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HomeMy WebLinkAboutPK07-288 - Original - Public Health Seattle & King County - Nurse Family Partnership - 01/01/2007 w KENT WlA HII.GT.H CONSULTANT SERVICES AGREEMENT between the City of Kent and Public Health — Seattle & King County THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Public Health — Seattle & King County organized under the laws of the State of Washington, located and doing business at 401 51h Ave South, Suite 1000, Seattle, WA 98104 (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 Nurse Family Partnership services through the Best Beginnings pogram to first time pregnant and parenting young, low income women in Kent; from pregnancy through the child's second birthday. 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 $50,000 ($25,000 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 S 10,000) 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, all medical records established and maintained by PHSKC that relate to patient identifiable health care information provided in accordance with this agreement (hereinafter called "patient records") are the property of PHSKC. The City shall have access to patient records for purposes of providing quality assurance/quality improvement,review and audit purposes during regular business hours. 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. Each party to this Agreement agrees to hold harmless and indemnify the other party and its officers, officials, and employees from any loss, claim, or liability arising from or in connection with the negligent or tortuous actions or inactions of its officers, officials, and employees. In any dispute concerning the performance of this Agreement, each party shall pay all its own legal costs and attorneys' fees. 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. After termination, all patient records established and maintained by PHSKC are the property of PHSKC. The City shall have access to patient records for purposes of providing quality assurance/quality improvement, review and audit purposes during regular business hours. CONSULTANT SERVICES AGREEMENT-2 (Over$10,000) 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. 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 CONSULTANT SERVICES AGREEMENT-3 (Over$10,000) 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 : KE7 10 �— tom" B <B - ,c , 4�L Y� Y� (signature) (signature) Print Name: D AA) 117 I`'U C1^' W\1(n, ►`A D PrinjNae: uzette Cooke Its P4ekC1at2- r HjZ!LT-4 b FF( C F7, Its Mayor �� 2 5 2007 tile) DATE: DATE: �� 7A NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: David Fleming, Director and Health Officer Katherin Johnson, Human Services Manager Public Health - Seattle &King County City of Kent 401 5`h Ave— Suite 1000 220 Fourth Avenue South Seattle, WA 98104 Kent, WA 98032 (206) 296-4600 (telephone) (253) 856-5070 (telephone) (206) 296-4600 (facsimile) (253) 856-5073 (facsimile) APPROVED AS TO FORM: r K nt aw' ep ent P Human Services\General Fund\General Fund 2007-2008 ContractTublic Health CSA 2007-2008\ 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: l. 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 �J day of Se, , 200 By: For: Nry(A R M t EI M JD Title P)9W6, 0¢— -NC>�•R— Date: SEP 2 5 2007 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- PUBLIC HEALTH —SEATTLE & KING COUNTY Best Beginnings This program provides intensive home visiting and case management services to first-time teen parents through the Best Beginnings nurse home visiting program This funding will provide: Outputs Unduplicated Kent clients 6 Number of Kent clients referred 10 Number of visits provided 120 Membership & Participation in the South King Council of Human Services Outcome(s) Increased access to health care (including prenatal and well child care) for low-income children and pregnant women in Kent Reduced instances of reportable child abuse and neglect in the home for participants Delayed birth of second child leading to improved economic stability of young mothers and increased ability to become self-sufficient Budget Personnel $25,000 Nonpersonnel $ - 0 - Total $25,000 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 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(4th Qtr 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 • i EXHIBIT A SCOPE OF WORK (CONTINUED) 2007 CONSULTANT SERVICES AGREEMENT — PUBLIC HEALTH — SEATTLE & KING COUNTY Best Beginnings Pursuant to Item 1 of the Consultant Services Agreement executed on January 1, 2007, Public Health — Seattle & King County 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 3 3 2 Number of clients referred 2 2 3 Number of visits provided 30 30 2nd 1 Unduplicated City of Kent clients served 3 6 2. Number of clients referred 2 4 3 Number of visits provided 30 60 3`d 1 Unduplicated City of Kent clients served 0 6 2 Number of clients referred 3 7 3. Number of visits provided 30 90 4th 1 Unduplicated City of Kent clients served 0 6 2 Number of clients referred 3 10 3 Number of visits provided 30 120 The above services shall be provided by December 31, 2007. 2007 Reimbursement: $25,000 Please sign to indicate acceptance of the Year 2007 Performance Measures listed above ;T SEP 2 5 2007 David Fleming' ubllc Health—Seattle& King County Director Date Kathenn J on, H s uman Services Manager Date EXHIBIT A SCOPE AND SCHEDULE OF WORK 2008 CONSULTANT SERVICES AGREEMENT- PUBLIC HEALTH —SEATTLE & KING COUNTY Best Beginnings This program provides intensive home visiting and case management services to first-time teen parents through the Best Beginnings nurse home visiting program This funding will provide: Outputs Unduplicated Kent clients 6 Number of Kent clients referred 10 Number of visits provided 120 Membership & Participation in the South King Council of Human Services Outcomes) Increased access to health care (including prenatal and well child care) for low-income children and pregnant women in Kent Reduced instances of reportable child abuse and neglect in the home for participants Delayed birth of second child leading to improved economic stability of young mothers and increased ability to become self-sufficient Budget Personnel $25,000 Nonpersonnel $ - 0 - Total $25,000 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 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(4`h Qtr Exhibit B) December 15, 2008 Outcome Based Evaluation Report(Exhibit C) July 31, 2008/January 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— PUBLIC HEALTH — SEATTLE & KING COUNTY Best Beginnings Pursuant to Item 1 of the Consultant Services Agreement executed on January 1, 2007, Public Health — Seattle & King County 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 3 3 2 Number of clients referred 2 2 3. Number of visits provided 30 30 2"d 1 Unduplicated City of Kent clients served 3 6 2 Number of clients referred 2 4 3. Number of visits provided 30 60 3`d 1. Unduplicated City of Kent clients served 0 6 2 Number of clients referred 3 7 3 Number of visits provided 30 90 4th 1 Unduplicated City of Kent clients served 0 6 2 Number of clients referred 3 10 3 Number of visits provided 30 120 The above services shall be provided by December 31, 2008. 2008 Reimbursement: $25,000.00 Please sign to indicate acceptance of the Year 2008 Performance Measures listed above �1 ;e. SEP 2 5 2007 David Fleming, Publi He — Battle 8 Kind County Director Date m / 7Kathenn Johns , H usm 8 uman a Imes Manager Date Exhibit B General Fund KENT 2007 Billing Voucher WASHINGTON and Service Report PARKS, RECREATION S COMMUNITY SERVICES To: Agency: Public Health —Seattle & King County Merina Hanson Housing & Human Services Parks, Recreation & Community Services program Contact: Lois Schipper 2204 Ave. South, Kent, WA 98032 Telephone: 206.296.4562 mhanson(o)-ci kent wa us E-mail: lois.schipper@metrokc.gov Phone: 253 856-5077 Reporting Period Program Amount Requested Best Beginnings Is BUDGET SUMMARY FOR DEPARTMENT USE ONLY Total Contract Amount $ 25,000.00 VENDOR NUMBER#33152 Current Request $ ACCOUNT CODE 1000-6370-64150-4861 Amount Remaining $ 2005 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 ro 4 Unduplicated # of Kent clients served 3 3 0 0 Number of clients referred annually 2 2 3 3 Number of visits provided 30 30 30 30 *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: OWN N W M `� W '> O H cc 3 c O cc H a� N = cv O > �a LL o ( _ a� w F- V Z p _m (D _- L " L ii LLI a Y C. E Q d U E O Ecu d W L Q O f6 U ... y N N c O O C O- O cn .� N C O L x O X � N E o E :3 c O Z O V LL cu rn ^ c M N r _� L w Q E L = a) O O r + c LLI o v o �N N z c O m W — -o O- .z= � � oILo N w Y3 YF Z O E o > CCO ++ E to O (0 (6 m Q Cn (n cog O 04 � VTR • W n LLJ O2 � � � f O \ k 071 LL § 5 Z 2 k W E CL @ a E 7 = J 0 ƒ t a- j $ / LL \ $ / ( / E o Im o 0- � R ) E § c 0 z § L \ im / 0 E X W E % 0 § » a me J q ; 7 a)(° E 2 * © k \ 0 Lo \ — £ a: E \ ) k / / £ zcc = p E E 2 § 2 \ a a) 5 ■ ■ E a 2 a / � o � OCNN + V ■ � LU 2 r_ E O M $ O V . O m .j 75 m _ Z ( > E 4-- cn Z k d / LU .2 § < ƒ Y _ _ CL / § _ E � < k $ � -a \ 0 $ § ƒ m 0 a CD E E o U LL z 0 Ecu D @ t 0 & x ° o c G j E 5 k a p c § k o> ` ° £ & § ' \ \ ƒ @ 2 \ h Ne V; / / E u a)7 \ 1 \ \ E cn / \ ) t < = m moo © ON_ � + CL LLU � � M a E O $ 5 Z ? ( \ L \ a Z 3 k k LLI 2 ~ ƒ \ f = ca / E _ § IL u /_ � k 2 Cd cu LL / 0 \ E $ I ƒ % CL \ CD E E o U U- z 0 2 / \ s k � © x G m 0 f LU \ \ 2 % k ` P ` ° £ g \ ; ) 2 .�; ) k } \ 4-0© / & k UI § t 2 _ ■ — 2 N :) 2 a) a) E k d / \ co o _ z 2 § 2 ■ m m $ 5 ° (D \ \ O 3 3 \ 2 m = Agency KENT Exhibit D Program WA5N.NQTON 2007 Demographic Report Date PARKS, RECREATION S 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 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 En lish 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 \1147KENT• Exhibit D Program WASHINGTON 2008 Demographic Report Date PARKS, RECREATION 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 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 Ethnici ' Asian/Pacific Islander Black/Afncan 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 EXHIBIT E INSURANCE REQUIREMENTS FOR CONTRACTS WITH KING COUNTY Insurance The City acknowledges, agrees and understands that King County is self-insured for all of its liability exposures. King County agrees, at its own expense, to maintain through its self-insurance program coverage for its liability exposures for the duration of this Agreement To the extent of County negligence, the County's self insurance program shall be primary insurance with respect to this Agreement Any insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the County's self- insurance and shall not contribute with it The County shall furnish the City with a Certificate of Self-Insurance 101VIVI C 0� Vz- KENT Exhibit F w. PARKS RECREATION S COMMUNIT 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 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 s 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 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 transaction originated may pursue available remedies including suspension and/or debarment Diw1D FLE►'K(0 wi D Primary Co tractor/Sub-Contractor(Print) Title Date �I(2tC-7 k NE►f-t-r►+ 0FF( CFr2_ SEP 2 5 2007 Signature of Primary Contractor/Sub-Contractor Title Date (a Adopted from HUD Form-2992 09/04 3 of 3