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KENT
Document
WASHINGTON
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: Children's Home Society
Vendor Number: 34209
JD Edwards Number
Contract Number: PrOq, CS o9,
This is assigned by City Clerk's Office
Project Name: Strengthening Families
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: 1-1-2009 Termination Date: 12-31-2010
Contract Renewal Notice (Days): 30 (thirty)
Number of days required notice for termination or renewal or amendment
Contract Manager: Merina Hanson Department: Parks - Human Services
Detail: (i.e. address, location, parcel number, tax id, etc.):
Human Services General Fund contract with Children's Home Society for the
Strengthening Families program.
5 Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08
r
KENT
W AS MI N G T 0 N
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Children's Home Society
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Children's Home Society of Washington organized under the laws of
the State of Washington, located and doing business at 3300 NE 65`h Street, Seattle, WA 98115
(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 administer the Strengthening Families project, reaching out to low-
income families with children ages birth to five. 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, 2010. 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 $40,000 ($20,000 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 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. S - BFNae:::
e)
(signature)
D signature)Print Name: - Przee
Cooke
Its President CEO It or(rat
DATE: " a` 9 DATE: 3 7 V
CONSULTANT SERVICES AGREEMENT - 4
(Over$10,000)
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
D. Sharon Osborne Katherin Johnson, Human Services Manager
Children's Home Society City of Kent
PO Box 15190 220 Fourth Avenue South
Seattle, WA 98115 Kent, WA 98032
(206) 695-3200 (telephone) (253) 856-5070 (telephone)
(206) 695-3201 (facsimile) (253) 856-6070 (facsimile)
A ROVED TO FORM:
Ke t La partment
P Human Semic \General Fund\Geneal Fund 2009-1010 Camact\Chlldren's Home Sodety CSA 2009-2010 doc
r
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_.
By: -
For: D. Sharo Osborne, President/CEO
Title: Vice President, Operations
Date:
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
Hanson, Merina
From: Marilyn Detrick- 01 [ManlynD@chs-wa org]
Sent: Tuesday, February 24, 2009 2 36 PM
To: Hanson, Menna
Cc: Sharon Osborne -01
Subject:" RE PLEASE REPLY re contract
CYes, enna Please make that exchange
nice talking with you
n Detrick
Director of Administration
Children's Home Society of Washington
206-695-3281
-----Original Message-----
From: Hanson, Menna [mailto:MHanson@cLkent.wa.us]
Sent: Tuesday, February 24, 2009 2:30 PM
To: Marilyn Detrick - 01
Cc: Sharon Osborne - 01
Subject: FW: PLEASE REPLY re: contract
Importance: High
Hi Marilyn...
As we discussed on the phone today, please reply back to this e-mail giving me permission to swap out
the first page of the 2009-2010 CSA between the City of Kent and Children's Home Society The new
language addresses the two-year nature of the contract and acknowledges that the second year of
funding is dependent upon availability of funds, etc.
Thanks!
Merina Hanson
From: Hanson, Menna
Sent: Thursday, February 19, 2009 8:40 AM
To: 'sharono@chs-wa.org'
Subject: PLEASE REPLY re: contract
Importance: High
I received your signed contracts, however the first page was not replaced as requested in this email.
If you give me permission via email I can swap out the page, otherwise I will need to send the entire
contract back to your attention with the revised page included Sorry for any confusion and please let
me know if you have any questions.
Merina Hanson
Kent Housing & Human Services
1
From: Hanson, Merina
Sent: Wednesday, January 21, 2009 11:33 AM
To: 'sharono@chs-wa.org'
Subject: Children's Home Society CSA 2009-2010.doc
Importance: High
Good afternoon! I hope that you received the e-mail message yesterday regarding
the need for additional language in the CSA you recently received from the City of
Kent. I have attached the CSA with the updated language in Section II, Time of
Completion. Please print three copies of the first page of your CSA and replace
with the first pages of the three copies you have in hand. Please call me with any
questions.
Mert a.f(a v ow
Senior Human Services Coordinator
City of Kent Housing & Human Services
220 4th Ave S.
Kent, WA 98032
T 253.856 5070 1 F 253.856.6070
mhansonOci.kent.wa.us
www.ci.kentma us
<<Children's Home Society CSA 2009-2010 doc>>
2
�. Exhibit A
WASHINOTON KENT Scope and Schedule of Work
PARKS, RECREATION S COMMUNITY SERVICES 2009-2010 Consultant Services Agreement
Agency: Children's Home society of Washington 2009 Funding:. $20 000
Program: Strengthening Families 2010 Funding: $20 000
This funding Comprehensive services for low-income families with
will provide: children aged birth to five Total: $40,000
Annual Program Outputs: Program Outcome:
Unduplicated Kent Clients 6 Improved birth to 5 services
Home Visits 91
Days of Child Care 81
Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1, 2009, Children's
Home Society of Washington shall provide the approximate number of City of Kent clients with the
following services each year of the CSA:
Quarter Service Unit Number of "' Cum-mulative
Units Total
1st Unduplicated City of Kent clients served 1 1
Home Visits 22 22
Days of Child Care 20 20
2" Unduplicated City of Kent clients served 1 2
Home Visits 23 45
Days of Child Care 20 40
3rd Unduplicated City of Kent clients served 2 4
Home Visits 23 68
Days of Child Care 20 60
4th Unduplicated City of Kent clients served 2 6
Home Visits 23 91
Days of Child Care 21 81
The above services shall be provided by December 31, 2009 for year one of the two-year agreement and
December 31, 2010 for year two 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)
J11
• Scope and Schedule of Work
KENT
WASHINGTON 2009-2010 Consultant Services Agreement
PARKS, RECREATION S
COMMUNITY SERVICES
Agency: Children's Home Society of Washington 2009 Funding: $20,000
Program: Strengthening Families 2010 Funding: 20 000
This funding Comprehensive services for low-income families with
will provide: children aged birth to five Total: $40,000
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 (or online if requested) by the loth of the following month for
the previous quarter of service. The reporting timeline is as follows:
a.��r,
Report "Due Date "„ !
Billing Voucher & Service Report (Exhibit B) loth day following each quarter
Final Billing Voucher (4th Qtr Exhibit B) December 15th, 2009/December 15th, 2010
Outcome Based Evaluation Report (Exhibit C) January 29th, 2010/January 31st, 2011
Client Demographic Data (Exhibit D) January 291h, 2010/January 315t, 2011
Signature
Please sign below to indicate acceptance of the Year 2009 and Year 2010 Performance Measures listed
above.
D. Sharon Osbo n ildren's Home Society GEE) of WA Date
Press
Katherin Johnsoh-,"HJ'rr<n §6rvices ganager Date (�
Exhibit B General Fund
KENT Billing Voucher & Service Report
V✓ASHINGTON 2009-2010
PARKS, RECREATION S
COMMUNITY SERVICES
To: Hanson Agency: Children's Home Society of WA
MerinaHousing & Human Services
Parks, Recreation & Community Services Program Contact: John Nae ele
220 4th Ave. South, Kent, WA 98032 Telephone: (253) 852-2584 g „ -
mhanson(a)ci kent wa us E-mail: johnn@chs-wa.org
Phone: (253) 856-5077
Reporting Period Program Amount Requested
Strengthening Families $
BUDGET SUMMARY
O �PAF >1+)115 `ONt x'` , Total Contract Amount $ 20,000 (per year)
Current Request $
Amount Remaining $
2009/2010
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
P Each Quarter Service Units Service Units (ALL Funding
This Quarter To Date Sources
Service UnitlPerformance Measure 1 st 2nd 13` 4
Unduplicated # of Kent clients served 1 1 2 2
Number of Home Visits 22 23 23 23
Days of Child Care 20 20 20 21
*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
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KENT Exhibit D Program
Annual Demographic Report Date
COMMUNITY SERVIIICES 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
N—ormandy Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated King Count
Unknown
TOTAL
Household Income Level
30% of Median or Below
50%of Median or Below
80%of Median or Below
Above 80% of Median
Unknown
TOTAL
Gender
Male
Female
TOTAL
Age
0-4 years
5- 12 years
13- 17 years
18-34 years
35-54 years
55-74 years
75+years
Unknown
TOTAL
Ethnicity
Asian/Pacific Islander
Black/African American
Hispanic/Latino(a)
Native American/Alaskan Native
White/Caucasian
Other
Unknown
TOTAL
Female Headed Household
Disabling Condition
Limited English Speaking
Unduplicated means count each client only once per calendar year
"List of all clients served in client residence category and Kent clients only in rest of the categories
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.
2. Automobile Liability insurance covering all owned, non-owned,
hired and leased vehicles. Coverage shall be written on
Insurance Services Office (ISO) form CA 00 01 or a substitute
form providing equivalent liability coverage. If necessary, the
policy shall be endorsed to provide contractual liability coverage.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Commercial General Liability insurance shall be written with
limits no less than $1,000,000 each occurrence, $1,000,000
general aggregate and a $1,000,000 products-completed
operations aggregate limit.
2. Automobile Liability insurance with a minimum combined single
limit for bodily injury and property damage of $1,000,000 per
accident.
EXHIBIT E (Continued )
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the
following provisions for Automobile Liability and Commercial General
Liability insurance:
1. The Contractor's insurance coverage shall be primary insurance as
respect the City. Any Insurance, self-insurance, or insurance pool
coverage maintained by the City shall be excess of the Contractor's
insurance and shall not contribute with it.
2. The Contractor's insurance shall be endorsed to state that coverage
shall not be cancelled by either party, except after thirty (30) days
prior written notice by certified mail, return receipt requested, has
been given to the City.
3. The City of Kent shall be named as an additional insured on all
policies (except Professional Liability) as respects work performed
by or on behalf of the contractor and a copy of the endorsement
naming the City as additional insured shall be attached to the
Certificate of Insurance. The City reserves the right to receive a
certified copy of all required insurance policies. The Contractor's
Commercial General Liability insurance shall also contain a clause
stating that coverage shall apply separately to each insured against
whom claim is made or suit is brought, except with respects to the
limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating
of not less than ANII.
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of
the amendatory endorsements, including but not necessarily limited to
the additional insured endorsement, evidencing the insurance
requirements of the Contractor before commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insureds under its
policies or shall furnish separate certificates and endorsements for
each subcontractor. All coverages for subcontractors shall be subject
to all of the same insurance requirements as stated herein for the
Contractor.
White, Tammy
From: Hills, Chris
Sent: Monday, March 16, 2009 9 29 AM
To: White, Tammy
Subject: RE Insurance Question
Tammy,
Yes, it's ok for this year.
I will handle this the same way we've dealt with the other Human Services claims-made policies. I have a call in to
Menna and will request she have them alter their coverage at renewal.
Thanks for bringing this to my attention,
Chris
From: White, Tammy
Sent: Friday, March 13, 2009 2:00 PM
To: Hills, Chris
Subject: Insurance Question
Chris,
Human Services is entering into a contract with Children's Home Society to provide various
services to low income families. The Comm'I Gen'I Liability Coverage is only on a claims-made
basis. Will you accept this coverage limitation?
<< Message: FW. PLEASE REPLY re. contract» << Message: Certificate.pdf-Adobe Reader»
Thanks.
Tammy.
1
Client# 573815 CHILDHOM2
ACORD.M CERTIFICATE OF LIABILITY INSURANCE 12124108°NY'"'
PRODUCER THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION
Kibble&Prentice,a USI Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 370 HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Seattle,WA 98111
206 441-6300 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA Philadelphia Insurance Company 23850
Children's Home Society Of WA INSURERB Philadelphia Indemnity Insurance Co. 18058
P.O. Box 15190
INSURER C
Seattle,WA 98115
INSURER D
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
I POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRH TYPE OF INSURANCE POLICY NUMBER DATE MM D/YYI DATE(MMfDD/YYI LIMITS
A GENERAL LIABILITY PHPK316199 06/01/08 06/01109 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY PREMIETORENTED $300000
X CLAIMS MADE DOCCUR MED EXP(Any one person) $15 000
PERSONAL&ADV INJURY S1 00O 000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMPlOPAGG s2,000,000
POLICY P
JECTRO LOC
A AUTOMOBILE LIABILITY PHPK316199 06/01/08 06/01/09 COMBINED SINGLE LIMIT $1 000
X ANY AUTO (Ea accident) r ,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS
BODILY INJURY $
X NON OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG S
B EXCESSIUMBRELLA LIABILITY PHUB240309 06/01/08 06/01/09 EACH OCCURRENCE $10 000 000
OCCUR CLAIMS MADE AGGREGATE S10,000,000
S
DEDUCTIBLE S
X RETENTION $10000 S
A WORKERS COMPENSATION AND PHPK316199 06/01/08 06/01/09 NrSTATU-�JTj I ER
OTH-
DRYEMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WA STOP GAP E L EACH ACCIDENT S1,000,000
OFFICERIMEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE 0,000,000
If yes,descnbe under
SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT S1,000,000
A OTHER Package-Co PHPK316199 06/01/08 06/01/09 1,000,000 Occ
2,000,000 Agg
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
*10 Days notice non-payment
Re Kinship Navigators Services; Family Caregiver Support Program; Kinship
Caregivers Support Program
The State of Washington,Southwest Washington Agency on Aging and Disabilities,their
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Southwest Washington Agency on DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ 45 DAYSWRITTEN
Aging&Disabilities NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
201 NE 73rd St,Suite 201 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Vancouver,WA 98665-8343 REPRESENTATIVES
Attn:Alicia Sampath A THORIZED REPRESENTATIV
ACORD 25(2001108)1 of 3 #S3237203IM3237202 DJWJU o ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may
require an endorsement A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsements)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon
ACORD 25S(2001/08) 2 of 3 #S3237203/M3237202
DESCRIPTIONS (Continued from Page 1)
elected and appointed officials,agents,and employees are included as an additional
insured as respects written contract.
AMS 25 3(2001/08) 3 of 3 #S3237203/M3237202
POLICY CHANGE DOCUMENT
POLICY NO.: PHPK316199
Philadelphia Indemnity Insurance Companyl 6211 KIBBLE & PRENTICE COMMERCIAL INSUR
NAMED INSURED Children's Home Society of Washington
Childrens Home Society Asset Management
MAILING ADDRESS PO Box 15190
Seattle, WA 98115-0190
POLICY PERIOD FROM 06/01/2008 TO 06/01/2009 at
12 01 A M Standard Time at your mailing address shown above
CHANGE EFFECTIVE 03/04/2009 CHANGE# 13
DESCRIPTION
In consideration of the premium reflected, the policy is amended as indicated below
Added:
CG2005 Additional Insured-Controlling Interests
City of Kent
Housing & Human Services
Attn: Menna Hanson
220 4th Ave S
Kent, WA 98032
With respect to funding provided for the Strengthening Families Program
conducted by the insured.
Per attached schedule
Path ID 3510949
Total Annual Total Prorate
Additional/Return Premium$ 0.00 Additional/Return Premium$ 0.00
NO CHANGE NO CHANGE
COUNTERSIGNED BY
(Date) (Authorized Representative)
Insurance Policy Page 1 of 1
8
Philadelphia Indemnity Insurance Company
Additional Insured Schedule
Policy Number: PHPK316199
Additional Insured
City of Covington
Human Services Department
Attn Victoria Throm
16720 SE 271st St Ste 100
Covington, WA 98042-7342
CG2026 - General Liability
Additional Insured
City of Kent Parks, Rec. & Comm Services
220 4th Ave S
Kent, WA 98032-5838
CG2026 - General Liability
Additional Insured
Douglas County, Their Depts Elected &
Appointed Officials Employees and Agents
PO Box 15190
Seattle, WA 98115
CG2026 - General Liability
Additional Insured
King County Mental Health Chemical Abuse
& Dependency Services Division, It's
Officers, Officials, Employees & Agents
821 2nd Ave Ste 610
Seattle, WA 98104-1539
CG2026 - General Liability
Additional Insured
King County Mental Health Chemical
Abuse & Dependency Services Division
821 2nd Ave Ste 610
Seattle, WA 98104-1539
CG2026 - General Liability
Page 1 of 4
Philadelphia Indemnity Insurance Company
Additional Insured Schedule
Policy Number: PHPK316199
Additional Insured
Seattle King County Dept of Public
Health
999 3rd Ave Ste 1520
Attn: Jeffrey Brown
Seattle, WA 98104-4060
CG2026 - General Liability
Additional Insured
Wenatchee Valley YMCA
Director or Health Enhancement
Attn; Aaron Lindholm
PO Box 1974
Wenatchee, WA 98807-1974
CG2026 - General Liability
Additional Insured
King County Community Sery Div
821 2nd Ave Ste 500
Attn Natalie Buys
Seattle, WA 98104-1537
CG2005 - General Liability
Additional Insured
City of Vancouver Event Management
PO Box 1995
Vancouver, WA 98668-1995
CG2026 - General Liability
RE: The Born Learning Event, Ester Park, May 12, 2007
Page 2 of 4
Philadelphia Indemnity Insurance Company
Additional Insured Schedule
Policy Number: PHPK316199
Additional Insured
The City of Renton
Attn: Jim Lovsted GVA Kidder
Mathews Property Management
601 Union St Ste 4720
Seattle, WA 98101-1356
WA - Loc #17 - 334 (BLDG/PREMS-OFFICE-NOC-NFP)
CG2011 - WA - Loc #17 - 334 (BLDG/PREMS-OFFICE-N CC-NFP)
Additional Insured
City of Renton
Human Services Division
Renton City Hall
1055 S Grady Way FI 5
Renton, WA 98057-3232
WA - Loc #17 - 334 (BLDG/PREMS-OFFICE-NOC-NFP)
CG2026 - WA - Loc #17 - 334 (BLDG/PREMS-OFFICE-NOC-NFP)
Additional Insured
Lifel-ink International Adoption
331 S York Rd
Bensenville, IL 60106-2673
CG2026 - General Liability
Page 3 of 4
Philadelphia Indemnity Insurance Company
Additional Insured Schedule
Policy Number: PHPK316199
Additional Insured
City of Renton HR&RM
Attn Paulie Sulky
1055 S Grady Way
Renton, WA 98057-3232
CG2005 - WA - Loc #17
Additional Insured
Municipal Court of Seattle
Attn: Lorri Cox, Sr Court Specialist
PO Box 34987
Seattle, WA 98124-4987
CG2026 - General Liability
As respects the drop in day care services
Additional Insured
City of Kent
Housing & Human Services
Attn. Menna Hanson
220 4th Ave S
Kent, WA 98032-5838
CG2005 - General Liability
With respect to funding provided for the Strengthening Families
Page 4 of 4
KETIT Exhibit F
w.
PARKS RECREATION S
COMMUNIN 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
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
Primary Contractor/Sub-Contractor(Punt) Title Date
Children ' s Home Society of A President/CEO
Si a ur f Pnma Contractor/S ontractor Title Date
X S
c�
Adopted from HUD Form-2992
09/04
3of3
REQUEST FOR MAYOR'S SIGNATURE
® Please FIII in All Applicable Boxes
ICEAIT
WA.....T X S\
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAIN DEPARTMENT) \ 2(
Originator: Merina Hanson Phone (Originator): x5077
Date Sent: February 10, 2009 Date Required: February 19, 2009
Return Signed Document to: M. Hanson CONTRACT TERMINATION DATE: 12-31-2010
VENDOR NAME: Children's Home Society DATE OF COUNCIL APPROVAL: 12-09-2008*
Brief Explanation of Document:
Human Services General Fund contract with Children's Home Society of Washington for
the Strengthening Families program, reaching out to low-income families with children
ages birth to five. This CSA is a two year contract for 2009-2010, with the second year
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 b;completed by the Law Department)
Received: (���L�1
� �l� I}� i1144
s;
Approval of Law Dept.: C�rtwt1 �{, �� ��ir Y�t i ��i Ih!4,
ft
Law Dept. Comments: A V rz
(e"d 7
Date Forwarded to May
1
Shaded Areas To Be Completed By 4dminfstratron Staff o,I L2
_� _ ; -�� all-
Received: _ -t istf
Recommendations and Comments: j:�of Kent
- 'Office of the Mayor t N
Disposition: / f/ /¢ f
Date Returned: ��