HomeMy WebLinkAboutEC13-106 - Original - Green River Community College - Small Business Assistance Center Consulting Services - 04/05/2013 KENT
i WASHINOTON
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
State of Washington, Green River Community College's
Small Business Assistance Center
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and State of Wahington, Green River Community College's Small
Business Assistance Center organized under the laws of the State of Washington, located and
doing business at 417 Ramsey Way, Suite 112, Kent, WA 98032, (253) 856-9595 (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:
See attached scope of work exhibit A
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, 2013.
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to
exceed $12,000 , 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
work and shall utilize all protection necessary
subcontractors in the performance of the contract o p
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:
By; �---, By:
(signature) ze� (signature)
Print Name: Leslie Moore Prin N9 •e uzette Cooke
Its Dan for Branch Ca=ises Its Ma or _
411(/13)
DATE: DATE: �
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Leslie Moore, Dean for Branch Campuses & Josh Hall, Economic Development Specialist
Continuting Education City of Kent
Green River Community College, Small 220 Fourth Avenue South
Business Assistance Center Kent, WA 98032
417 Ramsey Way, Suite 112
Kent, WA 98032 (253) 856-5707 (telephone)
(253) 856-6454 (facsimile)
(253) 833-9111 x3375 (telephone)
253 288-3780 facsimile
APPROVED S TO F M:
Kent Law Department
[In this field,you may enter the electronic filepath where the contract has been saved]
CONSULTANT SERVICES AGREEMENT - 5
(Over$10,000)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
3. During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
S. 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 1st day of April 2013 ,
By: C Yl GT1 C_
For: Green River Community College, Small Business Assistance Center
Title: Dean for Branch Campuses and Cnntinning Eduration
Date: April 1, 2013
EEO COMPLIANCE DOCUMENTS - 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee
equal employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS - 2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as that was entered
into on the (date), between the firm I represent and the City of
Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City
of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity
Policy that was part of the before-mentioned Agreement.
Dated this day of 120
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3
EXHIBIT A
In 2013-2014 SBAC will focus on fewer clients with higher impacts. Small Business billable hours are
calculated at $120 per hour. For a$12,000 grant, Kent will receive 100 hours of direct client services
representing approximately three growth companies for 60 hours, and 8 to 10 small business start-up or
maintenance companies A growth company would be characterized as a company that would grow by
$500K to $1 M in revenue and add 5 to 10 jobs. As all clients are self-selecting, this is the best SBAC
estimation of impacts over a 12-month period based on previous years of experience Actual results are
based on a number of factors, not all of which are under the control of the SBAC.
Confidentiality is a chief concern in reporting on SBAC activities Reporting forms will identify clients
by number only and not by company name or owner.
Following is the Scope of Service for the Consultant Services Agreement between the City of Kent and
Green River Community College's Kent Small Business Assistance Center for the calendar year 2013.
I. Description of Work
Consultant shall perform the following services for the City in accordance with the following described
plans and/or specifications
Green River Community College's Kent Small Business Assistance Center shall offer to Kent residents
and to individuals seeking to open a business in Kent one-on-one counseling and classes in the following
areas.
Small Business management Buying or selling a business
Business location analysis Marketing and sales
Financial and cash flow management Human Resource management
Expanding into new markets Export assistance
Inventory control Strategic planning
Sources of capital Business plan development
Counseling sessions shall be available at no cost to the client Workshops and classes shall be available at
no or low cost to the participant. Information for lending options shall be available for those clients
needing capital The consultant shall provide quarterly reports to the City and an in-person meeting to
discuss the number of clients served, number of counseling hours,jobs created and saved, pending
proposals, and loans approved (See template, Attachment A)
Consultant further represents that the services furnished under this Agreement will be performed in
accordance with generally accepted professional practices in effect at the time those services are
performed.
Amount being awarded by the City of Kent for 2013 is $12,000 00 to be reimbursed quarterly to Green
River Community College upon receipt of invoice.
Exhibit A
Small Business Assistance Center
�* 417 Ramsay Way, Suite 112
�• We1 Kent, WA 98032-4501
(253) 856-9595
COMMUNITY COLLEGE
Kent Business Development Report: First Quarter 2013
Current Quarter Year-to-Date 2013
Total Counseling Hours
Counseling hours include individual client meetings and prep time
Total Number of Clients
Start-Up Clients
Growth and Development Clients
Jobs Created or Saved
"Jobs Created"is defined by the number ofjobs created through the expansion of a current business or the start-lip
of a new business "Jobs Saved"are determined by client follow-up and whether services received impacted ability
to maintain jobs, the services may be assistance with loans, business plans, and access to resource information
Pending Loans /Private Investments
Loan proposal numbers and dollar value are based on reviewing client's loan applications, assisting clients in
completing loan applications, and referring clients to banks to submit applications
Financing Approved
"Financing Approved"indicates the number and dollar values of loans approved by lending institutions
BUSINESS SUCCESS STORIES
Growth Start-Up
EXHIBIT B
INSURANCE REQUIREMENTS FOR
CONSULTANT SERVICES AGREEMENTS
Insurance
The Consultant 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 Consultant, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Consultant shall obtain insurance of the types described below:
1. 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.
Commercial General Liability insurance shall be written on
ISO occurrence form CG 00 01. The City shall be named as
an Additional Insured under the Consultant's Commercial
General Liability insurance policy with respect to the work
performed for the City using ISO additional insured
endorsement CG 20 10 11 85 or a substitute endorsement
providing equivalent coverage.
2. Workers' Compensation coverage as required by the
Industrial Insurance laws of the State of Washington.
B. Minimum Amounts of Insurance
Consultant shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined
single limit for bodily injury and property damage of
$1,000,000 per accident.
2. Commercial General Liability insurance shall be written with
limits no less than $1,000,000 each occurrence, $2,000,000
general aggregate.
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 Consultant'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 Consultant's
insurance and shall not contribute with it.
2. The Consultant'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 Consultant 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 Consultant'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
Consultant 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 Consultant before commencement of the work.
F. Subcontractors
Consultant 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 Consultant.
CERTIFICATE OF LIABILITY INSURANCE Issue Date4/3/2013
ISSUED BY: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
State of Washington AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Department of Enterprise Services CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
Office of Risk Management AFFORDED BY THE STATE OF WASHINGTON SELF INSURANCE
PO Box 41466 LIABILITY PROGRAM.
Olympia WA 98504-1466
COVERAGE AFFORDED BY
State of Washington Self Insurance Liability Program
INSURED: THE STATE OF WASHINGTON, INCLUDING ALL ITS AGENCIES AND
DEPARTMENTS, IS SELF-INSURED FOR TORT LIABILITY CLAIMS. ALL
State of Washington CLAIMS MUST BE FILED WITH THE STATE OFFICE OF RISK
Green River Community College MANAGEMENT FOR PROCESSING IN ACCORD WITH STATUTORY
ATTN• Darcy S{Ivest REQUIREMENTS.
12401 SE 320th Street
Auburn, WA 98092-3622
COVERAGES
THIS IS TO CERTIFY COVERAGE DESCRIBED BELOW IS PROVIDED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBJECT
TO ALL THE TERMS,EXCLUSIONS,AND CONDITIONS OF SUCH PROGRAM.
POLICY EFFECTIVE EXPIRATION
TYPE OF COVERAGE NUMBER DATE DATE LIMITS
GENERAL LIABILITY Self-Insured Continuous Continuous BODILY INJURY,PROPERTY $5,000,000
® GENERAL LIABILITY DAMAGE&PERSONAL INJURY
® OCCURRENCE COVERAGE COMBINED EACH OCCURRENCE
AUTOMOBILE LIABILITY BODILY INJURY&PROPERTY $5,000,000
❑ANY AUTO DAMAGE COMBINED EACH
IR ALL OWNED AUTOS ACCIDENT
❑SCHEDULED AUTOS
❑HIRED AUTOS
❑NON-OWNED AUTOS
WORKERS COMPENSATION AND STATUTORY
EMPLOYERS LIABILITY
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS- Coverage applies as respects tort liability Claims against
the State of Washington as covered by the Tort Claims Act (RCW 4.92 et seq.) The Certificate Holder is named as
additional insured, but only as respects the negligence of the State of Washington.
CERTIFICATE HOLDER: CANCELLATION
CITY OF KENT SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, THE
STATE OF WASHINGTON WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN
ATTN' JOSH HALL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
220 FOURTH AVE SOUTH TO MAIL SUCH NOTICE SHALL NOT IMPOSE ANY OBLIGATION OR LIABILITY
KENT,WA 98032 UPON THE STATE OF WASHINGTON, ITS OFFICIALS, EMPLOYEES, AGENTS
OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE-
CERTIFICATE
NUMBER CRT 13-429 LU Isaki,State Risk Manager
Campbell, Melynda (DES)
From: CertificateInsuranceForml@ofm.wa.gov
Sent Monday,April 01, 2013 2 27 PM
To: OFM CI
Subject CertificatelnsuranceForml
YOUR AGENCY: Green River Community College
YOUR NAME: Darcy Silvest
YOUR PHONE: 253-833-9111 x2042
YOUR EMAIL: dsilvestCDareenriver.edu
OUTSIDE ENTITY:City of Kent
ATTN NAME:Josh Hall
CERTIFICATE HOLDER E-MAIL:JHall(Dkentwa.aov
CERTIFICATE HOLDER FAX:
CERTIFICATE HOLDER ADDRESS: 220 Fourth Ave South
CERTIFICATE HOLDER CITY:Kent
CERTIFICATE HOLDER STATE:WA
CERTIFICATE HOLDER ZIP:98032
CERTIFICATE HOLDER REASON: Request per contract
AGREEMENT:YES
MAILING NAME:
MAILING ADDRESS:
MAILING CITY:
MAILING STATE:
MAILING ZIP:
OTHER INSTRUCTIONS:
I t
REQUEST FOR MAYOR'S SIGNATURE
KENT Please Fill in All Applicable Boxes
'A AS HI OTC.
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT)
Originator Phone (Originator)
a
Date Sent: y �?J Date Required
Return Signed Document to CONTRACT TERMINATION DATE: 3
VENDOR NAME: DATE OF COUNCIL APPROVAL:
Brief Explanation of Document.
V 15 Can fy�a.(�t 1,5; 5rA dl
All Contracts Must Be Routed Through the Law Department
(This Area to be Completed 8 the Law Department)
1
Received:
Approval of Law Dept -
Law Dept. Comments: Ito
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ApR ^c
6
Date Forwarded to Mayor: ' 1j 4
APR 0 2013
Shaded Areas to Be Completed by Administration Staff
Received: 4Y UT O f tfT Kent
e MaYOr
Recommendations & Comments:
Disposition:
(tl
Date Returned: � ��