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HomeMy WebLinkAboutPK11-166 - Original - South King County Mobile Medical Van ff records M = gem e KENT WAS„,„GroN 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: Public Health - Seattle/King County 3`J Vendor Number: (025 JD Edwards Number Contract Number: This is assigned by City Clerk's Office Project Name: So. King County Mobile Medical Van Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 1/1/2011 Termination Date: 12/31/2012 Contract Renewal Notice (Days): thirty (30) days Number of days required notice for termination or renewal or amendment Contract Manager: Jason Johnson Department: Parks, Human Services Detail: (i.e. address, location, parcel number, tax id, etc.): Human Services 1% General Fund CSA S Pubhc\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 KENT CONSULTANT SERVICES AGREEMENT between the City of Kent and Public Health, Seattle - King County South King County Mobile Medical Program THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Public Health, Seattle — King County, organized under the laws of the State of Washington, located and doing business at 401- Fifth Avenue, Suite 1300, Seattle, WA 98104, (206)263-8740 (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 South King County Mobile Medical Program provides homeless people in Kent with integrated medical, dental, psychiatric, outreach, and case management services. Kent clients are provided intensive assistance in accessing follow-up and ongoing care, behavioral health treatment, medical benefits, shelter/housing assistance, and other critical community supports. City of Kent funding will focus primarily on dental services 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 III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed S30,286 ($15,143 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 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 quarterly payment invoices to the City for work performed, and a final bill upon completion of all services described in this CONSULTANT SERVICES AGREEMENT - 1 (Over.�10,000) 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 and upon the request of the City, the County will provide copies of all records and data requested by the City chat are within the Consultant's possession pertaining to this project, which copies 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. CONSULTANT SERVICES AGREEMENT- 2 (Over$10,000) Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, mcludmg all legal costs and attorney fees, arising out or 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 complered 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. King County, a charter county government under the constitution of the State of Washington maintains a fully funded Self-Insurance program as defined in King County Code 4.12 for the protection and handling of the County's liabilities including injuries to persons and damage to property. 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. 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 CONSULTANT SERVICES AGREEMENT - 3 (Over$70 000) 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 he available for any designated recycled product B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section VII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full _force and effect and no further assignment shall be made without additional written consent F Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant G. Entire Aareement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or CONSULTANT SERVICES AGREEMENT- 4 (Over$10,000) other representative of the City, and such statements shall not he 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 a!l of which will together corstitute this one Agreement. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. CON LTANT: CITY OF KENT: 6y: -- By: (signature) (signature) Print Name: Joan Hines I Pr, t me. uzette_Cooke Its Public eal CHS Division Manager I Moor _ a DATE DATE.-- NOTICES TO BE SENT TO: NOTICES TO BF SENT TO: CONSULTANT: CITY OF KENT: 1 Linda Lee Katherin Johnson, Housing & Human Services Public Health - Seattle & King County Manager 401- Fifth Avenue, Suite 1300 City of Kent Seattle, WA 98104 220 Fourth Avenue South Kent, WA 98032 (206)263-8740 (telephone) (206) 295-0629 (facsimile) (253) 856-5070 (telephone) (253) 856-6070 (facsimile) APPROVED-AS TO FORM: ,4W 1� - , L,- '—vim` Kenpartment [In this field,you may enter the ele¢ inn filepa where`he mntratt has been saved] CONSULTANT SERVICES AGREEMENT - 5 i 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 oopor unity 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 arty 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 wi-h the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. Dated this day of 20- By: For- Title: � � Dater _ EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMIINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY_ j i 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 nondiscrim[nation 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 sha'I be f lied 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__. B _ y' - I For: Title: Date: i EEO COMPLIANCE DOCUMENTS - 3 ® Exhibit A KENT Scope and Schedule of Work .S. ix PARK, RLC REATICN s 2011-2012 Consultant Services Agreement COMMUNITY SERVICES A enc Seattle/King County Dept of Public health 2011 Fundin : $15,143 -Program.,-- South Kmc County Mobile Medical 2012 Fun 15 Program_ _ - 9' $_ ,143a This funding Access to the Mobile Medical Van Dental Services for - will provide: homeless people In Kent Total: $30,286 Annual Program Ouuts: _ Program Outcome. Unduplicated Kent Clients 81 Improving Health and Well-being Dental Encounter 108 — uarterl Re ort of Pro ram Data 4 — SKCHS Membership/Partici ation Yes Pursuant to Item F. of the Consultant Services Agreement (CSA) executed on January 1, 2011, CCY3 Safe Havens Visitation Center shall provide the approximate number of City of Kent clients with the following services each year of the CSA Quarter Service Unit j27 Curriufaltives Tota1" Undu heated City of Kent clients served 20Dental Encounter 77 ---- uarterl Report of Pro ram Data 1 1 SKCHS Membership/Participation Yes Yes 2nd Undu Heated City of Kent clients served 20 40 Dental Encounter 27 54 Quarterly Report of Program Data 1 _ 2 SKCHS Membership/Participation Yes Yes 3ro Undu heated Crt of Kent clients served 20 60 Dental Encounter 27 81 uarterl Report of Program Data 1 3 SKCHS Membership/ParticEpatron Yes Yes 4c1' - Unduplicated City of Kent clients served 21 81 Dental Encounter 27 108 Quart rly Repart of Program Data 1 4 SKCHS Membershf /Particci ation I Yes Yes 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. 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. Exhibit A (continued) KEAIT Scope and Schedule of Work 2011-2012 Consultant Services Agreement PARKS RECREATION S COMMUNITY 5ERWCES Agene _ Seattle/King County Dept of Public Health 2011 Funding--_ $15 143 Program-' South King County Mobile Medical Program 2012 Funding; 515,143 This funding _ Access to the Mobile Medical Van Dental Services for will provide: - homeless people in Kent Tbtal: _ -- $30,286 Contract Administration (Continued) - The Consultant will hold active membership with the South King Council of Human Services http•/Jskchs orjj - All records related to this CSA must be retained for three (3) years plus the current year. Deporting 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 10`h of the following month for the previous quarter of service. The reporting timeline is as follows. itepoit" bue Dai:e`_ Billing Voucher & Service Report (Exhibit B) 10"' day following each quarter Final Billing Voucher (4th Qtr Exhibit B) December 15`h, 2011/December 15", 2012 Outcome Based Evaluation Report (Exhibit C) January 29"', 2012/January 31"', 2013 Client Demographic Data (Exhibit D) January 29`h, 2012/January 31s`, 2013 Signature Please sign below to indicate acceptance of the Year 2011 and Year 2012 Performance Measures listed above ��� _ l _4_[ 3clin Haynes Division Manager Date 3, 2� Kathenn J on, Hum n Service Manager Date a Exhibit B General Fund T 2011 Billing Voucher and Service Report PARKS, RECREATION & COMMUNITY SERVICES To: Agency: Public Health - Seattle & King County, Jason Johnson Mobile Medical Program Housing & Human Services;_ . .;_ 401 Fifth Avenue, Suite 1000 Parks, Recreation & Community Services'- Seattle, WA- 98104-1818 _ 220 4th Ave. South, Kent, WA 98032 _ t Program Contact: John Gilvar, Manager_ Phone: (253) 856-5061 _ _ Telephone: 206-369-3489 E-mail: Ja)ohnson@ci.kenLwa__'Us - _'�` ' Fax: 206-205-6236 _ y- E-mail: of hn gilvar(a�kingcounty.Clov Reporting Period Program Amount Requested South King County Mobile Medical Program $ `r.' BUDGETSUMMARY =� y: ,FOR,D=EPARTMENT[7SE,_©NLY,4° Total Contract Amount ,VENDOR-NUMBER`l# cPO,i€ ^,` Current Request $ '�=r -ACCOUNT cODE_, ' -_' _ _- " Amount Remaining $ 2011 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date _ New City of l otal Kent Total Service Service Unit Description _X '. Service Units Planned Kent Funded Funded Units to Date Each Quarter Service Units Service Units (ALL Furdmg This Quarter To Date Sources) Service Unit/Performance Measure 1S 2n 3 4 ' Unduplicated * of Kent clients served 20 20 20 21 Dental Encounters 27 27 27 27 Quarterly Report of Full Program Data 1 1 1 1 SKCHS Membership/Participation Yes Yes Yes Yes i- _ I _ "Please attach a narrative explanation to this report in the event that the program is not meeting d performance measures. Unduplicated Number of Residents in Panther Lake Annexed Area (quarter) (ytd) Authorized Signature Date FOR DEPARTMENT'USE O_NEY AUTHORIZED FOR PAYMENT =- - , „�,., _ <,_ _ _ _ 01 7BY-" = 2 r z__;r --- f DATE: Exhibit B General Fund KENT 2012 Billing Voucher N I <. (,X and Service Report PARKS, RECREATION COMMUNITY SERVICES To: Agency: Public Health - Seattle & King County, Jason Johnson Mobile Medical Program Housing & Human Services 401 Fifth Avenue, Suite 1000 Parks, Recreation & Community Services Seattle, WA 98104-1818 220 4" Ave. South, Kent, WA-98032 - _ Program Contact: John Gllvar, Manager Phone: (253) 856-5061 - _ Telephone: 206-369-3489 E-mail. lajohnson@ci_kent wa..us _ Fax: 206-205-6236 = I E-mail: John gilvar(u_kingcounty_gov Reporting Period Program Amount Requested South King County Mobile Medical Program $ - BUDGET SUMMARY hxY J z _FOR DEPARTMENT USE-ONLY, '_ _ Total Contract Amount $ VENDOR NUMBER# 06 9"' ,' _ � .,�-�; Current Request $ ji�C60UNT-c0DE Amount Remaining $ _ 2012 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date New Cdy of_ Total Kent Total Service Service Unit Description - - Service Units Planned Kent Funded Funced - Un-s to Date Each Quarter Service Urirs Serelce Units (ALL Funding This_Q_carter To Date Sources) Service Unit/Performance Measure 1S 2n 3rd 4th Unduplicated # of Kent clients served 20 20 20 21 Dental Encounters _ 27 27 ! 27 27 - _ Quarterly Report of Full Program Data 1 1 1 1 SKCHS Membershtp/Participation Yes Yes Yes Yes -- -_- vu` `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 - = FORDEPARTMENT USE-ONLY M` AUTHORIZED FOR PAYMENT BY., ,_ . _ - �' — - - �" DATE: i � G / hoc OGG � mmLLI a � » » M /O . U e e � 23 O \ 0 (D / � ± ± / M CD e \ 2 E E _ — 2 o c @ d 0 0 / /2 LUq / 7 ( \ < c = z o � a . 7 E in / ƒ \ cr s \ \ cu » [ o E 5 X cm \ r / L Q £ \ - \ \ ƒ 7 \ u 22ID 2 ( 0 / ¥: o/ \ w -0 o 0 7 -�} }E z [ ( / (D ± m } / mz }[ /2z = E 2 0 e m §fie \ \ c 2 U ƒ / &2 � = 4-10 3 / }G l® m 3 k 3 \ \ a) Agency Exhibit D Program PARKS RECRLATION S Annual Demographic Report Date COMMUNITY SFRJICES Unduplicated Number of Clients Served* A enc !Program _ Unduplicated (New) Indiviauals th s Year Chent Residence** Algona Auburn Black Diamond Cowin Des Moines Enumclaw _ Federal Wa Kent Maple Vaile - Milton Normandy Park _ __Pacific Renton SeaTac Seattle _ Tukwila_ Unmcorporated King Count Unknown _ TOTAL Household tncnm_e Leyeh _ 30% of Median or Below _ 50% of Median or Below 80%of Median or Below Above 80%of Media Unknown TOTAL Gender Male _ Female TOTAL -Age 0-4-years 5- 17 years 13- 17 years 18-3A years 35- 54 years 55-74,lears - 75+years - Unknown TOTAL _ Ethnicity. AsianlPacific Islander Black/African American Hispanic1Latino(a Native American/Alaskan Native_ _ Wnite/Caucasia_n Other _ Unknown TOTAL Female Headed Household Disabling Condition = _ Limited English S ep aking- - -, ' Unduplicated means court 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 f ATTACHMENT E INSURANCE REQUIREMENTS FOR CONSUIJANT AGIIEEMENTS Insurance The Contractor shall procure and maintain for the duration of the Agreement, insurance against clarms for injuries to persons or damage to property which may arise from or in connection wrth the perforniance of the work hereunder by the Contractor, their agents, representatives, ernployces or subcontra tors. A. King County, a charter county government under the constitution of the State of Washington maintains a fully funded Self-Insurance program as defined in King County Code 4.12 for the protection and handling of the County's liabilities including injuries to persons and damage to property. e KENT Exhibit F PARKS RECREATION S CCMMUNIT'SiRVIfF: 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-vear 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) wish commission of any of the offenses enumerated in pa-agraph (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 attacn an explanation to this proposal Instructions for Certification (A) 1 By signing and submi�Mng this proposal, the prospective primary participant is providing the certification set out below 2 The inability of a persor 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 whethe' 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 certificatiop 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 remecies available to the Federal Government/City of Kent, the department or agency may terminate-his 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 certfication 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, persorl, 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 i of 3 transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participa:)on in this covered transaction, unless authorized by the department or agency entering into this transaction 7 The prospective prmary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, 5usoension, Ineligibility and Voluntary Exclu- sion - Lower Tier Covered Transaction," provided by the department or agency entering into this ccvered transaction, without modification, in all lover tier covered transactions and n all solicitations for lower tier covered transactions & A participant in c covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it s 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 elig ility 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 coirse 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 GovernmenUCity 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 crospective lower tier participant is unable to certify to any of the statements in this certification, such prospect ve participant shall attach an explanation to this proposal Instructions for Certification (13) 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 parbcrpant leams that its certification was erroneous when submitted or has become erroneous by reason of changed cn cumstances 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 th,s 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 k-iowingly 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 it will Include 6 The prospective lower tier participant further agrees by submitting this proposal that 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 er-oneous A participant may decide the method and frequency by which it determines the eligibility of its p-mcipa's Eacn par-,icipant may, but is not required to, check the Nonprocurement List 8 Nolhirg contained in the foregoing shall be cons,rued to require establishment of a system of records in order to render in good faith the certification recurred by this clause The knowledge and information of a participant is not required to exceee 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 vo'untanly excluded from participation in this transaction, in addition to other remedies available to the Federal GovernmenJCity of Kent the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment Prim CoractorfSub-C tr tor(Print) Title Da i Signal u n tor! - actor Title aIk te - � (s, Adopted from HUD Form-2992 09104 i - I 1 3of3 REQUEST FOR MAYOR'S SIGNATURE HGIElJ T Please Fill in All Applicable Boxes Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) Originator: J. Johnson Phone (Originator)- x5061 Date Sent: March 9, 2011 Date Required: Return Signed Document to: J. Johnson 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. *Passed as part of the 2011 City of Kent budget Venders included : Public Health — Seattle/King County (Mobile Medical Van) All Contracts Must Be Routed Through The Law Department (This area to be completed by the Law Department) Received: Approval of Law Dept.: DECEIVED Law Dept. Comments: MAR 0 g 2011 r.ity of Kent tilce Ci tine tAaY0r KENT P Date Forwarded to Mayor: 16 4 I f Shaded Areas To Be Completed By Administration Staff Received: Recommendations-and Comments: L //�V V Disposition: LA CITY Cf KENT CITY flLr`K Date Returned: