HomeMy WebLinkAboutEC16-120 - Original - Green River Community College - Small Business Assistance Center - 03/24/2016 n
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CONTRACT COVER SHEET
This is to be cornpleted by the ContractManager prior to subrnission
to City Clerks Offire. All portions are to be corripie : d..
Xf you have questions,, please contact City Clerk's Office.
Vendor Name: -1 illvcK CuWw . (ollfnt SWrdl
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Vendor INIumber.
JD Edwards Number
This is assigned by City Clerk's Office
Project: N C4 1 1 OU5fry,513 )q9si
Description: Interlocal Agreement. ® Change Order El Amendment 171 Contract
Other: r
Contract Effective:iv Date: ;d1t2 14 Teriniun tion Date,:
Contract Reneyval iMo lc (Days).-
Number of clays required notice for termination or renewal or amendment
Contract Manages" Cal I L( VVJ Departuyient- ,
Contract Amount; 100
Approval Authority-. ❑ Del)artment Director 0mayor ❑City Council
Detail. (i.e. address, location, parcell nurnber, tax id, tc.).-
adaW10877 8 14
KENT
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Green River Community College Small Business Assistance Center
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Green River Community College organized under the laws of the State of
Washington, located and doing business at 417 Ramsey Way, Suite 112, Kent WA 98032, (253) 856-9595
(hereinafter the "Consultant").
I. DESCRIPTION OF WORK.
Consultant shall perform the following services for the City in accordance with the following
described plans and/or specifications:
As described in attached Exhibit A, Scope of Work
Consultant further represents that the services furnished under this Agreement will be performed in
accordance with generally accepted professional practices within the Puget Sound region in effect at the
time those services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in
Section I above immediately upon the effective date of this Agreement. Consultant shall complete the
work described in Section I by December 31, 2016.
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to exceed
$23,100, for the services described in this Agreement. This is the maximum amount to be
paid under this Agreement for the work described in Section I above, and shall not be
exceeded without the prior written authorization of the City in the form of a negotiated and
executed amendment to this agreement. The Consultant agrees that the hourly or flat rate
charged by it for its services contracted for herein shall remain locked at the negotiated
rate(s) for a period of one (1) year from the effective date of this Agreement. The
Consultant's billing rates shall be as delineated in Exhibit A.
B. The Consultant shall submit quarterly payment invoices to the City for work performed, and
a final bill upon completion of all services described in this Agreement. The City shall
provide payment within forty-five (45) days of receipt of an invoice. If the City objects to
all or any portion of an invoice, it shall notify the Consultant and reserves the option to only
pay that portion of the invoice not in dispute. In that event, the parties will immediately
make every effort to settle the disputed portion.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in
accordance with Ch. 51.08 RCW, the parties make the following representations:
CONSULTANT SERVICES AGREEMENT - 1
(Over$20,000)
A. The Consultant has the ability to control and direct the performance and details of its
work, the City being interested only in the results obtained under this Agreement.
B. The Consultant maintains and pays for its own place of business from which
Consultant's services under this Agreement will be performed.
C. The Consultant has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained Consultant's services, or the Consultant is engaged in an independently
established trade, occupation, profession, or business of the same nature as that
involved under this Agreement.
D. The Consultant is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
E. The Consultant has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by Consultant's
business, and has obtained a Unified Business Identifier (UBI) number from the
State of Washington.
F. The Consultant maintains a set of books dedicated to the expenses and earnings of
its business.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party thirty (30) days written notice at its address set forth on the signature block of
this Agreement. After termination, the City may take possession of all records and data within the
Consultant's possession pertaining to this project, which may be used by the City without restriction. If
the City's use of Consultant's records or data is not related to this project, it shall be without liability or
legal exposure to the Consultant.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the
Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation,
national origin, or the presence of any sensory, mental, or physical disability, discriminate against any
person who is qualified and available to perform the work to which the employment relates. Consultant
shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with
City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance
Statement.
VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers,
officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or
suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's
performance of this Agreement, except for that portion of the injuries and damages caused by the City's
negligence.
The City's inspection or acceptance of any of Consultant's work when completed shall not be
grounds to avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement is subject to RCW
4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to
property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers,
officials, employees, agents and volunteers, the Consultant's liability hereunder shall be only to the extent
of the Consultant's negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION
PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL
CONSULTANT SERVICES AGREEMENT - 2
(Over$20,000)
INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES
FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER.
In the event Consultant refuses tender of defense in any suit or any claim, if that tender was made
pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having
jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant's part, then
Consultant shall pay all the City's costs for defense, including all reasonable expert witness fees and
reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful
refusal on the Consultant's part.
The provisions of this section shall survive the expiration or termination of this Agreement.
VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by
this reference.
IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide
reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of the
work under this Agreement.
X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents, drawings,
designs, reports, or any other records developed or created under this Agreement shall belong to and
become the property of the City. All records submitted by the City to the Consultant will be safeguarded
by the Consultant. Consultant shall make such data, documents, and files available to the City upon the
City's request. The Consultant acknowledges that the City is a public agency subject to the Public Records
Act codified in Chapter 42.56 of the Revised Code of Washington. As such, the Consultant agrees to
cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act.
The City's use or reuse of any of the documents, data, and files created by Consultant for this project by
anyone other than Consultant on any other project shall be without liability or legal exposure to
Consultant.
XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor
with the authority to control and direct the performance and details of the work authorized under this
Agreement, the work must meet the approval of the City and shall be subject to the City's general right of
inspection to secure satisfactory completion.
XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary
precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the
performance of the contract work and shall utilize all protection necessary for that purpose. All work shall
be done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to
materials, tools, or other articles used or held for use in connection with the work.
XIII. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its
contractors and consultants to use recycled and recyclable products whenever practicable. A price
preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the
covenants and agreements contained in this Agreement, or to exercise any option conferred by this
Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those
covenants, agreements or options, and the same shall be and remain in full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any
dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means
of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules
and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in
CONSULTANT SERVICES AGREEMENT- 3
(Over$20,000)
writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the
parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred
in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or
award provided by law; ,provided, however, nothing in this paragraph shall be construed to limit the City's
right to indemnification under Section VII of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the parties at
the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written
notice hereunder shall become effective three (3) business days after the date of mailing by registered or
certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this
Agreement or such other address as may be hereafter specified in writing.
E. Assignment. Any assignment of this Agreement by either party without the written consent
of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment,
the terms of this Agreement shall continue in full force and effect and no further assignment shall be
made without additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of the City
and Consultant.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative
of the City, and such statements shall not be effective or be construed as entering into or forming a part
of or altering in any manner this Agreement. All of the above documents are hereby made a part of this
Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any
language contained in this Agreement, the terms of this Agreement shall prevail.
H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and
municipal laws, rules, and regulations that are now effective or in the future become applicable to
Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or
accruing out of the performance of those operations.
I. Public Records Act. The Consultant acknowledges that the City is a public agency subject to
the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents,
notes, emails, and other records prepared or gathered by the Consultant in its performance of this
Agreement may be subject to public review and disclosure, even if those records are not produced to or
possessed by the City of Kent. As such, the Consultant agrees to cooperate fully with the City in satisfying
the City's duties and obligations under the Public Records Act.
J. City Business License Required. Prior to commencing the tasks described in Section I,
Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of
the Kent City Code.
K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any
number of counterparts, each of which shall constitute an original, and all of which will together constitute
this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page
CONSULTANT SERVICES AGREEMENT - 4
(Over$20,000)
to the other by fax or email and that signature shall have the same force and effect as if the Agreement
bearing the original signature was received in person.
IN WITNESS, the parties below execute this Agreement, which shall become effective on
the last date entered below.
CONSULTANT: CITY OF KENT:
By: By:
(signature) Si nature)
Print game: 14-, 0 A!eL- Print Vam Su ette Cooke
IvFavor
Its Its
DATE: DATE: -3
1z
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT,
Leslie Moore, Dean [Kurt Hansen, Deputy Director
Green River Community College City of Kent
417 Ramsey Way, Suite 112 220 Fourth Avenue South
Kent, WA 98032 Kent, WA 98032
253-288-3375] (telephone) (253) 856-5706 (telephone)
(facsimile) (253) 856-5464 (facsimile)
APPROV l AS T7 M: I
I ---,
CV'VVX
r
Kent Law Department
CONSULTANT SERVICES AGREEMENT - 5
(Over$20,000)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
3. During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
By:
For: LCSG/g, /Rooec &A, W Ayei2 Gomm.eoQe6
Title: AR 0/ Zq/myy &&Vries
Date: 31�///1,
EEO COMPLIANCE DOCUMENTS - 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee
equal employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS - 2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as that was entered
into on the (date), between the firm I represent and the City of
Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City
of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity
Policy that was part of the before-mentioned Agreement.
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3
1
EXHIBIT A
Scone of Service
In 2016 Green River Community College Small Business Center will provide one-on-one business
advising and entrepreneur education in direct client services for the City of Kent. Funding from the City
of Kent will be$23,100. Small Business billable hours will be calculated at$125 per hour. For the
$23,100 grant, Kent will receive 185 hours of direct client services.
Our services will target 10 mutually selected small business clients for the City of Kent for a total of 105
hours of one-on-one business advising. The clients will sign an additional release of information form to
allow the economic development department to view the company progress. The Small Business Center
will also provide 80 hours of entrepreneur class training. Client hours will be calculated for one-on-one
technical assistance delivered to the client including time spent on client research.
Business advising sessions are available to clients at no cost. Clients can meet with business advisors at
the Green River College Kent Campus, at their place of business or another place of their choosing.
Confidentiality is a chief concern in reporting on SBAC activities. Reporting forms may identify non-
contract Kent clients by number only and not by company name or owner except for the 10 City of Kent
clients funded directly by City of Kent funding.
The Small Business Center will focus on these areas of service to start-up and maintenance clients:
• Business plan development
• Business location analysis
• Marketing and sales
• Small Business management
• Sources of capital
• Entrepreneur Education
Additional activities included in this grant include:
1. Quarterly reports to the City and regular monthly in-person meetings to discuss services provided
and outcomes
2. Collaboration with the City and local entities such as the King County Library and the KDP
3. Participation in"Meet-Ups"hosted by the City and co-marketed with the Small Business Center
4. See announcement on page 2 for entrepreneur class announcement. The entrepreneur class is 20
hours of training and will be offered 4 times throughout the year for a total of 80 hours.
2
The Entrepreneur's Journeg
Startup Crowth Success
Sponsored hv:
• City of Kent&c
• Green River College SBDC
000
KENT
q I5
Facilitated by: Kirk J. Davis,MBA of lr
Director, Green River College SBDC
i
Class
1
51t�rtug Growth Success
. Launch and Research 4.Management T.Strategy
Where Entrepreneurs begin Creating happy customers Decisions that lead to success
2. Business flan&Pitch 5.Marketing S.Execution
You've got to pitch to get rich Make and keep customers Ideas into racoon
3. Business Funding 6.Money 9.Leadership
The lifeblood of business Improve$performance Rally people to a better future
10,Innovation
Customers want new&improved
Class Information:
Location:Green River College Kent Campus,417 Ramsay Way,Kent,,Room#324
Bates:Weekly,Wednesday afternoons(10 weeks)January 27,2016-Marsh 30,2016
Times: 4:00 p.m.to 6:00 p.m. (2 hours) A. sll�'
Cost: Free, All businesses and entrepreneurs invited . No-Cost Business Advising c a t t€c E
- Handouts and Materials are provided . Export Assistance n ^„ r� i c Ai';'3
. Government Contracting AwBowAft
To Register Call: 253.5,20. 261 • Business Management RAO
Otr�?il&! 99i�fgtdf f�l
. FundingGuida...nce
More Information: www.greenriversbdc.com • Entrepreneur Education � `•eti i r;, Ttr r,
EXHIBIT B
INSURANCE REQUIREMENTS FOR
CONSULTANT SERVICES AGREEMENTS
Insurance
The Consultant shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which
may arise from or in connection with the performance of the work hereunder
by the Consultant, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Consultant shall obtain insurance of the types described below:
1. Automobile Liability insurance covering all owned, non-
owned, hired and leased vehicles. Coverage shall be written
on Insurance Services Office (ISO) form CA 00 01 or a
substitute form providing equivalent liability coverage. If
necessary, the policy shall be endorsed to provide
contractual liability coverage.
Commercial General Liability insurance shall be written on
ISO occurrence form CG 00 01. The City shall be named as
an Additional Insured under the Consultant's Commercial
General Liability insurance policy with respect to the work
performed for the City using ISO additional insured
endorsement CG 20 10 1185 or a substitute endorsement
providing equivalent coverage.
2. Workers' Compensation coverage as required by the
Industrial Insurance laws of the State of Washington.
B. Minimum Amounts of Insurance
Consultant shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined
single limit for bodily injury and property damage of
$1,000,000 per accident.
2. Commercial General Liability insurance shall be written with
limits no less than $2,000,000 each occurrence, $4,000,000
general aggregate.
EXHIBIT B (Continued)
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability
insurance:
1. The Consultant's insurance coverage shall be primary insurance as
respect the City. Any Insurance, self-insurance, or insurance pool
coverage maintained by the City shall be excess of the Consultant's
insurance and shall not contribute with it.
2. The Consultant's insurance shall be endorsed to state that coverage shall
not be cancelled by either party, except after thirty (30) days prior
written notice by certified mail, return receipt requested, has been given
to the City.
3. The City of Kent shall be named as an additional insured on all policies
(except Professional Liability) as respects work performed by or on behalf
of the Consultant and a copy of the endorsement naming the City as
additional insured shall be attached to the Certificate of Insurance. The
City reserves the right to receive a certified copy of all required insurance
policies. The Consultant's Commercial General Liability insurance shall
also contain a clause stating that coverage shall apply separately to each
insured against whom claim is made or suit is brought, except with
respects to the limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not
less than ANII.
E. Verification of Coverage
Consultant shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of
the Consultant before commencement of the work.
F. Subcontractors
Consultant shall include all subcontractors as insureds under its policies or
shall furnish separate certificates and endorsements for each subcontractor.
All coverages for subcontractors shall be subject to all of the same insurance
requirements as stated herein for the Consultant.
CERTIFICATE OF LIABILITY INSURANCE Issue Bate 2129/2016
ISSUED BY: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
State of Washington AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Department of Enterprise Services CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
Office of Risk (Management AFFORDED BY THE STATE OF WASHINGTON SELF INSURANCE
PCB Box 41466 LIABILITY PROGRAM.
Olympia WA 98504-1466
COVERAGE AFFORDED BY
State of Washington Self Insurance Liability Program
INSURED: THE STATE OF WASHINGTON, INCLUDING ALL ITS AGENCIES AND
DEPARTMENTS,IS SELF-INSURED FOR TORT LIABILITY CLAIMS. ALL
State of Washington CLAIMS MUST BE FILED WITH THE STATE OFFICE OF RISK
Green River College MANAGEMENT FOR PROCESSING IN ACCORD WITH STATUTORY
ATTN: Stephenie Cheng-LaBoyne REQUIREMENTS.
12401 SE 320th Street
Auburn, WA 98092-3622
COVERAGES
THIS IS TO CERTIFY" COVERAGE DESCRIBED BELOW IS PROVIDED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY(PERTAIN,THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBJECT
TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH PROGRAM.
POLICY EFFECTIVE EXPIRATION
TYPE OF COVERAGE NUMBER DATE DATE LIMITS
GENERAL LIABILITY Self-insured Continuous Continuous BODILY INJURY,PROPERTY $5,000,000
Z GENERAL LIABILITY DAMAGE&PERSONAL INJURY
Z OCCURRENCE COVERAGE COMBINED EACH OCCURRENCE
AUTOMOBILE LIABILITY BODILY INJURY&PROPERTY $5,000,000
11 ANY AUTO DAMAGE COMBINED EACH
ALL OWNED AUTOS
ACCIDENT
SCHEDULED AUTOS
0 HIRED AUTOS
NON-OWNED AUTOS
WORKERS COMPENSATION AND L&I Continuous Continuous WC—STATUTORY
EMPLOYERS LIABILITY 52WEGE1229 6/30/15 6130/18
EL-$1,000,000--per AacidenU$1,000,000 Disease
per Policyl$1,000,000 Disease per Employee
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECM ITEMS.. Coverage applies as respects tort liability claims against
the State of Washington as covered by the Tort Claims Act (RCW 4.82 et seq.) The Certificate Holder is named as
additional Insured, but only as respects the negligence of the State of Washington..
CERTIFICATE HOLDER: CANCELLATION
CITY OF KENT SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, THE
STATE OF WASHINGTON WILL ENDEAVOR TO MAIL AA DAYS WRI7TEN
ATTN. JULIE PULLIAM NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
400 WEST GO WE TO MAIL SUCH NOTICE SHALL NOT IMPOSE ANY OBLIGATION OR LIABILITY
KENT,WA 98032 UPON THE STATE OF WASHINGTON, ITS OFFICIALS, EMPLOYEES, AGENTS
OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE:
CERTIFICATE NUMBER CRT 16-447 Lu Iss�I�,State Risk than er
Came ball, Me!ynda (DES)
From: CertificateinsuranceForml@ofm.wa.gov
Sent: Friday, February 26,2016 2:30 PM
To: OFM C1
Subje&. CertificatelnsuranceForml
YOUR AGENCY: Green River College
YOUR NAME: Stephenie Cheng-LaBoyne
YOUR PHONE: 253-288-3353
YOUR EMAIL., whenA-l@bovne0greenriver.edu
OUTSIDE ENTITY:City of Kent
ATTN NAME:Julie Pulliam
CERTIFICATE HOLDER E-MAIL:JPu Ilia ma kentwa.gov
CERTIFICATE HOLDER FAX:
CERTIFICATE HOLDER ADDRESS:400 West Gowe
CERTIFICATE HOLDER CITY: Kent
CERTIFICATE HOLDER STATE:WA
CERTIFICATE HOLDER ZIP:98032
CERTIFICATE HOLDER REASON: Request for SBAC contract
AGREEMENT:YES
MAILING NAME:
MAILING ADDRESS:
MAILING CITY:
MAILING STATE:
MAILING ZIP:
OTHER INSTRUCTIONS:
REQUEST FOR MAYOR'S SIGNATURE
• Please Fill in All Applicable Boxes
KEG`+ T
'A1, nl mruwrY
Originator: Phone (Originator):
Date Sent: Date of Council Approval:
Return Date of Approval from
Finan
Signed Document to: w (only required on contras $1�000 &ever or can any Grant
Ag moments
Date Required: Date of-Appro,val from Disk Mana er: /
Vendor Name- Budgeted: YE NO l
Budget Fund: Jc)Gc,4ic , i t
Brief Explanation of Document:
10 0 .
Aff Contracts Must Be Routed Through The Law Department
Ri ark a aw Department) I
Received:
Lew Department Approved as to Form: 2016
ry
Law Dept. Comments: KENT LAW .,
date Forwarded' to Mayor,
Shaded areas To Be Completed By Administration Staff
Received:
Recommendations and Comments:
Date Returned:
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TO: Leslie Moore, Dean — Green River Community College
DATE: March2, 2016
PROJECT: Consultant Service Agreement
Sending To .
[ Xl Consultant Service Agreement
( l Change Order
F 1 Drawing/Plans
[ lSpecifications
F l Vendor Set-up Form
[ Xl Request to obtain a City of Kent Business license
THESE DOCUMENTS ARE SENT FOR THE FOLLOWING REASONS
[ l ForAppnova|
[ � For Your Use
[ lAs Requested
� l For Review and Comment
[}{ l For Signature and Return
[ lOther
NOTE:PLEASE Please review and sign the enclosed agreement and send a copy of your
current business license. Please return in the provided envelope.
iftyof Kent, Economic 0, Community Development
220 Fourth Ave. S.
Kent, WA 98032
(253) 855-5702
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Unified Business 10 #: 171 004 565 , ' l
Business ID #: 1
4, Location: 1 a
r WASHINGTON STATE COMMUNITY COLLEGE DISTRICT #10 ;
GREEN RIVER COMMUNITY COLLEGE
124401 SE 320TH ST
AUBURN GSA 98092 5622 �
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TAX REGISTRATION
INDUSTRIAL INSURANCE
UNEMPLOYMENT INSURANCE
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