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CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Office.
Vendor Name: Catholic Community Services
Vendor Number: 33536
JD Edwards Number
Contract Number: ft7- 077
This is assigned by City Clerk's Office
Project Name: HOME Men's Shelter
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: 01/01/2009 Termination Date: 12/31/2009
Contract Renewal Notice (Days): 30
Number of days required notice for termination or renewal or amendment
Contract Manager: Jason Johnson Department: Parks, Human Services
Detail: (i.e. address, location, parcel number, tax id, etc.):
S Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08
400111111
KENT
WASHINGTON
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Catholic Community Services
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Catholic Community Services organized under the laws of the State
of Washington, located and doing business at 100 - 23rd Ave S., Seattle, WA 98144, (206) 324-
4835 (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:
Catholic Community Services will provide staffing to the H.O.M.E. Men's Shelter in
Kent. 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 Outcomes 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 within the Puget Sound
region in effect at the time those services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks
described in Section I above immediately upon the effective date of this Agreement. Upon the
effective date of this Agreement, Consultant shall complete the work described in Section I by
December 31', 2009, with the City's sole option to extend the agreement for up to one (1)
additional one year term. 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 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 amendment to this 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) throughout the term of this
Agreement, unless the parties negotiate an amendment to this Agreement. The
Consultant's billing rates shall be as delineated in Exhibit A.
CONSULTANT SERVICES AGREEMENT - 1
(Over$10,000)
B. The Consultant shall submit quarterly payment invoices to the City for work
performed, and a final bill upon completion of all services described in this
Agreement. The City shall provide payment within forty-five (45) days of receipt of
an invoice. If the City objects to all or any portion of an invoice, it shall notify the
Consultant and reserves the option to only pay that portion of the invoice not in
dispute. In that event, the parties will immediately make every effort to settle the
disputed portion.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent
Contractor-Employer Relationship will be created by this Agreement and that the Consultant has
the ability to control and direct the performance and details of its work, the City being interested
only in the results obtained under this Agreement.
V. TERMINATION. Either party may terminate this Agreement, with or without
cause, upon providing the other party thirty (30) days written notice at its address set forth on
the signature block of this Agreement. After termination, the City may take possession of all
records and data within the Consultant's possession pertaining to this project, which may be
used by the City without restriction. If the City's use of Consultant's records or data is not
related to this project, it shall be without liability or legal exposure to the Consultant.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under
this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on
behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age,
sexual orientation, national origin, or the presence of any sensory, mental, or physical disability,
discriminate against any person who is qualified and available to perform the work to which the
employment relates. Consultant shall execute the attached City of Kent Equal Employment
Opportunity Policy Declaration, Comply with City Administrative Policy 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.
The provisions of this section shall survive the expiration or termination of this
Agreement.
CONSULTANT SERVICES AGREEMENT - 2
(Over$10,000)
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, including all appeals, 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.
I. Counterparts. This Agreement may be executed in any number of counterparts,
each of which shall constitute an original, and all of which will together constitute this one
Agreement.
IN WITNESS, the parties below execute this Agreement, which shall become
effective on the last date entered below.
CONSULTANT: CITY OF KENT:
By: By:
(signa ur ) (srgnature)
Print Name: rf,4&4f_) Print a : S zette Cooke
Its eti� ,.r Its r
(title)
DATE: 03 DATE: D
CONSULTANT SERVICES AGREEMENT - 4
(Over$10,000)
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Josephine Tamayo Murray Katherin Johnson
Catholic Community Services City of Kent
100 - 23rd Ave S 220 Fourth Avenue South
Seattle, WA 98144 Kent, WA 98032
206-328-5701 (telephone) (253) 856-5070 (telephone)
206-324-4835 (facsimile) (253) 856-6070 (facsimile)
AP ROVED TO FORM:
Ke La rtment
[In this field,you may enter the electrow Fllepath where the contract has been saved]
CONSULTANT SERVICES AGREEMENT - 5
(Over$10,000)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and It will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
3. During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this day of 200 7.
By:
For: [" �c. � r�Wel�j
Title: y
Date: 1)3,6?hf
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 complied full with all of the requirements and obligations as outlined in the City
I declare that p y q 9
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
f�• Exhibit A
v KENT Scope and Schedule of Work
RECREATION s
COMMUNITY SERVICES 9 2009 Consultant services Agreement
COM M
Agency: Catholic Community Services 2009 Funding: $20 000
Program: HOME Men's Shelter
This funding Catholic Community Services will provide staffing to the
will provide: H 0 M E. Men's Shelter in Kent This includes intake, Total: $20,000
referral, over-night staffing, and coordination with
partner service providers, volunteers, and participants.
Annual Program Outputs " "' Program Outcome:
Unduplicated Kent Clients 70 Increasin Self-Reliance
Staffing Hours 650
Unduplicated Referrals to SMH 36
Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1, 2009, Catholic
Community Services shall provide the approximate number of City of Kent clients with the following
services each year of the CSA:
Quart4ir ° SeMce"Unit Number of' Cumulative
Units Total
15t Unduplicated City of Kent clients served 18 18
Staffing Hours 163 163
Unduplicated Referrals to SMH 9 9
2"d Unduplicated City of Kent clients served 18 36
Staffing Hours 163 326
Unduplicated Referrals to SMH 9 18
3rd Unduplicated City of Kent clients served 17 53
Staffing Hours 162 488
Unduplicated Referrals to SMH 9 27
4th Unduplicated City of Kent clients served j 17 70
Staffing Hours 1 162 650
Unduplicated Referrals to SMH 1 9 36
The above services shall be provided by December 31, 2009 for year one of the agreement.
Contract Administration
The Consultant shall notify the City, in writing, within ten (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 CSA must be retained for three (3) years plus the current year.
Continued on Next Page
�� Exhibit A (continued)
KENT Scope and Schedule of Work
W•SN!h OTON 2009 Consultant Services Agreement
PARKS, RECREATION S
COMMUNITY SERVICES
Agency: Catholic Community Services 2009 Funding. 20 000
Pro ram: HOME Men's Shelter
This funding Catholic Community Services will provide staffing to the
will provide: _ H.O.M.E Men's Shelter in Kent. This includes intake, Total: $20,000
referral, over-night staffing, and coordination with
partner service providers,volunteers, and participants.
Reporting Requirements and Timeline
The agency will be reimbursed on a quarterly basis, upon submittal of appropriate documentation. Such
documentation will Include the following (as applicable): Billing Voucher & Service Report (Exhibit B);
Outcome Based Evaluation Report (Exhibit C); and Client Demographic Data (Exhibit D). These items must
be submitted on forms provided by the City (or online if requested) by the 10`h of the following month for
the previous quarter of service. The reporting timeline is as follows:
Report _- Due Date
Billing Voucher & Service Report (Exhibit B) 10th day following each quarter
Final Billing Voucher (4`h Qtr Exhibit B) December 15`h, 2009/December 15a', 2010
Signature
Please sign below to Indicate acceptance of the Year 2009 Performance Measures listed above.
Bill erman, Director - CCS Date
2$ 0
KatheriYJoly6son, l4uman Services Manager Date
Exhibit B General Fund
KENT 2009 Billing Voucher
WASHINGTON and Service Report
PARKS RECREATION S
COMMUNITY SERVICES
To: Agency: CCS — HOME Men's Shelter
Jason Johnson 100 23rd Ave S
Housing & Human Services Seattle, WA 98144
Parks, Recreation & Community Services
220 4th Ave. South, Kent, WA 98032 Program Contact: Tracy Myers
Telephone: 253-850-2517 "
jalohnson@cl kent.wa us Fax: 253-850-2503
Phone: (253) 856-5061 E-mail: tracym@ccsww.org
Reporting Period Program Amount Requested
CCS — HOME Men's Shelter $
BUDGET SUMMARY
FOWDEPAI�TMEN Total Contract Amount $ 20,000.00
VENDOR-NUMBER# PO# Current Request $
ACCOUNT CODE Amount Remaining $
2009 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 1t 2 nd 3r 4 th
Unduplicated # of Kent clients served 18 18 17 17
Staffing Hours 163 163 162 162
Unduplicated Referrals to SMH 9 9 9 9
*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:
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Agency
Program
KENT Exhibit D g
"`"
PARKSS REC RECREATION S Annual Demographic Report Date
COMMUNITY SERVICES Unduplicated Number of Clients Served`
Agency/Program Unduplicated New Individuals this Year
Client Residence"
Algona
Auburn
Black Diamond
Bunen
Covington
Des Moines
Enumclaw
Federal Way
Kent
Maple Valle
Milton
Normandy Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated King Count
Unknown
TOTAL
Household Income Level "
30% of Median or Below
50% of Median or Below
80% of Median or Below
Above 80% of Median
Unknown
TOTAL
Gender "
Male
Female
TOTAL
Age
0-4 years
5 - 12 years
13 - 17 years
18-34 years
35 - 54 years
55 -74 years
75+years
Unknown
TOTAL
Ethnicity
Asian/Pacific Islander
BlacklAfncan American
Hispanic/Latino(a)
Native American/Alaskan Native
White/Caucasian
Other
Unknown
TOTAL
Female Headed Household
Disabling Condition
Limited English Speaking
' Unduplicated means count each client only once per calendar year
"List of all clients served in client residence category and Kent clients only in rest of the categories
ATTACHMENT E
INSURANCE REQUIREMENTS FOR
CONSULTANT AGREEMENTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement, insurance
against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of the work hereunder by the Contractor, their agents,
representatives, employees or subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Commercial General 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 1185 or a substitute endorsement providing
equivalent coverage
2. Automobile Liability insurance covering all owned, non-owned, hired and leased
vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA
00 01 or a substitute form providing equivalent liability coverage If necessary,
the policy shall be endorsed to provide contractual liability coverage.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Commercial General Liabiltty insurance shall be written with limits no
less than $500,000 each occurrence, $1,000,000 general aggregate and
a$1,000,000 products-completed operations aggregate limit.
2. Automobile Liability insurance with a minimum combined single
limit for bodily injury and property damage of $1,000,000 per
accident.
EXHIBIT E (Continued )
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain,the following provisions
for Automobile Liability and Commercial General Liability insurance:
1. The Contractor's insurance coverage shall be primary insurance as respect the City.
Any Insurance, self-insurance, or insurance pool coverage maintained by the City
shall be excess of the Contractor's insurance and shall not contribute with it
2. The Contractor's insurance shall be endorsed to state that coverage shall not be
cancelled by either party, except after thirty (30) days prior written notice by certified
mail, return receipt requested, has been given to the City.
3. The City of Kent shall be named as an additional insured on all policies (except
Professional Liability) as respects work performed by or on behalf of the contractor
and a copy of the endorsement naming the City as additional insured shall be attached
to the Certificate of Insurance. The City reserves the right to receive a certified copy
of all required insurance policies. The Contractor's Commercial General Liability
insurance shall also contain a clause stating that coverage shall apply separately to
each insured against whom claim is made or suit is brought, except with respects to
the limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less than
AN IL
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.
Mrr'„y Certificate of Coverage Date.5%13/2008
Certificate Holder This Certificate is issued as a matter of information only and
Corporation of the Catholic Archbishop of Seattle confers no rights upon the holder of this certificate.This certificate
Chancery Office does not amend, extend or alter the coverage afforded below.
710 9th Ave
Seattle, WA 98104 Company Affon ding Coverage
THE CATHOLIC MUTUAL RELIEF
SOCIETY OF AMERICA
Covered Location 10843 OLD MILL RD
Catholic Community Services Seattle/King County OMAHA, NE 68154
100 23rd Avenue South
Seattle,WA 98144-2302
Coverages
This is to certify that the coverages listed below have been issued to the certificate holder named above for the certificate
indicated, notwithstanding any requirement, term or condition of any contract or other document with respect to which this
certificate may be issued or may pertain, the coverage afforded described herein is subject to all the terms,exclusions and
conditions of such coverage. Limits shown may have been reduced by paid claims.
Coverage Effective Coverage Expiration
Type of Coverage Certificate Number Date Date Limits
Property
Real&Personal Property
General Liability Genei at Aggregate 2,000,000
Products-Comp/OP Agg
�✓ Occurrence Personal&Adv Injury
Claims Made 8558 7/l/2008 7/1/2009 Each OMirrence 500,000
®
Fire Damage(Any one fire)
Med Exp(Any one pei son)
Excess Liability
8558 7/l/2008 7/1/2009 Each Occurrence 500,000
Other
Each Occm rence
Desctnption of Operations/LocationsNehicles/Special Items
Coverage only extends for claims arising out of Emergency Assistance and HOME Men's Shelter,Emergency Assistance to Families and
Individuals, and Intake for Cold Weather Shelter in Kent, WA,for the term of the certificate Includes $1,000.000 Counseling Errors&
Omissions Coverage Excludes Medical and Legal Liability Includes CMRS XS $900,000 XS$100,000 S I Auto
Holder of Certificate rtr Cancellation
Additional Protected Person(s) Should any of the above described coverages be cancelled
City of Kent,Its Elected& Appointed Officials,and Its before the expiration date thereof,the issuing company will
Employees &Agents endeavor to mail days written notice to the holder of
certificate named to the left, but failure to mail such notice shall
impose no obligation or liability of any land upon the company,
its agents or representatives
- Authorized Representative
00002044
ENDORSEMENT
(TO BE ATTACHED TO CERTIFICATE)
Effective Date of Endorsement 7/1/2008 Charge Credit
Cancellation Date of Endorsement 7 l 200
Certificate Holder Corporation of the Catholic Archbishop of Seattle
Chancery Office
710 9th Ave
Seattle, WA 98104
Certificate No 8558 of The Catholic Mutual Relief Society is amended as follows
SECTION II- ADDITIONAL PROTECTED PF,RSON(S)
It is understood and agreed that Section II-Liability(only with respect to Coverage D-General
Liability,Coverage F-Medical Payments to Others and Coverage H-Counseling Errors and Omissions) is
amended to include as an Additional Protected Person(s) members of the organizations shown in the
schedule,but only with respect to their liability for the Protected Person(s) activities or activities they
perform on behalf of the Protected Person(s)
It is further understood and agreed that coverage extended under this endorsement is limited to and applies
only with respect to liability assumed by contract or agreement,and this extension of
coverage shall not enlarge the scope of coverage provided under this certificate or increase the limit of
liability thereunder Unless otherwise agreed by contract or agreement,coverage extended under this
endorsement to the Additional Protected Person(s) will not precede the effective date of this certificate of
coverage endorsement or extend beyond the cancellation date
Schedule-ADDITIONAL PROTECTED PERSON(S)
City of Kent,Its Elected&Appointed Officials,and Its Employees&
Agents
Remarks Coverage only extends for claims arising out of Emergency Assistance and HOME Men's
Shelter,Emergency Assistance to Families and Individuals, and Intake for Cold Weather
Shelter in Kent, WA, for the term of the certificate Includes $1,000,000 Counseling Errors
&Omissions Coverage Excludes Medical and Legal Liability Includes CMRS XS
$900,000 XS $100,000 S I Auto
+n�—f�
l� AW-U4
Authorized epresentative
PKS122(1-99)
White, Tammy
From: Hills, Chris
Sent: Friday, May 15, 2009 10 43 AM
To: White, Tammy
Cc: Johnson, Jason, Johnson, Kathenn
Subject: RE Insurance Question
Tammy and Jason,
I have confirmed that the illegible code provided on the Certificate actually means that CCS has a $100,000 SIR and has
an Excess policy through Catholic Mutual in the amount of$900,000.
Thus, they have $1,000,000 worth of Auto Liability coverage and comply with the requirements I set.
Let me know if there are any additional questions,
Chris
From: White, Tammy
Sent: Wednesday, May 13, 2009 7:36 AM
To: Hills, Chris
Cc: Johnson, Jason
Subject: Insurance Question
Chris,
Jason has a couple of contracts with Catholic Community Services (CCS) where you have asked
for auto coverage in the amount of $1 million covering all owned, non-owned, hired, and leased
vehicles. The only reference that CCS has for auto coverage is the statement on the attached
certificate that says "XS $100,000 S.I. Auto." I assume that this means CCS' auto coverage is
self-insured, but the certificate does not say to what vehicles it extends. Will you accept this as
proper evidence of auto coverage? Also, will you accept this significant reduction in the amount
of auto coverage you requested?
The only contract that really requires any driving is a 2-year, $20,000 contract for volunteer
chore services where CCS staff or volunteers will provide in-home chore assistance. However,
the description of work also provides that CCS will provide transportation for low income
disabled adults.
Can you let me know your thoughts on this? Jason said it had taken him a long time just to get
these insurance documents from CCS.
<< File. 20090513072658847 pdf>>
Thanks.
Tammy
Law
5774
1
KENT Exhibit F
PARKS RECREATION S
COMMUNITY SERVICES City of Kent
Certification Regarding Debarment and Suspension
Agency Name of Program(s)
Certification A: Certification Regarding Debarment, Suspension, and Other Responsibility
Matters - Primary Covered Transactions
1. The prospective primary participant certifies to the best of its knowledge and belief that its principals,
a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal debarment or agency,
b) Have not within a three-year period preceding this proposal, been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a
public transaction, violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification, or destruction of records, making false statements, or receiving
stolen property,
c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this
certification, and
d) Have not within a three-year period preceding this application/ proposal had one or more public
transactions(Federal, State, or local)terminated for cause or default
2. Where the prospective primary participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal
Instructions for Certification (A)
1 By signing and submitting this proposal, the prospective primary participant is providing the
certification set out below
2 The inability of a person to provide the certification required below will not necessarily result in
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
S 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 of Primary Contractor/Sub-Contractor Title Date
(a
Adopted from HUD Forth-2992
OWN
3of3
REQUEST FOR MAYOR'S SIGNATURE
• Please Fill in All Applicable Boxes
KEMT
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT)
Originator: Jason Johnson Phone (Originator): 5061
Date Sent: 01/27/2009 Date Required:
Return Signed Document to: 3. Johnson CONTRACT TERMINATION DATE: 12/31/2009
VENDOR NAME: Catholic Community DATE OF COUNCIL APPROVAL: 12/09/2008*
Services - HOME Men's Shelter
Brief Explanation of Document: Human Services General Fund contract with Catholic
Community Services. Catholic Community Services will provide staffing to the H.O.M.E.
Men's Shelter in Kent.. This CSA is a one year contract for 2009, with the 2010 yeaF of
funding contingent upon availability of funds and successful agency performance.
*Passed as part of the 2009 City of Kent budget
All Contracts Must Be Routed Through The Law Department
]] (This area to be completed by the Law Department) 111 -' y � Jam' VYir
Received: 1.iVt� d�l,fl�iC - t e to
r ?�iL
Approval of LavM40pt.:a 2009 �✓ is /� '(���� S
�$ j Ate
Law D ><l e[A DEPT
Date Forwarded to Mayor:
Shaded Areas To Be Completed By Administration Staff
Received:
l,' 1
Recommendations and Comments: 1J U
Disposition:
Date Returned: