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HomeMy WebLinkAboutPK13-024 - Original - Dynamic Partners - Children with Special Needs Program - 03/05/2013 eme records M ---T KE 0 T i WASHINGTOH - _' Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: Dynamic Partners (previously Dynamic Family Services) Vendor Number: 33862 JD Edwards Number Contract Number: /kl 3- 0arz This is assigned by City Clerk's Office Project Name: Childen With Special Needs Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 01-01-13 Termination Date: 12-31-14 Contract Renewal Notice (Days): 30 Number of days required notice for termination or renewal or amendment Contract Manager: Menna Hanson Department: Parks - Human Services Detail: (i.e. address, location, parcel number, tax id, etc.): Human Services General Fund Contract with Dynamic Partners (previously known as Dynamic Family Services and/or Children's Therapy Center) for the Children with Special Needs Program. - Human Services Per Capita Funding 5 Publlc\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 KENT W A 5 M I N G T D N CONSULTANT SERVICES AGREEMENT h i f between the City Kent and o Dynamic Partners THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Dynamic Partners organized under the laws of the State of Washington, located and doing business at 10811 SE Kent Kangley Road, Kent, WA 98030 (hereinafter the "Consultant"). I. DESCRIPTION OF WORK. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: Consultant shall administer the Children with Special Needs program through quality pediatric therapy and support services for children. The following exhibits are attached and incorporated by this reference as if fully set forth herein; Exhibit A, Scope and Schedule of Work, Exhibit B, Insurance Exhibit, and Exhibit C, Debarment Certification. Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time those services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon the effective date of this Agreement. Upon the effective date of this Agreement, Consultant shall complete the work described in Section I by December 31, 2014. This Agreement, however, is contingent upon the availability of funds to be allocated through the City's budget process. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed $110,000 ($55,000 per year), plus applicable Washington State sales tax, 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 City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Consultant has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Consultant maintains and pays for its own place of business from which Consultant's services under this Agreement will be performed. C. The Consultant has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Consultant's services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Consultant's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the Consultant's possession pertaining to this project, which may be used by the City without restriction. If the City's use of Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant shall execute the attached City of Kent Equal Employment CONSULTANT SERVICES AGREEMENT - 2 (Over$10,000) Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's liability hereunder shall be only to the extent of the Consultant's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event Consultant refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant's part, then Consultant shall pay all the City's costs for defense, including all reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the Consultant's part. The provisions of this section shall survive the expiration or termination of this Agreement. VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of the work under this Agreement. X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents, drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and become the property of the City. All records submitted by the City to the Consultant will be safeguarded by the Consultant. Consultant shall make such data, documents, and files available to the City upon the City's request. The City's use or reuse of any of the documents, data and files created by Consultant for this project by anyone other than Consultant on any other project shall be without liability or legal exposure to Consultant. XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor with the authority to control and direct the performance and details of the work CONSULTANT SERVICES AGREEMENT - 3 (Over$10,000) authorized under this Agreement, the work must meet the approval of the City and shall be subject to the City's general right of inspection to secure satisfactory completion. XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XIII. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section VII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or CONSULTANT SERVICES AGREEMENT - 4 (Over$10,000) other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. CONSULTANT: CITY OF KENT: / c By: By: S:: �signat�re) (signature) Print Name: ,)A Pr' t N Suzette Cooke Its r Z cI I s Ma or T (tale) DATE: a-I�• 1?4 DATE: 3 NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Jon Botten, Executive Director Katherin Johnson, Human Services Manager Dynamic Partners City of Kent 10811 Kent Kangley Rd 220 Fourth Avenue South Kent, WA 98030 Kent, WA 98032 (253) 854-5660 (telephone) (253) 856-5070 (telephone) (253) 854-7025 (facsimile) (253) 856-6070 (facsimile) APPROVED AS N• V Kent Law Department CONSULTANT SERVICES AGREEMENT - 5 (Over$10,000) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. Dated this day of , 20,. By: /Yzz For: 1) /N t-v\ i c- �6O� M�.`(L� Title: C \� Date: EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. Dated this day of , 20 By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 40 ���. Exhibit A WASH KENT Scope and Schedule of Work nGTOry PARKS COMM ITY ERVIC s 2013-2014 Consultant Services Agreement COMMUNITY SERVICES 9 Agency: Dynamic Partners 2013 Funding: 55 000 Program: Children with Special Needs 2014 Funding: 55 000 This funding Quality pediatric therapy and support services for low- will provide: income Kent children with development delays and Total: $110,000 disabilities. Annual Program Outputs: - Program Outcomes: Unduplicated Kent Residents 150 Improved ability to meet developmental Units of Medical Care* 336 milestones. (*therapy and/or early Intervention services at 145 per service Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1, 2013, Consultant shall provide the approximate number of City of Kent clients with the following services each year of the CSA: Quarter Service Unit "' # of Units Cumulative Total 1st Unduplicated City of Kent clients served 37 37 Units of Medical Care 84 84 2nd Unduplicated City of Kent clients served 37 74 Units of Medical Care 84 168 3rd Unduplicated City of Kent clients served 38 112 Units of Medical Care 84 252 4th Unduplicated City of Kent clients served 38 150 Units of Medical Care 84 336 ANNUAL South King Council of Human Services Participation Yes/No Yes/No The above services shall be provided by December 31, 2013 for year one of the two-year agreement and December 31, 2014 for year two of the agreement. Contract Administration - The Consultant shall notify the City, in writing, within ten (10) days of any changes in program personnel or board membership. - The Consultant shall separately report the number of clients served who reside in the newly annexed Panther Lake area as detailed in the provided maps. - The Consultant shall provide the City with a current list of its board of directors, general or limited partners, as applicable. - The Consultant will hold active membership with the South King Council of Human Services http://skchs.org/ - All records related to this CSA must be retained for three (3) years plus the current year. Exhibit A (continued) • Scope and Schedule of Work K N ET 2013-2014 Consultant Services Agreement PARKS, Rt'-HLATION S COMMUNITY SERVICES Agency: Dynamic Partners 2013 Funding: $55 000 Program: Children with Special Needs 2014 Funding: $55 000 This funding Quality pediatric therapy and support services for low- will provide: income Kent children with development delays and Total: $110,000 disabilities. Reporting Requirements and Timeline All data and required forms shall be submitted through SharelApp: htto://sharelapg.culturearants.ora/Index/login Service Unit Report - Data from this form will be used to track each program's progress toward meeting the goals stipulated in the Scope of Work. It shall be submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 15), along with the Reimbursement Request. Reimbursement Request - This form will be filled out on SharelApp and serve as the invoicing mechanism for payment to your agency/program. It shall be submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 15), unless otherwise specified. Demographic Data Report - The agency shall collect and retain the data requested on this form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted annually in SharelApp (by January 15). Annual Outcome Data Report - Outcome data shall be submitted in SharelApp no later than the 15th following the end of the second quarter (i.e. July 15). Data should demonstrate the program's progress toward Outcomes specified in the Scope of Work. Report Due Date Service Unit Report and Reimbursement Request 15th day following each quarter Final Reimbursement Request (4th Qtr) December 15th, 2013/December 15th, 2014 Demographic Data Report January 15th, 2013/January 15th, 2014 Annual Outcome Data Report January 15th, 2013/3anuary 15th, 2014 Signature Please sign below to indicate acceptance of the Year 2013 and Year 2014 Performance Measures listed above. Jon Botten, Exe ive Efire&or - Dynamic Partners Date Z . i3 Katherin Johnson, kuAia ervices Manager Date ATTACHMENT B INSURANCE REQUIREMENTS FOR HUMAN SERVICES GENERAL FUND AGREEMENTS Insurance The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Contractor shall obtain insurance of the types described below: 1. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The Commercial General Liability insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or modification of the Commercial General Liability insurance for liability arising from explosion, collapse or underground property damage. The City shall be named as an insured under the Contractor's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. 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. B. Minimum Amounts of Insurance Contractor shall maintain the following insurance limits: 1. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $1,000,000 general aggregate and a $1,000,000 products-completed operations aggregate limit. 2. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. EXHIBIT B (Continued ) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance; 1. The 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. OP ID- SR AFRO 7118 CERTIFi%.,ATE OF LIABILITY ML,a,ZANCE DAT 0DYYVY] 7f18/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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) PRODUCER 206-623-7035 NAMEACT Sprague Israel Giles 206682 4993 PHONE - FAX 1501 Fourth Avenue,Suite 2000 A/C No Ext we No Seattle,WA 981 01-1 63 7 E-MAIL ADDRESS Robert Karl PRODUCER DYNAM-1 CUSTOMER 10 q INSURER(S)AFFORDING COVERAGE NAIC N INSURED Dynamic Family Services INSURER Philadelphia Indemnity Ins 18058 The Children's Therapy Center INSURER B South King Intervention INSURER Program 10811 Kent-Kangley Road INSURER D Kent,WA 98030 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADDTYPE OF INSURANCE L UB LTR POLICY NUMBER MM/DD/YYYY MM DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X PHPK888028 07125/12 07125/13 DAMAGE T R D 100,00 PREMISES Ea occurrence) $ CLAIMS-MADE L'J OCCUR MED EXP(Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 3,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) A ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PHPK888028 07/25/12 07125113 PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNEDAUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ , DEDUCTIBLE S I _ RETENTION $ $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY T RY LIMITSX ER A ANY PROPRIETOR/PARTNERIEXECUTIVE YIN PHPK888028 07/25/12 07125113 EL EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED'+ NIA (Mandatory in NH) WA STOP GAP E L DISEASE-EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 A Professional Liab PHPK888028 07125/12 07/25113 Occ Form 1,000,00 Employee Theft LIMIT.$150,000$1,000 DED 07125/12 07/25/13 Aggregate 3,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is additional insured with respects liability arising out of operations by or on behalf of the named insured for General Liability per form PI-GLD-HS attached CERTIFICATE HOLDER CANCELLATION CITY032 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Kent ACCORDANCE WITH THE POLICY PROVISIONS Housing&Human Services Attn Merina Hanson AUTHORIZED REPRESENTATIVE 220 Avenue South �/ 4 Kentt,,WA 98032 �i�'— ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD POLICY NUMBER. PHPK888028 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) City of Kent Information required to complete this Schedule, if not shown above, will be shown in the Declarations Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf A. In the performance of your ongoing operations, or B. In connection with your premises owned by or rented to you CG 20 26 07 04 ©ISO Properties, Inc, 2004 Page 1 of 1 ❑ 1 PI-GLD-HS (10111) THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy If such specific coverage applies,the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement For complete details on specific coverages, consult the policy contract wording Coverage Applicable Limit of insurance Page# Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments—Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments—Bail Bonds $5,000 5 Supplementary Payment—Loss of Earnings $1,000 oer day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 Additional Insured—Newly Acquired Time Period Amended 6 Additional Insured—Medical Directors and Administrators included 7 Additional Insured—Managers and Supervisors(with Fellow included 7 Employee Coverage) Additional Insured—Broadened Named insured incluoed 7 Additional Insured—Funding Source included 7 Additional Insured—Home Care Providers Included 7 Additional Insured—Managers, Landlords, or Lessors of Premises Included 7 Additional Insured—Lessor of Leased Equipment Included 7 Additional Insured—Grantor of Permits Included 8 Additional Insured—Vendor Included 8 Additional Insured—Franchisor Included 9 Additional Insured—When Required by Contract Included 9 Additional Insured—Owners, Lessees, or Contractors Included 9 Additional Insured—State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc , with its permission ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 TranSTer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury—includes Mental Anguish Included 11 Personal and Advernsing Injury—includes Abuse of Process, Included 11 Discrimination A. Extended Property Damage SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a is deleted in its entirety and replaced by the following a. Expected or Intended Injury "Bodily injury" or property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury" or"property damage" resulting from the use of reasonable force to protect persons or property B. Limited Rental Lease Agreement Contractual Liability SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2 Exclusions, Paragraph b Contractual Liability is amended to include the following (3) Based on the named insured's request at the time of claim, we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50 000 This coverage extension only applies to rental lease agreements This coverage is excess over any renter is liability insurance of the client C. Non-Owned Watercraft SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2 Exclusions, Paragraph g. (2) is deleted in its entirety ane replaced by the following (2) A watercraft you do not own that is (a) Less than 58 feet long, and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft This insurance is excess over any other valid and collectible insurance available to the insured wnether primary, excess or contingent D. Damage to Property You Own, Rent or Occupy SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc , with its permission ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10111) LIABILITY, Subsection 2 Exclusions, Paragraph j. Damage to Property, Item (1) is deleted in its entirety and replaced with the following (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a $30,000 omit A client is defined as a person under your direct care and supervision E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you is not otherwise excluded from this Coverage Part, the word "fire" is changed to "fire, lightning, explosion, smoke, or leakage from automatic fire protective systems" where it appears in a. The last paragraph of SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, is deleted in its entirety and replaced by the following Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner A separate limit of insurance applies to this coverage as described in SECTION III— LIMITS OF INSURANCE b. SECTION III—LIMITS OF INSURANCE, Paragraph 6 is deleted in its entirety and replaced by the following Subject to Paragraph 5 above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises,while rented to you, or in the case of damage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner c. SECTION V—DEFINITIONS Paragraph 9 a., is deleted in its entirety and replaced by the following A contract for a lease of premises However, that portion of the contract for a lease of premises that indemnifies any person or organization for carnage by fire, lightning, explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract", 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4. Other Insurance, Paragraph b. Excess insurance, (1) (a) (it) is deleted in its entirety and replaced by the following That is insurance for fire,lightning,explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission of the owner, 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc with its permission O 2011 Pniladelphia Indemnity Insurance Company PI-GLD-HS (10/11) a. $1,000,000, or b. The amount shown in the Declarations as the Damage to Premises Rented to You Limit This is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, or leaks from automatic fire protective systems or any combination thereof F. HIPAA SECTION I—COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amended to include the following We will pay those sums that the insured becomes legally obligated to pay as damages because of a "violation(s)" of the Health Insurance Portability and Accountability Act(HIPAA) We have the right and the duty to defend the insured against any "suit ""investigation," or"civil proceeding" seeking these damages However, we will have no duty to defend the insured against any"suit" seeking damages, "investigation," or"civil proceeding"to which this insurance does not apply 2. Paragraph 2. Exclusions is amended to include the following additional exclusions. This insurance does not apply to a. Intentional,Willful, or Deliberate Violations Any willful, intentional, or deliberate "violation(s)" by any insured b. Criminal Acts Any"violation"which results in any cnminal penalties under the HIPAA c. Other Remedies Any remedy other than monetary damages for penalties assessed d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services 3. SECTION V—DEFINITIONS is amended to include the following additional definitions. a. "Civil proceeding" means an action by the Department of Health and Human Services (HHS) arising out of"violations " b. "Investigation" means an examination of an actual or alleged"violation(s)"by HHS However, "investigation' does not include a Compliance Review c. "Violation" means the actual or alleged failure to comply with the regulations included in the HIPAA Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc , with its permission Q 2011 Philadelphia Indemnity insurance Company PI-GLD-HS (10/11) G Medical Payments—Limit Increased to$20,000, Extended Reporting Period If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part 1. The Medical Expense Limit is changed subject to all of the terms of SECTION III - LIMITS OF INSURANCE to the greater of a. $20,000, or b. The Medical Expense Limit shown in the Declarations of this Coverage Part 2. SECTION I—COVERAGE, COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a (3)(b) is deleted in its entirety and replaced by the following (b) The expenses are incurred and reported to us within three years of the date of the accident H. Athletic Activities SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph a Athletic Activities is deleted in its entirety and replaced with the following e. Athletic Activities To a person injured while taking part in athletics I Supplementary Payments SECTION 1—COVERAGES, SUPPLEMENTARY PAYMENTS -COVERAGE A AND B are amended as follows 1. b.is deleted in its entirety and replaced by the following. 1. b. Up to $5000 for cost of bad bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies We do not have to furnish these 1.d. is deleted in its entirety and replaced by the following 1, d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit', including actual loss of earnings up to$1,000 a day because of time off from work J. Employee indemnification Defense Coverage SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added We will pay, on your behalf, defense costs incurred by an"employee" in a criminal proceeding occurring in the course of employment The most we will pay for any"employee"who is alleged to be directly involved in a criminal proceeding is$25,000 regardless of the numbers of"employees," claims or"suits"brought or persons or organizations making claims or bringing "suits Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc , with its permission ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10111) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION 1—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to include the following We will pay for the cost to replace keys and locks at the "clients" premises due to theft or other loss to keys entrusted to you by your"client," up to a $10,000 limit per occurrence and $10,000 policy aggregate We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors, trustees, authorized representatives or any one to whom you entrust the keys of a "client"for any purpose commit, whether acting alone or in collusion with other persons The following, when used on this coverage; are defined as follows a. "Client' means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services b. "Employee" means- (1) Any natural person (a) While in your service or for 30 days after termination of service, (b) Who you compensate directly by salary, wages or commissions, and (c) Who you have the right to direct and control while performing services for you, or (2) Any natural person who is furnished temporarily to you (a) To substitute for a permanent"employee" as defined in Paragraph (1) above, who is on leave, or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean (a) Any agent, broker, person leased to you by a labor leasing firm,factor, commission merchant, consignee, independent contractor or representative of the same general character, or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an "employee " c. "Manager" means a person serving in a directorial capacity for a limited liability company L. Additional Insureds SECTION II—WHO IS AN INSURED is amended as follows 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc , with its permission ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following a. Coverage under this provision is afforded until the end of the policy period 2. Each of the following is also an insured a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors Managers and supervisors who are your"employees' are also insureds for"bodily injury"to a co- "employee' while in the course of his or her employment by you or performing duties related to the conduct of your business This provision does not change Item 2 a(1)(a)as it applies to managers of a limited liability company c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance d. Funding Source—Any person or organization with respect to their liability arising out of (1) Their financial control of you, or (2) Premises they own, maintain or control while you lease or occupy these premises This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization e. Home Care Providers—At the first Named insured's option, any person or organization under your direct supervision and control wnile providing for you private home respite or foster home care for the developmentally disabled f. Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions This insurance does not apply to (1) Any"occurrence"which takes place after you cease to be a tenant in that premises, or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from wnom you lease eguiDment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc , with its permission ©2011 Philadelphia Indemnity insurance Company PI-GLD-HS(10/11) organization is an insured only with respect to liability for"bodily injury," "property damage" or "personal and advertising inury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment encs With respect to the insurance afforded to these additional insureds, this insurance does not apply to any"occurrence"which takes place after the equipment lease expires, h Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies (a) The existence maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults street banners or decorations and similar exposures, (b) The construction, erection, or removal of elevators, or (c) The ownership, maintenance, or use of any elevators covered by this insurance I. Vendors—Only with respect to"bodily injury" or"property damage" arising out of"your products' which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions (1) The insurance afforded the vendor does not apply to (a) "Bodily injury" or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement, (b) Any express warranty unauthorized by you, (c) Any physical or chemical change in the product made intentionally by the vendor, (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the orsgmal container, (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distnbution or sale of the products, (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product, Page 8of12 Includes copyrighted material of Insurance Services Office, Inc., with its permission ©2011 Philadelphia Indemnity insurance Company PI-GILD-HS(10/11) (g) Products which, after distnbution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor, or (h) "Bodily injury" or"property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf However, this exclusion does not apply to (i) The exceptions contained in Sub-paragraphs (d) or(f), or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products (2)This insurance does not apply to any msuted person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing }. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you k. As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss Such person or organization is an additional insured for"bodily injury," "property damage" or"personal and advertising injury" but only for liability arising out of the negligence of the named insured The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement These limits are included within and not in addition to the limits of insurance shown in the Declarations I. Owners, Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage" or"personal and advertising injury" caused, in whole or in part, by (1) Your acts or omissions, or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract With respect to the insurance afforded to these additional insureds, the following additional exclusions apply This insurance does not apply to 'bodily injury" or"property damage"occurring after (a) All work, including materials, parts or equipment fumished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed, or (b) That portion of"your work" out of which the injury or damage anses has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc , with its permission ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) m State or Political Subdivisions—Any state or political subdivision as required, subject to the following provisions (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract (2) This insurance does not apply to (a) "Bodily injury," "property damage" or"personal and advertising injury" arising out of operations performed for the state or municipality, or (b) "Bodily injury" or"property damage" included within the"products-completed operations hazard " - - -- --- M. Duties in the Event of Occurrence, Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows a. is amended to include This condition applies only when the"occurrence" or offense is known to (1) You, if you are an individual, (2) A partner, if you are a partnership, or (3) An executive officer or insurance manager, if you are a corporation b. is amended to include This condition will not be considered breached unless the breach occurs after such claim or"suit" is known to (1) You, if you are an individual, (2) A partner, if you are a partnership, or (3) An executive officer or insurance manager, if you are a corporation N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fad to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,8 Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc , with its permission, ©2011 Philadelphia Indemnity Insurance Company , PI-GLD-HS (10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us The insured must do nothing after loss to impair them At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following "Bodily injury" means a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these, and b. Except for mental anguish, includes death resulting from the foregoing (Item a above) at any time R. Personal and Advertising Injury—Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluoed from this Coverage Part, the definmon of"personal and advertising injury" is amended as follows 1. SECTION V—DEFINITIONS, Paragraph 14 b is deleted in its entirety and replaced by the following b Malicious prosecution or abuse of process, 2. SECTION V—DEFINITIONS, Paragraph 14 is amended by adding the following Discrimination based on race, color, religion, sex, age or national origin, except when a. Done intentionally by or at the direction of, or with the knowledge or consent of (1) Any insured, or (2) Any executive officer, director, stockholder, partner or member of the insured, b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured, Page 11 of 12 includes copyrighted material of Insurance Services Office, inc.,with its permission ©2011 Philadelphia indemnity Insurance Company PI-GLD-HS(10111) c. Directly or indirectly related to the sale, rental lease or sublease or prospective sales, rental lease or sub-lease of any room, dwelling or premises by or at the direction of any insured, or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling The above does not apply to fines or penalties imposed because of discrimination A Page 12 of 12 Includes copyrighted material of insurance Services Office, Inc., with its permission ©2011 Philadelphia Indemnity Insurance Company KENT Exhibit C w.= PARKS RECREATION S COMMUNITY SERVICES City of Kent Certification Regarding Debarment and Suspension Agency Name of Program(s) Certification A: Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions 1. The prospective primary participant certifies to the best of its knowledge and belief that its principals, a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal debarment or agency, b) Have not within a three-year period preceding this proposal, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction, violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false statements, or receiving stolen property, c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification, and d) Have not within a three-year period preceding this application/ proposal had one or more public transactions (Federal, State, or local) terminated for cause or default 2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal Instructions for Certification (A) 1 By signing and submitting this proposal, the prospective primary participant is providing the certification set out below 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction The prospective participant shall submit an explanation of why it cannot provide the certification set out below The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3 The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default 4 The prospective primary participant shall provide immediate written notice to the department or agency to whom this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances 5 The terms covered transaction, debarred, suspended, ineligible, lower tier covered 1 of 3 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 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 Exclusion - Lower Tier Covered Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions 8 A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous A participant may decide the method and frequency by which it determines this eligibility of its principals Each participant may, but is not required to, check the Non-procurement List 9 Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings 10 Except for transactions authorized under paragraph (6) of these instructions, if a participant in a covered transaction 11 Knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default Certification B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal depart- ment 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 2of3 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 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 Exclusion - Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions 7 A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous A participant may decide the method and frequency by which it determines the eligibility of its principals Each participant may, but is not required to, check the Nonprocurement List 8 Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings 9 Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment Executive Directo Pn t) � Title Date Signature o xec tive Director Title Date (3, Adopted from HUD Form-2992 09104 3of3 �� REQUEST FOR MAYOR'S SIGNATURE �� KENT Please Fill in All Applicable Boxes µn x<.rry Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) Originator: Merina Hanson Phone (Originator): 856-5077 Date Sent: 02-26-13 Date Required: 03-06-13 Return Signed Document to: M. Hanson CONTRACT TERMINATION DATE: 12-31-14 VENDOR NAME: DATE OF COUNCIL APPROVAL: Dynamic Partners 12-11-12 (as part of City Budget/Human Svcs per capita) Brief Explanation of Document: Human Services General Fund Contract with Dynamic Partners (previously Dynamic Family Services) for the Children with Special Needs program. RtI YVtt I (Human Services Per Capita Funding) MAR Q 5 2013 City of Kent Office of the Mayor All Contracts Must Be Routed Through The Law Department (This area to be completed by the Law Department) Received: t 41 Approval of Law Dept:: FEB w S 2093 Law Dept. Comments. KENT LAW PEP Date Forwarded to Mayor: Shaded Areas To Be Completed By Administration Staff Received: RECEIVED Recommendations and Comments: MAR 6 2013 34R]1F. "An, /3 iYiaya,� f� Disposition CITY OF KENT CITY CLERK Date Returned: