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HomeMy WebLinkAboutPK10-125 - Original - South King Council of Human Services - Capacity Building - 4/10/10 0 ecords M gemer����� • 7 KENT - Document WASHINGTOH 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: South King Council of Human Services Vendor Number: 33386 JD Edwards Number Contract Number: Pic, This is assigned by City Clerk's Office Project Name: Capacity Building Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 4/10/2010 Termination Date: August 31,2010 Contract Renewal Notice (Days): 0 Number of days required notice for termination or renewal or amendment Contract Manager: Katherin Johnson Department: Parks, Housing & Human Services Detail: The Capacity Project will reach out specifically to smaller organizations serving Kent to be sure the organizations serving refugees, immigrant groups and cutural communitities have equal opportunity to participate in the City application process. 5 Pub I lc\Reco rdsMa nage ment\Forms\ContractCover\a dcc7832 1 11/08 4e KENT WAS HINGTON CONSULTANT SERVICES AGREEMENT between the City of Kent and South King Council of Human Services THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and the South King Council of Human Services organized under the laws of the State of Washington, located and doing business at 4800 South 188th Street, Suite 232, SeaTac, WA 98188, (206) 462.6644 (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: The Capacity Project will reach out specifically to smaller organizations serving Kent to be sure the organizations serving refugees, immigrant groups, and cultural communities have equal opportunity to participate in the City application process. The project will grant writing assistance, focus of program areas, community collaborations, or regional meetings with particular groups as needed to build capacity. The project will identify appropriate resources and/or convene necessary meetings. 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 August 31, 2010. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed $5,000 for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) 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 Exhibit A. CONSULTANT SERVICES AGREEMENT - 1 (Under$10,000) B. The Consultant shall submit Exhibit C as monthly 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 (Under$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 (Under$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 Iurisdiction 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 (Under$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. 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: /Io B"tN (sfg ature) (signature) Print Name: P e: Jeff Watling Its: o�4Q —R�3- Director, Parks, Recreation and (title) Community Services DATE: DATE: _7 I p NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Mary Ellen Stone, Chair Katherin Johnson [South King Council of Human Services City of Kent 4800 South 188th Street, Suite 232, 220 Fourth Avenue South SeaTac, WA 98188 Kent, WA 98032 (206) 462.6644 (telephone) (253) 856.5073 (telephone) facsimile (253) 856.6070 (facsimile) [In this field,you may enter the electronic f lepath where the contract has been saved] CONSULTANT SERVICES AGREEMENT - 5 (Under$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 , 201j By: 4& For: tiC" fS Title: �('l/� Date: l an 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 $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of (4 � C Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as "�V E�T that was entered into on the 5�_ 7c)> 0 (date) between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. Dated this 9 day of ��� , 20 ( C). By: d 1 ) .�7irXlx For: Title Date: C/ EEO COMPLIANCE DOCUMENTS - 3 Exhibit A KENT Scope and Schedule of Work W•$MINOTO. PARKS, RECREATION s COMMUNITY SERVICES 9 Consultant Services Agreement Agency: South King Council Program: Capacity Pro ect 2010 Funding: $5 000 This funding Grant writing assistance, focus of program areas, will provide: community collaborations, and/or regional meetings Total: $5,000 with particular groups to build capacity The project will identify appropriate resources and/or convene necessary meetings. Annual 006"eirri'dut uts: program outcome.- Increase community capacity to serve immigrant/refugee communities in Kent. Number of Technical Assistance 60 Hours Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on March 31, 2010, South King Council of Human Services shall provide the approximate number of City of Kent agencies with the following services during the CSA: Month Service Unit Number of Cumulative " Units Total April Number of Hours of Technical Assistance 12 12 May Number of Hours of Technical Assistance 12 24 June Number of Hours of Technical Assistance 12 36 July Number of Hours of Technical Assistance 12 48 August Number of Hours of Technical Assistance 12 60 The above services shall be provided by August 31, 2010. Contract Administration The Consultant shall notify the City, in writing, within ten (10) days of any changes in program personnel or board membership. The Consultant shall provide the City with a current list of its board of directors, general or limited partners, as applicable. All records related to this CSA must be retained for three (3) years plus the current year. Continued on Next Page Exhibit A (continued) KENT Scope and Schedule of Work WASH in*TO N 2009-2010 Consultant Services Agreement PARKS, RECREATION S COMMUNITY SERVICES A enc : South King Council Program: Capacity Project 2010 Funding: $5 000 This funding Grant writing assistance,focus of program areas, will provide: community collaborations, and/or regional meetings Total: $5,000 with particular groups to build capacity The project will identify appropriate resources and/or convene necessary meetings. Reporting Requirements and Timeline The agency will be reimbursed on a monthly basis, upon submittal of appropriate documentation. Such documentation will include the following (as applicable): Billing Voucher & Service Report (Exhibit B); The reporting timeline is as follows: Report Billing Voucher & Service Report (Exhibit B) 10th day following each month Signature Please sign below to indicate acceptance of the Year 2010 Performance Measures listed above. Mary EI 7_e, Board Chair Date 2 C Kathenn nsoiliAuman Services Manager Date 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. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01. The City shall be named as an Additional 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. 2. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. 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, $2,000,000 general aggregate. 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 A:VII. 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. Exhibit C Billing Voucher & Service Report �rKcNT 2010 WASHINGTON PARKS, RECREATION & COMMUNITY SERVICES To: Agency: South King Council of Human Katherin Johnson Services Housing & Human Services Parks,Recreation & Community Services program Contact: Nathan Phillips 2204 Ave. South, Kent, WA 98032 klohnson@cl kent wa us Telephone: (206) 462.6644 Phone: (253) 856-5073 E-mail: nathan@skchs.org Reporting Period Program Amount Requested Capacity Project $ BUDGET SUMMARY FOR DEPA0ftMtN'T USE ONLY Total Contract Amount $ 5,000 (per year) Current Request $ Amount Remaining $ 2010 KENT FUNDED SERVICE UNITS Total Kent Service Unit Description Service Units Planned Funded p Each Quarter Service Units To Date Service UnittPerformance Measure 1st 2" Number of Technical Assistance 36 24 Hours Authorized Signature Date FOR DEPARTMENT USE ONLY AUTHORIZED FOR PAYMENT BY: DATE: Client# 55251 SOUTKIN5 DATE(MMIDONYYY) ACORM CERTIFICATE OF LIABILITY INSURANCE 05/03/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bell-Anderson Ins.-Kent C/L ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P O Box 887 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 724 West Smith St. Kent,WA 98035-0887 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Hartford Casualty Insurance Com South King Council of Human Services INSURER B 4800 S 188th St Suite 232 INSURER C Sea Tac,WA 98188 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 IN SR rypE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MM/DD/YYYY DATE MM/DD/YYYY A GENERAL LIABILITY 52SBAVU0919 05/09/2010 05/09/2011 EACH OCCURRENCE $1,000,000 TO X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES 1 E.RENTED $300 000 CLAIMS MADE F-x1 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY 51,000,000 GENERAL AGGREGATE s2,000,000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 52000000 POLICY PROJECT17 LOC A AUTOMOBILE LIABILITY 52SBAVU0919 05/09/2010 05/09/2011 COMBINED SINGLE LIMIT $1,000 000 ANY AUTO (Ea accident) r ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Peracudent) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS l UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 52SBAVU0919 05109/2010 0510912011 1 TIC CRYSTATTI orH- EMPLOYERS LIABILITY EEL- A ANY PROPRIETOR/PARTNER/EXECUTIVE WA STOP GAP E L EACH ACCIDENT $1,000,000 pFPICER/MEMBE EXCLUDED (Mandatory In NHr E L DISEASE-EA EMPLOYEE $1,000,000 If yes describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS The certificate holder is additional insured for general liability, but only if required by written contract or written agreement per the attached endorsement#SS0008 04/05 and IH1200 11/85 CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Kent DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL AS DAYS WRITTEN 220 4th Ave S NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Kent,WA 98032 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE ACORD 25(2009/01)1 of 2 #S262977/M262976 © 1988-2009 ACORD CORPORATION All rights reserved The ACORD name and logo are registered marks of ACORD CJL IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(es)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 endorsement(s) DISCLAIMER The Certificate of Insurance 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 25(2009/01) 2 of 2 #S262977/M262976