HomeMy WebLinkAboutPK17-366 - Original - Coalition for Refugees from Burma - Refugee & Immigrant Youth Advisory Council - 01/01/2017 Records M erne'n- ,
KENT
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771
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: Coalition for Refugees from Burma
Vendor Number: 1380408
JD Edwards Number
Contract Number: - 3ULP
This is assigned by City Clerk's Office
Project Name: Refugee & Immigrant youth Advisory Council
Description: ❑ Interlocal Agreement ❑ Change Order n Amendment M Contract
Other:
Contract Effective Date: 1/1/17 Termination bate: 1 /31/18
Contract Renewal Notice (Days): 30 days
Number of days required notice for termination or renewal or amendment
Contract Manager: Dinah Wilson Department: Parks-Human Services
Contract Amount: $10,000
Approval Authority: (CIRCLE ONE) IDepartment Directod Mayor City Council
Detail: (i.e. address, location, parcel number, tax id, etc,):
This is a General fund small grants contract...... Funding provided to increase civic
-------------
engagement and leadership development for youth.
tp 34/7/15
•
KENT
W♦.3.11HO.O.
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Coalition for Refugees from Burma
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Coalition for Refugees from Burma, organized under the laws of the State
of Washington, located and doing business at 1265 Main Street, Suite #309, Seattle, WA 98144
(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 provide support to plan and implement a Refugee & Immigrant Youth
Advisory Council, which will include at least 14 Kent residents. The following exhibits are
attached and incorporated by this reference as if fully set forth herein: Exhibit A, Project
Scope of Services; Exhibit B, Income Guidelines; Exhibit C, Billing Voucher and Service
Report; Exhibit D, Kent Annual Outcome Report; Exhibit E, Insurance Requirements; and
Exhibit F Certification Regarding Debarment and Suspension,
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
$10,000 ($5,000 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.
CONSULTANT SERVICES AGREEMENT - 1
($20,000 or Less)
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in
accordance with Ch. 51.08 RCW, the parties make the following representations:
A. The Consultant has the ability to control and direct the performance and details of its
work, the City being interested only in the results obtained under this Agreement.
B. The Consultant maintains and pays for its own place of business from which
Consultant's services under this Agreement will be performed.
C. The Consultant has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained Consultant's services, or the Consultant is engaged in an independently
established trade, occupation, profession, or business of the same nature as that
involved under this Agreement.
D. The Consultant is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
E. The Consultant has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by Consultant's
business, and has obtained a Unified Business Identifier (UBI) number from the
State of Washington.
F. The Consultant maintains a set of books dedicated to the expenses and earnings of
its business.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party thirty (30) days written notice at its address set forth on the signature block of
this Agreement. After termination, the City may take possession of all records and data within the
Consultant's possession pertaining to this project, which may be used by the City without restriction. If
the City's use of Consultant's records or data is not related to this project, it shall be without liability or
legal exposure to the Consultant.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the
Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation,
national origin, or the presence of any sensory, mental, or physical disability, discriminate against any
person who is qualified and available to perform the work to which the employment relates. Consultant
shall execute the attached City of Kent Equal Employment 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 duty to defend, indemnify, and hold the City
CONSULTANT SERVICES AGREEMENT - 2
($20,000 or Less)
harmless, and Consultant's liability accruing from that obligation shall be only to the extent of the
Consultant's negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION
PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL
INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES
FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER.
In the event Consultant refuses tender of defense in any suit or any claim, if that tender was made
pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having
jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant's part, then
Consultant shall pay all the City's costs for defense, including all reasonable expert witness fees and
reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful
refusal on the Consultant's part.
The provisions of this section shall survive the expiration or termination of this Agreement.
VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit E 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.
CONSULTANT SERVICES AGREEMENT - 3
($20,000 or Less)
C. Resolution of Disputes and Governing Law, This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any
dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means
of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules
and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in
writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the
parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred
in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or
award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's
right to indemnification under Section VII of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the parties at
the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written
notice hereunder shall become effective three (3) business days after the date of mailing by registered or
certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this
Agreement or such other address as may be hereafter specified in writing.
E. Assignment. Any assignment of this Agreement by either party without the written consent
of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment,
the terms of this Agreement shall continue in full force and effect and no further assignment shall be
made without additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of the City
and Consultant.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or 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 Reguired. Prior to commencing the tasks described in Section I,
Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of
the Kent City Code.
K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any
number of counterparts, each of which shall constitute an original, and all of which will together constitute
this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page
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.
CONSULTANT SERVICES AGREEMENT - 4
($20,000 or Less)
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: LL CITY OF KENT:
I" `''� ��wk
By: ` ' By:
(signature) (signature)
` P i ame: Julie Parascondoia, CPRP
Print Name: �'d �' `� Its: Director, Parks, Recreation and
Its: C."�I'WAXV V-" (,I L) Community Services Department
(title) /
DATE: �' ' �1 DATE:
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Mona Han, Executive Director Dinah R. Wilson
Coalition for Refugees from Burma City of Kent
1265 Main Street, Suite #309 220 Fourth Avenue South
Seattle, WA 98144 Kent, WA 98032
206.860.5939 (telephone)
253.856.5076 (telephone)
253. 856-6070 facsimile
P:Human Services 2017-2018 Parallel Application Contracts
CONSULTANT SERVICES AGREEMENT - 5
($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, I agree to fulfill the five requirements referenced above.
Nw Ai A `t A ri
By:
'Ok
For`'�n� �u � drGeS �7Q.!'Gt�e( {1��c'CaiL C�Jz=rn�
Title: CxFcu rive: Nzac-CoR
Date: 5-. 11 • P-o(:t-
EEO COMPLIANCE DOCUMENTS - 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee
equal employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS - 2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as that was entered into on
the (date) between the firm I represent and the City of
Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City
of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity
Policy that was part of the before-mentioned Agreement.
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3
•
KENT
W A S N I N O T O N
PARKS. RECREATION S
COMMUNITY SERVICES
EXHIBIT A
2017-2018 CONSULTANT SERVICES AGREEMENT
PROJECT SCOPE OF SERVICES
PARALLEL HUMAN SERVICES SMALL FUND GRANT
COALITION FOR REFUGEES FROM BURMA
Consultant/Consultant: Coalition for Refugees from Start Date: 3/1/17
Burma
Project Title: Refugee & Immigrant Youth Advisory End Date: 12/31/18
Council
Funding will provide Program Outcome: Project 2017 $5,000
support to plan and will increase civic Funding:
implement a Refugee & engagement and leadership 2018 $5,000
Immigrant Youth Advisory development for youth. Funding
Council, which will include at Outcomes will be measured Total City $10,000
least 14 Kent residents. through a pre and post-test, of Kent
with annual results provided Funds:
to the City via Exhibit D.
Project Manager: Siobhan Whalen
Telephone: 978-302-5156 cell E-mail: swhalen@allburmarefugees.org
City Contact Manager: Dinah Wilson
Telephone: 253.856.5076 Fax: 253.856.6070 E-mail: drwilson@kentwa.gov
Coalition for Refugees from Burma (hereinafter referred to as "the
Consultant") shall utilize City of Kent Human Services Funds (GF budget) to
perform the activities specified below. Such services shall be provided in a manner
which fully complies with all applicable federal, state and local laws, statutes, rules
and regulations, as are now in effect or may be hereafter amended.
1) Project Budget
The Consultant shall apply the following funds to the project in accordance with the
Biennium Line Item Budget Summary below:
Line Item Budget
Personnel Services 10 000.00 (biannually)
Total City of Kent Funds: 10 000.00
2017-2018 CRB Consultant Services Agreement Scope of Services
Page 1
2) Performance Measures
A. Number Served
The Consultant agrees to serve, at minimum, the following unduplicated number of
persons each year of the Consultant Services Agreement:
Quarters 1st Znd 3rd 4th
Quarter Quarter Quarter Quarter Total
3AN. - APRIL - 3ULY - OCT. — Per
MARCH 3UNE SEPT. DEC. year
No. of unduplicated
persons assisted 3 1 4 1 3 14 14
B. Units of Service
The Consultant agrees to provide, at minimum, the following units of service by
quarter:
Quarters 1st Znd 3rd 4th
Quarter Quarter Quarter Quarter Total
3AN. - APRIL - 3ULY - OCT. — Per
MARCH 3UNE SEPT. DEC. year
Youth leadership
meetings (#of meetings) 1 5 5 5 16
C. Definition of Services
Youth leadership meetings are defined as one to two hour sessions where youth
discuss and are provided guidance and training on issues such as Advisory Council
governance, strategic planning, civic engagement, policy development, how to
influence government, youth engagement, etc.
3) Records
A. Project Files
The Consultant shall maintain files for this project containing the following items:
1. Notice of Grant Award.
2. Consultant Services Agreement and all contract exhibits.
3. A copy of this Scope.
4. Correspondence regarding budget revision requests.
5. Copies of all reports submitted to the City for this project.
6. Billing vouchers submitted for payment.
7. Client Intake Form.
2017-2018 CRB Consultant Services Agreement Scope of Services
Page 2
8. Documentation of client income. The Consultant shall screen all clients
served with funds provided under this Contract to ensure that at least
51% of the total number of clients served do not have a gross annual
family income in excess of the limits specified in Exhibit B.
Adjusted gross income as defined by the Internal Revenue Service Form
1040 shall be used to determine persons' or households' income. The
following methods may be used to determine income eligibility:
a) Confirmation of participation in the free/reduced price meals
program;
b) IRS income tax return;
c) Paystubs; or
d) Documentation of qualification for participation in a "means-
tested" federal or state program at least as restrictive as Federal
Income Program Guidelines.
Income guidelines may be adjusted periodically by the federal
government. The Consultant agrees to use updated Income Guidelines,
which will be provided by the City.
B. Record Retention Period
All records required by this Scope and the Consultant Services Agreement shall
be retained by the Consultant in an accessible file for a period of three (3) years
from the end of the term of this Agreement.
4) Contract Administration
A. Changes in Personnel or Board Membership
The Consultant shall notify the City, in writing, within ten (10) days of any changes
in program personnel or board membership.
The Consultant shall provide the City with a current list of its board of directors,
general or limited partners, as applicable.
B. Attendance at Kent Cultural Diversity Initiative Group Meetings
Unless excused by the City, the Consultant will attend a minimum of three (3) Kent
Cultural Diversity Initiative Group meetings in 2017 and five (5) in 2018.
C. Meetings between the Consultant and City of Kent
The Consultant shall meet with City staff and other organizations receiving Parallel
Human Services Small Fund Grant funds up to three times over the next two years
(2017-2018).
2017-2018 CRIB Consultant Services Agreement Scope of Services
Page 3
5) Reports, Invoicing and Reporting Schedule
A. Reports
1. All data and required forms shall be submitted to: drwilson@kentwa,.g_pv
,2. Billing Voucher and Service Report - Data from this form will be used to track
each program's progress toward meeting the goals stipulated in the Scope of
Services. 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.
3. Annual Outcome Data Report - Outcome data shall be submitted 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 Services.
B. Invoicing and Reporting Schedule
The Consultant shall submit Billing Vouchers and Service Reports to the City in
accordance with the following schedule:
1st 2 nd & 3rd Quarter Billing Voucher 151" day following each quarter
& Service Report (Exhibit C)
4 1h Quarter Billing Voucher & Service December 15thl
Report
Annual Outcome Data Report January 15, 2018
(Exhibit D)
2017-2018 CRB Consultant Services Agreement Scope of Services
Page 4
EXHIBIT B
INCOME GUIDELINES
Effective 4/14/17
Median Family Income = $9+6„000
*Median Sty% 800/0
MEDIAN MEDIAN
FAMILY EXTREMELY VERY LOW
SIZE LOW LOW INCOME
INCOME INCOME
1 $20,200 $33,600 $50,400
2 $23,050 $38,400 $57,600
3 $25,950 $43,200 $64,800
4 $28,8001 $48,000 $72,000
5 $31,150 $51,850 $77,800
6 $33,450 $55,700 $83,550
7 $37,140 $59,550 $89,300
8 $41,320 $63,400 $95,050
*The FY 2014 Consolidated Appropriations Act changed the definition
of extremely low-income to be the greater of 30/501h (60%) of the
Section 8 very low-income limit or the poverty guideline as established
by the Department of Health and Human Services (HHS), provided
that this amount is not greater than the Section 8 50%, very low-
income limit. Consequently, the extremely low-income limits may
equal the very low (50%) income limits.
Income Limit areas are based on FY 2017 Fair Market Rent (FMR)
areas.
KENT Exhibit C
WAS"'IN*I C N
Billing Voucher& Service Report
PARKS, RECREATION & 2017
COMMUNITY SERVICES
To: Consultant/Agency: Coalition for Refugees from
Dinah Wilson Burma
Housing & Human Services
Parks,, Recreation & Community Services Program Contact: Siobhan Whalen
220 4h Ave. South, Kent, WA 98032 Telephone: 978-302-5156 (cell)
drwilson@kentwa.gov
Phone: (253) 856-5076 1 E-mail: swhalen@allburmarefugees.org
Reporting Period Program Amount Requested
Qtr. Refugee & Immigrant Youth Advisory Council $
SEC. 1: BUDGET SUMMARY (CALCULATIONS BASED ON YEARLY BUDGET)
For Department Use Only Total Contract Amount $ 10,000.00
Total 2017 Contract Amount $ 5,000.00
Amount Requested This Qtr. $
Amount Requested YTD $
Amount Remaining YTD
(subtract amount requested
YTD from 2017 contract
amount)
SEC. 2: 2017 LINE ITEM BUDGET SUMMARY (ANNUAL)
ORIGINAL TOTAL REVISED CUMULATIVE
COST CATEGORIES BUDGET REQUESTED BUDGET TO DATE
1 Personnel Costs
(Attach Time Sheets) $5,000.00
GRAND TOTAL
$5,000,00
Page 1 of 6
SEC. 3: ANNUAL PERFORMANCE MEASURES -2017 KENT FUNDED SERVICE UNITS
Note: Unduplicated client counts must be reported bath quarterly and year-to-date
Service Unit®escripitibri Clontracted to Total Clients Actually Year to
Serve Contracted Served date Total
Service Unit/Performance � nd rd cn Total
Measure 1 2 3 Contracted to 1 st 2nd 3rd 4th
Serve
Uinduplicated # of Kent clients
(persons) served 3 4 1 3 4 14
"Youth leadership meetings
(# of meetings)
1 5 5 5 16
Sec. 4: NARRATIVE
Provide a quarterly program narrative, including an explanation if you are behind in either progress
toward meeting performance measures or projected expenditure rate.
Page 2 of 6
Sec. 5; DEMOGRAPHIC INFORMATION
Number of Households or Persons Assisted (please specify"H" or"P"; most agencies should, report persons):
Race Unduplicated Ethnicit - Ur rid lhtfuplicated
Quarter Unduplicated 'Year to YeartoDate
(All) Quarter(Hispan,le) Date (Hi oink)
Ally'*
1 2 3 4 1 2 3 4
White
Black/African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native AND White
Asian AND White
Black/African American AND White
American Indian/Alaska Native AND
Black/African American
Other Multi-Racial
GRAND TOTAL CLIENTS
*Of the total number served this quarter, how many, if any, were Hispanic? For example, an individual may identify as
White racially and report that he/she is of Hispanic descent.
**Total should be same number served each quarter
Incon�e'Level Unduplicated Quarter Undupllicated Year
to,Date
1 2 3 4
Extremely ILow Income 0-30% of MFI
Low Income 31-50% of MFI
Moderate Income 51-80% of MFI
Above Moderate Income 81% + of MFI
GRAND TOTAL CLIENTS
Page 3 of 6
'Uhd'O i6ated"aparterAge
UnduplAcatdcl Yeas
fd Lea
1 '2 3
U -4 years
5 - 12years
1'3 - 17 years
18 - 34 years
35 - 54 years
55 - 74 years
75+ years
Unknown
GRAND TOTAL CLIENTS
Gender Unduplicated Quarter Unduplicated Year
'to Date
1 2 3 4
Female
Male
GRAND TOTAL CLIENTS
Female Qnddpliceted k artei Und�uplieated,Year
to Date
ti 2 3 4
GRAND TOTAL CLIENTS
Persons with bisabitaties, Unduplicated 0ivarter' Unduiplicateld;Year
to bate
2, 3 4
GRAND TOTAL CLIENTS
Page 4 of 6
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete,
and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives
set forth in the terms and conditions of the Kent human services grant. I am aware that any false,
fictitious, or fraudulent information, or the omission of any material fact, may subject me to
criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise.
Consultant Authorized Signature Date
,,Poyfnent Aluthprization this secilon to be can pl6ted by City of KiDnt,onily)
Contractual Obligatio'ns Met?
YES NO (Circle one
Enter notes if Agency underperformed:
Authorized
By: Date:
Page 5 of 6
Instructions
Refer to:Accomplishments by Performance Measures in your Consultant Services Agreement.
Sec. 1: BUDGET SUMMARY
Enter the amount requested this quarter. Year to Date(YTD) and the budget balance.
SEC.2: LINE ITEM BUDGET SUMMARY
Enter the amount requested by budget line item quarterly and YTD.
SEC.3: PERFORMANCE MEASURES
Unduplicated Count of Households/Persons Assisted
Projections:Circle either persons or households according to the method of counting clients specified in your Consultant Services
Scope. Insert the projected number of clients to be served as specified in your Consultant Services Scope.
Achievements: Insert the unduplicated number of clients served during the reporting period. Unduplicated number means that a
person or a household served by your agency may be counted only once during the calendar year. You may report only those persons
or households for which you maintain written records.This record must be established at the time the person or household is first
served by your agency.
Year to Date: Insert the total unduplicated number of clients served to date.
Service Units
Insert the service unit measures specified in your Consultant Services Scope. Insert the projected number of service units for the
reporting period. Insert the actual number of service units provided during the Reporting Period.The actual number of service units
provided may be duplicated counts. Duplicated means that a client served by your agency may receive service one or more times
during the calendar year in one or more of the service unit categories.
SEC.4: NARRATIVE EXPLANATION
You must provide a narrative explanation if your agency is behind in meeting either performance measures specified in your Consultant
Services Scope or your expenditure rate.Your expenditure rate should equal approximately one quarter of your HHS contract amount
per quarter.
SEC. 5: DEMOGRAPHIC INFORMATION
Race:You are required to collect racial and ethnic information for the clients served.There are 10 race categories to select from. Each
client should select one of these categories. Clients identifying themselves as
Hispanic also need to select from the race categories.
Example:A client selects Hispanic as his ethnicity and white as his race.The grand total in the first column will not match the grand
total in the second column. You may only have a few clients who identify as Hispanic.
Female Head of Household: Insert the unduplicated number of single female head of households with dependents served during the
reporting period.
Income Only-All Projects require income screening: Insert the unduplicated clients served who are Low Income(51 —80%), Very
Low-income(31-50%)and Extremely Low-income(0-30%).
Persons with Disabilities:The ADA defines a person with a disability as a person who has a physical or mental impairment that substantially limits one or more
major life activity.This includes people who have a record of impairment,even if they do not currently have a disability.It also includes individuals who do not have a
disability but are regarded as having a disability.The ADA also makes it unlawful to discriminate against a person based on that person's association with a person
with a disability.
Page 6 of 6
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ATTACHMENT E
COALITION FOR REFUGEES FROM BURMA
INSURANCE REQUIREMENTS FOR
2017-2018 CONSULTANT SERVICES AGREEMENT
Insurance
The Contractor shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which
may arise from or in connection with the performance of the work hereunder
by the Contractor, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Commercial General Liability insurance shall be written on ISO
occurrence form CG 00 01 and shall cover liability arising from
premises, operations, independent contractors, products-completed
operations, personal injury and advertising injury, and liability
assumed under an insured contract. The Commercial General Liability
insurance shall be endorsed to provide the Aggregate Per Project
Endorsement ISO form CG 25 03 1185. 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.
EXHIBIT E (Continued )
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability
insurance:
1. The 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 AWII.
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.
POLICY CHANGE DOCUMENT
POLICY NO.: PHPK1578380
Philadelphia Indemnity Insurance Companyl 26262 DML Insurance Services, Inc.
NAMED INSURED Coalition for Refugees from Burma
MAILING ADDRESS 1265 S Main St Ste 309
Seattle, WA 98144-2010
POLICY PERIOD: FROM 01/01/2017 TO 01/01/2018 at
12:01 A.M. Standard Time at your mailing address shown above.
CHANGE EFFECTIVE 03/20/2017 CHANGE # 1 REVISION # 1
DESCRIPTION
In consideration of the premium reflected, the policy is amended as indicated below:
Added:
Additional Insured
RE:
City of Kent
Per the attached schedules
Path ID 10591629
Total Annual Total Prorate
Additional/Return Premium$ 0.00 Additional/Return Premium$ 0.00
NO CHANGE NO CHANGE
COUNTERSIGNED BY
(Date) (Authorized Representative)
04/04/2017
Issue Date Insurance Policy Page 1 of 1
Philadelphia Indemnity Insurance Company
Additional Insured Schedule
Policy Number: PHPK1578380
Additional Insured
City of Kent
220 Fourth Ave S
Kent, WA 98032-5838
CG2026 - General Liability
Named Insured receives small grant from City of Kent
Page 1 of 1
POLICY NUMBER: PHPK157B3B0 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
Information required to complete this Schedule, if not shown above,will be shown in the Declarations.
A. Section II — 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. In the performance of your ongoing operations; 1. Required by the contract or agreement; or
or 2. Available under the applicable Limits of
2. In connection with your premises owned by or Insurance shown in the Declarations;
rented to you. whichever is less.
However: This endorsement shall not increase the
1. The insurance afforded to such additional applicable Limits of Insurance shown in the
insured only applies to the extent permitted by Declarations.
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 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1
ls� •
KENT Exhibit F
PARKS, RECREATION S
COMMUNITY SERVICES City of Kent
Certification Regarding Debarment and Suspension
Coalition for Refugees from Burma Refugee & Immigrant Youth Advisory Council
Agency Name of Program(s)
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
II.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 certification was erroneous when Submitted or has becorne
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 al!l lower tier covered transactions and i:n 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 (Print)
Mona T. Han Executive Director
Signature of Executive Director Date
'o7 1�� 4/24/17
Adopted from HUD Form-2992
09104
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