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HomeMy WebLinkAboutPK11-271 - Original - Sound Mental Health - Safe & Sound Visitation Center - 06/13/2011 40*5vm*-. Records Management K NT 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 Mary Simmons, City Clerks Office. Vendor Name: SCLkVk Jo A-� Wr-4 Contract Number: This is assigned by Mary Simmons Vendor Number: Project Name: c_. -k �� �Ou�+ 0 /— Contract Effective Date: Contract Termination Date: Contract Renewal Notice (Days): o Number of days required notice for terminate or renewal or amendment Contract Manager: ✓l S:f VI 14C--x Department: Pk('LS du A/A 1 96 0, of S Abstract: ADCL7832 07/02 0 Y KENT w.s.i.GTO. i 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 I. DESCRIPTION OF WORK. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: The City is under contract with U.S. Department of Justice Office on Violence Against Women (OVW), to provide safe, supervised visitation and exchanges for families separated by domestic violence. Sound Mental Health will provide the staffing and language interpretation to execute these services. Exhibit A, Special Conditions and Schedule of Work; Exhibit B, Service Reporting; Exhibit C, Annual Outcome Report; Exhibit D, Annual 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. i II. TIME OF COMPLETION. The parties agree that work will begin on the tasks n n described in Section I above immediately upon the effective date of this Agreement. Upon the e 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 total not to exceed $107,838 ($92,424 for personnel and $15,414 for interpreters) 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 quarterly payment invoices to the City for work performed, and a final bill upon completion of all services described in this Agreement. The consultant shall also submit documentation in the form of staff timesheets and interpreter bills showing the payment reimbursement request. The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Consultant has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Consultant maintains and pays for its own place of business from which Consultant's services under this Agreement will be performed. C. The Consultant has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Consultant's services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Consultant's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the Consultant's possession pertaining to this project, which may be used by the City without restriction. If the City's use of Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant shall execute the attached City of Kent Equal Employment 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) 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. With the exception of Sound Mental Health (SMH) medical and clinical records, 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. With the exception of SMH medical and clinical records, Consultant shall make such data, documents, and files available to the City upon the City's request. The City shall have the right to access and review SMH medical and clinical records related to services provided under this Agreement during an audit process, but all SMH medical and clinical records shall remain the exclusive property of SMH. 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. i CONSULTANT SERVICES AGREEMENT - 3 (Over $10,000) XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor with the authority to control and direct the performance and details of the work authorized under this Agreement, the work must meet the approval of the City and shall be subject to the City's general right of inspection to secure satisfactory completion. XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XIII. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section VII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant. CONSULTANT SERVICES AGREEMENT - 4 (Over$10,000) G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. CONSULTANT: CITY OF KENT: By: yz-x -/ /- By: ell (signature) (signature) Print Name: David R. stone Print ame: S tte Cooke Its CEO Its Ma or tl t� DATE: 0 4 l 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 T FORM: Kent Law Department P,CmflFl Wl =FikaM3-Se&fly GeoaMMH SsSdomW OVW CSA 2011-12 doe CONSULTANT SERVICES AGREEMENT - 5 (Over$10,000) v 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; n The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. w 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. # Dated this day of �Ct� , 20LL. r By: a For: Sound Mental Health Title: CEO Date: EEO COMPLIANCE DOCUMENTS - 1 e i CITY OF KENT ADMINISTRATIVE POLICY 4 NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 3 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. a : I k, 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. t I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. Dated this day of , 20 By: For: Title: b Date: 1 EEO COMPLIANCE DOCUMENTS - 3 Exhibit A `/ KENT Schedule of Work and Special Conditions PARKS, ITY SERVICES 9 RECREATION a COMMUNITY 2011-2012 Consultant Services Agreement Agency: Sound Mental Health Program: Safe and Sound Visitation Center This funding Safe, supervised visitation and exchanges for families separated due to domestic violence will provide: Reporting Requirements and Timeline 9 The Agency will be reimbursed on a quarterly basis, not to exceed $13,203.43 per quarter for staffing and $2,202.00 per quarter for interpreter services, upon submittal of appropriate documentation. Such documentation will include the following (as applicable): Billing Voucher & Service Report (an example of which is attached to the Consultant Services Agreement as Exhibit B), data to complete the OVW Semi- Annual Report (an example of which is attached to the Consultant Services Agreement as Exhibit D), copies of staff timesheets, and interpreter bill. These items must be submitted to the City by the 1Oth of - the-following-month-for-the-previous quarter of service. Please note-that the terms"recipient`and - r "grantee" as used throughout the below-listed Special Conditions are intended to mean the City of Kent. The reporting timeline is as follows: Report = Due Date ' Billing Voucher & Service Report Exhibit B 10th day following each .quarter Semi-annual Report Data Exhibit D 10th day following each quarter Support documentation for reimbursement 10th day following each quarter Special Conditions 1. The recipient agrees to comply with the financial and administrative requirements set forth in the current edition of the Office of Justice Programs (OJP) Financial Guide. 2. The recipient agrees to comply with the organizational audit requirements of OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations, and further understands and agrees that funds may be withheld, or other related requirements may be imposed, if outstanding audit issues (if any) from OMB Circular A-133 audits (and any other audits of OJP grant funds) are not satisfactorily and promptly addressed, as further described in the current edition of the OJP Financial Guide, Chapter 19. is 3. Recipient understands and agrees that it cannot use any federal funds, either directly or indirectly, in support of the enactment, repeal, modification or adoption of any law, regulation or policy, at any level of government without the express prior written approval of OVW, in order to avoid violation of 18 USC § 1913. The recipient may, however, use federal funds to collaborate with and provide information to Federal, State, local, tribal and territorial public officials and agencies to develop and implement policies to reduce or eliminate domestic violence, dating violence, sexual assault, and stalking (as those terms are defined in 42 USC 13925(a)) when such collaboration and provision of information is consistent with the activities otherwise authorized under this grant program. 4. The recipient must promptly refer to the DO] DIG any credible evidence that a principal, employee, agent, contractor, sub grantee, subcontractor, or other person has either 1) submitted a false claim for grant funds under the False Claims Act; or 2) committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving grant funds. This condition also applies to any sub recipients. Potential fraud, waste, abuse or misconduct should be reported to the OIG by - Mall: Office of the Inspector General U.S Department of Justice Investigations Division ` 950 Pennsylvania Avenue, N.W., Room 4706 Washington, DC 20530 Email: oio.hothne@usdol.aov Hotline. (contact information in English and Spanish), (800) 869-4499 Or hotline fax: (202) 616-9881 Additional information is available from the DOJ OIG website at www usdoi gov/oig. 5. The grantee agrees to comply with all relevant statutory and regulatory requirements which may include, among other relevant authorities, the Violence Against Women Act of 1994, P.O. 103-322, the Violence Against Women Act of 2000, P.L. 106-386, the Omnibus Crime Control and Safe Streets Act of 1968, 42 U.S.C. 3711 et seq., the Violence Against Women and Department of Justice Reauthorization Act of 2005, P.L. 109-162, and OVW's implementing regulations at 28 CFR Part 90. 6. Approval of this award does not indicate approval of any consultant rate in excess of$450 per day. A detailed Justification must be submitted to and approved by the Office on Violence Against Women prior to obligation or expenditure of such funds. — 7.Ihe�ee agrees to submit semiannual progress reports a describe proJe�activities-c wring t e reporting period. Progress reports must be submitted within 30 days after the end of the reporting periods, which are January 1 - June 30 and July 1 - December 31 for the duration of the award. Future awards may be withheld if progress reports are delinquent. Grantees are required to submit this information online, through the Grants Management System (GMS), on the semi-annual progress report for the relevant OVW grant programs. Therefore, the Consultant is required to submit quarterly progress reports to the City. 8. Under the government Performance and Results Act (GPRA) and VAWA 2000, grantees are required to collect and maintain data that measure the effectiveness of their grant-funded activities. Accordingly, the grantee agrees to submit semi-annual electronic progress reports on program activities and program effectiveness measures. Information that grantees Just collect under GPRA and VAWA 2000 includes, but is not limited to: 1) number of persons served; 2) number of persons seeking services who could not be served; 3) number of supervised visitation and exchange centers supported by the program; 4) number of supervised visits between parents and children; and 5) number of supervised exchanges between parents and children. Therefore, the Consultant is responsible for reporting this data quarterly to the City. 9. The recipient agrees to submit quarterly financial status reports to OVW. At present, these reports are to be submitted on-line (at https://grants.ojo.usdol.gov) using Standard Form SF 269A, not later than 45 days after the end of each calendar quarter. The recipient understands that after October 15, 2009, OVW will discontinue its use of the SF269A, and will require award recipients to submit quarterly financial status reports within 30 days after the end of each calendar quarter, using the government-wide Standard Form 425 Federal Financial report from (available for viewing at www whitehouse.gov/omb/grants/standard forms/ffr.pdf). Beginning with the report for the fourth calendar quarter of 2009 (and continuing thereafter), the recipient agrees that it will submit quarterly financial status reports to OVW on-line (at https://grants.o7P.usdoj.gov) using the SF 425 Federal Financial Report form, not later than 30 days after the end of each calendar quarter. The final report shall be submitted not later than 90 days following the end of the grant period. Therefore, the Consultant is required to submit quarterly progress reports to the City. 10. Pursuant to 28 CFR sec 66.34, the Office on Violence Against Women reserves a royalty-free, nonexclusive and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, in whole or in part (including in the creation of derivative works), for Federal Government purposes: a. Any work that is subject to copyright and was developed under this award, sub award, contract or subcontract pursuant to this award; and b. Any work that is subject to copyright for which ownership was purchased by a recipient, sub recipient or a contractor with support under this award r In addition, the recipient (or sub-recipient, contractor or subcontractor) must obtain advance written approval for the Office on Violence Against Women program manager assigned to this award, and must comply with all conditions specified by the program manager in connection with that approval before: 1) using award funds to purchase ownership of, or a license to use, a copyrighted work; or 2) incorporating any copyrighted work, or portion thereof, into a new work developed under this award. It is the responsibility of the recipient (and of each sub recipient, contractor of subcontractor as applicable) to ensure that this condition is included in any sub award, contract of subcontract under this award. 11.The grantee agrees that grant funds will not support activities that may compromise victim safety, such as: pre-trial diversion programs not approved by OVW or the placement of offenders in such programs; mediation, couple counseling, family counseling or any other manner of Joint victim-offender counseling; mandatory counseling for victims, penalizing victims who refuse to testify, or promoting procedures that would require victims to seek legal sanctions against their abusers (e.g., seek a protection order, file formal complaint); or the placement of perpetrators in anger management programs. r 12. All materials and publications (written, visual, or sound) resulting from award activities shall contain the following-statement: "This-project-was supported by Grant No..awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women. 13. Within 45 days after the end of any conference, meeting, retreat, seminar, symposium, training activity, or similar event funded under this award, and the total cost of which exceeds $20,000 in award funds, the recipient must provide the program manager with the following information and itemized costs: a. Name of event b. Event dates c. Location of event d. Number of federal attendees e. Number of non-federal attendees f. Costs of event space, including rooms for break-out sessions g. Costs of audio visual services h. Other equipment costs (eg., computer fees, telephone fees) i. Costs of printing and distribution j. Costs of meals provided during the event 9 k. Costs of refreshments provide3d during the event I. Costs of event planner m. Costs of event facilitators and n. Any other direct costs associated with the event The recipient must also itemize and report any of the following attend (including participants, presenters, speakers costs that are paid or reimbursed with cooperative agreement funds: a. Meals and incidental expenses (M&IE portion of per diem) b. Lodging c. Transportation to/from event location (e.g., common carrier, privately owned vehicle (POV) d. Local transportation (e.g., rental care POV) at event locations Note that if any item is paid for with registration fees, or any other non-award funding, then that portion of the expense does not need to be reported. 14.TERMS OF THE COOPERATIVE AGREEMENT The Office on Violence Against Women (OVW) has elected to enter into a Cooperative Agreement with the City of Kent and its project partners, The YWCA of King County, The King County Coalition Against Domestic Violence, the King County Prosecutor's Protection Order Advocacy Program, and the Unified Family Court Division of the King County Superior Court, to increase available supervised visitation and safe exchange w services for victims of domestic violence, child abuse, sexual assault, teen dating violence, and stalking. This decision reflects a strong mutual interest in increasing the safety and well-being of victims and their children during supervised visitations and safe exchanges. The award recipient acknowledges that OVW will plan a substantial role in shaping and monitoring the project. STATEMENT OF FEDERAL INVOLVEMENT The Office on Violence Against Women (OVW) will: a. Provide the services of a Federal Program Specialist as a single point of contact for the administration of this cooperative agreement b. Monitor program development and implementation, and fulfill an oversight function regarding the project c. Review and approve content and format of the materials produced in conjunction with this project d. Provide input, re-direct the project as needed, and actively monitor the project biy methods including but not limited to ongoing contact with the recipients e. Approve sites and dates of all project related activities. STATEMENT OF RECIPIENT RESPONSIBILITIES The City-of-Kent-will work callaboratively-in_the implementation of-the-grant-project-with the-YWCA-of King County, the King County Coalition Against Domestic Violence, the King County Prosecutor's Protection Order Advocacy Program, and the Unified Family Court Division of the King County Superior Court. Recipients will: a. Work closely with OVW in the development and implementation of this project b. Ensure that a multi-disciplinary team participates in project development and implementation. The multidisciplinary team should include representatives from the grantee agency, the state or local court, and the domestic violence/sexual assault agency. Representatives will participate in the consulting committee; attend meetings and institutes, as designated by OVW; and substantially participate in the planning and implementation of visitation and exchanges services as outlined by the grant program. c. Identify a representative of the grantee agency to serve as project coordinator. This representative will substantially participate in all aspects of the grant project; coordinate development and implementation activities; and attend meetings and institutes, as designated by OVW. d. Send project staff and collaborative partners to meetings and institutes, as designated by OVW. e. Participate in all OVW funded technical assistance opportunities related to the Supervised Visitation Grant Program, including, but not limited to, grantee meetings, on-site technical assistance, and site visits. f. Allocate project funds, as designated by OVW, for allowable costs to participate in OVW sponsored technical assistance. Funds designated for OVW sponsored technical assistance may not be used for any other purpose without prior approval of OVW. Technical assistance includes, but is not limited to, peer-to-peer consultations, focus groups, mentoring site visits, conferences and workshops conducted by OVW designated technical assistance providers or OVW designated consultants and contractors. g. Provide OVW with the agenda for any training seminars, workshops or conferences not sponsored by OVW that project staff propose to attend using grant funds. The grantee must receive prior approval from OVW before using OVW grant funds to attend any training, workshops, or conferences not sponsored by OVW. To request approval, grantees must submit a Grant Adjustment Notice (GAN) request through the Grants Management System to OVW with a copy of the event's brochure, curriculum and/or agenda, a description of the hosts or trainers, and an estimated breakdown of costs. The GAN request should be submitted to OVW at 20 days before registration for the event is due. Approval to attend non OVW sponsored programs will be given on a case by case basis. h. Ensure that grant funds will be used to support supervised visitation and safe visitation exchange of children by and between parents in situations involving domestic violence, child abuse, sexual assault, or stalking. In accordance with 42 USC 10420, the grantee may not use grant funds to support individual counseling , family counseling, parent education, support groups or therapeutic supervision. The grantee may not mandate victims to parent education or other program services. i. Ensure that grant funds will not be used to provide offsite or overnight visitation services. Offsite visitation includes, but is not limited to, any monitored visit between a child and a non-custodial Y parent that occurs outside the premises of the visitation center. Overnight visitation includes, but is not limited to, any monitored visit between and child and a non-custodial parent that occurs outside of the normal operating hours of the visitation center. 11 j. Develop formal affiliations with organizations that will be able to provide services and consultation to the programs in their work with children and parents. Accordingly, grantees must establish a consulting committee that includes experts in the following fields: child abuse and neglect, mental health, batterer's intervention, law enforcement, child protection services and advocacy for victims of domestic violence, dating violence, stalking and sexual assault. k. Develop and implement adequate security measures, including but not limited to, adequate facilities, procedures, and personnel capable of preventing violence, for the operation of supervised visitation programs or safe visitation exchange. I. Agree that if fees are charged for use of programs or services, any fees charged must be based on the income of the individuals using the programs or services, unless otherwise provided by court order. a m. Ensure that the grant project is developed and implemented in a manner that is consistent with the Guiding Principles of the Supervised Visitation Program. The Guiding Principals embody the statutory requirements and objectives of the Supervised Visitation Program. They are intended to guide practice of OVW grantees. The standards and practices included within the Guiding Principles are considered to be good practice when addressing the needs of victims and their children. Centers -funded-under the Supervised Visitation Program can are encouraged to go beyond the practices outlined within the Guiding Principles. n. Participate in quarterly collaborative partner meetings, MOU committee meetings, and regularly communicated with expert/services committee. Sound Mental Health Billing Rates SMH Interpreter Payment Rates - 2011 • American Sign language $55/hr • Dynamic Language $45/hr • Language Connection $40/hr • Polylang $35/hr l SMH Safe &Sound Salary (hourly rate) Schedule - 2011 Safe & Sound Program Manager - $28.00 Visit Monitors - $14.95 - $17.68 DOE Support/Reception - $12.45 I i I t a Exhibit B KENT 2011 Quarterly WASHINGTON Billing Voucher PARKS, RECREATION S COMM and Service Report 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.or. — deporting Period- -- Program - ----Amount Requested--- Safe and Sound Visitation Center: Personnel $ Safe and Sound Visitation Center: Interpreters $ BUDGET SUMMARY F©R DEPARTM04T UsEbNLY Total Contract Amount $ 107,838 VENDOR NUMB,E-R, PO Current Request $ ACCOUNT CODE Amount Remaining $ 107,838 This invoice shall be accompanied by the information described in the following Progress Report. The information for the Progress Report is due to the City of Kent on the 10th day of the month following the quarter. This invoice shall be accompanied by support documentation such as copy of timesheets and interpreters bill showing invoice amount requested Authorized Signature Date FOR DEPARTMENT USE ONLY AUTHORIZED FOR PAYMENT BY: DATE: ♦ 4i e OMB Clearance#1122-0009 Expiration Date 06/30/2011 U.S. Department of Justice Office on Violence Against Women SEMI-ANNUAL PROGRESS REPORT FOR Safe Havens:Supervised Visitation and Safe Exchange Grant Program Brief Instructions:This form must be completed for each Safe Havens: Supervised Visitation and Safe Ex- change Grant Program (Supervised Visitation Program) grant received The grant administrator or coordinator must ensure that the form is completed fully with regard to all grant activities. If the program involves more than one site (either for provision of services or for planning), there will still be only one form completed for each program Grant partners, however, may complete sections relevant to their portion of the grant Grant administrators or coordinators are responsible for compiling and submitting a single report that reflects all information collected from grant partners All grantees should read each section to determine which items they must answer, based on the activities engaged in under this grant during the current reporting period. Sections Al, B, C2. C3, E, and F of this form must be completed by all grantees In subsections A2, C1, and C4, and section D, grantees must answer an initial question about whether they engaged in certain activities during the current reporting period If the response is yes,then the grantee must complete that section or subsection. If the response is no,the rest of that section or subsection is skipped. For example, if you receive funds to hire staff for the purposes of planning and protocol development,you will complete sections A, B, C2, C3, C4, E, and F(and answer'no' in C1 and D); or if you receive funds to hire staff for services and training,you will complete sections A, B, C1, C2, C3, D, E, F(and answer 'no' in C4). The activities of volunteers or interns should be reported if they are coordinated or supervised by Supervised Visitation Program-funded staff or if Supervised Visitation Program funds substantially support their activities. For further information on filling out this form, refer to the separate set of instructions, which contains detailed definitions and examples illustrating how questions should be answered a _ t Section A General Information 1 Al' Grant Information 1 i A2: Staff Information 3 Section B Program Activities 4 Section C Function Areas 5 Cl: Training and Staff Development 5 C2* Coordinated Community Response 8 C3 Policies 10 C4: Planning 12 Section D: Services 14 Section E• Community Measures 19 Section F. Narrative 20 i d ) i i 3 Supervised Visitation Program Semi-Annual Progress Report Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 GENERAL INFORMATION Al' Grant Information All grantees must complete this subsection. i - 1. Date of report (format date with 6 digits,like-01/a1,/o9) 2. Current reporting period January 1-June 30 ❑ July 1-December 31 j 2 0 1 1 (Year) 3. Grantee name KENT CITY OF 4. Grant number 2009-Cw-Ax-KO07 (the federal grant number assigned to your Supervised Visitation Program grant) 5. Type of implementing agency/organization (Check one.) ❑ Court(state or local) ❑ Supervised visitation center ❑ Domestic violence program ❑ Supervised visitation and exchange center ❑ Sexual assault program ❑ Tribal government ❑ State government ❑ Unit of local government ❑ Supervised exchange center ❑ Other(specify): 5A. Is this a faith based organization? ❑ Yes ❑ No 6. Grant description (Check all that apply and report the number of sites tfor each type of grant.) f Of f■� 11 M. B71 t 1 "-9 t 1 ❑ Supervised Visitation Program (development) ❑ Supervised Visitation Program (continuation) ��❑ � �� 7. Point of contact (person responsible for the day-to-day coordination of the grant) First name MI Last name Agency/organization name Address City State®Zip code Telephone Facsimile E-mail S. Does this grant specifically address tribal populations? (Check yes if your Supervised Visitation Program grant focuses on tribal populations, and indicate which tribes or nations you serve or intend to serve ) ❑ Yes ❑ No If yes, which tribes/nations: Supervised Visitation Program Semi-Annual Progress Report • 1 • Office on Violence Against Women OMB Clearance#M2-0009 Expiration Date 06/30/2011 9. What percentage of your Supervised Visitation Program grant funds was directed to each of these areas? (Report the area(s)addressed by your Supervised Visitation Program grant during the current reporting period and estimate the approximate percentage of funds[or resources] used to address each area. 9 Grantees that are providing visitation and/or exchange services should use the number of cases in each area. Grantees that are in a planning phase should consider services that they anticipate provid- ing.) Throughout this form,the term sexual assault includes both assaults committed by offenders who are strangers to the victim/survivor and assaults committed by offenders who are known to, related by blood or marriage to, or in a dating relationship with the victim/survivor.The term domestic violence/ dating violence applies to any pattern of coercive behavior that is used by one person to gain power ) and control over a current or former intimate partner or dating partner Stalking is defined as a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress Child abuse means a threat to a child's health or welfare by physical, mental, or emotional injury or impairment, sexual abuse or exploi- tation, deprivation of essential needs, or lack of protection from these, by a person responsible for the child (or as defined by your state's statutes ) (See separate instructions for more complete definitions) a Sexual assault Domestic ulo)enee/dafingviolence Stalking Child abuse TOTAL (must equal 100%) 0% 3 s i 5 Supervised Visitation Program Semi-Annual Progress Report 2 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 2 A _ Staff Information o motion Were Supervised Visitation Program funds used to fund staff positions during the current reporting period? Check yes If Supervised Visitation Program grant funds were used to pay staff, Including part-time staff and contractors. ❑ Yes—answer question 10 ❑ No—skip to section B 10. Staff (Report the total number of full-time equivalent(FTE]staff funded by the Supervised Visitation Program grant during the current reporting period. Report staff by functions performed, not by title or location. Include employees who are part-time and/or only partially funded with these grant funds as well as consultants/contractors. Report grant-funded overtime If an employee or contractor was employed or utilized for only a portion of the reporting period, prorate appropriately. For example, if you hired a full-time administrator in October who was 100% funded with Supervised Visitation Program funds,you would report that as.5 FTE. Report all FTEs in decimals, not percentages. One FTE is equal to 1,040 hours - 40 hours per week x 26 weeks.See separate instructions for examples of how to calculate and prorate FTEs.) Administrator(fiscal manager, executive director, project coordinator) Program/center coordinator(training coordinator,, visitation services- coordinator, volunteer coordinator) Security Supervisinrr staff for visitation and exchangf - Support staff(administrative assistant, receptionist, bookkeeper, accountant) Trainer Ir Translator/Interpreter ctim- advocate(nart-&viirnmental, included domestic violence, sexual -- --- , assault and dual) Other (specify): TOTAL 0001 Supervised Visitation Program Semi-Annual Progress Report 3 Office on Violence Against Women f OMB Clearance#1122-0009 Expiration Date 06/30/2011 i BPROGRAM ACTIVITIES U4 All grantees must complete this section. r 11. Program activities (Check all program activities supported with Supervised Visitation Program funds during the current reporting penod.) I 0 Establishment or expansion of supervised visitation and exchange services. Development of commun ity-based consulting committeesfo plan and/or implementvisi= Cation and exchange services. Development and implementation of policies and procedures regarding security, intake, i case referral, record keeping, and confidentiality. 4 Enhancement of program services to address special needs of underserved populations. Development and implementation of effective training for project staff and volunteers. g 1 12. Program priorities addressed by your grant (In addition to the program activities identified above, the Supervised Visitation Grant Application and Program Guidelines may have identified program priority areas that would receive priority consider- ation. If your program addressed any of these priority areas during the current reporting penod, list 5 them below) F; s' Y. P ,l .i .i Supervised Visitation Program Semi-Annual Progress Report 4 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 C FUNCTION AREAS Training and Staff Development Were your Supervised Visitation Program funds used for training and/or staff development during the current reporting period? Check yes if Supervised Visitation Program-funded staff provided training or staff development,or if grant funds directly supported the training or staff development ❑ Yes—answer questions 13-17 ❑ No—skip to C2 For purposes of this reporting form,training means providing information on sexual assault, domes- tic violence, dating violence, child abuse, and/or stalking that enables professionals to Improve their response to victims/survivors as it relates to their role in the system Staff development is training at- tended by staff funded under your Supervised Visitation Program grant. 13. Training and staff development events provided (Report the total number of training events and the total number of staff development events provided during the current reporting period with Supervised Visitation Program funds.) Total number of training events provided (excluding staff development events) (� Total number of staff development events provided II ih 14. Number of people trained ! I (Report the number of people trained during the current reporting period by Supervised Visitation Program-funded staff or training supported by Supervised Visitation Program funds. Use the category that is most descriptive of the people who attended the training event. If you do not know how many people to report in specific categories,you may report the overall number in "Multidisciplinary,"but this category should be used only as a last resort. Do not include staff funded under your Supervised Visita- tion Program grant who attended staff development events.) ' 11 t 1 11 1 1 ' Advocacy organization staff(NAACP, �� Prosecutors AARP) Sex offender treatment provider �❑ Attorneys/law students(does not in- clude prosecutors) Social service organization staff(non-(� Batterer intervention program staff shelter)overnmental- food bank, homeless Child welfare workers/children's advo- Substance abuse treatment provider cates Corrections personnel Supervised visitation and exchange p (probation, center staff(staff not funded under parole, and correctional facilities staff) your Supervised Visitation Program Court personnel (judges, clerks, media- grant) grant) tion staff) Translators/interpreters Government agency staff(vocational Tribal government/Tribal government �❑ rehabilitation, food stamps, TANF) agency staff Guardians ad Litem Victim advocates(non-governmental, �❑ Health professionals(doctors, nurses) includes sexual assault, domestic vio lence, and dual) Law enforcement officers Victim assistants(governmental, Legal services staff(does not include includes victim-witness specialists/ attorneys) coordinators) Mental health professionals Volunteers Multidisciplinary(various disciplines at Other(specify): same training) E TOTAL701 Supervised Visitation Program Semi-Annual Progress Report • 5 • Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 a' 15. Training content areas (Indicate all topics covered in training events provided with your Supervised Visitation Program funds during the current reporting period Do not include topics covered in staff development events. See definitions of training and staff development at the beginning of subsection C1. Check all that apply.) Domestic violence,dating violence,sexual assault,and child Sexual assault statutes/codes E abuse Stalking statutes/codes ❑Advocate response Supervised visitation and exchange []Child abuse overview, dynamics,and services u Other(specify) ❑Child development Underserved populations ; []Child protective services Issues specific to families who: ❑Child witnesses are American Indian or Alaska Native Custody statutes/codes are Asian confidentiality are black or African American ❑Dating violence overview,dynamics,and services ;__ are elderly ❑Domestic violence overview,dynamics, 11 are Hispanic or Latino and services I I are homeless or living in poverty a Dynamics relating to non-offending parents and offending parents ;_; are immigrants, refugees,or asylum seekers ❑Family law L; are lesbian,gay, bisexual,transgender,or ntersex ❑Parenting issues ;� � are Native Hawaiian or other Pacific Islander ❑Resources for families = El Safety planning - have disabilities ❑Sexual assault overview,dynamics,and services = have limited English proficiency , ❑Stalking overview,dynamics,and services have mental health issues , ❑Supervised visitation have substance abuse issues exchange � ;—� ❑Other(specify) F live in rural areas Justice system Other(specify)- ❑Civil court procedures Organization and community Issues;— Collaboration ❑Child abuse statutes/codes Custody statutes/codes Community response to sexual assault Coordinated community response ❑Domestic violence/dating violence statutes/codes ❑ Technology Expert testimony _ ❑ Other(specify), Family law ❑Judicial response ❑Law enforcement response ❑Mandatory reporting requirements ❑Probation response ❑Protection orders(including full faith and credit) 16. Number of staff who attended staff development events (Report the number of staff funded under your Supervised Visitation Program grant who attended staff development events ) Number of people Supervised Visitation Program Semi-Annual Progress Report 6 • Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 17. (Optional)Additional information (Use the space below to discuss the effectiveness of training activities funded or supported by your Supervised Visitation Program grant and to provide any additional information you would like to share about your training activities beyond what you have provided in the data above. An example might in- clude: "The visitation center program director and the chlldren's program director at the local domestic violence center developed a training curriculum based upon 'The Batterer as Parent'by Lundy Bancroft and Jay Silverman. This training was delivered to local professionals, including attorneys, mental health professionals, and child protective service workers. Evaluation results showed increased knowledge in the effects of DV on children and how to work with battering parents ")(Maximum 2000 Characters) Supervised Visitation Program Semi-Annual Progress Report • 7 • Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 30C2 Coordinated Community Response All grantees must complete this subsection. 18. Coordinated community(CCR) response activities (Check the appropriate boxes to indicate the agencies or organizations, even if they are not memoran dum of understanding.(MOU1 partners or consulting committee members, that you provided family re- ferrals to, received referrals from, engaged in consultation with, provided technical assistance to, and/ or attended meetings with, during the current reporting period, according to the usual frequency of the ; interactions If the interactions were not part of a regular schedule,you will need to estimate the fre- quency with which these interactions occurred during the current reporting period. If Supervised Visita- tion Program-funded staff participated in a task force or work group, indicate that under"Meetings"by checking the frequency of the meetings and the types of organizations participating. Indicate which of these agencies/organizations are consulting committee members for your Supervised Visitation Pro- gram grant. In the last column, indicate the agencies or organizations with which you have an MOU for the purposes of the Supervised Visitation Program grant) If you have a planning grant, report planning meetings, consulting committee members, and MOU partners Daily Weekly Monthly Weekly Monthly Quarterly Advocacy organization (NAACP,AARP) Batterer intervention �t program J Child advocacy program �� -child protective services Corrections (probation, parole, and correctional l facilities) { :Court.- Domestic violence pro gram ; ,- fl�l i Educational institutions" _MW h organizations _ �' e _ _ Faith-based organization j 4yernment agency ��� mom-e ��tv Ye` �' ' b � -�i ; off „peps NF ((��' EZ �JNS,) ocial Security, .; Health/mental health �) organization u ' Caw enforcemei _ - x�= i agency a „ , • __ „„R,,.... - ; Legal organization (legal services, bar as- ' sociation, law school) Prosecutor's office t Sexual assault organiza- tion 0�6 8€+cial.serieesrgan =_ tron ( g 1 non overnmentat Substance abuse treat- ment provider - „- "Fff�al goverflmerrC��b�- _ government agency Other(SDecifv): Supervised Visitation Program Semi-Annual Progress Report 8 Office on Violence Against Women OMB Clearance#1122-0009 19. (Optional)Additional information Expiration Date 06/30/2011 (Use the space below to discuss the effectiveness of CCR activities funded or supported by your Super- vised Visitation Program grant and to provide any additional information you would like to share about .4 your CCR activities beyond what you have provided in the data above. An example might include an in- crease in appropriate referrals to the supervised visitation center from the three local courts following a series of planning meetings of a multi-disciplinary workgroup with membership from judges, domes- tic violence programs, law enforcement agencies, and the supervised visitation center. (Maximum 2000 Characters) I I I I t i t F ; F i t t I I t t 1 i 1 t t t t i t ; 1 i t I 1 t t � F i I � I i t t � I F t I I I t � I I Supervised Visitation Program Semi-Annual Progress Report 9 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 Policies All grantees must complete this subsection. 1AC3 Were your Supervised Visitation Program funds used to develop,substantially revise, or implement policies or protocols during the current reporting period? Check yes if Supervised Visitation Program-funded staff developed,substantially revised,or implement- ed policies or protocols, or if Supervised Visitation Program funds directly supported the development, revision, or Implementation of policies or protocols. ❑ Yes—answer questions 20-21 ❑ No—skip to C4 20. Types of policies or protocols developed,substantially revised,or implemented during the current reporting period (Check all the types of policies or protocols developed, substantially revised, or implemented during the current reporting period. Check all that apply) Center operations ❑ Confidentiality ❑ Flexible hours of operation ❑ Income-based fees (sliding scale) ❑ Program does not charge fees ❑ Recordkeeping and report writing ❑ Staff, board, and/or volunteers represent the diversity of your service area ❑ Other(specify): Service provision Ej Appropriate response to underserved populations ❑ Child-friendly(toys,games, appropnate decor) ❑ Court feedback procedures ❑ Courtesy monitoring ❑ Document exchange procedures ❑ Mandatory training on domestic violence/dating violence, sexual assault, child abuse, and stalking ❑ Out-of-jurisdiction referrals ❑ Parent education program procedures ❑ Service termination ❑ Supervised exchan a rocedures s ❑ Other(specify). Security and safety ❑ Different entrances for parties ❑ Escort for children and custodial parent ❑ Metal detectors ❑ Panic button(s) a ❑ Private, secure drop-off locations for children ❑ Private, secure entrances for children and custodial parent ❑ Security guards Security measures in place(cameras, staff, etc.) ❑ Security staff observations ❑ Staggered arrival/departure times ❑ Other(specify): Supervised Visitation Program Semi-Annual Progress Report 10 Office on Violence Against Women s s , OMB Clearance#1122-0009 Expiration Date 06/30/2011 21. (Optional)Additional information (Use the space below to discuss the effectiveness of policy development activities funded or supported by your Supervised Visitation Program grant and to provide any additional information you would like to share about your policy development activities beyond what you have provided in the data above. An { example might include an increase in the number of families participating in the supervised visitation program following the development and implementation of an income-based fee scale) (Maximum 2000 characters) I I Supervised Visitation Program Semi-Annual Progress Report • 11 • Office on Violence Against Women - OMB Clearance#1122-0009 Expiration Date 06/30/2011 la) C 4 Planning l Are you in the planning phase of a Safe Havens Development Grant? Check yes if you have a Supervised Visitation Program development grant and you are in the planning phase. Only those grantees who received a Supervised Visitation Program development grant and who are in the planning phase will answer questions 22-25 ❑ Yes—answer questions 22-25 ❑ No—skip to section D 22. Planning meetings i (Report the total number of planning meetings and the total number of people attending planning I' meetings during the current reporting period) I 23. Planning activities conducted (Check all that apply.) Conducting needs assessments ❑ Creating goals and objectives Creating personnel and agency policies ❑ Identifying location(s)for visitation center(s) ❑ Identifying resources ; ❑ Identifying visitation center models ❑ Other(spec/fy) € 24. Number of site visits to visitation and/or exchange centers (Report the number of site visits to visitation and/or exchange centers.) Number of visits r i n i s ) i Supervised Visitation Program Semi-Annual Progress Report 12 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 25. (Optional)Additional information (Use the space below to discuss the effectiveness of planning activities funded or supported by your Supervised Visitation Program grant and to provide any additional information you would like to share about your planning activities beyond what you have provided in the data above An example might include describing the location that has been found for the future visitation center and listing the com- munity resources/members(construction, painting, refurbishing, etc]that have contributed to making the center usable.) (Maximum 2000 characters) -- --- -- -- ------------------------ II ------------------------ - - - - -- -- - - - -- - - -- Supervised Visitation Program Semi-Annual Progress Report 13 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 i 1 a SERVICES 44 f Were your Supervised Visitation Program funds used to provide services to families during the current reporting period? Check yes if Supervised Visitation Program-funded staff provided services to families, or if Supervised Visitation Program grant funds were used to support services to families during the current reporting period. j ❑ Yes—answer questions 26-36 ❑ No—skip to section E 26. Number of families served,partially served,and families seeking services who were not served Please do to answer this question without referring to the separate set of instructions for further expla- nation and examples of how to distinguish among these categories (Report the following, to the best of your ability, as an unduplicated count for each category during the current reporting period. This means that each family who sought or received services during the current reporting period should be counted ' only once and in only one of the listed categories. Do not count or report families that do not meet grant eligibility or statutory requirements) A. Served: Families who received the service(s)they requested, if those services were provided under your Supervised Visitation Program grant �. Partially served: Families who received pine serviCe(s), ,)rtces they requested, if those services were provided under your Supervised Visita- Cion Programgrant ,� TOTAL SERVED and PARTIALLY SERVED(26A+26B) -C. Families seeking services who were not served: 176`milles.who'siought services -,and did not receive service(s)they needed, if those services were provided under _your Supervised Visitation Program grant f 27. Reasons families seeking services were not served or were partially served (Check all that apply. If you check"Party(ies) not accepted into program,"report on the reason(s)in question 28) ❑ Hours of operation ❑ ` Insufficient/lack of culturally appropriate services ❑ Insufficient/lack of services for people with disabilities ❑ Insufficient/lack of language capacity(including sign language) ❑ Party(ies) not accepted into program — _.__.. ❑_ ) ❑ , Program reached capacity Program rules not acceptable to party(ies) ! ❑ Services inappropriate or inadequate for people with substance abuse issues ❑Ej Services inappropriate or inadequate for people with mental health issues Services not appropriate for party(les) ❑ ' Transportation Other(specify): Supervised Visitation Program Semi-Annual Progress Report 14 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 28. Number of families not accepted into program and reasons (Report the total number of families who were not accepted into the program during the current report- ing period by the reason they were not accepted.) Conflict of interest• Client urnil ling to agree_ it prigrarn rules Too dangerous _tither (specify): TOTAL D 29. Demographics of family members served or partially served (Report the numbers of parents and children served. These numbers should be based on the individu- als in the families counted in questions 26A and 26B. Because individuals may identify in more than one category of race/ethnicity, the total for "Race/ethnicity"may exceed the total number of victims/ survivors reported in 26A and 26B However, the total number of victims/survivors reported under "Race/ethnicity"should not be less than the total number of victims/survivors reported in 26A and 26B. The total number of victims/survivors reported under "Gender"and the total number reported under"Age"should equal the total number of victims/survivors reported in 26A and 26B. Those vic- tims/survivors for whom gender, age, and/or race/ethnicity are not known should be reported in the "Unknown"category.) 1 1 . 1 . USE 1 1 . 1 . 611 0 e ♦ - `1a Black or African American _ -Arrserican tnd"rari and Alaska Native Asian Native Hiwa(l4 nd�o theirP�cific7lslandei- - Hispanic or Latino -�-� White , "_' Unknown TOTAL RACE/ETHNICITY =` ?S&uld rsotbe less than the sum-of 26A and 2qB) f _ • ---- '- `_ -�-- Female Male . ��14 Unknown TOTAL tirFtrisshould a tlies�a t3# 4au a 11__ o Oto6 to12C � 13 to 17 18to 24 25 to 59 _ s ffs s� Unknown TOTAL(Parent Columns should equal the sum of 26A and 26B) 0 0 0 1 1 1IT People with disabilities People with limited English proficiency E= �� People who are immigrants/refugees/asylum seekers � �-- People who live in rural areas �' Supervised Visitation Fiog arlSeri i eport • 15 • Ofr,c - .tolence Against Women • l Y r OMB Clearance#1122-0009 Expiration Date 06/30/2011 30. Number of families by primary victimization and referral source (Report the number of families by primary type of victimization and referral source. This is an undupli- cated count and each family should only be counted once. This should equal , the sum of 26A and 26B. Refer to the separate set of instructions for further explanation and examples.) � a Child welfare agency .-Other social services' �� � Criminal court order Family court order o Juvenile court order "W court order Protection order 0 C� — J 0 Other civil court ' order Mediation services ,Self-referral Other Other (specify): y�{,� •, sag j ``�'""``'''(� �,..Y , E 31. Family issues (Report all of the issues identified for each family, including victimization and other problems or challenges. The column "Total number of families"should equal the sum of 26A and 26B and should be identical to the numbers in the "Total number of families"column reported in question 30. Multiple victimizations and problems may be reported for each family) A eB e e 1 a 32. Services provided with Supervised Visitation Program funds 1 (Report the number of families receiving each of these services and the number of times the services were provided during the current reporting period. See separate instructions for examples.) INMBW 3 Group supervision —� ,drie-to-onesupervision Supervised exchange --_ -_- —1--�---- _--- - � •sue �=e , , -blephone monitoring Other(specify). Supervised Visitation Program Semi-Annual Progress Report 16 Office on Violence Against Wome OMB Clearance#1122-0009 Expiration Date 06/30/2011 33. Visits terminated (Document each supervised visitation that is terminated for any reason. Report the total number of vis- its terminated dunng the current reporting period. See definition of terminated in the separate instruc- tions.) Totaloccurrences Child's request Note-,Non with program rules-a � ��� A 6 6 No-shows I.-Patent's request _-_ a_a a „N,., ,. Other(specify)] - -------------------- -------TOTAL- 0 x � 34. Safety and security problems (Report the number of safety and security problems, including the number of parental abduction cases that occurred during supervised visitation and/or supervised exchange funded under the Supervised Visitation Program grant during the current reporting period.) M�J1j 1 1 1 1 1 Attempted parental abductions Attempted to Cdn CT tact- -her patfiy = a= -'- ' Parental abductions ecurityr`staff unavailable Threats Violence _ i Violation of protection order ' — —r Other(specify). TOTAL 35. Services terminated or completed (Report the number of families whose services were terminated or completed during the current report- ing period. Report the family by the primary reason.) Cessation of threats/use of violence Change in court order 3+a" Child refuses to participate Deceased Deported ------------------ Habitual o inpliayles Habitual no-shows or cancellations Incarcerated Moved Mutual agreement of bath9par t _ Parent completed treatment program ;Supervisor's discretion Unknown =m � � :Other(specify)-, TOTAL Supervised Visitation Program Semi-Annual Progress Report 17 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 36. (Optional)Additional information (Use the space below to discuss the effectiveness of services funded or supported by your Supervised Visitation Program grant and to provide any additional information you would like to share about services beyond what you have provided in the data above. An example might include the results of an internal survey that shows that custodial parents feel increased safety for themselves and their children due to the services and safety measures available at your visitation center) (Maximum 2000 characters) i H uy9a f a fp i i a 5, P ! i I 6 k e s 1 l d i J d 1 !i I a y� Supervised Visitation Program Semi-Annual Progress Report IS Office on Violence Against Women a OMB Clearance#1122-0009 Expiration Date 06/30/2011 I COMMUNITY MEASURES 30 All grantees must complete this section. 37. Parental abductions (Report the number of parental abduction cases, identified through criminal prosecution and custody violation court records, that occurred In thejudicial districts that routinely use your supervised visita- tion and/or exchange center[s]during the current reporting period) Criminal Civil 38. Limitations (If the information provided in question 37 is limited in any way, describe the efforts you made to ob- tain that information, the reasons for the limitations, and what steps you are taking to address those limitations. For example, if the data includes non-parental abductions, and/or if yourjunsdiction's data collection methods do not provide information on parental abductions, and/or if you have begun to implement different data collection tools, please report that here.) Supervised visitation Program Semi-Annual Progress Report • 19 • Office on Violence Against Women ,l OMB Clearance#1122-0009 Expiration Date 06/30/2011 i a I NARRATIVE Ui All grantees must answer question 39 Please limit your response to the space provided. 39. Report on the status of your Supervised Visitation grant goals and objectives as of the end of the cur- rent reporting period. (Report on the status of the goals and objectives for your grant as of the end of the current reporting period, as they were identified in your grant proposal or as they have been added or revised Indicate whether the activities related to your objectives for the current reporting period have been completed, are in progress, are delayed, or have been revised Comment on your successes and challenges, and provide any additional explanation you feel is necessary for us to understand what you have or have not accomplished relative to f your goals and objectives. If you have not accomplished objectives that should have been accomplished during the current reportinO period, you must provide an explanation.) All grantees must answer questions 40 and 41 on an annual basis.Submit responses on the January to June reporting form only. Please limit your response to the space provided. 40. What do you see as the most significant areas of remaining need,with regard to improving services to victims/survivors of sexual assault, domestic violence,dating violence,and stalking,increasing the t safety of families and enhancing community response(including offender accountability for both batterers and sex offenders?) l (Consider geographic regions, underserved populations, service delivery systems, types of victimization, and challenges and barriers unique to your state or service area) 41. What has the Supervised Visitation Program funding allowed you to do that you could not do prior to receiving this funding? (e g expand hours, develop new services and/or programs, build partnerships, and provide additional security) iflliestions 42 smi "pr ional. Please limit your response to the space provided. 42. Provide any additional information that you would like us to know about your Supervised Visitation Program grant and/or the effectiveness of your grant. (if you have other data or information regarding your program that would more fully or accurately reflect the effectiveness of your Supervised Visitation Program other than the data you have been asked to provide on this form, answer this question. If you have not already done so elsewhere on this form, feel free to discuss any of the following policies, and/or protocols, community collaboration, the removal or reduction of barriers and challenges for families, promising practices, positive or negative unintended consequences, and parental abductions) 43. Provide any additional information that you would like us to know about the data submitted. (If you have any information that could be helpful in understanding the data you have submitted in this report, please answer this question For example, if you submitted two different progress reports for the same reporting period,you may explain how the data was apportioned to each report;or if you funded staff but did not report any corresponding services you may explain why, or if you did not use program funds to support either staff or activities during the reporting period, please explain how program funds were used, if I you have not already done so) Public Reporting Burden Paperwork Reduction Act Notice.Under the Paperwork Reduction Act,a person is not required to respond to a col- lection of information unless it displays a currently valid OMB control number We try to create forms and instruc- tions that are accurate,can be easily understood,and which impose the least possible burden on you to provide us with information The estimated average time to complete and file this form is 60 minutes per form If you have comments regarding the accuracy of this estimate,or suggestions for making this form simpler,you can write to the Office on Violence Against Women, U S Department of Justice,800 K Street, NW,Washington, DC 20531 Supervised Visitation Program Semi-Annual Progress Report • 20 • Office on Violence Against Women OMB Clearance#1122-0009 APPENDIX A Expiration Date 06/30/2011 Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question#39 Status Goals/Objectives i 1 I i Key Activities Comments y Status Goals/Objectives i Key Activities i 3£{ P A { 5 fi 4 Comments Supervised Visitation Program Semi-Annual Progress Report 21 Office on Violence Against Women OMB Clearance#1122-0009 APPENDIX A Expiration Date 06/30/2011 Describe your goals and objectives, as outlined In your grant proposal, or as revised- Question#39(cont t) Status t Goals/Objectives s Key Activities d j Comments j � t i Status Goals/Objectives k t E Key Activities i e I Comments Supervised Visitation Program Semi-Annual Progress Report 22 Office on Violence Against Women OMB Clearance#1122-0009 APPENDIX A Expiration Date 06/30/2011 Describe your goals and objectives, as outlined in your grant proposal, or as revised -Question #39 (cont 2) ( Status Goals/Objectives F I Key Activities i i Comments a Status Goals/Objectives a a r E Kev Activities � s b f Comments 3 3 a Supervised Visitation Program Semi-Annual Progress Report • 23 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 d What do you see as the most significant areas of remaining need, with regard to improving services to vic- tims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing the safety of families and enhancing community response (including offender accountability for both batterers and sex offenders,2)-Question #40 3 Y d e 3 e I S d f i Supervised Visitation Program Semi-Annual Progress Report 24 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 What do you see as the most significant areas of remaining need,with regard to Improving services to vic- tims/survivors of sexual assault, domestic violence, dating violence and stalking, Increasing the safety of families and enhancing community response(including offender accountability for both batterers and sex offenders?)-Question #40(cont.) Supervised Visitation Program Semi-Annual Progress Report 25 • Office on Violence Against Women J• M OMB Clearance#1122-0009 Expiration Date 06/30/2011 What has the Supervised Visitation Program funding allowed you to do that you could not do prior to receiv- ing this funding?-Question #41 } a r yt} 8 1 i 1 i F i i Supervised Visitation Program Semi-Annual Progress Report 26 Office on Violence Against Women i OMB Clearance#1122-0009 Expiration Date 06/30/2011 What has the Supervised Visitation Program funding allowed you to do that you could not do prior to receiv- ing this funding?-Question #41(cont.) Supervised Visitation Program Semi-Annual Progress Report • 27 • Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 Provide any additional Information that you would like us to know about your Supervised Visitation Program grant and/or the effectiveness of your grant.-Question #42 u 6 3 9 Z G s Supervised Visitation Program Semi-Annual Progress Report 28 Office on Violence Against Women OMB Clearance X 1122-0009 Expiration Date 06/30/2011 Provide any additional information that you would like us to know about your Supervised Visitation Program grant and/or the effectiveness of your grant.-Question*42(cont.) Supervised Visitation Program Semi-Annual Progress Report 29 • Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 Provide any additional Information that you would like us to know about the data submitted. Question #43 9 r'. r i 's i d s J 4 Supervised Visitation Program Semi-Annual Progress Report 30 Office on Violence Against Women OMB Clearance#1122-0009 Expiration Date 06/30/2011 Provide any additional Information that you would like us to know about the data submitted -Question#43 (cont.) Supervised Visitation Program Semi-Annual Progress Report • 31 Office on violence Against Women ( � qm moo O (N C\l [ T-:, Wnn / Co CU -0 -0 0 0 ` C ƒ { ± 3 Q o m s -E E--- --Q)- Z o o e ( k k k ( w O CN O / \ I : CL q k E < @ e a 9 \� 6 r ci � _ k � -C [ 0 0 \ 2 E a) § / E G U \ 2 § R U \ x / U) 0 $ W ° o a) � 2 \ k LLI § D ,�, ww k / � k 6�: )« _ . W1S( u } 2:cu E o I \ { E \ \ / S 2 \ a \ /G < 6 § a 0 k / \ of D Agency 000000* KENT Exhibit D Program W ASXINGTON PARKS, RECREATION i5, Annual Demographic Report Date COMMUNITY SERVICES Unduplicated Number of Clients Served" Agency/Program Undu licated New Individuals this Year Client Residence" Algona Auburn Black Diamond Burien Covington Des Moines Enumclaw Federal Way Kent Maple Valle Milton Normandy Park Pacific - — -- - Renton SeaTac Seattle Tukwila Unincorporated King County Unknown TOTAL Household Income Level 300/a of Median or Below 50% of Median or Below 80°% of Median or Below Above 80%of Median Unknown TOTAL Gentler - Male Female TOTAL Age - 0-4 years 5- 12 years 13- 17 years 18- 34 years 35 - 54 years 55-74 years 75+years Unknown TOTAL Ethnicity ---_ _ Asian/Pacific Islander Black/African American Hispanic/Latino(a) Native Amencan/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. I 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: I 1. Commercial General Liability insurance shall be written with i 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. f G 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# 12u_ S.. NMENT ACORDa. CERTIFICATE OF LIABILITY INSURANCE 1231/2010"' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Darker Smith &Feek,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ellevue (425-709-3600) ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 2233 112th Avenue NE J Bellevue,WA 98004 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Granite State Insurance C Sound Mental Health INSURER B Philadelphia Indemnity Insurance Co 1600 E Olive St NSURERC 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ' LTR NSR DATE MWDDIYY DATE MMIDDIYY A X GENERAL LIABILITY 027560124 01/01/11 01/01/12 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300 000 PREMISES a RENTED ns X CLAIMS MADE OCCUR MED EXP(Any one person; $5 000 X- Retro Date 01101186 PERSONAL BADV INJURY s1 0D0 000_ GENERAL AGGREGATE $3 000 000 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG Q 000 000 , PRO- X POLICY JECT LOC B X AUTOMOBILE LIABILITY PHPK668405 01/01/11 01/01/12 COMBINED SINGLE LIMIT �e X ANY AUTO (Ea accident) S1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ N HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ ` RETENTION $ $ " A WORKERS COMPENSATION AND 027560124 01101111 01/01112 1 TORY LIMTI s I X I o R EMPLOYERS LIABILITY WA Stop Gap Only EL EACH ACCIDENT $1,000,000 ANY PRCPRIETOR/PARTNER/EXECUTIVE OFFICERWEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $1,000,000 It yes describe under SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $1,000,000 A OTHER Professional 027560124 11/01/11 01/01/12 $1,000,000 Each Claim Liability $3,000,000 Aggregate Retro Date 01/01/86 Cgg DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS City of Kent is included as an Additional Insured per endorsement 96571 08104 attached t CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment of Premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OFKENT 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 R Wilson,CDBG Coordinator IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 220 4th Avenue S REPRESENTATIVES 4 Kent,WA 98032 AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #M94951 V SL000 o ACORD CORPORATION 1988 JJ a � l IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the pohcy(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) i DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing msurer(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(2001/08) 2 of 2 #M94951 i f 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-F—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 temporarly occupied b. Been committed by your "employee" against a by you with the permission of the owner client of your Human Services facility, and 3 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 i 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 -1 - I I c. $25,000 for damages caused by a the furnishing or failure to furnish professio "resident" services in the medical treatment of"rent 3 Paragraph 4 b (b) of Section IV — Commercial General Liability Conditions — Other Insurance, is 3. As respects the violation of 'Rights of Resider 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 ci 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. WANER OF IMMUNITY -permission--of—theowner—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. Exclus;o:rs, CCVERAGE 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"; I 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 86571 08/04 -2- 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 (1)(a)or(b) above, or following provision: 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 advertising signs, awnings, canopies, cellar (b)—Rented to—rn the care,—custody entrances, coal holes, driveways, control of, or over which physical manholes, marquees, hoistaway openings, control is being exercised for any sidewalk vaults, street banners, or purpose by you, any of your decorations and similar exposures; or "employees","volunteer workers",any partner or member (if you are a partnership orfoint 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 C. An Independent Curitractor is an Insured only _ 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 also an insured under another policy, or would partnership or venture, your managers and be an insured under such policy but for its supervisors aree also insureds, 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 h Students in training, but not for"bodily injury"or their duties related to the conduct of your "property damage' arising out of his or her business; 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 j 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 (hereinafter called Additional Insured) to name (1} Their financial control of you; or as an insured is an insured but only with l respect to liability arising out of your premises, "your work" for the Additional Insured, or acts or 86571 08104 -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 insurances 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 seances by or for you, including than those required by such contract. (1) The preparing, approving, or failing 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 project (other than service, is deleted and replaced by the following maintenance, or repairs) to be performed by or on behalf of the Additional Insureo(s) at the site a. Coverage under this provision 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 (2) Afforded only until the end of the policy intended use by any person or organization period of this Coverage Part or the next other than another contractor or subcontractor anniversary of its inception date, whichever engaged in performing operations for a principal is earlier. as a part of the same project. 86571 08/04 -4- KET1T Exhibit F PARKS RECREATION 3 COMMUNITY SERVICES City of Kent Certification Regarding Debarment and Suspension i 9 Agency Name of Program(s) Certification A: Certification Regarding Debarment, Suspension, and Other Responsibility ti 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 ) i 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 c, 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 t of 3 I 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 0—Except forrtransaction"uthor¢ed-under paragraph (6) of these-instructionrrf-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 .4 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 4 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 i Signature of Primary contr odSub-Con for Title Date (3, Adopted from HUD Form-2992 09/04 3of3 REQUEST FOR MAYOR'S SIGNATURE v K1tNT Please Fill in All Applicable Boxes WASriw GTON Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) Originator: Jason Johnson Phone (Originator): x5061 Date Sent: June 8, 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: The City is under contract with U.S. Department of Justice Office on Violence Against Women (OVW), to provide safe, supervised visitation and exchanges for families separated by domestic violence. Sound Mental Health will provide the staffing and language interpretation to execute these services. *Passed as part of the 2011 City of Kent budget f% Ali Contracts Must Be Routed Through The Law Department (This area to be completed by the Law Department) RECEIVED Received: RECEIVED Approval of Law Dept.: Law Dept. Comments: JUN D 9 2011 L, City of Kent EN�, �' Office of the Mayor W DEPT. Date Forwarded to Mayor: , Shaded Areas To Be Completed By Administration Staff Received: 1[ Recommendations and Comments: - Ell Disposition. l 4' Date Returned: