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HomeMy WebLinkAboutCAG2021-280 - Original - Restore Assemble Produce (RAP) - Just Breathe Classes - 06/10/20216/8/21 OK to sign 6/8/2021, TW. CAG2021-280 CONSULTANT SERVICES AGREEMENT - 1 (Over $20,000) CONSULTANT SERVICES AGREEMENT between the City of Kent and Restore Assemble Produce (RAP) THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Restore Assemble Produce (RAP) organized under the laws of the State of Washington, located and doing business at 407 West Gowe St. Kent, WA 98032 (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: JUST BREATHE program will provide tools for mental stress relief through various specifically designed stress relief activities (physical activity), workshops and adult and peer mental health first aide and supports.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 $50,000 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 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 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 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 Con 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, 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 having jurisdiction (or other agreed tribunal) to have been a wrongful the al 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 bject to the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington. As such, the Consultant agrees to euse of any of the documents, data, and files created by 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 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 - (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: LaTasha Jackson Rodriguez 407 West Gowe St. Kent, WA 98032 (253) 223-2194 (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 06/10/2021 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: Restore Assemble Produce (RAP) Program: Just Breathe Contact: LaTasha Jackson Rodriguez 407 West Gowe St. Kent, WA 98032 (253) 223-2194 (telephone) rapyouth1@gmail.com Program Description: JUST BREATHE program will provide tools for mental stress relief through various specifically designed stress relief activities (physical activity), workshops and adult and peer mental health first aide and supports Pursuant to Section I. of the Consultant Services Agreement (CSA) executed on April 16, 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: Just Breathe Camp and Fitness Camp Description: 4 full day group sessions will be held on a variety of topics including healthy behaviors and reducing anxiety and stress. 4 Fitness Camps will be held with Big WU Fitness promoting physical fitness and healthy eating. 8 Service Unit 2: RAP Radio segments Description: At least 10 sessions covering wellness, stress relief and healthy behaviors will be covered in RAP radio programs. 10 Service Unit 3: Grantee learning Circle Description: Staff will participate in at least one learning circle hosted by the City of Kent Human Services Division. 1 Funds Awarded: $50,000 Unduplicated Kent Youth Contracted to Serve 75 Outcomes Resulting from Service Units Achievement Rate Target Outcome 1: Increase health and well being Youth improve mental and emotional well-being and have skills and tools to overcome the impacts of mental and emotional stress. 75% 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 - The form (provided by City of Kent Human Services Division) will be filled out electronically and serve as the invoicing mechanism for payment to your agency/program. It shall be submitted monthly, no later than the 10th of the month following the end of the month unless otherwise specified. Service Unit Report - the goals stipulated in the Scope of Work. It shall be submitted monthly, no later than the 10th of the month, along with the Reimbursement Request. Annual Outcome Data Report - Outcome data shall be submitted no later than the January 10, 2022. Scope of Work. Report Due Date Service Unit Report and Reimbursement Request 10th day following end of each month that services are provided. Final Reimbursement Request January 10th, 2022 EXHIBIT B INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance Restore Assemble Produce (hereinafter 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.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. EXHIBIT B (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions 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 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. STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS Pq �ox 8539?�5 Rx ardson, X 75085-3925 Named Insured AT2 M-15-194B-FACD F U 001152 3125 RESTORE ASSEMBLE PRODUCE (NONPROFIT) 27309 111TH PL SE MEW KENT WA 98030-9042 s �'I.I.I�'�I'�'I'�I�I�III�'I��I�111111I11�"���llll�l"'IIIII..'Il u, Office Policy Policy Number 98-B8-B811-1 Policy Period Effective Date Expiration Date 12 Months OCT 24 2020 OCT 24 2021 The poli y period begins and ends at 12:01 am standard time att ie premises location. Agent and Mailing Address D JONES INS AND FIN SVCS INC 124 4TH AVE S STE 210 KENT WA 98032-5874 PHONE: (253) 850-3226 (253) 981-3150 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgageekienholder written notice in compliance with the policy provisions or as required by law. Entity: NONPROFIT NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM $ 382.00 Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007240 294 I Continued on Reverse Side of Page N Page 1 of 7 530-686 a.2 05-31-2011 (olf3231c) M 7240 RENEWAL DECLARATIONS (CONTINUED) Office Policy for RESTORE ASSEMBLE PRODUCE Policy Number 98-138-13811-1 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 27309 111TH PL SE No Coverage $ 51,600 25% KENT WA 98030-9042 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEXES) CovA- Inflation Coverage Index: N/A Cov B - Consumer Price Index: 259.1 SECTION I - DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007240 Continued on Next Page $250 Page 2 of 7 M 7240 RENEWAL DECLARATIONS (CONTINUED) Office Policy for RESTORE ASSEMBLE PRODUCE Policy Number 98-138-13811-1 RE SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that po licy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A- Buildings) Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007241 294 Continued on Reverse Side of Page Page 3 of 7 N M 7240 RENEWAL DECLARATIONS (CONTINUED) Office Policy for RESTORE ASSEMBLE PRODUCE Policy Number 98-138-13811-1 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included a SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007241 Continued on Next Page Page 4 of 7 RN F1 RENEWAL DECLARATIONS (CONTINUED) Office Policy for RESTORE ASSEMBLE PRODUCE Policy Number 98-138-13811-1 SECTION II - LIABILITY COVERAGE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. M 7240 LIMIT OF INSURANCE $1,000,000 $5,000 $300,000 LIMIT OF INSURANCE $2,000,000 $2,000,000 Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4102 Businessowners Coverage Form FE-6999.2 "Terrorism Insurance Cov Notice CMP-4819.1 Unauthorized Business Card Use CMP-4247.1 Amendatory Endorsement FE-3650 Actual Cash Value Endorsemet CMP-4572 Amendment of Premium Cond CMP-4561.1 Policy Endorsement CMP-4705.2 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4706 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4703.1 Utility Interruption Loss Incm Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007242 294 Continued on Reverse Side of Page Page 5 of 7 N M 7240 RENEWAL DECLARATIONS (CONTINUED) Office Policy for RESTORE ASSEMBLE PRODUCE Policy Number 98-138-13811-1 CMP-4779 Employers Liability CMP-4860 Al Design Person Org CMP-4787 Waiver of Trans Rgt of Recov FD-6007 Inland Marine Attach Dec " New Form Attached SCHEDULE OF ADDITIONAL INTERESTS Interest Type: Addl Insured -Section II Endorsement #: CMP4860 Loan Number: N/A KENT SCOOL DISTRICT 12033 SE 256TH ST KENT WA 980306643 This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. o rn- Secretary President Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007242 Continued on Next Page Page 6 of 7 M 7240 RENEWAL DECLARATIONS (CONTINUED) Office Policy for RESTORE ASSEMBLE PRODUCE Policy Number 98-B8-B811-1 NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Your coverage amount.... It is up to you to choose the coverage and limits that meet your needs. We recommend that you purchase a coverage limit equal to the estimated replacement cost of your structure. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an estimate from Xactware, Inc®using information you provide about your structure. We can accept the type of estimate you choose as long as it provides a reasonable level of detail about your structure. State Farm ®does not guarantee that any estimate will be the actual future cost to rebuild your structure. Higher limits are available at higher premiums. Lower limits are also available, as long as the amount of coverage meets our underwriting requirements. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your structure. Prepared AUG 21 2020 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007243 294 Page 7 of 7 N 98-B8-B811-1 007243 M 7240 STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Pq Ric Poxardson, 8539fX 75085-3925 Policy Number 98-B8-B811-1 Named Insured Policy Period Effective Date Expiration Date M-15-194B-FACD F U 12 Months OCT 24 2020 OCT 24 2021 The poli y period begins and ends at 12:01 am standard RESTORE ASSEMBLE PRODUCE time att ie premises location. (NONPROFIT) KENT WA 98030-9042 win ATTACHING INLAND MARINE Automatic Renewal -If the policy period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgageekienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8724 Inland Marine Conditions FE-8744.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted inaterial of Insurance Services Office, Inc., with its perinission. 007244 530-686 a.2 05-31-2011 (olf3232c) 98-138-6811-1 M 7240 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE NUMBER COVERAGE INSURANCE AMOUNT FE-8744.1 Inland Marine Computer Prop $ 25,000 $ 500 Loss of Income and Extra Expense $ 25,000 Prepared AUG 21 2020 F D-6007 007244 OTHER LIMITS AND EXCLUSIONS MAYAPPLY- REFER TO YOUR POLICY © Copyright, State Farin Mutual Automobile Insurance Company, 2008 Includes copyrighted inaterial of Insurance Services Office, Inc., with its perinission. ANNUAL PREMIUM Included Included 98-138-13811-1 007245 FE-6999.2 Page 1 of 1 In accordance with the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015, this disclosure is part of your policy. FE-6999.2 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Coverage for acts of terrorism is not excluded from your current policy. However your policy does contain other exclusions which may be ap- plicable, such as an exclusion for nuclear hazard. You are hereby notified that under the Terrorism Risk Insurance Act, as amended in 2015, the def- inition of act of terrorism has changed. As defined in Section 102(1) of the Act: The term "act of ter- rorism" means any act that is certified by the Sec- retary of the Treasury —in consultation with the Secretary of Homeland Security, and the Attorney General of the United States —to be an act of ter- rorism; to be a violent act or an act that is dan- gerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been commit- ted by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the con- duct of the United States Government by coer- cion. Under this policy, any covered losses resulting from certified acts of terrorism may be partially reimbursed by the United States Gov- ernment under a formula established by the Ter- rorism Risk Insurance Act, as amended. Under the formula, the United States Government generally reimburses 85% through 2015, 84% beginning on January 1, 2016; 83% beginning on FE-6999.2 January 1, 2017; 82% beginning on January 1, 2018; 81% beginning on January 1, 2019; and 80% beginning on January 1, 2020 of covered terrorism losses exceeding the statutorily estab- lished deductible paid by the insurance company providing the coverage. The Terrorism Risk Insur- ance Act, as amended, contains a $100 billion cap that limits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in any one calendar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. There is no separate premium charged to cover insured losses caused by terrorism. Your insur- ance policy establishes the coverage that exists for insured losses. This notice does not expand coverage beyond that described in your policy. THIS IS YOUR NOTIFICATION THAT UNDER THE TERRORISM RISK INSURANCE ACT, AS AMENDED, ANY LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM UNDER YOUR POLICY MAY BE PARTIALLY REIM- BURSED BY THE UNITED STATES GOVERN- MENT AND MAY BE SUBJECT TO A $100 BILLION CAP THAT MAY REDUCE YOUR COV- ERAGE. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2015 98-B8-B811-1 007245 M 7240 STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS Pq �ox 8539?�5 We ardson, X 75085-3925 Addl Insured -Section II Only AT2 001153 KENT SCOOL DISTRICT 12033 SE 256TH ST KENT WA 98030-6503 M-15-194B-FACD F U 3125 'III'I�I��'I.III'I...11�111111111�II��II�'�'�I�11I111111�1III�II u, Office Policy Policy Number 98-B8-B811-1 Policy Period Effective Date Expiration Date 12 Months OCT 24 2020 OCT 24 2021 The poli y period begins and ends at 12:01 am standard time att ie premises location. Named Insured RESTORE ASSEMBLE PRODUCE (NONPROFIT) 27309 111TH PL SE KENT WA 98030-9042 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgageekienholder written notice in compliance with the policy provisions or as required by law. Entity: NONPROFIT NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM $ 382.00 Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007246 294 Al Continued on Reverse Side of Page N Page 1 of 7 530-686 a.2 05-31-2011 (olf3231c) RENEWAL DECLARATIONS (CONTINUED) Office Policy for KENT SCOOL DISTRICT Policy Number 98-138-13811-1 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 27309 111TH PL SE No Coverage $ 51,600 25% KENT WA 98030-9042 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEXES) CovA- Inflation Coverage Index: N/A Cov B - Consumer Price Index: 259.1 SECTION I - DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007246 Continued on Next Page $250 Page 2 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for KENT SCOOL DISTRICT Policy Number 98-138-13811-1 RE SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that po licy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A- Buildings) Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007247 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for KENT SCOOL DISTRICT Policy Number 98-138-13811-1 Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Unauthorized Business Card Use Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY Included $5,000 $5,000 $15,000 $10,000 30 Days $2,500 $2,500 $5,000 $50,000 $15,000 Included a The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007247 Continued on Next Page Page 4 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for KENT SCOOL DISTRICT Policy Number 98-138-13811-1 SECTION II - LIABILITY COVERAGE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. LIMIT OF INSURANCE $1,000,000 $5,000 $300,000 LIMIT OF INSURANCE $2,000,000 $2,000,000 Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4102 Businessowners Coverage Form FE-6999.2 "Terrorism Insurance Cov Notice CMP-4819.1 Unauthorized Business Card Use CMP-4247.1 Amendatory Endorsement FE-3650 Actual Cash Value Endorsemet CMP-4572 Amendment of Premium Cond CMP-4561.1 Policy Endorsement CMP-4705.2 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4706 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4703.1 Utility Interruption Loss Incm Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007248 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for KENT SCOOL DISTRICT Policy Number 98-138-13811-1 CMP-4779 Employers Liability CMP-4860 Al Design Person Org CMP-4787 Waiver of Trans Rgt of Recov FD-6007 Inland Marine Attach Dec " New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 007248 Continued on Next Page Page 6 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for KENT SCOOL DISTRICT Policy Number 98-138-13811-1 U NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted inaterial of Insurance Services Office, Inc., with its perinission. 007249 294 Page 7 of 7 N 98-B8-B811-1 007249 STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Pq Ric Poxardson, 8539fX 75085-3925 Policy Number 98-B8-B811-1 Named Insured Policy Period Effective Date Expiration Date M-15-194B-FACD F U 12 Months OCT 24 2020 OCT 24 2021 The poli y period begins and ends at 12:01 am standard RESTORE ASSEMBLE PRODUCE time att ie premises location. (NONPROFIT) 27309 111TH PL SE il KENT WA 98030-9042 ATTACHING INLAND MARINE Automatic Renewal -If the policy period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgageekienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8724 Inland Marine Conditions FE-8744.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared AUG 21 2020 © Copyright, State Farin Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted inaterial of Insurance Services Office, Inc., with its perinission. 007250 530-686 a.2 05-31-2011 (olf3232c) 98-138-6811-1 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8744.1 Inland Marine Computer Prop $ 25,000 $ 500 Included Loss of Income and Extra Expense $ 25,000 Included Prepared AUG 21 2020 F D-6007 007250 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farin Mutual Automobile Insurance Company, 2008 Includes copyrighted inaterial of Insurance Services Office, Inc., with its perinission. 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: Merl aHanson(May 10, 202106:59 PDT) Email: mhanson@kentwa.gov Signature: 10L9- Email: rlashley@kentwa.gov Signature: 47d/2 2gyad(M60 Julie Parascondola (Jun 7, 2021 08:24 PDT) Email: jparascondola@kentwa.gov Restore Assemble Produce -Just Breathe Final Audit Report 2021-06-07 Created: 2021-05-10 By: KateLynn Jennings (kjennings@kentwa.gov) Status: Signed Transaction ID: CBJCHBCAABAAIAW4Gd3GIQzgM19hk4TuNtLXdwg3Uw47 "Restore Assemble Produce -Just Breathe" History Document created by KateLynn Jennings (kjennings@kentwa.gov) 2021-05-10 - 1:53:34 PM GMT- IP address: 146.129.252.126 Document emailed to Merina Hanson (mhanson@kentwa.gov) for signature 2021-05-10 - 1:56:01 PM GMT Email viewed by Merina Hanson (mhanson@kentwa.gov) 2021-05-10 - 1:58:34 PM GMT- IP address: 98.232.40.129 Document e-signed by Merina Hanson (mhanson@kentwa.gov) Signature Date: 2021-05-10 - 1:59:09 PM GMT - Time Source: server- IP address: 98.232.40.129 Document emailed to LaTasha Jackson -Rodriguez (rapyouth1 @gmail.com) for signature 2021-05-10 - 1:59:12 PM GMT Email viewed by LaTasha Jackson -Rodriguez (rapyouth1@gmail.com) 2021-05-10 - 1:59:18 PM GMT- IP address: 66.249.88.175 '3 Email viewed by LaTasha Jackson -Rodriguez (rapyouth1@gmail.com) 2021-06-03 - 9:01:58 PM GMT- IP address: 66.249.84.73 Document e-signed by LaTasha Jackson -Rodriguez (rapyouth1 @gmail.com) Signature Date: 2021-06-03 - 9:05:57 PM GMT - Time Source: server- IP address: 73.118.200.3 Document emailed to Ronald Lashley (rlashley@kentwa.gov) for signature 2021-06-03 - 9:05:59 PM GMT Email viewed by Ronald Lashley (rlashley@kentwa.gov) 2021-06-03 - 11:35:37 PM GMT- IP address: 146.129.252.126 E� Document e-signed by Ronald Lashley (rlashley@kentwa.gov) Signature Date: 2021-06-03 - 11:51:08 PM GMT - Time Source: server- IP address: 146.129.252.126 Adobe Sign Document emailed to Julie Parascondola (jparascondola@kentwa.gov) for signature 2021-06-03 - 11:51:10 PM GMT Email viewed by Julie Parascondola (jparascondola@kentwa.gov) 2021-06-07 - 3:23:43 PM GMT- IP address: 146.129.252.126 Document e-signed by Julie Parascondola Qparascondola@kentwa.gov) Signature Date: 2021-06-07 - 3:24:03 PM GMT - Time Source: server- IP address: 146.129.252.126 Agreement completed. 2021-06-07 - 3:24:03 PM GMT 0 Adobe Sign