HomeMy WebLinkAboutPK15-095 - Original - South King Council of Human Services - Capacity Project - 03/17/2015 Records M eni F
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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: South King Council of Human Services
Vendor Number: 33386
JD Edwards Number
Contract Number: 6 dt ''42�
This is assigned by City Clerk's Office
Project Name: Capacity Project
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: 01-01-15 Termination Date: 12-31-16
Contract Renewal Notice (Days): 30 -
Number of days required notice for termination or renewal or amendment
Contract Manager: Lori Guilfoyle Department: Parks- Human Services
Contract Amount: $5,000 per year
Approval Authority: ❑ Department Director ®Mayor ❑City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
Human Services General Fund Contract with South King Council of Human Services for
the Capacity Project. This CSA is a two-year contract for 2015-2016, with the second
year of funding contingent upon availability of funds and successful performance.
Passed as part of the 2015 City of Kent budget.
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_ _ I
ICETlT
W1S IN�T.N
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
South King Council of Human Services
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and South King Council of Human Services organized under the laws of
the State of Washington, located and doing business at 126 Southwest 148th Street, Suite
C100, Box #282, Burien, WA 98166 (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 support by building a stronger safety net, bringing new
funding and resources to south county and providing free capacity building services
to agencies that provide direct services. 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, 2016. This agreement is, however, contingent upon the availibility 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 $10,000 ($5,000 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 The Consultant's billing rate shall be as delineated in Exhibit A.
CONSULTANT SERVICES AGREEMENT - 1
(Under$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
(Under$10,000)
i
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.
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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
(Under$10,000)
i
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
(Under$10,000)
other representative of the City, and such statements shall not be effective or be construed as
P Y�
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.
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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
(signat(ure) (signature)'
Print Name: Da ,\1 , /� � ✓ Print N4nYe:,,,§uzette Cook,.
Its: �� ��e L 121 Its - Mayor
(title) / --
DATE: s� r DATE: / f fSJ
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
David Daw, Project Director Merina Hanson, Human Services Manager
South King Council of Human Services City of Kent
126 Southwest 148th Street, Suite C100, 220 Fourth Avenue South
Box #282, Kent, WA 98032
Burien, WA 98166
(253) 856-5070 (telephone)
(253) 856-6070 (facsimile)
206-462-6643 (telephone)
n/a_(facsimile)
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CONSULTANT SERVICES AGREEMENT - 5
(Under$10,000)
I
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment 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 day of //T 20S7
By: �r
For: S�2 ,Q e
Title: iJ /✓l��C��PGL.E
Dater
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 A 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.
I
Dated this day of 20 .
By:
For:
i
Title:
Date:
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EEO COMPLIANCE DOCUMENTS - 3
I
Exhibit A
KENT Scope and Schedule of Work
PARKS, RECREATION s
COMMUNITY SERVICES 9 2015-2016 Consultant Services Agreement !�
'.
Agency: South King Council of Human Services 2015 Funding; $5 000
Program: Capacity Building 2016 Funding: 5 000
This funding Support agencies that provide direct services by
will provide: building a stronger safety net, bringing new funding Total* $10,000
and resources to south county and providing free
capacity building services to south county agencies to
improve their ability to provide services and attract
funding.
Annual Program Outputs: Program Outcomes:
Technical Assistance (hours of 55 Human services providers will have increased
assistance provided to an agency opportunities for mutual support, information
or community group) exchange and community education.
Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1 2015, 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
iSt Technical Assistance 13 13
2"d Technical Assistance 14 27
3rd Technical Assistance 14 41
4`h Technical Assistance 14 55
The above services shall be provided by December 31, 2015 for year one of the two-year agreement and
December 31, 2016 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/
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- All records related to this CSA must be retained for three (3) years plus the current year.
I
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Exhibit A (continued)
KE a T Scope and Schedule of Work
2015-2016 Consultant Services Agreement
PARKS, RECREATION S
COMMUNITY SERVICES
Agency; South King Council of Human Services 2015 Funding: ` $5 000
Program; Capacity Project 2016 Funding: 5 000
This funding Support agencies that provide direct services by
will provide: building a stronger safety net, bringing new funding Total: i $10,000
and resources to south county and providing free
capacity building services to south county agencies to
improve their ability to provide services and attract
funding.
Reporting Requirements and Timeline
All data and required forms shall be submitted through SharelApp:
http://sharelapp.culturegrants.org/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.
Re ort Due Date _
Service Unit Report and Reimbursement Request 151h day following each quarter
Final Reimbursement Request (4th Qtr) December 15th, 2015/December 15th, 2016
Demographic Data Report January 15th, 2016/January 15t', 2017
Annual Outcome Data Report January 15U', 2016/January 15th, 2017
Signature
Please sign below to indicate acceptance of the Year 2015 and Year 2016 Performance Measures listed
abo e.
David Daw, Project Director South King Council of Human Date
Services %p
M rA�c i a Harsdn, Human Services Manager Date
EXHIBIT 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.
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:
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EXHIBIT B (Continued)
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.
LC ® CERTIFICATE OF LIABILITY INSURANCE D4/2 lGwrrrr)
8/4/2014
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: It the certificate holder is an ADDITIONAL INSVRED,the policy(ies) must be endorsed. If SUBROGATION 15 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 NANTA KGri White, CISR
Bell Anderson Agency, Inc, PHONE (425)291-5200 .fgzsi 291-5190
600 S.W. 39th St, Suite 200 AI AplagEsatkoriw@bell-anderson.com
INSURERS AFFORDING COVERAGE NAIC C
Renton WA 98057 INSURER A American Casualty Co. Of 20427
INSURED
INSURER B:
South King Council Of Human Services INSURER C:
4800 S. 186th St. INSURER D:
Suite 232 INSURER E:
Seatac WA 98188 INSURER F:
COVERAGES CERTIFICATE NUMBER-CL148404007 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,
INLm SR TYPE OF INSURANCE R POLICY NUMBER M LCY EFF MODIOY EXP NYYYj LIMITS
GENERAL LIABILITY EACH OCCURRENCE S 2,000,000
X COMMERCIAL GENERAL L0181LIFRIED—
TY PREMISES Ea o,cyrrarcoi S 300,000
A CLAIMSMADE OCCUR 4030674095 /9/2014 /9/2015 MED EXP fAny one rsnn) $ 10,000
PERSONAL S ADV INJURY S 2,000,000
GENERAL AGGREGATE S 4,000,000
fEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 4,000,000
POLICY PRO. LOC S
P.M.BILE LIABILITY COMBINED SINGE LIMIT
Ea accident 1,000,00()
AANYAUTO BODILY INJURY(Per person) S
ALL OWNED SCHEDULED 030674095 /9/2014 /9/2015 BODILY INJURY P J AUTOS AUTOS ( or accrdonl $
HIREDAUTOE N
AUT SWNED P nddon) E $
UMBRELLA LINE DGWR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED I I RETENTION $
A WORKERS COMPENSATION WC STATU- OTH.
AND EMPLOYERS'LIABILITY
YIN FR
ANY PROPRIETOWPARTNERlEXECUTIVE❑ NIA L E EACH ACCIDENT S 1,000,000
OFFICEPIMEMBER EXCLUDED?
tMandatory in NH) dO3O674095 /9/2014 /912015 E.L.DISEASE-EA EMPLOYE $ 1 000 DDO
If yes.dosLdba uMer
DESCRIPTION OF OPERATIONS babes (wA Stop Gap) E,L.DISEASE-POLICY LIMIT $ 2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attaeb ACORD 101,Additional Remarks Schedule,If more space is required)
City of Kent is additional insured for general liability, and Hired non owned auto liability, but only if
required by written contract or written agreement per the attached endorsements IISB146932E 0611.
CERTIFICATE HOLDER CANCELLATION
ccain@kentwa.gov 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.
220 4th Avenue S
Kent, WA 98032 AUTHORIZED REPRESENTATIVE
James Hunt/K,TW
ACORD 25(2010105) 01988.2010 ACORD CORPORATION. All rights reserved,
IN8025,9aimmm Thn Ar.nOn nama and Inn^ora raniaferad,warlre of Ar.non
POLICY NUMBER INSURED NAME AND ADDRESS
B 4030674095 SOUTH KING COUNCIL OF HUMAN RESOURCES
4800 S 122TR ST
SUITE 232
SEATAC, WA 98188
------ T `ya` a ig8€ .r.. .. ss:e ju h ---.
FORMS AND ENDORSEMENTS SCHEDULE
COMMERCIAL PROPERTY III
FORM NUMBER FORM TITLE
SB147084B 07/2009 Fungi, Wet Rot, Dry Rot and Microbe Exclusion
SB300129A 03/2006 Targeted Hacker Attack
SB300179E 06/2011 Choice Endorsement
SB300456A46 07/2007 Concurrent Causation, Earth Movement and Water Dam
S230OS96A 01/2008 Identity Theft/Recovery Services Endorsement
COMMERCIAL GENERAL LIABILITY
FORM NUMBER FORM TITLE
SB146902E 06/2011 Hired Auto and Nonowned Auto Liability
SE146932E 06/2011 Blanket Additional Insured - Liability Extension
SE147079A 01/2006 War Liability Exclusion
SE147000A 01/2006 Exclusion - Silica
SB1470032 07/2009 Fungi/Mold/Mildew/Yeast/Microbe Exclusion
SB147089A 01/2006 Employment - Related Practices Exclusion
SB300000C 04/2010 Businessowners Liability Coverage Form
SB300018A 01/2006 Stop Gap Coverage Liability Coverage Endorsement
SB300113C 06/2011 Additional Insured - Designated Person
S2300441A 01/2007 Fiduciary Liability Coverage Form
SB300449A 01/2007 Single Limit of Insurance Endorsement
SB3004SOA 01/2007 Employment Practices Liability Coverage Form
SB300849A 07/2009 Recd and Distribution of Material or information
*** PLEASE READ THE ENCLOSED IMPORTANT NOTICES CONCERNING YOUR POLICY ***
FORM NUMBER FORM TITLE
CNA77042XX 11/2013 Notification of Pending Law Change to Terr Risk
SE146959I 08/2013 Policyholders Jurisdictional Inspection
SB300144C 01/2008 Offer of Terrorism Coverage Notice
I
Countersignature
- _+ J_ V Sacrelar
Chalnnaa of-fhe 9oazd
SB-146895-A (Ed. 01/06) INSURED Page 6 of 6
Guilfoyle, Lori
From: Hills, Chris
Sent: Friday, March 13, 2015 3:33 PM
To: Guilfoyle, Lori
Subject: RE: insurance
Lori,
American Casualty Company of Reading is a subsidiary of CAN. The Endorsement you have is acceptable proof that the
City is an Additional Insured based upon the contract requirement to name the City. Feel free to add this to the
insurance documents.
Chris Hills
Risk Manager
-----Original Message-----
From: Guilfoyle, Lori
Sent: Friday, March 13, 2015 3:27 PM
To: Hills, Chris
Subject: insurance
Hi Chris-see attached -THANK YOU!
Lori Guilfoyle, Human Services Coordinator Housing and Human Services Parks, Recreation and Community Services
220 Fourth Avenue South, Kent, WA 98032
Main 253-856-5070 1 Direct 253-856-5061 IguilfoVle@KentWA.goV
CITY OF KENT, WASHINGTON
KentWA.gov Facebook Twitter YouTube
PLEASE CONSIDER THE ENVIRONMENT BEFORE PRINTING THIS E-MAIL
-----Original Message-----
From: Parks-Human-Svcs-Copy-Room@I<entwa.gov [mailto:Parks-Human-Svcs-Copy-Room@I<entwa.go_v]
Sent: Friday, March 13, 2015 3:22 PM
To: Guilfoyle, Lori
Subject:
This E-mail was sent from "Parks-Human-Svcs-Copy-Room" (Aficio MP 5000).
Scan Date: 03.13.2015 15:22:23 (-0700)
Queries to: Parks-Human-Svcs-Copy-Room@I<entwa.gov
t
SB-146932-E
CNA (Ed. 06/11)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED - LIABILITY EXTENSION
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered
as an additional insured on any other endorsement now or hereafter attached to this Policy.
1. ADDITIONAL INSURED—BLANKET VENDORS own acts or omission or those of its
employees or anyone else acting on its
WHO IS AN INSURED is amended to include as an behalf. However, this exclusion does not
additional insured any person or organization (referred apply to:
to below as vendor) with whom you agreed, because
of a written contract or agreement to provide (1) The exceptions contained in
insurance, but only with,_respect to "bodily injury" or Subparagraphs d. orf.; or
"property damage" arising out of"your products"which (2) Such inspections, adjustments, tests or
are distributed or sold in the regular course of the servicing as the vendor has agreed to
vendor's business, subject to the following additional make or normally undertakes to make in
exclusions: the usual course of business, in
1. The insurance afforded the vendor does not apply connection with the distribution or sale of
to: - the products.
a. "Bodily injury"or "property damage"for which 2. This insurance does not apply to any insured
the vendor is obligated to pay damages by person or organization, from whom you have
reason of the assumption of liability in a acquired such products, or any ingredient, part or
contract or agreement. This exclusion does container, entering into, accompanying or
not apply to liability for damages that the containing such products.
vendor would have in the absence of the 3. This provision 2. does not apply to any vendor
contract or agreement; included as an insured by an endorsement issued
b. Any express warranty unauthorized by you; by us and made a part of this Policy.
c. Any physical or chemical change in the 4. This provision 2. does not apply if"bodily injury"or
product made intentionally by the vendor; "properly damage" included within the "products-
completed operations hazard" is excluded either
d. Repackaging, except when unpacked solely by the provisions of the Policy or by endorsement.
for the purpose of inspection, demonstration,
testing, or the substitution of parts under 2, MISCELLANEOUS ADDITIONAL INSUREDS
instructions from the manufacturer, and then WHO IS AN INSURED is amended to include as an
repackaged in the original container; insured any person or organization (called additional
e. Any failure to make such inspections, insured) described in paragraphs 2.a. through 2.h.
adjustments, tests or servicing as the vendor below whom you are required to add as an additional
has agreed to make or normally undertakes to insured on this policy under a written contract or
make in the usual course of business, in agreement but the written contract or agreement must
connection with the distribution or sale of the be:
products; 1. Currently in effect or becoming effective during the
f. Demonstration, installation, servicing or repair term of this policy; and
operations, except such operations performed 2. Executed prior to the "bodily injury," "property
at the vendor's premises in connection with damage"or"personal and advertising injury," but
the sale of the product;
Only the following persons or organizations are
g. Products which, after distribution or sale by additional insureds under this endorsement and
you, have been labeled or relabeled or used coverage provided to such additional insureds is
as a container, part or ingredient of any other limited as provided herein:
thing or substance by or for the vendor; or
a, Additional Insured—Your Work
h. "Bodily injury" or "property damage" arising
out of the sole negligence of the vendor for its That person or organization for whom you do
work is an additional insured solely for liability
SB-146932-E Page 1 of 5
(Ed. 06/11)
i
SB-146932-E
CNA (Ed. 06/11)
due to your negligence specifically resulting This insurance does not apply to "bodily
from your work for the additional insured injury, "property damage" or "personal and
which is the subject of the written contract or advertising injury" arising out of operations
written agreement. No coverage applies to performed for the state or municipality,
liability resulting from the sole negligence of c. Controlling Interest
the additional insured.
The insurance provided to the additional Any persons or organizations with a
insured is limited as follows: controlling interest in you but only with respect
to their liability arising out of:
(1) The, Limits of Insurance applicable to the (1) Their financial control of you;or
additional insured are those specified in
the written contract or written agreement (2) Premises they own, maintain or control
or in the Declarations of -this policy, while you lease or occupy these
whichever is less. These Limits of premises.
Insurance are inclusive of, and not in
addition to,the Limits of Insurance shown This insurance does not apply to structural
in the Declarations. alterations, new construction and demolition
operations performed by or for such additional
(2) The coverage provided to the additional insured.
insured by this endorsement and
paragraph F.9. of the definition of"insured d. Managers or Lessors of Premises
contract' under Liability and Medical A manager or lessor of premises but only with
Expenses Definitions do not apply to respect to liability arising out of the ownership,
"bodily injury" or "property damage" maintenance or use of that specific part of the
arising out of the "products-completed premises leased to you and subject to the
operations hazard"unless required by the following additional exclusions:
written contract or written agreement.
This insurance does not apply to:
(3) The insurance provided to the additional
insured does not apply to "bodily injury," (1) Any "occurrence" which takes place after
"property damage," or "personal and you cease to be a tenant in that premises,-
advertising injury' arising out of the or
rendering or failure to render any (2) Structural alterations, new construction or
professional services. demolition operations performed by or on
b. State or Political Subdivisions behalf of such additional insured.
A state or political subdivision subject to the e, Mortgagee,Assignee or Receiver
following provisions: A mortgagee, assignee or receiver but only
(1) This insurance applies only with respect with respect to their liability as mortgagee,
to the following hazards for which the assignee, or receiver and arising out of the
stale or political subdivision has issued a ownership, maintenance, or use of a premises
permit in connection with premises you by you.
own, rent, or control and to which this This insurance does not apply to structural
insurance applies: alterations, new construction or demolition
(a) The existence, maintenance, repair, operations performed by or for such additional
construction, erection, or removal of insured.
advertising signs, awnings, canopies, f. Owners/Other Interests—Land is Leased
cellar entrances, coal holes,
driveways, manholes, marquees, An owner or other interest from whom land
hoistaway openings, sidewalk vaults, has been leased by you but only with respect
street banners, or decorations and to liability arising out of the ownership,
® similar exposures; or maintenance or use of that specific part of the
land leased to you and subject to the following
(b) The construction, erection, or additional exclusions:
removal of elevators; or
(2) This insurance applies only with respect This insurance does not apply to:
to operations performed by you or on your (1) Any "occurrence" which takes place
behalf for which the state or political after you cease to lease that land; or
subdivision has issued a permit.
SB-146932-E Page 2 of 5
(Ed. 06/11)
SB-146932-E
CNA (Ed. 06111)
(2) Structural alterations, new Damage To Property, is replaced by the
construction or demolition operations following:
performed by or on behalf of such k. Damage To Property
additional insured.
g. Co-owner of Insured Premises "Property damage"to:
A co-owner of a premises co-owned by you 1. Property you own, rent or occupy,
and covered under this insurance but only including any costs or expenses
with respect to the co-owners liability as co- incurred by you, or any other person,
organization
owner of such premises. orgzation or entity, for repair,
replacement, enhancement,
h. Lessor of Equipment restoration or maintenance of such
property for any reason, including
Any person or organization from whom you
lease equipment. Such person or organization prevention injury a person or
are insureds only with respect to their liability damage to another's prope ty;
arising out of the maintenance, operation or 2. Premises you sell, give away or
use by you of equipment leased to you by abandon, if the "property damage"
such person or organization. A person's or arises out of any part of those
organization's status as an insured under this premises;
endorsement ends when their written contract
or agreement with you for such leased 3. Property loaned to you;
equipment ends. 4. Personal property in the care,
With respect to the insurance afforded these custody or control of the insured;
additional insureds, the following additional 5. That particular part of any real
exclusions apply: property on which you or any
This insurance does not apply: contractors or subcontractors working
directly or indirectly in your behalf are
(1) To any "occurrence" which takes place performing operations, if the"property
after the equipment lease expires;or damage" arises out of those
2 To "bodily injury," operations; or
O y j ry," "property damage" or
"personal and advertising injury" arising 6. That particular part of any property
out of the sole negligence of such that must be restored, repaired or
additional insured. replaced because "your work" was
Any insurance provided to an additional insured
incorrectly performed on it.
designated under paragraphs b, through h. above Paragraph 2 of this exclusion does not
does not apply to "bodily injury" or "property apply if the premises are "your work" and
damage" included within the "products-completed were never occupied, rented or held for
operations hazard." rental by you.
3. The following is added to Paragraph H. of the Paragraphs 1, 3, and 4, of this exclusion
BUSINESSOWNERS COMMON POLICY do not apply to "property damage' (other
CONDITIONS: than damage by fire or explosion) to
H. Other Insurance premises:
4. This insurance is excess over any other (1) rented to you:
insurance naming the additional insured (2) temporarily occupied by you with the
as an insured whether primary, excess, permission of the owner, or
contingent or on any other basis unless a (3) to the contents of premises rented to
written contract or written agreement you for a period of 7 or fewer
specifically requires that this insurance be consecutive days.
either primary or primary and A separate limit of insurance applies to
noncontributing. Damage To Premises Rented To You as .
4. LEGAL LIABILITY—DAMAGE TO PREMISES described in Section D Liability and
A. Under B. Exclusions, 1. Applicable to Medical Expenses Limits of Insurance.
Business Liability Coverage, Exclusion k.
SB-146932-E Page 3 of 5
(Ed.06/11)
SB-146932-E
CNA (Ed. 06/11)
Paragraphs 3, 4, 5, and 6 of this (2) Any partner, if you or an additional
exclusion do not apply to liability insured is a partnership;
assumed under a sidetrack agreement. (3) Any manager, if you or an additional
Paragraph 6 of this exclusion does not insured is a limited liability company;
apply to "property damage" included in (4) Any "executive officer' or insurance
the "products-completed operations manager, if you or an additional insured is
hazard."
a corporation;
B. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the last (5) Any trustee, if you or an additional
paragraph of 2. Exclusions is deleted and insured is a trust; or
replaced by the following: (6) Any elected or appointed official, if you or
Exclusions c, d, e,f, g, h, 1, k, I, m, n, and o, an additional insured is a political
do not apply to damage by fire to premises subdivision or public entity.
while rented to you or temporarily occupied by This paragraph e, applies separately to you
you with permission of the owner or to the and any additional insured.
contents of premises rented to you for a
period of 7 or fewer consecutive days. A 7. Bodily Injury
separate limit of insurance applies to this Section F. Liability and Medical Expenses
coverage as described in Section D. Liability Definitions, item 3. "Bodily Injury" is deleted and
And Medical Expenses Limits Of replaced with the following:
Insurance.
"Bodily injury" means bodily injury, sickness or
C. The first Paragraph under item 5. Damage To disease sustained by a person, including death,
Premises Rented To You Limit of Section humiliation, shock, mental anguish or mental
D. Liability And Medical Expenses Limits injury by that person at any time which results as
Of Insurance is replaced by the following: a consequence of the bodily injury, sickness or
The most we will pay under Business Liability disease.
for damages because of"property damage" 6. Expanded Personal and Advertising Injury
to any one premises, while rented to you, or Definition
temporarily occupied by you, with the
permission of the owner, including contents of a. The following is added to Section F. Liability
such premises rented to you for a period of 7 and Medical Expenses Definitions, item 14.
or fewer consecutive days, is the Damage to Personal and Advertising Injury, in the
Premises Rented to You limit shown in the Businessowners General Liability
Declaration. Coverage Form:
5. Blanket Waiver of Subrogation h. Discrimination or humiliation that results in
injury to the feelings or reputation of a natural
We waive any right of recovery,we may have person, but only if such discrimination or
against: humiliation is:
a. Any person or organization with whom you 1. Not done intentionally by or at the
have a written contract that requires such a direction of:
waiver.
a. The insured; or
6. Broad Knowledge of Occurrence
b. Any "executive officer," director,
The following items are added to E. stockholder, partner, member or
Businessowners General Liability Conditions manager (if you are a limited liability
in the Businessowners Liability Coverage company)of the insured; and
Form:
® 2. Not directly or indirectly related to the
a. Paragraphs a. and b. apply to you or to any employment, prospective employment,
additional insured only when such past employment or termination of
"occurrence," offense, claim or"suit"is known employment of any person or person by
to: any insured.
(1) You or any additional insured that is an b. The following is added to Exclusions, Section
individual; B„
SB-146932-E Page 4 of 5
(Ed. 06/11)
SB-146932-E
CNA (Ed. 066/11)
(15)Discrimination Relating to Room, Personal and Advertising Injury Liability is
Dwelling or Promises excluded either by the provisions of the Policy
Caused by discrimination directly or or by endorsement
indirectly related to the sale, rental, lease 9. Personal and Advertising Injury Redefined
or sub-lease or prospective sale, rental, Section F. Liability and Medical Expenses
lease or sub-lease of any room, dwelling Definitions, item 14, Personal Advertising Injury,
or premises by or at the direction of any Paragraph c. is replaced by the following:
insured.
(1fiJ Fines or Penalties c. The wrongful eviction from, wrongful entry
into, , or invasion of the right of private
Fines or penalties levied or imposed by a occupancy of a room dwelling or premises
governmental entity because of that a person or organization occupies
discrimination. committed by or on behalf of it's owner,
c. This provision (Expanded Personal and landlord or lessor.
Advertising Injury) does not apply if
i
SB-146932-E Page 5 of 5
(Ed. 06111)
KETI I Exhibit C
PARKS.•RECREnn ON S
C°MMUN11Y SENVICES City of Kent
Certification Regarding Debarment and Suspension
E,r'tw'• "6.i�r`k,d"f E+Fj l'`�('S'`tR a- i�1t �F! 4(G'1{ �f �irl ,ii� ,�1 d:;' L.✓'Y�Z
Agency 1 - _G/ > Name of Programs )
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.
S. 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
1 of 3
i
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 department or agency.
2. Where the prospective lower tier participant is unable to certify to any of the statements
in this certification, such prospective participant shall attach an explanation to this
proposal.
Instructions for Certification (B)
1. By signing and submitting this proposal, the prospective lower tier participant is
providing the certification set out below.
2. The certification in this clause is a material representation of fact upon which reliance
was placed when this transaction was entered into. If it is later determined that the
prospective lower tier participant knowingly rendered an erroneous certification, in
addition to other remedies available to the Federal Government/City of Kent, the
department or agency with which this transaction originated may pursue available
2 of
II
remedies, including suspension and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the
person to which this proposal is submitted if at any time the prospective lower tier
participant learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms covered transaction, debarred, suspended, ineligible, lower tier
covered transaction, participant, person, primary covered transaction,
principal, proposal, and voluntarily excluded, as used in this clause, have the
meanings set out in the Definitions and Coverage sections of rules implementing
Executive Order 12549. You may contact the person to which this proposal is
submitted for assistance in obtaining a copy of these regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly enter into
any lower tier covered transaction with a person who is debarred, suspended,
declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the department or agency with which this trans-
action 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 j
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 j
debarment.
Executive Director (Print) Title Date
Sig e of Exp tive Director (Ite Date
(3.
Adopted from HUD Form-2992
09/04
3 of
i
I
2014 Adopted 2014 Human Services Funding Sources&Costs
Human Services Funded Agencies/Programs Expenditure General Fund Per Capital 'CDBG3
Planning&Administration $ 678,441 $ 495,541 $ - $ 182,900
Catholic Community Services of W Washington - 83,000 - 73,000 10,000
Child Care Resources 35,320 35,320 -
Children's Home Society of Washington 20,000 - 20,000 -
Communities in Schools of Kent 35,000 - 35,000 -
Crisis Clinic 5,000 - 5,000 -
Domestic Abuse Women's Network(DAWN) 65,000 - 65,000 '.. -
Dynamic Family Services 55,000 - 55,000 -
Emergency Feeding Program 10,000 - - 10,000
Health Point 40,000 - 30,000 10,000
Home Repair Program 569,424 - - 569,424
Jewish Family Service 10,000 - 10,000 -
Kent Food Bank and Emergency Services 70,000 - 70,000 -
Kent Youth and Family Services 125,000 - 125,000 -
King County Bar Foundation 10,000 - 10,000 -
King County Sexual Assault Resource Center 25,000 - 25,000 -
Mercy Housing 10,000 - 10,000 -
Multi-Service Center 215,175 - 151,000 64,175
Neighborhood House 10,000 - 10,000 -
Refugee Woman's Alliance(ReWA) 25,000 - - 25,000
Pediatric Interim Care Center Inc 10,000 - 10,000
Senior Services 10,000 - 10,000 -
Sound Mental Health 12,000 - 12,000 -
South King Council of Human Services 10,000 - 10,000
Ukrainian Community Center of Washington 10,000 - 10,000 -
Valley Cities Counseling and Consultation 32,000 32,000 -
Washington Community Alliance for Self-Help(WA CASH) 25,000 - - 25,000
Washington Women's Employment& Education(WWEE) 35,000 - 35,000 -
YWCA 18,000 - 18,000
Indigent Counsel(Public Defense) 676,292 676,292 - -
2% Liquor Profits-King County Alcohol Services 30,796 30,796 - -
Puget Sound Clean Air 49,289 49,289 - -
TotalFundingSources; $ 3,014,737. $ 1,251,918 $ -$48,320 $ 914,499:
1.Based on$7.04 per capita x 120,500(population)_$848,320. ',
2.2%of Liquor Profits distributed to any local government must be spent on alcoholism treatment programs. Ali
3.Community Development Block Grant funding source of$914,499 may change depending on final allocation from HUD.
C:\Users\lguilfoyle\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\KNP62JAG\Human Services 2014 Budget Funding
Sources
3/12/2015
REQUEST FOR MAYOR'S SIGNATURE
IsE a T Please Fill in All Applicable Boxes
Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT)
Originator: Lori Guilfoyle APPROVALS:
Date Sent: 03-12-15 DATE OF COUNCIL APPROVAL: 12/17/14
Return Signed Document to: Lori Guilfoyle DATE OF CHIEF ADMINISTRATIVE
OFFICER APPROVAL: N/A _
VENDOR NAME: South King Council of DATE OF FINANCE DIRECTOR
Human Services APPROVAL:12/17/14
Date Required:03-23-15
Phone (Originator):253 856-5061 BUDGETED: YES ® NO
FUND: General Fund
Brief Explanation of Document:
Human Services General Fund contract with South King Council of Human Services for
the Capacity Project. This CSA is a two-year contract for 2015-2016, with the second
year of funding contingent upon availability of funds and successful performance.
Passed as part of the 2015 City of Kent budget.
All Contracts Must Be Routed Through The Law Department
4�
Ts;aYa Co,b, cpmpleted by the Law Department) ( p
d
Received:
. 4 f .
Approval of Law Dept.: �`
a'
Law Dept. Comments:
Date Forwarded to Mayor: t
4 , f4
Shaded Areas To Be Completed By Administration Staff
Received:
Recommendations and Comments:
Date Returned: t