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PK15-263 - Original - Refugee Women's Alliance- Contract- 1/1/2015
IND ' w1 LON ® co r g ' WP9HIHGTGN 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: Refugee Women's Alliance Vendor Number: 50699 JD Edwards Number I Contract Number: FY. 1 - Zip This is assigned by City Clerk's Office Project Name: Senior Nutrition & Wellness Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment M Contract ❑ Other: Contract Effective Date: 1/1/15 Termination Date: 12/31/16 Contract Renewal Notice (Days): 30 days Number of days required notice for termination or renewal or amendment Contract Manager: Dinah Wilson Department:-Parks-Human Services Contract Amount: $11,182 Approval Authority: (CIRCLE ONE) Department Director Mao City Council Detail: (i.e. address, location, parcel number, tax id, etc.): This is_a CDBG-funded contract. A_ monthly congregate meal and health education program is provided at Birch Creek for refugee and immigrant seniors. tp 34/7/7.5 CDBG AGREEMENT BETWEEN THE CITY OF KENT AND REFUGEE WOMEN'S ALLIANCE CASE MANAGEMENT AND EMERGENCY ASSISTANCE PROJECT SENIOR NUTRITION AND WELLNESS PROJECT This Agreement, entered into this 51h day of May, 2015, between the City of Kent, a Washington municipal corporation (hereinafter the "City") and Refugee Women's Alliance (hereinafter the "Agency"). RECITALS WHEREAS, the City is an entitlement City applicant for Community Development Block Grant ("CDBG") funds (Catalogue of Federal Domestic Assistance-CFDA 14.218) under the Housing and Community Development Act of 1974 (the "Act"), as amended, Pub. L. No. 93-383, 88 Stat. 633 (1974), and anticipates receiving CDBG funds for the purpose of carrying out eligible community development and housing activities under the Act and under regulations promulgated by the Department of Housing and Urban Development ("HUD"), at 24 CFR § 570, et seq.; and WHEREAS, the City desires to contract with the Agency for the performance of certain eligible activities described within this Agreement; and WHEREAS, it is appropriate and mutually desirable that the Agency be designated by the City to undertake the aforementioned eligible activities, so long as the requirements of the Act, HUD regulations, and state and local laws are adhered to, as provided for herein; and WHEREAS, the purpose of this Agreement is to provide for cooperation between the City and the Agency, as the parties to this Agreement, in the provision of such eligible activities; and WHEREAS, the parties are authorized and empowered to enter into this Agreement pursuant to the Act, RCW 35.21.730 to .735, and/or by the Constitution and the enabling laws of the State of Washington; NOW THEREFORE, For and in consideration of the terms and conditions provided in this Agreement, the parties mutually covenant and agree as follows: INDEX TO AGREEMENT PARTI - GENERAL CONDITIONS ........................................................................................................... 1 1. Scope Of Agreement.................................................................................................................. 1 2. Scope Of Project....................................................................................................................... 1 3. Purpose And Primary Objective - § 570.200 a 3 1 4. Commencement And Termination Of Project(s)............................................................................. 5. Administration .......................................................................................................................... 3 6. Compensation And Method Of Payment........................................................................................ 3 7. Eligible Costs............................................................................................................................4 S. Operating Budget......................................................................................................................4 9. Funding Alternatives And Future Support ..................................................................................... 5 10. Amendments............................................................................................................................. 5 11. Assignment And Subcontracting.................................................................................................. 5 12. Hold Harmless And Indemnification ............................................................................................. 55 13. Project Close-Out.................................................................... .......................... .............._ ..... 14. Insurance................................................................................................................................. 6 15. Conflict Of Interest.................................................................................................................... 6 16. Suspension And Termination Of Agreement.................................................................................. 6 17. Safeguarding Of Client Information ............................................................................................. 7 PART II - FEDERAL, STATE, AND LOCAL PROGRAM REQUIREMENTS ..........................................................7 1. Nondiscrimination ..................................................................................................................... 7 2. Section 504 And Americans With Disabilities Act.......................................................I................. 10 3, Procurement Standards ........................................................................................................... 10 4. Uniform Administrative Requirements And Cost Principles - § 570.502, 570.610............................. 10 5. Data Universal Numbering System .......................................................................................................................11 6. Program Income - § 570.504.................................................................................................... 11 7. Public Information................................................................................................................... 11 8. Other Federal And State Requirements...................................................................................... 12 9. Local Requirements................................................................................................................. 12 Public service programs must comply with sections 9 and 10: ........................... ................................. 12 10. Nonsubstitution For Local Funding...... .................. ........................ ..........................._............. 12 11. Faith-Based Activities - §570.200(j).......................................................................................... 12 Acquisition or improvement of real property projects must comply with sections 11 through 18: ............. 13 12. Accessibility.......................... . ...................... . ...................................................................... 13 . . . . 13. Environmental Review ............................................................................................................. 13 14. Labor Standards - § 570.603.................................................................................................... 15 15. Volunteers - 24 CFR § 70.........................................................................................................15 16. Acquisition And Relocation.. ..................................................................................................... 15 17. Public Ownership..................................................................................................................... 16 18. Reversion Of Assets - § 570.505............................................................................................... 16 19. Property Management Standards .............................................................................................. 16 20. Additional Local Requirements .................................................................................................. 17 PART III - MONITORING & REPORTING REQUIREMENTS......................................................................... 17 1. Monitoring.............................................................................................................................. 17 2. Program Reporting .................................................................................................................. 17 3. Fiscal Reporting Responsibilities................................................................................................ 18 4. Audits.................................................................................................................................... 18 PART IV - RECORDKEEPING REQUIREMENTS........................................................................................ 18 1. Program Records and Inspections ............................................................................................. 18 2. Program Benefit Records - § 570.506(b).................................................................................. 19 3. Financial Records.................................................................................................................... 20 4. Records Of Program Operations, Management And Evaluation ...................................................... 20 5. Property Records .................................................................................................................... 21 6. Procurement Records - OMB Circular A-110 ............................................................................... 21 7. Nondiscrimination And Equal-Opportunity Records - § 570.506(g) ................................................ 21 8. Conflict Of Interest.................................................................................................................. 22 9. Verification Of Subcontractor's Eligibility - 24 CFR 5.................................................................... 22 10. Additional Requirements for Acquisition or Improvement of Real Property Projects.......................... 22 PART I - GENERAL CONDITIONS 2. SCOPE OF AGREEMENT The agreement between the parties shall consist of this Agreement and its signature page; the recitals page; the general conditions and any special conditions; the federal, state and local program requirements; the monitoring and reporting requirements; the recordkeeping requirements; each and every project exhibit, appendix, and attachment incorporated into the Agreement; all matters and laws incorporated by reference herein; and any written amendments made according to the general conditions. This Agreement supersedes any and all former agreements applicable to projects attached as Exhibits to this Agreement. 2. SCOPE OF PROJECT A. The Agency shall use the funds provided herein only to perform the activities authorized by this Agreement and as set forth in the CDBG Project Scope of Services, a draft of which is attached as Exhibit A and incorporated by this reference. Because this Agreement is executed prior to funds being allocated to the City through federal appropriations, the City will forward to Agency a final Exhibit A that the City will create if federal appropriations are awarded to the City for Agency's services, and that final Exhibit A, which may include adjustments in allocations or scope imposed as a condition of the final federal appropriations, shall relate back to and be incorporated into this Agreement. In the case of multiple projects, each project shall correspond to a separate Exhibit. This Agreement may be amended from time to time, in accordance with the general conditions, for the purpose of adding new projects, amending the scope of work, or for any other lawful purpose. B. Agencies funded by the City to carry out neighborhood revitalization, community economic development, or energy conservation projects shall meet the qualifications of a Community Based Development Organization (CBDO) pursuant to 24 C.F.R. § 570.204(c). The "carry out" requirement "means that the CBDO undertakes the funded activities directly or through contract with an entity other than the [City], or through the provision of financial assistance for activities in which it retains a direct and controlling involvement and responsibilities." 24 C.F.R. § 570.204(a)(4). 3. PURPOSE AND PRIMARY OBJECTIVE — 42 U.S.C. § 530(C), 24 C.F.R. § 570.200(a)(3). "The primary objective of this chapter and of the community development program of each grantee under this chapter is the development of viable urban communities, by providing decent housing and a suitable living environment and expanding economic opportunities, principally for persons of low and moderate income. Consistent with this primary objective, not less than 70 percent of the aggregate of the Federal assistance provided to States and units of general local government [of CDBG expenditures] under section 5306 of this title and, if applicable, the funds received as a result of a guarantee or a grant under section 5308 of this title, shall be used for the support of activities that benefit persons of low and moderate income ..." 42 U.S.C. § 5301(c), 24 C.F.R. § 570.200(c). 1 Income limits for persons eligible to be served by these activities are outlined in Exhibit B, which is attached and incorporated by this reference. The income guidelines attached as Exhibit B at the time this Agreement is executed shall be in draft form if federal income guidelines for the contract year have not been released and posted to The Department of Housing and Urban Development's web site prior to the execution of this Agreement. If federal income guidelines are in draft form, the City will forward to Agency a final Exhibit B including any adjustments imposed by the federal government once it is generated by the federal government at the time it finalizes its appropriations, and that final Exhibit B shall relate back to and be incorporated into this Agreement. The following requirements apply: A. The Agency shall ascertain household income of persons applying for and receiving assistance to assure compliance with the income limits defined in Exhibit B; and shall maintain records pursuant to Part IV of this Agreement, Section 2(B); or B. If the activity exclusively serves a clientele, which by federal regulation is "presumed" to be low and moderate income, individual income verification is not required. Persons eligible for this presumption are specified in Part IV of this Agreement, Section 2(C). In this case, the Agency shall maintain appropriate data to validate the presumption, as provided in Part IV, Section 2(C); or C. If the activity is such that it is not feasible to identify and record beneficiaries, the total population of the area from which the beneficiaries are drawn must be predominantly low and moderate income. In this case, the Agency shall maintain substantiation data as required by Part IV of this Agreement, Section 2(D). D. The benefit to low and moderate income beneficiaries must be in the form of a free or reduced cost service. If beneficiaries are charged for services, the charges to low and moderate income beneficiaries, and to all other beneficiaries, shall be as specified in the Exhibit(s), if applicable. Changes to the structure of charges during the term of this Agreement (and, in the case of a facility project, for five years thereafter) must preserve an identical discount for low and moderate income beneficiaries, and the change must be approved by the City. E. The low and moderate income limits in effect at the time of execution of this Agreement are specified in Exhibit B. These limits are revised periodically by HUD. It is the Agency's responsibility to use any revised limits when they take effect. Revisions will be announced by and can be obtained from the City. 4. COMMENCEMENT AND TERMINATION OF PROJECT(S) A. The City shall furnish the Agency with a written notice to proceed. No work on a project shall occur without prior written approval from the City. Agency 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. Termination dates for individual projects shall be specified in the appropriate Exhibits. Costs incurred prior to the date written notice to proceed was given or after the termination date will not be reimbursed. The termination date may be changed through an amendment of this Agreement. 2 i B. Although the term of this Agreement shall run from January 1, 2015 through December 31, 2016, this Agreement, however, is contingent upon the availability of funds to be allocated through federal appropriations. Therefore, should funds to support Agency's services not be made available through anticipated federal appropriations, this Agreement shall immediately terminate without risk or liability to the City and without obligation to disburse funds or to reimburse Agency any funds expended in anticipation of funding availability.. All work shall be done at Agency's own risk, and Agency shall be responsible for all losses associated with services provided before the City issues its written notice to proceed. All acts consistent with the authority of the Agreement and prior to the date of the Agreement's execution are hereby ratified and affirmed, and the terms of this Agreement shall be deemed to have applied. 5. ADMINISTRATION A. The Agency shall appoint a liaison person who shall be responsible for overall administration of CDBG funded project(s) and coordination with the City's Parks, Recreation, and Community Services Department. The person appointed shall be designated in Exhibit C, which is attached and incorporated by this reference. The Agency shall also designate one or more representatives who shall be authorized to submit the Billing Voucher and Service Report, and Final Service Report, which are attached as Exhibit D and D-1, respectively. The name of the liaison person and representative shall be specified in the Exhibit. B. The Agency shall provide ten (10) days written notice to the City of any changes in program personnel or Board membership. C. The agency shall provide the City with a current list of its Board of Directors, general or limited partners, as applicable. 6. COMPENSATION AND METHOD OF PAYMENT A. The City shall reimburse the Agency only for eligible costs allowed pursuant to this Agreement, which are part of the activities specified in the Exhibit(s), and in an amount not to exceed the amount specified in Exhibit A, plus any miscellaneous surplus office equipment, as available, related to the provision of services under this Agreement, and according to the procedures developed by the City of Kent. Reimbursement shall be based on a Billing Voucher and Service Report, which shall be submitted to the City by the Agency's authorized representative. B. The City of Kent uses a variety of measures as indicators of satisfactory contract performance. The Agency will be expected to meet 100% of the performance measures as defined in Exhibit A. Exceptions may be made in cases where circumstances beyond the Agency's control impact their ability to meet their units of service and the Agency has shown reasonable effort to overcome those circumstances. Exceptions are made at the discretion of the City's Human Services Manager. C. If the Agency does not meet performance goals, payment for services rendered under the agreement will be reduced by the rate calculated for each service unit. For example if an Agency contracted to provide 100 bed-nights a quarter for $5,000.00 and only provide 75 bed-nights, payment would be $3,750.00 instead of $5,000.00. 3 D. The Agency shall submit a Billing Voucher and Service Report on a quarterly basis. Billing Vouchers and Service Reports are due in accordance with the schedule and budget incorporated as Exhibit A and in accordance with Section 7 below. If the due date falls on a Saturday or Sunday, Billing Vouchers and Service Reports are due on the prior Friday. If the due date falls on a City holiday, Billing Vouchers and Service Reports are due the next working day following the holiday. The Final Service Report is due in accordance with the schedule listed in Exhibit A. If the Agency's line item budget includes personnel services costs, the Agency shall submit a CDBG Public Services Project Time Sheet (attached as Exhibit G if applicable) with the Billing Voucher and Service Report. The City will make payment to the Agency not more than forty-five (45) days after said Billing Voucher and Service Report is received and approved by the City's Parks, Recreation, and Community Services Department. The City will issue a statement of correction in the event the Billing Voucher and Service Report is erroneous. Payment by the City shall not constitute approval of the services for which payment is requested. The City does not, by making such payment, waive any rights it may have pursuant to this Agreement to require satisfactory performance of the services promised herein. The City reserves the right to demand and recover reimbursements made for ineligible costs. 7. ELIGIBLE COSTS A. All costs incurred must be reasonable and of a nature which clearly relate to the specific purposes and end product of the Agreement under which the services are being performed. Care must be taken by all concerned in incurring costs to assure that expenditures conform to these general standards and the following criteria for eligibility of costs. B. To be eligible for reimbursement, costs must: (1)Be necessary and reasonable for proper and efficient execution of the contractual requirements and in accordance with an approved budget. (2)Be no more liberal than policies, procedures, and practices applied uniformly to other activities of the Agency. (3)Be accorded consistent treatment through application of account policy and procedures approved and/or prescribed herein. (4)Not be allowable under or included as costs of any other federal, state, local or other agency-financed programs in either prior or current periods. (5)Be net of all applicable credits such as purchase discounts, rebates or allowances, sales of publication or materials, or other income or refunds. (6)Be fully documented. B. OPERATING BUDGET The Agency shall apply the funds received from the City under this Agreement in accordance with the Budget Summary found in Exhibit A. No line-item expense therein shall cause expenditure in excess of ten (10) percent or more of the budget line-item amount over the life of the Agreement without the prior written consent of the City. Any request for a line-item expense which exceeds ten (10) percent of 4 the budgeted amount shall specifically state the reasons for the requested increase and a justification for the corresponding decrease in other fine-item(s). 9. FUNDING ALTERNATIVES, FUTURE SUPPORT, AND LIMITED RELEASE A. The City makes no commitment to future support and assumes no obligation for future support of the activities contracted for herein, except as may be expressly set forth in this Agreement. B. Payment for the services provided herein is based on the expectation that future revenues will be available to the City for such purposes. Should anticipated sources of revenue not become available or become unavailable to the City for use in the CDBG program, the City shall immediately notify the Agency in writing of such unavailability and in that event, Agency fully releases City from any claims, damages, or liability, related to lack of funding, the amount funded, or uncertainty for that portion of the Agreement originally intended to be paid with such funds. 10. AMENDMENTS Either party may request modifications in the scope of permissible activities, terms, or conditions of this Agreement. Proposed modifications which are mutually agreed upon shall be incorporated by a written amendment to this Agreement. 11. ASSIGNMENT AND SUBCONTRACTING A. The Agency shall not assign any portion of this Agreement without the written consent of the City, and it is further agreed that said consent must be sought by the Agency not less than fifteen (15) days prior to the date of any proposed assignment. B. Any work or services assigned or subcontracted hereunder shall be subject to each provision of this Agreement and proper bidding procedures to the extent herein. The Agency agrees that it is as fully responsible to the City for the acts and omissions of its subcontractors and their employees and agents, as it is for the acts and omissions of its own employees and agents, as defined in paragraph Part I, Section 12(B). 12. HOLD HARMLESS AND INDEMNIFICATION A. The Agency agrees that it is financially responsible and liable to the City for any audit exception or other financial loss to the City which occurs due to the Agency's negligence or failure to comply with the terms of this Agreement. B. The Agency further agrees to defend, indemnify, and hold the City, its elected and appointed officials, agents, and employees, while acting within the scope of their duties as such, harmless from and against all claims, demands, and causes of action of any kind or character, including the cost of defense thereof, arising in favor of any person(s), including Agency's employees or third parties on account of personal injuries, death, or damage to property arising out of services performed or omissions of services or in any way resulting from the acts or omissions of the Agency " and/or its agents, employees, volunteers, subcontractors, or representatives under this Agreement. 5 13. PROJECT CLOSE-OUT The Agency acknowledges and agrees that the amounts set forth in the Exhibit(s) shall be used only to reimburse the Agency for eligible costs incurred by the Agency during the period set forth in said Exhibit(s) and that upon expiration of such period, or upon earlier termination pursuant to this Agreement, the Agency shall have no interest in any said amount which is not required to reimburse the Agency for eligible costs incurred before such expiration or earlier termination. 1.4. INSURANCE Agency shall maintain insurance in the types and amounts set forth in Exhibit E, which is attached and incorporated by this reference. 15. CONFLICT OF INTEREST A. Interest of Officers Employees or Agents - No officer, employee, or agent of the City or Agency who exercises any functions or responsibilities in connection with the planning and carrying out of the City CDBG program or the Agency's project, or any other person who exercises any functions or responsibilities in connection with the City's Parks, Recreation, and Community Services Department, shall have any personal financial interest, direct or indirect, in the Agreement, and the City and Agency shall take appropriate steps to assure compliance. B. Interest of Subcontractor and Their Employees - The Agency agrees that it will incorporate into every contract or subcontract, which is required to be in writing and made pursuant to this Agreement, the following provisions: The Contractor covenants that no person who presently exercises any functions or responsibilities in connection with the City CDBG program has any personal financial interest, direct or indirect, in this Agreement. The Contractor further covenants that he/she presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of his/her services hereunder. The Contractor further covenants that in the performance of this Agreement, no person having any conflict of interest shall be employed. Any actual or potential conflict of interest on the part of the Contractor or his/her employees must be disclosed to the Agency and the City. 16. SUSPENSION AND TERMINATION OF AGREEMENT A. Suspension for Failure to Perform - In the event of a failure to comply with any terms or conditions of this Agreement or failure to provide in any manner the activities or other performance as agreed to herein, the City reserves the right to withhold all or any part of payment, suspend all or any part of the Agreement, or prohibit the Agency from incurring additional obligations of funds until the City is satisfied that corrective action has been taken or completed as more specifically outlined in the Exhibit(s) to this Agreement. The option to withhold funds is, in addition to and not in lieu of, the City's right to terminate the Agreement pursuant to Paragraph (B) of this Section 16. 6 I B. Termination of Agreement by City - This Agreement is subject to termination upon thirty (30) days written notice by the City to the Agency in the event that: (1)The Agency mismanages or makes improper or unlawful use of CDBG funds; (2)The Agency fails to comply with any term or condition expressed herein or any applicable federal, state, or local regulations or ordinances; (3)CDBG funds no longer become available from the federal government or through the City; (4)The Agency fails to carry out activities required by this Agreement; or (5)The Agency fails to submit reports or submits incomplete or inaccurate reports in any material respect. C. Termination of Agreement by the Agency- This Agreement is subject to termination upon thirty (30) days written notice by the Agency to the City in the event that: (1)The City fails in its commitment under this Agreement to provide funding for services rendered, as herein provided; or (2)CDBG funds no longer become available from the federal government or through the City. D. Unless otherwise terminated pursuant to Paragraphs (B) and (C) of this Section 16, this Agreement shall terminate on the termination date specified on the Exhibit(s) and shall be subject to extension only by mutual agreement and amendment in accordance with Part I, Section 10 of this Agreement. E. Upon termination of this Agreement, any unexpended balance of Agreement funds shall remain in the City CDBG fund. F. In the event termination occurs under Paragraph (B) of this Section 16, the Agency shall return to the City all funds that were expended in violation of the terms of this Agreement including, but not limited to, any unexpended CDBG funds distributed to the Agency under this Agreement, any accounts receivable, or any assets or interests therein of any type and in any form acquired, leased, or rehabilitated with CDBG monies. 17. SAFEGUARDING OF CLIENT INFORMATION The use or disclosure by any party of any confidential information concerning a recipient or client for any purpose not directly connected with the City's or the Agency's responsibilities with respect to services provided under this Agreement is prohibited, except upon written consent of the recipient or client, his/her attorney, his/her responsible parent or guardian, or as otherwise provided by law. PART II - FEDERAL, STATE, AND LOCAL PROGRAM REQUIREMENTS 1. NONDISCRIMINATION A. General — The Agency shall comply with all federal, state, and local laws prohibiting discrimination on the basis of age, sex, marital status, race, creed, religion, color, national origin, or the presence of any sensory, mental, or physical handicap. 7 These requirements are specified in Chapter 49.60 RCW; Section 109 of the Housing and Community Development Act of 1974, Pub. L. No. 93-383 as amended and codified as 42 U.S.C. § 5309; Title VI of the Civil Rights Act of 1964, 42 U.S.C. §§ 2000d, et seq.; Title VIII of the Civil Rights Act of 1968, 42 U.S.C. §§ 3601, et seq.; Executive Order 11063; Executive Order 11246, as amended by Executive Orders 11375, 11478, 12086 and 12107; Section 3 of the Housing and Urban Development Act of 1968, 12 U.S.C.§ 1701(u), and implementing regulations at 24 CFR § 135; Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, et seq.; and the Age Discrimination Act of 1975, 42 U.S.C. § 6101, et seq. Specifically, the Agency is prohibited from taking any discriminatory actions defined in the HUD regulations at 24 C.F.R. § 570.602 and shall take such affirmative and corrective actions as are required by the regulations at 24 C.F.R. § 570.602. B. Specific Discriminatory Actions Prohibited: (1)The Agency shall not, under any program or activity to which this Agreement may apply, directly or through contractual or other arrangements, on the grounds of age, sex, marital status, race, creed, religion, color, national origin, or the presence of any sensory, mental, or physical handicap: i. Deny any person facilities, services, financial aid, or other benefits provided under the program or activity. ii. Provide any person with facilities, services, financial aid, or other benefits which are different, or are provided in a form different, from that provided to others under the program or activity. iii. Subject any person to segregated or separate treatment in any facility or in any matter or process related to receipt of any service or benefit under the program or activity. iv. Restrict in any way access to or enjoyment of any advantage or privilege enjoyed by others in connection with facilities, services, financial aid, or other benefits under the program or activity. v. Treat any person differently from others in determining whether the person satisfies any admission, enrollment, eligibility, membership, or other requirement or condition which individuals must meet in order to be provided facilities, services, or other benefits provided under the program or activity. vi. Deny any person any opportunity to participate in a program or activity as an employee. (2)The Agency shall not utilize criteria or methods of administration which have the effect of subjecting individuals to unlawful discrimination on the basis of race, color, national origin, sex, age, marital status, creed, religion, or presence of any sensory, mental, or physical handicap, or which have the effect of defeating or substantially impairing accomplishment of the objectives of the program or activity by unlawfully discriminating against individuals of a particular race, color, national origin, sex, age, marital status, creed, religion, or presence of any sensory, mental, or physical handicap. (3)The Agency, in determining the site or location of housing or facilities provided in whole or in part with funds under this Agreement, may not make selections of such site or location which have the effect of excluding individuals from, denying 8 i i i them the benefits of, or subjecting them to unlawful discrimination on the grounds of race, color, national origin, sex, age, marital status, creed, religion, or presence of any sensory, mental, or physical handicap; or which have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the Act or of HUD regulations. C. Fair Housing - The Agency shall take necessary and appropriate actions to prevent discrimination in federally-assisted housing and lending practices related to loans insured or guaranteed by the federal government (The Fair Housing Act VII, 42 U.S.C. § 3601, et seq.; Executive Order 11063, 24 CFR § 108). D. Employment : (1)In all solicitations under this Agreement, the Agency shall state that all qualified applicants will be considered for employment. The words "equal opportunity employer" in advertisements shall constitute compliance with this section. (2)The Agency shall not unlawfully discriminate against any employee or applicant for employment in connection with the Agreement because of age, sex, marital status, race, creed, religion, color, national origin, or the presence of any sensory, mental, or physical handicap, except when there is a bona fide occupational limitation. Such action shall include, but not be limited to the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training (Chapter 49.46 RCW, Executive Order 11246, as amended). (3)To the greatest extent feasible, the Agency shall provide training and employment opportunities for lower income residents within the area served by CDBG assisted projects (Section 3, Housing and Urban Development Act of 1968, 12 U.S.C. § 1701u, as amended). E. Contractors and Suppliers: iers: (1)No contractor, subcontractor, union, or vendor engaged in any activity under this Agreement shall engage in any unlawful discrimination as defined in any federal, state, or local law. (2)AII firms and organizations, as required under applicable HUD regulations, shall be required to submit to the Agency certificates of compliance demonstrating that it has, in fact, complied with the immediately foregoing provision; provided, that certificates of compliance shall not be required from firms and organizations with fewer than 25 employees, with yearly sales of less than $10,000, or on contracts less than $10,000. (3)To the greatest extent feasible, the Agency shall purchase supplies and services for activities under this Agreement from vendors and contractors whose businesses are located in the area served by CDBG-funded activities or owned in substantial part by project area residents (Section 3, Housing and Urban Development Act of 1968, 12 U.S.C. § 1701u, as amended). (4)CDBG funds shall not be used directly or indirectly to employ, award contracts to, or otherwise engage the services of, or fund any contractor or sub-recipient during any period of debarment, suspension, or placement in ineligibility status under the provisions of 24 CFR § 24. 9 F. Notice: (1)The Agency shall include the provisions of the appropriate subsections A, B, C, D, and E of this Part II, Section 1 in every contract or purchase order for goods and services under this Agreement, and shall send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice advising the said labor union or worker's representative of the commitments made in these subsections. (2)In advertising for employees, goods, or services for the activities under this Agreement, the Agency shall utilize minority publications in addition to publications of general circulation. 2. SECTION 504 AND AMERICANS WITH DISABILITIES ACT If the Agency is a nonprofit corporation, the Agency warrants and represents that it has completed a Disability Self-Evaluation Questionnaire for all programs and services offered by the Agency (including any services not subject to this Agreement) and has evaluated its services, programs, and employment practices for compliance with Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, as amended ("504") and the Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12101, et seq., ('DADA"). The Agency warrants and represents that it has completed a 504/ADA Disability Assurance of Compliance, which is attached as Exhibit H and incorporated by this reference, and shall submit it to the City. 3. PROCUREMENT STANDARDS In awarding contracts pursuant to this Agreement, the Agency shall comply with all applicable requirements of local and state law for awarding contracts, including but not limited to procedures for competitive bidding, contractor's bonds, and retained percentages (Ch. 60.28 RCW, Ch. 39.12 RCW, and Ch. 39.04 RCW). In addition, the Agency shall comply with the requirements of the U.S. Office of Management and Budget ("OMB") Circular A-110, Attachment O, relating to "Procurement Standards," and with Executive Order 11246 regarding nondiscrimination in bid conditions for projects over $10,000. Where federal standards differ from local or state standards, the stricter standards shall apply. 4. UNIFORM ADMINISTRATIVE REQUIREMENTS AND COST PRINCIPLES - 24 CFR §§ 570.502 and 570.610. All nonprofit Agencies shall comply with the policies, guidelines, and requirements of OMB Circular Nos. A-133 "Audits of Institutions of Higher Education and Other Non-Profit Institutions," A-122 "Cost Principles for Non-Profit Organizations," and A-110 including: (1) Attachment A, "Cash Depositories," except for Paragraph 4 concerning deposit insurance; (2) Attachment B, Bonding and Insurance"; (3) Attachment C, "Retention and Custodial Requirements for Records"; (4) Attachment F, "Standards for Financial Management Systems"; (5) Attachment H, "Monitoring and Reporting Program Performance," Paragraph 2; (6) Attachment N, "Property Management Standards, except for Paragraph 3 concerning the standards for real property as it applies to federal agencies only and except that paragraphs 6 and 8 are modified so that the disposition of personal property is allowed only under the 10 guidance and approval of the City; and (7) Attachment O, "Procurement Standards." 5. DATA UNIVERSAL NUMBERING SYSTEM Pursuant to 2 C.F.R. §25.100(a), the City is required to establish a Dun and Bradstreet (D & B) Data Universal Numbering System (DUNS) as a universal identifier in order to receive federal financial assistance. In addition, programs or sub-recipients receiving sub-awards from the City shall establish a DUNS. 2 C.F.R. § 25.200(c)(1). The Agency shall provide its DUNS to the City. 6. PROGRAM INCOME — 24 CFR § 570.504. A. All income directly generated from the use of CDBG funds, as defined in 24 CFR § 570.500(a), is Program Income and shall be recorded, reported, and treated as funds subject to all the requirements of this Agreement. B. Unless otherwise specifically provided by the special conditions herein, Program Income received during the term of this Agreement may be retained and used by the Agency to extend the service or other activity for which the CDBG funds are provided, subject to the regulations of 24 CFR § 570.01, et seq., and all the same terms and conditions of this Agreement. Any retained Program Income shall be disbursed to pay for eligible expenses under this Agreement before additional funds are requisitioned from the City. C. Any Program Income not permitted to be retained for eligible activities as defined above, shall be refunded to the City, together with any interest earned thereon, at quarterly intervals. D. Program Income on hand at the end of the term of this Agreement shall, unless otherwise provided, be used for activities envisioned under this Agreement until it is expended. Program Income generated from the use of CDBG funds under this Agreement but received after the term of this Agreement shall, unless otherwise provided, be governed by any succeeding CDBG funding agreement or, if there is no succeeding agreement, shall be used for activities eligible under 24 CFR § 570.504(c) until it is expended. E. Rules on Program Income are established in the CDBG regulations (24 CFR § 570.504); OMB Circular No. A-122, Cost Principles for Nonprofit Organizations; and OMB Circular A-110, attachment D, Program Income. Separate instructions for Program Income dealing with the proceeds from the sale of personal property are set forth in Attachment N to OMB, Circular No. A-110, Property Management Standards. 7. PUBLIC INFORMATION A. In all news releases and other public notices related to projects funded under this Agreement, the Agency shall include information identifying the source of funds as the City of Kent CDBG program. B. The Agency acknowledges that this Agreement and any other information provided by it to the City and/or relevant to the project(s) described in the Exhibit(s), are subject to the Washington State Public Disclosure Act, Chapter 42.56 RCW, except to the extent specifically exempted from disclosure therein. 11 � 8. OTHER FEDERAL AND STATE REQUIREMENTS The absence of mention in this Agreement of any other federal or state requirements, which apply to the award and expenditure of federal funds made available by this Agreement, is not intended to indicate that those federal or state requirements are not applicable to Agency activities. The Agency shall comply with all other federal and state requirements relating to the expenditure of federal funds, including but not limited to the Hatch Act (5 U.S.C. § 15) regarding political activities and the Architectural Barrier Act of 1968 (42 U.S.C. § 4151, et sec.). 9. LOCAL REQUIREMENTS The activities performed under this Agreement are for the purposes of serving City residents and the Agency shall, to the extent reasonably possible, not use said funds to provide services outside the corporate boundary of the City, or for any other purpose, except as specifically authorized by this Agreement. Public service programs must comply with sections 9 and 10: 10. NON-SUBSTITUTION FOR LOCAL FUNDING The CDBG funding made available under this Agreement shall not be utilized by the Agency to reduce substantially the amount of local financial support for community development activities below the level of such support prior to the availability of funds under this Agreement. 11. FAITH-BASED ACTIVITIES - 24 CFR § 570.200(j). A. Organizations that are religious or faith-based are eligible, on the same basis as any other organization, to participate in the CDBG program. Neither the Federal government nor a State or local government receiving funds under CDBG programs shall discriminate against an organization on the basis of the organization's religious character or affiliation. B. Organizations that are directly funded under the CDBG program may not engage in inherently religious activities, such as worship, religious instruction, or proselytism, as part of the programs or services funded under this part. If an organization conducts such activities, the activities must be offered separately, in time or location, from the programs or services funded under this part, and participation must be voluntary for the beneficiaries of the HUD-funded programs or services. C. A religious organization that participates in the CDBG program will retain its independence from Federal, State, and local governments, and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that it does not use direct CDBG funds to support any inherently religious activities, such as worship, religious instruction, or proselytism. Among other things, faith-based organizations may use space in their facilities to provide CDBG-funded services, without removing religious art, icons, scriptures, or other religious symbols. In addition, a CDBG-funded religious organization retains its authority over its internal governance, and it may retain religious terms in its organization's name, select its board members on a religious basis, and include religious references in its organization's mission statements and other governing documents. 12 D. An organization that participates in the CDBG program shall not, in providing program assistance, discriminate against a program beneficiary or prospective program beneficiary on the basis of religion or religious belief. E. CDBG funds may not be used for the acquisition, construction, or rehabilitation of structures to the extent that those structures are used for inherently religious activities. CDBG funds may be used for the acquisition, construction, or rehabilitation of structures only to the extent that those structures are used for conducting eligible activities under this part. Where a structure is used for both eligible and inherently religious activities, CDBG funds may not exceed the cost of those portions of the acquisition, construction, or rehabilitation that are attributable to eligible activities in accordance with the cost accounting requirements applicable to CDBG funds in this part. Sanctuaries, chapels, or other rooms that a CDBG- funded religious congregation uses as its principal place of worship, however, are ineligible for CDBG-funded improvements. Disposition of real property after the term of the grant, or any change in use of the property during the term of the grant, is subject to government-wide regulations governing real property disposition (see 24 CFR 84 and 85). F. If the City voluntarily contributes its own funds to supplement the federally funded activity, the City has the option to segregate the Federal funds or commingle them. However, if the funds are commingled, this section applies to all of the commingled funds. Acquisition or improvement of real property projects must comply with sections 11 through IS: 12. ACCESSIBILITY Any buildings or other facilities designed, constructed, or altered with federal funds pursuant to this Agreement are subject to the requirements of the Architectural Barriers Act of 1968 (42 U.S.C. § 4151, et seq.) and shall comply with the Uniform Federal Accessibility Standards (Appendix A to 24 CFR § 40.1, et seq. for residential structures, and Appendix A to 41 CFR § 101-19, et seq. for general type buildings). When applicable, certain multifamily housing units designed and constructed for first occupancy after March 13, 1991, with assistance provided under this Agreement, must comply with the Fair Housing Accessibility Guidelines, 24 CFR § 100.1, et seq., as amended. 13. ENVIRONMENTAL REVIEW A. National Environmental Policy Act - The City retains environmental review responsibility for purposes of fulfilling requirements of the National Environmental Policy Act as implemented by HUD Environmental Review Procedures (24 CFR § 58.1, et sec.). The City may require the Agency to furnish data, information, and assistance for the City's review and assessment in determining whether an Environmental Impact Statement must be prepared. The Agency shall be solely responsible for the cost of compliance with all such federal laws and authorities including the cost of preparing plans, studies, reports, and the publication of notices that may be required. B. Other Federal Environmental Laws - 13 (1)Historic Preservation - Activities affecting property listed in or found to be eligible for inclusion in the National Register of Historic Places will be subject to requirements set forth in HUD Environmental Review Procedures at 24 CFR § 58.1, et seq. The Agency shall meet the historic preservation requirements of Pub. L. No. 89-665 (16 U.S.C. § 470(i)), and the Archaeological and Historic Preservation Act of 1974, Pub. L. No. 93-291 (16 U.S.C. § 469a-1), and Executive Order 11593, including the procedures prescribed by the Advisory Council on Historic Preservation in the regulations at 36 CFR § 801, et seq. (2)Architectural Barriers - Any facility constructed pursuant to this Agreement shall comply with design requirements of the Architectural Barriers Act of 1968 (42 U.S.C. §§ 4151, et seq.), and the Uniform Federal Accessibility Standards (US Government Printing Office, 1985-494-187). (3)National Flood Insurance - When applicable, the use of CDBG funds for acquisition or construction purposes in identified special flood hazard areas shall be subject to Agency mandatory purchase of flood insurance as required by Section 102(a) of the Flood Disaster Protection Act of 1973 (Pub. L. No. 93-237, 42 U.S.C. § 2414 and 42 U.S.C. §§ 4001-4128). (4)Lead-Based Paint - Whenever funds under this Agreement are used directly or indirectly for construction, rehabilitation, or modernization of residential structures, the Agency shall comply, at its sole expense, with the HUD Lead- Based Paint regulations (24 CFR § 35) issued pursuant to the Lead-Based Paint Poisoning Prevention Act, as amended (42 U.S.C. §§ 4801, et seq.) and the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. §§ 4851, et seq.), with regard to lead-based paint, and with any and all applicable federal, state, and local laws, regulations, or standards hereafter enacted or issued with regard to lead-based paint. Without limiting the foregoing, the Agency shall remove or cover, prior to the date for completion of the work funded hereunder and in compliance with all applicable, laws, regulations, and in conformity with guidelines issued by HUD, all lead-based paint with lead content above the threshold established by HUD on surfaces affected by the work funded under this Agreement. The Agency shall defend, indemnify, and hold harmless the City from any liability, loss, damage, or expense, including costs and attorneys' fees, relating in any way to lead-based paint at the property or the abatement or disposal thereof. This provision shall survive expiration and satisfaction of this Agreement, whether by payment, forgiveness, foreclosure, or otherwise. (5)Other - Clean Air Act as amended, 42 U.S.C. § 7401, et seq.; Water Pollution Control Act, 33 U.S.C. §§ 1367, et seq., as amended; Environmental Protection Agency regulations, 40 CFR §§ 1.1, et seq. C. State Environmental Policy Act - Agencies which are branches of government under RCW 43.21C.030 retain responsibility for fulfilling the requirements of the State Environmental Policy Act, Chapter 43.21C RCW and the regulations and ordinances adopted there under. If the Agency is not a branch of government under RCW 43.21C.030, the City may require the Agency to furnish data, information, and assistance, as necessary, to enable the City to comply with the State Environmental Policy Act. D. Satisfaction of Environmental Requirements 14 (1) Limitations on Activities Pending Clearance - Per 24 CFR § 58.22(a). The Agency shall not commit assistance under this Agreement until HUD has approved the City's Request for Release of Funds (RROF) and the related certification from the City. In addition, until the RROF has been approved by HUD, neither the City nor the Agency may commit non-HUD funds on or undertake an activity or project under a program listed in § 58.1(b) if the activity or project would have an adverse environmental impact or limit the choice of reasonable alternatives. Provided; however, that an option agreement, self-Help Homeownership Opportunity Program funds, and relocation assistance may be excluded from the limitation above per 24 CFR § 58.22(d), (e) and (f) respectively. (2) Notice to Proceed - Project execution under this Agreement, by either the City or the Agency, shall not proceed until satisfaction of all applicable requirements of the national and state environmental policy acts. A written notice to proceed will not be issued by the City until all such requirements are complied with. 14. LABOR STANDARDS - 24 CFR § 570.603 A. The Agency shall require that project construction contractors and subcontractors pay their laborers and mechanics at wage rates in accordance with the Davis-Bacon Act, as amended (40 U.S.C. §§ 3141 and 3142), and that they comply with the Copeland Act (18 U.S.C. § 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§ 3701, et seq.); provided that this section shall not apply to rehabilitation of residential property only if such property contains not less than eight (8) units. In addition to complying with these federal labor standards, the Agency shall further require that all project construction contractors comply with all applicable state and local public works bidding and contracting regulations, specifically including, without limitation, the prevailing wage provisions set forth in Ch. 39.12 RCW and all regulations adopted by the State of Washington Department of Labor and Industries. B. The Agency shall require that project construction contractors and subcontractors comply with Federal Labor Standards Provisions (HUD form 4010) and the Davis- Bacon wage determinations (attached as Exhibits I and J, respectively if applicable). For construction contracts, a copy of the Federal Labor Standards Provisions (HUD form 4010) and the current Davis-Bacon wage determinations must be included in all construction bid specs and/or contracts over $2,000. 15. VOLUNTEERS 24 CFR § 70 If the Agency or the Contractor/Subcontractor uses volunteers to perform services on a federally-assisted construction project, it shall ensure that work is performed without promise, expectation or receipt of compensation for services rendered. Volunteer files shall include: (1) the name and address of the agency sponsoring the project; (2) a description of the project; and (3) the number of volunteers and the hours donated to the project. 16. ACQUISITION AND RELOCATION A. Any acquisition of real property for any activity assisted under this Agreement shall comply with the Federal Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. §§ 4601, et seq. (hereinafter the 15 'Uniform Act" and the government-wide regulations applicable to all federally- assisted projects, effective April 2, 1989, at 49 CFR §§ 34.1, et seq. B. Implementation of any project provided for in this Agreement will be undertaken so as to minimize involuntary displacement of persons, businesses, nonprofit organizations, or farms to the greatest extent feasible. C. Any displacement of persons, businesses, nonprofit organizations, or farms occurring as the result of acquisition of real property assisted under this Agreement shall comply with the Uniform Act, and the regulations at 49 CFR §§ 24.1, et seq., required by federal CDBG regulations at 24 CFR § 570.606. The Agency shall comply with the regulations pertaining to costs of relocation and written policies, as specified by the City of Kent's Displacement Policy. 17. PUBLIC OWNERSHIP For Agencies which are not municipal corporations organized under the laws of the State of Washington, it may become necessary to grant the City a property interest where the subject project calls for the acquisition, construction, reconstruction, rehabilitation, or installation of publicly-owned facilities and improvements. 18. REVERSION OF ASSETS - 24 CFR § 570.505. Any real property under the Agency's control that was acquired or improved in whole or in part with CDBG funds in excess of $25,000 must be either: A. Used to meet one of the national objectives set forth in 24 CFR § 570.208 of the CDBG regulations until five (5) years after expiration of the Agreement, or such longer period of time as determined by the City. For Acquisition or improvement of real property projects, the Agency and the City shall execute a Community Facility Covenant Agreement. B. Disposed of in a manner that results in the City being reimbursed in the amount of the current fair market value of the property, less any portion attributable to expenditures of non-CDBG funds for acquisition of, and improvements to, the property. Such reimbursement is not required after the period of time specified in Paragraph (A) above. 19. PROPERTY MANAGEMENT STANDARDS A. The Agency shall meet the following procedural requirements for all property acquired in whole or in part with CDBG funds: (1)Property records shall be maintained accurately and provide for a description of the property; manufacturer's serial number or other identification number; acquisition date and cost; source of the property; percentage of CDBG funds used in the purchase of property; and location, use, and condition of the property. (2)A physical inventory of property taken and the results of that inventory are reconciled with the property records at least once every two (2) years to verify the existence, current utilization, and continued need for the property. 16 i O 3 A controls stem shall be in effect to ensure safeguards to prevent adequate Y q loss, damage, or theft of the property which shall be investigated and fully documented. B. The disposition of real property acquired in whole or in part with CDBG funds shall be at no less than its current appraised fair market value (or for a lease, at the current market value), except that such property may be disposed of for a lesser value, including by donation, if the disposition at the lesser value is for a use which qualifies under one of the criteria set forth in 24 CFR § 570.208 for meeting the national objectives and is permissible under state and local law. Where the disposition is for a lesser value, the recipient shall maintain documentation that the use meets one of the national objectives pursuant to 24 CFR § 570.208. 20. ADDITIONAL LOCAL REQUIREMENTS A. Mortgage or Leasehold Agreement - In acquisition, rehabilitation, and construction projects, the City shall enter into a deed of trust or leasehold agreement with the Agency to secure and protect the City's and the public's interest in the property. B. Adequate Value - In acquisition projects, the City shall require evidence through a property appraisal, title search, or other means to ensure that there is adequate value so as to secure the City's financial interest. C. City Ordinance, Codes, and Regulations - In acquisition and construction projects, the Agency shall comply with all applicable City ordinances, codes, and regulations. D. Additional Public Information - For all construction projects, the Agency shall erect a sign to City specifications at the construction site, which identifies the source of funds, except that this requirement may be waived for construction projects of $5,000 or less. PART III - MONITORING & REPORTING REQUIREMENTS 1. MONITORING Agency understands and agrees that it will be monitored by the City and HUD from time to time to assure compliance with all terms and conditions of this Agreement and all applicable local, state, and federal laws, regulations, and promulgated policies. Monitoring by the City under this Agreement shall include, but not be limited to: (1) on-site inspections by City staff, (2) quarterly performance reviews, and (3) an annual evaluation. 2. PROGRAM REPORTING A. For public service programs - A Billing Voucher and Service Report shall be submitted at least quarterly, even if no reimbursement is requested. The report is due on in accordance with the schedule listed in Exhibit A. If the due date falls on a Saturday or Sunday, the Billing Voucher and Service Report is due on the prior Friday. If the due date falls on a City holiday, the Billing Voucher and Service Report is due the next working day following the holiday, The report shall detail information on service units or steps/milestones accomplished during the months/quarters as outlined in Exhibit A. The Final Service Report Form is provided 17 by the City and is attached as Exhibit D-1 to this Agreement; it is also due in accordance with the schedule listed in Exhibit A. B. For acquisition or improvement of real property projects - Projects qualifying to meet the national objective to serve low- and moderate-income persons (under Part I, Section 3) shall submit a demographic report providing income, race, and head of household information for the beneficiaries of the CDBG Project, which shall cover a one year period extending back from the date of the report. If the facility is and remains occupied during the project, this report is due thirty (30) days after the date the project was closed. If the facility is first occupied or reoccupied after the close of the project, the report is due one year from the date of the last project closing. 3. FISCAL REPORTING RESPONSIBILITIES The Agency shall provide fiscal statements or reports as may be required from time to time by the City, which statements or reports, or both, must indicate the status of all accounts and funds being used to perform under this Agreement. The Agency shall maintain proper documentation and records of all expenditures incurred pursuant to the terms of this Agreement in a manner as will facilitate auditing by either HUD or the City. 4. AUDITS A. If the Agency is a nonprofit corporation and expends a total of $500,000 or more in federal financial assistance and has received federal financial assistance from the City during its fiscal year, it shall have an independent audit conducted of its financial statement and conditions, which shall comply with the requirements of generally accepted auditing standards (GAAS); General Accounting Office (GAO's) Standards for Audits of Governmental Organizations, Programs, Activities, and Functions; and OMB Circular A-133, as amended, and as applicable. The Agency shall provide a copy of the audit report no later than thirty (30) days after the audit's completion or six (6) months subsequent to the end of the Agency's fiscal year, whichever date is sooner. The Agency shall provide to the City its response and corrective action plan for all findings and reportable conditions contained in its audit. When reference is made in its audit to a "Management Letter" or other correspondence made by the auditor, the Agency shall provide copies of those communications and the Agency's response and corrective actions plan. B. The Catalog of Federal Domestic Assistance (CFDA) number for the CDBG program is 14.218. PART IV - RECORD KEEPING REQUIREMENTS 1. PROGRAM RECORDS AND INSPECTIONS The Agency shall make, maintain, and preserve books and records, of whatever form, detailing all CDBG-related expenditures and costs incurred by the Agency. All such books and records shall be made available to representatives of the City or HUD, or both, for formal inspection and, where necessary, copying. Intentional 18 i noncompliance with this provision shall constitute a material breach of this Agreement. Throughout the term of this Agreement, the Agency shall establish and maintain current the records described in this Section. These records shall conform to the requirements and specifications of their individual source authorities, which are cited herein. Be advised that the listing in this Section is intended only to assist the Agency in identifying the required records and their respective authorities, and is not all inclusive. A. Time for Retention of Records - Except where otherwise specifically provided, all records as of the end of the term of this Agreement shall be kept in an accessible file for four (4) years thereafter (24 CFR § 570.502(b)(3)(ix)). Exceptions to the four (4) year retention period are as follows: (1) Records that are the subject of litigation, claim, or audit findings shall be retained for ten (10) years after the date all issues have been resolved and final action taken; and (2) Records for real property and equipment shall be retained for three (3) years after its final disposition, with the retention period starting from the date of the disposition, replacement, or transfer at the direction of the City (24 CFR § 570.84(b)). B. Contract and Amendments - A complete copy of this Agreement and all amendments thereto and notices there under. C. Records of City Approvals - Copies of all requests for amendments or revisions to this Agreement and the City's subsequent approval or denial of such requests as are required under this Agreement. D. Subcontracts and Agreements - Complete copies of all contracts, subcontracts, and agreements with third parties into which the Agency enters in the performance under this Agreement; and all correspondence, reports, and other documentation pertaining to such contracts, subcontracts, and agreements. E. Records identifying the assisted activity - A complete description of each activity assisted, in whole or in part, with CDBG funds under this Agreement, including: (1)Location(s), organization, operating hours, qualifications for service or participation, etc.; (2)Fees or charges for services, fee waivers, or fee scales for CDBG-assisted participants. F. Additional Contract Requirements - The Agency shall submit to the City a copy of the most recent independent financial audit and a current list of the Agency's board of directors. 2. PROGRAM BENEFIT RECORDS - 24 CFR § 570.506(b). As applicable, the following categories of records shall be maintained, for the discrete activities which are assisted in whole or in part with funding under this Agreement (or for all the Agency's activities if funding under this Agreement is not specifically allocated to particular activities) for the purpose of documenting that a majority of the beneficiaries are persons of low- or moderate-income. A. Records specifying by dollar amount, family size, and household income limits used to determine income level; 19 B. For service activities serving individual clients without regard to their residence location within the City/County, records documenting: (a) manner in which each client's income is determined in all cases; (b) determination that each individual client's income is or is not within low- or moderate-income limits; (c) date determination was made; and (d) tabulation of the individual determinations. C. For a service or facility which exclusively serves a class of beneficiaries, the members of which are presumed to be low- or moderate-income eligible absent general evidence to the contrary (abused children, battered spouses, senior citizens, adults meeting the Bureau of the Census' Current Population Reports definition of"severely disabled," homeless persons, illiterate persons, persons living with AIDS and migrant farm workers), records documenting: (1) that the facility exclusively serves the eligible class; and (2) there is no generally available data indicating specific population served is not predominantly low- or moderate-income. D. For a service or facility which offers benefits uniformly without regard to income to all persons residing within a delineated area, records establishing: (1) boundaries of the service area; (2) the income characteristics of families and unrelated individuals in the service area; and (3) if the percent of low- and moderate-income persons in the service area is less than fifty-one (51) percent, data showing that the area qualifies under the exception criteria set forth at 24 CFR § 570.208(a)(1)(ii). 3. FINANCIAL RECORDS Agency shall maintain all accounting records that accurately record the source and application of all funds; and recording funds received under this Agreement, all other receipts, assets, authorizations and appropriations, obligations, disbursements and unobligated balances (OMB Circular A-133 and A-110, Attachment F). The records must: A. Permit comparison of actual outlays with budgeted amounts; B. Permit reporting of financial data on the accrual basis; C. Be supported by source documentation; D. Be independently audited usually annually, but not less frequently than every two years. 4. RECORDS OF PROGRAM OPERATIONS, MANAGEMENT AND EVALUATION Agency shall maintain all records of: A. Operating policies and procedures; B. Employee qualifications, training, and evaluation; C. Principal operations data: work units completed; clients served, classified by client and service characteristics; staff hours utilized; etc. D. Self-evaluation of services, programs. and employment practices for compliance with 504 and ADA requirements. 20 5. PROPERTY RECORDS Agency shall maintain all records identifying any real and personal property acquired or improved in whole or in part with funds under this Agreement (OMB Circular A-110) as follows: A. Itemized inventory of real property recording legal and common descriptions and address, date of acquisition and/or improvements, cost of acquisition and/or improvements, and CDBG-funded share of cost; B. Itemized inventory of all non-expendable personal property recording full identification, current location, date and cost of acquisition, and CDBG-funded share of cost; C. Complete records of any authorized disposition of real or non-expendable personal property including how and to whom disposed, date, amount of disposition proceeds, market value at time of disposition and how determined, intended use, and any conditions governing use following disposition; D. At the termination of this Agreement, a record of the total purchase cost of all remaining unused expendable personal property. 6. PROCUREMENT RECORDS - OMB Circular A-110 Agency shall maintain all records of: A. Agency's adopted code of conduct governing officers' and employees' actions in contracting and purchasing; B. Agency's standard operating procedures for authorizing and executing purchases and contract procurements of various sizes and types. C. Agency's individual purchases or contracts over $10,000 as required by the OMB Circular A-110. D. Agency's procurement procedures utilized and the bases for supplier selection/contract award, for individual purchases or contracts over $10,000. 7. NONDISCRIMINATION AND EQUAL-OPPORTUNITY RECORDS - 24 CFR § 570.506(g). Agency shall maintain: A. A recordation and tabulation of the racial classification of all individual persons or households receiving program benefits, and of whether these benefited persons are single head of household. B. A tabulation of all Agency employees classified by race, position, and salary in the format of the U.S. Equal Employment Opportunity Commission Form EEO-4. C. Data identical to that required under A. and B. above for any subcontractor or agent employed in the performance under this Agreement. D. Documentation of all substantive actions taken to assure that no prohibited discrimination occurs in the conduct of any of the Agency's operations. E. Documentation of all actions taken to make minority residents aware of the Agency's services and provide them with equal access to benefits. 21 F. Record of the racial classification and gender of the majority owners of each private for-profit business with which the Agency contracts with any funds provided under this Agreement. S. CONFLICT OF INTEREST A. Records documenting that all Agency board members, officers, employees and consultants have been informed of the conflict of interest provisions of 24 CFR § 570.611 and have acknowledged understanding those provisions. B. Complete records of all requests for exceptions submitted under 24 CFR § 570.611(d). 9. VERIFICATION OF SUBCONTRACTOR'S ELIGIBILITY - 24 CFR § 5. The Agency shall maintain records documenting that the Agency, all subcontractors, and consultants have been determined not to be currently debarred, suspended, denied participation or declared ineligible to participate in federal government funded programs. Verification of eligibility shall be accomplished by signing the Certification Regarding Debarment and Suspension, which is attached and incorporated as Exhibit F . 10. ADDITIONAL REQUIREMENTS FOR ACQUISITION OR IMPROVEMENT OF REAL PROPERTY PROJECTS A. For construction contracts over $100,000, records documenting compliance with the bonding requirements of 24 CFR § 85.36 (h). B. Flood Insurance, Flood Disaster Protection Act of 1973; and Federal Insurance Administration Notice in Federal Register Vol. 24, No. 133, July 13, 1989. (1)Record of determination whether the assisted project is located within a designated flood plain or flood hazard area. (2)If the project is within such area: (1) Evidence of current participation in the National Flood Insurance Program; and (2) Evidence of flood insurance coverage in force on all significant project structures. C. Lead-Based Paint - Records required to document compliance with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801, et sec.), as amended and the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. §§ 4851, et seq.), and the implementing regulations 24 CFR § 35. D. Labor Standards - Records required to document compliance with all requirements of Davis-Bacon and Related Acts (40 U.S.C. §§ 3141 and 3142); Contract Work Hours and Safety Standards Act (40 U.S.C. § 3701, et sec.); Copeland Act (18 U.S.C. § 874); US Secretary of Labor Regulations (29 CFR §§ 3, 5, 6, and 7). E. Real Property Acquisition and Relocation - Records required to document compliance with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. §§ 4601, et seq., as amended; and the implementing regulations 49 CFR § 24. The agency shall consult the City for complete instruction prior to undertaking any action which may result in displacement of persons as defined at 49 CFR § 24.2(g). 22 F. Miscellaneous Records - The Agency shall maintain such other records as may be required by HUD or the City. i I 23 it REFUGEE WOMEN'S ALLIANCE: TCITY OF KENT: Sian in blue or black ink onlg Print Name: Mahnaz Kourourian Eshetu 'Pri4'Na e: Suzette Cooke Title: Executive Director Title - Mayor DATE: � 1o1Y/2®(5 DATE: NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: REFUGEE WOMEN'S ALLIANCE CITY OF KENT: Mahnaz Kourourian Eshetu, Executive Director Dinah Wilson, CDBG Coordinator Refugee Women's Alliance City of Kent 4008 Martin Luther Jr. Way South 220 Fourth Avenue South Seattle, WA 98108 Kent, WA 98032 Phone: 206.721,8440 Phone: 253.856.5076 Fax: 253.856.6070 APPROVED AS TO FeORM:,If Kent Law Department 24 i Z/ e KK FE INT EXHIBIT A W''A$H IN GTOI 2015-2016 CDBG PROJECT SCOPE OF SERVICES PARKS, RECREATION S Refugee Women's Alliance (ReWA) COMMUNITY SERVICES Project Title: Case Management and Emergency Assistance Start Date: 1/1/15 Project No.: BG1517-1617 End Date: 12/31/16 Funding will provide linguistically/culturally appropriate case 2015 $16,182 management and emergency assistance grants to immigrant and Funding: refugee clients residing in Kent. 2016 $16,182 Funding Total City $32,364 of Kent Funds: Project Manager: Amina Ahmed Telephone: 206.957.2245, Ext. 11 Fax: 253.856.6070 E-mail: amina@rewa.or CDBG Coordinator/City Contact: Dinah Wilson Telephone: 253.856.5076 Fax: 253.856.6070 E-mail: drwilson@kentwa. ov Refugee Women's Alliance (hereinafter referred to as "the Agency") shall utilize City of Kent Community Development Block Grant funds to perform the activities specified below. Such services shall be provided in a manner which fully complies with all applicable federal, state and local laws, statutes, rules and regulations, as are now in effect or may be hereafter amended. 1) Project Budget The Agency shall apply the following funds to the project in accordance with the Biennium Line Item Budget Summary below: Line Item Budget_ _- Personnel Services $20,000.00 $10,000 annually) Office or Operating Supplies Consultant or Purchased Services $ Construction Contracts $ Communications $ Travel and Training $ _Grants _ $12,364.00 $6,182annuall Total City of Kent Funds: 32 364.00 2015-2016 ReWA CDBG Project Scope of Services: Agreement with City of Kent- Page 1 I 2) Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of persons each year of the CDBG Agreement: Reporting Periods 1st 2nd 3rd 4th Quarter Quarter Quarte Quarter Total APRIL— r OCT. — Per JAR. -MARCH JUNE JULY - DEC. Year SEPT. Number of unduplicated persons assisted 2 2 2 2 8 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: Reporting Periods 1st 2" 3rd 4m Quarter Quarter Quarter Quarter Total JAN, to April to JULY to Per June ocT. to MARCH SEPT. DEC. Year Financial Aid (# of Emergency Assistance 2 2 2 2 8 Grants Case Management Hours 13 13 13 14 53 C. Definition of Services Case Management: Case management is defined as providing culturally/linguistically appropriate systems, navigation and coordination of services for immigrant/refugees residing in Kent. It includes assessment, planning, facilitation, advocacy, access to basic needs, and connection to appropriate services for successful integration. This service is measured per hour under this agreement. Emergency Assistance Grants: One-time payment made to the provider of services on behalf of City of Kent residents for housing or utility costs to prevent eviction or homelessness; repayment by the household is not expected. PAYMENT SHALL NOT BE MADE DIRECTLY TO THE CLIENT. The Agency shall not provide assistance for security deposits or other assistance that could be returned to residents or,the Agency. (Attachment 1 provides guidelines for assistance. Verification of Payment shall be submitted to the City. See Conflict of Interest restrictions in CDBG Agreement, Part I, General Conditions, Paragraph 15.) 2015-2016 ReWA CDBG Project Scope of Services: Agreement with City of Kent - Page 2 3) Records A. Project Files The Agency shall maintain files for this project containing the following items (all Agency files must contain items 1 — 7, however items 8 — 12 are required only if the costs are paid for by the CDBG budget. If clients are not presumed eligible; e.g., homeless, #13 client income must be documented): 1. Notice of Grant Award. 2. CDBG Agreement and all contract exhibits. 3. Motions, resolutions, or minutes documenting Board or Council actions. 4. A copy of this Scope and the City's Notice to Proceed on this project. 5. Correspondence regarding budget revision requests. 6. Copies of all invoices and reports submitted to the City for this project. 7. Bills confirming amount of rent or utilities for payment. 8. Copy of agency check made out to vendor. 9. Client ID verification. 10. Verification of client address. 11. Copies of approved invoices and warrants. 12. Payroll time sheets for actual salary and fringe benefit costs. Time sheets must be signed by a supervisor and annotated to document percent of time charged against this project if less than full time. 13. Documentation of office costs (e.g., log sheets of copy machine use, postage, telephone use, costs of office supplies, etc.) when these costs are shared with other programs and no invoice is available. As an alternative, annotated invoices may be used to document charges as appropriate. 14. Documentation of mileage charges for private auto use must include: a) odometer reading at beginning and end of trip, b) destination and starting location, and c) purpose for trip. 15. Documentation of the solicitation process used to select vendors and subcontractors with original purchase orders and subcontracts. 16. Documentation required by Part IV, Paragraph S, if any funds provided under this Scope are used to acquire equipment. 17. Documentation of client income. Unless clients are presumed eligible based on CDBG regulations, the Agency shall screen all clients served with funds provided under this Contract to ensure that at least S1% of the total number of clients served do not have a gross annual family income in excess of the limits specified in Exhibit B. Adjusted gross income as defined by the Internal Revenue Service Form 1040 shall be used to determine persons' or households' income. The following methods may be used to determine income eligibility: a) IRS income tax return; b) Client income certification on a form approved by the City; or c) Documentation of qualification for participation in a "means-tested" federal or state program at least as restrictive as CDBG with regard to Income Guidelines. Income guidelines may be adjusted periodically by HUD. The Agency agrees to use updated Income Guidelines, which will be provided by the City. 2015-2016 ReWA CDBG Project Scope of Services: Agreement with City of Kent- Page 3 B. Record Retention Period All records required by this Scope shall be retained by the Agency for the period of time specified in the Agreement - Part IV. The period of time shall commence on January 1 of the year following the year in which the final invoice was paid. 4) Reports, Invoicing and Reporting Schedule A. Reports The Agency shall collect and report client information to the City quarterly on the Service Units section of Exhibit D (Billing Voucher and Service Report) to be provided by the City. Exhibits D and D-1 (including backup documents) shall be submitted electronically to drwilson(clkentwa.gov in accordance with the schedule outlined in Paragraph 3.6. below. Copies of supporting documents shall be emailed as well, or sent via the U.S. Postal Services and postmarked within two days of the due dates listed below.' In addition, quarterly reports shall be submitted through SharelApp: htti)://sharelapp culturegrants.org/index/login . B. Invoicing and Reporting Schedule The Agency shall submit Billing Vouchers and Service Reports to the City in accordance with the following schedule: Ist 2ntl & 3rd Quarter Billing Voucher & 151h day following each quarterZ� Service Report (Exhibit D) 4th Quarter Billing Voucher & Service December 15th Report CDBG Public Services Project Time 15th day following each quarter Sheet Exhibit G if applicable) Final Service Report (Exhibit D-1) January B, 2016 ' If the due date falls on a Saturday or Sunday, Billing Vouchers and Service Reports are due on the prior Friday. If the due date falls on a City holiday, Billing Vouchers and Service Reports are due the next working day following the holiday- 2 All dates are 2015 unless otherwise noted; new schedule will be provided for 2016. 2015-2016 ReWA CDBG Project Scope of Services: Agreement with City of Kent- Page 4 ATTACHMENT 1 Rental Assistance Project Guidelines 1. Only current Kent residents are eligible for assistance 2. Emergency rental assistance may be paid to a third party landlord on behalf of an individual for a period of up to three consecutive months 3. Direct assistance is not allowed 4. Rent/expenses must be less than income 5. Tenants must provide evidence of source of income, identification, current lease/rental agreement/eviction notice 6. Assistance provided when no other financial options exist 7. Any exceptions to above guidelines are considered on a case by case basis as approved by City of Kent CDBG Coordinator and ReWA Program Director S. No cash assistance given to residents Utility Assistance Project Guidelines (heat gas water, sewer, garbage) 1. Only current Kent residents are eligible for assistance 2. Resident/household can only be assisted once 3. Funds not for utility hook up costs 4. Tenants must provide evidence of source of income, identification, and delinquent/shut off notice 5. Assistance provided when no other financial options exist 6. Financial assistance must be mailed directly to utility provider 7. Any exceptions to above guidelines are considered on a case by case basis as approved by City of Kent CDBG Coordinator and ReWA Program Director 8. No cash assistance given to residents Guidelines for Motel Vouchers 1. Only current Kent residents are eligible for assistance 2. Last known permanent address must be Kent in order to be eligible 3. Resident/household can only be assisted once 4. Checks must be made out to the resident hotel S. No more than two-night stay 6. Verification/id of all household members (full name, date of birth, sex) 7. Any exceptions to above guidelines are considered on a case by case basis as approved by City of Kent CDBG Coordinator and ReWA Program Director S. No cash assistance given to residents Backup documentation that Must be Submitted with Quarterly Reports 1. Bills confirming amount of rent or utilities for payment 2. Verification of client address 3. Copy of agency check made out to vendor 4. Copies of approved invoices and warrants 2015-2016 ReWA CDBG Project Scope of Services: Agreement with City of Kent - Page 5 I^00�del KENT EXHIBIT A WASHINGTON 2015-2016 CDBG PROJECT SCOPE OF SERVICES PARKS, RECREATION & Refugee Women's Alliance (ReWA) COMMUNITY SERVICES Project Title: Senior Nutrition and Wellness Program Start Date: 1/1/15 Project No.: BG1520-1620 End Date: 12/31/16 Funding will provide ethnically appropriate and nutritious 2015 $11,182 congregate meals and health education for refugee and Funding: immigrant seniors residing in Kent. Seniors will also be 2016 $11,182 connected to services. Meals shall be provided monthly. Seniors Funding are defined as persons 62 years of age or older. Total City $22,364 Certification of age must be provided in client files and of Kent information must be maintained showing that the program Funds: is designed for seniors. Project Manager: Amina Ahmed Telephone: 206.957.2245, Ext. 11 Fax: 253.856.6070 E-mail: amina@rewa.or CDBG Coordinator/City Contact: Dinah Wilson Telephone: 253.856.5076 Fax: 253.856.6070 E-mail: drwilson@kentwa.gov Refugee Women's Alliance (hereinafter referred to as "the Agency") shall utilize City of Kent Community Development Block Grant funds to perform the activities specified below. Such services shall be provided in a manner which fully complies with all applicable federal, state and local laws, statutes, rules and regulations, as are now in effect or may be hereafter amended. 1) Project Budget The Agency shall apply the following funds to the project in accordance with the Biennium Line Item Budget Summary below: Line Item Budget Personnel Services 16,364.00 $8,182 annual) Food & Supplies 6,000.00 $3,000 annual) Consultant or Purchased Services $ Construction Contracts $ Communications Travel and Training $ Grants $ Total City of Kent Funds: $22,364.00 2015-2016 ReWA-Seniors CDBG Project Scope of Services: Agreement with City of Kent- Page 1 2) Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of persons each year of the CDBG Agreement: Reporting Periods 1st 2"d 3rd 4u' Quarter Quarter Quarter Quarter Total JAN. - APRIL - mLY- OCT. - Per MARCH ]UNE SEPT. DEC. Year Number of persons assisted 6 6 7 6 25 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: Reporting Periods 1st 2" 3rd 4tn Quarter Ap�iltto Quarter Quarter Total JAN. to JULY to OCT. to Per MARCH June SEPT Year DEC. Food 3 3 3 3 12 Training Education Classes 1 1 1 1 4 C. Definition of Services Food: Defined as ethnically appropriate, nutritious meals served in a congregate setting to seniors on a monthly basis. This service is measured per meal served. Training Education Classes: Defined as health education information provided to teach people about health and wellness and how to improve their health. Seniors will also be connected to services. This service is measured per session. 3) Records A. Project Files The Agency shall maintain files for this project containing the following items (all Agency files must contain items 1 — 7, however items 8 — 12 are required only if the costs are paid for by the CDBG budget. If clients are not presumed eligible; e.g., homeless, #13 client income must be documented): 1. Notice of Grant Award. 2. CDBG Agreement and all contract exhibits. 3. Motions, resolutions, or minutes documenting Board or Council actions. 4. A copy of this Scope and the City's Notice to Proceed on this project. S. Correspondence regarding budget revision requests. 6. Copies of all invoices and reports submitted to the City for this project. 2015-2016 ReWA-Seniors CDBG Project Scope of Services: Agreement with City of Kent- Page 2 7. Bills confirming amount of rent or utilities for payment. S. Copy of agency check made out to vendor. 9. Client ID verification. 10. Verification of client address. 11. Copies of approved invoices and warrants. 12. Payroll time sheets for actual salary and fringe benefit costs. Time sheets must be signed by a supervisor and annotated to document percent of time charged against this project if less than full time. 13. Documentation of office costs (e.g., log sheets of copy machine use, postage, telephone use, costs of office supplies, etc.) when these costs are shared with other programs and no invoice is available. As an alternative, annotated invoices may be used to document charges as appropriate. 14. Documentation of mileage charges for private auto use must include: a) odometer reading at beginning and end of trip, b) destination and starting location, and c) purpose for trip. 15. Documentation of the solicitation process used to select vendors and subcontractors with original purchase orders and subcontracts. 16. Documentation required by Part IV, Paragraph 5, if any funds provided under this Scope are used to acquire equipment. 17. Documentation of client income. Unless clients are presumed eligible based on CDBG regulations, the Agency shall screen all clients served with funds provided under this Contract to ensure that at least 51% of the total number of clients served do not have a gross annual family income in excess of the limits specified in Exhibit B. Adjusted gross income as defined by the Internal Revenue Service Form 1040 shall be used to determine persons' or households' income. The following methods may be used to determine income eligibility: a) IRS income tax return; b) Client income certification on a form approved by the City; or c) Documentation of qualification for participation in a "means-tested" federal or state program at least as restrictive as CDBG with regard to Income Guidelines. Income guidelines may be adjusted periodically by HUD. The Agency agrees to use updated Income Guidelines, which will be provided by the City. B. Record Retention Period All records required by this Scope shall be retained by the Agency for the period of time specified in the Agreement - Part IV. The period of time shall commence on January 1 of the year following the year in which the final invoice was paid. 4) Reports, Invoicing and Reporting Schedule A. Reports The Agency shall collect and report client information to the City quarterly on the Service Units section of Exhibit D (Billing Voucher and Service Report) to be provided by the City. Exhibits D and D-1 (including backup documents) shall be submitted electronically to drwilson(obkentwa.gov in accordance with the schedule outlined in Paragraph 3.B. below. 2015-2016 ReWA-Seniors CDBG Project Scope of Services: Agreement with City of Kent- Page 3 J p 9 Y 9 Copies of supporting documents shall be emailed as well, or sent via the U.S. Postal Services and postmarked within two days of the due dates listed below.' In addition, quarterly reports shall be submitted through SharelApp: htto•//sharelapo culturegrants org/index/login . B. Invoicing and Reporting Schedule The Agency shall submit Billing Vouchers and Service Reports to the City in accordance with the following schedule: 15' 2nd & 3rd Quarter Billing Voucher & S5th day following each quarterZ Service Re ort Exhibit D 4th Quarter Billing Voucher & Service December 15th Report CDBG Public Services Project Time 15`h day following each quarter Sheet Exhibit G if applicable) Final Service Report (Exhibit D-1) January 8, 2016 If the due date falls on a Saturday or Sunday, Billing Vouchers and Service Reports are due on the prior Friday. If the due date falls on a City holiday, Billing Vouchers and Service Reports are due the next working day following the holiday. 2 All dates are 2015 unless otherwise noted; new schedule will be provided for 2016. 2015-2016 ReWA-Seniors CDBG Project Scope of Services: Agreement with City of Kent- Page 4 EXHIBIT B 2015 HUD INCOME GUIDELINES Effective 316/15 Median Family income = $39,600 3A% - 'So% BOc/o ME IIlN MEDIANMEUZAN P T9zLY EXTREMELY" UERY LOW ., SIZE Lipw/ LOW, TNCONIE INCOME NCOME 1 $18,850 $31,400 $46,100 2 $21,550 $35,850 $52,650 3 $24,250 $40,350 $59,250 4 $26,900 $44,800 $65,800 5 $29,100 $48,400 $71,100 6 $32,570 $52,000 $76,350 7 $36,730 $55,600 $81,600 8 $40,890 $59,150 $86,900 I EXHIBIT C APPOINTMENT OF LIAISON 8c AUTHORIZATI0N TO SIGN BILLING V0UCHERS & SERVICE REPORTS 2015-2016 CDBG AGREEMENT Appointment of Liaison The Agency appoints the following person as the liaison for the CDBG Agreement between the City and the Agency; this person shall be responsible for overall administration of the CDBG funded program: 4Li&P� 14tlMect � n� iLx S & ppC) �D12 Liaisons (title) Authorization to Sign Billing Vouchers Service Reports The Agency authorizes the following,individual(s) to sign Billing Vouchers & Service Reports for costs incurred and services provided pursuant to the CDBG Agreement between the Agency and the City; billing vouchers shall not be processed for payment unless they are signed by an authorized individual(s): Authorized Individual(s): (Type Name) (title (title) � Y ` (Signature) Additional Authorized Individual (if applicable): (Type Name) �e)/ - (title) (Signature) (Date) Exhibit D CDBG • Billing Voucher & Service Report SENT 20151 WA511 NOTON PARKS, RECREATION & COMMUNITY SERVICES To: Agency: Refugee Women s Alliance Dinah Wilson Housing & Human Services Parks, Recreation &Community Services Program Contact. Amina Ahmed 220 4th Ave. South, Kent WA '98032 r Telephone: (206) 957-2245, Ext. 222 drwilson@kentwa.gov E-mail: amina@rewa.org Phone: (253) 856-5076 Reporting Period Rrogram AmorrtRsquested _ . ,. Case Management & Emergency Assistance Project SEC. .1: BUDGET SIJMMARY For Department Use Only Total Contract Amount $ 32,364.00 2015 Contract Amount $ 16,182.00 Amount Requested This Qtr. $ Amount Requested YTD $ Amount Remaining (subtract — amount requested YTD from 2015 contract amount) SEC. 2: 2015 LINE ITEM BUDGET SUMMARY ORIGINAL TOTAL REVISED CUMULATIVE GpST CATEGORIES BUDGET REQCIESTED allbGET e TO DATE 1 Personnel Costs Attach Time Sheets $10,000.00 2 Grants $ 6,182.00 GRAND TOTAL $16,182.00 Agency will receive 2016 reporting form in 201& 2015-2016 ReWA CM/EMS Assistance CDBG Project Scope of Services - Page 1 of 6 ------------- TMS ,; bI�1�IE�' FUNDED E[?lC 011 1Ei'i SEC. 4: PERFORMANCE MEASURES - 2015 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date se+ cenlesceptecs Goteda9 ir�ts ictttEiyaT= C:EirttSpaGeel iifie .. . . fabTtita7, Total Service Unit/Performance 15` 2nd 3rd 4ch Contracted to 1 st 2nd 3rd 4th Measure Serve Unduplicated #of Kent clients' (persons) served 2 2 2 2 8 Financial Aid (# of Emergency Assistance Grants) 2 2 2 2 8 Case Management Hours 13 13 13 14 53 Sec. 5: NARRATIVE Provide a narrative explanation if you are behind in either progress toward meeting performance measures or projected expenditure rate. IF 2015-2016 ReWA CM/EMS Assistance CDBG Project Scope of Services - Page 2 of 6 i Sec. 6: DEMOGRAPHIC INFORMATION Number of Households or Persons Assisted (please specify "H" or "P"): IZCe unduplicated Quaver Unduplicated Quarter Undue Unduplicated' (All} (Ftispanfcj Year to YeartDate pdtQ IHis�nicj ' 3 . .4 1 .2; ,.,.3 4 - White Black/African American i Asian -- American Indian or Alaska Native Native Hawaiian or Other Pacific Islander American Indian or Alaska Native AND White Asian AND White Black/African American AND White American Indian /Alaska Native AND Black/African American Other Multi-Racial GRAND TOTAL CLIENTS Income Level Unduplicated'-Quarter i Unduplicated dear'- 1 2 -3 4 n. Extremely Low Income 0-30% of MFI Low Income 31-50% of MFI Moderate Income 51-80% of MFI Above Moderate Income 81% + of MFI GRAND TOTAL CLIENTS Ll 2015-2016 ReWA CM/EMS Assistance CDBG Project Scope of Services - Page 3 of 6 t'eiti��:}��d'et�tc}; (Sa1tt� „_ , _ _ Urtplrcated G,trsarte� ! 11, u�rc^at�C , marl= as i� i 55 1 Total Female Headed Households Homelessorr€pleTe kt3fy ifr�r xiivlats tario ham_'=: ° Ua€lupileated' uarte trd€ €Iteted r krrassistecViFtc,trarrEt€ona'ars ez� t Fiousid tc 4a Individuals Families Total Homeless Agency Authorized Signature Date _ -a -- � 'I Pay�rt�n�,4cr��rc��htaa��c�t 'tC1r�sevtic�t t�bazrtpl�ed- ���afi l��t>�t�n[�r} Qr1 r fu C tag ts� a fVfet17 t rtotes3 Ag nay-,a�tdeipe € d = _ = fttht,�I'z� _ 2015-2016 ReWA CM/EMS Assistance CDBG Project Scope of Services - Page 4 of 6 ATTACHMENT Rental Assistance Project Guidelines 1. Only current Kent residents are eligible for assistance 2. Resident/household can only be assisted once 3. Rent/expenses must be less than income 4. Tenants must provide evidence of source of income, identification, current lease/rental agreementleviction notice 5. Rental assistance must go directly to property manager 6. Acceptance will be made only when no other financial options exist 7. Any exceptions to above guidelines are considered on a case by case basis as approved by City of Kent CDBG Coordinator and ReWA Program Director 8. No cash assistance given to residents Utility Assistance Project Guidelines (heat gas water, sewer, garbage) 1. Only current Kent residents are eligible for assistance 2. Resident/household can only be assisted once 3. Funds not for utility hook up costs 4. Tenants must provide evidence of source of income, identification, and delinquent/shut off notice 5. Acceptance will be made only when no other financial options exist 6. Financial assistance must be mailed directly to utility provider 7. Any exceptions to above guidelines are considered on a case by case basis as approved by City of Kent CDBG Coordinator and ReWA Program Director 8. No cash assistance given to residents Guidelines for Motel Vouchers 1. Only current Kent residents are eligible for assistance 2. Last known permanent address must be Kent in order to be eligible 3. Resident/household can only be assisted once 4. No more than two-night stay 5. Verification/id of all household members (full name, date of birth, sex) 6. Any exceptions to above guidelines are considered on a case by case basis as approved by City of Kent CDBG Coordinator and ReWA Program Director 7. No cash assistance given to residents Backup documentation that Must be Submitted with Quarterly Reports or Kept in Client File 1. Client Requisition Request/Voucher with client name, address, reason for payment, & payment amount-submit with report 2. Verification of client address. e.g., driver's license or other document keep on file 3.- Copy of agency check made out to vendor-keep on file 4. Copies of approved invoices and warrants-keep on file 2015-2016 ReWA CM/EMS Assistance CDBG Project Scope of Services - Page 5 of 6 Instructions Refer to:Accomplishments by Performance Measures in your CDBG Contract. Sec. 1: BUDGET SUMMARY Enter the amount requested this quarter, Year to Date (YTD) and the budget balance. SEC.2: LINE ITEM BUDGET SUMMARY Enter the amount requested by budget line item quarterly and YTD. SEC. 3: PERSONNEL FUNDED IN WHOLE OR IN PART BY CDBG GRANT Enter the names and titles of personnel being charged to the CDBG grant. Remember all hours charged to CDBG must be tracked and a timesheet certifying the hours worked were to directly support the CDBG funded program must be signed by the employee and supervisor and submitted to the City with the request for reimbursement. SEC.4: PERFORMANCE MEASURES Unduplicated Count of Households/Persons Assisted Projections: Circle either persons or households according to the method of counting clients specified in your CDBG Contract Scope. Insert the projected number of clients to be served as specified in your CDBG Contract Scope. Achievements: Insert the unduplicated number of clients served during the reporting period. Unduplicated number means that a person or a household served by your agency may be counted only once during the calendar year.You may report only those persons or households for which you maintain written records. This record must be established at the time the person or household is first served by your agency. Year to Date: Insert the total unduplicated number of clients served to date. Service Units Insert the service unit measures specified in your CDBG Contract Scope. Insert the projected number of service units for the reporting period. Insert the actual number of service units provided during the Reporting Period. The actual number of service units provided may be duplicated counts. Duplicated means that a client served by your agency may receive service one or more times during the calendar year in one or more of the service unit categories. SEC. 5: NARRATIVE EXPLANATION You must provide a narrative explanation if your agency is behind in meeting either performance measures specified in your CDBG Contract Scope or your expenditure rate. Your expenditure rate should equal approximately one quarter of your HHS contract amount per quarter. SEC. 6: DEMOGRAPHIC INFORMATION Race:You are required to collect racial and ethnic information for the clients served.There are 10 race categories to select from. Each client should select one of these categories. Clients identifying themselves as Hispanic also need to select from the race categories. Example:A client selects Hispanic as his ethnicity and white as his race.The grand total in the first column will not match the grand total in the second column. You may only have a few clients who identify as Hispanic. Female Head of Household: Insert the unduplicated number of single female head of households with dependents served during the reporting period. Income Only for Non-presumed Benefit Projects which require income screening: Insert the unduplicated clients served who are Low Income(51 —80%), Very Low-income(31-50%)and Extremely Low-income(0-30%). You do not have to complete if your CDBG project directs services toward the following clients: abused children, elderly persons, DV victims, homeless persons,those meeting the federal definition of severely disabled persons, illiterate adults,persons living with aids, or migrant farm workers. Homeless: For programs providing transitional and permanent housing insert the unduplicated clients served. 2015-2016 ReWA CM/EMS Assistance CDBG Project Scope of Services - Page 6 of 6 Exhibit D CDBG • Billing Voucher & Service Report KENT 2015' W<$HIN GTGN PARKS, RECREATION & COMMUNITY SERVICES To: Agency: Refugee Women's Alliance Dinah Wilson Housing &Human Services Parks, Recreation &Community Services Program Contact: Amina Ahmed 220 4`"Ave. South, Kent, WA 98032 Telephone:;(206) 957-2245, Ext. 222 drwilson@kentwa.gov E-mail: amina@rewa.org Phone: 253 856-5076 Rep4rfiIn Period Program' Amount Requested Senior Nutrition & Wellness Program SEC; 1.BUDGEf SUMMARY CALCULATIONS BASEDO YEARLY 13UDGET Fpr Department Use`Oniy` Total Contract Amount $ 22,364.00 2015 Contract Amount $ 11,182.00 Amount Requested This Qtr. $ Amount Requested YTD $ Amount Remaining (subtract amount requested YTD from 2015 contract amount) SEC. 2: 2015 LINE ITEM BUDGET SUMMARY(ANNUAL) ORIGINAL", TOTAL REVISED CUMULATIVE COST CATEGORIES BUDGET REQUESTED UUtiGET TO [?ATE " 1 Personnel Costs (Attach Time Sheets) $ 8,182.00 2 Food & Supplies $ 3,000.00 GRAND TOTAL $11,182.00 Agency will receive 2016 reporting form in 2016. Page 1 of 5 i _ P'EE _1}NtEE. "It2Ei ) W€ i4� = ' = Y SEC. 4: PERFORMANCE MEASURES - 2015 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date ervFce i 1511i I3ertr o — xniar d Daft 'I e: 5� - � a Total Service Unit/Performance 1st 2n' 3`d 4`n Contracted to 1st 2nd 3rd 4th Measure Serve # of Kent clients served-persons (unduplicated count) 6 6 7 6 25 Food (# of meals served) 3 3 3 3 9 Training Education Classes (#health education sessions___ 1 1 1 1 4 Sec. 5: NARRATIVE Provide a narrative explanation if you are behind in either progress toward meeting performance measures or projected expenditure rate. Sec. 6: DEMOGRAPHIC INFORMATION Page 2 of 5 Number of Households or Persons Assisted (please specify "H" or "P"): :(a e. . ._- - Unduplicatvd Quatter UnduplfS tgd,Glu�rYer ;tJndu�'" Uc---- ate'dI spailiC},`' ' Y!ear1Q Y aPtz Rife 21 Date PJL White Black/African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander American Indian or Alaska Native AND White Asian AND White Black/African American AND White American Indian]Alaska Native AND Black/African American j Other Multi-Racial GRAND TOTAL CLIENTS Income Level Unduplicated;{�uartsr = Unduplicated Ysar = to Date - Extremely Low Income 0-30% of MFI Low Income 31-50% of MFI Moderate Income 51-80% of MFI Above Moderate Income 81% + of MFI GRAND TOTAL CLIENTS Page 3 of 5 # p��ay y�- �` ii F=xi t ➢i l ,�[ { 24i � i �i kL4.EkLC4161 =. (A ,�I�ERS �LEl i ff 41 ,gM IT- , t v Total Female Headed Households kta ele5s �o lew.0 fp itl v�duaf '&�att xe�wf�c5 tta�e and ilk�atet�€�a�rte�' � ft����r - Ra , Nt' =TW14it4t n an—Or MM -no Me — _i Individuals Families Total Homeless Agency Authorized Signature Date =X-Mtract ,I';+ I€g_Oti i i i i r 777 TIT Page 4 of 5 Instructions Refer to:Accomplishments by Performance Measures in your CDBG Contract. Sec. 1: BUDGET SUMMARY Enter the amount requested this quarter,Year to Date (YTD) and the budget balance. SEC.2: LINE ITEM BUDGET SUMMARY Enter the amount requested by budget line item quarterly and YTD. SEC.3: PERSONNEL FUNDED IN WHOLE OR IN PART BY CDBG GRANT Enter the names and titles of personnel being charged to the CDBG grant. Remember all hours charged to CDBG must be tracked and a timesheet certifying the hours worked were to directly support the CDBG funded program must be signed by the employee and supervisor and submitted to the City with the request for reimbursement. SEC. 4: PERFORMANCE MEASURES Unduplicated Count of Households/Persons Assisted Projections: Circle either persons or households according to the method of counting clients specified in your CDBG Contract Scope. Insert the projected number of clients to be served as specified in your CDBG Contract Scope. Achievements: Insert the unduplicated number of clients served during the reporting period. Unduplicated number means that a person or a household served by your agency may be counted only once during the calendar year.You may report only those persons or households for which you maintain written records.This record must be established at the time the person or household is first served by your agency. Year to Date: Insert the total unduplicated number of clients served to date. Service Units Insert the service unit measures specified in your CDBG Contract Scope. Insert the projected number of service units for the reporting period. Insert the actual number of service units provided during the Reporting Period.The actual number of service units provided may be duplicated counts. Duplicated means that a client served by your agency may receive service one or more times during the calendar year in one or more of the service unit categories. '.. SEC.5: NARRATIVE EXPLANATION You must provide a narrative explanation if your agency is behind in meeting either performance measures specified in your CDBG Contract Scope or your expenditure rate.Your expenditure rate should equal approximately one quarter of your HHS contract amount per quarter. SEC. 6: DEMOGRAPHIC INFORMATION Race:You are required to collect racial and ethnic information for the clients served. There are 10 race categories to select from. Each client should select one of these categories. Clients identifying themselves as Hispanic also need to select from the race categories. Example:A client selects Hispanic as his ethnicity and white as his race.The grand total in the first column will not match the grand total in the second column. You may only have a few clients who identify as Hispanic. Female Head of Household: Insert the unduplicated number of single female head of households with dependents served during the reporting period. Income Only for Non-presumed Benefit Projects which require income screening: Insert the unduplicated clients served who are Low Income(51 —80%), Very Low-Income(31-50%) and Extremely Low-Income(0-30%). You do not have to complete if your CDBG project directs services toward the following clients: abused children, elderly persons, DV victims, homeless persons,those meeting the federal definition of severely disabled persons, illiterate adults,persons living with aids, or migrant farm workers. Homeless: For programs providing transitional and permanent housing insert the unduplicated clients served. Page 5 of 5 i Final Exhibit D-1 CDEO ICY VT Service Report-ReWA WA .....0N 2®1V PARKS, RECREATIONS '.. COMMUNITY SERVICES To: Dinah Wilson, CDBG Coordinator Agency: Refugee Women's Alliance Housing & Human Services Parks,hRecreation &Community Services Program Contact: Amina Ahmed 2204 Ave. South, Kent, WA 98032 Telephone:',(206) 957-2245 x222 drwilson@kentwa.gou E-mail: amina@rewa',org Phone: 253) 856-5076 Reporting Period = = Program, , Final Q4 Case Management & Emergency Assistance SEC. 1 : PERFORMANCE MEASURES - 2015 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date ervlce tlritescripttott = Ctttrac#ed to-- cliextt& A Date Seoie Serveri� Tgta1 Service Unit/Performance Measure 1st 2nd 3`d 4ch 1st 2nd 3rd 4th Unduplicated # of Kent clients (persons) 2 3 2 2 served Case Management Hours 13 13 13 14 Financial Aid (# of Emergency Assistance 2 2 2 2 Grants) Sec. 2: NARRATIVE - Provide a narrative explanation if you did not meet performance measures for the contract year Agency will receive 2016 reporting form in 2016. Page 1 of 3 Sec. 3: DEMOGRAPHIC INFORMATION Number of Households or Persons Assisted (please specify "H" or "P")- Rice d" F a Z Z M, og g'g'g'N,N, ZOE, White Black/African American Asian American Indian or Alaska Native -Native Hawaiian orOther Pacific—Islander American Indian or Alaska Native AND White Asian AND White Bl1iick_1Afnczin American AND White American Indian�/Alaska Native AND Black/African American Other Multi-Racial GRAND TOTAL CLIENTS 77777777777777777777�,=��-,,,i;-p t"-be Extremely Low Income 0-30% of VIR —Low,—Incomie-3-1-50% of MFI Moderate Income 51-80% of MFI Above Moderate Income 81% + of MFI GRAND—TOTAL CLIENTS__ ise h 6,14 ----awH6did I,!", E Total Female Headed Households Page 2 of 3 i �INIA to this Contract kfcinetess* Complete.Qnly farindivlduals,&farrtll�es W}o have ilpdtlplicat�d Quarter Lfndul�cated Year beenas`sistod with trarlsittnnal arid, errnarYer�t hausin = to Deter Individuals Families Total Homeless Final Service R7 -_6rt Review (this seetion to be oi»pleted by Ci ':9f Kent only) " Contractual;Obligatians t�e2? _ YES NO (Circle Ane) . _ Agency Raid.in Full? YES Nd (Circle erne) - _ = "Enter explanattan-ifAgeney underperformed and paid in full, Revl Wed t5ete ey Page 3 of 3 Final Exhibit D-1 CDDG �1d T Service Report-ReWA N45NIN GTON 2015 PARKS, RECREATION & '.. COMMUNITY SERVICES To: Dinah Wilson, CDBG Coordinator Agency. Refugee Women's Alliance Housing & Human Services Parks, Recreation &'.Community Services ca Program Contact: Amina Ahmed 2204 Ave. South, Kent, WA 98032 Telephone: (206) 957-2245 x222 drwilson@kentwa.gov Phone: 253 856-5076 Email: amina@rewa'.org Reporting Perlsd _ = Pragralltl�. ; Final Q4 Senior Nutrition & Wellness Program SEC. 1 : PERFORMANCE MEASURES - 2015 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date Service Unit Descrij5t�on. _ Contracted tsi Clients-Actually lFear to Date Se"rve Servest Total Service Unit/Performance Measure 15' 2od 3`df 4'h 1st 2nd 3rd 4th # of Kent clients served (unduplicated 6 6 7 6 persons) Food (#Congregate Meals Served) 3 3 3 3 Training Education Classes (# of Health 1 1 1 1 Education Classes) Sec. 2: NARRATIVE - Provide a narrative explanation if you did not meet performance measures for the contract year Agency will receive 2016 reporting form in 2016. Page 1 of 3 Sec. 3: DEMOGRAPHIC INFORMATION Number of Households or Persons Assisted (please specify "H" or "P"): € ruf p t d 4u er. 'U, d f O t L14�dt� iti ifle e ` �( "_.. t� � � — i i t t i i( t�:'�v) �rlt8ic_ �t[t�f3IG� i �r--�.HI' Mi w Ni White Black/African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander American Indian or Alaska Native AND White Asian AND White Black/African American AND White F n Indian /Alaska Native AND rican American ulti-Racial TOTAL CLIENTS 6dijip-Ttt a t C u ti ,; tncfttptce 'f r Extremely Low Income 0-30% of MFI Low Income 31-50% of MFI Moderate Income 51-80% of MFI Above Moderate Income 81% + of MFI GRAND TOTAL CLIENTS rralFl� 1ec1 Hor1h€aCds = _ „ _ tnc �rpltCatecLQ� l{ric �Sitt _Y Total Female Headed Households Page 2 of 3 i tfaneiess.' orrgslet�s[�ly ft�r individuals f2miliesv✓Ii4 have Unddplicated tuatter Ut�tiu�liczi}ed Veer begin es�isted Wit�i Iran rtiona!`and `errriar�r t housin �Date 1 .• '2 3 4 ' Individuals Families Total Homeless ff Fer al Setwice Repait Reurevw (this sectaon to fze completed byr City of Kent ant Gon#tactual=0bllgatiaris Meth Y $ ND tGircfe one) - - _ - - u _ Agency P4id rn C=10 YES NQ '(�ircie one) Enter expianation if Agency underperfarrrted and paid in Reuiswed Date; By' - `- Page 3 of 3 ATTACHMENT E REFUGEE WOMEN'S ALLIANCE INSURANCE REQUIREMENTS FOR 2015-2016 C®BG AGREEMENT 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 non-owned and hired vehicles. Coverage shall be written.on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 3. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. 4. Excess Liability insurance covering both the Commercial General Liability and Automobile policies. B. Minimum Amounts of Insurance Contractor shall maintain the following insurance limits: Page 1 of 3 EXHIBIT E (Continued) 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. 3. Excess Liability insurance shall be written with limits no less than $1,000,000 per occurrence in excess of both the CGL and Auto Liability policies cited above. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Contractor's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it. 2. The Contractor's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Contractor's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. O. 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. Page 2 of 3 i EXHIBIT E (Continued) 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. Page 3 of 3 REFUG-1 OP ID:SR CERTIFICATE OF LIABILITY INSURANCE AEIMMrDDnrrr, 11(2a/2a 14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 3Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT.CONSTITUTE A CONTRACT BETWEEN [HI: ISSUING INSURER(S), AUTHORIZED 2EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If thecertificate holder is an ADDITIONAL INSURED, the Poticy(ies) must be endorsod. If SUBROGATION IS WAIVED,subject to _ the tens and Conditions of the policy, Cartel,policies may require zn endorsement, A statement on this cartificate does not Confer rights to the certificate holder In lieu of such endoreemsm(s). t'pr LONTACI PRODUCER Spra$ue,Israel Giles PHONE - ;FAX 1501 Fourth Avenue.Suite 730 Arc No Ertl- WC,Not_-- Seattle,WA 48901-3225 E'n'A A DD1 at55:CA License#0192858 -_ John PollcarlMatf Conroy . INSURMSI AFFORDING COVERAGE NAIGN. INSUReRA:Philadelphia Indemnity_Ins. 1805B INSURED Refugee Women's Alliance INSURER a: 4008 Martin Luther King Jr Way Seattle,WA 9B108 wsuaERc; - IN5URERD: _ I INSURER E: INSURER r: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AM'REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BF_ 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. L7�- POLIcYfi F POUCYEXP ILTF, TYPEOFINSURANCB f PoUcYNUMaFR IMMIDO"YY MMIDD(YYYYI LIMITS GENERAL UASIIJTY EACH OCCURRENCE $ 1,000,060 D G ST EFTI FC A X_ coMMERnAL GENER�AL UAeaITY X PHPK1261707 11/21(2014i91/2t120t5 PR nsEs Ea«u,;rL s 100,000 CLAIMS-M4DE , x OCCUR ME)EXP{M one p=rspn) c 5,0D X Abuse/Molestation --� PrxsovALeaov lNJuar s 1,OOD,000 X Erms B.Omissions - II GENERALAGGREGATE $ 2,OOQ00 j GENL AGGREGATE UNDTAPPLIES PER 1 PRODUCTS-COMPIOP ADD 5 2,000.00 x l POLICY I PRO- LOC ! $ COMBINED SINGLE LIMIT 1,000�00 AUTOMOBILE LIRBItITV Es K.atlenll ANYAUTO - PHPK12617DI 11121f2D14 11/21/2015 6001LY INJURY(Pei parson) a - __ ALL OWNED j SCHEDULED BODILY INJURY tier awdenl) 3 AUTOS I NON-OWNEDAUTOS PROPERTY DAMAGE $ X HIRED AUTOS AUTOS - ERACCIDEN a UMSRELLALIAB I X OCCUR EACH OCCURRENCE $ 4,000,00 A X ,EXCESSLWB CLAIMSMADEI ,OHUBABIS63 1112112014i 11121=15 AGGREGATE � s 4,000,00 I DED X RETENTIONS 10,000 a WORKERS COMPENSATION I 'M1CSTATY,tML-1 X OTH AND EMPLAYERS'LIABILITY A ANY PROPRIETOR ARTNEWEXECLmVE YlN PHPK126t707 19l2172014 1112112015 E.L.EACH AccmENi I3 1,DD0,00 GLnCER(MEMBER EXCLUDED? ❑ td IA IPI Mandabryin AN) I I ASTOP GAP EL DISFISE-EA EMPLOYE 3 1,000r0O "If yeS,tle¢cdhe under E.L DISEASE-PO+-ICY LIMIT S 1,000,00 DESCRIPTION OF OPERATONS Cnkw A Empioyea PHPK1261707 I1Tt2112014 1112112015 Limit 100,04 Dishonesty Ded• 1,00 i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 10I,AMJIHonal R-Mtrks Sche vku if more space is nMt. ) Certificate holder is additional insured with respects liability arising out j of operations by or on behalf of the named insured for General Liability, subject to a written contract being in force CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL er DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Qity of Kent _ Human CJerYICeS Division AUITIORIIEp REPRESENTATIVE 2204th Avenue South `. - - Kent,WA 98032 ©1968-2010 ACORD CORPORATION. Atl rights reserved. , ACORD 25(2010105) The ACORD name and logo are registared marks of ACORD f PFGLD-HS(10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, GENERAL LIABILITY DELUXE ENDORSEMENT, HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage_applies,the terms,conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy,unless otherwise noted on this endorsement. The following Is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages,consult the policy contract wording. Cabie Limit of fnsurance Pageq overage Appfic Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability - $50,o0D limit 2 Nan-Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent,or Occupy $30,000 limit Damage tc Premises Rented to You $1,OOQ000 3 HIPAA Clarification 4 Medical payments $20,000 5 Medical Payments—Extended Reporting Period ^ 3 years _ 5 Athletic Activities Amended 5 Supplementary Payments—Bail Bonds - $5,O00 5 Supplementary Payment—Loss of Eamings $1,000 per day - 5 Employee Indernmi cation Defense Coverage $25,1)00 5 Key and Lock Replacement—Janitorial Services Client Coverag= $10,000limit 6 Additional Insured—Newly Acquired Time Perod - Amended 6 Additional Insured—Medleal Directors and Administrators Included 7 Additional Insured—Managers and Supervisors(with Fellow - Included 7 _ Em to ee(;Overa e) _ Additional Insured—Broadened Named Insured - Included 7 Additional Insured— Funding Source Included 7 Additional insured—Home Care Providers Included 7 Additional Insured—Managers, Land4ords, or Lessors of Premises Included 7 Additional Insured—Lessor of Leased Equipment Included 7 Additional insured-Grantor of Permits Included 8 AddifionalInsured—Vendor Included 8 Additional Insured—Franchiser Included Additional Insured—When Required by Contract Included i 9 Additional Insured—Owners, Lessees,or Contractors Included 9 li Additional Insured—State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (1 Oil 1) Ditles n the Evert of Occurrence i.iaim or Suit Included 1i U mnrentidnal F iWrilur to Disclose Haze{-ds - Inclined T I oI nch ied 10 ifi Tra Rights of Recovery Against Others ToUs I J, . .. Included Liberalization - - - ncWded Bodily Injury Includes Mental Anguish I}-- _ Included - Ferso� and Advertising Injury—iocludss 0 PrProcess, Discnmination T" A. Extended Property Damage _ SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the fallowing: a. Expected or Intended Injury "Bodily injury" or property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to"bodily injury" or"property damage"resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability _ SECTION I—COVERAGES,COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2, Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim,we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000, This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. c. Non-Owned Watercraft _ SECTION I—COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2,Exclusions, Paragraph g. (2)is deleted in its entirety and replaced by the following: (2) A watercraft you do not awn that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property fora charge-, This provision applies to any person,who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and colleebbia insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I —COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 - includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) LIABILITY,Subsection 2. Exclusions, Paragraph j, Damage to Property, Item (1) is deleted in its entirety and replaced with the following: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity,for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property, unless the damage to property is caused by your client, up to a $30,000 limit. A client is defined as a person under your direct care and supervision. E. Damage to Premises Rented to You 1. If damage by fire to premises rented to you Is not otherwise excluded from this Coverage Part, '... the word "fire" Is changed to"fire, lightning, explosion, smoke, or leakage from automatic fire protective systems"where it appears in: a. The last paragraph of SECTION I—COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions; is deleted in its entirety and replaced by the following: Exclusions c.through n.do not apply to damage by fire, lightning,explosion, smoke, or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner.A separate limit of insurance applies to this coverage as described In SECTION III—LIMITS OF INSURANCE. b. SECTION III—LIMITS OF INSURANCE, Paragraph 6, is deleted in its entirety and replaced by the following: Subject to Paragraph 5. above,the Damage To Premises Rented To You Limit is the mast we will pay under Coverage A for damages because of"property damage"to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke,or leakage from automatic fire protective systems while rented to you or temporarily occupied by you with permission of the owner. c. SECTION V—DEFINITIONS, Paragraph 9.a., is deleted in its entirety and replaced by the following: A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke,or leakage from automatic fire protective systems to premises while rented to you or temporarily occupied by you with permission of the owner is not an "Insured contract"; 2. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Subsection 4.Other Insurance, Paragraph b. Excess Insurance, (1) (a) (ii) Is deleted in its entirety and replaced by the following That is insurance for fire, lightning, explosion, smoke, or leakage from automatic fire protective systems for premises rented to you or temporarily occupied by you with permission or the owner; 3. The Damage To Premises Rented To You Limit section of the Declarations is amended to the greater of: Page 3 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10111) a. $1,000,000. or b. The amount shown in the Declarations as the Darnage to Premises Rented to Yoa Limit This Is the most we will pay for all damage proximately caused by the same event, whether such damage results from fire, lightning,explosion, smoke,or leaks from automatic fire protective systems or any combination thereof. F. HIPAA SECTION I—COVERAGES,COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, is amended as follows: 1. Paragraph 1. Insuring Agreement is amendedto include the following: We will pay those sums that the insured becomes legally obligated to pay as damages because of a"violation(s)' of the Health Insurance Portability and Accountability Act(HIPAA). We have the right and the duty to defend the insured against any"suit,""investigation,° or"civil proceeding" seeking these damages. However,we will have no duty to defend the insured against any _ seeking damages,"investigation," or"civil proceeding"to which this insurance does not apply. 2. Paragraph 2. Exclusions is amended to include the following additional exclusions: This insurance does not apply to: a. Intentional,Willful, or Deliberate Violations Any willful, intentional, or deliberate"violation(s)" by any insured. b. Criminal Acts Any"violation`which results in any criminal penalties under the HIPAA. c. Other Remedies Any remedy other than monetary damages for penalties assessed. d. Compliance Reviews or Audits Any compliance reviews by the Department of Health and Human Services. 3. SECTION V—DEFINITIONS is amended to include the following additional definitions: a. "Civil proceeding"means an action by the Department of Health and Human Services (HHS) arising out of"violations." b. "Investigation'means an examination of an actual or alleged"violation(s)" by HHS. However, "Investigation" does not include a Compliance Review. c. "Violation"means the actual or alleged failure to comply with the regulations included in the HIPAA. Page 4 of 12 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) - G. Medical Payments—Limit Increased to$20,000, Extended Reporting Period - If COVERAGE C MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: 1, The Medical Expense Limit is changed subject to all of the terms of SECTION III - LIMITS OF INSURANCE to the greater of: a, $20,000-or b, The Medical Expense Limit shown in the Declarations of this Coverage Part. 2. SECTION I—COVERAGE,COVERAGE C MEDICAL PAYMENTS, Subsection 1. Insuring Agreement, a. (3) (b) is deleted in its entirety and replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident. H. Athletic Activities - SECTION I—COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e.Athletic Activities is deleted in its entirety and replaced with the following: e. Athletic Activities To a person injured while taking part in athletics. t. Supplementary Payments SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS -COVERAGE A AND B are amended as follows: 1. b.is deleted in its entirety and replaced by the following: 1. b. Up to $5000 for cost of bail bonds required because of accidents or traffic law violations arlsing out of the use of any vehicle to which the Bodily Injury Liability Coverage applies.We do not have to furnish these. - 1.d. is deleted in its entirety and replaced by the following: 1. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to $1,000 a day because of time off from work. J. Employee indemnification Defense Coverage _ SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B the following is added: We will pay, on your behalf, defense costs Incurred by an"employee" in a criminal proceeding occurring in the course of employment. The most we will pay for any"employee"who is alleged to be directly involved in a criminal proceeding is $25,000 regardless of the numbers of"employees,"claims or"suits"brought or persons or organizations making claims or bringing "suits. Page 5 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) K< ley and Lock Replacement—Janitorial Services Client Coverage - SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND 13 is amended to include the following: We will pay for the cost to replace keys and lacks at the"clients"premises due to theft or other loss to keys entrusted to you by your"client," up to a$1 V00 limit per occurrence and $10,000 policy aggregate. We wil( not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors,trustees, authorized representatives or any one to whom you entrust the keys of a"client"for any purpose commit,whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows. a. "Client" means an individual,company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee"means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary,wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee"as defined in Paragraph (1)above, who is on leave;or - (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm,factor,commission merchant, consignee,Independent contractor or representative of the same general character, or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an"employee." c. "Manager"means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION fl—WHO 1S AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with fs permission. 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Coverage Part, Paragraph 1a. is deleted in its entirely and replaced by the follmeing: a.- Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: . a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not Include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your'employees"are also insureds for"bodily injury" to a co- "employee'while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a) as it applies to managers of limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also Insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source—Any person or organization with respect to their liability arising out of: (1) Their financial control of you;or (2) Premises they own,maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Nome Care Providers—At the first Named Insureds option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership,maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You=Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 '.....,. Includes copyrighted material of Insurance Services Office,Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10M1) organization is an insured only with respectto liability for"bodily Infury,',property damage"or "personal and advertising injury"caused, in whole or in pare, by your maintenance, operation or use or equipment'cased fo you by such person or organization:. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional-insureds,this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which This insurance applies: (a) The existence, maintenance, repair,construction, erecton, or removal of advertising signs, awnings, canopies,cellar entrarces,coal holes,driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance,or use of any elevators covered by this insurance, i. Vendors—Only with respect to"bodily injury"or"property damage"arising out of"your products" which are distributed or sold in the regular course of the vendor's business,.subject to the following additional exclusions: (7) The insurance afforded the vendor does not apply to: (a) "Bodily injury" or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement, (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor, (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f} Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLO-HS (10/11) I (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or - (h) 'Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of Its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) I he exceptions contained in Sub-paragraphs.(d)or(f); or (ii) Such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products, (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. j. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract—Any person or organization where required.by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily injury," "property damage"or"personal and advertising Injury"but only for liability arising out of the negligence of the named insured, The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of '.. insurance shown In the Declarations I. Owners, Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage"or"personal and advertising injury"caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting or your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: (a) All work, Including materials, parts or equipment furnished in connection with such work, on the project(other than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or - (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company rl-GLD-HS(10/11) in, State or Political Subdivisions—Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on vour behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) "Bodily injury,""property damage"or"personal and advertising injury" arising out of operations performed for the state or municipality,or (b) "Bodily injury"or"property damage"included within the "products-completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition applies only when the`'occurrence" or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership, or (3) .An executive officer or insurance manager,if you are a corporation, b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim-or"suit" is known to: (1) You, if you are an individual; _ (2) A partner, if you are a partnership, or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 6.Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 8.Transfer of Rights of Page 10 of 12 includes copyrighted material of Insurance Services office,Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company i PI-GI_D-HS(10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following: - If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after lass to impair them. At our request, the insured will bring"suit"or transfer those rights to us and help us enforce them. Therefore, the insured can waive the insurer's rights of recovery prior to the occurrence of a . loss,provided the waiver is made in a written contract. P. Liberalization - SECTION IV--COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additionaf coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these;and b. Exceptfor mental anguish, includes death resulting from the foregoing (Item a,above) at any time. R. Personal and Advertising Injury—Abuse of Process,Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of"personal and advertising Injury" is amended as follows: 1. SECTION V—DEFINITIONS, Paragraph 14.1b. is deleted in its entirety and replaced by the following: '... b. Malicious prosecution or abuse of process; 2. _ SECTION V—DEFINITIONS, Paragraph 14. is amended by adding the following Discrimination based on race, color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of, or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer, director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company Pi-GLD-HS 00111) c. Directly or indirectly related io the sale, rental, lease or sublease or prospective sales, rental, !ease or sub-lease of any room, dwelling or premises by or at the direction of any insured, or d. Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling, The above does not apply to fnes of penalties imposed because of discrimination. Page 12 of 12 Includes copyrighted 2its permission. o11 Philadelphia Indemnity insuranceC Company _ EXHIBIT F City of Kent 2015-2016 Certification Regarding Debarment and Suspension Refugee Women's Alliance Case Management and Emergency Assistance/BG1517- Agency 1617 Name of Project/Project Number I Senior Nutrition and Wellness Program/BG1520-1620 Name of Project/Project Number 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 l of 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 which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of these regulations. 6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered 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 knowingly enters into a lower tier covered transaction with a person who is 2 of 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, Ineli- gibility and Voluntary Exclusion - Lower Tier Covered Transactions 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Instructions for Certification (B) 1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to whom this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier 3 of 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 Non- procurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this trans- action originated may pursue available remedies including suspension and/or debarment. Primary Contractor/Sub-Contractor Date - (Prmt/�elow) Authorized Signature of Primary Title Contractor/Sub-Contractor (Sign Below) , 4 of -------------- \ . \: 48 \ 4-1 \ \ i 000000 000 oa 000 o' m o o i ry ii a o N b N N L L N N E o F ----------------- u m c� ry m 3 I 2 c w of w °,m n j m R p N------------- w N n L U 0 Q N p ry 2 � N � I U u U1 s x � w U a m m v E p ¢z �0 rn N N O N L �r L a tY 3 0 Y 0 Eo &: t38 xa 9fl cwi E m PLEASE READ! Coversheet for Exhibit H I I am attaching Exhibit H, which you completed in a previous contract year. Return it with your contract documents if there have been no changes to program access, employment and reasonable accommodation, and physical accessibility since you last completed Exhibit H. EXHIBIT hl P"Cttir9 E5041ADA DISABILITYASSURANCE OF cbMPLIANCE Complying with Section 504 of the Rehabilitation Act of 1973, as amended, and the Americans With Disabilities Act of 1'990, two federal laws which prohibit discrimination against qualified people with_ disabilities. I understand that federal and state laws prohibit discrimination,in public accommodations and employment based solely o.n disability. In addition, I recognize that Section 504 'requires recipients of federal funds (either directly or through contracting with a'governmental entity receiving federal funds) to make their programs, services, and activities, when viewed in their entirety, accessible to qualified acid/or eligible people with disabilities. I agree to comply with, and to require that all subcontractors complywith, the Section 504/ADA "requirements. I understand that reasonable accommodation.is required in both program services and employment, except where to do so would'cause an undue hardship or burden., - I agree to cooperate in any compliance review and to provide reasonable access to the premises of all places of business and employment and.to records,.files, information, acid employees therein to the City of Kent for reviewing compliance with Section 504 and ADA. requirements. . I agree that any violation of the specific provisions and terms of the 504/ADA Disability Assurance of Compliance and/or Corrective Action Plan required herein or Section 504 or the ADA, shall be .deemed a breach of a material provision of the Contract between the City of Kent and the Contractor. such a breach shall be grounds for cancellation, termination, or suspension, in whole'or impart, of. Contract by the City of Kent. According to the responses to the questions in the 5041ADA Self-Evaluation YES NO Questionnaire, (company name) P,jk,�u W s 0 91 .13 is in compliance with 504/ADA. If the above response is NO, the following corrective actions willbe taken,- Corrective Action Plan rn:tgrr?ri°FPt i�?tv8 The following Corrective Action Plan is submitted to comply with Seci n �D4 andi,,M&uirement General Requirements Actions To Be Taken Completion Date Program Ac cess Actions To Be Taken Completion Date 5041ADA Contract Forts 3-06 . .... . 1 . . . . - .. . .. . _ .. 504[ADA DISABILITY ASSURANCE OF COMPLIANCE (continued) Employment and Reasonable Accommodation Actions To Be Taken Completion Date -Physical Accessibility Actions To Be Taken Completion Date I Declare Under Penalty of Perjury under the Laws of the State of Washington that the ' Foregoing is True and Correct. Signature of authorized sigrator V . © r� Ert�Erf r rlZ�Jr� t �` i� L r��7 Type or print name of authorized signator Title Telephone For Notary: State of County of Vr N G-- Signed and sworn before me on (date) 2 /t P 9 IL- —1 c 10 by (print authorized si nator name) S . ri i /+ ," t e FA 1 7— �7 Notary PublicNotary signature: \ kl� State of washington Notary (print name):; A CQ S v L 4Ac08 IN 18L: . My Appointment Eepfres Feb B,2014 My appointment Aires: 2 1 Contractor. Company Name Street Address City State zip l REQUEST FORMAYOR'S SIGNATURE ® Please fill in all applicable boxes � Director Reviewed: Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) _ Originator: Dinah Wilson-Parks/Human Services Phone (Originator): x5076 _ Date Sent: 7/24/15 Date Required: ASAP Return Signed Document to: Dinah Contract Termination Date: 12/31/16 VENDOR NAME: CDBG Contracts (see cover Date Finance Notified: 7/25/14 sheets) (Only required on contracts $10,000 and over or on any Gra DATE OF COUNCIL APPROVAL: 11/4/14 Date Risk Manager Notified: � ( -` f 9 _ (Required on Non-City Standard Contracts/Agreements__ Has this Document been SpeOfolly Account Number: ; Authorized in the Budget? i�YES NO Brief Explanation of Document: I have attached the 2015 CDBG Agreements. CDBG Funds are awarded to non-profits to provide public service and capital projects that benefit Kent residents. Examples include funds awarded to Multi-Service Center to provide grants to prevent renters from being evicted from their homes and funds provided to Refugee Women's Alliance to fund case management and emergency assistance to refugees and immigrants. These contracts are forwarded for the Mayor's signature on an annual basis and are retroactive to January 1, 2015, although funds cannot be disbursed until the City signs its contract with HUD. We anticipate signing the HUD contract in the Fall. All Contracts Must Be Routed Through The Law Department - - (This area to be completed by the Law Department) ✓a Received: Approval of Law Dept.' , t �i „r Law Dept. Comments: ' Date Forwarded to Mayor: Shaded Areas To Be Completed By Administration Staff Received ecommendations and Comments:R Fay�,r' Disposition: Date Returned