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CAG2019-106 - Original - Asian Counseling and Referral Services - Whole Health Oriented Mental Health Program - 01/01/2019
KENT Records Management Document WASHING iOn 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: Asian Counseling and Referral Services Vendor Number (JDE): Contract Number (City Clerk): OC.11 1- l Re Category: Contract Agreement Sub-Category (if applicable): noose an item. Project Name: Whole Health Oriented Mental Health Program Contract Execution Date: 1-1-2019 Termination Date: 12-31-2020 Contract Manager: Lori Guilfoyle Department: Parks Contract Amount: $20,000 (10,000 per year) Budgeted: ® Grant? Part of NEW Budget: ❑ Local: ❑ State: ❑ Federal: ❑ Related to a New Position: ❑ Basis for Selection of Contractor? Bid: ❑ RFP: ® Small Works Roster: ❑ Quotes: ❑ Approval Authority: ® Director ❑ Mayor ❑ City Council Other Details: `�✓ �, T CONSULTANT SERVICES AGREEMENT between the City of Kent and Asian Counseling and Referral Service THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Asian Counseling and Referral Service organized under the laws of the State of Washington, located and doing business at 3639 Martin Luther King Jr Way S., Seattle, WA 98108 and (206) 695-7518 (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: Asian Counseling and Referral Service will provide the WHOLE HEALTH ORIENTED MENTAL HEALTH PROGRAM. A culturally competent whole health oriented mental health services for Asian Pacific Islander (API) individuals living in Kent with a chronic mental illness to promote recovery, wellness and whole health addressing physical, mental, and social wellbeing. The following exhibits are attached and incorporated by this reference as if fully set forth herein; Exhibit A, Scope and Schedule of Work, Exhibit B, Insurance Exhibit and Exhibit C, Debarment Certification. 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 12/31/2020. III. COMPENSATION. A. The City shall pay the Consultant, based on time and materials, an amount not to exceed $20,000 ($10,000 per year), for the services described in this Agreement. This is the maximum amount to be paid under this Agreement for the work described in Section I above, and shall not be exceeded without the prior written authorization of the City in the form of a negotiated and executed amendment to this agreement. The Consultant agrees that the hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's billing rates shall be as delineated in Exhibit A. B. The Consultant shall submit quarterly payment invoices to the City for work performed, and a final bill upon completion of all services described in this Agreement. The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option to only pay that portion of the invoice not in dispute. In that event, the parties will immediately make every effort to settle the disputed portion. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor- Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: CONSULTANT SERVICES AGREEMENT - 1 ($20,000 or Less) A. The Consultant has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. B. The Consultant maintains and pays for its own place of business from which Consultant's services under this Agreement will be performed. C. The Consultant has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Consultant's services, or the Consultant is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. D. The Consultant is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. E. The Consultant has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Consultant's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. F. The Consultant maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth on the signature block of this Agreement. After termination, the City may take possession of all records and data within the -Consultant's possession pertaining to this project, which may be used by the City without restriction. If the City's use of Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the Consultant. VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is qualified and available to perform the work to which the employment relates. Consultant shall execute the attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers, officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits, including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of this Agreement, except for that portion of the injuries and damages caused by the City's negligence. The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to avoid any of these covenants of indemnification. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees, agents and volunteers, the Consultant's duty to defend, indemnify, and hold the City harmless, and Consultant's liability accruing from that obligation shall be only to the extent of the Consultant's negligence. CONSULTANT SERVICES AGREEMENT - 2 ($20,000 or Less) IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. In the event Consultant refuses tender of defense in any suit or any claim, if that tender was made pursuant to this indemnification clause, and if that refusal is subsequently determined by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant's part, then Consultant shall pay all the City's costs for defense, including all reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and fees incurred because there was a wrongful refusal on the Consultant's part. The provisions of this section shall survive the expiration or termination of this Agreement. VIII. INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit 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. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. C. Resolution of Disputes and Governing-Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute, difference or claim arising from the parties' performance of this Agreement, the exclusive means CONSULTANT SERVICES AGREEMENT - 3 ($20,000 or Less) of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties' performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section VII of this Agreement. D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice hereunder shall become effective three (3) business days after the date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such other address as may be hereafter specified in writing. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant. G. Entire Agreement. The written provisions and terms of this Agreement, together with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the City, and such statements shall not be effective or be construed as entering into or forming a part of or altering in any manner this Agreement. All of the above documents are hereby made a part of this Agreement. However, should any language in any of the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall prevail. H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those operations. I. Public Records Act. The Consultant acknowledges that the City is a public agency subject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes, emails, and other records prepared or gathered by the Consultant in its performance of this Agreement may be subject to public review and disclosure, even if those records are not produced to or possessed by the City of Kent. As such, the Consultant agrees to cooperate fully with the City in satisfying the City's duties and obligations under the Public Records Act. J. City Business License Required. Prior to commencing the tasks described in Section I, Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the Kent City Code. CONSULTANT SERVICES AGREEMENT- 4 ($20,000 or Less) 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 to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. CONSULTANT: CITY OF KENT: B � ,y: By: vo,4 0�IZY4-1 4, (signature) (signature) Print Name: Elisa Del Rosario Pri ame: Julie Parascondola Its: Deputy Director Its: Parks Director f (title) DATE:_ a1 �`�1(I DATE: I NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: CONSULTANT: CITY OF KENT: Elisa Del Rosario, Deputy Director Lori Guilfoyle Asian Counseling and Referral Service City of Kent 3639 Martin Luther King Jr Way S. 220 Fourth Avenue South Seattle, WA 98108 Kent, WA 98032 (206) 695-7518 (telephone) 253-856-5061 (telephone) N/A facsimile 253-856-6070 facsimile ATTEST: Kent City Clerk CONSULTANT SERVICES AGREEMENT- 5 ($20,000 or Less) DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the prime contractor will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime Contractor, that the Prime Contractor complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. By: For: Title: Date: /�9 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. 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: • Exhibit A KENT W. Scope and Schedule of Work PARKS, RECREATION S 2019-2020 Consultant Services Agreement COMMUNITY SERVICES ' Agency: Asian Counseling and Referral Service 2019 Fund p 10 000 Program: WHOLE HEALTH ORIENTED MENTAL HEALTH 2O20 Funding: $10,000 PROGRAM _ This funding Culturally competent whole health oriented mental $20,000 will provide: health services for Asian Pacific Islander (API) Total: individuals living with a chronic mental illness to promote recovery, wellness and whole health addressin physical, mental and social wellbeing Annual Program Service Units: Pro ram Outcomes: Unduplicated Kent Residents 100 Improving Health and Well-Being Mental Health Counseling 4000 Individuals to improve their mental and physical health, overall well-being, and ability to live independently. Pursuant to Item I. of the Consultant Services Agreement (CSA) executed on January 1. 2019, Consultant shall provide the approximate number of City of Kent clients with the following services each year of the CSA: Quarter Service Unit # of Units Cumulative Total 1st Unduplicated City of Kent clients served 25 25 Mental Health Counseling 60 minutes 1000 _ 1000 2nd Unduplicated City of Kent clients served 25 50 Mental Health Counseling 60 minutes 1000 2000 3rd Unduplicated City of Kent clients served 25 75 Mental Health Counseling 60 minutes 1000 3000 4tn Unduplicated Cit of Kent clients served 25 100 Mental Health Counselin 60 minutes 1000 4000 The above services shall be provided by December 31, 2019 for year one of the two-year agreement and December 31, 2020 for year two of the agreement. Contract Administration - The Consultant shall notify the City, in writing, within ten (10) days of any changes in program personnel or board membership. - The Consultant shall provide the City with a current list of its board of directors, general or limited partners, as applicable. - All records related to the CSA must be retained for three (3) years plus the current year. Exhibit A (continued) KENT Scope and Schedule of Work 2019-2020 Consultant Services Agreement PARKS. RECREATION S COMMUNITY SERVICES A enc : Asian Counselinq and Referral Service 2019 Funding: 10 000 -Program: Mental Health 2020 Funding: 10 000 This funding Culturally competent whole health oriented mental $20,000 will provide: health services for Asian Pacific Islander (API) Total: individuals living with a chronic mental illness to promote recovery, wellness and whole health addressing physical, mental, and social wellbeing Reporting Requirements and Timeline All data and required forms shall be submitted electronically. Service Unit Report- Data from this form will be used to track each program's progress toward meeting the goals stipulated in the Scope of Work. It shall be submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 15), along with the Reimbursement Request, Reimbursement Request - This form will be filled out electronically and serve as the invoicing mechanism for payment to your agency/program. It shall be submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 8), unless otherwise specified. Demographic Data Report - The agency shall collect and retain the data requested on this form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted annually (by January 15). Annual Outcome Data Report - Outcome data shall be submitted no later than the 15th following the end of the second quarter (i.e. July 15). Data should demonstrate the program's progress toward Outcomes specified in the Scope of Work. __Report Due Date Service Unit Report and Reimbursement Request 15th day following each quarter Final Reimbursement Request (4th Qtr) _ January 81h, 2020/January 8th, 2021 Demographic Data Report _ January 151h, 2020/January 151h, 2021 Annual Outcome Data Report January 15th, 2020/January 15th, 2021 Signature Please sign below to indicate acceptance of the Year 2019 and Year 2020 Performance Measures listed abo Deputy director, Elisa Del Rosario, Asian Counseling and Date Referr e Merina s ,Human Servi Manager Date - All records related to this CSA must be retained for three (3) years plus the current year. 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 Liability insurance shall be written on ISO occurrence form CG 00 01. The City shall be named as an Additional Insured under the Consultant's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 2. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Consultant shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate. EXHIBIT B (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant's insurance and shall not contribute with it. 2. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. E. Verification of Coverage Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Consultant before commencement of the work. F. Subcontractors Consultant shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Consultant. DATE(MMDDIYYYYI ACOR" CERTIFICATE OF LIABILITY INSURANCE 1/9/2019 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 be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Annie San tOrelll Degginger McIntosh and Associates HCNEo Ext: (425)740-5200 _FAX o: c425l740-5201 PO Box 1400 E-MAIL Annie@dmainsurance.com ADDRESS: 3977 Harbour Point Blvd SW INSURER(S)AFFORDING COVERAGE NAIC# Mukilteo WA 98275 INSURERA:Granite State Insurance Co INSURED INSURER B: Asian Counseling & Referral Service, Inc., DBA: ACRS INSURER C: 3639 Martin Luther King Jr Way INSURER D: INSURER E: Seattle WA 98144 INSURER F: COVERAGES CERTIFICATE NUMBER:18-19 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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. INSRSUBRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADDL WVD POLICY NUMBER MM DDIYYYY) (MMIDDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 IAIMA ToA CLAIMS-MADE �OCCUR PREM SES Ea occurRENTE0rence $ 100,000 X 02LX066417134-2 4/15/2018 4/15/2019 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER-. GENERAL AGGREGATE $ 3,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 3,000,000 X JECT OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ AALL OWNED SCHEDULED AUTOS AUTOS 01-CA-069969060-1 4/15/2018 4/15/2019 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY d 1DAMAGE $ HIREDAUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED I X I RETENTION$ 10,000 29-UD-042966667-3 4/15/2018 4/15/2019 1 $ If516K�If1X�Xl PER X OTH- XXXEMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE WA STOP GAP E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED' El N/A A (Mandatory in NH) 02LX066417134-2 4/15/2018 4/15/2019 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Sexual Abuse and 02LX066417134-2 4/15/2018 4/15/2019 Each Occurrence $1,000,000 Molestation Aggregate $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Kent is included as Additional Insured per attached forms 2026(07/04) and 86571 (0804) with respect to any and all operations of the Named Insured. All endorsements apply per required Written Contract. CERTIFICATE HOLDER CANCELLATION lguilfoyle@kentwa.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 220 4th Ave S. ACCORDANCE WITH THE POLICY PROVISIONS. Kent, WA 98032 AUTHORIZED REPRESENTATIVE L David Tyner, III/AN L L� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY EXTENSION ENDORSEMENT FOR HUMAN SERVICES PROGRAMS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. DEFENSE EXTENSION finding of guilt that is held in abeyance for any reason, pending the completion of any remedial The following is added to COVERAGE A — activity such as community service or BODILY INJURY AND PROPERTY DAMAGE counseling; or LIABILITY, 2. Exclusions, a. Expected Or Intended Injury and COVERAGE B — 3. For any type of civil charge(s)whatsoever. PERSONAL AND ADVERTISING INJURY The most we will pay for defense under this LIABILITY, 2. Exclusions, a. Knowing violation defense extension is$25,000. Of Rights Of Another B. LEGAL LIABILITY EXTENSION However, we will reimburse you for the sums that you voluntarily reimburse to an "employee" of yours 1. The last paragraph of Section I — Coverages for the reasonable and necessary defense costs A — 2. Exclusions, is deleted and replaced by that he or she incurs in order to defend himself or the following: herself against criminal charges made against him Exclusions c.through n.do not apply to: or her, but this insurance only applies if: a. damage by fire, lightning, explosion, smoke 1. The alleged acts out of which such criminal or leaks from automatic fire protective charges arise are alleged to have: systems; and a. Arisen out of and in the course of your b. damage caused by a "resident' ; employment of the "employee"; and to premises rented to you or temporarily b. Been committed by your "employee" occupied by you with the permission of the against a client of your Human Services owner. facility; and 2. Paragraph 6. of Section III — Limits of c. Taken place during that period of time that Insurance is deleted and replaced by the the "employee"was employed by you: and following: d. Taken place during the policy period and in 6. Subject to 5. above, the Damage To the"coverage territory"; and Premises Rented To You Limit is the most 2. All the criminal charges are either dismissed we will pay under COVERAGE A for without prejudice or your "employee" is found damages because of"property damage". not guilty of all criminal charges by a court of a. resulting from fire, lightning, explosion, law. smoke or leaks from automatic fire This exception does not apply to any protective systems, or any combination reimbursement of sums that you voluntarily thereof; and reimburse to your "employee" for the reasonable b. caused by a "resident'; and necessary defense costs that he or she incurs in order to defend himself or herself against to premises, rented to you or temporarily criminal charges made against him or her: occupied by you with the permission of the owner. Damage To Premises Rented To 1. For any criminal charge(s) arising out of the You Limit is the greater of: ownership, maintenance, use or entrustment to others of any aircraft, "auto' or watercraft; or a. $200,000 for damages due to fire; lightning, explosion, smoke or leaks 2. For any criminal charge(s) where your from automatic fire protective systems, "employee" receives anything less than either a or any combination there of; or complete dismissal with prejudice or a not guilty verdict on all charges, including without limitation, any deferred adjudication or similar 86571 08104 -1- b. The Damage To Premises Rented To q. Fines or penalties assessed by a court or You Lit-nit shown in the Declarations; regulatory authority. and r. Liability arising out of any act or omission c. $25,000 for damages caused by a in the furnishing or failure to furnish "resident" . professional services in the medical 3 Paragraph 4.b.(b) of Section IV — Commercial treatment of"residents. General Liability Conditions — Other Insurance, is 3. As respects the violation of "Rights of deleted and replaced by the following: Residents" Coverage the following definition is (b) That is property insurance for premises added to Section V-- Definitions: rented to you or temporarily occupied by "Rights of residents"means: you with the permission of the owner; a. Any right granted to a resident under any 4. Paragraph a., "Insured Contract", of state law regulating your business as a paragraph 9. of Section V — Definitions is health care facility. deleted and replaced by. b. The "rights of residents" as included in the a. A contract for a lease of premises. United States Department of Health and However, that portion of the contract for a Welfare regulations governing participation lease of premises that indemnifies any of Intermediate Care Facilities and Skilled person or organization for damage by fire, Nursing Facilities, regardless of whether smoke, or leaks from sprinklers to premises your facility is subject to those regulations. while rented to you or temporarily occupied E. WAIVER OF IMMUNITY by you with the permission of the owner is not an "insured contract." We will waive, both in the adjustment of claims and in the defense of "suits" against the insured, any 5. The following is added to SECTION V. charitable or governmental immunity of the insured, Definitions: unless the insured requests in writing that we not do "Resident" means a person who is disabled and so. placed by the insured. Waiver of immunity as a defense will not subject us C. LIQUOR LIABILITY EXCLUSION — EXCEPTION to liability for any portion of a claim or judgment in FOR FUND RAISING EVENTS excess of the applicable limit of insurance. Paragraph c. of 2. Exclusions, COVERAGE A F. WHO IS AN INSURED (SECTION 1) is amended by adding the following Paragraph 2. of Section 11—Who Is An Insured is subparagraph: deleted and replaced by the following: This exclusion does not apply to "bodily injury" or 2. Each of the following is also an insured, but "property damage" arising out of the selling, serving only while working within the scope of their or furnishing of alcoholic beverages at any fund- duties for the insured: raising events. a. "Employees"; D. VIOLATION OF RIGHTS OF RESIDENTS COVERAGE (PATIENT'S RIGHTS) b. "Volunteer Workers"; 1. The following is added to Section I — However, no"employees"or"volunteer Coverages — Coverage A, paragraph 1. workers" are insureds for.- Insuring Agreement: (1) "Bodily injury" or"personal and "Bodily injury" damages arising out of the advertising injury": violation of "Rights of Residents" shall be deemed an "occurrence.'' (a) To you, to your partners or members(if you are a partnership 2. As respects the coverage provided in or joint venture),to your members paragraph A.1. of this endorsement, the (if you are al limited liability following exclusions are added to Section I — company),to a co-"employee" Coverages—Coverage A—2. Exclusions: while in the course of his or her This insurance does not apply to. employment or performing duties related to the conduct of your p. Liability arising out of the willful or business, or to your other intentional violation of "Rights of "volunteer workers"while Residents." 86571 08/04 -2- performing duties related to the (2) Premises they own, maintain or control conduct of your business; while you lease or occupy these (b) To the spouse, child, parent, premises, brother or sister of that co- This insurance does not apply to structural "employee"or"volunteer worker" alterations, new construction and as a consequence of Paragraph demolition operations performed by or for (1)(a) above; that person or organization. (c) For which there is any obligation to g. Any State or Political Subdivision subject to share damages with or repay the following provision: someone else who must pay This insurance applies only with respect to damages because of the injury the following hazards for which the state or described in Paragraphs(1)(a) or political subdivision has issued a permit in (b) above; or connection with premises you own, rent, or (d) Arising out of his or her providing control and to which this insurance applies: or failing to provide professional (1) The existence, maintenance, repair, health care services. construction, erection, or removal of (2) "Property damage"to property: advertising signs, awnings, canopies. a) Owned; cellar entrances, coal holes, driveways. ( occupied p or used b y, manholes, marquees, hoistaway (b) Rented to, in the care, custody or openings. sidewalk vaults, street control of, or over which physical banners, or decorations and similar control is being exercised for any exposures; or purpose by you; any of your (2) The construction, erection, or removal "employees', "volunteer workers", of elevators; or any partner or member(if you are a partnership or joint venture), or (3) The ownership, maintenance, or use of any member(if you are a limited any elevators covered by this liability company). insurance. c. An Independent Contractor is an Insured However, the insurance afforded for any only for the conduct of your business and organization and subsidiary thereof not solely while performing services for a client named in the Declarations as a Named of the Named Insured; Insured, does not apply to injury or damage d. Medical directors and administrators, with respect to which an insured under this endorsement is also an insured under including professional persons; another policy, or would be an insured e. If you are an organization other than a under such policy but for its termination or partnership or joint venture, your managers the exhaustion of its limits of insurance. and supervisors are also insureds; h. Students in training; but not for "bodily d. If you are a limited liability company your injury" or "property damage' arising out of members are insureds, but only with his or her rendering or failure to render respect to their duties related to the professional services to patients; conduct of your business; i. Your members but only with respect to their e. Any organization and subsidiary thereof liability for your activities or activities they which you control and actively manage on perform on your behalf; the effective date of this endorsement: j, Your trustees or members of the board of f. Any person or organization that has governors while acting within the scope of financial control of you or owns, maintains their duties as such on your behalf; or controls premises occupied by you and k. Any entity you are required in a written requires you to name them as an additional contract (hereinafter called Additional insured but only with respect to their liability Insured) to name as an insured is an arising out of: insured but only with respect to liability (1) Their financial control of you; or arising out of your premises, "your work"for 86571 08104 -3- the Additional Insured, or acts or omissions With respect to Additional Insured(s) who are of the Additional Insured in connection with architects, engineers, or surveyors, this the general supervision of "your work" to insurance does not apply to "bodily injury," the extent set forth below. "property damage" or "personal and advertising (1) The Limits of Insurance provided on injury" arising out of the rendering or failure to behalf of the Additional Insured(s) are render any professional services by or for you, not greater than those required by such including: contract. (1) The preparing, approving, or failing to (2) The coverage provided to the prepare or approve, maps, shop drawings, Additional Insured(s) is not greater than opinions, reports, surveys, field orders, that customarily provided by the policy change orders; or drawings and forms specified in and required by the specifications; and contract. (2) Supervisors, inspection, or engineering (3) All insuring agreements, exclusions, services. and conditions of this policy apply. Any coverage provided under this provision (4) In no event shall the coverages or shall be excess over any other valid and Limits of Insurance in this endorsement collectible insurance available to the Additional be increased by such contract. Insured(s) whether primary. excess, contingent, or on any other basis unless a contract Except when required otherwise by contract, specifically requires that this insurance be this insurance does not apply to: primary or you request that it apply on a (1) "Bodily injury" or "property damage" primary basis. occurring after: Paragraph 4.a. of Section If — Who Is An (a) All work on the project (other than Insured is deleted and replaced by the service, maintenance, or repairs) to be following: performed by or on behalf of the Additional a. Coverage under this provision is, subject to Insured(s) at the site of the covered (1) and(2) below: operations has been completed; or (1) Effective on the acquisition or (b) That portion of"your work" out of which formation date; and the injury or damage arises has been put to its intended use by any person or (2) Afforded only until the end of the policy organization other than another contractor period of this Coverage Part or the next or subcontractor engaged in performing anniversary of its inception date, operations for a principal as a part of the whichever is earlier. same project. 86571 08/04 -4- POLICY NUMBER: 02LX066417134-1 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Blanket as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance 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. CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 KENT Exhibit C PARKS,RECREATION d COMMUNITY SERVICES City of Kent Certification Regarding Debarment and Suspension Asian Counseling and Referral Service Mental Health Agency Name of Program Certification A: Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions 1. The prospective primary participant certifies to the best of its knowledge and belief that its principals; a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal debarment or agency; b) Have not within a three-year period preceding this proposal, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false statements, or receiving stolen property; c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and d) Have not within a three-year period preceding this application/ proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. 2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Instructions for Certification (A) 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to whom this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. S. 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 11.Knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency may terminate this transaction for cause of default. Certification B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Instructions for Certification (B) 1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of these regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclu- sion - Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph (5) of these instructions, if a participant in a lower covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government/City of Kent, the department or agency with which this transaction originated may pursue available remedies including suspension and/or debarment. Executive Director (Print) Title Date Signature of Executive Director Title Date (3, Adopted from HUD Form-2992 09/04 EEO COMPLIANCE DOCUMENTS - 1