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HomeMy WebLinkAboutPK17-431 - Original - Circulo de Mamas - Latin Women Driving Classes - 01/01/2017 e m en't, Records M KEN,- Wn3narst;ron 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 253-855-5725. Vendor Dame: Circulo de Mamas Vendor Number:. JD Edwards Number Contract Dumber: 1 This is assigned by City Clerk's Office Project Dame: Women Driving Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment X Contract ❑ Other: Contract Effective Date: 01/01/ 017 Termination Date: 12/31/ 018 Contract Renewal Notice (Days): 30 Number of days required notice for ternginatien renewal or amendment Contract Manager: Dinah Wilson Department: Parks Human Services Contract Amount: 2,000 Approval Authority: ❑ Director F-1 Mayor ❑ City Council Meeting Date ® Division Manager Detail: (i.e. address, location, parcel number, tax id, etc.): FYI...Circulo de Mamas is sponsored by Entre Hermanos • KENT w.�H .oro� CONSULTANT SERVICES AGREEMENT between the City of Kent and ENTRE HERMANOS THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Entre Hermanos, organized under the laws of the State of Washington, located and doing business at 1105 23rd Avenue, Seattle, WA 98122 (hereinafter the "Consultant"). I. DESCRIPTION OF WORK. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: Consultant shall increase self-sufficiency for Latina women through driving classes and helping them to obtain learner's permits. The following exhibits are attached and incorporated by this reference as if fully set forth herein: Exhibit A, Project Scope of Services; Exhibit B, Income Guidelines; Exhibit C, Billing Voucher and Service Report; Exhibit D, Kent Annual Outcome Report; Exhibit E, Insurance Requirements; and Exhibit F Certification Regarding Debarment and Suspension. Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time those services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon the effective date of this Agreement. Consultant shall complete the work described in Section I by December 31, 2018. This Agreement, however, is contingent upon the availability of funds to be allcoated through the City's budget process. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed $7,000 ($3,500 per year), for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be as delineated in Exhibit A. B. The Consultant shall submit quarterly payment invoices to the City for work performed, and a final bill upon completion of all services described in this Agreement. The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. 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: B is i n,tc)re) P)iAntNamc: Merina H nson Print Narnc: 4CV/s F t�m IkE7z-- Its: Housing & Hunan Services Manager v — Parks Department, Its:, Housing & HUrnan Services Division - , DATE:" D A IT- NOTICES TO BE SENT TO; NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Luis Fernando Rarnire/ [Jrn6n, XQCLAiV0 Director j Dinah R. VAlson Entre Hermanos City of Kent 220 Fourth Avenue South Seattle, WA 98122 Kent, WA 98032 206.322.7700 (telephone) 253.856,5076 (telephone) 253, 856 6070 (facsimile) CONSULTANT SERVICES AGRF I K NI S (.520,000 or Less) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. S. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By: For: 6-t1/S �— Title: Date: EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date) between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 • KENT WASHI%GrcN PARKS, RECREATION S COMMUNITY SERVICES EXHIBIT A 2017-2018 CONSULTANT SERVICES AGREEMENT PROJECT SCOPE OF SERVICES PARALLEL HUMAN SERVICES SMALL FUND GRANT ENTREHERMANOS FISCAL SPONSOR OF CIRCULO DE MAMAS Consultant/Consultant: Entre Hermanos (Fiscal Start Date: 1/1/17 Sponsor of Circulo De Mamas Project Title: Women Driving End Date: 12/31/18 Funding will provide Program Outcome: 2017 $3,500.00 assistance for Latina Project will increase self- Funding: women to attend sufficiency for Latina 2018 $3,500.00 workshops that orient them women. Outcomes will be Funding to driving and securing measured through pre and Total City $7,000.00 learner's permits. This post-surveys and the of Kent program will benefit 12 number of learner's permits Funds: Kent residents. obtained, with annual results provided to the City via Exhibit D. Project Manager: Jacqueline Garcia Telephone: 206 249-5504 E-mail: circulodemamasseattle@gmail.com City Contact Manager: Dinah Wilson Telephone: 253.856.5076 Fax: 253.856.6070 E-mail: drwilson@kentwa.gov Entre Hermanos (hereinafter referred to as "the Consultant") shall utilize City of Kent Human Services Funds (GF budget) to perform the activities specified below. Such services shall be provided in a manner which fully complies with all applicable federal, state and local laws, statutes, rules and regulations, as are now in effect or may be hereafter amended. 1) Project Budget The Consultant shall apply the following funds to the project in accordance with the Biennium Line Item Budget Summary below: Line Item Budget Personnel Services $2,750.00 (biannually) Consultant Services (contracts with $ 750.00 (biannually) private consultants such as childcare 2017-2018 Entre Hermanos (FS of Circulo de Mamas)-Consultant Services Agreement Scope of Services Page 1 1 r` providers; copies of consultant bills should be submitted to the City) Total City of Kent Funds: $7,000.00 2) Performance Measures A. Number Served The Consultant agrees to serve, at minimum, the following unduplicated number of persons each year of the Consultant Services Agreement: Quarters ist 2nd 3rd 4tn Quarter Quarter Quarter Quarter Total ]AN. — APRIL — JULY — OCT. — Per MARCH JUNE SEPT. DEC. year No. of unduplicated persons assisted 0 4 4 4 12 B. Units of Service The Consultant agrees to provide, at minimum, the following units of service by quarter: Quarters ist 2nd 3rd 4tn Quarter Quarter Quarter Quarter Total ]AN. — APRIL — JULY — OCT. — Per MARCH JUNE SEPT. DEC. year # of instruction (learner's) permits 0 2 3 3 8 C. Definition of Services An instruction permit is defined as documentation provided by the State of Washington that allows an individual to legally practice driving. 3) Records A. Project Files The Consultant shall maintain files for this project containing the following items: 1. Notice of Grant Award. 2. Consultant Services Agreement and all contract exhibits. 3. A copy of this Scope. 4. Correspondence regarding budget revision requests. 5. Copies of all reports submitted to the City for this project. 6. Billing vouchers submitted for payment. 2017-2018 Entre Hermanos (FS of Circulo de Mamas)-Consultant Services Agreement Scope of Services Page 2 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) Confirmation of participation in the free/reduced price meals program; b) IRS income tax return; c) Paystubs; or d) Documentation of qualification for participation in a "means- tested" federal or state program at least as restrictive as Federal Income Program Guidelines. Income guidelines may be adjusted periodically by the federal government. The Consultant agrees to use updated Income Guidelines, which will be provided by the City. B. Record Retention Period All records required by this Scope and the Consultant Services Agreement shall be retained by the Consultant in an accessible file for a period of three (3) years from the end of the term of this Agreement. 4) Contract Administration A. Changes in Personnel or Board Membership The Consultant shall notify the City, in writing, within ten (10) days of any changes in program personnel or board membership. The Consultant shall provide the City with a current list of its board of directors, general or limited partners, as applicable. B. Attendance at Kent Cultural Diversity Initiative Group Meetings Unless excused by the City, the Consultant will attend a minimum of three (3) Kent Cultural Diversity Initiative Group meetings in 2017 and five (5) in 2018. C. Meetings between the Consultant and City of Kent The Consultant shall meet with City staff and other organizations receiving Parallel Human Services Small Fund Grant funds up to three times over the next two years (2017-2018). 2017-2018 Entre Hermanos (FS of Circulo de Mamas)-Consultant Services Agreement Scope of Services Page 3 5) Reports, Invoicing and Reporting Schedule A. Reports 1. All data and required forms shall be submitted to: drwilson(cbkentwagov 2. Billing Voucher and Service Report - Data from this form will be used to track each program's progress toward meeting the goals stipulated in the Scope of Services. It shall be submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 15), along with the Reimbursement Request. 3. Annual Outcome Data Report - Outcome data shall be submitted no later than the 15th following the end of the fourth quarter. Data should demonstrate the program's progress toward Outcomes specified in the Scope of Services. B. Invoicing and Reporting Schedule The Consultant shall submit Billing Vouchers and Service Reports to the City in accordance with the following schedule: 1st ,2 nd & 3 rd Quarter Billing Voucher 151E day following each quarter & Service Report (Exhibit C) 4 1h Quarter Billing Voucher & Service December 15thl Report Annual Outcome Data Report January 15, 2018 (Exhibit D) 2017-2018 Entre Hermanos (FS of Circulo de Mamas)-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 /0 MEDIAN MEDIAN FAMILY EXTREMELY VERY LOW SIZE LOW` LOW INCOME INCOME INCOME 1 $20,200 $33,600 $50,400 2 $2.3,050 $38,400 $57,600 3 $2.5,950 $43,200 $64,800 4 $2.8,800 $48,000 $72,000 5 $31,150 $51,850 $77,800 6 $33,450 $55,700 $83,550 7 $37,140 $59,550 $89,300 8 $41,320 $63,400 $95,050 *The FY 2014 Consolidated Appropriations Act changed the definition of extremely low-income to be the greater of 30/501h (60%) of the Section 8 very low-income limit or the poverty guideline as established by the Department of Health and Human Services (HHS), provided that this amount is not greater than the Section 8 50% very low- income limit. Consequently, th,e extremely low-income limits may equal the very low (50%) income limits. Income Limit areas are based on FY 2017 Fair Market tent (FMR) areas. 4^4�� KENT Exhibit C W-f'IINGTO. Billing Voucher & Service Report PARKS, RECREATION 2017 COMMUNITY SERVICES To: Consultant/Agency: Entre Hermanos, Fiscal Sponsor Dinah Wilson of Circulo De Mamas Housing & Human Services Parks,, Recreation & Community Services Program Contact- Jacqueline Garcia 220 4h Ave. South, K W enit, A 98032 Telephone- (206)'249-5504 drwilson@kentwa.gov Phone: (253) 856-5076 1 E-mail: circulodemamasseattle@gmail.com Reporting Period Program Amount Requested Qtr. Women Driving $ SEC. 1: BUDGET SUMMARY (CALC I ULATIONS BASED ON! YEARLY BUDGET) For Department Use Only Total Contract Amount $ 7,000.00 Total 2017 Contract Amount $ 3,500.00 Amount Requested This Qtr. $ Amount Requested YTD $ Amount Remaining YTD (subtract amount requested YTD from 2017 contract amount) SEC. 2: 2017 LINE ITEM BUDGET SUMMARY (ANNUAL) ORIGINAL, TOTAL REVISED CUMULATIVE COST CATEGORIES BUDGET REQUESTED BUDGET TO DATE, 1 Personnel Costs $2,750.00 2 Consultant Services (contracts with private $ 750,00 consultants such as childcare providers; copies of consultant bills should be submitted to L the,Ci!y) Page 1 of 6 GRAND TOTAL $3,500.00 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#o serve Contracted 'Served Pate Total Service Unit/Performance �t 2 nd 3 rd 4 kn Total Contracted to 1st 2nd 3rd 4th Measure Serve Unduplicated ##of Kent clients (persons) served 3 4 3 4 1 14 Youth leadershiip meetings (# of meetings) 1 5 5 5 15 Sec., 4: NARRATIVE Provide a quarterly program narrative, including an explanation if you are behind in either progress toward meeting performance measures or projected expenditure rate. Page 2 of 6 Sec. 5: DEMOGRAPHIC INFORMATION Number of Households or Persons Assisted (please specify "H" or"P most agencies should report persons): Rance Unduplicated Ethnicity- Und p. Undboli'cated Quarter Uhduplic t d Year to Yoar to Date (All) Quarter(Hispanic*) Date (Hispadic) All** 1 2 3 4 1 2 3 4 W Mite 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 income Levu Unduplicated Quarter UridWl ated'Year to,Date 1 2 8 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 'Utadupii ated Quarter Undu01idzit d,'Y0dr Age 12 3 4 a -4 years 5 - 12 years 13 - 17 years 13 -34 years 3 -54 years 55 - 74 years 75+ years Unknown GRAND TOTAL CLIENTS Gender Unduplicated Quarter` Undulpiicated Year to gate 1 2 3 4 Female Male GRAND TOTAL CLIENTS Female Headed Households Undoplicated Quarter 'UndUplideted'Year '6'. to GRAND TOTAL CLIENTS Persons with Disabilities Unduplicated Quarter Unduplicated 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, false statements, false claims or otherwise. Consultant Authorized Signature Date Payment Authprization this section"to be completed by City,of Kept,olply) Contractual Obligations Met? YES NO , (Circle Caine Enter n6f6s'IfAd6ncy underperformed: AUthori2od 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 r-- co O O ONN a11-71.-: wMM w L�, L w � � c c O � � 'D 'D O 0 0 J CLCL ZEE °C co a� Za o o a cu F- O 0 '~ a cn Z ti ao Of U wT- V- Yoo p -� CL co N N E Q ro — 0) O E (Q L 1 � d w Q C6 a..r ca N cn L c O u- a c c o c� a o CL a. o L x .a u E o c ° Z o •— aD t c � a w cl c i t `m ul a o a In N L C A z W O L O C O N a)a� � a� � E O •V o c W W U U c0:i Z E O Z d ca N C ` +. . W. � Z u � � � � L o m �n ; cn- c '� '� c O U O iri Y O r° ro O V N cnCn �. dco� QUIU] a E co ATTACHMENT E Circulo de Mamas INSURANCE REQUIREMENTS FOR 2017-2018 CONSULTANT SERVICES AGREEMENT Insurance The Contractor shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Contractor shall obtain insurance of the types described below: 1. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and shall cover liability arising from premises, operations, independent contractors, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract. The Commercial General Liability insurance shall be endorsed to provide the Aggregate Per Project Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or modification of the Commercial General Liability insurance for liability arising from explosion, collapse or underground property damage. The City shall be named as an insured under the Contractor's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. B. Minimum Amounts of Insurance Contractor shall maintain the following insurance limits: 1. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $1,000,000 general aggregate and a $1,000,000 products-completed operations aggregate limit. 2. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. EXHIBIT E (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Contractor's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it. Z. The Contractor's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Contractor's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. E. Verification of Coverage Contractor shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Contractor before commencement of the work. F. Subcontractors Contractor shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Contractor. ENTRE-2 OP ID:SB ACORO DATE(MMIDDMYY) CERTIFICATE OF LIABILITY INSURANCE 03/2312017 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 endorsement(s). PRODUCER 425-576-0464 c Ne cT Sandie Brase Lee Insurance Services,Inc. PHONE 425-576-0464 FAX 425-576-1915 11410 98th Avenue Northeast Arc,No,Evil: FAX No Kirkland,WA 98033-4325 EpMAIL ,san a ee-nsurance.com John J.Economus INSURE S AFFORDING COVERAGE NAIC p INSURER A:First National Insurance Co. 24724 INSURED Entre Hermanos INSURER B: PO Box 1217 Seattle,WA 98122 INSURER C: _ INSURER D: INSURER E: ENSURER 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. INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE [ OCCUR X 25CC20752400 03/30/2017 03/3012018 DAMAGE TO RENTED $ 1,000,000 PREMISES(Ea occurrence)MED EXP(Any one rson) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑joeT 71 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT fEa accident $ ANYAUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY BODILY INJURY Peraccident S AUTOS ONLY AUTOS ONLY PeOr aEaiRdent AMAGE S S UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS LIAO CLAIMS-MADE I AGGREGATE S DEDEC) RETENTION$ $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITYANY PROPRIIETgOERRIPARTNER/EXECUTNE YIN I 25CC20752400 0313012017 03l3012018 E.L.EACH ACCIDENT S W 1,000,000 andEffM to NH)EXCLUDED? N I A E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY_ LIMIT s B Professional LP7745277D 0313012017 0313012018 �Occurence 1,000,000 Aggregate 2,000,000 i eitsyc�` Wen°TFf ousing an��u san 'erwc�"s anthAc i��naY'InsLi�Vul �BS�eCLSod If more apace Is required) their interest in operations of insured where required by written contract. CERTIFICATE HOLDER CANCELLATION CITOFKE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Kent ACCORDANCE WITH THE POLICY PROVISIONS. Housing and Human Services 220 Fourth Ave So AUTHORIZED REPRESENTATIVE Kent,WA 98118 Aakw�. &&dc ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD iDE241EO47 GINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS "^ 0. N COMMERCIAL GENERAL LIABILITY m CG 76 35 02 07 u1 m w - d JRSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. r 4 W LIABILITY PLUS ENDORSEMENT LO a coIf oi ient modifies insurance provided under the following: U. o MMERCIAL GENERAL LIABILITY COVERAGE PART a 7 SCHEDULE c w a of Person or Organization: City of Kent 0 Housing and Human services 220 Fourth Ave So Kent, WA 98118 ADDITIONAL INSURED — BY WRITTEN lease or occupy, subject to the following CONTRACT, AGREEMENT OR PERMIT, OR additional provisions: SCHEDULE (a) This insurance does not apply to The following paragraph is added to WHO IS AN any "occurrence" which takes place INSURED (Section II): after you cease to be a tenant in any premises leased to or rented to 4. Any person or organization shown in the Sched- you; ule or for whom you are required by written con- (b) This insurance does not apply to tract, agreement or permit to provide insurance any structural alterations, new con- is an insured, subject to the following additional struction or demolition operations provisions: performed by or on behalf of the a. The contract, agreement or permit must be person or organization added as an in effect during the policy period shown in insured; the Declarations, and must have been exe- (2) Your ongoing operations for that in- cuted prior to the "bodily injury", "property sured, whether the work is performed damage", or personal and advertising by you or for you; injury". (3) The maintenance, operation or use by b. The person or organization added as an in- you of equipment leased to you by such sured by this endorsement is an insured only person or organization, subject to the to the extent you are held liable due to: following additional provisions: (1) The ownership, maintenance or use of (a) This insurance does not apply to that part of premises you own, rent, any "occurrence"which takes place after the equipment lease expires; Includes Copyrighted Material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services, 2001 CC 76 35 02 07 Page 1 of 4 EP AFP-M ETA2.17•PA 1UT 001.0403.0144•M DocuSign Envelope ID:F1D326B5-23DC-49FE-BEFB-219DE241EO47 GINAL TRANSACTIDNMAY INCLUDE, (b) This insurance does not apply to This exclusio "bodily injury" or "property dam- against any ir.. age" arising out of the sole negli- other wrongdoing g gence of such person or employment, trainil organization; by that insured, if caused the "bodily. (4) Permits issued by any state or political damage" involved tht g(o' Z'D subdivision with respect to operations nance, use or entrustrrk"' 3' performed by you or on your behalf, aircraft, "auto" or water? 'C 0 A) CO subject to the followingadditional pro- or operated b or rente~ � '� `� ° co m ca P P Y o � :� ��CDCD vision: sured. 0 80 a g m This insurance does not apply to "bodily This exclusion does„ o�a injury", "property damage", or (1) A watercraft N.o 0 ) ° Z m "personal and advertising injury" arising you own or re z A) out of operations performed for the state 2 '� o CO or municipality. ( ) A watercraft c. The insurance with respect to any architect, (a) Less tt- engineer, or surveyor added as an insured (b) Not b by this endorsement does not apply to prop "bodily injury", "property damage", or "per- p sonal and advertising injury" arising out of (3) Parking al. the rendering of or the failure to render any next to, premix. professional services by or for you, includ- vided the "auto" ing: rented or loaned to you (1) The preparing, approving, or failing to (4) Liability assumed under any prepare or approve maps, drawings, contract" for the ownership, I,. opinions, reports, surveys, change or- nance or use of aircraft or watercraft; . ders, designs or specifications; and (5) "Bodily injury" or "property damage" (2) Supervisory, inspection or engineering arising out of: services. (a) the operation of machinery or d. This insurance does not apply to "bodily equipment that is attached to, or part of, a land vehicle that would injury" or "property damage" included within qualify under the definition of the "products-completed operations haz- "mobile equipment" if it were not and". subject to a compulsory or financial responsibility law or other motor ve- A person's or organization's status as an insured un- hicle insurance law in the state der this endorsement ends when your operations for where it is licensed or principally that insured are completed. garaged; or No coverage will be provided if, in the absence of this (b) the operation of any of the machin- endorsement, no liability would be imposed by law on ery or equipment listed in Paragraph f.(2) or f.(3) of the definition of you. Coverage shall be limited to the extent of your "mobile equipment". negligence or fault according to the applicable princi- ples of comparative fault. (6) An aircraft you do not own provided it is not operated by any insured. NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT LIABILITY TENANTS'PROPERTY DAMAGE LIABILITY Exclusion g. of COVERAGE A (Section 1) is replaced When a Damage To Premises Rented To You Limit is by the following: shown in the Declarations, Exclusion J. of Coverage A, Section I is replaced by the following: g. "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or J. Damage To Property entrustment to others of any aircraft, "auto" "Property damage" to: or watercraft owned or operated by or rented or loaned to any insured. Use includes oper- (1) Property you own, rent, or occupy, including ation and `loading or unloading". any costs or expenses incurred by you, or Page 2 of 4 AMMETA2-1 7•PRINT001.040"1 45-M De ID:F1D32665-23DC-49FE-BEFB-219DE241EO47 GINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS -- any other person, organization or entity, for WHO IS AN INSURED — MANAGERS repair, replacement, enhancement, restora- tion or maintenance of such property for any The following is added to Paragraph 2.a. of WHO IS reason, including prevention of injury to a AN INSURED (Section II): person or damage to another's property; (2) Premises you sell, give away or abandon, if Paragraph(1) does not apply to executive officers, or the "property damage" arises out of any part to managers at the supervisory level or above. of those premises; SUPPLEMENTARY PAYMENTS — COVERAGES A (3) Property loaned to you; AND B — BAIL BONDS — TIME OFF FROM (4) Personal property in the care, custody or WORK control of the insured; Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — (5) That particular part of real property on which COVERAGES A AND B is replaced by the following: you or any contractors or subcontractors working directly or indirectly on your behalf b. Up to $3,000 for cost of bail bonds required are performing operations, if the "property because of accidents or traffic law violations damage" arises out of those operations, or arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. (6) That particular part of any property that must We do not have to furnish these bonds. be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — "aragraphs (1), (3) and (4) of this exclusion do COVERAGES A AND B is replaced by the following: of apply to "property damage" (other than d. All reasonable expenses incurred by the in- amage by fire) to premises, including the con- sured at our request to assist us in the in- nts of such premises, rented to you.A separate vestigation or defense of the claim or "suit", pit of insurance applies to Damage To Prem- including actual loss of earnings up to $500 s Rented To You as described in Section III a day because of time off from work. -imits Of Insurance. agraph (2) of this exclusion does not apply if EMPLOYEES AS INSUREDS — HEALTH CARE premises are "your work" and were never SERVICES Ipied, rented or held for rental by you. Provision 2.a.(1)(d) of WHO IS AN INSURED (Section Iraphs (3), (4), (5) and (6) of this exclusion II) is deleted, unless excluded by separate endorso- A apply to liability assumed under a side- ment. agreement. aph(6) of this exclusion does not apply to EXTENDED COVERAGE FOR NEWLY ACQUIRED rty damage" included in the "products- ORGANIZATIONS `ed operations hazard". Provision 3.a. of WHO IS AN INSURED (Section II) is of LIMITS OF INSURANCE (Section III) replaced by the following: the following: a. Coverage under this provision is afforded 5. above, the Damage To Premises only until the end of the policy period. You Limit is the most we will pay un- EXTENDED "PROPERTY DAMAGE" {age A for damages because of lamage" to any one premises, while )u, or in the case of damage by fire, Exclusion a. of COVERAGE A (Section I) is replaced ' to you or temporarily occupied by by the following: nission of the owner. a. "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. 'remises Rented To You limit is the This exclusion does not apply to "bodily injury" `t Occurrence Limit shown in the or "property damage" resulting from the use of amount shown in the Declarations reasonable force to protect persons or property. nises Rented To You Limit. Page 3 of 4 EP NT�1 04030147.{A AFP.META2.17•PRINTD01.D40M146•M DocuSign Envelope ID:F1D326B5-23DC-49FE-BEFB-219DE241E047 GINAL TRANSACTiONMAY INCLUDE ADOiTIONALFORMS "" EXTENDED DEFINITION OF BODILY INJURY interrupted only by a street, roadway, waterway, or right-of-way of a railroad. Paragraph 3. of DEFINITIONS (Section V) is replaced by the following: INCREASED MEDICAL EXPENSE LIMIT 3. "Bodily injury" means bodily injury, sickness or The Medical Expense Limit is amended to$10,000. disease sustained by a person, including mental anguish or death resulting from any of these at KNOWLEDGE OF OCCURRENCE any time. The following is added to Paragraph 2. Duties In The TRANSFER OF RIGHTS OF RECOVERY Event Of Occurrence, Offense, Claim Or Suit of COMMERCIAL GENERAL LIABILITY CONDITIONS The following is added to Paragraph 8. Transfer Of (Section IV): Rights Of Recovery Against Others To Us of COM- MERCIAL GENERAL LIABILITY CONDITIONS (Sec- Knowledge of an "occurrence", claim or "suit" by tion IV): your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an We waive any rights of recovery we may have against officer of the named insured has received such notice any person or organization because of payments we from the agent, servant or employee. make for injury or damage arising out of your ongoing operations or "your work" done under a contract with UNINTENTIONAL FAILURE TO DISCLOSE ALL that person or organization and included in the HAZARDS "products-completed operations hazard". This waiver applies only to a person or organization for whom you The following is added to Paragraph 6. Representa- are required by written contract, agreement or permit tions of COMMERCIAL GENERAL LIABILITY CONDI- to waive these rights of recovery. TIONS (Section IV): AGGREGATE LIMITS OF INSURANCE — PER If you unintentionally fail to disclose any hazards ex- LOCATION isting at the inception date of your policy, we will not deny coverage under this Coverage Form because of For all sums which the insured becomes legally obli- such failure. However, this provision does not affect gated to pay as damages caused by "occurrences" our right to collect additional premium or exercise our under COVERAGE A (Section 1), and for all medical right of cancellation or non-renewal. expenses caused by accidents under COVERAGE C (Section 1), which can be attributed only to operations LIBERALIZATION CLAUSE at a single "location": The following paragraph is added to COMMERCIAL Paragraphs 2.a. and 2.b. of Limits of Insurance (Sec- GENERAL LIABILITY CONDITIONS (Section IV): tion 111) apply separately to each of your "locations" owned by or rented to you. 10. If a revision to this Coverage Part, which would provide more coverage with no additional pre- "Location" means premises involving the same or mium, becomes effective during the policy period connecting lots, or premises whose connection is in the state shown in the Declarations, your pol. icy will automatically provide this additional cov, erage on the effective date of the revision. Page 4 of 4 AFF-META2•i 7•P ocuSign Envelope ID:F1D326B5-23DC-49FE-BEFB-219DE241E047 GINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" Liberty Mutual. COMMERCIAL GENERAL LIABILITY FNSVRANCE CG 76 35 02 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Kent Housing and Human services 220 Fourth Ave so Kent, wA 98118 ADDITIONAL INSURED — BY WRITTEN lease or occupy, subject to the following CONTRACT, AGREEMENT OR PERMIT, OR additional provisions: SCHEDULE (a) This insurance does not apply to The following paragraph is added to WHO IS AN any "occurrence" which takes place INSURED (Section II): after you cease to be a tenant in any premises leased to or rented to 4. Any person or organization shown in the Sched- you; ule or for whom you are required by written con- (b) This insurance does not apply to tract, agreement or permit to provide insurance any structural alterations, new con- is an insured, subject to the following additional struction or demolition operations provisions: performed by or on behalf of the a. The contract, agreement or permit must be person or organization added as an in effect during the policy period shown in insured; the Declarations, and must have been exe- (2) Your ongoing operations for that in- cuted prior to the "bodily injury", "property sured, whether the work is performed damage", or "personal and advertising by you or for you; injury". (3) The maintenance, operation or use by b. The person or organization added as an in- you of equipment leased to you by such sured by this endorsement is an insured only person or organization, subject to the to the extent you are held liable due to: following additional provisions: (1) The ownership, maintenance or use of (a) This insurance does not apply to that part of premises you own, rent, any "occurrence"which takes place after the equipment lease expires; Includes Copyrighted Material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services, 2001 CC 76 35 02 07 Page 1 of 4 EP AFP-META2-17-PRINT001-D403-01"-M DocuSign Envelope ID:F1D326B5-23DC-49FE-BEFB-219DE241E047 GINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS (b) This insurance does not apply to This exclusion applies even if the claims "bodily injury" or "property dam- against any insured allege negligence or age" arising out of the sole negli- other wrongdoing in the supervision, hiring, gence of such person or employment, training or monitoring of others organization; by that insured, if the "occurrence" which caused the "bodily injury" or "property (4) Permits issued by any state or political damage" involved the ownership, mainte- subdivision with respect to operations nance, use or entrustment to others of any performed by you or on your behalf, aircraft, "auto" or watercraft that is owned subject to the following additional pro- or operated by or rented or loaned to any in- vision: sured. This insurance does not apply to "bodily This exclusion does not apply to: injury", "property damage", or (1) A watercraft while ashore on premises "personal and advertising injury" arising you own or rent; out of operations performed for the state or municipality. (2) A watercraft you do not own that is: c. The insurance with respect to any architect, (a) Less than 52 feet long; and engineer, or surveyor added as an insured (b) Not being used to carry persons or by this endorsement does not apply to property for a charge; "bodily injury", "property damage", or "per- sonal and advertising injury" arising out of (3) Parking an "auto" on, or on the ways the rendering of or the failure to render any next to, premises you own or rent, pro- professional services by or for you, includ- vided the "auto" is not owned by or ing: rented or loaned to you or the insured; (1) The preparing, approving, or failing to (4) Liability assumed under any "insured prepare or approve maps, drawings, contract" for the ownership, mainte- opinions, reports, surveys, change or- nance or use of aircraft or watercraft; or ders, designs or specifications; and (5) "Bodily injury" or "property damage" (2) Supervisory, inspection or engineering arising out of: services. (a) the operation of machinery or d. This insurance does not apply to "bodily equipment that is attached to, or or "property dama e" included within part of, a land vehicle that would injury" g qualify under the definition of the "products-completed operations haz- "mobile equipment" if it were not and". subject to a compulsory or financial responsibility law or other motor ve- A person's or organization's status as an insured un- hicle insurance law in the state der this endorsement ends when your operations for where it is licensed or principally that insured are completed. garaged; or No coverage will be provided if, in the absence of this (b) the operation of any of the machin- endorsement, no liability would be imposed by law on ery or equipment listed in Paragraph f.(2) or f.(3) of the definition of you. Coverage shall be limited to the extent of your "mobile equipment". negligence or fault according to the applicable princi- ples of comparative fault. (6) An aircraft you do not own provided it is not operated by any insured. NON-OWNED WATERCRAFT AND NON-OWNED AIRCRAFT LIABILITY TENANTS'PROPERTY DAMAGE LIABILITY Exclusion g. of COVERAGE A (Section 1) is replaced When a Damage To Premises Rented To You Limit is by the following: shown in the Declarations, Exclusion j. of Coverage A, Section I is replaced by the following: g. "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or j• Damage To Property entrustment to others of any aircraft, "auto" "Property damage" to: or watercraft owned or operated by or rented or loaned to any insured. Use includes oper- (1) Property you own, rent, or occupy, including ation and `goading or unloading". any costs or expenses incurred by you, or Page 2 of 4 A F P-META 2-17-P R I N T 001-040 3-0145-MI -vcuSign Envelope ID:F1D326B5-23DC-49FE-BEFB-219DE241E047 GINAL TRANSACT;CNMAv INCLUDE ACCiTiONALFORMS J any other person, organization or entity, for WHO IS AN INSURED — MANAGERS repair, replacement, enhancement, restora- tion or maintenance of such property for any The following is added to Paragraph 2.a. of WHO IS reason, including prevention of injury to a AN INSURED (Section II): person or damage to another's property; (2) Premises you sell, give away or abandon, if Paragraph (1) does not apply to executive officers, or the "property damage" arises out of any part to managers at the supervisory level or above. of those premises; SUPPLEMENTARY PAYMENTS — COVERAGES A (3) Property loaned to you; AND B — BAIL BONDS — TIME OFF FROM (4) Personal property in the care, custody or WORK control of the insured; Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — (5) That particular part of real property on which COVERAGES A AND B is replaced by the following: you or any contractors or subcontractors working directly or indirectly on your behalf b. Up to $3,000 for cost of bail bonds required are performing operations, if the "property because of accidents or traffic law violations damage" arises out of those operations, or arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. (6) That particular part of any property that must We do not have to furnish these bonds. be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph i.d. of SUPPLEMENTARY PAYMENTS — Paragraphs (1), (3) and (4) of this exclusion do COVERAGES A AND B is replaced by the following: not apply to "property damage" (other than d. All reasonable expenses incurred by the in- damage by fire) to premises, including the con- sured at our request to assist us in the in- tents of such premises, rented to you. A separate vestigation or defense of the claim or 'suit", limit of insurance applies to Damage To Prem- including actual loss of earnings up to $500 ises Rented To You as described in Section III a day because of time off from work. — Limits Of Insurance. Paragraph (2) of this exclusion does not apply if EMPLOYEES AS INSUREDS — HEALTH CARE the premises are "your work" and were never SERVICES occupied, rented or held for rental by you. Provision 2.a.(1)(d) of WHO IS AN INSURED (Section Paragraphs (3), (4), (5) and (6) of this exclusion II) is deleted, unless excluded by separate endorse- do not apply to liability assumed under a side- ment. track agreement. Paragraph(6) of this exclusion does not apply to EXTENDED COVERAGE FOR NEWLY ACQUIRED "property damage" included in the "products- ORGANIZATIONS completed operations hazard". Provision 3.a. of WHO IS AN INSURED (Section II) is Paragraph 6. of LIMITS OF INSURANCE (Section III) replaced by the following: is replaced by the following: a. Coverage under this provision is afforded 6. Subject to 5. above, the Damage To Premises only until the end of the policy period. Rented To You Limit is the most we will pay un- EXTENDED "PROPERTY DAMAGE" der Coverage A for damages because of "property damage" to any one premises, while Exclusion a. of COVERAGE A (Section 1) is replaced rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by by the following: you with permission of the owner. a. `Bodily injury" or "property damage" expected or intended from the standpoint of the insured. The Damage To Premises Rented To You limit is the This exclusion does not apply to This injury" higher of the Each Occurrence Limit shown in the or "property damage" resulting from the use of Declarations or the amount shown in the Declarations reasonable force to protect persons or property. as Damage To Premises Rented To You Limit. CG 76 35 02 07 Page 3 of a EP AFP•M ETA 2.17•P R I NT DD 1.0403•0146•M DocuSign Envelope ID:F1D32665-23DC-49FE-BEFB-219DE241E047 GINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" EXTENDED DEFINITION OF BODILY INJURY interrupted only by a street, roadway, waterway, or right-of-way of a railroad. Paragraph 3. of DEFINITIONS (Section V) is replaced by the following: INCREASED MEDICAL EXPENSE LIMIT 3. "Bodily injury" means bodily injury, sickness or The Medical Expense Limit is amended to$10,000. disease sustained by a person, including mental anguish or death resulting from any of these at KNOWLEDGE OF OCCURRENCE any time. The following is added to Paragraph 2. Duties In The TRANSFER OF RIGHTS OF RECOVERY Event Of Occurrence, Offense, Claim Or Suit of COMMERCIAL GENERAL LIABILITY CONDITIONS The following is added to Paragraph 8. Transfer Of (Section IV): Rights Of Recovery Against Others To Us of COM- MERCIAL GENERAL LIABILITY CONDITIONS (Sec- Knowledge of an `occurrence", claim or "suit" by tion IV): your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an We waive any rights of recovery we may have against officer of the named insured has received such notice any person or organization because of payments we from the agent, servant or employee. make for injury or damage arising out of your ongoing operations or "your work" done under a contract with UNINTENTIONAL FAILURE TO DISCLOSE ALL that person or organization and included in the HAZARDS "products-completed operations hazard". This waiver applies only to a person or organization for whom you The following is added to Paragraph 6. Representa- are required by written contract, agreement or permit tions of COMMERCIAL GENERAL LIABILITY CONDI- to waive these rights of recovery. TIONS (Section IV): AGGREGATE LIMITS OF INSURANCE -- PER If you unintentionally fail to disclose any hazards ex- LOCATION isting at the inception date of your policy, we will not deny coverage under this Coverage Form because of For all sums which the insured becomes legally obli- such failure. However, this provision does not affect gated to pay as damages caused by "occurrences" our right to collect additional premium or exercise our under COVERAGE A (Section 1), and for all medical right of cancellation or non-renewal. expenses caused by accidents under COVERAGE C (Section 1), which can be attributed only to operations LIBERALIZATION CLAUSE at a single "location": The following paragraph is added to COMMERCIAL Paragraphs 2.a. and 2.b. of Limits of Insurance (Sec- GENERAL LIABILITY CONDITIONS (Section IV): tion III) apply separately to each of your "locations" owned by or rented to you. 10. If a revision to this Coverage Part, which would provide more coverage with no additional pre- "Location" means premises involving the same or mium, becomes effective during the policy period connecting lots, or premises whose connection is in the state shown in the Declarations, your pol- icy will automatically provide this additional cov- erage on the effective date of the revision. Page 4 of 4 AFP-META2.17-PRINT001-04030147-M `r KENT Exhibit F :+A-r.;..RG(;RCAT,)r.:y s` "" City of Kent Certification Regarding Debarment and Suspension Entre Hermanos Women Driving 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 8: 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 (8) 1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available 2 d 3 remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, loafer tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment. Executive Director (Print) Title (Print) Gvt S � ll' Z j, Signature of Executive Director Date Adopt ZromHUD Form-2992 09/04 3 of 3