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HomeMy WebLinkAboutPK17-399 - Original - Sikh Society in Care of Humanity - Contract - 1/1/17 4^60�'a ge 0 R c 0-� r d s `r „/ V✓XSMYMGTQN Document I I CONTRACT' COVER SHEET This is to be completed by the Contract Manager prior to submission to the City Clerk's Office. All portions are to be completed. If you have questions, please contact the City Clerk's Office at 253-856-5725. Vendor Name: Sikh Society in Care of Humanity Vendor Number: 1557350 JD Edwards Number Contract Number: �l ' ` This is assigned by City Clerk's Office Project Name: Learn! Integrate! Know! Engage! Description: ❑ Tnterlocal Agreement ❑ Change Order ❑ Amendment 0 Contract © Other: Contract Effective Date: 01/01/2017 Termination Date: 12/31/2018 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Dinah Wilson Department: Parks Human Services Contract Amount: $7,000 Approval Authority: E] Director E] Mayor Fj City Council Meeting Date ® Division Manager Detail: (i.e. address, location, parcel number, tax id, etc.)!: \,.74 eo�,**• KENT CONSULTANT SERVICES AGREEMENT between the City of Kent and Sikh Society in Care of Humanity THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Sikh Society in Care of Humanity organized under the laws of the State of Washington, located and doing business at 13272 SE 2271h Place, Kent, WA 98042 (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 workshops to educate Sikh/Punjabi community about civil rights, civic engagement, strategies to increase integration into the wider community, etc. The following exhibits are attached and incorporated by this reference as if fully set forth herein; Exhibit A, Project Scope of Services; Exhibit S, Billing Voucher and Service Report; Exhibit C, Kent Annual Outcome Report; and Exhibit E, 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 $7,000 ($3,500 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 I I 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. Insurance is not required for this Agreement (See Exhibit D). 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 CONSULTANT SERVICES AGREEMENT- 3 ($20,000 or Less) 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 Ack. The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or possessed by the City of Kent. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. J. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page 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) 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 DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By: For: Title: Date: g-1 k EEO COMPLIANCE DOCUMENTS - 1 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: CITY OF KENT: By: By:L AZ (Signature) (signa re Print Name: Merina Hans n Print Name: NlwapLel_��- '�n _12 (.�_V)Q� Its: Housing & Human Services Manager Its: Parks Department, (title) Housing & Human Services Division DATE:—... DATE: ­T -7 NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Amarjit Singh, Board President Dinah R. Wilson Sikh SOCH City of Kent P.0, Box 59480 220 Fourth Avenue South Renton, WA 98058 Kent, WA 98032 206.778.4021 (telephone) 253.856.5076 (telephone) 251 856-6070 (facsimile) Pi II um an Serwlce,;2017-2018 P a NRLI A rip I Ica tIon Contracts CONSULTANT SERVICES AGREEMENT 5 ($20,000 or Less) 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 . oc'k Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as _ �S(� that was entered into on the 0-1�( 31'Zoti"7 (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: Sikh So(,H Title: Dil2c-'or' Date: G•,If &/-��-� i EEO COMPLIANCE DOCUMENTS - 3 • KENT WASNINOTON PARKS. RECREATION & COMMUNITY SERVICES EXHIBIT A 2017-2018 CONSULTANT SERVICES AGREEMENT PROJECT SCOPE OF SERVICES PARALLEL HUMAN SERVICES SMALL FUND GRANT SIKH SOCIETY IN CARE OF HUMANITY (SIKH SOCH) Consultant/Consultant: Sikh Soch Start Date: 1/1/17 Project Title: Learn! Integra e! Know! Engage! LIKE End Date: 12/31/18 Funding will provide Program Outcome: 2017 $3,500 workshops to educate Sikh/Punjabi community will Funding: Sikh/Punjabi community increase civic engagement, 2018 $3,500 about civil rights, civic knowledge of rights, and Funding engagement, strategies to community integration. Total City $7,000 increase integration into the Outcomes will be measured of Kent wider community, etc. through surveys rating the Funds: workshops, with annual results provided to the City via Exhibit C. Project Manager: Satwinder Kaur Telephone: 206 371-4416 E-mail: satwinderkl29@gmail.com City Contact Manager: Dinah Wilson Telephone: 253.856.5076 Fax: 253.856.6070 E-mail: drwilson@kentwa.gov Sikh Society In Care Of Humanity (SIKH SOCH) (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: 2017-2018 Sikh SOCH Consultant Services Agreement Scope of Services Page 1 Line Item Budget Workshop Costs $2,000.00 (biannually) Consultant Services $1,000.00 (biannually) Communications 500.00 (biannually) Total City of Kent Funds: $3,500.00 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 ist 2nd 3rd 4th Quarter Quarter Quarter Quarter Total JAN. — APRIL — JULY — OCT. — Per MARCH JUNE SEPT. DEC. year No. of unduplicated 85 Persons assisted 0 30 25 30 B. Units of Service The Consultant agrees to provide, at minimum, the following units of service by quarter: Quarters in 2nd 3rd 4th Quarter Quarter Quarter Quarter Total JAN. — APRIL — JULY — OCT. — Per MARCH JUNE SEPT. DEC. year Workshops (#of workshops) 0 1 1 1 3 C. Definition of Services Workshops: Meetings or community gatherings facilitated by speakers who lead a discussion or educational session on topics such as civil rights, civic engagement, strategies to increase integration into the wider community, etc. 3) Records A. Project Files The Consultant shall maintain files for this project containing the following items: 1. Notice of Grant Award 2017-2018 Sikh SOCH Consultant Services Agreement Scope of Services Page 2 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. Workshop sigin-in sheets B. Record Retention Period All records irequiired 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, genieral 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). S) Reports, Invoicing and Reporting Schedule A. Reports 1. All data and required forms shall be submitted to: drwilson@kentwa,g_Qv 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. 2017-2018 Sikh SO,CH Consultant Services Agreement Scope of Services Page 3 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"d & 3'd Quarter Billing Voucher 15th day following each quarter & Service Report Exhibit B 4th Quarter Billing Voucher & Service December 15thl Report Annual Outcome Data Report January 15, 2018 (Exhibit C) 2017-2018 Sikh SOCH Consultant Services Agreement Scope of Services Page 4 KENT Exhibit B W-,11 1-GTO H Billing Voucher & Service Report PARKS, RECREATION & 2017 COMMUNITY SERVICES To: Dinah Wilson Consultant/Agency: Sikh Society In Care Of Humanity Housing & Human Services (SIKH SOCH) Parks, Recreation & Community Services h 220 4 Ave. South, Kent, WA 98032 Program Contact: Satwinder Kaur drwilson@kentwa.gov Telephone: (206) 371-4416 Phone: (253) 85,6-5076 E-mail: satwinderkl29@gmail.com Reporting Period Program Amount Requested Qtr. Learn! Integrate! Know! Engage! (LIKE) Workshops $ SEC. 1: BUDGET SUMMARY (CALCULATIONS BASED ON YEARLY BUDGET) For Department Use Only Total Contract Amount $ 3,500.00 Total 2017 Contract Amount $ 3,500.00 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 C,OST'CATP-GORIES, BUDGET REQUESTED BUDGET TO DATE Workshop Costs (attach receipts with billing) $2,000,00 2 Consultant Services (attach consultant $1,000.00 invoice) 3 Communications $ 500.00 GRAND TOTAL $3,500.00 Page 1 of 5 SEC. 3: ANNUAL PERFORMANCE MEASURES - 2017 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date Sera cd,Uh t. escrl tiort -Contracted try Total � Clients Actually Year to Serve CCobtracte'd' ' Seared Late Total Service Unit/Performance sc � ra 1n Total Measure 4 Contracted to 1st 2nd 3rd 4th Serve Unduplicated #of Kent clients (persons) served 0 30 28 30 85 Workshops (#of workshops) 0 1 1 1 3 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 5 Sec. 5: DEMOGRAPHIC INFORMATION Number of Households or Persons Assisted (please specify "H" or"P"; most agencies should report persons): Race Unddplicated Ethnicity- Und'Llp.,, .Uhidupllicated Quarter Unduplicated Year to Year to Date (Ali) Quarter(Hispanic*), Date (Hispanic) 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-facial 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 Age Unduplicated CIuarter, hdyplicated Year tray late 1 2 U -4 years 5 - 12 years 13 - 17years 18 -34 years 35- 54 yearn 55 - 74 years 75+ years Unknown GRAND TOTAL CLIENTS Page 3 of 5 Gender Linduplicat r C uprt r. 9ndwaplicpted Year to r�Pte` 1 4 Female Male GRAND TOTAL CLIENTS Persons With Cii abiiitios Unduplicated Quarter Uodupli ated'Year W Wte' 1 2 4 GRAND TOTAL CLIENTS 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 Cate Plrnintlutleirialtir�u it ' s sclkion tc� ba crr� l±eeOfCen# cnl ; Contractd4,0bfigg�flcarn Met?', "YES (Orcle one), Enter notes if Ag ftY uhd rp rfdrrnedw Authorized 3i: data. Page 4 of 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. 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 5 of 5 H rl— OD O N N W M Mcu ca o W cu ca O -' � O QQ Q (D (1) W ca Z E E Z U U c > Q � � Q- _ ZT-- N vco r r 4aCL L N N E Q M — o E cC L I yam+ a w Q cd c� N E (D `- c O w Q- o c (D `. 4 (DCL 0 CL L x 0 E o L � � o z p D :E � .� (D c �- W o L o cn l O Q W (� 'Q E A •Z v rn Z E N Z ca N c rL3 ui� Q V _N to 90 En E 0 o cn ATTACHMENT D INSURANCE REQUIREMENTS FOR 2017-2018 CONSULTANT SERVICES AGREEMENT No insurance is required for this contract. • KENT Exhibit E PARKS- RECREATION b COMMUNITY SERVICES City of Kent Certification Regarding Debarment and Suspension Sikh Society in Care of Humanity Learn! Integrate! Know! Engage! (LIKE Workshops 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, 1 of 3 principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of these regulations. 6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. 7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines this eligibility of its principals. Each participant may, but is not required to, check the Non-procurement List. 9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 10. Except for transactions authorized under paragraph (6) of these instructions, if a participant in a covered transaction 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 13: 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 (13) 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 2of3 remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment. Executive Director (Print) Title (Print) Ala 1 n k"C" iR�L r Signature of Executive Director Date h 7 l "ZI/ zo I Adopted from HUD Form-2992 09/04 3of3