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Home My WebLink AboutPK17-400 - Original - Kona Kai Coffee- Contract - 01/01/17 eme Rue-,% cords KEN T ,,, , , WASHINGTON Document 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: Kona Kai Coffee Vendor Number: 1325136 JD Edwards dumber Contract Number: p This is assigned by City CIerk's Office Project Name: Hospitality Education and Train Description: ❑ Interlocal Agreement ❑ Change Order El Amendment 0 Contract ❑ Other: Contract Effective Date: 01 01 2017 Termination Date: 12/31/2017 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment. Contract Manager: Dinah Nilson Department: Parks Human Svcs.. Contract Amount: = IL"c Approval Authority: ❑ Director Mayor ❑ City Council Meeting Date ❑ Director N Division Manager Detail: (Le.-addressj location- parcel number-1--tax-id,-etc.) _ . ..w_._..w.... . ........ • 4000'* KENT W w3 HINOTOry CONSULTANT SERVICES AGREEMENT between the City of Kent and Kona Kai Coffee THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Kona Kai Coffee, organized under the laws of the State of Washington, located and doing business at 124 4`h Ave. South, #180, Kent, WA 98032 (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 support job training and education of Kent residents in the hospitality and food services industry. 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, 2017. 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 $3,000, for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be as delineated in Exhibit A. B. The Consultant shall submit quarterly payment invoices to the City for work performed, and a final bill upon completion of all services described in this Agreement. The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: CONSULTANT SERVICES AGREEMENT - 1 ($20,000 or Less) A. The Consultant has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Consultant maintains and pays for its own place of business from which Consultant's services under this Agreement will be performed. C. The Consultant has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Consultant's services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Consultant's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the Consultant's possession pertaining to this project, which may be used by the City without restriction. If the City's use of Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's duty to defend, indemnify, and hold the City harmless, and Consultant's liability accruing from that obligation shall be only to the extent of the Consultant's negligence. CONSULTANT SERVICES AGREEMENT - 2 ($20,000 or Less) 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. 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 CONSULTANT SERVICES AGREEMENT - 3 ($20,000 or Less) 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 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) 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 gn,ature) (sighat re) Print Name: Merina Hanson Print Name: Its: Housing & Human Services Manager Parks Department, Its: '0V(Xyt4W Waa':Cc'p—' Housing & Human Services Division (title) D ATE:L--2"7,-t� DATE: ...... NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Mychal Boiser, Executive Director Dinah R. Wilson Kona Kai Coffee City of Kent 124 4 t h Ave. South, #180 220 Fourth Avenue South Kent, WA 98032 Kent, WA 98032 253.951.7088 (telephone) 253,856,5076 (telephone) 253. 856-6070 (facsimile) P:Hurnan 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 thie Agreement; The questions are as follows: 1. 1 have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. B. During the time of this Agreement the prime contractor will provide a written statement to all new emiployees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will aictively 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: kW'UAL&K. For: W— Title:1' 7A5C---, Date: (P- \-I 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 Is KENT WASH ING TO N PARKS, RECREATION S COMMUNITY SERVICES EXHIBIT A 2017 CONSULTANT SERVICES AGREEMENT PROJECT SCOPE OF SERVICES PARALLEL HUMAN SERVICES SMALL FUND GRANT KONA KAI COFFEE Consultant/Consultant: Kona Kai Coffee Start Date: 1/1/17 Project Title: Hospitality Education and Train H.E.A.T. End Date: 12/31/17 Funding will support job Program Outcome: Project 2017 $3,000 training and education of will increase training and Fundin Kent residents in the employment skills for Kent Total $3,000 hospitality and food residents. Outcomes will be City of services industry. Training measured through case notes Kent will be provided to five (5) and Funds: Kent residents, many of correspondence/communication whom were formerly with employers. Annual results homeless or are at risk for will be provided to the City via homelessness. Exhibit D. Project Manager: Mychal Boiser Telephone: 253 951-7088 E-mail: mychal@konakaicoffee.org City Contact Manager: Dinah Wilson Telephone: 253.856.5076 Fax: 253.856.6070 E-mail: drwilson@kentwa.gov Kona Kai Coffee (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 Line Item Budget Summary below: Line Item Budget Personnel Services 1 $2,250.00 Consultant Services 2017-2018 Kona Kai Coffee Consultant Services Agreement Scope of Services Page 1 Total City of Kent Funds: 750.00 2) Performance Measures A. Number Served The Consultant agrees to serve, at minimum, the following unduplicated number of persons: Quarters lst 2nd 3rd 4th Quarter Quarter Quarter Quarter Total Jan- April- July- Oct-Dec per March June Sept year No. of unduplicated persons assisted 10 1 2 2 5 B. Units of Service The Consultant agrees to provide, at minimum, the following units of service by quarter: Quarters 1st Quarter 2"d Quarter 3rd 4th Quarter Total Jan-Mar April-June Quarter Sept-Dec per July-Aug ear Employment orjob 0 0 0 1 1 training (# employed or enrolled in an internship program) C. Definition of Services Employment or job training is defined as the number of Kent residents securing a job or enrolled in an internship program placing the resident on a pathway to employment. 3) Records A. Project Files The Consultant shall maintain files for this project containing the following items: 1. Notice of Grant Award. 2017-2018 Kona Kai Coffee Consultant Services Agreement Scope of Services Page 2 2. Parallel Human Services Small Fund Grant 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. 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) IRS income tax return; b) Paystubs; or c) 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 2017-2018 Kona Kai Coffee Consultant Services Agreement Scope of Services Page 3 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). 5) 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, ]an 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: 1't 2"di & 3 rd Quarter Billing Voucher 15th day following each quarter & Service Report (Exhibit Q 4 1h Quarter Billing Voucher & Service December 15thl Report Annual Outcome Data Report January 15, 2018 (Exhibit D) 2017-2018 Kona Kai Coffee Consultant Services Agreement Scope of Services Page 4 EXHIBIT B INCOME GUIDELINES Effective 4/14/17 Median Family Income = $96,000 *Median 500/0 80% MEDIAN MEDIAN FAMILY EXTREMELY VERY LtAUVI' 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 $28,800 $48,000 $72,000 5 $31,150 $51,850 $77,800 6 $33,450 $ 5,700 $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 30/501" (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 law (50%) income limits. Income Limit areas are based on FY 2017 Fair Market Rent (FMR) areas. K E • NT Exhibit C W.5 I-N:rTO. Billing Voucher & Service Report PARK3, RECREATION & 2017 COMMUNITY SERVICES To: Consultant/Agency: Kona Kai Coffee Dinah Wilson Housing & Human Services Parks, Recreation & Community Services Program Contact: Mychal Boiser 220 4 Ih Ave. Southi, Kent, WA 98032 Telephone: (253) 9151-70188 drwilson@kentwa.gov Phone: (253) 856-5076 E-mail: mychal@konakaicoffee.org Reporting Period Program Amount Requested Qtr. Hospitality Education and Train (H.E.A.T.) $ SEC. 1: BUDGET SUMMARY (CALCULATIONS BASED ON YEARLY BUDGET) For IDepartr ent Use Only Total Contract Amount $ 3,000.00 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 (costs $2,250.00 for staff employed at Kona Kai Coffee using the agency tax ID # & business license) 2 Consultant Services (employment agreement $ 750.00 and billing vouchers from consultants} or private contractor with a WA Page 1 of 6 State business license and #, must be submitted to the City with billing voucher) GRAND TOTAL $3,000.00 SEC. 3: ANNUAL PERFORMANCE MEASURES - 2017 KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date Service Unit Description Contracted to Total Clients Actually 'Year to Serve Contracted Served Date Total Service Unit/Performance nd rd Rh Total Measure 1s' 2 3 4 Contracted to 1st 2nd 3rd 4th Serve Unduplicated #of Kent clients (persons) served 0 1 2 2 5 Employment or job training (# employed or enrolled in an 0 0 0 1 1 internship program) 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); Pace Unduplicated Ethnicity Undue. �Undupl ated Quarter Qndupticated dear to Year to Date (All) Quarter(Htsparnie) Date "Iapuenic) All** 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 lrid rrroe;Le i 91 Undupillcated,Quarter Ulndupblicat d,Yeair td mate 1 2 3 4 Extremely Low 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 Age l ndup�l sated Qpartair ;4Jn wup�IcatrM Year k:110 I ak 1 2 3 4 6-4 years 5 - 12years 13 - 17 years 18 - 34 years 3 - 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 Heeded Households Unduplrcated;0parter Unduplicated Year tc Date' GRAND TOTAL CLIENTS Persons with Disabilities Uriduplic ted,Quarter LINuplicated Year to Date 1 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, falsestatements, false claims or otherwise. Consultant Authorized Signature Date PpyMenit Authorization this section to be came pleted lbyCiSy of Kent only) Contractual Obligations Met?, YES , NO (Circle one Enter notes if Agency Underperformed: Authorized Date,: By: 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 ti co O O Q N N aIM: IM: W cY) m o w i!, L>, W Cc Co oCU CO :3 :3 -0 -0 O 0 0 J o- o- cu Z E E ocu Z 0 o � a 0 ,m N Ch Z ti o O W L Yoo N N E Q O E � W Q (0 (o O .0 C 0 W Q' O_ N C O 4. im co O O (u CL Q L- X O . O u E `o 10— Z p a) y t �- K LV clO c cu O v v1 L: V O 5 �+ ou aj EEa» C O Ira a W a� E d v 0 zu (n Z E U Z y.I v W n u ce E 0 in �(< c t: t: c O O CU as QLnNa 0 c EXHIBIT E INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance The Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Consultant, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Consultant shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non- owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01. The City shall be named as an Additional Insured under the Consultant's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Consultant shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $2,000,000 each occurrence, $4,000,000 general aggregate. EXHIBIT B (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant's insurance and shall not contribute with it. 2. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. E. Verification of Coverage Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Consultant before commencement of the work. F. Subcontractors Consultant shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Consultant. ----M*i KONAKAIC01 HMCMLILLEN '4�ft REX CERTIFICATE OF LIABILITY INSURANCE DATE 03 2112IY7 03/211201 T THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME:Denali Alaskan _ 80 W.Tudor Road Insuranee LLC PHONE ) JA'IC No):(907)222-5842 ac,No,Ext):(907 257-1625 Anchorage,AK 99503 ADE•MA[LDRESS:dalinfo@da-insurance.com INSURE S AFFORDING COVERAGE NAIC a INSURER A:Philadelphia Indemnity Insurance Company INSURED INSURER B: Kona Kai Coffee INSURER c: 124 4th Ave S.#180 INSURER D: Kent,WA 98032 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ FLTR NSR TYPE OF INSURANCE IADDL SUER POLICY NUMBER POLICY EFF MMIDDIYYYII 1 POLICY EXP I LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE 7X7 OCCUR X I PHPK1560103 0913012016 0913012017 DRMMGE TO REN��D 5 100,000 1 5,000 MED EXP(Any one person) I$ PERSONAL 8 ADV INJURY is 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER ` I I GENERAL AGGREGATE I$ 2,000,000 X POLICY JECQT ;LOC II, PRODUCTS-COMPlOP AGG S 2,000,000 OTHER: j STOP GAP LIAB 'S 1,000,000 AUTOMOBILE LIABILITY { COMBINED SINGLE LIMIT(Ea accident) $ ANY AUTO OWNED SCHEDULED I BODILY INJURY Per person) $ AUTOS ONLY AUTOS BODILY BODILY INJURY Per accident $ AUTOS ONLY AUTO OfILY j { OPERd DAMAGE S S A X UMBRELLA LIAa X OCCUR EACH OCCURRENCE S 1,000,000 EXCESS LIAR I CLAIMS-MADE PHUB558943 0913012016 09/30/2017 AGGREGATE 3 1,000,000 DEO I X I RETENTION$ 10,000 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y TN PERT Ti OTH- ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT S QFn etoMjMQWl EXCLUDED? INIA((MManddatory n n I I E.L.DISEASE-EA EMPLOYEE $ if es,describe under DESCRIPTION OF OPERATIONS bel I E.L.DISEASE-POLICY LIMIT $ F i i DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The City of Kent,its elected and/or appointed officials,employees and agents are named as additional insureds per the attached endorsement,PIGLDHS 10111. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent-Housing and Human Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 220 Fourth Ave South Kent,WA 98032 AUTHORIZED REPRESENTATIVE LAJ ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PI-EPE-HS-WA(06/09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ELITE PROPERTY ENHANCEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FORM CAUSES OF LOSS--SPECIAL FORM I. Schedule of Additional Elite Enhancement Endorsement Coverages and Limits The following is a summary of increased Limits of Insurance and/or additional coverages provided by this endorsement. This endorsement is subject to the provisions of your policy. Coverage Applicable Limit of Insurance Pa e# Foundations Included 3 Business Personal Property Within 1600 feet 4 Fire Department Service Charge $50,000 4 Pollutant Clean Up and Removal $50,000 4 Emergency Vacating Expense $25 000 4 Automated External Defibrillators AEDs $5 000 5 Lease Cancellation Moving Expenses $5 000 5 Joint or Disputed Loss Agreement Included 5 Green Consultant Ex pense Coverage $5 000 7 Newly Acquired or Constructed Property 180 Da s 7 Personal Effects $50,000 8 Property of Others Various 8 Valuable Papers and Records $I Q QQQ 8 P Off-Premises, Including Stock $500 QQQ 8 Property at Conventions, Fairs Exhibitions or Special Events $100 000 9 Outdoor Pr $50,000 9 Garages/Storage Sheds $5 000 g Retaining Walls $10 000 9 Accounts Receivable $100 000 10 Business Income and Extra Expense $300 000 11 Residential Room Reserve $100,000 12 Fire Extinguisher Recharge $25 000 12 Lock Replacement $10 000 12 Reward Reimbursement $50,000 12 Inventory and Appraisals of Loss $50,000 13 Ordinance or Law-Undamaged Portion of the Building Building Limit 13 Ordinance or Law-Demolition Cost $500,000 Ordinance or Law-Increased Cost of Construction $500 000 Spoilage 1600 feet $50,000 15 Pair Sets or Parts Amended 15 Fine Arts $50,000 16 EDP Equipment and Media $10,000 17 DaE@92 to Property of Home Care Provider $50,000 20 Mobile Medical Equipment $15 000 20 Vacancy Clause Modification 90 Days 20 Earthquake Sprinkler Leakage $30 000 20 Page 1 of 24 ®2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA (06/09) Coverage Applicable Limit of Insurance Page# Dampness/Extremes of Temperature Exclusion removed 21 Furs $10 000 21 Precious Metals $25 000 21 Water Coverage $30 000 21 Property in Transit Includes Common Carrier $100 000 $10 000 22 Off Premises Power Failure $50,000 22 Extended Business Income 180 Days 23 Utility Services(Business Income(and extra expense) Included 23 Coverage) Page 2 of 24 ®2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. PI-EPE-HS-WA(06/09) II. Elite Enhancement Endorsement Conditions A. Applicability of Coverage Coverage provided in forms attached to your policy is amended by this endorsement where applicable. If two or more coverages apply to the same loss or damage, the broader coverage and only the broader coverage,will apply. B. Limits of Insurance 1. When coverage is provided by this form and another coverage form attached to this policy, the greater Limits of Insurance will apply. In no instance will multiple limits apply to coverages which may be duplicated within this policy. 2. Limits of Insurance identified herein are not excess of, nor applicable in addition to, Limits of Insurance provided by the coverage or Cause of Loss forms applicable to this endorsement, unless otherwise stated. 3. Coverage is considered to be on an occurrence basis(not on a per location basis). 4. The deductible listed in the Property Declarations will apply unless specific deductible provisions are set forth under any coverage enhancement. C. Adjusters' Fees Coverages provided herein are not applicable to the generation of fees you may incur by retaining a public adjuster or appraiser. D. Applicability of Exclusions Specific exclusionary endorsements attached to the policy supersede coverage provisions contained in this coverage enhancement. E. Requirement for Covered Cause of Loss Except where a specific Covered Cause of Loss is identified in this coverage enhancement, coverage for the losses described herein are applicable only for Covered Causes of Loss as designated in the Causes of Loss Form attached to the policy. F. Otherinsurance If there is other insurance under a separate policy covering the same loss or damage as provided for in this coverage enhancement, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, regardless of whether you are able to collect. However, we will not pay more than the applicable Limit of Insurance. Ill. The BUILDING AND PERSONAL PROPERTY COVERAGE FORM Section A.Coverage is amended as follows.- A. Foundations 1. Covered Property is amended to include the following: Foundations of buildings, structures, machinery or boilers if their foundations are below the lowest basement floor; or the surface of the ground, if there is no basement. Page 3 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) 2. Property Not Covered g. is deleted. B. Business Personal Property 1. b.Covered Property the first paragraph is amended to: Your Business Personal Property located in or on the building described in the Declarations or in the open(or in a vehicle)within 1600 feet of the described premises, consisting of the following unless otherwise specked in the Declarations or on the YOUR BUSINESS PERSONAL PROPERTY—SEPARATION OF COVERAGE form. IV. The BUILDING AND PERSONAL PROPERTY COVERAGE FORM, 4.Additional Coverages is amended as follows: c. Fire Department Service Charge The Limit of Insurance for this Additional Coverage is increased to$50,000. d. Pollutant Clean Up and Removal The Limit of Insurance for this Additional Coverage is increased to$50,000 for the sum of all covered expenses arising out of Covered Causes of Loss occurring during each separate 12 month period of this policy. V. The BUILDING AND PERSONAL PROPERTY COVERAGE FORM,4.Additional Coverages,the following are added: A. Emergency Vacating Expense 1. The coverage provided by this policy is extended to apply to the reasonable expenses that you incur in the"emergency"vacating of the premises of your facility described in the Declarations, provided that vacating is necessary due to an "emergency" situation resulting from a Covered Cause of Loss. 2. "Emergency"will mean imminent danger arising from an external event or a condition in the facility which would cause loss of life or harm to occupants. 3. We will not pay for any expenses under this Extension arising out of: a. A strike, bomb threat or false fire alarm, unless vacating is ordered by a civil authority; b. A planned vacating drill; or c. The vacating of one or more patients or residents that is due solely to their individual medical condition. 4. The most we will pay for Emergency Vacating Expenses in any one occurrence under this Extension is$25,000. The deductible for Emergency Vacating Expenses is$250 per occurrence. No other exclusions in your policy apply to this Extension. However, specific exclusionary endorsements attached to the policy supersede coverage provisions contained in this coverage Page 4 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) enhancement. B. Automated External Defibrillators We will pay for direct physical loss or damage to automated external defibrillators(AEDs)at the premises described in the Declarations. The most we will pay for loss or damage under this coverage is limited to$5,000 for any one occurrence,which is in addition to the Business Personal Property Limit stated in the Declarations. C. Lease Cancellation Moving Expenses The Company will reimburse the Insured any moving expenses necessitated by the Insured's need to relocate due to the cancellation of the lease at the insured's premises listed on the Declarations page during the policy period, provided that the lease cancellation occurs as a result of a Covered Cause of Loss. The limit for this coverage will be$5,000 per policy period for all Insureds combined. No deductible applies to this coverage. D. Joint or Disputed Loss Agreement 1. This coverage is intended to facilitate payment of insurance proceeds when: a. Both a boiler and machinery policy and this commercial property policy are in effect; b. Damage occurs to Covered Property that is insured by the boiler and machinery policy and this commercial property policy;and c. There is disagreement between the insurers as to whether there is coverage or as to the amount of the loss to be paid, if any, by each insurer under its own policies. 2. This coverage does not apply if: a. Both the boiler and machinery insurer(s)and we do not admit to any liability;and b. Neither the boiler and machinery insurer(s)nor we contend that coverage applies under the other insurer's policy. 3. The provisions of this coverage apply only if all of the following requirements are met: a. The boiler and machinery policy carried by the named insured, insuring the Covered Property, contains a similar provision at the time of the loss or damage,with substantially the same requirements, procedures and conditions as contained in this endorsement; b. The damage to the Covered Property was caused by a loss for which: (1) Both the boiler and machinery insurer(s)and we admit to some liability for payment under the respective policies; or (2) Either: (a) The boiler and machinery insurer(s)does not admit to any liability for payment, while we contend that: (i) All liability exists under the boiler and machinery policy; or Page 5 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) (ii) Some liability exists under both the boiler and machinery policy and this commercial property policy; (b) We do not admit to any liability for payment,while the boiler and machinery insurer(s) contends that: (i) All liability exists under this commercial property policy; or (lii) Some liability exists under both the boiler and machinery policy and this commercial property policy; or (c) Both the boiler and machinery insurer(s)and we: (i) Do not admit to any liability for payment; and (ii) Contend that some or all liability exists under the other insurer's policy; and c. The total amount of the loss is agreed to by you,the boiler and machinery insurer(s) and us. 4. If the requirements listed in Paragraph 3.above are satisfied,we and the boiler and machinery insurer(s)will make payments to the extent, and in the manner, described as follows: a. We will pay, after your written request, the entire amount of loss that we have agreed as being covered, if any, by this commercial property policy and one-half(1/2)the amount of the loss that is in disagreement. b. The boiler and machinery insurer(s)will pay, after your written request, the entire amount of loss that they have agreed as being covered, if any, by the boiler and machinery policy and one-half(1/2)the amount of loss that is in disagreement. c. Payments by the insurers of the amounts that are in disagreement, as described in Paragraphs a.and b.above, do not alter,waive or surrender any rights of any insurer against any other with regard to the portion of the loss for which each insurer is liable. d. The amount in disagreement to be paid by us under this endorsement shall not exceed the amount payable under the equivalent Loss Agreement(s)of the boiler and machinery policy. e. The amount to be paid under this endorsement shall not exceed the amount we would have paid had no boiler and machinery policy been in effect at the time of loss. In no event will we pay more than the applicable Limit of Insurance shown in the Declarations. f. Acceptance by you of sums paid under this endorsement does not alter, waive or surrender any other rights against us. 5. Arbitration a. If the circumstances described in Paragraph 3.b.(1)exist and the boiler and machinery insurer(s)and we agree to submit our differences to arbitration, the boiler and machinery insurer(s)and we will determine the amount each will pay and will pay the insured within 90 days.Arbitration will then take place within 90 days after payment of the loss under the terms of this endorsement. Page 6 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) b. If any of the circumstances described in Paragraph 3.b.(2)exist,then the boiler and machinery insurer(s)and we agree to submit our differences to arbitration within 90 days after payment of the loss under the terms of this endorsement. c. You agree to cooperate with any arbitration procedures.There will be three arbitrators: one will be appointed by us, and another will be appointed by the boiler and machinery insurer(s).The two arbitrators will select a third arbitrator. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction.A decision agreed to by two of the three arbitrators will be binding on both parties. Judgment on any award can be entered in any court that has jurisdiction. 6. Final Settlement Between Insurers The insurer(s)found responsible for the greater percentage of the ultimate loss must return the excess contribution to the other insurer(s). In addition,the insurer(s)found responsible for the greater portion of the loss must pay Liquidated Damages to the other insurer(s)on the amount of the excess contribution of the other insurer(s). Liquidated Damages are defined as interest from the date the insured invokes this Agreement to the date the insurer(s)that contributed the excess amount is reimbursed.The interest is calculated at 1.5 times the highest prime rate from the Money Rates column of the Wall Street Journal during the period of the Liquidated Damages.Arbitration expenses are not a part of the excess contribution for which liquidated damages are calculated.Arbitration expenses will be apportioned between insurers on the same basis that the ultimate loss is apportioned. E. Green Consultant Expense Coverage In the event of a total loss to a covered building due to a covered cause of loss, and the building has been replaced and rebuilt as a LEED®(Leadership in Energy and Environmental Design) Certified Green Building,the company will reimburse the Insured up to$5,000 for the service of a consultant for the design of the structure. Prior to payment,construction of the replaced building must be completed and have a minimum of Silver Rating Level LEED®Green Building certification. VI. The BUILDING AND PERSONAL PROPERTY COVERAGE FORM,5.Coverage Extensions is amended as follows: A. Newly Acquired or Constructed Property (3)Period Of Coverage is deleted in its entirety and replaced with the following: Wdh respect to insurance on or at each newly acquired or constructed property, coverage will end when any of the following first occurs: (a) This policy expires; (b) 180 days expire after you acquire the property or begin construction of that part of the building that would qualify as Covered Property; or (c) You report values to us. We will charge you additional premium for values reported from the date you acquire the property or begin construction of that part of the building that would qualify as Covered Property. Page 7 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) B. Personal Effects and Property of Others is deleted in its entirety and replaced with the following: You may extend the insurance that applies to Your Personal Property to apply to: (1) Personal effects owned by you, your volunteers,your officers, your partners or your employees. The most we will pay for loss or damage under this extension is $50,000 at each described premises. (2) Personal Property of others in your care, custody or control. The most we will pay for loss or damage under this Extension is$50,000 for personal property other than money and securities of residents or clients, or$5,000 for money and securities at each described premises of residents or clients. However, we will not pay more than$10,000 for loss or damage to the personal property other than money and securities of any one resident or client, or$500 for loss of money and securities of any one resident or client. (3) We will not pay for loss or damage in any one occurrence under this Extension until the amount of loss or damage exceeds$250. We will then pay the amount of loss or damage in excess of$250 up to the applicable limit of insurance under this Extension. No other deductible applies to this extension. (4) Under this Extension, the value of your residents' or clients'money and securities will be calculated as the smaller of the following: (a) The cost to replace the money or securities at the time of loss; or (b) The actual cash value of the money or securities at the time of loss. However, at your option, the cost of replacing securities may be calculated using the market value of the securities at the time the claim is settled. C. Valuable Papers And Records(Other Than Electronic Data) 1. You may extend the insurance that applies to Your Business Personal Property to apply to the cost to replace or restore the lost information on valuable papers and records, including those which exist on electronic or magnetic media, for which duplicates do not exist. 2. Under this Extension,the most we will pay to replace or restore the lost information is $100,000 at each described premises, unless a higher limit is shown in the Declarations. Such amount is additional insurance.We will also pay for the cost of blank material for reproducing the records(whether or not duplicates exist), and (when there is a duplicate)for the cost of labor to transcribe or copy the records. The costs of blank material and labor are subject to the applicable Limit of Insurance on Your Business Personal Property and therefore coverage of such costs is not additional insurance. D. Property Off-Premises, Including Stock 1. You may extend the insurance provided by this Coverage Form to apply to your Covered Property while it is away from the described premises, if it is: a. Temporarily at a location you do not own, lease or operate; b. In storage at a location you lease, provided the lease was executed after the beginning of the current policy term;or Page 8 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) c. At any fair, trade show or exhibition. 2. This Extension does not apply to property: a. In or on a vehicle; or b. In the care, custody or control of your salespersons, unless the property is in such care, custody or control at a fair, trade show or exhibition. 3. The most we will pay for loss or damage under this Extension is$500,000. The most we will pay for loss or damage under this extension is$100,000 for losses occurring at a convention, fair, exhibition, or special event E. Outdoor Property You may extend the insurance provided by this Coverage Form to apply to the following property if located within 1600 feet of the premises described in the Declarations:your outdoor fences and netting, outdoor lighting, outdoor pools, court surfaces, radio and television antennas (including satellite dishes),trees, shrubs, plants, lawns, and playground equipment, including the cost of debris removal, caused by or resulting from any of the following Causes of Loss: 1. Fire; 2. Lightning; 3. Explosion; 4. Riot or civil commotion; S. Aircraft or vehicles; 6. Vandalism and malicious mischief; or 7. Theft. The most we will pay for loss or damage under this Extension is$50,000. The most we will pay for any one tree, shrub, plant or acre of lawn, including the cost of debris removal, is$1,000. Signs will be covered for all perils with no limitation. Vll. BUILDING AND PERSONAL PROPERTY COVERAGE FORM,5.Coverage Extensions are amended to include the following: A. Garages/Storage Sheds Coverage for your building is extended to apply to any garages or storage sheds located at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. Coverage for all garages or storage sheds is subject to a$5,000 Limit of Insurance per location. B. Retaining Walls Coverage for your building is extended to apply to any retaining walls, which are not part of the Building, located at the premises described in the Declarations caused by or resulting from any Page 9 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) Covered Cause of Loss. Coverage for all retaining walls is subject to a$10,000 Limit of Insurance per location. C. Accounts Receivable 1. Coverage for Your Business Personal Property is extended to apply to your records of accounts receivable: a. At a described premises or in or on a vehicle in transit between described premises; or b. If the records must be removed from a described premises to protect them from the threat of a Covered Cause of Loss. We will pay for a loss while they are: (1) At a safe place away from your described premises; or (2) Being taken to and returned from that place. 2. Coverage for Your Business Personal Property is extended to apply to the amounts due from your customers that you are unable to collect due to a Covered Cause of Loss, including: a. Interest charges on any loan required to offset amounts you are unable to collect pending our payment of these amounts; b. Collection expenses in excess of your normal collection expenses that are made necessary by the loss; and c. Other reasonable expenses that you incur to reestablish your records of accounts receivable that result from direct physical loss or damage by any Covered Causes of Loss to your records of accounts receivable, including credit or charge card slips. 3. Accounts receivable loss payment will be determined as follows: a. Determine the total of the average monthly amounts of accounts receivable for the 12 months immediately preceding the month in which the loss occurs; and The total above will be adjusted for any normal fluctuations in the amount of accounts receivable for the month in which the loss occurred or for any demonstrated variance from the average for that month. b. The following will be deducted from the total amount of accounts receivable: (1) The amount of the accounts for which there is no loss; (2) The amount of the accounts that you are able to reestablish or collect; and (3) An amount to allow for probable bad debts that youf are normally unable to collect; c. You will pay us the amount of all recoveries you receive for a loss paid by us. But any recoveries in excess of the amount we have paid belong to you. 4. Additional Exclusions a. We will not pay for a loss caused by or resulting from any of the following: Page 10 of 24 ©2009 Philadelphia indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) (1) Alteration,falsification, concealment or destruction of records of accounts receivable done to conceal the wrongful giving,taking or withholding of money, securities or other property. This exclusion applies only to the extent of the wrongful giving, taking or withholding. (2) Bookkeeping, accounting or billing errors or omissions. b. We will not pay for loss that requires any audit of records or any inventory computation to prove its factual existence. The most we will pay under this Coverage Extension is$100,000. D. Business Income and Extra Expense 1. Coverage is extended to cover Business Income and Extra Expense incurred when your covered building or business personal property listed on the Declarations is damaged by a covered Cause of Loss. We will pay any Extra Expense you incur: a. To continue your normal operations at the described premises; b. To continue your normal operations at replacement premises or temporary locations; including: (1) Relocation expenses; and (2) Costs to equip or operate the replacement or temporary locations; or c. To minimize the suspension of your normal operation if you cannot continue them. 2. Civil Authority We will pay for the actual loss of Business Income you sustain and necessary Extra Expense you incur that is caused by action of civil authority that prohibits access to the described premises due to direct physical loss of or damage to property,other than at the described premises, caused by or resulting from any Covered Cause of Loss. 3. Contingent Business Property We will pay for the actual loss of Business Income you sustain,and necessary Extra Expense you incur when Contingent Business Property is damaged by a Covered Cause of Loss. We will reduce the amount of your Business Income loss, other than Extra Expense, to the extent you can resume operations, in whole or in part, by using any other available: a. Source of materials; or b. Outlet for your products. 4. Coverage is extended to apply to your mobile shredding operations and your mobile medical units. The most we will pay under this section is$300,000 for any one occurrence. No coinsurance Page 11 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. PI-EPE-HS-WA(06/09) shall apply to this coverage. 5. The following, when used in this section, is defined as follows: "Contingent Business Property"means property operated by others on whom you depend to: a. Deliver materials or services to you or to others for your account(Contributing Locations); b. Accept your products or services(Recipient Locations); c. Manufacture products for delivery to your customers under contract of sale (Manufacturing Locations); or d. Attract customers to your business(Leader Locations). E. Residential Room Reserve Coverage is extended to apply to actual net loss of income that you incur resulting from holding a resident's room when the resident has been temporarily hospitalized due to an accident or illness. Coverage begins three days after the funding for the resident's room has been suspended. The Limit of Insurance applicable to any one occurrence is$5,000. The most we will pay for all losses under this extension is$100,000. F. Fire Extinguisher Recharge Coverage is extended to cover expenses you incur to recharge portable fire extinguishers, dry chemical, carbon dioxide, or liquid automatic fire extinguishing systems and the cost of resetting automatic fuel shut-off connections, if any of the above are discharged to fight a fire or are discharged due to a mechanical malfunction. The most we will pay for loss or damage under this extension is$25,000. No deductible shall apply to this coverage. G. Lock Replacement Coverage is extended to cover necessary expense to repair or replace exterior or interior door locks of a covered building: 1. If your door keys are stolen in a covered theft loss;or 2. When your property is damaged and your door keys are stolen by the burglars. The most we will pay under this extension is$10,000 for any one occurrence. No deductible shall apply to this coverage. H. Reward Reimbursement Coverage is extended to provide a reward for information that leads to a criminal conviction in connection with loss or damage to Covered Property by a Covered Cause of Loss; provided that the reward is pre-approved by the Company. The most we will pay for loss or damage under Page 12 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) this extension is $50,000 regardless of the number of persons involved providing information. No deductible shall apply to this coverage. I. Inventory and Appraisals Coverage is extended to cover your expenses, excluding those for public adjusters and appraisers, to record information, compile inventories, or obtain appraisals we require to comply with the loss conditions of this coverage form. The most we will pay for loss or damage under this extension is$50,000 for any one loss to Covered Property caused by a Covered Cause of Loss. No deductible shall apply to this coverage. J. Ordinance or Law Under this Additional Coverage, we will not pay any costs due to an ordinance or law that you were required to comply with before the loss, even when the building was damaged, and with which you failed to comply. 1. Coverage A—Coverage For Loss to the Undamaged Portion of the Building If a Covered Cause of Loss occurs to covered Building property shown in the Declarations,we will pay for loss of value to the undamaged portion of the building caused by enforcement of any ordinance or law that: a. Requires the demolition of parts of the same property not damaged by a Covered Cause of Loss; b. Regulates the construction or repair of buildings,or establishes zoning or land use requirements at the described premises; and c. Is in force at the time of loss. Coverage A is included within the Limit of Insurance applicable to the covered Building property shown in the Declarations.This is not additional insurance. 2. Coverage B—Demolition Cost Coverage If a Covered Cause of Loss occurs to covered Building property,we will pay the cost to demolish and clear the site of undamaged parts of the property caused by enforcement of building,zoning or land use ordinance or law. The Limit of Insurance for Demolition Cost Coverage is$500,000(in addition to the Building Limit). 3. Coverage C—Increased Cost of Construction Coverage If a Covered Cause of Loss occurs to covered Building property,we will pay for the increased cost to repair, rebuild or construct the property caused by enforcement of building, zoning or land use ordinance or law. If the property is repaired or rebuilt, it must be intended for similar occupancy as the current property, unless otherwise required by zoning or land use ordinance or law. Page 13 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. PI-EPE-HS-WA(06/09) The Limit of Insurance for Increased Cost of Construction is$500,000(in addition to the Building Limit). 4. Under Coverage A—Coverage for Loss to the Undamaged Portion of the Building: a. If the Replacement Cost coverage option applies and the property is repaired or replaced,on the same or another premises, we will not pay more for loss of value to Covered Property, including loss caused by enforcement of an ordinance or law,than the lesser of: (1) The amount you actually spend to repair, rebuild or reconstruct the building, but not for more than the amount it would cost to restore the building on the same premises and to the same height, floor area, style and comparable quality of the original property insured; or (2) The Limit of Insurance applicable to the covered Building property. b. If the Replacement Cost coverage option applies and the property is not repaired or replaced, or if the Replacement Cost coverage option does not apply,we will not pay more for the loss of value to Covered Property, including loss caused by enforcement of an ordinance or law, than the lesser of: (1) The actual cash value of the building at the time of loss; or (2) The Limit of Insurance applicable to the covered Building property. 5. We will not pay more under Coverage B—Demolition Cost Coverage than the lesser of the following: a. The amount you actually spend to demolish and clear the site of the described premises; or b. The applicable Demolition Cost Limit of Insurance shown in 2.above. 6. We will not pay Under Coverage C—Increased Cost of Construction Coverage: a. Until the property is actually repaired or replaced, at the same or another premises; and b. Unless the repairs or replacement are made as soon as reasonably possible after the loss or damage, not to exceed two years. We may extend this period in writing during the two years. c. If the building is repaired or replaced at the same premises, or if you elect to rebuild at another premises, the most we will pay under Coverage C is the lesser of: (1) The increased cost of construction at the same premises; or (2) The applicable Increased Cost of Construction Limit of Insurance shown in 3. above. d. If the ordinance or law requires relocation to another premises, the most we will pay under Coverage C is the lesser of: Page 14 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) (1) The increased cost of construction at the new premises(not to exceed the increased cost of construction at the same premises); or (2) The applicable Increased Cost of Construction Limit of Insurance shown in 3. above. 7. We will not pay for: a. The enforcement of any ordinance or law which requires demolition, repair, replacement, reconstruction, remodeling or remediation of property due to contamination by"pollutants"or due to the presence,growth, proliferation, spread or any activity of"fungus,"wet or dry rot or bacteria; or b. Any costs associated with the enforcement of an ordinance or law which requires any insured or others to test for, monitor, clean up, remove,contain,treat, detoxify or neutralize,or in any way respond to,or assess the effects of"pollutants,""fungus,"wet or dry rot or bacteria. 8. The terms of this endorsement apply separately to each building to which this endorsement applies. K. Spoilage 1. We will pay for direct physical loss or damage to your perishable Business Personal Property, and perishable personal property of your residents or clients while at or within 1600 feet of the described premises caused by spoilage due to changes in temperature or humidity resulting from: a. Complete or partial interruption of electrical power to the described premises due to conditions beyond your control; or b. Mechanical breakdown or failure of heating, cooling or humidity control equipment or apparatus at the described premises. 2. Coverage does not apply to: a. The disconnection of any heating, cooling or humidity control equipment or apparatus from the source of power; b. The deactivation of electrical power caused by the manipulation of any switch or other device used to control the flow of electrical power or current; or c. The inability of an Electric Utility Company or other power source to provide sufficient power due to: (1) Lack of fuel; or (2) Governmental order; d. The inability of a power source at the described premises to provide sufficient power due to lack of generating capacity to meet demand;or e. Breaking of any glass that is a permanent part of any refrigerating, cooling or humidity control unit. Page 15 of 24 ®2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) The most we will pay for loss or damage in any one occurrence is$50,000. L. Pair,Sets or Parts 1. Pair or Set: In case of loss to any part of a pair or set we may: a. Repair or replace any part to restore the pair or set to its value before the loss;or b. Pay the difference between the value of the pair or set before and after the loss. 2. Parts: In case of a loss to any part of Covered Property consisting of several parts when complete, we will only pay for the value of the lost or damaged part. M. Fine Arts 1. Coverage applies to"fine arts."Covered Causes of Loss are extended to include risks of direct physical loss or damage except: a. Any repairing, restoration or retouching process. b. Breakage of fragile`fine arts"articles, including art glass windows, statuary, marbles, glassware, bric-a-brac, porcelains and similar fragile articles, unless caused by: (1) The"specked causes of loss"; (2) Building glass breakage; (3) Earthquake; or (4) Flood. c. Dishonest or criminal acts by you, any of your partners, employees, directors,trustees, authorized representatives or anyone to whom you entrust the property for any purpose (other than a bailee for hire or carrier): (1) Acting alone or in collusion with others; or (2) Whether or not occurring during the hours of employment. This exclusion does not apply to acts of destruction by your employees; but theft by employees is not covered. d. Voluntary parting with any property by you or anyone else to whom you have entrusted the property, if induced to do so by any fraudulent scheme,trick, device or false pretense. e. Any of the following: (1) Wear and tear; (2) "Fungus"(except when"fungus" results from fire or lightning), rust, corrosion, Page 16 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) decay,deterioration, hidden or latent defect or any quality in the property that causes it to damage or destroy itself; (3) Nesting or infestation, or discharge or release of waste products or secretions by insects or rodents; or (4) Dampness or dryness of atmosphere or changes in or extremes in temperature. 2. The most we will pay in any one occurrence for loss or damage to"fine arts"caused by or resulting from any Covered Cause of Loss is: a. The value of the lost or damaged"fine arts";or b.$50,000;whichever is less. 3. The following,when used in this section, means: a. "Antique"means an object at least 100 years old. b. "Fine arts"means paintings,etchings, pictures,tapestries, rare or art glass,art glass windows,valuable rugs, statuary, sculptures, "antique"furniture, "antique"jewelry, bric- a-brac, porcelains and similar property of rarity, historical value or artistic merit. N. EDP Equipment and Media 1. Coverage a. Covered Property, as used in this Coverage Form means Electronic Data Processing devices operated by you at the premises listed on the Declarations. The Covered Property must be either your property or property belonging to others,which is in your care and used by you in your business or profession. b. Covered Property,as used in this section of this enhancement, means"data"and "media"owned proprietarily by you. The Covered Property must be either your property or property belonging to others, which is in your care and used by you in your business or profession. (1) "Data"means information stored electronically and includes facts, instructions, concepts and programs converted to a form useable in electronic data processing operations. (2) "Media"means devices which store information which is accessible to computers. c. Property Not Covered: (1) Accounts, records, documents and other valuable papers, except as they may be converted to"data"and stored on"media",and then only in that converted form; (2) Property of yours that you have rented, leased or loaned to someone else; or (3) Electronic alarm systems. d. Coverage Extensions (1) Provided you store duplicate"data"at a separate premises and provided such Page 17 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) "data" is not insured elsewhere under this or any other insurance policy,we will cover that"data"at each such storage location. (2) We will also pay for loss to Covered Property while temporarily located away from your premises and while in transit within: (a) The United States of America; (b) Puerto Rico; and (c) Canada. The most we will pay under this Coverage Extension is$2,500 for any single occurrence. (3) We will continue to cover your Covered Property while being transferred to and while at a temporary safe storage location,whenever utilized to avoid imminent loss. You are required, however, to provide us with written notice within 10 days following such move. (4) We will also pay for expenses you incur for the removal of debris provided: (a) The debris is Covered Property; (b) The Cause of Loss is not excluded by any part of this policy; and (c) The debris is located at a location scheduled in this policy. The most we will pay under this Coverage Extension is$10,000 in any one loss, but not to exceed a total of$10,000 under this EDP coverage enhancement section. (5) We will also pay 80%of the actual rental cost for replacement electronic equipment, beginning forty-eight(48) hours after a covered loss has occurred to Covered Property under the EDP coverage listed in the preceding paragraphs, provided such equipment will assist in continuing operations at no less than 80% of normal capacity. This Coverage Extension will end when the covered loss has been settled or when the amount of coverage provided under this Coverage Part is exhausted, whichever occurs first. The most we will pay under the terms of this Coverage Extension is$2,500 in any one loss. (6) We will also pay you for the expense you incur in recharging or refilling fire protection devices which are designed specifically to protect the Covered Property under this EDP coverage section,when these devices have been used in protecting such property from a covered loss. The most we will pay under the terms of this Coverage Extension is$2,500 in any one loss. e. Covered Causes of Loss Page 18 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) Covered Causes of Loss means risk of direct physical loss to Covered Property except those Causes of Loss listed in the Exclusions. 2. Exclusions We will not pay for loss or damage caused by or resulting from any of the items listed below. a. Governmental Action Seizure or destruction of property by order of governmental authority. This exclusion will not apply to acts or destruction ordered by governmental authority and taken at the time of a fire to prevent its spread if the fire falls within a Covered Cause of Loss under the terms of this policy. b. Nuclear Hazard (1) Any weapon employing atomic fission or fusion;or (2) Nuclear reaction or radiation, or radioactive contamination from any other cause. But we will pay for direct loss caused by resulting fire if the fire would be covered under the terms of this policy. c. War and Military Action (1) War, including undeclared or civil war; (2) Warlike action by military forces, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these. d. Delay, loss of market, loss of income, loss of use or any other cause of consequential loss. e. Wear and tear, any quality in the Covered Property that causes it to damage or destroy itself, gradual deterioration, depreciation or damage done by insects, vermin or rodents. We will pay for direct loss caused by resulting fire or explosion if the fire or explosion would be covered under the terms of this Coverage Part. f. Dishonest acts committed by you, anyone else with an interest in the Covered Property, or your or their employees,whether or not such an act occurs during the hours of employment; nor will we pay for a loss caused by dishonest acts by anyone entrusted with the Covered Property, except a common carrier for hire. g. Dryness, dampness, changes in temperature, corrosion or rust. But, if the air conditioning system that services the Covered Property is damaged by a Covered Cause of Loss we will pay for any direct resulting damage to Covered Property. h. Breakage of tubes, bulbs, lamps or articles made of glass. But we will pay for such loss caused directly by fire, lightning, explosion,windstorm,earthquake, flood, vandalism, aircraft, rioters, strikers,theft or attempted theft, or by accident to vehicles carrying the Page 19 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) Covered Property. i. Processing or work performed upon the Covered Property. But we will pay for direct loss caused by resulting fire or explosion if the fire or explosion would be covered under this Coverage Form. 3. Limits, Deductibles, Valuation a. Limit of Insurance The most we will pay for any loss under the EDP section is$10,000. b. Deductible We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds the contents Deductible shown in the Declarations. We will then pay the amount of loss or damage in excess of the Deductible, up to the applicable Limit of Insurance. c. Valuation The value of the Covered Property will be determined as of the time and place of loss using the actual replacement cost of property similar to the Covered Property. In no event will our liability above exceed the cost to repair or replace the property with similar property of equal value. 0. Damage to Property of Home Care Providers You may extend the insurance provided by this Coverage Form to apply to direct physical loss of or damage to property owned by, or in the care, custody or control of a"home care provider," caused by a patient placed by you or an appropriate governmental agency on your behalf, in the care of the"home care provider"or employees of the insured. This Extension also extends to vehicles and self-propelled machines and outdoor trees, shrubs and plants owned by, or in the care, custody or control of the"home care provider"or employees of the insured. 'Home care provider' means a foster parent(or parents)paid or unpaid by you or an appropriate governmental agency on your behalf,to care for one or more patients on a continuous basis away from your premises. The most we will pay for loss or damage in any one occurrence under this Extension is$50,000. P. Mobile Medical Equipment You may extend the insurance provided by this Coverage Form to apply to your mobile medical equipment, including equipment which you rent. The most we will pay for loss or damage under this Extension is$15,000. Vlll. The BUILDING AND PERSONAL PROPERTY COVERAGE FORM, Section E. Loss Conditions is amended as follows: 6. b.Vacancy Provisions the first paragraph is amended to: If the building where loss or damage occurs has been vacant for more than 90 consecutive days before that loss or damage occurs Page 20 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. PI-EPE-HS-WA(06/09) IX. CAUSES OF LOSS—SPECIAL FORM, Section B. Exclusions, is amended as follows 1.b. Earth Movement is amended to include: (6) If Earth Movement described in b.(1)through(6)above, results in sprinkler leakage,we will pay up to$30,000 for loss or damage by that sprinkler leakage. 2.d. (7) is amended to: The following cause of loss to personal property: Marring or scratching. But if an excluded cause of loss that is listed in 2.d.(1)through (7)results in a"specified cause of loss"or building glass breakage, we will pay for the loss or damage caused by that "specified cause of loss"or building glass breakage. X. CAUSES OF LOSS—SPECIAL FORM Section C. Limitations is amended as follows: 3.a. is amended to: $10,000 for fur garments and garments trimmed with fur. 3.b. is amended to: $25,000 for trophies, medals,jewelry,watches,watch movements,jewels, pearls, precious and semi-precious stones, bullion,gold, silver, platinum and other precious alloys or metals. This limit does not apply to jewelry and watches worth$100 or less per item. XI. CAUSES OF LOSS—SPECIAL FORM, Additional Coverage—Water is added: "Water"is included as a Covered Cause of Loss. We will not pay more than$30,000 in any one occurrence. a. "Water" means: (1) Flood, surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, all whether driven by wind or not; (2) Mudslide or mudflow; (3) Water that backs up or overflows from a sewer, drain or sump; or (4) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations,walls,floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings. This extension applies to all claim expenses including, but not limited to building, business personal property, personal property of others, business income and extra expense and debris removal. However, this extension does not apply to roof drainage systems,gutters, Page 21 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) or downspouts. XII. CAUSES OF LOSS—SPECIAL FORM, Section F.Additional Coverage Extensions is amended as follows: 1. Property in Transit,c.is amended to (1) The most we will pay for loss or damage under this extension is$100,000. (2) For your covered property while in the care, custody or control of a common carrier an additional limit of insurance of$10,000 is added XIII. CAUSES OF LOSS—SPECIAL FORM, Section F.Additional Coverage Extensions is amended to include: 5. Off-Premises Power Failure We will pay for loss of or damage to Covered Property, caused by the interruption of service to the described premises. The interruption must result from direct physical loss or damage by a Covered Cause of Loss to"water supply services,""communication supply services," or"power supply services," not on the described premises. a. "Water supply services"means the following types of property supplying water to the described premises: (1) Pumping stations; and (2) Water mains. b. "Communication supply services" means property supplying communication services, including telephone, radio, microwave or television services to the described premises, such as: (1) Communication transmission lines including optic fiber transmission lines; (2) Coaxial cables; and (3) Microwave radio relays except satellites. "Communication supply services"does not include overhead communication lines. c. "Power supply services"means the following types of property supplying electricity, steam, or gas to the described premises: (1) Utility generating plants; (2) Switching stations; (3) Substations; (4) Transformers; and (5) Transmission lines. "Power supply services"does not include overhead transmission lines. Page 22 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) This coverage extension does not apply to loss of Business Income or Extra Expense. The most wewill pay for loss or damage under this extension is$50,000. XIV. BUSINESS INCOME (AND EXTRA EXPENSE)COVERAGE FORM,Section A. COVERAGE,5. Additional Coverages is amended as follows: c. Extended Business Income(1)(b)(ii)is amended to the following: (ii) 180 consecutive days after the date determined in(1)(a)above. c. Extended Business Income(2)(b)(ii)is amended to the following: (ii) 180 consecutive days after the date determined in (2)(a)above. XV. BUSINESS INCOME (AND EXTRA EXPENSE)COVERAGE FORM,Section A.COVERAGE, 5. Additional Coverages is amended to include: e. Utility Services (1) If a specific limit of coverage for Business Income and Extra Expense is included in the policy(not a part of this Elite form), then coverage is extended to include loss or damage that you incur due to the interruption, caused by a Covered Cause of Loss, of "water supply services," "communication supply services,"or"power supply services"to the premises described on the declarations. (a) "Water supply services"mean the following types of property supplying water to the described premises: (1) Pumping stations; and (ii) Water mains. (b) "Communication supply services" meaning property supplying communication services, including telephone, radio, microwave or television services,to the described premises, such as: (i) Communication transmission lines including optic fiber transmission lines; (ii) Coaxial cables; and (iii) Microwave radio relays except satellites. It does not include overhead transmission lines. (c) "Power supply services"meaning the following types of property supplying electricity, steam, or gas to the described premises: (i) Utility generating plants; (ii) Switching stations; (iii) Substations; (iv) Transformers; and Page 23 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. PI-EPE-HS-WA(06/09) (v) Transmission lines. It does not include overhead transmission lines. (2) We will only pay for loss you sustain after the first twelve(12) hours following the direct physical loss or damage to the off-premises property to which this enhancement applies. This coverage extension does not apply to direct physical damage to Covered Property. Page 24 of 24 ©2009 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc.,with its permission. �T Exhibit F PARKS,RCCRCATi ON 6 COMMUN"Y$CRVIc's City of Kent Certification Regarding Debarment and Suspension Kona Kai Coffee Hospitality Education and Train (HEAT ) 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 1 of 3 meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of these regulations. 6. The prospective primary participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. 7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines this eligibility of its principals. Each participant may, but is not required to, check the Non-procurement List. 9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 10. Except for transactions authorized under paragraph (6) of these instructions, if a participant in a covered transaction 11.Knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default. Certification B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Instructions for Certification (B) 1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available 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 trans- action originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification Is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment. Executive Director (Print) Title: Executive Director Mychal B ier Signatu Executive Director Date June 8, 2017 Adopted fro HUD Form- 92 09/04 3of3