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PK17-052 - Original - Mercy Housing - Family Support Program - 02/01/2017
, R. ecoird ' ` fly p f ;KET �` waHI��.o� � Document�� ��tou�dt�ul'1�1��1J9JJ111111 ' 1 /`,fffi�ii�ll�l[fff�l�l� �'� f�� 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: Mercv Housing Vendor Number: 323884 JD Edwards Number Contract Number: P1/- I-� ' 06Z This is assigned by City Clerk's Office Project Name: Family SUDDort Program Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 1-1-2017 Termination Date: 12-31-2018 Contract Renewal Notice (Days): 30 Number of days required notice for termination or renewal or amendment Contract Manager: Lori Guilfoyle Department: Parks Contract Amount: $20,000 Approval Authority: ® Department Director ❑ Mayor ❑ City Council Detail: (i.e. address, location, parcel number, tax id, etc.): Consultant shall administer the Family Support Program at Appian Way in Kent ........... -----------_____________ ......,... As of: 08/27/14 K NT CONSULTANT SERVICES AGREEMENT between the City of Kent and Mercy Housing Northwest THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Mercy Housing Northwest organized under the laws of the State of Washington, located and doing business at 2505 Third Avenue, Suite 204, Seattle WA 98121 (hereinafter the "Consultant"). I. DESCRIPTION OF WORK. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: Consultant shall administer the Family Support Program at Appian Way Apartments in Kent. The following exhibits are attached and incorporated by this reference as if fully set forth herein; Exhibit A, Scope and Schedule of Work, Exhibit B, Insurance Exhibit and Exhibit C, Debarment Certification. Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time those services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon the effective date of this Agreement. Consultant shall complete the work described in Section I by December 31, 2018. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed $20,000 ($10,000 per year), 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 ($20,000 or Less) 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 ($20,000 or Less) 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. Recymclal?[ k!M teriia,ls. 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 G_overniDgg,_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 ($20,000 or Less) 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. Assi nmenC. 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 Lawns,. 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. ]. City_..._6.1Is_in ss 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. Cotpnterparts_and__Sucd„ryiatures,,, bfax of LU2a. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute CONSULTANT SERVICES AGREEMENT - 4 ($20,000 or Less) 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, II agree ,tto,fulfill the five requirements referenced above. By: V/" � � ��1. For: }tw *� tr5 Title: Date:., EEO COMPLIANCE DOCUMENTS - 1 this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page 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. All acts consistent with the authority of this Agreement and prior to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. CONSULTANT:Q CITY OF KENT: 8 __... sg�raki'J ) (signature) Awmiw' By Print Name: Print ame: Julie Parascondola, CPRP Its: nvt4 ..1.w �- Its: Director, Parks, Recreation and (true) Community Services Department DATE: 6 n L67 .v G DATE:_---�7`_���°.� .. _____. _ .__.. _ ___.... . ..._......._,_,.,_ -....... . .....m NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Kate Parker Lori Guilfoyle Mercy HousingCityof Kent ^-z6t4fce-5 2505 �V; RV4' �� 220 Fourth Avenue South SCA4, le WIk r1�IZ� Kent, WA 98032 206.602.3485 (telephone) (253) 856-5061 (telephone) (facsimile) (253) 856-6070 (facsimile) _.... P.\Homan Services\General Fund\General Fund 2017-18 csgUact\Cstrac[s\Mercy Housing CONSULTANT SERVICES AGREEMENT - 5 ($20,000 or Less) 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 Exhibit A (continued) NT Scope and Schedule of Work w<,.1„G.o" 2017-2018 Consultant Services Agreement PAHKs, RtCHrAIION L COMMIJM Y SERVICES Agency: Mercy Housing Northwest 2017 Funding: $10,000 Program: Family Support at Appian Way 2018 Funding: $10,000 __........__ . ......,... ._.. .................. This funding will Mercy Housing Northwest will provide family support provide: services including direct one-on-one meetings and Total: $20,000 assistance, group programming and outreach and advocacy for low-income and formerly homeless families with children at Appian Way Apartments in Kent. Reporting Requirements and Timeline All data and required forms shall be submitted through SharelApp: Ihtt sharelapp.culturegrinta.o[g�io§Igx/,I_pgin Service Unit Report - Data from this form will be used to track each program's progress toward meeting the goals stipulated in the Scope of Work. It shall be submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 15), along with the Reimbursement Request. Reimbursement Request - This form will be filled out on SharelApp and serve as the invoicing mechanism for payment to your agency/program. It shall he submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Dec 15), unless otherwise specified. Demographic Data Report - The agency shall collect and retain the data requested on this form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted annually in SharelApp (by January 15). Annual Outcome Data Report - Outcome data shall be submitted in SharelApp no later than the 15th following the end of the fourth quarter. Data should demonstrate the program's progress toward Outcomes specified in the Scope of Work. _ - . ---------- —. ....... _ _ .._...._ .__ . . ..... ........... _ .. ...... . . _ .. _.... Report Due Date Service Unit Report and Reimbursement Request 15`" day following each quarter Final Reimbursement Request (4'h Qtr) December 15", 2017/December 15`", 2018 Demographic Data Report January 15", 2018/January 15t , 2019 Annual Outcome Data Report January 15`', 2018/January 15", 2019 Signature Please sign below to indicate acceptance of the Year 2017 and Year 2018 Performance Measures listed above. �.2A1.2 _ BIII Rumpf, M c o_Usinglllxkutive Director Date .. T L Merino Hanson, H�n Servicesage Date , Exhibit A w a ANT Scope and Schedule of Work PARCOMM RE ERVIC s 2017-2018 Consultant Services Agreement coMrnuwrr srrvices ..,....... ................................ ____.... ["encv: Mercy Housinq Northwest 2017 Fundmq �$10,000 ........... __._ _ ...m _ Program Familv Support at Appian Way2017 Fundina: $10,000 ....... ......... This funding Mercy Housing Northwest will provide family support will Provide: services including direct one-on-one meetings and Total: $20,000 assistance, group programming and outreach and advocacy for low-income and formerly homeless families with children at Appian Way Apartments in Kent. Annual Program Outputs: Pro ram Outcomes: Unduplicated Kent Residents 60 Increased academic success. Family Support (points of service) 500 _._.. __...........-................... ..........................m._ ........ Individuals and/or families improve health (physwical/dental/mental). Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1, 2017, Consultant shall provide the approximate number of City of Kent clients with the following services each year of the CSA: Quarter Service Unit # of Units Cumulative Tota I .. 1st Unduplicated City of Kent clients served 15 15 Family Support (points of service) 125 125 2ntl Unduplicated City of Kent clients served 15 30 ..... _..... __ .._... ...... .... .,........ ....._. Family Support (points of service) 125 250 _.. .. .. ... — ........ ...... ..... 3r0 Unduplicated City of Kent clients served 15 45 Familv Support (points of service) 125 375 4`" Unduplicated City of Kent clients served 1115 60 Family Support (points of service) 125 500 ... ANNUAL South Kinq Council of Human Services Participation Yes/No Yes/No The above services shall be provided by December 31, 2017 for year one of the two-year agreement and December 31, 2018 for year two of the agreement. Contract Administration - The Consultant shall notify the City, in writing, within ten (10) days of any changes in program personnel or board membership. - The Consultant shall separately report the number of clients served who reside in the newly annexed Panther Lake area as detailed in the provided maps. - The Consultant shall provide the City with a current list of its board of directors, general or limited partners, as applicable. - The Consultant will hold active membership with the South King Council of Human Services htmtp (/skchs.nrg/ - All records related to this CSA must be retained for three (3) years plus the current year. EXHIBIT B INSURANCE REQUIREMENTS FOR HUMAN SERVICES GENERAL FUND AGREEMENTS Insurance The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Contractor shall obtain insurance of the types described below: 1. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The Commercial General Liability insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or modification of the Commercial General Liability insurance for liability arising from explosion, collapse or underground property damage. The City shall be named as an insured under the Contractor's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Automobile Liabilit insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. B. Minimum Amounts of Insurance Contractor shall maintain the following insurance limits: 1. Commercial General Liabilitv insurance shall be written with limits no less than $1,000,000 each occurrence, $1,000,000 general aggregate and a $1,000,000 products-completed operations aggregate limit. 2. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: EXHIBIT B (Continued) 1. The Contractor's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it. 2. The Contractor's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Contractor's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. E. Verification of Coverage Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. F. Subcontractors Contractor shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Contractor. ,y KENT_ Exhibit C PfiRNSi YPECREiITION 5 °~~„�111111I°E` City of Kent Certification Regarding Debarment and Suspension Agency Name of Pr rams Certification A: Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions 1. The prospective primary participant certifies to the best of its knowledge and belief that its principals; a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal debarment or agency; b) Have not within a three-year period preceding this proposal, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false statements, or receiving stolen property; c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and d) Have not within a three-year period preceding this application/ proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. 2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Instructions for Certification (A) 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to whom this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the 1 of 3 meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of these regulations. 6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. 7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines this eligibility of its principals. Each participant may, but is not required to, check the Non-procurement List. 9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 10. Except for transactions authorized under paragraph (6) of these instructions, if a participant in a covered transaction 11. Knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default. Certification B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Instructions for Certification (B) 1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available 2 of 3 remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this trans- action originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment. Executive Director (Print) Title Date Signature of Exe utive Director Title Date (3 Adopted from HUD Form-2992 09/04 3 of AC '� CERTIFICATE OF LIABILITY INSURANCE D06/30 02015 ) 06/30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-303-481-7821 NAME, T Edgewood Partners Insurance Center (EPIC) PHONE [Greenwood Village - Branch ID 153271 A,C,N-.^'"' MAU ,. .,. 6400 S Fiddlers Green Circle, Suite 1430 ADDRO$S --- -" - - INSURERISIAFFORDINGCOVERAGE NAIC4 Greenwood Village, CO 80111 INSURERA NAVIGATORS SPECIALTY INS CO �36056 INSURED INSURERS SENTINEL INS CO LTD 11000 MercyHousing, Inc. ". ,,, _ ......_._ ............._...... . . .... INSURER C. NAVIGATORS INS CO 42307 1999 Broadway, Suite 1000 INSURERD TRAVELERS PROP. CAS CO OF AMER 25674 ',INSURER E: Denver, CO 60202 INSURERF COVERAGES CERTIFICATE NUMBER: 44461324 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �"TY TYPE LIMITS TNSRI � IAPP4`suek _-- � �POLICV EFF' POLICY E%P LTR TYPE OF INSURANCE {ucn wnm POLICY NUMBER wwnnnrnl IMMIOOIYVYYI A X COMMERCIAL GENERAL LIABILITY CE15CGLO88750IC 07/01/15 07/01/16 EACH OCCURRENCE $ 1,000,000 BAMAGt$P}PEN NBC ..1 ,.__ ., CLAIMS MADE X I OCCUR PRCM4$[,$j_E0-9-01--mg $ 500 000 X $2.0,000 SIR MEOEXP IAny one Perann) 8 Excluded PERSONAL&ADVINJURY $ 1000000 GENL AGGREGATE GAT LIMIT APPLIES PER GENERAL AGGREGATE $ 2 000,000 POLICY D yJTi �X.. LOG PRODUCTS-COMPIOPAGG_ $ 2,000,000 QIP ERt J$ B AUTOMOBILE LIABILITY '57UENKW2211 07/01/15 07701/16 `COeMBIIINO4OWNDLE L NN 1 I$ 1,000,000 ANY AUTO BODILY INJURY IPBrpersen)ALL $ AUTOS OWNED SCHEDULED NONOOWNED `rldpILY�NJURV(NGEaco10en!] $- X YPIPMAdrF $ X HIRED AUTOS X AUTOS el°W.eL..,Ae4lh ............. -- $ C I UMBRELLA LIAD X IOCCUR SE15EXC756051IV 07/01/15 07/01/16 EACH OCC URR ENCE � $ 5,000,OD X EXCESS LAB AGGREGATE $ 5,000,000 CLAIMS MADE ,... .. __._ .. _._ DED RETENTIONS 0 $ WORKERS COMPENSATION D TRNB6AOfi418015 07/01/15 07/01/16 X S�nnrTP +� ANY EMPLOYERS'LIAOILITY - ' D OANY FFICE MEME RIPARTNERIEXECUTIVE YIN NIA TC20TIB 6AO6417915 07/01/15 07/01/16 EL EACH ACCIDENT J$ 1 000,000 OFFICER(MEMBER EXCLUDE07 (Mandawryin NH) EL DISEASE EA EMPLUYEf;�$ 1 0 0-0-1 000 IF yes,describe under 1,000 1000 DESCRIPTION QF OPERATIONS below I E L DISEASE POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Ramarka Schedule,may be att.ch.d l mare apace is required) RE: Appian Way Mercy, LLC - 25618 26th Place South, Kent, WA 98032. The City of Kent, its elected and/or appointed officials, its officers, agents, employees, Volunteers and representatives are listed as Additional Insureds, insofar as the work obligations and activities performed by the Owner/Developer and authorized by the City of Kent permit are concerned. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Development Engineering 220 4th Avenue South AUTHORIZED REPRESENTATIVE Kent„ WA 98032 A ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD LRydduck 44461324 9b DATE(MMIDofYYYV) "+ CERTIFICATE OF LIABILITY INSURANCE 07/01/201fi THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-303-481 7821 CONTACT NAME Edgewood Partners Insurance Center (EPIC) PHONE FAx [Greenwood Village - Branch ID 153271 .,u (303) 481-7821 ➢tmr ual.. (855) 228.-1425 '".G. . EVOPC NREPCerts@e 3chrokers.com 6400 S Fiddlers Green Circle, Suite 1430 E-MAIL h .... INSIRERISAFFORDING COVERAGE NAIL# Greenwood Village, CO 80111 INSURER A: NAVIGATORS SPECIALTY INS 11 36056 INSURED INSURER TRAVELERS PROP CAS CO OF AMER 25674 Mercy Housing, Inc. INSURER C NAVIGATORS INS..CO I42307 1999 Broadway, Suite 1000 INSURER D- INSURER E- J Denver, CO 80202 INSURERF COVERAGES CERTIFICATE NUMBER: 47319272 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ASIR AOBL 54YnIRr POLICY EFF POLICY EXP LTR TYPE OFINSURANCE en unrnV POLICY NUMBER IMMInr!yyyY1 fMMInnIVWYI LIMITS A X COMMERCIAL GENERAL LIABILITY 'CE16CGL088750IC 07/01/16 07/01/17 EACH OCCURRENCE $ 1,000,000 " ' 1 DAMAUE DO MEN FED CLAI MS MADE X„I OCCUR Pr EMI_c„[F_. ,,,, u1 _ $ 500,000 X $10,000 SIR MED EXP(Arry oua uarnon) $ Excluded PERSONAL LADVINJURY $ 1,000,000 GENLAGGREGArE HIMIrAPPLIES PER: GENERALAGOREGArE $ 2,000,000 POLICY� JEC7 X... HOC PRODUCTS-CON4/OPAGG $ 2,- -- 000 $ D AUTOMOBILE LIABILITY TS-CAP-9F33796-16 07/01/16 07/01/17 COMBINED SINGLE CIVIL § 1,000,000 Lr.s 11CC,rnFYIYu_ ..... ANY AUTO BODILY INJURY(Per persao).....$ .....— ALL OWNED X SCHEDULED BODILY INJURY(P recudaoq $ ADFOS AUTos . ...__ x... x NON.owNED _ PRJ7PrRrYnAMAcsc '..$ HIRED AUTOS AUTOS tr t aanso$Ny7IX.._ ........_._ $ C UMBRELLA LIAO X OCCUR SE16EXC7580511V 07/01/16 07/01/17 EACH OCCURRENCE $ 5,000,000 X EXCESS HAD CIAIMS-MADE- AGGRECArE $ 5,000,000 RED RFrFNrION$0 $ WORKERS COMPENSATION B TRJVB6AO6418016 07/01/16 07/01/17 XPEH OIH AND EMPLOYERS LIABILITY rI IFF FR B ANY PROPRIETOR/PARTNERIEXECUTIVE YIN TC20111 06417916 07/01/16 07/01/17 EL EACH ACGIDENr $ 1,000,000 OFFICERWEMBER EXCLUDED'! F!IJNIA - (MandatoryinNH) EL DISEASE EA EMPLOYEE; $ 1,000,000 byes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD I$1,Additional Remarks Schedule,maybe attached if more space is required) RE: Mercy Housing Northwest - 2505 Third Avenue, Suite 204, Seattle, WA 98121. With respect to Contractual obligations between parties. Coverage is primary and noncontributory. Certificate Holder is included as Additional Insured with respect to General Liability as required by written contract per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Services Manager 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Kent,, WA 98032 I „ USA I r ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD jacarter 47319272 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 07/01/2016 NAME OF INSURED: Mercy Housing, Inc. This page left intentionally blank. SUPP(10100) COMMERCIAL GENERAL LIABILITY POLICY NUMBER: CE13CGLO887501C CG 20 12 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Any State or Governmental Agency or Subdivision or Political Subdivision for whom during the policy period you and such person or organization have agreed in writing in a contract or agreement that such State or Governmental Agency or Subdivision or Political Subdivision be added as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to in- 2. This insurance does not apply to: clude as an insured any state or governmental a. "Bodily injury", "property damage" or "personal agency or subdivision or political subdivision shown in and advertising injury" arising out of operations the Schedule, subject to the following provisions: performed for the federal government, state or 1. This insurance applies only with respect to opera- municipality, or tions performed by you or on your behalf for which b. "Bodily injury" or "property damage" included the state or governmental agency or subdivision or within the "products-completed operations political subdivision has issued a permit or au- hazard". thorization. CG 20 12 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 AC--" 06/29 CERTIFICATE OF LIABILITY INSURANCE DATE M/2OYYYY) s/29/z01e III I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such andorssins s. PRODUCER 1.303-481--7821 CONTACT NAME: NFtEPCerte Edgewocd Partners Insurance Center (EPIC) PM'l)NE "' __ -- ---' _-- eeft (303 FAX 4MC Na ) 481-7821 .-.-,.- ljA1C,Nn1;.. (855) 228-1425 [Greenwood Village - trench ID 153271 EMAIL -- -- 1400 S Fiddlers Green Circle, Suite 1130 AUORBSIL NREPCeats@epiobrokers•com _ INSURERJS)AFFORDING COVERAGE _ NAICN Greenwood Village, CO 80111 INSURERA: FIRST SPECIALTY INS CORP 34916 INSURERS. TRAVELERS PROP CAS CO OF AMER 25679 Mercy Housing, Inc. INSURERC: NAVIGATORS INS CO 42307 -.... ....... ------ - -___,. 1999 Broadway, Suite 1000 INSURERD- INSURER E Denver, CO 80202 , .- .... . ....... .......—._ ___...... INSURER F COVERAGES CERTIFICATE NUMBER: 53291302 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH...__. . 111, ------ADbL BfyRR __._ .._.. ...._ .POLICY EFF POLICYEXP....... ..." LIMITS ......_. ____. LTA TYPE OF INSURANCE POI ICY sdiai IMMIDDIYYYYI IMMIDIIIYYYVI LIMITS ucn uvn A X COMMERCIAL GENERAL LIABILITY IRG200387801 07/01/18 07/01/19 EACHOCCURRENCE $ 1,000,000 CLAIMS MADE l X_-J OCCUR aaMm OFv(I-"llRENTED—Ten—m $ 500,000 X $10 000 SIR .,, .. ... ...-, MFO EXP I I one s an) $ Excluded PERSONALBADV INJURY $ 1,000,000 GFNLAG(IRFCWF LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,0001000 EXXACY .,,. PRCT O- g- JL LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OEI If.R: $ B AUTOMOBILE LIABILITY TCAP9P337796IND18 07/01/18 07/01/19 COMMINEDSINOLd LIMIT $ 1,000,000 4fY aLYaNJU .. ... ......,,,. __. X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY _ AUTOS ( -- HIRED NON SOWNED LY PROPEid—t) AGE AUTOS ONI V A1110S ONLY m n �� $ If C UMBRELLALIAB X I OCCUR SE18EXC758051IV 07/01/18 07/01/19 EACH OCCURRENCE t$ 5,000,000 X EXCESS LIAR J CLAIMS-MADE AGGREGATE is 5,000,000 OLD RE rFNTnMA ---- .........,IS B WORKERS COMPENSATION MIB6A06418018 07/01/18 07/01/19 X E4na TE ERH AND EMPLOYERS'LIABILITY YIN B ANYPROPRIETORIPARTNEWEXFCU FIVE TC2 JUB6AO6417918 07/01/18 07/01/19 EL EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDFD? N NIA - (Mandatory in NIT -"' EL DISEASE-EAEMPIOYEE. S 110001000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICVLIMIF $ 1,000,000 j -7 0 ESC RIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Sc lied die,may he attached If more space Is rep u l red) RE: Mercy Housing Northwest - 2505 Third Avenue, Suite 204, Seattle, WA 98121. With respect to Contractual obligations between parties. Coverage is primary and noncontributory. Certificate Holder is included as Additional Insured with respect to General Liability as required by written Contract per the terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Rent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Services Manager 220 Fourth Avenue South AUTHORIZED REPRESENTATIVE Rent„ WA 98032 USA ��� C� -�� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD khiggins 53291302 r.,�l� _ 0C5Z' SUPPLEMENT TO CERTIFICATE OF INSURANCE 06/DATE 29/2018 NAME OF INSURED: Mercy Housing, Inc. This page left intentionally blank. SUPP(10100)