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HomeMy WebLinkAboutPK17-203 - Original - West Fenwick Futsal Court 4,0,0'ow*,.. Records Management �4 IcNT Document WASH N G TO N CAN �i CONTRACT COVER SHEET 1911. This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: King County Parks Vendor Number: JD Edwards Number Contract Number: P P-1 " 1,0,3 This is assigned by City Clerk's Office Project Name: West Fenwick Futsal Court Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 4/4/17 Termination Date: 12/31/18 Contract Renewal Notice (Days): 0 Number of days required notice for termination or renewal or amendment Contract Manager: Lynn Osborn/BL Department: Parks Planning & Dev. Contract Amount: $75,000.00 Approval Authority: ❑ Department Director ❑Mayor ®City Council Detail: (i.e. address, location, parcel number, tax id, etc.): A King County Youth Sports Facilities Grant (KC project 1131259, KC contract 5917135) to help fund the development of a futsal court in West Fenwick Park. Division Contract #PPD17-05 adccW 10877_8_14 King County YSFG AGREEMENT Department/Division: Natural Resources and Parks / Parks and Recreation Division Agency: Kent Parks Project Title: West Fenwick Futsal Court Amount: $ 75,000 Project: 1131259 Contract: 5917135 Term Period: January 1,2017 To December 31,2018 THIS CONTRACT is entered into by KING COUNTY (the "County"), and Kent Parks (the "Agency"), whose address is 220 4th Ave S, Kent, WA 98032 , WHEREAS, the Agency is either a public agency or a non-profit organization whose land or facility will provide recreational or athletic opportunities primarily to youth under 21 years of age; WHEREAS, King County has selected the identified Agency to be awarded a Youth Sports Facilities Grant to assist in capital improvements for increased recreational opportunities; WHEREAS, the Agency and/or landowner whose property will receive these improvements will develop, program, operate, and maintain the facility to address a recreation need in King County; and WHEREAS, King County is authorized to administers the Youth Sports Facilities Grant (YSFG) and enter into agreements for the use of King County funds by public agencies and/or not-for-profit organizations to provide a service to the public under King County Ordinance 10454; NOW THEREFORE, in consideration of payments, covenants, and agreements hereinafter mentioned, to be made and performed by the parties hereto, the parties covenant and do mutually agree as follows: 1. SCOPE OF SERVICES The Agency shall provide services and comply with the requirements set forth hereinafter and in the following attached exhibits, which are incorporated herein by reference: ® Scope of Services Attached hereto as Exhibit I ® Budget Attached hereto as Exhibit 11 ® Invoice Voucher Attached hereto as Exhibit III ® Reporting Attached hereto as Exhibit IV ® Design Documents Attached hereto as Exhibit V ® Insurance Certificate Attached hereto as Exhibit VI ® W-9 Attached hereto as Exhibit VII 2. TERM OF CONTRACT This Agreement shall commence on January 1, 2017, and shall expire on the December 31, 2018, unless extended or earlier terminated, pursuant to the terms and conditions of this Agreement. 3. PREMISES This grant project is located at: West Fenwick Park,Kent Commonly known as {West Fenwick Park, Kent), and referred to herein as "the Premises." 4. PARTIES All communication, notices, coordination, and other tenets of this Agreement shall be managed by: On behalf of County: Butch Lovelace, YSFG Program Manager King County Parks and Recreation Division 201 South Jackson Street, Suite 700 Seattle, WA 98104-3855 Email: butch.lovelace@kingcounty.gov Phone: 206.477.4577 On behalf of Agency: Brian Levenhagen Kent Parks 220 4th Ave S Kent, WA 98032 253-856-5116 bjlevenhagen@kentwa.gov 5. COMPENSATION AND METHOD OF PAYMENT A. The County shall reimburse the Agency for satisfactory completion of the services and requirements specified in this Agreement after the Agency submits an invoice and all accompanying reports as specified in the attached exhibits. The County will initiate authorization for payment after approval of corrected invoices and reports. The County shall make payment to the Agency not more than thirty (30) days after a complete and accurate invoice is received. B. The Agency shall submit its final invoice and all outstanding reports within fifteen (15) days of the date this Agreement expires or is terminated. If the Agency's final invoice and reports are not submitted by the day specified in this subsection, the County will be relieved of all liability for payment to the Agency of the amounts set forth in said invoice or any subsequent invoice. 6. OPERATING BUDGET When a budget is attached hereto as Exhibit II, the Agency shall apply the funds received from the County under this Agreement in accordance with said budget. If, at any time during the Term of this Agreement, the Agency expects that the cumulative amount of transfers among the budget categories, i.e. Project Tasks, may exceed ten percent (10%) of the Agreement amount, then the Agency shall request an amendment to this Agreement. Supporting documents necessary to explain fully the nature and purpose of the amendment must accompany each request for an amendment. County approval of any such amendment shall not be unreasonably withheld. 7. COMMUNICATION The Agency shall recognize King County Parks as a fiscal sponsor for the grant project in the following manner: A. Plaque: At the time of project completion or dedication, whichever comes first, the Agency shall install on or near the facility a plaque provided by the County that notes King County as a fiscal sponsor. B. Events: The Agency shall invite and recognize King County Parks at all events promoting the project during construction, and at the final project dedication. C. Community relations: The Agency shall recognize King County Parks as a fiscal sponsor in all social media, websites,brochures,banners,posters,press releases, and other promotional material related to the Project. 8. PRIORITY OF USE, PUBLIC ACCESS: SCHEDULING These funds are provided for the purpose of developing, renovating or repairing sports facilities primarily serving persons under 21 years of age in low and moderate income communities within King County. The Agency shall give priority of use to persons under the age of twenty-one. Fees for use of the project shall be no greater than those generally charged by public operators of similar facilities in King County. Notwithstanding temporary closure for required maintenance or repairs, the minimum period of time the Agency must ensure the facility is available for use is set forth in the table below. If the facility is retired or otherwise removed from use before the end of the specified period, then the Agency shall reimburse the County's funding on a pro rata basis, determined by dividing the number of years of lost public use by the total years of required dedication, multiplied by the total County grant amount. By way of example only, if the County makes a $10,000 grant to Agency X, then the Agency's project must be dedicated to public use including priority of use by youth for a minimum of 5 years. If Agency X eliminates public access to the project after 3 years, such that 2 years of public access and youth priority are lost,then Agency X must repay the County$4,000 (2/5 * 10,000= $4,000). Grant Amount Required Public Use& Youth Priority(in years) $14,999 Five(5) $15,000—$29,999 Eight(8) $30,000—$49,999 Twelve(12) $50,000—$75,000 Fifteen(15) If the completed project is subject to scheduling or reservation for use, then the Agency shall post the use schedule and the Agency's scheduling or reservation policies, practices, and information in a highly visible location near the project and/or on their website; and the Agency shall permit the public to schedule or reserve use of the completed project consistent with the requirements of this Section. The Agency's duties under this Section will survive the expiration or earlier termination of this Agreement. 9. GREEN BUILDING AND SUSTAINABLE DEVELOPMENT King County is committed to promoting and using green building practices in construction projects. Though not required, King County strongly encourages practices that conserve resources, use recycled content materials, maximize energy efficiency, and otherwise consider environmental, economic and social benefits in the design and construction of a building project. 10. INTERNAL CONTROL AND ACCOUNTING SYSTEM The Agency shall establish and maintain a system of accounting and internal controls which complies with applicable, generally accepted accounting principles, and governmental accounting and financial reporting standards in accordance with Revised Code of Washington (RCW) Chapter 40.14. 11. MAINTENANCE OF RECORDS A. The Agency shall maintain accounts and records, including personnel, property, financial, and programmatic records and other such records as may be deemed necessary by the County to ensure proper accounting for all Agreement funds and compliance with this Agreement. B. These records shall be maintained for a period of six (6) years after the expiration or earlier termination of this Agreement unless permission to destroy them is granted by the Office of the Archivist in accordance with RCW Chapter 40.14. C. The Agency shall inform the County in writing of the location, if different from the Agency address listed on page one of this Agreement, of the aforesaid books, records, documents, and other evidence and shall notify the County in writing of any changes in location within ten(10)working days of any such relocation. 12. RIGHT TO INSPECT King County reserves the right to review and approve the performance of Agency with regard to this Agreement, and,at its sole discretion,to inspect or audit the Agency's records regarding this Agreement and the Project upon reasonable notice during normal business hours. 13. COMPLIANCE WITH ALL LAWS AND REGULATIONS The Agency, in cooperation and agreement with the owners of the Premises, shall comply with all applicable laws, ordinances and regulations in using funds provided by the County, including, without limitation, those relating to providing a safe working environment to employees and, specifically, the requirements of the Washington Industrial Safety and Health Act (WISHA); and, to the extent applicable, those related to "public works," payment of prevailing wages, and competitive bidding of contracts. The Agency specifically agrees to comply and pay all costs associated with achieving such compliance without notice from King County; and further agrees that King County, does not waive this Section by giving notice of demand for compliance in any instance. The Agency shall indemnify and defend the County should it be sued or made the subject of an administrative investigation or hearing for a violation of such laws related to this Agreement. 14. CORRECTIVE ACTION A. If the County determines that a breach of contract has occurred or does not approve of the Agency's performance, it will give the Agency written notification of unacceptable performance. The Agency will then take corrective action within a reasonable period of time, as may be defined by King County in its sole discretion in its written notification to the Agency. B. The County may withhold any payment owed the Agency until the County is satisfied that corrective action has been taken or completed. 15. TERMINATION A. The County may terminate this Agreement in whole or in part, with or without cause, at any time during the Term of this Agreement, by providing the Agency ten (10) days advance written notice of the termination. B. If the termination results from acts or omissions of the Agency, including but not limited to misappropriation, nonperformance of required services, or fiscal mismanagement, the Agency shall return to the County immediately any funds,misappropriated or unexpended, which have been paid to the Agency by the County. C. Any King County obligations under this Agreement beyond the current appropriation year are conditioned upon the County Council's appropriation of sufficient funds to support such obligations. If the Council does not approve such appropriation, then this Agreement will terminate automatically at the close of the current appropriation year. 16. FUTURE SUPPORT; UTILITIES AND SERVICE The County makes no commitment to support the services contracted for herein and assumes no obligation for future support of the activity contracted for herein except as expressly set forth in this Agreement. The Agency understands, acknowledges, and agrees that the County shall not be liable to pay for or to provide any utilities or services in connection with the construction, operation, maintenance, or use of the project contemplated herein. 17. HOLD HARMLESS AND INDEMNIFICATION The Agency agrees for itself, its successors, and assigns, to defend, indemnify, and hold harmless King County, its appointed and elected officials, and employees from and against liability for all claims, demands,suits, and judgments, including costs of defense thereof, for injury to persons, death, or property damage which is caused by, arises out of, or is incidental to any use of or occurrence on the Project that is the subject of this Agreement, or the Agency's exercise of rights and privileges granted by this Agreement, except to the extent of the County's sole negligence. The Agency's obligations under this Section shall include: A. The duty to promptly accept tender of defense and provide defense to the County at the Agency's own expense; B. Indemnification of claims made by the Agency's employees or agents; and C. Waiver of the Agency's immunity under the industrial insurance provisions of Title 51 RCW, but only to the extent necessary to indemnify King County, which waiver has been mutually negotiated by the parties. In the event it is necessary for the County to incur attorney's fees, legal expenses or other costs to enforce the provisions of this Section, all such fees, expenses and costs shall be recoverable from the Agency. In the event it is determined that RCW 4.24.115 applies to this Agreement,the Agency agrees to protect, defend, indemnify and save the County, its officers, officials, employees and agents from any and all claims, demands, suits, penalties, losses damages judgments, or costs of any kind whatsoever for bodily injury to persons or damage to property (hereinafter "claims"), arising out of or in any way resulting from the Agency's officers, employees, agents and/or subcontractors of all tiers, acts or omissions, performance of failure to perform the rights and privileges granted under this Agreement, to the maximum extent permitted by law or as defined by RCW 4.24.115,as now enacted or hereafter amended. A hold harmless provision to protect King County similar to this provision shall be included in all Agreements or subcontractor Agreements entered into by Agency in conjunction with this Agreement. The Agency's duties under this Section will survive the expiration or earlier termination of this Agreement. 18. INSURANCE A. Liability Insurance Requirements. Notwithstanding any other provision within this Agreement, the Agency and it subcontractors shall procure and maintain coverage and limits for no less than the following: 1. Commercial General Liability. Insurance Service "occurrence" form CG 00 01 (current edition), to include Products-Completed Operations, insurance against claims for injuries to persons or damages to property that may arise from or in connection with activities under this Agreement. The insurance coverage shall be no less than One Million Dollars ($1,000,000) combined single limit per occurrence, and Two Million Dollars ($2,000,000) in the aggregate. 2. Automobile Liability. If activities require vehicle usage. Insurance Services form number CA 00 01 (current edition), covering BUSINESS AUTO COVERAGE, Symbol 1 "any auto". If the grant includes the use of automobiles, the Limit of Liability shall be no less than One Million Dollars($1,000,000)per occurrence. 3. Workers Compensation/Stop Gap. If the recipient or its contractors) has/have employees. Statutory Workers Compensation coverage and Stop Gap Liability for a limit no less than One Million Dollars($1,000,000)per occurrence. 4. Professional Liability. If the grant includes the use of Professional Services. Professional Liability coverage shall be no less than One Million Dollars ($1,000,000) per claim and in the aggregate. B. If the grant involves the construction of a capital project or involves the purchase of equipment greater than Five Thousand ($5,000) in value, the Agency shall provide "All Risk" Builders Risk or Property coverage for the full replacement value of the project/property built/purchased. King County shall be listed as an additional Loss payee as our interests may appear. . C. King County and its officers, officials, employees and agents shall be covered as additional insured on Agency's and its contractor(s') commercial general liability insurance and, if applicable, commercial auto liability insurance, with respect to liability arising out of activities performed by the Agency and its contractors. Additional Insured status shall include Products-Completed Operations. D. To the extent of the Agency's or its contractor's negligence, their insurance respectively shall be primary insurance with respect to the County, its officers, employees and agents. Any insurance or self-insurance maintained by the County, and its officers, officials, employees or agents shall not be subjected to contribution in favor of the Agency or its contractors insurance, and shall not benefit either in any way. The Agency's and its contractors' insurance shall apply separately to each insured against whom a claim is made or a lawsuit is brought, subject to the limits of the insurer's liability. E. Coverage shall not be suspended,voided, canceled,reduced in coverage or in limits except by the reduction of the applicable aggregate limit by claims paid, until after thirty (30) days' prior written notice has been given to and change in coverage accepted by King County. F. The insurance provider must be licensed to do. business in the State of Washington and maintain a Best's rating of no less than A-VIII. Within five (5) business days of County's request, Agency must provide a Certificate of Insurance and Additional Insured Endorsement(s) (CG 20 10 11/85 or its equivalent) to the County. The Agency shall be responsible for the maintenance of their contractors' insurance documentation. G. If the Agency is a municipat corporation or an agency of the State of Washington and is self-insured for any of the above insurance requirements, a certification of self-insurance shall be attached hereto and be incorporated by reference and shall constitute compliance with this Section. H. The Agency's duties under this Section shall survive the expiration or earlier termination of this Agreement. The Agency understands, acknowledges and agrees that for the relevant period of public use set forth in Section 8, the Agency shall maintain insurance and name the County as an additional insured, all of which shall be consistent with the requirements of this Section. 19. ANTI-DISCRIMINATION King County Code chapters 12.16, 12.17 through 12.18 apply to this Agreement and are incorporated by this reference as if fully set forth herein. In all hiring or employment made possible or resulting from this Agreement, there shall be no discrimination against any employee or applicant for employment because of sex, age, race, color, creed, religion, national origin, sexual orientation, gender identity or expression,marital status or the presence of any sensory, mental, or physical disability unless based upon a bonafide occupational qualification, or age except by minimum age and retirement provisions, and this requirement shall apply to but not be limited to the following: employment, advertising, lay-off, or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. No person shall be denied or subjected to discrimination in receipt of the benefit of any services or activities made possible by or resulting-from this Agreement on the grounds of sex, race, color, creed, national origin, religion, sexual orientation, gender identity or expression, age (except minimum age and retirement provisions), marital status, or the presence of any sensory, mental, or physical handicap. Any violation of this provision shall be considered a violation of a material provision of this Agreement and shall be grounds for cancellation, termination or suspension in whole or in part of this Agreement by King County and may result in ineligibility for further King County agreements. [Community Partner Name] shall also comply with all applicable anti-discrimination laws or requirements of any and all jurisdictions having authority. 20. CONFLICT OF INTEREST KCC Chapter 3.04 (Employee Code of Ethics) is incorporated by reference as if fully set forth hence, and the Agency agrees to abide by all conditions of said chapter. Failure by the Agency to comply with any requirement of said KCC Chapter shall be a material breach of contract. 21. POLITICAL ACTIVITY PROHIBITED None of the funds, materials, property, or services provided directly or indirectly under this Agreement shall be used for any partisan political activity or to further the election or defeat of any candidate for public office. 22. PROJECT MAINTENANCE; EQUIPMENT PURCHASE, MAINTENANCE, AND OWNERSHIP A. As between the County and the Agency, the Agency shall be responsible to operate and maintain the completed project at its own sole expense and risk. The Agency shall maintain the completed project in.good working condition consistent with applicable standards and guidelines. The Agency understands, acknowledges, and agrees that the County is not responsible to operate or to maintain the project in any way. B. The Agency shall be responsible for all property purchased pursuant to this Agreement, including the proper care and maintenance of any equipment. C. The Agency shall establish and maintain inventory records and transaction documents (purchase requisitions, packing slips, invoices, receipts) of equipment and materials purchased with Agreement funds. The Agency's duties under this Section shall survive the expiration of this Agreement. 23. NOTICES Whenever this Agreement provides for notice to be provided by one party to another, such notice shall be in writing, and directed to the person specified in Section 4 of this Agreement. Any such notice shall be deemed to have been given on the date of delivery, if mailed, on the third (3rd) business day following the date of mailing; or, if sent by fax, on the first (1st) business day following the day of delivery thereof by fax. Notice sent solely by e-mail shall be deemed to have been given on the date of transmission. Either party may change its address, fax number, email address, or the name of the person indicated as the recipient by notice to the other in the manner aforesaid. 24. ASSIGNMENT The Agency shall not assign any portion of rights and obligations under this Agreement or transfer or assign any claim arising pursuant to this Agreement without the written consent of the County. The Agency must seek such consent in writing not less than fifteen (15) days prior to the date of any proposed assignment. 25. CONTRACT AMENDMENTS This Agreement together with the attached exhibits expressly incorporated herein by reference and attached hereto shall constitute the whole Agreement between the Parties. Either party may request changes to this Agreement. No modifications or amendment of this Agreement shall be valid or effective unless evidenced by an Agreement in writing signed by the Parties. 26. WAIVER OF DEFAULT Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver or breach of any provision of the Agreement shall not be deemed to be a waiver of any other or subsequent breach and shall not be construed to be a modification of the terms of the Agreement unless stated to be such through written approval by the County, which shall be attached to the original Agreement. 27. TAXES The Agency agrees to pay on a current basis all taxes or assessments levied on its activities and property, including, without limitation, any leasehold excise_tax due under RCW Chapter 82.29A; PROVIDED, however, that nothing contained herein will modify the right of the Agency to contest any such tax, and the Agency will not be deemed to be in default as long as it will, in good faith,be contesting the validity or amount of any such taxes. 28. WASHINGTON LAW CONTROLLING; WHERE ACTIONS BROUGHT This Agreement is made in and will be in accordance with the laws of the State of Washington, which will be controlling in any dispute that arises hereunder. Actions pertaining to this Agreement will be brought in King County Superior Court, King County, Washington. 29. PARAGRAPH HEADINGS The paragraph headings contained herein are only for convenience and reference and are not intended to be a part of this Agreement or in any manner to define, limit, or describe the scope or intent of this Agreement or the particular paragraphs to which they refer. 30. PUBLIC DOCUMENT This Agreement will be considered a public document and will be available for inspection and copying by the public. 31. LEGAL RELATIONS Nothing contained herein will make, or be deemed to make, the County and the Agency a partner of one another, and this Agreement will not be construed as creating a partnership or joint venture. Nothing in this Agreement will create, or be deemed to create, any right, duty or obligation in any person or entity not a party to it. 32. SINGULAR AND PLURAL Wherever the context will so require, the singular will include the plural and plural will include the singular. 33. PERMITS AND LICENSES The Agency shall design, develop and construct the Project in accordance will all applicable laws and regulatory requirements including environmental considerations, permitting determinations, and other legal requirements. All activities and improvements shall be performed by Agency at its sole expense and liability. The Agency shall, at its sole cost and expense, apply for, obtain and comply with all necessary permits, licenses and approvals required for the Project, 34. INTERPRETATION OF COUNTY RULES AND REGULATIONS If there is any question regarding the interpretation of any County rule or regulation, the County decision will govern and will be binding upon the Agency. 35. POLICE POWERS OF THE COUNTY Nothing contained in this Agreement will diminish, or be deemed to diminish, the governmental or police powers of the County. 36. ENTIRE AGREEMENT This Agreement, including its attachments, constitutes the entire Agreement between the County and the Agency. It supersedes all other agreements and understandings between them, whether written, oral or otherwise. KING C O TY ; AGENCY: K t Parks FOR King Cc unty Executive Sig e /t Date NAME (Please typ 'e or p nt), Titl Dat Exhibit 1 kg King County YowBigBac1W d Youth Sports Facilities Grant Scope of Services Please detail the scope of work to be performed under this contract as described in the YSFG application. You may use and expand upon the application text. Please be thorough in your description of both the entire project and how the YSFG grant will be spent on your project. The work being performed under this contract will construct a 3,800 square foot futsal court at West Fenwick Park on the West Hill of Kent. This project will use high quality materials that will provide a high level of play, and a durable synthetic turf playing surface that is playable in wet weather. The boards will be composed of a high density plastic that is both safe and durable. The posts will be made from galvanized steel. The futsal court will allow for high intensity use year round. It will provide a new attraction at an aging community park, and take advantage of the park's existing amenities, such as parking, a restroom, drinking fountains and seating areas. This project meets the community's need for more high quality recreational opportunities, and this specific area's need for more opportunities to play soccer. Kent's West Hill has a diverse population, and a large percentage of low-income residents. Soccer is a very accessible sport since a ball is all you need to play. The futsal court will be designed and built to be ADA accessible, ensuring all Kent residents have access to it. L X W C �. � C � LL N Cf) O LL ILA O O O � p LL-L L m U V 16 d t • • .0 d w m L � O O �! Q� N � N 0 • V L • O 0- 0 L @ a � o C7 � '—c LL ii. M ci E � o m a U) io O N y Y N t0 H V 47 • 0 IL c 0 c — C (0 O c a F a Z c u o y C - O j L N fn N U V (.l 0 C N N O ,^ 2 � m (n c L U C N O L d U _ \ \ / k / % \ q 9 ( = n _ 0 a e # ■ u 2a a) a2 6. 0 ) (L _ k CL t ( 7 a / ) \ 7 q 0- ƒ f \ $ \ § \ \ § 2 ■ _ / \ d _ \ \ E 5 § % _ 7 0 E ) { Ln S \ = Ecro 9 / d % \ f \ 2 m 2 � ƒ ¢ \ � \ 2 » ^ § ± \ 2 . S [ \CD cn Exhibit III L9 King County FAVOWN Your Big Backyard Youth Sports Facilities Grant Reimbursement Request Submit To: From: King County Parks Organization: Attention: Butch Lovelace Address: 201 South Jackson, Suite 700 Seattle, WA 98104-3855 Contact: Phone: THIS REIMBURSEMENT REQUEST IS FOR ACTIVITIES/SERVICES RENDERED UNDER THE YOUTH SPORTS FACILITY GRANT(YSFG)AGREEMENT IDENTIFIED AS: PROJECT NAME CONTRACT# THE COSTS AS PRESENTED IN THIS REQUEST WERE INCURRED BETWEEN THE TIME PERIODS OF(DATES) TO ❑ CHECK WHEN THIS IS FINAL REIMBURSEMENT REQUEST PLEASE READ CAREFULLY BEFORE SUBMITTING A REIMBURSEMENT REQUEST It is the responsibility of the Agency(grant recipient) to clearly document and list with highlights the supporting documentation of the incurred expenses. You must also clearly and adequately document the match expended. Track these expenses and reimbursements on the budget form(Exhibit II) and submit this page, the budget form (Exhibit II), and all supporting documents together when requesting reimbursement. I CERTIFY THAT THE REIMBURSEMENT REQUEST IN THE AMOUNT OF$ HAS BEEN INCURRED AND PAYMENT HAS BEEN MADE OR IS NOW DUE AND THAT NECESSARY RECEIPTS OR INVOICES ARE ATTACHED.I ALSO CERTIFY THAT THE MATCH EXPENDED ON THIS PROJECT AS NOTED ON THE BUDGET FORM IS ACCURATE AND DOCUMENTED. AUTHORIZED SIGNATURE DATE TITLE Exhibit IV LM King Co uurty Your Big Backyard Youth Sports Facilities Grant Invoicing& Recordkeeping 1. King County grant funds can be requested and paid to the Agency only after the costs have been incurred. To receive reimbursement, the Agency must submit to King County Parks an accurate and complete invoice based on the Budget (Exhibit II) with supporting documentation such as bills which have been paid, receipts or invoices that are due and payable. DO NOT SEND PARKS THE ORIGINALS; KEEP ORIGINALS IN YOUR PROJECT FILE AND SEND COPIES. 2. The attached budget form (Exhibit II), is the same budget form used for the application. That form should be used for tracking the budget and submitted when requesting reimbursement, either in part or whole, and updated through the life of the grant. It is used for all stages of the grant—application, contract submittal, and reimbursement request. 3. The Agency will receive reimbursement from King County within approximately 15 working days after Parks receives the invoice. The Agency must pay any bills due before or after receipt of County funds. 4. The Agency shall follow the guidelines as outlined in Sections 10 & 11 of the Contract related to recordkeeping. Exhibit V k9 King County t u„ Your Big Backyard Youth Sports Facilities Grant Design Documents Please provide design documents and any specifications that detail the project,particularly related to the YSFG portion if part of a larger project. Scale your documents to 8 '/z x I I inches if possible. Include the following details if applicable: • Facility dimensions • Specifications on drainage, irrigation, and lighting, fencing and other applicable information related to fields • Material and equipment specifications • Playgrounds: The manufacturer is usually able to provide a schematic design that details the layout and specific playground pieces • Site plan The design of the project is still in development. The facility will be very similar to the one shown in the attached photo. The exact location is yet to be determined because it is being built in conjunction with a larger park renovation project. The planning process for that larger renovation project will begin in summer 2017. Attached is the original site plan for the futsal court that the funding board had some questions about. The hope is that building this project in conjunction with the newly renovated park will allow us to better integrate the futsal court with the higher use area of the park around the restroom building. �� �� E .. ,C . <, � ,_� �, -%�. :�::., •' ��� 4V �!. �� � 4.,.ram ��, 4 , t. � � f ' IR. �/ .; i _� E'�i i� ,I .♦ �R" f -�1 �t � d � �_ f ' ;� w t ��. �� � . �_ �� �� �_ _� w �� '= ``t '�� � �'( ,{� i � ..' d �. ,: c'. i�,� 1, .� �. 4� t, � � � \ � V a ` � ? ` �fr t 1 �` t %; r , ' , .`�� �, 4 �. �� i � .�,"�., , � �.� � tr t ,�, / ,�� �� � � �{ � �. �, �,�. i ,1� � �S 1, .;y: `r�, .} ,.� � r r b 7 3 m � $u- L �I k f t „� xp w. � ■ , a. gam,. t/ t § O i CD r V a O µ Ptf o c � " Exhibit VI LV King County Your Big Backyard Youth Sports Facilities Grant Certificate of Insurance Please return a Certificate of Insurance naming King County as additional insured. See Sections 17 and 18 of the Contract for additional information regarding insurance requirements. Insurance requirements may vary depending on the scope of the project. Please call the YSFG project manager if you have questions related to the insurance requirements for your project. ACO® DATE(MM/DD/YYYY) IllCERTIFICATE OF LIABILITY INSURANCE 3/1/2017 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 endorsements. PRODUCER CONTANAME:CT Conni E Scott Seattle-Alliant Insurance Services, Inc. PHONE 206-204-9140 FAX 206 Seattle -204-9205 Seat cscott@alliant.com WA 98101 @ Fifth Avenue, Suite 1500 E-MAIL alliant.com INSURERS AFFORDING COVERAGE NAIC 9 INSURER A:Princeton Excess&Surplus Lines In 10786 INSURED KE583802 INSURERB:Safety National Casualty Corporatio 15105 City of Kent INSURER C: 220 Fourth Avenue South Kent WA 98032-5895 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:314899456 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILiR TYPE OF INSURANCE INSD WVD POLICY NUMBER MRVDDY/YYYY) (MM1DD1rt`YY1 LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y N1A3RL000006906 1/1/2017 1/1/2018 EACH OCCURRENCE $5,000,000 CLAIMS-MADE x�OCCUR DAMAGE T REN ED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEa LOC PRODUCTS-COMP/OP AGG $ OTHERS SIR $250,000 A AUTOMOBILE LIABILITY Y Y N1A3RL000006906 1/1/2017 1/1/2018 IN ED S INGLE LIMIT $ Ea accident ' 5,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS HIRED AUTOS NON-OWNED R P RTYDAMA $ AUTOS Per accident _ Deductible SIR $250,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ g WORKERS COMPENSATION SP4056170 1/1/2017 1/1/2018 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000' OFFICER/MEMBER EXCLUDED?(Mandatory in NH) ❑N NIA E.L.DISEASE-EA EMPLOYE $1.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Stop Gap N1A3RL000006906 1/1/2017 1/1/2018 Each Occurrence $5,000,000 Aggregate $5,000,000 Deductible $250,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Work Comp has a $500,000 SIR RE: YSFG grant funds for installation of a Futsal Court at West Fenwick Park CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE King County Parks THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Butch Lovelace ACCORDANCE WITH THE POLICY PROVISIONS. 201 South Jackson St., 7th FL Seattle WA 98104 3855 AUTHORIZED REPRES+,S TIVE L ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THE PRINCETON EXCESS AND SURPLUS LINES INSURANCE COMPANY AMENDMENT OF DEFINITION OF INSURED Named Insured Endorsement Number -Washington Public Entity Group(WAPEG) Policy Number Endorsement Effective N 1-A3-RL-0000069 01/01/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following: GENERAL LIABILITY COVERAGE PART This endorsement changes the policy effective on the inception date of the policy unless another date is indicated above. The following is added to the definition of Insured in the Liability Conditions, Definitions and Exclusions section of the policy: g. With respect to Bodily Injury and/or Property Damage under the General Liability Coverage Part, any person or organization with whom you have agreed in a written contract or written agreement to assume the Tort Liability for a specified activity or operation is an Insured with regards to such specified activity or operation. However, this insurance only applies with respect to liability for Bodily Injury or Property Damage caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf. The following provisions also apply: (1) The written contract or written agreement must be in effect at the inception of the Policy Period or become effective during the Policy Period, and (2) The written contract or written agreement must be executed prior to the Bodily Injury or Property Damage. Subject to the paragraphs above, any such person's or organization's status as an Insured ends when any of the following first occurs: this policy terminates; the written contract or written agreement terminates; or the specified activity or operation terminates. Tort Liability means liability that would be imposed by law in the absence of any contract or agreement. All other terms and conditions remain unchanged. Includes copyrighted material of the Insurance Services Office, Inc., with its permission. RL 2100 06/07 Page 1 of 1 fix !? lh ) � Request for Taxpayer Identification number and Give form to Certification King County.. KING COUNTY Do not send to IRS. SUBSTITUTE W-9 Name (as shown on Invoice) City of Kent Business Type ®Association ®Corporation-- Enter Tax Classification D Disregarded Entity C (C corporation), S (S corporation) El Division ®Government ❑Individual [Limited Liability Company ®Non Profit ®Partnership []Sole Proprietor ®Trust/Estate Business Registration Information Enter where you are registered to do business and the corresponding State Registration Number Physical Address 220 Fourth Avenue South WA UBI 173-000-002 City, State, and Zip Kent, WA 98032 Remit Address (if different than above) SAME City, State, and Zip Tax Reporting Name and Tax Identification Number or Social Security Number Enter your Tax reporting Name and address. The Tax Identification number provided must match the name given on the"Tax Reporting Name" line. For individuals, this is your social security number(SSN). Tax Reporting Name City of Kent Tax Reporting Address 220 Fourth Avenue South Tax Reporting City, State, and Zip Kent, WA 98032 Tax Identification Number, Employer Identification Number or Social Security Number: 9 1 6 LO 0 1 2 5 4 Under penalties of perjury, I certify that: 1. The number shown on this form is my correct tax reporting name and identification number. 2. 1 am a U.S. citizen, U.S. person or U.S. Business Entity. 3. 1 am not subject to backup withholding due to failure to report interest and dividend income. 4. 1 am exempt from FATCA reporting. Certification instructions. If you are not a U.S. citizen, U.S. person or U.S. Business Entity, you must cross out item 2 above. Yo i eed to vide a completed King County W9 form as well as a copy of your W-8. Sign Here► Print Name of Signer► +y (2J 5 C'={"1% Date Signed ► --)-/d2l 1-7 Version: 1 King County Substitute W9 Dated 4/8/2014