed a scroll which was given to the City of Kent by delegates from Kent's Sister City Yangzhou, China, to be hung in City Halt. C. Community Events. (CFN-198) Hodgson noted that there will be a Cmco de Mayo celebration on Sunday, May 7` , at the Park and Ride Lot on Lincoln Avenue. jD. Poster Design Contest Awards. (CFN-122) Cesi Velez of the Police Department announced the winners of the Drinking Driver Task Force Poster Design Contest, and certificates were presented to them. E. Employee of the Month. (CFN-147) Employee of the Month Chris Hankins of the Planning Services Division of Community Development was introduced and commended for his good work ethic, helpfulness, and attitude. He received an Employee of the Month plaque from Mayor Cooke. F. Introduction of Appointees. (CFN-122&839) Mayor Cooke introduced Mary Lou Becvar and Pamela Roberts, her appointees to the Drinking Driver Task Force, and Tonya Wongvanich and Jack Becvar, her appointees to the Arts Commission. CONSENT CALENDAR RANNIGER MOVED to approve Consent Calendar Items A through U Clark seconded and the motion carved. A. _Approval of Minutes. (CFN-198) The minutes of the regular Council meeting of April 18, 2006 were approved. 1 Kent City Council Minutes May 2, 2006 B Approval of Bills. (CFN-104) Bills were not available for approval C Highland Park Bill of Sale. (CFN-484) The Bill of Sale from Highland Park for 7 samtary sewer manholes, 1,271 linear feet of PVC sewer line, 584 centerline linear feet of asphalt roadway, 3 storm manholes, 11 catch basins, 52,600 cubic feet of detention pond storage, and 1,198 linear feet of PVC sewer line was accepted D. Garrison Greens Bill of Sale. (CFN-484) The Bill of Sale from Garrison Greens for 8 gate valves, 3 hydrants, 983 linear feet of waterline, 12 sanitary sewer manholes, 2,735 linear feet of SDR-35 sewer line, 1,035 centerline linear feet of asphalt roadway, 4 storm manholes, 12 catch basins, 50 linear feet of biofiltration swale, 52,800 cubic feet of detention pond storage, and 2,690 linear feet of SDR-21/D.I CL 52 sewer line was accepted E. Benson Storage Bill of Sale. (CFN-484) The Bill of Sale from Benson Storage for 3 gate valves, 1 hydrant, and 319 linear feet of waterline was accepted. F. Laurel Court Bill of Sale. (CFN-484) The Bill of Sale from Laurel Court for 1 blow-off assembly, 10 fittings, 1 hydrant, 509 linear feet of D.I. waterline, 4 sanitary sewer manholes, and 337 linear feet of PVC sewer line was accepted G. Kent East Hill Operations Center Agreement. (CFN-239) The Mayor was authorized to sign the Consultant Services Agreement with Wagner Architects Planners for Phase I of the Kent East Hill Operations Center located at 5821 South 240th Street in the amount of S216,165 H. Washington Traffic Safety Commission "Click It Or Ticket" Grant. (CFN-122) The Kent Police Department was authorized to apply for a Washington Traffic Safety Commission"Click It or Ticket" Grant. I. Division of Alcohol and Substance Abuse RUaD Contract Amendment. (CFN-122) The Reduce Underage Drinking Contract Amendment for additional funds in the amount of$3,500, was accepted. J. United Way of King County"Soar" Grant. (CFN-122) The Kent Drinking Driver Task Force award, a"SOAR" mini-grant in the amount of$1,500 was accepted. K. Washington Traffic Safetv Commission Mini Grant (Seatbelt Education). (CFN-122) The Kent Drinking Driver Task Force award, a mini-grant from the Washington Traffic Safety Commission (WTSC) in the amount of$799 was accepted. The funds will be used to implement a seat belt education campaign L. Washington State Safety Restraint Coalition Grant. (CFN-122) The Kent Drinking Driver Task Force award, a mini-grant from the Washington State Safety Restraint Coalition in the amount of$800 to purchase flashing safety lights was accepted. M. Washington Traffic Safety Commission Mini-Grant(LCD Projector). (CFN-122) The Kent Drinking Driver Task Force award, a WTSC mini-grant in the amount of$799 to purchase an LCD projector was accepted. 2 Kent City Council Minutes May 2, 2006 N Community Block Grant Annual Action Plan Amendment. (CFN-118) The proposed amendment to the 2005 Community Development Block Grant Annual Action Plan, including funding allocations was approved Funds originally allocated to HomeSight's First Homes Program through the City's 2005 Community Development Block Grant(CDBG) Annual Action Plan were withdrawn because of service delivery issues In addition, the City did not use the full 20% of its CDBG allocation to administer the CDBG program These two events led to the recapture of approximately $140,000 in 2005 CDBG funds. A public hearing was held on April 13, 2006 Reallocation of recapture funds would go to the following programs • Award $80,000 to The Alliance Center, a One-Stop Human Service Center. • Award approximately $35,000 to Kent Home Repair Program. • Award $15,000 to Green River Community College, Micro-enterprise Development. • Award$10,000 to Washington CASH, City of Kent Micro-enterprise Initiative O King Conservation District Grant for Glenn Nelson Park. (CFN-118) The King Conservation District Number 9 Grant of$5,320 to fund the Glenn Nelson Park Urban Forestry Report was accepted, and the expenditure of funds in the Urban Forestry budget was approved P. King Conservation District Grant for Clark Lake Inlet. (CFN-118) The King Conservation District Number 9 Grant of$8,581 61 to fund the Clark Lake Inlet Project was accepted, and the expenditure of funds in the Native Plant budget was approved. IQ. First Quarter Development Fees. (CFN-118) The development fees from Rykles and Sharp LLC in the amount of S8,550 was accepted and the expenditure of funds in the Turnkey Park budget was approved. R. Town Square Plaza Master Plan. (CFN-1298) The master plan design from Portico, Inc. for Town Square Plaza was accepted. S. Drinking Driver Task Force Re-appointments. (CFN-122) The Mayor's re-appointments of I , Ms Mary Lou Becvar and Ms. Pamela Roberts to continue serving as members of the Kent Drinking Driver Task Force were confirmed Their new appointments will continue until 1/1/09. T. Tahoma Vista Final Plat. (CFN-1272) The final plat Mylar for Tahoma Vista was approved and the Mayor was authorized to sign the Mylar. U. Kent Arts Commission Appointments. (CFN-839) The Mayor's appointment of Ms Tanya Wongvamch and Mr. Jack Becvar as members of the Kent Arts Commission were confirmed Their appointments will continue until 10/31/2007. OTHER BUSINESS A. Comprehensive Plan & Zoning Amendment—Muth Amendment. (CFN-377&131) Planning Manager Charlene Anderson explained that the proposed resolution begins a process to review the 3 Kent City Council Minutes May 2, 2006 comprehensive plan to provide for a land use designation that allows for real property to be used for construction and maintenance of a regional detention facility, relocation of a reach of Johnson creek, and restoration of wetland and buffer, and that it also declares an emergency in order to address these improvements at the earliest possible time. She added that without this amendment, the current land use designation of Agricultural one unit per ten acres (A-10) does not allow for use of the real pro- perty as a regional detention facility. Anderson pointed out that amendments normally occur only once a year, but that in this case the staff would like to begin the process to review the proposed amendment outside that annual cycle. HARMON MOVED to adopt Resolution No 1720 declaring an emergency and commencing a process to revise the City's Comprehensive Plan to allow for regional storm water detention, stream relocation, and wetland restoration on certain property zones A-10 in Kent. Watson seconded and the motion carried. ADDED ITEM ' B. Critical Areas Ordinance. (CFN-961) City Attorney Brubaker explained that Council adopted the Critical Areas Ordinance on April 19, 2005, that the state has filed appeals, and that it is the opinion of the Central Puget Sound Growth Management Hearings Board that the City's actions do not comply with the Growth Management Act. He pointed out that the current ordinance is still in effect, but must be brought into compliance by October 19, 2006, after which a hearing will be held. He explained that a decision must be made as to whether to appeal the Board's decision, and that the appeal must be filed by May 19 He then explained the appeal process and noted that each level of appeal costs money and contains risk He added that the process could take as long as four years He then outlined the options available to the Council and the impacts of non-compliance. Brubaker then answered Councilmembers' questions relating to the impacts, options, compliance, risks, best available science and so forth. Paul Morford, P. O. Box 6345, Kent, urged the Council to stand on principle rather than compromise. Karen Steele, 33`d District Chair, 17837 1" Avenue South, Normandy Park, said the Council should not give in to the state Bill Dmsdale, 13700 SE 2661h, Kent, stated that property values would decrease if the ordinance were reversed Ron Mikrovich, 23208 115`h Avenue SE, Kent, urged the Council to be strong and not let the state take land Gary Young, 11624 SE 51h, Bellevue, expressed appreciation for the actions the Council has taken and urged them to appeal the decision. Tom Sharp, 24254 143`d Avenue SE, Kent, stated that the figures used are arbitrary and that the Council should consider what the city wants, and not back down to the state. Mayor Cooke announced that the Council would like to have an executive session on this issue, and that there has been no determination that action will follow. REPORTS Council President. (CFN-198) Ranniger reminded everyone of the Cinco de Mayo celebration on Sunday Public Safety Committee. (CFN-198) Thomas reported that the next meeting willl be held at 5.00 p.m on May 18. The Mayor pointed out that the ban on aerial fireworks, which was discussed by this committee, will be on the May 16`h Council agenda. 4 Kent City Council Minutes May 2, 2006 Public Works Committee. (CFN-198) Raplee noted that the next meeting will be held on May 15 at500pm Planning and Economic Development Committee. (CFN-198) Harmon stated that the committee will meet at 4-00 p.m. on May 15 and that one of the items on the agenda will be historic preservation of property. Parks and Human Services Committee. (CFN-198) Ranmger reported on the Washington Cultural Congress which she recently attended, and noted that the committee will meet at 4.00 p in. on vlay 18 Administrative Reports. (CFN-198) Hodgson reported that construction on the City Hall parking lot will begin May 8 and that parking will be available in the garage. tHe then reminded Councilmembers that in addition to the Critical Areas Ordinance, there will be discussion during the Executive Session relating to property, on which action may be taken when the regular meeting reconvenes He added that the session will take 45 minutes EXECUTIVE SESSION The meeting recessed to Executive Session at 8:50 p.m. and reconvened at 10:00 p.m. (CFN-198) ACTION AFTER EXECUTIVE SESSION Property Acquisition. (CFN-239) RANNIGER MOVED to authorize the Mayor, in lieu of eminent domain proceedings, to sign all documents necessary to purchase the Schmidt Property, one of the Naden Avenue assemblage, Parcel Number 6000000020, in an amount not to exceed $241,300 00 plus closing costs, subject to review and final approval of all terms and conditions by the City Attorney Harmon seconded and the motion carried. Critical Areas Ordinance. (CFN-961) Hodgson pointed out that the Critical Areas Ordinance was discussed in Executive Session, that no decisions were made, and that it will be brought forward at the Council meeting on May 16. ADJOURNMENT At 10.02 p.m WATSON MOVED to adjourn. Thomas seconded and the motion carried. i Brenda Jacober, CMC City Clerk 5 l Kent City Council Meeting Date May 16, 2006 Category Consent Calendar 1. SUBJECT: 2006 PREMERA BLUE CROSS CONTRACT — AUTHORIZE * 2. SUMMARY STATEMENT: Authorize the Mayor to sign the Premera Blue Cross i 2006 Administrative Services Contract The City is self-insured for this program. The 2006 contract reflects a 4% increase in administrative fees by Premera Blue Cross and is budgeted in the Health & Welfare fund. The annual cost is approximately $582,183. The projected budget for the self-funded Premera Blue Cross program including claims for 2006 is $9,800,000. 3. EXHIBITS: Premera Blue Cross 2006 Administrative Services Contract 4. RECOMMENDED BY: Operations Committee (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure') X Revenue? _ Currently in the Budget? Yes X No If no: Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda IItem No 6C ADMINISTRATIVE SERVICE CONTRACT BETWEEN PREMERA BLUE CROSS AND CITY OF KENT EFFECTIVE JANUARY 1, 2006 THROUGH DECEMBER 31, 2006 (The "Contract Period") This Contract is effective by and between the group named above (hereinafter referred to as the "Plan Sponsor"), and Premera Blue Cross (hereinafter referred to as the "Claims Administrator" or"we," "us," or"our") WHEREAS, the Plan Sponsor has established an employee benefit plan (hereinafter referred to as the "Plan") which provides for payment of certain welfare benefits to and for certain eligible individuals as defined in writing by the Plan Sponsor, such individuals being hereinafter referred to as "Members", and, WHEREAS, the Plan Sponsor has chosen to self-insure the benefit program(s) provided under the Plan, and WHEREAS, the Plan Sponsor desires to engage the services of the Claims Administrator to provide administrative services for the Plan, NOW THEREFORE, in consideration of the mutual covenants and conditions as contained herein the parties hereto agree to the provisions in this Contract, including any Attachments and endorsements thereto The parties below have signed as duly authorized officers and have hereby executed this Contract If this Contract is not signed and returned to the Claims Administrator within sixty (60)days of its delivery to the Plan Sponsor or its agent, the Claims Administrator will assume the Plan Sponsor's concurrence and the Plan Sponsor will be bound by its terms IN WITNESS WHEREOF the parties hereto sign their names as duly authorized officers and have executed this Contract CITY OF KENT BY DATE. Title ADDRESS: PREMERA BLUE CROSS BY X DATE. March 21, 2006 H.R. Brereton Barlow President and Chief Executive Officer P O Box 327 Seattle, WA 98111-0327 TABLE OF CONTENTS 1. DEFINITIONS.................................................................................................................... .....1 2. DUTIES AND RESPONSIBILITIES OF THE PLAN SPONSOR............................................. 1 21 Documentation 1 22 Plan Sponsor's Fiduciary Authority 1 23 Defense of the Plan 1 24 Administrative Duties 1 25 Taxes, Assessments, and Fees 2 26 Compliance With Law . 2 27 Appeals 2 28 Funding 2 3. DUTIES AND RESPONSIBILITIES OF THE CLAIMS ADMINISTRATOR.............................3 31 Administrative Duties .... .. . . . ..... 3 32 Appeals 3 33 Claims Processing 3 34 Funding Support 3 35 Annual Accounting 4 4. LIMITS OF THE CLAIMS ADMINISTRATOR'S RESPONSIBILITY.......................................4 41 Recoveries 4 4 2 Independent Contractor 4 4 3 Limits of Liability 4 5. FEES OF THE CLAIMS ADMINISTRATOR............................................................................4 5 1 Payment Time Limits .4 5 2 Late Payments . ..4 5 3 Customization Fees .. . .. .... 5 6. AUDIT......................................................................................................................................5 j 7. SUBROGATION......................................................................................................................5 8. TERM OF CONTRACT............................................................................................................6 8 1 Contract Period . . .... .... .. . 6 8 2 Changes to Fees . ........... . . . .......... 6 9. TERMINATION........................................................................................................................6 9.1. Termination With Notice 6 9.2. Contract Period Expiration . .6 9.3. Termination Due to Insolvency .. .......... 6 9.4 Termination Due to Inability to Perform .. .... . 6 9 5 Termination For Nonpayment 7 9 6 Plan Sponsor Liability Upon Termination ... 7 9.7 Final Accounting 7 9 8 Claims Runout 7 10. DISCLOSURE .......................................................................................................................7 11. OTHER PROVISIONS...........................................................................................................8 11 1 Choice of Law 8 112 Trademarks 8 11 3 Parties To The Contract 8 114 Notice 8 11 5 Integration 8 116 Assignment 8 12. ATTACHMENTS TO THE ADMINISTRATIVE SERVICE CONTRACT................................8 ATTACHMENT A — BLUECARD® PROGRAM......................................................................... 10 Liability Calculation Method Per Claim ... ...... ... .. 10 BlueCard Worldwide" 11 BlueCard Fees and Compensation - Overview . .11 Access Fees .11 How Access Fees Affect The Plan 11 ATTACHMENT B —CENSUS INFORMATION ..........................................................................12 ATTACHMENT C — REPORTING..............................................................................................13 ATTACHMENT D — FEES OF THE CLAIMS ADMINISTRATOR.............................................. 14 Administration Fees 14 Brokerage Fees and Commissions (included in Administration Fee)- 14 Additional Fees 14 Claims Runout Processing Fee 14 BlueCard Fees . 14 Care Facilitation 14 ATTACHMENT E — BUSINESS ASSOCIATE AGREEMENT ...................................................16 ATTACHMENT F — CARE FACILITATION................................................................................17 ATTACHMENT G — RIGHT OF CONVERSION.........................................................................18 Responsibilities of the Claims Administrator ... ........... .. . . . .. .. .. ................. . 18 Compensation. . ....... . . ............... .. .. .... .... ........... ... .18 1 1. DEFINITIONS Adverse Benefit Determination Any of the following a denial, reduction, or termination of, or a failure to provide or make payment (m whole or in part)for, a benefit, including payment that is based on a determination of the eligibility of a Member to participate in the Plan This includes any denials, reductions, or failures to provide or make payment resulting from the application of utilization review or limitations on experimental and investigational services, medical necessity, or appropriateness of care Contract Period The period shown on the Face Page of this Contract The Contract Period begins at 12 01 a m on the starting date shown on the Face Page and ends at midnight on the ending date shown on the Face Page Effective Date The date this Contract takes effect (the first day of the Contract Period) The Effective Date is shown on the Face Page of this Contract Plan The employee benefit plan established and maintained by the Plan Sponsor that is being administered under this Contract Member A Subscriber or dependent who is eligible for coverage as stated in the Plan and who is enrolled as required in the Plan Subscriber A person who is eligible for coverage under the plan by virtue of an employee-employer relationship or other relationship between the person and the Plan Sponsor, and who is enrolled as required in the Plan 2. DUTIES AND RESPONSIBILITIES OF THE PLAN SPONSOR 2.1. Documentation The Plan Sponsor shall provide the Claims Administrator with a copy of any documents describing the benefit program(s) that the Claims Administrator needs to rely upon in performing its responsibilities under this Contract 2.2. Plan Sponsor's Fiduciary Authority The Plan Sponsor shall have final discretionary authority to determine the benefit provisions and to construe and interpret the terms of the Plan The Plan Sponsor shall have final discretionary authority to determine eligibility for benefits and the amount to be paid by the Plan 2.3. Defense of the Plan The Plan Sponsor shall be responsible for defending any legal action brought against the Plan, including a claim for benefits by or on behalf of any individual or entity, including but not limited to any Member or former Member, any fiduciary or other party This responsibility includes the selection and payment of counsel The Plan Sponsor shall not settle any legal action or claim without the prior consent of the Claims Administrator if the action or claim could result in the Claims Administrator being liable, including for example, any liability for contribution to or indemnification of the Plan Sponsor or other third party either directly or indirectly 2.4. Administrative Duties Unless specifically delegated to the Claims Administrator by this Contract, the Plan Sponsor shall be responsible for the proper administration of the Plan including the following a The Plan Sponsor shall provide the Claims Administrator a complete and accurate list of all individuals eligible for benefits under the benefit program(s) and to update those lists monthly The Claims , Administrator shall be entitled to rely on the most recent list until it receives documentation of any change thereto b. The Plan Sponsor shall distribute to all eligible Members all appropriate and necessary materials and documents, including but not limited to benefit program booklets, summary plan descriptions, material 7486T 1 modifications, enrollment applications and notices required by law or that are necessary for the operation of the Plan c. The Plan Sponsor shall provide the Claims Administrator with any additional information necessary to perform its functions under this Contract as may be requested by the Claims Administrator from time to time d If the Plan Sponsor writes or revises its benefit booklet, the Claims Administrator must review and approve in advance the draft of the benefit booklet that is printed and distributed to Members ` 2.5. Taxes, Assessments, and Fees The Plan Sponsor shall be responsible for all taxes, assessments and fees levied by any local, state or federal authority in connection with the Claims Administrator's duties pursuant to this Contract 2.6. Compliance With Law • The Plan Sponsor shall be responsible for the Plan's continuing compliance with all applicable federal, state and local laws and regulations, as currently amended These include but are not limited to • The Internal Revenue Code • The Health Insurance Portability and Accountability Act of 1996 (HIPAA) • The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) • The Balanced Budget Act of 1997 The Plan Sponsor, and not the Claims Administrator, is the"plan administrator" and the "plan sponsor" for purposes of all federal laws that apply to the Plan Sponsor and impose duties or obligations on such entities The Plan Sponsor shall be responsible for determining whether it is subject to COBRA and, if so, for notifying Members of their COBRA rights both initially and upon the occurrence of a qualifying event, for calculating and collecting premiums for COBRA continuation of coverage and for promptly notifying the Claims Administrator when an individual is no longer eligible for COBRA continuation of coverage If the Plan Sponsor is subject to ERISA, the Plan Sponsor is responsible to prepare and maintain its ERISA plan document • If the Plan Sponsor elects to opt out of compliance with certain federal mandates as allowed by HIPAA, the Plan Sponsor is responsible to file its opt-out with federal regulators for each contract period and to notify Members of the opt-out in accordance with federal law and regulations then in effect The Plan Sponsor agrees to hold the Claims Administrator and the Network harmless for any and all consequences arising from the Plan Sponsor's failure to file an opt-out as required by law for a given contract period, errors in the opt-out filing, or failure to notify a Member as required by federal law 2.7. Appeals If an adverse decision is made in the Claims Administrator's second level of review, the Plan Sponsor shall offer the Member a review by an Independent Review Organization (I RO) The Plan Sponsor shall pay all costs of the IRO review 2.8. Funding The Plan Sponsor shall be solely liable for all benefits payable to members under the Plan that are adjudicated by the Claims Administrator The Plan Sponsor agrees to the following a Provision Of Funds The Plan Sponsor shall maintain adequate funds from which the total cost of all claims for each preceding week will be paid to the Claims Administrator by wire transfer Funds must be provided within forty-eight (48) hours of phone notification by the Claims Administrator to a person designated by the Plan Sponsor b Late Payments If timely payment for the claims is not received by the Claims Administrator, the Plan Sponsor shall pay the Claims Administrator a daily late charge This late charge is calculated from the first day following the forty-eight (48) hour period stated above This late charge is based on the average monthly prime rate posted by Bank of America/Nations Bank during the Contract Period, plus two (2) percent on the amount of the late payments for the number of days late Late charges are due at the end of the Contract Period as part of the annual accounting or, if earlier, upon termination of the Contract 7486T 2 i c Notices Notices required by this subsection and subsection 3 4 shall be by fax, e-mail, or telephone, as agreed upon in writing by the Plan Sponsor and the Claims Administrator 3. DUTIES AND RESPONSIBILITIES OF THE CLAIMS ADMINISTRATOR 3.1. Administrative Duties The Claims Administrator agrees to perform the following administrative services for the Plan Sponsor The ' Claims Administrator shall a assist in the preparation and printing of the benefit program booklets, identification cards, and other , materials necessary for the operation of the Plan, and distribute identification cards to Members, b perform reasonable internal audits as stated in section 6 of this Contract , c answer inquiries from the Plan Sponsor, Members, and service providers regarding the terms of the Plan, although final authority for construing the terms of the Plan's eligibility and benefit provisions is the Plan Sponsor's, d prepare and provide the Plan Sponsor with reports of the operations of the Plan in accordance with "Attachment C— Reporting", e coordinate with any stop-loss insurance carrier; f when "preferred provider' or"network provider" benefits are provided, maintain a network of hospital and professional providers, paid claims will reflect any negotiated provider discounts, g perform care facilitation services as identified in "Attachment F—Care Facilitation " In provide a Certificate of Group Health Coverage to Members when their coverage under this Plan terminates or upon their request within 24 months of termination In the event the Claims Administrator does not have adequate information to complete the Certificate, the Plan Sponsor will be responsible for completing the missing information on the Certificate and forwarding it to the Member 3.2. Appeals a The Claims Administrator shall review and respond to the initial appeals of Adverse Benefit Determinations (see section 1)as described in the benefit booklet provided by the Claims Administrator for this Plan b The Claims Administrator shall also provide a second review of adverse appeal decisions made after its , initial review This review will be conducted as described in the benefit booklet provided by the Claims Administrator for this Plan c If an adverse decision is made in the Claims Administrator's second level of review, the Claims , Administrator also agrees to facilitate a review of the appeal by an Independent Review Organization (IRO) on behalf of the Plan Sponsor The Claims Administrator will submit all documentation regarding the appeal to the IRO and work with the IRO as needed to complete its review The Claims administrator shall pass all costs of the IRO review on to the Plan Sponsor 3.3. Claims Processing The Claims Administrator shall process all eligible claims incurred after the Effective Date of this Contract which , are properly submitted in accordance with the procedures set forth in the Plan Sponsor's benefit booklet The Claims Administrator shall make reasonable efforts to determine that a claim is covered under the terms of the Plan as described in the benefit booklet, to apply the coordination of benefits provisions, identify subrogation claims, and make reasonable efforts to recover subrogated amounts administratively as stated in section 7 of this Contract, and prepare and distribute benefit payments to Members and/or service providers 3.4. Funding Support r The Claims Administrator shall follow the steps below to facilitate the Plan Sponsor's funding of its Plan 7486T 3 1 a Claim payment checks will be issued on the Claims Administrator's check stock However, as stated in subsection 2 8 above, the responsibility for funding benefits is the Plan Sponsor's and the Claims Administrator is not acting as an insurer b The Claims Administrator shall notify the Plan Sponsor weekly by telephone or electronic medium of the amount due for the prior week's claims 3.5. Annual Accounting Within 120 days of the end of the Contract Period, we shall perform an annual accounting of claims activity and report to the Plan Sponsor r 4. LIMITS OF THE CLAIMS ADMINISTRATOR'S RESPONSIBILITY It is recognized and understood by the Plan Sponsor that the Claims Administrator is not an insurer and that the Claims Administrator's sole function is to provide claims administration services and the Claims Administrator shall have no liability for the funding of benefits The Claims Administrator is empowered to act on behalf of the Plan Sponsor in connection with the Plan only as expressly stated in this Contract or as mutually agreed to in writing by the Claims Administrator and the Plan Sponsor This Contract is between the Claims Administrator and the Plan Sponsor and does not create any legal relationship between the Claims Administrator and any Member or any other individual 4.1. Recoveries If, during the course of an audit performed internally by the Claims Administrator as described in subsection 3 1 b above or by the Plan Sponsor pursuant to section 6 below, any error is discovered, the Claims Administrator shall use reasonable efforts to recover any loss resulting from such error The Plan Sponsor does not cover Foot Orthotics for any diagnosis, which includes but is not limited to diabetes or corrective purposes The Claims Administrator agrees to reimburse the Plan Sponsor any Foot Orthotics claim payment made in error throughout the duration of this agreement unless such payment is recovered as stated in this subsection 4 1 4.2. Independent Contractor I The Claims Administrator is an independent contractor with respect to the services being performed pursuant to this Contract and shall not for any purpose be deemed an employee of the Plan Sponsor 4.3. Limits of Liability It is recognized by the parties that errors may occur and it is agreed that the Claims Administrator will not be held liable for such errors unless they resulted from its gross negligence or willful misconduct The Plan Sponsor agrees to defend, indemnify, and hold harmless the Claims Administrator from all claims, damages, liabilities, losses, and expenses arising out of the Claims Administrator's performance of administration services under the terms of this Contract, so long as they did not arise out of the Claims Administrator's gross negligence or willful misconduct 5. FEES OF THE CLAIMS ADMINISTRATOR 5.1. Payment Time Limits By the first of each month, The Plan Sponsor shall pay the Claims Administrator in accordance with the fee schedule set forth in "Attachment D— Fees Of The Claims Administrator"that is incorporated herein by reference 5.2. Late Payments a If, for any reason whatsoever, the Plan Sponsor fails to make a timely payment required under this Contract by the tenth day of the month in which payment is due, the Claims Administrator may suspend 7486T 4 performance of services to the Plan Sponsor, including processing and payment of claims, until such time as the Plan Sponsor makes the required payment, including interest as set forth in b below b In the event of late payment, the Claims Administrator may terminate this Contract pursuant to subsection 9 5 below Acceptance of late payments by the Claims Administrator shall not constitute a waiver of its right to cancel this Contract due to delinquent or nonpayment of fees c The Claims Administrator will charge interest to the Plan Sponsor on all payments received after the tenth day of the month in which they are due, including amounts paid to reinstate this Contract after termination pursuant to subsection 9 5 below, at the average prime rate posted by Bank of America/Nations Bank during the Contract Period plus two (2) percent on the amount of the late payments for the number of days late Interest will be in addition to any other amounts payable under this Contract 5.3. Customization Fees The Plan Sponsor shall pay the Claims Administrator a "customization fee"when the Plan Sponsor requests either of the following a A plan benefit configuration that the Claims Administrator has not determined to be standard for the plan type Customization fees for nonstandard plan benefits assessed at this Contract's Effective Date are listed in "Attachment D — Fees Of The Claims Administrator" b An off-anniversary benefit change, regardless of whether the desired benefit is standard for the plan type The customization fee for each off-anniversary change shall be $2,000 Customization fees for off- anniversary changes shall be invoiced separately to the Plan Sponsor For purposes of customization fees, "benefits" include eligibility, termination, continuation and benefit payment provisions, benefit terms, limitations, and exclusions, funding arrangement changes, and any other standard provisions of the Plan Fees are computed based on current administrative costs to implement and administer the benefit Customization fees for custom benefits that take effect on the Effective Date shown on the Face Page of this Contract are due and payable prior to that Effective Date Customization fees for off-anniversary benefit changes are due and payable prior to the effective date of the change 6. AUDIT Within thirty(30)days of written notice from the Plan Sponsor, the Claims Administrator shall allow an authorized agent of the Plan Sponsor to inspect or audit all records and files maintained by the Claims Administrator which are directly pertinent to the administration of the Plan for the current or most recently ended contract period Such documents shall be made available at the administrative office of the Claims Administrator during normal business hours The Plan Sponsor shall be liable for any and all fees charged by the auditor All audits shall be subject to the Claims Administrator's audit policies and procedures then in effect To the extent that the Plan Sponsor requests data and reports that are beyond the scope of the Claim Administrator's audit policies and procedures, the Plan Sponsor shall reimburse the Claims Administrator for the additional administrative costs incurred in producing such data and reports Any agent or auditor who has access to the records and files maintained by the Claims Administrator shall agree not to disclose any proprietary or confidential information used in the business of the Claims Administrator 7. SUBROGATION The Claims Administrator shall make reasonable efforts to pursue subrogation claims administratively on behalf j of the Plan However, the Claims Administrator shall have no affirmative duty to pursue subrogation claims beyond those specified in subsection 3 3 above The Plan Sponsor shall have the sole discretion to bring any legal claim or action to enforce the Plan's subrogation provisions The Claims Administrator will cooperate with the Plan Sponsor in the event the Plan Sponsor brings any legal action to enforce the subrogation provisions of the Plan Any costs and attorneys' fees incurred in pursuing such subrogation claims shall be the responsibility of the Plan Sponsor 7486T 5 8. TERM OF CONTRACT 8.1. Contract Period The term of this Contract shall be the Contract Period shown on the Face Page of this Contract Except as stated otherwise in subsection 9 3 below, the terms and conditions of this Contract and the fee schedule set forth in are established for the Contract Period t8.2. Changes to Fees The Plan Sponsor acknowledges that the fee schedule set forth in "Attachment D— Fees Of The Claims Administrator" and the services provided for in this Contract are based upon the terms of the Plan and the enrollment as they exist on the Effective Date of this Contract Any substantial changes, whether required by law or otherwise, in the terms and provisions of the Plan or in enrollment may require that the Claims Administrator incur additional expenses The parties agree that any substantial change, as determined by the Claims Administrator, shall result in the alteration of the fee schedule, even if the alteration is during the Contract Period The phrase "any substantial change" shall include, but not be limited to a a fluctuation of ten (10) percent or more in the number of Members as set forth on the census information included in "Attachment B—Census Information" which is herein incorporated by reference and made a part of this Contract, b the addition of benefit program(s) or any change in the terms of the Plan's eligibility rules, benefit provisions or record keeping rules that would increase administration costs by more than $10,000; c any change in claims administrative services, benefits or eligibility required by law that would increase administration costs by more than $10,000; d any change in administrative procedures from those in force at the inception of this Contract that is agreed upon by the parties, e any additional services which the Claims Administrator undertakes to perform at the request of the Plan Sponsor which are not specified in this Contract such as the handling of mailings or preparation of statistical reports and surveys not specified in the Claims Administrator's standard Employer Group Reporting set 9. TERMINATION 9.1. Termination With Notice The Plan Sponsor may terminate this Contract at any time by giving the Claims Administrator thirty (30) days written notice 9.2. Contract Period Expiration This Contract will terminate on the last day of the Contract Period or the last day of any extension of the Contract Period granted by the Plan Administrator. 9.3. Termination Due to Insolvency Either party may terminate this Contract effective immediately by giving written notice to the other if a party becomes insolvent, makes a general assignment for the benefit of creditors, files a voluntary petition of bankruptcy, suffers or permits the appointment of a receiver for its business or assets, or becomes subject to any proceeding under any bankruptcy or insolvency law, whether foreign or domestic A party is insolvent if it has ceased to pay its debts in the ordinary course of business, cannot pay its debts as they become due, or the sum of its debts is greater than the value of its property at a fair valuation a9.4. Termination Due to Inability to Perform If loss of services is caused by, or either party is unable to perform any of its obligations under this Contract, or to enjoy any of its benefits because of natural disaster, action or decrees of governmental bodies or communication failure not the fault of the affected party, such loss or inability to perform shall not be deemed a breach. The party 7486T 6 r who has been so affected shall immediately give notice to the other party and shall do everything possible to resume performance Upon receipt of such notice, all obligations under this Contract shall be immediately suspended If the period of nonperformance exceeds thirty (30) days from the receipt of such notice, the party whose performance has not been so affected may, as its sole remedy, terminate this Contract by written notice to the other party effective immediately In the event of such termination, the Plan Sponsor shall remain liable to the Claims Administrator for all payments due, together with interest thereon as provided for in subsection 5 2 c above 9.5. Termination For Nonpayment The Claims Administrator may, at its sole discretion, terminate this Contract if the period of nonpayment exceeds thirty (30) days from the date the payment becomes delinquent as outline in section 5 2 c 9.6. Plan Sponsor Liability Upon Termination t In the event this Contract is terminated prior to the end of the Contract Period, the Plan Sponsor shall remain liable to the Claims Administrator for all delinquent sums together with interest thereon as provided for in subsection 5 2 c above Furthermore, the Claims Administrator will have incurred fixed costs which, but for the termination, would have been recouped over the course of the Contract Period Therefore, in the event that the Contract terminates pursuant to subsections 9 1 or 9 5 above, the Plan Sponsor shall also pay the Claims Administrator as liquidated damages, and not as a penalty, an amount equal to two (2) months administration fees This monthly fee shall be determined by multiplying the rate set forth in "Attachment D—Fees Of The Claims Administrator," multiplied by the average number of Members covered by the Plan for the immediately preceding six (6) month period or such shorter period if this Contract has not been in effect for a period of six (6) months The Plan Sponsor shall remain liable for claims incurred during the Contract Period but not paid during the Contract Period and for the claims run-out processing fee set forth in the "Fees Of The Claims Administrator" attachment 9.7. Final Accounting Within one hundred twenty (120) days of termination by either party, the Claims Administrator shall deliver to the Plan Sponsor an interim accounting Within fifteen (15) months of termination the Claims Administrator shall deliver to the Plan Sponsor a complete and final accounting of the status of the Plan At the expense of the Plan Sponsor, the Claims Administrator shall make available a record of deductibles and coinsurance levels for each Member and deliver this information to the Plan Sponsor or its authorized agent 9.8. Claims Runout The Plan Sponsor continues to be solely liable for claims received by the Claims Administrator after the Contract terminates For the fifteen (15)-month period following termination of this Contract, the Claims Administrator shall continue to process eligible claims incurred prior to termination, or adjustments to claims incurred prior to termination, that the Claims Administrator receives no more than twelve (12) months after the date of termination at the claims run-out processing fee rate set forth in "Attachment D— Fees Of The Claims Administrator" I If the Claims Administrator receives claims for Plan benefits more than twelve (12) months after the date this Contract terminates, Claims Administrator shall return those claims to the Plan Sponsor lithe Plan Sponsor wants to negotiate a different arrangement or have the claims sent to a different address, the Plan Sponsor must contact the Claims Administrator no later than the start of the fourteenth month after the date this Contract terminates This "Claims Runout" provision shall survive termination of this Contract. ' 10. DISCLOSURE It is recognized and understood by the Plan Sponsor that the Claims Administrator is subject to all laws and regulations applicable to Claims Administrators and health care service contractors It is also recognized and understood by the Plan Sponsor that the Claims Administrator is not acting as an insurer and also is not providing stop-loss insurance 7486T 7 i 11. OTHER PROVISIONS 11.1. Choice of Law The validity, interpretation, and performance of this Contract shall be controlled by and construed under the laws of the state of Washington, unless federal law applies Any and all disputes concerning this Contract shall be resolved in King County Superior Court or federal court as appropriate 11.2. Trademarks The Claims Administrator reserves the right to, the control of, and the use of the words "Premera Blue Cross", "MSC Incorporated as Premera Blue Cross"and all symbols, trademarks and service marks existing or hereafter established The Plan Sponsor shall not use such words, symbols, trademarks or service marks in advertising, promotional materials, materials supplied to Members or otherwise without the Claims Administrator's prior written consent which shall not be unreasonably withheld 11.3. Parties To The Contract The Plan Sponsor hereby expressly acknowledges, on behalf of itself and all of its Members, its understanding that this Administrative Service Contract constitutes a Contract solely between the Plan Sponsor and the Claims Administrator, that the Claims Administrator is an independent corporation operating under a license with the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans (the "Association") permitting the Claims Administrator to use the Blue Cross Service Mark in the States of Washington and Alaska, and that the Claims Administrator is not contracting as the agent of the Association The Plan Sponsor further acknowledges and agrees that it has not entered into this Administrative Service Contract based upon representations by any person other than the Claims Administrator, and that no person, entity or organization other than the Claims Administrator shall be held accountable or liable to the Plan Sponsor for any of the Claims Administrator's obligations to the Plan Sponsor created under this Administrative Service Contract This provision shall not create any additional obligations whatsoever on the Claims Administrator's part other than those obligations created under other provisions of this Administrative Service Contract 11.4. Notice Except for the notice given pursuant to the "Funding" subsection of section 2, any notice required or permitted to be given by this Contract shall be in writing and shall be deemed delivered three (3) days after deposit in the United States mail, postage fully prepaid, return receipt requested, and addressed to the other party at the address ' 11.5. Integration This Contract, including any appendices or attachments incorporated herein by reference, embodies the entire ' Contract and understanding of the parties and supersedes all prior oral and written communications between them Only a writing signed by both parties hereto hereof may modify the terms 11.6. Assignment Neither party shall assign this Contract or any of its duties or responsibilities hereunder without the prior written approval of the other 12. ATTACHMENTS TO THE ADMINISTRATIVE SERVICE CONTRACT The following attach to and become part of the body of this Contract and they are herein incorporated by reference ATTACHMENT A —BLUECARD® PROGRAM ATTACHMENT B—CENSUS INFORMATION ATTACHMENT C — REPORTING ATTACHMENT D— FEES OF THE CLAIMS ADMINISTRATOR ATTACHMENT E— BUSINESS ASSOCIATE AGREEMENT ATTACHMENT F—CARE FACILITATION ATTACHMENT G — RIGHT OF CONVERSION 7486T 8 ATTACHMENT H-EXTENDED POST-PAYMENT RECOVERY SERVICES 1 1 i I 1 1 1 1 1 t 7486T 9 ATTACHMENT A — BLUECARDO PROGRAM Premera Blue Cross, like all Blue Cross and/or Blue Shield Licensees, participates in a program called ' "BlueCard " Whenever Members access health care services in Clark County, Washington or outside Washington and Alaska, the claim for those services may be processed through BlueCard and presented to us for payment Payment is made according to the terms and limitations of your plan document and network access rules in the BlueCard Policies then in effect Under BlueCard, when Members receive covered services within the area served by another Blue Cross and/or Blue Shield Licensee (called the "Host Blue" in this section), Premera Blue Cross remains responsible for fulfilling our obligations under this contract The Host Blue will only be responsible for such services as contracting with providers and handling all interaction with contracting providers 1 The Host Blue must perform these duties in accordance with applicable BlueCard Policies The financial terms of BlueCard are described generally below Liability Calculation Method Per Claim The amount the Member pays for covered services obtained in Clark County, Washington or outside Washington and Alaska through BlueCard is calculated on the lower of 1)the billed charges for the covered services, or 2) the "negotiated price"that the Host Blue passes on to Premera Blue Cross for the covered services Most often, the Plan Sponsor's liability for covered services processed through BlueCard is calculated on the same amount on which the Member's liability is calculated However, in rare cases required by the Host Blue's contract with the provider, the Plan Sponsor's liability will be calculated on the Host Blue's negotiated price even when that price exceeds the billed charge The methods used to determine the negotiated price will vary among Host Blues according to the terms of their provider contracts Often, the negotiated price will consist of a simple discount, which reflects the actual price allowed as payable by the Host Blue But, sometimes, it is an estimated price that factors in the Host Blue's expected settlements, withholds, any other contingent payment arrangements and non-claims transactions with the Member's health care provider or with a specified group of providers The negotiated price may also be a discount from billed charges that reflects an average expected savings with the Member's health care provider or a specified group of providers The price that reflects average savings may result in greater variation above or below the actual price than will the estimated price In accordance with national BlueCard policy, these estimated or average prices will also be adjusted from time to time to correct for overestimation or underestimation of past prices However, the amount on which the Member's and the Plan Sponsor's payments are based remains the final price for the covered services billed on that claim In addition, if the Host Blue's negotiated price is an estimated or average price, as described above, some portion of the amount the Plan Sponsor pays may be held in a variance account by the Host Blue, pending settlement with its contracting providers Because all amounts paid are final, any funds held in a variance account do not belong to the Plan Sponsor and are eventually exhausted by provider settlements and through prospective adjustments to the negotiated prices Some states may mandate a surcharge or a method of calculating what Members must pay on a claim that differs from BlueCard's usual method noted above and is not pre-empted by federal law If such a mandate is in force on the date the Member received care in that state, the amounts the Member and the Plan Sponsor must pay for any covered services will be calculated using the methods required by that state's mandate Such methods might not reflect the entire savings expected on a particular claim The calculation methods described above in this section do not apply to BlueCard Worldwide claims Under BlueCard, recoveries from a Host Blue or from contracting providers of a Host Blue can arise in several ways Examples are antifraud and abuse audits, provider/hospital audits, credit balance audits, utilization review refunds, and unsolicited refunds In some cases, the Host Blue will engage third parties to assist in discovery or collection of recovery amounts The fees of such a third party are netted against the recovery Recovery amounts, net of any fees, will be applied in accordance with applicable BlueCard Policies, which generally require correction on a claim-by-claim or prospective basis ' PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 10 PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 BlueCard Worldwide® If Members are outside the United States, the Commonwealth of Puerto Rico, Jamaica and the British and U S r Virgin Islands, they may be able to take advantage of BlueCard Worldwide BlueCard Worldwide is unlike the national BlueCard program in certain ways For instance, although BlueCard Worldwide provides a network of contracting hospitals, it offers only referrals to doctors and other health care providers When receiving care from doctors or other health care providers, Members will have to submit claim forms on their own behalf to obtain reimbursement for the services provided through BlueCard Worldwide BlueCard Fees and Compensation - Overview ' The Plan Sponsor understands and agrees to the following, a To pay certain fees and compensation to us which we are obligated under BlueCard to pay to the Host Blue, to the Blue Cross and Blue Shield Association, or to the BlueCard vendors These fees are billed to the Plan Sponsor as shown in "Attachment D— Fees Of The Claims Administrator" b That fees and compensation under BlueCard may be revised from time to time without the Plan Sponsor's prior approval in accordance with the Blue Cross and Blue Shield Association's standard provisions for revising fees and compensation under BlueCard Some of these fees and compensation are charged each time a claim is processed through BlueCard Examples of these are access fees (see "Access Fees" and "How Access Fees Affect The Plan" below), administrative expense allowance fees, Central Financial Agency Fees, and ITS Transaction Fees Also, some of these claim- based fees, such as the access fee and the administrative expense allowance fee, may be passed on to the Plan Sponsor as an additional claim liability Examples of fees not charged for each claim are an 800 number fee and a fee for providing provider directories If you want an updated listing of these types of fees or the amount of these fees paid directly by you, please contact us Access Fees Host Blues may charge the Claims Administrator an access fee for making their discounted rates and the resulting savings available on claims incurred by the Plan Sponsor's Members Access fees are based on the difference between the amount paid by the Host Blue and the amount this Plan would have paid if it had dealt with the out-of-area provider directly The access fee, if one is charged, may equal up to 10 percent of the Host Licensee's discount/differential savings, but may not exceed $2,000 per claim The access fee may be charged only if the Host Blue's arrangement with the provider prohibits billing Members for amounts in excess of the discounted rate However, providers may bill for deductibles, coinsurance, amounts in excess of stated benefit , maximums, and charges for noncovered services In the event a participating provider discount cannot be passed along to the Member, no discount or access fee will apply How Access Fees Affect The Plan When the Claims Administrator is charged an access fee, it will be charged to the Plan Sponsor as a claims expense If the Claims Administrator receives an access fee credit, it will be given to the Plan Sponsor as a claims expense credit Access fees are considered a claims expense because they represent claims dollars the Plan Sponsor is unable to avoid paying Instances may occur in which the Claims Administrator does not pay a claim (or pays only a small amount) because the amounts eligible for payment were applied to the deductible and/or coinsurance In these instances, the Claims Administrator will pay the access fee and pass it along to the Plan Sponsor as a claims expense even though little or none of the claim was paid PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 11 PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 ATTACHMENT B - CENSUS INFORMATION Administration Fees, effective January 1, 2006, are based on the following rNumber of Active and Retired Members: Employee Spouse Children Medical 780 516 824 Dental 824 536 862 SNumber of COBRA Members: Employee Spouse Children Medical 10 3 2 LDental 5 2 2 Other Carriers Offered: Group Health Cooperative 1 1 PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 12 PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 ATTACHMENT C - REPORTING 1 A standard package of reports covering the Contract Period will be provided to the Plan Sponsor within the fees , set forth in "Attachment D— Fees Of The Claims Administrator " The reports will cover • Earned premium • Paid claims • Census data • Claims summaries by • Provider type • Service type • Coverage type Please note that reports, format, and content may be modified from time to time as needed ! ! 1 1 ! ! i PLAN SPONSOR: City of Kent ! PLAN NUMBER: 1018212 Page 13 PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 ATTACHMENT D - FEES OF THE CLAIMS ADMINISTRATOR Pursuant to the Administrative Service Contract, the Plan Sponsor shall pay the Claims Administrator the fees, as set forth below, for administrative services Administration Fees: Composite Per Employee Per Month (PEPM) 1/1/06— 12/31/06 Actives (Classes A001,A002) $60 33 Retirees (Class R001) $61 77 Freestanding Dental (Class A003) $ 8 89 Brokerage Fees and Commissions (included in Administration Fee): Medical $2 36 PEPM 1 Freestanding Dental $0 36 PEPM Additional Fees: Booklets $2 05 per book ID Cards $0 88 per card Prescription Drug Charge $1 40 per claim Conversion Contract Fee $1,000 per conversion Claims Runout Processing Fee: 10% of runout claims processed BlueCard Fees: Tracked and billed as part of the Annual Accounting 1 Care Facilitation: Included in Administration Fee See "Attachment F—Care Facilitation"for an overview of services provided PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 14 PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 Extended Post-Payment Recovery Services: Claims Administrator will perform the services listed below on a pay-for-performance, contingent fee ("Contingent , Fee") basis, which shall be calculated as a percentage of the gross amount recovered with respect to any particular claim See attachment H for an overview of services provided Post Payment Recovery Contingent Fee Category Coordination of Benefits 25% Subrogation 25% unless claim requires engagement of outside counsel, in which case the Contingent Fee amount shall be 35% , Provider Billing Errors 25% Credit Balance 25% ' Hospital Billing and Chart Review 35% a The Plan Sponsor may terminate the Calypso extended services section of this agreement at any point throughout the contract period within 30 days written notice to the Claims Administrator b The Plan Sponsor can request that any subrogation case the Claims Administrator is pursuing on their behalf be dropped immediately with written notice from the Plan Sponsor PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 15 PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 ' ATTACHMENT E - BUSINESS ASSOCIATE AGREEMENT PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 16 ' PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 ATTACHMENT F - CARE FACILITATION Claims Administrator agrees to provide the following care facilitation programs for the fees shown in "Attachment D— Fees Of The Claims Administrator" Service Description Care Management , Prospective and retrospective review for medical Clinical review necessity, appropriate application of benefits Prospective review is not mandatory for provision of benefits Voluntary program to provide cost-effective alternatives for Case management care of complex or catastrophic conditions This service also educates members and assists members and providers in managing breast & lung cancer ' Includes preventive care programs for members Health Awareness Education immunization reminders, cancer screening reminders, and health education and information ' Includes provision of evidence-based clinical practice and Quality Programs preventive care guidelines to members and providers, chart tools, and quality of care program activities ' Prescription drug formulary Development of formulary and access to providers and promotion members on-line Physician-based pharmacy Physician education on cost-effective prescribing , management ePocrates Software to provide physicians with up-to-date drug and plan formulary information ' Education for members using multiple drugs to review Polypharmacy prescriptions with their providers to decrease incidences of adverse drug interactions ' Follow-up with members and physicians to minimize Point-of-sale Pharmacy inappropriate or excessive drug therapies identified when drugs are dispensed ' Pharmacy Rebate Included as a credit to retention/administration fee Demand Management Round-the-clock access for members to RNs to answer questions about health care PLAN SPONSOR: City of Kent , PLAN NUMBER: 1018212 Page 17 PLAN DOCUMENT EFFECTIVE DATE: January 1,2006 , ATTACHMENT G — RIGHT OF CONVERSION FOR TERMINATED MEMBERS The Plan Sponsor requests that the Claims Administrator provide a conversion privilege to terminated Members ' in consideration of the following Responsibilities of the Claims Administrator ' The Claims Administrator shall make available to Members an opportunity to obtain health care coverage (hereinafter referred to as Conversion Contract)when they are no longer eligible for coverage under the Plan due to • Termination of employment • Termination of benefits for the class in which the Member belongs • A covered dependent's attainment of the limiting age ' A covered spouse's legal separation or divorce Death of a covered employee The Claims Administrator shall not be required to issue a Conversion Contract if the Member becomes covered under a group health insurance policy within 31 days after termination of his or her coverage under the Plan Application and payment of the applicable rate for the Conversion Contract must be made by the Member within 31 days after such individual's conversion privilege of its group health coverage contracts Rates for the Conversion Contract shall be determined by the Claims Administrator and be the same as those then in effect for coverage offered under the standard conversion privilege of its group health coverage contracts Rates will not be guaranteed and the Claims Administrator will have the right to change the rate of any Conversion Contract Compensation The Plan Sponsor shall pay the Claims Administrator a $1,000 conversion privilege fee for each conversion contract issued to a former Member The Claims Administrator shall notify the Plan Sponsor of the conversion privilege fees owed in connection with the weekly notification of claims paid ' PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 18 ' PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 ATTACHMENT H - EXTENDED POST-PAYMENT RECOVERY SERVICES ' Claims Administrator shall provide a set of Extended Post Payment Recovery Services to the Plan Sponsor as , described below Claims Administrator will perform these services on a pay-for-performance, contingent fee ("Contingent Fee") basis, which shall be calculated as a percentage of the gross amount recovered with respect to any particular claim Contingent Fees are shown in "Attachment D— Fees Of The Claims Administrator Post Payment Recovery Explanation of Services Category Claims Administrator's investigators and auditors will work to identify and pursue overpayments due to member's missing or inaccurate COB ' information Claims Administrator utilizes questionnaires and Coordination of Benefits interviews with providers, employers and members to determine if Plan Sponsor is the primary or secondary insurer Claims Administrator's investigators, auditors and attorneys identify and ' pursue overpayments due to Subrogation opportunities Claims ' Administrator's research to obtain accurate subrogation information and determine group's subrogation rights include questionnaires and interviews with providers, employers and members as well as a review of medical records For verified overpayments Claims Administrator Subrogation manages attorney and member notification, files necessary liens, coordinates case documentation, and provides representation for arbitration hearings ' The Plan Sponsor will be pre-notified of Claims Administrator's intent to file suit and retains the right to authorize or deny any legal action ' Claims Administrator's post-payment editing programs and investigators and auditors perform additional screens and tests where , billing information is inconsistent with age/services rendered or where Provider Billing Errors there appears to be up-coding or unbundling of services A recovery process is then employed to request and recover verified ' overpayments This service requires an on-site review of the provider's financial ' records and discussions with their staff Credit balances are verified as owed to Plan Sponsor and the source of the credit is determined The Credit Balance credit is reviewed with the provider and approved for payment back to Claims Administrator or the Plan Sponsor Hospital Billing and Chart This service requires an on-site review of the member's medical charts ' Review and interviews with provider staff by registered nurses Calypso out- sources the on-site review work to an independent vendor who ensures PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 19 PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 ' Post Payment Recovery Explanation of Services Category that • Service is consistent with diagnosis and billing is consistent with services • There has been no unbundling of services, diagnosis up-coding or billing maximization • Services rendered were prescribed by the physician and the doctor's notes were signed ' Standardized billing and payment policies were used Calypso provides support for this vendor's efforts as well as processes ' all recoveries 1 PLAN SPONSOR: City of Kent PLAN NUMBER: 1018212 Page 20 PLAN DOCUMENT EFFECTIVE DATE: January 1, 2006 Kent City Council Meeting Date Mav 16, 2006 Category Consent Calendar 1. SUBJECT: 2006 GROUP HEALTH CONTRACT—AUTHORIZE 2. SUMMARY STATEMENT: Authorize the Mayor to sign the 2006 Group Health Cooperative of Puget Sound contract for the City's insured HMO plan The 2006 contract reflects an approximate 14% increase in the health care premiums charged by Group Health and is budgeted in the Health and Welfare fund The projected budget for the Group Health Cooperative of Puget Sound contract for 2006 is $295,000 3. EXHIBITS: Group Health Contract 4. RECOMMENDED BY: Operations Committee (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure? X Revenue? Currently in the Budget? Yes X No If no: Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda ' Item No 6D EMPLOYEE SERVICES Sue Viseth, Director Phone 253-856-5276 Fax 253-856-6270 K E N T W A S H I N G T O N Address 220 Fourth Avenue S Kent, WA 98032-5895 May 2, 2006 TO: Kent City Council Operations Committee FROM: Becky Fowler, Benefits Manager THROUGH: Sue Viseth, Employee Services Director SUBJECT: Group Health Cooperative 2006 Contract MOTION: I move to recommend the 2006 Group Health Cooperative contract for the city's insured HMO plan be placed on the City Council consent calendar for the May 16, 2006 meeting. SUMMARY: Renewal of the Group Health Cooperative of Puget Sound contract for the city's insured health maintenance Organization (HMO). The 2006 contract reflects an approximate 14% increase in the health care premiums charged by Group Health Cooperative and is budgeted in the health and welfare fund. ' BUDGET IMPACT: $295,451 (Health &Welfare Fund) BACKGROUND: The City purchases insurance with Group Health Cooperative of Puget Sound. Group Health is a non-profit, health maintenance organization (HMO) providing primary care medical and specialty center throughout the Pacific Northwest. Approximately 46 employees and their families are covered under our Group Health Cooperative plan. i I t Kent Council Operations Committee 1 Group Health Cooperative May 2, 2006 @GroupHecikh COOPERATIVE Group Medical Coverage Agreement for Kent, City Of Group Health Cooperative(also referred to as"GHC")is a nonprofit health maintenance organization furnishing health care coverage on a prepayment basis. The Group identified below wishes to purchase such coverage This Agreement sets forth the terms under which that coverage will be provided,including the rights and responsibilities of the contracting parties; requirements for enrollment and eligibility,and benefits to which those enrolled under this Agreement are entitled. The Agreement between GHC and the Group consists of the following: • Standard Provisions • Attached Benefit Booklet • Signed Group application • Premium Schedule • All attachments and endorsements included or issued hereafter Group Health Cooperative Signed _ (� Tide: President and Chief Executive Officer Kent,City Of,0036900 jSigned: Title: This Agreement will become effective January 1,2006 and will continue in effect until terminated or renewed as herein provided for. C24431 -0036900 1 PA-11330 @GroupHeafih a C OPERATIVE Group Medical Coverage Agreement Table of Contents Standard Provisions Attachment 1 Benefit Booklet Attachment 2 Premium Schedule Attachment 3 Medicare Endorsement C24431 -0036900 2 PA-11330 Standard Provisions 1. GHC agrees to provide benefits as set forth in the attached Benefit Booklet to enrollees of the Group. 2. Monthly Prerrdum Payments. For the initial term of this Agreement,the Group shall submit to GHC for each Member the monthly premiums set forth in the current Premium Schedule and a verification of enrollment. Payment must be received on or before the due date and is subject to a grace period of ten(10)days Premiums are subject to change by GHC upon thirty(30)days written notice. Premium rates will be revised as a part of the annual renewal process. In the event the Group increases or decreases enrollment at least twenty-five percent(25%)or more,GHC reserves the right to require re-rating of the Group. 3. Dissemination of Information. Unless the Group has accepted responsibility to do so, GHC will disseminate information describing benefits set forth in the Benefit Booklet attached to this Agreement 4. Identification Cards.GHC will furnish cards,for identification purposes only,to all Members enrolled under this Agreement. 5. Administration of Agreement.GHC may adopt reasonable policies and procedures to help in the administration of this Agreement.GHC reserves the right to construe the provisions of this Agreement and make all determinations regarding benefit entitlement and coverage. 6. Modification of Agreement. Except as required by federal and Washington State law,this Agreement may not be modified without agreement between both parties. No oral statement of any person shall modify or otherwise affect the benefits,limitations and exclusions of this Agreemeut,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 1 7. Indemnification. GHC agrees to indemnify and hold the Croup harmless against all claims,damages,losses and expenses,including reasonable attorney's fees,arising out of GHC's failure to perform,negligent performance or willful misconduct of its directors,officers,employees and agents of their express obligations under this Agreement. The Group agrees to indentrafy and hold GHC harmless against all claims, damages,losses and expenses,including reasonable attorney's fees,ansing out of the Group's failure to perform,negligent performances or willful misconduct of its directors,officers,employees and agents of their express obligations under this Agreement. The indemnifying party shall give the other party prompt notice of any claim covered by this section and provide reasonable assistance(at its expense). The indemnifying party shall have the right and duty to assume the control of the defense thereof with counsel reasonably acceptable to the other party. Either party may take part in the defense at its own expense after the other party assumes the control thereof. 8. Compliance With Lary. The Group and GHC shall comply with all applicable state and federal laws and regulations in performance of this Agreement. This Agreement is entered into and governed by the laws of Washington State,except as otherwise pre-empted by ERISA and other federal laws. 4. Governmental Approval. If GHC has not received any necessary government approval by the date when notice is required under this Agreement,GHC will notify the Group of any changes once governmental approval has been received GHC may amend this Agreement by giving notice to the Group upon receipt of government approved rates, benefits, limitations,exclusions or other provisions, in which case such rates,benefits,limitations,exclusions or provisions will go into effect as required by the governmental agency. All amendments are deemed accepted by the Group unless the Group gives GHC written notice of non-acceptance within thirty(30)days after receipt of anrendnient, in which event this Agreement and all rights to services and other benefits terminate the first of the month following thirty(30)days after receipt of non-acceptance. 10. Confidentiality. Each party acknowledges that performance of its obligations under this Agreement may involve access to and disclosure of data,procedures,materials,lists,systems and information,including medical records,employee C24431 -0036900 3 PA-11330 benefits information,employee addresses,social security numbers,e-mail addresses,phone numbers and other confidential information regarding the Group's employees(collectively the"information"). The information shall be kept strictly confidential and shall not be disclosed to any thud party other than:(i)representatives of the receiving party (as permitted by applicable state and federal law)who have a need to know such information in order to perform the services required of such party pursuant to this Agreement,or for the proper management and administration of the receiving party,provided that such representatives are informed of the confidentiality provisions of this Agreement and agree to abide by them,(u)pursuant to court order or(ui)to a designated public official or agency pursuant to the requirements of federal,state or local law,statute,rule or regulation. The disclosing party will provide the other party with prompt notice of any request the disclosing party receives to disclose information pursuant to applicable legal requirements, so that the other party may object to the request and/or seek an appropriate protective order against such request. Each party shall maintain the confidentiality of medical records and confidential patient and employee information as required by applicable law. 11. Arbitration. Any dispute,controversy or difference between GHC and the Group arising out of or relating to this Agreement,or the breach thereof,shall be settled by arbitration in Seattle,Washington in accordance with the Commercial Arbitration Rules of the American Arbitration Association, and judgment on the award rendered by the arbitrator(s)may be entered in any court havmg junsdiction thereof. ,Except as may be required bylaw,neither party nor arbitrator may disclose the existence,content or results of any arbitration hereunder without the prior written consent of both parties. 12. HIPAA. Definition of Terms. Terms used,but not otherwise defined,in this Section shall have the same meaning as those terms have in the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). Transactions Accepted. GHC will accept Standard Transactions,pursuant to HIPAA,if the Group elects to transmit such transactions. If the Group sends transactions to GHC that do not comply with applicable HIPAA standards,the Group will he deemed by such action to be representing and warranting that it is not a Covered Entity or otherwise required to comply with HIPAA standards for electronic transactions,either directly,or as an agent of another individual or entity. The parties agree that all the terms,conditions,representations and warranties contained in this section are express obligations of the Group,and the Group shall indemnify GHC for any breach of this section. 13. Termination of Entire Agreement. This is a guaranteed renewable Agreement and cannot be terunated without the mutual approval of each of the parties,except in the circumstances set forth below. a. Nonpayment or Non-Acceptance of Premium.Failure to make any monthly premium payment or contribution in accordance with subsection 2 above shall result in termination of this Agreement as of the prep uum due date The Group's failure to accept the revised premiums provided as part of the annual renewal process shall be considered nonpayment and result in non-renewal of this Agreement. The Group may terminate this Agreement upon fifteen(15) days written notice of preen mm increase,as set forth in subsection 2 above. b. Misrepresentation. GHC may rescind or terminate this Agreement upon written notice in the event that material misrepresentation,fraud or omission of information was used in order to obtain Group coverage. Either party may terminate this Agreement in the event of material misrepresentation,fraud or omission of information by the other party in performance of its responsibilities under this Agreement c. Underwriting Guidelines.GHC may terminate or non renew this Agreement in the event the Group no longer meets underwriting guidelines established by GHC that were in effect at the time the Group was accepted. 14. Withdrawal or Cessation of Services. a. GHC may determine to withdraw from a Service Area or from a segment of its Service Area after GHC has demonstrated to the Washington State Office of the Insurance Commissioner that GHC's clinical,financial or administrative capacity to service the covered Members would be exceeded b. GHC may determine to cease to offer the Group's current plan and replace the plan with another plan offered to all covered Members withm that line of business that includes all of the health care services covered under the replaced plan and does not significantly limit access to the services covered under the replaced plan GHC may also allow unrestricted conversion to a fully comparable GHC product. C24431 -0036900 4 PA-11330 GHC will provide wntten notice to each covered Member of the discontinuation or non-renewal of the plan at least ninety(90)days prior to disconnnuatzon. j � 1 r i C24431 -0036900 5 PA-11330 Dear Group Health Subscriber: This booklet contains important information about your healthcare plan. This is your 2006 Group Health Benefit Booklet(Certificate of Coverage). It explains the services and benefits you and those enrolled on your contract are entitled to receive from Group Health Cooperative. Sections of this document may be bolded and italicized,which identifies changes that Group Health has made to the plan. The benefits reflected in this booklet were approved by your employer or association who contracts with Group Health for your healthcare coverage. If you are eligible for Medicare,please read Section 1V.J as it may affect your prescription drug coverage. We recommend you read it carefully so you'll understand not only the benefits,but the exclusions,limitations,and eligibility requirements of this certificate. Please keep this certificate for as long as you are covered by Group Health. We will send you revisions if there are any changes in your coverage. This certificate is not the contract itself, you can contact your employer or group administrator if you wish to see a copy of the contract(Medical Coverage Agreement). We'll gladly answer any questions you might have about your Group Health benefits. Please call our Group Health Customer Service Center at(206)901-4636 in the Seattle area,or toll-free in Washington, 1-888-901-4636. Thank you for choosing Group Health Cooperative. We look forward to working with you to preserve and erdiance your health. Very truly yours, Scott Armstrong President PA-1133a02 CA-139502,CA-2220,CA-1984,CA-107600,CA-2581,CA-2587,CA-1385,CA-6100,clg230 PA-1133a02 Benefit Booklet Table of Contents Section I. Introduction A. Accessing Care B. Cost Shares C Subscriber's Liability D. Claims Section U. Allowances Schedule iSection 111. Eligibility, Enrollment and Termination A Eligibility B. Enrollment C. Effective Date of Enrollment D Eligibility for Medicare E. Tem-iinatron of Coverage F Services After Termination of Agreement G. Continuation of Coverage Options Section IV. Schedule of Benefits A. Hospital Care B Medical and Surgical Care C Chemical Dependency Treatment D. Plastic and Reconstructive Services E. Home Health Care Services F. Hospice Care G. Rehabilitation Services H. Devices,Equipment and Supplies i Tobacco Cessation J. Drugs,Medicines,Supplies and Devices K. Mental Health Care Services L. Emergency/Urgent Care M. Ambulance Services N. Slalled Nursing Facility Section V. General Exclusions Section VI. Grievance Processes for Complaints and Appeals Section VII. General Provisions A. Coordination of Benefits B. Subrogation and Reunbnrsement Rights C. Miscellaneous Provisions jSection VIII. Definitions Attachment: Group Medicare Coverage C7"31 -0036900 1 PA-113302 Section I. Introduction Group Health Cooperative(also referred to as"GHC")is a nonprofit health maintenance organization furnishing health care primarily on a prepayment basis. Read This Benefit Booklet Carefully This Benefit Booklet is a statement of benefits,exclusions and other provisions, as set forth in the Group Medical Coverage Agreement("Agreement')between GHC and the employer or Group. A full description of benefits,exclusions,lirmts and Out-of-Pocket Expenses can be found in the Schedule of Benefits, Section IV;General Exclusions, Section V, and Allowances Schedule,Section H. These sections must be considered together to fully understand the benefits available under the Agreement Words with special meaning are capitalized They are defined in Section VM. A. Accessing Care Members are entitled to Covered Services only at GHC Facilities and from GHC Personal Physicians.Except as follows: • Emergency care, • Self-Referral to women's health care providers,as set forth below, • Visits with GHC-Designated Self-Referral Specialists,as set forth below, • Care provided pursuant to a Referral. Referrals must be requested by the Member's Personal Physician and approved by GHC,and • Other services as specifically set forth in the Allowances Schedule and Section W. Primary Care. Members must select a GHC Personal Physician when enrolling under the Agreement.One Personal Physician may be selected for an entire family,or a different Personal Physician may be selected for each family member. If the Personal Physician is not selected at the time of enrollment,GHC will assign a Personal Physician,and a letter of explanation will be sent to the Member. Selecting a Personal Physician or changing from one Personal Physician to another can be accomplished by contacting GHC Customer Service,or accessing the GHC website at www.ghc_org The change will be made within twenty-four (24)hours of the receipt of the request, if the selected physician's caseload permits. A listing of GHC Personal Physicians,Referral specialists,women's health care providers and GHC-Designated Self- Referral Specialists is available by contacting GHC Customer Service at(206)9014636 or(888)901-4636,or by accessing GHC's website at www.ghc.org. In the case that the Member's Personal Physician no Longer participates in GHC's network,the Member will be provided access to the Personal Physiclan for up to sixty(60)days following a written notice offering the Member a selection of new Personal Physicians from which to choose. Specialty Care. Unless otherwise indicated in this section,the Allowances Schedule or Section IV.,Referrals are ' required for specialty care and specialists. GHC-Designated Self-Referral Specialist. Members may make appointments directly with GHC-Designated Self- t Referral Specialists at Group Health-owned or-operated medical centers without a Referral from their Personal Physician. Self-Referrals are available for the following specialty care areas:allergy,audiology, cardiology,chemical dependency,chiropractic/manipulative therapy,dermatology,gastroenterology,general surgery,hospice,manipulative therapy,mental health,neproology,neurology,obstetrics and gynecology,occupational medicine;, oncology/hematology,ophthalmology,optometry,orthopedics,otolaryngoLogy(ear,nose and throat),physical therapy, smoking cessation,speechllanguage and learning services'and urology. "Medicare patients need a Referral for these specialists. C24431 -0036900 2 PA-1133ao2 Women's Health Care Direct Access Providers. Female Members may see a participating General and Family Practitioner,Physician's Assistant,Gynecologist,Cemfied Nurse Midwife,Licensed Midwife,Doctor of Osteopathy, Pediatrician,Obstetrician or Advanced Registered:Nurse Practitioner who is contracted by GHC to provide women's health care services directly,without a Referral from their Personal Physician,for Medically Necessary maternity care, covered reproductive health services,preventive care(well care)and general examinations,gynecological care and follow-up visits for the above services.Women's health care services are covered as if the Member's Personal Physician had been consulted,subject to any applicable Cost Shares,as set forth in the Allowances Schedule If the Member's women's health care provider diagnoses a condition that requires Referral to other specialists or hospitalization,the I Member or her chosen provider must obtain preauthorization and care coordination in accordance with applicable GHC requirements. Second Opinions. The Member may access,upon request,a second opinion regarding a medical diagnosis or treatment plan from a GHC Provider. Emergent and Urgent Care. Emergent care is available at GHC Facilities. If Members cannot get to a GHC Facility, Members may obtain Emergency services from the nearest hospital. Members or persons assuming responsibility for a Member must notify GHC by way of the GHC Emergency Notification Line within twenty-four(24)hours of admission to a non-GHC Facility,or as soon thereafter as medically possible. Members may refer to Section IV.for more information about coverage of Emergency services. In the GHC Service Area,urgent care is covered only at GHC medical centers, GHC urgent care clinics or GHC Provider's offices. Urgent care received at any hospital emergency department is not covered unless authorized in advance by a GHC Provider. Members may refer to Section IV,for more information about coverage of urgent care services Outside the GHC Service Area,urgent care is covered at any medical facility. Members may refer to Section IV.for more information about coverage of urgent care services Recommended Treatment.GHC's Medical Director or his/her designee will determine the necessity,nature and extent of treatment to be covered 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 any recommended treatment or diagnostic plan to the extent permitted by law. Members who obtam care not recommended by GHC,do so with the full understanding that GHC has no obligation for the cost,or liability for the outcome,of such care. Coverage decisions may be appealed as set forth in Section VI. Major Disaster or Epidemic.In the event of a major disaster or epidemic,GHC will provide coverage according to GHC's best judgment,within the limitations of available facilities and personnel.GHC 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. 1 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 I causes,GHC shalt 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 while its facilities and services are so affected In no case shall GHC have any liability or obligation on account of delay or failure to provide or arrange such services. B. Cost Shares The Subscriber shall be liable for the following Cost Shares when services are received by the Subscriber and any of hisilier Dependents. 1. Copayments.Members shall be required to pay Copayments at the time of service as set forth in the Allowances Schedule. Payment of a Copayment does not exclude the possibility of an additional billing if the service is determined to be a non-Covered Service. C24431 -4036900 3 PA-1133a02 2. Coinsurance.Members shall be required to pay Coinsurance for certain Covered Services as set forth in the Allowances Schedule. 3. Out-of--Pocket Limit.Total Out-of-Pocket Expenses incurred during the same calendar year shall not exceed the Out-of-Pocket Limit set forth in the Allowances Schedule.Out-of-Pocket Expenses which apply toward the Out-of- Pocket Limit are set forth in the Allowances Schedule. 4. Deductibles. In addition to any applicable annual Deductible,there may be service-specific Deductibles as set forth in the Allowances Schedule- C. Subscriber's Liability The Subscriber is liable for(1)payment to the Group of his/her contribution toward the monthly premium, if any;(2) payment of Cost Share amounts for Covered Services provided to the Subscriber and his/her Dependents, as set forth in the Allowances Schedule;and(3)payment of any fees charged for non-Covered Services provided to the Subscriber and his/her Dependents,at the time of service- Payment of an amount billed by GHC must be received within thirty(30)days of the billing date. D. Claims Claims for benefits may be made before or after services are obtained. To make a claim for benefits under the Agreement,a Member(or the Member's authorized representative)must contact GHC Customer Service,or submit a claim for reimbursement as described below. Other inquiries,such as asking a health care provider about care or coverage,or submitting a prescription to a pharmacy, will not he considered a claun for benefits. If a Member receives a bill for services the Member believes are covered under the Agreement,the Member must,within ninety(90)days of the date of service,or as soon thereafter as reasonably possible,either(1) contact GHC Customer Service to make a claim or(2)pay the bill and submit a claim for reimbursement of Covered Services to GHC,P.O.Box 34585,Seattle,WA 98124-1585. In no event,except in the absence of legal capacity,shall a claim be accepted later than one(1)year from the date of service. GHC will generally process claums for benefits within the following timef wrics after GHC receives the claims: • Pre-service claims—within fifteen(15)days. • Claims involving urgently needed care—within seventy-two(72)bours. • Concurrent care claims—within twenty-four(24)hours. • Post-service claims—within thirty(30)days Timeframnes for pre-service and post-service claims can be extended by GHC for up to an additional fifteen(15)days. ' Members will be notified in writing of such extension prior to the expiration of the initial timeframe. C24431 -0036900 4 PA-1133a02 Section II. Allowances Schedule The benefits described in this schedule are subject to all provisions,limitations and exclusions set forth in the Group Medical Coverage Agreement "Welcome"Outpatient Services Waiver Not applicable. jAnnual Deductible No annual Deductible. Plan Coinsurance No plan Coinsurance. Lifetime Maximum $2,000,000 per Member for Covered Services incurred,unless otherwise indicated. Up to$5,000 is restored automatically each January 1 for benefits paid by GHC dunmg the prior calendar year Hospital Services • Covered inpatient medical and surgical services,including acute chemical withdrawal(detoxification) iCovered in full • Covered outpatient hospital surgery(including ambulatory surgical centers) Covered subject to the applicable outpatient services Copayment Outpatient Services • Covered outpatient medical and surgical services Covered subject to a$10 outpatient services Copayment per Member per visit. • Allergy testing Covered subject to the applicable outpatient services Copayment. 1 • Oncology(radiation therapy,chemotherapy) Covered subject to the applicable outpatient services Copayment. 1 Drugs—Outpatient(including mental health drugs,contraceptive drugs and devices and diabetic supplies) • Prescription drugs,medicines,supplies and devices for a supply of thirty(30)days or less when listed in the GHC drug formulary Covered subject to the lesser of GHC's charge or a$10 Copayment. • Over-the-counter drugs and medicines Not covered. C24431-0036900 5 PA-1133a02 • Allergy serum Covered subject to the applicable prescription drug Cost Share(as set forth above)for each thirty(30)day supply. • Injectables Injections that can be self-administered are subject to the applicable prescription drug Cost Share(as set forth above). Injections necessary for travel are not covered. • Mail order drugs and medicines Covered subject to the applicable prescription drug Cost Share(as set forth above)for each thirty(30)day supply or less. • Growth hormones Covered in full. Out-of-Pocket Limit(Stop Loss) Limited to an aggregate maximum of$2,000 per Member or$4,000 per family per calendar year Except as otherwise noted in this Allowances Schedule,the total Out-of-Pocket Expenses for the following Covered Services are included in the Out-of- Pocket Limit- • Inpatient services • Outpatient services • Emergency care at a GHC or non-GHC Facility • Ambulance services Acupuncture Covered subject to the applicable outpatient services Copayment for Self-Referrals to a GHC Provider up to a maximum of eight(8)visits per Member per medical diagnosis per calendar year.When approved by GHC, additional visits are covered subject to the applicable outpatient services Copayment Ambulance Services • Emergency ground/air transport Covered at 80% • Non-emergent groundlair interfacility transfer ' Covered at 80%for GHC-initiated transfers,except hospital-to-hospital ground transfers covered in full. , Chemical Dependency • Inpatient services Covered subject to the applicable inpatient services Copayment • Outpatient services t Covered subject to the applicable outpatient services Copayment. • Benefit period Allowance Covered up to$13,000 per Member per any twenty-four(24)consecutive calendar month period. C24431 -0036900 6 PA-1133a02 Acute detoxification covered as any other medical service. Charges incurred are not subject to the twenty-four(24)month maximum, Dental Services(including accidental injury to natural teeth) Not covered,except as set forth in Section W.B.24. Devices,Equipment and Supplies(for home use) Covered at 80%for: • Durable medical equipment • Orthopedic appliances • Post-mastectomy bras hrnited to two(2)every six(6)months Covered at 80%for: • Ostomy supplies • Prosthetic devices Diabetic Supplies Insulin,needles,syringes and lancets-see Drugs-Outpatient. External insulin pumps,blood glucose monitors,testing reagents and supplies-see Devices,Equipment and Supplies. When Devices,Equipment and Supplies have a dollar maximum,diabetic supplies are not subject to this maximum benefit limit. Diagnostic Laboratory and Radiology Services Covered in full. Emergency Services • At a GHC Facility Covered subject to a$75 Copayment per Member per Emergency visit. Copayment is waived if the Member is admmtted as an inpatient to the hospital directly from the emergency department.Emergency admissions are covered subject to the applicable inpatient services Cost Share. • At a non-GHC Facility tCovered subject to a$125 Deductible per Member per Emergency visit. Emergency care Deductible is waived if the Member is admitted as an inpatient to the hospital directly from the emergency department.Emergency admissions are covered subject to the applicable inpatient services Cost Share. Hearing Examinations and Hearing Aids • Hearing examinations to deternime hearing loss Covered subject to the applicable outpatient services Copayment j • Hearing aids,including hearing aid examinations Not covered. Hoare Health Services Covered in full.No visit limit. C24431 -0036900 7 PA-1133a02 Hospice Services Covered in full Inpatient respite care is covered for a maximum of five(5)consecutive days per occurrence. Infertility Services(including sterility) Not covered. Manipulative Therapy Covered subject to the applicable outpatient services Copayment for Self-Referrals to a GHC Provider for manipulative therapy of the spore and extremities in accordance with GHC clerical criteria up to a maximum of ten(10)visits per Member per calendar year. When approved by GHC,additional manipulation visits are covered subject to the applicable outpatient services Copayment. Maternity and Pregnancy Services • Delivery and associated Hospital Care Covered subject to the applicable inpatient services Copayment • Routine prenatal and postpartum care Covered subject to the applicable outpatient services Copayment. • Pregnancy termination Covered subject to the applicable Copayment for involuntary/voluntary termination of pregnancy. Mental Health Services • Inpatient services Covered subject to the applicable inpatient services Copayment for up to twelve(12)days per Member per calendar year at a GHC-approved mental health care facility. Copayment does not apply to the Out-of-Pocket limit_ • Outpatient services r Covered subject to the applicable outpatient services Copayment for up to twenty(20)visas per Member per calendar year Copayment does not apply to the Out-of-Pocket Limit. , Naturopathy Covered subject to the applicable outpatient services Copayment for Self-Referrals to a GHC Provider up to a maximum of i three(3)visits per Member per medical diagnosis per calendar year.When approved by GHC,additional visits are covered subject to the applicable outpatient services Copayment. Nutritional Services • Phenylketonuria(PKU)supplements ' Covered in full. • Enteral therapy(formula) Covered at 80%for elemental formulas.Necessary equipment and supplies are covered under Devices,Equipment and Supplies. C24431 -0036900 8 PA-1133a02 i • Parenteral therapy(total parenteral nutrition) Covered in full for parenteral formulas.Necessary equipment and supplies are covered under Devices,Equipment and Supplies Obesity Related Services Covered subject to the applicable Copayment for bariatne surgery.Weight loss programs,medications and related physician visits for medication monitoring are not covered. On the Job Injuries or Illnesses Not covered,including injuries or illnesses incurred as a result of self-employment Optical Services • Routine eye examinations 1 Covered subject to the applicable outpatient services Copayment once every twelve(12)months. • Lenses,including contact lenses,and frames Not covered,except contact lens after cataract surgery is covered in full when in lieu of mtraocular lens. Organ Transplants Covered subject to the applicable Copayment up to a$200,000 lifetime benefit maximum(including donor costs up to $50,000),and a twelve(12)month benefit wait period_ Plastic and Reconstructive Services(plastic surgery,cosmetic surgery) • Surgery to correct a congenital disease or anomaly,or conditions following an injury or resulting from surgery Covered subject to the applicable Copayment. • Cosmetic surgery,including complications resulting from cosmetic surgery Not covered. Podiatric Services • Medically Necessary foot care Covered subject to the applicable Copayment. • Foot care(routine) Not covered,except in the presence of a non-related Medical Condition affecting the lower limbs. Pre-Existing Condition Covered with no wait Preventive Services(well adult and well child physicals,immunizations,pap smears,mammograms) C24431 -0036900 9 PA-1133a02 Covered subject to the applicable outpatient services Copayment when in accordance with the well care schedule established by GHC. Eye refractions are not included under preventive care. Physicals for travel,employment,insurance,license,are not covered Rehabilitation Services • Inpatient physical,occupational and restorative speech therapy services combined, including services for neurodevelopmentally disabled children age six(6)and under Covered subject to the applicable inpatient services Copayment for up to sixty(60)days per calendar year. • Outpatient physical,occupational and restorative speech therapy services combined,including services for neurodevelopmentally disabled children age six(6)and under Covered subject to the applicable outpatient services Copayment for up to sixty(60)visits per calendar year. Sexual Dysfunction Services Not covered. Skilled Nursing Facility(SNF) Covered in full up to thirty(30)days per condition per Member per calendar year Sterilization(vasectomy,tuba[ligation) Covered subject to applicable Copayments Temporomandibular Joint(TMJ)Services • Inpatient and outpatient TM7 services Covered subject to the applicable Copayment up to$1,000 maximum per Member per calendar year. • Lifetime benefit maximum Covered up to$5,000 per Member. i Tobacco Cessation • Individual/group sessions Covered in full. • Approved pharmacy products Covered subject to the lesser of GHC's charge or the applicable prescription drug Cost Share(as set forth above in Drugs-Ouipadent)for each thirty(30)day supply or less of a prescription or refill when prescribed by a GHC Provider and obtained at a GHC Facility. I Section M. Eligibility,Enrollment and Termination A. Eligibility In order to be accepted for enrollment and continuing coverage under the Agreement, individuals must meet any eligibility requirements imposed by the Group,and/or all applicable plan documents,reside or work in the Service Area C24431 -0036900 10 PA-1133a02 i and meet all applicable requirements set forth below,except for temporary residency outside the Service Area for purposes of attending school,court-ordered coverage for Dependents or other unique family arrangements,when approved in advance by GHC. GHC has the right to verify eligibility. 1. Subscribers_Bona fide LEOFF II employees who have been continuously employed on a regularly scheduled basis of not Iess than twenty(21)hours per week orlobshare shall be eligible for enrolbnem. Elected officials and council members shall be eligible for enrollment LEOFF 1 employees will not be covered under this plan. 2.Dependents.The Subscriber may also enroll the following: a. The Subscriber's legal spouse. b. Unmarried dependent children who are under the age of twenty-three(23)and are chiefly dependent on the Subscriber for support and maintenance,provided proof of such dependency is furnished to GHC upon request. i "Children'means the cluldren of the Subscriber,including adopted children,stepchildren,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. Dependents of L.EOFF I employees are eligible for coverage under this agreement. 3. Temporary Coverage for Newborns. When a Member gives birth,the newborn will be entitled to the benefits set forth in Section 1V.from both 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 the Agreement All contract provisions, linutations and exclusions will apply except Section III F and UI.G. 4. Limiting Age Extension. Eligibility may be extended past the limiting age for an unnamed person enrolled as a Dependent on his/her twenty-third(23rd)birthday if The Dependent is totally incapable of self-sustaining employment because of a developmental or physical disability incurred prior to attainment of the limiting age set forth in 2.above,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 GHC upon request,but not more frequently than annually after the two (2)year period following the Dependent's attainment of the hunting age. B. Enrollment 1. Application for Enrollment.Application for enrollment rmist be made on an application form furnished and approved by GHC Applicants will not be enrolled or premiums accepted until the completed application form has been received and approved by GHC.The Group is responsible for subirutting completed application forms to GHC. GHC reserves the right to refuse enrollment to any person whose coverage under any Medical Coverage Agreement issued by Group Health Cooperative or Group Health Options,Inc, has been terminated for cause,as set forth in Section III.E.below a. Newly Eligible Persons.Newly eligible Subscribers and their Dependents may apply for enrollment in writing to the Group within thirty-one(3 1)days of becoming eligible. b. New Dependents. A written application for enrollment of a newly dependent person,other than a newborn or adopted newborn child,must be made to the Group within thirty-one(3 1)days after the dependency occurs. C24431 -0036900 11 PA-1111a02 A written application for enrollment of a newborn child must be made to the Group within sixty(60)days following the date of birth,when there is a change in the monthly premium payment as a result of the additional Dependent. A written application for enrollment of an adoptive child must be made to the Group within sixty(60)days from the day the child is placed with the Subscriber for the purpose of adoption and the Subscriber assumes financial responsibility for the medical expenses of the child,if there is a change in the monthly premium payment as a result of the additional Dependent. When there is no change in the monthly premium payment,it is strongly advised that the Subscriber enroll the newborn or newly adoptive child as a Dependent with the Group to avoid delays in the payment of claims. c. Open Enrollmeut. GHC will allow enrollment of Subscribers and Dependents,who did not enroll when newly eligible as described above,during a limited period of time specified by the Group and GHC. d. Special Enrollment. GHC will allow special enrollment for persons who initially declined em olhrient when otherwise eligible because such persons had other health care coverage and have had such other coverage terminated due to cessation of employer contributions,exhaustion of COBRA continuation coverage or loss of eligibility,except for loss of eligibility for cause;or have had such other coverage exhausted because such person reached a Lifetime Maximum limit. GHC or the Group may require confirmation that when initially , offered coverage such persons submitted a written statement declining because of other coverage Apphcahon for coverage under the Agreement must be made within thirty-one(31)days of the termination of previous coverage In the event a Subscriber or person eligible to be a Subscriber acquires a person eligible to be a Dependent by birth,marriage,adoption or placement for adoption,GHC will allow special enrollment for the person eligible to be a Subscriber,his/her spouse and the newly acquired Dependent. Application for coverage under the Agreement must be made within thirty-one(31)days of the acquisition of the new Dependent,except that sixty (60)days is permitted to enroll newborn and adopted children as described above_ 2. Limitation on Enrollment.The Agreement will be open for applications for enrollment as set forth in this Section III.B.Subject to prior approval by the Washington State Office of the Insurance Commissioner,GHC may lumt enrollment,establish quotas or set priorities for acceptance of new applications if it determines that GHC's capacity, in relation to its total enrollment, is not adequate to provide services to additional persons C. Effective Date of Enrollment 1. Provided eligibility criteria are met and applications for enrollment are made as set forth in Sections HI.A.and HLB. above,enrollment will be effective as follows: • Enrollment for a newly eligible Subscriber and listed Dependents is effective on the date of hire • Enrollment for a newly dependent person,other than a newborn or adoptive child,is effective the first(1st)of the month following application. • Enrollment for newborns is effective from the date of birth. • Enrollment for adoptive children is effective from the date that the adoptive child is placed with the Subscriber for the purpose of adoption and the Subscriber has assumed financial responsibility for the medical expenses of the child. 2. Commencement of Benefits for Persons Hospitalized on Effective Date.Members who are admitted to an , inpatient facility prior to their enrollment under the Agreement,and who do not have coverage under another agreement, will receive covered benefits beginning on their effective date,as set forth in subsection C.I.above.If a Member is hospitalized in a non-GHC Facility,GHC reserves the right to require transfer of the Member to a GHC Facility. The Member will be transferred when a GHC Provider, in consultation with the attending physician, determines that the Member is medically stable to do so. If the Member refuses to transfer to a GHC Facility,all further costs incurred during the hospitalization are the responsibility of the Member. D. Eligibility for Medicare Under the Tax Equity and Fiscal Responsibility Act of 1982(TEFRA),actively employed Members and their spouses who are eligible for Medicare benefits must decide whether to choose the benefits of the Agreement or the Medicare C24431 -0036900 12 PA-1 133a02 program as their primary source of health care coverage.The Group is responsible for providing the Member with 1 necessary information regarding TETRA eligibility and the selection process Members Residing Outside the GHC Medicare Advantage Service Area. Except as defined by federal regulations (i.e.,TEFRA),if a Member or their spouse is or becomes eligible for Medicare,they must,effective the date that Medicare becomes the primary payer,enroll in and maintain both Medicare Parts A and B coverage. Failure to enroll in both Medicare Parts A and B,upon the effective date of eligibility,will result in termination of coverage under the Agreement. An individual shall be deemed eligible for Medicare when he/she has the option to receive Part A Medicare benefits. Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status. Members Residing Inside the GHC Medicare Advantage Service Area. Except as defined by federal regulations, (i.e.,TEFRA),if a Member or their spouse is or becomes eligible for Medicare,they must, effective the date that Medicare becomes the primary payer,enroll in and maintain both Medicare Parts A and B coverage and enroll in the GHC Medicare Advantage Plan. Failure to do so upon the effective date of Medicare eligibility will result in termination of coverage under the Agreement An individual shall be deemed eligible for Medicare when helsbe has the option to receive Part A Medicare benefits. All applicable provisions of the GHC Medicare Advantage Plan are fully set forth in the Medicare Endorsement(s) attached to the Agreement(if applicable) I3 Termination of Coverage 1. Termination of Specific Members.Specific Members may be terminated from the Agreement for any of the following reasons: a. Loss of Eligibility. If a Member no longer meets the eligibility requirements set forth in Section III.A.,and is not enrolled for continuation coverage as described in Section III.G.below,coverage under the Agreement will terminate at the end of the month during which the loss of eligibility occurs,unless otherwise specified by the Group Ib. For Cause.Coverage of a Member maybe terminated upon ten(10)working days written notice for: i. Material misrepresentation,fraud or omission of information in order to obtain coverage. ii. Permitting the use of a GHC identification card or number by another person, or using another Member's identification card or number to obtain care to which a person is not entitled. iii. Nonpayment of charges,as set forth in Section I.C. In the event of termination for cause,GHC reserves the right to pursue all civil remedies allowable under federal and state law for the collection of claims,losses or other damages G Premium Payments.Nonpayment of premiums or contribution for a specific Member by the Group. 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 the Agreement Any Member may appeal a termination decision through GHC's grievance process as set forth in Section V1. 2. Certificate of Creditable Coverage. Unless the Group has chosen to accept this responsibility,a certificate of creditable coverage(which provides information regarding the Member's length of coverage under the Agreement) will be issued automatically upon termination of coverage,and may also be obtained upon request. jF. Services After Termination of Agreement C244 31-0036900 13 PA-1133a02 1. Members Hospitalized on the Date of Termination.A Member who is receiving Covered Services as a registered bed patient in a hospital on the date of termination shall continue to be eligible for Covered Services while an inpatient for the condition which the Member was hospitalized,until one of the following events occurs. • According to GHC clinical criteria,it is no longer Medically Necessary for the Member to be an inpatient at the facility. • The remaining benefits available under the Agreement for the hospitalization are exhausted,regardless of whether a new calendar year begins. • The Member becomes covered under another agreement with a group health plan that provides benefits for the hospitalization. • The Member becomes enrolled under an agreement with another carrier that would provide benefits for the hospitalization if the Agreement did not exist. • The Member becomes eligible for Medicare. This provision will not apply if the Member is covered under another agreement that provides benefits for the hospitalization at the time coverage would terminate, except as set forth in this section,or if the Member is eligible for COBRA continuation coverage as set forth in subsection G.below. 2. Services Provided After Termination.The Subscriber shall be liable for payment of all charges for services and items provided to the Subscriber and all Dependents after the effective date of termination, except those services covered under subsection F.1. above Any services provided by GHC will be charged according to the Fee Schedule. G. Continuation of Coverage Options 1. Continuation Option. A Member no longer eligible for coverage under the Agreement(except in the event of termination for cause,as set forth in Section III E)may continue coverage for a period of up to three(3)months subject to notification to and self-payment of premiums to the Group. This provision will not apply if the Member is eligible for the continuation coverage provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). This continuation option is not available if the Group no longer has active employees or otherwise terminates. 2. Leave of Absence. While on a Group approved leave of absence,the Subscriber and listed Dependents can continue to be covered under the Agreement provided: • They rerun eligible for coverage,as set forth in Section III.A., • Such leave is in compliance with the Group's established leave of absence policy that is consistently applied to all employees, • The Group's leave of absence policy is in compliance with the Family and Medical Leave Act when applicable, and • The Group continues to remit premiums for the Subscriber and Dependents to GHC. 3. Self-Payments During Labor Disputes. In the event of suspension or termination of employee compensation due to a strike,lock-out or other labor dispute,a Subscriber may continue umnternipted coverage under the Agreement through payment of monthly premiums 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 Agreement is no longer available,the Subscriber shall have the opportunity to apply for an individual GHC Group Conversion Plan or,if applicable,continuation coverage(see subsection 4.below),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. 4. Continuation Coverage Under Federal Law. This section applies only to Groups who must offer continuation coverage under the applicable provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 C24431 -0036900 14 PA-1133a02 1 (COBRA),as amended,and only applies to grant continuation of coverage rights to the extent required by federal law Upon loss of eligibility,continuation of Group coverage may be available to a Member for a limited time after the Member would otherwise lose eligibility,if required by COBRA The Group shall inform Members of the COBRA election process and how much the Member will be required to pay directly to the Group. 5. GHC Group Conversion Plan. Members whose eligibility for coverage under the Agreement,including I continuation coverage,is terminated for any reason other than cause,as set forth in Section IIIX I b.,and who are not eligible for Medicare or covered by another group health plan,may convert to GHC's Group Conversion Plan. If the Agreement terminates,any Member covered under the Agreement at termination may convert to a GHC Group Conversion Plan,unless he/she is eligible to obtain other group health coverage within thirty-one(31)days of the termination of the Agreement. An application for conversion must be tide within thirty-one(31)days following termination of coverage under the Agreement. Coverage under GHC's Group Conversion Plan is subject to all terms and conditions of such plan, including premium payments. A physical examination or statement of health is not required for enrollment in GHC's Group Conversion Plan. The Pre-Existing Condition limitation under GHC's Group Conversion Plan will apply only to the extent that the limitation remains unfulfilled under the Agreement. By exercising Group Conversion rights,the Member may waive guaranteed issue and Pre-Existing Condition waiver rights under Federal regulations. Persons wishing to purchase GHC's individual and Family coverage should contact GHC Marketing. Section IV. Schedule of Benefits Benefits are subject to all provisions of the Group Medical Coverage Agreement,including,without limitation,the Accessing Care provisions and General Exclusions. Members must refer to Section II.,the Allowances Schedule,for Cost Shares and specific benefit limits that apply to benefits listed in this Schedule of Benefits. Members are entitled to receive only benefits and services that are Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by GHC's Medical Director,or his/her designee,and as described herein. All Covered Services are subject to case management and utilization review at the discretion of GHC. A. Hospital Care Hospital coverage is limited to the following services: 1. Room and board,including private room when prescnbed,and general nursing services. 2. Hospital services(including use of operating room, anesthesia,oxygen,x-ray,laboratory and radiotherapy services). 3. Alternative care arrangements may be covered as a cost-effective alternative in lieu of otherwise covered Medically Necessary hospitalization,or other covered Medically Necessary institutional care. Alternative care arrangements in lieu of covered hospital or other institutional care must be determined to be appropriate and Medically Necessary based upon the Member's Medical Condition. Coverage must be authorized in advance by GHC as appropriate and Medically Necessary. Such care will be covered to the same extent the replaced Hospital Care is covered under the Agreement. 4. Drugs and medications administered during confinement. 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 between a GHC Provider and the attending physician.If the Member refuses to transfer,all further costs incurred during the hospitalization are the responsibility of the Member. B. Medical and Surgical Care C24431 -0036900 15 PA-1133a02 i Medical and surgical coverage is limited to the following: 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 and blood derivatives and their administration. 6. Preventive care(well care)services for health maintenance in accordance with the well care schedule established by GHC. Preventive care includes:routine mammography screening,physical examinations and routine laboratory tests for cancer screening in accordance with the well care schedule established by GHC,and immunizations and vaccinations listed as covered in the GHC drug formulary(approved drug list). A fee may be charged for health education programs. The well care schedule is available in GHC clinics,by accessing GHC's website at www.ghaorg,or upon request Covered Services provided during a preventive care visr;which are not in accordance with the GHC well care schedule,are subject to the applicable Cost Shares. 7. Radiation therapy services t 8. Reduction of a fracture or dislocation of the j aw or facial bones;excision of tumors or non-dental cysts of the law, cheeks,lips,tongue,gums,roof and floor of the mouth, and incision of salivary glands and ducts. 9. Medical implants. Excluded:internally implanted insulin pumps, artificial hearts,artificial larynx and any other implantable device that has not been approved by GHC's Medical Director,or his/her designee. 10. Respiratory therapy. 11. Outpatient total parenteral nutritional therapy;outpatient elemental formulas for malabsorption;and dietary formula for the treatment of phenylketonuria(PKU).Coverage for PKU formula is not subject to a Pre-Existing Condition waiting period,if applicable. Equipment and supplies for the administration of enteral and parenteral therapy are covered under Devices, Equipment and Supplies. Excluded:any other dietary formulas, oral nutritional supplements,special diets,prepared foods/meals and formula for access problems- 12. Visits with GHC Providers,including consultations and second opinions,in the hospital or provider's office. I3. Optical services. Routine eye examinations and refractions received at a GHC Facility once every twelve(12)months,except when Medically Necessary. 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 covered only when needed due to a change in the Member's Medical Condition,but no more than once in a twelve (12)month period C24431 -0036900 16 PA-1133a02 Excluded: evaluations and surgical procedures to correct refractions not related to eye pathology and complications related to such procedures,and contact lens fittings and related examinations,except as set forth above. 14 Matemity cue,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,and in accordance with Board of health standards for screening and diagnostic tests during pregnancy. Hospitalization and delivery,including home births for low risk pregnancies. Planned home births must be authorized in advance by GHC. Voluntary(not medically mdieated and non-therapeutic)or involuntary termination of pregnancy. The Member's physician,in consultation with the Member,will determine the Member's length of inpatient stay following delivery.Pregnancy will not be excluded as a Pre-Existing Condition under the Agreement.Treatment for postpartum depression or psychosis is covered only under the mental health benefit. Excluded:birthing tubs and genetic testing of non-Members for the detection of congenital and heritable disorders. 15. Transplant services,including heart,heart-lung,single lung,double I=&kidney,pancreas,cornea,intestinal/multi- visceral,bone marrow, Liver transplants and stem cell support(obtained from allogeneic or autologous peripheral blood or marrow)with associated high dose chemotherapy Services are limited to the following_ a. Evaluation testing to determine recipient candidacy, b. Matchurg tests, c. Inpaaent and outpatient medical expenses listed below for transplantation procedures. Covered Services must be directly associated with, and occur at the time of,the transplant. The following transplantation expenses are subject to the organ recipient's lifetime benefit maximums set forth in the Allowances Schedule: • Hospital charges, • Procurement center fees, • Professional fees, • Travel costs for a surgical team, • Excision fees,and • Donor costs for a covered organ recipient are limited to procurement center fees, travel costs for a surgical team and excision fees d. Follow-up services for specialty visits, e. Rehospitalization,and f. Maintenance medications. Excluded:donor costs to the extent that they are reimbursable by the organ donor's insurance,treatment of donor complications,living expenses and transportation expenses, except as set forth under Section N.M. Coverage for all transplants and any related seances,items and drugs shall be excluded until the Member has been continuously enrolled under the Agreement,or any prior GHC or GHO Medical Coverage Agreement, for twelve (12)consecutive months without any lapse in coverage,except for children who have been continuously enrolled with GHC since birth,or if 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. Manipulative therapy. Self-Referrals for manipulative therapy of the spine and extremities are lmmted to one(1)evaluation and ten(10) marnpulahous when provided by GRC Providers. C24431 -0036900 17 PA-1133a02 o Additional visits are covered when approved by GHC Excluded:supportive care rendered prunarily to maintain the level of correction already achieved,care rendered prunarily for the convenience of the Member,care rendered on a non-acute,asymptomatic basis,charges for office visits other than the imtial evaluation and any other services that do not meet GHC clinical criteria as Medically , Necessary. 17. Medical and surgical services and related hospital charges,including orthognathic(jaw)surgery,for the treatment of temporomandibular joint(TMJ)disorders.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 Section W.H.I.,Orthopedic Appliances. Orthognathic(jaw)surgery for the treatment of TMJ disorders,radiology services and TMJ specialist services, including fitting/adjustment of splints are subject to the benefit limit set forth in the Allowances Schedule Excluded are the following,regardless of origin or cause: orthognathic(law)surgery in the absence of a TMJ or severe obstructive sleep apnea diagnosis except for newborn infants with congenital anomalies,treatment for cosmetic purposes, dental services,including orthodontic therapy and any hospitalizations related to these exclusions. 18. Treatment of growth disorders by growth hormones 19 Diabetic training and education. 20 Detoxification services for alcoholism and drug abuse. For the purposes of this section, "acute chemical withdrawal"means withdrawal of alcohol and/or drugs from a Member for whom consequences of abstinence are so severe that they require medical/nursing assistance in a hospital setting,which is needed unmediately to prevent serious impairment to the Members health Coverage for acute chemical withdrawal is provided without prior approval If a Member is hospitalized in a non- ` GHC Facility/program,coverage is subject to payment of the Emergency Deductible. The Member or person assimiuig responsibility for the Member must notify 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 Facility/program,GHC reserves the right to require transfer of the Member to a GHC Facility/program upon consultation between a GHC Provider and the attending physician.If the Member refuses transfer to a GHC Facility/program,all further costs incurred during the hospitalization are the responsibility of the Member. 21. Circumcision_ 22, Bariatric surgery and related hospitalizations when GHC criteria are met. Excluded- pre and post surgical nutntiotnl counseling and related weight loss programs,prescribing and monitoring of drugs,structured weight loss aarl/or exercise programs and specialized nutritional counseling. 23. Sterilization procedures. 24 General anesthesia services and related facility charges for dental procedures will be covered for Members who are under seven(7)years of age, or are physically or developmentally disabled or have a Medical Condition where the Member's health would be put at risk if the dental procedure were performed in a dentist's office. Such services must be authorized in advance by GHC and performed at a GHC hospital or ambulatory surgical facility. Excluded-dentist's or oral surgeon's fees. 25, Self-Referrals to GHC acupuncturists and naturopaths for Covered Services,as set forth in the Allowances Schedule. Additional visits are covered when approved by GHC. Laboratory and radiology services are covered only when obtained through a GHC Facility. C24431-0036900 18 PA-I 133a02 j - Excluded:herbal supplements,preventive care visits to acupuncturists and naturopaths and any services not within the scope of their licensure. 26, Once Pre-Existing Condition wart periods,if any,have been met,Pre-Existing Conditions are covered in the same nnanner as any other illness. C. Chemical Dependency Treatment. Chemical dependency means an illness characterized by a physiological or psychological dependency,or both,on a controlled substance and/or alcoholic beverages, and where the user's health is substantially impaired or endangered or his/her social or economic function is substantially disrupted. For the purposes of this section,the definition of Medically Necessary shall be expanded to include those services necessary to treat a chemical dependency condition that is having a clinically significant impact on a Member's emotional,social,medical and/or occupational functioning. Chemical dependency treatment services are covered as set forth below at a GHC Facility or GHC-approved treatment program,subject to the benefit period Allowance set forth in the Allowances Schedule. Any Cost Shares for chemical dependency services under the terms of the Agreement shall not be applied toward the benefit period Allowance. 1. Chemical Dependency'Treatment Services.All alcoholism and/or drug abuse treatment services must be:(a) provided at a facility as described above,and(b)deemed Medically Necessary as defined above. Chemical dependency treatment may include the following services received on an inpatient or outpatient basis:diagnostic evaluation and education, organized individual and group counseling and/or prescription drugs and medicines. Court-ordered treatment shall be covered only if determined to be Medically Necessary as defined above 2. Benefit Period.For the purposes 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 and shall continue for twenty-four(24)consecutive calendar months,provided that coverage under the Agreement remains m force All subsequent benefit periods thereafter will begin on the first day Covered Services are received after the expiration of the previous twenty-four(24)month benefit period D. Plastic and Reconstructive Services.Plastic and reconstructive services are covered asset forth below: 1. Correction of a congenital disease or congenital anomaly,as determined by a GHC Provider. A congenital anomaly will be considered to exist if the Member's appearance resulting from such condition is not within the range of normal human variation. 2. Correction of a Medical Condition following an injury or resulting from surgery covered by GHC which has j produced a major effect on the Member's appearance,when in the opinion of a GHC Provider,such services can reasonably be expected to correct the condition. 3. Reconstructive surgery and associated procedures,including internal breast prostheses,following a mastectomy, regardless of when the mastectomy was performed Members will be covered for all stages of reconstruction on the nondiseased breast to make it equivalent in size with the diseased breast. Compheations of covered mastectomy services,including lymphedemas,are covered. Excluded- complications of noncovered surgical services. E. Home Health Care Services. Home health care services,as set forth in this section,shall be covered when provided by and referred m advance by a GHC Provider for Members who meet the following criteria: C24431 -0036900 19 PA-1133a02 L 1. The Member is unable to leave home due to his/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. 3. A GHC Provider has determined that such services are Medically Necessary and are most appropriately rendered in the Member's home, For the purposes of this section,"skilled home health care"means 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. Covered Services for home health care may include the following 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 covered 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:custodial care and maintenance care,private duty or continuous nursing care in the Members 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 do not meet the definition of skilled home health care above or are not specifically listed as covered under the Agreement. F. Hospice Care. Hospice care is covered in lieu of curative treatment for terminal illness for Members who meet all of the i following criteria: • A GHC Provider has determined that the Members illness is terminal and life expectancy is six(6)months or less. • The Member has chosen a palliative treatment focus(emphasizing comfort and supportive services rather than treatment aimed at curing the Members terminal illness). • The Member has elected in writing to receive hospice care through GHC's Hospice Program or GHC's approved hospice program • The Member has available a primary care person who will be responsible for the Member's home care • A GHC Provider and GHC's Hospice Director,or his/her designee,have determined that the Member's illness can be appropriately managed in the home. Hospice care shall mean a coordinated program of palliative and supportive care for dying Members by an interdisciplinary team of professionals and volunteers centering primarily in the Member's home 1. Covered Services.Care 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, limited services by a Home Health Aide under the supervision of a Registered Nurse and homemaker services it. Continuous care services in the Member's home when prescribed by a GHC Provider,as set forth in this paragraph."Continuous care"means skilled nursing care provided in the home during a period of crisis in order to maintain the terminally ill Member 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 is covered up to twenty-four(24)hours per day during periods of crisis.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. For short-term care,inpatient hospice services shall be covered in a facility designated by GHC's Hospice Program or GHC-approved hospice program when authorized in advance by a GHC Provider and GHC's Hospice Program or GHC-approved hospice program C24431 -0036900 20 PA-1133a02 Inpatient 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). c. Other covered hospice services may include the following: i. Drugs and biologicals that are used primarily for the relief of pain and symptom management. ii. Medical apphances and supplies pnmanly for the relief of pain and symptom management. iii. Counseling seances for the Member and his/her primary care-giver(s). iv. Bereavement counseling services for the family. 2. Hospice Exclusions. All services not specifically listed as covered in this section are excluded,including: a. Financial or legal counseling services. b. Meal services e Custodial or maintenance care in the home or on an inpatient basis,except as provided above. d. ,S'erVleeS not specifically listed as covered by the Agreement. e. Any services provided by members of the patient's family. f. All other exclusions listed in Section V.,General Exclusions,apply. G. Rehabilitation Services. 1. 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 the Agreement,including the following: a. All services must be provided at a GHC or GHC-approved rehabilitation facility and must be prescribed and provided by a GHC-approved rehabihtation team that may include medical,nursing,physical therapy, occupational therapy,massage therapy and speech therapy providers. b. Services are limited to those necessary to restore or improve functional abilities when physical,senson- perceptual and/or communication impairment exists due to injury,illness or surgery. Such services are provided only when GHC's Medical Director,or his/her designee,determines that significant,measurable miprovement 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 a.,above. c. Coverage for inpatient and outpatient services is limited to the Allowance set forth in the Allowances Scbedule. Excluded specialty rehabilitation programs not provided by GHC,long-tens rehabilitation programs;physical therapy,occupational therapy and speech therapy services when such services are available(whether application is made or not)through 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 as set forth in subsection 2 below),recreational,hfe-enhancing,relaxation or palliative therapy, implementation of home maintenance programs;programs for treatment of learning problems;any services not specifically included as covered in this section;and any services that are excluded under Section V. 2. Neurodevelop mental Therapies for Children Age Six(6)and Under. 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 Allowances Schedule. Excluded- 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 programs offered by public school districts;recreational,life-enhancing,relaxation or palliative therapy;implementation of home maintenance programs,programs for treatment of learning problems; any services not specifically included as covered in this section;and any services that are excluded under Section V. H. Devices,Equipment and Supplies. C24431 -0036900 21 PA-""a02 Devices,equipment and supplies,which restore or replace functions that are common and necessary to perform basic activities of daily living,are covered as set forth in the Allowances Schedule. Examples of basic activities of daily living are dressing and feeding oneself,maintaining personal hygiene,lifting and gripping in order to prepare meals and carrying groceries. 1. Orthopedic Appliances.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. Excluded:arch supports,including custom shoe modifications or inserts and their fittings except for therapeutic shoes,modifications and shoe inserts for severe diabetic foot disease,and orthopedic shoes that are not attached to an appliance 2. Ostomy Supplies.Ostomy supplies for the removal of bodily secretions or waste through an artificial opening. 3. Durable Medical Equipment. Durable medical equipment is equipment which can withstand repeated use,is pnniarily and customarily used to serve a medical purpose,is useful only in the presence of an illness or mgury and used in the Member's home. Durable medical equipment includes.hospital beds, wheelchairs,walkers,crutches, canes,glucose monitors, external insulin pumps, oxygen and oxygen equipment. GHC,in its sole discretion,will determine if equipment is made available on a rental or purchase basis. 4. Prostbetic Devices. Prosthetic devices are items which replace all or part of an external body part,or function thereof. When authorized in advance,repair,adjustment or replacement of appliances and equipment is covered- Excluded.items which are not necessary to restore or replace functions of basic activities of daily living;and replacement or repair of appliances,devices and supplies due to loss,breakage from willful damage,neglect or wrongful use,or due to personal preference. 1. Tobacco Cessation.When provided through GHC,services related to tobacco cessation are covered,limited to- t. Participation in one individual or group program per calendar year; 2_ Educational materials;and 3. One course of mcotine replacement therapy per calendar year,provided the Member is actively participating in a GHC-designated tobacco cessation program. J. Drugs,Medicines,Supplies and Devices.This benefit,for purposes of creditable coverage,Is actuarially equal to or greater than the Medicare Part D prescription drug benefit. Eligible Members who are also eligible for Medicare Part D pharmacy benefits can remain covered under the Agreement and not be subject to Medicare4mposed late enrollment penalties should they decide to enroll in a Medicare Part D pharmacy plan at a later date- The Agreement may include Medicare Part D pharmacy benefits as part of the GHC Medicare Advantage Plan required for Medicare eligible Members who live in the GHC Medicare Advantage Service Arm See Section HI.D. for more information. A Member who discontinues coverage under the Agreement must meet eligibility requirements in order to re-enroll Legend medications are drugs which have been approved by the Food and Drug Administration(FDA)and which can, under federal or state law,be dispensed only pursuant to a prescription order. These drugs,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 unproved 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),contraceptive drugs and devices and their fitting,diabetic supplies,including insulin syringes,lancets,urine-testing reagents,blood-glucose monitoring reagents and insulin,are covered as set forth below. All drugs,supplies,medicines and devices must be prescribed by a GHC Provider for conditions covered by the Agreement,obtained at a GHC pharmacy and,unless approved by GHC in advance,be listed in the GHC drug formulary. The prescription drug Cost Share,as set forth in the Allowances Schedule,applies to each thirty(30)day C2443 1 -0036900 22 PA-1 I33a02 i ` supply. Cost Shares for single and multiple thirty(30)day supplies of a given prescription are payable at the time of delivery_ Injectables that can be self-admimstered are also subject to the prescription drug Cost Share Drug formulary (approved drug list)is defined as a list of preferred pharmaceutical products,supplies and devices developed and maintained by GHC. Generic drugs will be dispensed whenever available.Brand name drugs will be dispensed if there is not a generic equivalent.In the event the Member elects to purchase brand-name drugs instead of the generic equivalent(if available), or if the Member elects to purchase a different brand-name or generic drug than that prescribed by the Member's Provider,and it is not determined to be Medically Necessary,the Member will also be subject to payment of the additional amount above the applicable pharmacy Cost Share set forth in the Allowances Schedule. A generic drug is defined as a drug that is the pharmaceutical equivalent to one or more brand name drugs Such generic drugs have been approved by the Food and Drug Adrmnistration as meeting the same standards of safety,purity,strength and effectiveness as the brand name drug. A brand name drug is defined as a prescription drug that has been patented and is only available through one manufacturer. "Standard reference compendia"means the American Hospital Formulary Service-Dmg Information;the American Medical Association 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 i 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 over-the-counter drugs,medicines, supplies and devices not requiring a prescription understate law or regulations,drugs used in the treatment of sexual dysfunction disorders,medicines and injections for anticipated illness while traveling;vitamins,including Legend(prescription)vitamins,and any other drugs,mcdremes and injections not listed as covered in the GHC drug formulary unless approved in advance by GHC as Medically Necessary. The Member will be charged for replacing lost or stolen drugs,medicines or devices. The Member's Right to Sare and Effective Pharmacy Services. State and federal laws establish standards to assure safe and effective pharmacy services, and to guarantee Members' Tight to know what drugs are covered under the Agreement and what coverage limitations are in the Agreement. Members who would like more information about the drug coverage policies under the Agreement,or have a question or concern about their pharmacy benefit,may contact GHC at(206)901-4636 or(888)901-4636. Members who would like to know more about their rights under the law,or think any services received while enrolled may not conform to the terms of the Agreement,may contact the Washington State Office of Insurance Commissioner at (800)562-6900. Members who have a concern about the pharmacists or pharmacies serving them,may call the State Department of Health at(360)2364825. K. Mental Health Care Services. GHC and Washington State law have established standards to assure the competence and professional conduct of mental health service providers,to guarantee Members'rights to informed consent to treatment,to assure the privacy of their medical information,to enable Members to know which services are covered under the Agreement and to know the limitations on their coverage. Members who would like a more detailed description than is provided here of covered benefits for mental health services under the Agreement,or have questions or concerns about any aspect of their mental health benefits,may contact GHC at(888)9014636. Members who would like to know more about their rights under the law, or think any services received while enrolled may not conform to the terms of the Agreement or their tights under the law,may contact the Washington State Office of the Insurance Commissioner at(800)562-6900 Members who have a concern about the qualifications or professional conduct of their mental health provider may call the Washington StateDepa►tment ofHeafth at 1(900) 525-0127. Services that are provided by a mental health practitioner will be covered as mental health care,regardless of the cause of the disorder. C24431 -0036900 23 PA-1133a02 1. Outpatient Services.Outpatient mental health services place priority on restoring the Member to his/her level of fimctioning prior to the onset of acute symptoms or to achieve a clinically appropriate level of stability as determined by GHC's Medical Director,or bis/her designee. Treatment for clinical conditions may utilize psycluatnc,psychological and/or psychotherapy Services to achieve these objectives Coverage for each Member is provided according to the outpatient mental health care Allowance set forth in the Allowances Schedule.Psychiatric medical services,including medical management and prescriptions,are covered as set forth in Sections IV.B.and N.J. 2. Inpatient Services.Charges for services described in this section,including psychiatric Emergencies resulting in i inpatient services,shall be covered up to the maximum benefit set forth in the Allowances Schedule.This benefit shall include coverage for acute treatment and stabilisation of psychiatric Emergencies in GHC-approved hospitals. When medically indicated,outpatient electro-convulsive therapy(ECT) is covered in lieu of inpatient services. Coverage for services incurred at non-GHC Facilities shall exclude any charges that would otherwise be excluded for hospitahzation within a GHC Facility. Partial hospitalization is covered subject to the maximum inpatient benefit limit described in the Allowances i Schedule Every two(2)partial hospitalization days 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 Allowances Schedule. Subject to the rnaximum inpatient mental health care Allowance set forth in the Allowances Schedule,services provided under involuntary commitment statutes shall be covered at facilities approved by GHC.Services for any involuntary court-ordered treatment program beyond seventy-two(72)hours shall be covered only if determined to be Medically Necessary by GIIC's Medical Director,or lusher designee. Coverage for voluntary/involuntary Emergency inpatient psychiatric services is subject to the Emergency care benefit set forth in Section IV.L.,including the twenty-four(24)hour notification and transfer provisions. Outpatient eleetro-convulsive therapy treatment is covered subject to the outpatient surgery Cost Share 3. Exclusions and Limitations for Outpatient and Inpatient Mental Health Treatment Services. Covered Services are limited to those authorized by GHC's Medical Director,or his/her designee,for covered clinical conditions for which,the reduction or removal of acute clinical symptoms or stabilization can be expected given the most clinically appropriate level of mental health care intervention. Partial hospitalization programs are covered only under subsection IC2.(Inpatient Services). Excluded:treatment specific to and solely for personality disorders;learning,communication and motor stalls disorders;mental retardation;academic or career counseling;sexual and identity disorders;and personal growth or relationship enhancement. Also excluded:assessment and treatment services that are primarily vocational and academic;court-ordered or forensic treatment, including reports and summanes,not considered Medically Necessary;written information other than clinical records;work or school ordered assessment and treatment not considered Medically Necessary;counseling for overeating;psychoanalysis;nicotine related disorders,treatment or consultations provided by telephone;relationship counseling or phase of life problems(V code only diagnoses),all forms of day treatment(non-partial hospital programs);custodial care;and specialty programs for mental health therapy not specifically authorized by Behavioral Health Services and approved by GHC. Any other services not specifically listed as covered in this section.All other provisions,exclusions and limitations under the Agreement also apply. L. Emergency/Urgent Care. All services are covered subject to the Cost Shares set forth in the Allowances Schedule. Emergency Care(See Section VM.for a definition of Emergency.) 1. At a GHC Facility.GHC wtU cover Emergency care for all Covered Services. C24431 - 0036900 24 PA-1133a02 2. At a Non-GHC Facility.Usual,Customary and Reasonable charges for Emergency care for Covered Services are covered subject to: a. Payment of the Emergency care Deductible;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. 3. Waiver of Emergency Care Cost Share. a. Waiver for Multiple Injury Accident.If two or more Members in the same Family Unit require Emergency care as a result of the same accident,coverage for all Members will be subject to only one(1)Emergency care Cost Share b. Emergencies Resulting in an Inpatient Admission.Ifthe Member is admitted to a GHC Facility directly from the emergency room,the Emergency care Copayment is waived.However,coverage will be subject to the inpatient services Cost Share. 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 Facihty,upon consultation between a GHC Provider and the attending physician 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 from GHC Providers,unless a GHC Provider has authorized such follow-up care from a non-GHC Provider in advance. Urgent Care(See Section VIII for a definition of Urgent Condition.) jInside the GHC Service Area,care for Urgent Conditions is covered only at GHC medical centers, GHC urgent care clinics or GHC Providers'offices,subject to the applicable Cost Share. Urgent care received at any hospital emergency 1 department is not covered unless authorized in advance by a GHC Provider. Outside the GHC Service Area,Usual,Customary and Reasonable charges are covered for Urgent Conditions received at any medical facility,subject to the applicable Cost Share iM. Ambulance Services. 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 VIII.) 1. Emergency Transport to any Facility.Each Emergency is covered asset forth in the Allowances Schedule. 2. Interfacility Transfers.GHC-initiated non-emergent transfers to or from a GHC Facility are covered as set forth in the Allowances Schedule. N. Skilled Nursing Facility(SNF). Skilled nursing care in a GHC-approved skilled nursing facility when full-time slalled nursing care is necessary in the opinion of the attending GHC Provider,is covered as set forth in the Allowances Schedule. When prescribed by a GHC Provider,such care may include room and board;general musing 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:personal comfort items such as telephone and television,rest cures and custodial,domiciliary or convalescent care Section V. General Exclusions In addition to exclusions listed throughout the Agreement,the following are not covered: 1. Services or supplies not specifically listed as covered in the Schedule of Benefits,Section IV. C24431 -0036900 25 PA-113342 2. Except as specifically listed and identified as covered in Sections IV.E.,N.D_,N.H.and IV.7., corrective appliances and artificial aids mcluding:eyeglasses;contact lenses and services related to their fitting;hearing devices and hearing aids,including related examinations,take-home drugs, dressings and supplies following hospitalization,and any other supplies,dressings,appliances,devices or services which are not specifically listed as covered in Section IV 3. Cosmetic services,including treatment for complications resulting from cosmetic surgery,except as provided in Section IV.D. 4. Convalescent or custodial care_ 5. Durable medical equipment such as hospital beds,wheelchairs and walk-aids,except while in the hospital or as set forth in Section N.E.,N.E.,N.F.or N.H. 6. Services rendered as a result of work-related injuries,illnesses or conditions,including injuries,illnesses or conditions incurred as a result of self-employment_ 7. Those parts of an examination and associated reports and immunizations required for employment,unless otherwise noted in Section I V.B.,immigration,license,travel or insurance purposes that are not deemed Medically Necessary by GHC for early detection of disease. S. Services and supplies related to sexual reassignment surgery,such as sex change operations or transformations and procedures or treatments designed to alter physical characteristics. 9. Diagnostic testing and medical treatment of sterility,infertility and sexual dysfunction,regardless of origin or cause, unless otherwise noted in Section N E. 10. 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: (a)medical coverage,medical"no fault"coverage,Personal Injury Protection coverage or similar medical coverage contained in said policy; and/or(b)uninsured motorist or undennsuied motorist coverage s 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,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/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/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/her agents shall do nothing to prejudice GHC's right to enforce this exclusion In the event the Member fails to cooperate fully,the Member shall be responsible for reimbursing GHC for such medical expenses. GHC shall not enforce this exclusion as to coverage available under uninsured motorist or undennsured motorist coverage until the Member has been made whole,unless the Member fails to cooperate fully with GHC as described above. GHC shall not pay any attorneys' fees or collection costs to attorneys representing the injured person where it has retained its own legal counsel of 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. Under no circumstances will GHC pay legal fees for services whieb were not reasonably and necessarily incurred to secure recovery and/or which do not benefit GHC. If it becomes necessary for GHC to enforce the provisions of this section by initiating any action against the injured person or bis/her agent,then the injured person agrees to pay GHC's attorneys' fees and costs associated with the action. 11. Voluntary(not medically indicated and nontherapeutic)termination of pregnancy,unless otherwise noted in Section N.B. 12. The cost of services and supplies resulting from a Membefs loss of or willful damage to appliances,devices, supplies and materials covered by GHC for the treatment of disease,injury or illness. C24431 -0036900 26 PA-1133aO2 ' 13. Orthoptic therapy(i.e.,eye training). 14. Specialty treatment programs such as weight reduction,"behavior modification programs"and rehabilitation, including cardiac rehabilitation. 15 Services required as a result of war,whether declared or undeclared.Care needed for mlunes or conditions resulting from active or reserve military service. 16. Nontherapeutic sterilization,unless otherwise noted in Section IV.B.,and procedures and services to reverse a therapeutic or nontherapeutic sterilization. 17. Dental care,surgery,services and appliances, including:treatment of accidental injury to natural teeth, reconstructive surgery to the jaw in preparation for dental implants,dental implants,periodontal surgery and any other dental services not specifically listed as covered in Section IV_ GHC's Medical Director,or his/her designee, will determine whether the care or treatment required is within the category of dental care or service. 18 Drugs,medicines and injections,except as set forth in Section IV.J. Any exclusion of drugs,medicines and mjections,including those not listed as covered in the GHC drug formulary(approved drug list),will also exclude their administration. I9. Experimental or investigational services. 1 GHC consults with GHC's Medical Director and then uses the criteria described below to decide if a particular service is experimental or investigational. a. A service is considered experimental or investigational for a Member's condition if any of the following statements apply to it at the time the service is or will be provided to the Member. I t. The service cannot be legally marketed in the United States without the approval of the Food and Drug Administration("FDA")and such approval has not been granted. ii. The service is the subject of a current new drug or new device application on file with the FDA. iii The service is provided as part of a Phase I or Phase H clinical trial,as the experimental or research arm of a Phase III clinical trial,or in any other manner that is intended to evaluate the safety,toxicity or efficacy of the service. iv. The service is provided pursuant to a written protocol or other document that lists an evaluation of the service's safety,toxicity or efficacy as among its objectives. v. The service is under continued scientific testing and research concerning the safety,toxicity or efficacy of services. vi. The service is provided pursuant to informed consent documents that describe the service as experimental or investigational,or in other terms that indicate that the service is being evaluated for its safety,toxicity or efficacy vir The prevailing opinion among experts,as expressed in the published authoritative medical or scientific literature,is that(1)the use of such service should be substantially confined to research settings,or(2) further research is necessary to determine the safety,toxicity or efficacy of the service. b. In making deternimations whether a service is experimental or investigational,the following sources of information will be relied upon exclusively: i. The Member's medical records, Li. The written protocols)or other documents)pursuant to which the service has been or will be provided, rii. Any consent documents)the Member or Member's representative has executed or will be asked to execute, to receive the service, iv. The files and records of the Institutional Review Board(IRB)or similar body that approves or reviews research at the institution where the service has been or will be provided,and other information concerning the authority or actions of the IRB or similar body, v. The published authoritative medical or scientific literature regarding the service,as applied to the Member's illness or injury,and C24431-0036900 27 PA-1133a02 vi. Regulations,records,applications and any other documents or actions issued by, filed with or taken by,the FDA or other agencies within the United States.Department of Health and Human Services,or any state agency performing similar fimctions. Appeals regarding denial of coverage can be submitted to the Member Appeals Department,or to GHC's Medical Director at P.O.Box 34593, Seattle,WA 9 8 124-1 593.GHC will respond in writing within twenty(20)working days of the receipt of a fully documented appeal request.An expedited appeal is available if a delay would jeopardize the Member's life or health. 20 Mental health care,except as specifically provided in Section W.K. 21. Hypnotherapy,and all services related to hypnotherapy. 22. Genetic testing and related services,unless determined Medically Necessary by GHC's Medical Director,or his/her designee,and in accordance with Board of HcaIth standards for screening and diagnostic tests,or specifically provided in Section IV B. Testing for non-Members is also excluded. 23. Follow-up visits related to a non-Covered Service. 24. Fetal ultrasound in the absence of medical indications. 25. Routine foot care,except in the presence of a non-related Medical Condition affecting the lower limbs. 26. Complications of non-Covered Services. 27. Treatment of obesity,including bariatnc surgery, except as set forth in Section W.B. 28. Services or supplies for which no charge is made,or for which a charge would not have been made if the Member had no health care coverage or for which the Member is not liable,services provided by a member of the Member's family 29, Autopsy and associated expenses 30. Services provided by government agencies,except as required by federal or state law. 31 Services related to temporomandibular joint disorder(TM.n and/or associated facial pain or to correct congenital conditions,including bite blocks and occlusal equilibration,except as specified as covered in Section W.B. 32 Services covered by the national health plan of any other country. 33. pre-Existing Conditions,except as specifically provided in Section IV.B.26. Section VI. Grievance Processes for Complaints and Appeals The grievance processes to express a complaint and appeal a denial of benefits are set forth below. Filing a Complaint or Appeal The complaint process is available for a Member to express dissatisfaction about customer service or the quality or availability of a health service. The appeals process is available for a Member to seek reconsideration of a denial of benefits. Complaint Process Step 1: The Member should contact the person involved,explain his/her concerns and what he/she would like to have done to resolve the problem The Member should be specific and make his/her position clear. C24431 -0036900 28 PA-113302 Step 2: If the Member is not satisfied, or if he/she prefers not to talk with the person involved,the Member should call the ' department head or the manager of the medical center or department where he/she is having a problem That person will investigate the Member's concerns. Most concerns can be resolved in this way. Step 3: If the Member is still not satisfied,he/she should call the GHC Customer Service Center toll free at(888)901-4636. Most concerns are handled by phone within a few days. In some cases the Member will be asked to write down his/her concerns and state what he/she thinks would be a fair resolution to the problem A Customer Service Representative or Service Quality Coordinator will investigate the Member's concern by consulting with involved staff and their supervisors, and reviewing pertinent records,relevant plan policies and the Member Rights and Responsibilities statement. This process can take up to thirty(30)days to resolve after receipt of the Member's written statement. If the Member is dissatisfied with the resolution of the complaint,he/she may contact the Service Quality Coordinator or the ICustomer Service Center. Appeals Process Step 1:If the Member wishes to appeal a decision denying benefits,he/she must submit a request for an appeal either orally or in writing to the Member Appeals Department,specifying why he/she disagrees with the decision. The appeal must be submitted within 180 days of the denial notice he/she received If the Member is located west of the Cascade Mountains, appeals should be directed to GHC's Member Appeals Department,P O Box 34593, Seattle,WA 98124-1593,(206)901- 7350 or toll free(888)901-4636;or if the Member is located east of the Cascade Mountains,to GHC's Member Appeals Departmnent,P.O.Box 204,Spokane,WA 99110-0204,(509)838-9100 or toll free(800)497-2210. 1 An Appeals Coordinator will review initial appeal requests. GHC will then notify the Member of its determination or need for an extension of time within fourteen(14)days of receiving the request for appeal. Under no circumstances will the review timeframe exceed thirty(30)days without the Member's written permission. If the appeal request is for an experimental or investigational exclusion or hmitation,GHC will make a determination and notify the Member in writing within twenty(20)working days of receipt of a fully documented request In the event that additional time is required to make a determination, GHC will notify the Member in writing that an extension in the review timeframe is necessary. Under no circumstances will the renew timeframe exceed twenty(20)days without the Member's written permission I There is an expedited appeals process in place for cases,which meet criteria or where the Member's doctor states clinical urgency exists If a delay would jeopardize the Member's life,or materially jeopardize the Member's health,the Member can request an expedited appeal in writing to the above address, or by calling GHC's Member Appeals Department in western Washington at(206)901-7350 or toll free(888)901-4636,or in eastern Washington at(509)838-9100 or toll free(800)497- 2210. The Member's request for an expedited appeal will be processed and a decision issued no later than seventy-two(72) hours after receipt. If GHC fails to grant or reject the Member's request within the applicable required timeframe,the Member may proceed as if the complaint has been rejected. Step 2:(OptionaL step)If the Member is not satisfied with the decision reached by the Appeals Coordinator regarding a denial of benefits,he/she may request a hearing by the appeals committee by submitting a request within thirty(30)days of the date of the decision letter.If the Member is located west of the Cascade Mountains,the request can be mailed to GHC's Member Appeals Department,P.O.Box 34593,Seattle,WA 98124-1593,or if the Member is located east of the Cascade Mountains,to GHC's Member Appeals Department,P.O.Box 204,Spokane,WA 99210-0204.* The appeals committee is the final review authority within GHC and its decisions are final. The Member is encouraged to present his/her case to the appeals committee in person. The hearing,and written notification to the Member of the appeals conmrittee decision,will be made wabm thirty(30)working days of the Member's request. As an alternative to this appeal step,the Member may proceed to Step 3 below Step 3:If the Member is not satisfied with the decision nude in Step 1 or Step 2 above,or if GHC exceeds the timneframes stated in Step I or Step 2 above without good cause and without reaching a decision, a final level of appeal is available through an independent review organization.An independent review organization is not legally affiliated or controlled by GHC. Once a decision is made through an independent review,the decision is final and cannot be appealed through GHC. C24431 -0036900 29 PA-1133a02 •If the Member's health plan is governed by the Fmployee Retirement Income Security Act,known as"ERISA"(most employment related health plans,other than those sponsored by governmental entities or churches—ask employer about ' plan), the Member has the right to file a lawsuit under Section 502(a)of ERISA to recover benefits due to the Member under the plan at any point after completion of Step l of the appeals process.Members may have other legal rights and remedies available under state or federal law. Section Vll. General Provisions ' A. Coordination of Benefits 1. Benefits Subject to This Provision.As described in subsection 6.below, all benefits provided under the Agreement are subject to the provisions listed in this section. 2. Definitions. a. Plan.The definition of a"plan"mcludcs the following sources of benefits or services: i. Individual, group or blanket disability insurance policies and health care service contractor and health maintenance organization group or individual agreements,issued by insurers,health care service contractors and health maintenance organizations; ii. Labor-management trusteed plans,labor organization plans,employer organization plans or employee benefit organization plans; llr. Governmental programs;and iv. 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 b. Allowable Expense. "Allowable expense"means any Usual,Customary and Reasonable 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 an allowable expense c. Claim Determination Period."Claim determination period"means a calendar year,except the Member's first claim determination period shall begin on the Member's effective date of coverage under the Agreement and end on December 31 of that same calendar year In no event will a claim determination period for any Member extend beyond the last day the Member is covered under the Agreement- 3- 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,GHC may,with any consent necessary,release to or obtain from any other insurer,organization or person any information,regarding any person which GHC considers necessary for such purpose.Any Member claiming benefits under the Agreement shall provide GHC with the information necessary for such purpose. , 4. Facility of Payment.Whenever coverage has been provided or paid for under any other plan which should have been provided under the Agreement in accordance with this provision,GHC shall have the right,exercisable alone and in its sole discretion,to pay over to any plan snaking such payments any amounts GHC shall determine to be warranted in order to satisfy the intent of this provision. Amounts so paid shall be considered as coverage or benefits paid under the Agreement and,to the extent of such payments, GHC shall be fully discharged from liability under the Agreement. 5. Right of Recovery.Whenever benefits have been provided by GHC 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,GHC shall have the right to recover the reasonable cash value of such benefits,to the extent of such C24431 -0036900 30 PA-1133a02 ` excess,from one or more of the following, as GHC shall determine:any persons to or for or with respect to whom ' such benefits were provided,any other insurers,service plans,other organizations or other plans. 6. Effect on Benefits. a. This provision shall apply in determining the benefits for a Member covered under the Agreement for a particular claim determination period if,for the allowable expenses incurred by the Member during such period, the sum of: 1 i. The reasonable cash value of the benefits that would be provided under the Agreement in the absence of this provision, and ii. 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 b. As to any claim determination period with respect to which this provision is applicable,the reasonable cash value of the benefits provided under the 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 c.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, GHC is not required, and will not take into 1 consideration,Deductibles,Copayments or other Cost Share provisions. c. If another plan winch is involved in subparagraph b.of this section and which contains a provision coordinating its benefits with those of the Agreement would,according to its rules,determine its benefits after the benefits of this plan have been determined,and the rules set forth in subparagraph d.of this section would require the Agreement to detemume its benefits before such other plan,then the benefits of such other plan will be ignored for the purposes of determining the benefits under the Agreement. d. For the purposes of subparagraph c.of this section,the rules establishing the order of benefit determination are: i. The benefits of a plan which covers the person on whose expenses a claim is based as a Subscriber shall be determined before the benefits of a plan which covers such person as a Dependent. ii. If a Dependent is covered under both parents'medical plans,the benefits of the plan of the parent whose birthday,excluding year,falls earlier in the calendar year are determined before those of the plan of a parent whose birthday,excluding year,falls later in the calendar year. a) 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 he determined before the benefits of a plan which covers the child as a Dependent of the parent without custody;and b) 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 1 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 a)and b)above, if there is a court decree which would otherwise establish financial responsibility for the health care expenses of 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 winch covers the child as a Dependent. in- When rules i.and ii.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 C24431 -0036900 31 PA-1133a02 a) The benefits of a plan covering the person 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 b) 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 a)of this subsection shall not apply. ' iv_ If none of the above rules determines the order of benefits,the benefits of the plan which covered an employee,Member 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_ e. When this provision operates to reduce the total amount of benefits otherwise to be provided to a person covered under the Agreement during any claim determination period,the reasonable cash value of each benefit that would be provided in the absence of this provision shalt be reduced proportionately and such reduced amount shall be charged against any applicable benefit trout of the Agreement. 7. Effect of Medicare. i Members Residing Outside the GHC Medicare Advantage Service Area. If a Member is or becomes eligible for Medicare coverage and Medicare is determined to be the primary bill payer,the Member must enroll in,and maintain both Medicare Part A and Part B coverage in order to be eligible for continuing coverage under the Agreement. Medicare prunary/secondary payer guidelines and regulations will determine primary/secondary payer status. i When GHC renders care to a Member who is eligible for Medicare benefits,and Medicare is deemed to be the primary bill payer under Medicare primary/secondary payer guidelines and regulations,GHC will seek Medicare reimbursement for all Medicare covered services. B. Subrogation and Reimbursement Rights "Injured Person"under this section means a Member covered by the Agreement who sustains an injury and any spouse, dependent or other person or entity that may recover on behalf of such Member,including the estate of the Member and, if the Member is a minor,the guardian or parent of the Member.When referred to in this section,"GHC's Medical Expenses"means the expense incurred and the reasonable value of the services provided by GHC for the care or treatment of the injury sustained by the Injured Person. If the Injured Person's injuries were caused by a third party giving rise to a claim of legal liability against the third party and/or payment by the third party to the Injured Person and/or a settlement between the third party and the Injured Person,GHC shall have the right to recover GHC's Medical Expenses from any source available to the hijured Person as a result of the events causing the injury,including but not limited to fiords available through applicable third party liability coverage and umnsured/underinsured motorist coverage This right is commonly referred to as"subrogation." GHC shall be subrogaed to and may enforce all rights of the Injured Person to the extent of GHC's Medical Expenses. GHC's subrogation and reimbursement rights shall be limited to the excess of the amount required to fully compensate the Injured Person for the loss sustained,including general damages However,in the case of Medicare Advantage Members, GHC's right of subrogation shall be the full amount of GHC's Medical Expenses and Is limited only as required by Medicare , If the Injured Person is entitled to or does receive money from any source as a result of the events causing the injury, including but not limited to any parry's liability insurance or uninsured/underinsured motorist funds,then GHC's Medical Expenses provided or to be provided to the Injured Person are secondary,not primary,and will be paid only if the Injured Person fully cooperates with the terms and conditions of the Agreement. As a condition of receiving benefits under the Agreement,the Injured Person agrees that acceptance of GHC services is constructive notice of this provision in its entirety and agrees to reimburse GHC for the benefits the Injured Person received as a result of the events causing the injury. The Injured Person and his/her agents shall cooperate fully with GHC in its efforts to collect GHC's Medical Expenses. This cooperation includes,but is not limited to,supplying GHC with information about any third parties,defendants C24431 -0036900 32 PA-1133a02 and/or insurers related to the Injured Person's claim and informing GHC of any settlement or other payments relating to the Injured Person's injury.The Injured Person and his/her agents shall permit GHC,at GHC's option,to associate with the Injured Person or to intervene in any legal,quasi-legal,agency or any other action or claim filed.If the Injured Person takes no action to recover money from any source,then the Injured Person agrees to allow GHC to initiate its own direct action for reimbursement or subrogation,including,but not lunited to,billing the Injured Person directly for GHC's Medical Expenses The Injured Person and his/her agents shall do nothing to prejudice GHC's subrogation and reimbursement rights.The Injured Person shall promptly notify GHC of any tentative settlement with a third parry and shall not settle a clams without protecting GHC's interest If the Injured Person fails to cooperate fully with GHC in recovery of GHC's Medical Expenses,the Injured Person shall be responsible for directly reimbursing GHC for GHC's Medical Expenses and GHC retains the right to bill the Injured Person directly for GHC's Medical Expenses. To the extent that the Injured Person recovers funds from any source,the Injured Person agrees to hold such monies in trust or in their possession until GHC's subrogation and reimbursement rights are fully determined ' GHC shall not pay any attorney's fees or collection costs to attorneys representing the Injured Person 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_Under no circumstance will GHC pay legal fees for services which were not reasonably and necessarily incurred to secure recovery,which do not benefit GHC and/or where no written fee agreement has been entered into with GHC. If it becomes necessary for GHC to enforce the provision of this section by initiating any action against the Injured Person or his/her agent,then the Injured Person agrees to pay GHC's attorney's fees and costs associated with the action. Implementation of this section shall be deemed a part of claims administration under the Agreement and GHC shall therefore have sole discretion to interpret its terms. tC. Miscellaneous Provisions 1. Identification Cards.GHC will furnish cards,for identification purposes only,to all Members enrolled under the Agreement. 2. Administration of Agreement.GHC may adopt reasonable policies and procedures to help in the administration of the Agreement. GHC reserves the right to construe the provisions of the Agreement and to make all determinations regarding benefit entitlement and coverage. 3. Modification of Agreement.No oral statement of any person shall modify or otherwise affect the benefits, limitations and exclusions of the Agreement,convey or void any coverage, increase or reduce any benefits under the Agreement or be used in the prosecution or defense of a claim under the Agreement. 4. Confidentiality. GHC and the Group shall keep Member information strictly confidential and shall not disclose any information to any thud parry other than (i)representatives of the receiving party(as permitted by applicable state and federal law)who have a need to know such information in order to perform the services required of such party pursuant to the Agreement,or for the proper management and administration of the receiving party,provided that such representatives are informed of the confidentiality provisions of the Agreement and agree to abide by them,(ii) pursuant to court order or(ili)to a designated public official or agency pursuant to the requirements of federal,state or local law,statute,rule or regulation. S. Nondiscrimination.GHC does not discriminate on the basis of physical or mental disabilities in its employment practices and services. 1 Section VIII- Definitions Agreement: The Medical Coverage Agreement between GHC and the Group t C24431 -0036900 33 PA-1133a02 Allowance: The maximum amount payable by GHC for certain Covered Services under the Agreement,as set forth in the Allowances Schedule_ Coinsurance: The percentage amount the Member and GHC are required to pay for Covered Services received under the Agreement. Percentages for Covered Services are set forth in the Allowances Schedule Contracted Network Pharmacy: A pharmacy that has contracted with GHC to provide covered legend(prescription)drugs and medicines for outpatient use under the Agreement. Copsyment: The specific dollar amount a Member is required to pay at the time of service for certain Covered Services under the Agreement,as set forth in the Allowances Schedule, Cost Share: The portion of the cost of Covered Services the Member is liable for under the Agreement Cost Shares for specific Covered Services are set forth in the Allowances Schedule. Cost Share includes Copayments,Coinsurances and/or Deductibles. Covered Services: The services for which a Member is entitled to coverage under the Agreement. Deductible: A specific amount a Member is required to pay for certain Covered Services before benefits are payable under the Agreement. The applicable Deductible amounts are set forth in the Allowances Schedule. Dependent- Any member of a Subscriber's family who meets all applicable eligibility requirements,is enrolled hereunder and for whom the premium prescribed in the Premium Schedule has been paid. Emergency: The emergent and acute onset of a symptom or symptoms,including severe pain,that would lead a prudent layperson acting reasonably to believe that a health condition exists that requires immediate medical attention,if failure to provide medical attention would result in serious impairment to bodily junction or serious dysfunction of a bodily organ or part, or would place the Member's health in serious jeopardy. Family Unit: A Subscriber and all his/her Dependents. , Fee Schedule: A fee-for-service schedule adopted by GHC,setting forth the fees for medical and hospital services. GHC-Designated Self-Referral Specialist: A GHC specialist specifically identified by GHC to whom Members may self- refer GHC Facility: A facility(hospital,medical center or health care center)owned, operated or otherwise designated by GHC. GHC Medicare Plan: A plan of coverage for persons enrolled in Medicare Part A(hospital insurance)and Part B(medical insurance). GHC Personal Physician: A provider who is employed by or contracted with GHC to provide primary care services to i 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 the Agreement which a Member can access without a Referral. Personal Physicians 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 or provider with whom GHC has contracted to provide health care services to Members enrolled under the Agreement,including,but not hunted to physicians,podiatrists,nurses,physician assistants, social workers, optometrists,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 Revised Code of Washington. Group: An employer,union,welfare trust or bona-fide 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. j 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. C24431 -0036900 34 PA-1133a02 Lifetime Maximum: The maximum value of benefits provided for Covered Services under the Agreement after which benefits under the Agreement are no longer available as set forth m the Allowances Schedule. The value of Covered Services is based on the Fee Schedule, as defined above. I Medical Condition:A disease,ilhiess or injury. Medically Necessary: Appropriate and clinically necessary services,as determined by GHC's Medical Director,or his/her designee,according to generally accepted principles of good medical practice,which are rendered to a Member for the diagnosis,care or treatment of a Medical Condition. Services must be medically and clinically necessary for benefits to be covered under the Agreement. The cost of services and supplies,which are not Medically Necessary shall be the responsibility of the Member.In order to be Medically Necessary, services and supplies must meet the following 1 requirements: (a)are not solely for the convenience of the Member,his/her family or the provider of the services or supplies; (b) are the most appropriate level of service or supply which can be safely provided to the Member,(c) are for the diagnosis or treatment of an actual or existing Medical Condition unless being provided under GHC's schedule for preventive services; (d)are not for recreational,life-enhancing,relaxation or palliative therapy,except for treatment of terminal conditions;(e)are appropriate and consistent with the diagnosis and which, in accordance with accepted medical standards in the State of Washington,could not have been omitted without adversely affecting the Member's condition or the quality of health services rendered;(f)as to inpatient care, could not have been provided in a provider's office,the outpatient department of a hospital or a non-residential facility without affecting the Members condition or quality of health services rendered;(g)are not primarily for research and data accumulation;and(h) are not experimental or investigational. The length and type of the treatment program and the frequency and modality of visits covered shall be determined by GHC's Medical Director,or his/her designee ' Medicare: The federal health insurance program for the aged and disabled Member: Any Subscriber or Dependent enrolled under the Agreement Out-of-Pocket Expenses: Those Cost Shares paid by the Subscriber or Member for Covered Services,which are applied to the Out-of-Pocket Limit. Out-of-Pocket Limit(Stop Loss): The maximum amount of Out-of-Pocket Expenses incurred and paid,during the calendar year for Covered Services received by the Subscriber and his/her Dependents within the same calendar year. The Out-of- Packet Linut amount and Cost Shares that apply are set forth in the Allowances Schedule.Charges in excess of UCR services in excess of any benefit level and services not covered by the Agreement are not applied to the Out-of-Pocket Limit- Pre-Existing Condition: A condition for which there has been diagnosis,treatment(including the use of prescribed drugs) 1 or medical advice within the three(3)month period prior to the effective date of coverage.The Pre-Existing Condition wait period will begin on the first day of coverage,or the first day of the enrollment waiting period if earlier. Referral: A written temporary agreement requested in advance by a GHC Provider and approved by GHC that entitles a ' Member to receive Covered Services from a specified 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 the Agreement.Members who have a complex or serious medical or psychiatric condition may receive a standing Referral for specialist services. Self-Referred: Covered Services received by a Member from a designated women's health care specialist or GHC- Designated Self-Referral Specialist that are not referred by a GHC Personal Physician. Service Area:Washington counties of Benton,Columbia,Franklin,Island,King,Kitsap,Kittitas,Lewis,Mason,Pierce,San Juan,Skagit,Snohomish,Spokane,Thurston Walla Walla,Whatcom,Whitman and Yakima; Idaho counties of Kootenai and Latah,and any other areas designated by GHC. Stop Loss: See Out-of-Pocket Limit Subscriber: A person employed by or belonging to the Group who tneets all applicable eligibility requirements,is enrolled under the Agreement and for whom the premiums specified in the Premium 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. C24431 -0036900 35 PA-1133a02 i Usual,Customary and Reasonable(UCR): A term used to define the level of benefits which are payable by GHC when expenses are incurred from a non-GHC Provider Expenses are considered Usual, Customary and Reasonable if the charges ' are consistent with those normally charged to others by the provider or organization for the same services or supplies;and the charges are within the general range of charges made by other providers in the same geographical area for the same semee or supplies. i t l 1 1 i i t 1 i 1 i t C24431 -0036900 36 PA-1133a02 i EMPLOYER GROUP PROGRAMS GROUP MEDICARE COVERAGE i t t i t 1 t 1 i Employer Group Medicare Endorsement l Group Health MA Plan @GroupHeaKh COOPERATIVE Group Health Cooperative Medicare Advantage Plan (GHMA PIan) Following is a brief outline of the benefits available to Group Members who are also enrolled in the , Group Health Cooperative Medicare Advantage plan. A more detailed plan summary is provided to GHMA Plan Members directly. In no event shall the benefits of the GHMA plan duplicate the benefits under the Group Medical Coverage Agreement. The benefits available to persons enrolled in both the Group Health Cooperative Medical Coverage Agreement and the Group Health Cooperative Medicare Advantage Plan will be the higher level of benefit available under the plans, as determined by Group Health Cooperative. Unless otherwise stated, the provisions, limitations and exclusions, including provider access requirements of the Group Medical Coverage Agreement apply to the benefits available under the Group Health Cooperative Medicare Advantage Plan. The benefits described in this outline apply only to Members who are covered under Medicare Part A and Part B, and who are enrolled in the Group Health Cooperative Medicare Advantage Plan as set forth in the Group Medical Coverage Agreement.This includes those Members with Medicare Part B only, who have been continuously enrolled in the Group Health Cooperative Medicare Advantage Plan (formerly known as Medicarc+Choice), since December 31, 1998. 1 1 t i Employer Group Medicare Endorsement 2 Group Health MA Plan i I -Inpatient Hospital Member pays for each benefit Member pays the lesser of the Care period Group Cost Share or the following (includes substance Copayment: abuse and rehabilitation — Days 1 -60: an initial — $100 each day for day(s) 1-3 services) Deductible of$952. — $0 each day for day(s)490 — Days 61 - 90: $238 each day. for a Medicare-covered stay at a — Days 91 - 150. S476 each network hospital lifetime reserve day. There is no Cost Share for Please call 1-800-MEDICARE additional days received at a (1-800-633-4227)for network hospital. information about lifetime reserve days. Member is covered for unlimited days each benefit period. 2 -Inpatient Mental Member pays the same Member pays the lesser of the Health Care Deductible and Copayments as Group Cost Share or the following inpatient hospital care(above) Copayment: except Medicare beneficiaries may only receive 190 days in a — $100 each day for day(s) 1 3 psychiatric hospital in a lifetime. — $0 each day for day(s)4-90 for a Medicare-covered stay at a network hospital Medicare beneficiaries may only receive 190 days in a psychiatric hospital in a lifetime. 3 - Skilled Nursing Member pays for each benefit There is no Cost Share for services 1 Facility period, following at least a 3-day received at a skilled nursing (in a Medicare-certified covered hospital stay: facility. skilled nursing facility) — Days 1 -20. $0 for each day. Member is covered at the Group — Days 21 - 100: $119.00 for benefit or up to 100 days per each day. benefit period after a 3-day ' Medicare-certified hospital stay. There is a limit of 100 days for each benefit period. Note: When a 3-day Medicare- covered hospital stay does not occur and the plan determines that the Member otherwise meets all ' Medicare criteria, the plan may Employer Group Medicare Endorsement 3 Group Health MA Plan 118 ` y V ist 6® authorize Medicare-covered skilled nursing care for up to 100 days. 4-Home Health Care There is no Cost Share for all There is no Cost Share for (includes Medically covered home health visits. Medicare-covered home health Necessary intermittent visits. skilled nursing care, home health aide services and rehabilitation services, etc.) 5-Hospice Member pays part of the cost for Member must receive care from a outpatient drugs and inpatient Medicare-certified hospice. respite care. r Member must receive care from Hospice services in a Medicare- a Medicare-certified hospice_ certified hospice are reimbursed directly by Medicare when the Member enrolls in a Medicare- certified hospice. Member a 20%o'of Medicare- Member a s 6-Doctor Office Visits pays P Y approved amounts after _ The lesser of the Group Cost Medicare Part 13 Deductible is Share or$15 for each primary satisfied. care doctor office visit for Medicare-covered services. The lesser of the Group Cost Share or$100 for each Medicare-covered ambulatory surgical center. The lesser of the Group Cost Share or$100 for each Medicare-covered outpatient hospital services visit. Member pays the lesser of the Group Cost Share or $15 for each Medicare-covered consultation and certain specialist visits. 7-Chiropractic Member is covered for manual Member pays the lesser of the Services manipulation of the spine to Group Cost Share or$15 for each ' Employer Group Medicare Endorsement 4 Croup Health MA Plan r 16 t - - — ' correct subluxation, provided by Medicare-covered visit (manual chiropractors or other qualified manipulation of the spine to providers. correct subluxation). Routine care not covered_ Routine chiropractic services not covered. Member pays 20%of Medicare- approved amounts after Medicare Part B Deductible is Isatisfied. 8-Podiatry Services Member pays 20%of Medicare- Member pays the lesser of the ' approved amounts after Group Cost Share or$15 for each Medicare Part B Deductible is Medicare-covered visit (Medically satisfied. Necessary foot care)_ ' Member is covered for Routine podiatry care not covered. Medically Necessary foot care, including care for Medical Conditions affecting the lower limbs. iRoutine care not covered- 9 -Outpatient Mental Member pays 50%of Medicare- For Medicare-covered mental Health Care approved amounts with the health services, Member pays the exception of certain situations lesser of the Group Cost Share or and services for which Member $15 for each individual/group pays 20%of approved charges therapy visit. after Medicare Part B Deductible is satisfied. 10-Outpatient Member pays 20%of Medicare- There is no Cost Share for each Substance Abuse Care approved amounts after Medicare-covered visit. Medicare Part B Deductible is satisfied. 11 -Outpatient Member pays 20% of Medicare- Member pays the lesser of the ' Services/Surgery approved amounts for the doctor Group Cost Share or$100 for each after Medicare Part B Deductible Medicare-covered visit to an is satisfied. ambulatory surgical center: Member pays 20%of outpatient Member pays the lesser of the facility charges after Medicare Group Cost Share or$100 for each Part B Deductible is satisfied. Medicare-covered visit to an outpatient hospital facility 12-Ambulance Member pays 20%of Medicare- Member pays the lesser of the Employer Group Medicare Endorsement 5 Group Health MA Plan Services approved amounts or applicable Group Cost Share or$75 per each (Medically Necessary Fee Schedule charge after one-way trip. Hospital to hospital ambulance services) Medicare Part B Deductible is ambulance transfers initiated by satisfied. GHC are covered in full. 13- Emergency Care Member pays 201/o of the facility Member pays the lesser of the (Member may go to any charge or applicable Copayment Group Cost Share or$50 for each Emergency room if for each Emergency room visit Medicare-covered Emergency Member reasonably after Medicare Part B Deductible room visit;Member does not pay believes Emergency is satisfied; Member does NOT this amount if Member is admitted care is necessary.) pay this amount if Member is to the hospital within 1 day for the admitted to the hospital for the same condition. same condition within 3 days of , the Emergency room visit. Worldwide coverage. Member pays 20% of doctor charges after Medicare Part B Deductible is satisfied.NOT covered outside the U S except under limited circumstances_ 14 - Urgently Needed Member pays 20%of Medicare- Member pays the lesser of the Care approved amounts or applicable Group Cost Share or$15 for each (This is NOT Copayment after Medicare Part Medicare-covered urgently needed , Emergency care.) B Deductible is satisfied. care visit. NOT covered outside the U.S. Worldwide coverage. except under limited circumstances. 15-Outpatient Member pays 20%of Medicare- Member pays the lesser of the Rehabilitation Services approved amounts after Group Cost Share or$15 for each (occupational therapy, Medicare Part B Deductible is occupational therapy,physical physical therapy,speech satisfied. therapy and/or speech/language and language therapy) therapy visit_ Medicare will cover up to $1,750 a year for physical and speech therapy services combined; Medicare will cover up to$1,750 a year for occupational therapy services These limits apply to 1 outpatient therapy services provided in outpatient medical centers and skilled nursing facilities. Additional visits available if Medically Necessary as determined by GHC. Employer Group Medicare Endorsement 6 Group Health MA Plan 16-Durable Medical Member pays 20%of Medicare- Member pays the lesser of the Equipment approved amounts after Group Cost Share or 20%of the ' (includes wheelchairs, Medicare Part B Deductible is cost for each Medicare-covered oxygen, etc.) satisfied. item. ' 17-Prosthetic Devices Member pays 20% of Medicare- Member pays the Iesser of the (includes braces, approved amounts after Group Cost Share or 20%of the artificial limbs and eyes, Medicare Part B Deductible is cost for each Medicare-covered ' etc.) satisfied. item. 18-Diabetes Self- Member pays 20%of Medicare- There is no Copayment for Monitoring Training approved amounts after diabetes self-monitoring training. and Supplies Medicare Part B Deductible is (includes coverage for satisfied. Member pays the lesser of the glucose monitors,test Group Cost Share or 20% of the strips, lancets and self- cost for each Medicare-covered management training) diabetes supply item. Member pays the lesser of the Group Cost Share or $15 for each separate office visit. 19-Diagnostic Tests, Member pays 20%of Medicare- There is no Cost Share for the X-Rays and Lab approved amounts, except for following Medicare-covered 1 Services approved lab services after service(s): Medicare Part B Deductible is satisfied. — clinical/diagnostic lab services 1 — radiation therapy There is no Cost Share for — X-ray visits Medicare-approved lab services. ' 20_ Bone Mass Member pays 20%of Medicare- There is no Cost Share for each Measurement approved amounts after Medicare-covered bone mass ' (for people with Medicare Part B Deductible is measurement. Medicare who are at satisfied. risk) Member pays the lesser of the Group Cost Share or$15 for each separate office visit. 21 - Colorectal Member pays 20%of Medicare- There is no Cost Share for Screening Exams approved amounts after Medicare-covered colorectal (for people with Medicare Part B Deductible is screening exams. I Medicare age 50 and satisfied. older) Member pays the lesser of the Group Cost Share or$15 for each separate office visit. Employer Group Medicare Endorsement 7 Group Health MA Plan Member pays the lesser of the ' Group Cost Share or$100 for each Medicare-covered ambulatory surgical center visit and for each Medicare-covered outpatient hospital services visit. ' 22-Immunizations There is no Cost Share for the There is no Cost Share for the (Flu vaccine,Hepatitis pneumonia and flu vaccines. pneumonia and flu vaccines. B vaccine-for people with Medicare who are Member pays 20%of Medicare- No Referral necessary for at risk, pneumonia approved amounts for the Medicare-covered flu and vaccine) Hepatitis B vaccine after pneumonia vaccines. ' Medicare Part B Deductible is satisfied. There is no Cost Share for the Hepatitis B vaccine. Member may only need the pneumonia vaccine once in the Member's lifetime. Contact ' doctor for further details. 23 - Mammograms Member pays 20%of Medicare- There is no Cost Share for (annual screening) approved amounts. Medicare-covered screening (for women with mammograms. Medicare age 40 and No Referral necessary for , older) Medicare-covered screenings. Member pays the lesser of the Group Cost Share or$15 for each separate office visit. , 24-Pap Smears and There is no Cost Share for a pap There is no Cost Share for , Pelvic Exams smear once every 2 years, Medicare-covered pap smears and (for women with annually for beneficiaries at high pelvic exams. Medicare) risk. , Member pays 20%of Medicare- approved amounts for pelvic ' exams. 25- Prostate Cancer There is no Cost Share for 'There is no Cost Share for ' Screening Exams approved lab services and a Cost Medicare-covered prostate cancer (for men with Medicare Share of 20%of Medicare- screening exams. age 50 and older.) approved amounts for other ' related services after Medicare Part B Deductible is satisfied. Employer Group Medicare Endorsement g Group Health MA Plan ' 26 - Outpatient Most prescription drugs not Most drugs not covered by Prescription Drugs covered unless Member Medicare. See Group outpatient purchases Medicare Part D. prescription drug benefit. r 27 -Dental Services Not covered unless Medicare Not covered unless Medicare criteria met, criteria met. 28 -Hearing Services Routine hearing exams and There is no Cost Share for hearing hearing aids not covered. aids up to 1 aid(s). Member pays 20%of Medicare- Member pays: approved amounts for diagnostic — The lesser of the Group Cost ' hearing exams after Medicare Share or$15 for each Part B Deductible is satisfied. Medicare-covered hearing exam(diagnostic hearing exams). $0 for each routine hearing test ' up to 1 test(s) once every 24- months. ' — $0 for each fitting-evaluation for a hearing aid up to 1 fitting(s)-evatuation(s)once every 24-months. rBenefit limited to$250 for hearing aids once every 24-months. Must use plan providers. 29—Vision Services Member is covered for one pair There is no Cost Share for the ' of eyeglasses or contact lenses following items: after each cataract surgery after _ Medicare-covered eye wear Medicare Part B Deductible is (one pair of eyeglasses or ' satisfied. contact lenses after each cataract surgery). Members with Medicare who are _ Glasses,limited to 1 pair(s) of at risk are covered for annual glaucoma screenings after standard glasses covered up to Medicare Part B Deductible is UCR once every 24-months, satisfied. or; ' — Contacts,limited to I pair(s)of Member pays 20%of Medicare- standard contacts covered up ' approved amounts for diagnosis to UCR once every 24-months. and treatment of diseases and conditions of the eye after Member pays: ' Medicare Part B Deductible is — The lesser of the Group Cost Employer Group Medicare Endorsement 9 Group Health MA Plan roa = — A _ satisfied. Share or$15 for each Medicare-covered eye exam i Routine eye exams and glasses (diagnosis and treatment for not covered. diseases and conditions of the eye). — The lesser of the Group Cost ' Share or S15 for each GHC- covered routine eye exam, limited to 1 exam(s) once every 24-months. Benefit limited to$100 toward ' purchase of frames once every 24 months. Must use plan providers. , 30-Physical Exams 1f coverage to Medicare Part B A one time only physical exam is begins on or after January 1, available within the first six 2005,Member may receive a months of the Member's new Part one time physical exam within B coverage The exam does not the first six months of the include laboratory tests. ' Member's new Part B coverage. This will not include laboratory Member pays the lesser of the tests. Contact plan for further Group Cost Share or$15 for the ' details. Member pays 20%of the office visit. Medicare-approved amount after Medicare Part B Deductible is There is no Cost Share for routine , satisfied. physical exams Limited to 1 exam(s) every two years. Health/Wellness Medicare will pay for two Covered in full for the following: ' Education cessation-counseling attempts SilverSneakers per year; each attempt includes 4 The SilverSneakers fitness sessions each of either shorter program is available on a visits of 3 to 10 minutes each, or voluntary basis. longer visits (longer than 10 , minutes each) depending on Lifetime Fitness what the Member and their The Lifetime Fitness program is doctor decide. available on a voluntary basis. ' For more information, call the GHC Resource Line toll-free at 1- 800-992-2279 or 206-326-2800, or the TTY line at 711 or 1-800-833- 6388. Employer Group Medicare Endorsement 10 Group Health MA Plan Must use plan providers. ' In addition to the original Medicare smoking&tobacco use ' cessation benefit,Member receives the following GHC covered benefit: ' Smoking& Tobacco Use Cessation: When Member is enrolled and actively participating in the Free and Clear ProgramTM, services i provided through GHC related to smoking and tobacco use cessation are covered, limited to: Participation in one individual or group program per calendar year; One course of nicotine ' replacement therapy per calendar year; Educational materials covered in full. Must use plan providers. Transportation Not covered. Routine transportation not (Routine) covered. Medically Necessary ambulance services are covered ' (see section 12). Point of Service Non-emergent and/or non-urgently needed care received while temporarily traveling outside GHC's Medicare Service Area is payable at Medicare benefit levels ' up to $2,000 per Member per calendar year. The GHC MA Plan pays 80%of Medicare allowable ' reimbursement schedules for Medicare covered services ONLY. Member is responsible for all 1 Medicare inpatient and outpatient Deductibles and Coinsurances. ' Member pays the lesser of the Group Cost Share or 20%of the cost for each stay in a non-network Employer Group Medicare Endorsement 11 Group Health MA Plan � ab hospital or inpatient psychiatric 1 hospital. 1 1 1 1 1 1 i i 1 1 1 i Employer Group Medicare Endorsement 12 Group Health MA Plan ' Group: CITY OF KENT Group #: 00369 Reference ID#• 0600369003 For Attachment to Group Medical Coverage Agreement Group Health Cooperative Benefit Description INSIDE THE NETWORK: ' MANAGED CARE PROVIDERS SO Deductible 100% Coinsurance $2,000 Out of Pocket $10 Office Visit Copay $10 Outpatient Surgery Copay $10 Prescnption Drug Copay $0 Hospital Inpatient Copay ' $75 Emergency Room Copay None Optical Rider No PEC wait Group Offering: Dual Choice MONTHLY HEALTH CARE PREMIUM This schedule reflects monthly premium effective: ' 1/1/2006 - 1/1/2007 Subscriber $341.34 Subscriber&Spouse $763.62 ' Subscriber&Chdd(ren) $689.32 Subscriber,Spouse&Child(ren) S1,093.24 MEDICARE SUPPLEMENTAL HEALTH CARE DUES vanta e Medicare emitiled with All Medicare $312.10 Subscriber and Spouse, 1 AB Medicare $734.38 Subscriber and Spouse,2 AB Medicare $624.19 Subscriber and Cbild(ren), 1 AB Medicare $659.09 ' Subscriber and Family, 1 AB Medicare $1,063.99 Subscriber and Family,2 AB Medicare $953.&0 ' Brokerage: included Underwriter: cl Kent City Council Meeting Date May 16, 2006 Category Consent Calendar 1. SUBJECT: PUBLIC RECORDS ORDINANCE —ADOPT 2. SUMMARY STATEMENT: Adoption of Ordinance No. 37? which repeals Chapter 1 05 of the Kent City Code and enacts a new Chapter 1.05 entitled "Public Records," in response to recent legislative amendments and recodification of the state Public Records Act. During the 2005 regular legislative session, state legislators adopted two bills, SSHB 1758 and SHB 1133 These bills amend the state Public Records Act to, among other things, allow records to be produced by public agencies on an installment basis, limits the time within which a dissatisfied requester must file an action seeking court review of an agency's denial of a request, and recodified the Public Records Act to chapter 42.56 RCW beginning July 1, 2006. Due to these two major legislative amendments, the law department has determined that amendments to Kent's code are in order. The law department also reviewed the city's entire public records chapter and determined that revisions were in order to provide for a more user friendly ordinance. 3. EXHIBITS: Operations Committee memo 4/24/06 and Ordinance 4. RECOMMENDED BY: Operations Committee (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure? N/A Revenue? N/A Currently in the Budget? Yes No If no: Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda Item No. 6E LAW DEPARTMENT Tom Brubaker, City Attorney Phone: 253-856-5770 K E N T Fax: 253-856-6770 WASHINGTON Address: 220 Fourth Avenue S. Kent, WA. 98032-5895 April 24, 2006 To: Operations Committee From: Arthur"Pat" Fitzpatrick, Deputy City Attorney r Regarding: Public Records — Kent City Code 1.05 and State Legislative SSHB 1758 and SHB 1133 - Ordinance MOTION: I move to recommend/not recommend an ordinance repealing Chapter 1.05 of the Kent City Code, entitled "Public Records," and enacting a new Chapter 1.05 entitled, "Public Records," in response to the recent legislative amendments and recodification of the state Public Records Act. SUMMARY: Prior to March 2002, the city regulated public records through the city's policy manual. On March 5, 2002, the Kent City Council adopted Ordinance No. 3588, which codified the city's public records disclosure process. At the time of adoption, both the city's prior policy and its current ordinance were consistent with the state's Public Records Act codified at Ch. 42.17 of the Revised Code of Washington. During the 2005 regular legislative session, state legislators adopted Second Substitute House Bill 1758 (SSHB 1758), which amends the state Public Records Act to allow records to be produced by public agencies on an installment basis, allows an agency to require a deposit for the cost of photocopying, requires the appointment of a public records officer, and limits the time within which a dissatisfied requester must file an action seeking court review of an agency's denial of a request. Also during the 2005 legislative session, state legislators adopted Substitute House Bill 1133 (SHB 1133), which recodified the Public Records Act such that beginning July 1, 2006, the state's Public Records Act will be codified in chapter 42.56 RCW. Due to these two major legislative amendments, the law department has determined that amendments to Kent's code is in order. The law department also reviewed the city's entire public records chapter and determined that revisions were in order to provide for a more user friendly ordinance. Currently, the Kent City Code does not include a provision which allows the city to provide records on an installment basis in response to a request for public records. Prior to the Operations Committee April 24, 2006 Page: 2 legislative action taken in 2005, the city would compile all records responsive to a request for public records before it would make them available for inspection or photocopying. SSHB 1758 revised the state RCWs to allow public agencies to provide responsive records on an installment basis. This means that as the city responds to a request for a large amount of records, it may make those records available to the requestor as they are located. This provides an increased level of customer service to the public as they are provided some of the records on a quicker basis. SSHB 1758 also provides that a public agency may request a deposit equal to 10% of the estimated cost for providing photocopies, which deposit may be collected for each part of a request made on an installment basis. The final substantial revision made by SSHB 1758 is the requirement that lawsuits must be filed within one year from the date the city claims records, or portions thereof, are exempt from disclosure or one year from the date the city produced the last record responsive to a public records request. Due to the amendments to and recodification of the Public Records Act, it is necessary to update the Kent City Code to implement the changes. In addition to the above revisions, other changes have been made in the proposed ordinance to include housekeeping revisions to correct title references of those charged with responding to public records request and reorganize the existing code for easier readability. Because of the reorganization, the proposed ordinance repeals and readopts the chapter. The attached grid summarizes the specific changes to the city code. BUDGET IMPACT: None. o� 2 Operations Committee April 24, 2006 Page: 3 Changes to Ch. 1.05 of the Kent City Code Title Proposed Change Purpose - KCC 1,05.010 . Adds reference to ch. 42.56 RCW • Reference is made to the city's website Recodification of RCW Amendments . Acknowledges recodification of the state Public Adopted Records Act to ch. 42.56 RCW. KCC 1.05.020 . Adopts future amendments to state law into the Kent City Code Definitions . Defines "Public Records Act" and "copies," and KCC 1.05.030 adopts other terms in the RCW. Records Subject to Disclosure • The majority of this section was previously located KCC 1.05.040 at KCC 1.05.080. • The last two sentences were previously located at KCC 1.05.060. • Minor revisions were also made in an attempt to make the section easier to understand. Index of Public Records Not . This section combines and simplifies two prior Maintained sections, KCC 1.05.020 and KCC 1.05.030, to make KCC 1.05.050 the contents easier to understand. • No substantive changes were made to these sections Form and Manner of Request for . The language contained in this section was Public Records previously located at KCC 1.05.040(A) and (B). The KCC 1.05.060 remaining portion, subsections (C) through (E), of KCC 1.05.040 is now located at KCC 1.05.070. Submittal of Request for Public . The introductory language is new, which officially Records—Designation of Public designates the city's records administrator as its Records Officer. public records officer in accordance with the state KCC 1.05.070 Public Records Act. • The remaining language contained in this section was previously located at KCC 1.05.040, subsections (C) through (E). i 3 Operations Committee April 24, 2006 Page. 4 Changes to Ch. 1.05 of the Kent City Code Title Proposed Change Initial Response to Request • This section was previously located at KCC KCC 1.05.080 1.05.050, and in reorganizing the chapter, prior subjections (A)(4) and (A)(5) were removed. Supplemental Response to • This section is new. Request—Additional Time— . The purpose is to place the public on notice that a Clarification clarification may be needed or that the city may KCC 1.050.90 need to extend the deadline by which records will be produced. Disclosure of Records—Process • This section combines prior two prior sections KCC 1.05.100 regarding inspection of records (KCC 1.05.070) and format of records (KCC 1.05.060). • This section also includes a new subsection which allows the city to produce records on an installment basis. Final Response to Request • This section was previously the last sentence in KCC KCC 1.05.110 1.05.060. Copying and Delivering—Costs • This section was previously KCC 1.05.100. KCC 1.05.120 . This section also includes a new reference to charges for records disclosed on an installment basis. Deposit for Copying • This section was previously KCC 1.05.110, but the KCC 1.05.130 amount of the deposit required was revised from 75% to 10% to bring it in line with the revised Public Records Act. Payment of Required Fees • This section was previously KCC 1.05.120. i KCC 1.05.140 Failure to Pay Required Costs • This section was previously KCC 1.05.130. KCC 1.05.150 Denial of Request—Appeal . This section was previously KCC 1.05.090. KCC 1.05.160 . This section also amends the date by which an appeal may be deemed final from two business days to seven calendar days. 4 ORDINANCE NO. AN ORDINANCE of the city council of the city of Kent, Washington, repealing Chapter 1.05 of the Kent City Code, entitled "Public Records," and enacting a new Chapter 1.05 entitled "Public Records" in response to the recent amendments and recodification of Washington's Public Records Act. RECITALS A. On March 5, 2002, the Kent City Council adopted Ordinance No. 3588, which established the process, consistent with Washington's Public Records Act, by which the public could access city records. B. During the 2005 regular legislative session, state legislators adopted Second Substitute House Bill 1758, which amended the state Public Records Act to allow records to be produced by public agencies on an installment basis, to allow an agency to require a deposit for the cost of photocopying, to require the appointment of a public records officer, and to limit the time within which a dissatisfied requester must file an action seeking court review of an agency's denial of a request. C. Also during the 2005 regular legislative session, state legislators adopted Substitute House Bill 1133, which recodified the Public Records Act such that beginning July 11 2006, the state's Public Records Act will be codified in chapter 42.56 RCW. i 1 Public Records-Ch. 1.05 KCC State Legislative SSHB 1758 and SHB 1133 D. Due to the amendments to and recodification of the Public Records Act, and the need to update the city's code, the repeal and reenactment of chapter 1.05 of the Kent City Code is in order. NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT, WASHINGTON, DOES HEREBY ORDAIN AS FOLLOWS: ORDINANCE , SECTION 1. - ReAea/er. Chapter 1.05 of the Kent City Code, entitled "Public Records," is repealed in its entirety. SECTION 2. - AdoAtion. A new chapter 1.05, entitled "Public Records," is added to the Kent City Code as follows: CHAPTER 1.05 PUBLIC RECORDS Sec. 1.05.010. Purpose. The purpose of this chapter is to establish the process for requesting public records and responding to requests for public records as required by Washington's Public Records Act, currently codified in chapter 42.17 RCW, t and soon to be recodified in chapter 42.56 RCW. Failure of the city to fully comply with any provision of this chapter shall not result in any liability imposed upon the city other than as provided in the Public Records Act. This chapter shall be posted on the city's website at www.a.kent.wa.us. Section 1.05.020. Recodification of RCW — Amendments - Adopted. During the 2005 regular session of the Washington Legislature, the legislature passed Substitute House Bill 1133, chapter 274, Laws of 2005, wherein the provisions of Washington's Public Records Act, codified in chapter 42.17 of the Revised Code of Washington ("RCW' , will be recodified into a new chapter of the RCW, at chapter 2 Public Records-Ch. 1.05 KCC State Legislative SSH81758 and SH81133 42.56 RCW, effective July 1, 2006. Any recodification or amendment of any provision of the RCW referenced in this chapter is hereby adopted as if specifically set forth herein in full. i Section 1.05.030. Definintions. ■ A. For the purposes of this chapter, the following terms shall be defined as follows: 1. Pubbc Records Act shall mean that portion of the Revised Code of Washington currently codified in chapter 42.17 RCW relating to the disclosure of public records, and which will be recodi ied to chapter 42.56 RCW as of July 1, 2006, as currently enacted or hereafter amended. 2. Copies shall mean any duplicated version of any record regardless of the original form of the record. B. Except as provided in subsection A of this section, all terms used in this chapter shall have the same meaning as set forth in the Public Records Act. Sec. 1.05.040. Records subject to disclosure. The city need only disclose records or portions of records to the extent required by the Public Records Act and nothing in this chapter shall be interpreted as requiring the disclosure of any record that is not subject to disclosure by the Public Records Act or other applicable law. Records or portions of records may be withheld or redacted to the extent necessary or permissible by law. The city shall not be required to create records or documents in response to a request for public records that do not exist at the time the request is made. A public records request is not continuing in nature, and will not be treated as such even if requested. In the event additional records are created after the date of the requester's original public records request, the requester will be required to submit a new request for the later created records. i 3 Public Records-Ch. 1.OS KCC State Legislative SSHB 1758 and SHB 1133 i i Sec. 1.05.050. Index of public records not maintained. A. In General. The Public Records Act requires all cities and public agencies to maintain and make available a current index of certain public records. However, the Public Records Act also provides that if maintaining such an index would be unduly burdensome, or would interfere with agency operation, a city need not maintain such an index but it must issue and publish a formal order specifying the reasons why and the extent to which compliance would be unduly burdensome. B. Findings. The city of Kent is comprised of twelve (12) departments, and each department consists of numerous subdivisions. Each individual subdivision of the city performs a unique public service. Each subdivision may also utilize and produce various forms of "writings" as that term is defined in the Public Records Act, and thousands of writings are produced or utilized each day by these subdivisions. These writings may be maintained in several formats, including but not limited to: paper records, computer files, photographs, audio recordings, video recordings, etc. Filing systems vary from division to division due to different paper filing systems and the various computer programs used by each subdivision. Also, subdivisions of the city are physically located at various places within the city. As such, it is unduly burdensome, if not impossible, and would detract from the purpose of providing essential services to the citizens of Kent, to provide a current index of public records. C. Order. The city orders that it is not required to maintain a current index of j public records based upon the findings set forth in subsection C of this section, provided, that the city shall make available for review or copying any indexes that are maintained for city use to the extent not exempt from review or copying. Sec. 1.05.060. Form and manner of request for public records. A. All requests for public records shall be made in writing and delivered in person, ' by mail, or through the city's online public records request form available on the city's 4 Public Records-Ch. 1.05 KCC State Legislative SSHB 17S8 and SHB 1133 i internet web site. Requests delivered by facsimile; electronically, other than those requests submitted through the city's online public records request form; by telephone; or orally will not be accepted as valid requests for public records. B. The city will provide a public records request form that may be used by those requesting public records. The public records request may be submitted on the form provided by the city, or in another written format that contains the following information: 1. The date of the request; 2. The name of the requester; 3. The full address of the requester; 4. The telephone number of the requester; 5. A complete description of the requested record; 6. The title and date of the requested record, if known; 7. The location of the requested record, if known; and B. Whether the requester intends to review the records or to obtain a copy of the records. Sec. 1.05.070. Submittal of a request for public records — Designation of public records officer. A. The city's records administrator shall be the city's public records officer to whom members of the public may direct requests for disclosure of public records and who will oversee the city's compliance with public records disclosure requirements. B. Except as set forth in subsection C of this section, all requests for public records shall be submitted to the city's records administrator located within the city clerk's office, 220 Fourth Avenue South, Kent, Washington 98032, (253) 856-5725, or his or her designee, or online through the city's internet website located at www.a.kent.wa.us. 5 Public Records-Ch. 1.05 KCC State Legislative SSHB 1758 and SHB 1133 C. In order to provide for a more efficient response to requests for public records, the city has designated various records coordinators throughout the city as described in subsections (1) through (4) of this subsection who may receive and respond to public record requests directly. If the record requested is not identified in subsections (1) through (4), or the requester is unsure of where to file the request, the request shall be filed with the records administrator located in the city clerk's office. 1. The records coordinator of the police department may receive and respond to a request to inspect and/or photocopy police reports. The request shall to comply with KCC 1.05.060 and shall be delivered to the police department, 232 Fourth Avenue South, Kent, Washington 98032. 1 2. The records coordinator of the fire department may receive and respond to a request to inspect and/or photocopy fire reports. The request shall comply with KCC 1.05.060 and shall be delivered to Fire Station 74, 24611 116th Avenue Southeast, Kent, Washington 98031. 3. The records coordinator of the community development department may receive and respond to a request to inspect and/or photocopy planning files which the records coordinator, in his or her discretion, determines are readily available and easily accessible to the requester without the expenditure of significant staff time. In the event the records coordinator believes the request cannot be fulfilled without staff impacts, then he or she shall refer the requester to the records administrator located in the city clerk's office. 4. The records coordinator of the public works department may receive and respond to a request to inspect and/or photocopy public works files which the records coordinator, in his or her own discretion, determines are readily available and accessible to the requester without the expenditure of significant staff time. In the event the records coordinator believes the request cannot be fulfilled without staff impacts, then he or she shall refer the requester to the records administrator located in the city clerk's office. 6 Public Records-Ch. 1,05 KCC State Legislative SSHB 17S8 and SHB 1133 D. If the requester submits the request on the form provided by the city, the records administrator, or his or her designee, should indicate on the form the estimation of time necessary to provide a final response to the request. In the event the estimation of time necessary for providing records is not indicated on the form, the estimated time for providing disclosable records shall be twenty-one (21) calendar days. Records provided in response to a public records request shall be those documents of record available for disclosure as of the date of the request. E. The city recognizes that in limited circumstances, processing a request for public records may result in more of an expense to the city than merely copying and providing the records to the requester. In light of this, each city department may designate within its own department certain 'over the counter" records available to the public for immediate inspection without the requirement of a formal public records request as set forth in this section. As an alternative to obtaining over the counter records through the process provided in the remainder of this chapter, a requester may obtain over the counter records pursuant to this subsection. In the event a photocopy of such over the counter records is requested pursuant to this subsection, and if the requested record is an eight and one-half (8-1/2) by fourteen (14) inch page or smaller, the department may provide up to ten (10) pages free of charge. If the requester requests that records be duplicated, and such records exceed ten (10) pages or are records other than a paper record of eight and one-half (8-1/2) by fourteen (14) inches or smaller, a public records request will be required and the applicable duplication cost shall be paid. A requester who obtains over the counter records through this subsection shall not be entitled to the remedies provided pursuant to the Public Records Act. Sec. 1.OS.080. Initial response to request. A. The city shall make an initial response to the request for public records within five (5) business days of receipt of the request. In the event a request for public records is received after 5:00 p.m., the request shall be deemed to have been 7 Public Records-Ch. 1.05 KCC State Legislative S5HB 1758 and SHB 1133 received on the next business day. Depending upon the nature of request, the city r may respond initially by: 1. Providing the record, or the disclosable portions of the record, after the payment of applicable fees; l 2. Acknowledging the city's receipt of the request accompanied by a reasonable estimate of the time necessary for further response; or 3. Denying the request. B. In the event the requester completes the city's standard public records request form, the returned copy provided to the requester shall constitute the initial response by the city with the estimation of time necessary for further response. In the event the estimation of time necessary for providing records does not appear on the form, the estimated time for providing disclosable records shall be twenty-one (21) calendar days. Sec. 1.05.090. Supplemental response to request— Additional time — Clarification. A. From time to time, the city will need additional time to respond to a request for records in order to locate and assemble records, notify third persons or agencies affected by the request, determine whether any records or portions of records are exempt from disclosure, or determine whether denial should be made to the disclosure of all or a part of the requested records. In the event additional time is needed, the city will take reasonable steps to advise the requester of the additional time necessary. B. At the time of the city's initial response, or subsequent to the city's initial response, the city may require the requester to clarify his or her request in order to provide the city with information sufficient to allow the city to determine which records are being requested and whether such records relating to the request exist. In the event the requester fails to clarify the request within twenty-one (21) calendar days of 8 Public Records-Ch. 1.05 KCC State Legislative SSHB 1758 and SHB 1133 the date the request for clarification is delivered to the requester, the request may be denied. Sec. 1.05.100. Disclosure of records - Process. A. Copies of records. In the event a requester requests copies of records, the records shall be copied pursuant to the terms of this chapter. B. Review of records. In the event a requester chooses to review records, the city shall notify the requester once the records which respond to the request are available for review. The records will be available for review at reasonable dates and times as determined by the records administrator after consultation with the requester. Appointments to review records may be broken into intervals so as to not excessively interfere with the city's provision of other essential services. Records that have been retreived for review shall be made available to the requester for an initial period of twenty-one (21) calendar days. This period may be extended upon agreement of the records administrator and the requester in order to provide a reasonable amount of time to inspect the records. In the event a requester fads to contact the records administrator to arrange to review the records within twenty-one (21) calendar days of being notified that the records are available for review, the records request shall be deemed satisfied, the records shall be returned to the originating department, and if the requester wishes to review the records, he or she will be required to submit a new request for the records and the process will begin anew. C. Partial or Installment basis. If the city determines that records responsive to a public records request are voluminous, the city may make the records available for review or copying on a partial or installment basis as the records are assembled and become available for review or duplication. An installment of records that has been copied shall be made available for retrieval for a period of twenty-one (21) calendar days. An installment of records that has been retreived for review shall be made available to the requester for an initial period of twenty-one (21) calendar days. This 9 Public Records-Ch. 1.05 KCC State Legislative 55H81758 and SHB 1133 period may be extended upon agreement of the records administrator and the requester in order to provide a reasonable amount of time to inspect the records. In the event a requester fads to retreive an installment of copied records, or to contact the records administrator to arrange to review an installment of records within twenty- one (21) calendar days of being notified that the records are available for review, the j records request shall be deemed satisfied, the records shall be returned to the originating department, and if the requester wishes to obtain the records, he or she will be required to submit a new request for the records and the process will begin anew. D. Format of records Any records or portions of records disclosed by the city will be provided to the requester in the same format as they are retained; provided, that any disclosable records contained on a computer or other electronic or mechanical device shall, at the discretion of the city, be provided in printed form, on disk, or in another format. If the requester specifies a format in which the records should be disclosed, the city will disclose the records in the requested format if: (1) it is determined that disclosable records exist, (2) the city is capable of providing the records in the format requested, (3) the format requested is reasonable, and (4) the requester pays all costs associated with providng the records in the format requested. The costs associated with providing records in the format requested by the requester shall not be constrained by costs allowed by state law for providing photocopies, as requesting records in a special format shall be deemed an additional service provided by the city that is not constrained by the limintations set forth in state law. Sec. 1.05.110. Final response to request. The city's response to a request for records shall be deemed complete and final upon: (1) requester's inspection of the records; or (2) in the event copies were requested, upon notification to the requester that the copies requested are available for payment and pick-up; or (3) in the event no records exist which are responsive to the request, upon such notification to the requester. 10 Public Records-Ch. 1.05 MCC State Legislative SSHB 1758 and SHB 1133 Sec. 1.05.120. Copying and delivering—Costs. A. In the event a requester requests copies of records, prior to the disclosure of any public record, copying costs shall be collected. The city's records administrator shall establish, update, and post applicable copying costs as appropriate. The city clerk shall have the department's cost schedule available for inspection upon request. If copied records are provided on an installment basis as set forth in KCC 1.05.100, the city may charge the requester for those copying costs as they accrue in making each installment available. B. The requester shall pay all costs associated with the cost of delivering records. C. Payment of copying and delivery fees shall be made prior to the disclosure of public records. When required pursuant to KCC 1.05.130, the payment of a deposit shall be made prior to the copying of any records. Sec. 1.05.130. Deposit for copying. The city may, in its discretion, require the requester to deposit a sum equal to ten (10) percent of the estimated copying cost prior to duplication of the records. In the event a deposit is required, the city will inotify the requester of the necessity of the deposit. Any deposit shall be made in accordance with KCC 1.05.140. In the event the actual copying costs are less than the amount deposited by the requester, the city will return the sum in excess of the actual amount to the requester. Sec. 1.05.140. Payment of required fees. The payment of all costs associated with this chapter shall be made by cash, credit card, money order, or check payable to the city of Kent. Payment shall be made in person at the customer service desk located in the Centennial Center, 400 West Gowe St., Kent, Washington 98032, or by mail to the records administrator, city clerk's office, 220 Fourth Avenue South, Kent, Washington 98032. 11 Public Records-Ch. 1.05 KCC State Legislative SSH81758 and SHB 1133 Sec. 1.05.150. Failure to pay required costs. In the event a requester fails to pay for costs incurred within thirty (30) calendar days of notification of those costs, the city shall require the requester to pay in full the past due amount owed, together with any accrued interest, before it will begin processing a new request, a pending request, or a subsequent installment of a request from the delinquent requester. In addition, for any future requests, the city may require advance payment of the full amount of the estimated costs before the city begins to process a new request or a pending request from that requester. Any copied records associated with a request for copies for which payment of copying costs has not been received within thirty (30) calendar days of receiving notice may be destroyed in order to avoid storage costs. The requester shall be responsible for any costs associated with this chapter, and the city may take any steps available by law to collect the outstanding costs. Sec. 1.05.160. Denial of request — Appeal. In the event the records administrator denies a request, or any portion of a request for public records, the requester shall appeal the denial to the city clerk. In the event no response to the appeal is delivered to the requester within seven (7) calendar days of the city's receipt of the appeal, the denial may be deemed final. j SECTION 3. — Savin s The existing chapter 1.05 of the Kent City Code, t which is repealed and replaced by this ordinance, shall remain in full force and effect until the effective date of this ordinance. , SECTION 4. — Severabilily If any one or more section, 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. 12 Public Records—Ch. 1.05 KCC State legislative SSHB 1758 and SHB 1133 SECTIONS. — Effective Date. This ordinance shall take effect and be in force thirty (30) days from and after its passage as provided by law. SUZETTE COOKE, MAYOR ATTEST: BRENDA JACOBER, CITY CLERK APPROVED AS TO FORM: TOM BRUBAKER, CITY ATTORNEY 1 PASSED: day of May, 2006. APPROVED: day of May, 2006. PUBLISHED: day of May, 2006. 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 n V6. MDIN�e .H617MNF ERSIM aac 13 Public Records-Ch. 1.05 KCC State Legislative SSHB 1758 and SHB 1133 Kent City Council Meeting Date May 16, 2006 Category Consent Calendar 1. SUBJECT: AFFIDAVIT OF CORRECTION FOR FLOWER COURT FINAL PLAT — AUTHORIZE 2. SUMMARY STATEMENT: Authorize the Mayor to sign the Affidavit of Correction to the Flower Court Final Plat map 3. EXHIBITS: Public Works Director's memorandum 4. RECOMMENDED BY: Public Works (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure? NIA Revenue? N/A Currently in the Budget? Yes No If no: Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue. Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION- ACTION: Council Agenda Item No. 6F PUBLIC WORKS DEPARTMENT Larry R. Blanchard, Public Works Director • KEN T Phone 253-856-5500 wnsniNcroN Fax 253-856-6500 Address 220 Fourth Avenue S Kent,WA 98032-5895 Date: April 18, 2006 To: Chair Debbie Raplee and Public Works Committee Members PW Committee Meeting Date. May 1,2006 From: Robert Hankins Through: Larry Blanchard Subject: Affidavit of Correction for Flower Court Final Plat Motion: ■ Required ❑ Not Required ❑ For Information Only Recommend Council to accept the Affidavit of Corrections to the Flower Court Final Plat Map. Will document be required? ❑ Ordinance ❑ Resolution ❑ Agreement ❑ Contract ❑ Policy ❑ SOP's ■ Other Governing Policies Procedures Rules & Regulations: RCW 58.10.030 Resurvey and Corrected Plat WAC 332.130.050 (3) Survey Map Requirements Background/History: An error was found in the recorded Final Plat Map for Flower Court FSU-2003-4/RPP5-2052806. The recorded Flower Court Final Plat Map indicates in several locations Public Drainage Easements that were supposed to be Private Drainage Easements The signed and notarized Affidavit of Correction is the required document of correction for the errors in the final plat map. The plat's location is at the SE corner of 102"d Avenue SE & SE 236"' Street. Summary: Correction of errors in the Flower Court Final Plat Map - King County Recording No. 20051102001643. Recommendations: Council acceptance of the Affidavit of Corrections to the Flower Court Final Plat Map P IAdttrcUdmrnSvplPWC..Utc Uci,.nPagedx t RE: Affidavit of Correction of a plat. Flower Court-FSU-2003 /K1VA RPP5-2052806 (King County Rec. No. 20051102001643) An error was found in the recorded Final Plat Map for the above mentioned 31 lot project. The recorded Flower Court Final Plat Map indicates in several locations Public Drainage Easements that were supposed to be Private Drainage Easements (please see attached recorded Plat Map page 4 of The recorded Flower Court Plat Map can be corrected using a document called"Affidavit of Correction of Plat". The Affidavit is stamped, signed and notarized; and dated,by the surveyor (William Shupe Holmberg,PLS no. 11332) who signed the original Plat Map. Because land rights are best transferred by the clear intent of the grantor and the clear acceptance of the grantee, the City's position should be that the public nglrts were never asked for and therefore never given or accepted; regardless of the recording and approval of the plat. A mislabeling of the easement does not by itself establish a public right. The Council approved the development under the assumption that all labels were correct and that the easement was to be privately assigned and maintained.. ..any other interpretation would invalidate the approval by the council of the development. The Affidavit of Correction only requires the signature of the government authority(City of Kent) and the surveyor of record asking for the change to the recorded plat. The easiest remedy is to have Council discuss the mistake in open discussion....declare this was a labehng error ....declare that the easements are to be private...thus imparting public notice of the true intent and thereby terminating any acceptance of a public right to the easement. The Council Chamnan will sign the Affidavit of Correction and it will be recorded. This would seem to put the matter to rest as a"minor" correction and fulfill the obligation of the Council in addressing"public"nghts within the City. Site located at the SE corner of 102nd Ave. SE and SE 236"' St. Prepared by REH 4-14-06 AFFIDAVIT,' OF CORRECTION OF PLAT City of Kent 220 Fourth Avenue South Rent,WA 98032-5895 City of Kent Approvals- CITY OF KENT DEPARTMENT OF ASSESSMENTS Examned and approved this day of Examined and approved this day of 120 20_ a-: (Title: ) Assessor g Examined and approved this day of z 1 20_ Deputy Assessor ORIGINAL a Account Number 172205-9286 0 172205-9276 Title: SW'/,ofSW'/<, S 17T. 22 R. 5 172205-9214 a GRANTOR: None GRANTEE:None Sa1d dQCttntetlt(S)W8i8fif9t#ftM LEGAL DESCRIPTION record by Pacific NorthweetTtlleas aocommodatton Drily.It hag niX been examined as to pro:or exectAton or ss to its effect moon title. THE PLAT OF FLOWER COURT AS RECORDED IN VOLUME 230 OF PLATS,PAGES 75 TO 78, RECORDS OF KING COUNTY,WASHINGTON,UNDER RECORDING NUMBER 20051102001643. Affidavit of Correction of Plat City of Kent 220 Fourth Avenue South Kent,WA 98032-5895 To:King County Recording Department STATE OF WASHINGTON) )SS COUNTY OF KING ) I,William Shupe Holmberg being first duly sworn on oath,deposes and says: THAT he is a registered land surveyor,THAT he made a survey of the land comprising the plat of Flower Court which plat was recorded on the 2""day of Nov ,2005.in volume 230 of plats on pages 75-78 under recording number 20051102001643 Records of King County,Records and Elections Department, Seattle,Washington. THAT there being an error,the affiant approves the following change on said plat: ALL DRAINAGE EASEMENTS WITHIN THE PLAT OF FLOWER COURT WERE INTENDED TO BE PRIVATE DRAINAGE EASMENTS IN SEVERAL PLACES UPON THE FACE OF THE PLAT THESE EASEMENTS WERE MIS-LABLED AS"PUBLIC' THE EASEMENTS SHOULD BE CORRECTLY LABLED AS"PRIVATE" A PUBLIC DEDICATION OF THE EASEMENTS WAS NEVER ASKED FOR BY THE CITY OF KENT. ALL OTHER MATTERS ON THE PLAT OF FLOWER COURT REMAIN UNCHANGED PUBLIC UTILITY EASEMENTS ARE TO REMAIN AND ARE NOT AFFECTED BY THIS AFFIDAVIT THE LOTS AFFECTED BY THIS AFFIDAVIT OF CORRECTION ARE SUBJECT TO ALL TERMS, CONDITIONS,RESTRICTIONS AND EASMENTS AS SHOWN ON THE ORIGINAL PLAT(EXCEPT THOSE NOTED FOR THIS AFFIDAVIT OF CORRECTION)OF FLOWER COURT UNDER RECORDING NUMBER 2005 1 10200 1643. SgUPE lY �rz �1332 1 L LAIC Surveyor Sea! EXPIRES 11/30/06 SUBSCRIBED AND SWORN to before me this _`day of any 20 O( (.�ilQ" 1 .9i1 Registered Ywd Surveyor NOTARY PUBLIC In and for the State of Certificate No_ 11332 Washington,residin ZOZ//! g at: /t57/71` S6 OCK .OiH T711r G[/Q.��l%�2G'� ►lflT!r1�i r.. .... FSU-2003-- 4 f KIVA1 RPP5-21. FLOWER COURT 31 LOTS A PORTION OF THE SW114 OF THE SW114 OF SECA7, T.22JI. CITY OF KENT, KING COUNTY, WASHINGTON 0 M - - - - N LINE SW1/4 SW1/4 S88'35'49"E — PUBLIC R/Yd o SZO 236#h ST , 0' COMMON AREA FOR _ „ 10' PUBIC SIDEWALK UWATER, LANDSCAPING S88 35 49 E 208.00 & UTILITY EASEMENT D PEDESTRIAN ACCESS 44 23' 41 50' 1 1 37.50' 37 50' 1 1 37.50' i 9,76' TRACT C 15' S'( I FFR{yATIr ( 1 i 5' PRIVATE — i i 5' PRIVATE SP�RT COURT I --] }— SEWER --� f— SEWER 1 �( I I EASEMENT Li1 t EASEMENT jw 0 S IORMWATE �� 31 3�p 2 9 28 ETENT{ON ( I r 1 w w r t6 <o ;o( 2.507 S.F. 'v 2,507 S.F. ° 2,510 S.F. 2,507 S_F. 1 C3co 2,613 S.F. ( r7 0 PUBIL N z w t o} 'COMMON I �I DRAINAGE `DOT v t AREA I oL EASEMENT o i cD to IS88'43'24"E z — — ? — - — — —- "; —�—� * I �I O � .�. — - - - - - - - - - Z 1 i p N A FOR 43.98' 41.50' 37.50' 37.50' n 37.50' 1 j �� O CCESS { 22. 3' S'1 N88'43'36"W 66.00' 27.97' 37.40' 1 } O I 15' COMMON AREA I ( 0 „ ,, , t V) N ( FOR STORM WATER, ( I o tr Z N o M Cfl:._ 1' n . 1 LANDSCAPING AND I I W H-<w N � ACCESS (o u CC) �c) 04 R a: P2,583 S.F. :� lAY^r�„. y , ,D vl 2 a o a Z 21675 S.f. �c I*------� 8'43'364 i 2,739 S.F. ( I p iu�i� TRACT 'D` { 5' PRIVATE 66.58- i I { z t^ P►ttVATZsugl,13'3sa --� I S88'43'36"E o J o �- T-- 1 66.01 ------- b EASEME PUBLIC I I 0 I -^I � DRAINAGE 1 ...LLL M ^ EASEMENT ( I- ` _ T �_� N83"43'3o"W 8 4 2,497 S.F. ; ^1 2 ( I ,j o 10' SIDE t UTILITY E CO I * S8843'36"E 1 2,475 S.F. d 66.58' i ( } 0 15.1s' 3 _r133'43'3(3 W Ln I i IS88'43'36"E -------� -13.5:'IT° �1t7. o { 2 I b j PTO IVATE I / ' \�- -7 —��- — '� { SEWER I ( I / 2,899 S.F. t — j— M ( I M 'pl EASEMENT ( 0 j 15' COMMON AREA 1 ( rnl 2,497 S.F. I nj ( I� I ( POR STORMWATER, !i I o l 1 ( S88'43'3 "E M' 2.20 o S.F. I (� 1G IO I PEDESTRIAN ACCESS1 I G AND �,I i DF - 15-PRIVATE 66.58' ( i S8843736"E I I i" -- I----+--- S83-43r35"EII i �I ( SEWER 6T ._-1 1 1 � V PRIVATE 07.02' L_ i t �I I EASEMENT0 110 PUBLI UBLI 1 I5 PRIVATE �, Tc Irj- } t vy nPAINAf:F Kent City Council Meeting Date May 16, 2006 Category Consent Calendar 1. SUBJECT: WATER RESOURCE INVENTORY AREA (WRIA) 8 INTERLOCAL AGREEMENT EXTENSION — AUTHORIZE 2. SUMMARY STATEMENT: Authorize the Mayor to sign an extension of the Interlocal Agreement for the watershed basins within Watershed Resource Inventory Area (WRIA) 8. 3. EXHIBITS: Public Works Director's memorandum 4. RECOMMENDED BY: Public Works Committee (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure? N/A Revenue? N/A Currently in the Budget? Yes No If no: Unbudgeted Expense- Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda Item No. 6G PUBLIC WORKS DEPARTMENT Larry R. Blanchard, Public Worlcs Director Phone 253-856-5500 11-17 KENT Fax 253-856-6500 WASH IN 6 T o N Address 220 Fourth Avenue S Kent,WA 98032-5895 Date: April 26, 2006 To: Chair Debbie Raplee and Public Works Committee Members PW Committee Meeting Date. May 1, 2006 From: Mike Mactutis, Environmental Engineering Manager Through: Larry Blanchard, Public Works Director Subject: Extension of the hiterlocal Agreement for Watershed Resource Inventory Area 8 Motion: ■ Required ❑ Not Required ❑ For Infoimation Only Recommend City Council authorization for the Mayor to sign an extension to the Interlocal Agreement for the Watershed Basins within Watershed Resource Inventory Area (WRIA) 8. Will document be required? ❑ Ordinance ❑ Resolution ■ Agreement ❑ Contract ❑ Policy ❑ SOP's ❑ Other Governing Policies Procedures Rules & Regulations: Background/History: hi March 1999, the federal government listed Puget Sound Chinook salmon as threatened under the Endangered Species Act Concerned about the need to protect and restore habitat for Chinook salmon for future generations, 27 local governments in WRIA 8, including Kent, signed an Interlocal Agreement(ILA) in 2001 tojomtly fund the development of a conservation plan to protect and restore salmon habitat. The parties entered into the ILA share interest in and responsibility for addressing long term watershed planning and conservation for the watershed basins in WRIA 8 and wish to provide for planning, funding and implementation of various activities and projects An example of this collaborative effort is the WRIA 8 Chinook Salmon Conservation Plan, which was adopted by City Council in August 2005. To continue in this effort, an extension of the ILA for one additional project year is requested. ISummary: An Interlocal Agreement (ILA) for participation in WRIA 8 was entered on in 2001. The agreement remains in effect for an initial term of five (5) years. Before the terns expires, the City of Kent wishes to extend the ILA for an additional term of one (1)project year, to end on December 31,2006 Recommendations: Authorize the Mayor to sign an extension to the Interlocal Agreement for the watershed basins within Watershed Resource Inventory Area(WRIA) 8 P IPuNieUdminSupMdhIPWC~tff eUawnPngedx i EXTENSION TO THE INTERLOCAL AGREEMENT For the Watershed Basins within Water Resources Inventory Area 8 This Extension to Interlocal Agreement for the Watershed Basins within Water Resource Inventory Area (WRIA) 8 ("Agreement"), entered into by the Counties of King and Snohomish, the Cities of Bellevue, Bothell, Clyde Hill, Edmonds, Issaquah, Kenmore, Kent, Kirkland, Lake Forest Park, Maple Valley, Medina, Mercer Island, Mill Creek, Mountlake Terrace, Mukilteo, Newcastle, Redmond, Renton, Sammamish. Seattle, Shoreline, Woodinville, and the Towns of Beaux Arts Village, Hunts Point and Yarrow Point, ("Onginal Parties") extends the original term of the Agreement through December 31, 2006, ("Extension") to allow all or some portion of the Original Parties additional time to pursue initiation of activities related to implementation of the Lake Washington/Cedar/Sammamish Watershed Chinook Salmon Plan ("Plan"). Through the Agreement, the Original Parties completed the drafting of the Plan in 2005 and are engaged in the process of Plan approval and ratification through their individual legislative bodies. The parties to this Extension ("Parties") wish to extend the Agreement through December 31, 2006, in order to obtain such approval and ratification and to pursue initiation of activities related to implementation of the Plan. Section 3 of the Agreement allows the term of the Agreement to be extended through wntten agreement of the Parties This Extension is effective upon execution by a sufficient number of the Original Parties meeting the condition for effectiveness for the original Agreement, i e , pursuant to Section 3 of the Agreement, execution by at least nine (9)of the eligible jurisdictions within WRIA 8 representing at least seventy percent(70%) of the affected population Only the Original Parties signing this Extension shall be bound by the terms of the Agreement as extended by this Extension. The Agreement term is hereby extended through December 31, 2006, except that billing for services provided by the Service Provider and payment for such services by the Parties executing this Extension may extend beyond December 31, 2006, until all such billings have been paid. This Extension may be executed in counterparts. All other terms of the Agreement shall remain unaffected by this Extension and shall remain in full i force and effect ■ IN WITNESS WHEREOF, this Extension is executed by the entities so signing on the dates indicated below Approved as to form: TOWN OF BEAUX ARTS VILLAGE By: By- Title- Title- Date- Date: 1 Approved as to form: CITY OF BELLEVUE By. By: Title Title: Date• Date. Approved as to form CITY OF BOTHELL By: By: Title- Title Date• Date. Approved as to form: CITY OF CLYDE HILL By By. Title. Title- Date- Date: Approved as to form: CITY OF EDMONDS By: By: Title: Title Date: Date: Approved as to form: TOWN OF HUNTS POINT By: By: Title• Title: Date• Date: 2 ,� Approved as to form: CITY OF ISSAQUAH By: By: 1 Title• Title- Date. Date. rApproved as to form. CITY OF KENMORE By By jTitle: Title. Date Date: Approved as to form: CITY OF KENT By: By: Title• Title- _ Date: Date: Approved as to form: KING COUNTY ■ By: • By: — Title• Title Date: Date. Approved as to form: CITY OF KIRKLAND By: By: Title• Title. Date: Date: 3 Approved as to form CITY OF LAKE FOREST PARK By: By: Title Title' Date. Date: Approved as to form' CITY OF MAPLE VALLEY By: By: Title: Title Date Date: Approved as to form. CITY OF MEDINA By By. Title Title- Date, Date: Approved as to form: CITY OF MERCER ISLAND By: +By: Title- Title. Date: Date' Approved as to form: CITY OF MILL CREEK By: By' Title Title: Date: Date: 4 Approved as to form- CITY OF MOUNTLAKE TERRACE By By: Title- Title: Date Date: Approved as to form- CITY OF MUKILTEO By: By: ' Title- Title. Date Date: Approved as to form: CITY OF NEWCASTLE By. By. _ Title- Title. rDate- Date: Approved as to form: CITY OF REDMOND By. By. Title- Title. Date: Date- Approved as to form: CITY OF RENTON By: By: Title- Title: Date- Date: 5 Approved as to form. CITY OF SAMMAMISH By: By, , Title- Title: _ Date* Date. Approved as to form. CITY OF SEATTLE By: By. Title Title Date. Date: Approved as to form CITY OF SHORELINE By: By: Title Title: Date: Date- Approved as to form: SNOHOMISH COUNTY By: By: Title Title- Date- Date: Approved as to form: CITY OF WOODINVILLE By: By: Title: Title: Date• Date- 6 i Approved as to form: TOWN OF YARROW POINT By. By. Title. Title- Date Date I j Kent City Council Meeting Date May 16, 2006 Catcgory Consent Calendar 1. SUBJECT: SIGNAL MAINTENANCE SHOP LEASE AGREEMENT— AUTHORIZE 2. SUMMARY STATEMENT: Authorize the Mayor to execute a Lease Agreement with Plemmons Industries Inc , subject to final terms and conditions acceptable to the ICity Attorney and Public Works Director. i 3. EXHIBITS: Public Works Director memorandum 4. RECOMMENDED BY: Public Works Committee (Committee, Staff, Examiner, Commission, etc ) 5. FISCAL IMPACT Expenditure? $15,200 Revenue? Currently in the Budget? Yes No X If no• Unbudgeted Expense: Fund General Amount $15,200.00 Unbudgeted Revenue. Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda Item No. 6H I PUBLIC WORKS DEPARTMENT Larry R Blanchard, Public Worlcs Director Phone 253-356-5500 tZ000 KENT Fax 253-556-6500 w.s n i H c r o n Address 220 Fourth Avenue S Kent,WA 93032-5895 j Date: April 27, 2006 To: Chair Debbie Raplee and Public Works Committee Members PW Committee Meetma Date. May 1, 2006 From: Steve Mullen, Transportation Engineering Manager Through: Larry Blanchard, Public Works Director Subject: Lease Agreement with Plemmons Industries for Traffic Signal Maintenance Facility Motion: ■ Required ❑ Not Required ❑ For Information Only Authorize the Mayor to execute a Lease Agreement with the Plemmons Industries,for a period of 3 Years and 10 days, to lease warehouse space to be used as the Traffic Signal Maintenance Facility per the attached Lease Agreement subject to revision as may be agreed by the City Attorney and Public Works Director. Will document be required? ❑ Ordinance ❑ Resolution ■ Agreement Contract ❑ Policy ❑ SOP's ❑ Other Governing Policies Procedures Rules & Regulations: Background/History: The Traffic Signal and Streetlight Maintenance shop has been located in the "Red Barn" building, at 206 S. Railroad Avenue, after the building was no longer used by the Kent Public Market. The building is being marketed for sale, hence the Traffic Signal and Streetlight Maintenance shop must relocate to a new interim facility, pending design and construction of the East Hill Operations Facility. A lease agreement was negotiated with Plemmons Industries for a suitable facility in the Plemmons Industrial Park, at 1621 South iCentral Avenue. Summary: The attached agreement provides a three year, ten day lease to provide an interim facility to support the Traffic Signal and Streetlight Maintenance activity of the Public Works Department, Engineering Division. The leased space includes approximately 4,000 square feet of office/warehouse facility, at a rental rate of$1,696/month plus $175/month for common area 1 P IPublrcfAdmmSuplPl17G'omnrr![ee44clrorrPage dx Page 1 of 2 maintenance thru October 31, 2007, then a rental rate of $1,760/month plus $185/month for common area maintenance. Recommendations: Recommend the City Council authorize the Mayor to execute the attached lease agreement with Plemmons Industries, Inc, subject to revision of the contract language as may be agreed by the City Attorney and Public Works Director. i i f i t i Page 2 of 2 P I PnblieLldoemSnplPWComrmttee{AcuonPage doc LEASE WAREHOUSE tTHIS LEASE, dated the 27th day of April, 2006, by and between PLEMMONS INDUSTRIES, INC., as "Landlord", 1 and CITY OF KENT as "Tenant", is upon the following terms and conditions. 1. Premises: Landlord leases to Tenant and Tenant leases from Landlord the premises situated in Kent, Washington, (the "Premises")legally described as follows: Unit(s) 24&25, Plemmons Industrial Park, 1621 Central Avenue South, Kent, Washington,being a portion of Lot 19, Horseshoe Acre Tracts to Kent, as per plat recorded in Volume 15 of Plats on Page 10, Records of King County, Except the East 10 feet thereof conveyed to King County for Road, and Except the West 15 feet thereof, Situate in the City of Kent, County of King, State of Washington 2. Term of Lease: The term of this Lease shall be for 3 (Three) Year, Zero(0) Months, and 10(Ten) Days, and shall commence on the 22nd day of May, 2006, (the "Commencement Date") and end on the 30th day of April, 2009 (the "Expiration Date"). 3. Minimum Rent; CAM Charges; Common Areas: a) Tenant covenants and agrees to pay to Landlord as base rental for the Premises, without deduction,o ffset,prior notice or demand, in advance, a minimum monthly rental of $**See Addendum** ( ). All rents specified herein to be paid to Landlord are payable in advance on of before the first day of each month during the term of this Lease. Rent shall be payable to the Landlord at P O. Box 1068, Kent, WA 98035, or to such other party or such other place as the Landlord may hereafter designate in writing. I f Landlord consents, Tenant may occupy the Premises prior to such commencement date upon payment of rent on a prorated bans and compliance with all terms of this Lease. The pro-rala rent for the month of April 15, 2006 shall be paid upon execution of this Lease. b) Tenant shall pay to Landlord, as additional rents, an amount estimated by Landlord to be Tenant's share of Common Area Maintenance Charges ("CAM Charge(s)") (as defined in this section) This amount is payable on or before the first day of each month during the term of this Lease The monthly CAM Charge at the start of the lease term shall be $**See Addendum** ( The Landlord can adjust the monthly CAM Charge at any time during the terns of this Lease on the basis of Landlord's then reasonable anticipated costs for the current accounting period An accounting period is one (1) full calendar year, except that the first accounting period shall commence on the date the term commences and the last accounting period shall end on the date the term expires or terminates. The teen "Common Area Maintenance Charges" means and includes all sums expended by Landloid for the supervision, management, operation, maintenance and repair of the common areas and an allowance to Landlord for Landlord's supervision of maintenance and operation of the common areas, including without limitation, the costs of each and all of the following items sweeping; resurfacing and re-striping of parking lots; repainting, building and unprovements repair, landscaping, ice and snow removal, supplying directional signs and other markers; car stops; lighting; insurance premiums, water and all utilities not paid directly by Tenant; and other costs necessary in Landlord's judgment for the supervision, management, operation, maintenance and repair of the common areas. c) Landlord reserves the right from time to time to alter said common areas and to exercise control and management of the common areas and to establish, modify, change and enforce such rules and regulations as Landlord in its discretion may deem necessary and desirable Tenant agrees to abide by and conforni to such rules and regulations and shall be responsible for compliance by its employees, agents, customers and invitees The failure of Landlord to enforce any of such rules and regulations against Tenant shall not be deemed as a waiver of same. Landlord shall have the right to close all or any portion of common areas at such tines and for such penods as may, in the opinion of the Landlord, be necessary to prevent a dedication thereof. or to preserve the status thereof as private property. or to prevent the accrual of considered a material breach of the Lease Tenant shall not be entitled to interest on such deposit. The rights of the Landlord against the Tenant for a breach of this Lease shall in no way be limited or restricted by the Security Deposit,but Landlord shall have the absolute pght to pursue any available remedy to protect its interests herein, as if this deposit had not been trade. Should Tenant comply with all the terns, covenants and conditions required by this Lease, the Security Deposit, less any sums owing to Landlord, shall be returned to Tenant within a reasonable time after termination of the Lease, vacation of the Premises by Tenant. Should the Premises be sold, Landlord may transfer or deliver the Security Deposit to purchaser of the interest and Landlord shall then be discharged from any further liability with respeei to the Security Deposit. 5. Interest and Late Charges: (a) All amounts payable by Tenant to Landlord, including without )initiation, rent, CAM Charges, o ther c barges d ue to L andlord and any amounts p aid b y L andlord o n b ehal f o f Tenant a nd reimbursable to Landlord, not paid within three (5) days of when due, as required herein, shall bear interest at the rate of twelve percent (12%) per year from the date of any delinquency in payment thereof to the date paid In addition, if Tenant fails to pay rent, CAM Charges, other charges due to Landlord or any such amounts within three (5) days of the date due,then Tenant shall pay a late charge of Ten and No/100 Dollars ($10 00) per day per each unit included in the Lease for each day after the third (3rd) day after the date due that rent, CAM Charges, other charges due to Landlord or any such amounts remain unpaid The late charges are due when late rent is paid (b) Tenant agrees to pay Fifty and No/100 Dollars ($50 00)to Landlord on any NSF check tendered to Landlord by Tenant. The above late charge applies to rent for which payment has been attempted on a NSF check until said NSF check is replaced with a cashier's or certified check. No personal checks will be accepted after the 2itl NSF check. 6. Taxes; Assessments: Tenant agrees to pay any increase in real estate taxes due and payable on the Premises for each full calendar year during the tens of this Lease over the real estate taxes due and payable on the Premises for the year in which the Commencement Date occurs. On or before March 31st of each year, or as soon thereafter as reasonably practicable, L andlord s hall c ertify t o Tenant, (a) the amount o f the t otal increase, if any, in real estate taxes d uc a nd payable for that year for the project of which the Premises are a part (the "Project"), and (b) Tenant's "proportionate share" of the total increase, which shall be equal to that portion of the total increase which bears the same relation to the total increase as the total floor area of the Premises bears to the total floor area of alll rentable space in the Project. Tenant shall pay the proportionate share so certified on or before April 30 of such year, or within thirty (30) days of the date Landlord gives Tenant its certification For the calendar year in which this Lease terminates, the pro\,isions of this section shall apply, but Tenant's liability for its "proportionate share" of any tax increase for said year shall be appropriately prorated. Should there presently be in effect or should there be enacted during the terns of this Lease, any law, statute or ordinance, levying any tax (other than Federal, State or local income tax) upon rents, Tenant shall pay such tax or shall reimburse Landlord on demand for any such taxes paid by Landlord. 7. Use of Premises: The Premises are to be used for the purpose of conducting therein the business of General warehousing for the City of Kent Traffic Signal maintenance shop, and for no other business or purpose without the written consent of Landlord, which consent may be withheld in Landlord's sole discretion if any change in the use of the , Premises or alteration thereof by Tenant results in an increase in Landlord's insurance premiums, Tenant, promptly upon request, shall reimburse Landlord for the increased cost of such insurance. 8. Conduct of Business: (a)Tenant shall not leave the Premises unoccupied or vacant, but shall continuously during the entire tern of tlus Lease carry on its business Said business shall be kept open continuously each day during the hours customary for business of like character to be open (b)Tenant shall not do anything which may injure the Building,commit waste on the Premises or be a nuisance or menace to other Tenants in the project Tenant shall not allow any objectionable liquid, odor or noise to be emitted from the Premises. Tenant shall not store gasoline or other highly combustible materials on the Premises, which would violate any applicable fire code or regulation nor conduct any operation that will increase Landlord's fire insurance rate for the Premises. Tenant shall not overload the floors of the Premises or the electrical lines and circuits in the Premises If Tenant desires to use electrical equipment that require more capacity than the capacity of the existing electrical lines and circuits in the Premises, then before using such equipment Tenant shall, at its expense, increase the capacity of such tines and . ... . . . . _1__n -_-----1__--—1- _11 --A .,1 u..M nil .....loo oral droll hP cnincrt to hereby agrees that all dumpsters and cans will comply with the Uniform Fire Code, Section 11.20.1(d). The outside storage of any item is strictly prohibited and will be enforced Any T enant storing an item outside of t heir a nit will be served a 10-day notice to comply and/or have their tenancy terminated 10. Inside Storage: Tenant shall not store any item(s) above the office, restroom, or hallways. All storage must be on approved storage racking or on the warehouse floor surface i11. Signs and Advertising: Tenant may erect signage stating its name,business or product after first securing Landlord's approval of the size, color, design and verbiage and all necessary governmental approvals All signage installed by Tenant shall be removed upon tennination of this Lease with the sign location restored to its former state. (SEE EXHIBIT"A", SIGN CRITERIA.) 12, Alterations and Improvements: Tenant shall make no alterations, additions or improvements to the Premises without Landlord's pnor written approval and without a valid building permit issued by the appropriate governmental agency Detailed plans and specifications for such altetations and improvements shall first be submitted and approved by the Landlord in writing Landlord shall not unreasonably wif-diold its approval Tenant shall not install any exterior lighting fixtures, shades or awnings or do any exterior decoration or painting, or make any structural alterations without the previous written consent of Landlord Any and all such alterations, additions and improvements will be made in a good and workmanlike manner at the sole expense of Tenant All alterations, additions, or other improvements that may be made on or to the Premises by either of the parties hereto, except trade fixtures put in at the expense of Tenant, shall be the property of Landlord and shall remain on and be surrendered with the Premises as a pait thereof at the termination of this Lease without hindrance, molestation, or injury by Tenant, except that Landlord, at its option, may require Tenant, at Tenant's expense, to remove any part or all of the alterations, additions or improvements made by Tenant Any injury caused by Tenant's movuia its trade fixtures in and out of the Premises or by the removal of the alterations, additions or improvements made by Tenant shall be repaired by Landlord at Tenant's expense tNothing contained herein, however, shall prohibit Tenant from making necessary, normal, and emergency repairs to said improvements without Landlord's consent 13. Property Damage or Personal Injury: Landlord shall not be liable for any personal property damage or personal injury occurring on or to the Premises or to any persons in or on the Premises including but not limited to. (1) any loss of property by theft or burglary, (2) any damage to person or property on or about the Premises from the operation of any elevator or the use of any utility on the Premises, (3) any damage or injury caused by action of the natural elements, (4) any damage or injury resulting from the conduct of the employees of Tenant, whether negligent or otherwise, or (5) any damage or injury that may result from any bursting, stoppage, or leakage of any water, steam, or gas pipe, sewer, basin, toilet, hot water tank, or drain. 14. Exterior Maintenance: Landlord shall repair and maintain the roof, gutters, downspouts, exterior walls, foundation, ' curbs and exterior paved areas in good condition. Landlord shall be under no liability for repair of or maintenance to any store front installed by Tenant. Except for such obligations of Landlord,Tenant shall keep the Premises neatly maintained and in good order and repair. If the Premises has a separate entrance, Tenant shall keep the entrance free and clear of snow, ice, debris and obstructions of every kind. 15. Interior Maintenance: Tenant shall, at its own expense maintain the interior of the Premises at all times in good condition and repair, all in accordance with the laws of the State of Washington and in accordance with all directions and regulations of any proper officer of the governmental agencies having jurisdiction, and Tenant shall comply with all requirements of law touching the Premises other than with respect to structural repairs Tenant's responsibility shall include maintenance and repair of the electrical system, plumbing, drainpipes to sewers, air-conditioning and heating systems, overhead and personnel doors, carpet, blinds, windows and glass It is the responsibility of the Tenant to maintain pest and or rodent control for the said interior Premises At the expiration of the term hereof, Tenant shall surrender the Premises in good condition, reasonable wear and tear and damage by fire or other casualty excepted The term"good condition"means the good physical condition and cleanliness of the Premises and each portion of the Premises, including the items listed above, all alterations, additions, or other improvements made by Tenant, and all trade fixtures installed by Tenant forthwith, and if Tenant refuses or neglects to commence such repairs and complete the same with reasonable dispatch, Landlord may make or cause such repairs to be made Tenant agrees to forthwith, on demand, pay the Landlord the cost of labor and materials thereof with interest at 12% percent per year Tenant also hereby waives any claim for damages, including loss of business, resulting from any such repairs or t alterations, provided that in the exercise of its rights under this section, Landlord shall provide adequate access to the Premises and shall not unreasonably interfere with the conduct of Tenant's business 18. Parking Area: Landlord hereby grants to Tenant and to its employees, agents, customers and invitees the non- exclusive right for and during the term of this Lease, to use the parking area; such use to be in conunon with all other occupants of the project, whether as Tenants or as owners, and their employees, agents, customers and invitees. Tenant shall control the use of such parking spaces so that there will be no unreasonable interference with the normal traffic flow, and shall not permit any parking an landscaped or unpaved surface Landlord reserves the unrestricted right to make changes in the parking areas which shall at all times be subject to the exclusive control and management of the Landlord Landlord shall have the right from time to time to establish reasonable rules and regulations with respect to the parking areas Under no circumstances shall trucks serving the Premises be pennitted to block traffic flow 19. Liens; Exculpation; Tenant's Indemnity: Tenant shall not allow any liens to attach to the Premises as a result of its activities Landlord shall not be liable for any loss or injury, to persons or damage to property in the Premises from any cause or causes whatsoever, which at any time may be suffered or sustained by Tenant, or by any person whosoever at any time may be using, occupying or visiting the Premises Tenant shall defend, indemnify and hold Landlord harmless from and against any and all liability, claims, damages, costs and expenses of any kind whatsoever, ansing out of or relating to any injury to persons or property, or death of persons however occurring on or about the Premises, except to the extent caused by Landlord's negligence of Landlord 20. Tenant's Insurance: Tenant, at its cost,shall procure and maintain in full force and effect during the term of this Lease a policy of commercial general liability insurance (including contractual liability and products and completed operations liability) with liability limits of not less than $1,000,000, single limit, insuring against all liability of Tenant, its employees, agents and contractors arising out of or in connection with Tenant's use and occupancy of the Premises and property damage insurance w ith 1 lability l imits o f n of less than$1,000,000, A 11 s uch c ommercial general I lability and p roperty d amage insurance shall insure performance by Tenant of the indennuty provisions of Section 19 above. Landlord and Landlord's Agent shall be additional named insureds on such insurance policy. All insurance policies required to be carried by Tenant under this Lease shall: (i) be issued by insurance companies authorized to do business in the State of Washington with a rating of ANII or better as rated in the most recent edition of Best's Insurance Reports, (n) be issued as a primary policy, and(ni)contain an endorsement requiring thirty(30)days' prior written notice from the insurance company to both Landlord and Tenant, and, if requested by Landlord, to Landlord's lender, before cancellation or change in the coverage, scope, of amount of any policy. Each policy or a certificate of the policy, together with evidence of payment of premiums, shall be deposited with Landlord on or before the Commencement Date, and on renewal of the policy not less than ten (10) days before expiration of the term of the policy. 21.Personal Property Insurance: All personal property is the sole responsibility and risk of Tenant. Tenant understands that Landlord will not insure Tenant's personal property To the extent Tenant does not obtain insurance coverage for the full value of Tenant's personal property stored in or on the Premises,Tenant agrees that Tenant will personally assume all risk of loss, including without limitation, damage or loss by burglary, fire, vandalism or venrmn 22. Release and Subrogation: Landlord and Tenant release each other, and their respective employees, agents and contractors, from, and waive their entire claim of recovery for, any claims for damage to the Premises and the Project and to Tenant's alterations, additions and improvements, trade fixtures and personal property that are caused by or result from fire, lightening or any other perils normally included in an "all risk"or"special causes of loss" property insurance policy whether or not such loss or damage is due to the negligence of Landlord, or its employees, agents or contractors, or of Tenant, or its employees, agents or contractors Landlord and Tenant shall cause each insurance policy obtained by it to provide that the insurance company waives all right of recovery by way of subrogation against either party in connection with any damage covered by such insurance policy I occur Such abatement of rent shall be Tenant's sole recout se in the ev cnt of an interruption of services to be provided by Landlord hereunder. Tenant shall control the temperature in the Premises to prevent freezing o anyd r plumbing or sprinkler system. 24. Assignment and Subletting: Tenant shall not assign or in any manner transfer this Lease or interest herein, or sublet the Premises or any part thereof, or allow anyone to occupy the Premises, without the prior written consent of Landlord, which consent shall not be unreasonably withheld. Consent by Landlord to one assignment of the lease, or to one subletting of the Premises, shall not opei ate as a consent to a subsequent assignment of subletting Tenant shall not change the name under which it does business in the Premises without Landlord's prior written consent. 25. Bankruptcy: If Tenant becomes a Debtor under Chapter 7 of the Bankruptcy Code ("Code") or a petition for I reorganization or adjustment of debts is tiled concerning Tenant under Chapters l l or 13 of the Code, or a proceeding is filed under Chapter 7 of the Code and is transferred to Chapters I 1 or 13 of the Code, the Trustee or Tenant, as Debtor and as Debtor-In-Possession, may not elect to assume this Lease or to assign this Lease to a third party unless, at or before the time of such assumption and/or assignment,the Trustee or Tenant has (a)cured all defaults under the Lease and paid all swiss due and owing to Landlord under the Lease, and (b) deposited with Landlord a sum equal to two (2) month's rent to be held by Landlord(without any allowance for interest thereon)to secure Tenant's future performance under the Lease 26. Eminent Domain: If the whole of the Premises hereby leased shall be taken by eminent domain, then the terra of this Lease shall cease as of the day possession is taken by such public authority and the rent shall be paid up to that date. If only a part of the Premises shall be taken by eminent domain and the remainder of the Premises not so taken can be made tenantable for the purposes for which Tenant has been using the Premises, then this Lease shall continue in full force and effect as to the remainder of the Premises and all of the terms herein provided shall continue in effect, except that the minimum rent shall be reduced in proportion to the amount of the Premises taken, and Landlord, at its own cost and expense, shall make all necessary repairs and alterations in the Premises required by such taking; provided, however, that if more than fifty percent (50%) of the floor area of either the building m winch the Premises are located or the Project shall be taken by eminent domain, , then Landlord may elect to ternmate this Lease as of the date possession thereof is taken. All damages awarded for such taking shall belong to and be the property of the Landlord whether such damages shall be awarded as compensation for dimmution of the value of the leasehold or to the fee of the Premises, but Landlord shall not be entitled to any portion of the award made to Tenant for cost of removal of stock and fixtures. 27.Destruction of the Premises: If the Premises are partially or totally destroyed by fire or other casualty, then Landlord may elect to either (a) restore the Premises to substantially the same condition as they were in immediately before such destruction, or (b) terminate this Lease effective as of the date of such destruction. If Landlord does not give Tenant notice within sixty(60)days after the date of such destruction of its election to restore the Premises, then Landlord shall be deemed to have elected to terminate this Lease. If Landlord elects to restore the Premises, then Landlord shall use commercially reasonable efforts to complete s uch restoration within one hundred eighty (180) days after the date on which Landlord obtains all permits necessary for such restoration, provided, hou ever, that such one hundred eighty 0 RO) day period shall be extended by a period equal to any delays caused by Force Maleure, and such destruction shall not terminate this Lease The term "Force Ma�eure"means stakes, lockouts, labor disputes, shortages of labor or materials, fire or other casualty, Acts of God or any other cause beyond the reasonable control of Landlord 28. Default: The occurrence of any of the following shall constitute a default by Tenant under this Lease: j (a) Failure to Pay Rent. Failure to pay rent, CAM Charges or any other due to Landlord when charges due,if the failure continues for a period of three(5)days after notice of such default has been given es Landlord to Tenant. (b) Failure to Comply with Rules and Regulations. Failure to comply with the Rules and Regulations,if any, if the failure continues for a period of forty-eight(48)hours after notice of such default is a ven by Landlord to Tenant. If the failure to comply cannot reasonably be cured within forty-eight (48) hours, then Tenant shall not be m default under this Lease if Tenant commences to cure the failure to comply within forty-eight (48) hours and diligently and in good faith continues to cure the failure to comply. (c) Other Defaults. Failure to perform any other provision of this Lease, ff the failure to perform is not cured within ten (10) days after notice of such default has been given by Landlord to Tenant If the default cannot reasonably he cured within ten (IM days. then Tenant shall not he in default under this Lease if Tenant comme.nc, t� t (a) Maintain Lease in Force. Maintain this Lease in full force and effect and recover the rent and other t monetary charges as they become due, without terminating Tenant's right to possession, irrespective of whether Tenant shall have abandoned the Premises. If Landlord elects to not terminate the Lease, Landlord shall have the right to attempt to re-let the Premises at such rent and upon such conditions and for such a term, and to do all acts necessary to maintain or preserve the Premises as Landlord deems reasonable and necessary without being deemed to have elected to tenninate the Lease including removal of all persons and property from the Premises; such property may be removed and stored in a public warehouse or elsewhere at the cost of and for the account of Tenant in the event any such re-letting occurs, this Lease shall terminate automatically upon the new Tenant taking possession of the Premises_ Notwithstanding that Landlord falls to elect to terminate the Lease initially, Landlord at any time during the term of this Lease may elect to terminate this Lease by virtue of such previous default of Tenant. (b) Terminate Lease. Terminate Tenant's right to possession by any lawful means, in which case this Lease shall terminate and Tenant shall immediately surrender possession of the Premises to Landlord. in such event Landlord shall be entitled to recover from Tenant all darnages incurred by Landlord by reason of Tenant's default including without limitation thereto, the following:(i)The worth at the time of award of any unpaid Rent which had been earned at the time of such termination; plus(it)the worth at the time of award of the amount by which the unpaid Rent which would have been earned after termination until the time of award exceeds the amount of such rental loss that Tenant pro"es could have been reasonably avoided, plus (in) the worth at the time of award of the amount by which the unpaid Rent for the balance of the Term after the time of award exceeds the amount of such rental loss that is proved could be reasonably avoided; plus(iv) any other amount necessary to compensate Landlord for all the detriment proximately caused by Tenant's failure to perform its obligations under this Lease or which in the ordinary course of things would be likely to result therefrom, including without lumtation, any costs or expenses incurred by Landlord in (A) retaking possession of the Premmses, including reasonable attorney fees theiefor, (B)maintaining or preserving the Premises after such default, (C) preparing the Premises for reletting to a new tenant, including repairs or necessary alterations to the Premises for such reletting, (D) leasing commissions, and (E) any other costs necessary or appropriate to relet the Premises, plus (v) at Landlord's election, such other amounts in addition to or in lieu of the foregoing as may be permitted from time to time by applicable state law. Upon any such re-entry Landlord shall have the right to make any reasonable repairs, alterations or modifications to the Piermses, which Landlord in its sole discretion deems reasonable and necessary. As used in Subsection 29(b)(1) the "worth at the tune of award"is computed by allowing interest at the rate of twelve percent(12%)per year from the date of default As used in Subsections 29(b)(n)and (in)the"worth at the time of award"is computed by discounting such amounts at the discount rate of twelve(12%)per year. 30. Deliveries to Premises and Trash: All deliveries of merchandise, supplies and materials to the Premises and removal of trash, garbage and other waste shall be made at such hours and in accordance with such rules as Landlord shall prescribe for the project. In event Landlord's rules so prescribe, Tenant shall provide adequate covered metal receptacles for trash, garbage and other waste, located at Landlord's direction, and shall not be visible to members of the public Tenant shall not pen-nit an accumulation of boxes, waste or other refuse matter. 31. Surrender on Termination: (a)On the expiration or sooner termination of this Lease,Tenant shall deliver all keys to t Landlord, have final utility readings completed showing paid for by the date of move out, and surrender and vacate the Premises in good condition, clean and free of debris inside and out, with all mechanical, electrical and plumbing systems , in good operating condition; all signage removed and any damage to the Premises resulting from removal of signage properly repaired to Landlord's reasonable satisfaction and all repairs called for under the Lease completed The Premises shall be delivered in the same or better condition as at the commencement of the term. subject only to ordinary wear and tear Tenant acknowledges that Tenant will be charged for the cleaning of carpet, blinds, and any excess dirt, debris, and or rubbish caused by the nature of Tenant's business and such will not be considered ordinary wear and tear These cleaning charges are not included in the Non-Refundable Cleaning Fee Should Tenant paint walls a different color or walls become excessively stained or dirty, Tenant will be held responsible at Tenant's sole expense, for patching and priming walls prior to move-out Tenant further agrees to remove all of its furnishings and trade fixtures that remain its property and properly repair all damage resulting from such removal to Landlord's reasonable satisfaction Failure to remove said property shall be abandonment of same and Landlord may dispose of it in any manner without liability Any trade fixtures left in the Premises after the expiration or sooner termination of this Lease shall be considered as abandoned by the Tenant and shall become and remain property of Landlord. (b) If Tenant fails to vacate the Premises upon the expiration or sooner termination of this Lease, then Landlord t may elect either 61 to treat Tenant as a tenant from month-to-month snhiect to all nrovisions for tern and for hale rent space shall become part of the Lease and Page I of this Lease shall be amended to include and state all correct data as to the new space However, if the new space does not meet with Tenant's approval, Tenant shall have the tight to cancel this Lease upon giving Landlord thn-ty (30) days notice within ten (10) days of receipt of Landlord's notification If Tenant cancels this Lease pursuant to this Section 33,Tenant shall vacate the Budding and the Premises within thirty (30) days of its delivery to Landlord of the notice of cancellation 34.Notice to Vacate: Tenant shall provide to Landlord a wntten notice of intent to vacate Premises. Said notice is to be received by Landlord not less than ninety(90) days prior to the expiration of the lease term If said intent is to vacate the Premises after the expiration of the lease teen,Tenant shall notify Landlord not less than 30 (thirty) days prior to the end of the calendar month. 35. Hold-Over: If the Tenant shall, with the written consent of Landlord, ]told over after expiration of the term of the Lease, or extension hereof, such tenancy shall be for an indefinite period of time on a month-to-month tenancy, which tenancy may be terminated as provided by the laws of the State of Washington During such tenancy, Tenant agrees to pay to the Landlord the holdover rate as set forth in Paragraph 31(b), unless a different rate is agreed upon, and to be bound by all the terns, covenants, and conditions herein specified, as far as applicable. 36. Heirs and Successors: Subject to the provisions herein pertaining to assignment and sub-letting, the covenants and agreements to this Lease shall be binding upon the heirs, legal representative, successors and assigns of any or all of the parties hereto 37. Notices: All notices to this Lease provided to be given by either paity hereto shall be deemed to have been given, when made in writing and deposited in the United States mail,certified and postage prepaid and addressed as follows TO LANDLORD: Plemmons Industries, Inc. P.O Box 1068 Kent, WA 98035 TO TENANT: City of Kent Suzett Cooke I 220 Fourth Avenue S. Kent, WA 98032 The address to which any notice, demand or other writing may be given,made or sent to either party may be changed by written notice given by such party as above provided 38. Fees; Deposits: If Tenant vacates the Premises or defaults before the end of lease term, the last one month's rent shall be forfeited. This does not alleviate Tenant's monthly responsibility to the monthly rent If Tenant faithfully performs in accordance with the teens of this Lease, the rent on deposit will be applied to the last one month's rent, providing notice of termination is given in the timely manner set forth within. ' Tenant hereby agrees to pay a one-time $120 00 (One hundred Twenty and No/100 Dollars) non-refundable cleaning fee upon the initial rental of each unit This fee is not reassessed on renewals This fee excludes the cost of cleaning the carpet and blinds and servicing the HVAC unit(if any) This fee will be waived for the City of Kent Tenant's using a dumpster understands that the dumpster or cans must be kept inside the Premises. Before the Security Deposit is refunded,proof must be shown to the Landlord that all garbage fees have been paid in full. 39. Severabi6ty: If any provision of the Lease is held to be invalid, unenforceable or illegal, the remaining provisions shall not be affected and will be enforced to the fullest extent permitted by law. 40.Attorney's Fees: If either party shall bring any action for relief agamst the other party,declaratory or otherwise, arising out of this Lease, including any action by Landlord for the recovery of rent or possession of the Premises, any trial, any 1 appeal, or any post judgment proceedings, or if either party engages an attorney to represent it in connection with the bankruptcy or reorganization of the other party, then the losing party shall pay the successful party a reasonable sum for nttnmev'c fPPe whirl, shall he riPPmPri to have aerniPrl nn the rnminPnremPtit of cnrh aetinn and shall he nail whothpi or not ordinance or an The temr "Hazardous or other hazardous Substance,, governmental order as defined or listed b shall mean an pertaining y any Lnvirom y hazardous, tw is t° the protection of rental Law and shall Include, ' rnfecirous health, safety or the at•radioactive substance, environment (a) Use of hazardous without hmttatton,petroleum oil and its asteanfractions leaked, disposed of Substances. matetra Hazardous SubstanG�s otherwise ref Tenant shall not cause or eased on or under the Premises Permit an Of this Lease, yl"°a11Y used and sold in the Tenant may y Hazardous Substance to Tenant's reasonabl ant may store such Hazardous , prudent and y Use and be Spilled , Substances on tile e P�n� eS" of the bus,res on the Pr only of care in the use Y anticipated needs, Tenant those handhn e shad eom but ont Permitted by Paragraph 7 quantity and taxici g and storage of Ha P1Y with all 1 DvIron Y 'n quantities necessary t3 ofHazardou zardous Substances and shall take atilll caws and to satlSA' a Substances used nd exercise the lira handled or stored o chest degree (b)Notices. Tenant sball mimedratel n the Premises measures to minimize the disposal or otherrelease ofa Hazardous Substance on from a Y nottfy Landlord u governmental a pon becoming aware Premises genet °r any other , under or adjacent to of the following connection t(u with any the Piolation of an person relating the premises; (')any spill, leak, Y Envrromnental Law b to any Hazardous Substaneei]any notice or communication with respect to the Prenuses or under or ad9acent to the (C) Spills and Releases. In Tenants activities o under the Premises caused b the event of a n °r in of the same Y Tenant or any spilt, leak, disposal or Tenant shall of its contractors other release of a released Hazardous Su (t) immediately undertake all emerges gents or employees Hazardous Subs necessarySubstance, (ti p oyees or invitees, or the susprctonnoe on or or appropriate to ensure) promptly undertake all Investigatory necessar satisfaction, and (Ill) that an gatory Y t°costout cicanut that (or threatened or sus provide Landlord co Y Hazardous Substances contamination removal and l and remove the certtficaUon that a Petted release p1eS of all comes o other response or the response p ndence with an eliminated toLandlord' action posse action y govemmental a Landlord s reasonable shall be nY contamination has been eliminated. ' a detailed re gene Landlord Prepared and all such ce port documentin Y regarding the release rtttications shall be All such response action gall such res made b shall be posse action, and a Y an environmental consultant)reason Performed, all such re (d) Condition U on ports reason, Tenant shall remove Termination. Y acceptable to all Hazardous IIPon expiration of this Lease or sooner to substances from the Premises and restore the affected areas b f Of the facilities. Following substances and facilities used intmation of this Lease g such removal, y pall rng an for the On or handlingFor any Tenant shall certify in y damage caused b of hazardous (e) Indemnit wntiii9 to Landlord that all Such renno installation orremoval all damages, char Y by Tenant. Tenant shall defend i asserted against charges, cleanup costs, remedial actions, ndenuirf complete. bainst Landlor costs and expenses,hold Landlord ha warranty or other defaul, the Premises or the Project b which rmless front and a or employees or y Tenant under tivs y reason of, may be imposed on, against any and invitees Lease,or or in connection with(r)an incurred or paid by, or release of an ' or any subtennt or (ri the acts or omissions Of T y misrepresentation b Y Hazardous Substance o other person Far Tenant, or an reach of expiration or sooner to n the Pre whom Tenant would otherwise be liable contractors munatton of this Ibises or the Project 'Hie agents Lease, pravrstons of this resulting 45. The followin Section 44 shall survive the g Addendums are hereby incorporated and trade 46. The following Exhibit is herebypart of this lease a „ into agreement: A"and 'f$i? incorporated and made part of this Lease a 47' All rents are calculated based on esti agreement nA�� mated), a per unit cost and not per square foot cost.EXECUTED THIS----_ DAY OF (Ail warehouse square footages are 20 ATTEST; RD: PLEMMONS INDUSTRIES, INC. 1 ADDENDUM"A" IMPORTANT INFORMATION FOR PLEMMONS INDUSTRIAL PARK WAREHOUSE TENANTS PHONE NUMBER FOR UTILITIES AND SERVICES: Puget Sound Enerry 1-888-225-5773 Post Office(Kent-Main, to set up delivery) 253-520-7576 Waste Management Garbage Service 253-939-9792 IQwest 1-800-603-6000 UTILITIES/SERVICES The Landlord will have meter read as close to day of possession as possible. The Landlord will allow three (3) business days before instructing the electrical company to discontinue service It is the responsibility of the Tenant to contact the above utilities/services and put these services into their name prior to or on the first day of occupancy. SIGNAGE: All window signage must be in uniform WHITE lettering The suite door signage must be in the uniform lettering also. Signage is a Tenant cost. Auburn Sign Company is familiar with our requirement,please call 854-2333 Wood warehouse front signs are allowed (SEE EXHIBIT ".A", SIGN CRITERIA), and can be purchased from Auburn Sign No advertising or bulletins are allowed on the doors or windows KEYS/LOCKS: Re-keying of any office/unit door is not permitted without the prior consent of the Landlord. Plemmons hidustries, Inc. will not release a key nor allow entry to any Tenant's unit to any person(s), except Tenant, without the prior written consent of the Tenant. Such consent memo must include full name of person and reason for key release Person receiving key must have verifiable identification NO EXCEPTIONSi Call the Property Manager for more information. RENT PAYMENT: Rent is due on or before the first of each month. NO NOTICE OR INVOICE WILL BE SENT. It is the Tenant's responsibility to mail the rent payment or deliver it to the main office during business hours. Monday-Friday 8:00 a.m. - 5:00 p.m WATER METERS: If your unit does not have a water meter,one will be installed.The installation will require interrupting your water service and lavatory facilities for a short perod of time. Notice will be given 24 hours prior to installation Access to the unit for the sole purpose of reading the meter is hereby considered authonzed by the Tenant Prior to installation of a water meter, report any water leaks or running toilets unmediately. Tenants will be responsible for and billed for excessive usage caused by a leak. WATER/SEWER BILLING: Water meters will be read at time of occupancy or installation and on the 15th of every month following with the bills being sent out by the 20th An access charge will be added to each billing in the amount of$2 00 (Two Dollars) which is subject to change The water/sewer bill is due and payable with the next months rent & CAM payment on the first of the month. Water/sewer bills not paid by the 10th of the month will incur a $25.00 late fee plus $1.00 per day until and including the day payment is received There is no grace period. If a water meter is not installed in your unit, you will be billed a pro rata share of the remaining water bill from the City of Kent. MAINTENANCE Please refer to paragraphs 16, 17, 18 & 19 of your lease. These paragraphs explain in detail the responsibility of both Landlord and Tenant in regards to repairs and maintenance. If you have a problem and feel it is our responsibility, please 1� call (253) 854-2600 and report it We will attend to it in a timely manner and emergency needs will be seen to as soon as possible If you are a new Tenant and have occupied your unit for 30 days or less and experience a problem, call us It could be somethine we missed during our riisnertinn anti/nr enmPthlnrr l\rP ilPi1PVP ,1,P ck, ,,IA i.,, f DI—_ i^..1 ___ DELIVERIES: Landlord accepts no responsibility for and is to be held harmless for any packages, materials, etc , delivered to the corporate offices by couriers or any delivery set-vice for the Tenants. MAIUMAIL BOXES: The mailboxes are located at the front of the complex, next to 1609 Building All tenants will be charged a $10.00 (Ten Dollars and no/100ths) postal key fee. If keys are returned upon move out the fee will be refunded Contact the Main Post Office located at 10612 SE 240th in Kent regarding mail delivery and your mailbox. Their phone number is (253) 852- 3950. PARKING/STORAGE: Do not park in front of any unit(s) other than your own. Center area parking is common parking for Tenants and customers only Storage of any vehicle or trailer is not pennitted Any vehicle left for over one(t) week will be subject to , towing at owner's expense ALARM SYSTEM: If you wish to install a alarm system, the Landlord does not object However, you need to secure written permission from the Landlord When ascertaining permission for your alarm system, you must provide the Landlord with the pass code, name, address, and phone number of alarm service provider and an emergency number to call in case of accidental activation of the system or an emergency. WAREHOUSE FLOORS: ' Painting of warehouse floors is strictly prohibited. Call the Property Manager at(253) 854-2600 if you have any needs or questions. Landlord: Plemmons Industries,Inc. Teresa P Hutchens,Property Manager Date Tenant: CITY OF KENT Suzette Cooke Date EXHIBIT "A" SIGN CRITERIA Northwest f Tape u "io Lpem 30 RECEIVING 12"X48° SHIPPING 16' UP FROM DOOR S WINDOW l� i 1 t • All signs must be 3' X 6' and centered 16"up from door and windows(as per above sample.) • All sialis must have radius corners, the body of the sign must be painted in Rodda Paint Company's CP13 Pigeon #532001 with the edge trammed in the Rodda Teal color #KT249611791. Any "shipping" or"receiving" signs will be in the Pigeon color base with Teal letters. • Use of any color of letters identifying your business name is acceptable and logos are also 1 acceptable. Advertising of any kind, however. Is not acceptable. Phone numbers are not acceptable. • Only one sign per Tenant will be allowed. • All signs must be approved by the Landlord prior to installation. It is advised to have the drawing approved, prior to fabrication. In lieu of 3' z 6' sign above door,Tenant may install the following: I • White vinyl lettering of business name may be applied to window. Letters shall not exceed 3" in height and must be centered on window, 16" down from top portion of window. ADDENDUM`B" RENT SCHEDULE , Tenant covenants and agrees to pay Landlord a minimum monthly rental for the Prenuses according to the following schedule. Pro-rated Rent and CAM from May 22, 2006 through May 31, 2006 $603.50 (Six Hundred Three Dollars and No/100ths) June 1, 2006 through October 31, 2007 $1,696.00 (One Thousand, Six Hundred,Ninety-Six Dollars and No/100ths) Rent. $175.00 (One Hundred, Seventy-Five Dollars and No/100ths) Common Area Maintenance (CAM) November 1, 2007 through April 30,2009 $1,760.00 (One Thousand, Seven Hundred, Sixty Dollars and No/100ths) Rent. $185.00 (One Hundred, Eighty-Five Dollars and No/100ths) Common Area Maintenance (CAM) Landlord: PLEMMONS INDUSTRIES,INC. Date: 1 Teresa P. Hutchens, Property Manager Tenant: City of Kent Date: Suzette Cooke Kent City Council Meeting Date Mav 16, 2006 Category Consent Calendar 1. SUBJECT: SOUTH RIDGE ESTATES BILL OF SALE —ACCEPT 2. SUMMARY STATEMENT: Accept the Bill of Sale for South Ridge Estates (Portions of SE 282A St.) for 790 centerline linear feet of streets, 9 catch basins, 135 linear feet of biofiltration swale, 1 box culvert, 1 storm water quality vault, and 336 linear feet of sewer This project is located at SE 282nd St., from 132"d Ave SE to 140`" Ave SE. 3. EXHIBITS: Bill of Sale 4. RECOMMENDED BY: Public Works Director (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure? N/A Revenue? N/A Currently in the Budget? Yes No If no: Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 1 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda Item No. 6I Bill of Sale Page 1 of 3 i460 KENT WASH I NGT ON MAIL TO: ENGINEERING DEPARTMENT ATTN-. 220 4"' AVENUE SOUTH KENT,WASHINGTON 98032 PROJECT: �)-%7It.F,n6e LOCATION:�+4Pa -;�t 1'16 Yyf 5,6: :Y,, 1 TAX ACCT NO: BILL OF SALE CITY OF KENT L KING COUNTY,WASHINGTON THIS INSTRUMENT tm�ade this day of 1 ,iv"> 20 t` _, by and betw I-1 een nL-he':;— e hereinafter called" rantors", and City of Kent, a municipal corporation of King County, State of Washington,herinafter called "Grantee": WITNESSETH: That the said Grantors for a valuable consideration,does hereby grant,bargain, sell to Grantee the following described improvements: A. WAT . MAINS: together with a total of gate valves at $ each, hydrants at$ each and/ or any other appurtenances thereto. ON FROM TO (street, esmt, etc) Including linear feet at$ per I.F of (size & type) waterline. B. RY S_ EWERS: Togethe vith a total of ma nt oles at $ each and a tenances thereto. j� ON OM J/ (street, esmt, etc) Including linear feet at$ per LF of (size & type) server line. C. STREETS: Together with curbs, gutters, sidewalks, and I or any other appurtenances thereto. Bill of Sale Page 2 of 3 0 CF of detention pond storage with a total cost of$ Q and /or any other appurtenances thereto. ON � g� FROM sTA- �2,c4+2,C3 TO 5� --A 3 2fi1 (street, esmt, etc) Including 33 L , ,1inear feet at$ G'�OC7� per LF of � Z (size & type) `� \ C_ sewer line. To have and to hold the same to the said Grantee,its successors and assigns forever. The undersigned hereby covenants that it is the lawful owner of said property; and that the same is free from all encumbrances;that all bills for labor and material have been paid; that it has the right to sell the same aforesaid; that it will warrant and defend the same against the lawful claims and demand of all person. The Bill of Sale is given on consideration of the agreement of the Grantee for itself, its ' successors and assigns to incorporate said utilities in its utility system and to maintain them as provided in the applicable City Ordinances. IN WITNESS WHEREOF,the undersigned has caused this instrument to be executed on this day of `� '1 , l 1�2� , 20 f'C STATE OF WASHINGTON ) ) SS COUNTY OF KIN��G On this day of _, ] ('�( ,before me, the undersigned A Notary Public in and for the State of Washington, duly commissioned and sworn,Personally appeared /�/L:: .')l:7 1 ) to me known to be the individual described in and who executed the foregoing instrument, and acknori[edged to me that he/she signed and sealed this instrument as his/her free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN under my hand and official seal this -, - ( day w _jr'- 20 f . y� ") _ DPETERSON Notary Public in and for the BETH-ANN State of Washington, residing at NOTARSTATE OF COMhAfSSIA,Iy Commission Expires: APRIL v ^" STATE OF WASHINGTON ) Bill of Sale Page 3of3 Witness my hand and official seal hereto affix the day and year first above written. INotary Public in and for the State of Washington, residing at My Commission Expires: The Bill of Sale is given and accepted pursuant to a motion duly made,seconded, and passed by the City Council of the City of Kent, King County,Washington, on the day of , 20 • KEN T W A S H I N G T O N ADDENDUM TO BILL OF SALE CITY OF KENT KING COUNTY, WASHINGTON The figures used on the Bill of Sale for -r Sc 99z- '5f-5r, , M4. Rq-i;O 7v 5f4 U-to projectdated 4f-,1&2 t , were based on the "As-Built" Engineering Plans dated rnS fS:f.L.l / �6 �> , for the same said botcl-p Rat 6c-_ rFs 4z�S project. 7t� Al- k/,L72;at7AZ the undersigned P.E. or land surveyor is the person responsible for the preparation of the Bill of Sale and is an employee of fNG. , the firm responsible for the preparation of the "As-Built" Engineering Drawings. Signature Kent City Council Meeting Date May 16, 2006 Category Consent Calendar ' 1. SUBJECT: SOUTH RIDGE ESTATES BILL OF SALE ADDENDUM— ACCEPT ' 2. SUMMARY STATEMENT: Accept the Bill of Sale for South Ridge Estates for 7,758 32 centerline linear feet of streets, 51 catch basins, 7,551 linear feet of storm lot drains, 39 clean outs, 90 linear feet of dispersal trench, 322,950 cubic feet of detention pond storage, 1 storm restrictor, 1 overflow gate, and 5,527 linear feet of sewer. This project is located at SE 282nd St. and 1441h Ave SE. 3. EXHIBITS: Bill of Sale 4. RECOMMENDED BY: Public Works Director (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure? N/A Revenue? N/A Currently in the Budget? Yes No If no: Unbudgeted Expense- Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda Item No. 6.1 ADDENDUM TO BILL OF SALE ' CITY OF KENT KING COUNTY, WASHINGTON The figures used on the Bill of Sale for }South Ridge Estates (final plat) project dated iki&A 4-S 1 , t �a� 1 , were based on the "As-Built" Engineering plans dated August 14, 2001 for the same ' said South Ridge Estates project. Stephen D. Matson, P.E. the undersigned P.E. or land surveyor is the person responsible for the preparation rof the Bill of Sale and is an employee of Baseline Engineering, Inc. the firm responsible for the preparation of the "As-Built" Engineering Drawings. Signatu e Date i Page 1 of 5 ' MAIL TO: ' ENGINEERING= DEPARTMENT ATTN Mark Damon 220 - 4th Avenue South Kent, Washington 98032 PROJECT: South Ridge Estates LOCATION: 144th Ave SE a, SE 282nd Street extended TAX ACCT NO: #342205-9219, -9064, -9183, -9179, -9014, - 9182, -9176 BILL ^F S ALE ' CITY OF KENT ' KING COUNTY, WASHINGTON THIS IN TRUMENT made this 6T�i day of AV GwT 2001 ' and between 1 UL10UtS 4 ` WAS, iN hereinafter called "Grantors", and City of Kent, a municipal corporation of King County, State of Washington, hereinafter called "Grantee": WITNESSETH: That the said Grantor for a valuable consideration, does hereby grant, bargain, ' sell to the Grantee the following described improvements: A. WATERMAINS: Together with a total of gate valves at $ each, hydrants at $ each and/or any ' other appurtenances thereto. ON FROM TO (street, esmt, etc) Including linear feet at $ per LF of (size) (type) waterline. ' i ' Page 2 of 5 ' B. SANITARY SEWER: Together with a total of manholes at $ each and/or any other anniirtPna-nceS thereto. ' ON FROM TO (street, esmnt, etc.) Including lineal feet at $ per LF of ' (size) (type) sewer line. ' C. STREETS: Together with curbs gutters, sidewalks, and/or any other appurtenances thereto ON FROM TO LF (street, esmnt, etc.) SE 280th Place sta 25+00 sta 35+72.46 1,072.46 LF or, 2viSt ,�.,fteet (east) Sta 5v+.n..� s+a 54+93 Q1 493.91 LF (west) sta 60+00 sta 62+16.19 216.19 LF ' SE 281st Place sta 70+00 sta 68+39.97 838.97 LF SE 282nd Street sta 10+00 sta 49+19 32919.00 LF 140th Avenue SE sta 40+00 sta 47+17.79 717.79 LF ' 142nd Place SE sta 20+00 sta 25+00 500.00 LF Including 7,758.32 centerline LF at $ 74.83 per LF ($580,553.80 lump sum) of public (type) streets, 7,758.32 LF asphalt roadway. D. STORM SEWERS: Together with a total of 0 manholes at $ N/A each or a ' total of 33 Type 1 catch basins at $ 650.50 each, _ 8 Type 1L catch basins at $ 750.00 each, 8 Type 2-48" catch basins at $ 1,500.00 each, ' 1 Type 2-54" catch basins at $ 3,000.00 each, 1 Type 2-72" catch basins at $ 8,000.00 each, 7,551 LF of 6" storm lot drains at $ 10.00_ LF, 39-6" clean outs at $ 100.00 each, 0 LF of biofiltration swale or drainage ditch with a total cost of$ O CF, 90 LF of dispersal trench at $ 25 LF with a total cost of$ 2,250 , 1 of 322,950 CF of detention ponds storage with a total cost of $ 85,000.00 , 1 storm restrictor with a total cost of$ 650.00 , 1 overflow grate with a total cost of$ 2,000.00 , and/or any other appurtenances thereto. 1 Page 3 of 5 ' ON FROM TO LF (Street, a',Sai�nt, %tc.) SE 280th Place: 12" PVC sta 25+15 sta 27+75 324 LF 18" PVC sta 27+75 sta 34+70 709 LF 12" PVC SE 280th Pl. sta 36+15 SE 281st St. sta 61+80 215 LF SE 281st Street: ' (east) 12" PVC sta 50+00 sta 53+50 433 LF (west) 12" PVC sta 61+80 sta 62+61 143 LF (south of cul-de-sac) ' 12" PVC sta 62+10 detention pond 140 LF SE 281st Place: ' 12" DIP sta 70+00 sta 73+00 317 LF 12" PVC sta 70+16 sta 70+41.27 37 LF 12" PVC @ 73 +00 16' left to 16' right 32 LF , 12" P V C @ 77+97.62 16' left to 16' right 32 LF 12" PVC sta 77+97.62 sta 78+38.97 66 LF SE 282nd Street: ' 12" PVC sta 11+50 sta 23+40 1,367 LF 18" PVC sta 23+40 sta 24+20 80 LF 24" PVC @ 24+30 18' left to 18' right 36 LF ' 140th Avenue SE: 18" PVC sta 40+00 sta 47+17.79 800 LF ' 142nd Avenue SE: 12" PVC sta 20+60.42 sta 25+15 460 LF 144th Avenue SE: 12" PVC sta 19+40 sta 22+72 392 LF ' 12" DIP sta 19+12 sta 19+40 44 LF Including 3,541 lineal feet at $ 14 per LF of 12" (size) PVC (type) storm sewer line. Including 1,599 lineal feet at $ 18 per LF of 18" (size) ' PVC (type) storm sewer line. Including 36 lineal feet at $ 24 per LF of 24" (size) PVC (type) storm sewer line. Including 361 lineal feet at $ 28 per LF of 12" (size) , DIP (type) storm sewer line. ' Page 4 of 5 ' To have and to hold the same to the said Grantee, its successors and assigns fcrever. The undersigned hereby covenants that it is the lawful owner of said property; and that the same is free from all encumbrances; that all bills for labor and material have been paid; that is has the right to sell the same aforesaid; that it will warrant and defend the same against the lawful claims and demands of all persons. ' The Sill of Sale is given on consideration of the agreement of the Grantee for itself, its successors and assigns to incorporate said utilities in its utility system and to maintain them as provided in the applicable City Ordinances. ' IN WITNESS WHEREOF, the undersigned has caused this instrument to be executed on this day of 20 ' STATE OF WASHINGTON ) l� SS COUNTY OF KING On this day of , 20 L_, before me, the undersigned, a Notary Public in an for the State of W shington, duly commissioned and sworn, personally appeared ' � � to me known to be the individual described in and who executed e foregoing instrument, and ' acknowledged to me that he signed and sealed this instrument as/ned ary act and deed for the uses and purposes ' therein menti ' GIVENeal this day of 20 r Notary Public in and for the State of Washington, residing at My Commission Expires: 1 Page 5 of 5 STATE OF WASHINGTON , )SS 'COUNTY OF KING ) On this day of before me, the undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared C— 1 // 1 C � and to me known to be the rL' and respectively of kk � C ,, the_ ' that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said for the uses and purposes therein mentioned, and on oath stated that they were authorized to execute the said instrument. ' WITNESS my hand and official seal hereto affix the day and year first above ' written. `\ 4 , NARY�,:tP�� 4NoPublicyi�n�and for the State of Washington, !' p�gL1G m residing at yl(A ++++�•.,c, � 9.03 � My Commission Expires: The Bill of Sale is given and accepted pursuant to a motion duly made, seconded, and ' passed by the City Council of the City of Kent, King County, Washington, on the day of 120 ' Kent City Council Meeting Date May 16, 2006 LCategory Consent Calendar 1. SUBJECT: BROOKSIDE COURT BILL OF SALE — ACCEPT 2. SUMMARY STATEMENT: Accept the Bill of Sale for Brookside Court for 6 manholes, 805 linear feet of sanitary sewer, 1,040 centerline cubic feet of streets, 2 storm manholes, 26 catch basins, and 1,900 linear feet of sewer line This project is located at 27842 — 132❑d Ave SE 3. EXHIBITS: Bill of Sale 4. RECOMMENDED BY: Public Works Director (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure'? N/A Revenue? N/A Currently in the Budget? Yes No ■ If no: Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds ' DISCUSSION: ACTION: Council Agenda Item No. 6K Bill of Sale Page 1 of') KENT WASHINGTON MAIL TO: ENGINEERING DEPARTMENT ATTN: 220 4rit AVENUE SOUTH KENT,WASHINGTON 98032 f EG Ti PROJECT: FF 1 ' ` 1`•i "�Y` ' LOCATION: TAX ACCT NO: BILL OF SALE CITY OF KENT KING COUNTY,WASHINGTON THIS INSTRUMENT made this M day of_4 � 20 0 1/ , by and between GCN(©1J ( 41-1- C- , hereinafter tailed "Grantors", and City of Kent,a municipal corporation of King County,State of Washington,herinafter called"Grantec": WITNESSETH: ' That the said Grantors for a valuable consideration,does hereby grant,bargain,sell to Grantee the following described improvements: A. WATERMAINS: together with a total of gate valves at$ each, hydrants at S each and/or any other appurtenances thereto. iON FROM TO (street,esmt,etc) Including linear feet at$ per LF of (size& type) waterline. B. SANITARY SEWERS: Together with a total of manholes at $ 1' Igo D each and/or any other appurtenances thereto. ON 55 1114` pL FROM L-or 1 TO Lvr 7 (street,esmt,etc) Including 60S� linear feet at$ /f, �`' per LF of `f (size& type) t'VG sewer line. and /ar anv other annurtenances Bill of Sale Page 2 of 3 CF of detention pond storage with a total cost of$ and /or any other appurtenances thereto. ON FROM TO (street,esmt, etc) Including L goo linear feet at$ rZ per LF of &C� (size& type) sewer line. To have and to hold the same to the said Grantee,its successors and assigns forever. The undersigned hereby covenants that it is the lawful owner of said property; and that the same is free from all encumbrances; that all bills for labor and material have been paid; that it has the right to sell the same aforesaid; that it will warrant and defend the samc against the lawful claims and demand of all person. The Bill of Sale is given on consideration of the agreement of the Grantee for itself,its successors amr,assigns to incorporate said utilities in its utility system and to maintain them as provided in thelapplicable City Ordinances. II IN WITNESS WHEREOF,the undersigned has caused this instrument to be executed on this '-,`" day of 20 eD STATE OF WASHINGTON ) )SS COUNTY OF KING ) I On this /8 day of /vld.(1�_,20 O rf ,before me,the undersigned A Notary Public in and for the S to of Washington,duly commissioned and sworn,Personally appeared 4 t c-H►+gkcJ - A . 6q/C.426Y to me known to be the individual described in and who executed the foregoing instrument,and acknowledged to me that he/she signed and sealed this instrument as his/her free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN under my hand and official seal this day of 20 _. yt�~ary^�>F N ry nblc 614Xl State of Was@ngtob residing at + ! fA0(il G>( My Commission Expires. ! 11 04 i Bill of Sate Page 3 of 3 Witness my hand and official seal hereto affix the day and year first above written. Notary Public in and for the State of Washington, residing at My Commission Expires: The Bill of Sale is given and accepted pursuant to a motion duly made,seconded,and passed by the City Council of the City of Kent,King County,Washington,on the day of 120 i i i 1 t t i i i KEN T W A S H I N G T O N ADDENDUM TO BILL OF SALE CITY OF KENT KING COUNTY, WASHINGTON The figures used on the Bill of Sale for d>eo Qo�S/,!�� project dated _ ,were based on the"As-Built" Engineering Plans dated ,for the same said project. the undersigned P.E. or land surveyor is the person responsible for the preparation of the Bill of Sale and is an employee of �y�� f D �57RY-( 1�/�l ,the firm responsible for the preparation of the "As-Built" Engineering Drawings. ignature Kent City Council Meeting Date May 16, 2006 Category Consent Calendar I. SUBJECT: PEDIATRIC INTERIM CARE CENTER BILL OF SALE—ACCEPT 2. SUMMARY STATEMENT: Accept the Bill of Sale for Pediatric Interim Care Center for 1 gate valve, 1 hydrant, 206 centerline cubic feet of streets, 2 storm manholes, and 46 linear feet of sewer line This project is located at 4th Ave S and Saar St 1 3. EXHIBITS: Bill of Sale 4. RECOMMENDED BY: Public Works Director (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure? N/A Revenue? N/A Currently in the Budget? Yes No If no: Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount$ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda Item No 6L Bill of Sale Page 1 of 3 APR ENT -- - ` i � WASHINGTON MAIL TO: ENGINEERING DEPARTMENT ATTN: Heather Thomas 220 a AVENUE SOUTH KENT,WASHINGTON 98032 PROJECT: Pediatric Interim Care Center LOCATION: NEC of 41'Ave.S.&Saar St. TAX ACCT NO: 982700790,982700795, 982700800 BILL OF SALE CITY OF KENT KING COUNTY,WASHINGTON THIS INSTRUMENT made this i-.;. day of April 2006 _,by and between_� ro��rr« li zvz,� Lm2� T>�u t-,4 ct .4j Nof�ay-f 1 hereinafter called"Grantors",and City of Kent,a municipal corporation of King County,State of Washington,herinafter called"Grantee": WITNESSETH: That the said Grantors for a valuable consideration,does hereby grant,bargain,sell to Grantee the following described improvements: A. WATER MAINS: together with a total of 1 gate valves at$800 each, I hydrants at$2,600 each and I or any other appurtenances thereto. ON Saar Street FROMEx. 12"Main TO PICC South property line (street,esmt, etc) Including 30 linear feet at$ 30 per LF of 8" (size& type) Ductile Iron waterline. i B. SANITARY SEWERS: Together with a total of 0 manholes at $ each and/or any other appurtenances thereto. iON FROM TO (street,esmt,etc) tIncluding 0 linear feet at$ per LF of (size& type) sewer line. Bill of Sate Page 2 of 3 LF of biofiltration swale or drainage ditch with a total cost of$ CF of detention pond storage with a total cost of S ,and/or any other appurtenances thereto. ON Fourth Avenue S. FROM East TO West,North of Saar St. (street,esmt,etc) Including 46 linear feet at S 22 per LF of 12" (size& type) PVC SDR-35 sewer line. To have and to hold the same to the said Grantee,its successors and assigns forever. The undersigned hereby covenants that it is the lawful owner of said property; and that the same is free from all encumbrances; that all bills for labor and material have been paid; that it has the right to sell the same aforesaid; that it will warrant and defend the same against the lawful claims and demand of all person. The Bill of Sale is given on consideration of the agreement of the Grantee for itself, its successors and assigns to incorporate said utilities in its utility system and to maintain them as provided in the applicable City Ordinances. IN WIT�ESS WHEREOF,the undersigned has caused this instrument to be executed on this day of -ice..- ,20 0 U c/ STATE OF WASHINGTON ) ) SS COUNTY OF KING ) On this day of 1 c ,20_0 before me,the undersigned A Notary Public i and for tl a St of Washington,duly commissioned and sworn,Personally appeared �. ,Lz` br2v�x to me known to be the individual described in and who executed the foregoing instrument,and acknowledged to me that he/she signed and seated this instrument as his/her free- and voluntary act and deed for the uses and purposes therein mentioned. GIVEN under my hand and official seal this day of 9 L,2006, IV Notary Public in and for the ,ja�TA Ry'; to of Washington,residing at My Commission Expires: °F w�'Sl' . 1 Bill of Sale Page 3 of 3 purposes therein mentioned,and on oath stated that they are authorized to execute the said instrument. Witness my hand and official seal hereto affix the day and year first above written. Notary Public in and for the State of Washington, residing at My Commission Expires: The Bill of Sale is given and accepted pursuant to a motion duly made,seconded,and passed by the City Council of the City of Kent,King County,Washington,on the day of 920 i t I I t t \S:r KEN T 1 W A S H I N G T O N ADDENDUM TO BILL OF SALE CITY OF KENT KING COUNTY,WASIIINGTON The figures used on the Bill of Sale for Kent Pediatric Interim Care Center project dated 8/1/05 ,were based on the"As-Built" Engineering Plans dated to L6 ,for the same said Pediatric Interim Care Center project. Jason Hubbell the undersigned P.E. or land surveyor is the person responsible for the preparation of the Bill of Sale and is an employee of Barahausen Consulting Engineers, Inc. ,the firm responsible for the preparation of the"As-Built" Engineering Drawings. Signature Kent City Council Meeting Date May M, 2006 Category Consent Calendar 1. SUBJECT: LARCHER OFFICE BUILDING BILL OF SALE —ACCEPT 2, SUMMARY STATEMENT: Accept the Bill of Sale for Larcher Office Building for 4 gate valves, 1 hydrant, 30 linear feet of water, 25 linear feet of sanitary sewer, 286 centerline cubic feet of streets, 3 storm manholes, 5 catch basins, 95 linear feet of biofiltration swale, 1,256 cubic feet of detention pond, and 372 linear feet of sewer line. This project is located at 24401 — 104`h Ave SE. i 1 3. EXHIBITS: Bill of Sale 4. RECOMMENDED BY: Public Works Director (Committee, Staff, Examiner, Commission, etc.) ' 5. FISCAL IMPACT Expenditure? N/A Revenue? N/A Currently in the Budget? Yes No If no. I Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 1 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds ' DISCUSSION: ACTION: Council Agenda ' Item No. 6M d 08/13/2003 14:18 2537351309 THE VEIMIu A+'3X. Pa6E 02 40 000 i KENT WAS V 1 N G T O N MAIL TO: ENGINEERING DEPARTMENT ATTN: 220 4"AVENUE SOUTH KENT,WASHINGTON 98032 PROJECT: IAKTrmomcv>nm1xNG LOCATION: 24401 1W AVERT BILL OF SALE CITY OF RINT KING COUNTY,WASHINGTON ZfJo3 THIS INSTRUMENT made this J,0 day of d u*15r ,by and between DAVID LARC'FIER ,hereinafter called "Grantors", and City of Kent, a municipal corporation of King County, State of Washington, hereinafter called `Grantee": IWITNESSI~TH: That the said Grantors for a valuable consideration, does hereby grant, bargain, sell to the Grantee the following described improvements: A. WATERIMAINS: Together with a total of 4 gate valves at S4,200 each, 1 hydrants at$750.00 each and/or any other appurtenances thereto. ON FROM TO 104C&i AVE. S.E. 12" MAIN NEW E.H. Including 30 linear feet at$30.00 per LF of b" _(size) D.I. (size & type)waterline. 1 B. SANITARY S .Wl RS: Together with a total of 0 manholes at S each and/or any other appurtenances thereto. ON FROM TO 104"'AVE. S.E. N.E. IiUTLDING CORNER MAIN LINE 2'iO3 14: 12 25_7_351310 THE !<EIHIG ASSOC. 03 , 95 LF of Nofiltration swale or drainage ditch with a total i cost of S3,200.00 , t 2 6.00� CF of detention pond storage with a total cost of S93800.00 , and/or any other appurtenances thereto. ON FROM TO ON-SITE PARKING LOT CB#t 104T4AVE.S.E. Including 372 linear feet at $19.00 per LF of 12" {size & typel DI sewer line. To have and to bold the same to the said Grantee, its successors and assigns forever. The undersigned hereby covenants that it is the lawful owner of said property, and that the same is free from all encumbrances; that all bills for labor and material have been paid; that it has the right to sell the same aforesaid; that it will warrant and defend the same against the lawful claims and demands of all persons. The Bill of Sale is given on consideration of the agreement of the Grantee for itself, its successors and assigns to incorporate said utilities in its utility system and to maintain them as provided in the applicable City Ordinances. IN WITNESS �VHEROF, the undersi ned has caused this instrument to be executed on this day of STATE OF WASHiNGTON ) i )SS COUNTY OF KING 1 On this VQ day of A14W57-,J�ZDQ_3, before me, the undersigned, A Notary Public in and for the State of Washington, duly commissioned and sworn, Personally appeared t7. AU i b t_&k0_H e-P. to me known to be the individual lde�cribed in and who executed the foregoing instrument, and acknowledged to me that _ he signed and scaled this instrument as free and voluntary act and deed or the u9es and purposes therein mentioned. GIVEN under nd official seal this Z y —day of Auw5u 1 yd2QG3 NOT Notary Public in and for the State of —104— Washington, residing at �F�1T PUBW My Commission Expires: - -11 ir3!13,`2003 14:18 25=;=.5I-'M9 THE PEI IG ASS-:OC- PAGE F)4 Witness any hand and official seal hereto affix the day and year first above written. jNotary Public in and for the State of Washington, residing at My Commission Expires: The Bill of sale is given and accepted pursuant to a motion duly made, seconded, and passed by the City Council of the City of Kent, King County, Washington, on the day of , 19 1 1 i i 1 1 i - t Kent City Council Meeting Date May 16, 2006 Category Consent Calendar 1. SUBJECT: GRAY HILL BILL OF SALE — ACCEPT 2. SUMMARY STATEMENT: Accept the Bill of Sale for Gray Hill for 1,914 linear feet of sanitary sewer. This project is located at 21507 S. 42'd Ave. I t t 3. EXHIBITS: Bill of Sale 4. RECOMMENDED BY: Public Works Director (Committee, Staff, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure" N/A Revenue? N/A Currently in the Budget? Yes No If no: Unbudgeted Expense- Fund Amount $ Unbudgeted Revenue. Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds DISCUSSION: ACTION: Council Agenda Item No. 6N 1 Bill of Sale Pa;e 1 of 3 KENT W A 5 H I N G T O N MAIL TO: ENGINEERING DEPARTMENT ATTN: Il L;//tL y7f� tc� s 220 4TH AVENUE SOUTH KENT, WASHINGTON 98032 PROJECT: Grav Hill LOCATION: 21507 South 42nd Avenue TAX ACCT NO: 102204-9010 BILL OF SALE CITY OF KENT 1 KING COUNTY,WASHINGTON THIS INSTRUMENT made this °° � day of Akf�V420t,9 by and between ✓--1 14// L4L ,hereinafter called "Grantors", and City of Kent, a municipal corporation of King County, State of Washington, herinafter called"Grantee": WITNESSETH: That the said Grantors for a valuable consideration,does hereby grant,bargain,sell to Grantee the following described improvements: A. WATF,RMAINS: together with a total of gate valves at$ each, hydrants at$ each and/or any other appurtenances thereto. ON FROM TO (street,estnt,etc) Including linear feet at$ per LF of (size & type) waterline. B. SANITARY SEWERS: Together with a total of 15 manholes at $ 1.800.00 each and/or any other appurtenances thereto. ON Gray Hill,Donofrio,and Scalzo Property Sites FROM 42nd Avenue South TO Scalzo Property Site (street,esmt,etc) Including 740/1,174 linear feet at $ 45.00/22.00 per LF of 10"/8" (size & type) HDPE/PVC sewer line. (' QTARFTQ• Tnnathar with Pnrhe mittare eldaxvUR-e 9ndt /nr AnV nthar annnrtangnepe Bill of Sale ! f I Page 2 of 3 LF of biofiltration swale or drainage ditch with a total cost of$ CF of detention pond storage with a total cost of$ , and/or any other appurtenances thereto. ON FROM TO (street, esmt,etc) Including linear feet at$ per LF of (size S type) sewer line. To have and to hold the same to the said Grantee,its successors and assigns forever. The undersigned hereby covenants that it is the lawful owner of said property; and that the same is free from all encumbrances; that all bills for labor and material have been paid; that it has the right to sell the same aforesaid; that it will warrant and defend the same against the lawful claims and demand of all person. The Bill of Sale is given on consideration of the agreement of the Grantee for itself,its successors and assigns to incorporate said utilities in its utility system and to maintain them as 'provided in the applicable City Ordinances. IN WITNESS WHEREOF,the undersigned has caused this instrument to be executed on this day of20F /fJ 9 C STATE OF WASHINGTON ) SS COUNTY OF KING ) On this ?/ day of 206'io , before me, the undersigned A Notary Public in and for the State of Washington. duly commissioned and sworn,Personally appeared I/c. ,,(irr to me known to be the individual described in and who evikuted the foregoing instrument,and acknowledged to me that he/she signed and sealed this instrument as his/lier free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN under my hand and official seal this Z! day of:7�`—20 ERACHECA. BRYSON N�ublic in and`fla tr eI PUBLIC State of Washington, residing at WASHINGTON ON EXPIRES T 17,2008 My Commission Expires: �T - 17--o Bill of Sale IPage 3 of 3 purposes therein mentioned, and on oath stated that they are authorized to execute the said instrument. Witness my hand and official seal hereto affix the day and year first above written. Notary Public in and for the State of Washington, residing at IMy Conunission Expires: The Bill of Sale is given and accepted pursuant to a motion duly made,seconded, and passed by the City Council of the City of Kent, Ding County, Washington, on the day of 20 i i 1 t i t 1 f I 140 ,7 KENT WA S H ING TO N ADDENDUM TO BILL OF SALE CITY OF KENT KING COUNTY, WASHINGTON The figures used on the Bill of Sale for Gray Hill project dated March 9, 2004 were based on the "As-Built" Engineering Plans dated March 11, 2004 for the same said Gray Hill project. Hal P. Grubb the undersigned P.E. or land surveyor is the person responsible for the preparation of the Bill of Sale and is an employee of Barahausen Consulting Engineers, Inc. , the firm responsible for the preparation of the "As-Built" Engineering Drawings. ignature 10238 015 doe tKent City Council Meeting Date May 16, 2006 ICategory Consent Calendar 1. SUBJECT: BURKHARDT HEIGHTS BILL OF SALE — ACCEPT 1 2. SUMMARY STATEMENT: Accept the Bill of Sale for Burkhardt Heights for 4 gate valves, 1 hydrant, 530 linear feet of watermains, 3 sewer manholes, 825 linear feet of sanitary sewer, 520 centerline linear feet of streets, 10 catch basins, 37,000 cubic feet of detention pond storage, and 705 linear feet of sewer. This project is located at 27031 — 117`' PI SE 3. EXHIBITS: Bill of Sale 4. RECOMMENDED BY: Public Works Director (Committee, Staff, Examiner, Commission, etc.) i5. FISCAL IMPACT Expenditure? N/A Revenue? N/A Currently in the Budget? Yes No If no: Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds I DISCUSSION: ACTION: Council Agenda Item No. 60 i MAIL '10: ENGINCERNG DEPARPOT PROACI ENG I NCLR Al IN.� 4r _:�YoD3Qa-5. 220 4111 AVCNUC SOU11I KENT, WASI I I NG I ON 98032 PRWICT- QupL_- iaRDT _HF_� LOCATION TAX ACCT NO i # 7e,-7 BILL OF SALE CITY OF KENT ' KING COUNTY. WASIIINGfON Zoo TI I I S I NSTRLIIICNT made this 7 clay or _�( 1�y .lA_,, by and bel.ween {'{Ngz> ff� :S4 fiCP-H hereinaftercalled "Grant.ors" . and CITY OF KENT. a municipal corporal ion of King Counly. State of Washington, hereinafter called "Grantee" : W i I NCSSETI I: That said Grantors for a valuable consideration. does hereby grant.. bargain. and sell to the Grantee. the following describer) improvements : A. together with a . total of A gale valves at $ 400 each. I hydrants at each and/or any other appurtenances thereto. QN EROM 10 (street. esmt. etc. ) �> E7t:' 11-7 f LP,ca SE S. 2,70� cQL--,)D� - sic- ii3oL_g ' Including 2-00r linear feet at S ZD per LF of g« (size) D.T_ . (type) waterline. j { Ito L-F Rc.�p 33� ��'n • ��' i 4P1 uic (st.reet. e5mL. etc. ) SF— 0,70t!� 5(: i� IIto auI 1 n Pi F . e df c�1 -C�t-SaC. , including a25 linear feet at $ 3o per I_f of ell (size) talc ( type) sewer line. C. MUJ Logether with curbs , guLt.ers , sidewalks. and/or any other appurtenances thereto. � C[3L)IS (street. esmL. eLc. ) 1 f-7 Ft_ . 5� sE z7o sT. SC'o I-j-0- 0-C- I ncluding S2,0 cenLerline I_F at $ -70 per LF of ASPH4r-T (type) streets, Zfb' feet: asplrall. roadway. D. STORM SCWI3i; Logether with a LoLal of o manholes at Z $ 0 each or a LoLal of 1D catch basins al, $ 1000 each. 1_1: of Wofill.raLzon swale or- orainage diLch with a Local cost. of A 37600 Cr- of delenLion pond storage wMi a total cost of $ 4O,e!�0 , and/or airy other appurLenances Lherelo. ON [ROM L , (street., esart. etc. ) 1 l"7 PL sE 2-7 Including 705 linear feel. at 1S•00 per 1.1- of ( 2- (size) ` R, V c_ (type) sewer line. To have and to bold I Ire same to Lhe said GranLee. Us successors and assigns forever. aforesaid: LhaL it: will warrant and defend the same against Lhe lawful claims and demands of all persons. t the Bill of Sale is given in consideral.ion of Lhe agreemenl- of We GrEintee for itself, its successors and assigns Lo incorporal.e said ul.iliLies in its utiliLy syst.em and to mainLain them as provided in Lhe applicable City Ordinances. IN WH NESS Idl4LRLOF, the undersigned has caused Lhis instrument Lo be executed on Lhis day off__ �T> _ F STATE 017 WASI I I NG oti ) )SS COUNTY OF KING ) tOn Lhis q_t clay oflufP , before me. Lhe 1 undersigned, a Notary Purlis in and for Me SLaLe H�of Wash► g Lon, duly commissioned and sworn, personally appeared del? ` } k Lo me known Lo be the individual described in and who exeruLed the foregoing instrument, and acknowledged Lo me Lhal. (� lie)_signed and sealed this said insLrrrmenL as Pre ' and volunLary aci. and deed for Lhe uses and purposes therein mentioned. GIVEN under my hand and official seal Lhis ! clay 0f _ My Commission Expires : STA CC OF WASI I i NGTON ) )SS COUNTY OF KING ) On this day of 19 before me. Lhe undersigned, a Notary Public in all(] for the SLaLe of WashingLon, duly comissioned and sworn. personally appeared and Lo me known Lo be the and respectively of _ Lhe LIial, exemLed Lhe foregoing insl.runrenL , and acknowledged Lhe said insl:rumerit Lo be the free and volunLary act and deed of said for Lhe uses and purposes t.luerein menLioned, and on oaLh slated Lhal. Lirey are auLhorized Lo execuLe Lhe said instrument.. WiLness my hand and official seal herel.o affixed Lhe clay and year firsL above wriLLen. Notary Public: in and for Lhe Slate of Washington. residing at. My Commission Expires: This Gill of Sale is given and accepLed pursuanL Lo a motion duly made, seconded, and passed by Lhe CiLy Council of the CiLy of Kent, King County. Washington, on Lhe day of 19 CITY OF KEN I cify OF MAY 08 261 �URk�-Ff�QT �CIG� t ENGINEERING DEPT # 7q`7 ADDENDUM TO BILL OF SALE N CT CITY OF KENT KING COUNTY, WA5HINGTON F The figures used on the Bill of Sale for ByRie-HAgbT- e:-nHTs �.. {C�v� `tq00 z0fZ- ^roject dated � �� 0 � were 1 based on the "As-Built"' -ngineering Plans dared S� 3�a for the same said ELfq-) o—f �U # �j_ }'}�IG�{ {�-• project. �R �1E5 ��l i4(=G�-� r P. the undersigned ?. '-I . or land surveyor is the person responsible for the preparation of the Bill of Sale and is an emoloyee of �hiC3to�l Rts�� the firm responsible for the orecaration Of 4he "As-Built" -Engineering Drawings . i Sig, Lura Date: I „ . M558 Kent City Council Meeting Date May 16, 2006 Category Other Business 1. SUBJECT: AERIAL FIREWORKS PROHIBITION ORDINANCE—ADOPT (TO TAKE EFFECT IN 2007) 2. SUMMARY STATEMENT: Due to the danger to persons and property that is created when a firework is launched into the air, and due to the repeated complaints received by the city, staff has been directed to create an ordinance for council consideration that strikes a balance between the desire of the public to enjoy fireworks on the Fourth of July and the desire of the public to remain safe from hazards that lighting fireworks may create. To that end, staff has prepared the attached ordinance that would ban aerial fireworks ' Because the proposed ordinance is more restrictive than state law, it must be adopted one year prior to its effective date. Should this ordinance be passed at the May 16, 2006, city council meeting, it will not affect the discharge of fireworks in Kent until the Fourth of July holiday in 2007. 3. EXHIBITS: Memorandum and Ordinance 4. RECOMMENDED BY: Public Safety Committee (Committee, Stall, Examiner, Commission, etc.) 5. FISCAL IMPACT Expenditure9 N/A Revenue? N/A Currently in the Budget? Yes No If no Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: 1 Councilmember moves, Councilmember seconds to adopt Ordinance No.,.920D, which defines the term "consumer firework" and prohibits aerial consumer fireworks within Kent. ' DISCUSSION:- ACTION: Lid Council Agenda Item No. 7A LAW DEPARTMENT Tom Brubaker, City Attorney ' Phone: 253-856-5770 K E N T Fax: 253-856-6770 WASH[NGTON ' Address: 220 Fourth Avenue S. Kent, WA. 98032-5895 ' May 9, 2006 ' To: City Council From: Arthur"Pat" Fitzpatrick, Deputy City Attorney Regarding: Ordinance Prohibiting Aerial Fireworks in Kent Currently, the Kent City Code permits the sale or purchase of "consumer fireworks" each year ' between June 281h and July 4`h, and permits their discharge between the hours of 9 00 a.m and 11 00 p m on the Fourth of July It is not legal to use, sell, or purchase fireworks within the city on any other date or at any other time, including around the New Year's holiday ' "Consumer fireworks" are those typically available at fireworks stands within city limits, and include some "aerial devices" "Aerial devices" are defined by the Washington Administrative Code as various types of fireworks that are propelled into the air It is important to note that while some aerial devices are classified as consumer fireworks and are therefore permitted in Kent pursuant to its current ordinance, many other illegal aerial devices are available at ' reservations and are discharged within the city limits over the Fourth of July holiday As such, both legal and illegal aerial devices are discharged within the city limits of Kent Each year, Kent receives a number of complaints regarding the discharge of fireworks Many of I these complaints relate to fireworks that are launched into the air Citizens also complain of the noise, litter, and hazards caused by fireworks Fireworks that are launched into the air cannot be controlled by the user and they can fly over and onto neighboring property This can cause a real or perceived safety hazard as the fireworks can land on shake roofs and other combustible property and dry vegetation Because it is often difficult to determine which types of aerial fireworks are legal and illegal, the public is faced with confusion regarding which aerial devices they are permitted to use Educating the public as to which devices are permitted is difficult, and enforcing the law can be a challenge for the Police Department. ' While state law permits the use of certain fireworks at limited times, the law also allows cities to prohibit the use and sale of fireworks within their boundaries In King County, 53% of the cities completely ban fireworks, while 47% of the cities permit the sale and discharge of "consumer 1 fireworks" over the Fourth of July holiday With the above in mind, staff was directed to amend the city's code in such a way that strikes a balance between the desire of the public to enjoy fireworks on the Fourth of July, and the desire ' of the public to remain safe from the hazard and disruption that discharging fireworks may create While the attached ordinance does not ban most consumer fireworks, it would make it illegal to sell, possess, or discharge all aerial fireworks Memorandum 1 May 9,2006 Page 2 1 It is important to remember that in the event the city wishes to adopt an ordinance that is more , restrictive than state law, the ordinance must be adopted one year prior to the effective date of the ordinance. As such, the adoption of the attached ordinance would not be effective until , 2007 In order for an ordinance to be effective for July 4, 2007, it must be adopted by the City Council no later than the June 20, 2006, council meeting 1 i 1 1 1 i 1 1 1 1 1 1 i 1 ORDINANCE NO. AN ORDINANCE of the city council of the city of Kent, Washington, amending Chapter 13.05 of the Kent ' City Code regarding fireworks to add a definition of "common fireworks" to the chapter in such a manner that would have the effect of prohibiting the sale, possession or ' discharge of certain aerial type fireworks, and which clarifies that fireworks that are not "consumer fireworks" may not be sold, possessed, or discharged within the city of Kent. ' RECITALS ' A. On the July Fourth holiday, and during the period leading up to and following the holiday, the city's public safety system is stretched to its limits due to the ' high volume of calls for assistance due to the discharge of fireworks. A majority of the calls relate to fireworks that are launched into the air, which therefore create a fire hazard to nearby property. A number of the calls also relate to the noise that aerial fireworks cause, as well as the debris that lands on nearby property. B. Certain aerial fireworks cause a substantial risk of fire due to ignited debris falling on the rooftops of structures and on combustible vegetation. In addition, hot or ignited debris falling from aerial fireworks can present a risk to the 1 health of citizens. ' 1 Fireworks—ProhibitAeria/Devices C. In an effort to limit the hazards and disturbance caused by aerial type ' fireworks, the city council for Kent has determined that it is in the interest of the ' public health, safety, and welfare to ban all aerial fireworks within the city limits. NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT, WASHINGTON, , DOES HEREBY ORDAIN AS FOLLOWS: ORDINANCE SECTION 1. — Amendment, Chapter 13.05 of the Kent City Code, entitled "Fireworks," is amended as follows: ' Chapter 13.05. FIREWORKS ' Sec. 13.05.005. Definition—Consumer fireworks. As used in this chapter, the term "consumer firework," in its singular or plural form, shall have the same meaning as set forth in section 212-17-035 of the Washington Administrative Code, provided that the term shall not mean an aerial device, aerial shell, mortar, or any combination item that contains any effect of an aerial device, aerial shell, or ' mortar. Sec. 13.05.010. Sale and discharge of fireworks. , A. Sale, purchase or possession. It is legal to sell or purchase consumer fireworks within this city only during the following times and dates: from 12:00 noon to 11:00 , p.m. on June 28th; and from 9:00 a.m. to 11:00 p.m. on each day from June 29th through July 4th. It is only legal to possess consumer fireworks within this city from 12:00 noon on June 28th through 11:00 p.m. on July 4th. It shall not be legal to sell, purchase, or possess consumer fireworks at any other time, specifically including, ' without limitation, from December 27th through December 31st. B. Use and discharge. It is legal to use or discharge consumer fireworks within ' this city only between the hours of 9:00 a.m. and 11:00 p.m. on July 4th. It shall not ' be legal to use or discharge consumer fireworks at any other time, specifically 2 Fireworks—ProftibitAeriai Devices ' t including, without limitation, from 6:00 p.m. on December 31st of any year until 1:00 a.m. of the subsequent year. C. Other fireworks prohibited. Except as provided by a permit properly applied ' for and issued pursuant to this chapter and Chapter 70.77 RCW, it shall, at all times, be unlawful to sell, purchase, possess, use, or discharge fireworks other than ' consumer fireworks. Sec. 13.05.020. Local fireworks permits. Application for all local ' fireworks permits required by the state fireworks law, Chapter 70.77 RCW, shall be made to the fire marshal. The fee for such permit shall be established by city council ' ordinance or resolution, which amount covers the aty's administrative costs for permit processing, issuance, and inspection. Pursuant to RCW 70.77.555, this permit fee and ' the costs for all needed permits and local licenses from application to and through processing, issuance and inspection shall not exceed one hundred dollars ($100) for ' any one (1) year, except that the fees for display permits will not exceed five thousand dollars ($5,000) for any one permit. ' 13.05.030. Public display of fireworks. The fire marshal is authorized, pursuant to RCW 70.77.280, to issue a permit for a public display of fireworks. After review and investigation of an application for a permit, the fire marshal may grant, deny, or grant with reasonable conditions, a permit for a public display of fireworks; provided, however, that any such permit shall only be issued for the discharge of fireworks between the hours of 9:00 a.m. and 11:00 p.m: (1) on the fourth of July for Fourth of July ceremonies; (2) for high school events of a state certified public or private high school; iprovided, that such events are officially sanctioned by the governing body of such high school; or ' (3) for wedding ceremonies. ' The issuance of a permit for a public display of fireworks for a time or purpose different than stated herein is not permitted unless approved by the city council 3 Fireworks—Prohibit Aerial Devices following consideration of the review, investigation and recommendation of the fire ' marshal. Sec. 13.05.040. Reckless discharge or use of fireworks. It is unlawful for any person to discharge or use fireworks in a reckless manner which creates a substantial risk of death or serious physical injury to another person or damage to the property of another. , Sec. 13.05.050. Penalty. Any person violating the provisions of KCC ' 13.05.010, 13 05.020, and 13.05.030 shall be guilty of a misdemeanor, and shall be punished by imprisonment not to exceed ninety (90) days and a fine not to exceed , one thousand dollars ($1,000). Any person violating the provisions of KCC 13.05 040 shall be guilty of a gross misdemeanor and shall be punished by imprisonment not to , exceed one (1) year and a fine not to exceed five thousand dollars ($5,000). A person is guilty of a separate offense for each day during which he or she commits, continues ' or permits a violation of the provisions of this chapter. Sec. 13.05.060. Ban authority due to fire danger. A. The city of Kent recognizes the unique risk that exists when the discharge of fireworks is combined with a high fire danger. Under such conditions, the city has , determined that it is in the interests of the public health, safety, and welfare to establish an emergency procedure for banning fireworks when the risk of fire is high. ' B. The fire marshal, subject to the city council's prior approval, may ban the sale, use, and/or discharge of fireworks within the city limits of Kent in the event the risk of ' fire in King County or the city of Kent has been determined by the Washington State Department of Natural Resources ("DNR"), or a qualified DNR official, to be "very , high/extreme" or otherwise at the highest fire danger level. C. At each location at which fireworks are sold, the vendor shall post a notice of , at least eight inches by ten inches in size that shall contain the language set forth in ' 4 Fireworks—ProhibitAeriai Devices ' ' subsection B of this section. Such notice shall be posted in such a manner that it is ' clearly visible to those who purchase fireworks. ' SECTION 2 — Severability. If any one or more section, 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 3, — Effective Date. This ordinance shall take effect one year from and after its date of adoption and passage. ' SUZETTE COOKE, MAYOR ATTEST: ' BRENDA JACOBER, CITY CLERK APPROVED AS TO FORM: TOM BRUBAKER, CITY ATTORNEY 1 ' 5 Fireworks—Proh1h&Aeria1 Devices ADOPTED and PASSED: May , 2006. APPROVED: May , 2006. PUBLISHED: May , 2006. I hereby certify that this is a true copy of Ordinance No. adopted and passed by the city council of the city of Kent, Washington, and approved by the mayor of the city of Kent as hereon indicated. ' 'BRENDA JACOBER, CITY CLERK (SEAL) P\Civil\ORDINANCE\Fireworks-2006-Amendments-Rcwsed doc 6 Fireworks—ProhibitAeria/Devices , ' Kent City Council Meeting Date May 16. 2006 Category Other Business ' 1. SUBJECT: CRITICAL AREAS ORDINANCE 2. SUMMARY STATEMENT: On April 19, 2006, the Growth Management Hearings Board issued its Final Decision and Order regarding an appeal filed by the State of Washington of the Ci ty's Critical Areas Ordinance. This date has been set for the City Council to consider its options in light of the Growth Management Hearing Board's decision. i t3. EXHIBITS: None ' 4. RECOMMENDED BY: N/A (Committee, Staff, Examiner, Commission, etc.) t5. FISCAL IMPACT Expenditure`? N/A Revenue? N/A Currently in the Budget? Yes No If no: ' Unbudgeted Expense: Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember moves, Councilmember seconds 1 ' DISCUSSION: ACTION: Council Agenda Item No. 7B 1 Kent City Council Meeting Date May 16, 2006 Category Bids 1. SUBJECT: SERVICE CLUB BALLFIELDS RESTROOM AND CONCESSION BUILDING 2. SUMMARY STATEMENT: The bid opening was held on May 9, 2006 with one bid submitted by Clements Brothers, Inc for the amount of$587,823, excluding IWashington State Sales Tax (WSST) The Engineer's estimate is $557,822, excluding WSST. The Parks Director recommends authorizing the Mayor to enter into an agreement with Clements Brothers, Inc. for the amount of$587,823, to complete the Service Club Ballfield Restroom and Concession Building Project. 3. EXHIBITS: Bid Tab 4. RECOMMENDED BY: Parks Director (Committee, Staff, Examiner, Commission, etc.) I5. FISCAL IMPACT Expenditure? N/A Revenue? N/A 1 Currently in the Budget? Yes X No If no: Unbudgeted Expense- Fund Amount $ Unbudgeted Revenue: Fund Amount $ 6. CITY COUNCIL ACTION: Councilmember foyw moves, Councilmember seconds authorize the Mayor to enter into an agreement with Clements Brothers, Inc for the amount of$587,823, plus Washington State Sales Tax, to complete the Service Club Ballfield Restroom and Concession Building Project. ' DISCUSSION: ACTION: (� Council Agenda Item No. 8A 1 KENT Wwsxixorox BID TABULATION FORM KENT PARKS, RECREATION &COMMUNITY SERVICES CITY OF KENT, WASHINGTON PR03ECT: PR 06 05 NAME: Service Club Ballfield Restroom & Concession Building - ReBid DATE: May 9, 2006 DUE: 10:00 a.m. OPENED: 10:15 a.m. Bidder: Total Lump Sum Bid: in dollars 1. Clements Bros. Inc. $587,823.00 Bonney Lake WA ARCHITECT'S ESTIMATE: $557,822 Staff reviewed the bid and verified references and will make a recommendation to Kent City Council to award the bid to Clements Bros. Inc. for $587,823. The low bid will be awarded by City Council on Tuesday, May 16, 2006. Questions may be directed to Shane Gilbertson, project manager, at(253) 856- 5115 or sgilbertson@ci.kent.wa.us. REPORTS FROM STANDING COMMITTEES AND STAFF A. COUNCIL PRESIDENT B. MAYOR C. OPERATIONS COMMITTEE I ties D. PUBLIC SAFETY COMMITTEE E PUBLIC WORKS F. PLANNING AND ECONOMIC DEVELOPMENT COMMITTEE G PARKS AND HUMAN SERVICES COMMITTEE H. ADMINISTRATIVE REPORTS 1 i REPORTS FROM SPECIAL COMMITTEES i t t CITY OF KENT OPERATIONS COMMITTEE MEETING MINUTES March 21, 2006 Committee Members Present: Tim Clark, Chair, Debbie Ranniger, and Debbie Raplee who arrived after agenda items #1 and 2 were presented • The meeting was called to order by Chair Tim Clark at 4 12 PM • Chair Clark announced that the informational item from the Finance Department would be presented prior to agenda item 43, allowing Debbie Raptee additional time to arrive 1. Approval of Minutes Dated February 21,2006 Debbie Ranniger moved to approve the minutes of the February 21, 2006, Operations Committee meeting. The motion was seconded by Tim Clark and passed 3-0, with Debbie Raplee's concurrence. 2. Approval of Vouchers Dated February 28, 2006 and March 15,2006 Debbie Ranniger moved to approve the vouchers dated February 28, 2006, and March 15, 2006. The motion was seconded by Tim Clark and passed 3-0, with Debbie Raplee's concurrence. For Information Purposes Only- Finance Director Bob Nachlinger presented a PowerPoint presentation on the 4`h Quarter 2005 Financial Report. 3. PRR Communications Consulting Contract Economic Development Manager Nathan Torgelson and Communications and Marketing Manager Sylvia McDaniel explained the purpose of the contract 1 Debbie Ranniger moved to recommend a S35,000 one-year(2006) contract for communications and marketing consulting services using budgeted Communications budget dollars. Debbie Raplee seconded the motion, which passed 2-1. Discussion ensued concerning the fact that the RFP for the consulting contract was developed prior to the City Council retreat, at which time the Strategic Plan was developed Committee members requested that Sylvia McDaniel work with PRR Communications prior to April 4, 2006, to revise the Scope of Work in the Agreement in order to include ideas from the development of the Strategic Plan This item will appear on the April 4, 2006 Council Agenda under"Other Business". The meeting adjourned at 4:51 PM. J Thompson Acting Operations Committee Secretary 1 PUBLIC WORKS COMMITTEE MINUTES April 3, 2006 COMMITTEE MEMBERS PRF,SENT: Committee Chair Debbie Raplee and Committee Member Ron Hannon were present Elizabeth Watson sat in for Tim Clark.The meeting was called to order at 5:06 p.m. Approval of Minutes Dated March 20, 2006 Coni nittee Member Harmon moved to approve the minutes of March 20,2006. The motion was seconded by A alson and passed 3-0. Condemnation Ordinance for South 228rh Street Widening Project At Torn Rrubaker's request this acin teas moved up on the agenda Tim LaPorte explained that in order to construct the S. 228"' Street Widening Project (S. 228"i street will be widened from three lanes to five between 64t"Ave S and Military Road) It will be necessary to acquire private property from four property owners. He said the ordinance provides the mechanism to proceed, if necessary, to condemnation on those properties for which the typical methods of negotiation have failed. Brubaker I explained when you bet close to construciiori it is very costly to have delays. Brubaker further explained that this ordinance m ust b e i n g lace or the project may be delayed at a significant cost. Watson asked that condemnations be hrouaht back to the committee at a later date Harmon moved to recommend authorization to adopt the Condemnation Ordinance, for South 228t" for obtaining needed ri;ht-of-way for the S. 228"' Street Widening Project. The motion was seconded by Watson and passed 3-0. Presentation of Overall Work Plan—Fleet Section Alice Conrad gave an informational PowerPoint presentation on the overall 2006 work plan for the Fleet Section of PW Operations. She mentioned that the US Marshall's office used the Fleet Sections services because of how good our model is Presentation of Overall Work Plan —Development This item was removed from the agenda. It will be heard at the April 17, Public Works Conunittee meeting. jPresentation of Overall Work Plan —Land Survey&Desi2n Tim LaPorte combined the Land Survey and Design presentations, explaining how they support Public Works, Police, Fire, and explained the function of the Survey section. Ken Laugholz gave an overview of various projects that ate underway at this time in the City and briefly explained what the Design Section does Mark Howlett, Construction Management went over current construction projects within the City. Harmon asked about downtime due to the trains going through town. LaPorte said there are 14-16 trips (includes both tracks) which equates to approximately 2.5 hours a day Tim LaPorte went on to discuss funding for vanous projects I Update-LID 329—SR516174"' Ave SiEnal &Intersection improvements—Information Only Tin-t LaPorte explained that the C ity w as shocked at t he i nerease i n cost for the actual b ill for the signal; the new cost estimate included$187,795 for railroad work. Following the project,UPRR billed the City $445,355. The higher railroad costs will result in a significant increase in the LID Page 1 of assessment. Harmon asked if there is a drop dead date to pay. Mullen said no, we're still waiting for an explanation from UPRR. The LID will come back to Council at a lat cr date. LID 351 Segregation Tun LaPorte explained that High Ridge Condo. Assoc., the authorized agent for the owners of record of the property originally affected by LID 351, Assessment#140, located on the S. side of SE 2641)' St_ and W. of 104`h Ave SE has requested segregation due to the properly being a 12-unit condominium. The PW Director recommends passage. No unbudgeted Fiscal/Personnel impact. This LID was originally assessed for St. Improvements in the amount of$19,352.16, with the balance as of March 22, 2006 being$12,901.46. The newly segregated amount would be$1,075.12 for each unit Watson moved to recommend that the City Council pass Resolution, directing the Finance Director to scgreeate Assessment No.140, levied under LID 351, in to 12 equal assessments. The motion was seconded by Harmon and passed 3-0. Transportation Master Plan Task Force—Recommended Task Force Member List Steve Mullen explained how Task Force Members were selected and what their function will be. He further explained the TMP Task Force will represent the community interests and provide valuable perspectives; offer reconunendations and prioritize transportation projects and programs for coustdcration by the City Council, cuhmnatmg in the adoption of the Transportation ),Iaster Plan Patrick Birnon, East Hill resident and Alaska Distribution Company Manager was added to the list of Task Force Members. There was no action taken on this item.It was recommended that the attached list of community representative be endorsed by the City Council to be invited to serve on the ThIP Task force, Clearwire Lease Agreement 3.5 NIG Reservoir Site Brad Lake explained how CleaiAvuc LLC has negotiated a five year lease agreement with the Kent Water Division to use 10 sq ft. of property and space on the Kent lattice tower, located in the water reservoir facility at 28502 124°i Avenue SE; as well as necessary access to install and operate a wireless Internet service antenna on the Kent lattice tower at the cost of$1,350 per month. Harmon moved t o recommend C ouncil t o a uthorize t he Mayor to s ign t he C iearwire L ease Agreement for the 3.5 MG Reservoir Site The motion was seconded by Watson and passed 3-0. Adiourned: The meeting was adjourned at 6:10 p m. Next Meeting Scheduled for: The next meeting is scheduled for Monday,April 17,2006 at 5:00 p in. j Cheryl Vi th, , Administrative Assistant III Page 2 of 2 1 t CONTINUED COMMUNICATIONS A. t t t t t t t 1 1 1 1 r rEXECUTIVE SESSION r 1 1 ACTION AFTER EXECUTIVE SESSION 1 i 1 1 1 i 1 1 1 1 i 1 r