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HomeMy WebLinkAboutILA1999-0378 - Change Order - #1 - King County Housing Authority - Valley Kee & Springwood Apartments Policing Services - 01/03/2001 Contract #: 625-2000-0008 KING COUNTY HOUSING AUTHORITY CHANGE ORDER TO CONTRACT FOR SOCIAL SERVICES BETWEEN KING COUNTY HOUSING AUTHORITY AND THE CITY OF KENT POLICE DEPARTMENT DATE: 12 - 12 -oo AGENCY: The City of Kent Police Department 220 Fourth Avenue South Kent, WA 98031 CONTRACT FOR: The Agency shall fiirmsh the residents of the King County Housing Authority communities of Sprmgwood Apartments and Valli Kee Homes, drug elimination services, employing the community policing concept, including the operation of a police substation on site in Springwood Apartments with two (2)half-time police officers The Contract is changed as follows: Delete. 2. Contract Documents. (2) Exhibits, as listed, Exhibit A -- Scope of Work Exhibit B Project Budget and Invoice Schedule Exhibit C Reporting Requirements Exhibit D Invoice Fonnat Exhibit E - Resident Contact Data Report Exhibit F Quarterly Narrative Reports Exhibit G Section 3 Certification Requirements Exhibit G-1 Section 3 Certification Form(Agency) Exhibit G-2 Section 3 Certification Form (Operatives) Exhibit H Insurance Requirements King County Housing Authority and the City of Kent Police Department Change Order to Contract for Social Services Page I of Replace with: 2. Contract Documents. (2) Exhibits, as listed, Exhibit A Scope of Work(Revised 12-00) Exhibit B Project Budget and Invoice Schedule (Revised 12-00) Exhibit C Reporting Requirements (Revised 12-00) Exhibit D Invoice Format(Revised 12-00) Exhibit E Resident Contact Data Report(Revised 12-00) Exhibit F Monthly Narrative Report (Revised 12-00) Exhibit G Section 3 Certification Requirements Exhibit G-1 Section 3 Certification Form (Agency) (Revised 12-00) Exhibit G-2 Section 3 Certification Form (Operatives) (Revised 12-00) Exhibit H Insurance Requirements Delete: 3. Terms of the Contract. A. Duration of Contract: The Contract shall be in full force and effect for a period commencing December 1, 1999, and ending November 30, 2000, unless sooner terminated, pursuant to Section 8, Default and Termination, herein Time is of the essence for this Contract This Contract may be extended for additional twelve (12) month periods, up to a total of thirty-six (36) months, through written amendments, change orders or other modifications to this Contract Replace with: 3. Terms of the Contract. A. Duration of Contract: The Contract shall be in full force and effect for a period commencing December 1, 1999, and ending November 30, 2001, unless sooner terminated, pursuant to Section 8, Default and Termination, herein Time is of the essence for this Contract This Contract may be extended for one additional twelve (12) month period through written amendments, change orders or other modifications to this Contract Delete: 24. Notices. Any notices required or permitted by this Contract shall be in writing and shall be either personally delivered or sent by first-class mail, certified with return receipt requested, and addressed to the parties as follows King County Housing Authority and the City of Kent Police Department Change Order to Contract for Social Services Page 2 of 4 If to KCHA Deanna L Briese Drug Elimination Grant Coordinator King County Housing Authority 27360— 129th Place SE Kent, WA 98031 Replace with: 4. Notices. Any notices required or permitted by this Contract shall be in writing and shall be either personally delivered or sent by first-class mail, certified with return receipt requested, and addressed to the parties as follows If to KCHA Wendy Morgan Southeast Area Resident Services Administrator King County Housing Authority 600 Andover Park West Tukwila, WA 98188 Change in Total Contract Value: The original Total Contract Value was $ 84,452 00 Net change by previously authorized Change Orders $ 0000 The Total Contract Value prior to this Change Order was $ 84,452 00 The Total Contract Value will be increased by this Change Order in the amount of $ 84,452 00 The new Total Contract Value including this Change Order will be $168,904 00 This Change Order is subject to the conditions herein set forth as follows A The aforementioned changes and work affected thereby are subject to all contract stipulation and covenants, B The rights of the King County Housing Authority are not prejudiced, and C All claims against the King County Housing Authority incidents/to or as a consequence of the aforementioned change/changes are satisfied King County Housing Authority and the City of Kent Police Department Change Order to Contract for Social Services Page 3 of 4 This Change Order is not valid until signed by both the Housing Authority and the Agency Signature of the Agency indicates agreement herewith, including any adjustment in the Total Contract Value, Scope of Work or other aspects of the Contract KING CqUNTY CITY OF KENT HOUSING U ORITY LICE DEP BY BY Stephen J orman /Jay:rlltofethe ExecutivDirector City of Kent 600 over Park West 220 Fourth Avenue South Seattl , WA 98188 Kent, WA 98032-5895 DATE /L/r q00 DATE f —� King County Housing Authority and the City of Kent Police Department Change Order to Contract for Social Services Page 4 of 4 EXIT A- SCOPE OF WORK(REVIS*12-00) THE CITY OF KENT POLICE DEPARTMENT OVERVIEW OF CONTRACT: Contract Number: 625-2000-0008 Contract Period: December 1, 1999 to November 30, 2001 Total Contract Value: $168,904 00 December, 1999 to November 30, 2000 $84,452 00 December, 2000 to November 30, 2001 $84,452 00 Provision of Services: The Agency shall furnish the residents of the Icing County Housing Authority communities of Spnngwood Apartments and Valli Kee Homes, drug elimination services, employing the community policing concept, including the operation of a police substation on site in Springwood Apartment with two (2) half-time police officers providing a mimmum total of 160 hours of service per month In performing such services, the Agency shall at all times comply with all Federal, State and local statutes, rules and ordinances applicable to the performance of such services and the handling of any funds used in connection herewith KCHA may, subject to the provisions contained in Section 8, Default and Termination, by written notice of default to the Agency, terminate this Contract for (a) acts by the Agency outside of the scope of described services or (b) failure to perform any of the services or reporting activities specified in this Contract SCOPE OF WORK TO BE PERFORMED BY AGENCY: The Agency shall furnish the residents of Springwood Apartments and Valli Kee Homes, drug elimination services, employing the community policing concept and will operate a police substation on site in Sprmgwood Apartments with two one half-time police officers serving the two communities, providing a mimmum total of 160 hours of service per month The City of Kent Police Department agrees that it will not reduce its current level of police services to the public housing developments, particularly in the areas of community policing, patrol, criminal investigation, records, dispatch and special operations Kent Police Department will cooperate with KCHA to eliminate drug-related crime in KCHA communities based upon the Drug Elimination Grant written proposal as the Plan of Operations to establish the manner and method of performance for community police services to be provided The City of Kent Police Department will participate in semi-annual program evaluation and reporting based on program goals as stated in the Drug Elimination Grant written proposal Either party to the contract may amend the scope of the plan of operations through written request for an amendment The Executive Director of the King County Housing Authority and the Mayor of the City of Kent shall provide final determinations regarding the establishment of an amendment to the plan of operations The City of Kent Police Department will provide the following services King County Housing Authonty and The City of Kent Police Departrnent Exhibit A—Scope of Work(Revised 12-00) Page 1 of 3 EXIT A- SCOPE OF WORK(REVIS*12-00) THE CITY OF KENT POLICE DEPARTMENT Description 1. Community Policing A Resident Contact (Walk-in's &Telephone) twenty(20) Activities residents per month minimum B Walking/Bicycle Patrols. Ten(10) Patrols per each site per month minimum C Community Policing Contacts One hundred (100) people per month minimum in Sprmgwood Apartments and twenty-five (25) people per month minimum in Valli Kee Homes D On-View Contacts/Investigations Ten(10) per month minimum E Self-Initiated Field Activities (Prevention/Mediation/ Intervention) Ten(10)per month minimum F Enforcement Contacts/Patrol Assists/Traffic Reports /Follow Ups, etc. As they occur 2. Crime Prevention Activities A Coordinate, tram and support the activities of on site for Springwood Apartments recreation, social services programs, resident council and and Valli Kee Homes KCHA At least one (1) activity per quarter per site serving a minimum of fifteen(15)residents B Crime Prevention, Security and Safety Education Programs Provide Housing Staff with one (1)program per semester or work one-on-one with staff C Advise KCHA in the planing and implementation of other security programs As requested D Home Safety/ Security Surveys of residents One to two (1-2)per Quarter E Childhood Safety/Crime Prevention Programs. Two (2) per Year per Site F Youth Prevention Activities One (1) per Quarter per Site G Apartment Watch Meetings or other prevention activities One (1)per Quarter King County Housing Authority and The City of Kent Police Department Exhibit A—Scope of Work(Revised 12-00) Page 2 of 3 EXIT A- SCOPE OF WORK(REVIS*12-00) THE CITY OF KENT POLICE DEPARTMENT Descriptionof Qualifications 3. Coordination and A Attend Resident Council Meetings and maintain Communication Activities communication lines with resident leaders Ongoing B The Agency will coordinate support efforts with other social service agencies, schools,job support and health care providers serving resident families and make referrals for services As needed C Provide Housing Management with a calendar of officer's monthly schedules D Attend all Team meetings to plan, coordinate and schedule programs,problem-solve, and maintain project communication 4. Reporting Activities A Outcome-based program reports and data information to KCHA As needed or as requested by KCHA staff B Report to Housing management all police concerns, incidents of drugs and drug related crime occurrences, and non-emergency criminal activities in the communities Coordinate crime reduction efforts C Respond to Housing Management written requests for services or information and provide requested public information which deals with criminal activity in KCHA communities King County Housing Authority and The City of Kent Police Department Exhibit A—Scope of Work(Revised 12-00) Page 3 of 3 EXHIBIT B - PROAT BUDGET AND INVOICE SCHEE's<ClLE (REVISED 12-00) THE CITY OF KENT POLICE DEPARTMENT TOTAL CONTRACT VALUE: $168,904.00 PROJECT BUDGET DECEMBER 1, 1999—NOVEMBER 30, 2000: Service Activity: Amount Allocated: Springwood Police Substation: community policing services for residents of Springwood Apartments and Valli Kee Homes in $84,452 00 Kent Project Budget: $84,452.00 PROJECT BUDGET DECEMBER 1, 2000—NOVEMBER 30, 2001: Service Activity: Amount Allocated: Springwood Police Substation: community policing services for residents of Spnngwood Apartments and Valli Kee Homes in $84,452 00 Kent Project Budget: $84,452.00 INVOICE SCHEDULE DECEMBER 1, 1999—NOVEMBER 30, 2000: Invoices for payment shall be submitted for each of the Contract Months listed below no later than ten (10) days after the end of the Contract Month The value of the reimbursement requested shall be based upon the schedule provided below The total value of reimbursement requested during this Contract Period shall not exceed the Project Budget for this Contract Period Contract Month Invoice Due Reimbursement Schedule December 1999 January 10, 2000 $7,037 66 January 2000 February 10, 2000 $7,037 66 February 2000 March 10, 2000 $7,037 66 March 2000 April 10, 2000 $7,037 66 April 2000 May 10,2000 $7,037 66 May 2000 June 10, 2000 $7,037 66 June 2000 July 10, 2000 $7,037 66 July 2000 August 10, 2000 $7,037 66 August 2000 September 10, 2000 $7,037 66 September 2000 October 10,2000 $7,037 66 October 2000 November 10, 2000 $7,037 66 November 2000 1 December 10, 2000 $7,037 74 Total Value: $84,452.00 King County Housing Authority and The City of Kent Police Department Exhibit B—Project Budget and Invoice Schedule(Revised 12-00) Page 1 of 2 EXHIBIT B - PROAPT BUDGET AND INVOICE SCHALE (REVISED 12-00) THE CITY OF KENT POLICE DEPARTMENT INVOICE SCHEDULE DECEMBER 1, 2000—NOVEMBER 30, 2001: Invoices for payment shall be submitted for each of the Contract Months listed below no later than ten(10) days after the end of the Contract Month The value of the reimbursement requested shall be based upon the schedule provided below The total value of reimbursement requested during this Contract Period shall not exceed the Project Budget for this Contract Period Contract Month Invoice Due Reimbursement Schedule December 2000 January 10, 2001 $7,037 66 January 2001 February 10,2001 $7,037 66 February 2001 March 10,2001 $7,037 66 March 2001 April 10, 2001 $7,037 66 April 2001 May 10, 2001 $7,037 66 May 2001 June 10, 2001 $7,037 66 June 2001 July 10, 2001 $7,037 66 July 2001 1 August 10, 2001 $7,037 66 August 2001 September 10, 2001 $7,037 66 September 2001 October 10, 2001 $7,037 66 October 2001 November 10, 2001 $7,037 66 November 2001 December 10, 2001 $7,037 74 Total Value: $84,452.00 King County Housing Authority and The City of Kent Police Department Exhibit B—Project Budget and Invoice Schedule(Revised 12-00) Page 2 of 2 EXHIBIT AREPORTING REQUIREMENTS (WISED 12-00) THE CITY OF KENT POLICE DEPARTMENT Monthly Narrative Reports: The Agency shall submit Narrative Reports, providing overviews of project progress and achievements, to KCHA no later than ten(10) days after the close of each Contract Month The format for the Narrative Reports is attached as Exhibit F Monthly Resident Contact Data Reports: The Agency shall submit a Resident Contact Data Report, providing demographic information regarding program participants receiving services during the reporting period, to KCHA no later than ten (10) days after the close of each Contract Month The format for the Resident Contact Data Report is attached as Exhibit E Monthly Invoices: The Agency shall submit Invoices to KCHA no later than ten(10)days after the close of each Contract Month, as described within the Project Budget and Invoice Schedule (see Exhibit B) The Invoice format is attached as Exhibit D Schedule of Program Activities: The Agency shall submit to KCHA a written Schedule of Program Activities regarding the services and activities supported through this Contract The Agency shall notify KCHA in writing of changes to this schedule Insurance: Certification(s) of insurance coverage as required by the social services contract shall be delivered to the Contracting Officer of KCHA before execution of the Contract Information regarding insurance requirements is provided in Exhibit H Copy of Grievance Procedure: If available, the Agency shall provide a copy of the Agency's written client grievance procedure to KCHA within fifteen (15) days of the execution of the Contract Section 3 Certification Form: The Agency shall submit a Section 3 Certification Form to KCHA semi-annually, beginning within ten (10) working days of execution of this Contract Information regarding Section 3 requirements is provided in Exhibit G and the Section 3 Certification Form is attached as Exhibit G-1 Taxpayer Identification and Certification: The Agency shall submit to KCHA a completed W-9 "Request for Taxpayer Identification and Certification" Form with the executed Contract Monitoring and Coordination: At least once during the duration of this Contract, KCHA will visit the Agency to momtor contract progress The Agency shall be expected to work as a team member and coordinate efforts with KCHA on-site management, KCHA Resident Services staff and other service providers King County Housing Authority and The City of Kent Police Department Exhibit C—Reporting Requirements(Revised 12-00) Page 1 of 1 EXHIPT D—INVOICE FORMAT (REVISED 12-00) THE CITY OF KENT POLICE DEPARTMENT Contract Number: 625-2000-0008 Name and Address of Contractor: The City of Kent Police Department Spnngwood Apartments /Valli Kee Homes Community Policing 220 Fourth Avenue South Kent, WA 98032-5895 Contract Month: ❑ December 2000 ❑ June 2001 ❑ January 2001 ❑ July 2001 ❑ February 2001 ❑ August 2001 ❑ March 2001 ❑ September 2001 ❑ April 2001 ❑ October 2001 ❑ May 2001 ❑ November 2001 Amount Requested this Contract Month: Total Amount of Contract Budget $168,904 Reimbursement to Date Amount Requested this Contract Month: Balance Invoice Prepared and Submitted By: Name Title SIGNATURE Date Coding (To be completed by KCHA staff): 420-4230-105-625-080 King County Housing Authority and The City of Kent Police Department Exhibit D-Invoice Format(Revised 12-00) Page 1 of 1 o — 0000a o0000 00 0000 00 000o y J F o -- a N W N n N b N C N U _ M° r _C N E � ° w /mi/ll O e e o -- �.y U N x N O > x '- a ' os W > q ~ V C q3 a ° ° ate � a ° U E U b a 2 � c � q U PW F a L 1-i CCy � K P Y W W y Q W W r O F U O � b a — H o — — m e w e b m C W V C W O c0 ° w � mrn0 OwQwa dGU '� F4xrn0 v. C `" VJUO L E � ? 3X OF' � dd0 Uq wi Sw V x .. ti xxa U 'E' zod " .�, dca UG \ \ — ) ; — {\ \ . 2 : $ k / 7 | { � \ F - - � / _ \ \ \ ( } \ ƒj \\ \ ) / \ \ \ � \ \ [ % , e ) \ ` / - 1� m cz 92_ < _ § < , u : u \ � _ \ « _ ; _ \i� , u : , R' ; r i e F N N N hI b I C N U _ O N p" m N �z N p aG N O � U N q W a x v ~ E o q S q O � N O M D �--i V U O C c ^ Z N N U O _ O U O �LUy. F "y U00 Kai fr 'c' Q 4Y1 Cl F o Y S y x V] W g4 W m 5 q x x aa0 b H Wz " 0 m U N x F a e `w' 3 6 U � Q U v, w F � F > O U d q u x u a u E "— Q g U a .m, Q fa U Q W U .e. Q Ci U / \ � ) ; — / � ( 4 \ `_ \ \ \ \\\Lj ! s{ ! q § 4 d ( � q - \ � � / - \ � ) ) f uz r ; lE | � 1 . ! « ! § $ � ! 9 $ ! ! ] ! / ! l : I , @ ; f , ) , ! _ & $ - o � � ! / ] = � � ;�3lla ; : ! / k ® ° ° ; i ` ° ; EXHIBIT F—MOALY NARRATIVE REPORT FOROT (REVISED 12-00) THE CITY OF KENT POLICE DEPARTMENT MONTHLY NARRATIVE REPORT: Service Activity: Kent Police Department Springwood Substation and Community Policing Please provide a brief summary of program activities, addressing the following issues for the service activities described within this Contract 1. Highlights: Describe highlights of program activities and accomplishments 2. Performance Standards: Please describe progress toward the accomplishment of program objectives and standards Also, please describe any performance standard(s) not on target and provide explanation Include differences when the number of hours worked are over or under the minimum 160 per month 3. Crime Reduction Outcomes: Please describe examples of successful changes in crime trends in your communities What lessons have you learned about your community policing efforts as a result of these changes 4. Problems and Program Adjustments: Please describe any major problems identified and any solutions, corrective actions and/or adjustments made to your program to address identified problems 5. Other Comments: Please provide any other comments or observations you wish, and explain differences in the number of hours worked from the required 117 REPORTING SCHEDULE: This Monthly Narrative Report should be submitted to KCHA no later than ten(10) days after the close of each Contract Month 1999 —2000 Contract Month Report Due December 1999 January 10,2000 January 2000 February 10, 2000 February 2000 March 10, 2000 March 2000 Aril 10, 2000 April 2000 May 10,2000 May 2000 June 10, 2000 June 2000 July 10, 2000 July 2000 Au ust 10, 2000 August 2000 September 10, 2000 September 2000 October 10,2000 October 2000 November 10, 2000 November 2000 December 10, 2000 King County Housing Authority and The City of Kent Police Department Exhibit F—Monthly Narrative Report Format(Revised 12-00) Page 1 of 1 EXHIBIT F—MOIWLY NARRATIVE REPORT FORT (REVISED 12-00) THE CITY OF KENT POLICE DEPARTMENT 2000-2001 Contract Month Report Due December 2000 January 10, 2001 January 2001 February 10, 2001 February 2001 March 10, 2001 March 2001 April 10, 2001 April 2001 May 10,2001 May 2001 June 10,2001 June 2001 July 10, 2001 July 2001 August 10,2000 August 2001 September 10, 2001 September 2001 October 10, 2001 October 2001 November 10, 2001 November 2001 December 10, 2001 King County Housing Authority and The City of Kent Police Department Exlubit F—Monthly Narrative Report Format(Revised 12-00) Page 2 of 1 EXHIBIT ASECTION 3 CERTIFICATION RE#IREMENTS THE CITY OF KENT POLICE DEPARTMENT Purpose of Section 3 Requirements: The work to be performed under this Contract is on a project subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U S.0 1701u (Section 3) The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD-assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing The parties to this Contract agree to comply with HUD's regulations in 24 CFR Part 135, which implements Section 3 As evidenced by their execution of this Contract, the parties to this Contract certify that they are under no contractual or other impediment that would prevent them from complying with the Part 135 regulations Agency Requirements: The Agency agrees to send to each labor organization or representative of workers with which the Agency has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of the Agency's commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice The notice shall describe the Section 3 preference, shall set forth minimum number and lob titles subject to hire, availability of apprenticeship and training positions, the qualifications for each, and the name and location of the person(s) taking applications for each of the positions, and the anticipated date the work shall begin The Agency agrees to include this Section 3 clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this Section 3 clause, upon a finding that the subcontractor is in violation of the regulations in 24 CFR Part 135. The Agency will not subcontract with any subcontractor where the Agency has notice or knowledge that the subcontractor has been found in violation of regulations in 24 CFR Part 135 The Agency will certify that any vacant employment positions, including training positions, that are filled (1) after the Agency is selected but before the Contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed, were not filled to circumvent the Agency's obligations under 24 CFR Part 135 The Agency shall submit a Section 3 Certification form (see Exhibits G-1 and G-2 [Section 3 Certification Forms] and Exhibit C [Reporting Requirements]) Non-Compliance: Non-compliance with HUD's regulations in 24 CFR Part 135 may result in sanctions, termination of this Contract for default, and debarment or suspension from future HUD assisted contracts King County Housing Authority and TheCity of Kent Police Department Exhibit G- Section 3 Certification Requirements Page 1 of 1 EXHIBIT G-1 -- SEAN 3 CERTIFICATION FORM(A*CY) (REVISED 12-00) THE CITY OF KENT POLICE DEPARTMENT 121 KING COUNTY HOUSING AUTHORITY SECTION 3 CERTIFICATION FORM (Agency to return this Section 3 Certification Form ONLY) Section 3 of the Housing and Urban Development (HUD) Act of 1968, as amended, requires that Housing Authorities and agencies receiving HUD funding encourage, to the greatest extent possible, the hiring of low-income persons To this end, we ask that you provide the following information Based on the chart below,were any of your current staffs income, for at least one of the past three years, at or below the low-income limit listed for his or her household (circle one) YES NO If YES, were any of these individual(s) Housing Authority Resident(s) (circle one)? YES NO If YES,how many? F ily Low-Income Limits er ear) For King or 1 2 3 4 5 6 7 8 Snohomish Person Person Person Person Person Person Person Person Counties Income in $ 35,150 40,150 45,200 50,200 54,200 58,250 62,250 66,250 For Pierce 1 2 3 4 5 6 7 8 CountyPerson Person Person Person Person Person Person Person Income in $ 27,500 31,400 35,350 1 39,300 1 42,400 45,550 48,700 51,850 I certify that of my staff, for at least one of the immediate past three years, has/have been at or below the low-income level as designated above Signature Date Title King County Housing Authority and The City of Kent Police Department Exhibit G-1 - Section 3 Certification Form(Agency)(Revised 12-00) Page 1 of I EXHIBIT G24kECTION 3 CERTIFICATION FO*(OPERATIVES) (REVISED 12-00) CITY OF KENT POLICE DEPARTMENT • KING COUNTY HOUSING AUTHORITY SECTION 3 CERTIFICATION FORM (To be distributed to operatives of the Agency directly connected with the provision of contracted services ) Section 3 of the Housing and Urban Development (HUD) Act of 1968, as amended, requires that Housing Authorities and agencies receiving HUD funding, to the greatest extent possible, direct that funding to businesses that provide economic opportunities to low-income persons To this end, we ask that you provide the following information Name Address Date of Hiring Housing Authority Resident (circle one)? YES NO Based on the chart below,please indicate whether your income, for at least one of the past three years,was at or below the low-income limit listed for your household My income level, for at least one of the past three years,was at or below the low-income limit (circle one) YES NO Family Low-Income Limits er ear) For King or 1 2 3 4 5 6 7 8 Snohomish Person Person Person Person Person Person Person Person Counties Income in $ 35,150 40,150 45,200 50,200 54,200 58,250 62,250 66,250 For Pierce 1 2 3 4 5 6 7 8 Count Person Person Person Person Person Person Person Person Income in$ 27,500 31,400 35,350 39,300 42,400 45,550 48,700 51,850 I certify that my income, for at least one of the immediate past three years, has been at or below the low-income level as designated above Signature Date Title King County Housing Authority and City of Kent Police Department Sxlnbit G-2-Section 3 Certification Form(Operatives)(Revised 12-00) Page 1 of 1 EX&IT H—INSURANCE REQUIREATS THE CITY OF KENT POLICE DEPARTMENT Requirements for Insurance: The Agency, at its own cost, shall procure by the date of execution of this agreement and maintain for the duration of the agreement, insurance against claims for injuries to persons or damages to property which may anse from or in connection with performance of work pursuant to this agreement by the Agency, its agents, representatives, employees and/or subcontractors The nummum limits of this insurance coverage shall be $1,000,000 general liability insurance combined single limit per occurrence for bodily injury,personal injury and property damage Any deductible or self-insured retentions shall be the sole responsibility of the Agency. Such insurance shall cover the King County Housing Authority, its officers, employees, and agents as additional insured against liability ansing out of activities performed by or on behalf of the Agency pursuant to this agreement If the Agency is a Municipal Corporation or an agency of the State of Washington and is self-insured for any of the above insurance requirements, a certification of self-insurance shall be attached hereto and be incorporated by reference and shall constitute compliance with this insurance requirement Maintenance of Insurance Maintenance of the proper insurance for the duration of the Contract is a material element of the Contract Material changes in the required coverage or cancellation of the coverage shall constitute a material breach of the Contract. King County Housing Authority and the City of Kent Police Department Exhibit H-Insurance Requirements Page 1 of 1