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HomeMy WebLinkAboutEC18-020 - Original - Green River Community College - GRCC Small Business Assistance - 01/23/2018 Records M erne , wa.,�o.o. Document " CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to the City Clerk's Office. All portions are to be completed. If you have questions, please contact the City Clerk's Office at 253-856-5725. Vendor Name: Green River Community College Vendor Number: 34167 JD Edwards Number Contract Number: t-C/ l 9 This is assigned by City Clerk's Office Project Name: Yearly agreement with GRCC to help assist residents with small business Description: ❑ Interlocal Agreement ❑ Change Order ® Amendment ❑ Contract ❑ Other: Contract Effective Date: when signed Termination Date: 12/31 18 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Michelle Wilmot Department: Econ & Comm Development Contract Amount: $32,000 Approval Authority: ❑ Director ® Mayor ❑ City Council N/A Meeting Date KENT ' CONSULTANT SERVICES AGREEMEN between the City of Kent and Green River Community College Small Business Development Center (SIBAC) THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Green River Community College organized under the laws of the State of WA, located and doing business at 417 Ramsey Way, #112, Kent, WA 98032, 253-856-9595 (hereinafter the "Consultant"). I. DESCRIPTION OF WORK. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: The SBAC will focus on Kent clients recommeded to the Center by City and local banks. Details are described and attached in the scope of work, exhibit A Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time those services are performed. II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in Section I above immediately upon the effective date of this Agreement. Consultant shall complete the work described in Section I by December 31, 2018. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed $32,000 plus applicable Washington State sales tax, for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be as delineated in Exhibit A. B. The Consultant shall submit quarterly payment invoices to the City for work performed, and a final bill upon completion of all services described in this Agreement. The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. CONSULTANT SERVICES AGREEMENT - 1 (Over$20,000) IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. The Consultant has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Consultant maintains and pays for its own place of business from which Consultant's services under this Agreement will be performed. C. The Consultant has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Consultant's services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Consultant's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the Consultant's possession pertaining to this project, which may be used by the City without restriction. If the City's use of Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's duty to defend, indemnify, and hold the City CONSULTANT SERVICES AGREEMENT - 2 (Over$20,000) harmless, and Consultant's liability accruing from that obligation shall be only to the extent of the Consultant's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event Consultant refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant's part, then Consultant shall pay all the City's costs for defense, including all reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the Consultant's part. The provisions of this section shall survive the expiration or termination of this Agreement. VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit B attached and incorporated by this reference. IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of the work under this Agreement. X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents, drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and become the property of the City. All records submitted by the City to the Consultant will be safeguarded by the Consultant. Consultant shall make such data, documents, and files available to the City upon the City's request. The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. The City's use or reuse of any of the documents, data, and files created by Consultant for this project by anyone other than Consultant on any other project shall be without liability or legal exposure to Consultant. XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent contractor with the authority to control and direct the performance and details of the work authorized under this Agreement, the work must meet the approval of the City and shall be subject to the City's general right of inspection to secure satisfactory completion. XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. All work shall be done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. XIII. MISCELLANEOUS PROVISIONS. A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its contractors and consultants to use recycled and recyclable products whenever practicable. A price preference may be available for any designated recycled product. B. Nan-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. CONSULTANT SERVICES AGREEMENT - 3 (Over$20,000) C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; pr_ i d, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section VII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assiornroent. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public Records Act. The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or possessed by the City of Kent. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. 1. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received in person. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. All acts consistent with the authority of this Agreement and prior CONSULTANT SERVICES AGREEMENT - 4 (Over$20,000) to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. _..._.r.,_,_._......,. ................._....-....._.. CONSULTANT: CITY OF KENT: By; By IL (slc7 ature) /�by (srgnat Print Name: IZ� Print Name:_ __yA,na Ralph') Its_ G . A CAAR7T4&5 Its__ Mayor DATE: /C d .. DATE: ��2�1� NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Leslie Moore, Dean Michelle Wilmot Green River Community College City of Kent 417 Ramsey Way, #112 220 Fourth Avenue South Kent, WA 98032 Kent, WA 98032 (253) 288-3375 (telephone) (253) 856-5709 (telephone) ._.... ........... ...... ...._.. ............ .. ......... AP7ZOFORM: KqAt Law epartment CONSULTANT SERVICES AGREEMENT - 5 (Over$20,000) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1, I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3„ During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By .... �pp w, L� For: 1�� ?,lVR -- CaLLEZsE— �J C Title: Date: ........................._._.....................-.....__........ EEO COMPLIANCE DOCUMENTS - 1 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to $10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women„ Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 Exhibit A December 21, 2017 To: Michelle Wilmot, Economic Development Manager From: Leslie Moore, Dean for Branch Campuses and Continuing Studies Subject: Small Business Development Center Budget Request for 2018 The Green River College Kent Small Business Development Center (SBDC) is requesting a $32,000 Kent Economic Development grant to support a portion of one Certified Small Business Advisor position. This is an increase from previous years due to the increase in Kent clients relative to the overall funding structure, and based on the fact that we are now fully- staffed with two full-time advisors. During 2015, the last time we had two full time business advisors (and one government contracting advisor) for the entire year, the center provided 328 service hours to Kent clients. At our billable hourly rate of $135, a $32,000 grant would require 237 hours of direct service. This would be more in line with the community model for the larger cities of Auburn and Kent to pay more than our smaller communities of Enumclaw, Covington and Maple Valley. Those smaller cities pay $10,000 each for 75 hours of direct service. The policy of the SBDC is to help all clients who come through the door. Actual client hours are always more than grant deliverable hours. Kent numbers would very likely be much larger than the minimum 237 hours required for grant deliverables. The majority of hours would be spent for one-on-one advising along with outreach, presentations and workshops. The funding model with a Kent increase is as follows: State Funding (SBDC) $100,000 1.2 Business Advisor Community Funding $83,000 1.0 Business Advisor Dept. of Defense Funding $72,000 .08 Business Advisor, Govt. Contracting College Funding $85,000 Support Staff and Operations The college partners with the community to advance economic development in Kent and surrounding area and utilizes three certified business advisors including Jeremy Mauck, Taryn Hornby and Darrell Sundell, who work together to provide a wide range of technical assistance to businesses. The clients advised and their associated economic impacts are reflected in submitted quarterly reports. Thank you for your consideration. Cc. Kurt Hanson Jeremy Mauck Exhibit A EXHIBIT A Scope f Servigg In 2018, the SBDC will focus on Kent clients recommended to the Center by the City and local banks. Small business billable hours are calculated at $135 per hour. For a $32,000 grant, Kent will receive a minimum of 237 hours of direct client services. Client hours are calculated for one-on-one technical assistance and for presentations and workshops. Client needs differ in levels of assistance in any given year, so the continuation of client relationships year-to-year is expected. As all clients are self-selecting, this is the best SBDC estimation of impacts over a 12-month period based on previous years of experience. Actual results are based on a number of factors, not all of which are under the control of the SBDC. Consultant shall perform the following services for the City in accordance with the following described plans and/or specifications: The SBDC will focus on these areas of service for growth businesses: • Financial and cash flow management • Growth strategies • Access to capital • Expanding into new markets • Employee training and development The SBDC Center will focus on these areas of service for start-up and maintenance clients: Business plan development Business location analysis • Marketing and sales Small business management • Sources of capital Business counseling sessions shall be available at no cost to the client. The consultant shall provide quarterly reports to the City and participate in an in-person meeting to discuss services provided and outcomes. Confidentiality is a chief concern in reporting on SBDC activities. Reporting forms will identify clients by client number only and not by company name or owner. The dates of the sessions, a description of the subjects covered during each, and length of each meeting will also be included in the report. Additionally, the report will include the cumulative quarterly results of services provided, including the number of part-time and full-time jobs retained or created, and the amount of financial capital acquired for business support and/or reinvestment. Finally, the consultant will request that client testimonials be provided to the Mayor and City Council, either in writing, or verbally at a City Council meeting, in an effort to build awareness of the services provided by the SBDC. Exhibit A These reports must accompany the quarterly invoices for payment. Consultant further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices in effect at the time those services are performed. EXHIBIT B INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance The Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Consultant, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Consultant shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. Commercial General Liabilit insurance shall be written on ISO occurrence form CG 00 01. The City shall be named as an Additional Insured under the Consultant's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Consultant shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate. C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant's insurance and shall not contribute with it. 2. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VII. E. Verification of Coverage Consultant shall furnish the City with original cerbf Cates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Consultant before commencement of the work. F. Subcontractors Consultant shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Consultant. CERTIFICATE OF LIABILITY INSURANCE Issue Date 1 212 712 01 7 ISSUED BY: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY State of Washington AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Department of Enterprise Services CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE Office of Risk Management AFFORDED BY THE STATE OF WASHINGTON SELF INSURANCE PO Box 41466 LIABILITY PROGRAM. Olympia WA 98504-1466 COVERAGE AFFORDED BY State of Washington Self Insurance Liability Program INSURED: THE STATE OF WASHINGTON, INCLUDING ALL ITS AGENCIES AND DEPARTMENTS, IS SELF-INSURED FOR TORT LIABILITY CLAIMS. ALL State of Washington CLAIMS MUST BE FILED WITH THE STATE OFFICE OF RISK Green River College MANAGEMENT FOR PROCESSING IN ACCORD WITH STATUTORY ATTN: Darcy Silvest REQUIREMENTS. 12401 SE 320th Street Auburn, WA 98092 COVERAGES THIS IS TO CERTIFY COVERAGE DESCRIBED BELOW IS PROVIDED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBJECT TO ALL THE TFRMj EXCLUSIONS AND CONDITIONS OF SUCH PROGRAM. POLICY EFFECTIVE EXPIRATION TYPE OF COVERAGE NUMBER DATE DATE LIMITS GENERAL LIABILITY Self-Insured Continuous Continuous BODILY INJURY,PROPERTY $5,000,000 0 GENERAL LIABILITY DAMAGE&PERSONAL INJURY ® OCCURRENCE COVERAGE COMBINED EACH OCCURRENCE AUTOMOBILE LIABILITY BODILY INJURY&PROPERTY $5,000,000 ANY AUTO DAMAGE COMBINED EACH ALL OWNED AUTOS ACCIDENT SCHEDULED AUTOS ❑HIRED AUTOS ©NON-OWNED AUTOS WORKERS COMPENSATION AND L&I Continuous Continuous WC—STATUTORY EMPLOYERS LIABILITY 52WEGE1229 6V30/17 6/30l18 '... EL-$1,000,000—per Aoddenf!$1,000,000 Disease per Policyl$1,000,000 Disease per Employee OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS: Coverage applies as respects tort liability claims against the State of Washington as covered by the Tort Claims Act (RCW 4.92 at seq) The Certificate Holder is named as additional insured, but only as respects the negligence of the State of Washington. CERTIFICATE HOLDER: CANCELLATION CITY OF KENT SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, THE STATE OF WASHINGTON WILL ENDEAVOR TO MAIL !§ DAYS WRITTEN 400 WEST GOWE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE KENT,WA 98032 TO MAIL SUCH NOTICE SHALL NOT IMPOSE ANY OBLIGATION OR LIABILITY UPON THE STATE OF WASHI , ITS OFFICIALS, EMPLOYEES, AGENTS fREftESENTATIVES. ED REPRESE TATIVE: D /CERTIFICATE NUMBER CRT 18-342 s State Risk Man. .r Campbell, Melvnda (DES) From: noreply@formstack.com Sent: Wednesday, December 27,2017 2:11 PM To: OFM Cl; Erickson, Paul (WaTech) Subject: DES-Cert Ins Request Forml -Green Self Insurance Form - Certificate of Liability Insurance CERTIFICATE OF LIABILITY INSURANCE REQUEST FORM Sent: Dec 27, 2017 2:11 PM Form record ID: 374062233 Copy and paste the string below into the Excel file CRT SE 01 Auburn, City 400 Kent, Julie ??- Green 3 0th WA DarcySilvesttisslve�t raa eenfaver,eduof West WA Pulliam p)-i4mCd ken9wa.gou Kent Gowe 98032 Your Agency Green Agency Address 12401 SE 320th St. Auburn,WA 98092 Your Name Darcy Silvest Your Emaff dsilves a�� etojygrxdu Your Phone (253) 833-9111 Outside Entity City of Kent "ATTN" Name Julie Pulliam Certificate Holder Email i1, ijiaa;n[cz kentwfa,voy Certificate Holder Address 400 West Gowe Kent,WA 98032 Reason for Certificate Requested Date Certificate Needed Dcc 28, 2017 Requirements Reviewed? Yes t 4n w w n vx , u n w ;. d M ,; r�ifkn'+J„ M 4rx rrl�` miyal rony re, «.«.�:, . .�faM,. .,�. . � ,,.,.arwZjL` "8 BUSINESS LICENSE N„ I AFm � SfArE,OF I4 E WASHINGTON Unified Business ID#: 171004565 Business ID#: 001 Municipality n Location: 0001 r'C WASHINGTON STATE COMMUNITY COLLEGE DISTRICT#10 Expires: Mar 31, 2018 ^, GREEN RIVER COLLEGE 12401 SE 320TH ST I AUBURN, WA98092-3622 r UNEMPLOYMENT INSURANCE -ACTIVE INDUSTRIAL INSURANCE#262808009-ACTIVE MINOR WORK PERMIT-ACTIVE TAX REGISTRATION -ACTIVE -8 DUTIES OF MINORS: Np � CLERICAL a p I� LICENSING RESTRICTIONS: �I It is the business's responsibility to comply with minor work permit requirements. See WAC 296-125-030 and WAC q 296-125-033 for non-Agrlculural and WAC 296-131-125 for Agricultural guidelines and restricted activities. p I'e k Service occupations if a minor works past 8:00 p.m., minor must be supervised by a responsible adult employee who is on the premises at all times. WAC 296-125-030(30) Ib' l� k r; I„ r t h L'0 ^ Id 1 D fhis tlnaurn nt lit the rr rEi Pr w:m fidorw rnr nr Intl liu?riw authon7i,d f n dui bur,irw,s ond rrotnPd a rvi By xii rPuuq Chi.d�rr i n r n e nt T Vie I rn N ri rPifir I e rvifurrmn nou rlir iplrlir tnorr vJri r,l rhY¢ kn�i Iianti with aIIei trr1Ir31r I Wj I m uirrrrtVer i�Ctarrntwlvt� a[1ti r1Yt1 nl ili�rn.,- vvvll ti• ndurOtffl in co 4 fl 1 � - Y ➢ l7,reUor DcpmimenmfRevenue ,.. e, a_L f.1, ,,. ,fi mow.,, t u +� :,� tl,.ru., STATE OF WASHINGTON US): 171004565 001 0001 Expires: Mar 31, 2018 WASHINGTON STATE COMMUNITY UNEMPLOYMENT INSURANCE- COLLEGE DISTRICT#10 ACTIVE GREEN RIVER COLLEGE INDUSTRIAL INSURANCE 4262808009 12401 SE 320TH ST -ACTIVE AUBURN,WA 98092-3622 MINOR WORK PERMIT-ACTIVE TAX REGISTRATION-ACTIVE REQUEST FOR MAYOR'S SIGNATURE a T Please Fill in All Applicable Boxes Oriqinator: Julie Pulliam Phone (originator): 5702 Date Sent: 01/15/18 bate of Council Approval: N/A Return Date of Approval from Finance: Signed Document to: Julie Pulliam (Only required on contracts $10,000 &over or on any Grant A. reements) Yearly.bud et Date Required: When signed Date of Approval from Risk Manager: 12/27/17 GRCC Small Business Assistant Center Budgeted: YES ® NO ❑ Budget Fund: 10004115.64190.1221 Yearly agreement with Green River Community College for the Small Business Assistant Center with a focus on helping Kent Residents with start-up and banking options. Will not exceed $32,000 and expire on 12/31/18 All Contracts Must Be Routed Through The Law Department RECEIVEDis.area to be completed by the Law Department) Received: Law Departm�MA4p O as to Form; Law 6"4, p� ^uev ID ida W D PT Date Forwarded to Mayor: iJa3��g Shaded Areas To Be Completed By Administration Staff Received: Recommendations and Comments: Date Returned: f r.:MNYipalXXY%{4MYm�ANIXiigM pq mmna rw Mnv6PeNaw4vxtPozw,.