HomeMy WebLinkAboutPK07-105 - Original - Multi-Service Center - Trasitional Housing & Shelter Program - 01/01/2007 1
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KENT
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CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission to City Clerks Office. All
portions are to be completed, if you have questions, please contact Mary Simmons, City
Clerks Office.
Vendor Name: MIA I � Sf y 0 Le ��r
Contract Number: 191cO7 - 0 S'
This is assigned by Mary Simmons
Vendor Number:
Project Name: go-
Contract Effective Date: � -7
Contract Termination Date: —t*4
Contract Renewal Notice (Days):
Number of days required notice for terminatio or renewal or amendment
Contract Manager: /4C)OLI S 01 S0✓�
r
Department: I f vVl 4-n PAIL5
Abstract:
1aI,4q1L I o 64 GS
Lill �LC,
ADCL7832 07/02
KENT W PS HINGTDN RECEIVED MAR 0 6 2W
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Multi-Service Center
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Multi-Service Center organized under the laws of the State of Washington, located
and doing business at P.O. Box 23699, 1200 S. 336th Street, Federal Way, WA 98093 (hereinafter the
"Consultant").
I. DESCRIPTION OF WORK.
Consultant shall perform the following services for the City in accordance with the following described
plans and/or specifications:
Consultant shall provide housing options and comprehensive services for homeless families and
individuals via the Transitional Housing & Shelter program. The Transitional Housing & Shelter
program is part of a joint agreement entered into between the Consultant and the Cities of Kent,
Des Moines, Renton, SeaTac and Tukwila The following exhibits are attached and incorporated
by this reference as if fully set forth herein. Exhibit A, Scope and Schedule of Work; Exhibit B,
Billing Voucher and Service Report; Exhibit C, Kent First and Final Outcome Report; Exhibit D,
Demographic Report; Exhibit E, Insurance Certificate; and Exhibit F, Debarment Certification.
Consultant further represents that the services furnished under this Agreement will be performed in
accordance with generally accepted professional practices in effect at the time those services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in
Section I above immediately upon the effective date of this Agreement Upon the effective date of this
Agreement, Consultant shall complete the work described in Section I by December 31, 2008. This Agreement,
however, is contingent upon the availability of funds to be allocated through the City's budget process, as well
as the other cities participating in the joint agreement During the term of this Agreement should the City
determine that funds to support Consultant's services are no longer available, the City shall provide Consultant
seven (7) days advance written notice of summary termination.
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to exceed
$113,000 ($56,500 per year) for the services described in this Agreement. This is the maximum
amount to be paid under this Agreement for the work described in Section I above, and shall not
be exceeded without the prior written authorization of the City in the form of a negotiated and
executed supplemental agreement. The Consultant agrees that the hourly or flat rate charged by
it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of
CONSULTANT SERVICES AGREEMENT- 1
(Over S10,000)
one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be as
delineated in Exhibit A.
B. The Consultant shall submit quarterly payment invoices to the City for work performed, and a
final bill upon completion of all services described in this Agreement. The City shall provide
payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any
portion of an invoice, it shall notify the Consultant and reserves the option to only pay that
portion of the invoice not in dispute. In that event, the parties will immediately make every
effort to settle the disputed portion
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement and that the Consultant has the ability to control and
direct the performance and details of its work, the City being interested only in the results obtained under this
Agreement.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party thirty (30) days written notice at its address set forth on the signature block of this
Agreement. After termination, the City may take possession of all records and data within the Consultant's
possession pertaining to this project. which may be used by the City without restriction If the City's use of
Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the
Consultant.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the
Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national
origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is
qualified and available to perform the work to which the employment relates Consultant shall execute the
attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative
Policy 12, and upon completion of the contract work, file the attached Compliance Statement.
VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers,
officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits,
including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of
this Agreement, except for that portion of the injuries and damages caused by the City's negligence.
The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to
avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115,
then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused
by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees,
agents and volunteers, the Consultant's liability hereunder shall be only to the extent of the Consultant's
negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF
IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF
THIS INDEMNIFICATION THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE
MUTUALLY NEGOTIATED THIS WAIVER.
CONSULTANT SERVICES AGREEMENT-2
(Over$10,000)
The provisions of this section shall survive the expiration or termination of this Agreement.
VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement,
insurance of the types and in the amounts described in Exhibit E attached and incorporated by this reference.
IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide
reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of the work
under this Agreement.
X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents,
drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and
become the property of the City All records submitted by the City to the Consultant will be safeguarded by the
Consultant Consultant shall make such data, documents, and files available to the City upon the City's request.
The city's use or reuse of any of the documents, data and files created by Consultant for this project by anyone
other than Consultant on any other project shall be without liability or legal exposure to Consultant.
XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor
with the authority to control and direct the performance and details of the work authorized under this
Agreement, the work must meet the approval of the City and shall be subject to the City's general right of
inspection to secure satisfactory completion.
XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary
precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the
performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be
done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to materials, tools,
or other articles used or held for use in connection with the work.
XIII. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its
contractors and consultants to use recycled and recyclable products whenever practicable. A price preference
may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the
covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement
in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements
or options, and the same shall be and remain in full force and effect
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute,
difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving
that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction
of the King County Superior Court, King County, Washington, unless the parties agree in writing to an
alternative dispute resolution process In any claim or lawsuit for damages arising from the parties'
performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending
or bringing such claim or lawsuit, in addition to any other recovery or award provided by law; provided,
however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section
VII of this Agreement
CONSULTANT SERVICES AGREEMENT-3
(Over$10,000)
D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the
addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice
hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail,
and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such
other address as may be hereafter specified in writing.
E. Assi ng ment. Any assignment of this Agreement by either party without the written consent of
the non-assigning party shall be void If the non-assigning party gives its consent to any assignment, the terms
of this Agreement shall continue in full force and effect and no further assignment shall be made without
additional written consent
F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement
shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the
City, and such statements shall not be effective or be construed as entering into or forming a part of or altering
in any manner this Agreement. All of the above documents are hereby made a part of this Agreement.
However, should any language in any of the Exhibits to this Agreement conflict with any language contained in
this Agreement, the terms of this Agreement shall prevail.
H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal
laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business,
equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance
of those operations.
IN WITNESS, the parties below execute this Agreement,which shall become effective on the last
date entered below.
CONSU ANT: CITY O T-
By By:
(signature) (signature)
Print Name: Dini Duclos Print ame: S ette Cooke
Its CEO Its a or
(Ttlle)
DATE: 3,,191r7(True) DATE- — 'O -7
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Dini Duclos, CEO Katherin Johnson, Human Services Manager
Multi-Service Center City of Kent
P O Box 23699 220 Fourth Avenue South
Federal Way, WA 98093 Kent, WA 98032
(253) 835-7678 (telephone) (253) 856-5070(telephone)
(253) 835-7511 (facsimile) (253) 856-6070 (facsimile)
AP IIOVED A,� TO F RM:
en Law e m nt
CONSULTANT SERVICES AGREEMENT-4
(Over$'10,000)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all
contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with
the regulations of the City's equal employment opportunity policies.
The following questions specifically identify the requirements the City deems necessary for any contractor,
subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of
the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier
willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of
contract and it will be at the City's sole determination regarding suspension or termination for all or part of the
Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color,
national origin, age, or the presence of all sensory, mental or physical disability.
3. During the time of this Agreement the prime contractor will provide a written statement to all new
employees and subcontractors indicating commitment as an equal opportunity employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of
women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime
Contractor, that the Prime Contractor complied with the requirements as set forth above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this 2 _ day of 200z.
By:_,d.- /,J�
For: Multi-Service Center
Title-Chief Executive Officer
Date: 3lfc/O r7
EEO COMPLIANCE DOCUMENTS - 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All
contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity
within their organization and, if holding Agreements with the City amounting to $10,000 or more within any
given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal
opportunity employer
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and
equal opportunity requirements shall be considered in breach of contract and subject to suspension or
termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works
Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are
familiar with the regulations and the City's equal employment opportunity policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS-2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I,the undersigned, a duly represented agent of Company, hereby
acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement
known as that was entered into on the (date) ,
between the firm I represent and the City of Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent
Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part
of the before-mentioned Agreement.
Dated this day of , 200_
By:
For:
Title:
Date-
EEO COMPLIANCE DOCUMENTS-3
EXHIBIT A
SCOPE AND SCHEDULE OF WORK
2007
CONSULTANT SERVICES AGREEMENT
MULTI-SERVICE CENTER
Housing (Transitional Housing & Shelter)
This program provides housing options and comprehensive services for homeless families and
individuals in crisis Clients receive assistance developing comprehensive, individualized goal-
directed plans, emergency and transitional shelter, and assistance obtaining stable housing.
This funding will provide:
Outputs
Unduplicated Kent clients 74
Number of bednights 6,000
Number of families turned away No minimum
Unduplicated Des Moines clients 9
Number of bednights 270
Number of families turned away No minimum
Unduplicated Renton clients 16
Number of bednights 435
Number of families turned away No minimum
Unduplicated SeaTac clients 19
Number of bednights 570
Number of families turned away No minimum
Unduplicated Tukwila clients No minimum*
Number of bednights No minimum*
Number of families turned away No minimum*
*Tukwila does not establish minimum performance measures for this program as it is viewed as regional
support MSC does track these performance measures for Tukwila.
Membership and participation in the South King County Council of Human Services
Outcome(s)
Emergency Shelter Clients will experience a demonstrated ability to plan toward obtaining more
stable housing
Transitional Housing Clients will experience a demonstrated ability to retain and/or maintain current
housing
EXHIBIT A
SCOPE OF WORK (CONTINUED)
MULTI-SERVICE CENTER— 2007 CONSULTANT SERVICES AGREEMENT
Housing (Transitional Housing & Shelter)
Budget
City of Kent Budget:
Personnel $30,000
Nonpersonnel $10,000
$40,000
City of Des Moines Budget:
Personnel $ -0-
Nonpersonnel $ 2,500
$ 2,500
City of Renton Budget:
Personnel $ 2,500
Nonpersonnel $ 2,500
$ 5,000
City of SeaTac Budget:
Personnel $ 5,200
Nonpersonnel $ -0-
$ 5,200
City of Tukwila Budget:
Personnel $ 2,000
Nonpersonnel $ 1,000
$ 3,800
Reporting Requirements and Timeline
The agency will be reimbursed on a quarterly basis, upon submittal of appropriate documentation.
Such documentation will include the following (as applicable) Billing Voucher & Service Report
(Exhibit B), Outcome Based Evaluation Report (Exhibit C), and Client Demographic Data (Exhibit D)
These items must be submitted on forms provided by the City by the 10th of following month for the
previous quarter of service The reporting timeline is as follows
Billing Voucher& Service Report(Exhibit B) 10T" day following each quarter
Final Billing Voucher(41h Qtr Exhibit B) December 15,2007
Outcome Based Evaluation Report(Exhibit C) August 1,2007/January 31, 2008
Client Demographic Data (Exhibit D) January 31, 2008
Contract Administration
The Consultant will notify the City, in writing, within (10) days of any changes in program personnel or
board membership.
The Consultant shall provide the City with a current list of its board of directors, general or limited
partners, as applicable
All records related to this contract must be retained for three years plus the current year
EXHIBIT A
SCOPE OF WORK (CONTINUED)
MULTI-SERVICE CENTER— 2007 CONSULTANT SERVICES AGREEMENT
Housing (Transitional Housing & Shelter)
Pursuant to Item 1 of the Consultant Services Agreement executed on January 1, 2007, Multi-
Service Center shall provide the approximate number of clients from the Cities of Kent, Des
Moines, Renton, SeaTac and Tukwila with the following services:
PerformanceCity of Kent Measures:
Number of Unduplicated Kent Clients 18 18 19 19 74
2 Number of bednights 1,500 1,500 1,500 1,500 6,000
3 Number of turnaways - - - - No Minimum
QUARTER
City of Des MTotal
oines
1 Number of Unduplicated Des Moines Clients 2 2 2 3 9
2 Number of bednights 42 42 43 43 270
3 Number of turnaways - - - - No Minimum
f
72Numberr
- -be of Unduplicated Renton Clients 4 4 4 4 16 of bednights 108 109 109 109 435
3 Number of turnaways - - - No Minimum
7Number
nduplicated SeaTac Clients 4 5 5 5 19
dnights 142 142 143 143 570
3 Number of turnaways - - - - No Minimum
QUARTER
City of Tukwila Performance Measures . .
1 Number of Unduplicated Tukwila Clients - - No Minimum
2 Number of bednights - - - - No Minimum
3 Number of turnaways - - - - No Minimum
EXHIBIT A
SCOPE OF WORK (CONTINUED)
MULTI-SERVICE CENTER - 2007 CONSULTANT SERVICES AGREEMENT
Housing (Transitional Housing & Shelter)
The above services (preceding page) shall be provided by December 31, 2007
2007 Reimbursement: City of Kent $40,000
City of Des Moines $ 2,500
City of Renton $ 5,000
City of SeaTac $ 5,200
City of Tukwila $ 3,800
Total $56,500
Please sign to indicate acceptance of the Year 2007 Performance Measures listed above.
,L4,_ 3,�Zd 7
Dini Duclos C cutive Officer Datd /hi
3.14.0 7
Kathenn Jo on, PkjMap6erviclmanager Date
EXHIBIT A
SCOPE AND SCHEDULE OF WORK
2008
CONSULTANT SERVICES AGREEMENT
MULTI-SERVICE CENTER
Housing (Transitional Housing & Shelter)
This program provides housing options and comprehensive services for homeless families and
individuals in crisis Clients receive assistance developing comprehensive, individualized goal-
directed plans, emergency and transitional shelter, and assistance obtaining stable housing
This funding will provide:
Outputs
Unduplicated Kent clients 74
Number of bednights 6,000
Number of families turned away No minimum
Unduplicated Des Moines clients 9
Number of bednights 270
Number of families turned away No minimum
Unduplicated Renton clients 16
Number of bednights 435
Number of families turned away No minimum
Unduplicated SeaTac clients 19
Number of bednights 570
Number of families turned away No minimum
Unduplicated Tukwila clients No minimum*
Number of bednights No minimum*
Number of families turned away No minimum*
*Tukwila does not establish minimum performance measures for this program as it is viewed as regional
support. MSC does track these performance measures for Tukwila
Membership and participation in the South King County Council of Human Services
Outcome(s)
Emergency Shelter Clients will experience a demonstrated ability to plan toward obtaining more
stable housing
Transitional Housing Clients will experience a demonstrated ability to retain and/or maintain current
housing
EXHIBIT A
SCOPE OF WORK (CONTINUED)
MULTI-SERVICE CENTER— 2008 CONSULTANT SERVICES AGREEMENT
Housing (Transitional Housing & Shelter)
Budsaet
City of Kent Budget:
Personnel $30,000
Nonpersonnel $10,000
$40,000
City of Des Moines Budget:
Personnel $ -0-
Nonpersonnel $ 2,500
$ 2,500
City of Renton Budget:
Personnel $ 2,500
Nonpersonnel $ 2,500
$ 5,000
City of SeaTac Budget:
Personnel $ 5,200
Nonpersonnel $ -0-
$ 5,200
City of Tukwila Budget:
Personnel $ 2,000
Nonpersonnel $ 1,000
$ 3,800
Reporting Requirements and Timeline
The agency will be reimbursed on a quarterly basis, upon submittal of appropriate documentation
Such documentation will include the following (as applicable) Billing Voucher & Service Report
(Exhibit B), Outcome Based Evaluation Report (Exhibit C), and Client Demographic Data (Exhibit D)
These items must be submitted on forms provided by the City by the 10`h of following month for the
previous quarter of service The reporting timeline is as follows
Billing Voucher&Service Report(Exhibit B) 10T"day following each quarter
Final Billing Voucher(41h Qtr Exhibit B) December 15, 2008
Outcome Based Evaluation Report(Exhibit C) August 1, 2008/January 31, 2009
Client Demographic Data (Exhibit D) January 31, 2009
Contract Administration
The Consultant will notify the City, in writing, within (10) days of any changes in program personnel or
board membership
The Consultant shall provide the City with a current list of its board of directors, general or limited
partners, as applicable
All records related to this contract must be retained for three years plus the current year
EXHIBIT A
SCOPE OF WORK (CONTINUED)
MULTI-SERVICE CENTER— 2008 CONSULTANT SERVICES AGREEMENT
Housing (Transitional Housing & Shelter)
Pursuant to Item 1 of the Consultant Services Agreement executed on January 1, 2008, Multi-
Service Center shall provide the approximate number of clients from the Cities of Kent, Des
Moines, Renton, SeaTac and Tukwila with the following services:
TotalCity of Kent Performance Measures:
1 Number of Unduplicated Kent Clients 18 18 19 19 74
2 Number of bednights 1,500 1,500 1,500 1,500 6,000
3 Number of turnaways - - - - No Minimum
QUARTER
MoinesCity of Des . Measures:1 Number of Unduplicated Des Moines Clients 2 2 2 3 9
2 Number of bednights 42 42 43 43 270
3 Number of turnaways - - - - No Minimum
1 Number of Unduplicated Renton Clients 4 4 4 4 16
2 Number of bednights 108 109 109 109 435
3 Number of turnaways - - - - No Minimum
1 Number of Unduplicated SeaTac Clients 4 5 5 5 19
2 Number of bednights 142 142 143 143 570
3 Number of turnaways - - - - No Minimum
QUARTER
City of . Measures'.
Number of Unduplicated Tukwila Clients - - - - No Minimum
2 Number of bednights - - - - No Minimum
3 Number of turnaways - - - - No Minimum
EXHIBIT A
SCOPE OF WORK (CONTINUED)
MULTI-SERVICE CENTER - 2008 CONSULTANT SERVICES AGREEMENT
Housing (Transitional Housing & Shelter)
The above services (preceding page) shall be provided by December 31, 2008
2008 Reimbursement: City of Kent $40,000
City of Des Moines $ 2,500
City of Renton $ 5,000
City of SeaTac $ 5,200
City of Tukwila $ 3,800
Total $56,500
Please sign to indicate acceptance of the Year 2008 Performance Measures listed above.
3 191e
Dini Duclos,Chi ecutive Officer Date '
13 • ��•�
Katherin Jo son, HLk&Service anager Date
Exhibit B General Fund
KENT 2007 Billing Voucher
WASH IN GTON and Service Report
PARKS, RECREATION S. (page 1 of 2)
COMMUNI7Y SERVICES
To:
Jason Johnson Agency: Multi-Service Center
Housing & Human Services
Parks, Recreation & Community Services Program Contact:
220 4th Ave. South, Kent, WA 98032 Telephone:
JaJohnsonCED-6kent wa.us E-mail:
Phone: 253 856-5061
Reporting Period Program Amount Requested
Housing $
BUDGET SUMMARY
FOR DEPARTMENT USE-ONLY Total Contract Amount $ 56,500
VENDOR NUMBER#34755 PO# Current Request $
ACCOUNT CODE 1000-631q-6,41 0-4821 Amount Remaining $
2007 SERVICE UNITS
Note: Unduplicated client counts must be reported both quarterly and year-to-date. Performance
Measure #3 (number of turnaways)will be reported quarterly and year-to-date for informational
purposes only.
Please attach a narrative explanation to this report in the event that the program is not
meeting performance measures.
City of Kent Performance Measures. Planned Service Units New City Total City Total Servis ,i
Funded Service Funded Units to Date
1st 2nd 3rd 4th Units Service Units (ALL Funding.
This Quarter To Date Sources)
Number of Unduplicated Kent Clients 18 18 19 19
Number of bednights 1,500 1,500 1,500 1,500
Number of turnaways - - - -
City of Des Molnes Performance - Planned Service Units New wit `�� ,Total ct€ '!" r et Semci <,
Measures; Funded Service Funded Units to Date
1st 2nd 3rd 4th Units Service Units (ALL Funding
This Quarter ._ To Date Sources)
Number of Unduplicated Des Moines Clients 2 2 2 3
Number of bednights 42 42 43 43
Number of turnaways - - - -
Exhibit B General Fund
KENT 2007 Billing Voucher
W ASH IN GTON and Service Report
PARKS, RECREATION S (page 2 of 2)
COMMUNITY SERVICES
Multi-Service Center
Housing
> en t7n �tf 3UrE5: i R ervlc� NewCity~3 otal i , ' otat Service
Funded Service Funded Units to Date
1st 2nd 3rd 4th Units Service Units (ALL Funding
This Quarter To Date Sources)
Number of Unduplicated Renton Clients 4 4 4 4
Number of bednights 108 109 109 109
Number of turnaways - - -
City of SeaTac Performance Mi ` ures _--- Planned Service Units New city 1 oral city Totai'Service ,
Funded Service Funded Units to Date
jstnd 3rd 4th Units Service Units (ALL Funding
This Quarter To Date Sources)
Number of Unduplicated SeaTac Clients 4 5 5 5
Number of bednights 142 142 143 143
Number of turnaways - - -
City of Tukwila Performance Planned Service Units t z New city `�1-- - -totalCity y-== Total Service
Measures: Funded Service Funded , Units to Date
1st 2nd 3rd 4th� Units Service Units (ALL Funding
This Quarter To Date Sources)
Number of Unduplicated Tukwila Clients - -
Number of bednights - - -
Number of turnaways - - - -
Authorized Signature Date
FOR DEPARTMENT USE ONLY
AUTHORIZED FOR PAYMENT
BY: DATE:
Exhibit B General Fund
\Z
�WKNT 2008 Billing Voucher
WASHINGTON and Service Report
PARKS. RECREATION & (page 1 of 2)
COMMUNITY SERVICES
To:
Jason Johnson Agency: Multi-Service Center
Housing & Human Services
Parks, Recreation & Community Services Program Contact:
220 4th Ave. South, Kent, WA 98032 Telephone:
JaJohnson(cD_ci kent.wa.us E-mail:
Phone: 253 856-5061
Reporting Period Program Amount Requested
Housing Is
BUDGET SUMMARY
DEPARTMENT USE-ONLY Total Contract Amount $ 56,500
VENDOR NUMBER#34755 PO# Current Request $
ACCOUNT CODE1000-6370.4 50.4821 Amount Remaining $
2008 SERVICE UNITS
Note: Unduplicated client counts must be reported both quarterly and year-to-date. Performance
Measure #3 (number of turnaways)will be reported quarterly and year-to-date for informational
purposes only.
Please attach a narrative explanation to this report in the event that the program is not
meeting performance measures.
City of Kent Performance Measures: Planned Service Units New city Total City' iTotal service_
Funded Seance= Funded `° Units to Date
�� Units Service Units (ALL Funding'
Ist 2nd :3:r:d
This Quarter To Date Sources)
Number of Unduplicated Kent Clients 18 18 19 19
Number of bednights 1,500 1,500 1,500 1,500
Number of turnaways
City of Des Moines Performance' Planned Service Units'F -New di�6.-' i,':__ TotWi c 'r= Tt W
*iar�ei e
Measures: = Funded Service Funded Units to Date _
1st 2nd 3rd 4th Units Service Units (ALL Funding
This Quarter To Date Sources)
Number of Unduplicated Des Moines Clients 2 2 2 3
Number of bednights 42 42 43 43
Number of turnaways
Exhibit B General Fund
Ns
�KKNT 2008 Billing Voucher
WASH l GTON and Service Report
PARKS, RECREATION S (page 2 of 2)
COMMUNITY SERVICES
Multi-Service Center
Housing
ti en o orm nc'e eas6�ii: ne 4' n New d lty o a - o a" ery
Funded Service Funded Units to Date',
1st 2nd 3rd 4th Units Service Units (ALL Funding
This Quarter To Date Sources)
Number of Unduplicated Renton Clients 4 4 4 4
Number of bednights 108 109 109 109
Number ofturnaways - - -
City ofSeaTac Performance Measures; Planned iM6e Units New 6ty` "' `1b fGtity" ` Total Service
Funded Service uuded Units to Date "
Ist 2nd ;3rd 4th -Units Service Units (ALL Funding
_This Quarter To Date Sources)
Number of Unduplicated SeaTac Clients 4 5 5 5
Number of bednights 1 142 142 143 143
Number of turnaways -
City of Tukwila Performance Planned Service Units New sty _total CO ��3_ Totai service
Measures: Funded Sete "Funded Units to Date`'
1st 2nd 3rd 4th Units Service Units (ALL Funding,,
This Quarter _ To Date, Sources}
Number of Unduplicated Tukwila Clients - - -
Number of bednights - - -
Number of turnaways - - -
i
Authorized Signature Date
FOR DEPARTMENT USE ONLY
AUTHORIZED FOR PAYMENT
BY: DATE:
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Agency
KENT Exhibit D Program
WASHINGTON 2007 Demographic Report Date
PARKS, RECREATION S
COMMUNITY SERVICES Unduplicated Number of Clients Served`
A enc /Pro ram Unduplicated New Individuals this Year
Client Residence"
Algona
Auburn
Black Diamond
Bunen
Covington
Des Moines
Enumclaw
Federal Way
Kent
Maple Valle
Milton
Normandy Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated King Count
Unknown
TOTAL
Household Income Level �
30% of Median or Below
50% of Median or Below
80% of Median or Below
Above 80% of Median
Unknown
TOTAL
Gender -
Male
Female
TOTAL
Age
0-4 years
5- 12 years
13- 17 years
18- 34 years
35- 54 years
55 - 74 years
75+ years
Unknown
TOTAL
Ethnicity
Asian/Pacific Islander
Black/African American
Hispanic/Latino(a)
Native American/Alaskan Native
White/Caucasian
Other
Unknown
TOTAL
Female Headed Household
Disabling Condition
Limited English Speaking
Unduplicated means count each client only once per calendar year
"List of all clients served in client residence category and Kent clients only in rest of the categories
Agency
•
KENT Exhibit D Program
W/.9HIN6TON
PARKS RECREATIONS 2008 Demographic Report Date
COMMUNITY SERVICES Unduplicated Number of Clients Served*
Agency/Program Unduplicated New Individuals this Year
Client Residence** -'
Algona
Auburn
Black Diamond
Buren
Covington
Des Moines
Enumclaw
Federal Way
Kent
Maple Valle
Milton
Normandy Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated King Count
Unknown
TOTAL
Household Income Level
30% of Median or Below
50% of Median or Below
80%of Median or Below
Above 80% of Median
Unknown
TOTAL
Gender
Male
Female
TOTAL
Age - . . 77
0-4 years
5- 12 years
13- 17 years
18 - 34 years
35 - 54 years
55 - 74 years
75+years
Unknown
TOTAL
Ethnicity -
Asian/Pacific Islander
Black/African American
Hispanic/Latino(a)
Native American/Alaskan Native
White/Caucasian
Other
Unknown
TOTAL
Female Headed Household
Disabling Condition
Limited English Speaking
'Unduplicated means count each client only once per calendar year
"List of all clients served in client residence category and Kent clients only in rest of the categories.
ATTACHMENT E
INSURANCE REQUIREMENTS FOR
CONSULTANT AGREEMENTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement, insurance
against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of the work hereunder by the Contractor, their agents,
representatives, employees or subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Commercial General Liabilitv insurance shall be written on ISO occurrence form
CG 00 01 and shall cover liability arising from premises, operations, independent
contractors, products-completed operations, personal injury and advertising
injury, and liability assumed under an insured contract The Commercial General
Liability insurance shall be endorsed to provide the Aggregate Per Project
Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or
modification of the Commercial General Liability
insurance for liability arising from explosion, collapse or underground property
damage The City shall be named as an insured under the Contractor's
Commercial General Liability insurance policy with respect to the work
performed for the City using ISO additional
insured endorsement CG 20 10 11 85 or a substitute endorsement providing
equivalent coverage.
2. Automobile Liability insurance covering all owned, non-owned, hired and leased
vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA
00 01 or a substitute form providing equivalent liability coverage. If necessary,
the policy shall be endorsed to provide contractual liability coverage.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Commercial General Liability insurance shall be written with limits no
less than $500,000 each occurrence, $1,000,000 general aggregate and
a $1,000,000 products-completed operations aggregate limit.
2. Automobile Liability insurance with a minimum combined single
limit for bodily injury and property damage of $1,000,000 per
accident.
EXHIBIT E (Continued )
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain,the following provisions
for Automobile Liability and Commercial General Liability insurance:
1. The Contractor's insurance coverage shall be primary insurance as respect the City.
Any Insurance, self-insurance, or insurance pool coverage maintained by the City
shall be excess of the Contractor's insurance and shall not contribute with it.
2. The Contractor's insurance shall be endorsed to state that coverage shall not be
cancelled by either party, except after thirty (30) days prior written notice by certified
mail, return receipt requested, has been given to the City.
3. The City of Kent shall be named as an additional insured on all policies (except
Professional Liability) as respects work performed by or on behalf of the contractor
and a copy of the endorsement naming the City as additional insured shall be attached
to the Certificate of Insurance. The City reserves the right to receive a certified copy
of all required insurance policies The Contractor's Commercial General Liability
insurance shall also contain a clause stating that coverage shall apply separately to
each insured against whom claim is made or suit is brought, except with respects to
the limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less than
ANII.
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of the amendatory
endorsements, including but not necessarily limited to the additional insured
endorsement, evidencing the insurance requirements of the Contractor before
commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insureds under its policies or shall furnish
separate certificates and endorsements for each subcontractor All coverages for
subcontractors shall be subject to all of the same insurance requirements as stated herein
for the Contractor.
ACORD CERTIFICATE OF LIABILITY INSURANCE CSR VA GATE(MMIODI/06
MULTI-2 03 23 06
PRODUCER THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Sprague Israel Giles HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
1501 Fourth Avenue, Suite 2000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Seattle WA 98101-1637
Phone:206-623-7035 Fax:206-682-4993 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A. Ama Mean States rnsucanca Co
INSURERS General Ina Co of America
Multi.-Service Center INSURER
PO Box 23699 INSURER
Federal Way WA 98093-0699
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LTR INSR TYPE OF INSURANCE POLICY NUMBER I DATE MM POLICY EXPIRAnON
ATDIYY DATE MMIDDIYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE SS OOO OOO
A I X X COMMERCIAL GENERAL LIABILITY 01CH06504310 03/01/06 03/01/07 PREMISE81 Eaocararca) $100,000
CLAIMS MADE I X I OCCUR MED EXP(Any ore Pe.a^) $Excluded
X $1,500 Deduct PERSONAL&ADV INJURY f 1 00O 000
BI/PD/PI/AI GENERAL AGGREGATE 52,000,000
GE N'L AGGREGATE LIMIT APPLIES PER PRODUCTS•COMPIOP AGG f2,000,000
X POLICY PELT LOC STOP GAP
AUTOMOBILE LIABILITY
O000 COMBINED SINGLE LIMIT $1
A X X ANY AUTO OICG302945 03/01/06 03/01/07
(Eaawdent) , r 00
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Par pmoo) S
X HIREDAUTOS
BODILY INJURY S
X NON-OWNED AUTOS (Par axitlenl)
PROPERTY DAMAGE S
(Per acudenl)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EAACC $
AUTO ONLY AGO S
EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE f l 00O 000
A X X7 OCCUR 7CLAIMSMADE OISU38020010 03/01/06 03/01/07 AGGREGATE f1,000,000
f
DEDUCTIBLE i
RETENTION S S
WORKERS COMPENSATION AND TWC 9TA U- ER
EMPLOYERS'LIABILITY —'
ANY PROPRIETOR/PARTNERIEXECUTIVE EL EACH ACCIDENT f
OFFICERIMEMBER EXCLUDED?
EL DISEASE-EA EMPLOYEE S
ea, a under
S
SPECIALAL PROVISIONS below EL DISEASE-POLICY LIMIT i
OTHER
B Professional LP774476 03/01/06 03/01/07 Per Clm $1,000,000
Liabilitv I I Agg. $2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Evidence of Insurance - All Properties and Locations
RECEIVED APR 0 3 2006
CERTIFICATE HOLDER CANCELLATION
TWIMOOO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$O SHALL
To Whom it May Concern IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATNES.
AUTOO PRESENT
ACORD 25(2001108) C)ACORD CORPORATION 1988
""REPRIMED FROM THE FORMS LIBRARY""
0 0 RECEIVED APR 0 3 2006
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFUI.t .
LIABILITY PLUS ENDORSEMENT CG 76 35 10 01
COMMERCIAL GENERAL LIABILITY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Kent
Re: 13510 SE 272"d Street, Kent, WA
ADDITIONAL INSURED - BY WRITTEN CONTRACT, (2) Your ongoing operations for that insured,
AGREEMENT OR PERMIT, OR SCHEDULE whether the work is performed by you or for
The following paragraph is added to WHO IS AN INSURED you;
(Section II): (3) The maintenance, operation or use by you
of equipment leased to you by such person
5. Any person or organization shown in the Schedule or or organization, subject to the following
for whom you are required by written contract, additional provisions,
agreement or permit to provide insurance is an (a) This insurance does not apply to any
insured, subject to the following additional provisions: 'occurrence" which takes place after
a. The contract, agreement or permit must be in the equipment lease expires,
effect during the policy period shown in the (b) This insurance does not apply to
Declarations, and must have been executed poor "bodily injury' or 'property damage'
to the "bodily injury," 'property damage,' arising out of the sole negligence of
'personal and advertising injury.' such person or organization;
b. The person or organization added as an insured (q) Permits issued by any state or political
by this endorsement is an insured only to the subdivision with respect to operations
extent you are held liable due to. performed by you or on your behalf, subject
(1) The ownership, maintenance or use of that to the following additional provision
part of premises you own, rent, lease or This insurance does not apply to 'bodily
occupy, subject to the following additional injury,' 'property damage; 'personal and
provisions. advertising mjuy arising out of operations
(a) This insurance does not apply to any performed for the state or municipality:
'occurrence" which takes place after C. The insurance with respect to any architect,
you cease to be a tenant in any engineer, or surveyor added as an insured by this
premises leased to or rented to you, endorsement does not apply to 'bodily Injury,'
(b) This insurance does not apply to any 'property damage,' 'personal and advertising
structural alterations, new construction injurya arising out of the rendering of or the
or demolition operations performed by failure to render any professional services by or
or on behalf of One person or for you, including-
organization added as an insured;
1
Includes Copyrighted Material of
Insurance Services Office, Inc, wth its permlsson.
Copynght insurance Services Office, Inc, 2001 Page 1 of 9
i
` • '^'REPRINTED FROM THE FORMS UBRARY-'' •
CG 76 35 10 01
COMMERCIAL GENERAL LIABILITY
(1) The preparing, approving, or failing to (4) Liability assumed under any 'insured
prepare or approve maps, drawings, contract" for the ownership, maintenance or
opinions, reports, surveys, change orders, use of aircraft or watercraft, or
designs or specifications; and (5) "Bodily injury" or 'property damage'
(2) Supervisory, inspection or engineering arising out of the operation of any of the
services, equipment listed in paragraph Q2) or f(3)
d. This insurance does not apply to 'bodily injury' of the definition of 'mobile equipment'
or "property damage' included within the (6) An aircraft you do not own provided d is not
'products-completed operations hazard.' operated by any insured.
A person's or organization 's status as an insured
under this endorsement ends when your TENANTS' PROPERTY DAMAGE LIABILITY
operations for that insured are completed. When a Damage to Premises Rented to you Limit is shown
No coverage will be provided if, in the absence In the Declarations, Exclusion J of Coverage A, Section I is
of this endorsement, no liability would be replaced by the following
imposed by law on you. Coverage shall be limited ), Damage To Property
to the extent of your negligence or fault according
to the applicable principles of comparative fault. "Property damage" to'
(1) Property you own, rent, or occupy, including any
NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT costs or expenses incurred by you, or any other
LIABILITY person, organization or entity, for repair,
Exclusion g of COVERAGE (Section 1) is replaced by the replacement, enhancement, restoration or
following maintenance of such property for any reason,
including prevention of injury to a person or
g. 'Bodily injury' or 'property damage' arising out damage to another's property;
of the ownership, maintenance, use or (2) Premises you sell, give away or abandon, if the
entrustment to others of any aircraft, "auto" or 'property damage" arises out of any part of
watercraft owned or operated by or rented or those premises;
loaned to any insured. Use includes operation (3) Property loaned to you,
and "loading or unloading." (4) Personal property in the care, custody or control
This exclusion applies even if the claims against of the insured,
any insured allege negligence or other {5) That particular part of real property on which you
wrongdoing in the supervision, hinng, or any contractors or subcontractors working
employment, training or monitoring of others by directly or indirectly on your behalf are
that insured, it the 'occurrence' which caused performing operations, if the 'property damage"
the 'bodily injury' or "property damage" arises out of those operations, or
involved the ownership, maintenance, use or (6) That particular part of any property that must be
entrustment to others of any aircraft, "auto" or restored, repaired or replaced because your
watercraft that is owned or operated by or rented work' was incorrectly performed on it.
or loaned to any insured. Paragraphs (1), (3) and (4) of this exclusion do not
This exclusion does not apply to: apply to 'property damage' (other than damage by
fire) to premises, including the contents of such
(1) A watercraft while ashore on premises you premises, rented to you. A separate limit of insurance
own or rent, applies to Damage To Premises Rented To You as
(2) A watercraft you do not own that is. described in Section III • Limits Of Insurance
(a) Less than 52 feet long, and Paragraph (2) of this exclusion does not apply if the
(b) Not being used to carry persons or premises are 'your work' and were never occupied,
property for a charge, rented or held for rental by you.
(3) Parking an 'auto" on, or on the ways next Paragraphs (3), (4), (5) and (6) of this exclusion do
to, premises you own or rent, provided the not apply to liability assumed under a sidetrack
'auto' is not owned by or rented or loaned agreement
to you or the insured,
Includes Copynghted Malenal or
Insurance Services Office, Inc, wah its pemnssion.
Cepynght. Insurance Services Office, Inc, 2001 Page 2 of 3
• '^'REPRINTED FROM THE FORMS LIBRARY• -
CG 76 35 10 01
COMMERCIAL GENERAL LIABILITY
Paragraph (6) of this exclusion does not apply to EXTENDED °PROPERTY DAMAGE"
'property damage" included In the Exclusion a. of COVERAGE A (Section 1) is amended to
'products-completed operations hazard.' read:
Paragraph 6. of Section III is replaced by the following: a. 'Bodily injury' or 'property damage' expected or
6, Subject to 5. above, the Damage To Property Limit is intended from the standpoint of the insured This
the most we will pay under Coverage A for damages exclusion does not apply to 'bod,ly Injury" or
because of 'property damage' to any one premises, property damage resulting from the use of
reasonable force to protect persons or property
while rented to you, or in the case of damage by fire,
white rented to you or temporarily occupied by you INCREASED MEDICAL EXPENSE LIMIT
with permission of the owner. The medical expense limit is amended to $10,000.
The Tenants' Property Damage to Premises Rented to You KNOWLEDGE OF OCCURRENCE
limit is the higher of $200,000 or the amount shown in the The following is added to Paragraph 2. Duties In The Event
Declaratons as Damage to Premises Rented to You Limit. Of Occurrence, Offense, Claim Or Suit of COMMERCIAL
WHO IS AN INSURED - MANAGERS GENERAL LIABILITY CONDITIONS (Section IV):
The following is added to Paragraph 2.a. of WHO IS AN Knowledge of an 'occurrence," claim or 'suit' by. your
INSURED (Section 11). agent, servant or employee shall not in itself constitute
Paragraph (1) does not apply to executive officers, or to knowledge of the named insured unless an officer of the
managers at the supervisory level or above named insured has received such notice from the agent,
SUPPLEMENTARY PAYMENTS - COVERAGES A AND B - servant or employee.
BAIL BONDS UNINTENTIONAL FAILURE TO DISCLOSE ALL HAZARDS
Paragraph t.b. of SUPPLEMENTARY PAYMENTS - The following is added to Paragraph 6. Representations of
COVERAGESA AND B is replaced by the following, COMMERCIAL GENERAL LIABILITY CONDITIONS (Section
IV).
b. Up to $2,000 for cost of bail bonds required because If you unintentionally fail to disclose any hazards existing
of accidents or traffic law violations arising out of the at the inception date of your policy, we will not deny
use of any vehicle to which the Bodily Injury Liability coverage under this Coverage Form because of such failure.
Coverage applies We do not have to furnish these However, this provision does not affect our right to collect
bonds, additional premium or exercise our right of cancellation or
EMPLOYEES AS INSUREDS - HEALTH CARE SERVICES non-renewal
Provision 2 a(1) d of WHO IS AN INSURED (Section 11) is LIBERALIZATION CLAUSE
deleted, unless excluded by separate endorsement. The following paragraph is added to COMMERCIAL
EXTENDED COVERAGE FOR NEWLY ACQUIRED GENERAL LIABILITY CONDITIONS (Section IV):
ORGANIZATIONS 10. If a revision to this Coverage Part, which would
Provision 4.a. of WHO IS AN INYSURED (Section 11) Is provide more coverage with no additional premium,
replaced by the following becomes effective during the policy penod in the state
a. Coverage under this provision is afforded only shown in the Declarations, your policy will
until the end of the policy period automatically provide this additional coverage on the
effective date of the revision
� I
incMes Copyrighted Material of
Insurance Services Office, Inc, wiVi its permission.
Copyright, Insurance Services Office, Inc. 2001 Page 3 of 3
KENT Exhibit F
PARKS RECREATION S
COMMUNITY SERVICES City of Kent
Certification Regarding Debarment and Suspension
Agency Name of Program(s)
Certification A: Certification Regarding Debarment, Suspension, and Other Responsibility
Matters - Primary Covered Transactions
1. The prospective primary participant certifies to the best of its knowledge and belief that its principals,
a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal debarment or agency,
b) Have not within a three-year period preceding this proposal, been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a
public transaction, violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification, or destruction of records, making false statements, or receiving
stolen property,
c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State, or local)with commission of any of the offenses enumerated in paragraph (1)(b) of this
certification, and
d) Have not within a three-year period preceding this application/ proposal had one or more public
transactions (Federal, State, or local)terminated for cause or default.
2. Where the prospective primary participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal.
Instructions for Certification (A)
1. By signing and submitting this proposal, the prospective primary participant is providing the
certification set out below.
2. The inability of a person to provide the certification required below will not necessarily result in
dental of participation in this covered transaction The prospective participant shalt submit an
explanation of why it cannot provide the certification set out below The certification or explanation
will be considered in connection with the department or agency's determination whether to enter
into this transaction However, failure of the prospective primary participant to furnish a certification
or an explanation shall disqualify such person from participation in this transaction
3. The certification in this clause is a material representation of fact upon which reliance was placed
when the department or agency determined to enter into this transaction If it is later determined
that the prospective primary participant knowingly rendered an erroneous certification, in addition
to other remedies available to the Federal Government/City of Kent, the department or agency
may terminate this transaction for cause of default
4 The prospective primary participant shall provide immediate written notice to the department or
agency to whom this proposal is submitted if at any time the prospective primary participant learns
that its certification was erroneous when submitted or has become erroneous by reason of
changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered
transaction, participant, person, primary covered transaction, principal, proposal, and
voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and
Coverage sections of the rules implementing Executive Order 12549 You may contact the
department or agency to which this proposal is being submitted for assistance in obtaining a copy
of these regulations
6. The prospective primary participant agrees by submitting this proposal that, should the proposed
covered transaction be entered into, it shall not knowingly enter into any lower tier covered
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transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by the department or agency
entering into this transaction
7. The prospective primary participant further agrees by submitting this proposal that it will include
the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclu-
sion - Lower Tier Covered Transaction," provided by the department or agency entering into this
covered transaction, without modification, in all lower tier covered transactions and in all
solicitations for lower tier covered transactions
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded
from the covered transaction, unless it knows that the certification is erroneous A participant may
decide the method and frequency by which it determines this eligibility of its principals Each
participant may, but is not required to, check the Non-procurement List
9 Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause The knowledge and
information of a participant is not required to exceed that which is normally possessed by a
prudent person in the ordinary course of business dealings.
10 Except for transactions authorized under paragraph (6) of these instructions, if a participant in a
covered transaction
11. knowingly enters into a lower tier covered transaction with a person who is suspended,debarred,
ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies
available to the Federal Government/City of Kent, the department or agency may terminate this
transaction for cause of default
Certification B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion - Lower Tier Covered Transactions
1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its
principals is presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal department or agency.
2. Where the prospective lower tier participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal
Instructions for Certification (B)
1. By signing and submitting this proposal, the prospective lower tier participant is providing the
certification set out below
2. The certification in this clause is a material representation of fact upon which reliance was placed
when this transaction was entered into. If it is later determined that the prospective lower tier
participant knowingly rendered an erroneous certification, in addition to other remedies available to the
Federal Governmen/City of Kent, the department or agency with which this transaction originated may
pursue available remedies, including suspension and/or debarment
3. The prospective lower tier participant shall provide immediate written notice to the person to which this
proposal is submitted if at any time the prospective lower tier participant learns that its certification was
erroneous when submitted or has become erroneous by reason of changed circumstances
4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction,
participant, person, primary covered transaction, principal, proposal, and voluntarily excluded,
as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules
implementing Executive Order 12549 You may contact the person to which this proposal is submitted
for assistance in obtaining a copy of these regulations
5 The prospective lower tier participant agrees by submitting this proposal that, should the proposed
covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction
with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by the department or agency with which this
transaction originated
6. The prospective lower tier participant further agrees by submitting this proposal that it will include this
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clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -
Lower Tier Covered Transaction," without modification, In all lower tier covered transactions and In all
solicitations for lower tier covered transactions
7 A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that It is not debarred, suspended, Ineligible, or voluntarily excluded from
the covered transaction, unless it knows that the certification Is erroneous A participant may decide
the method and frequency by which It determines the eligibility of Its principals. Each participant may,
but Is not required to, check the Nonprocurement List
8. Nothing contained In the foregoing shall be construed to require establishment of a system of records
In order to render in good faith the certification required by this clause The knowledge and information
of a participant is not required to exceed that which Is normally possessed by a prudent person in the
ordinary course of business dealings
9. Except for transactions authorized under paragraph (5) of these Instructions, If a participant In a lower
covered transaction knowingly enters Into a lower tier covered transaction with a person who Is suspended,
debarred, ineligible, or voluntarily excluded from participation In this transaction, In addition to other
remedies available to the Federal Government/City of Kent, the department or agency with which this trans-
action originated may pursue available remedies including suspension and/or debarment.
Primary Contractor/Sub-Contractor(Print) I Title Date
Multi—Service Center
Sign a of Primary Contractor/Sub-Contractor Title Date
elEp 3 O
(3,
Adopted from HUD Form-2992
09/04
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