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HomeMy WebLinkAboutPK07-156 - Original - Ukrainian Community Center of WA - Community Advocacy Project - 01/01/2007 ® Records Management "7**400"**KENT Document WASHINOTON 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. ' .�.�et/,i, ii�a v,� ,Cf�VV m o va i �vlY �J Vendor Name: C�^' ` "' w Vendor Number: �� y JD Edwards Number Contract Number: pKor)- This is assigned by Mary Simmons Description: C�I-- Detail: Ucs (-,hGrAI firt nd 1 °/o ron'fl' cf: Project Name: �� VV Ca Uj Contract Effective Date: " o:f Termination Date: 1 Z 3 1 —vA Contract Renewal Notice (Days): j r 7j 1 -bags Number of days required notice for termination or renewal or amendment Contract Manager: fAtyim lls" Department: Pa" ftvVtLw wv c les Abstract: S Pabhc\RecordsManagement\Forms\ContractCover\ADCL7832 07/02 Human Service Agencies Based on 1%oll Previous Year's Budgeted Revenue Program 2006 BUDGET 2007 BUDGET ACAP -Apple Parent 10,000 CCS- Housing for Men 30,000 CCS - Emergency Assistance 55,280 CCS - Volunteer Chore Services 5,000 CFCA-Sprmgwood Career Dev 10,000 Children's Therapy Center 28,000 35,000 CHC- Primary Medical 58,450 57,000 CHC- Primary Dental 15,000 20,000 Crisis Clinic 5,000 5,000 Communities in Schools - Kent 10,000 10,000 YWCA Community Advocacy 30,000 30,000 DAWN - Shelter 30,000 33,000 DAWN - Comm Advocacy 10,000 Jewish Family Serv-Refugee Ser 7,500 7,500 Kent Food Bank 36,000 52,000 KYFS- Family Counseling 47,082 47,000 KYFS-Teen Parent Housing 7,500 8,000 KYFS-Teen Substance Abuse 14,500 KC Sexual Assault Res Center 20,600 21,000 Senior Svcs -Transportation 7,500 SKCMSC- Housing 40,000 40,000 SKCMSC- HEART - 9,000 10,000 •,�,,Rlkrainian Community Center • 7,500.------ """' 10,000 Valley Cities- Counseling 15,000 15,000 Valley Cities-Sr Counseling 30,000 30,000 VCCC - FWYFS Family Support 10,000 WWEE - Econ Self Sufficiency 35,000 35,000 Childcare Subsidies 12,675 13,000 TBD- Home Visiting Services 25,000 25,000 TBD- Emergency Assistance 25,962 TBD- HS Needs Assessment 30,000 Children's Home Society 10,000 Conselo 12,000 SKCMSC -Emergency Services 55,000 TBD- Homeless Men's Services 30,000 Safe Havens 68,565 YWCA- Children's Dom Violence 5,000 663,049 698,565 206 000000**46 KENT WASHINGTON CONSULTANT SERVICES AGREEMENT between the City of Kent and Ukrainian Community Center of WA THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Ukrainian Community Center of WA organized under the laws of the State of Washington, located and doing business at 221 Hardie Ave NW, Renton, WA 98055 (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 case management services to assist low-income, Kent refugee families in overcoming barriers to self-sufficiency. 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 term of this Agreement shall run from January 1, 2007,through December 31, 2008. However, due to the delay in execution of this Agreement,the parties agree that all actions consistent with the authority of this Agreement and prior to the date of the Agreement's execution are hereby ratified and affirmed, and the terms of this Agreement shall be deemed to have applied The parties agree that 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. 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 $20,000 ($10,000 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 parry 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 1.2, 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. Assignment. 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. CONSULTANT: CITY OF 1�T: By: `-7 By: (srgrtatureJ (signature) Print Name: ��' rint me Suzette Cooke Its 619.0409-c-rWIZ, Its Mayor DATE: �at�Z_� DATE: o(rr J NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Oleg Pynda, Executive Director Katherin Johnson, Human Services Manager Ukrainian Community Center of WA City of Kent 221 Hardie Ave NW 220 Fourth Avenue South Renton, WA 98055 Kent, WA 98032 (425) 430-8229 (telephone) (253) 856-5070 (telephone) (425) 430-8224 (facsimile) (253) 856-5073 (facsimile) APPROVED AS TO FORM: CONSULTANT SERVICES AGREEMENT-4 (Over$10,000) Ke t aw D rent P Human Servlces%General Fun&General Fund 2007-2008 Contract\UCCWA CSA 2007-2008\ CONSULTANT SERVICES AGREEMENT-5 (Over S10,000) 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 / , 200 By: �N� For: &e)ZE'Z;Z_ 1yA/PAA-- Title: 407—X• Ae-eeWs Date: tyy ©2 �7 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— UKRAINIAN COMMUNITY CENTER OF WA Community Advocacy Project This program provides services to assist refugee families in overcoming barriers to self- sufficiency by providing immediate assistance to families and need through advocacy and case management. This funding will provide: Outputs Unduplicated Kent clients served 50 Cultural Orientation Workshop 2 Parenting Education Workshop 1 Membership & Participation in the South King Council of Human Services Outcome(s) Increased knowledge of community resources and educational opportunities, leading to increased self-sufficiency for refugee families. Budget Personnel $9,250 Nonpersonnel $ 750 Total $10,000 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 10t" 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 Citr Exhibit B) December 14, 2007 Outcome Based Evaluation Report(Exhibit C) July 31, 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) 2007 CONSULTANT SERVICES AGREEMENT — UKRAINIAN COMMUNITY CENTER OF WA Community Advocacy Project Pursuant to Item 1 of the Consultant Services Agreement executed on January 1, 2007, Ukrainian Community Center of WA shall provide the approximate number of City of Kent clients with the following services: Quarter Service Unit Number of Cumulative Units Total 1st 1. Unduplicated City of Kent clients served 12 12 2. Cultural orientation workshop provided 0 0 3 Parenting education workshop provided 0 0 2nd 1. Unduplicated City of Kent clients served 12 24 2 Cultural orientation workshop provided 1 1 3 Parenting education workshop provided 0 0 3rd 1. Unduplicated City of Kent clients served 13 37 2. Cultural orientation workshop provided 0 1 3. Parenting education workshop provided 0 0 4th 1. Unduplicated City of Kent clients served 13 50 2. Cultural orientation workshop provided 1 2 3. Parenting education workshop provided 1 1 The above services shall be provided by December 31, 2007. 2007 Reimbursement: $10,000.00 Please sign to indicate acceptance of the Year 2007 Performance Measures listed above. 6&::�: /- 02--0 7 Oleg Pynda, UVrainiaffcedaftunity Center of WA Executive Director Date Katherin J6hnsdqUdusinJ&Human Services Manager Date ' EXHIBIT A SCOPE AND SCHEDULE OF WORK 2008 CONSULTANT SERVICES AGREEMENT— UKRAINIAN COMMUNITY CENTER OF WA Community Advocacy Project This program provides services to assist refugee families in overcoming barriers to self- sufficiency by providing immediate assistance to families and need through advocacy and case management. This funding will provide: Outputs Unduplicated Kent clients served 50 Cultural Orientation Workshop 2 Parenting Education Workshop 1 Membership & Participation in the South King Council of Human Services Outcome(s) Increased knowledge of community resources and educational opportunities, leading to increased self-sufficiency for refugee families Budget Personnel $9,250 Nonpersonnel $ 750 Total $10,000 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 10t" 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(4th Qtr Exhibit B) December 15, 2008 Outcome Based Evaluation Report(Exhibit C) July 31, 20081January 30, 2009 Client Demographic Data (Exhibit D) January 30, 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) 2008 CONSULTANT SERVICES AGREEMENT— Pursuant to Item 1 of the Consultant Services Agreement executed on January 1, 2007, Ukrainian Community Center of WA shall provide the approximate number of City of Kent clients with the following services: Quarter Service Unit Number of Cumulative Units Total 1st 1. Unduplicated City of Kent clients served 12 12 2 Cultural orientation workshop provided 0 0 3. Parenting education workshop provided 0 0 2nd 1. Unduplicated City of Kent clients served 12 24 2. Cultural orientation workshop provided 1 1 3. Parenting education workshop provided 0 0 3`d 1. Unduplicated City of Kent clients served 13 37 2. Cultural orientation workshop provided 0 1 3 Parenting education workshop provided 0 0 4th 1. Unduplicated City of Kent clients served 13 50 2. Cultural orientation workshop provided 1 2 3. Parenting education workshop provided 1 1 The above services shall be provided by December 31, 2008. 2008 Reimbursement: $10,000 Please sign to indicate acceptance of the Year 2008 Performance Measures listed above. Oleg Pynda, Ukrainian Corn ity Center of WA Executive Director Date Katherin Johnso , H ing H an Se ices Manager Dat Exhibit B General Fund �WKENT 2007 Billing Voucher 1147 WASHINGTON and Service Report PARKS, RECREATION 6 COMMUNITY SERVICES To: Agency: Ukrainian Community Center of WA Merina Hanson Housing & Human Services Parks,Recreation & Community Services program Contact: Oleg Pynda 2204 Ave. South, Kent, WA 98032 Telephone: (253) 854-8229 mhanson(D_ci.kent wa.us Phone: 253 856-5077 E-mail: opynda@uccwa.org . Reporting Period Program Amount Requested Community Advocacy Project $ BUDGET SUMMARY FOR DEPARTMENT USE ONLY Total Contract Amount $10,000.00 VENDOR NUMBER 36415 �� � Current Request $ ACCOUNT CODE 1000-6370-64150-4830 Amount Remaining $ 2007 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date New City of Total Kent Total Service Service Unit Description Service Units Planned Kent Funded Funded Units to Date Each Quarter Service Units Service Units (ALL Funding This Quarter To Date Sources Service Unit/Performance Measure 15 2" 3 4 Unduplicated # of Kent clients served 12 12 13 1 13 Cultural orientation workshops 0 1 0 1 Parenting education workshops 0 0 0 1 *Please attach a narrative explanation to this report in the event that the program is not meeting performance measures. Authorized Signature Date FOR DEPARTMENT USE ONLY AUTHORIZED FOR PAYMENT BY' DATE: ' ~ p o O N N o CL W CO) W O � m Cl) = m cu LL 0 N W `� fl Y a E a rn c — E o `6 U w m Q t w ci o v N N U C O O c Q O N O cu 0 CL O X � N E O 3 Z O 0 U Z, m Wcu L 'a Q m N E p L T L .0 N i' O +/ c x v �� d L W E o =3 "a C �- >1 6W N z = p O j O O 7 w W � U ui N a) a p — co N v W W aN i E p cu fn �L 3 Y z E E It 2:° > Cp R E N a U ca N � w Q cn Un o CD O N N 0 W CO) T- W E C d OCD U mo V >, (D -- Q Z c Cl) > m > co 2 La Y ° a CL m `° O E L E d W ++ Q d t � rr �, L (6 O L v C O O C 0- O Cl) C O O Q. O X � N E O i° Z c U m o .. V a o i p x C) O W o .0 m d E C� O Ow = O O a0 w Z �o Cp O _ C O a .z= ° L W .•j o :3 cu 3 � o z E E O N V _ a � y ++ !d a O U m N (�6 tE0 N rn c �v O W a) 00 g CD CD 0 q $ - o W 4) W 7 � O L) 0 � M 2 O / � 7 2 cu � \ k \ m 2 \ Z @ £ § / LLI \ \ \ § [ ) f o / LL _ ) / k § ƒ / o CL � x E 2 ° U 0 Z § cm /D E / � R f xLLJ ) k 0 5 / ) 3 7 c $ >1 , . _ g CDf (> k a 5 \ @ k / k /_ a) § } 3 % § $ § 2 D { 2 cc 3 7 & @ ■ E co § o m O O k $ a) < m e o o � o 0 O N N ol 0 W M r W r_ E C � O � � U mo 0 O T- ^ a co ai Z_ c c > L O m LL ,- F— 0 Z LV Y c ¢ c .` m rn CL a w m Q m s co L v a w C O O C CL O U Y C O a aD x E E `o LL Z 0 O rn :r +' ` N a V N 'a a .0 o i N U �+ C W w`o a E V '6 m w Z a G +O- >+ ou c N O N }} o V oz ul fz E E o U w N = U to E N o� @ @ O C1 cn a Q Agency KENT Exhibit D Program. W T PARKS,, RECREATION 2007 Demographic Report Date, RECR S COMMUNITY SERVICES Unduplicated Number of Clients Served" Agency/Program Unduplicated New Individuals this Year Client Residence*' >„ , Algona Auburn Black Diamond Burien 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 Gender TOTAL Male Female Age TOTAL r7 0-4 years 5- 12 years 13- 17 years 18-34 years 35- 54 years 55 -74 years 75+years Unknown Ethnici TOTAL 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 40 Agency: KENT• Exhibit D Program W`SHINGTON RECREATION PARKS, RECRE 2008 Demographic Report Date S COMMUNITY SERVICES Unduplicated Number of Clients Served" Agency/Program Unduplicated New Individuals this Year Client Residence" Algona Auburn Black Diamond Burien Covington Des Moines Enumclaw Federal Wa 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 i 0-4 ears 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 Amercan/Alaskan Native White/Caucasian Other Unknown TOTAL Female Headed Household Disabling Condition Limited English S eakin 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 CDBG 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 Liability 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. 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 $1,000,000 each occurrence, $1,000,000 general aggregate and a $1,000,000 products-completed operations aggregate limit 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. EXHIBIT E (Continued ) 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 OP ID DATE(MMIDDIYYYY) UKRAI-1 04/10/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Marsh AdvAmer CBC HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 9830 Colonnade Blvd #400 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Antonio T% 79230 Phone. 888-591-1954 Fax.-210-737-3584 I INSURERS AFFORDING COVERAGE INAIC# INSURED INSURER American States Insurance 1 19704 INSURER B Ukrainian Community Center Mr. Oleg Pynda LIN9UREPC - -- -� -- 221 Hardie Avenue NW INSURER Renton WA 98055 INSLIR- ------'- "' - ---- ER F ) COVERAGES THE POLICIES OF INSURANCE LISTED BELOVI HAVE BEEN ISSUED TO THE INSURCO NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OP OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAAN,THE INSURANCE AFFORDED EY THE POUCIES OEIK RIBEO HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH PO[ICES AGGREGATE LIGHTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR-ADD'U" ___ ______.�-__ .__ _ ___.___-_--7POLICY Em, NE PSLlCYEXPIRATION ___ LTR INSR TYPEOF INSURANCE POLICY NUMBER DATE(MMIDD/YY DATE(MMlDDJYY LIMITS j G ENERAL LIABILITY EACH OCCURRENCE _ j S 1,OOO,OOO A x IX COMMERCIAL GENERAL LIABILITY OICE58051180 04/30/06 04/30/07 PREMISES(Eaocacel _ls200,000 i I =CLAIMS MADE I7,OCCUR MED EXP(Any one person) 1 S lO,OOO PERSONAL S ADV INJURY [$1,000,000 GENERAL AGGREGATE _%s 2,000,,00_0 GEN'L AGGREGATE LIMIT APPLIES PER PROCUCTS•COMPIOP AGG I S 2,OOO,OOO -- POLICY F'I PRO I -I LOC Em Liab j 1,000,000 - { p AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT �$ ANY AUTO (Ea a[Gdenl)T� I�ALL OWNED AUTOS BODILY INJURY { SCHEDULED AUTOS ! (Per person) $ 1 HIRED AUTOS BODILY INJURY- I S NON Otti (Per amdenq NED AUTOS PROPERTY DAMAGE $ I � �(Per ar_cldeni) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT I$ ANY AUTO OTHCRTHAN EA ACC $ __ AUTO ONLY -" AGG S 1 t I EXCESS/UMBRELLA LIABILITY I EACH CCCUKPENCE S OCCUR L.CLAIMSb1ADE AGGREGATE S — —i i S yj DEDUCTIBLE :S «_ ' RETEtITION S ,$ WORKERS COMPENSATION AND I 1 �TCRYLI,AITS_ ER EMPLOYERS'LIABILITY I --- '— E L EACH ACCIDENT S ANY PROPRIETOR EXCLUDED? - --- - _- OFTICER;IdEMBER EXCLUDECJ7 EL DISEASE-EA EMPLOYEE S It yes itescnbe — -------- SPECIALPROVISIONSneICw EL DISEASE-POLICY LIMIT'S I OTHER { DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Kent is named Additional Insured as their interest may appear. CERTIFICATE HOLDER CANCELLATION CKENT-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE.TO DO SO SHALL City of Rent 220 IMPOSE NO OBLIGATION OR LIABILITY OrF ANY KIND UPON THE INSUREFj;ITS AGENTS OR Fourth Avenue South Kent WA 98032 REPRESENREPRESENTATIVES AUTHORIZED REPRESENTA «"/Fn+y / #M ",C "b`A '=6y�gy l ACORD 25(2001108) t ©ACORD CORPORATION 1988 AMERICAN STATES INSURANCE COMPANY PAGE 01 SEATTLE, WASHINGTON * POLICY CHANGE _ i` POLICY NUMBER: O1-CE-580511-8 r _7� n6 sc*********5tKKK Y Ycic>�c>rnt>�r NAMED UKRAINIAN COMMUNITY CENTER OF AGENT: SEABURY & SMITH INC MAILING 221HHARDIE AVE NW POABOXR659520ANTAGE AMERICA ADDRESS: RENTON, WA 98055 SAN A70ONIO, TX 78265 7395-2048 POLICY PERIOD: FROM 04-30-06 TO 04-30-07 * * THE CHANGE IN YOUR POLICY RESULTS IN NO CHANGE IN PREMIUM. * ADDED ADDITIONAL INSURED IN FAVOR OF RING COUNTY COMMUNITY SERVICES DIVISION. k p r r 9-CM(01-86) CENTRAL (SUSRA ) AGENT COPY PREPARED 12-04-06 C-A�-04PRiNf001 v>M&0001-E POLICY CHANGE EXTENSION PAGE 02 EFFECTIVE: 11/17/06 i NAMED INSURED: UKRAINIAN COMMUNITY CENTER OF POLICY NUMBER: 01-CE-580511-8 *GI�;N RAC� L�jABTz1,77'��'py* THE FOLLOWING HAS BEEN CHANGED ------------------------------ ---------------------------------------------------------------------------------- CLASSI COVERAGE INFORMATION I EXPOSURE I RATE PREMIUM ---------------------------------------------------------------------------------- STOP GAP — EMPLOYERS LIABILITY 92400 STOP GAP —*EMPOLOYER'S LABILITY USES POLICY'S PREM/OPS PREMIUM BASE BI 1 $ 11.00 CERTIFIED ACTS OF TERRORISM $ 2.00 THE FOLLOWING FORMS HAVE BEEN ADDED OR CHANGED ---------------------------------------------- CG7635(1001) s 9—CM(01-86) CENTRAL (SUSRA ) PREPARED 12-04-06 C-AG-KPRI NT001-34 461MM m THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i 5 A F E C O° 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 renton city of kent city of seattle KING COUNTY COMMUNITY SERVICES DIVISION 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 6. 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 prior "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 (4) Permits issued by any state or polftfcal 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 fallowing additional injury," "property damage," "personal and provisions. advertising injury" arising out of operations (a) This insurance does not apply to any performed for the state or municipality: o "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 injury" 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 the person or for you, including. organization added as an insured, Includes Copyrighted Material of Insurance Services Office, Inc,with Its permission Copyright,Insurance Services Office, Inc,2001 Page 1 of 3 CA -047aINr0a1-3446p(M CO 76 35 10 01 COMMERCIAL GENERAL LIABILITY (1) The preparing, approving, or falling 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 f(2) or 1(3) d. This insurance does not apply to "bodily Injury" of the definition of"mob+le equipment" or "property damage" included within the (6) An aircraft you do not own provided it 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 j, Damage To Property to the extent of your negligence or fault according to the applicable principles of comparative fault (Property damage" to' (i) 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 A (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, hiring, or any contractors or subcontractors working employment, training or monitoring of others by directly or indirectly on your behalf are that insured, if the "occurrence" which caused performing operations, if the "property damage" the "bodily injury" or "property damage" arises out of those operations, or x involved the ownership, maintenance, use or (6) That particular part of any property that must be restored, repaired entrustment to others of any aircraft, "auto" or replaced because your watercraft that is owned or operated by or rented work" was incorrectllyy 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 Copyrighted Material of Insurance Services Office, Inc,with its permission Copyright,Insurance Services Office,Inc, 2001 Page 2 of 3 r.Wana.miMMA4ec rnns-e CG 76 35 10 01 r I 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 well pay under Coverage A for damages exclusion does not apply to "bodily Injury" or "property damage" resulting from the use of because of "property damage" to any one premises, reasonable force to protect persons or property while rented to you, or in the case of damage by fire, while 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 Declarations 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 II). 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 1.b. of SUPPLEMENTARY PAYMENTS - The following is added to Paragraph 6. Representations of COVERAGES A AND B is replaced by the following COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV). b. Up to $2,000 for cost of bail bonds required because If you unintentionally fail to disclose any hazards existing of accidents or traffic law violations arising out of the at the inception date of your policy, we will not deny use of any vehicle to which the Bodily Injury Liability coverage under this Coverage Form because of such failure. Coverage applies We do not have to furnish these However, this provision does not affect our right to collect bonds. additional premium or exercise our right of cancellation or EMPLOYEES AS INSUREDS- HEALTH CARE SERVICES non-renewal Provision 2 a(1) d. of WHO IS AN INSURED (Section 11) is LIBERALIZATION CLAUSE deleted, unless excluded by separate endorsement The following paragraph is added to COMMERCIAL EXTENDED COVERAGE FOR NEWLY ACQUIRED GENERAL LIABILITY CONDITIONS (Section IV): ORGANIZATIONS 10. If a revision to this Coverage Part, which would Provision 4 a of WHO IS AN INSURED (Section 11) is provide more coverage with no additional premium, replaced by the following, becomes effective during the policy period in the state a. Coverage under this provision is afforded only shown in the Declarations, your policy will until the end of the policy period automatically provide this additional coverage on the effective date of the revision Includes Copyrighted Material of o Insurance Services Office, Inc,with its permission Copyright, Insurance Services Office,Inc,2001 Page 3 of 3 C•AG W RINTN1.3446mW-E ls� KENT Exhibit F PARKS RECREATON S COMMUNITY SERVICE$ 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 denial of participation in this covered transaction The prospective participant shall 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 1 of 3 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 Government/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 2of3 6. The prospective lower tier participant further agrees by submitting this proposal that it will Include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclu- sion - 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 & 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 transaction originated may pursue available remedies including suspension and/or debarment Primary Contractor/Sub-Contractor(Print) Title Date Signature=&Sor Title Date (3, Adopted from HUD Form-2992 09/04 3of3