HomeMy WebLinkAboutPK17-076 - Original - Jewish Family Services - Contract - 1/1/17 Records M e
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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: .newish Family Services
Vendor Number: 799,29
.ID Edwards Number
Contract Number: II _ �
This is assigned by City Clerk's Office
Project Name: Refugee and Immigrant Service Center
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment 0 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 Cuilfoyle Department: Parks
Contract Amount: 20 000
Approval Authority M Department Director F� Mayor El City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
Consultant shall administer the Refugee and Immigrant Services Center in Kent.
As of: 08/27/14
KEN T
w.a.. ..ora.
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Jewish Family Services
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Jewish Family Services organized under the laws of the State of Washington,
located and doing business at 1601 161h Ave, Seattle, WA 98122 (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 Refugee and Immigrant Service Center located in Kent that
provides an array of services including cultrual orientation, information and referral, pre-
employment services and training, job placement and retention. 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. This Agreement, however, is contingent upon the
availability of funds to be allcoated through the City's budget process.
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to exceed
$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. 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
($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. 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
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 ouitlines, 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. 1 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 wlli provide a written statement to
all new employees and subcontractors, indicating commitment as an equal opportunity
employer,
4. During the time of the Agreement 1, 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 cornplied with the requirements as set forth
above.
By signing below, I a to fulfill the five requirements referenced above.
By:
For:
j�_
Title:
Date;
EEO COMPLIANCE DOCUMENTS - I
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 amid prior
to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed
to have applied.
CONSULTANT: CITY O KENT:
By: By;
(sic nature) (signature)
Print Name -,,— Print Name: Julie Parascondola, CPRP
Its:- C11-7-D Its: Director, Parks, Recreation and
DATE: Community Services Department
................
DATE;._....
NOTICE TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Will Berkovitz Lori Guilfoyle
Jewish Family Services City of Kent
1601 16t'' Ave 220 Fourth Avenue South
Seattle, WA ,98122 Kent, WA 98032
206.461.3240 (telephone) (253) 856-5061 (telephone)
(facsimile
..... .......
P Vluman SemctslGeilwal 2017-1B
CONSULTANT SEPVICFS AGREEMENT 5
($20,000 of..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
WAs—morok Scope and Schedule of Work
PARKS. RECREATION s COMMUNITY SERVICES 9 2017-2018 Consultant Services Agreement
Agency: Jewish Family Service 2017 Funding: $10 000
Program: Refugee and Immigrant Service Centers 2018 Funding: 10 000
This funding Resettlement, ESL classes, pre-employment and
will provide: employment services for refugees and immigrants. Total: $20,000
Annual Program Outputs: Program Outcomes:
Unduplicated Kent Residents 16
Number of Job Placements 6 Individuals and/or families will have access to
Trainin /Worksho /Class Hours 60 services that increase self-sufficiency.
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
Total
1st Unduplicated City of Kent clients served 4 4
Number of Job Placements 1 1
Training/Workshop/Class Hours 15 15
2nd Unduplicated City of Kent clients served 4 8
Number of Job Placements 1 2
Training/Workshop/Class Hours 15 30
3rd Unduplicated City of Kent clients served 4 _ 12
Number of Job Placements 2 4
Training/Workshop/Class Hours 15 45
4th Unduplicated City of Kent clients served_ 4 16
Number of Job Placements 2 6
Training/Workshop/Class Hours 15 60
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
http://skchs.org/
- All records related to this CSA must be retained for three (3) years plus the current year.
Exhibit A (continued)
• Scope and Schedule of Work
KENT
W 0, 2017-20,18 Consultant Services Agreement
P. RK5, RECJaEATrjo,4 a
COMMUNITY SERVICES
enc : Jewish Family Service 2017 Funding: 0,000
Program: Refugee and Immigrant Service Center __..._. 2018 IFrund'ir>i9: ...._..
This funding Resettlement, ESL classes, pre-employment and
will provide:: employment services for refugees and immigrants, Total: $20,000
Reporting Requirements and Timeline
All data and required farms shall be submitted through SharelApp:
htt sharela .culture rants,or index to in
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 agenicy/program, It shall be submitted quarterly, no later than the 15th of the month
following the end of the quarter (i.e. April 15, July 15, Oct 15, Dec 15), unless otherwise specified.
Demographic hic 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 SharelAp'p (by January 1.5).
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,
. _. .._.._. .. __ ...... ..._..._._..�.�-
_Re ort Due Date
Service Unit Report and Reimbursement Request 1.5"' day following each quarter
Final Reimbursement wRequest (4"' Qtr) December 15" 2017/December 15", 2018
Demographic Data Report January w151r', 2018/:January 15`', 2019
Annual Outcome Data Report January 15'r', 2018/January 15"', 2019
Signature
Please sign below to indicate acceptance of the Year 2017 and Year 2018 Performance pleasures listed
above. d
Will B rkovitz, Jev i fi n ily Services CEO Date
me
0n1 Hama a rvice_ "-" ___.�...w_....�_... ...___ ��..�_� .__.:... .....m...._._.__ ._.... . . -__..._.....
s Manager Date
OP ID:5R
�44.�R� CERTIFIkoATE OF LIABILITY INSURP-wNCE D 0z161zo 1161201 6
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 endorsemen s.
CONTACT
PRODUCER NAME:
Sprague Israel Giles PHONE FAX
1601 Fourth Avenue,Suite 730 c No Exl: arc No
Seattle,WA 98101-3225 ADDRESS:
Robert Karl PROD ER JEWIS-1
CUSTOME D#:
INSURERS AFFORDING COVERAGE NAIC# _
INSURED Jewish Family Service INSURER A:Philadelphia Indemnity Ins. 18058
Seattle Association for Jews INSURER B
with Disabilities
INSURER C
Home Care Associates
1601 16th Ave INSURER D:
Seattle,WA 98122-4000 INSURER E:
INSURER F
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 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. —
BR POLICY EFF POLICY EXP
I SI TYPE OF INSURANCEIbI POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
DAMAGE TO RENTFff___
A X COMMERCIAL GENERAL LIABILITY X PHPK1456111 0211812016 02118l2017 PREMISES Ea occurrence $ 100,00
CLAIMS-MADE F_XI OCCUR I MED EXP(Any one person) $ 5,00
PERSONAL&ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 2,000,00
POLICY PRO-JECI LOC I i $
AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ 1,000,00
(Ea accident)
A X ANY AUTO BODILY INJURY(Per person) $
_ ALL OWNED AUTOS I BODILY INJURY(Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS PHPK1456111 0211812016 02/1812017 (PER ACCIDENT) $
X NON-OWNED AUTOS (Comp Ded $ 50
Coll Ded $ 1,00
UMBRELLALIAB OCCUR I EACH OCCURRENCE $
FJ(C EBB LIAB _ I �CLAIMS-MADE I AGGREGATE
i r------ ----f$
DEDUCTIBLE I L--
RETENTION $ $
WORKERS COMPENSATION I we STIT T X OTH-
AND EMPLOYERS'LIABILITY
A ANY PROPRIETORIPARTNERIEXECUTIVE Y[ N 1 A PHPK1456111 i 02/1812016 02118/2017 E.L.EACH ACCIDENT $ 1,000,00
OFFICERIMEMBEREXCLUDED? WA STOP GAP I E.L.DISEASE-EA EMPLOYEE $ 1,000,00
(Mandatory in NH)
[f yes,describe under E L.DISEASE-POLICY LIMIT $ 1,000,00
DESCRIPTION OF OPERATIONS below
I
I
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space Is required)
City of Kent, Housing & Human Services, Parks, Recreation & Community
Services are additional insured with respects liability arising out of
operations by or on behalf of the named insured for General Liability per
CO2026 attached, 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 BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Kent
Housing &Human Services AUTHORIZED REPRESENTATIVE
220 Fourth Avenue
Kent,WA 98032 14. xJ
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: PHPK1456111 COMMERCIAL GENERAL LIABILITY
CG 20 26 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)Or Organization(s):
City of Kent
Housing &Human Services
Information required to complete this Schedule if not shown above,will be shown in the Declarations.
A. Section tl — Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the following is added to
organization(s) shown in the Schedule, but only Section III—Limits Of Insurance:
with respect to liability for"bodily injury", "property If coverage provided to the additional insured is
damage" or "personal and advertising injury" required by a contract or agreement, the most we
caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the
omissions or the acts or omissions of those acting amount of insurance:
on your behalf:
1. Required by the contract or agreement; or
1. In the performance of your ongoing operations;
or 2. Available under the applicable Limits of
Insurance shown in the Declarations;
2. In connection with your premises owned by or
rented to you. whichever is less.
However: This endorsement shall not increase the
applicable Limits of Insurance shown in the
1. The insurance afforded to such additional Declarations.
insured only applies to the extent permitted by
law:and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 26 0413 0 Insurance Services Office, Inc.,2012 Page 1 of 1
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 it 85. There shall
be no endorsement or modification of the Commercial General Liability
insurance for liability arising from explosion, collapse or underground
property damage. The City shall be named as an insured under the
Contractor's Commercial General Liability insurance policy with respect to the
work performed for the City using ISO additional insured endorsement CG 20
10 11 85 or a substitute endorsement providing equivalent coverage.
2. Automobile Liability insurance covering all owned, non-owned, hired and
leased vehicles. Coverage shall be written on Insurance Services Office (ISO)
form CA 00 01 or a substitute form providing equivalent liability coverage. If
necessary, the policy shall be endorsed to provide contractual liability
coverage.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Commercial General Liability insurance shall be written with limits no less
than $1,000,000 each occurrence, $1,000,000 general aggregate and a
$1,000,000 products-completed operations aggregate limit.
2. Automobile Liability insurance with a minimum combined single limit for
bodily injury and property damage of $1,000,000 per accident.
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability insurance:
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.
KENT Exhibit C
......,
PARKS. RECREATION .l
CoM.UNI SERVICES City of Kent
Certification Regarding Debarment and Suspension
A nc M s
Y NNaeQf Pro 9 ram( )
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
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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
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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 certfficat|on was erroneous when submitted or has become
erroneous by reason ofchanged circumstances,
4. The terms covered transaction, debarred, suspended, ineligible, lower tier
cowered transaction/ participant, person, primary covered transaction,
principal, proposal, and voluntarily excluded, as used in this clause, have the
meanings set out )n 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 o 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.
G. The Prospective lower tier participant further agrees by submitting this proposal that
it will include this clause tided "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 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 iserroneous' 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 Nonprocurernent List.
8. Nothing contained in the foregoing shall be construed to require establishment of
system of records in order to render in good faith the certification required by this
clause. The knowledge and information of parUcipamt |s not required to exceed that
which is normally possessed by prudent person in the ordinary course of business
dealings.
g. Except for transactions authorized under paragraph (5) of these imstrucboms, if a
participant in a lower covered transaction knowingly enters into lower tier covered
transaction with a person who is smspemded, debarred, ineligible, or voluntarily
,excluded from participation in this transaction, in addition to other remedies ova||oWe
to the Federal Governrneni/Oty of Kent, the department or agency with which this
transaction originated may pursue ava�i|mNe remedies including suspension and/or
debarment.
Executi e or- (Print) Title Date
Signature tive Director Title Date
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Adopted from vuoerm~2eoz
09/04
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