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PK09-101 - Original - HealthPoint - Primary Dental & Primary Medical Programs - 03/09/2009
40 w:w*�., Records Ma-M- --- ---' geme- - -- ZKENT WA5H1.Gr04 _ Document 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: Health Point Vendor Number: 33917 JD Edwards Number Contract Number: P<oR- 10 This is assigned by City Clerk's Office Project Name: Primary Dental and Primary Medical Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 01-01-09 Termination Date: 12-31-10 Contract Renewal Notice (Days): 30 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 Health Point (formerly Community Health Centers of King County) for the Primary Denal and Primary Medical programs. S•Pub I is\RecordsMa nagement\Forms\ContractCover\adcc7832 1 11108 r ��,KcNT WPl....T.I CONSULTANT SERVICES AGREEMENT between the City of Kent and HealthPoint THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and HealthPoint organized under the laws of the State of Washington, located and doing business at 955 Powell Ave SW, Suite A, Renton, WA 98057 (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 Primary Dental and Primary Medical programs to low-income and undennsured residents of Kent. The following exhibits are attached for each program 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 $80,000 ($40,000 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 b or resulting from the concurrent negligence of the Consultant 9 P P Y Y 9 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) 2 a t 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) f 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: ! pure (signature) Print Name: //�o�l B��E Pr' t Na e: S zette Cooke Its It a or (tr e /�/O n DATE: DATE: `� CONSULTANT SERVICES AGREEMENT - 4 (Over$10,000) NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Thomas Trompeter, CEO Katherin Johnson, Human Services Manager HealthPoint City of Kent 955 Powell Ave SW, Suite A 220 Fourth Avenue South Renton, WA 98057 Kent, WA 98032 (425) 277-1311 (telephone) (253) 856-5070 (telephone) (425) 277-1566 (facsimile) (253) 856-6070 (facsimile) A ROVED TO FORM: I Ke t Law" rtment P Human Services\General Fund\General Fund 2009-1010 Contract\HealthPoint CSA 2009-2010 doc 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 fi��e requirements referenced above. Dated this ✓ da -of— �� ijV , 200_. By: l G For: ( ®I Title: C � 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 i Hanson, Merina From: Tom Trompeter[tjtrompeter@HealthPointCHC org] Sent: Friday, February 27, 2009 10 23 AM To: Hanson, Manna Cc: Faith Wimberley Subject: RE Health Point CSA 2009-2010 doc You have my permission to make the substitution From: Hanson, Menna [mailto:MHanson@ci.kent.wa.us] Sent: Friday, February 27, 2009 9:09 AM To: Tom Trompeter Cc: Faith Wimberley Subject: FW: Health Point CSA 2009-2010.doc Importance: High Hi Tom, As we discussed on the phone this morning, I am forwarding you the replacement page for the contract you signed and returned to me. The page attached will replace the first page and includes language that addresses the two year nature of our contracts, and that the second year of funding is dependent upon available funds, etc. Please respond to this email giving me your permission to replace the first page with the page attached. Once I have that I will send your signed contracts through for the Mayor's signature. Thank you! Merina Hanson From: Hanson, Merina Sent: Wednesday, February 25, 2009 10:44 AM To: 'Trompeter@healthpomtchc.org' Subject: FW: HealthPoint CSA 2009-2010.doc Hi Tom. I just received your contracts and I am guessing that you never actually got the message below. notice now that it defaulted to your old chckc org email address. Could you please review the attachment and give me permission via email to swap out the first page of the agreements you signed?Thanks very much! The additional language is required by our City Attorney and addresses the two-year nature of our contracts and that the second year of funding is dependent upon available funds. Please let me know if you have any questions... Merina Hanson 1 Exhibit A v WASHINOTON KENT Scope and Schedule of Work PARKS, RECREATIONS COMMUNITY SERVICES 2009-2010 Consultant Services Agreement Agency: HealthPoint 2009 Fundin $20 000 Program: Primary Dental 2010 Fundin : $20,000 This funding Comprehensive primary dental care to low income and will provide: uninsured families and individuals. Services are provided Total: $40,000 to uninsured and underinsured clients on a sliding-fee scale according to family size and income. Annual Program Outputs: Program Outcome: Unduplicated Kent Clients 146 Increased access tcwrelical services Number of Dental Visits 1 136 Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1, 2009, HealthPoint shall provide the approximate number of City of Kent clients with the following services each year of the CSA: g�Y�_ hd�r 'p''.4hra=-l— r.v89• __ pie. 5c#'�s'"�� o',=� , "^(�y�f :,.. . ,��- _ - _ Quarter= 'Serviceilnit • . umber of �° Cumulative Units Total 15t Unduplicated City of Kent clients served 11 11 Number of dental visits 34 34 Unduplicated 2 nd u t d Cityof Kent clients served 11 22 dlic a Number of dental visits 34 68 3rd Unduplicated City of Kent clients served 12 34 Number of dental visits 34 102 4th Unduplicated City of Kent clients served 12 46 Number of dental visits 34 136 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) • T Scope and Schedule of Work KEN WASH .O,o. 2009-2010 Consultant Services Agreement PARKS, RECREATION S COMMUNI7Y SERVICES A c"�en : HealthPoint 2009 Furidin :� $20 000 Program: Primary Dental 2010-Funding: $20 000 This funding Comprehensive primary dental care to low income and will provide: uninsured families and individuals. Services are provided Total: $40,000 to uninsured and underinsured clients on a sliding-fee scale according to family size and income. 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: Report Due Date Billing Voucher & Service Report (Exhibit B) 10th 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 315L, 2011 Client Demographic Data (Exhibit D) January 291h, 2010/January 315t, 2011 Signature Please sign below to in ica cepta_ of e Year 2009 and Year 2010 Performance Measures listed above. Thomas Trompeter, Ex utive Director AealthPoint Dat J'.:� - o9 Katherin Johnson, man Ser ces M ager Date Exhibit A W nS rviry GrOry KENT Scope and Schedule of Work PARKS, RECREATIONS COMMUNITY SERVICES 2009-2010 Consultant Services Agreement Agency: HealthPoint 2009 Fundin $20 000 Program: Primary Medical 2010 Funding: 20 000 This funding Comprehensive primary medical care to low income and will provide: uninsured families and individuals. Services are provided Total: $40,000 to uninsured and underinsured clients on a sliding-fee scale according to family size and income Annual Program Outputs: . Program ram 6dtc6tyi6. Unduplicated Kent Clients 46 Increased access to medical services Number of Medical Visits 120 Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1, 2009, Health Point shall provide the approximate number of City of Kent clients with the following services each year of the CSA: Quarter' Service ,Number of, __ - Cumulative . Units Total 1st Unduplicated City of Kent clients served 11 11 Number of medical visits 30 30 2nd Unduplicated City of Kent clients served 11 22 Number of medical visits 30 60 3`d Undu licated City of Kent clients served 12 34 Number of medical visits 30 90 4`h Unduplicated City of Kent clients served 12 46 Number of medical visits 30 120 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) • T Scope and Schedule of Work KEN WASHINGTON 2009-2010 Consultant Services Agreement PARKS, RECREATION S COMMUNITY SERVICES Adenc : `° `=','a HealthPoint 2009 Funding: $20,000 Program: Primary Medical 2010 Funding: 20 000 This funding Comprehensive primary medical care to low income and will provide: uninsured families and individuals. Services are provided Total: $40,000 to uninsured and undennsured clients on a sliding-fee scale according to family size and income. 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 10th 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 (4th Qtr Exhibit B) December 151h, 2009/December 15th, 2010 Outcome Based Evaluation Report (Exhibit C) January 29th, 2010/January 315t, 2011 Client Demographic Data (Exhibit D) January 29th, 2010/January 31st, 2011 Signature Please sign below to indicat cept he Year 2009 and Year 2010 Performance Measures listed above. Thomas Trompeter, E ve DirecbVr - HealthPoint Date Katherin Johnson,/HumWserVices Plianager Date Exhibit B General Fund KENT Billing Voucher & Service Report WASHING70N 2009-2010 PARKS, RECREATION S, COMMUNITY SERVICES To: Agency: HealthPoint Merina Hanson Housing & Human Services Parks,Recreation & Community Services Program Contact Faith Wimberley 2204 thAve. South, Kent, WA 98032 Telephone: (425) 203-0419 mhanson(cD,ci.kent wa.us E-mail: Wimberley@healthpointchc.org Phone: (253) 856-5077 Reporting Period Program Amount Requested HealthPoint Primary Dental $ BUDGET SUMMARY J "Fcaa QEPaiirnnENr usE oN�Y" 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 Unit/Performance Measure I't 2n 3r 4 Unduplicated # of Kent clients served 11 11 12 12 Number of dental visits 34 34 34 34 *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 gY; DATE: Exhibit B General Fund KENT Billing Voucher & Service Report WASHINGTON 2009-2010 PARKS, RECREATION S COMMUNITY SERVICES To: Agency: HealthPoint Merina Hanson Housing & Human Services Parks,Recreation & Community Services Program Contact Faith Wimberley 220 4 Ave. South, Kent, WA 98032 Telephone: (425) 203-0419 mhanson(aD_cl.kent wa us E-mail: fwimberley@healthpointchc.org Phone: (253) 856-5077 Reporting Period Program 'Amount Requested HealthPoint Primary Medical $ BUDGET SUMMARY FOR DEPART NIIEIVT=tJSE 1t��Y 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 Unit/Performance Measure i st 2 nd 3 rd 4 th Unduplicated # of Kent clients served 11 11 12 12 Number of medical visits 30 30 30 30 *Please attach a narrative explanation to this report in the event that the program is not meeting performance measures. Authorized Signature Date FOR DEPARTMENT USE ONLY AUTHORIZED FOR PAYMENT BY: DATE: moo _ moo O Cq CN � C6� � Wqn / W O m M m -0 -0 O o 0 J Q � � k 17, Z § § \ co z o 0 � kk / 00 § 2 o d \W �q q q co E < g _ \ / a u \ f _ § W ƒ \ / 5 \ / cu cl 2 0- § U E o / k g 7 : 7 V $ k o 0 0 W o f L) k ƒ ) 222 c 2 > j w _ o 0 0 : 0 \ 2 � ƒ -a@ s ) § z % % 2 @ 2 co �j �j / § k d 3 \ ƒ° ° % 2 o U ■ 2 3 \ < Gei § e 2 E Cl) 0 0 0 $ ƒ Agency KENT Exhibit D Program. Vf.SMIN OTON S Annual Demographic Report Date PARKS, RECREATION COMMUNITY SERVICES Unduplicated Number of Clients Served' Agency/Program Undu licated New Individuals this Year Client Residence" Algona Auburn Black Diamond Buren Covington Des Moines Enumclaw Federal Way Kent Maple Valle Milton Normandy Park Pacific Renton SeaTac Seattle Tukwila Unincorporated King County 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 CONSULTANT 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. 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 1185. 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 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 Consultant 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. I � EXIIIBIT 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 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. AC RD CERTIFICATE OF LIABILITY INSURANCE CSR 1 DATE6/11l/08 COMMLJ-1 06/11/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sprague Israel Giles HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1501 Fourth Avenue, Suite 2000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Seattle WA 98101-1637 Phone: 206-623-7035 Fax:206-682-4993 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Amen can Economy Insurance Co INSURER B General Ins C0 of America Community Health Centers et al INSURER American states Insurance 00 HealthPoint 955 Powell Avenue SW, Suite A INSURER1) Renton WA 98057 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 LTR NSR TYPE OF INSURANCE TNSFFPOLICY NUMBER DATEYMMIDD/rrE DATLI E MMlOD ION LIMITS GENERAL LIABILITY EACH OCCURRENCE s2,000,000 A X X COMMERCIAL GENERAL LIABILITY 02BP466307-3 06/01/08 06/01/09 PREMISES(Ea occurence $2,000,000 CLAIMS MADE KI OCCUR MED EXP(Any one person) $10,000 X STOP GAP PERSONAL&ADV INJURY s2,000,000 GENERAL AGGREGATE $4,000,000 �J GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPlOP AGG s4,000,000 X POLICY --_ PRO - JECT -- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 IF000,000 B j X ANY AUTO ' 24CC180567-2 06/01/08 06/O1/09 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY (Per accident) $ X NON-OWNED AUTOS X ;$250_C omp PROPERTY DAMAGE $ I X 1$500 Coll (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTD OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $1,000,000 C X OCCUR F-1 CLAIMS MADE OJSU382271-30 06/01/08 06/01/09 AGGREGATE $ 1,000,000 $ DEDUCTIBLE $ X ' RETENTION $10,000 I $ i WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED'+ E L DISEASE-EA EMPLOYEE $ If yes describe under SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $ ] OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The City of Kent, Its elected and/or appointed officials, its employees and agents & King County are named as additional insureds with respects to funding. CERTIFICATE HOLDER CANCELLATION KENT004 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Kent NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Planning Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Katherin Johnson 220 4th Ave S REPRESENTATIVES Kent WA 98032-5B95 AUTHO E PRESENT ACORD 25(2001108) ©ACORD CORPORATION 1988 White, Tammy From: Hanson, Menna Sent: Wednesday, March 04, 2009 10-37 AM To: White, Tammy Subject: FW- HealthPoint Insurance Attachments: FQHCDeeming_2009 Hi Tammy—This is what Faith sent back to me. Please let me know if this works.Thanks! Merina From: Faith Wimberley [madto:fimberley@HealthPointCHC.org] Sent: Wednesday, March 04, 2009 10:36 AM To: Hanson, Merina Cc: Tom Trompeter Subject: RE: HealthPoint Insurance Hi Merina, Here is our insurance coverage for the provision of care. As a Federally Qualified Health Center(FQHC),we participate in federally backed insurance coverage for malpractice and service delivery. I believe this is what you are looking for. The other document is our coverage for items not covered under the scope of our FQHC coverage. Please contact me with any questions or comments. I hope this resolves the issue for you. Thank you, Faith Wimberley Resource Development Manager HealthPomt formerly Community Health Centers of King County 425.203 0419 955 Powell AveSW Renton WA 98057 E-mail transmission warning• Unencrypted,unauthenticated Internet e-mail is not secure Internet messages may be corrupted or incomplete, or may incorrectly identify the sender.Please contact the sender directly if you wish to arrange for more secure communication or to authenticate this message uo� DEPARTMENT OF HEALTH & HUMAN SERVICES Health Resources and Services Administration OCT 0200$ Bureau of Primary Health Care Rockville MD 20857 executive Director _mrrunity Health Centers of King County [dba HealthPoint] .J[)ti # 101300 955 Powell Avenue Srnl Reference: Malpractice Liability Coverage - Renewal Health Center Deeming Letter Coverage Effective January 1, 2009 through December 31, 2009 Dear Executive Director: The Health Resources and Services Administration (HRSA) in accordance with Section 224 (g) of the Publi:. Health Service (PHS; Act, 42 U. S.C. §233 (g) , as amended by the Federally Suoror_ed Health Centers Assistance Act of 1993 (FSHCAA) , 1P. L. 04-73) , deems the above named entity to be an employee of the OHS, for the purposes of section 224, effective January 1, 2009. Section 224 (a ) provides ilability protection under the Fed ral Tort Claims Act (FTCA) for damage for personal injury, including death, resulting from the performance of medical surgical, Marta' , and related functions and is exclusive of any other action or proceeding. The 1995 amendments to FSHCAA clarified that FICA coverage etiterds to deemed health centers and their: ( 1) officers; (2) governing board members; (3) full- and oart--time health center emplo,ees; (4) Licensed or certified )health care practitioner contractors (who are not corporations) providing full-tame services (i .e. , on average at least 32 1� hours per week) ; and ( 5) licensed or certified health care practitioner contractors lwho are not corporations) providing part-tim.e services in th— fields of family practice, general internal medicine, general- pediatrics, or obstetrics/gynecology. Volunteers are neither .mploDyees nor contractors and therefore are not eligibta for FTCA coverage. 1 , addition, FICA coverage is comparable to an "occurrence" policy without a monetary can. Therefore, any coverage limits that may be mandated by other organizat_ons are met . Page 2 This action is based on the assurances provided in your FTCA deeming application, as required under 42 U. S.C. §233 (h) , with regard to: (1) implementation of appropriate policies and procedures to reduce the risk of malpractice; (2) implementation of a system whereby professional credentials and privileges, references, claims history, fitness, professional review organization findings, and licensure status of health professionals are reviewed and verified; (3) cooperation with the Department of Justice (DOJ) in the defense of claims and actions to prevent claims in the future; and (4 ) cooperation with DOJ in providing information related to previous malpractice claims history. Deemed health centers must Continue to receive funding under Section 330 of the PHS Act, 42 U. S.C. §254 (b) , in order to maintain FTCA coverage. If the deemed entity loses its Section 330 funding, its coverage under the FTCA will end immediately upon termination of the grant. In addition to the FTCA statutory and regulatory requirements, every deemed health center is expected to follow HRSA' s FTCA- related policies and procedures included on the enclosed list . These documents can be found online at http : //www.bphc. hrsa . gov/pinspals/default .htm. For further information., please contact your FIRSA Project Officer as listed on your notice of grant award. inc erel , James Macrae Associate Administrator Enclosure Health Resources and Services Administration Federal Tort Claims Act (FICA) -Related Program Assistance Letters (PALS) And Policy Information Notices (PINs) This list highlights the PALS and PINs most relevant for FICA- _____ _ __related matters. P_leas_e__consult HRSA' s Web Site http: //www.bphc.hrsa.gov/pinspals/default .htm for a listing of all HRSA PALS and PINs . PALS 1999-15 Questions and Answers on the Federal Tort Claims Act Coverage for Section 330 Deemed Grantees 2005-01 Federal Tort Claims Act Policy Clarification on Coverage of Corporations Under Contract with Health Centers PINs 1999-08 Health Centers and the Federal Tort Claims Act 2001-11 Clarification of Policy for Health Centers Deemed Covered Under the Federal Tort Claims Act for Medical Malpractice 2001-16 Credentialing and Privileging of Health Center Practitioners 2001-19 Procedure for Handling Subpoenas and Other Requests for Testimony of Health Center Employees in Private Litigation 2002-07 Scope of Project Policy 2002-22 Clarification of Bureau of Primary Health Care Credentialing and Privileging Policy Outlined in Policy Information Notice 2001-16 2002-23 New Requirements for Deeming Under the Federally Supported Health Centers Assistance Act Updated: July 9, 2007 WASHIMGTOS 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 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(Print) Title Date Signature of Prima Co o Su tr t Title Date (a Adopted from HUD Form-2992 09/04 3of3 REQUEST FOR MAYOR'S SIGNATURE • Please Fill in All Applicable Boxes KENT W. I..T Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT `( o Originator: Merina Hanson Phone (Originator): x5077 Date Sent: March 3, 2009 Date Required: March 11, 2009 Return S! ned Document to: M. Hanson CONTRACT TERMINATION DATE: 12-31-2010 VENDOR NAME: Health Point DATE OF COUNCIL APPROVAL: 12-09-2003* Brief Explanation of Document: Human Services General Fund contract with Health Point (formerly Community Health Centers of King County) for the Primary Dental and Primary Medical programs, assisting low-income and underinsured residents of Kent. 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 be compieted by the Law Department) <f g4il'( ri"lazz/�1 Received: ��� ;tGlt�tYL` Li Approval of Law Dept.: Law Deptj C mm nts: Date Forwarded tq Mayor.: \J Shaded Areas LLTo Be Completed By Administration Staff Received: Recommendations and Comments: Disposition: 9/� Date Returned: