HomeMy WebLinkAboutAD09-098 - Original - Green River Community College - 2009 Small Business Assistance Program - 04/07/2009 Records Mlanniel�gementKENTDocumentC�
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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 Clerks Office.
Vendor Name: �P-I) r
f dor Number:
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Contract Number �ocq-
This is assigned by Deputy City Clerk
Description: 4?
Detail
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Project Name: ram, ems;� 'L / 40
Contract Effective Date: J Termination Date:
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager::]�, f�Vd� Department: / Ca . 4".
Abstract:
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5 Pubhc\RecordsManagement\Forms\CondractCover\ADCL7832 07/02
KENT
AASH I4G TON
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Green River Community College's (GRCC)
Kent Small Business Assistance Center (SBAC)
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Green River Community College's Kent Small Business Assistance
Center organized under the laws of the State of Washington, located and doing business at 417
Ramsey Way, Suite 112, Kent, WA. 98032, (253) 856-9595 (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:
Green River Community College's Kent Small Business Assistance Center shall offer
to Kent residents and to individuals seeking to open a business in Kent one-on-one
counseling and classes as described in Counsultant's scope of services, which is
attached and incorporated as Exhibit A.
Consultant further represents that the services furnished under this Agreement will be
p 9
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.
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to
exceed $21,102.00 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) for a period of
one (1) year from the effective date of 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. By their execution of this
Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following
representations:
A. 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.
B. The Consultant maintains and pays for its own place of business from which
Consultant's services under this Agreement will be performed.
C. The Consultant has an established and independent business that is eligible
for a business deduction for federal income tax purposes that existed before
the City retained Consultant's services, or the Consultant is engaged in an
independently established trade, occupation, profession, or business of the
same nature as that involved under this Agreement.
D. The Consultant is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
E. The Consultant has registered its business and established an account with
the state Department of Revenue and other state agencies as may be
required by Consultant's business, and has obtained a Unified Business
Identifier (UBI) number from the State of Washington.
F. The Consultant maintains a set of books dedicated to the expenses and
earnings of its business.
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
CONSULTANT SERVICES AGREEMENT - 2
(Over$10,000)
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.
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 B 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
CONSULTANT SERVICES AGREEMENT - 3
(Over$10,000)
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.
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.
CONSULTANT SERVICES AGREEMENT - 4
(Over$10,000)
H. Compliance with Laws The Consultant agrees to comply with all federal, state, and municipal
laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business,
equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance
of those operations.
IN WITNESS, the parties below execute this Agreement,which shall become effective on the last
date entered below.
CONSULTANT: CITY OF KEN
By: By:
(signal ereJ (s+gnalure)
Print Name* �S)r� ��� Pri ame S)zetteCooke
Its ��j � _ yz nG6, C ylSea Its a or
J (�irre) �tl
DATE: 31 2-3 / C3 �� DATE: � i� 9
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Leslie Moore Ben Wolters
Green River Community College's Economic Development Director
Kent's Small Business Assistance Center City of Kent
417 Ramsey Way, Suite 112 220 Fourth Avenue South
Kent, WA 98032 Kent, WA 98032
253-833-9111 x 3375 (telephone) (253) 856-5703 (telephone)
253-288-3480 (facsimile) (253) 856-6700 (facsimile)
APPROVED AS TO FORM:
nt f4 Wartment
CONSULTANT SERVICES AGREEMENT-4
(Over$10,000)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all
contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with
the regulations of the City's equal employment opportunity policies.
The following questions specifically identify the requirements the City deems necessary for any contractor,
subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is regmred 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 \�k_cM C_ , 200 .
By:_ 6�
For: Kent's Small Business Assistance Center
Title: Dean for Branch Campuses and Continuing Education
Date: March 23, 2009
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 opportumty 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 rtwt� Cc 11g Gtnn am hereby
acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement
aid S-m
known as C'Q i wws l/'-0-1,t-e W- 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 2 day of�C-L_ , 200-1.
By:
For: Kent's Small Business Assistance Center
Title: Dean for Branch Campuses and Continuing Education
Date: March 23, 2009
EEO COMPLIANCE DOCUMENTS-3
EXHIBIT A
Following is the Scope of Service for the Consultant Services Agreement between the
City of Kent and Green River Community College's Kent Small Business Assistance
Center for the calendar year 2009
I. Description of Work
Consultant shall perform the following services for the City in accordance with the
following described plans and/or specifications:
Green River Community College's Kent Small Business Assistance Center shall offer to
Kent residents and to individuals seeking to open a business in Kent one-on-one
counseling and classes in the following areas.
Small Business management
Buying or selling a business
Business location analysis
Marketing and sales
Financial and cash flow management
i luman Resource management
Expanding into new markets
Inventory control
Strategic planning
Sources of capital
Business plan development
Focus on addition clients on the East lhll of Kent
Increase specified training topics such as business stabilization in tough times
Counseling sessions shall be available at no cost to the client. Workshops and classes
shall be available at a low cost to the participant Lending options shall be available for
those clients needing capital The consultant shall provide quarterly reports to the City
(sec template, Exhibit A) on number of clients served, number of counseling hours,jobs
created and saved, new loan proposals and loans approved.
Consultant further represents that the services furnished under this Agreement will be
perlonned in accordance with generally accepted professional practices in effect at the
time those services are performed
Amount being awarded by the City of Kent for 2009 is $21,102 00, to be reimbursed
quarterly to Green River Community College upon receipt of their invoice
Template
Exhibit A
Kent Small Business Assistance Center
k. ��� 417 Ramsay Way, Suite 112
-- — - - Kent, WA 98032-4501
C O M M U N I T Y C 0 L L E G E (253) 856-9595
Kent Business Development Report: First Quarter 2009
Current Quarter Year-To-Date 2009
All Counseling Sessions with
All Kent Clients
One on One Counseling is a session that is 45 minutes or more spent with an individual client
All Counseling Sessions with
Kent City Limit Clients
One on One Counseling is a session that is 45 minutes or more spent with an individual client.
New Counseling Clients who
Meet CDBG Requirements
Counseled clients(from above)who met CDBG requirements
Total Counseling Hours
Counseling hours include individual client meetings and prep time.
Jobs Created or Saved
`Jobs Created' is defined by the number of Jobs created through the expansion of a current business or the start up of a
new business `Jobs Saved' are determined by client follow-up and whether services received impacted ability to maintain
Jobs, the services may be assistance with loans,business plans,and access to resource information
New Loan Proposals
New loan proposal numbers and dollar value are based on reviewing clients' loan applications,assisting clients in
completing loan applications, and referring clients to banks to submit applications
Loans Approved
`Loans Appro,,ed' indicates the number and dollar values of loans approved by lending institutions
EXHIBIT B
INSURANCE REQUIREMENTS FOR
CONSULTANT SERVICES AGREEMENTS
Insurance
The Consultant 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 Consultant, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Consultant shall obtain insurance of the types described below:
1. 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.
2. 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 Consultant's Commercial General
Liability insurance policy with respect to the work performed
for the City using ISO additional
insured endorsement CG 20 10 11 85 or a substitute
endorsement providing equivalent coverage.
B. Minimum Amounts of Insurance
Consultant shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined
single limit for bodily injury and property damage of
$1,000,000 per accident.
2. 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.
EXHIBIT B (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 Consultant'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 Consultant's
insurance and shall not contribute with it.
2. The Consultant'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 Consultant 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 Consultant'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
Consultant 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 Consultant before commencement of the work.
F. Subcontractors
Consultant 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 Consultant.
I
-CERTIFICATE OF LIABILITY INSURANCE Issue Date0311212007
ISSUED BY: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
State of Washington AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Office of Financial Management CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
Risk Management Division AFFORDED BY THE STATE OF WASHINGTON SELF INSURANCE-
PO Box 41027 LIABILITY PROGRAM.
Olympia WA 98504-1027
COVERAGE AFFORDED BY
State of Washington Self Insurance Liability Program
INSURED: THE STATE OF WASHINGTON, INCLUDING ALL ITS AGENCIES AND
DEPARTMENTS, 13 SELF-INSURED FOR TORT LIABILITY CLAIMS. ALL
State of Washington CLAIMS MUST BE FILED WITH THE STATE OFFICE OF RISK
Green River Community College MANAGEMENT FOR PROCESSING IN ACCORD WITH STATUTORY
ATTN Darcy Silvest REQUIREMENTS.
12401 SE 320th Street
Auburn WA 98002
THIS IS TO CERTIFY COVERAGE DESCRIBED BELOW IS PROVIDED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED NOT
WITH STANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBJECT
TO ALL THE TERMS,EXCLUSIONS,AND CONDITIONS OF SUCH PROGRAM.
POLICY EFFECTIVE EXPIRATION
TYPE OF COVERAGE NUMBER DATE DATE LIMITS
GENERAL LIABILITY Self-Insured Continuous Continuous BODILY INJURY, PROPERTY $5,000,000
® GENERAL LIABILITY DAMAGE&PERSONAL INJURY
® OCCURRENCE COVERAGE COMBINED EACH OCCURRENCE
AUTOMOBILE LIABILITY BODILY INJURY&PROPERTY $5,000,000
❑ANY AUTO DAMAGE COMBINED EACH
®ALL OWNED AUTOS ACCIDENT
❑SCHEDULED AUTOS
❑HIRED AUTOS
❑NON-OWNED AUTOS
WORKERS COMPENSATION AND STATUTORY
EMPLOYERS LIABILITY
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS: Coverage applies as respects tort liability Claims against
the State of Washington as covered by the Tort Claims Act (RCW 4 92 et seq} The Certificate Holder Is named as,
additional insured, but only as respects the negligence of the State of Washington.
-CEIR'1TIFICATE-HOLDER: C/#N ELLATIF}N
CITY OF KENT SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, THE
STATE OF WASHINGTON WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN
ATTN: BEN WOLTERS, DIRECTOR ECONOMIC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
DEVELOPMENT TO MAIL SUCH NOTICE SHALL NOT IMPOSE ANY OBLIGATION OR LIABILITY
200 FOURTH AVENUE UPON THE STATE OF WASHINGTON, ITS OFFICIALS, EMPLOYEES, AGENTS
OR REPRESENTATIVES.
KENT,WA 98032
A=ZEREPRESE TIVE:
CERTIFICATE NUMBER CRT 07-296 dministrator
REQUEST FOR MAYOR'S SIGNATURE
KENT Please Fill In All Applicable Boxes
WASHINGTON
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT)
Onginator: w"d L } �S Phone (Originator).
Date Sent: 3 ( 3� j D r Date Requned:
Return Signed Document to: CONTRACT TERMINATION DATE: ►:3i �6
VENDOR NAME: & r DATE OF COUNCIL APPROVAL: �3 D
Brief Explanation of Document: (/�/���f� (� /� hf/i St�,� �/ "(Y7�/�'/y�[���I j,
l f(i�l IN� �' ` ` � Six` 4Jv�� ��r l V '• �'�-�V+.
All Contracts Must Be Routed Through the Law Department
(This Area to be Completed B�,the Law epar tment)
n r
Received:
Approval of Law Dept.: 1 t i PVV
Law Dept. Comments: 1��.�'�� v; `- i0,0" Cj
Date Forwarded to Mayor: (n
Shaded Areas to Be Completed by Administration Staff rr.�
Received.
Recommendations & Comments: hi 4wi
T'OF KENT
Disposition: CITY
Date Returned:
Iage5870 • 3/05