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PK17-533 - Original - Puget Sound Training Center - Employment & Training Services - 01/01/2017
�Records M � Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: Puget Sound Training Center Vendor Number: JD Edwards Number Contract Number: PK I� ,533 This is assigned by City Clerk's Office Project Name: Employment & Training Services Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 111/17 Termination Date: 12/31/18 Contract Renewal Notice (Days): 30 days Number of days required notice for termination or renewal or amendment Contract Manager: Dinah Wilson Department: Parks-Human Services Contract Amount: $5,000 Approval Authority: (CIRCLE ONE) L �artment C7i re cto Mavo City Council Detail: (i.e. address, location, parcel number, tax id, etc.): This is a CDBG-funded contract Fundinq will provide comprehensive employment services to underserved individuals in Kent. tp 34/7/15 CDBG AGREEMENT BETWEEN THE CITY OF KENT AND PUGET SOUND OPPORTUNITIES INDUSTRIALIZATION CENTER, D/B/A PUGET SOUND TRAINING CENTER EMPLOYMENT AND TRAINING SERVICES This Agreement, entered into this 15th day of SeptemLgr, 2017„ between the City of Kent, a Washington municipal corporation (hereinafter the "City") and Puget Sound Training Center (hereinafter the "Agency"). RECITALS WHEREAS, the City is an entitlement City applicant for Community Development Block Grant ("CDBG") funds (Catalogue of Federal Domestic Assistance-CFDA 14.218) under the Housing and Community Development Act of 1974 (the "Act"), as amended, Pub. L. No. 93-383, 88 Stat. 633 (1974), and anticipates receiving CDBG funds for the purpose of carrying out eligible community development and housing activities under the Act and under regulations promulgated by the Department of Housing and Urban Development ("HUD"), at 24 CFR § 570, et seq.; and WHEREAS, the City desires to contract with the Agency for the performance of certain eligible activities described within this Agreement; and WHEREAS, it is appropriate and mutually desirable that the Agency be designated by the City to undertake the aforementioned eligible activities, so long as the requirements of the Act, HUD regulations, and state and local laws are adhered to, as provided for herein; and WHEREAS, the purpose of this Agreement is to provide for cooperation between the City and the Agency, as the parties to this Agreement, in the provision of such eligible activities; and WHEREAS, the parties are authorized and empowered to enter into this Agreement pursuant to the Act, RCW 35.21.730 to .735, and/or by the Constitution and the enabling laws of the State of Washington; NOW THEREFORE, For and in consideration of the terms and conditions provided in this Agreement, the parties mutually covenant and agree as follows: INDEX To AGREEMENT PARTI - GENERAL CONDITIONS .....................................................................................................1 1. Scope Of Agreement ................................................................................................................................. 1 2. Scope Of Project..................... .................................................................................................... .............. 1 3. Purpose and primary objective - 42 U.S.C. § 530(c), 24 C.F.R. § 570.200(a)(3). .................... 1 4. Commencement And Termination Of Project(s).................................................................................. 2 5. Administration............................................................................................................................................. 3 6. Compensation And Method Of Payment................................................................................................ 3 7. Eligible Costs............................................................................................................................................... 4 S. Operating Budget....................................................................................................................................... 5 9. Funding Alternatives, Future Support, and Limited Release ..........................................................- 5 10. Amendments............................................................................................................................................... 5 11. Assignment And Subcontracting............................................................................................................. 5 12. Hold Harmless And Indemnification.....................................................................................................- 5 13. Project Close-Out....................................................................................................................................... 6 14. Insurance..................................................................................................................................................... 6 15. Conflict Of Interest .................................................................................................................................... 6 16. Suspension And Termination Of Agreement........................................................................................ 6 17. Safeguarding Of Client Information ....................................................................................................... 7 PART II - FEDERAL, STATE, AND LOCAL PROGRAM REQUIREMENTS .......................................8 1. Nondiscrimination ...................................................................................................................................... 8 2. Section 504 And Americans With Disabilities Act.............................................................................. 10 3. Financial Management And Procurement Standards........................................................................ 10 4. Uniform Administrative Requirements And Cost Principles And Recordkeeping - 2 CFR Part 200, 24 CFR §§ 570.502, and 570.610. ..................... ....................................................................... 11 5. Data Universal Numbering System 6. Lobbying.....................................................................................................................................................................12 7. Program Income - 24 CFR § 570.504................................................................................................. 12 8. Public Information.................................................................................................................................... 13 9. Other Federal And State Requirements .............................................................................................. 13 10. Local Requirements ................................................................................................................................. 13 Public service programs must comply with sections 10 and 11 ....................... ............................... 1344 11. Non-Substitution For Local Funding................................................................................................. 1344 12. Faith-based activities - 24 CFR § 570.200(j).................................................................................. 14 .,r�..orr., n ,.,.a must ,......i,, ,. iak *i-,, I� rti.,r.,��..h 1�C15 r^A..yulaluull Qi Il nl�;avva„I eaLII,. uo �.yun s Id ust COm 1 TYIIAI UG:�..tIVIA.9. J,.G 13. Accessibility............................................I ............................................................................,............,,...... 15 14. Environmental Review............................................................................................................................. 15 15. Labor Standards - 24 CFR § 570.603 ............................................................................................. 1647 16. Volunteers 24 CFR § 70...............................................................,......................................,................... 17 17. Acquisition And Relocation.............................................. ............,................,......,..,......._---------- .......... 17 18. Public Ownership.................................................................................................................................. 174-9 19. Reversion Of Assets - 24 CFR § 570.505......... ................................................_,.............................. 18 20. Property Management Standards.................................. _.....,...................................................,.......... 18 21. Additional Local Requirements.......................................................................................................... 1849 PART III - MONITORING & REPORTING REQUIREMENTS..........................................................19 1. Monitoring........... .........................................................................._.._,...,,.,...........,................................... 19 2. Program Reporting............................................................_..........................................................,.......... 19 3. Fiscal Reporting Responsibilities.......................................................................................................1929 4. Audits....................... ..................................................................................................,............................... 20 PART IV - RECORDKEEPING REQUIREMENTS.............................................................................20 1. Program Records and Inspections........................................................................................................ 20 2. Program Benefit Records - 24 CFR § 570.506(b). ........................................................................... 21 3. Financial Records................................ ........ .. 22 ii 4. Records Of Program Operations, Management And Evaluation.................................................2224 5. Property Records......................................................................................................... ............................23 6. Nondiscrimination And Equal-Opportunity Records - 24 CFR § 570.506(g). .-..........................23 7. Conflict Of Interest ..............................................................................................................................2324 B. Verification Of Subcontractor's Eligibility - 24 CFR § 5........................................................ ..........24 9. Additional Requirements for Acquisition or Improvement of Real PROPERTY PROJECTS_.....24 iiii PART I- GENERAL 1140ITI NS 1. SCOPE OF AGREEMENT The agreement between the parties shall consist of this Agreement and its signature page; the recitals page; the general conditions and any special conditions; the federal, state and local program requirements; the monitoring and reporting requirements; the recordkeeping requirements; each and every project exhibit, appendix, and attachment incorporated into the Agreement; all matters and laws incorporated by reference herein; and any written amendments made according to the general conditions. This Agreement supersedes any and all former agreements applicable to projects attached as Exhibits to this Agreement. It is the intent of the parties that all applicable federal regulations and requirements are incorporated herein, including, but not limited to, 24 CFR § 570, 2 CFR § 200, and 24 CFR § 570. 2. SCOPE OF PROJECT A. The Agency shall use the funds provided herein only to perform the activities authorized by this Agreement and as set forth in the CDBG Project Scope of Services, a draft of which is attached as First Amendment to Exhibit A and incorporated by this reference. Because this Agreement is executed prior to funds being allocated to the City through federal appropriations, the City will forward to Agency a final First Amendment to Exhibit A that the City will create if federal appropriations are awarded to the City for Agency's services, and that final First Amendment to Exhibit A, which may include adjustments in allocations or scope imposed as a condition of the final federal appropriations, shall relate back to and be incorporated into this Agreement. In the case of multiple projects, each project shall correspond to a separate Exhibit. This Agreement may be amended from time to time, in accordance with the general conditions, for the purpose of adding new projects, amending the scope of work, or for any other lawful purpose. B. Agencies funded by the City to carry out neighborhood revitalization, community economic development, or energy conservation projects shall meet the qualifications of a Community Based Development Organization (CBDO) pursuant to 24 C.F.R. § 570.204(c). The `carry out" requirement "means that the CBDO undertakes the funded activities directly or through contract with an entity other than the City, or through the provision of financial assistance for activities in which it retains a direct and controlling involvement and responsibilities." 24 C.F.R. § 570.204(a)(4). 3. PURPOSE AND PRIMARY OBJECTIVE - 42 U.S.C. § 530(C), 24 C.F.R. § 570.200(a)(3). "The primary objective of this chapter and of the community development program of each grantee under this chapter is the development of viable urban communities, by providing decent housing and a suitable living environment and expanding economic opportunities, principally for persons of low and moderate income. Consistent with this primary objective, not less than 70 percent of the aggregate of the Federal assistance provided to States and units of general local government [of CDBG expenditures] under section 5306 of this title and, if applicable, the funds received as a result of a guarantee or a grant under section 5308 of this title, shall 1 be used for the support of activities that benefit persons of low and moderate income ..." 42 U.S.C. § 5301(c), 24 C.F.R. § 570.200(c). Income limits for persons eligible to be served by these activities are outlined in Exhibit B, which is attached and incorporated by this reference. The income guidelines attached as Exhibit B at the time this Agreement is executed shall be in draft form if federal income guidelines for the contract year have not been released and posted to The Department of Housing and Urban Development's web site prior to the execution of this Agreement. If federal income guidelines are in draft form, the City will forward to Agency a final Exhibit B. including any adjustments imposed by the federal government once it is generated by the federal government at the time it finalizes its appropriations, and that final Exhibit B shall relate back to and be incorporated into this Agreement. The following requirements apply: A. The Agency shall ascertain household income of persons applying for and receiving assistance to assure compliance with the income limits defined in Exhibit B; and shall maintain records pursuant to Part IV of this Agreement, Section 2(B); or B. If the activity exclusively serves a clientele, which by federal regulation is "presumed" to be low and moderate income, individual income verification is not required. Persons eligible for this presumption are specified in Part IV of this Agreement, Section 2(C). In this case, the Agency shall maintain appropriate data to validate the presumption, as provided in Part IV, Section 2(C); or C. If the activity is such that it is not feasible to identify and record beneficiaries, the total population of the area from which the beneficiaries are drawn must be predominantly low and moderate income. In this case, the Agency shall maintain substantiation data as required by Part IV of this Agreement, Section 2(D). D. The benefit to low and moderate income beneficiaries must be in the form of a free or reduced cost service. If beneficiaries are charged for services, the charges to low and moderate income beneficiaries, and to all other beneficiaries, shall be as specified in the Exhibit(s), if applicable. Changes to the structure of charges during the term of this Agreement (and, in the case of a facility project, for five years thereafter) must preserve an identical discount for low and moderate income beneficiaries, and the change must be approved by the City. E. The low and moderate income limits in effect at the time of execution of this Agreement are specified in Exhibit B. These limits are revised periodically by HUD. It is the Agency's responsibility to use any revised limits when they take effect. Revisions will be announced by and can be obtained from the City. 4. COMMENCEMENT AND TERMINATION OF PROIECT(S) A. The City shall furnish the Agency with a written notice to proceed. No work on a project shall occur without prior written approval from the City. Agency 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. Termination dates for individual projects shall be specified in the appropriate Exhibits. Costs incurred prior to the date written notice to proceed was given or after the termination date will not be 2 reimbursed. The termination date may be changed through an amendment of this Agreement. B. Although the term of this Agreement shall run from January 1, 2017 through December 31 2018, this Agreement, however, is contingent upon the availability of funds to be allocated through federal appropriations. Therefore, should funds to support Agency's services not be made available through anticipated federal appropriations, this Agreement shall immediately terminate without risk or liability to the City and without obligation to disburse funds or to reimburse Agency any funds expended in anticipation of funding availability. All work shall be done at Agency's own risk, and Agency shall be responsible for all losses associated with services provided before the City issues its written notice to proceed. All acts consistent with the authority of the Agreement and prior to the date of the Agreement's execution are hereby ratified and affirmed, and the terms of this Agreement shall be deemed to have applied. 5. ADMINISTRATION A. The Agency shall appoint a liaison person who shall be responsible for overall administration of CDBG funded project(s) and coordination with the City's Parks, Recreation, and Community Services Department. The person appointed shall be designated in Exhibit C, which is attached and incorporated by this reference. The Agency shall also designate one or more representatives who shall be authorized to submit the Billing Voucher and Service Report, and Final Service Report, which are attached as First Amendment to Exhibit D and D-1, respectively. The name of the liaison person and representative shall be specified in the Exhibit. B. The Agency shall provide ten (10) days written notice to the City of any changes in program personnel or Board membership. C. The agency shall provide the City with a current list of its Board of Directors, general or limited partners, as applicable. 6. COMPENSATION AND METHOD OF PAYMENT A. The City shall reimburse the Agency only for eligible costs allowed pursuant to this Agreement, which are part of the activities specified in the Exhibit(s), and in an amount not to exceed the amount specified in First Amendment to Exhibit A., plus any miscellaneous surplus office equipment, as available, related to the provision of services under this Agreement, and according to the procedures developed by the City of Kent. Reimbursement shall be based on a Billing Voucher and Service Report, which shall be submitted to the City by the Agency's authorized representative. B. The City of Kent uses a variety of measures as indicators of satisfactory contract performance. The Agency will be expected to meet 100% of the performance measures as defined in Exhibit A. Exceptions may be made in cases where circumstances beyond the Agency's control impact their ability to meet their units of service and the Agency has shown reasonable effort to overcome those circumstances. Exceptions are made at the discretion of the City's Human Services Manager. 3 I C. If the Agency does not meet performance goals, payment for services rendered under the agreement will be reduced by the rate calculated for each service unit. For example if an Agency contracted to provide 100 bed-nights a quarter for $5,000.00 and only provide 75 bed-nights, payment would be $3,750.00 instead of $5,000.00. D. The Agency shall submit a Billing Voucher and Service Report on a quarterly basis. Billing Vouchers and Service Reports are due in accordance with the schedule and budget incorporated as First Amendment to Exhibit A and in accordance with Section 7 below. If the due date falls on a Saturday or Sunday, Billing Vouchers and Service Reports are due on the prior Friday. If the due date falls on a City holiday, Billing Vouchers and Service Reports are due the next working day following the holiday. The Final Service Report is due in accordance with the schedule listed in First Amendment to Exhibit A. If the Agency's line item budget includes personnel services costs, the Agency shall submit a CDBG Public Services Project Time Sheet (attached as Exhibit G if applicable) with the Billing Voucher and Service Report. The City will make payment to the Agency not more than forty-five (45) days after said Billing Voucher and Service Report is received and approved by the City's Parks, Recreation, and Community Services Department. The City will issue a statement of correction in the event the Billing Voucher and Service Report is erroneous. Payment by the City shall not constitute approval of the services for which payment is requested. The City does not, by making such payment, waive any rights it may have pursuant to this Agreement to require satisfactory performance of the services promised herein. The City reserves the right to demand and recover reimbursements made for ineligible costs. 7. ELIGIBLE COSTS A. All costs incurred must be reasonable and of a nature which clearly relate to the specific purposes and end product of the Agreement under which the services are being performed. Care must be taken by all concerned in incurring costs to assure that expenditures conform to these general standards and the following criteria for eligibility of costs. B. To be eligible for reimbursement, costs must: (1)Be necessary and reasonable for proper and efficient execution of the contractual requirements and in accordance with an approved budget. (2)Be no more liberal than policies, procedures, and practices applied uniformly to other activities of the Agency. (3)Be accorded consistent treatment through application of account policy and procedures approved and/or prescribed herein. (4)Not be allowable under or included as costs of any other federal, state, local or other agency-financed programs in either prior or current periods. (5)Be net of all applicable credits such as purchase discounts, rebates or allowances, sales of publication or materials, or other income or refunds. (6)Be fully documented. 4 S. OPERATING BUDGET The Agency shall apply the funds received from the City under this Agreement in accordance with the Budget Summary found in First Amendment to Exhibit. A. No line-item expense therein shall cause expenditure in excess of ten (10) percent or more of the budget line-item amount over the life of the Agreement without the prior written consent of the City. Any request for a line-item expense which exceeds ten (10) percent of the budgeted amount shall specifically state the reasons for the requested increase and a justification for the corresponding decrease in other line-item(s). 9. FUNDING ALTERNATIVES, FUTURE SUPPORT, AND LIMITED RELEASE A. The City makes no commitment to future support and assumes no obligation for future support of the activities contracted for herein, except as may be expressly set forth in this Agreement. B. Payment for the services provided herein is based on the expectation that future revenues will be available to the City for such purposes. Should anticipated sources of revenue not become available or become unavailable to the City for use in the CDBG program, the City shall immediately notify the Agency in writing of such unavailability and in that event, Agency fully releases City from any claims, damages, or liability, related to lack of funding, the amount funded, or uncertainty for that portion of the Agreement originally intended to be paid with such funds. 10. AMENDMENTS Either party may request modifications in the scope of permissible activities, terms, or conditions of this Agreement. Proposed modifications which are mutually agreed upon shall be incorporated by a written amendment to this Agreement. 11. ASSIGNMENT AND SUBCONTRACTING A. The Agency shall not assign any portion of this Agreement without the written consent of the City, and it is further agreed that said consent must be sought by the Agency not less than fifteen (15) days prior to the date of any proposed assignment. B. Any work or services assigned or subcontracted hereunder shall be subject to each provision of this Agreement and proper bidding procedures to the extent herein. The Agency agrees that it is as fully responsible to the City for the acts and omissions of its subcontractors and their employees and agents, as it is for the acts and omissions of its own employees and agents, as defined in paragraph Part I, Section 12(B). 12. HOLD HARMLESS AND INDEMNIFICATION A. The Agency agrees that it is financially responsible and liable to the City for any audit exception or other financial loss to the City which occurs due to the Agency's negligence or failure to comply with the terms of this Agreement. B. The Agency further agrees to defend, indemnify, and hold the City, its elected and appointed officials, agents, and employees, while acting within the scope of their duties as such, harmless from and against all claims, demands, and causes of 5 action of any kind or character, including the cost of defense thereof, arising in favor of any person(s), including Agency's employees or third parties on account of personal injuries, death, or damage to property arising out of services performed or omissions of services or in any way resulting from the acts or omissions of the Agency and/or its agents, employees, volunteers, subcontractors, or representatives under this Agreement. 13. PROJECT CLOSE-OUT The Agency acknowledges and agrees that the amounts set forth in the Exhibit(s) shall be used only to reimburse the Agency for eligible costs incurred by the Agency during the period set forth in said Exhibit(s) and that upon expiration of such period, or upon earlier termination pursuant to this Agreement, the Agency shall have no interest in any said amount which is not required to reimburse the Agency for eligible costs incurred before such expiration or earlier termination. 14. INSURANCE Agency shall maintain insurance in the types and amounts set forth in Exhibit E,, which is attached and incorporated by this reference. 15. CONFLICT OF INTEREST A. Interest of Officers Employees, or - The Agency shall abide by and enforce the conflict of interest requirement set forth in 24 CFR 570.611, 2 CFR 200.112, and 2 CFR 200.318. No employee, agent, consultant, officer, or elected official or appointed official of the City, or of any designated public agencies, or of subrecipients that are receiving CDBG funds shall have any personal financial interest, direct or indirect, in the Agreement, and the City and Agency shall take appropriate steps to assure compliance. 24 CFR 570.611 B. Interest of Subcontractor and Their Employees - The Agency agrees that it will incorporate into every contract or subcontract, which is required to be in writing and made pursuant to this Agreement, the following provisions: The Contractor covenants that no person who presently exercises any functions or responsibilities in connection with the City CDBG program has any personal financial interest, direct or indirect, in this Agreement. The Contractor further covenants that he/she presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of his/her services hereunder. The Contractor further covenants that in the performance of this Agreement, no person having any conflict of interest shall be employed. Any actual or potential conflict of interest on the part of the Contractor or his/her employees must be disclosed to the Agency and the City. 16. SUSPENSION AND TERMINATION OF AGREEMENT A. Suspension for Failure to Perform - In the event of a failure to comply with any terms or conditions of this Agreement or failure to provide in any manner the activities or other performance as agreed to herein, the City reserves the right to 6 withhold all or any part of payment, suspend all or any part of the Agreement, or prohibit the Agency from incurring additional obligations of funds until the City is satisfied that corrective action has been taken or completed as more specifically outlined in the Exhibit(s) to this Agreement. The option to withhold funds is, in addition to and not in lieu of, the City's right to terminate the Agreement pursuant to Paragraph (B) of this Section 16. B. Termination of Agreement by City - This Agreement is subject to termination upon thirty (30) days written notice by the City to the Agency in the event that: (1)The Agency mismanages or makes improper or unlawful use of CDBG funds; (2)The Agency fails to comply with any term or condition expressed herein or any applicable federal, state, or local regulations or ordinances; (3)CDBG funds no longer become available from the federal government or through the City; (4)The Agency fails to carry out activities required by this Agreement; or (5)The Agency fails to submit reports or submits incomplete or inaccurate reports in any material respect. C. Termination of Agreement by the Agency- This Agreement is subject to termination upon thirty (30) days written notice by the Agency to the City in the event that: (1)The City fails in its commitment under this Agreement to provide funding for services rendered, as herein provided; or (2)CDBG funds no longer become available from the federal government or through the City. D. Unless otherwise terminated pursuant to Paragraphs (B) and (C) of this Section 16, this Agreement shall terminate on the termination date specified on the Exhibit(s) and shall be subject to extension only by mutual agreement and amendment in accordance with Part I, Section 10 of this Agreement. E. Upon termination of this Agreement, any unexpended balance of Agreement funds shall remain in the City CDBG fund. F. In the event termination occurs under Paragraph (B) of this Section 16, the Agency shall return to the City all funds that were expended in violation of the terms of this Agreement including, but not limited to, any unexpended CDBG funds distributed to the Agency under this Agreement, any accounts receivable, or any assets or interests therein of any type and in any form acquired, leased, or rehabilitated with CDBG monies. 17. SAFEGUARDING OF CLIENT INFORMATION The use or disclosure by any party of any confidential information concerning a recipient or client for any purpose not directly connected with the City's or the Agency's responsibilities with respect to services provided under this Agreement is prohibited, except upon written consent of the recipient or client, his/her attorney, his/her responsible parent or guardian, or as otherwise provided by law. 7 PART II - (FEDERAL, STATE, AND LOCAL PROGRAM REQUIREMENTS 1. NONDISCRIMINATION A. General - The Agency shall comply with all federal, state, and local laws prohibiting discrimination on the basis of age, sex, marital status, race, creed, religion, color, national origin, or the presence of any sensory, mental, or physical handicap. These requirements are specified in Chapter 49.60 RCW; Section 109 of the Housing and Community Development Act of 1974, Pub. L. No. 93-383 as amended and codified as 42 U.S.C. § 5309; Title VI of the Civil Rights Act of 1964, 42 U.S.C. §§ 2000d, et seq.; Title VIII of the Civil Rights Act of 1968, 42 U.S.C. §§ 3601, et seq.; Executive Order 11063; Executive Order 11246, as amended by Executive Orders 11375, 11478, 12086 and 12107; Section 3 of the Housing and Urban Development Act of 1968, 12 U.S.C.§ 1701(u), and implementing regulations at 24 CFR § 135; Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, et seq.; and the Age Discrimination Act of 1975, 42 U.S.C. § 6101, et seq. Specifically, the Agency is prohibited from taking any discriminatory actions defined in the HUD regulations at 24 C.F.R. § 570.602 and shall take such affirmative and corrective actions as are required by the regulations at 24 C.F.R. § 570.602. B. 'Specific Discriminatory Actions Prohibited: (1)The Agency shall not, under any program or activity to which this Agreement may apply, directly or through contractual or other arrangements, on the grounds of age, sex, marital status, race, creed, religion, color, national origin, or the presence of any sensory, mental, or physical handicap: i. Deny any person facilities, services, financial aid, or other benefits provided under the program or activity. ii. Provide any person with facilities, services, financial aid, or other benefits which are different, or are provided in a form different, from that provided to others under the program or activity. iii. Subject any person to segregated or separate treatment in any facility or in any matter or process related to receipt of any service or benefit under the program or activity. iv. Restrict in any way access to or enjoyment of any advantage or privilege enjoyed by others in connection with facilities, services, financial aid, or other benefits under the program or activity. v. Treat any person differently from others in determining whether the person satisfies any admission, enrollment, eligibility, membership, or other requirement or condition which individuals must meet in order to be provided facilities, services, or other benefits provided under the program or activity. vi. Deny any person any opportunity to participate in a program or activity as an employee. (2)The Agency shall not utilize criteria or methods of administration which have the effect of subjecting individuals to unlawful discrimination on the basis of race, color, national origin, sex, age, marital status, creed, religion, or presence of 8 any sensory, mental, or physical handicap, or which have the effect of defeating or substantially impairing accomplishment of the objectives of the program or activity by unlawfully discriminating against individuals of a particular race, color, national origin, sex, age, marital status, creed, religion, or presence of any sensory, mental, or physical handicap. (3)The Agency, in determining the site or location of housing or facilities provided in whole or in part with funds under this Agreement, may not make selections of such site or location which have the effect of excluding individuals from, denying them the benefits of, or subjecting them to unlawful discrimination on the grounds of race, color, national origin, sex, age, marital status, creed, religion, or presence of any sensory, mental, or physical handicap; or which have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the Act or of HUD regulations. C. Fair Housing - The Agency shall take necessary and appropriate actions to prevent discrimination in federally-assisted housing and lending practices related to loans insured or guaranteed by the federal government (The Fair Housing Act (42 U.S.C. 3601-19) and implementing regulations at 24 CFR part 100 et seq.; Executive Order 11063, as amended by Executive Order 12259 (3 CFR, 1959-1963 Comp., p. 652 and 3 CFR, 1980 Comp., p. 307) (Equal Opportunity in Housing Programs) and implementing regulations at 24 CFR part 107. The Agency shall also administer programs related to housing and urban development in a manner to affirmatively further fair housing. 24 CFR Parts 5, 91, 92, 570, 574, 576, and 903. D. Employment : (1)In all solicitations under this Agreement, the Agency shall state that all qualified applicants will be considered for employment. The words "equal opportunity employer" in advertisements shall constitute compliance with this section. (2)The Agency shall not unlawfully discriminate against any employee or applicant for employment in connection with the Agreement because of age, sex, marital status, race, creed, religion, color, national origin, or the presence of any sensory, mental, or physical handicap, except when there is a bona fide occupational limitation. Such action shall include, but not be limited to the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training (Chapter 49.46 RCW, Executive Order 11246, as amended). (3)To the greatest extent feasible, the Agency shall provide training and employment opportunities for lower income residents within the area served by CDBG assisted projects (Section 3, Housing and Urban Development Act of 1968, 12 U.S.C. § 1701u, as amended). E. Contractors and Suppliers: (1)No contractor, subcontractor, union, or vendor engaged in any activity under this Agreement shall engage in any unlawful discrimination as defined in any federal, state, or local law. (2)AII firms and organizations, as required under applicable HUD regulations, shall be required to submit to the Agency certificates of compliance demonstrating 9 that it has, in fact, complied with the immediately foregoing provision; provided, that certificates of compliance shall not be required from firms and organizations with fewer than 25 employees, with yearly sales of less than $10,000, or on contracts less than $10,000. (3)To the greatest extent feasible, the Agency shall purchase supplies and services for activities under this Agreement from vendors and contractors whose businesses are located in the area served by CDBG-funded activities or owned in substantial part by project area residents (Section 3, Housing and Urban Development Act of 1968, 12 U.S.C. § 1701u, as amended). (4)CDBG funds shall not be used directly or indirectly to employ, award contracts to, or otherwise engage the services of, or fund any contractor or sub-recipient during any period of debarment, suspension, or placement in ineligibility status under the provisions of 2 CFR § 2424. The Agency shall certify that it and all subconsultants and subcontractors are not listed on the government-wide Excluded Parties List System in the System for Award Management (SAM), in accordance with OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 and 12689, "Debarment and Suspension," as set forth at 2 CFR 2424. Additional policies concerning debarment and suspension are found at 2 CFR Part 180 and 2 CFR Part 2424. F. Notice: (1)The Agency shall include the provisions of the appropriate subsections A, B, C, D, and E of this Part II, Section 1 in every contract or purchase order for goods and services under this Agreement, and shall send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice advising the said labor union or worker's representative of the commitments made in these subsections. (2)In advertising for employees, goods, or services for the activities under this Agreement, the Agency shall utilize minority publications in addition to publications of general circulation. 2. SECTION 504 AND AMERICANS WITH DISABILITIES ACT If the Agency is a nonprofit corporation, the Agency warrants and represents that it has completed a Disability Self-Evaluation Questionnaire for all programs and services offered by the Agency (including any services not subject to this Agreement) and has evaluated its services, programs, and employment practices for compliance with Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, as amended ("504") and the Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12101, et seq., ('DADA"). The Agency warrants and represents that it has completed a 504/ADA Disability Assurance of Compliance, which is attached as Exhibit H and incorporated by this reference, and shall submit it to the City. 3. FINANCIAL MANAGEMENT AND PROCUREMENT STANDARDS The Agency shall comply with, and shall require any sub-contractor funded in whole or in part with CDBG funds to comply with the following financial and program management and procurement standards: 10 A. Agency shall adhere to the principles and standards governing federal grant distribution set forth in the "Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards" (2 CFR Part 200). B. Agency shall comply with all applicable requirements of local and state law for awarding contracts, including but not limited to procedures for competitive bidding, contractor's bonds, and retained percentages (Ch. 60.28 RCW, Ch. 39.12 RCW, and Ch. 39.04 RCW). In addition, the Agency shall comply with the requirements of 2 CFR § 200.318 (General procurement standards) through 200.326 (Contract provisions).Where federal standards differ from local or state standards, the stricter standards shall apply. C. Agency shall comply with 24 CFR Part 570 and 2 CFR Part 200 regarding the management and disposition of cash and real and personal property acquired with CDBG funds. D. Agency shall comply with 24 CFR 570.489, Program and Administrative Requirements. E. Agency shall comply with 24 CFR 570.490. 4. UNIFORM ADMINISTRATIVE REQUIREMENTS AND COST PRINCIPLES AND RECORDKEEPING - 2 CFR Part 200, 24 CFR §§ 570.502, and 570.610. A. Agency shall comply with 2 CFR Part 200, "Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards", except that: (1)Section 200.305 "Payment" is modified for lump sum drawdown for financing of property rehabilitation activities, in accordance with § 570.513. (2) Section 200.306 "Cost sharing or matching" does not apply. (3) Section 200.307 "Program income" does not apply. Program income is governed by § 570.504. (4)Section 200.308 "Revisions of budget and program plans" does not apply. (5) Section 200.311 "Real property" does not apply, except as provided in § 570.200(j). Real property is governed by § 570.505. (6) Section 200.313 "Equipment" applies, except that when the equipment is sold, the proceeds shall be program income. Equipment not needed by the subrecipient for CDBG activities shall be transferred to the recipient for the CDBG program or shall be retained after compensating the recipient. Records to be maintained include: u Contract and Amendments - A complete copy of this Agreement and all amendments thereto and notices there under. ii Records of City Approvals - Copies of all requests for amendments or revisions to this Agreement and the City's 11 subsequent approval or denial of such requests as are required under this Agreement. iii I Subcontracts and Agreements - Complete copies of all contracts, subcontracts, and agreements with third parties into which the Agency enters in the performance under this Agreement; and all correspondence, reports, and other documentation pertaining to such contracts, subcontracts, and agreements. (iv) Records identifying the assisted activity, - A complete description of each activity assisted, in whole or in part, with CDBG funds under this Agreement, including: (a)Location(s), organization, operating hours, qualifications for service or participation, etc.; (b)Fees or charges for services, fee waivers, or fee scales for CDBG-assisted participants. B. Section 200.343 "Closeout" applies to closeout of subrecipients. C. Additional Contract Requirements - The Agency shall submit to the City a copy of the most recent independent financial audit and a current list of the Agency's board of directors. 5. DATA UNIVERSAL NUMBERING SYSTEM Pursuant to 2 C.F.R. §25.100(a), the City is required to establish a Dun and Bradstreet (D & B) Data Universal Numbering System (DUNS) as a universal identifier in order to receive federal financial assistance. In addition, programs or sub-recipients receiving sub-awards from the City shall establish a DUNS. 2 C.F.R. § 25.200(c)(1). The Agency shall provide its DUNS to the City. 6. LOBBYING In accordance with 2 CFR 200.450, the Agency shall not use CDBG funds for lobbying purposes. 7. PROGRAM INCOME - 24 CFR § 570.504. A. All income directly generated from the use of CDBG funds, as defined in 24 CFR § 570.500(a), is Program Income and shall be recorded, reported, and treated as funds subject to all the requirements of this Agreement. B. Unless otherwise specifically provided by the special conditions herein, Program Income received during the term of this Agreement may be retained and used by the Agency to extend the service or other activity for which the CDBG funds are provided, subject to the regulations of 24 CFR § 570.01, et seq., and all the same terms and conditions of this Agreement. Any retained Program Income shall be disbursed to pay for eligible expenses under this Agreement before additional funds are requisitioned from the City. C. Any Program Income not permitted to be retained for eligible activities as defined above, shall be refunded to the City, together with any interest earned thereon, at quarterly intervals. 12 D. Program Income on hand at the end of the term of this Agreement shall, unless otherwise provided, be used for activities envisioned under this Agreement until it is expended. Program Income generated from the use of CDBG funds under this Agreement but received after the term of this Agreement shall, unless otherwise provided, be governed by any succeeding CDBG funding agreement or, if there is no succeeding agreement, shall be used for activities eligible under 24 CFR § S70.504(c) until it is expended. E. Rules on Program Income are established in the CDBG regulations (24 CFR § 570.504); 2 CFR § 200.307Program Income. Proceeds from the sale of real property, equipment, or supplies are not program income; such proceeds will be handled in accordance with the requirements of Subpart D--Post Federal Award Requirements of 2 CFR § 200, Property Standards §§ 200.311 Real property, 200.313 Equipment, and 200.314 Supplies, or as specifically identified in Federal statutes, regulations, or the terms and conditions of the Federal award. 2 CFR § 200.307(d). S. PUBLIC INFORMATION A. In all news releases and other public notices related to projects funded under this Agreement, the Agency shall include information identifying the source of funds as the City of Kent CDBG program. B. The Agency acknowledges that this Agreement and any other information provided by it to the City and/or relevant to the project(s) described in the Exhibit(s), are subject to the Washington State Public Disclosure Act, Chapter 42.56 RCW, except to the extent specifically exempted from disclosure therein. 9. OTHER FEDERAL AND STATE REQUIREMENTS The absence of mention in this Agreement of any other federal or state requirements, which apply to the award and expenditure of federal funds made available by this Agreement, is not intended to indicate that those federal or state requirements are not applicable to Agency activities. The Agency shall comply with all other federal and state requirements relating to the expenditure of federal funds, including but not limited to the Hatch Act (5 U.S.C. § 15) regarding political activities and the Architectural Barrier Act of 1968 (42 U.S.C. § 4151, et seq.). 10. LOCAL REQUIREMENTS The activities performed under this Agreement are for the purposes of serving City residents and the Agency shall, to the extent reasonably possible, not use said funds to provide services outside the corporate boundary of the City, or for any other purpose, except as specifically authorized by this Agreement. Public service programs must comply with sections 11-12: 11. NON-SUBSTITUTION FOR LOCAL FUNDING The CDBG funding made available under this Agreement shall not be utilized by the Agency to reduce substantially the amount of local financial support for community development activities below the level of such support prior to the availability of funds under this Agreement. 13 12. FAITH-BASED ACTIVITIES - 24 CFR § 570.200(j). A. Organizations that are religious or faith-based are eligible, on the same basis as any other organization, to participate in the CDBG program. Neither the Federal government nor a State or local government receiving funds under CDBG programs shall discriminate against an organization on the basis of the organization's religious character or affiliation. B. Organizations that are directly funded under the CDBG program may not engage in inherently religious activities, such as worship, religious instruction, or proselytism, as part of the programs or services funded under this part. If an organization conducts such activities, the activities must be offered separately, in time or location, from the programs or services funded under this part, and participation must be voluntary for the beneficiaries of the HUD-funded programs or services. C. A religious organization that participates in the CDBG program will retain its independence from Federal, State, and local governments, and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided that it does not use direct CDBG funds to support any inherently religious activities, such as worship, religious instruction, or proselytism. Among other things, faith-based organizations may use space in their facilities to provide CDBG-funded services, without removing religious art, icons, scriptures, or other religious symbols. In addition, a CDBG-funded religious organization retains its authority over its internal governance, and it may retain religious terms in its organization's name, select its board members on a religious basis, and include religious references in its organization's mission statements and other governing documents. D. An organization that participates in the CDBG program shall not, in providing program assistance, discriminate against a program beneficiary or prospective program beneficiary on the basis of religion or religious belief. E. CDBG funds may not be used for the acquisition, construction, or rehabilitation of structures to the extent that those structures are used for inherently religious activities. CDBG funds may be used for the acquisition, construction, or rehabilitation of structures only to the extent that those structures are used for conducting eligible activities under this part. Where a structure is used for both eligible and inherently religious activities, CDBG funds may not exceed the cost of those portions of the acquisition, construction, or rehabilitation that are attributable to eligible activities in accordance with the cost accounting requirements applicable to CDBG funds in this part. Sanctuaries, chapels, or other rooms that a CDBG- funded religious congregation uses as its principal place of worship, however, are ineligible for CDBG-funded improvements. Disposition of real property after the term of the grant, or any change in use of the property during the term of the grant, is subject to government-wide regulations governing real property disposition (see 24 CFR 84 and 85). F. If the City voluntarily contributes its own funds to supplement the federally funded activity, the City has the option to segregate the Federal funds or commingle them. However, if the funds are commingled, this section applies to all of the commingled funds. 14 Acagilsition or im rvm n r M properly proieM 13 through, 20: 13. ACCESSIBILITY Any buildings or other facilities designed, constructed, or altered with federal funds pursuant to this Agreement are subject to the requirements of the Architectural Barriers Act of 1968 (42 U.S.C. § 4151, et seq.) and shall comply with the Uniform Federal Accessibility Standards (Appendix A to 24 CFR § 40.1, et seq. for residential structures, and Appendix A to 41 CFR § 101-19, et seq. for general type buildings). When applicable, certain multifamily housing units designed and constructed for first occupancy after March 13, 1991, with assistance provided under this Agreement, must comply with the Fair Housing Accessibility Guidelines, 24 CFR § 100.1, et seq., as amended. 14. ENVIRONMENTAL REVIEW A. National Environmental Policy Art - The City retains environmental review responsibility for purposes of fulfilling requirements of the National Environmental Policy Act as implemented by HUD Environmental Review Procedures (24 CFR § 58.1, et seq.). The City may require the Agency to furnish data, information, and assistance for the City's review and assessment in determining whether an Environmental Impact Statement must be prepared. The Agency shall be solely responsible for the cost of compliance with all such federal laws and authorities including the cost of preparing plans, studies, reports, and the publication of notices that may be required. B. Other Federal Environmental Laws - (1)Historic Preservation - Activities affecting property listed in or found to be eligible for inclusion in the National Register of Historic Places will be subject to requirements set forth in HUD Environmental Review Procedures at 24 CFR § 58.1, et seq. The Agency shall meet the historic preservation requirements of Pub. L. No. 89-665 (16 U.S.C. § 470(i)), and the Archaeological and Historic Preservation Act of 1974, Pub. L. No. 93-291 (16 U.S.C. § 469a-1), and Executive Order 11593, including the procedures prescribed by the Advisory Council on Historic Preservation in the regulations at 36 CFR § 801, et seq. (2)Architectural Barriers - Any facility constructed pursuant to this Agreement shall comply with design requirements of the Architectural Barriers Act of 1968 (42 U.S.C. §§ 4151, et sec.), and the Uniform Federal Accessibility Standards (US Government Printing Office, 1985-494-187). (3)National Flood Insurance - When applicable, the use of CDBG funds for acquisition or construction purposes in identified special flood hazard areas shall be subject to Agency mandatory purchase of flood insurance as required by Section 102(a) of the Flood Disaster Protection Act of 1973 (Pub. L. No. 93-237, 42 U.S.C. § 2414 and 42 U.S.C. §§ 4001-4128). (4)Lead-Based Paint - Whenever funds under this Agreement are used directly or indirectly for construction, rehabilitation, or modernization of residential structures, the Agency shall comply, at its sole expense, with the HUD Lead- Based Paint regulations (24 CFR § 35) issued pursuant to the Lead-Based Paint 15 Poisoning Prevention Act, as amended (42 U.S.C. §§ 4801, et seq.) and the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. §§ 4851, et sec.), with regard to lead-based paint, and with any and all applicable federal, state, and local laws, regulations, or standards hereafter enacted or issued with regard to lead-based paint. Without limiting the foregoing, the Agency shall remove or cover, prior to the date for completion of the work funded hereunder and in compliance with all applicable, laws, regulations, and in conformity with guidelines issued by HUD, all lead-based paint with lead content above the threshold established by HUD on surfaces affected by the work funded under this Agreement. The Agency shall defend, indemnify, and hold harmless the City from any liability, loss, damage, or expense, including costs and attorneys' fees, relating in any way to lead-based paint at the property or the abatement or disposal thereof. This provision shall survive expiration and satisfaction of this Agreement, whether by payment, forgiveness, foreclosure, or otherwise. (5)Other - Clean Air Act as amended, 42 U.S.C. § 7401, et seq.; Water Pollution Control Act, 33 U.S.C. §§ 1367, et seq., as amended; Environmental Protection Agency regulations, 40 CFR §§ 1.1, et seq. C. State Environmental Pohcy Act - Agencies which are branches of government under RCW 43.21C.030 retain responsibility for fulfilling the requirements of the State Environmental Policy Act, Chapter 43.21C RCW and the regulations and ordinances adopted there under. If the Agency is not a branch of government under RCW 43.21C.030, the City may require the Agency to furnish data, information, and assistance, as necessary, to enable the City to comply with the State Environmental Policy Act. D. Satisfaction of Environmental Re uirements (1) Limitations on Activities Pending Clearance - Per 24 CFR § 58.22(a). The Agency shall not commit assistance under this Agreement until HUD has approved the City's Request for Release of Funds (RROF) and the related certification from the City. In addition, until the RROF has been approved by HUD, neither the City nor the Agency may commit non-HUD funds on or undertake an activity or project under a program listed in § 58.1(b) if the activity or project would have an adverse environmental impact or limit the choice of reasonable alternatives. Provided; however, that an option agreement, self-Help Homeownership Opportunity Program funds, and relocation assistance may be excluded from the limitation above per 24 CFR § 58.22(d), (e) and (f) respectively. (2) Notice to Proceed - Project execution under this Agreement, by either the City or the Agency, shall not proceed until satisfaction of all applicable requirements of the national and state environmental policy acts. A written notice to proceed will not be issued by the City until all such requirements are complied with. 15. LABOR STANDARDS - 24 CFR § 570.603 A. The Agency shall require that project construction contractors and subcontractors pay their laborers and mechanics at wage rates in accordance with the Davis-Bacon Act, as amended (40 U.S.C. §§ 3141 and 3142), and that they comply with the Copeland Act (18 U.S.C. § 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§ 3701, et seq.); provided that this section shall not 16 apply to rehabilitation of residential property only if such property contains not less than eight (8) units. In addition to complying with these federal labor standards, the Agency shall further require that all project construction contractors comply with all applicable state and local public works bidding and contracting regulations, specifically including, without limitation, the prevailing wage provisions set forth in Ch. 39.12 RCW and all regulations adopted by the State of Washington Department of Labor and Industries. B. The Agency shall require that project construction contractors and subcontractors comply with Federal Labor Standards Provisions (HUD form 4010) and the Davis- Bacon wage determinations (attached as Exhibits I and ], respectively if applicable). For construction contracts, a copy of the Federal Labor Standards Provisions (HUD form 4010) and the current Davis-Bacon wage determinations must be included in all construction bid specs and/or contracts over $2,000. 16. VOLUNTEERS 24 CFR § 70 If the Agency or the Contractor/Subcontractor uses volunteers to perform services on a federally-assisted construction project, it shall ensure that work is performed without promise, expectation or receipt of compensation for services rendered. Volunteer files shall include: (1) the name and address of the agency sponsoring the project; (2) a description of the project; and (3) the number of volunteers and the hours donated to the project. 17. ACQUISITION AND RELOCATION A. Any acquisition of real property for any activity assisted under this Agreement shall comply with the Federal Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. §§ 4601, et seq. (hereinafter the "Uniform Act" and the government-wide regulations applicable to all federally- assisted projects, effective April 2, 1989, at 49 CFR §§ 34.1, et seq. B. Implementation of any project provided for in this Agreement will be undertaken so as to minimize involuntary displacement of persons, businesses, nonprofit organizations, or farms to the greatest extent feasible. C. Any displacement of persons, businesses, nonprofit organizations, or farms occurring as the result of acquisition of real property assisted under this Agreement shall comply with the Uniform Act, and the regulations at 49 CFR §§ 24.1, et seq., required by federal CDBG regulations at 24 CFR § 570.606. The Agency shall comply with the regulations pertaining to costs of relocation and written policies, as specified by the City of Kent's Displacement Policy. 18. PUBLIC OWNERSHIP For Agencies which are not municipal corporations organized under the laws of the State of Washington, it may become necessary to grant the City a property interest where the subject project calls for the acquisition, construction, reconstruction, rehabilitation, or installation of publicly-owned facilities and improvements. 17 19. REVERSION OF ASSETS - 24 CFR § 570.505. Any real property under the Agency's control that was acquired or improved in whole or in part with CDBG funds in excess of $25,000 must be either: A, Used to meet one of the national objectives set forth in 24 CFR § 570.208 of the CDBG regulations until five (5) years after expiration of the Agreement, or such longer period of time as determined by the City. For Acquisition or improvement of real property projects, the Agency and the City shall execute a Community Facility Covenant Agreement. B. Disposed of in a manner that results in the City being reimbursed in the amount of the current fair market value of the property, less any portion attributable to expenditures of non-CDBG funds for acquisition of, and improvements to, the property. Such reimbursement is not required after the period of time specified in Paragraph (A) above. 20. PROPERTY MANAGEMENT STANDARDS A, The Agency shall meet the following procedural requirements for all property acquired in whole or in part with CDBG funds: (1)Property records shall be maintained accurately and provide for a description of the property; manufacturer's serial number or other identification number; acquisition date and cost; source of the property; percentage of CDBG funds used in the purchase of property; and location, use, and condition of the property. (2)A physical inventory of property taken and the results of that inventory are reconciled with the property records at least once every two (2) years to verify the existence, current utilization, and continued need for the property. (3)A control system shall be in effect to ensure adequate safeguards to prevent loss, damage, or theft of the property which shall be investigated and fully documented. B, The disposition of real property acquired in whole or in part with CDBG funds shall be at no less than its current appraised fair market value (or for a lease, at the current market value), except that such property may be disposed of for a lesser value, including by donation, if the disposition at the lesser value is for a use which qualifies under one of the criteria set forth in 24 CFR § 570.208 for meeting the national objectives and is permissible under state and local law. Where the disposition is for a lesser value, the recipient shall maintain documentation that the use meets one of the national objectives pursuant to 24 CFR § 570.208. 21. ADDITIONAL LOCAL REQUIREMENTS A. Mortgage or Leasehold Agreement - In acquisition, rehabilitation, and construction projects, the City shall enter into a deed of trust or leasehold agreement with the Agency to secure and protect the City's and the public's interest in the property. B. Adequate - In acquisition projects, the City shall require evidence through a property appraisal, title search, or other means to ensure that there is adequate value so as to secure the City's financial interest. is C. City Ordinance, Codes, and Regulations - In acquisition and construction projects, the Agency shall comply with all applicable City ordinances, codes, and regulations. D. Additional Public Information - For all construction projects, the Agency shall erect a sign to City specifications at the construction site, which identifies the source of funds, except that this requirement may be waived for construction projects of $5,000 or less. PART III - MONITORING & REPORTING REQUIREMENTS 1. MONITORING Agency understands and agrees that it will be monitored by the City and HUD from time to time to assure compliance with all terms and conditions of this Agreement and all applicable local, state, and federal laws, regulations, and promulgated policies. Monitoring by the City under this Agreement shall include, but not be limited to: (1) on-site inspections by City staff, (2) quarterly performance reviews, and (3) an annual evaluation. 2. PROGRAM REPORTING A. For public service programs - A Billing Voucher and Service Report shall be submitted at least quarterly, even if no reimbursement is requested. The report is due on in accordance with the schedule listed in First Amendment to First Amendment to Exhibit A. If the due date falls on a Saturday or Sunday, the Billing Voucher and Service Report is due on the prior Friday. If the due date falls on a City holiday, the Billing Voucher and Service Report is due the next working day following the holiday. The report shall detail information on service units or steps/milestones accomplished during the months/quarters as outlined in First Amendment to Exhibit A. The Final Service Report Form is provided by the City and is attached as First Amendment to Exhibit D-1 to this Agreement; it is also due in accordance with the schedule listed in First Amendment to Exhibit A. B. For acquisition or improvement of real property projects - Projects qualifying to meet the national objective to serve low- and moderate-income persons (under Part I, Section 3) shall submit a demographic report providing income, race, and head of household information for the beneficiaries of the CDBG Project, which shall cover a one year period extending back from the date of the report. If the facility is and remains occupied during the project, this report is due thirty (30) days after the date the project was closed. If the facility is first occupied or reoccupied after the close of the project, the report is due one year from the date of the last project closing. 3. FISCAL REPORTING RESPONSIBILITIES The Agency shall provide fiscal statements or reports as may be required from time to time by the City, which statements or reports, or both, must indicate the status of all accounts and funds being used to perform under this Agreement. The Agency shall maintain proper documentation and records of all expenditures incurred pursuant to the terms of this Agreement in a manner as will facilitate auditing by either HUD or the City. 19 4. AUDITS A. If the Agency is a nonprofit corporation and expends a total of $750,000 or more in federal financial assistance and has received federal financial assistance from the City during its fiscal year, it shall have an independent audit conducted of its financial statement and conditions, which shall comply with the requirements of 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. The Agency shall provide a copy of the audit report no later than thirty (30) days after the audit's completion or six (6) months subsequent to the end of the Agency's fiscal year, whichever date is sooner. The Agency shall provide to the City its response and corrective action plan for all findings and reportable conditions contained in its audit. When reference is made in its audit to a "Management Letter" or other correspondence made by the auditor, the Agency shall provide copies of those communications and the Agency's response and corrective actions plan. B. The Catalog of Federal Domestic Assistance (CFDA) number for the CDBG program is 14.218. PART IV — RECORDKEEPING RE,]MJIRENMiENTS 1. PROGRAM RECORDS AND INSPECTIONS The Agency shall make, maintain, and preserve books and records, of whatever form, detailing all CDBG-related expenditures and costs incurred by the Agency. All such books and records shall be made available to representatives of the City or HUD, or both, for formal inspection and, where necessary, copying. Intentional noncompliance with this provision shall constitute a material breach of this Agreement. Throughout the term of this Agreement, the Agency shall establish and maintain current the records described in this Section. These records shall conform to the requirements and specifications of their individual source authorities, which are cited herein. Be advised that the listing in this Section is intended only to assist the Agency in identifying the required records and their respective authorities, and is not all inclusive. A. Time for Retention of Records - Except where otherwise specifically provided, all records as of the end of the term of this Agreement shall be kept in an accessible file for four (4) years thereafter (24 CFR § 570.502(b)(3)(ix)). Exceptions to the four (4) year retention period are as follows: (1) Records that are the subject of litigation, claim, or audit findings shall be retained for ten (10) years after the date all issues have been resolved and final action taken; and (2) Records for real property and equipment shall be retained for three (3) years after its final disposition, with the retention period starting from the date of the disposition, replacement, or transfer at the direction of the City (24 CFR § 570.84(b)). B. Contract and Amendments - A complete copy of this Agreement and all amendments thereto and notices there under. 20 C. Records of City Ap Loyals - Copies of all requests for amendments or revisions to this Agreement and the City's subsequent approval or denial of such requests as are required under this Agreement. D. Subcontracts and Agreement s - Complete copies of all contracts, subcontracts, and agreements with third parties into which the Agency enters in the performance under this Agreement; and all correspondence, reports, and other documentation pertaining to such contracts, subcontracts, and agreements. E. Records identifying the assisted activity - A complete description of each activity assisted, in whole or in part, with CDBG funds under this Agreement, including: (1)Location(s), organization, operating hours, qualifications for service or participation, etc.; (2)Fees or charges for services, fee waivers, or fee scales for CDBG-assisted participants. F. Additional Contract Requirements - The Agency shall submit to the City a copy of the most recent independent financial audit and a current list of the Agency's board of directors. 2. PROGRAM BENEFIT RECORDS - 24 CFR § 570.506(b). As applicable, the following categories of records shall be maintained, for the discrete activities which are assisted in whole or in part with funding under this Agreement (or for all the Agency's activities if funding under this Agreement is not specifically allocated to particular activities) for the purpose of documenting that a majority of the beneficiaries are persons of low- or moderate-income. A. Records specifying by dollar amount, family size, and household income limits used to determine income level; B. For service activities serving individual clients without regard to their residence location within the City/County, records documenting: (a) manner in which each client's income is determined in all cases; (b) determination that each individual client's income is or is not within low- or moderate-income limits; (c) date determination was made; and (d) tabulation of the individual determinations. C. For a service or facility which exclusively serves a class of beneficiaries, the members of which are presumed to be low- or moderate-income eligible absent general evidence to the contrary (abused children, battered spouses, senior citizens, adults meeting the Bureau of the Census' Current Population Reports definition of "severely disabled," homeless persons, illiterate persons, persons living with AIDS and migrant farm workers), records documenting: (1) that the facility exclusively serves the eligible class; and (2) there is no generally available data indicating specific population served is not predominantly low- or moderate-income. D. For a service or facility which offers benefits uniformly without regard to income to all persons residing within a delineated area, records establishing: (1) boundaries of the service area; (2) the income characteristics of families and unrelated individuals in the service area; and (3) if the percent of low- and moderate-income persons in the service area is less than fifty-one (51) percent, data showing that the area qualifies under the exception criteria set forth at 24 CFR § 570.208(a)(1)(ii). 21 3. FINANCIAL RECORDS Agency shall maintain a financial management system in accordance with 2 CFR § 200.302 and 24 CFR 570.506(h). Agency shall maintain all accounting records that accurately record the source and application of all funds. The records must contain information pertaining to Federal awards, authorizations, obligations, unobligated balances, assets, expenditures, income and interest and be supported by source documentation. Agency shall maintain evidence to support how the CDBG funds provided to such entities are expended. Such documentation must include, to the extent applicable, invoices, schedules containing comparisons of budgeted amounts and actual expenditures, construction progress schedules signed by appropriate parties (e.g., general contractor and/or a project architect), and/or other documentation appropriate to the nature of the activity. Agency records pertaining to obligations, expenditures, and drawdowns must be able to relate financial transactions to either a specific on in year grant or to program income received during a specific program year. Financial records, supporting documents, statistical records, and all other records pertinent to a Federal award shall be retained for a period of three years from the date of submission of the final expenditure report or, for Federal awards that are renewed quarterly or annually, from the date of the submission of the quarterly or annual financial report, respectively, as authorized by the Federal awarding agency. The only exceptions are the following: A. If any litigation, claim, or audit is started before the expiration of the three-year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved and final action taken. B. Records for real property and equipment acquired with Federal funds shall be retained for three years after final disposition. C. When records are transferred to or maintained by the Federal awarding agency, the three-year retention requirement is not applicable to the recipient. D. This section does not apply to records maintained by contractors or subcontractors. 2 CFR § 200.333. 4. RECORDS OF PROGRAM OPERATIONS, MANAGEMENT AND EVALUATION Agency shall maintain all records of: A. Operating policies and procedures; B. Employee qualifications, training, and evaluation; C. Principal operations data: work units completed; clients served, classified by client and service characteristics; staff hours utilized; etc. D. Self-evaluation of services, programs, and employment practices for compliance with 504 and ADA requirements. 22 S. PROPERTY RECORDS Agency shall maintain all records identifying any real and personal property acquired or improved in whole or in part with funds under this Agreement as follows: A. Itemized inventory of real property recording legal and common descriptions and address, date of acquisition and/or improvements, cost of acquisition and/or improvements, and CDBG-funded share of cost; B. Itemized inventory of all non-expendable personal property recording full identification, current location, date and cost of acquisition, and CDBG-funded share of cost; C. Complete records of any authorized disposition of real or non-expendable personal property including how and to whom disposed, date, amount of disposition proceeds, market value at time of disposition and how determined, intended use, and any conditions governing use following disposition; D. At the termination of this Agreement, a record of the total purchase cost of all remaining unused expendable personal property. E. Agency shall submit reports at least annually on the status of real property in which the Federal government retains an interest, unless the Federal interest in the real property extends 15 years or longer (2 CFR 200.329). 6. NONDISCRIMINATION AND EQUAL-OPPORTUNITY RECORDS - 24 CFR § 570.506(g). Agency shall maintain: A. A recordation and tabulation of the racial classification of all individual persons or households receiving program benefits, and of whether these benefited persons are single head of household. B. A tabulation of all Agency employees classified by race, position, and salary in the format of the U.S. Equal Employment Opportunity Commission Form EEO-4. C. Data identical to that required under A. and B. above for any subcontractor or agent employed in the performance under this Agreement. D. Documentation of all substantive actions taken to assure that no prohibited discrimination occurs in the conduct of any of the Agency's operations. E. Documentation of all actions taken to make minority residents aware of the Agency's services and provide them with equal access to benefits. F. Record of the racial classification and gender of the majority owners of each private for-profit business with which the Agency contracts with any funds provided under this Agreement. 7. CONFLICT OF INTEREST A. Records documenting that all Agency board members, officers, employees and consultants have been informed of the conflict of interest provisions of 24 CFR § 570.611 and have acknowledged understanding those provisions. B. Complete records of all requests for exceptions submitted under 24 CFR § 570.611(d). 23 8. VERIFICATION OF SUBCONTRACTORS ELIGIBILITY - 24 CFR § 5. The Agency shall maintain records documenting that the Agency, all subcontractors, and consultants have been determined not to be currently debarred, suspended, denied participation or declared ineligible to participate in federal government funded programs. Verification of eligibility shall be accomplished by signing the Certification Regarding Debarment and Suspension, which is attached and incorporated as iExhibit. F . 9. ADDITIONAL REQUIREMENTS FOR ACQUISITION OR IMPROVEMENT OF REAL PROPERTY PROJECTS A. For construction contracts over $100,000, records documenting compliance with the bonding requirements of 24 CFR § 85.36 (h). B. Flood Insurance, Flood Disaster Protection Act of 1973; and Federal Insurance Administration Notice in Federal Register Vol. 24, No. 133, July 13, 1989. (1)Record of determination whether the assisted project is located within a designated flood plain or flood hazard area. (2)If the project is within such area: (1) Evidence of current participation in the National Flood Insurance Program; and (2) Evidence of flood insurance coverage in force on all significant project structures. C. Lead-Based Paint - Records required to document compliance with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801, et sec.), as amended and the Residential Lead-Based Paint Hazard Reduction Act of 1992 (42 U.S.C. §§ 4851, et seq.), and the implementing regulations 24 CFR § 35. D. Labor Standards - Records required to document compliance with all requirements of Davis-Bacon and Related Acts (40 U.S.C. §§ 3141 and 3142); Contract Work Hours and Safety Standards Act (40 U.S.C. § 3701, et sec.); Copeland Act (18 U.S.C. § 874); US Secretary of Labor Regulations (29 CFR §§ 3, 5, 6, and 7). E. Real Property Acquisition and Relocation - Records required to document compliance with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. §§ 4601, et seq., as amended; and the implementing regulations 49 CFR § 24. The agency shall consult the City for complete instruction prior to undertaking any action which may result in displacement of persons as defined at 49 CFR § 24.2(g). F. Misg0aneous Records - The Agency shall maintain such other records as may be required by HUD or the City. 24 PUGET SOUND TRAINING CENTER : CITY OF KENT: Si n , r lack ink oniv � Y Prim e:_ Joseph P. Drake Pr' t me:..�le �p Title; Fxerutivp Dirantnr Title: u DATE;_ dlr-f- '� � ....,.,.,.........,...,...., DATE: NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: PUGET SOUND TRAINING CENTER: CITY OF KENT: Marisol Tapia, Senior Program Manager Dinah Wilson, CDBG Coordinator Puget Sound Training Center City of Kent 270 SW 43rd ST, Bldg. 3 220 Fourth Avenue South Renton, WA 98057 Kent, WA 98032 Phone: 425.656.5950 Phone: 253.856.5076 Fax: 253.856.6070 25 Z 0* ^A^61 KENT EXHIBIT A AASH IN GTOX 2017-2018 CDBG PROJECT SCOPE OF SERVICES PARKS, RECREATION & PUGET SOUND TRAINING CENTER COMMUNITY SERVICES Project Title: Employment and Training Services Start Date: 1/1/17 Project No.: BG1726-1826 End Date: 1/31/18 Funding will provide comprehensive employment services to 2017 $5,000 underserved individuals in Kent. Funding: 2018 $5,000 Fundina Total City $10,000 of Kent Funds: Project Manager: Marisol Tapia Telephone: 425.656.5950 Fax: 425-656-5951 E-mail: marisolt@pstraininqcenter.com CDBG Coordinator/City Contact: Dinah Wilson Telephone: 253.856.5076 Fax: 253.856.6070 E-mail: drwilson@kentwa.qov Puget Sound Training Center (hereinafter referred to as "the Agency") shall utilize City of Kent Community Development Block Grant funds 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 Agency shall apply the following funds to the project in accordance with the Biennium Line Item Budget Summary below: Line Item Budaet Personnel Services _ $10,000.00 ($5,000 annually) Office or Operating Supplies $ Consultant or Purchased Services $ Construction Contracts $ Communications $ Travel and Traininq $ Grants $ Total City of Kent Funds; $10.000.00 2017-2018 PSTC-Employment Services CDBG Scope of Services: Agreement with City of Kent - Page 1 2) Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of persons each year of the CDBG Agreement: Quarters i:t 2na 3rd 4en Quarter Quarter Quarter Quarter Total JAN. — APRIL _ JULY— OCT. - Per MARCH JUNE SEPT. DEC. year No. of unduplicated persons assisted 10 10 10 10 40 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter; Quarters ist 2nd 3rd 4U' Quarter Quarter Quarter Quarter Total JAN. — APRIL_ JULY — OCT. - Per MARCH JUNE SEPT. DEC. year Education/Training Classes (#of traininq classes) 2 2 2 2 8 C. Definition of Services Education/Training Classes: Education/Training classes include forklift training and certification, computer training, warehouse training, and first aid & CPR training. This service is measured by the # of classes provided. Each training course is 40 hours of class instruction. 3) Records A. Project Files The Agency shall maintain files for this project containing the following items (all Agency files must contain items 1 - 7, however items 8 - 12 are required only if the costs are paid for by the CDBG budget. If clients are not presumed eligible; e.g., homeless, #13 client income must be documented): 1. Notice of Grant Award. 2, CDBG Agreement and all contract exhibits. 3. Motions, resolutions, or minutes documenting Board or Council actions. 4. A copy of this Scope and the City's Notice to Proceed on this project. 5, Correspondence regarding budget revision requests. 6. Copies of all invoices and reports submitted to the City for this project. 7. Bills for payment. 8. Copies of approved invoices and warrants. 9. Payroll time sheets for actual salary and fringe benefit costs. Time sheets must be signed by a supervisor and annotated to document percent of time charged against this project if less than full time. 2017-2018 PSTC-Employment Services CDBG Scope of Services: Agreement with City of Kent- Page 2 M Documentation of office costs (e.g., log sheets of copy machine use, postage, telephone use, costs of office supplies, etc.) when these costs are shared with other programs and no invoice is available. As an alternative, annotated invoices may be used to document charges as appropriate. 11. Documentation of mileage charges for private auto use must include: a) odometer reading at beginning and end of trip, b) destination and starting location, and c) purpose for trip. 12, Documentation of the solicitation process used to select vendors and subcontractors with original purchase orders and subcontracts. 13, Documentation required by Part IV, Paragraph 5, if any funds provided under this Scope are used to acquire equipment. 14. Documentation of client income. Unless clients are presumed eligible based on CDBG regulations, the Agency 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) Client income certification on a form approved by the City; or c) Documentation of qualification for participation in a "means-tested" federal or state program at least as restrictive as CDBG with regard to Income Guidelines. Income guidelines may be adjusted periodically by HUD. The Agency agrees to use updated Income Guidelines, which will be provided by the City. B. Record Retention Period All records required by this Scope shall be retained by the Agency for the period of time specified in the Agreement - Part IV. The period of time shall commence on January 1 of the year following the year in which the final invoice was paid. 4) Reports, Invoicing and Reporting Schedule A. Reports The Agency shall collect and report client information to the City quarterly on the Service Units section of Exhibit D (Billing Voucher and Service Report) to be provided by the City. Exhibits D and D-1 (including backup documents) shall be submitted electronically to d''rwilson@kQntwi_gov in accordance with the schedule outlined in Paragraph 3.B. below. Copies of supporting documents shall be emailed as well, or sent via the U.S. Postal Services and postmarked within two days of the due dates listed below.' 1 If the due date falls on a Saturday or Sunday, Billing Vouchers and Service Reports are due on the prior Friday. If the due date falls on a City holiday, Billing Vouchers and Service Reports are due the next working day following the holiday. 2017-2018 PSTC-Employment Services CDBG Scope of Services: Agreement with City of Kent- Page 3 B. Invoicing and Reporting Schedule The Agency shall submit Billing Vouchers and Service Reports to the City in accordance with the following schedule: 15t 2nd & 3`d Quarter Billing Voucher & 15th day following each quarter Service Report (Exhibit D) 4` Quarter Billing Voucher & Service December 15th3 Report CDBG Public Services Project Time 15`" day following each quarter Sheet (Exhibit G. if aoDlicable) Final Service Report (Exhibit D-1) January 12, 2018 &Time Sheet (Exhibit G, if applicable) 2 All dates are 2017 unless otherwise noted; a revised Exhibit A and/or new reporting schedule will be provided for 2018. 2017-2018 PSTC-Employment Services CDBG Scope of Services: Agreement with City of Kent - Page 4 EXHIBIT B INCOME GUIDELINES Effective 4/14/17 Median Family Income = $96,000 *Median 500/0 800/0 MEDIAN MEDIAN FAMILY EXTREMELY VERY LOW SIZE LOW LOW INCOME INCOME INCOME 1 $20,200 $33,600 $50,400 2 $23,050 $38,400 $57,600 3 $25,950 $43,200 $64,800 4 $28,800 $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, the extremely low-income limits may equal the very low (50%) income limits. Income Limit areas are based on FY 2017 Fair Market Rent (FMR) areas. EXHIBIT C APPOINTMENT OF LIAISON & AUTHORIZATION TO SIGN BILLING VOUCHERS & SERVICE REPORTS 2017-2018 CDBG AGREEMENT Appointment of Liaison The Agency appoints the following person as the liaison for the CDBG Agreement between the City and the Agency; this person shall be responsible for overall administration of the CDBG funded program: Liaison: Marcni Tania. Senior Programs Manager (title) Authorization to Sign Billing Vouchers & Service Reports The Agency authorizes the following individual(s) to sign Billing Vouchers & Service Reports for costs incurred and services provided pursuant to the CDBG Agreement between the Agency and the City; billing vouchers shall not be processed for payment unless they are signed by an authorized individual(s): Authorized Individual(s): Joseph R.Drake, Executive Driector (TYp Na (title) Additional Authorized Individual (if applicable): (Type Name) (title) (Signature) (Da te) � KE4T Exhibit CDBG W,q H,NGTQH BillingVoucher & Service Report PARKS, RECREATION 2017 COMMUNITY SERVICES Submit To: Dinah Wilson Agency: Puget Sound Training Center Housing & Human Services Parks, Recreation & Community Services 220 4`h Ave. South, Kent, WA 98032 Program Contact: 6.5Mar95 l Tapia Telephone: 425.656.5950 drwilson@kentwa.gov E-mail: marisolt@pstrainingcenter.com Phone: (253) 856-5076 Reporting Period Program Amount Requested Employment and Training Services $ SEC. 1: BUDGET SUMMARY (CALCULATIONS BASED ON YEARLY BUDGET) For Department Use Only Total Contract Amount $ 10,000.00 Total 2017 Contract Amount $ 5,000.00 Amount Requested This Otr. $ Amount Requested YTD $ Amount Remaining YTD (subtract amount requested YTD from 2017 contract amount) SEC. 2: 2017 LINE ITEM BUDGET SUMMARY (ANNUAL) ORIGINAL TOTAL REVISED CUMULATIVE COST CATEGORIES BUDGET REQUESTED BUDGET TO DATE 1 Personnel Costs (Attach Time Sheets) $5,000.00 2 Other $0 GRAND TOTAL $5,000.00 Page 1 of 5 SEC. 3: PERSONNEL FUNDED IN WHOLE OR IN PART BY CDBG GRANT SEC. 4: 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 Total Service Unit/Performance 1s` 2°d 3�d 4`h Contracted to 1st 2nd 3rd 4th Measure Serve Unduplicated # of Kent clients (persons) served 10 10 10 10 40 Education/Training Classes (# of training classes) 2 2 2 2 8 Sec. 5: NARRATIVE Provide a narrative explanation if you are behind in either progress toward meeting performance measures or projected expenditure rate. Page 2 of 5 Sec. 6: DEMOGRAPHIC INFORMATION Number of Households or Persons Assisted (please specify "H" or "P"). Race Unduplicated Unduplicated Undup`. Unduplicated Quarter Quarter(Hispanic) Year to Year to Date (All) Date (Hispanic) AI( 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 Income Level Unduplicated Quarter Unduplicated Year to Date 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 5 Female Headed Households Unduplicated Quarter Unduplicated Year to Date 1 2 3 4 Total Female Headed Households i I Homeless*`Complete only for individuals&families who have Unduplicated Quarter Unduplicated Year ` been assisted with transitional and permanent housing to Date 1 2 3 4 Individuals Families Total Homeless 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 Federal award. l 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. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812). Agency Authorized Signature Date Payment Authorization this section to be completed by,City of Kent only Contractual Obligations Met? YES NO Circle one Enter notes if Agency underperformed: Authorized Date:: Bye Page 4 of 5 Instructions Refer to:Accomplishments by Performance Measures in your CDBG Contract. 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: PERSONNEL FUNDED IN WHOLE OR IN PART BY CDBG GRANT Enter the names and titles of personnel being charged to the CDBG grant. Remember all hours charged to CDBG must be tracked and a timesheet certifying the hours worked were to directly support the CDBG funded program must be signed by the employee and supervisor and submitted to the City with the request for reimbursement, SEC.4; PERFORMANCE MEASURES Unduplicated Count of Households/Persons Assisted Projections: Circle either persons or households according to the method of counting clients specified in your CDBG Contract Scope. Insert the projected number of clients to be served as specified in your CDBG Contract 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 CDBG Contract 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. 5: NARRATIVE EXPLANATION You must provide a narrative explanation if your agency is behind in meeting either performance measures specified in your CDBG Contract Scope or your expenditure rate. Your expenditure rate should equal approximately one quarter of your HHS contract amount per quarter. SEC.6: 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 for Non-presumed Benefit Projects which 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%). You do not have to complete if your CDBG project directs services toward the following clients: abused children, elderly persons, DV victims, homeless persons, those meeting the federal definition of severely disabled persons, illiterate adults,persons living with aids, or migrant farm workers. Homeless: For programs providing transitional and permanent housing insert the unduplicated clients served. Page 5 of 5 CDBG r Exhibit D-1 T Service Report-Puget Sound Training Center �!%I fY9N f}TON PARKS, RECREATION S 2017 COMMUNITY SERVICES To: Dinah Wilson, CDBG Coordinator Agency: Puget Sound Training Center Housing & Human Services Parks, Recreation & Community Services 220 4ch Ave. South, Kent, WA 98032 Program Contact: 6.5Mar95 l Tapia Telephone: 425.656.5950 drwilson@kentwa.gov Phone: (253) 856-5076 E-mail: marisolt@pstrainingcenter.com Reporting Period Program Final Q4 Employment and Training Services SEC. 1 : PERFORMANCE MEASURES - 2017 KENT FUNDED SERVICE UNITS Unduplicated client counts must be reported both quarterly and year-to-date Service Unit Description Contracted to Serve Clients Actually Served Year to Date Total Service Unit/Performance Measure 1" 2ntl 3rd 4`h 1st 2nd 3rd 4th Unduplicated # of Kent clients 10 10 10 10 (persons) served Education/Training Classes (# of training classes) 2 2 2 2 Sec. 2: NARRATIVE Provide a narrative explanation if you did not meet performance measures for the contract year Page 1 of 3 Sec. 3: DEMOGRAPHIC INFORMATION Number of Households or Persons Assisted (please specify "H" or "P"): Race Unduplicated Quarter Unduplicated Quarter Undup Unduplicated (All) (Hispanic) Yearto YeartoDate Date (Hispanic)`' AII 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 Income Level Unduplicated Quarter Unduplicated Year to Date 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 Female Headed Households Unduplicated Quarter Unduplicated Year to Date 1 2 3 4 Total Female Headed Households Page 2 of 3 Homeless*Complete only for individuals &families who have Unduplicated Quarter Unduplicated Year been assisted with transitional and permanent housing to Date 1 2 3 4 Individuals Families Total Homeless Final Service Report Review this section to be completed by Cit of Kent only) Contractual Obligations Met? YES NO (Circle one) Agency Paid in Full? YES NO (Circle one) Enter explanation if Agency underperformed and paid in full: Reviewed _ Date: By: Page 3 of 3 ATTACHMENT E P'UGET SOUND TRAINING CENTER INSURANCE REQUIREMENTS FOR 2017-2018 CDBG 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. Excess Liability insurance covering the Commercial General Liability policy. 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. Excess Liability insurance shall be written with limits no less than $1,000,000 per occurrence in excess of both the CGL and Auto Liability policies cited above. Page 1 of 2 EXHIBIT E (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Contractor's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it. 2. The Contractor's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the contractor and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Contractor's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. 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. Page 2 of 2 PUGET-3 OP 11 RHR d►coizr�° TE(MMIDO1YYYY) CERTIFICATE OF LIABILITY INSURANCE °A09/1212017 0 911 212 0 1 7 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 riqhts to the certificate holder in lieu of such endorsement(sl. PRODUCER 425-255-2486 CONTACT Ruth Hubbartl,CISR CPIW HUB INSURANCE AGENCY PHONE 425-255-2486 FAx 1102 Bronson Way North JAC,N.,E.11 . ..... I(Mo.Nor425.235-8674 P.o. Box 796 ,MqIL rilubbard.hubin0l insuremall-net Renton,WA 98057-0796 fe0011E66 -. -- -- - - Ruth Hubbard,CISR,CPIW,DAE INSURERISI AFFORDING COVERAGE HAICp INSURERA:Ohlo Security Insurance CO '24082 INSURED PUget SOUnd Training Center INSURER B[ Puget Sound OIC(Inc dba -- -- -- -- -- ---- 268-270 SW 43rd St,Ste 3-DBE INSURER C: Renton,WA 98057 INSURER° INSURER E ......... INSURER F: ....... __. COVERAGES CERTIFICATE(NUMBER: REVISIONNUMBER:_. 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. jNS TYPE OF INSURANCE DDri°�R POLICY NUMBER POLICY Err POLICY EXP IMM,nnrvvwr MMrnnnvw, _. LIMITS A X COMMERCIAL GENERAL LIABILITY $ 1.000,000 EACH OCCURRENCE CLAWSMADE X OCCUR BKW57913345 07/25t2017 0712512018 DAMAGE TO PRINTED 1,000,000 _ X PREM�ISES(E&=Uf0n&A) $ . .... .- MED ENE- yone zrRaa $ 1 11 5,000 PERSONAL&ADV INJURY $ Excluded UEN L AGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY jECPT I Xi I LOC PRODUCTS-COMPIOPAGG $ 2,000,000 'rH R. -. AUTOMOBILE LIABILITY 'cr.IMNNED SINGLE LIMI r (EA mcnldanlL_ S ANY AUTO Rnnn v INLIJRv IP Pi $ . ONMED ,- SCHEDULE❑ _-- AUTOS ONLY A@U TO{SyWN[&y BODILY INJURVIPsrseedenll S ,.j AUTOSONLV ALIE`OSONI.Y {1N 0cEsRi3mwill' AMA6iE •. $ c A ( UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 X Excess une culMs-MADE IES057913345 0712512017 07I2512018 AGGREGATE S 1,000,000 oED RETENTIONS, g A WORKERS COMPENSATION PER OTH AND EMPLOYERS LIABILITY CTATLIITFM , MR YIN IBKW57913345 0710212017 0710212019 1,000,000 ANY PROPRIETORMARTMEWEX (VIA ECUTIVE I F EACH ACCIDENT g {{��rrlGl RtMIFM RExcl urcsrDp ` WA STOP GAP y R7Andprcory Pn ill I F I DISEASE_ FA EMPI nvEE s 1,000,000. It yes desenbe undeF 2,000,000 Cry Q%OF O ON5 EI nISFASF PnII(`Y LIMIT R DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,AUEifl..ei Remarks Schedule,may be attached if more space is required) Certificate holder is named as an additional insured as respects to their interest in all operations of the named insured subject to policy terms and conditions. Form CG8810 attached. CERTIFICATE HOLDER CANCELLATION CITYKEN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Human Services Dept 220 4th Avenue South Kent,WA 98032-5895 AUTHORIZED REPRESENTATIVE I` t/—, ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT PAGE NON-OWNED AIRCRAFT 2 NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY -ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGESAANDB 3 ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6 WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES 6 NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 " KNOWLEDGE OF OCCURRENCE, OFFENSE,CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 x BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU © 20131-iberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 8 With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. NON-OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, exclusion g.Aircraft, Auto Or Watercraft does not apply to an aircraft provided, 1. It is not owned by any insured; 2. It is hired, chartered or loaned with a trained paid crew; 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot; and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically "§ in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. NON-OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I -Coverage A-Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 52 feet long; and (b) Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY -ELEVATORS 1. Under Paragraph 2. Exclusions of Section I -Coverage A - Bodily Injury And Property Damage Liabil- ity, Subparagraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any properly insurance, whether primary, excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: 1. Under Paragraph 2. Exclusions of Section I-Coverage A-Bodily Injury and Property Damage Liability: a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the follow- "' ing: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to: (i) Premises rented to you for a period of 7 or fewer consecutive days; or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III - Limits of Insurance. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission, Page 2 of 8 b. The last paragraph of subsection 2. Exclusions is replaced by the following: Exclusions c. through n, do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III -Limits Of Insurance. 2. Paragraph 6. under Section III -Limits Of Insurance is replaced by the fallowing: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to: a. Any one premise: (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection sys- tems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following: 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract'. E. MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS -COVERAGESAAND B 1. Under Supplementary Payments -Coverages A and B, Paragraph 1.b. is replaced by the fallowing: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit', including actual loss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2, under Section II -Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or 'property damage' occurs, or the "per- sonal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 8 b. Premises or facilities rented by you or used by you; or c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or d. Operations performed by you or on your behalf for which the slate or political subdivision has issued a permit subject to the following additional provisions: (1) This insurance does not apply to "bodily injury", "property damage", or "personal and ad- vertising injury" arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury" or "property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar expo- sures; or (b) The construction, erection, or removal of elevators; or �Ip (c) The ownership, maintenance, or use of any elevators covered by this insurance. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insur- ance afforded to such additional insured will not be broader than that which you are required by „ the contract or agreement to provide for such additional insured. With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. Y With respects to Paragraph ti above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage". We have no duly to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV -Commercial General Liability Condi- tions. © 20131-iberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 8 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I -Coverage A-Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury" or "property damage" arising from the sole negligence of the additional insured. b, "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or"property damage" occurs. c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occur- rence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. d. "Bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is- sued by us and made a part of this policy. 3. With respect to the insurance afforded to these additional insureds, the following is added to Section III -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declaralio ns. H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION J. This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS is amend- ed as follows: a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc,,,wilh its permission. Page 5 of 8 b. The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the addi- tional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. I. ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. 'r 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: C An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; M b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a"suit" by the additional insured. 2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as slated in the Declarations of this policy and defined in Section III - Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS/MALPRACTICE WHO IS AN INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II -Who Is An Insured is replaced with the following: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employ- 9 ment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1) (a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or(b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing profes- sional health care personnel to others, or if coverage for providing professional health care ser- vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply. Paragraphs (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" jab responsibilities assigned by you, includes the direct supervision of other "employ- ees" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and © 20131-iberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office.Inc.,with its permission. Page 6 of 8 advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury", or caused in whole or in part by their intoxica- tion by liquor or controlled substances. The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section 11 -Who Is An Insured is replaced by the following; 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will quality as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or farmed by you; I Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. d. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV - Commercial General Liability Conditions, the following is added to Condition 6. Repre- sentations: Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Under Section IV -Commercial General Liability Conditions, the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1. of Section II -Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses, claims or "suits" shall have received such notice from the agent, servant or y, "employee". = N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. 0. BODILY INJURY REDEFINED Under Section V-Definitions, Definition 3. is replaced by the following. 3. "Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sick- ness or disease. © 20131-iberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services OKce,Inc,with its permission, Page 7 of 8 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury' or 'property damage" resulting from the use of reasonable force to protect persons or property, Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV -Commercial General Liability Conditions, the following is added to Condition 8. Trans- fer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the 'products-completed operations hazard" provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization', and n 2, The injury or damage occurs subsequent to the execution of the written contract or written agree- ment. © 20131-iberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 8 of 8 EXHIBIT F City of Kent 2027-2018 Certification Regarding Debarment and Suspension Puget Sound Tra nine Center, Ernpjoyment andTrainingrv' 1726- 1826 Agency Name of Project/Project Number 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 1 of 4 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 which 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 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 knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in 2 of 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, Ineli- gibility 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 remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to whom this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," without modification, in all lower tier covered 3 of 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 Non- procurement 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 of agency with which this trans- action originated may pursue available remedies including suspension and/or debarment. f Agerucy '�� Y r� � Date (Rr� 6 Si nature of A9encY/Sub-ReciPient Title .. ..._m ..... ................ .. 9 elowy d 0 d� 4 of a o a a o o.o o ca oo c a�ao w � a a a 0 M N V O O h N O; O 4 v� G ry N Ea o F u a ry a m o N d U � N � v G N y y o m a � m n _ U' n ma n a L m ez ry ry c 0 N m O c U W o� p U h c a a N G 6 m O m � c O N c m m O �O m L 0 l0 _ m m O � C j Y o >, g E 8 ° o £ m o � '� o " U E m zaa �.,es wg'i avti xca >F= — W � EXHIBIT H 504/ADA DISABILITY ASSURANCE OF COMPLIANCE COMPLETE AND RETURN WITH SIGNED CONTRACT Complying with Section 504 of the Rehabilitation Act of 1973, as amended, and the Americans With Disabilities Act of 1990, two federal laws which prohibit discrimination against qualified people with disabilities. I understand that federal and state laws prohibit discrimination in public accommodations and employment based solely on disability. In addition, I recognize that Section 504 requires recipients of federal funds (either directly or through contracting with a governmental entity receiving federal funds) to make their programs, services, and activities, when viewed in their entirety, accessible to qualified and/or eligible people with disabilities. I agree to comply with, and to require that all subcontractors comply with, the Section 504/ADA requirements. I understand that reasonable accommodation is required in both program services and employment, except where to do so would cause an undue hardship or burden. I agree to cooperate in any compliance review and to provide reasonable access to the premises of all places of business and employment and to records, files, information, and employees therein to the City of Kent for reviewing compliance with Section 504 and ADA requirements. I agree that any violation of the specific provisions and terms of the 504/ADA Disability Assurance of Compliance and/or Corrective Action Plan required herein or Section 504 or the ADA, shall be deemed a breach of a material provision of the Contract between the City of Kent and the Contractor. Such a breach shall be grounds for cancellation, termination, or suspension, in whole or in part, of this Contract by the City of Kent. According to the responses to the questions in the 504/ADA Self-Evaluation YES NO Questionnaire, (company name) ❑ ❑ is in compliance with 504/ADA. If the above response is NO, the following corrective actions will be taken: Corrective Action Plan The following Corrective Action Plan is submitted to comply with Section 504 and ADA requirements.. General Requirements Actions To Be Taken Completion Date Program Access Actions To Be Taken Completion Date 504/ADA Contract Form 9/17 Page 1 504/ADA DISABILITY ASSURANCE OF COMPLIANCE (continued) Employment and Reasonable Accommodation Actions To Be Taken Completion Date Physical Accessibility Actions To Be Taken Completion Date I Declare, d. Penalty of Perjury under the Laws of the State of Washington that the Foreg � u d Cprrect. r' Sig ate o a th r'zed signator Type or prinUP of authorized signator Title Telephone For Notarv: 9 State of Count of kyw Signed and sworn bef re me on date) by (print authorized , ra ..� signator name) t KELUE C BOVLON Notary siignatur _�.t.. NOTARY PUBLIC Notary (print name): t / Y STATE OF WASHINOTON COMMISSION EXPIRES My appointment expires: __ SEPTEMBER 29,2020 Contractor: Compd4yName �j v� ;AuJ �,3d ' '?4"Jon Cop Street Address City State Zip 504/ADA Contract Form 9/17 Page 2 504/ADA SELF-EVALUATION AND ASSURANCE OF COMPLIANCE Instructions FORMS TO BE COMPLETED AND PLACED IN YOUR PROJECT FILE: 504/ADA Self-Evaluation Questionnaire Form This form will help you evaluate your organization's or firm's programs and services, employment, and facilities, to ensure they are accessible to people with disabilities. Complete the 504/ADA Self-Evaluation Questionnaire and keep it on file at your office. Do not return It with your contract. The City will review the questionnaire when it conducts an on-site review of your grograrn. "Quick Look" Barriers Checklist This form is designed to give a quick appraisal of potential problem areas for accessibility. It should be completed and kept with your contract file and be made available when the City conducts an on-site review of your project. FORM TO BE COMPLETED AND RETURNED WITH YOUR SIGNED CONTRACT: 504/ADA Assurance of Compliance Form — Exhibit H • Complete this form, which is enclosed as Exhibit H. The form must be notarized. Return the ordinal copy of the notarized form to me. If your organization or firm is out of compliance with any of the 504/ADA requirements, indicate on the 504/ADA Disability Assurance of Compliance form the corrective actions that will be taken to achieve compliance and the date these actions will be completed. • Sign the Assurance of Compliance form and send the original back with your contract. Keep a copy of the form on file in your office for use during on-site reviews. You will be notified at least one week in advance of any scheduled review. If you have questions regarding this process, or if you require this material in an alternate format, please contact Dinah Wilson at 253-856-5076, or by e-mail: drwilson@ci.kent,wa.us . For TDD Relay Service for the Hearing Impaired, call 1-800-833-6388. For TDD Relay Service for Braille call 1-800-833-6385. 504/ADA General Information Federal and State laws prohibit discrimination based on disability. Section 504 of the Rehabilitation Act of 1973, as amended (504), and the Americans with Disabilities Act of 1990 (ADA) require that the City of Kent and all organizations and firms contracting with the City of Kent, except those providing tangible goods, comply with the 504/ADA accessibility requirements. Under 504 and ADA, a "qualified individual with a disability" is anyone who has, has a history of, or is perceived as having a physical or mental impairment which substantially limits one or more major life activities. Disabilities include, but are not limited to: mobility, visual, hearing, or speech disabilities; mental illness; epilepsy; learning disability; brain injury; HIV/AIDS; arthritis; cerebral palsy; multiple sclerosis; developmental disability; and alcohol and/or drug addiction. 504/ADA Contract Farms 1-9-03 DISABILITY RESOURCE LIST Note: Inclusion in this resource list does not constitute endorsement by the City of Kent, nor does omission imply non- endorsement. Our goal is to provide you with information on some key resources available. Please contact us if you know of a useful resource missing from this list. King County Office of Civil Rights Enforcement Disability Compliance Specialist, Yesler Building, Washington Assistive Technology Alliance 400 Yesler Way, Room 260, Seattle, WA 98104- (WATA) 2683; 206-296-7592 V, Information & referral to disability resources, 206-296-7596 TTY; 206-296-4329 Fax; including assistive technology options, funding e-mail: Civil-Rights.00R@metrokc.gov sources, legal issues, accommodations. web site: www.metrokc.gov/dias/ocre/ 509-328-9350 V/TTY; 800-214-8731 V/TTY; 509-326-2261 Fax; e-mail: spokane@seals.org Governor's Committee on Disability Issues and web site: wata.org/wata/eatrc/index.htm Employment (GCDE) Advises and informs the Governor, state and local Job Accommodations Network (JAN) governments, the business community, and the An international toll-free consulting service that disability community on ADA and other issues provides information regarding the ADA, job related to disability policy. accommodations and the employability of people Olympia: 360-438-3168 V, 360-438-3167 TTY; with disabilities. P.O. Box 6080, Spokane: 509-532-3149 V, 509-532-3113 TTY. 918 Chestnut Ridge Road, Suite 1, Morgantown, WV 26506-6080; GCDE publishes "Producing Materials in JAN--ADA Information 800-526-723� V/TTY; 800- Alternative Formats: A Guide for Agencies" which ADA-WORK (232-9675) V/TTY; provides information on producing materials in large web site: janweb.icdi.wvu.edu/ print, on audio tape or computer disk, and Braille. Send a written request for a copy. Emergency Procedures for Employees with Disabilities in Office Occupancies Northwest ADA/IT Center A procedural guideline funded by the US Fire Provides information on the Americans with Administration and developed by the National Disabilities Act and accessible information Institute of Standards and Technology with technology in Alaska, Idaho, Oregon and assistance from the National Task Force on Life Washington. Oregon Health & Science University Safety and People with Disabilities. Write for a copy: P.O. Box 574, Portland, Oregon 97207-0574 United States Fire Administration, 16825 South 800-949-4232, voice and TTY Seton Avenue, Emmitsburg, MD 21727. 503-418-0785, FAX; nwada@ohsu.edu Sprint Washington Telecommunications Relay Service (TRS) Provides free telephone accessibility with. TTY users. 500 108th Avenue NE, Suite 800, Bellevue, WA 98004; Relay Services: 800-833-6388 TTY; 800- 833-6384 V. ADA Technical Assistance Hotline (U.S. Dept. of Justice) Provides free technical assistance and informational materials to people with disabilities, businesses, state and local government agencies, and the general public on rights and responsibilities under Titles II and I II of the ADA. 800-514-0301 V/TTY. web site: www.usdoi,gov✓crt/ada/ 504/ADA Contract Forms 1-9-03 504/ADA SELF-EVALUATION QUESTIONNAIRE COMPLETE AND PLACE IN YOUR PROJECT FILE General Requirements Please check the appropriate answers. If necessary, attach additional pages of explanation. If you have fewer than 15 employees, please skip the first section and start with "Program Access." YES NO N/A 1 . Do you have a 504/ADA coordinator? If so, who? ❑ ❑ ❑ Name Title Phone 2. Do you have an internal grievance procedure that allows for quick and prompt solutions for any complaints based on alleged noncompliance with 504/ADA? ❑ ❑ ❑ 3. Do you have a policy that provides for notifying participants, applicants, employees, unions, and professional organizations holding collective bargaining or professional agreements that you do not discriminate on the basis of disability? ❑ ❑ ❑ 4. Have you notified these individuals of your nondiscrimination policy? ❑ ❑ ❑ 5. Do you provide ongoing staff training to ensure that staff fully understand your policy of nondiscrimination on the basis of disability and can take all appropriate steps to facilitate the participation of individuals with disabilities in agency programs and activities? ❑ ❑ ❑ Program Access 1 . Do you notify the public and other interested parties that agency meetings, board of director meetings, hearings, conferences, public appearances by elected officials, and interviews will be held in accessible locations? ❑ ❑ ❑ 2. Do you notify the public and other interested parties that auxiliary aids (sign language interpreters, readers) will be provided, upon request, to participants with disabilities? ❑ ❑ ❑ 3. Do you have a Teletypewriter (TTY), or do you use the statewide Telecommunications Relay Service to facilitate communication with individuals who use TTYs for communication purposes? ❑ ❑ ❑ 4. Do you provide ongoing training to familiarize appropriate staff with the operation of the TTY (or Relay Service) and other effective means of communicating over the telephone with people with disabilities? ❑ ❑ ❑ 504/ADA Contract Form 9-28-17 1 Program Access (continued) YES NO NIA 5. Do you make available, upon request, written material in alternate formats for people who have disabilities? (Alternate formats include large print, Braille, and audiocassette tapes) ❑ ❑ ❑ 6. Are printed posters, announcements, and printed materials (including graphics) clearly legible and placed in physically accessible locations where print can be read from a wheelchair? ❑ ❑ ❑ 7. If you have a mailing list for the purposes of information dissemination, does it include various disability groups? ❑ ❑ ❑ 8. Are your TTY number and procedures for accessing your services printed on all material distributed to the public? ❑ ❑ ❑ 9. Do you have a policy and procedure for safe emergency evacuation of people with disabilities from your facility(s)? ❑ ❑ ❑ Employment and Reasonable Accommodation 1 . When gathering affirmative action data regarding disabilities, do you make it clear that: • the information requested is intended for use solely in connection with reporting requirements; • the information is voluntary; • the information will be kept confidential; and • refusal to provide or providing the information will not subject the applicant or employee to any adverse treatment? ❑ ❑ ❑ 2. If you make pre-employment medical inquiries or conduct pre- employment medical examinations: • Is the inquiry related to the applicant's ability to perform the job? ❑ ❑ ❑ • Do you condition offers of employment on the results of these examinations? ❑ ❑ ❑ • Is the examination required for all employees in the same job classification? ❑ ❑ ❑ • Are all applicants in the same job classification asked the same medical and/or interview questions? ❑ ❑ ❑ 3. During the application, interviewing, hiring, and employment process, do you provide reasonable accommodations to applicants and employees with disabilities? ❑ ❑ ❑ 504/AAA Contract Form 9-28-17 2 Employment and Reasonable Accommodation (continued) YES NO NIA 4. Do you have a written policy stating the following? 504/ADA requires that information concerning an applicant's medical condition or history must be kept separate from personnel records and may be shared in only three ways: (1) supervisors and managers may be informed of restrictions on the work or duties of individuals with disabilities and informed of necessary accommodation(s); (2) first aid and safety personnel may be informed if the condition might require emergency treatment; and (3) government officials investigating compliance with 504/ADA shall be provided with relevant information upon request. ❑ ❑ ❑ Physical Accessibility Complete the "Quick Look" Barriers Checklist and then answer the following questions: 1 . Is the building(s) where your business is located barrier-free? ❑ ❑ ❑ 2. If you checked NO to any of the items on the Employment and Reasonable Accommodation checklist above, would these areas prevent an individual with a disability from accessing your program(s) or service(s)? ❑ ❑ ❑ If access would be impacted, describe on the Corrective Action Plan what steps will be taken to eliminate the barrier(s). If there are extenuating circumstances which would make barrier removal a financial or administrative burden, please explain in the Corrective Action Plan. This 504/ADA Self-Evaluation Questionnaire was completed by: Print name Date Phone Number 5041ADA Contract Form 9-28-17 3 "QUICK LOOK" BARRIERS CHECKLIST COMPLETE AND PLACE IN YOUR PROJECT FILE This checklist is designed to give a quick appraisal of potential problem areas for accessibility. For detailed review standards, refer to the Washington State Administrative Code (WAC) 51-40-1100, Chapter 11—Accessibility. If you are not located in State of Washington, you may refer to federal ADA Accessibility Guidelines (ADAAG), state or local laws and regulations. YES NO NIA Building Access • Are 96" wide parking spaces designated with a 60" access aisle? ❑ ❑ ❑ • Are parking spaces near main building entrance? ❑ ❑ ❑ • Is there a "drop off' zone at the building entrance? ❑ ❑ ❑ Is the gradient from parking to building entrance 1 :12 or less? ❑ ❑ ❑ • Does the entrance doorway have at least 32" wide clearance? ❑ ❑ ❑ • Is the door threshold no more than 1/2" high? ❑ ❑ ❑ « Is the door handle easy to grasp? ❑ ❑ ❑ Are the doors easy to open (building entrance maximum 8.5 lbs. pressure, all internal doors 5 lbs. max.)? ❑ ❑ ❑ • Are other than revolving doors available? ❑ ❑ ❑ Building Corridors + Is path of travel free of obstruction and at least 36" wide? ❑ ❑ ❑ • Is floor surface firm and slip resistant? ❑ ❑ ❑ + Do obstacles (phones, fountains) protrude no more than 4"? ❑ ❑ ❑ Are elevator controls no higher than 48"? ❑ ❑ ❑ • Are elevator markings in Braille? ❑ ❑ ❑ Does elevator provide audible signals? ❑ ❑ ❑ • Elevator interior provides minimum 51" turning area for wheelchairs? ❑ ❑ ❑ Restrooms • Are restrooms near building entrance or personnel office? ❑ ❑ ❑ • Do doors have lever handles? ❑ ❑ ❑ • Do restroom entrance doors have at least 32" wide clearance? ❑ ❑ ❑ • Is restroom large enough for wheelchair turnaround (51" minimum)? ❑ ❑ ❑ « Are stall doors at least 32" wide? ❑ ❑ ❑ • Are grab bars provided in toilet stalls? ❑ ❑ ❑ • Are sinks at least 30" high with room for a wheelchair to roll under? ❑ ❑ ❑ • Are sink handles easily reached and used? ❑ ❑ ❑ • Are soap dispensers and towels no more than 48" from the floor? ❑ ❑ ❑ Personnel Office • Do doors provide at least 32" wide clearance? ❑ ❑ ❑ • Is the door easy to open? (max. 5 lbs. pressure) ❑ ❑ ❑ • Is the door threshold no more than 112" high? ❑ ❑ ❑ • Is the path of travel between furniture wide enough for wheelchairs? ❑ ❑ ❑ 504/ADA Contract Form 9-28-17 4 Corporations and Charities System Page 1 of 2 ,s CY options and Charities Filing _ BUSINESS INFORMATION Business Name: PUGET SOUND OPPORTUNITIES INDUSTRIALIZATION CENTER(PUGET SOUND OIC) UBI Number: 602 041 670 Business Type: WA NONPROFIT CORPORATION Business Status: ACTIVE Principal Office Street Address: 270 SW 43RD ST BLDG 3, RENTON Principal Office Mailing Address: Expiration Date: 04/30/2018 Jurisdiction: UNITED STATES,WASHINGTON Formation/ Registration Date: 04/26/2000 Period of Duration: Perpetual Inactive Date: Nature of Business: https://ccfs.sos.wa.gov/ 12/4/2017 Corporations and Charities System Page 2 of 2 REGISTERED AGENT INFORMATION Registered Agent Name: PUGET SOUND OPPORTUNITIES INDUSTRIALIZATION CENTER (PUGET SO Street Address: 270 SW 43RD ST BLDG 3, RENTON, WA, 98057-4936, UNITED STATES Mailing Address: GOVERNORS Title Governors Type Entity Name First Name Last Name GOVERNOR INDIVIDUAL JEANNETTE POWER-COOPER GOVERNOR INDIVIDUAL ROBERT KINGSLEY GOVERNOR INDIVIDUAL RON NEWTON GOVERNOR INDIVIDUAL PETER GUNTER GOVERNOR INDIVIDUAL GLORIA BARBER GOVERNOR INDIVIDUAL JOSEPH DRAKE GOVERNOR INDIVIDUAL HEIDI ODOM Back Filing History Name History Print Return to Business Search hhh https://ccfs.sos.wa.gov/ 12/4/2017 w ., � ., . . : : • w m . ^ rem m � Q o � z� � � my uu�I� Im� �� � �� o� III� fllu " ����mm I w mi .� � � �. � ��N �� �� i i d V lillll IIIIIIII III IVVV � � � � VIV lm imV �' � � i i �IIVV � � � OIV � � �� �i�@L" n � ... .. ! i .. .. 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