HomeMy WebLinkAboutCAG2021-221 - Original - Hmong Association of Washington - HAW Youth Support Workshops - 05/06/202118006390.64150.4633
May 4, 2021
OK to sign, TW, 5/4/2021.
CAG2021-221
CONSULTANT SERVICES AGREEMENT - 1
(Over $20,000)
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
Hmong Association of Washington
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter
the "City"), and Hmong Association of Washington (HAW) organized under the laws of the State of
Washington, located and doing business at 4004 NE 4TH ST, SUITE 107-270, Renton, WA, 98056
(hereinafter the "Consultant").
I. DESCRIPTION OF WORK.
The Consultant shall perform the following services for the City in accordance with the following
described plans and/or specifications:
Hmong mental health professionals will lead 10 workshops to focus on ensuring the mental
health, safety, and well-being of youth and provide financial support for 1-1 licensed therapist
sessions for youth low-income. 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.
The 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. The Consultant shall complete the
work described in Section I by December 31st, 2021.
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to exceed
$25,000 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. Compensation is available within the budget amount stated of this Agreement. However, in
special circumstances, and upon written agreement between the City and Consultant, funds
unspent from 2021 may carry over to first quarter of 2022. This budget alteration or carryover
will be documented through an amended Scope and Schedule of Work signed by the parties
to be attached and incorporated into this Agreement through a revised Exhibit A without the
need for a formal amendment to this Agreement.
C. The Consultant shall submit bi-monthly 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
CONSULTANT SERVICES AGREEMENT - 2
(Over $20,000)
portion of the invoice not in dispute. In that event, the parties will immediately make every
effort to settle the disputed portion.
D. Card Payment Program. The Consultant may elect to participate in automated credit card
payments provided for by the City and its financial institution. This Program is provided as an
alternative to payment by check and is available for the convenience of the Consultant. If the
Consultant voluntarily participates in this Program, the Consultant will be solely responsible
for any fees imposed by financial institutions or credit card companies. The Consultant shall
not charge those fees back to the City.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement. By their execution of this Agreement, and in
accordance with Ch. 51.08 RCW, the parties make the following representations:
A. The Consultant has the ability to control and direct the performance and details of its
work, the City being interested only in the results obtained under this Agreement.
B. The Consultant maintains and pays for its own place of business from which the
r 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 the 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 the
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
the
exposure to the Consultant.
VI. FORCE MAJEURE. Neither party shall be liable to the other for breach due to delay or failure
in performance resulting from acts of God, acts of war or of the public enemy, riots, pandemic, fire, flood,
or other natural
delayed due to a force majeure event shall not result in liability to the delayed party. Both parties represent
to the other that at the time of signing this Agreement, they are able to perform as required and their
performance will not be prevented, hindered, or delayed by the current COVID-19 pandemic, any existing
state or national declarations of emergency, or any current social distancing restrictions or personal
protective equipment requirements that may be required under federal, state, or local law in response to
the current pandemic.
If any future performance is prevented or delayed by a force majeure event, the party whose
performance is prevented or delayed shall promptly notify the other party of the existence and nature of
the force majeure event causing the prevention or delay in performance. Any excuse from liability shall be
CONSULTANT SERVICES AGREEMENT - 3
(Over $20,000)
effective only to the extent and duration of the force majeure event causing the prevention or delay in
performance and, provided, that the party prevented or delayed has not caused such event to occur and
continues to use diligent, good faith efforts to avoid the effects of such event and to perform the obligation.
Notwithstanding other provisions of this section, the Consultant shall not be entitled to, and the City
shall not be liable for, the payment of any part of the contract price during a force majeure event, or any
costs, losses, expenses, damages, or delay costs incurred by the Consultant due to a force majeure event.
Performance that is more costly due to a force majeure event is not included within the scope of this Force
Majeure provision.
If a force majeure event occurs, the City may direct the Consultant to restart any work or
performance that may have ceased, to change the work, or to take other action to secure the work or the
project site during the force majeure event. The cost to restart, change, or secure the work or project site
arising from a direction by the City under this clause will be dealt with as a change order, except to the
extent that the loss or damage has been caused or exacerbated by the failure of the Consultant to fulfill its
obligations under this Agreement. Except as expressly contemplated by this section, all other costs will be
borne by the Consultant.
VII. 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. The 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.
VIII. INDEMNIFICATION. The 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 the 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 the shall be only to the extent of the Consultant's
negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION
PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL
INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES
FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER.
In the event the 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
the
The provisions of this section shall survive the expiration or termination of this Agreement.
IX. 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.
CONSULTANT SERVICES AGREEMENT - 4
(Over $20,000)
X. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide reasonable
accuracy of any information supplied by it to the Consultant for the purpose of completion of the work under
this Agreement.
XI. 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. The Consultant shall make such data, documents, and files available to the City upon the
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
the Consultant for this project by
anyone other than the Consultant on any other project shall be without liability or legal exposure to the
Consultant.
XII. CITY'S RIGHT OF INSPECTION. Even though the 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.
XIII. WORK PERFORMED AT CONSULTANT'S RISK. The 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 the Consultant's own risk, and the 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.
XIV. 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
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 VIII 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,
CONSULTANT SERVICES AGREEMENT - 5
(Over $20,000)
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 the
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 the 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 a
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.
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CONSULTANT SERVICES AGREEMENT -
(Over $20,000)
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:
By:
Print Name: _______________________
Its:_______________________________
DATE:
CITY OF KENT:
By:
(signature)
Print Name: Dana Ralph
Its Mayor
DATE:
NOTICES TO BE SENT TO:
CONSULTANT:
Cynthia Yongvang
P.O. BOX 84601
Seattle, WA 98134
Hmong.of.washington@gmail.com
206.651.5480 (telephone)
N/A (facsimile)
NOTICES TO BE SENT TO:
CITY OF KENT:
Lori Guilfoyle
City of Kent
220 Fourth Avenue South
Kent, WA 98032
(253) (253) 856-5061 (telephone)
(253) (253) 856-6070 (facsimile)
APPROVED AS TO FORM:
Kent Law Department
ATTEST:
Kent City Clerk
05/06/2021
EEO COMPLIANCE DOCUMENTS - 1
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
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
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: ________________________________________
EEO COMPLIANCE DOCUMENTS - 2
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,
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
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS - 3
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
Scope and Schedule of Work
2021Consultant Services Agreement
Agency: Hmong Association of Washington (HAW)
Program: HAW Youth Support
Contact: Cynthia Yongvang
Hmong.of.washington@gmail.com
Program
Description:
Hmong mental health professionals will lead 10 workshops to focus on ensuring the
mental health, safety, and well-being of youth, and provide financial support to low-
income Hmong families for 1-1 licensed therapist sessions for youth.
Pursuant to Section I. of the Consultant Services Agreement (CSA) executed on April 20, 2021, Consultant shall provide the
approximate number of City of Kent clients with the following services:
Service Unit Descriptions and Deliverables Units for Kent Residents
Contracted to Serve
Service Unit 1: Workshops
Description: Workshops provided for youth 10 14 yrs and 15-18 yrs old will cover
topics including healthy relationships and personal boundaries from a cultural and familial
lens, basic mental health signs and symptoms, and provide some age-appropriate
strategies for how to cope. Parents will be provided basic information on mental health,
signs and symptoms of depression, anxiety, trauma, and suicidal ideation.
10 workshops
Service Unit 2: Mental Health Services
Description: Youth will be connected to mental health services.
2 youth
Service Unit 3: Learning Circle
Description: Staff will participate in at least one learning circle hosted by the City of Kent
Human Services Division.
1
Outcomes Resulting from Service Units Achievement
Rate Target
Outcome 1: Increase health and well being 75%
Funds Awarded: $25,000
Unduplicated Kent Clients Contracted
to Serve 12
Youth improve mental and emotional well-being and have skills and tools to overcome the impacts of
mental and emotional stress.
The above services shall be provided by December 31, 2021
Contract Administration
- The Consultant shall notify the City, in writing, within ten (10) days of any changes in agency
leadership or program personnel.
- The Consultant shall provide the City with a current list of its board of directors, general or limited
partners, as applicable.
- In special circumstances and upon written agreement between the City and Consultant through a
revised Scope and Schedule of Work, unspent funds the CSA can be carried over to 2022. The
revised Scope and Schedule of Work shall be attached and incorporated into the CSA.
- All records related to the CSA must be retained for three (3) years plus the current year.
Reporting Requirements and Timeline
All data and required forms shall be submitted electronically.
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 bi-monthly, no later than the 15th of the
month following the end of the month (i.e., July 15, Sept 15, Nov 10, Jan 10th), unless otherwise specified.
Service Unit Report -
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. July 15, Sept 15, Nov 10, Jan 10th), along with the
Reimbursement Request.
Annual Outcome Data Report - Outcome data shall be submitted no later than the January 10, 2022.
Report Due Date
Service Unit Report and Reimbursement
Request
10th day following every other month
Final Reimbursement Request January 10th, 2022
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.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
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 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.Commercial General Liability insurance shall be written with
limits no less than $1,000,000 each occurrence, $2,000,000
general aggregate.
2.
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provision for Commercial General Liability insurance:
1.The Consultant
respect the City. Any Insurance, self-insurance, or insurance pool
coverage maintained by the City shall be excess of the Consultant
insurance and shall not contribute with it.
2.The Consultant urance 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
also contain a clause stating that coverage shall apply separately to each
insured against whom claim is made or suit is brought, except with
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not
less than A:VII.
E. Verification of Coverage
Consultant shall furnish the City with original 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.
NAUTILUS INSURAN CECOVPAN
POLICY NUMBER' NNI IS1021
Named Insured' H1,1bNG ASSOCIATION OF WA
Endorsement Effective Date: 04 / 14 /2021
ENDORSEMENT# 02
Agency# 04611 0Y0
PACIFIC COAST E&S INSURANCE SERVICES
3302 Fuhrman Avenue E. Suite 300
Seattle, WA 90102
ENERAL HAN E ENDORSEMENT
IN CONSIDERATION OF THE PREMIUM CHARGED IT IS 14BREBY UNDERSTOOD AND AGREED FORM
L803(10/19) HA-,E BEEN ADDED & ATTACHED AIDING CITY OF KENT AS PRIMARY {
NON—CONTRIBUTORY ADDITIONAL INSURED.
PREMIUM IS FULLY EARNED.
Tax &FeeSchedule PREMIUM: ❑ None ❑ AP ❑ RP $ 100.14
SURPLUS LINES T X $ 2 . 1)0
STAMPING F E E • 1 0 Tota I Taxes & Fees $ 2.10
TOTAL PREMIUM DUE S 102.10
A .
All other terms and condhions remain unchanged
PRODUCER: WHITEFIELDS UNITED INS. DBA:
LE
KTi AVITT GROUP
Seattle, WA
T C Date Issu ed; 0 4/ 2.9 / 2 0 2 I t Or epreaen tal ve
S901 (07113) Includes -cop �rlghled m aterial of Insuranaa 5ervlceS Office, Ina., with its parm imlon.
POLICY NUMBER; NN11810 1 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -PRIMARY AND NONCO NTRIBILITORY
This endorsement modifies insurance provides under the foiio ing;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s) or Organization(s),
CITY OF KENT
220 FOURTH AVENUE SOUTH
KENT, WA 98032-5895
Location(s) of Covered Operations,
4004 NE 4TH ST
STE 107-270
RENTON WR 98056—
Description of +Nark Perform ed forthe Additional Insured,
CONSULTANT SERVICES.
A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s)
shown in the Schedule of this endorsement, but only with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury" caused, in whole or in part, by'.
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations, as described in the Schedule of this endorsement, for the
additional insured at the location(s) shown in the Schedule of this endorsement, but only for "occurrences" or
coverages not otherwise excluded in the Coverage Part to which this endorsement applies.
However_
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
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-
B. With respect to the insurance afforded to the additional insured, the following additional exclusions apply'.
This insurance does not apply to_
1. "Bodily injury", "property damage" "personal and advertising injury" or medical payments arising out of the
rendering of, or the failure to render, any professional architectural, engineering or surveying services,
including:
a. The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and spec ifications, or
11-Eb3 (i4119) Includes -cop �rlghusa m aterial of Insurance 5ervlcert Office, ino., with its parm isalon. Page 1 of 2
b. Supervisory, inspection, architectural, or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying
services_
2. "Bodily injury" or "property damage" occurring after'.
a. All work, including materials, parts or equipment furnished in connection with such work, on the project
(other than service, maintenance or repairs) to be performed by or on behalf of the add itionaI insured at
the location of the covered operations has been completed, or
b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by
any person or organization other than another contractor or subcontractor engaged in performing
operations for a principal as a part of the same project_
C. With respect to the insurance afforded to the additional insured, the toIlowing is added to Section III - Limits Of
Insurance,
It coverage provided to the additional insured is required by a contractor agreement. the most we will pay on
behalf of the additional insured is the amount of insurance'.
7. Requiredbythe contractoragreement;or
2. Available under the applicable limits of insurance;
whichever is less_
This endorsement shall not increase the applicable limits of insurance.
D. The following is added to 4.a. of Other Insurance of Section IV - Commercial General Liability Oond ition&
It required in a written contract, the Coverage Part to which this endorsement applies is primary and
noncontributory in the event of an "occurrence" caused, in whale or in part, by your acts or omissions, or the
acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the
additional insured at the location(s) designated in the Schedule of this endorsement_
All other terms and conditions remain unchanged.
1-8M (IW 19) Includes -cop �rlghusa m aierial of Insurance 5ervlcert Office, ino., with its parm isalon. Page 2 of 2
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
PRODUCER
Whitfields United Ins. dba:Leavitt
PO Box 65770
2121 70th Ave. W Suite B
University Place, WA 98464
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC#
INSURED HMONG ASSOCIATION OF WA
4004 NE 4TH ST, SUITE 107-270
RENTON, WA 98056
INSURER A: Nautilus Insurance Company
INSURER B:
INSURER C:
INSURER D:
INSURER E:
CC)V FRA C3FS
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
kDUL
TYPE F INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABILITY
NN1181021
10/09/2020
10/09/2021
EACH OCCURRENCE
$ IFOOOFOOO
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY
PREMISES Ea occurence
$
CLAIMS MADE Z OCCUR
MED EXP (Any one person)
$
X
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY PRO LOC
AUTOMOBILE
LIABILITY
ANYAUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANYAUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR CLAIMSMADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
TH-
TORY LIMITS ER
OR LIMIT OER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate Holder is named as Additional Insured with respects to their interest in the operations of the Named Insured.
Primary and Non -Contributory Additional Insured applies per attached L803(10/19)
***10 Days Notice of Cancellation for Non -Payment of Premium.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Kent
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL_ DAYS WRITTEN
220 Fourth Avenue South
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Kent, WA 98032-5895
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
t
ACORD25(2001/08) Fjl�.),QiFION 1988
DS#2768439
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD25 (2001/08)
1 of 3
Exhibit C
City of Kent
Certification Regarding Debarment and Suspension
Agency Name of Program(s)
Certification A: Certification Regarding Debarment, Suspension, and Other
Responsibility Matters - Primary Covered Transactions
1.The prospective primary participant certifies to the best of its knowledge and belief that
its principals;
a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal debarment or agency;
b) Have not within a three-year period preceding this proposal, been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State,
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification, or
destruction of records, making false statements, or receiving stolen property;
c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental
entity (Federal, State, or local) with commission of any of the offenses enumerated in
paragraph (1)(b) of this certification; and
d) Have not within a three-year period preceding this application/ proposal had one or more
public transactions (Federal, State, or local) terminated for cause or default.
2.Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Instructions for Certification (A)
1. By signing and submitting this proposal, the prospective primary participant is
providing the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant
shall submit an explanation of why it cannot provide the certification set out below.
The certification or explanation will be considered in connection with the department
or agency’s determination whether to enter into this transaction. However, failure of
the prospective primary participant to furnish a certification or an explanation shall
disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance
was placed when the department or agency determined to enter into this transaction.
If it is later determined that the prospective primary participant knowingly rendered
an erroneous certification, in addition to other remedies available to the Federal
Government/City of Kent, the department or agency may terminate this transaction
for cause of default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to whom this proposal is submitted if at any time the
prospective primary participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, lower tier
covered transaction, participant, person, primary covered transaction,
principal, proposal, and voluntarily excluded, as used in this clause, have the
2 of 3
meanings set out in the Definitions and Coverage sections of the rules implementing
Executive Order 12549. You may contact the department or agency to which this
proposal is being submitted for assistance in obtaining a copy of these regulations.
6. The prospective primary participant agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly enter into
any lower tier covered transaction with a person who is debarred, suspended,
declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the department or agency entering into this
transaction.
7. The prospective primary participant further agrees by submitting this proposal that it
will include the clause titled “Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction,” provided by
the department or agency entering into this covered transaction, without
modification, in all lower tier covered transactions and in all solicitations for lower tier
covered transactions.
8. A participant in a covered transaction may rely upon a certification of a prospective
participant in a lower tier covered transaction that it is not debarred, suspended,
ineligible, or voluntarily excluded from the covered transaction, unless it knows that
the certification is erroneous. A participant may decide the method and frequency by
which it determines this eligibility of its principals. Each participant may, but is not
required to, check the Non-procurement List.
9. Nothing contained in the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
10. Except for transactions authorized under paragraph (6) of these instructions, if a
participant in a covered transaction
11. Knowingly enters into a lower tier covered transaction with a person who is
suspended, debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal Government/City of
Kent, the department or agency may terminate this transaction for cause of default.
Certification 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
3 of 3
remedies, including suspension and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the
person to which this proposal is submitted if at any time the prospective lower tier
participant learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms covered transaction, debarred, suspended, ineligible, 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 trans-
action originated.
6. The prospective lower tier participant further agrees by submitting this proposal that
it will include this clause titled “Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction,” without
modification, in all lower tier covered transactions and in all solicitations for lower tier
covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective
participant in a lower tier covered transaction that it is not debarred, suspended,
ineligible, or voluntarily excluded from the covered transaction, unless it knows that
the certification is erroneous. A participant may decide the method and frequency by
which it determines the eligibility of its principals. Each participant may, but is not
required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
9. Except for transactions authorized under paragraph (5) of these instructions, if a
participant in a lower covered transaction knowingly enters into a lower tier covered
transaction with a person who is suspended, debarred, ineligible, or voluntarily
excluded from participation in this transaction, in addition to other remedies available
to the Federal Government/City of Kent, the department or agency with which this
transaction originated may pursue available remedies including suspension and/or
debarment.
Executive Director (Print)
Signature of Executive Director Date
(3/
Adopted from HUD Form-2992
09/04
Signature:
���--
Met ir a Hanson (Apr 27, 202107:00 PDT)
Email: mhanson@kentwa.gov
Signature: 10L9-
Email: rlashley@kentwa.gov
Signature: 9ccCce P�ua%cro�C�
Julie Parascondofa (Apr 29, 202110:56 PDT)
Email: jparascondola@kentwa.gov
Hmong Association of Washington - Youth
Support
Final Audit Report
Created: 2021-04-27
By: KateLynn Jennings (kjennings@kentwa.gov)
Status: Signed
Transaction ID: CBJCHBCAABAApfVwC1XbX-HkOS7UpMcWcWVo54-9pLcE
2021-04-29
"Hmong Association of Washington - Youth Support" History
Document created by KateLynn Jennings (kjennings@kentwa.gov)
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