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HomeMy WebLinkAboutPK11-172 - Original - Sound Mental Health - Safe & Sound Visitation Center - 03/18/2011 ecords M a g-e KENT _ Document WASHINGTON 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: Sound Mental Health Vendor Number: JD Edwards Number Contract Number: This is assigned by City Clerk's Office J Project Name: Safe and Sound Visitation Center Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment M 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 10/c General Fund CSA S Public\RecordsManagement\Farms\ContractCover\adcc7832 1 11/08 KENT WASHINGT G CONSULTANT SERVICES AGREEMENT between the City of Kent and Sound Mental Health - Safe and Sound Visitation Center THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Sound Mental Health organized under the laws of the State of Washington, located and doing business at 1200 Fifth Avenue, Suite 600, Seattle, WA 98101 (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: Sound Mental Health will provide safe, supervised visitation and exchanges for families separated by domestic violence. 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 $22,000 ($11,000 per year) for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be as delineated in Exhibit A. CONSULTANT SERVICES AGREEMENT - 1 (Over$10,000) B. The Consultant shall submit 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. VL DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant shall execute the attached City of Kent Equal Employment CONSULTANT SERVICES AGREEMENT - 2 (Over $10,000) Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's liability hereunder shall be only to the extent of the Consultant's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. 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 h 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$10,000) 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 be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section VII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or CONSULTANT SERVICES AGREEMENT - 4 (Over$10,000) 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: ct��01 By: 4 By: (� (s-ign ure (signature) Print Na :A,)ab LT �1� Pri Na e uzette Cooke Its Its Ma or e DATE: I DATE: NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: David R Stone, CEO Katherin Johnson, Housing & Human Services Sound Mental Health Manager 1600 East Olive Street City of Kent Seattle, WA 98122 220 Fourth Avenue South Kent, WA 98032 (206) 302-2200 (telephone) (206) 302-2210 (facsimile) (253) 856-5070 (telephone) (253) 856-6070 (facsimile) APPROVED AS TO FORM: Au�&nmw 6 L, KeAt Law Department [In this field,you may enter the electronic fllepath where the contract has been saved] CONSULTANT SERVICES AGREEMENT - 5 (Over$10,000) DECLARATION - CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. Dated this ej� day of 20 . By: M I For: Title: do v Date: EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. Dated this day of 120 By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 Exhibit A KENT W•SrvinGrOry Scope and Schedule of Work PARKS, ITY SERVICES 9 RECREATIONs COMMUNITY 2011-2012 Consultant Services Agreement Agency: Sound Mental Health 12011 Funding: 11 000 Program: Safe and Sound Visitation Center 2012 Funding: $11 000 This funding Safe, supervised visitation and exchanges for families will provide: separated due to domestic violence Total: $22,000 Annual Program Outputs: Program Outcome: Unduplicated Kent Clients 46 Building a Safer Community Visitation Hours 88 SKCHS Membership/Participation Yes Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1, 2011, Sound Mental Health Safe and Sound Visitation Center 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 Units Total 1st Unduplicated City of Kent clients served 11 11 Visitation Hours 22 22 SKCHS Membership/Participation Yes Yes 2nd Unduplicated City of Kent clients served it 22 Visitation Hours 22 44 SKCHS Membership/Participation Yes Yes 3rd Unduplicated City of Kent clients served 12 34 Visitation Hours 22 66 SKCHS Membership/Participation Yes Yes 4th Unduplicated City of Kent clients served 12 46 Visitation Hours 22 88 SKCHS Membership/Participation 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. - The Consultant will hold active membership with the South King Council of Human Services http://skchs.org/ i - All records related to this CSA must be retained for three (3) years plus the current year. Exhibit A (continued) `✓ KENT Scope and Schedule of Work wo � 2011-2012 Consultant !ervices Agreement PARKS RECREATION S COMMUNITY SERVICES Agency: Sound Mental Health 2011 Funding: 11 000 Program: Safe and Sound Visitation Center 2012 Funding: $11 000 This funding Safe, supervised visitation and exchanges for families will provide: separated due to domestic violence 'Total: $22,000 Reporting Requirements and Timeline The agency will be reimbursed on a quarterly basis, upon submittal of appropriate documentation. Such documentation will include the following (as applicable): Billing Voucher & Service Report (Exhibit B); Outcome Based Evaluation Report (Exhibit C); and Client Demographic Data (Exhibit D). These items must be submitted on forms provided by the City (or online If requested) by the 10`h 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 291h, 2012/January 315C, 2013 Client Demographic Data (Exhibit D) January 29th, 2012/January 315t, 2013 Signature Please sign below to indicate acceptance of the Year 2011 and Year 2012 Performance Measures listed above. 4:::2 1 David R on al Health, CEO Date Kathenn Johnso City en , Hum n Services Manager Date Exhibit B General Fund KENT 2011 Billing Voucher W AS NINOT ON and Service Report PARKS, RECREATION S COMMUNITY SERVICES Agency: Sound Mental Health To: Jason Johnson Program Contact: " Housing & Human Services Safe and Sound Visitation Center Parks, Recreation & Community Services Susie Winston, 220 4th Ave. South, Kent, WA 98032 1600 East Olive Street Seattle, WA 98122 jajohnson@ci.kent.wa.us Telephone: Phone: (253) 856-5061 Fax: ` E-mail: SusieW@smh.org Reporting Period Program Amount Requested Safe and Sound Visitation Center Fs BUDGET SUMMARY FOR DEPARTMENT USE ONLY - Total Contract Amount $ =VENDOR NUMBER# PO# Current Request $ 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 Total Kent Total Service Service Units Planned Kent Funded Funded Units to Date Service Unit Description Each Quarter Service Units Service Units (ALL Funding This Quarter To Date Sources) Service UnitlPerformance Measure 1't 2n 3r 4 th Unduplicated # of Kent clients served 11 11 12 12 Visitation Hours 22 22 22 22 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 FOR DEPARTMENT USE ONLY AUTHORIZED FOR PAYMENT BY: DATE: Exhibit B General Fund • 2012 Billing Voucher KENT WASH INGTGN and Service Report PARKS RECREATION &r- COMMUNITY SERVICES Agency: Sound Mental Health To: Jason Johnson Program Contact: Housing & Human Services Safe and Sound Visitation Center Parks, Recreation & Community Services Susie Winston, 1 220 4th Ave. South, Kent, WA 98032 1600 East Olive Street Seattle, WA 98122 jajohnson@ci.kent.wa.us Telephone: Phone: (253) 856-5061 Fax: E-mail: SusieW@smh.org Reporting Period Program Amount Requested Safe and Sound Visitation Center $ BUDGET SUMMARY FOR DEPARTMENT USE ONLY Total Contract Amount $ VENDOR NUMBER# PO# Current Request $ ACCOUNT CODE _ Amount Remaining $ 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 UnitlPerformance Measure I st 2n 3r 4 th Unduplicated # of Kent clients served 11 11 12 12 Visitation Hours 22 22 22 22 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) td p (q ) �Y ) Authorized Signature Date FOR DEPARTMENT USE ONLY AUTHORIZED FOR PAYMENT BY: DATE: � qq moo pqq CL � Wqm / . O -cu Co-0 -0 � -i C 0 Z § § \ 2 Z o 0 \ FU k) Z 0 0 W c o \ \ � qq = \ E � w � k _ E (n ƒ \ 0 R / : » cu CL [ / u E o U / / § _ / 2 / L o 0 % W o s 7 ( m § 0 5 § Ln c $ ` : G = S e o a) a) �: k > \ ( ± \ ■ ; ) ) zEE = 3 m © wx : ( > § $ \ � [ t t § 0 m U = 2 $ 2 2 m c0 �< \ \ i § n ± E ` O O 3 / a) Agency • KENT Exhibit D Program Annual Demographic Report Date PARKS, RECREATIONS COMMUNITY SERVICES Unduplicated Number of Clients Served* Agency/Program Undu licated New Individuals this Year Client Residence" Algona Auburn Black Diamond Buren Covington Des Moines Enumclaw Federal Way Kent Maple Valle Milton Normandy Park Pacific Renton SeaTac Seattle Tukwila Unincorporated King Count Unknown TOTAL Household tkome Level " 30% of Median or Below 50% of Median or Below 80% of Median or Below Above 80% of Median Unknown TOTAL Gender Male Female TOTAL Age 0 -4 years 5- 12 years 13- 17 years 18-34 years 35- 54 years 55- 74 years 75+years Unknown TOTAL Ethnicity Asian/Pacific Islander Black/African American His anic/Latino a Native American/Alaskan Native White/Caucasian Other Unknown TOTAL Female Headed Household Disabling Condition Limited English Speaking *Unduplicated means count each client only once per calendar year **List of all clients served In client residence category and Kent clients only in rest of the categories EXHIBIT E INSURANCE REQUIREMENTS FOR SERVICE CONTRACTS 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 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. 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. 3. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. 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. If the Contractor elects to purchase Claims Made coverage, the Contractor is then obligated to purchase "tail" coverage for a minimum of 3 years beyond the expiration of such coverage last purchased. EXHIBIT E (Continued) 2. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 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 ANII. E. Verification of Coverage Contractor 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 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. Client# 129 AMENT ACORD CERTIFICATE OF LIABILITY INSURANCE 1DATE 2/31/2010 ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Parker Smith &Feek, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 425-709-360D HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Bellevue ) ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 2233 112th Avenue NE Bellevue, WA 98004 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A Granite State Insurance C Sound Mental Health INSURERS Philadelphia Indemnity Insurance Co 1600 E Olive St INSURER C Seattle,WA 98122 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 VVITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN S SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR ITYPE OFINSURANCE POLICY NUMBER PDATEYMMFDDlYYB POLICY DATE MMIEXPI D/YIYON LIMITS A X GENERAL LIABILITY 027560124 01/01/11 01/01/12 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY IPIFA ETO R. EDn $300,DDD X CLAIMS MACE OCCUR MED EXP(Any one person, $5 ODD X Retro Date 01/01186 PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE s3,000,000 GEN L AGGREGATE LIM T APPLIES PER PRODUCTS-COMP/OP AGO $3000000 X PCUCYF—j J PRV CT F-ILOC B X AUTOMOBILE LIABILITY PHPK668405 01/01/11 01/01/12 COMBINED SINGLE LIMIT $1,DDD,000 X ANY AUTO IEa accident) AFL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (per person) HIRED AUTOS BODILY INJURY $ NON OWNED AUTOS (Per accident, - PROPERTY DAMAGE- $ I accidents GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EAADC $ AUTO ONLY AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ O,CJR �C.AIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND 027560124 01/01/11 01/01/12 WCSTATU X OTIJ- EMPLOYERS LIABILITY TORY LIMij ER A PROPRIEICRIPARTNERIEXECUTIVE NY WA Stop Gap Only E L EACH ACCIDENT $1,000,000 ON FRMEMBEREXCLUDED EL DISEASE-�AEMPLCYEE $1,000,000 II yes describe under SPECIAL PROVISIONS below ELDISEASE-PJLIC-LIMIT $1,000,000 A OTHER Professional 027560124 01/01111 01101/12 $1,000,000 Each Claim Liability $3,000,000 Aggregate Retro Date 01/01/86 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS City of Kent is included as an Additional Insured per endorsement 86571 08104 attached CERTIFICATE HOLDER CANCELLATION Ten DaV Notice for Non-PaVrrient of Premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEIORE THE EXPIRATION CITY OF KENT DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Parks Dept/Housing& Human Services, NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL Attn Dinah Wilson,CDBG Coordinator IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR 220 4th Avenue S REPRESENTATIVES Kent,WA 98032 AUTHORIZED REPRESENTATIVE .� ACORD 25(2001106)1 of 2 #M94951 (V�1f•�+_" SL000 a ACORD CORPORATION 1988 I IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies)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 on the reverse side of this form 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-S(2001108) 2 of 2 #M94951 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY EXTENSION ENDORSEMENT FOR HUMAN SERVICES PROGRAMS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. DEFENSE EXTENSION reason, pending the completion of any remedial activity such as community service or counseling,or The following is added to COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, a. Expected Or Intended Injury and 3 For any type of civil charge(s)whatsoever. COVERAGE B — PERSONAL AND ADVERTISING The most we will pay for defense under this defense INJURY LIABILITY, 2. Exclusions, a. Knowing extension is $25,000. violation Of Rights Of Another B. LEGAL LIABILITY EXTENSION However, we will reimburse you for the sums that you 1. The last paragraph of Section I — Coverages A — voluntarily reimburse to an "employee" of yours for the 2. Exclusions, is deleted and replaced by the reasonable and necessary defense costs that he or she following- incurs in order to defend himself or herself against Exclusions c. through n. do not apply to criminal charges made against him or her, but this insurance only applies if a damage by fire, lightning, explosion, smoke or 1 The alleged acts out of which such criminal charges leaks from automatic fire protective systems, and arise are alleged to have a. Arisen out of and in the course of your b. damage caused by a"resident"; employment of the "employee", and to premises rented to you or temporarily occupied b. Been committed by your "employee" against a by you with the permission of the owner client of your Human Services facility, and 2. Paragraph 6. of Section III — Limits of Insurance C. Taken place during that period of time that the is deleted and replaced by the following "employee"was employed by you, and d. Taken place during the policy period and in the 6. Subject to 5. above, the Damage To Premises "coverage territory", and Rented To You Limit is the most we will pay under COVERAGE A for damages because of 2 All the criminal charges are either dismissed without "property damage" prejudice or your "employee" is found not guilty of a. resulting from fire, lightning, explosion, all criminal charges by a court of law smoke or leaks from automatic fire protective systems, or any combination This exception does not apply to any reimbursement of thereof, and sums that you voluntarily reimburse to your "employee" b. caused by a"resident", for the reasonable and necessary defense costs that he or she incurs in order to defend himself or herself to premises, rented to you or temporarily against criminal charges made against him or her occupied by you with the permission of the owner Damage To Premises Rented To You 1. For any criminal charge(s) arising out of the Limit is the greater of ownership, maintenance, use or entrustment to a. $200,000 for damages due to fire, lightning, others of any aircraft, "auto"or watercraft, or explosion, smoke or leaks from automatic fire protective systems, or any combination 2. For any criminal charge(s) where your "employee" there of, or receives anything less than either a complete dismissal with prejudice or a not guilty verdict on all b. The Damage To Premises Rented To You charges, including without limitation, any deferred Limit shown in the Declarations, and adjudication or similar finding of guilt that is held in abeyance for any reason, pending the completion of 86571 08104 • • c. $25,000 for damages caused by a the furnishing or failure to furnish professioi "resident" services in the medical treatment of"resident: 3 Paragraph 4 b (b) of Section IV — Commercial General Liability Conditions — Other Insurance, is 3. As respects the violation of "Rights of Residen deleted and replaced by the following Coverage the following definition is added (b) That is property insurance for premises rented Section V-- Definitions to you or temporarily occupied by you with the "Rights of residents" means: permission of the owner, a. Any right granted to a resident under any st,- 4. Paragraph a., "Insured Contract", of paragraph 9. law regulating your business as a health c< of Section V— Definitions is deleted and replaced facility by b. The "rights of residents" as included in t a. A contract for a lease of premises However, United States Department of Health a that portion of the contract for a lease of Welfare regulations governing participation premises that indemnifies any person or Intermediate Care Facilities and Skilled Nursi organization for damage by fire, smoke, or Facilities, regardless of whether your facility leaks from sprinklers to premises while rented subject to those regulations. to you or temporarily occupied by you with theE. WAIVER OF IMMUNITY permission of the owner is not an "insured We will waive, both in the adjustment of claims and contract" the defense of"suits" against the insured, any charitat 5. The following is added to SECTION V Definitions' or governmental immunity of the insured, unless t insured requests in writing that we not do so. "Resident" means a person who is disabled and placed by the insured Waiver of immunity as a defense will not subject us C. LIQUOR LIABILITY EXCLUSION — EXCEPTION FOR liability for any portion of a claim or judgment in exce FUND RAISING EVENTS of the applicable limit of insurance Paragraph c of 2 Exclusions, COVERAGE AF. WHO IS AN INSURED (SECTION 1) is amended by adding the following Paragraph 2. of Section II — Who Is An Insured subparagraph deleted and replaced by the following This exclusion does not apply to "bodily injury" or 2. Each of the following is also an insured, but or "property damage" arising out of the selling, serving or while working within the scope of their duties for tl furnishing of alcoholic beverages at any fund-raising insured events a "Employees", D. VIOLATION OF RIGHTS OF RESIDENTS COVERAGE (PATIENT'S RIGHTS) b. "Volunteer Workers"; 1. The following is added to Section I — Coverages — However, no"employees"or"volunteer workers" Coverage A, paragraph 1. Insuring Agreement: are insureds for (1) "Bodily injury" or"personal and advertising "Bodily injury" damages arising out of the violation injury" of "Rights of Residents" shall be deemed an (a) To you, to your partners or members "occurrence" you are a partnership or joint venture) 2. As respects the coverage provided in paragraph to your members (if you are al limited A.1. of this endorsement, the following exclusions liability company), to a co-"employee" are added to Section I—Coverages —Coverage A while in the course of his or her —2. Exclusions: employment or performing duties This insurance does not apply to: related to the conduct of your business or to your other"volunteer workers" p Liability arising out of the willful or intentional while performing duties related to the violation of"Rights of Residents" conduct of your business, q. Fines or penalties assessed by a court or regulatory authority r. Liability arising out of any act or omission in the 86671 08104 -2- (b) To the spouse, child, parent, brother or (2) Premises they own, maintain or control sister of that co-"employee" or while you lease or occupy these premises "volunteer worker" as a consequence of Paragraph (1)(a) above, This insurance does not apply to structural alterations, new construction and demolition (c) For which there is any obligation to operations performed by or for that person or share damages with or repay someone organization else who must pay damages because g Any State or Political Subdivision subject to the of the injury described in Paragraphs following provision (1)(a) or(b)above, or This insurance applies only with respect to the (d) Arising out of his or her providing or following hazards for which the state or political failing to provide professional health subdivision has issued a permit in connection care services with premises you own, rent, or control and to which this insurance applies (2) "Property damage"to property (1) The existence, maintenance, repair, (a) Owned, occupied or used by, construction, erection, or removal of (b) Rented to, in the care, custody or advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, control of, or over which physical control is being exercised for any manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or purpose by you, any of your "employees", "volunteer workers", any decorations and similar exposures, or partner or member(if you are a partnership or joint venture), or any (2) The construction, erection, or removal of member(if you are a limited liability elevators, or company) (3) The ownership, maintenance, or use of any --e An Independuni Curitractor is an Insured onty--- x - ` elevators covered by this insurance. for the conduct of your business and solely while performing services for a client of the However, the insurance afforded for any Named Insured, organization and subsidiary thereof not named d. Medical directors and administrators, including in the Declarations as a Named Insured, does professional persons; not apply to injury or damage with respect to e. If you are an organization other than a which an insured under this endorsement is partnership or joint venture, your managers and also an insured under another policy, or would supervisors are also insureds, be an insured under such policy but for its termination or the exhaustion of its limits of d If you are a limited liability company your insurance members are insureds, but only with respect to their duties related to the conduct of your h Students in training, but not for"bodily iniury" r business, "property damage" arising out of his or her rendering or failure to render professional e Any organization and subsidiary thereof which services to patients; you control and actively manage on the i Your members but only with respect to their effective date of this endorsement, liability for your activities or activities they f Any person or organization that has financial perform on your behalf, control of you or owns, maintains or controls 1 Your trustees or members of the board of premises occupied by you and requires you to governors while acting within the scope of their name them as an additional insured but only duties as such on your behalf, with respect to their liability arising out of k. Any entity you are required in a written contract (1) Their financial control of you, or (hereinafter called Additional Insured) to name as an insured is an insured but only with respect to liability arising out of your premises, "your work"for the Additional Insured, or acts or 86571 08/04 -3- the Additional Insured, or acts or omissions of With respect to Additional Insured(s) who are the Additional Insured in connection with the architects, engineers, or surveyors, this insurance general supervision of "your work" to the extent does not apply to "bodily injury," "property damage" set forth below or"personal and advertising injury" arising out of the (1) The Limits of Insurance provided on behalf rendering or failure to render any professional of the Additional Insured(s) are not greater services by or for you, including than those required by such contract (1) The preparing, approving, or fading to prepare (2) The coverage provided to the Additional or approve, maps, shop drawings, opinions, Insured(s) is not greater than that reports, surveys, field orders, change orders, or customarily provided by the policy forms drawings and specifications, and specified in and required by the contract (2) Supervisors, inspection, or engineering (3) All insuring agreements, exclusions, and services conditions of this policy apply Any coverage provided under this provision shall be (4) In no event shall the coverages or Limits of excess over any other valid and collectible Insurance in this endorsement be increased insurance available to the Additional Insured(s) by such contract whether primary, excess, contingent, or on any other basis unless a contract specifically requires Except when required otherwise by contract, this that this insurance be primary or you request that it insurance does not apply to apply on a primary basis (1) `Bodily injury" or "property damage" occurring after Paragraph 4.a. of Section II — Who Is An Insured (a) All work on the protect (other than service, is deleted and replaced by the following maintenance, or repairs) to be performed by or on behalf of the Additional Insureos) at the site a. Coverage under this orovision is. subject to (1) of the covered operations has been completed, and (2) below: or (1) Effective on the acquisition or formation (b) That portion of`your work" out of which the date, and injury or damage arises has been put to its intended use by any person or organization (2) Afforded only until the end of the policy other than another contractor or subcontractor period of this Coverage Part or the next engaged in performing operations for a principal anniversary of its inception date, whichever as a part of the same protect is earlier 66571 06/04 .4- KENT Exhibit F PARKS RECREATION 5 COMMUNITY SERVICES City of Kent Certification Regarding Debarment and Suspension Agency Name of Program(s) Certification A: Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions 1. The prospective primary participant certifies to the best of its knowledge and belief that its principals, a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal debarment or agency, b) Have not within a three-year period preceding this proposal, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction, violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false statements, or receiving stolen property, c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification, and d) Have not within a three-year period preceding this application/ proposal had one or more public transactions (Federal, State, or local) terminated for cause or default 2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal Instructions for Certification (A) 1 By signing and submitting this proposal, the prospective primary participant is providing the certification set out below 2 The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction The prospective participant shall submit an explanation of why it cannot provide the certification set out below The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction 3 The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default 4 The prospective primary participant shall provide immediate written notice to the department or agency to whom this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances 5 The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549 You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of these regulations 6 The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered 1 of 3 transaction with'a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction 7 The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclu- sion - Lower Tier Covered Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions 8 A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous A participant may decide the method and frequency by which it determines this eligibility of its principals Each participant may, but is not required to, check the Non-procurement List 9 Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings 10 Except for transactions authorized under paragraph (6) of these instructions, if a participant in a covered transaction 11 Knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default Certification B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal Instructions for Certification (B) 1 By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below 2 The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment 3 The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances 4 The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549 You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations 5 The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated 2of3 6 The prospective lower tier participant further agrees by submitting this proposal that It will Include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclu- sion - Lower Tier Covered Transaction," without modification, In all lower tier covered transactions and In all solicitations for lower tier covered transactions 7 A participant In a covered transaction may rely upon a certification of a prospective participant In a lower tier covered transaction that It Is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification Is erroneous A participant may decide the method and frequency by which it determines the eligibility of Its principals Each participant may, but is not required to, check the Nonprocurement List 8 Nothing contained in the foregoing shall be construed to require establishment of a system of records In order to render In good faith the certification required by this clause The knowledge and Information of a participant Is not required to exceed that which is normally possessed by a prudent person In the ordinary course of business dealings 9 Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, Ineligible, or voluntarily excluded from participation In this transaction, In addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment Primary Contractor/Sub-Contractor(Print) Title Date Signature of Primary Contractor/ ub-Contractor Title Dat l C (3, Adopted from HUD Form-2992 09104 3of3 REQUEST FOR MAYOR'S SIGNATURE �� Please Fill in All Applicable Boxes K Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAIN DEPARTMENT) Originator: Jason Johnson Phone (Originator): x5061 Date Sent: February 28, 2011 Date Required: Return Signed Document to: J. Johnson CONTRACT TERMINATION DATE: 12-31-2012 VENDOR NAME: Sound Mental Health 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 All Contracts bust Be Routed Through The Law Department r (This area to be completed by the Law Department)) ''�vv j�T l Received: RECEIVED Ei.�p� �`;u r►v r /�GU E%011 V cfvv� ids Approval of Law Dept.: tnR ' 2011 Law Dept. Comments: MiLj<k EJtMti'6'S SCENT LA �EPT.KEt� . Date Forwarded to Mayor: 1 Shaded Areas To Be Completed By Administration Staff Received• {-1 l� Recommendations and Comments Disposition: Ctn Of Y;tNi ositian: Y �f ,'/ 710' Clll'C-RK Date Returned: