HomeMy WebLinkAboutPK11-044 - Original - Jewish Family Services - Refugee & Immigrant Employment Program - 12/27/2010 ecords NIA_ - = gemen'....
KENT Document
W ASHIMGTOV
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: Jewish Family Service
Vendor Number: 79920
JD Edwards Number
Contract Number: 1*/)-Oq `l
This is assigned by City Clerk's Office
Project Name: Refugee & Immigrant Service Centers
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: 01-01-11 Termination Date: 12-31-12
Contract Renewal Notice (Days): 30
Number of days required notice for termination or renewal or amendment
Contract Manager: Johnetta Rowsey Department: Parks, Human Services
Detail: (i.e. address, location, parcel number, tax id, etc.):
Human Services 1% General Fund CSA
S PublIc\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08
KENT
WASHINGTON
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Jewish Family Service
Immigrant/Refugee Employment Program
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Jewish Family Service organized under the laws of the State of
Washington, located and doing business at 1601 16th Avenue, Seattle, WA 98122 (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 Immigrant/Refugee Employment Program,
providing services that include ESL classes, employment placement, and follow-up
retention services. 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, 2012. 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 for the
services described in this Agreement..
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to
exceed $20,000 ($10,000 each 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) for a
CONSULTANT SERVICES AGREEMENT - 1
irn.A,- ¢if) nnn
period of one (1) year from the effective date of this Agreement. The Consultant's
billing rates shall be as delineated in Exhibit A.
B. The Consultant shall submit quarter 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,
CONSULTANT SERVICES AGREEMENT - 2
(Over$10,000)
discriminate against any person who is qualified and available to perform the work to which the
employment relates. Consultant shall execute the attached City of Kent Equal Employment
Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion
of the contract work, file the attached Compliance Statement.
VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its
officers, officials, employees, agents and volunteers harmless from any and all claims, injuries,
damages, losses or suits, including all legal costs and attorney fees, arising out of or in
connection with the Consultant's performance of this Agreement, except for that portion of the
injuries and damages caused by the City's negligence.
The City's inspection or acceptance of any of Consultant's work when completed shall not
be grounds to avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement is subject to RCW
4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or
damages to property caused by or resulting from the concurrent negligence of the Consultant
and the City, its officers, officials, employees, agents and volunteers, the Consultant's liability
hereunder shall be only to the extent of the Consultant's negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF
IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF
THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY
NEGOTIATED THIS WAIVER.
In the event Consultant refuses tender of defense in any suit or any claim, if that tender
was made pursuant to this indemnification clause, and if that refusal is subsequently determined
by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the
Consultant's part, then Consultant shall pay all the City's costs for defense, including all
reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and
fees incurred because there was a wrongful refusal on the Consultant's part.
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 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.
CONSULTANT SERVICES AGREEMENT - 3
inupr (tin nnm-
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.
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.
CONSULTANT SERVICES AGREEMENT - 4
(Over$10,000)
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:
B B
Y� Y:
(signature) Iq (signature)
Print N qrne: " P-t Print N Suzette Cooke
Its It Mayor
(true)
DATE: /Z. Z�/ D DATE: 7 ld
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Ken Weinberg, CEO Katherin Johnson, Housing & Human Services
Jewish Family Service Manager
1601 16`h Avenue City of Kent
Seattle, WA 98122 220 Fourth Avenue South
Kent, WA 98032
(206) 461-3240 (telephone)
(206) 461-3696 (facsimile) (253) 856-5070 (telephone)
(253) 856-6070 (facsimile)
APPROVED AST FORM:
Kent Law D nt
CONSULTANT SERVICES AGREEMENT - 5
rnvar ,tin nnn)
[In this field,you may enter the electronic Gepath where the contra[[has been saved]
L
CONSULTANT SERVICES AGREEMENT - 6
(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, ILatgree to fulfill the five requirements referenced above.
Dated this _�a7~ day of 20
By: T—
For:-
Title:
Date:
I 1IKA
CITY OF ICE PVT
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 , 20
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3
® Exhibit A
KENT Scope and Schedule of Work
PARKS, RECREATIONS
COMMUNITY SERVICES 2011-2012 Consultant Services Agreement
A enc : Jewish amil Service 2011 Funding: $10,000
i Program: Refugee & Immigrant Service Center 2012 Funding: $10,000
This funding ESL classes, employment placement and follow-up
will provide: retention services Total: _ $20,000
Annual Program Outputs .` =' = __- ',,,aFundin Priori Area:
Unduplicated Kent Clients 16 Increasm self reliance
Number of job placements 10 -Pro ram Outcome:
Number of ESL class hours 10 Reduce barriers to employment
SKCHS Membership/Participation Yes/No
Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1, 2011, Jewish
Family Service shall provide the approximate number of City of Kent clients with the following services
each year of the CSA:
Quarter Service Unit _'_ __ ___ _Number of Cumulative
fu
= Units Total
1st Undu licated City of Kent clients served 4 4
Number of Job Placements 3 3
Number of ESL Class Hours 3 3
SKCHS Membership/Participation Yes/No Yes/No
2nd Unduplicated City of Kent clients served 4 8
Number of Job Placements 2 5
Number of ESL Class Hours 2 5
SKCHS Membership/Participation Yes/No Yes/No
3`d Unduplicated City of Kent clients served 4 12
Number of Job Placements 3 8
Number of ESL Class Hours 3 8
SKCHS Membership/Participation Yes/No Yes/No
4th Unduplicated City of Kent clients served 4 16
Number of Job Placements 2 10
Number of ESL Class Hours 2 10
SKCHS Membership/Participation Yes/No Yes/No
The above services shall be provided by December 31, 2011 for year one of the two-year agreement and
December 31, 2012 for year two of the agreement.
41 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 separately report the number of clients served who reside in the newly
annexed Panther Lake area as detailed in the provided maps.
• The Consultant shall provide the City with a current list of its board of directors, general or limited
partners, as applicable.
• The Consultant will hold active membership with the South King Council of Human Services
http://skchs.org/
• All records related to this CSA must be retained for three (3) years plus the current year.
Exhibit A (continued)
T Scope and Schedule of Work
WASHINGTON 2011-2012 Consultant Services Agreement
PARKS, RECREATION S
COMMUNITY SERVICES
-Agency-: '= Jewish Family Service 2011 Funding, $10,000
Program: Refugee & Immigrant Service Center 2012 Funding $10 000
This funding will Case Management services to formally homeless
provide: families living at Appian Way Apts. Focus on achieving Total: $20,000
family stability, self-sufficiency, and success in
permanent housing. =
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 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, 2011/December 15th, 2012
Outcome Based Evaluation Report (Exhibit C) January 315t, 2012/January 315t, 2013
Client Demographic Data (Exhibit D) January 31", 2012/January 315t, 2013
Signature
Please sign below to indicate acceptance of the Year 2011 and Year 2012 Performance Measures listed
above. '
Ken Weinb g, CEO-J wi amily Service Date
12 Iln
Katherin Johnson, Human Sery es Manager Date
Exhibit B General Fund
KEIVT 2011 Billing Voucher
WASHINGTON and Service Report
PARKS, RECREATION &
COMMUNITY SERVICES
To:
Johnetta Rowsey Agency: Jewish Family Service
Housing & Human Services Program Contact: Shane Rock
Parks, Recreation & Community Services
220 4th Ave. South, Kent, WA 98032 Telephone: (206) 467-3240
E-mail: Brock@jfsseattle.org
jrowsey@ci.kent.wa.us =
Phone: (253)'856-5075
Reporting Period Program Amount Requested
Immigrant/Refugee Employment $
BUDGETSUMMARY
FOR DEPARTMENT USE,ONLY Total Contract Amount $
- , - -
VENDOR NUMBER# PO:€ Current Request
$
1AccoUNT,CODE - __< Amount Remainingra
$ -
2011 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)
th
Service Unit/Performance Measure l't 2" 3` 4
Unduplicated # of Kent clients served 4 4 4 4
Number of job placements 3 2 3 2
ESL class hours 3 2 3 2
SKCHS Membership/Participation Yes Yes Yes Yes I
*Please attach a narrative explanation to this report in the event that the program is not meeting
`performance measures.
Unduplicated Number of Residents in Panther Lake Annexed Area (quarter) (ytd)
Authorized Signature Date
"FOR DEPARTMENT USE ONLY
AUTHORIZED FOR PAYMENT
BY: .. 7. - DATE: _
Exhibit B General Fund
KEIdT 2012 Billing Voucher
WA5MINGTON and Service Report
PARKS, RECREATION S
COMMUNITY SERVICES
To:
Johnetta Rowsey Agency:_Jewish Family Service
Housing & Human Services Program Contact: Shane Rock
-Parks, Recreation & Community Services -
220 4th Ave. South, Kent, WA 98032 Telephone: (206) 467-3240
E-mail: Brock@jfsseattle.org
jrowsey@ci.kent.wa.us
Phone: (253) 856-5075
Reporting,Period'' �_ Program ' �'Anr6unt Requested
Immigrant/Refugee Employment $
_ _BUDGET SUMMARY ` _-
" ` Total Contract Amount
' FOR DEPARTMENT USE ONLY i $
3 tta
�WENDOR NUMBER# PO# F' Current Request $
AbCOUNT:cODt " Amount Remaining $
I -
2012 KENT FUNDED SERVICE UNITS
Note: Unduplicated client counts must be reported both quarterly and year-to-date
New City of Total Kent Total Service
Service Unit Description' Service Units Planned Kent Funded Funded Units to Date
Each Quarter Service Units Service Units (ALL Funding
This Quarter To Date Sources)
Service Unit/Performance Measure 1t 2 nd 3" 4
Unduplicated # of Kent clients served 4 4 4 14
Number of job placements 3 2 3 2 ;
ESL class hours 3 2 3 2 g
SKCHS Membership/Participation Yes Yes Yes Yes
*Please attach a narrative explanation to this report in the event that the program is not meeting
performance measures.
Unduplicated Number of Residents in Panther Lake Annexed Area (quarter) (ytd)
Authorized Signature Date
`7"FOR DEPARTMENT USE ONLY
AUTHORIZED FOR PAYMENT
BY: - DATE: " `
� N M
O 0
O N N
a r r
W/�/ M coc
W L
W
c
C -C
O
-o a
O 0 0
Q 0-
(D � ai
a Q)
a� � � -0 Z
E (D m
Z 0 0 Fa
Q � � a `�
F- O O V) cn
W r r U Q
� 00 F-- 6
N N E Q
C7 (Z U
R
a w Q
vi
i C O
LL Q O
N
O O
-aQ
E
U E o
U O Z p
.0
_ N
x o p `m
W CLO
a (D
a 0
�N Q) mL C >1
o� EEv O a
I�a aW � � E m v o
o7W E m U (D
z u z N O z Q coN
u r1 O Cq
rTr 3 ui C: ` ` O U 0 iri
m co O v N cn Q '
a° Q U) N En
Agency
a
KENT Exhibit D Program
WAS HIry GTON
a Annual Demographic Report Date
PARKS, RECREATION
COMMUNITY SERVICES Unduplicated Number of Clients Served*
Agency/Program Unduplicated New Individuals this Year
Client Residence ' _
Algona
Auburn
Black Diamond
Burien
Covington
Des Moines
Enumclaw
Federal Way
Kent
Maple Valle
Milton
Normandy Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated King Count
Unknown
TOTAL
Household Income Level
30% of Median or Below
50% of Median or Below
80% of Median or Below
Above 80% of Median
Unknown
TOTAL
Gender ----------
Male
Female
TOTAL
-Age- = _ _ __ _ _ -_=_-
0-4 years
5- 12 years
13- 17 years
18- 34 years
35- 54 years
55- 74 years
75+years
Unknown
TOTAL
Ethnics -___;__
Asian/Pacific Islander
Black/Afncan American
Hispanic/Latino(a)
Native American/Alaskan Native
White/Caucasian
Other -
Unknown
TOTAL
Female-Headed Household-="' `` '"' , -' arc' •-_-
Disabling Condition
Urnited En Iish,S eakin
Unduplicated means count each client only once per calendar year
'Lst of all clients'served in client residence category and Kent clients only in rest of the categories
ATTACE[MENT E
INSURANCE REQUIREMENTS FOR
HUMAN SERVICES AGREEMENTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement,insurance
against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of the work hereunder by the Contractor,their agents,
representatives, employees or subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Commercial General Liability insurance shall be written on ISO occurrence form
CG 00 01 and shall cover liability arising from premises, operations, independent
contractors,products-completed operations,personal injury and advertising
injury, and liability assumed under an insured contract. The Commercial General
Liability insurance shall be endorsed to provide the Aggregate Per Project
Endorsement ISO form CG 25 03 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 Contractor's
Commercial General Liability insurance policy with respect to the work
performed for the City using ISO additional
insured endorsement CG 20 10 11 85 or a substitute endorsement providing
equivalent coverage.
2. Workers' Compensation coverage as required by the Industrial Insurance laws of
the State of Washington.
3. Professional Liability insurance appropriate to the Consultant's profession.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Commercial General Liability insurance shall be written with limits no
less than$1,000,000 each occurrence, $1,000,000 general aggregate
and a$1,000,000 products-completed operations aggregate limit.
2. Professional Liability insurance shall be written with limits no less
than$1,000,000 per claim and $1,000,000 policy aggregate limit.
I II
EXIMIT E (Continued )
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following provisions
for Automobile Liability and Commercial General Liability insurance:
1. The Contractor's insurance coverage shall be primary insurance as respect the City.
Any Insurance, self-insurance, or insurance pool coverage maintained by the City
shall be excess of the Contractor's insurance and shall not contribute with it.
2. _The Contractor's insurance shall be endorsed to state that coverage shall not be
cancelled by either party, except after thirty(30) days prior written notice by certified
mail,return receipt requested, has been given to the City.
3. The City of Kent shall be named as an additional insured on all policies (except
Professional Liability) as respects work performed by or on behalf of the contractor
and a copy of the endorsement naming the City as additional insured shall be attached
to the Certificate of Insurance. The City reserves the right to receive a certified copy
of all required insurance policies. The Contractor's Commercial General Liability
insurance shall also contain a clause stating that coverage shall apply separately to
each insured against whom claim is made or suit is brought, except with respects to
the limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not less than
AN IL
E. Verification of Coverage
Contractor shall famish the City with original certificates and a copy of the amendatory
endorsements, including but not necessarily limited to the additional insured
endorsement, evidencing the insurance requirements of the Contractor before
commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insureds under its policies or shall furnish
separate certificates and endorsements for each subcontractor. All coverages for
subcontractors shall be subject to all of the same insurance requirements as stated herein
for the Contractor.
A� CERTIFIG.`TE OF LIABILITY INSURA" .#E OF ID SR DATE(MM/DDYYYY)
JEWIS-1 02/17/10
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 Phnlacelphia Indemnity Ins
INSURER B
Jewish-Family Service INSURER
1601 16th Ave INSURER
Seattle WA 98122-4000
INS URER 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 RESPECTTO 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
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITSFA
NSR TYPE OF INSURANCE DATE MM/DD/YYYY) DATE MM/DD/YYYY
GENERAL LJABILITY EACH OCCURRENCE $ 1,000,000
X X COMMERCIAL GENERAL LIABILITY PRPK523681 02/18/10 02/18/11 PREMISES(Ea occurence) $ 100,000
CLAIMS MADE X❑ OCCUR _ MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG s2,000,000
POLICY PRO LOC
ECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000,000
A X ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
X HIREDAUTOS PHPK523681 02/18/10 02/18/11 BODILY INJURY
(Peracadent) $
X NON-OWNED AUTOS
X $500 Comp PROPERTY DAMAGE $
X 1 1,000 Collision (Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHERTHAN FAACC $
AUTO ONLY ADS $
EXCESS UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
It
DEDUCTIBLE It
RETENTION $ It
WORKERS COMPENSATION X ER
AND EMPLOYERS'LIABILITY YIN TORY LIMITS
A ANY PROPRIETOR/PARTNER/EXECUTIV� PHPK523681 02/18/10 02/18/11 EL EACH ACCIDENT $ 1,000,000
OF=ICER/NIEMBER EXCLUDED?
(Mandatory in NH) WA STOP GAP EL DISEASE-EA EMPLOYEE $ 1,000,000
If yes describe under E L DISEASE-POLICY LIMIT $ 1 0 0 0 0 0 0
SPECIAL PROVISIONS below r
OTHER
A Professional PHPK523681 02/18/10 02/18/11 Ea. Inca $1,000,000
Aggregate $2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is additional insured with respects liability arising out
of operations by or on behalf of the Named Insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
City of Kent
REPRESENTATIVES
Human Services
220 4th Avenue South AUUTHORITHORIZED PRESENTATIVE
rent WA 98032
ACORD 25(2009101) Vi 988- 09 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
KENT Exhibit F
w,
PARKS, RECREATION S
CDNMUNIW 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 necessanly 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 Contra r/Sub actor(Print) Title Date 11
v
Signature of Primary Contractor Sub-Contractor Title Date
K = Z_ , � ,�
(3,
Adopted from HUD Form-2992
09/04
3of3
\ REQUEST FOR MAYOR'S SIGNATURE
v K)t e T Please Fill in All Applicable Boxes
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT)
alftaj
Originator: Merina Hanson Phone Orl Inator : x5077
Date Sent: December 21St, 2010 Date Required: January 2nd, 2011
Return Signed Document to: M. Hanson CONTRACT TERMINATION DATE: 12-31-2012
VENDOR NAME: various DATE OF COUNCIL APPROVAL: 12-14-2010*
Brief Explanation of Document:
Human Services General Fund contracts with agencies for services to low-Income Kent
residents. The attached CSA's are two year contract for 2011-2012, with the second
year of funding contingent upon availability of funds and successful agency
performance. 'f t1:s cctc
*Passed as part of the 2011 City of Kent budget
6VCM 11-1e1udes Centc� Fv�Cc� r�erlrt �vviahV��,Cln�ldr�vcsll vtnSoc�"e1 CISLI
n AMj i 0 RCtn,tICf rnl ly Svcs, Mer(X) hUSlV7y, -J-FS ) rt, r-a)od i nk, K V,'f=S 1
4`L'Sar-C) MuthSC-V iceLI'llf-'x3i P(Cc ISh off,V169 (000u1OrI IS/ U6C4LVA , uvvVE-E
All Contracts Must Be Routed Through The Law Department
(This area to be completed by the Law Department)
Received:
J [- 2
Approval of Law Dept.:
1
Law Dept. Comments:
Date Forwarded to Mayor:
Shaded Areas To Be Completed By Administration Staff
Received.Recommendations and Comments: D E C E V�//
E
Disposition: /2127110 �� -� DEC 2 S 21Oa0
CITY Of KENT
Date Returned: CITY CLERK