HomeMy WebLinkAboutCity Council Committees - Committee of the Whole - 02/09/2021 (2)
KENT CITY COUNCIL
COMMITTEE OF THE WHOLE
Tuesday, February 9, 2021
4:00 PM
THIS IS A REMOTE MEETING
Due to COVID-19 and Health Safety Requirements,
and by Order of the Governor, this is a remote meeting
A live broadcast is available on Kent TV21,
www.facebook.com/CityofKent, and
www.youtube.com/user/KentTV21
To listen to this meeting,
call 1-888-475-4499 or 1-877-853-5257
and enter Meeting ID 973 9306 6841
Mayor Dana Ralph
Council President Toni Troutner
Councilmember Bill Boyce Councilmember Marli Larimer
Councilmember Brenda Fincher Councilmember Zandria Michaud
Councilmember Satwinder Kaur Councilmember Les Thomas
**************************************************************
Item Description Speaker
1. CALL TO ORDER
2. ROLL CALL
3. AGENDA APPROVAL
Changes from Council, Administration, or Staff.
4. DEPARTMENT PRESENTATIONS
A. Memorandum of Understanding between the City of Kent Bill Ellis
and Avenue 55, LLC for the Naden Avenue Assemblage - Avenue 55
Authorize
B. Medical, Dental, Vision, Life and Long-term Disability and Laura Horea
Stop Loss Insurance Vendor Contracts - Authorize
C. Ratify HP Laptop Purchase Utilizing CARES Act Funds James Endicott
D. Ordinance Approving the Change of Indirect Control of Christina Schuck
Astound Broadband, LLC - Adopt
E. Ordinance Amending KCC 9.42 Related to Unlawful Race Chief Rafael Padilla
Attendance - Adopt
Committee of the Whole Committee of the Whole - February 9, 2021
Regular Meeting
F. 2021 Community Development Block Grant Annual Action Dinah Wilson
Plan - Approve
G. Adjustment to the 2019 Community Development Block Dinah Wilson
Grant Budget to Accept Third Round of CARES Act
Coronavirus Funds (CDBG-CV) - Authorize
H. INFO ONLY: Request for Proposal for a Police Data Chief Rafael Padilla
Collection Consultant
I. King County Flood Control District Sub-Regional Meara Heubach
Opportunity Fund: Accept and Reallocate Funds for the
Lake Fenwick Aerator Improvements - Authorize
J. INFO ONLY: Construction Standards Update Mark Howlett
K. INFO ONLY: Traffic Safety Update Chad Bieren
L. INFO ONLY: Transportation Impact Fees April Delchamps
M. Payment of Bills - Authorize Paula Painter
N. Investment Advisory Agreement with Public Financial Paula Painter
Management, LLC - Authorize
O. Authorize the Use of accessoShoWare Center Operating Paula Painter
Fund Balance to Purchase Scoreboard - Authorize
P. Ordinance Providing Business Licensing Exemption for Paula Painter
Parks Performers - Adopt
5. ADJOURNMENT
NOTE: A copy of the full agenda is available in the City Clerk's Office and at
KentWA.gov.
Any person requiring a disability accommodation should contact the City Clerk's
Office in advance at 253-856-5725. For TDD relay service, call the Washington
Telecommunications Relay Service 7-1-1.
5/B
ECONOMIC AND COMMUNITY DEVELOPMENT DEPARTMENT
Kurt Hanson, Economic and Community Development Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5454
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Memorandum of Understanding between the City of Kent and
Avenue 55, LLC for the Naden Avenue Assemblage -
Authorize
MOTION: Authorize the Mayor to sign a Memorandum of Understanding
with Avenue 55, LLC to provide a framework for Avenue 55 and the City to
solicit and review proposals for the development and disposition of the
Naden Avenue Assemblage or portions of it, subject to final terms and
conditions acceptable to the Economic and Community Development
Director and City Attorney.
SUMMARY:
This Memorandum of Understanding (MOU) affirms the selection of Avenue 55 by
the Council President-appointed review panel for applications for Review of
-fold
purpose is as follows:
· The MOU gives Avenue 55 the exclusive right to negotiate and finalize
agreements with the City regarding the sale or long-term lease, construction,
and development of the Naden Property or portions of it for the term of the
MOU.
· The intent and purpose of this MOU is to clarify the expectations of the
parties and to provide a framework for the solicitation and review of
proposals for development of the Naden Property or portions of it. The
parties will cooperate in an attempt, subject to City Council approval, to
reach a mutually acceptable development proposal and development
the disposition of the property on developing and constructing an urban
manufacturing or flex tech campus and/or helping the City recruit a build-to-
suit, owner-operator manufacturing/flex tech employer, or a workforce
and/or business development facility (or a combination thereof) to bring
The anticipated result of site due diligence, feasibility, entitlements and marketing
undertaken by Avenue 55 during the term of the MOU is a development proposal
from Avenue 55 for Council consideration.
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The proposal will include relevant details known at the time of submission for the
future project including but not limited to design, prospective uses of the property,
potential/initial tenants, etc. If City staff determines that a proposal fulfills the
purpose of this MOU, City staff will recommend the proposal for consideration by
the City Council. The City Council may, in its sole discretion, accept or reject any
commitment to negotiate the terms of a development agreement. In the event the
terms of a development agreement are mutually acceptable to staff and Avenue 55,
the Council will then be asked to consider the development agreement and a public
hearing before the Council will be held.
In exchange for this MOU which provides Avenue 55 the opportunity to market the
property, the City will receive the marketing services, knowledge regarding the
highest and best use of the property, as well as site studies and entitlement work
performed by Avenue 55.
The MOU will be in effect for a period of 12 months after signature.
BUDGET IMPACT: None; non-binding memorandum
SUPPORTS STRATEGIC PLAN GOAL:
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
ATTACHMENTS:
1. Naden MOU (PDF)
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MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding (“MOU”) is between the City of Kent,
Washington, a municipal corporation, and Avenue 55, LLC, a limited liability
corporation (“Avenue 55”).
RECITALS
A. The City owns certain real property located to the north of Willis Street, the
south of West Meeker Street and to the east of State Route (SR) 167 and the
west of the Interurban Trail within the City of Kent, King County, Washington,
depicted and described in Exhibit A (“Naden Property”). The Naden Property is
currently accessed through Naden Avenue South and an old access easement
from West Meeker Street.
B. The Naden Property is highly visible and located midway between the Ports of
Tacoma and Seattle and just a few miles east of SeaTac International Airport.
The Naden Property is also adjacent to the Interurban Trail, SR-167, and SR-
516, and is within walking distance to the amenities and commuter rail of Kent
Station and Meeker Street—the historic Main Street of the City of Kent. Meeker
Street is undergoing a transformation into a promenade, connecting the
historic downtown to the Green River with more than 2,000 rental bedrooms
currently being added. After decades of public-private partnership in
developments related to “play” (e.g., Kent Station) and “live” (e.g., Ethos),
the City now seeks to bring “work” to the Downtown Subarea Plan’s vision of
a “live play work” commercial center.
C. The City is authorized to dispose of real property pursuant to RCW 35A.11.010.
D. The City’s Economic Development Plan, adopted in 2014, calls for “surplus city
property be developed for housing & commercial” uses. Since 2014, the City
has sold more than two dozen acres of surplus property for housing (excepting
11,000 square feet of ground floor retail in two apartment buildings on the
former Par 3 Riverbend Golf Course in the development now known as Ethos),
and comparatively little to none for commercial development.
E. Strategic action 5.4.1 of the Economic Development Plan calls for the City to
consider a dedicated master planning process for the Kent Industrial Valley
(where the Naden Property lays within this real estate submarket) focusing on
opportunities for industrial campus development in order to remain a
competitive economic place for advanced manufacturing.
F. Strategic action 6.1.4 of the plan calls for the City to “develop a maker space”
in the Kent Industrial Valley in support of workforce development collaboration.
It is understood that the development of maker spaces often requires public-
private partnerships.
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G. Pursuant to Resolution 1935, passed on October 14, 2016, the Naden Property
is formally listed as surplus to the City’s needs in accordance with the
requirements of chapter 3.12 KCC. Section 2 of the resolution provides,
“Public's Best Interest. It is in the public's best interest that this surplus
property shall be marketed and sold in one or more sections for reinvestment
and redevelopment to enhance city revenue and stimulate economic
development in the city's downtown core.”
H. The City ran a competitive Request for Qualifications process, with published
advertisements and disclosures to local media, to select a developer to
negotiate an option on the Naden Property with the City, subject to City Council
approval, in order to partner with the City to realize a shared vision on the
site.
I. The City sought an experienced, proven, conceptually innovative and qualified
development team to partner with its Economic and Community Development
department staff to: (1) help achieve the City’s objective to sell or lease the
property on the condition the property be utilized as an urban manufacturing
or flex tech campus at this site; and/or (2) help the City recruit a build-to-suit,
owner-operator manufacturing employer (or a combination thereof) to bring
more employment to Kent’s historic downtown.
J. The City Council President appointed a panel to select a development team for
Council consideration. After the panel’s review of four submissions and an
interview with the panel’s preferred development team on November 1, 2020,
the panel chose Avenue 55.
K. Avenue 55 will work in partnership with the City’s Economic and Community
Development department staff.
L. There is mutual understanding that the partnership with Avenue 55 will
include: joint marketing efforts for business recruitment including
development of materials and media; basic conceptual site planning and SEPA
entitlement performed by Avenue 55 with input from City staff to assist in
providing confidence to potential end users of the Naden Property; cooperation
to reach a mutually acceptable development proposal that achieves the public
objective of this MOU.
M. The parties understand this partnership constitutes the parties’ agreement to
explore development options for the Naden Property. There is mutual
understanding that the City will not offer capital to improve site development
conditions, and that Avenue 55 is not committing to building within a specified
timeline.
N. In exchange for providing Avenue 55 with the exclusive right to negotiate and
finalize an agreement regarding the sale or long-term lease of the Naden
Property, Avenue 55 will, at its sole cost, market the property and engage with
potential tenants on site and building designs that fulfill the purpose of this
MOU. Additionally, Avenue 55 will provide preliminary design for build-out for
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MOU – CITY OF KENT AND AVENUE 55
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any proposal, as well as preliminary site studies and preliminary architectural
and engineering design work.
Therefore, the parties agree as follows:
1. Purpose.
1.1 This MOU gives Avenue 55 the exclusive right to negotiate and finalize
agreements with the City regarding the sale or long-term lease,
construction, and development of the Naden Property or portions of it
for the term of the MOU.
1.2 The intent and purpose of this MOU is to clarify the expectations of the
parties and to provide a framework for the solicitation and review of
proposals for development of the Naden Property or portions of it. The
parties will cooperate in an attempt, subject to City Council approval, to
reach a mutually acceptable development proposal and development
agreement that will help achieve the City’s public objective of
conditioning the disposition of the property on developing and
constructing an urban manufacturing or flex tech campus and/or helping
the City recruit a build-to-suit, owner-operator manufacturing/ flex tech
employer, workforce and/or business development facilities (or a
combination thereof) to bring more employment to the City’s historic
downtown.
2. Term of the MOU.
2.1. The term of the MOU is 12 months from the effective date, unless
terminated or extended prior to that date. The effective date is the date
the last party signs the MOU.
2.2. The MOU may be extended or terminated by mutual written agreement
of the parties.
3. Property.
The Naden Property consists of 23 tax parcels, for a total of approximately 7.8 acres,
to the south of West Meeker Street, the north of Willis Street and to the east of SR
167 and the west of the Interurban Trail, depicted and described in Exhibit A.
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4. Marketing and Proposal Solicitation.
4.1. During the term of the MOU, Avenue 55 will market the Naden Property
and engage with potential tenants regarding site and building designs
that fulfill the purpose of this MOU. Avenue 55 will coordinate its
marketing efforts with the City. Avenue 55 will solely be responsible for
any costs associated with its marketing and solicitation.
4.2. The City may also solicit proposals and engage with potential tenants.
The City will present any proposals or potential tenants to Avenue 55
for input; provided, the City shall have final authority to approve or
disapprove any proposal.
5. Proposal Review.
Economic and Community Development department staff (“City staff”) will first
evaluate any development proposal submitted by Avenue 55. Such proposal shall
include all relevant details known at the time of submission for the future project
including but not limited to design, prospective uses of the property, potential/initial
tenants, etc. If City staff determines that a proposal fulfills the purpose of this MOU,
City staff will recommend the proposal for consideration by the City Council. The City
Council may, in its sole discretion, reject any proposal. The City Council’s acceptance
of a proposal shall not constitute the agreement to transfer the Naden Property, nor
shall such acceptance be interpreted in any manner to create liability on the part of
either party in the event the transfer of property does not occur. Rather, such
acceptance shall constitute a good faith commitment to negotiate the terms of a
development agreement in accordance with Section 6 of this MOU.
6. Development and Disposition of the Naden Property.
If the City Council accepts a proposal for development of the Naden Property or any
portion of it in accordance with Section 5 of this MOU, the parties will make a good
faith effort to negotiate a development agreement recorded against the property that
will be subject to City Council approval after a public hearing. Any transfer of any
portion of the Naden property will be at a value agreed to by City Council. This MOU
shall in no way bind the City Council to the terms of a development agreement or the
transfer of any property.
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7. Access to Naden Property.
During the term of this MOU, Avenue 55 and its designees will have the right to enter
upon and perform inspections and tests of the Naden Property, as reasonably
determined by Avenue 55 to be necessary, including performing environmental
testing, land surveys, and geo-technical testing. Avenue 55’s inspection and testing
of the Naden Property shall be at its sole risk, and Avenue 55 indemnifies, defends
and holds the City harmless from any and all claims, damages, liability, causes of
action, judgments and expenses (including reasonable attorney’s fees) arising out of
Avenue 55’s exercise of the rights granted in this Section 7. Any alteration of the
Naden Property shall be preapproved by Economic and Community Development staff
in writing.
8. Process for Submitting and Considering Proposals.
8.1. General Expectations. When submitting proposals, Avenue 55 will
provide City staff with preliminary site studies as well as preliminary
architectural and engineering design work for build-out.
8.2. Pre-Application Conference Process. Avenue 55 will engage with City
staff early and often through the City’s pre-application conference
process and other means to ensure a mutual understanding of the
requirements and expectations regarding stormwater management,
street construction and improvements, utility-related issues and
improvements, the King County trail, off-site improvement
requirements, and other development challenges, expectations, and
requirements.
8.3. Phase I Environmental Site Assessment. Avenue 55 will complete a
Phase I Environmental Site Assessment on the Naden Property.
8.4. SEPA. The parties acknowledge that it is in the best interest of the City
and Avenue 55 to ensure that the SEPA process is broad in scope and
conducted in such a manner as to allow for multiple development
scenarios on the site.
8.5. Change to Process. The process outlined in Sections 8.1-8.4 shall serve
as a guide and may be changed by mutual agreement of Avenue 55 and
City staff.
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8.6. Costs and Avenue 55 Solely Responsible. Avenue 55 will be responsible
for the costs of preliminary site studies as well as preliminary
architectural and engineering design work. It shall be Avenue 55’s
responsibility to fully understand the condition of the Naden Property,
as well as the development conditions and expectations with regards to
any development proposal, and nothing herein shall be interpreted to
shift any responsibility to the City.
8.7. Information Sharing. Avenue 55 will provide copies to the City of all
nonconfidential studies, test results, surveys, plans, designs, drafts, and
all other documents or information pertaining to the condition or
development of the Naden Property.
9. Miscellaneous.
9.1. This MOU is subject to the approval of the Kent City Council, and shall
not be valid or enforceable until approved by the Kent City Council and
signed by the City.
9.2. The City will not make any contributions to, nor incur any liabilities
associated with the development of the Naden Property other than as
outlined in this MOU.
9.3. Any portion of the Naden Property purchased or otherwise transferred
pursuant to this MOU will be purchased or transferred in its then current
condition and state of repair, “As Is.” Avenue 55 will be required to
satisfy itself prior to any closing for any portion of the Naden Property
that the Naden Property is suitable for the intended development.
9.4. Contingent upon City of Kent’s approval, which shall not unreasonably
be withheld, Avenue 55’s interest under this MOU may be assigned or
otherwise transferred to an entity sharing common ownership with
Avenue 55.
9.5. This MOU may be amended only by mutual written agreement of the
parties. No waiver, alteration, or modification of any of the provisions of
this MOU shall be binding unless in writing and signed by a duly
authorized representative of each party.
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9.6 The written provisions and terms of this MOU shall supersede all prior
verbal statements of any officer or other representative of the parties,
and such statements shall not be effective or be construed as entering
into or forming a part of or altering in any manner this MOU.
9.7 The legal presumption that an ambiguous term of this MOU should be
interpreted against the party who prepared the MOU shall not apply as
this MOU was jointly prepared by the parties.
9.8 This MOU may be signed in any number of counterparts and
electronically and be valid as if each authorized representative had
signed the original document.
AGREED AND ACCEPTED this ____ day of ____, 2021.
CITY OF KENT: AVENUE 55, LLC:
By:
By:
(signature)
(signature)
Print Name:
Print Name:
Its
Its
(title)
(title)
DATE:
DATE:
APPROVED AS TO FORM:
Kent Law Department
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HUMAN RESOURCES DEPARTMENT
Teri Smith, Human Resources Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5270
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Medical, Dental, Vision, Life and Long-term Disability and
Stop Loss Insurance Vendor Contracts - Authorize
MOTION: Authorize the Mayor to enter into agreements for:
Medical administrative services with Premera for four years, and Kaiser
Permanente for one year;
Dental administrative services with Delta Dental for one year;
Vision administrative services with Vision Service Plan, current contract
extension for two additional years;
Life insurance and long-term disability benefits with Cigna for two
years; and
Stop loss insurance with LifeWise for one year
subject to final terms and conditions acceptable to the Human Resources
Director and the City Attorney.
SUMMARY: The City of Kent contracts with Premera Blue Cross, Delta Dental of
Washington and Vision Service Plan, to be third-party administrators to process
medical, dental, and vision claims, and provide access to their networks of
providers. The City is self-insured for these programs. The City also contracts
organizatio
than 2020. Kaiser offered a 4.97% increase in cost.
Life and long-term disability insurance plans are offered through Cigna. The
renewal is 12.11% less than in 2020.
The City of Kent contracts with LifeWise for our individual and aggregate stop-
loss insurance coverage. The best offer received for 2021 was from LifeWise
with an 11.3% increase. Contracting with LifeWise provides us an additional
discount from Premera on the stop-loss integration fee. This stop-loss policy
provides added coverage to the City for individual medical claims exceeding
$200,000 per employee or dependent for each calendar year. Medical costs
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exceeding this amount are reimbursed to the City under this policy. We received
$340,000 in stop-loss reimbursements in 2020.
Our recommendation is to renew with these vendors based on the strength of their
plans, overall costs, customer service, discounts, and overall administration and
billing accuracy.
BUDGET IMPACT: The cost for these contracts is budgeted in the Health and
Wellness fund.
Premera - $1,852,700 for a four-year contract
Kaiser Permanente - $494,500 for a one-year contract
Delta Dental - $59,640 for a one-year contract
Vision Service Plan - $44,000 for a two-year contract extension
Cigna - $473,000 for a two-year contract
LifeWise - $1,082,000 for a one-year contract
SUPPORTS STRATEGIC PLAN GOAL:
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
ATTACHMENTS:
1. Premera - ASC 2021_2025 (PDF)
2. Kaiser - Contract 2021 (PDF)
3. Delta Dental - ASC 2021 (PDF)
4. VSP - ASC Amendment 2021_2022 (PDF)
5. Cigna - Basic ADD Insurance Policy Amendment 2021_2022 (PDF)
6. Cigna - Basic Life Insurance Policy Amendment 2021_2022 (PDF)
7. Cigna (PDF)
8. Cigna - Vol Life Insurance Policy Amendment 2021_2022 (PDF)
9. LifeWise - Contract 2021 (PDF)
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The Claims Administrator's fee for recovering payments through a class action suit on behalf of the Plan
Sponsor has been changed to $50,000. The fee amount appears in Fee For Class Action Recoveries in
the Attachment. The method of calculating the Plan Sponsor's portion of the fee has not changed, and
the fee amount will continue to be deducted from the money paid to the Plan Sponsor. Each participating
plan sponsor pays its part of the fee based on the proportion of the amount the Claims Administrator
recovers for that plan sponsor compared to the Claims Administrator's total amount recovered for all its
lines of business.
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The Claims Administrator has contracted with one or more
vendors that use technology to provide Members easier
and more convenient access to medical care. Providers
covered under the Virtual Care benefit offer their services
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messaging and video chat.
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The virtual care services do not include real-time visits via
online and telephonic methods between Members and
their doctors or other providers who also maintain a
physical location.
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An Independent Licensee of the Blue Cross Blue Shield Association
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BY: DATE:
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BY: DATE: January 1, 2021
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P.O. Box 327
Seattle, WA 98111-0327
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BUUBDINFOU!C!DFOTVT!JOGPSNBUJPO
Administration Fees, effective January 1, 2021, are based on the following:
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Medical/Rx7201, 212
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!
BUUBDINFOU!E!!GFFT!PG!UIF!DMBJNT!BENJOJTUSBUPS!
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BUUBDINFOU!E
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Pursuant to the Administrative Service Contract, the Plan Sponsor shall pay the Claims Administrator the fees, as set forth
below, for administrative services.
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$53.62per employee per month
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Administration Fee (Medical/Rx)$50.12
Administrative Fee (Dental)$0.00
Producer Fee$3.50
Total$53.62
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The base administration fee, not including other charges such as producer fees, is guaranteed as shown below during the period from
1/1/2021 through 12/31/2024. This period shall be known as the "administration fee guarantee period."
Contract Period BeginsContract Period Ends
YearAmount
Year 1$50.001/1/202112/31/2021
Year 2$51.001/1/202212/31/2022
Year 3$52.021/1/202312/31/2023
Year 4$53.061/1/202412/31/2024
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The charge for processing runout claims is an amount equal to the active administration fee at the time of termination, times the
average number of subscribers for the 3-month period preceding the termination date, times two.
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BlueCard Fees are tracked and billed monthly in addition to claims expense.
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Provider groups enter into agreements with Premera or other Blue Cross and/or Blue Shield Licensees (Host
Blues) for value-based programs. Such programs include the Blue Distinction Total Care program, Global
Outcomes Contracts, accountable care organizations, patient-centered medical homes, shared savings
arrangements, and global payment/total cost of care arrangements. Premera and the Host Blues may pay value-
based program providers for meeting the programs' standards for treatment outcomes, cost, quality, and care
coordination. The Plan Sponsor shall pay the Claims Administrator a per-member-per month (PMPM) amount
established for each value-based program provider group. The PMPM amount will be multiplied by the number of
the Plan Sponsor's Members that are attributed to each provider group. The PMPM amounts differ between the
provider groups, and may change during the Contract Period.
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The Plan Sponsor shall pay the Claims Administrator a fee for its work in pursuing class action recoveries on
behalf of the Plan Sponsor as described in Subsection 3.5. The fee shall be a proportionate share of $50,000
based on the proportion of the amount recovered on behalf of the Plan Sponsor compared to the total amount
recovered by the Claims Administrator for all lines of business.
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See Attachment F CareCompass360° for an overview of services provided. Services are included in the Claims
Administrator's Administration Fee except where stated below.
Qfstpobm!Ifbmui!Tvqqpsu!Not included in Administration Fee. $245 per actively
(See Appendix 2)!engaged Member per month of active engagement.
CftuCfhjoojoht!Nbufsojuz!Engagement fee: $50 one-time fee per
(See Appendix 3)!Member when the
Member registers for the
program and downloads
the mobile application
!High Risk Maternity Case $350 additional one-time
Management fee for Members engaged
in high-risk case
management
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(See Appendix 4)
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Claims Administrator will perform the services listed below on a pay-for-performance, contingent fee ("Contingent
Fee") basis, which shall be calculated as a percentage of the gross amount recovered with respect to any
particular claim. See "Attachment G Extended Post-Payment Recovery Services" for an overview of services
provided.
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Coordination of Benefits 25 percent
Subrogation 25 percent unless Claims Administrator, in its sole
option or discretion, engages outside counsel, in
which case the Contingent Fee amount shall be 35
percent, whether or not the case involves litigation
or other dispute resolution process.
25 percent if, after Claims Administrator has
worked a subrogation case, the Plan Sponsor
takes over responsibility for the case and settles
directly.
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In all cases, Plan Sponsor is also responsible for
payment of any court costs, such as filing fees,
witness fees or court reporter fees.
Provider Billing Errors 25 percent
Credit Balance 25 percent
Hospital Billing and Chart Review 35 percent
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BUUBDINFOU!G!!DBSFDPNQBTT471±!
Appendix 1!
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Claims Administrator agrees to provide the following care facilitation services.
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Prospective and retrospective review for medical
Clinical review
necessity, appropriate application of benefits.
Includes provision of evidence-based clinical practice and
Quality Programs preventive care guidelines to Members and providers,
chart tools, and quality of care program activities.
Round-the-clock access for Members to registered nurses
NurseLine
to answer questions about their health care.
Pharmacy
Prescription drug formulary Development of formulary and access to providers and
promotion Members on-line
Physician-based pharmacy Physician education on cost-effective prescribing
management
Enhanced Controlled Substances
Utilization Program (Opioid
Management)
Standard Option
Software to provide physicians with up-to-date drug and
ePocrates
plan formulary information.
Follow-up with Members and physicians to minimize
Point-of-sale Pharmacy inappropriate or excessive drug therapies identified when
drugs are dispensed.
The Claims Administrator has contracted with one or more
vendors that use technology to provide Members easier
and more convenient access to medical care. Providers
covered under the Virtual Care benefit offer their services
Virtual Care exclusively through secure chat, text, voice or audio
messaging and video chat.
The virtual care services do not include real-time visits via
online and telephonic methods between Members and
their doctors or other providers who also maintain a
physical location.
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BUUBDINFOU!J!!QFSGPSNBODF!HVBSBOUFFT!
!
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FGGFDUJWF!20203132!UISPVHI!2304203132!)Uif!#Bhsffnfou!Qfsjpe#*
This Performance Guarantee Agreement is between Premera Blue Cross of Washington ("the Company"), and
City of Kent ("the Group"). The Company will provide an acceptable level of service as described herein or will
pay the penalties also described herein.
TFDUJPO!2/!UFSN
The term of this Agreement shall only be the Agreement Period.
Provided this Agreement is executed prior to or on the Effective Date, the Company’s fulfillment of the
performance guarantees set forth in this Agreement shall be measured from the Effective Date.
In the event that this Agreement is not executed prior to or on the Effective Date, the Company’s performance
shall be measured in accordance with Section 3.C.
The performance guarantees under this Agreement are contingent on the Company receiving timely payment of
administrative fees or subscription charges, as applicable, from the Group.
TFDUJPO!3/!QFSGPSNBODF!HVBSBOUFFT!BOE!QFOBMUZ!BNPVOUT
The Company guarantees its performance as stated below. The maximum amount of accumulated penalties
for the Agreement Period shall be $28,200.00
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1)Account Management: Quarterly Account Management Team Satisfaction Survey
The Company will provide an online survey that measures the effectiveness of account management in
providing superior service to the client. The Account Management Survey shall be distributed to appropriate
members of the Group’s benefits staff, and/or third party benefit consultants as selected by the Group, at the
end of each quarter. The Group and its selected associates shall complete the Online Account Management
Survey within thirty (30) days of receipt. The failure of the group to respond to one of the quarterly surveys shall
nullify the Account Management Survey metric, and the Company will not pay the penalty.
Following the end of each quarter and receipt of the survey response(s) from the Group, the Company will
calculate the Mean Score in each performance assessment category by using a mean score calculation. The
Account Management Commitment will be deemed as fulfilled if Question 8 “Overall Satisfaction with Account
Management Team” is equal to or greater than 3 on a 5 point satisfaction scale. Surveys with no response will
be removed from our scoring computation. Only completed survey’s submitted within 30 days of distribution will
be used to score Account Management performance.
This metric is Corporate Standard and reporting will be Group Specific; Quarterly Survey; Annual Settlement
The estimated penalty for this metric will be $4,300.00
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2)Claims : Claims Accuracy - Dollars
The Company guarantees that at least 99% of total benefit dollars payments shall be accurate (less than 1% to
be in error) in a contract year, when overpayments and underpayments are combined, not offset against one
another. Calculated as Total Dollars Paid less Total Absolute Value of Dollar Errors, divided by Total Dollars
Paid, based on annual randomly selected audit sample, not less than 99%.
This metric is Corporate Standard and reporting will be Group Specific. Reported annually.
The estimated penalty for this metric will be $4,300.00
3)Claims : Claims Accuracy - Frequency
95% of the Groups clean claims shall be paid without error (payment and procedural) in a contract year.
Calculated as Total Claims With No Errors divided by Total Claims Paid, and based on annual randomly
selected audit sample, not less than 95%.
This metric is Corporate Standard and reporting will be Group Specific. Reported annually.
The estimated penalty for this metric will be $4,300.00
4)Claims : Claims Clean Claims Turnaround Time within 30 Days
Turnaround Time (TAT) is measured from the date a clean claim is received by the Company (either via paper
or electronic data interchanges) to the date it is processed for payment, denied, or pended for external
information. A clean claim is defined as one that has been received by The Company with the relevant and
correct information required to process the claim. This claim will have no defects or irregularities, includes any
required substantiating documentation, and can be adjudicated without interruption. The calculation for the
Claim Turnaround Time percentage will be measured on the percentage of all Clean Claims processed within
30 Days of Receipt divided by Total Clean Claims Processed (*excluding Blue Card claims), not less than 97%.
*Performance Standard will be tolled with respect to a claim during the period the claim is suspended for
information outside The Company's claims processing system or scope of responsibility or control (i.e., review
by other organizations not integrated into processing system).
This metric is Corporate Standard and reporting will be Group Specific. Reported quarterly.
The estimated penalty for this metric will be $4,300.00
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5)Contract Services: Booklets
Premera will guarantee booklet proofs within 45 business days of receipt of the group renewal confirmation.
Additional drafts or final (electronic) booklets will be provided within 10 business days of producer/client edits to
initial draft and repeat with each revision as necessary. Printing and mailing of booklets are not subject to
performance guarantee.
This metric is non-standard and reporting will be Group specific settled annually
The estimated penalty for this metric will be $2,400.00
6)Customer Service: Customer Service - Abandonment Rate
The Company guarantees that no more than 5 percent of incoming calls that are made to our toll-free customer
service telephone line shall be dropped before speaking to a Customer Service Representative. Customer
Service Abandonment Rate calculated as Total Abandoned Calls divided by Total Accepted Calls.
This metric is Corporate Standard and reporting will be Combined score of all PG Groups in Customer Service
Unit. Reported quarterly, settled using 12 mo avg.
The estimated penalty for this metric will be $4,300.00
7)Customer Service: Customer Service - Service Level within 30 seconds
The Company guarantees that 75% of all calls to their toll-free customer service telephone line will be answered
in thirty seconds or less. Answered means the time from when the caller selects the option to speak with an
agent until a Customer Service Representative answers the call. Results are calculated as Total Calls
Answered Within 30 Seconds divided by Total Calls Received.
This metric is Corporate Standard and reporting will be Combined score of all PG Groups in Customer Service
Unit.
Reported quarterly, settled using 12 mo avg
The estimated penalty for this metric will be $4,300.00
TFDUJPO!4/!!FWBMVBUJPO!PG!QFSGPSNBODF!BOE!QBZNFOU!PG!QFOBMUJFT
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A
A)At the end of the Agreement, the Company shall compile the necessary documentation and perform the
necessary calculations to evaluate its fulfillment of each performance guarantee set forth in this Agreement and
make this information available to the Group.
B)If the Company fails to meet any of the performance guarantees set forth in Section 2, the Company shall
pay to the Group the financial penalty based on the percentage set forth in Section 2.
C)In the event that this Agreement is not executed by the Effective Date, the Company’s performance shall be
measured from the first day of the month following the month this Agreement is executed. In such event the
applicable penalty amounts will be pro-rated for that portion of the year for which performance guarantee
metrics are in force.
D)Refer to Section 4 if the contract under which the Company provides insurance and/or administrative
services to the Group is terminated prior to the end of the term of this Agreement.
TFDUJPO!5/!!UFSNJOBUJPO!PG!BHSFFNFOU
If this Agreement terminates prior to the last day of the Agreement Period the Group is not entitled to any
penalties under Section 2 of this Agreement. This Agreement shall terminate upon the earliest of the following
dates:
A)the end of the Term of this Agreement;
B)the effective date of any state's or other jurisdiction's action which prohibits activities of the parties under this
Agreement;
C)the date upon which the Group either fails to meet its obligation to sufficiently fund the bank account from
which claims are paid (if applicable), or fails to make timely payments of either administrative fees or
subscription charges anytime during the plan year;
D)the date upon which the contract under which the Company provides services to the Group is terminated;
E)any other date mutually agreeable to the Company and Group.
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A nonprofit health maintenance organization
Group Medical Coverage Agreement
Kaiser Foundation Health Plan of Washington (KFHPWAis a nonprofit health maintenance organization, duly
registered under the laws of the State of Washington, furnishing health care coverage on a prepayment basis. The
Group identified below wishes to purchase such coverage. This Group Medical Coverage AGroup
e will be provided, including the rights and
responsibilities of the contracting parties; requirements for enrollment and eligibility; and benefits to which those
enrolled under this Group Agreement are entitled.
The Group Medical Coverage Agreement between KFHPWA and the Group consists of the following:
Standard Provisions
Evidence of Coverage
City of Kent, #0036900
This Group Agreement will continue in effect until terminated or renewed as herein provided for and is effective
January 1, 2021.
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C472980036900 1
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Standard Provisions
1.!KFHPWA agrees to provide benefits as set forth in the attached Evidence of Coverage (EOC) to enrollees
of the Group.
2. Monthly Premium Payments.
For the initial term of this Group Agreement, the Group shall submit to KFHPWA for each Member the
monthly premiums set forth in the current Premium Schedule and a verification of enrollment. Payment must be
received on or before the due date and is subject to a grace period of 10 days. Premiums are subject to change
by KFHPWA upon 30 days written notice. Premium rates will be revised as a part of the annual renewal
process.
KFHPWA reserves the right to re-rate this benefit package if the demographic characteristics change by more
than 15%.
3. Dissemination of Information.
Unless the Group has accepted responsibility to do so, KFHPWA will disseminate information describing
benefits set forth in the EOC attached to this Group Agreement.
4. Identification Cards.
KFHPWA will furnish cards, for identification purposes only, to all Members enrolled under this Group
Agreement.
5. Administration of Group Agreement.
KFHPWA may adopt reasonable policies and procedures to help in the administration of this Group Agreement.
This may include, but is not limited to, policies or procedures pertaining to benefit entitlement and coverage
determinations.
6. Modification of Group Agreement.
Except as required by federal and Washington State law, this Group Agreement may not be modified without
agreement between both parties.
No oral statement of any person shall modify or otherwise affect the benefits, limitations and exclusions of this
Group Agreement, convey or void any coverage, increase or reduce any benefits under this Group Agreement or
be used in the prosecution or defense of a claim under this Group Agreement.
7. Indemnification.
KFHPWA agrees to indemnify and hold the Group harmless against all claims, damages, losses and expenses,
KFHPWA failure to perform, negligent performance or
willful misconduct of its directors, officers, employees and agents of their express obligations under this Group
Agreement.
The Group agrees to indemnify and hold KFHPWA harmless against all claims, damages, losses and expenses,
inlure to perform, negligent performances or
willful misconduct of its directors, officers, employees and agents of their express obligations under this Group
Agreement.
The indemnifying party shall give the other party prompt notice of any claim covered by this section and
provide reasonable assistance (at its expense). The indemnifying party shall have the right and duty to assume
the control of the defense thereof with counsel reasonably acceptable to the other party. Either party may take
part in the defense at its own expense after the other party assumes the control thereof.
8. Compliance With Law.
The Group and KFHPWA shall comply with all applicable state and federal laws and regulations in
performance of this Group Agreement.
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This Group Agreement is entered into and governed by the laws of Washington State, except as otherwise pre-
empted by ERISA and other federal laws.
9. Governmental Approval.
If KFHPWA has not received any necessary government approval by the date when notice is required under this
Group Agreement, KFHPWA will notify the Group of any changes once governmental approval has been
received. KFHPWA may amend this Group Agreement by giving notice to the Group upon receipt of
government approved rates, benefits, limitations, exclusions or other provisions, in which case such rates,
benefits, limitations, exclusions or provisions will go into effect as required by the governmental agency. All
amendments are deemed accepted by the Group unless the Group gives KFHPWA written notice of non-
acceptance within 30 days after receipt of amendment, in which event this Group Agreement and all rights to
services and other benefits terminate the first of the month following 30 days after receipt of non-acceptance.
10. Grandfathered Health Plan.
For any coverage identified in an EOC as a "grandfathered health plan" under the Patient Protection and
Affordable Care Act (a/k/a the ACA), Group must immediately inform KFHPWA if this coverage does not
meet (or no longer meets) the requirements for grandfathered status including but not limited to any change in
its contribution rate to the cost of any grandfathered health plan(s) during the plan year. Group represents that,
for any coverage i
contribution rate more than five percent (5%) for any rate tier for such grandfathered health plan when
compared to the contribution rate in effect on March 23, 2010 for the same plan. Health Plan will rely on
ed health plan coverage
11. Confidentiality.
Each party acknowledges that performance of its obligations under this Group Agreement may involve access
to and disclosure of data, procedures, materials, lists, systems and information, including medical records,
employee benefits information, employee addresses, social security numbers, e-mail addresses, phone numbers
and other confident The
information shall be kept strictly confidential and shall not be disclosed to any third party other than: (i)
representatives of the receiving party (as permitted by applicable state and federal law) who have a need to
know such information in order to perform the services required of such party pursuant to this Group
Agreement, or for the proper management and administration of the receiving party, provided that such
representatives are informed of the confidentiality provisions of this Group Agreement and agree to abide by
them, (ii) pursuant to court order or (iii) to a designated public official or agency pursuant to the requirements of
federal, state or local law, statute, rule or regulation. The disclosing party will provide the other party with
prompt notice of any request the disclosing party receives to disclose information pursuant to applicable legal
requirements, so that the other party may object to the request and/or seek an appropriate protective order
against such request. Each party shall maintain the confidentiality of medical records and confidential patient
and employee information as required by applicable law.
12. HIPAA.
Definition of Terms. Terms used, but not otherwise defined, in this section shall have the same meaning as
those terms have in the Health Insur
Transactions Accepted. KFHPWA will accept Standard Transactions, pursuant to HIPAA, if the Group elects
to transmit such transactions. The Group shall ensure that all Standard Transactions transmitted to KFHPWA by
transactions. The Group shall indemnify KFHPWA for any breach of this section by the Group.
13. Termination of Entire Group Agreement.
This is a guaranteed renewable Group Agreement and cannot be terminated without the mutual approval of each
of the parties, except in the circumstances set forth below.
a. Nonpayment or Non-Acceptance of Premium. Failure to make any monthly premium payment or
contribution in accordance with Subsection 2. above shall result in termination of this Group Agreement as
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of the premium due date. The Group
renewal process shall be considered nonpayment and result in non-renewal of this Group Agreement. The
Group may terminate this Group Agreement upon 15 days written notice of premium increase, as set forth
in Subsection 2. above.
b. Misrepresentation. KFHPWA may rescind or terminate this Group Agreement upon written notice in the
event that intentional misrepresentation, fraud or omission of information was used in order to obtain
Group coverage. Either party may terminate this Group Agreement in the event of intentional
misrepresentation, fraud or omission of information by the other party in performance of its responsibilities
under this Group Agreement.
c. Underwriting Guidelines. KFHPWA may terminate this Group Agreement in the event the Group no
longer meets underwriting guidelines established by KFHPWA that were in effect at the time the Group
was accepted.
d. Federal or State Law. KFHPWA may terminate this Group Agreement in the event there is a change in
federal or state law that no longer permits the continued offering of the coverage described in this Group
Agreement.
14. Withdrawal or Cessation of Services.
a. KFHPWA may determine to withdraw from a Service Area or from a segment of its Service Area after
KFHPWA has demonstrated to the Washington State Office of the Insurance Commissioner that
KFHPWA
exceeded.
b. KFHPWA may determine to eplace the plan with another plan
offered to all covered Members within that line of business that includes all of the health care services
covered under the replaced plan and does not significantly limit access to the services covered under the
replaced plan. KFHPWA may also allow unrestricted conversion to a fully comparable KFHPWA product.
KFHPWA will provide written notice to each covered Member of the discontinuation or non-renewal of the
plan at least 90 days prior to discontinuation.
15. Limitation on Enrollment.
The Group Agreement will be open for applications for enrollment as described in the group master application.
Subject to prior approval by the Washington State Office of the Insurance Commissioner, KFHPWA may limit
enrollment, establish quotas or set priorities for acceptance of new applications if it determines that KFHPWA
capacity, in relation to its total enrollment, is not adequate to provide services to additional persons.
16.!Acceptance of Group Agreement
The Group agrees as having accepted the terms and conditions of this Group Agreement and any amendments
issued during the term of this Group Agreement, upon receipt by KFHPWA of any amount of premium
payment.
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Your
Kaiser Foundation Health Plan of
Washington
Evidence of Coverage
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Kaiser Foundation Health Plan of Washington
A nonprofit health maintenance organization
2021 Evidence of Coverage
CA-1888a21
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Important Notice Under Federal Health Care Reform
Kaiser Foundation Health Plan of Washington ( recommends each Member choose a Network Personal
Physician. This decision is important since the designated Network Personal Physician provides or arranges for
Network Personal Physician who
participates in one of the KFHPWA s family
members. For information on how to select a Network Personal Physician, and for a list of the participating
Network Personal Physicians, please call Kaiser Permanente Member Services at (206) 630-4636 in the Seattle area,
or toll-free in Washington, 1-888-901-4636.
For children, the Member may designate a pediatrician as the primary care provider.
The Member does not need Preauthorization from KFHPWA or from any other person (including a Network
Personal Physician) to access obstetrical or gynecological care from a health care professional in the KFHPWA
network who specializes in obstetrics or gynecology. The health care professional, however, may be required to
comply with certain procedures, including obtaining Preauthorization for certain services, following a pre-approved
treatment plan, or procedures for obtaining Preauthorization. For a list of participating health care professionals
who specialize in obstetrics or gynecology, please call Kaiser Permanente Member Services at (206) 630-4636 in the
Seattle area, or toll-free in Washington, 1-888-901-4636.
If the Member is receiving benefits for a covered mastectomy and elects breast reconstruction in connection with the
mastectomy, the Member will also receive coverage for:
All stages of reconstruction of the breast on which the mastectomy has been performed.
Surgery and reconstruction of the other breast to produce a symmetrical appearance.
Prostheses.
Treatment of physical complications of all stages of mastectomy, including lymphedemas.
These services will be provided in consultation with the Member and the attending physician and will be subject to
the same Cost Shares otherwise applicable under the Evidence of Coverage (EOC).
Statement of Rights
Carriers offering group health coverage generally may not, under federal law, restrict benefits for any hospital length
of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal
delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the
newborn
earlier than 48 hours (or 96 hours as applicable). In any case, carriers may not, under federal law, require that a
provider obtain authorization from the carrier for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Also, under federal law, a carrier may not set the level of benefits or out-of-pocket costs so that any later portion of
the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion
of the stay.
For More Information
KFHPWA will provide the information regarding the types of plans offered by KFHPWA to Members on request.
Please call Kaiser Permanente Member Services at (206) 630-4636 in the Seattle area, or toll-free in Washington, 1-
888-901-4636.
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Table of Contents
I. Introduction ................................................................................................................................................... 6
II. How Covered Services Work ........................................................................................................................ 6
A. Accessing Care. ........................................................................................................................................ 6
B. Administration of the EOC. ..................................................................................................................... 8
C. Confidentiality.......................................................................................................................................... 8
D. Modification of the EOC. ......................................................................................................................... 8
E. Nondiscrimination. ................................................................................................................................... 8
F. Preauthorization. ...................................................................................................................................... 9
G. Recommended Treatment. ....................................................................................................................... 9
H. Second Opinions. ..................................................................................................................................... 9
I. Unusual Circumstances. ........................................................................................................................... 9
J. Utilization Management. .......................................................................................................................... 9
III. Financial Responsibilities ........................................................................................................................... 10
A. Premium. ................................................................................................................................................ 10
B. Financial Responsibilities for Covered Services. ................................................................................... 10
C. Financial Responsibilities for Non-Covered Services. ........................................................................... 10
IV. Benefits Details ............................................................................................................................................ 11
Annual Deductible ......................................................................................................................................... 11
Coinsurance ................................................................................................................................................... 11
Lifetime Maximum ....................................................................................................................................... 11
Out-of-pocket Limit ...................................................................................................................................... 11
Pre-existing Condition Waiting Period ......................................................................................................... 11
Acupuncture .................................................................................................................................................. 12
Allergy Services ............................................................................................................................................ 12
Ambulance .................................................................................................................................................... 12
Cardiac Rehabilitation ................................................................................................................................... 12
Cancer Screening and Diagnostic Services ................................................................................................... 12
Circumcision ................................................................................................................................................. 13
Clinical Trials ................................................................................................................................................ 13
Dental Services and Dental Anesthesia ......................................................................................................... 13
Devices, Equipment and Supplies (for home use) ......................................................................................... 14
Diabetic Education, Equipment and Pharmacy Supplies .............................................................................. 15
Dialysis (Home and Outpatient) .................................................................................................................... 15
Drugs - Outpatient Prescription ..................................................................................................................... 16
Emergency Services ...................................................................................................................................... 18
Hearing Examinations and Hearing Aids ...................................................................................................... 19
Home Health Care ......................................................................................................................................... 19
Hospice .......................................................................................................................................................... 20
Hospital - Inpatient and Outpatient ............................................................................................................... 21
Infertility (including sterility) ........................................................................................................................ 22
Infusion Therapy ........................................................................................................................................... 22
Laboratory and Radiology ............................................................................................................................. 22
Manipulative Therapy ................................................................................................................................... 23
Maternity and Pregnancy ............................................................................................................................... 23
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Mental Health and Wellness .......................................................................................................................... 23
Naturopathy ................................................................................................................................................... 25
Newborn Services ......................................................................................................................................... 25
Nutritional Counseling .................................................................................................................................. 25
Nutritional Therapy ....................................................................................................................................... 26
Obesity Related Services ............................................................................................................................... 26
On the Job Injuries or Illnesses ..................................................................................................................... 26
Oncology ....................................................................................................................................................... 27
Optical (vision) .............................................................................................................................................. 27
Oral Surgery .................................................................................................................................................. 28
Outpatient Services ....................................................................................................................................... 28
Plastic and Reconstructive Surgery ............................................................................................................... 28
Podiatry ......................................................................................................................................................... 29
Preventive Services ....................................................................................................................................... 29
Rehabilitation and Habilitative Care (massage, occupational, physical and speech therapy) and
Neurodevelopmental Therapy ................................................................................................................ 30
Reproductive Health ...................................................................................................................................... 31
Sexual Dysfunction ....................................................................................................................................... 31
Skilled Nursing Facility................................................................................................................................. 31
Sterilization ................................................................................................................................................... 32
Substance Use Disorder................................................................................................................................. 32
Telehealth Services ....................................................................................................................................... 33
Temporomandibular Joint (TMJ) .................................................................................................................. 34
Tobacco Cessation ......................................................................................................................................... 34
Transgender Services .................................................................................................................................... 35
Transplants .................................................................................................................................................... 35
Urgent Care ................................................................................................................................................... 36
V. General Exclusions ...................................................................................................................................... 36
VI. Eligibility, Enrollment and Termination ................................................................................................... 38
A. Eligibility. .............................................................................................................................................. 38
B. Application for Enrollment. ................................................................................................................... 38
C. When Coverage Begins. ......................................................................................................................... 40
D. Eligibility for Medicare. ......................................................................................................................... 40
E. Termination of Coverage. ...................................................................................................................... 40
F. Continuation of Inpatient Services. ........................................................................................................ 41
G. Continuation of Coverage Options. ........................................................................................................ 41
VII. Grievances .................................................................................................................................................... 42
VIII. Appeals ......................................................................................................................................................... 43
IX. Claims ........................................................................................................................................................... 44
X. Coordination of Benefits ............................................................................................................................. 45
Definitions. .................................................................................................................................................... 45
Order of Benefit Determination Rules........................................................................................................... 47
Effect on the Benefits of this Plan. ................................................................................................................ 48
Right to Receive and Release Needed Information. ...................................................................................... 48
Facility of Payment. ...................................................................................................................................... 49
Right of Recovery. ........................................................................................................................................ 49
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Effect of Medicare. ........................................................................................................................................ 49
XI. Subrogation and Reimbursement Rights .................................................................................................. 49
XII. Definitions .................................................................................................................................................... 51
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KFHPWA believes this under the Patient Protection and Affordable Care Act
of 2010. Questions regarding this status may be directed to Kaiser Permanente Member Services at toll-free 1-888-
901-4636. Members may also contact the Employee Benefits Security Administration, U.S. Department of Labor at
toll-free 1-866-444-3272 or www.dol.gov/ebsa/healthreform.
I.!Introduction
This EOC is a statement of benefits, exclusions and other provisions as set forth in the Group Medical Coverage
Agreement between Kaiser Foundation Health Plan of Washington KFHPWAand the Group. The benefits were
approved by the Group who contracts with KFHPWA for health care coverage. This EOC is not the Group medical
coverage agreement itself. In the event of a conflict between the Group Medical Coverage Agreement and the EOC,
the EOC language will govern.
The provisions of the EOC must be considered together to fully understand the benefits available under the EOC.
Words with special meaning are capitalized and are defined in Section XII.
Contact Kaiser Permanente Member Services at 206-630-4636 or toll-free 1-888-901-4636 for benefits questions.
II.!How Covered Services Work
A.!Accessing Care.
1.!Members are entitled to Covered Services from the following:
Your Provider Network is KFH Core Network (Network). Members are entitled to Covered
Services only at Network Facilities and Network Providers, except for Emergency services and care
pursuant to a Preauthorization.
Benefits under this EOC will not be denied for any health care service performed by a registered nurse
licensed to practice under chapter 18.88 RCW, if first, the service performed was within the lawful scope of
such nurs license, and second, this EOC would have provided benefit if such service had been performed
by a doctor of medicine licensed to practice under chapter 18.71 RCW.
A listing of Core Network Pes and KFHPWA-
designated Specialists is available by contacting Member Services or accessing the KFHPWA website at
www.kp.org/wa.
Receiving Care in another Kaiser Foundation Health Plan Service Area
If you are visiting in the service area of another Kaiser Permanente region, visiting member services may
be available from designated providers in that region if the services would have been covered under this
EOC. Visiting member services are subject to the provisions set forth in this EOC including, but not limited
to, Preauthorization and cost sharing. For more information about receiving visiting member services in
other Kaiser Permanente regional health plan service areas, including provider and facility locations, please
call Kaiser Permanente Member Services at (206) 630-4636 in the Seattle area, or toll-free in Washington,
1-888-901-4636. Information is also available online at
www.wa.kaiserpermanente.org/html/public/services/traveling.
KFHPWA will not directly or indirectly prohibit Members from freely contracting at any time to obtain
health care services from Non-Network Providers and Non-Network Facilities outside the Plan. However,
if you choose to receive services from Non-Network Providers and Non-Network Facilities except as
otherwise specifically provided in this EOC, those services will not be covered under this EOC and you
will be responsible for the full price of the services. Any amounts you pay for non-covered services will not
count toward your Out-of-Pocket Limit.
2.!Primary Care Provider Services.
KFHPWA recommends that Members select a Network Personal Physician when enrolling. One personal
physician may be selected for an entire family, or a different personal physician may be selected for each
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family member. For information on how to select or change Network Personal Physicians, and for a list of
participating personal physicians, call Kaiser Permanente Member Services at (206) 630-4636 in the Seattle
area, or toll-free in Washington at 1-888-901-4636 or by accessing the KFHPWA website at
www.kp.org/wa. The change will be made within 24 hours of the receipt of the request if the selected
phy If a personal physician accepting new Members is not available in your area,
contact Kaiser Permanente Member Services, who will ensure you have access to a personal physician by
accept new Members.
In the case that the ersonal physician no longer participates in KFHPWA network, the
Member will be provided access to the personal physician for up to 60 days following a written notice
offering the Member a selection of new personal physicians from which to choose.
3.!Specialty Care Provider Services.
Unless otherwise indicated in Section II. or Section IV., Preauthorization is required for specialty care and
specialists that are not KFHPWA-designated Specialists and are not providing care at facilities owned and
operated by Kaiser Permanente.
KFHPWA-designated Specialist.
Preauthorization is not required for services with KFHPWA-designated Specialists at facilities owned and
operated by Kaiser Permanente. To access a KFHPWA-designated Specialist, consult your KFHPWA
personal physician. For a list of KFHPWA-designated Specialists, contact Member Services or view the
Provider Directory located at www.kp.org/wa. The following specialty care areas are available from
KFHPWA-designated Specialists: allergy, audiology, cardiology, chiropractic/manipulative therapy,
dermatology, gastroenterology, general surgery, hospice, mental health and wellness, nephrology,
neurology, obstetrics and gynecology, occupational medicine, oncology/hematology, ophthalmology,
optometry, orthopedics, otolaryngology (ear, nose and throat), physical therapy, smoking cessation,
speech/language and learning services, substance use disorder and urology.
4.!Hospital Services.
Non-Emergency inpatient hospital services require Preauthorization. Refer to Section IV. for more
information about hospital services.
5.!Emergency Services.
Emergency services at a Network Facility or non-Network Facility are covered. Members must notify
KFHPWA by way of the Hospital notification line (1-888-457-9516 as noted on your Member
identification card) within 24 hours of any admission, or as soon thereafter as medically possible. Coverage
for Emergency services at a non-Network Facility is limited to the Allowed Amount. Refer to Section IV.
for more information about Emergency services.
6.!Urgent Care.
Inside the KFHPWA Service Area, urgent care is covered at a Kaiser Permanente medical center, Kaiser
Permanente urgent care center or Network ProvideKFHPWA Service Area, urgent
care is covered at any medical facility. Refer to Section IV. for more information about urgent care.
7.!
Female Members may see a general and family practitioner, passistant, gynecologist, certified
nurse midwife, licensed midwife, doctor of osteopathy, pediatrician, obstetrician or advance registered
nurse practitioner who is unrestricted in your KFHPWA Network are services
directly, without Preauthorization, for Medically Necessary maternity care, covered reproductive health
services, preventive services (well care) and general examinations, gynecological care and follow-up visits
for the above services. W health care serNetwork Personal
Physician had been consulted, subject to any applicable Co
provider diagnoses a condition that requires other specialists or hospitalization, the Member or the chosen
provider must obtain Preauthorization in accordance with applicable KFHPWA requirements. For a list of
KFHPWA providers, contact Member Services or view the Provider Directory located at www.kp.org/wa.
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8.!Process for Medical Necessity Determination.
Pre-service, concurrent or post-service reviews may be conducted. Once a service has been reviewed,
additional reviews may be conducted. Members will be notified in writing when a determination has been
made.
First Level Review:
First level reviews are performed or overseen by appropriate clinical staff using KFHPWA approved
clinical review criteria. Data sources for the review include, but are not limited to, referral forms, admission
request forms, the s medical record, and consultation with the attending/referring physician and
multidisciplinary health care team. The clinical information used in the review may include treatment
summaries, problem lists, specialty evaluations, laboratory and x-ray results, and rehabilitation service
documentation. The Member or legal surrogate may be contacted for information. Coordination of care
interventions are initiated as they are identified. The reviewer consults with the requesting physician when
more clarity is needed to make an informed medical necessity decision. The reviewer may consult with a
board-certified consultative specialist and such consultations will be documented in the review text. If the
requested service appears to be inappropriate based on application of the review criteria, the first level
reviewer requests second level review by a physician or designated health care professional.
Second Level (Practitioner) Review:
The practitioner reviews the treatment plan and discusses, when appropriate, case circumstances and
management options with the attending (or referring) physician. The reviewer consults with the requesting
physician when more clarity is needed to make an informed coverage decision. The reviewer may consult
with board certified physicians from appropriate specialty areas to assist in making determinations of
coverage and/or appropriateness. All such consultations will be documented in the review text. If the
reviewer determines that the admission, continued stay or service requested is not a covered service, a
notice of non-coverage is issued. Only a physician, behavioral health practitioner (such as a psychiatrist,
doctoral-level clinical psychologist, certified addiction medicine specialist), dentist or pharmacist who has
the clinical expertise appropriate to the request under review with an unrestricted license may deny
coverage based on Medical Necessity.
B.!Administration of the EOC.
KFHPWA may adopt reasonable policies and procedures to administer the EOC. This may include, but is not
limited to, policies or procedures pertaining to benefit entitlement and coverage determinations.
C.!Confidentiality.
KFHPWA is required by federal and state law to maintain the privacy of Member personal and health
information. KFHPWA is required to provide notice of how KFHPWA may use and disclose personal and
health information held by KFHPWA. The Notice of Privacy Practices is distributed to Members and is
available in Kaiser Permanente medical centers, at www.kp.org/wa, or upon request from Member Services.
D.!Modification of the EOC.
No oral statement of any person shall modify or otherwise affect the benefits, limitations and exclusions of the
EOC, convey or void any coverage, increase or reduce any benefits under the EOC or be used in the prosecution
or defense of a claim under the EOC.
E.!Nondiscrimination.
KFHPWA does not discriminate on the basis of physical or mental disabilities in its employment practices and
services. KFHPWA will not refuse to enroll or terminate a Meme on the basis of age, sex, sexual
orientation, gender identity, race, color, religion, national origin, citizenship or immigration status, veteran or
military status, occupation or health status.
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F.!Preauthorization.
Refer to Section IV. for information regarding which services KFHPWA requires Preauthorization. Failure to
obtain Preauthorization when required may result in denial of coverage for those services; and the member may
be responsible for the cost of these non-Covered services. Members may contact Member Services to request
Preauthorization.
Preauthorization requests are reviewed and approved based on Medical Necessity, eligibility and benefits.
KFHPWA will generally process Preauthorization requests and provide notification for benefits within the
following timeframes:
Standard requests within 5 calendar days
o If insufficient information has been provided a request for additional information will be made within
5 calendar days. The provider or facility has 5 calendar days to provide the necessary information. A
decision will be made within 4 calendar days of receipt of the information or the deadline for receipt of
the requested information.
Expedited requests within 2 calendar days
o If insufficient information has been provided a request for additional information will be made within
1 calendar day. The provider or facility has 2 calendar days to provide the necessary information. A
decision will be made within 2 calendar days of receipt of the information or the deadline for receipt of
the requested information.
G.!Recommended Treatment.
KFHPWAdirector will determine the necessity, nature and extent of treatment to be covered in each
individual case and the judgment will be made in good faith. Members have the right to appeal coverage
decisions (see Section VIII.). Members have the right to participate in decisions regarding their health care. A
Member may refuse any recommended services to the extent permitted by law. Members who obtain care not
recommended by KFHPWAr do so with the full understanding that KFHPWA has no
obligation for the cost, or liability for the outcome, of such care.
H.!Second Opinions.
The Member may access a second opinion from a Network Provider regarding a medical diagnosis or treatment
plan. The Member may request Preauthorization or may visit a KFHPWA-designated Specialist for a second
opinion. When requested or indicated, second opinions are provided by Network Providers and are covered with
Preauthorization, or when obtained from a KFHPWA-designated Specialist. Coverage is determined by the
Member's EOC; therefore, coverage for the second opinion does not imply that the services or treatments
recommended will be covered. Preauthorization for a second opinion does not imply that KFHPWA will
authorize the Member to return to the physician providing the second opinion for any additional treatment.
Services, drugs and devices prescribed or recommended as a result of the consultation are not covered unless
included as covered under the EOC.
I.!Unusual Circumstances.
In the event of unusual circumstances such as a major disaster, epidemic, military action, civil disorder, labor
disputes or similar causes, KFHPWA will not be liable for administering coverage beyond the limitations of
available personnel and facilities.
In the event of unusual circumstances such as those described above, KFHPWA will make a good faith effort to
arrange for Covered Services through available Network Facilities and personnel. KFHPWA shall have no other
liability or obligation if Covered Services are delayed or unavailable due to unusual circumstances.
J.!Utilization Management.
Case management means a care management plan developed for a Member whose diagnosis requires timely
coordination. All benefits, including travel and lodging, are limited to Covered Services that are Medically
Necessary and set forth in the EOC. KFHPWA may review a Member's medical records for the purpose of
verifying delivery and coverage of services and items. Based on a prospective, concurrent or retrospective
review, KFHPWA may deny coverage if, in its determination, such services are not Medically Necessary. Such
determination shall be based on established clinical criteria and may require Preauthorization.
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KFHPWA will not deny coverage retroactively for services with Preauthorization and which have already been
provided to the Member except in the case of an intentional misrepresentation of a material fact by the patient,
Member, or provider of services, or if coverage was obtained based on inaccurate, false, or misleading
information provided on the enrollment application, or for nonpayment of premiums.
III.!Financial Responsibilities
A.!Premium.
The Subscriber is liable for payment to the Group of their contribution toward the monthly premium, if any.
B.!Financial Responsibilities for Covered Services.
The Subscriber is liable for payment of the following Cost Shares for Covered Services provided to the
Subscriber and their Dependents. Payment of an amount billed must be received within 30 days of the billing
date. Charges will be for the lesser of the Cost Shares for the Covered Service or the actual charge for that
service. Cost Shares will not exceed the actual charge for that service.
1.!Annual Deductible.
Covered Services may be subject to an annual Deductible. Charges subject to the annual Deductible shall
be borne by the Subscriber during each year until the annual Deductible is met. Covered Services must be
received from a Network Provider at a Network Facility, unless the Member has received Preauthorization
or has received Emergency services.
There is an individual annual Deductible amount for each Member and a maximum annual Deductible
amount for each Family Unit. Once the annual Deductible amount is reached for a Family Unit in a
calendar year, the individual annual Deductibles are also deemed reached for each Member during that
same calendar year.
Individual Annual Deductible Carryover. Under this EOC, charges from the last 3 months of the prior
year which were applied toward the individual annual Deductible will also apply to the current year
individual annual Deductible. The individual annual Deductible carryover will apply only when expenses
incurred have been paid in full. The Family Unit Deductible does not carry over into the next year.
2.!Plan Coinsurance.
After the applicable annual Deductible is satisfied, Members may be required to pay Plan Coinsurance for
Covered Services.
3.!Copayments.
Members shall be required to pay applicable Copayments at the time of service. Payment of a Copayment
does not exclude the possibility of an additional billing if the service is determined to be a non-Covered
Service or if other Cost Shares apply.
4.!Out-of-pocket Limit.
Out-of-pocket Expenses which apply toward the Out-of-pocket Limit are set forth in Section IV. Total Out-
of-pocket Expenses incurred during the same calendar year shall not exceed the Out-of-pocket Limit.
C.!Financial Responsibilities for Non-Covered Services.
The cost of non-Covered Services and supplies is the responsibility of the Member. The Subscriber is liable for
payment of any fees charged for non-Covered Services provided to the Subscriber and their Dependents at the
time of service. Payment of an amount billed must be received within 30 days of the billing date.
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IV.!Benefits Details
Benefits are subject to all provisions of the EOC. Members are entitled only to receive benefits and services that are
Medically Necessary and clinically appropriate for the treatment of a Medical Condition as determined by
KFHPWAmedical director and as described herein. All Covered Services are subject to case management and
utilization management.
Annual Deductible Member pays $0 per Member per calendar year or $0 per Family Unit per calendar year
Coinsurance Plan Coinsurance: Member pays nothing
Lifetime Maximum No lifetime maximum on covered Essential Health Benefits
Out-of-pocket Limit Limited to a maximum of $2,000 per Member or $4,000 per Family Unit per calendar year
The following Out-of-pocket Expenses apply to the Out-of-pocket Limit: Ambulance
coinsurance/Copayment, diagnostic laboratory and radiology Copayment, Emergency
services Copayment, hospital inpatient Copayment, hospital outpatient Copayment,
outpatient services Copayment, oral chemotherapy Copayment
The following expenses do not apply to the Out-of-pocket Limit: Benefit-specific
coinsurances, prescription drug Copayment, premiums, charges for services in excess of a
benefit, charges in excess of Allowed Amount, charges for non-Covered Services
Pre-existing Condition No pre-existing condition waiting period
Waiting Period
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Acupuncture
Member pays $10 Copayment
Acupuncture needle treatment.
Limited to 8 visits per medical diagnosis per calendar year
without Preauthorization. Additional visits are covered with
Preauthorization.
No visit limit for treatment for Substance Use Disorder.
Exclusions: Herbal supplements; any services not within the scope
Allergy Services
Allergy testing. Member pays $10 Copayment
Allergy serum and injections. Member pays $10 Copayment
Ambulance
Emergency ground or air transport to any facility. Member pays 20% ambulance coinsurance
Non-Emergency ground or air interfacility transfer to or from Member pays 20% ambulance coinsurance
a Network Facility when Preauthorized by KFHPWA.
Contact Member Services for Preauthorization. Hospital-to-hospital ground transfers: No charge;
Member pays nothing
Cardiac Rehabilitation
Cardiac rehabilitation is covered up to a total of 36 visits per Member pays $10 Copayment
cardiac event when clinical criteria is met.
Preauthorization is required after initial visit.
Cancer Screening and Diagnostic Services
Routine cancer screening covered as Preventive Services in Member pays $10 Copayment
accordance with the well care schedule established by
KFHPWA and the Patient Protection and Affordable Care Act
of 2010. The well care schedule is available in Kaiser
Permanente medical centers, at www.kp.org/wa, or upon
request from Member Services. See Preventive Services for
additional information.
Diagnostic laboratory and diagnostic services for cancer. See No charge; Member pays nothing
Diagnostic Laboratory and Radiology Services for additional
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information. Preventive laboratory/radiology services are
covered as Preventive Services.
Circumcision
Circumcision. Hospital - Inpatient: No charge; Member pays
nothing
Non-Emergency inpatient hospital services require
Preauthorization. Hospital - Outpatient: Member pays $10
Copayment
Outpatient Services: Member pays $10 Copayment
Clinical Trials
Notwithstanding any other provision of this document, the Hospital - Inpatient:
Plan provides benefits for Routine Patient Costs of qualified No charge; Member pays nothing
individuals in approved clinical trials, to the extent benefits
for these costs are required by federal and state law. Hospital - Outpatient:
Member pays $10 Copayment
Routine patient costs include all items and services consistent
with the coverage provided in the plan (or coverage) that is Outpatient Services:
typically covered for a qualified individual who is not Member pays $10 Copayment
enrolled in a clinical trial.
Clinical trials are a phase I, phase II, phase III, or phase IV
clinical trial that is conducted in relation to the prevention,
detection, or treatment of cancer or other life-threatening
disease or condition from which the likelihood of death is
probable unless the course of the disease or condition is
interrupted.
Clinical trials require Preauthorization.
Exclusions: Routine patient costs do not include: (i) the investigational item, device, or service, itself; (ii) items and
services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical
management of the patient; or (iii) a service that is clearly inconsistent with widely accepted and established standards
of care for a particular diagnosis
Dental Services and Dental Anesthesia
Dental services including accidental injury to natural teeth. Not covered; Member pays 100% of all charges
Dental services in preparation for treatment including but not Hospital - Inpatient: No charge; Member pays
limited to: chemotherapy, radiation therapy, and organ nothing
transplants. Dental services in preparation for treatment
require Preauthorization. Hospital - Outpatient: Member pays $10
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Copayment
Dental problems such as infections requiring emergency
treatment outside of standard business hours are covered as Outpatient Services: Member pays $10 Copayment
Emergency Services.
Hospital - Inpatient: No charge; Member pays
General anesthesia services and related facility charges for
nothing
dental procedures for Members who are under 7 years of age
or are physically or developmentally disabled or have a
Hospital - Outpatient: Member pays $10
Copayment
at risk if the d
office.
General anesthesia services for dental procedures require
Preauthorization.
Exclusions:
accidental injury to natural teeth, reconstructive surgery to the jaw in preparation for dental implants, dental implants,
periodontal surgery; any other dental service not specifically listed as covered
Devices, Equipment and Supplies (for home use)
Member pays 20% coinsurance
Durable medical equipment: Equipment which can
withstand repeated use, is primarily and customarily used
to serve a medical purpose, is useful only in the presence
Annual Deductible does not apply to glucose
Durable medical equipment includes hospital beds,
monitors, test strips, lancets or control solutions.
wheelchairs, walkers, crutches, canes, blood glucose
monitors, external insulin pumps (including related
supplies such as tubing, syringe cartridges, cannulae and
inserters), oxygen and oxygen equipment, and
therapeutic shoes, modifications and shoe inserts for
severe diabetic foot disease. KFHPWA will determine if
equipment is made available on a rental or purchase
basis.
Orthopedic appliances: Items attached to an impaired
body segment for the purpose of protecting the segment
or assisting in restoration or improvement of its function.
Ostomy supplies: Supplies for the removal of bodily
secretions or waste through an artificial opening.
Post-mastectomy bras/forms, limited to 2 every 6
months. Replacements within this 6-month period are
covered when Medically Necessary due to a change in
Prosthetic devices: Items which replace all or part of an
external body part, or function thereof.
Sales tax for devices, equipment and supplies.
When provided in lieu of hospitalization, benefits will be the
greater of benefits available for devices, equipment and
supplies, home health or hospitalization. See Hospice for
durable medical equipment provided in a hospice setting.
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Devices, equipment and supplies including repair, adjustment
or replacement of appliances and equipment require
Preauthorization.
Exclusions: Arch supports, including custom shoe modifications or inserts and their fittings not related to the
treatment of diabetes; orthopedic shoes that are not attached to an appliance; wigs/hair prosthesis; take-home
dressings and supplies following hospitalization; supplies, dressings, appliances, devices or services not specifically
listed as covered above; same as or similar equipment already in the Me
to loss, theft, breakage from willful damage, neglect or wrongful use, or due to personal preference; structural
rsonal vehicle
Diabetic Education, Equipment and Pharmacy Supplies
Diabetic education and training. Member pays $10 Copayment
Diabetic equipment: Blood glucose monitors and external Member pays 20% coinsurance
insulin pumps (including related supplies such as tubing,
syringe cartridges, cannulae and inserters), and therapeutic Annual Deductible does not apply to glucose
shoes, modifications and shoe inserts for severe diabetic foot monitors, test strips, lancets or control solutions.
disease. See Devices, Equipment and Supplies for additional
information.
Diabetic pharmacy supplies: Insulin, lancets, lancet devices,
Preferred generic drugs (Tier 1): Member pays
needles, insulin syringes, insulin pens, pen needles, glucagon
$10 Copayment per 30-days up to a 90-day supply
emergency kits, prescriptive oral agents and blood glucose
test strips for a supply of 30 days or less per item. Certain
Preferred brand name drugs (Tier 2): Member
brand name insulin drugs will be covered at the generic level.
pays $10 Copayment per 30-days up to a 90-day
See Drugs Outpatient Prescription for additional pharmacy
supply
information.
Non-Preferred generic and brand name drugs
(Tier 3): Not covered; Member pays 100% of all
charges
Annual Deductible does not apply to glucose
monitors, test strips, lancets or control solutions.
Note: A Member will not pay more than $100 for a
30-day supply of insulin to comply with state law
requirements.
Diabetic retinal screening. No charge; Member pays nothing
Dialysis (Home and Outpatient)
Dialysis in an outpatient or home setting is covered for Outpatient Services: Member pays $10 Copayment
Members with acute kidney failure or end-stage renal disease
(ESRD).
Dialysis requires Preauthorization.
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Injections administered by a Network Provider in a clinical Outpatient Services: Member pays $10 Copayment
setting during dialysis.
Self-administered injectables. See Drugs Outpatient
Preferred generic drugs (Tier 1): Member pays
Prescription for additional pharmacy information.
$10 Copayment per 30-days up to a 90-day supply
Preferred brand name drugs (Tier 2): Member
pays $10 Copayment per 30-days up to a 90-day
supply
Non-Preferred generic and brand name drugs
(Tier 3): Not covered; Member pays 100% of all
charges
Drugs - Outpatient Prescription
Prescription drugs, supplies and devices for a supply of 30
Preferred generic drugs (Tier 1): Member pays
days or less including diabetic pharmacy supplies (insulin,
$10 Copayment per 30-days up to a 90-day supply
lancets, lancet devices, needles, insulin syringes, insulin pens,
pen needles and blood glucose test strips), mental health and
Preferred brand name drugs (Tier 2): Member
wellness drugs, self-administered injectables medications for
pays $10 Copayment per 30-days up to a 90-day
the treatment arising from sexual assault, and routine costs for
supply
prescription medications provided in a clinicaRoutine
e Member that
Non-Preferred generic and brand name drugs
are consistent with and typically covered by the plan or
(Tier 3): Not covered; Member pays 100% of all
coverage for a Member who is not enrolled in a clinical trial.
charges
All drugs, supplies and devices must be for Covered Services.
All drugs, supplies and devices must be obtained at a
Annual Deductible does not apply to glucose
KFHPWA-designated pharmacy except for drugs dispensed
monitors, test strips, lancets or control solutions.
for Emergency services or for Emergency services obtained
outside of the KFHPWA Service Area, including out of the
Note: A Member will not pay more than $100 for a
country. Information regarding KFHPWA-designated
30-day supply of insulin to comply with state law
pharmacies is reflected in the KFHPWA Provider Directory
requirements
or can be obtained by contacting Kaiser Permanente Member
Services.
Prescription drug Cost Shares are payable at the time of
delivery. Certain brand name insulin drugs are covered at the
generic drug Cost Share.
Members may be eligible to receive an emergency fill for
certain prescription drugs filled outside of KFHPWA
business hours or when KFHPWA cannot reach the prescriber
for consultation. For emergency fills, Members pay the
prescription drug Cost Share for each 7-day supply or less, or
the minimum packaging size available at the time the
emergency fill is dispensed. A list of prescription drugs
eligible for emergency fills is available on the pharmacy
website at www.kp.org/wa/formulary. Members can request
an emergency fill by calling 1-855-505-8107.
Certain drugs are subject to Preauthorization as shown in the
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Preferred drug list (formulary) available at
www.kp.org/wa/formulary.
Injections administered by a Network Provider in a clinical Member pays $10 Copayment
setting.
Over-the-counter drugs not included under Reproductive Not covered; Member pays 100% of all charges
Health
Mail order drugs dispensed through the KFHPWA-designated Member pays the prescription drug Cost Share for
mail order service. each 30 day supply or less
Annual Deductible does not apply to glucose
monitors, test strips, lancets or control solutions.
Note: A Member will not pay more than $100 for a
30-day supply of insulin to comply with state law
requirements. Any cost-sharing paid will apply to the
annual Deductible.
The KFHPWA Preferred drug list is a list of prescription drugs, supplies, and devices considered to have acceptable
efficacy, safety and cost-effectiveness. The Preferred drug list is maintained by a committee consisting of a group of
physicians, pharmacists and a consumer representative who review the scientific evidence of these products and
determine the Preferred and Non-Preferred status as well as utilization management requirements. Preferred drugs
generally have better scientific evidence for safety and effectiveness and are more affordable than Non-Preferred
drugs. The preferred drug list is available at www.kp.org/wa/formulary, or upon request from Member Services.
Members may request a coverage determination by contacting Member Services. Coverage determination reviews
may include requests to cover non-preferred drugs, obtain Preauthorization for a specific drug, or exceptions to other
utilization management requirements, such as quantity limits. If coverage of a non-Preferred drug is approved, the
drug will be covered at the Preferred drug level.
Prescription drugs are drugs which have been approved by the Food and Drug Administration (FDA) and which can,
under federal or state law, be dispensed only pursuant to a prescription order. These drugs, including off-label use of
FDA-approved drugs (provided that such use is documented to be effective in one of the standard reference
compendia; a majority of well-designed clinical trials published in peer-reviewed medical literature document
improved efficacy or safety of the agent over standard therapies, or over placebo if no standard therapies exist; or by
the federal secretary of Health and Human Services) are covered.
American Hospital Formulary Service Drug Information; the American Medical Association Drug Evaluation; the
United States Pharmacopoeia Drug Information, or other authoritative compendia as identified from time to time by
the federal secretary of Health and Human Services. -
printed in health care journals or other publications in which original manuscripts are published only after having been
critically reviewed for scientific accuracy, validity and reliability by unbiased independent experts. Peer-reviewed
medical literature does not include in-house publications of pharmaceutical manufacturing companies.
Generic drugs are dispensed whenever available. A generic drug is a drug that is the pharmaceutical equivalent to one
or more brand name drugs. Such generic drugs have been approved by the Food and Drug Administration as meeting
the same standards of safety, purity, strength and effectiveness as the brand name drug. Brand name drugs are
dispensed if there is not a generic equivalent. In the event the Member elects to purchase a brand-name drug instead of
the generic equivalent (if available), the Member is responsible for paying the difference in cost in addition to the
prescription drug Cost Share, which does not apply to the Out-of-pocket Limit.
Drug coverage is subject to utilization management that includes Preauthorization, step therapy (when a Member tries
a certain medication before receiving coverage for a similar, but non-Preferred medication), limits on drug quantity or
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days supply and prevention of overutilization, underutilization, therapeutic duplication, drug-drug interactions,
incorrect drug dosage, drug-allergy contraindications and clinical abuse/misuse of drugs. If a Member has a new
prescription for a chronic condition, the Member may request a coordination of medications so that medications for
chronic conditions are refilled on the same schedule (synchronized). Cost-shares for the initial fill of the medication
will be adjusted if the fill is less than the standard quantity. Please contact Member Services for more information.
Specialty drugs are high-cost drugs prescribed by a physician that requires close supervision and monitoring for
serious and/or complex conditions, such as rheumatoid arthritis, hepatitis or multiple sclerosis. Specialty drugs must
be obtained through KFHPWA specialty pharmacy vendor and/or network of specialty pharmacies and are
covered at the appropriate cost share above. For a list of specialty drugs or more information about KFHPWA
specialty pharmacy network, please go to the KFHPWA website at www.kp.org/wa/formulary or contact Member
Services at 206-630-4636 or toll-free at 1-888-901-4636.
State and federal laws establish standards to assure
coverage limitations. Members who would like more information about the drug coverage policies, or have a question
or concern about their pharmacy benefit, may contact KFHPWA at 206-630-4636 or toll-free 1-888-901-4636 or by
accessing the KFHPWA website at www.kp.org/wa.
Members who would like to know more about their rights under the law, or think any services received while enrolled
may not conform to the terms of the EOC, may contact the Washington State Office of Insurance Commissioner at
toll-free 1-800-562-6900. Members who have a concern about the pharmacists or pharmacies serving them may call
the Washington State Department of Health at toll-free 1-800-525-0127.
Prescription Drug Coverage and Medicare: This benefit, for purposes of Creditable Coverage, is actuarially equal
to or greater than the Medicare Part D prescription drug benefit. Members who are also eligible for Medicare Part D
can remain covered and will not be subject to Medicare-imposed late enrollment penalties should they decide to enroll
in a Medicare Part D plan at a later date; however, the Member could be subject to payment of higher Part D
premiums if the Member subsequently has a break in creditable coverage of 63 continuous days or longer before
enrolling in a Part D plan. A Member who discontinues coverage must meet eligibility requirements in order to re-
enroll.
Exclusions: Over-the-counter drugs, supplies and devices not requiring a prescription under state law or regulations;
drugs and injections for anticipated illness while traveling; drugs and injections for cosmetic purposes; vitamins,
including most prescription vitamins; replacement of lost, stolen, or damaged drugs or devices; administration of
excluded drugs and injectables; drugs used in the treatment of sexual dysfunction disorders; compounds which include
a non-FDA approved drug; growth hormones for idiopathic short stature without growth hormone deficiency;
prescription drugs/products available over-the-counter or have an over-the-counter alternative that is determined to be
therapeutically interchangeable.
Emergency Services
Emergency services at a Network Facility or non-Network Network Facility: Member pays $75 Copayment
Facility. See Section XII. for a definition of Emergency.
Non-Network Facility: Member pays $125
Emergency services include professional services, treatment Copayment
and supplies, facility costs, outpatient charges for patient
observation and medical screening exams required to stabilize
a patient.
Members must notify KFHPWA by way of the Hospital
notification line within 24 hours of any admission, or as soon
thereafter as medically possible.
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If a Member is admitted as an inpatient directly from an
emergency department, any Emergency services Copayment
is waived. Coverage is subject to the hospital services Cost
Share.
If two or more Members in the same Family Unit require
Emergency services as a result of the same accident, coverage
for all Members will be subject to only one Emergency
services Copayment.
If a Member is hospitalized in a non-Network Facility,
KFHPWA reserves the right to require transfer of the
Member to a Network Facility upon consultation between a
Network Provider and the attending physician. If the Member
refuses to transfer to a Network Facility or does not notify
KFHPWA within 24 hours following admission, all further
costs incurred during the hospitalization are the responsibility
of the Member.
Follow-up care which is a direct result of the Emergency must
be received from a Network Provider, unless Preauthorization
is obtained for such follow-up care from a non-Network
Provider.
Hearing Examinations and Hearing Aids
Hearing exams for hearing loss and evaluation are covered Hospital - Inpatient:
only when provided at KFHPWA-approved facilities. No charge; Member pays nothing
Cochlear implants or Bone Anchored Hearing Aids (BAHA) Hospital - Outpatient:
when in accordance with KFHPWA clinical criteria. Member pays $10 Copayment
Covered services for cochlear implants and BAHA include Outpatient Services:
diagnostic testing, pre-implant testing, implant surgery, post-Member pays $10 Copayment
implant follow-up, speech therapy, programming and
associated supplies (such as transmitter cable, and batteries).
Hearing aids including hearing aid examinations. Not covered; Member pays 100% of all charges
Exclusions: Programs or treatments for hearing loss or hearing care including, but not limited to, externally worn
hearing or surgically implanted hearing aids and the surgery and services necessary to implant them except as
described above; hearing screening tests required under Preventive Services
Home Health Care
Home health care when the following criteria are met: No charge; Member pays nothing
Except for patients receiving palliative care services, the
Member must be unable to leave home due to a health
problem or illness. Unwillingness to travel and/or arrange
for transportation does not constitute inability to leave the
home.
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The Member requires intermittent skilled home health
care, as described below.
KFHPWA
services are Medically Necessary and are most
Covered Services for home health care may include the
following when rendered pursuant to a KFHPWA-approved
home health care plan of treatment: nursing care; restorative
physical, occupational, respiratory and speech therapy;
durable medical equipment; medical social worker and
limited home health aide services.
Home health services are covered on an intermittent basis in
rendered because of a medically predictable recurring need
for skilled home health care.
means reasonable and necessary care for the treatment of an
illness or injury which requires the skill of a nurse or
therapist, based on the complexity of the service and the
condition of the patient and which is performed directly by an
appropriately licensed professional provider.
Home health care requires Preauthorization.
Exclusions: Private duty nursing; housekeeping or meal services; any care provided by or for a family member; any
other services rendered in the home which do not meet the definition of skilled home health care above
Hospice
Hospice care when provided by a licensed hospice care No charge; Member pays nothing
program. A hospice care program is a coordinated program of
home and inpatient care, available 24 hours a day. This
program uses an interdisciplinary team of personnel to
provide comfort and supportive services to a Member and any
family members who are caring for the member, who is
experiencing a life-threatening disease with a limited
prognosis. These services include acute, respite and home
care to meet the physical, psychosocial and special needs of
the Member and their family during the final stages of illness.
must certify that the Member is terminally ill and is eligible
for hospice services.
Inpatient Hospice Services. For short-term care, inpatient
hospice services are covered with Preauthorization.
Respite care is covered to provide continuous care of the
Member and allow temporary relief to family members from
the duties of caring for the Member for a maximum of 5
consecutive days per 3-month period of hospice care.
Other covered hospice services, when billed by a licensed
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hospice program, may include the following:
Inpatient and outpatient services and supplies for injury
and illness.
Semi-private room and board, except when a private
room is determined to be necessary.
Durable medical equipment when billed by a licensed
hospice care program.
Hospice care requires Preauthorization.
Exclusions: Private duty nursing; financial or legal counseling services; meal services; any services provided by
family members
Hospital - Inpatient and Outpatient
The following inpatient medical and surgical services are Hospital - Inpatient: No charge; Member pays
covered: nothing
Room and board, including private room when
Hospital - Outpatient: Member pays $10
prescribed, and general nursing services.
Copayment
Hospital services (including use of operating room,
anesthesia, oxygen, x-ray, laboratory and radiotherapy
services).
Drugs and medications administered during confinement.
Medical implants.
Acute chemical withdrawal (detoxification).
Outpatient hospital includes ambulatory surgical centers.
Alternative care arrangements may be covered as a cost-
effective alternative in lieu of otherwise covered Medically
Necessary hospitalization or other Medically Necessary
institutional care with the consent of the Member and
recommendation from the attending physician or licensed
health care provider. Alternative care arrangements in lieu of
covered hospital or other institutional care must be
determined to be appropriate and Medically Necessary based
Such care is covered
to the same extent the replaced Hospital Care is covered.
Alternative care arrangements require Preauthorization.
Members receiving the following nonscheduled services are
required to notify KFHPWA by way of the Hospital
notification line within 24 hours following any admission, or
as soon thereafter as medically possible: acute chemical
withdrawal (detoxification) services, Emergency psychiatric
services, Emergency services, labor and delivery and
inpatient admissions needed for treatment of Urgent
Conditions that cannot reasonably be delayed until
Preauthorization can be obtained.
Coverage for Emergency services in a non-Network Facility
and subsequent transfer to a Network Facility is set forth in
Emergency Services.
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Non-Emergency hospital services require Preauthorization.
Exclusions: Take home drugs, dressings and supplies following hospitalization; internally implanted insulin pumps,
artificial larynx and any other implantable device that have not been approved by KFHPWA
Infertility (including sterility)
General counseling and one consultation visit to diagnose Member pays $10 Copayment
infertility conditions.
Specific diagnostic services, treatment and prescription drugs. Not covered; Member pays 100% of all charges
Exclusions: Diagnostic testing and medical treatment of sterility and infertility regardless of origin or cause; all
charges and related services for donor materials; all forms of artificial intervention for any reason including artificial
insemination and in-vitro fertilization; prognostic (predictive) genetic testing for the detection of congenital and
heritable disorders; surrogacy
Infusion Therapy
Medically Necessary infusion therapy includes, but is not Member pays $10 Copayment
limited to:
Antibiotics.
Hydration.
Chemotherapy.
Pain management.
Associated infused medications. No charge; Member pays nothing
Laboratory and Radiology
Nuclear medicine, radiology, ultrasound and laboratory No charge; Member pays nothing
services, including high end radiology imaging services such
as CAT scan, MRI and PET which are subject to
Preauthorization except when associated with Emergency
services or inpatient services. Please contact Member
Services for any questions regarding these services.
Services received as part of an emergency visit are covered as
Emergency Services.
Preventive laboratory and radiology services are covered in
accordance with the well care schedule established by
KFHPWA and the Patient Protection and Affordable Care Act
of 2010. The well care schedule is available in Kaiser
Permanente medical centers, at www.kp.org/wa, or upon
request from Member Services.
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Manipulative Therapy
Member pays $10 Copayment
Exclusions: Supportive care rendered primarily to maintain the level of correction already achieved; care rendered
primarily for the convenience of the Member; care rendered on a non-acute, asymptomatic basis; charges for any other
services that do not meet KFHPWA clinical criteria as Medically Necessary
Maternity and Pregnancy
Maternity care and pregnancy services, including care for Hospital - Inpatient: No charge; Member pays
complications of pregnancy and prenatal and postpartum care nothing
are covered for all female Members including dependent
daughters. Hospital - Outpatient: Member pays $10
Copayment
Delivery and associated Hospital Care, including home births
and birthing centers. Home births are considered outpatient Outpatient Services: Member pays $10 Copayment
services.
Members must notify KFHPWA by way of the Hospital
notification line within 24 hours of any admission, or as soon
thereafter as medically possible. in
length of inpatient stay following delivery.
Prenatal testing for the detection of congenital and heritable
disorders when Medically Necessary as determined by
KFHPWAccordance with Board
of Health standards for screening and diagnostic tests during
pregnancy.
Termination of pregnancy. Hospital - Inpatient: No charge; Member pays
nothing
Non-Emergency inpatient hospital services require
Preauthorization. Hospital - Outpatient: Member pays $10
Copayment
Outpatient Services: Member pays $10 Copayment
Exclusions: Birthing tubs; genetic testing of non-Members; fetal ultrasound in the absence of medical indications
Mental Health and Wellness
Mental health and wellness services provided at the most Hospital - Inpatient: No charge; Member pays
clinically appropriate and Medically Necessary level of nothing
mental health care intervention as determined by KFHPWA
medical director. Treatment may utilize psychiatric, Hospital - Outpatient: Member pays $10
psychological and/or psychotherapy services to achieve these Copayment
objectives.
Outpatient Services: Member pays $10 Copayment
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Mental health and wellness services including medical
management and prescriptions are covered the same as for Group Visits: No charge; Member pays nothing
any other condition.
Applied behavioral analysis (ABA) therapy, limited to
outpatient treatment of an autism spectrum disorder or, has a
developmental disability for which there is evidence that
ABA therapy is effective, as diagnosed and prescribed by a
neurologist, pediatric neurologist, developmental pediatrician,
psychologist or psychiatrist experienced in the diagnosis and
treatment of autism. Documented diagnostic assessments,
individualized treatment plans and progress evaluations are
required.
Services for any involuntary court-ordered treatment program
shall be covered only if determined to be Medically
Necessary by KFHPWAServices
provided under involuntary commitment statutes are covered.
If a Member is admitted as an inpatient directly from an
emergency department, any Emergency services Copayment
is waived. Coverage is subject to the hospital services Cost
Share. Coverage for services incurred at non-Network
Facilities shall exclude any charges that would otherwise be
excluded for hospitalization within a Network Facility.
Members must notify KFHPWA by way of the Hospital
notification line within 24 hours of any admission, or as soon
thereafter as medically possible.
Mental health and wellness services rendered to treat mental
disorders are covered. Mental Disorders means mental
disorders covered in the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders published by the
American Psychiatric Association, except as otherwise
excluded under Sections IV. or V. Mental Health and
Wellness Services means Medically Necessary outpatient
services, Residential Treatment, partial hospitalization
program, and inpatient services provided by a licensed facility
or licensed providers; including advanced practice psychiatric
nurses, mental health and wellness counselors, marriage and
family therapists and social workers, except as otherwise
excluded under Sections IV. or V.
Inpatient mental health and wellness services, Residential
Treatment and partial hospitalization programs must be
provided at a hospital or facility that KFHPWA has approved
specifically for the treatment of mental disorders.
Non-Emergency inpatient hospital services, including
Residential Treatment and partial hospitalization programs,
require Preauthorization.
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Exclusions: Academic or career counseling; personal growth or relationship enhancement; assessment and treatment
services that are primarily vocational and academic; court-ordered or forensic treatment, including reports and
summaries, not considered Medically Necessary; work or school ordered assessment and treatment not considered
Medically Necessary; counseling for overeating not considered Medically Necessary; specialty treatment programs
s not considered Medically Necessary; relationship counseling or phase of
life problems (Z code only diagnoses); custodial care not considered Medically Necessary; experimental or
investigational therapies, such as wilderness therapy.
Naturopathy
Naturopathy. Member pays $10 Copayment
Limited to 3 visits per medical diagnosis per calendar year
without Preauthorization. Additional visits are covered with
Preauthorization.
Laboratory and radiology services are covered only when
obtained through a Network Facility.
Exclusions: Herbal supplements; nutritional supplements;
licensure
Newborn Services
Newborn services are covered the same as for any other Hospital - Inpatient: No charge; Member pays
condition. Any Cost Share for newborn services is separate nothing
from that of the mother.
ospital stay while the birth
Preventive services for newborns are covered under
mother and baby are both confined, any applicable
Preventive Services.
Deductible and Copayment for the newborn are
waived
See Section VI.A.3. for information about temporary
coverage for newborns.
Hospital - Outpatient: Member pays $10
Copayment
Outpatient Services: Member pays $10 Copayment
Nutritional Counseling
Nutritional counseling. Member pays $10 Copayment
Services related to a healthy diet to prevent obesity are
covered as Preventive Services.
Exclusions: Nutritional supplements; weight control self-help programs or memberships, such as Weight Watchers,
Jenny Craig, or other such programs
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Nutritional Therapy
Medical formula necessary for the treatment of No charge; Member pays nothing
phenylketonuria (PKU), specified inborn errors of
metabolism, or other metabolic disorders.
Enteral therapy for malabsorption and an eosinophilic Member pays 20% coinsurance
gastrointestinal disorder.
Necessary equipment and supplies for the administration of
enteral therapy are covered as Devices, Equipment and
Supplies.
Parenteral therapy (total parenteral nutrition). No charge; Member pays nothing
Necessary equipment and supplies for the administration of
parenteral therapy are covered as Devices, Equipment and
Supplies.
Exclusions: Any other dietary formulas or medical foods; oral nutritional supplements not related to the treatment of
inborn errors of metabolism; special diets; prepared foods/meals
Obesity Related Services
Hospital - Inpatient: No charge; Member pays
Bariatric surgery and related hospitalizations when KFHPWA
nothing
criteria are met.
Hospital - Outpatient: Member pays $10
Services related to obesity screening and counseling are
Copayment
covered as Preventive Services.
Outpatient Services: Member pays $10 Copayment
Obesity related services require Preauthorization.
Exclusions: All other obesity treatment and treatment for morbid obesity including any medical services, drugs or
supplies, regardless of co-morbidities, except as described above; specialty treatment programs such as weight control
self-help programs or memberships, such as Weight Watchers, Jenny Craig or other such programs; medications and
related physician visits for medication monitoring
On the Job Injuries or Illnesses
On the job injuries or illnesses. Hospital - Inpatient: Not covered; Member pays
100% of all charges
Hospital - Outpatient: Not covered; Member pays
100% of all charges
Outpatient Services: Not covered; Member pays
100% of all charges
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Exclusions: Confinement, treatment or service that results from an illness or injury arising out of or in the course of
any employment for wage or profit including injuries, illnesses or conditions incurred as a result of self-employment
Oncology
Radiation therapy, chemotherapy, oral chemotherapy. Radiation Therapy and Chemotherapy:
Member pays $10 Copayment
See Infusion Therapy for infused medications.
Oral Chemotherapy Drugs:
Preferred generic drugs (Tier 1): Member pays
$10 Copayment per 30-days up to a 90-day supply
Preferred brand name drugs (Tier 2): Member
pays $10 Copayment per 30-days up to a 90-day
supply
Non-Preferred generic and brand name drugs
(Tier 3): Not covered; Member pays 100% of all
charges
Optical (vision)
Routine eye examinations and refractions, limited to once Routine Exams: Member pays $10 Copayment
every 12 months.
Exams for Eye Pathology: Member pays $10
Eye and contact lens examinations for eye pathology and to Copayment
monitor Medical Conditions, as often as Medically
Necessary.
Frames and Lenses: Not covered; Member pays
Contact lenses or framed lenses for eye pathology when
100% of all charges
Medically Necessary.
Contact Lenses or Framed Lenses for Eye
One contact lens per diseased eye in lieu of an intraocular
Pathology: No charge; Member pays nothing
lens is covered following cataract surgery provided the
Member has been continuously covered by KFHPWA since
such surgery. In the event a Member's age or medical
condition prevents the Member from having an intraocular
lens or contact lens, framed lenses are available. Replacement
of lenses for eye pathology, including following cataract
surgery, is covered only once within a 12-month period and
only when needed due to a change
prescription.
Exclusions: Eyeglasses; contact lenses, contact lens evaluations, fittings and examinations not related to eye
pathology; orthoptic therapy (i.e. eye training); evaluations and surgical procedures to correct refractions not related
to eye pathology and complications related to such procedures
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Oral Surgery
Reduction of a fracture or dislocation of the jaw or facial Hospital - Inpatient: No charge; Member pays
bones; excision of tumors or non-dental cysts of the jaw, nothing
cheeks, lips, tongue, gums, roof and floor of the mouth; and
incision of salivary glands and ducts. Hospital - Outpatient: Member pays $10
Copayment
KFHPWA
or treatment required is within the category of Oral Surgery or Outpatient Services: Member pays $10 Copayment
Dental Services.
Oral surgery requires Preauthorization.
Exclusions: Care or repair of teeth or dental structures of any type; tooth extractions or impacted teeth; services
related to malocclusion; services to correct the misalignment or malposition of teeth; any other services to the mouth,
facial bones or teeth which are not medical in nature
Outpatient Services
Covered outpatient medical and surgical services in a Member pays $10 Copayment
hronic disease management and
treatment arising from sexual assault. See Preventive Services
for additional information related to chronic disease
management.
See Hospital - Inpatient and Outpatient for outpatient hospital
medical and surgical services, including ambulatory surgical
centers.
Plastic and Reconstructive Surgery
Plastic and reconstructive services: Hospital - Inpatient: No charge; Member pays
nothing
Correction of a congenital disease or congenital anomaly.
Correction of a Medical Condition following an injury or
Hospital - Outpatient: Member pays $10
resulting from surgery which has produced a major effect
Copayment
KFHPWA
Outpatient Services: Member pays $10 Copayment
reasonably be expected to correct the condition.
Reconstructive surgery and associated procedures,
including internal breast prostheses, following a
mastectomy, regardless of when the mastectomy was
performed. Members are covered for all stages of
reconstruction on the non-diseased breast to produce a
symmetrical appearance. Complications of covered
mastectomy services, including lymphedemas, are
covered.
Plastic and reconstructive surgery requires Preauthorization.
Exclusions: Cosmetic services including treatment for complications resulting from cosmetic surgery; cosmetic
surgery; complications of non-Covered Services
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Podiatry
Medically Necessary foot care. Member pays $10 Copayment
Routine foot care covered when such care is directly related
to the treatment of diabetes and, when approved by
KFHPWAlinical conditions that
effect sensation and circulation to the feet.
Exclusions: All other routine foot care
Preventive Services
Preventive services in accordance with the well care schedule Member pays $10 Copayment
established by KFHPWA. The well care schedule is available
in Kaiser Permanente medical centers, at www.kp.org/wa, or
upon request from Member Services.
Screening and tests with A and B recommendations by the
U.S. Preventive Services Task Force (USPSTF).
Services, tests and screening contained in the U.S. Health
Resources and Services Administration Bright Futures
guidelines as set forth by the American Academy of
Pediatricians.
Services, tests, screening and supplies recommended in the
U.S.
preventive and wellness services guidelines.
Immunizations recommended by the Centers for Disease
Advisory Committee on Immunization Practices.
Flu vaccines are covered up to the Allowed Amount when
provided by a non-Network Provider.
Preventive services include, but are not limited to, well adult
and well child physical examinations; immunizations and
vaccinations; pap smears; routine mammography screening;
routine prostate screening; and colorectal cancer screening for
Members who are age 50 or older or who are under age 50
and at high risk.
Preventive care for chronic disease management includes
treatment plans with regular monitoring, coordination of care
between multiple providers and settings, medication
management, evidence-based care, quality of care
measurement and results, and education and tools for patient
self-management support. In the event preventive, wellness or
chronic care management services are not available from a
Network Provider, non-network providers may provide these
services without Cost Share when Preauthorized.
Services provided during a preventive services visit, including
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laboratory services, which are not in accordance with the
KFHPWA well care schedule are subject to Cost Shares. Eye
refractions are not included under preventive services.
Exclusions: Those parts of an examination and associated reports and immunizations that are not deemed Medically
Necessary by KFHPWA for early detection of disease; all other diagnostic services not otherwise stated above
Rehabilitation and Habilitative Care (massage,
occupational, physical and speech therapy) and
Neurodevelopmental Therapy
Rehabilitation services to restore function following illness, Hospital - Inpatient: No charge; Member pays
injury or surgery, limited to the following restorative nothing
therapies: occupational therapy, physical therapy, massage
therapy and speech therapy. Services are limited to those Outpatient Services: Member pays $10 Copayment
necessary to restore or improve functional abilities when
physical, sensori-perceptual and/or communication
impairment exists due to injury, illness or surgery.
Group visits (occupational, physical, speech
therapy or learning services):
Outpatient services require a prescription or order from a
Member pays one half of the office visit Copayment
physician that reflects a written plan of care to restore
function and must be provided by a rehabilitation team that
may include a physician, nurse, physical therapist,
occupational therapist, massage therapist or speech therapist.
Preauthorization is not required.
Habilitative care includes Medically Necessary services or
devices designed to help a Member keep, learn, or improve
skills and functioning for daily living. Services may include:
occupational therapy, physical therapy, speech therapy when
prescribed by a physician. Examples include therapy for a
child who is not walking or talking at the expected age. These
services may include physical and occupational therapy,
speech-language pathology and other services for people with
disabilities in a variety of inpatient and/or outpatient settings.
Neurodevelopmental therapy to restore or improve function
including maintenance in cases where significant
the services, limited to the following therapies: occupational
therapy, physical therapy and speech therapy. There is no
visit limit for Neurodevelopmental Therapy services.
Limited to a combined total of 60 inpatient days and 60
outpatient visits per calendar year for all Rehabilitation and
Habilitative care.
Services with mental health diagnoses are covered with no
limit.
Non-Emergency inpatient hospital services require
Preauthorization.
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Exclusions: Specialty treatment programs; inpatient Residential Treatment services; specialty rehabilitation programs
ior modification program; recreational, life-enhancing, relaxation or palliative therapy;
implementation of home maintenance programs
Reproductive Health
Medically Necessary medical and surgical services for Hospital - Inpatient: No charge; Member pays
reproductive health, including consultations, examinations, nothing
procedures and devices, including device insertion and
removal. Hospital - Outpatient: No charge; Member pays
nothing
See Maternity and Pregnancy for termination of pregnancy
services Outpatient Services: No charge; Member pays
nothing
Reproductive health is the care necessary to support the
reproductive system and the ability to reproduce.
Reproductive health includes contraception, cancer and
disease screenings, termination of pregnancy, maternity,
prenatal and postpartum care.
All methods for Medically Necessary FDA-approved No charge; Member pays nothing
(including over-the-counter) contraceptive drugs, devices and
products. Condoms are limited to 120 per 90-day supply.
Contraceptive drugs may be allowed up to a 12-month supply
and, when available, picked up in the
Sexual Dysfunction
One consultation visit to diagnose sexual dysfunction Member pays $10 Copayment
conditions.
Specific diagnostic services, treatment and prescription drugs. Not covered; Member pays 100% of all charges
Exclusions: Diagnostic testing and medical treatment of sexual dysfunction regardless of origin or cause; devices,
equipment and supplies for the treatment of sexual dysfunction
Skilled Nursing Facility
Skilled nursing care in a skilled nursing facility when full-No charge; Member pays nothing
time skilled nursing care is necessary in the opinion of the
attending physician, limited to a total of 30 days per condition
per calendar year.
Care may include room and board; general nursing care;
drugs, biologicals, supplies and equipment ordinarily
provided or arranged by a skilled nursing facility; and short-
term restorative occupational therapy, physical therapy and
speech therapy.
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Skilled nursing care in a skilled nursing facility requires
Preauthorization.
Exclusions: Personal comfort items such as telephone and television; rest cures; domiciliary or Convalescent Care
Sterilization
FDA-approved female sterilization procedures, services and No charge; Member pays nothing
supplies.
Non-Emergency inpatient hospital services require
Preauthorization.
Vasectomy. No charge; Member pays nothing
Non-Emergency inpatient hospital services require
Preauthorization.
Exclusions: Procedures and services to reverse a sterilization
Substance Use Disorder
Substance use disorder services including inpatient Hospital - Inpatient: No charge; Member pays
Residential Treatment; diagnostic evaluation and education; nothing
organized individual and group counseling; and/or
prescription drugs unless excluded under Sections IV. or V. Outpatient Services: Member pays $10 Copayment
Substance use disorder means an illness characterized by a
physiological or psychological dependency, or both, on a Group Visits: No charge; Member pays nothing
controlled substance and/or alcoholic beverages, and where
the user's health is substantially impaired or endangered or
their social or economic function is substantially disrupted.
For the purposes of this section, the definition of Medically
Necessary shall be expanded to include those services
necessary to treat a substance use disorder condition that is
having a clinically significant impact on a Mem
emotional, social, medical and/or occupational functioning.
Substance use disorder services must be provided at a
KFHPWA-approved treatment facility or treatment program.
Substance use disorder services are limited to the services
rendered by a physician (licensed under RCW 18.71 and
RCW 18.57), a psychologist (licensed under RCW 18.83), a
substance use disorder treatment program licensed for the
service being provided by the Washington State Department
of Social and Health Services (pursuant to RCW 70.96A), a
mastelevel therapist (licensed under RCW 18.225.090), an
advance practice psychiatric nurse (licensed under RCW
18.79) or, in the case of non-Washington State providers,
those providers meeting equivalent licensing and certification
requirements established in the state where the pro
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practice is located.
Court-ordered substance use disorder treatment shall be
covered only if determined to be Medically Necessary.
Preauthorization is required for Residential Treatment and
non-Emergency inpatient hospital services provided in out-of-
state facilities.
Acute chemical withdrawal (detoxification) services for Emergency Services Network Facility: Member
alcoholism and drug abuse. "Acute chemical withdrawal" pays $75 Copayment
means withdrawal of alcohol and/or drugs from a Member for
whom consequences of abstinence are so severe that they Emergency Services Non-Network Facility:
require medical/nursing assistance in a hospital setting or Member pays $125 Copayment
behavioral health agency (licensed and certified under RCW
71.24.037), which is needed immediately to prevent serious Hospital - Inpatient: No charge; Member pays
impairment to the Member's health. nothing
Coverage for acute chemical withdrawal (detoxification) is
provided without Preauthorization. If a Member is admitted
as an inpatient directly from an emergency department, any
Emergency services Copayment is waived. Coverage is
subject to the hospital services Cost Share. Members must
notify KFHPWA by way of the Hospital notification line
within 24 hours of any admission, or as soon thereafter as
medically possible.
KFHPWA reserves the right to require transfer of the
Member to a Network Facility/program upon consultation
between a Network Provider and the attending physician. If
the Member refuses transfer to a Network Facility/program,
all further costs incurred during the hospitalization are the
responsibility of the Member.
Exclusions: Experimental or investigational therapies, such as wilderness therapy; facilities and treatment programs
which are not certified by the Department of Social Health Services
Telehealth Services
Telemedicine No charge; Member pays nothing
Services provided by the use of real-time interactive audio
and video communications or store and forward technology
between the patient at the originating site and a Network
Provider at another location. Store and forward technology
means sending a Members medical information from an
originating site to the provider at a distant site for later
review. The provider follows up with a medical diagnosis for
the Member and helps manage their care. Services must meet
the following requirements:
Be a Covered Service under this EOC.
The originating site is qualified to provide the
service.
If the service is provided through store and forward
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technology, there must be an associated office visit
between the Member and the referring provider.
Is Medically Necessary.
Telephone Services and Online (E-Visits) No charge; Member pays nothing
Scheduled telephone visits with a Network Provider are
covered.
Online (E-Visits): A Member logs into the secure Member
site at www.kp.org/wa and completes a questionnaire. A
KFHPWA medical provider reviews the questionnaire and
provides a treatment plan for select conditions, including
prescriptions. Online visits are not available to Members
during in-person visits at a KFHPWA facility or pharmacy.
More information is available at
https://wa.kaiserpermanente.org/html/public/services/e-visit.
Exclusions: Fax and e-mail; telehealth services with non-contracted providers; telehealth services in states where
prohibited by law; all other services not listed above
Temporomandibular Joint (TMJ)
Medical and surgical services and related hospital charges for Hospital - Inpatient: No charge; Member pays
the treatment of temporomandibular joint (TMJ) disorders nothing
including:
Hospital - Outpatient: Member pays $10
Orthognathic surgery for the treatment of TMJ disorders.
Copayment
Radiology services.
TMJ specialist services.
Outpatient Services: Member pays $10 Copayment
Fitting/adjustment of splints.
Non-Emergency inpatient hospital services require
Preauthorization.
TMJ appliances. See Devices, Equipment and Supplies for Member pays 20% coinsurance
additional information.
Exclusions: Treatment for cosmetic purposes; bite blocks; dental services including orthodontic therapy and braces
for any condition; any orthognathic (jaw) surgery in the absence of a diagnosis of TMJ, severe obstructive sleep
apnea; hospitalizations related to these exclusions
Tobacco Cessation
Individual/group counseling and educational materials. No charge; Member pays nothing
Approved pharmacy products. See Drugs Outpatient KFHPWA-designated tobacco cessation program:
Prescription for additional pharmacy information. No charge; Member pays nothing when prescribed as
part of the KFHPWA-designated tobacco cessation
program and dispensed through the KFHPWA-
designated mail order service
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Other approved pharmacy products:
Preferred generic drugs (Tier 1): Member pays
$10 Copayment per 30-days up to a 90-day supply
Preferred brand name drugs (Tier 2): Member
pays $10 Copayment per 30-days up to a 90-day
supply
Non-Preferred generic and brand name drugs
(Tier 3): Not covered; Member pays 100% of all
charges
Transgender Services
Hospital - Inpatient: No charge; Member pays
Medically Necessary medical and surgical services for gender
nothing
reassignment.
Hospital - Outpatient: Member pays $10
Prescription drugs are covered the same as for any other
Copayment
condition (see Drugs - Outpatient Prescription for coverage).
Outpatient Services: Member pays $10 Copayment
Counseling services are covered the same as for any other
condition (see Mental Health and Wellness for coverage).
Non-Emergency inpatient hospital services require
Preauthorization.
Exclusions: Cosmetic services including treatment for complications resulting from cosmetic surgery; cosmetic
surgery; complications of non-Covered Services
Transplants
Transplant services, including heart, heart-lung, single lung, Hospital - Inpatient: No charge; Member pays
double lung, kidney, pancreas, cornea, intestinal/multi-nothing
visceral, liver transplants, and bone marrow and stem cell
support (obtained from allogeneic or autologous peripheral Hospital - Outpatient: Member pays $10
blood or marrow) with associated high dose chemotherapy. Copayment
Services are limited to the following: Outpatient Services: Member pays $10 Copayment
Inpatient and outpatient medical expenses for evaluation
testing to determine recipient candidacy, donor matching
tests, hospital charges, procurement center fees,
professional fees, travel costs for a surgical team and
excision fees. Donor costs for a covered organ recipient
are limited to procurement center fees, travel costs for a
surgical team and excision fees.
Follow-up services for specialty visits.
Rehospitalization.
Maintenance medications during an inpatient stay.
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Transplant services require Preauthorization.
Exclusions: Donor costs to the extent that they are re; treatment of donor
complications; living expenses except as covered under Section J. Utilization Management
Urgent Care
Inside the KFHPWA Service Area, urgent care is covered at a Network Emergency Department: Member pays
Kaiser Permanente medical center, Kaiser Permanente urgent $75 Copayment
Network Urgent Care Center: Member pays $10
Outside the KFHPWA Service Area, urgent care is covered at Copayment
any medical facility.
See Section XII. for a definition of Urgent Condition. Member pays $10
Copayment
Non-Network Provider: Member pays $125
Copayment
V.!General Exclusions
In addition to exclusions listed throughout the EOC, the following are not covered:
1. Benefits and related services, supplies and drugs that are not Medically Necessary for the treatment of an
illness, injury, or physical disability, that are not specifically listed as covered in the EOC, except as required by
federal or state law.
2. Services Related to a Non-Covered Service: When a service is not covered, all services related to the non-
covered service (except for the specific exceptions described below) are also excluded from coverage. Members
who have received a non-covered service, such as bariatric surgery, and develop an acute medical complication
(such as band slippage, leak or infection) as a result, shall have coverage for Medically Necessary intervention
to stabilize the acute medical complication. Coverage does not include complications that occur during or
immediately following a non-covered service. Additional surgeries or other medical services in addition to
Medically Necessary intervention to resolve acute medical complications resulting from non-covered services
shall not be covered.
3. Services or supplies for which no charge is made, or for which a charge would not have been made if the
Member had no health care coverage or for which the Member is not liable; services provided by a family
member, or self-care.
4. Convalescent Care.
5. Sn under the terms of any vehicle,
homeownericy, except for individual or group health insurance, pursuant to
personal injury protection coverage or similar medical coverage
contained in said policy. For the purpose of this exclusion, benefits shall be blee
Member if the Member receives benefits under the policy either as a named insured or as an insured individual
under the policy definition of insured.
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6. Services or care needed for injuries or conditions resulting from active or reserve military service, whether such
injuries or conditions result from war or otherwise. This exclusion will not apply to conditions or injuries
resulting from previous military service unless the condition has been determined by the U.S. Secretary of
Veterans Affairs to be a condition or injury incurred during a period of active duty. Further, this exclusion will
not be interpreted to interfere with or preclude coordination of benefits under Tri-Care.
7. Services provided by government agencies, except as required by federal or state law.
8. Services covered by the national health plan of any other country.
9. Experimental or investigational services.
KFHPWA consults with KFHPWAmedical director and then uses the criteria described below to decide if a
particular service is experimental or investigational.
a.
statements apply to it at the time the service is or will be provided to the Member:
1) The service cannot be legally marketed in the United States without the approval of the Food and Drug
2) The service is the subject of a current new drug or new device application on file with the FDA.
3) The service is the trialed agent or for delivery or measurement of the trialed agent provided as part of a
qualifying Phase I or Phase II clinical trial, as the experimental or research arm of a Phase III clinical
trial.
4) The service is provided pursuant to a written protocol or other document that lists an evaluation of the
5) The service is under continued scientific testing and research concerning the safety, toxicity or efficacy
of services.
6) The service is provided pursuant to informed consent documents that describe the service as
experimental or investigational, or in other terms that indicate that the service is being evaluated for its
safety, toxicity or efficacy.
7) The prevailing opinion among experts, as expressed in the published authoritative medical or scientific
literature, is that (1) the use of such service should be substantially confined to research settings, or (2)
further research is necessary to determine the safety, toxicity or efficacy of the service.
b. The following sources of information will be exclusively relied upon to determine whether a service is
experimental or investigational:
1) The Mrecords.
2) The written protocol(s) or other document(s) pursuant to which the service has been or will be
provided.
3)
execute, to receive the service.
4) The files and records of the Institutional Review Board (IRB) or similar body that approves or reviews
research at the institution where the service has been or will be provided, and other information
concerning the authority or actions of the IRB or similar body.
5) The published authoritative medical or scientific literature regarding the service, as applied to the
Memb
6) Regulations, records, applications and any other documents or actions issued by, filed with or taken by,
the FDA or other agencies within the United States Department of Health and Human Services, or any
state agency performing similar functions.
Appeals regarding KFHPWA denial of coverage can be submitted to the Member Appeal Department, or to
KFHPWA's medical director at P.O. Box 34593, Seattle, WA 98124-1593.
10. Hypnotherapy and all services related to hypnotherapy.
11. Directed umbilical cord blood donations.
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12. Prognostic (predictive) genetic testing and related services, unless specifically provided in Section IV. Testing
for non-Members.
13. Autopsy and associated expenses.
VI.!Eligibility, Enrollment and Termination
A.!Eligibility.
In order to be accepted for enrollment and continuing coverage, individuals must reside or work in the Service
Area and meet all applicable requirements set forth below, except for temporary residency outside the Service
Area for purposes of attending school, court-ordered coverage for Dependents or other unique family
arrangements, when approved in advance by KFHPWA. KFHPWA has the right to verify eligibility.
1. Subscribers.
Bona fide employees as established and enforced by the Group shall be eligible for enrollment. Please
contact the Group for more information.
2. Dependents.
The Subscriber may also enroll the following:
a. The Subscriber's legal spouse.
b. -registered domestic partner (as required by Washington state law) or if
specifically included as eligible by the Group, the Subscrib-state registered domestic partner.
State-registered domestic partners will be extended the same rights as spouses.
c. Children who are under the age of 26.
"Children" means the children of the Subscriber, spouse or eligible domestic partner, including adopted
children, stepchildren, children for whom the Subscriber has a qualified court order to provide
coverage and any other children for whom the Subscriber is the legal guardian.
totally incapable of self-sustaining employment because of a developmental or physical disability
incurred prior to attainment of the limiting age, and is chiefly dependent upon the Subscriber for
support and maintenance. Enrollment for such a Dependent may be continued for the duration of the
continuous total incapacity, provided enrollment does not terminate for any other reason. Medical
proof of incapacity and proof of financial dependency must be furnished to KFHPWA upon request,
but not more frequently than annually after the 2-year period following the Dependent's attainment of
the limiting age.
3. Temporary Coverage for Newborns.
When a Member gives birth, the newborn is entitled to the benefits set forth in the EOC from birth through
3 weeks of age. All provisions, limitations and exclusions will apply except Subsections F. and G. After 3
weeks of age, no benefits are available unless the newborn child qualifies as a Dependent and is enrolled.
B.!Application for Enrollment.
Application for enrollment must be made on an application approved by KFHPWA. The Group is responsible
for submitting completed applications to KFHPWA.
KFHPWA reserves the right to refuse enrollment to any person whose coverage under any medical coverage
agreement issued by Kaiser Foundation Health Plan of Washington Options, Inc. or Kaiser Foundation Health
Plan of Washington has been terminated for cause.
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1.!Newly Eligible Subscribers.
Newly eligible Subscribers and their Dependents may apply for enrollment in writing to the Group within
31 days of becoming eligible.
2.!New Dependents.
A written application for enrollment of a newly dependent person, other than a newborn or adopted child,
must be made to the Group within 31 days after the dependency occurs.
A written application for enrollment of a newborn child must be made to the Group within 60 days
following the date of birth when there is a change in the monthly premium payment as a result of the
additional Dependent.
A written application for enrollment of an adoptive child must be made to the Group within 60 days from
the day the child is placed with the Subscriber for the purpose of adoption or the Subscriber assumes total
or partial financial support of the child if there is a change in the monthly premium payment as a result of
the additional Dependent.
When there is no change in the monthly premium payment, it is strongly advised that the Subscriber enroll
the newborn or newly adoptive child as a Dependent with the Group to avoid delays in the payment of
claims.
3.!Open Enrollment.
KFHPWA will allow enrollment of Subscribers and Dependents who did not enroll when newly eligible as
described above during a limited period of time specified by the Group and KFHPWA.
4.!Special Enrollment.
a. KFHPWA will allow special enrollment for persons:
1) Who initially declined enrollment when otherwise eligible because such persons had other health
care coverage and have had such other coverage terminated due to one of the following events:
Cessation of employer contributions.
Exhaustion of COBRA continuation coverage.
Loss of eligibility, except for loss of eligibility for cause; or
2) Who initially declined enrollment when otherwise eligible because such persons had other health
care coverage and who have had such other coverage exhausted because such person reached a
lifetime maximum limit.
KFHPWA or the Group may require confirmation that when initially offered coverage such persons
submitted a written statement declining because of other coverage. Application for coverage must be
made within 31 days of the termination of previous coverage.
b. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their
Dependents (other than for nonpayment or fraud) in the event one of the following occurs:
1) Divorce or Legal Separation. Application for coverage must be made within 60 days of the
divorce/separation.
2) Cessation of Dependent status (reaches maximum age). Application for coverage must be made
within 30 days of the cessation of Dependent status.
3) Death of an employee under whose coverage they were a Dependent. Application for coverage
must be made within 30 days of the death of an employee.
4) Termination or reduction in the number of hours worked. Application for coverage must be made
within 30 days of the termination or reduction in number of hours worked.
5) Leaving the service area of a former plan. Application for coverage must be made within 30 days
of leaving the service area of a former plan.
6) Discontinuation of a former plan. Application for coverage must be made within 30 days of the
discontinuation of a former plan.
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c. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their
Dependents in the event one of the following occurs:
1) Marriage. Application for coverage must be made within 31 days of the date of marriage.
2) Birth. Application for coverage for the Subscriber and Dependents other than the newborn child
must be made within 60 days of the date of birth.
3) Adoption or placement for adoption. Application for coverage for the Subscriber and Dependents
other than the adopted child must be made within 60 days of the adoption or placement for
adoption.
4) Eligibility for premium assistance from Medicaid or a state C
(CHIP), provided such person is otherwise eligible for coverage under this EOC. The request for
special enrollment must be made within 60 days of eligibility for such premium assistance.
5) Coverage under a Medicaid or CHIP plan is terminated as a result of loss of eligibility for such
coverage. Application for coverage must be made within 60 days of the date of termination under
Medicaid or CHIP.
6) Applicable federal or state law or regulation otherwise provides for special enrollment.
C.!When Coverage Begins.
1.!Effective Date of Enrollment.
Enrollment for a newly eligible Subscriber and listed Dependents is effective on the date eligibility
requirements are met, provided the Subscriber's application has been submitted to and approved by
KFHPWA. Please contact the Group for more information.
Enrollment for a newly dependent person, other than a newborn or adoptive child, is effective on the
date eligibility requirements are met. Please contact the Group for more information.
Enrollment for newborns is effective from the date of birth.
Enrollment for adoptive children is effective from the date that the adoptive child is placed with the
Subscriber for the purpose of adoption or the Subscriber assumes total or partial financial support of
the child.
2.!Commencement of Benefits for Persons Hospitalized on Effective Date.
Members who are admitted to an inpatient facility prior to their enrollment will receive covered benefits
beginning on their effective date, as set forth in Subsection C.1. above. If a Member is hospitalized in a
non-Network Facility, KFHPWA reserves the right to require transfer of the Member to a Network Facility.
The Member will be transferred when a Network Provider, in consultation with the attending physician,
determines that the Member is medically stable to do so. If the Member refuses to transfer to a Network
Facility, all further costs incurred during the hospitalization are the responsibility of the Member.
D.!Eligibility for Medicare.
An individual shall be deemed eligible for Medicare when they have the option to receive Part A Medicare
benefits. Medicare secondary payer regulations and guidelines will determine primary/secondary payer status
for individuals covered by Medicare.
A Member who is enrolled in Medicare has the option of continuing coverage under this EOC while on
Medicare coverage. Coverage between this EOC and Medicare will be coordinated as outlined in Section IX.
The Group is also responsible for providing KFHPWA with a prospective timely
ineligibility for Medicare Advantage coverage under the Group, as well as providing a prospective notice to its
Members alerting them of the termination event. In the event the Group does not obtain Medicare Advantage
coverage, the loss of Medicare drug coverage, other coverage options that may be available to the Member, and
the possibility of late enrollment penalties if the Member does not apply for Medicare coverage within the
required timeframe will also need to be provided.
E.!Termination of Coverage.
The Subscriber shall be liable for payment of all charges for services and items provided to the Subscriber and
all Dependents after the effective date of termination.
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Termination of Specific Members.
Individual Member coverage may be terminated for any of the following reasons:
a. Loss of Eligibility. If a Member no longer meets the eligibility requirements and is not enrolled for
continuation coverage as described in Subsection G. below, coverage will terminate at the end of the
month during which the loss of eligibility occurs, unless otherwise specified by the Group.
b. For Cause. In the event of termination for cause, KFHPWA reserves the right to pursue all civil
remedies allowable under federal and state law for the collection of claims, losses or other damages.
Coverage of a Member may be terminated upon 10 working days written notice for:
1.) Material misrepresentation, fraud or omission of information in order to obtain coverage.
2.) Permitting the use of a KFHPWA identification card or number by another person or using
or number to obtain care to which a person is not entitled.
c. Premium Payments. Nonpayment of premiums or contribution for a specific Member by the Group.
Individual Member coverage may be retroactively terminated upon 30 days written notice and only in the
case of fraud or intentional misrepresentation of a material fact; or as otherwise allowed under applicable
law or regulation. Notwithstanding the foregoing, KFHPWA reserves the right to retroactively terminate
coverage for nonpayment of premiums or contributions by the Group as described above.
In no event will a Member be terminated solely on the basis of their physical or mental condition provided
they meet all other eligibility requirements set forth in the EOC.
Any Member may appeal a termination decision through KFHPWAappeals process.
F.!Continuation of Inpatient Services.
A Member who is receiving Covered Services in a hospital on the date of termination shall continue to be
eligible for Covered Services while an inpatient for the condition which the Member was hospitalized, until one
of the following events occurs:
According to KFHPWA clinical criteria, it is no longer Medically Necessary for the Member to be an
inpatient at the facility.
The remaining benefits available for the hospitalization are exhausted, regardless of whether a new
calendar year begins.
The Member becomes covered under another agreement with a group health plan that provides benefits for
the hospitalization.
The Member becomes enrolled under an agreement with another carrier that provides benefits for the
hospitalization.
This provision will not apply if the Member is covered under another agreement that provides benefits for the
hospitalization at the time coverage would terminate, except as set forth in this section, or if the Member is
eligible for COBRA continuation coverage as set forth in Subsection G. below.
G.!Continuation of Coverage Options.
1. Continuation Option.
A Member no longer eligible for coverage (except in the event of termination for cause, as set forth in
Subsection E.) may continue coverage for a period of up to 3 months subject to notification to and self-
payment of premiums to the Group. This provision will not apply if the Member is eligible for the
continuation coverage provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA). This continuation option is not available if the Group no longer has active employees or
otherwise terminates.
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2. Leave of Absence.
While on a Group approved leave of absence, the Subscriber and listed Dependents can continue to be
covered provided that:
They remain eligible for coverage, as set forth in Subsection A.,
applied to all employees,
applicable, and
The Group continues to remit premiums for the Subscriber and Dependents to KFHPWA.
3. Self-Payments During Labor Disputes.
In the event of suspension or termination of employee compensation due to a strike, lock-out or other labor
dispute, a Subscriber may continue uninterrupted coverage through payment of monthly premiums directly
to the Group. Coverage may be continued for the lesser of the term of the strike, lock-out or other labor
dispute, or for 6 months after the cessation of work.
If coverage under the EOC is no longer available, the Subscriber shall have the opportunity to apply for an
individual KFHPWA group conversion plan or, if applicable, continuation coverage (see Subsection 4.
below), or an individual and family plan at the duly approved rates.
The Group is responsible for immediately notifying each affected Subscriber of their rights of self-payment
under this provision.
4. Continuation Coverage Under Federal Law.
This section applies only to Groups who must offer continuation coverage under the applicable provisions
of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or the Uniformed
Services Employment and Reemployment Rights Act (USERRA) and only applies to grant continuation of
coverage rights to the extent required by federal law. USERRA only applies in certain situations to
employees who are leaving employment to serve in the United States Armed Forces.
Upon loss of eligibility, continuation of Group coverage may be available to a Member for a limited time
after the Member would otherwise lose eligibility, if required by COBRA. The Group shall inform
Members of the COBRA election process and how much the Member will be required to pay directly to the
Group.
Continuation coverage under COBRA or USERRA will terminate when a Member becomes covered by
Medicare or obtains other group coverage, and as set forth under Subsection E.
5. KFHPWA Group Conversion Plan.
Members whose eligibility for coverage, including continuation coverage, is terminated for any reason
other than cause, as set forth in Subsection E., and who are not eligible for Medicare or covered by another
group health plan, may convert to an individual KFHPWA group conversion plan. If coverage under the
EOC terminates, any Member covered at termination (including spouses and Dependents of a Subscriber
who was terminated for cause) may convert to a KFHPWA group conversion plan. Coverage will be
retroactive to the date of loss of eligibility.
An application for conversion must be made within 31 days following termination of coverage or within 31
days from the date notice of the termination of coverage is received, whichever is later. A physical
examination or statement of health is not required for enrollment in a KFHPWA group conversion plan.
VII.!Grievances
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Grievance means a written or verbal complaint submitted by or on behalf of a covered person regarding service
delivery issues other than denial of payment for medical services or non-provision of medical services, including
dissatisfaction with medical care, waiting time for medical services, provider or staff attitude or demeanor, or
dissatisfaction with service provided by the health carrier. The grievance process is outlined as follows:
Step 1: It is recommended that the Member contact the person involved or the manager of the medical
center/department where they are having a problem, explain their concerns and what they would like to have
done to resolve the problem. The Member should be specific and make their position clear. Most concerns can
be resolved in this way.
Step 2: If the Member is still not satisfied, they should call or write to Member Services at PO Box 34590,
Seattle, WA 98124-1590. 206-630-4636 or toll-free 1-888-901-4636. Most concerns are handled by phone
within a few days. In some cases, the Member will be asked to write down their concerns and state what they
think would be a fair resolution to the problem. An appropriate r
concern by consulting with involved staff and their supervisors, and reviewing pertinent records, relevant plan
policies and the Member Rights and Responsibilities statement. This process can take up to 30 days to resolve
en or verbal statement.
If the Member is dissatisfied with the resolution of the complaint, they may contact Member Services.
Assistance is available to Members who are limited-English speakers, who have literacy problems, or who have
physical or mental disabilities that impede their ability to request review or participate in the review process.
VIII.!Appeals
Members are entitled to appeal through the appeals process if/when coverage for an item or service is denied
due to an adverse determination made by the KFHPWA medical director. The appeals process is available for a
Member to seek reconsideration of an adverse benefit determination (action). Adverse benefit determination
(action) means any of the following: a denial, reduction, or termination of, or a failure to provide or make
payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to
, and
including, a denial, reduction, or termination of, or a failure to provide or make payment, in whole or in part, for
a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service
for which benefits are otherwise provided because it is determined to be experimental or investigational or not
Medically Necessary or appropriate. KFHPWA will comply with any new requirements as necessary under
federal laws and regulations. Assistance is available to Members who are limited-English speakers, who have
literacy problems, or who have physical or mental disabilities that impede their ability to request review or
participate in the review process. The most current information about your appeals process is available by
contacting KFHPWA Member Appeal Department at the address or telephone number below.
1.!Initial Appeal
If the Member or any representative authorized in writing by the Member wishes to appeal a KFHPWA
decision to deny, modify, reduce or terminate coverage of or payment for health care services, they must
submit a request for an appeal either orally or in writing to KFHPWAnt,
specifying why they disagree with the decision. The appeal must be submitted within 180 days from the
date of the initial denial notice. KFHPWA will notify the Member of its receipt of the request within 72
hours of receiving it. Appeals should be directed to KFHPWAnt, P.O. Box
34593, Seattle, WA 98124-1593, toll-free 1-866-458-5479.
A party not involved in the initial coverage determination and not a subordinate of the party making the
initial coverage determination will review the appeal request. KFHPWA will then notify the Member of its
determination or need for an extension of time within 14 days of receiving the request for appeal. Under no
circumstances will the review timeframe exceed 30 days with
For appeals involving experimental or investigational services KFHPWA will make a decision and
communicate the decision to the Member in writing within 20 days of receipt of the appeal.
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There is an expedited/urgent appeals process in place for cases which meet criteria or where delay using
the standard appeal review process will serios life, health or ability to regain
maximum function or subject the Member to severe pain that cannot be managed adequately without the
requested care or treatment. The Member can request an expedited/urgent appeal in writing to the above
address, or by calling KFHPWAl-free 1-866-458-5479. The nature of the
pe evaluated by a physician and if the request is not accepted as urgent, the member
will be notified in writing of the decision not to expedite and given a description on how to grieve the
decision. If the request is made by the treating physician who beli
definition of expedited, the request will be processed as expedited.
The request for an expedited/urgent appeal will be processed and a decision issued no later than 72 hours
after receipt of the request.
The Member may also request an external review at the same time as the internal appeals process if it is an
urgent care situation or the Member is in an ongoing course of treatment.
If the Member requests an appeal of a KFHPWA decision denying benefits for care currently being
received, KFHPWA will continue to provide coverage for the disputed benefit pending the outcome of the
appeal. If the KFHPWA determination stands, the Member may be responsible for the cost of coverage
received during the review period.
The U.S. Department of Health and Human Services has designated the Washington State Office of the
on as the health insurance consumer ombudsman.
The Consumer Protection Division Office can be reached by mail at Washington State Insurance
Commissioner, Consumer Protection Division, P.O. Box 40256, Olympia, WA 98504-0256 or at toll-free
1-800-562-6900. More information about requesting assistance from the Consumer Protection Division
Office can be found at http://www.insurance.wa.gov/your-insurance/health-insurance/appeal/.
2.!Next Level of Appeal
If the Member is not satisfied with the decision regarding medical necessity, medical appropriateness,
health care setting, level of care, or if the requested service is not efficacious or otherwise unjustified under
evidence-based medical criteria, or if KFHPWA fails to adhere to the requirements of the appeals process,
the Member may request a second level review by an external independent review organization not legally
affiliated with or controlled by KFHPWA. KFHPWA will notify the Member of the name of the external
independent review organization and its contact information. The external independent review organization
will accept additional written information for up to five business days after it receives the assignment for
the appeal. The external independent review will be conducted at no cost to the Member. Once a decision is
made through an independent review organization, the decision is final and cannot be appealed through
KFHPWA.
If the Member requests an appeal of a KFHPWA decision denying benefits for care currently being
received, KFHPWA will continue to provide coverage for the disputed benefit pending the outcome of the
appeal. If the KFHPWA determination stands, the Member may be responsible for the cost of coverage
received during the review period.
A request for a review by an independent review organization must be made within 180 days after the date
of the initial appeal decision notice.
IX.!Claims
Claims for benefits may be made before or after services are obtained. KFHPWA recommends that the provider
requests Preauthorization. In most instances, contracted providers submit claims directly to KFHPWA. If your
provider does not submit a claim to make a claim for benefits, a Member must contact Member Services, or submit a
claim for reimbursement as described below. Other inquiries, such as asking a health care provider about care or
coverage, or submitting a prescription to a pharmacy, will not be considered a claim for benefits.
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If a Member receives a bill for services the Member believes are covered, the Member must, within 90 days of the
date of service, or as soon thereafter as reasonably possible, either (1) contact Member Services to make a claim or
(2) pay the bill and submit a claim for reimbursement of Covered Services, or (3) for out-of-country claims
(Emergency care only) submit the claim and any associated medical records , including the type of service,
charges, and proof of travel to KFHPWA, P.O. Box 30766, Salt Lake City, UT 84130-0766. In no event, except in
the absence of legal capacity, shall a claim be accepted later than 1 year from the date of service.
KFHPWA will generally process claims for benefits within the following timeframes after KFHPWA receives the
claims:
Immediate request situations within 1 business day.
Concurrent urgent requests within 24 hours.
Urgent care review requests within 48 hours.
Non-urgent preservice review requests within 5 calendar days.
Post-service review requests within 30 calendar days.
Timeframes for pre-service and post-service claims can be extended by KFHPWA for up to an additional 15 days.
Members will be notified in writing of such extension prior to the expiration of the initial timeframe.
X.!Coordination of Benefits
The coordination of benefits (COB) provision applies when a Member has health care coverage under more than one
plan. Plan is defined below.
The order of benefit determination rules govern the order in which each plan will pay a claim for benefits. The plan
that pays first is called the primary plan. The primary plan must pay benefits according to its policy terms without
regard to the possibility that another plan may cover some expenses. The plan that pays after the primary plan is the
secondary plan. In no event will a secondary plan be required to pay an amount in excess of its maximum benefit
plus accrued savings.
If the Member is covered by more than one health benefit plan, and the Member does not know which is the primary
health plans to verify which plan is
primary. The health plan the Member contacts is responsible for working with the other plan to determine which is
primary and will let the Member know within 30 calendar days.
All health plans have timely claim filing requirements. If the Member or provider fails to submit the
claim to a secondary hea the plan can deny the claim. If
the Member experiences delays in the processing of the claim by the primary health plan, the Member or the
provider will need to submit the claim to the secondary health plan within its claim filing time limit to
prevent a denial of the claim.
If the Member is covered by more than one health benefit plan, the ider should file all
ith each plan at the same time. If Me
suaim
Definitions.
A. A plan is any of the following that provides benefits or services for medical or dental care or treatment. If
separate contracts are used to provide coordinated coverage for Members of a Group, the separate contracts
are considered parts of the same plan and there is no COB among those separate contracts. However, if
COB rules do not apply to all contracts, or to all benefits in the same contract, the contract or benefit to
which COB does not apply is treated as a separate plan.
1. Plan includes: group, individual or blanket disability insurance contracts and group or individual
contracts issued by health care service contractors or health maintenance organizations (HMO), closed
panel plans or other forms of group coverage; medical care components of long-term care contracts,
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such as skilled nursing care; and Medicare or any other federal governmental plan, as permitted by
law.
2. Plan does not include: hospital indemnity or fixed payment coverage or other fixed indemnity or fixed
payment coverage; accident only coverage; specified disease or specified accident coverage; limited
benefit health coverage, as defined by state law; school accident type coverage; benefits for non-
medical components of long-term care policies; automobile insurance policies required by statute to
provide medical benefits; Medicare supplement policies; Medicaid coverage; or coverage under other
federal governmental plans; unless permitted by law.
Each contract for coverage under Subsection 1. or 2. is a separate plan. If a plan has two parts and COB
rules apply only to one of the two, each of the parts is treated as a separate plan.
B. This plan means, in a COB provision, the part of the contract providing the health care benefits to which
the COB provision applies and which may be reduced because of the benefits of other plans. Any other part
of the contract providing health care benefits is separate from this plan. A contract may apply one COB
provision to certain benefits, such as dental benefits, coordinating only with similar benefits, and may apply
another COB provision to coordinate other benefits.
C. The order of benefit determination rules determine whether this plan is a primary plan or secondary plan
when the Member has health care coverage under more than one plan.
When this plan is primary, it determines payment for its benefits first before those of any other plan without
considering any otheetermines its benefits after those of
another plan and must make payment in an amount so that, when combined with the amount paid by the
primary plan, the total benefits paid or provided by all plans for the claim equal 100% of the total allowable
expense for that claim. This means that when this plan is secondary, it must pay the amount which, when
combined with what the primary plan paid, totals 100% of the allowable expense. In addition, if this plan is
secondary, it must calculate its savings (its amount paid subtracted from the amount it would have paid had
it been the primary plan) and record these savings as a benefit reserve for the covered Member. This
reserve must be used by the secondary plan to pay any allowable expenses not otherwise paid, that are
incurred by the covered person during the claim determination period.
D. Allowable Expense. Allowable expense is a health care expense, coinsurance or copayments and without
reduction for any applicable deductible, that is covered at least in part by any plan covering the person.
When a plan provides benefits in the form of services, the reasonable cash value of each service will be
considered an allowable expense and a benefit paid. An expense that is not covered by any plan covering
the Member is not an allowable expense.
The following are examples of expenses that are not allowable expenses:
1. The difference between the cost of a semi-private hospital room and a private hospital room is not an
allowable expense, unless one of the plans provides coverage for private hospital room expenses.
2. If a Member is covered by two or more plans that compute their benefit payments on the basis of usual
and customary fees or relative value schedule reimbursement method or other similar reimbursement
method, any amount in excess of the highest reimbursement amount for a specific benefit is not an
allowable expense.
3. If a Member is covered by two or more plans that provide benefits or services on the basis of
negotiated fees, an amount in excess of the highest of the negotiated fees is not an allowable expense.
4. An expense or a portion of an expense that is not covered by any of the plans covering the person is
not an allowable expense.
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E. Closed panel plan is a plan that provides health care benefits to covered persons in the form of services
through a panel of providers who are primarily employed by the plan, and that excludes coverage for
services provided by other providers, except in cases of Emergency or referral by a panel member.
F. Custodial parent is the parent awarded custody by a court decree or, in the absence of a court decree, is the
parent with whom the child resides more than one half of the calendar year excluding any temporary
visitation.
Order of Benefit Determination Rules.
When a Member is covered by two or more plans, the rules for determining the order of benefit payments are as
follows:
A. The primary plan pays or provides its benefits according to its terms of coverage and without regard to the
benefits under any other plan.
B. (1) Except as provided below (subsection 2), a plan that does not contain a coordination of benefits
provision that is consistent with this chapter is always primary unless the provisions of both plans state that
the complying plan is primary.
(2) Coverage that is obtained by virtue of membership in a Group that is designed to supplement a part of a
basic package of benefits and provides that this supplementary coverage is excess to any other parts of the
plan provided by the contract holder. Examples include major medical coverages that are superimposed
over hospital and surgical benefits, and insurance type coverages that are written in connection with a
closed panel plan to provide out-of-network benefits.
C. A plan may consider the benefits paid or provided by another plan in calculating payment of its benefits
only when it is secondary to that other plan.
D. Each plan determines its order of benefits using the first of the following rules that apply:
1. Non-Dependent or Dependent. The plan that covers the Member other than as a Dependent, for
example as an employee, member, policyholder, Subscriber or retiree is the primary plan and the plan
that covers the Member as a Dependent is the secondary plan. However, if the person is a Medicare
beneficiary and, as a result of federal law, Medicare is secondary to the plan covering the Member as a
Dependent, and primary to the plan covering the Member as other than a Dependent (e.g., a retired
employee), then the order of benefits between the two plans is reversed so that the plan covering the
Member as an employee, member, policyholder, Subscriber or retiree is the secondary plan and the
other plan is the primary plan.
2. Dependent child covered under more than one plan. Unless there is a court decree stating otherwise,
when a dependent child is covered by more than one plan the order of benefits is determined as
follows:
a) For a dependent child whose parents are married or are living together, whether or not they have
ever been married:
The plan of the parent whose birthday falls earlier in the calendar year is the primary plan; or
If both parents have the same birthday, the plan that has covered the parent the longest is the
primary plan.
b) For a dependent child whose parents are divorced or separated or not living together, whether or
not they have ever been married:
i. If a court decree states that one of the parents is responsible fo
care expenses or health care coverage and the plan of that parent has actual knowledge of
those terms, that plan is primary. This rule applies to claim determination periods
commencing after the plan is given notice of the court decree;
ii. If a court decree states one parent is to assume primary financial responsibility for the
dependent child but does not mention responsibility for health care expenses, the plan of the
parent assuming financial responsibility is primary;
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iii. If a court decree states that both parents are responsible for the dependent child
expenses or health care coverage, the provisions of a) above determine the order of benefits;
iv. If a court decree states that the parents have joint custody without specifying that one parent
has responsibility for the health care expenses or health care coverage of the dependent child,
the provisions of Subsection a) above determine the order of benefits; or
v. If there is no court decree allocating responsibility for the
expenses or health care coverage, the order of benefits for the child are as follows:
The plan covering the custodial parent, first;
The plan covering the spouse of the custodial parent, second;
The plan covering the non-custodial parent, third; and then
The plan covering the spouse of the non-custodial parent, last.
c) For a dependent child covered under more than one plan of individuals who are not the parents of
the child, the provisions of Subsection a) or b) above determine the order of benefits as if those
individuals were the parents of the child.
3. Active employee or retired or laid-off employee. The plan that covers a Member as an active
employee, that is, an employee who is neither laid off nor retired, is the primary plan. The plan
covering that same Member as a retired or laid off employee is the secondary plan. The same would
hold true if a Member is a Dependent of an active employee and that same Member is a Dependent of a
retired or laid-off employee. If the other plan does not have this rule, and as a result, the plans do not
agree on the order of benefits, this rule is ignored. This rule does not apply if the rule under Section
D.1. can determine the order of benefits.
4. COBRA or State Continuation Coverage. If a Member whose coverage is provided under COBRA or
under a right of continuation provided by state or other federal law is covered under another plan, the
plan covering the Member as an employee, member, Subscriber or retiree or covering the Member as a
Dependent of an employee, member, Subscriber or retiree is the primary plan and the COBRA or state
or other federal continuation coverage is the secondary plan. If the other plan does not have this rule,
and as a result, the plans do not agree on the order of benefits, this rule is ignored. This rule does not
apply if the rule under Section D.1 can determine the order of benefits.
5. Longer or shorter length of coverage. The plan that covered the Member as an employee, member,
Subscriber or retiree longer is the primary plan and the plan that covered the Member the shorter
period of time is the secondary plan.
6. If the preceding rules do not determine the order of benefits, the allowable expenses must be shared
equally between the plans meeting the definition of plan. In addition, this plan will not pay more than it
would have paid had it been the primary plan.
Effect on the Benefits of this Plan.
When this plan is secondary, it must make payment in an amount so that, when combined with the amount paid
by the primary plan, the total benefits paid or provided by all plans for the claim equal one hundred percent of
the total allowable expense for that claim. However, in no event shall the secondary plan be required to pay an
amount in excess of its maximum benefit plus accrued savings. In no event should the Member be responsible
for a deductible amount greater than the highest of the two deductibles.
Right to Receive and Release Needed Information.
Certain facts about health care coverage and services are needed to apply these COB rules and to determine
benefits payable under this plan and other plans. KFHPWA may get the facts it needs from or give them to
other organizations or persons for the purpose of applying these rules and determining benefits payable under
this plan and other plans covering the Member claiming benefits. KFHPWA need not tell, or get the consent of,
any Member to do this. Each Member claiming benefits under this plan must give KFHPWA any facts it needs
to apply those rules and determine benefits payable.
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Facility of Payment.
If payments that should have been made under this plan are made by another plan, KFHPWA has the right, at its
discretion, to remit to the other plan the amount it determines appropriate to satisfy the intent of this provision.
The amounts paid to the other plan are considered benefits paid under this plan. To the extent of such payments,
KFHPWA is fully discharged from liability under this plan.
Right of Recovery.
KFHPWA has the right to recover excess payment whenever it has paid allowable expenses in excess of the
maximum amount of payment necessary to satisfy the intent of this provision. KFHPWA may recover excess
payment from any person to whom or for whom payment was made or any other issuers or plans.
Questions about Coordination of Benefits? Contact the State Insurance Department.
Effect of Medicare.
Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status,
and will be adjudicated by KFHPWA as set forth in this section. KFHPWA will pay primary to Medicare when
required by federal law. When Medicare, Part A and Part B or Part C are primary, Medicare's allowable amount
is the highest allowable expense.
When a Network Provider renders care to a Member who is eligible for Medicare benefits, and Medicare is
deemed to be the primary bill payer under Medicare secondary payer guidelines and regulations, KFHPWA will
seek Medicare reimbursement for all Medicare covered services.
XI.!Subrogation and Reimbursement Rights
The benefits under this EOC will be available to a Member for injury or illness caused by another party, subject to
the exclusions and limitations of this EOC. If KFHPWA provides benefits under this EOC for the treatment of the
injury or illness, KFHPWA will be subrogated to any rights that the Member may have to recover compensation or
damages related to the injury or illness and the Member shall reimburse KFHPWA for all benefits provided, from
any amounts the Member received or is entitled to receive from any source on account of such injury or illness,
whether by suit, settlement or otherwise, including but not limited to:
Payments made by a third party or any insurance company on behalf of the third party;
Any payments or awards under an uninsured or underinsured motorist coverage policy;
Any ward or settlement;
Medical payments coverage under any automobile policy,
coverage or premises or homeowner
Any other payments from a source intended to compensate an Injured Person for injuries resulting from an
accident or alleged negligence.
This section more fully describes KFHPWA
"Injured Person" under this section means a Member covered by the EOC who sustains an injury or illness and any
spouse, dependent or other person or entity that may recover on behalf of such Member including the estate of the
Member and, if the Member is a minor, the guardian or parent of the Member. When referred to in this section, "
KFHPWA's Medical Expenses" means the expenses incurred and the value of the benefits provided by KFHPWA
under this EOC for the care or treatment of the injury or illness sustained by the Injured Person.
caused by a third party giving rise to a claim of legal liability against the third
party and/or payment by the third party to the Injured Person and/or a settlement between the third party and the
Injured Person, KFHPWA shall have the right to recover KFHPWA's Medical Expenses from any source available
to the Injured Person as a result of the events causing the injury. This right is commonly referred to as
"subrogation." KFHPWA shall be subrogated to and may enforce all rights of the Injured Person to the full extent of
KFHPWA's Medical Expenses.
By accepting benefits under this plan, the Injured Person also specifically ac
reimbursement. This right of reimbursement attaches when this KFHPWA has provided benefits for injuries or
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illnesses caused by another party and the Injured Person or the Insentative has recovered any
amountmbursement is cumulative with
and not exclusive of its subrogation right and KFHPWA may choose to exercise either or both rights of recovery.
In oights, the Injured Person agrees to assign KFHPWA any benefits or claims
or rights of recovery they may have under any automobile policy or other coverage, to the full exte
subrogation and reimbursement claims. This assignment allows KFHPWA to pursue any claim the Injured Person
may have, whether or not they choose to pursue the claim.
KFHPWAtion and reimbursement rights shall be limited to the excess of the amount required to fully
compensate the Injured Person for the loss sustained, including general damages.
Subject to the above provisions, if the Injured Person is entitled to or does receive money from any source as a result
of the events causing the injury or illness, including but not limited to any liability insurance or
uninsured/underinsured motorist funds, KFHPWAExpenses are secondary, not primary.
The Injured Person and their agents shall cooperate fully with KFHPWA in its efforts to collect KFHPWA's Medical
Expenses. This cooperation includes, but is not limited to, supplying KFHPWA with information about the cause of
injury or illness, any potentially liable third parties, defendants and/or insurers related to the Injured Person's claim.
The Injured Person shall notify KFHPWA within 30 days of any claim that may give rise to a claim for subrogation
or reimbursement. The Injured Person shall provide periodic updates about any facts that may impact KFHPWA
right to reimbursement or subrogation as requested by KFHPWA, and shall inform KFHPWA of any settlement or
other payments relating to the Injured Persone Injured Person and their agents shall permit KFHPWA,
at KFHPWA's option, to associate with the Injured Person or to intervene in any legal, quasi-legal, agency or any
other action or claim filed.
The Injured Person and their agents shall do nothing to prejudice KFHPWAd reimbursement
rights. The Injured Person shall promptly notify KFHPWA of any tentative settlement with a third party and shall
not settle a claim without protecting KFHPWA The Injured Person shall provide 21 days advance notice
to KFHPWA before there is a disbursement of proceeds from any settlement with a third party that may give rise to
a claim for subrogation or reimbursement. If the Injured Person fails to cooperate fully with KFHPWA in recovery
of KFHPWAenses, and such failmbursement
rights, the Injured Person shall be responsible for directly reimbursing KFHPWA for 100% of KFHPWA
Expenses.
To the extent that the Injured Person recovers funds from any source that in any manner relate to the injury or illness
giving rise to KFHPWA subrogation, the Injured Person agrees to hold such monies in
trust or in a separate identifiable account until KFHPWAtion and reimbursement rights are fully
determined and that KFHPWA has an equitable lien over such monies to the full extent of KFHPWA
Expenses and/or the Injured Person agrees to serve as constructive trustee over the monies to the extent of
KFHPWAenses. In the event that such monies are not so held, the funds are recoverable even if they
have been comingled with other assets, without the need to trace the source of the funds. Any party who distributes
funds without regard to KFHPWArogation or reimbursement will be personally liable to KFHPWA
for the amounts so distributed.
If reasonable collections costs have been incurred by an attorney for the Injured Person in connection with obtaining
recovery, KFHPWA will reduce the amount of reimbursement to KFHPWA by the amount of an equitable
apportionment of such collection costs between KFHPWA and the Injured Person. This reduction will be made only
if each of the following conditions has been met: (i) KFHPWA receives a list of the fees and associated costs before
at securing recovery for the Injured
Party.
To the extent the provisions of this Subrogation and Reimbursement section are deemed governed by ERISA,
implementation of this section shall be deemed a part of claims administration and KFHPWA shall therefore have
discretion to interpret its terms.
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XII.!Definitions
Allowance The maximum amount payable by KFHPWA for certain Covered Services.
Allowed Amount The level of benefits which are payable by KFHPWA when expenses are incurred from a
non-Network Provider. Expenses are considered an Allowed Amount if the charges are
consistent with those normally charged to others by the provider or organization for the
same services or supplies; and the charges are within the general range of charges made
by other providers in the same geographical area for the same services or supplies.
Members shall be required to pay any difference between a non-Networ
charge for services and the Allowed Amount, except for Emergency services or services
provided by a non-Network provider at a Network Facility.
Convalescent Care Care furnished for the purpose of meeting non-medically necessary personal needs
which could be provided by persons without professional skills or training, such as
assistance in walking, dressing, bathing, eating, preparation of special diets, and taking
medication.
Copayment The specific dollar amount a Member is required to pay at the time of service for certain
Covered Services.
Cost Share The portion of the cost of Covered Services for which the Member is liable. Cost Share
includes Copayments, coinsurances and Deductibles.
Covered Services The services for which a Member is entitled to coverage in the Evidence of Coverage.
Creditable Coverage Coverage is creditable if the actuarial value of the coverage equals or exceeds the
actuarial value of standard Medicare prescription drug coverage, as demonstrated
through the use of generally accepted actuarial principles and in accordance with CMS
actuarial guidelines. In general, the actuarial determination measures whether the
expected amount of paid claims under KFHPWAeast
as much as the expected amount of paid claims under the standard Medicare prescription
drug benefit.
Deductible A specific amount a Member is required to pay for certain Covered Services before
benefits are payable.
Dependent Any member of a Subscriber's family who meets all applicable eligibility requirements,
is enrolled hereunder and for whom the premium has been paid.
Emergency The emergent and acute onset of a medical, mental health or substance use disorder
symptom or symptoms, including but not limited to severe pain or emotional distress,
that would lead a prudent layperson acting reasonably to believe that a health condition
exists that requires immediate medical attention, if failure to provide medical attention
would result in serious impairment to bodily function or serious dysfunction of a bodily
organ or part, or would placif the Member is pregnant, the
health of the unborn child, in serious jeopardy, or any other situations which would be
considered an emergency under applicable federal or state law.
Essential Health Benefits set forth under the Patient Protection and Affordable Care Act of 2010,
Benefits including the categories of ambulatory patient services, Emergency services,
hospitalization, maternity and newborn care, mental health and substance use disorder
services, including behavioral health treatment, prescription drugs, rehabilitative and
habilitative services and devices, laboratory services, preventive and wellness services
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and chronic disease management and pediatric services, including oral and vision care.
Evidence of Coverage The Evidence of Coverage is a statement of benefits, exclusions and other provisions as
set forth in the Group Medical Coverage Agreement between KFHPWA and the Group.
Family Unit A Subscriber and all their Dependents.
Group An employer, union, welfare trust or bona-fide association which has entered into a
Group Medical Coverage Agreement with KFHPWA.
Hospital Care Those Medically Necessary services generally provided by acute general hospitals for
admitted patients.
KFHPWA-designated A specialist specifically identified by KFHPWA.
Specialist
Medical Condition A disease, illness or injury.
Medically Necessary Pre-service, concurrent or post-service reviews may be conducted. Once a service has
been reviewed, additional reviews may be conducted. Members will be notified in
writing when a determination has been made. Appropriate and clinically necessary
services, as determined by KFHPWAy accepted
principles of good medical practice, which are rendered to a Member for the diagnosis,
care or treatment of a Medical Condition and which meet the standards set forth below.
In order to be Medically Necessary, services and supplies must meet the following
requirements: (a) are not solely for the convenience of the Member, their family member
or the provider of the services or supplies; (b) are the most appropriate level of service or
supply which can be safely provided to the Member; (c) are for the diagnosis or
treatment of an actual or existing Medical Condition unless being provided under
KFHPWAs schedule for preventive services; (d) are not for recreational, life-enhancing,
relaxation or palliative therapy, except for treatment of terminal conditions; (e) are
appropriate and consistent with the diagnosis and which, in accordance with accepted
medical standards in the State of Washington, could not have been omitted without
adversely affecting the Membervices rendered; (f)
as to inpatient care, could not office, the outpatient
department of a hospital or a non-residen
condition or quality of health services rendered; (g) are not primarily for research and
data accumulation; and (h) are not experimental or investigational. The length and type
of the treatment program and the frequency and modality of visits covered shall be
determined by KFHPWAbeing medically necessary, to
be covered, services and supplies must be otherwise included as a Covered Service and
not excluded from coverage.
Medicare The federal health insurance program for people who are age 65 or older, certain
younger people with disabilities, and people with End-Stage Renal Disease (permanent
kidney failure requiring dialysis or a transplant, sometimes called ESRD).
Member Any enrolled Subscriber or Dependent.
Network Facility A facility (hospital, medical center or health care center) owned or operated by Kaiser
Foundation Health Plan of Washington or otherwise designated by KFHPWA, or with
whom KFHPWA has contracted to provide health care services to Members.
Network Personal A provider who is employed by Kaiser Foundation Health Plan of Washington or
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Physician Washington Permanente Medical Group, P.C., or contracted with KFHPWA to provide
primary care services to Members and is selected by each Member to provide or arrange
for the provision of all non-emergent Covered Services, except for services set forth in
the EOC which a Member can access without Preauthorization. Network Personal
Physicians must be capable of and licensed to provide the majority of primary health
care services required by each Member.
Network Provider The medical staff, clinic associate staff and allied health professionals employed by
Kaiser Foundation Health Plan of Washington or Washington Permanente Medical
Group, P.C., and any other health care professional or provider with whom KFHPWA
has contracted to provide health care services to Members, including, but not limited to
physicians, podiatrists, nurses, physician assistants, social workers, optometrists,
psychologists, physical therapists and other professionals engaged in the delivery of
healthcare services who are licensed or certified to practice in accordance with Title 18
Revised Code of Washington.
Out-of-pocket Expenses Those Cost Shares paid by the Subscriber or Member for Covered Services which are
applied to the Out-of-pocket Limit.
Out-of-pocket Limit The maximum amount of Out-of-pocket Expenses incurred and paid during the calendar
year for Covered Services received by the Subscriber and their Dependents within the
same calendar year. The Out-of-pocket Expenses which apply toward the Out-of-pocket
Limit are set forth in Section IV.
Plan Coinsurance The percentage amount the Member is required to pay for Covered Services received.
Preauthorization An approval by KFHPWA that entitles a Member to receive Covered Services from a
specified health care provider. Services shall not exceed the limits of the
Preauthorization and are subject to all terms and conditions of the EOC. Members who
have a complex or serious medical or psychiatric condition may receive a standing
Preauthorization for specialty care provider services.
Residential Treatment A term used to define facility-based treatment, which includes 24 hours per day, 7 days
per week rehabilitation. Residential Treatment services are provided in a facility
specifically licensed in the state where it practices as a residential treatment center.
Residential treatment centers provide active treatment of patients in a controlled
environment requiring at least weekly physician visits and offering treatment by a multi-
disciplinary team of licensed professionals.
Service Area Washington counties of Benton, Columbia, Franklin, Island, King, Kitsap, Kittitas,
Lewis, Mason, Pierce, Skagit, Snohomish, Spokane, Thurston, Walla Walla, Whatcom,
Whitman and Yakima.
Subscriber A person employed by or belonging to the Group who meets all applicable eligibility
requirements, is enrolled and for whom the premium has been paid.
Urgent Condition The sudden, unexpected onset of a Medical Condition that is of sufficient severity to
require medical treatment within 24 hours of its onset.
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Dental Care Service Contract
Declaration Page
Group Number(s) 00611
Group Name City of Kent
Effective Date 12:01 a.m. Pacific Time January 1, 2021
Term 12 Months
SM
Plan Type Delta Dental PPO Local Plan
Group identified above agrees to a Dental Care Service Contract with Delta Dental of Washington , a nonprofit
corporation incorporated in Washington State. This Contract is issued and delivered in the state of Washington and is
governed by Washington State laws. It is subject to the terms listed on these Declaration Page, the general Terms and
Conditions, the Certificate of Coverage, and any appendices and amendments, all of which are incorporated and made
part this Contract.
Rates
The monthly Administrative Fee payable by Group under this Contract Term during the period January 1, 2021 through December
31, 2021 shall be $7.10
accompany the eligibility listing. DDWA will then update the files and send a new billing to Group for the next month of coverage.
Accepted By: Accepted By:
City of Kent Delta Dental of Washington
220 4th Ave S Post Office Box 75983
Kent, WA 98032-5895 Seattle, WA 98175-0983
Signed: Signed:
Title: Title: Vice President
Underwriting and Actuarial
Date: Date: November 23, 2020
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Benefit Period
Benefit Period Start January 1 Benefit Period End December 31
Eligibility, Enrollment, and Termination
Eligibility - Employee As defined by Group Eligibility - Dependent As defined by Group
Start Date Election Yes End Date Election No
Probationary Period As defined by Group Probationary Period Waiver No
Retroactive Additions 180 Days Retroactive Terminations 180 Days
Participation
Minimum Enrollment 100
Participation % Employee Tied to Medical Participation % Dependent Tied to Medical
Plan Deductibles
Individual In-Network $50 Family In-Network $150
Individual Out-of-Network $50 Family Out-of-Network $150
Deductible Waived on Class I; Orthodontic Benefits; Accidental Injury Benefits
Expenses
Runout Period 6 Months
Plan Specific Information: Plan 02 - All Medical Plans
Plan Maximums
Plan Maximum $2,000 (19 years of age or older)
Unlimited (under the age of 19)
Orthodontic Maximum $1,800 Lifetime* Temporomandibular Not Covered
Maximum
*Medically Necessary Orthodontic treatment for members under the age of 19, as defined in the Certificate of Coverage, does not
accrue to the Orthodontic lifetime maximum.
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Plan Coinsurance
Delta Dental PPO Dentists Delta Dental Premier Dentists
Covered Dental Benefits
Non-Participating Dentists in
Dentists Outside of Washington State
Washington State
Class I 100% 100%
Class II 80% 80%
Class III 80% 80%
Temporomandibular Joint Not Covered Not Covered
Orthodontic 50% 50%
Accidental Injury 100% 100%
Plan Specific Information: Plan 03 - Retirees
Plan Maximums
Plan Maximum $1,500 (19 years of age or older)
Unlimited (under the age of 19)
Orthodontic Maximum $1,000 Lifetime* Temporomandibular Not Covered
Maximum
*Medically Necessary Orthodontic treatment for members under the age of 19, as defined in the Certificate of Coverage, does not
accrue to the Orthodontic lifetime maximum.
Plan Coinsurance
Delta Dental PPO Dentists Delta Dental Premier Dentists
Covered Dental Benefits
Non-Participating Dentists in
Dentists Outside of Washington State
Washington State
Class I 100% 100%
Class II 80% 80%
Class III 50% 50%
Temporomandibular Joint Not Covered Not Covered
Orthodontic 50% 50%
Accidental Injury 100% 100%
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Deviations
All of the Terms and Conditions in this Contract apply, except if specifically modified in this Deviations section. Any
modifications listed here supersede all referenced Articles in the standard Terms and Conditions section below.
The following custom language is added by this reference.
Section # Custom Language
Global Plan 03 For the purposes of Plan 03, the term Retiree may be inferred in place of the term Employee,
where applicable.
8.9Leave of Absence
Coverage for a subscriber and enrolled dependents may be continued for up to 180 days when the
employer grants the subscriber a leave of absence and premium charges continue to be paid. If a
medical leave is granted, the City of Kent may pay the required monthly charge for the employee
and enrolled dependents for up to 180 days. The 180-day leave of absence period counts toward
the maximum COBRA continuation period, except as prohibited by the Family and Medical Leave
Act of 1993.
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Dental Care Service Contract
Terms and Conditions
1.!Definitions
1.1. Administrative Fee: The monthly amount payable by Group as designated on the Declaration Pages.
1.2. Benefit Period: The time period that applies to the frequencies and limitations. The Benefit Period is shown on the
Declaration Page.
1.3. Certificate of Coverage: The benefit booklet, which describes in summary form the essential features of the Plan
coverage, and to or for whom the benefits hereunder are payable. The Certificate of Coverage is incorporated into this
Contract by this reference as if it were fully written in this document.
1.4. Contract: This agreement between DDWA and Group, including the Declaration Page, The Certificate of Coverage and any
and all appendices and amendments. This Contract constitutes the entire Contract between the parties and supersedes
any prior agreement, understanding or negotiation between the parties.
1.5. Covered Dental Benefit: Dental services that are covered under this Contract, subject to the limitations and exclusions set
forth in the Certificate of Coverage.
1.6. DDWA: Delta Dental of Washington, a nonprofit corporation incorporated in Washington State. DDWA is a member of
the Delta Dental Plans Association.
1.7. Declarations Page(s): The front page(s) of this Plan that provides the Group specific information and group specific
elections referred to in the Terms and Conditions.
1.8. Delta Dental: Delta Dental Plans Association: A nationwide not-for-profit organization of dental benefit carriers offering a
range of group dental benefit plans.
1.9. Delta Dental PPO Dentist: A Participating Dentist who has agreed to render services and receive payment in accordance
with the terms and conditions of a written Delta Dental PPO provider agreement, which includes looking solely to Delta
Dental for payment for covered services.
®
1.10. Delta Dental Premier Dentist: A Delta Dental Participating Dentist who has agreed to render services and receive
payment in accordance with the terms and conditions of a written Delta Dental provider agreement between DDWA and
such Dentist.
1.11. Delta Dental Participating Dentist: A licensed Dentist who has agreed to render services and receive payment in
accordance with the terms and conditions of a written Delta Dental Provider Agreement, which includes looking solely to
Delta Dental for payment for covered services. Delta Dental Participating Dentists include Delta Dental PPO Dentists and
Delta Dental Premier Dentists.
1.12. Dentist: A licensed dentist legally authorized to practice dentistry at the time and in the place services are performed.
This Contract provides covered services only if those services are performed by or under direction of a licensed Dentist or
other Licensed Professional operating within the scope of their license.
1.13. Eligibility Date: The date on which an Eligible Person becomes eligible to enroll in the Plan.
1.14. Eligible Dependent, Eligible Employee, or Eligible Person: Any dependent, employee or person who meets the conditions
of eligibility set forth on the Declaration Page.
1.15. Employee: A person who is designated as such by the Group for the purposes of this Plan.
1.16. Enrolled Dependent, Enrolled Employee, or Enrolled Person: Any Eligible Dependent, Eligible Employee or Eligible
Person, as applicable, who has completed the enrollment process and for whom Group has submitted the monthly
Administrative Fee to DDWA.
1.17. Filed Fee: The approved fee accepted by DDWA for a specific dental procedure performed by a Delta Dental Participating
Dentist, who has performed the dental service and submitted that fee.
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1.18. Group: The employer or entity that is contracting for dental benefits for its Employees in this Contract.
1.19. Licensed Professional: An individual legally authorized to perform services as defined in their license. Licensed
Professional includes, but is not limited to, denturists, hygienists, and radiology technicians.
1.20. Lifetime Maximum: The maximum amount DDWA will pay in the specified Covered Dental Benefit class for an insured
individual during the time that individual is on this Plan or any other Plan offered by this Employer.
1.21. Maximum Allowable Fee: The maximum dollar amount that will be allowed toward the reimbursement for any service
provided for a Covered Dental Benefit.
1.22. Non-Participating Dentist: A licensed Dentist who has not agreed to render services and receive payment in accordance
with the terms and conditions of a written Participating Dentist Agreement between a member of the Delta Dental Plans
Association and such Dentist.
1.23. Open Enrollment Period: The annual period in which Eligible Employees can select benefits Plans and add or delete
Eligible Dependents.
1.24. Participating Plan: Delta Dental of Washington and any other member of the Delta Dental Plans Association with which
Delta Dental contracts to assist in administering the Covered Dental Benefits described in this Contract.
1.25. Plan Coinsurance: The applicable percentage of Maximum Allowable Fees for Covered Dental Benefits that shall be paid
by DDWA as set forth in the Declaration Page. Sometimes this is referred to as the payment level.
1.26. Plan: This Contract that provides dental benefits. Any other Contract that provides dental benefits and meets the
Certificate of Coverage is a plan for the purpose of
coordination of benefits only.
1.27. Service Area: Washington State, the geographic area in which DDWA will issue this policy. Dental Benefits are provided
for covered services received outside of Washington State.
1.28. Standard Terms and Conditions: The non-Group specific terms and conditions that control this Contract, unless
specifically modified on the Declaration Page.
2.!Eligibility, Enrollment, and Termination
2.1. Employee Eligibility, Enrollment, and Termination
2.1.1. Employees are eligible to enroll in this Plan if they meet the condition of eligibility designated on the Declaration
Page.
2.1.2. Eligible Employees may enroll in this Plan on the effective date of this Contract. An employee hired after the effective
date of this Contract may enroll in this Plan after satisfying the probationary period indicated on the Declaration
Page.
2.1.3. Employees are eligible to enroll in this Plan on the first of the month after satisfying any probationary period
designated on the Declaration Page Declaration Page. For
Employee enrollment will start on the date the Employee is eligible. An Employee shall
continue to be eligible to enroll in this Plan during the time this Contract is in effect as long as the Employee remains
an Eligible Employee.
2.1.4. If indicated on the Declaration Page, DDWA will waive the Employee probationary period for an Employee hired after
the effective date of this Contract who is transferring into the Plan from enrollment in any other dental plan.
Enrollment for such Employee must be completed within 30 days of the transfer and the Employee must have been
enrolled for benefits under the prior dental plan in the month of transfer or immediately prior to the month of
transfer. The effective date of coverage for such Employee shall be the first day of the calendar month following
enrollment. Notification of previous coverage is required at the time of enrollment.
2.1.5. Eligible Employees become Enrolled Employees after fully completing the enrollment process, including payment of
Administrative Fee by Group to DDWA, and remain Enrolled Employees as long as they remain eligible under this Plan
and Group has made timely payments of monthly Administrative Fees on behalf of the Employee.
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2.1.6. An Enrolled Employee terminates from this Plan at the end of the month that the employee is no longer eligible for
enrollment unless the Group has electeDeclaration Page
Employee terminates on the date the Employee is no longer eligible. An Employee will also terminate from this Plan
at the end of the calendar month for which Group has made the last timely payment of the monthly Administrative
Fees on behalf of the Enrolled Employee, or upon termination of this Contract, whichever occurs first.
2.2. Dependent Eligibility, Enrollment, and Termination
2.2.1. Dependent coverage under this plan is available as indicated on the Declaration Page.
2.2.2. If covered, an Eligible Dependent is a dependent of an Enrolled Employee who meets the requirements for eligibility
established by the Group. Dependent eligibility validation documentation shall be maintained and verified by the
Group.
2.2.3. An Eligible Dependent shall become eligible to enroll in this Plan on the date the Eligible Employee becomes eligible
to enroll in this Plan, or on the first day of the calendar month following the month in which such person became an
Eligible Dependent of the Eligible Employee.
2.2.4. A foster child is covered from the time of placement.
2.2.5. A newborn is covered from the moment of birth, and an adopted child is covered from the date of assumption of a
legal obligation for total or partial support or upon placement of the child in anticipation of adoption of the child.
2.2.6. Eligible Dependents become Enrolled Dependents after fully completing the enrollment process, including payment
of Administrative Fee by the Group to DDWA. An Enrolled Dependent shall continue to be enrolled as long as the
Group has made timely payment of the monthly Administrative Fees on behalf of the Enrolled Employee to DDWA.
2.2.7. If the enrollment process is not completed within the time period selected which is represented in the Certificate of
Coverage, enrollment will not be accepted until the next Open Enrollment Period unless specified, or unless there is a
change in family status as defined in the Special Enrollment Period section of the Certificate of Coverage. If an
additional Administrative Fee for coverage is required and enrollment is not completed within the time period
selected, the newborn, adopted or foster child(ren) will be covered from the effective date of enrollment as defined
in the Certificate of Coverage.
2.2.8. An Enrolled Dependent terminates from this Plan when they are no longer an Eligible Dependent of an Eligible
Employee, or at the end of the calendar month for which Group has made timely payment of the monthly
Administrative Fees on behalf of the Enrolled Employee, or upon termination of this Contract, whichever occurs first.
2.2.9. An Enrolled Employee may terminate coverage of an Enrolled Dependent or reinstate an Eligible Dependent only at
renewal or extension of this Plan, or if there is a change in family status, as defined in the Special Enrollment Period
section of the Certificate of Coverage.
2.3. General Enrollment Information
2.3.1. An Enrolled Employee must complete the enrollment process for themselves or any newly Eligible Dependents within
the time period represented in the Certificate of Coverage. Late enrollment will not be accepted until the next Open
Enrollment Period unless specified, or unless there is a change in family status as defined in the Special Enrollment
Period section of the Certificate of Coverage.
2.3.2. DDWA requests that all completed enrollment information is received from the Group within 60 days of the
employee or .
2.3.3. Retroactive additions and terminations of enrollment for administrative purposes will only be accepted for the time
period indicated on the Declaration Page.
2.3.4. While satisfying the various requirements of the FMLA, the Paid Family and Medical Leave Act, and COBRA laws rests
primarily with the Group, DDWA will fully cooperate with Group in complying with these laws.
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3.!Participation Requirements, Administrative Fees, Invoicing, Payment, Reimbursement of Claims
3.1. Participation Requirements
3.1.1. This Contract requires participation of the required percentage or segment of Eligible Employees and Eligible
Dependents as indicated on the Declaration Page.
3.1.2. For Groups that elect a specific percentage of employee participation, Group will assure that percentage of Eligible
Employees are participating in this Plan.
3.1.3. For Groups that elect a specific percentage of dependent participation, Group will assure that specified percentage of
all Enrolled Employees enroll all of their Eligible Dependents, unless those dependents are enrolled in another dental
plan.
3.1.4. For Groups that elect to have employee or dependent enrollment in this Plan tied to enrollment in their Group-
sponsored medical plan, all Eligible Employees and their Eligible Dependents who are enrolled in the Group-
sponsored medical plan must be enrolled in this Plan regardless of whether or not they are enrolled as a dependent
in another dental plan. Eligible Employees or their Eligible Dependents who are not enrolled in the Group-sponsored
medical plan may not enroll in this Plan.
3.1.5. For Groups that elect voluntary enrollment, there is no participation requirement. All other enrollment requirements
apply.
3.2. Administrative Fee
3.2.1. Group shall submit a list of Enrolled Persons to DDWA prior to the beginning of each monthly eligibility period.
3.2.2.
verify the accuracy of information submitted to DDWA. An equitable adjustment of Administrative Fee shall be made
in the event of errors or delays in reporting eligibility.
3.2.3. DDWA shall not be obligated to recoup any funds paid to providers for treatment performed in good faith that the
eatment.
3.2.4. Legislative Surcharge Clause. If any governmental unit imposes any new tax or assessment or increases the rate of
any current tax or assessment that is measured directly by the payments made to DDWA by Group, or payment made
by DDWA for claims, then DDWA is authorized to increase the monthly Administrative Fee by the amount of such
new tax, assessment or increase, or pass through the exact tax amount to the Group separately.
3.2.5. If Group does not agree to the proposed adjustment within 30 days, DDWA may terminate this Contract at the end of
the month for which Administrative Fee had been received by DDWA prior to the date of such notice to Group and in
accordance with the provisions of this Contract.
3.2.6. The monthly Administrative Fee indicated on the Declaration Page will be remitted fully by Group as invoiced.
3.3. Invoicing and Payment
3.3.1. The Group shall pay the full invoiced amount to DDWA on or before the first day of each calendar month for which
benefits are to be provided.
3.3.2. Payment of Administrative Fee is by Electronic Funds Transfer (EFT) unless other specific payment methods are
approved by DDWA. The Group may elect to have DDWA pull the funds from their bank account via an ACH debt
transfer around the first of every month.
3.3.3. If Group objects to any portion of an invoice, Group will notify DDWA prior to the payment due date and specify the
amount and cause of the dispute. Group will pay any undisputed amounts in a timely manner. Any disputed
amounts will be resolved by direct negotiation between DDWA and Group.
3.3.4. If payment is not received within 30 days, DDWA may give written notice that payment is past due and may, at its
option, terminate all benefits and be released from all further obligations as set forth herein.
3.3.5. No person shall be entitled to benefits under this Contract during any month for which Administrative Fee payment
has not been received by DDWA.
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3.4. Reimbursement of Claims
3.4.1. DDWA shall notify Group monthly of the actual amount of claims paid by DDWA for that month. Notification will be
via email, which will constitute an invoice. Group will then have two business days to transfer funds electronically to
the appropriate DDWA bank account an amount equal to total claims paid for the month.
3.4.2. Funds are due on the date notified. If the funds are not transferred within five days of notification, a late fee of one
percent of total claim dollars on that invoice will be charged. An additional late charge of one percent of the total
claim dollars on that invoice will be charged if payment is not received within 30 days of the due date and an
additional late charge of one percent of the total claim dollars on that invoice for each subsequent 30-day period for
which payment is not received. The charges shall be included by DDWA with a subsequent payment notification.
4.!Benefits and Benefit Disputes
4.1. Benefits
4.1.1. Covered Dental Benefits, Limitations, and Exclusions are as described in the Certificate of Coverage and are subject to
the Plan maximum and deductible as defined on the Declaration Page.
4.1.2. Covered Dental Benefits are available for an Enrolled Person from the enrollment date until such enrollment
terminates.
4.1.3.
Covered Dental Benefits provided to an Enrolled Person are defined on the Declaration Page.
4.1.4. To determine Covered Dental Benefits for certain treatments, DDWA may require an Enrolled Person to obtain an
independent examination from a DDWA-appointed dentist. DDWA will pay all the charges incurred for this
examination.
4.2. Providers
4.2.1. Payment for services provided by a Delta Dental Participating Dentist will be made directly to the dentist. Contracts
between Delta Dental and its Delta Dental Participating Dentists provide that, if Delta Dental fails to pay the dentist
any amount owed, the Enrolled Person shall not be liable to the dentist for any sums owed by Delta Dental.
4.2.2. An Enrolled Person may elect the services of any licensed dentist. DDWA is not responsible for availability of any
particular licensed dentist. DDWA shall not be held liable for any act or omission on the part of the selected dentist.
4.2.3. DDWA shall be entitled to receive from any attending dentist, or from hospitals in which a dentist's care is rendered,
any records relating to treatment rendered to an Enrolled Person as may be required in the administration of claims.
4.2.4. The provider dispute resolution process as outlined in individual provider contracts is available upon request.
4.2.5. actual
fee or the Maximum Allowable Fee of the fee schedule defined below:
PPO Local Plan
Provider Type Fee Schedule
Delta Dental PPO Participating Dentist PPO Participating Dentist State Specific
Delta Dental Premier Participating Dentist Premier Participating Dentist State Specific
Non-Participating Dentist in Washington State Non-Participating Dentist State Specific
Non-Participating Dentists out of Washington State Participating Dentist
5.!Plan Details
5.1. Plan Maximum
5.1.1. The maximum amount payable by DDWA for Class I, II and III Covered Dental Benefits per Enrolled Person during
each Benefit Period is indicated on the Declaration Page. Charges for dental procedures requiring multiple treatment
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dates shall be considered incurred on the date the service is completed. Amounts for such procedures shall be
applied to the Plan maximum based on such incurred date.
5.1.2. If Orthodontic Benefits are covered, the annual or lifetime maximum amount payable by DDWA for Orthodontic
Benefits provided to an Enrolled Person will be indicated on the Declaration Page. If Orthodontic Benefits are covered
for children only, the maximum will apply only to those members.
5.1.3. If Temporomandibular Joint (TMJ) services are covered, the annual or lifetime maximum amount payable by DDWA
for dental services related to the treatment of TMJ disorders will be indicated on the Declaration Page.
5.2. Plan Coinsurance
Plan coinsurance amounts are indicated on the Declaration Page.
5.3. Plan Deductible
5.3.1. The plan deductible, if elected, is indicated on the Declaration Page.
5.3.2. Deductibles may apply to In-Network and Out-of-Network combined, In-Network and Out-of-Network separately, or
for Out-of-Network only, as indicated on the Declaration Page.
5.3.3. DDWA is not obligated to pay for Covered Dental Benefits until the deductible amount is satisfied during each Benefit
Period for each individual, unless the family deductible has been met during that Benefit Period. The family
deductible is accrued by deductible payments of the Enrolled Employee or any Enrolled Dependent.
5.3.4. Any elected deductible is waived on designated classes of benefits as indicated on the Declaration Page.
6.!
6.1. Certificates of Coverage
6.1.1. DDWA will issue to Group an electronic version of the Certificate of Coverage for this Plan in the form of a standard
DDWA benefit booklet, which summarizes the Covered Dental Benefits and other essential features of the Plan. If any
amendment to this Contract materially affects any benefits described in booklets, electronic versions of corrected
booklets or booklet inserts showing the change will be issued to Group. Generally, new Booklets and/or Inserts are
not issued mid-Contract Term unless as otherwise specified in this Contract.
6.1.2. Upon receipt of a written request, DDWA will provide to Group one printed booklet for each employee enrolled in
the Plan, plus an additional ten percent for a reserve supply. Group will reimburse DDWA for any additional costs due
to variation in booklet size or paper requested by Group. DDWA will have booklets delivered to Group within 15
business days after receipt of a signed booklet approval form from Group.
6.2. Confirmation of Treatment and Cost (also known as predetermination of benefits)
6.2.1. DDWA will provide descriptions of Confirmation of Treatment and Costs, claim review, and complaint and appeal
procedures in the benefit booklets issued to Group.
6.2.2. If a dentist or an Enrolled Person submits a request for a Confirmation of Treatment and Cost, DDWA will provide a
Confirmation of Treatment and Cost for the Enrolled Person. Such Confirmation of Treatment and Cost will be valid
when issued based on the information available at that time. A Confirmation of Treatment and Costs is not an
authorization for services nor a guarantee of payment but is a notification of Covered Dental Benefits available.
6.3. Quality Management
DDWA may utilize its Quality Management and Clinical Review processes to provide professional review of the adequacy,
criteria of services rendered to Enrolled Persons.
6.4. Provider Directories
DDWA shall provide Delta Dental Participating Dentist Directories to Group. This directory is available online, and may
also be requested by telephone as indicated in the Certificate of Coverage. It is understood that the composition of such
directory is subject to change. DDWA reserves the right to change the directory without notice.
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6.5. Dental Services Obligations
6.5.1. DDWA shall not be obligated to make payment for any services rendered to a person who is not an Enrolled Person at
the time the services were performed.
6.5.2. Nothing contained in this Contract shall be construed as obligating DDWA to render dental services; its sole obligation
being to pay the agreed-upon portion of dentist's charges for Covered Dental Benefits in accordance with the terms
of this Contract.
7.!
7.1. Notification to Enrolled Employees
Group shall provide information to all Enrolled Employees as to the existence and terms of this Contract. Group shall
make the Certificate of Coverage available to each Enrolled Employee.
7.2. Summary Plan Descriptions
If Group elects to prepare and print its own summary plan description, it does so at its own risk and expense. The Group-
prepared summary plan description must be based on the most current Certificate of Coverage provided by DDWA, and
will be for informational purposes only, not incorporated into this Contract. Group is responsible for assuring the
accuracy of any summary plan description that it elects to prepare and distribute. DDWA is not obligated to review or
approve any summary plan description prepared by Group, and will not provide any warranty for the content of the
Group-produced summary plan description.
7.3. Execution of Contract
7.3.1. Group shall sign and return any and all Contract documents within 30 days of the effective date or the date DDWA
sends the Contract document to Group or its authorized representative or agent, whichever is later.
7.3.2. If a signed Contract is not received by DDWA from the
date, but Group remits Administrative Fee, both parties agree to perform under this Contract in good faith until a
signed Contract is received, or until a notice of termination is received as detailed herein.
8.!General Provisions
8.1. Modification
No change in this Contract shall be valid unless evidenced by written amendment signed by an authorized representative
or agent of DDWA and an authorized representative or agent of Group.
8.2. Legal Action
Legal action to recover benefits provided for in this Contract may not be initiated prior to 60 days after receipt of claim by
DDWA. In addition, such legal action must commence within 6 years from the date the claim was received by DDWA.
8.3. Severability
Any provision of this Contract that is in conflict with any governing law or regulation of the State of Washington is hereby
amended to comply with the minimum requirements of such law or regulation.
8.4. Indemnification
8.4.1. DDWA shall indemnify and hold harmless Group, its affiliates and their respective directors, officers, employees and
, willful misconduct, criminal conduct,
fraud or its breach of a fiduciary responsibility related to or arising out of this Contract.
8.4.2. Group shall indemnify and hold harmless DDWA, its affiliates and their respective directors, officers, employees and
agent
fraud or its breach of a fiduciary responsibility related to or arising out of this Contract.
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8.5. Force Majeure
In the event DDWA is unable to perform its obligations under this Contract by reason of fire, casualty, lockout, strike,
labor condition, riot, war, act of God or by ordinance, law, order or decree of any legally constituted authority, then this
Contract may, at the option of DDWA, be suspended. During any period of suspension, DDWA shall not be required to
perform any service under this Contract, nor shall DDWA be liable for any damages arising from any event that
Administrative Fee payments shall also be suspended for the same period of time.
8.6. Privacy
DDWA and Group will act in accordance with applicable state and federal privacy requirements and disclosure
requirements, such as the Gramm-Leach-Bliley Act (GLBA) and the Health Insurance Portability and Accountability Act
(HIPAA), including any applicable regulations.
8.7. Domestic Partnership and Gender
For the purposes of this contract, the terms spouse, marriage, marital, husband, wife, widow, widower, next of kin, and
family shall be interpreted as applying equally to domestic partnerships or individuals in domestic partnerships as well as
to marital relationships and married persons. References to dissolution of marriage shall apply equally to domestic
partnerships that have been terminated, dissolved, or invalidated, to the extent that such interpretation does not conflict
with federal law. Where necessary, gender-specific terms such as husband and wife used in any part of this contract shall
be construed to be gender neutral, and applicable to individuals in domestic partnerships. This definition does not change
the election of the Group with regard to coverage for domestic partnerships.
8.8. Notice
Any notice under this Contract shall be sufficient if given by either Group or DDWA by regular mail to the other addressed
to the office stated on the front page of this Contract or to such other address as may be designated by written notice to
the other.
9.!Termination
9.1. Termination Notice
This Contract may be terminated effective at the end of the term by either Group or DDWA, or by either party giving
written notice to the other at least 30 days prior to the end of the Contract term, except as otherwise specifically
provided herein.
9.2. DDWA Termination
9.2.1. DDWA may elect to terminate this Contract, without prior approval of the Washington State Insurance
Commissioner, if any of the events outlined in this Section occur. Termination would be effective at the end of the
month for which Administrative Fees have been received by DDWA prior to the time of such election. If termination
occurs, DDWA will provide written notice to Group. If DDWA elects to terminate because of default by Group, then
Group shall be indebted to and agrees to pay DDWA the sum of all claims payments and expenses incurred for dental
services rendered from the date of default until the date of termination, including costs of recovery.
9.2.2. Events that allow termination:
a. A failure to pay Administrative Fee or perform Group's other obligations when due.
b. Any violation of published policies of DDWA.
c. Change or implementation of federal or state health care reform laws that no longer permit the continued
offering of such coverage.
9.2.3. Events that allow termination if the Group does not take corrective action consistent with their obligations under this
Contract:
a. Enrolled Persons committing fraudulent acts against DDWA.
b. Enrolled Persons who materially breach the terms of this Contract.
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9.3. Administrative Fee Reimbursement
If on termination of this Contract, Group has paid Administrative Fee to DDWA applicable to a period of time after the
termination date, DDWA shall, within 30 days after notification of termination, return such portion of Administrative Fee
to Group less any amounts due to DDWA.
9.4. Reinstatement
9.4.1. Acceptance by DDWA of the proper amount of Administrative Fee, after termination of this Contract and without
requiring a new application, shall reinstate the Contract as though it had never terminated, unless DDWA shall, within
5 business days of receipt of such payment, either:
a. Refund the payment so made, or
b. Issue to Group a new Contract accompanied by written notice stating clearly those respects in which the
new Contract differs from the terminated Contract in benefits, coverage or otherwise.
9.5. Expenses
Upon termination of this Plan, all claim payments and expenses incurred prior to the termination of the Plan, but not
submitted to DDWA within the runout period after the date of treatment will be excluded from any benefit
consideration.
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PLEASE ATTACH TO YOUR
VISION SERVICE PLAN DOCUMENT
AMENDMENT TO YOUR POLICY PERIOD
To be attached to and made part of Vision Care Policy Number 12229020, issued to City of Kent.
EXCEPT as specifically amended herein, said Policy shall remain in full force and effect.
IT IS HEREBY AGREED that effective January 1, 2018, the Policy Period shall be changed to SIXTY months.
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Life Insurance Company of North America
1601 Chestnut Street
Philadelphia, Pennsylvania 19192-2235
AMENDMENT
Policyholder: City of Kent Policy No.: OK - 969625
This Amendment is attached to and made part of the Policy specified above. It is subject to all of the policy provisions that
do not conflict with its provisions.
Policyholder and We hereby agree that the Policy is amended as follows:
Effective January 1, 2021, the following rates will remain in force for Class 1 for coverage under the Policy:
Premium Rate: Basic Insurance
Employee Rate: $0.02 per $1,000
No change in rates will be made until 24 months after the effective date of this Amendment. However, the Company
reserves the right to change the rates at any time during a period for which the rates are guaranteed if the conditions
described in the Changes in Premium Rates provision under the Administrative Provisions section of the Policy apply.
Except for the above, this Amendment does not change the Policy in any way.
Life Insurance Company of North America
William J. Smith, President
Date: September 21, 2020
Amendment No. 02
GA-00-4000.00
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LIFE INSURANCE COMPANY OF NORTH AMERICA
(herein called the Company)
Amendment to be attached to and made a part of the Group Policy
A Contract between the Company and
City of Kent
(herein called the Policyholder)
Policy No.: FLX - 968145
The Company and the Policyholder hereby agree that the Policy is amended as follows:
Effective January 1, 2021, the rates shown on the attached Schedule of Rates will be in force for coverage under the Policy.
No change in rates will be made until 24 months after the effective date of this Amendment. However, the Company
reserves the right to change the rates at any time during a period for which the rates are guaranteed if the conditions
described in the Changes in Premium Rates provision under the Administrative Provisions section of the Policy apply.
Except for the above, this Amendment does not change the Policy in any way.
FOR THE COMPANY
William J. Smith, President
Date: September 21, 2020
Amendment No. 02
TL-004780
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SCHEDULE OF RATES
The following monthly rates apply to all Classes of Eligible Persons unless otherwise indicated.
FOR EMPLOYEE BENEFITS
Basic Life Insurance $0.11 per $1,000
F OR S POUSE AND D EPENDENT C HILD B ENEFITS
Basic Life Insurance $1.00 Per Employee
F OR F ORMER E MPLOYEE B ENEFITS
Monthly Rates are based on units of $1,000.
Under Age 20 $.153 Age 60 - 64 $2.461
Age 20 - 24 $.144 Age 65 - 69 $4.065
Age 25 29 $.153 Age 70 - 74 $6.143
Age 30 - 34 $.177 Age 75 - 79 $9.792
Age 35 - 39 $.190 Age 80 - 84 $15.523
Age 40 - 44 $.243 Age 85 - 89 $24.106
Age 45 - 49 $.384 Age 90 - 94 $36.119
Age 50 - 54 $.726 Age 95 and over $51.278
Age 55 - 59 $1.347
A change in rates due to a change in the Former Employee's age will become effective on the Policy Anniversary
coinciding with or following the Former Employee's birthday.
F OR F ORMER S POUSES OR S POUSES OF F ORMER E MPLOYEE B ENEFITS
Monthly Rates are based on units of $1,000.
Under Age 20 $.153 Age 60 - 64 $2.461
Age 20 - 24 $.144 Age 65 - 69 $4.065
Age 25 29 $.153 Age 70 - 74 $6.143
Age 30 - 34 $.177 Age 75 - 79 $9.792
Age 35 - 39 $.190 Age 80 - 84 $15.523
Age 40 - 44 $.243 Age 85 - 89 $24.106
Age 45 - 49 $.384 Age 90 - 94 $36.119
Age 50 - 54 $.726 Age 95 and over $51.278
Age 55 - 59 $1.347
Spouse rates are based on the spouse's date of birth. A change in rates due to a change in the Spouse's age will become
effective on the Policy Anniversary coinciding with or following the Spouse's birthday.
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F OR F ORMER D EPENDENT C HILD B ENEFITS
Rates are based on $25,000 per Month.
Under Age 20 $2.377 Age 45 - 49 $9.777
Age 20 - 24 $2.777 Age 50 - 54 $16.377
Age 25 - 29 $2.977 Age 55 - 59 $23.477
Age 30 - 34 $3.600 Age 60 - 64 $38.250
Age 35 - 39 $4.177 Age 65 - 69 $54.077
Age 40 - 44 $6.200
Rates are based on $50,000 per Month
Under Age 20 $4.750 Age 45 - 49 $19.550
Age 20 - 24 $5.550 Age 50 - 54 $32.750
Age 25 - 29 $5.950 Age 55 - 59 $46.950
Age 30 - 34 $7.200 Age 60 - 64 $76.500
Age 35 - 39 $8.350 Age 65 - 69 $108.150
Age 40 - 44 $12.400
A change in rates due to a change in the Former Dependent Child's age will become effective on the Policy Anniversary
Date coinciding with or following the Former Dependent Child's birthday.
TL-004718
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LIFE INSURANCE COMPANY OF NORTH AMERICA
(herein called the Company)
Amendment to be attached to and made a part of the Group Policy
A Contract between the Company and
City of Kent
(herein called the Policyholder)
Policy No.: LK - 965532
The Company and the Policyholder hereby agree that the Policy is amended as follows:
Effective January 1, 2021, the following rates will remain in force for Classes 1 and 2 for coverage under the Policy:
$.29 per $100 of Covered Payroll
Covered Payroll for an Employee will mean his or her Covered Earnings for the insurance month prior to the date the
determination is made. However, an Employee's Covered Payroll will not include any part of his or her monthly Covered
Earnings which exceed $10,499.
No change in rates will be made until 24 months after the effective date of this Amendment. However, the Company
reserves the right to change the rates at any time during a period for which the rates are guaranteed if the conditions
described in the Changes in Premium Rates provision under the Administrative Provisions section of the Policy apply.
Except for the above, this Amendment does not change the Policy in any way.
FOR THE COMPANY
William J. Smith, President
Date: September 21, 2020
Amendment No. 02
TL-004780
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LIFE INSURANCE COMPANY OF NORTH AMERICA
(herein called the Company)
Amendment to be attached to and made a part of the Group Policy
A Contract between the Company and
City of Kent
(herein called the Policyholder)
Policy No.: FLX - 968146
PLEASE READ
IMPORTANT: The attached amendment to your policy has been made at your request, and will be effective on the date
shown within the amendment. Please review this amendment immediately and confirm that it accurately reflects your
request and is consistent with your intentions. If amended certificates have been provided, please review these as well. If
there are any errors or discrepancies, please notify your account manager or account service representative immediately. If
you have not notified your account manager or account service representative of any errors or concerns, continued payment
of premium more than 31 days after delivery of this amendment will be deemed acceptance of this amendment.
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LIFE INSURANCE COMPANY OF NORTH AMERICA
(herein called the Company)
Amendment to be attached to and made a part of the Group Policy
A Contract between the Company and
City of Kent
(herein called the Policyholder)
Policy No.: FLX - 968146
This Amendment is attached to and made part of the Policy specified above. It is subject to all of the policy provisions that
do not conflict with its provisions.
The Company and the Policyholder hereby agree that the Policy is amended as follows:
1. This Amendment will be in effect on the Effective Date(s) shown below only for insured Employees in Active Service
on that date. If an Employee is not in Active Service on the date his insurance would otherwise become effective, it
will be effective on the date he returns to Active Service.
Effective January 1, 2021, the Annual Enrollment Period under the Schedule of Benefits for Class 1 is deleted in its
entirety and is replaced by the following:
Annual Enrollment Period
For Employees
During an Annual Enrollment Period, an Employee currently insured under the Voluntary Life Insurance portion of
this Policy may increase his or her Voluntary Life Insurance Benefit by five units, as long as the total Benefit does not
exceed the Guaranteed Issue Amount, without satisfying the Insurability Requirement. An Employee who is eligible
for the Voluntary Life Insurance portion of this Policy but who has not previously enrolled may become insured under
the Policy as long as the total Benefit does not exceed the Guaranteed Issue Amount, without satisfying the Insurability
Requirement. Guaranteed Issue Amounts are shown above. Insurance will be effective on the later of the Policy
Anniversary following the Annual Enrollment Period.
An Employee may increase coverage or become insured for a Benefit in excess of amounts described above only if he
or she satisfies the Insurability Requirement. Any excess amounts will be effective on the later of the Policy
Anniversary following the Annual Enrollment Period or the date the Insurance Company agrees in writing to insure the
Employee.
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For Spouses
During an Annual Enrollment Period, an eligible Employee may elect coverage for his or her eligible Spouse. If a
Spouse is currently insured under the Voluntary Life Insurance portion of this Policy, his or her Voluntary Life
Insurance Benefit by five units, as long as the total Benefit does not exceed the Guaranteed Issue Amount, without
satisfying the Insurability Requirement. If a Spouse is eligible for the Voluntary Life Insurance portion of this Policy
but has not previously enrolled, he or she may become insured under the Policy as long as the total Benefit does not
exceed the Guaranteed Issue Amount, without satisfying the Insurability Requirement. Guaranteed Issue Amounts are
shown above. Insurance will be effective on the later of the Policy Anniversary following the Annual Enrollment
Period.
A Spouse may increase coverage or become insured for a Benefit in excess of amounts described above only if he or
she satisfies the Insurability Requirement. Any excess amounts will be effective on the later of the Policy Anniversary
following the Annual Enrollment Period or the date the Insurance Company agrees in writing to insure the Spouse.
A request for a Benefit reduction received during an Annual Enrollment Period will become effective on the later of
the Policy Anniversary following the Annual Enrollment Period.
TL-008025-1
2. Effective January 1, 2021, the rates shown on the attached Schedule of Rates will remain in force for coverage under
the Policy.
No change in rates will be made until 24 months after the effective date of this Amendment. However, the Company
reserves the right to change the rates at any time during a period for which the rates are guaranteed if the conditions
described in the Changes in Premium Rates provision under the Administrative Provisions section of the Policy apply.
Except for the above, this Amendment does not change the Policy in any way.
FOR THE COMPANY
William J. Smith, President
Date: September 21, 2020 (Revised Date: September 30, 2020)
Amendment No. 01
TL-004780
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SCHEDULE OF RATES
The following monthly rates apply to all Classes of Eligible Persons unless otherwise indicated.
F OR E MPLOYEE B ENEFITS
Voluntary Life Insurance
Monthly Rates are based on units of $1,000
Under Age 20 $.06 Age 60 - 64 $.73
Age 20 - 24 $.06 Age 65 - 69 $1.40
Age 25 29 $.06 Age 70 - 74 $2.50
Age 30 - 34 $.08 Age 75 - 79 $3.70
Age 35 - 39 $.09 Age 80 - 84 $6.61
Age 40 - 44 $.13 Age 85 - 89 $6.61
Age 45 - 49 $.23 Age 90 - 94 $6.61
Age 50 - 54 $.35 Age 95 and over $6.61
Age 55 - 59 $.61
A change in rates due to a change in the Employee's age will become effective on January 1 coinciding with or following
the Employee's birthday.
F OR S POUSE OR D OMESTIC P ARTNER B ENEFITS
Voluntary Life Insurance
Monthly Rates are based on units of $1,000.
Under Age 20 $.06 Age 60 - 64 $.73
Age 20 - 24 $.06 Age 65 - 69 $1.40
Age 25 29 $.06 Age 70 - 74 $2.50
Age 30 - 34 $.08 Age 75 - 79 $3.70
Age 35 - 39 $.09 Age 80 - 84 $6.61
Age 40 - 44 $.13 Age 85 - 89 $6.61
Age 45 - 49 $.23 Age 90 - 94 $6.61
Age 50 - 54 $.35 Age 95 and over $6.61
Age 55 - 59 $.61
Spouse rates are based on the spouse's date of birth. A change in rates due to a change in the Spouse's age will become
effective on January 1 coinciding with or following the Spouse's birthday.
F OR D EPENDENT C HILD B ENEFITS
Voluntary Life Insurance $.20 Per $1,000
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F OR F ORMER E MPLOYEE B ENEFITS
Monthly Rates are based on units of $1,000.
Under Age 20 $.153 Age 60 - 64 $2.461
Age 20 - 24 $.144 Age 65 - 69 $4.065
Age 25 29 $.153 Age 70 - 74 $6.143
Age 30 - 34 $.177 Age 75 - 79 $9.792
Age 35 - 39 $.190 Age 80 - 84 $15.523
Age 40 - 44 $.243 Age 85 - 89 $24.106
Age 45 - 49 $.384 Age 90 - 94 $36.119
Age 50 - 54 $.726 Age 95 and over $51.278
Age 55 - 59 $1.347
A change in rates due to a change in the Former Employee's age will become effective on the Policy Anniversary
coinciding with or following the Former Employee's birthday.
F OR F ORMER S POUSE OR D OMESTIC P ARTNERS OR S POUSE OR D OMESTIC P ARTNERS OF F ORMER E MPLOYEE
B ENEFITS
Monthly Rates are based on units of $1,000.
Under Age 20 $.153 Age 60 - 64 $2.461
Age 20 - 24 $.144 Age 65 - 69 $4.065
Age 25 29 $.153 Age 70 - 74 $6.143
Age 30 - 34 $.177 Age 75 - 79 $9.792
Age 35 - 39 $.190 Age 80 - 84 $15.523
Age 40 - 44 $.243 Age 85 - 89 $24.106
Age 45 - 49 $.384 Age 90 - 94 $36.119
Age 50 - 54 $.726 Age 95 and over $51.278
Age 55 - 59 $1.347
Spouse rates are based on the spouse's date of birth. A change in rates due to a change in the Spouse's age will become
effective on the Policy Anniversary coinciding with or following the Spouse's birthday.
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F OR F ORMER D EPENDENT C HILD B ENEFITS
Rates are based on $25,000 per Month.
Under Age 20 $2.377 Age 45 - 49 $9.777
Age 20 - 24 $2.777 Age 50 - 54 $16.377
Age 25 - 29 $2.977 Age 55 - 59 $23.477
Age 30 - 34 $3.600 Age 60 - 64 $38.250
Age 35 - 39 $4.177 Age 65 - 69 $54.077
Age 40 - 44 $6.200
Rates are based on $50,000 per Month
Under Age 20 $4.750 Age 45 - 49 $19.550
Age 20 - 24 $5.550 Age 50 - 54 $32.750
Age 25 - 29 $5.950 Age 55 - 59 $46.950
Age 30 - 34 $7.200 Age 60 - 64 $76.500
Age 35 - 39 $8.350 Age 65 - 69 $108.150
Age 40 - 44 $12.400
A change in rates due to a change in the Former Dependent Child's age will become effective on the Policy Anniversary
Date coinciding with or following the Former Dependent Child's birthday.
TL-004718
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BNFOENFOU!OP/23
To be attachedtoand made part of PolicyWA 518212issued to CityofKentasPolicyholder.
It is hereby agreed thePolicy shall beamendedasfollows:
EffectiveJanuary 1, 2021:
The followingSection has beenreplaced:
Section1, Declarations.
ThefollowingRider renews for the2021 Policy Year:
Specific AdvanceFunding Rider.
Allother terms and conditions of the contractremain unchanged.
MjgfXjtfBttvsbodf!Dpnqboz
Name andTitle of Officer
Signatureof Officer
Njdibfm!M/Lsvuu
Qsftjefou
Date of Signature MjgfXjtfBttvsbodf!Dpnqboz
1.Sign andreturncopytoLifeWiseAssuranceCompany.
2.Retain copy with Your Policy.
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PSL-500WAAM (9-18)Amendment
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This Declarationsfor Policy Number WA518212applyto the Policy TermJanuary 1, 2021through
December 31, 2021initsentirety.
TFDUJPO!2!EFDMBSBUJPOT
B/QPMJDZ!JOGPSNBUJPO
1.Policy NumberWA518212
2.PolicyholderCity ofKent
3.Policy TermJanuary 1,2021throughDecember31, 2021
4.Covered UnderlyingPlanCity ofKent’s Health Plan
5.ClaimAdministratorPremera Blue Cross
C/TQFDJGJD!CFOFGJU!TDIFEVMF
For all Eligible Losses exceptthose to which a Special RiskLimitation applies:
1.Covered Loss Basis
Covered Services Incurred fromJanuary 1, 2010throughDecember 31, 2021and Paidfrom
January 1,2021throughDecember31, 2021.
If an Eligible Claim Expense isdeniedbythe CoveredUnderlyingPlanand thatdenial is
subsequentlyreversedby anIndependent Review Organization (IRO),the datesuch Eligible
ClaimExpense was originally denied by the CoveredUnderlying Plan will be considered the
“Paid” date underthe above referenced Policy.
2.Covered Servicesinclude
Medical
PrescriptionDrug
3.NumberofCoveredUnits
Composite721
4.Specific Deductible perParticipant$200,000
(Please note:Specific deductible per Participantshallnotexceed the lesser of 5% of
expectedclaims or $100,000).
5.Specific Payable Percentage(in excess ofSpecificDeductible)100%
6.MaximumSpecific Benefitin excess of the Specific Deductible
PerPolicy TermUnlimited
PerLifetimeUnlimited
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PSL-500WA(9-18)1
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D/BHHSFHBUF!CFOFGJU!TDIFEVMF
For all Eligible Losses exceptthose to which a Special RiskLimitationapplies:
1.Covered Loss Basis
Covered Services Incurred fromJanuary 1, 2010throughDecember 31, 2021and Paidfrom
January 1,2021throughDecember31, 2021.
If an Eligible Claim Expense isdeniedbythe CoveredUnderlyingPlanand thatdenial is
subsequentlyreversedby anIndependentReview Organization (IRO),the datesuch Eligible
ClaimExpense was originally denied by the CoveredUnderlying Plan will be considered the
“Paid” date underthe above referenced Policy.
2.Covered Services include
Medical
PrescriptionDrug
3.NumberofCoveredUnits
Composite721
4.Aggregate Payable PercentageinexcessofDeductible100%
5.Aggregate Corridor200%
(Please note:Aggregate Corridorwill neverbeless than120% of expected claims).
6.Minimum AggregateDeductible
The greaterof:
A.$27,916,630; or
B.The sum of Aggregate MonthlyFactors, multiplied by the corresponding numberof
Covered Units used to calculate premiuminthe first month ofthe Policy Term, multiplied
by thenumber ofmonths in the PolicyTerm, multiplied by 95%.
7.Annual Aggregate Deductible
Is equal to thegreater of A or B,where:
A=The sum of the Monthly Aggregate Deductible Amounts applicable to each PolicyMonth
in the PolicyTerm
B =The MinimumAggregate Deductible
Please Note: Annual Aggregate Deductible cannot befinalized until the Monthly Aggregate
Deductible Amountsare calculated foreach Policy Month of the Policy Term.
8.Aggregate Monthly Factorper CoveredUnit
Composite$3,226.61
9.MaximumAggregateEligible Loss per Participant$200,000
10.MaximumAggregateBenefit perPolicy Term$1,000,000
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PSL-500WA(9-18)2
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E/QSFNJVN
Specific Monthly PremiumRate
Composite$128.79
Specific RateGuarantee Period12Months
Aggregate Monthly PremiumRatePer Covered Unit
Composite$0.02
Aggregate RateGuaranteePeriod12Months
The Specific Monthly Premium Rateand the Aggregate Monthly PremiumRateapplyonlytothis
Policy Term.
F/TQFDJBM!SJTL!MJNJUBUJPOT
Disabled /hospital confined, activelyatwork,activity of daily `
living, cognitively impaired, orsimilarrequirements waivedYes
Retirees IncludedYes
Other:Yes
LaseredIndividual
MemberID:60015680802
SpecificDeductible:$300,000
G/BGGJMJBUF
NameCovered UnderlyingPlan
None
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PSL-500WA(9-18)3
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INFORMATION TECHNOLOGY DEPARTMENT
Mike Carrington
220 Fourth Avenue South
Kent, WA 98032-5895
253-856-4600
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Ratify HP Laptop Purchase Utilizing CARES Act Funds
MOTION: Ratify the purchase of 65 laptops, docking stations, and
associated software and accessories utilizing CARES Act funding through
a cooperative purchasing agreement administered by NASPO ValuePoint
and entered into between HP, Inc. and the State of Minnesota as the Lead
Agency; amend the budget as may be necessary to authorize that
purchase using grant funds; and authorize future purchases of computer
equipment and associated accessories and services through that same
cooperative purchasing agreement, if those purchases can be made
agreement, which is currently in effect through July 31, 2021.
th
SUMMARY: On July 28, 2020, IT made a request to purchase up to 500 laptops,
docking stations, and warranty at an estimated cost of $1,001,687.00 utilizing the
CARES Act funding the City had received to allow City staff to work from home
during the pandemic. After completing our assessment of each user and their
specific computing needs, we were able to identify 370 users that could use the
Microsoft Surface Laptop 3, and then a group of 65 users that had a higher
computer processing requirement. This approval relates to ratifying the purchase of
65 higher processing computers through HP, Inc. and associated equipment for
$201,964.62.
With this ratification, IT is still well under its original request of $1,001,687.00,
however, the original request was too narrow as it only identified Microsoft as an
authorized vendor. IT is not requesting an increase of the budget, just to expand
the scope of authorization to include equipment purchased through HP, Inc. under
the NASPO cooperative purchasing agreement.
At the January 26, 2020, Committee of the Whole meeting, the proper contract with
HP, Inc. was pr
the contracting entity as Hewlett Packard Enterprise, instead of the proper
contracting entity-HP, Inc. That correction has been noted in the above motion.
BUDGET IMPACT: None
SUPPORTS STRATEGIC PLAN GOAL:
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Innovative Government - Delivering outstanding customer service, developing leaders, and
fostering innovation.
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
ATTACHMENTS:
1. CAG2020-404 - Original - HP, Inc. - Laptop Purchase through DES _05815-
017, (PDF)
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OFFICE OF THE CITY ATTORNEY
Pat Fitzpatrick, City Attorney
220 Fourth Avenue South
Kent, WA 98032
253-856-5770
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Ordinance Approving the Change of Indirect Control of
Astound Broadband, LLC - Adopt
MOTION: Adopt Ordinance No. 4390, approving the change of indirect
control of Astound Broadband, LLC.
SUMMARY: Astound Broadband, LLC (Astound) holds a franchise that authorizes
the installation of fiber within the rights-of-way throughout the City. The City
adopted this 10-year franchise on April 7, 2015. In 2017, the City approved an
indirect transfer of control when Radiate Holdco, LLC, acquired all of the
y approved
this indirect change in control and Astound remained the franchisee and as such is
bound by the terms of the franchise.
On December 7, 2020, Astound again requested approval of an indirect change in
control. Now, Stonepeak Infrastructure Partners plans to purchase 100% of the
membership interests of the parent company. This transaction will occur on the
parent company level and Astound will remain the franchisee and will continue to
be bound to the terms of the franchise.
Section 28.2 of the franchise requires that Astound notify the City of the impending
must approve or deny the request for transfer within 120 days. The City has
reviewed the materials provided and learned that the new parent company has no
current plans to change the local operations or structure of the operations or the
services offered. Astound will remain the franchisee and will be operated under the
direction of the existing management team. Additionally, the same terms and
conditions of the franchise will remain in place. For these reasons, it is
recommended that the City Council approve the indirect change of control as
described in this proposed ordinance.
BUDGET IMPACT: None
SUPPORTS STRATEGIC PLAN GOAL:
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
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Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
ATTACHMENTS:
1. Ordinance - Astound Broadband, LLC - Approval of Change Control (PDF)
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ORDINANCE NO. 4390
AN ORDINANCE of the City Council of the
City of Kent, Washington, approving the change of
indirect control of Astound Broadband, LLC, a
Franchisee of the City.
RECITALS
A. Astound Broadband, LLC ("Franchisee") owns, operates and
maintains a telecommunications system (the "System") in the City of Kent
pursuant to a franchise ("Franchise") granted by the City of Kent (“City") –
Ordinance No. 4144 - and Franchisee is the current duly authorized holder
of the Franchise.
B. Pursuant to an Agreement and Plan of Merger ("Agreement"),
funds associated with Stonepeak Infrastructure Partners ("Acquirer"), a
Delaware limited liability company, will purchase 100% of the membership
interests of Radiate Holdings, L.P., a Delaware limited partnership, (which
owns 100% of the indirect ownership interests in Franchisee), and, as a
result, the indirect control of Franchisee will change (the "Change of
Control").
C. Franchisee and Acquirer have requested the consent of the City
to the Change of Control in accordance with the requirements of the
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Astound Broadband, LLC
Approval of Change of Control -Ordinance
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Franchise Section 28.2, and have provided the City with all information
necessary to facilitate a decision by the City (the "Application").
D. The City has reviewed the Application, followed all required
procedures in order to consider and act upon the Application, and finds
Acquirer to be suitable to indirectly control Franchisee.
E. Per Section 28.2 of the Franchise, Franchisee must reimburse
the City for all direct and indirect costs and expenses reasonably incurred by
the City in considering this request to transfer.
NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT,
WASHINGTON, DOES HEREBY RESOLVE AS FOLLOWS:
ORDINANCE
SECTION 1. – Recitals Incorporated. The above Recitals are
incorporated into this Ordinance and constitute findings of the Kent City
Council.
SECTION 2. – Consent to Change of Control. The City Council hereby
consents to the Change of Control, all in accordance with the terms of the
Franchise and applicable law.
SECTION 3. – Franchise Authority. The City confirms that the
Franchise is valid and outstanding and in full force and effect and there are
no defaults under the Franchise. Subject to compliance with the terms of this
Ordinance, any action necessary with respect to the Change of Control has
been duly and validly taken.
2
Astound Broadband, LLC
Approval of Change of Control -Ordinance
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SECTION 4. – Terms of Franchise. This Change of Control does not
change any of the terms contained within the Franchise. Franchisee must
continue to comply with all such terms of the Franchise.
SECTION 5. – Continuing Agreement. This Ordinance shall have the
force of a continuing agreement with Franchisee and Acquirer, and the City
shall not amend or otherwise alter this Ordinance without the consent of
Franchisee and Acquirer.
SECTION 6. – Severability. If any one or more section, subsection,
or sentence of this ordinance is held to be unconstitutional or invalid, such
decision shall not affect the validity of the remaining portion of this ordinance
and the same shall remain in full force and effect.
SECTION 7. – Corrections by City Clerk or Code Reviser. Upon
approval of the City Attorney, the City Clerk and the Code Reviser are
authorized to make necessary corrections to this ordinance, including the
correction of clerical errors; ordinance, section, or subsection numbering; or
references to other local, state, or federal laws, codes, rules, or regulations.
SECTION 8. – Effective Date. This ordinance shall take effect and be
in force 30 days from and after its passage, as provided by law.
February 16, 2021
DANA RALPH, MAYOR Date Approved
ATTEST:
February 16, 2021
KIMBERLEY A. KOMOTO, CITY CLERK Date Adopted
February 19, 2021
Date Published
3
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Approval of Change of Control -Ordinance
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APPROVED AS TO FORM:
ARTHUR “PAT” FITZPATRICK, CITY ATTORNEY
4
Astound Broadband, LLC
Approval of Change of Control -Ordinance
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OFFICE OF THE CITY ATTORNEY
Pat Fitzpatrick, City Attorney
220 Fourth Avenue South
Kent, WA 98032
253-856-5770
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Ordinance Amending KCC 9.42 Related to Unlawful Race
Attendance - Adopt
MOTION: Adopt Ordinance No. 4391, relating to Chapter 9.42 of the Kent
operation of vehicles other than traditional side-by-side racing.
SUMMARY: On June 5, 2001, the City of Kent became the first municipality in
Washington, and possibly the nation, to pass an ordinance that makes it a crime to
attend an illegal street race in certain areas of the City and permits a judge to order
those convicted of illegal street racing to stay out of certain areas of the City
designated as no racing zones. Other municipalities in the south King County region
inance can be found in
chapter 9.42 KCC.
Street racing has been a criminal activity for decades. In some cases, many
hundreds of people attend these illegal events. While police face challenges in
catching racers in the act of racing, this ordinance targets attendance at these
events as opposed to just the act of racing. These codes have proven effective in
reducing the incidents of illegal street racing and the attendance of spectators at
illegal street racing events.
Street racing events typically occur at night, draw large crowds, and are associated
with criminal behaviors. Street racing has been associated with violent crime
including homicide, property damage, and large quantities of refuse left behind.
The events are also dangerous to both drivers and spectators.
Those who organize illegal street racing events tend to be well-connected through
social media, and street racing behaviors continue to evolve. While racing continues
to be a main attraction of these events, the events also have included drifting
whereby cars are purposely slid around corners. Moreover, the illegal racing
community has been known to take over private parking lots and roadways and
intersections to perform burnouts and donuts where cars are slid in a circular
motion in close proximity of spectators, other vehicles, and public facilities.
The City Council finds that it is in the interest of the public health, safety, and
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ckless vehicular activities other than traditional side-by-side racing.
BUDGET IMPACT: None
SUPPORTS STRATEGIC PLAN GOAL:
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
ATTACHMENTS:
1. Ordinance_Unlawful Race Attendance - Racing Definition Amendment (PDF)
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ORDINANCE NO. 4391
AN ORDINANCE of the City Council of the
City of Kent, Washington, amending Chapter 9.42 of
the Kent City Code, entitled “Unlawful Race
Attendance,” to amend the definition of “unlawful
race event” to include activities involving the
reckless operation of vehicles other than traditional
side-by-side racing.
RECITALS
A. On June 5, 2001, the City of Kent became the first municipality in
Washington, and possibly the nation, to pass an ordinance that makes it a
crime to attend an illegal street race in certain areas of the City and permits
a judge to order those convicted of illegal street racing to stay out of certain
areas of the City designated as no racing zones. Other municipalities in the
south King County region followed suit by passing similar ordinances. Kent’s
ordinance can be found in chapter 9.42 KCC.
B. Street racing has been a criminal activity for decades. In some cases,
many hundreds of people attend these illegal events. While police face
challenges in catching racers in the act of racing, this ordinance targets
attendance at these events as opposed to just the act of racing. These codes
have proven effective in reducing the incidents of illegal street racing and
the attendance of spectators at illegal street racing events.
C. Street racing events typically occur at night, draw large crowds, and
are associated with criminal behaviors. Street racing has been associated
1 Unlawful race Attendance
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Definition Amendment
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with violent crime including homicide, property damage, and large
quantities of refuse left behind. The events are also dangerous to both
drivers and spectators.
D. Those who organize illegal street racing events tend to be well-
connected through social media, and street racing behaviors continue to
evolve. While racing continues to be a main attraction of these events, the
events also have included drifting whereby cars are purposely slid around
corners. Moreover, the illegal racing community has been known to take
over private parking lots and roadways and intersections to perform
burnouts and donuts where cars are slid in a circular motion in close
proximity of spectators, other vehicles, and public facilities.
E. The City Council finds that it is in the interest of the public health,
safety and welfare to amend the Kent City Code to include within the
definition of an “unlawful racing event” reckless vehicular activities other
than traditional side-by-side racing.
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT,
WASHINGTON, DOES HEREBY ORDAIN AS FOLLOWS:
ORDINANCE
SECTION 1. – Amendment – Section 9.42.010. Section 9.42.010 of
the Kent City Code, entitled “Definitions,” is amended as follows:
Sec. 9.42.010. Definitions. Unless the context clearly requires
otherwise, the definitions in this section shall apply throughout this chapter.
A. Public place means an area, whether publicly or privately owned,
generally open to the public and includes, without limitation, the doorways
and entrances to buildings or dwellings and the grounds enclosing them,
streets, sidewalks, bridges, alleys, plazas, parks, driveways, and parking
lots.
2 Unlawful race Attendance
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Definition Amendment
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B. Unlawful race event means an event wherein persons willfully
compare or contest relative speeds by operation of one (1) or more motor
vehicles or wherein persons willfully demonstrate, exhibit, or compare
speed, maneuverability, or the power of one or more motor vehicles, in a
straight or curved direction, in a circular direction, around corners, or in
circles in an activity commonly referred to as “drifting,” or by breaking
traction.
SECTION 2. – Severability. If any one or more section, subsection,
or sentence of this ordinance is held to be unconstitutional or invalid, such
decision shall not affect the validity of the remaining portion of this ordinance
and the same shall remain in full force and effect.
SECTION 3. – Corrections by City Clerk or Code Reviser. Upon
approval of the city attorney, the city clerk and the code reviser are
authorized to make necessary corrections to this ordinance, including the
correction of clerical errors; ordinance, section, or subsection numbering; or
references to other local, state, or federal laws, codes, rules, or regulations.
SECTION 4. – Effective Date. This ordinance shall take effect and be
in force 30 days from and after its passage.
February 16, 2021
DANA RALPH, MAYOR Date Approved
ATTEST:
February 16, 2021
KIMBERLEY A. KOMOTO, CITY CLERK Date Adopted
February 19, 2021
Date Published
3 Unlawful race Attendance
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APPROVED AS TO FORM:
__________
ARTHUR “PAT” FITZPATRICK, CITY ATTORNEY
4 Unlawful race Attendance
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Definition Amendment
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PARKS, RECREATION AND COMMUNITY SERVICES
DEPARTMENT
Julie Parascondola
220 Fourth Avenue South
Kent, WA 98032
253-856-5100
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: 2021 Community Development Block Grant Annual Action
Plan - Approve
MOTION: Approve the proposed Community Development Block Grant 2021
Annual Action Plan, including funding allocations and contingency plans,
and authorize the Mayor to execute the appropriate certifications and
agreements subject to final terms and conditions acceptable to the Parks
Director and City Attorney.
SUMMARY: The City of Kent receives Community Development Block Grant
(CDBG) funds from the U.S. Department of Housing and Urban Development (HUD)
as an Entitlement City. To receive this funding, the City is required to submit a
Five-
Consolidated Plan is in effect from 2020-2024.
Each year the City must inform HUD and the community of the specific actions that
the City will execute to implement the objectives and strategies of the Consolidated
Plan; this is outlined in the 2021 Action Plan. The City estimates that it will receive
$1,139,685 in 2021 CDBG funds-the same amount that was allocated in 2020.
(After the City receives notice of the exact amount of CDBG, it will update the
amount before the Action Plan is submitted to HUD.) The Action Plan indicates the
objectives and strategies that will guide investments, along with a description of
each program that will receive funds.
In addition to investing the full 15% allowable by law into public service activities
and 20% in planning and administration, the City recommends that a significant
portion of CDBG funds be used to support the City's Home Repair Program. This
program serves many low/moderate-income homeowners in Kent by providing
needed repairs to maintain and preserve housing. The City also uses funds to
support transitional housing, short-term shelter, and permanent housing. In past
years, CDBG entitlement funds have been used for rental assistance, but this year
CDBG Coronavirus funds are used instead, and more General Funds are invested in
who own their own homes and renters who cannot afford to own homes.
Citizen Participation:
· August 5, 2020, the City held its first public hearing to receive comments from
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Kent residents, low/moderate-income persons, non-governmental organizations
(AKA nonprofits), and other interested parties regarding the development of the
before the draft Action Plan was released).
· January 14, 2021, the City of Kent published a public notice on its website and
informed the community, organizations, and stakeholders that the draft 2021
CDBG Annual Action Plan was available for review and comment for a period of
thirty (30) days (the 30-day comment period will not expire before the Annual
th
Action Plan is considered for final approval during the February 16 Council
meeting)
· On January 21, 2021, the Human Services Division convened a public hearing
for the purpose of taking comments on the 2021 Annual Action Plan
Human Services Commission Review: The Human Services Commission
reviewed the Action Plan during its meeting on January 21, 2021.
BUDGET IMPACT: The estimate of $1,139,685. may increase or decrease
depending upon the final federal appropriations bill Congress passes and how much
money is allocated to HUD. Therefore, the recommended funding includes a
contingency plan to address any potential fund changes that may occur when the
City receives its award notification letter from HUD. This budget was adopted as
part of the 2021/2022 Adopted Budget.
SUPPORTS STRATEGIC PLAN GOAL:
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
ATTACHMENTS:
1. 2021_CDBG-Action Plan (PDF)
2. Exhibit (PDF)
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CITY OF KENT
2021 COMMUNITY BLOCK GRANT ANNUAL ACTION PLAN
AP-05 Executive Summary - 91.200(c), 91.220(b)
1. Introduction
The City of Kent became a Community Block Grant (CDBG) entitlement City in in
2003. Entitlement cities receive a CDBG entitlement grant directly from the U.S.
Department of Housing and Urban Development (HUD), managing and staffing their
1
Cities are eligible to apply for a direct grant only if they have at
own programs.
least 50,000 residents and submit a multi-year Consolidated Plan (CP); the City
submits its plan every five years through the King County Consortium. In addition
to King County and Kent, the Consortium includes the cities of Auburn, Bellevue,
and Federal Way. The most recent five-year plan was approved by HUD and is
effective for 2020-2024. An Action Plan is submitted each year of the 2020-2024
CP; this Annual Action Plan (AAP) is for the 2021 program year, the second year of
the CP.
The CP identifies the objectives and outcomes that will guide the City as it
determines how to invest its grant. The objective of the CDBG Entitlement Program
is to develop urban communities by providing decent housing, a suitable living
environment, and economic opportunities, principally for low/moderate-income
persons. Low/moderate income persons are those earning less than 80% of the
area median income (AMI). The 2021 AAP will continue to pursue the objectives
outlined in the CP, tracking outcomes for each funded project.
2021 CDBG Allocation:
The City of Kent estimates that it will receive the same amount of CDBG in 2021
that HUD allocated in 2020: $1,139,685. Once HUD confirms the City’s final
allocation, the City will adjust its budget before submitting the 2021 Action Plan to
HUD. The City anticipates that HUD will verify the final allocation by March or April.
2. Summary of the objectives and outcomes identified in the Plan
Needs Assessment
The outcomes and objectives are:
Accessibility to decent housing
Accessibility to a suitable living environment
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1
The federal government uses a formula to calculate the amount of funding the City will receive each year; the
formula factors in several measures of community need, including population, population growth lag in
relationship to other metropolitan areas, residents in poverty, age of housing, and overcrowded units.
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Accessibility to economic opportunities
The mission of the City’s Human Services Division, which awards CDBG grants to
sub-recipients, is to create a healthy, thriving, and inclusive community for all Kent
residents by ensuring access to opportunity and high-quality services.
3.Evaluation of past performance
In 2020, the City used its CDBG funds to provide a wide variety of services which
met the objectives of the CDBG Entitlement Program. Work was primarily executed
by nonprofits (sub-recipients); however, City staff provided home repair services to
Kent homeowners and hired private contractors as needed.
In addition, the City collaborated regionally with consortium cities, suburban cities,
foundations, new and emerging organizations, businesses, faith-based
organizations, and government (county, federal, and State).
Accomplishments in 2020 were:
2020: $1,139,685
The City successfully addressed the goals of meeting basic needs, affordable
housing to homeless and at-risk persons, increasing self-sufficiency, and planning
and administration. Sub-recipients used Kent CDBG funds to provide:
Rent and utility assistance
Home repair assistance
Case management services to youth with intellectual disabilities and their
families
Case management and referral services to African women
Shelter
Transitional housing
Employment and training
Legal services to West African residents
Planning and administration activities
Outcomes for 2020 were:
Accessibility to decent housing
95 households received home repair assistance
111 persons received transitional housing
11 individuals received shelter
66 housing stability grants were provided (these grants are largely
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unduplicated)
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Accessibility to suitable living environment
79 youth with intellectual disabilities received case management services
68 persons received employment and training assistance
80 African women and individuals received case management and referral
services
17 West African and individuals received legal services
4. Summary of citizen participation process and consultation
process
Citizen participation (hereinafter referred to as Community Participation Process or
community participation) is the lifeblood of the Consolidated Plan. Regarding this
AAP, the City convened the first public hearing on August 5, 2020 (evening), before
this draft AAP was released, and a second one will be held on January 21, 2021
(afternoon), after the draft AAP is released.
At the August 5, 2020 hearing, the City solicited comments and input from
low/moderate income persons and households, non-governmental organizations,
nonprofits, and other interested parties regarding the development of the 2021
AAP. The City will take comments and input from the public regarding the proposed
use of funds for the 2021 program year at the hearing on January 21st.
5. Summary of public comments
To be updated after the second public hearing.
6. Summary of comments or views not accepted and the reasons
for not accepting them
All comments were accepted.
7. Summary
N/A
PR-05 Lead & Responsible Agencies – 91.200(b)
1. Describe agency/entity responsible for preparing the
Consolidated Plan and those responsible for administration of each
grant program and funding source
The following are the agencies/entities responsible for preparing the
Consolidated Plan and those responsible for administration of each grant
program and funding source.
Agency RoleName Department/Agency
Lead Agency City of Kent Parks, Recreation & Community Services
Department, Housing & Human Services Division
CDBG Merina Hanson, Housing & Human Services Manager & Dinah
AdministratorWilson, Senior CDBG Coordinator
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Narrative
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The City of Kent, Housing and Human Services Division, is the lead agency for the
CDBG Program. Merina Hanson, Housing and Human Services Manager, is the
program administrator, and Dinah Wilson, Senior CDBG Coordinator, is the program
manager.
In addition, sub-recipients that receive CDBG funds are responsible for executing
programs on behalf of the City and were consulted during the development of the
AAP. These agencies are listed in the AP-10 Consultation section of this document.
Consolidated Plan Public Contact Information
Merina Hanson
Housing and Human Services Manager
City of Kent
220 4th Ave S
Kent, WA 98032
253.856.5070
mhanson@kentwa.gov
Dinah Wilson
Senior CDBG Coordinator
253.856.5070
drwilson@kentwa.gov
AP-10 Consultation – 91.100, 91.200(b), 91.215(I)
1. Introduction
The City of Kent consulted with multiple entities, including South King County cities
(the cities of Auburn and Federal Way are the two other entitlement cities in South
County), the King County Housing Authority, King County Department of
Community and Human Services, nonprofit agencies delivering services in Kent and
the sub-region, Washington State Department of Social and Health Services, Public
Health-Seattle and King County, Kent Cultural Diversity Initiative Group, and United
Way of King County.
The City of Kent carries out homeless planning and coordination both sub-regionally
and regionally. Kent works with All Home (transitioning to the Regional Homeless
Authority), which includes King County, cities, mainstream systems, Safe Harbors,
housing funders, community agencies, United Way, the private sector (including
businesses), and homeless people.
Provide a concise summary of the jurisdiction’s activities to enhance
coordination between public and assisted housing providers and
private and governmental health, mental health and service
agencies.
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Kent Housing and Human Services Division meets regularly with other King County
jurisdictions, public housing authorities and State Departments to develop
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strategies and to implement plans to improve the quality of service and access for
low-income residents in the City and throughout the region. Additionally, the City
participates in quarterly meetings with King County staff, including Public
Health Seattle/King County, to review implementation and delivery of services
funded through regional efforts. The City will continue to participate in All Home
strategic planning efforts, funding review panels for Continuum of Care (CoC),
Emergency Shelter Grant, McKinney funding, and other housing funding application
review teams. Since the COVID-19 pandemic, staff are actively engaged in local
and regional emergency service coordination, including securing funding, PPE
supplies, etc. The City also participates in the Refugee Housing Task Force hosted
by DSHS, Office of Refugee and Immigrant Assistance, and attends quarterly
briefings provided by local refugee resettlement organizations. The CDBG
Coordinator sits on the King County Climate Equity Community Task Force. The
Task Force developed a new Sustainable and Resilient Communities section for the
2020-2025 King County Strategic Climate Action Plan (SCAP), which include goals
and guide priority areas for climate action based on community values and
concerns. The King County Council is currently taking public comments on the
SCAP.
Describe coordination with the Continuum of Care and efforts to
address the needs of homeless persons (particularly chronically
homeless individuals and families, families with children, veterans,
and unaccompanied youth) and persons at risk of homelessness
Staff worked extensively in 2018 to develop an Interlocal Agreement, creating a
formal collaboration on housing and homelessness issues between six cities in
South King County, including Kent. Kent has contributed funds to the South King
Housing and Homelessness Partnership since 2016; this partnership provided
additional staff capacity for tracking, developing, and implementing policies related
to affordable housing and homelessness to participating cities. City staff and the
Mayor attended collaborative meetings in 2018 to plan the future of the South King
Housing and Homelessness Partnership project. Meetings were held in March, June,
and October and drove the resolve of nine cities and King County to sign an
Interlocal Agreement starting in 2019. The City funds this project with Human
Services General Funds. Kent staff and other South King County stakeholders
continue to meet to deepen cross-jurisdictional coordination, create a common
understanding for housing and homelessness needs and strategies for South King
County, and move forward strategies in the South King County Response to
Homelessness. Two separate groups currently meet – the South King County
Homeless Action Committee and the South King County Joint Planners.
The local Continuum of Care (CoC), All Home, serves nearly all cities within King
County, and Kent City staff regularly participate in regional CoC discussions.
Describe consultation with the Continuum(s) of Care that serves the
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jurisdiction's area in determining how to allocate ESG funds, develop
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performance standards and evaluate outcomes, and develop funding,
policies and procedures for the administration of HMIS
All Home, King County, City of Seattle, and staff from local jurisdictions
collaborated to define and design a unified Regional Homeless System. This work
was coordinated in partnership with people with lived experience of homelessness,
homeless advocates, housing and service providers, Sound Cities Association (SCA)
members, and local business and philanthropy.
This ongoing collaboration seeks to address the fragmentation that currently exists
and is meant to improve outcomes for people experiencing homelessness by placing
persons experiencing homelessness at the center of the system design.
The National Innovation Service (NIS) was brought in to analyze the current
homeless response system through policy analysis and customer and provider
engagement, and to make recommendations to unify and redesign the system for
10
equity and impact. Their findings and recommendations are summarized in
Actionsto guide the system transformation. The Corporation for Supportive
Housing (CSH) was also brought in to provide support for the transition of the
Continuum of Care (CoC) governance.
In December 2018, County Executive Constantine and Seattle Mayor
Durkan accepted the NIS actions to transform and unify the region’s homeless
services. Joining All Home, King County, and the City of Seattle, leaders from the
Sound Cities Association, business, philanthropy, and the Lived Experience Coalition
identified the following four actions as top priorities to begin the work:
Institute a system-wide theory of change
Consolidate homelessness response systems under one regional authority
Become accountable to customers
Create a defined public/private partnership utilizing a funder collaborative
model
NIS was chosen to serve as project managers to support the development of these
four actions. Simultaneously, philanthropic partners contracted with CSH to develop
a Regional Action Plan, a critical tool to guide and align our work across the
community. Data and investment analyses conducted in late 2018 and early 2019
provided a baseline of local data to inform the development of the Regional Action
Plan. The pandemic slowed progress in 2020, however the work continues to move
forward.
The City consults with All Home staff and those working on the Regional Homeless
Authority, and they in turn, consult with the State on behalf of local jurisdictions,
including Kent. Staff participates in the Continuum of Care Application and Rank
Order Committee and Joint Recommendations Committee, which review
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recommendations for allocation of funds. Staff consults with King County on HUD
Homeless Management Information System (HMIS) data standards and
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performance indicators to capture and evaluate the CoC’s performance regarding
the reduction of homelessness through investments in homeless housing and
services, and rapid re-housing.
Describe Agencies, groups, organizations, and others who participated in
the process and describe the jurisdictions consultations with housing,
social service agencies and other entities
TO BE ADDED
In 2020 Kent was one of several jurisdictions (including Auburn, Burien, Federal
Way, Renton, and Tukwila) that jointly applied for a Department of Commerce
grant. Part of the focus was on existing and projected housing needs for all income
levels, household characteristics, population and employment trends, and
projections. The work emphasized land use policy analysis and regulatory
strategies, including preservation and anti-displacement, affordable housing
production, middle housing, and Transportation Oriented Development & Urban
Centers. Additional attention was on perceptions in the development community
(both for profit and non-profit) along with development of a tool that explores
construction feasibility for middle housing types and higher density housing. The
grant also funded some city-specific focus on strategies to increase the supply of
housing, minimize displacement, and evaluate our current housing goals. As a
result of the work, Kent created a draft Housing Options Plan policy document that
establishes routes for Kent to meet the growing demand for housing. The intent of
the plan is to identify how much and what housing types Kent has and needs, how
the City can preserve options and affordability for existing residents, how City
policies can better serve people who want to live in Kent but can’t find housing,
where we can improve, etc. This work is led by the city’s Long-Range Planning
Manager who consults with Human Services staff at key points during the process.
Kent also continues to partner with other jurisdictions as part of SKHHP. SKHHP’s
primary objectives include sharing technical information and resources to promote
sound housing policy, coordinating public resources to attract greater private and
public investment, and providing unified voice for South King County.
Identify any Agency Types not consulted and provide rationale for
not consulting
All agency types were consulted.
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Describe other local/regional/state/federal planning efforts
considered when preparing the Plan
Name of Plan Lead Organization How do the goals of
your Strategic Plan
overlap with the goals
of each plan?
2020-2024 King County King County Both plans prioritize
Consortium Consolidated Affordable Housing and
Plan Homelessness Prevention
2019 King County King County Kent worked with the
Analysis of Impediments county to develop a plan
to Fair Housing Choice for fair housing testing in
Kent. The Regional AI
includes goals that
indicate need for more
affordable housing and
greater access to housing
for communities
experiencing a
disproportionate need.
AP-12 Participation – 91.410, 91.105, 91.200(c)
1. Summary of citizen participation process/Efforts made to
broaden citizen participation
Summarize citizen participation process and how it impacted goal-
setting
While HUD uses the term Citizen Participation, the City calls its participation process
Community Participation; this title is more inclusive of all Kent residents.
Community participation and engagement are critical to the successful execution of
the City's Consolidated Plan. The goals of community participation are to:
Inform the community of the rules that the City follows to ensure adequate
opportunity for resident and stakeholder involvement
Hear the community's recommendations on how the City should invest CDBG
dollars
Consult with individuals who may not initiate contact with the City because of
language/cultural differences or who do not come from experiences where
government sought their opinions; and
Convene public hearings and meetings, initiate surveys, host community and
individual conversations, etc., to increase opportunities for nonprofits and
Kent residents to come together and discuss how they can leverage
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opportunities, share ideas, coordinate services and pool funding to achieve
the greatest impact
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The City developed and implemented a community participation process for the
nd
AAP; ___ (this number will be updated after the 2 public hearing) individuals
attended meetings, submitted comments, or responded to surveys. The City
intentionally reached out to Ethnic Community-Based Organizations and small
organizations, People of Color, disabled individuals, LGBTQ, elders, and other
under-served populations.
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menu of
combine
leverage
additional
Narrative
federal and
community.
CDBG funds state funds.
to provide a
Description
Agencies may
services to the
comprehensive
funding sources
. Prior to that,
recipients receive
-
Amount
3,419,055
Expected
Available
of ConPlan
Remainder
$
,685
$
December).
-
139
Total:
,
1
$
2
$
year (January
related relief and used unspent CDBG entitlement funds from 2003 to
184,948
-
Prior Year
$
Resources:
$
$0
Income:
Program
Expected Amount Available
,685
$
Expected Resources
139
,
Annual
1
year budget cycle which is contingent upon economic stability. The City does
capita amount of its General Fund budget to support human services programs
Allocation:
$
-
-
two
d a per
service
edicate
d
projects;
planning &
Capital and
public
Uses of Funds
administration
-
of
HUD
Funds
federal
Source
m
15 Expected Resources (91.420(b), 91.220(c)(1,2)
-
CDBG
Progra
The City diverted $184,948 from the 2020 CDBG entitlement budget to use for COVID
AP The City of Kent supports human services programs through its CDBG (federal) and General Fund (City of Kent tax dollars) budgets. The City uses a not receive notice of its CDBG award
until Congress passes its budget. As a result, CDBG subfunds during the spring or early summer of the Kent CDBG fiscalSince 2013, the City has one percent of the City’s budget supported
human services programs. Anticipated Resources 2 2018 to backfill those funds.
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icit additional resources.
A
Explain how federal funds will leverage those additional resources (private, state and local funds), including a description of how matching requirements will be satisfied CDBG funds
do not require a match; however, the City looks for opportunities to sol If appropriate, describe publicly owned land or property located within the jurisdiction that may be used to
address the needs identified in the plan N/
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Indicator
Goal Outcome
Public service activities for Low/Moderate Income Housing Benefit: Rehabilitated: 130 Household Housing UnitPublic service activities other than Low/Moderate Income Housing Benefit:
Persons AssistedOther: 54 OtherPublic service activities other than Low/Moderate Income Housing Benefit: 84 Persons AssistedOther: 0 Other
CDBG: CDBG: CDBG: CDBG: CDBG:
227,917
739,815$49,000$73,500$49,453
$$
Funding
Needs
Addressed
Affordable HousingHomelessEconomic OpportunitiesBasic Needs ServicesPlanning and Administration
income families to whom the jurisdiction will provide
-
Area
Geographic
Housing Housing Housing
-
--
91.220(c)(3)&(e)income, and moderate
Category
-
Affordable HousingHomelessHomelessNonCommunity DevelopmentNonCommunity DevelopmentHomelessNonCommunity DevelopmentPlanning and Administration
91.420,
-End
Year
20242024202420242024
income, low
-
Year
Start 20202020202020202020
defined by HOME 91.215(b)
Goal Name
Affordable Housing Prevent HomelessnessIncrease Self SufficiencyBasic NeedsPlanning and Administration
Sort
Order
20 Annual Goals and Objectives
-
12 3 45
AP Goals Summary Information Estimate the number of extremely lowaffordable housing as
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-
-
services)
risk for
-
activities include
risk of losing basic services,
unemployed and under
-
management, and supports for under
family residential housing (home repair
-
income residents
-
enterprise development, for those
-
/moderate
Investment of funds to preserve and maintain existing affordable housing. Planned Assistance to chronically homeless individuals and families and those atAssistance, including micro
Maintain Affordable Housing activities include rehabilitation of singleand energy efficiency assistancePrevent Homelessnesshomelessness to move to shelter and permanent housing. Planned
transitional housing, emergency shelter, case management, rental assistance, and supportive servicesSupport Economic Viability employedOpportunity to Meet Basic Needs Assistance to
preserve and maintain the safety net for those atincluding legal services, system navigation, case served residentsPlanning and Administration SupportInvestment in planning & implementation
strategies & CDBG staff to improve quality of life in the community for low
Descriptions
Goal NameGoal DescriptionGoal NameGoal DescriptionGoal NameGoal DescriptionGoal NameGoal DescriptionGoal NameGoal Description
12345
Goal
5/G/b
AP-35 Projects - 91.420, 91.220(d)
Introduction
# Project Name
1
Catholic Community Services: Katherine’s House
2
Multi-Service Center: Shelter & Supportive Housing
3
Open Doors for Multicultural Families: Special Needs Youth
4
Partner in Employment: Job Readiness & Training
5
St. Stephen's: Transitional Housing
6
Puget Sound Training Center: Employment & Training
7
Utopia: Street Outreach Services
8
West African Community Council: Immigration Legal Program
9
World Relief: Paradise Parking Plot Community Garden
10
YWCA: Anita Vista Transitional Housing
11City of Kent: Home Repair Program-Minor Home Repair
12East Hill Capital Project
13Planning and Administration
The City is investing in a range of needed services for Kent residents that include minor
home repair, transitional housing, shelter, educational services for individuals with
intellectual disabilities, legal immigration services, outreach to provide healthcare
resources and testing for individuals in the sex industry, training and employment, and a
community garden for new Americans.
The City will also target a portion of its investments on the East Hill of Kent, a
Racially/Ethnically Concentrated Area of Poverty (R/ECAP). City staff will work with
residents to respond to emerging needs and plan for future use of funds.
Describe the reasons for allocation priorities and any obstacles to
addressing underserved needs
The City's distribution of funds aligns with the City's objectives of accessibility to decent
housing, a suitable living environment, and economic opportunities.
CONTINGENCY PLANS
Public Services
In the event of a funding increase, the amount of the increase will be awarded to Puget
Sound Training Center and Utopia, which received under $10,000.
In the event of a funding decrease, the amount of the decrease will be deducted from a
project(s) guided by an equity lens. If possible, the City will provide at least $10,000 to
each project.
Capital
In the event of a funding increase, funds will be allocated to the City's Home Repair
Program and/or an East Hill capital project.
In the event of a funding decrease, the Home Repair Program budget will be reduced.
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AP-38 Project Summary
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Project Summary Information
1
Project Name Catholic Community Services: Katherine’s House
Target Area City of Kent
Goals Supported Prevent Homelessness
Needs Addressed Homeless Prevention
Funding CDBG: $14,000
Description Public Service: Sub-recipient provides shelter
and case management services to women
residing in transitional shelter
Target Date 12/31/2021
Estimate the number and It is estimated that 2 individuals will benefit.
type of families that will
benefit from the proposed
activities
Location Description City of Kent
Planned Activities Shelter and case management services to
women in recovery residing in transitional shelter
2
Project Name Multi-Service Center: Titusville Station
Permanent Housing
Target Area City of Kent
Goals Supported Prevent Homelessness
Needs Addressed Homeless Prevention
Funding CDBG: $49,000
Description Public Service: Funding used to provide
comprehensive case management and
permanent housing to homeless single adults.
Target Date 12/31/2021
Estimate the number and It is estimated that 30 individuals will benefit.
type of families that will
benefit from the proposed
activities
Location Description City of Kent
Planned Activities Permanent housing & case management
3
Project Name Open Doors for Multicultural Families: Special
Needs Youth
Target Area City of Kent
Opportunity to Meet Basic Needs
Goals Supported
Needs Addressed Opportunity to Meet Basic Needs
Buubdinfou;!3132`DECH.Bdujpo!Qmbo!!)3697!;!3132!Dpnnvojuz!Efwfmpqnfou!Cmpdl!Hsbou!Boovbm!Bdujpo!Qmbo!.!Bvuipsj{f*
Funding CDBG: $15,000
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Description Public Services: This project provides case
management services to youth with intellectual
disabilities and their families.
Target Date 12/31/2021
Estimate the number and It is estimated that 22 individuals will benefit.
type of families that will
benefit from the proposed
activities
Location Description City of Kent
Planned Activities Education support, family activities, information
& referral
4
Project Name Partner in Employment: Job Readiness &
Training
Target Area City of Kent
Support Economic Viability
Goals Supported
Economic Viability
Needs Addressed
Funding CDBG: $15,000
Description Public Services: Funds used to provide culturally
responsive case management & job readiness
skills to prepare Kent immigrants and refugees
find employment.
Target Date 12/31/2021
Estimate the number and It is estimated that 10 individuals will benefit.
type of families that will
benefit from the proposed
activities
Location Description City of Kent
Planned Activities Culturally responsive case management & job
readiness skills to prepare individuals for
employment
5
Project Name St. Stephen’s: Transitional Housing
Target Area City of Kent
Goals Supported Prevent Homelessness
Needs Addressed Homeless Prevention
Funding CDBG: $15,000
Description Public Services: This project provides transitional
housing to homeless families.
Target Date 12/31/2021
Estimate the number and It is estimated that 25 individuals will benefit.
Buubdinfou;!3132`DECH.Bdujpo!Qmbo!!)3697!;!3132!Dpnnvojuz!Efwfmpqnfou!Cmpdl!Hsbou!Boovbm!Bdujpo!Qmbo!.!Bvuipsj{f*
type of families that will
benefit from the proposed
activities
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Location Description City of Kent
Planned Activities Housing
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6
Project Name Puget Sound Training Center
Target Area City of Kent
Goals Supported Support Economic Viability
Needs Addressed Support Economic Viability
Funding CDBG: $8,500
Description Public Services: This project provides employment and
training services to under-served individuals.
Target Date 12/31/2021
Estimate the number It is estimated that 44 individuals will benefit.
and type of families
that will benefit from
the proposed activities
Location Description City of Kent - Renton residential/industrial area that
borders Kent
Planned Activities Employment and training services
7
Project Name Utopia: Street Outreach Services
Target Area City of Kent
Goals Supported Opportunity to Meet Basic Needs
Needs Addressed Opportunity to Meet Basic Needs
Funding CDBG: $5,000
Description Public Services: This project provides healthcare
resources and testing for individuals in the sex
industry.
Target Date 12/31/2021
Estimate the number It is estimated that 19 individuals will benefit.
and type of families
that will benefit from
the proposed activities
Location Description City of Kent
Planned Activities Street outreach to provide healthcare resources and
testing for individuals in the sex industry
8
Project Name West African Community Council: Immigration and
Legal Program
Target Area City of Kent & Kent R/ECAP
Opportunity to Meet Basic Needs
Goals Supported
Needs Addressed Opportunity to Meet Basic Needs
Funding CDBG: $15,000
Description Public Services: This project provides culturally
Buubdinfou;!3132`DECH.Bdujpo!Qmbo!!)3697!;!3132!Dpnnvojuz!Efwfmpqnfou!Cmpdl!Hsbou!Boovbm!Bdujpo!Qmbo!.!Bvuipsj{f*
responsive legal assistance to immigrants.
Target Date 12/31/2021
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Estimate the number It is estimated that 11 individuals will benefit.
and type of families
that will benefit from
the proposed activities
Location Description City of Kent, warehouse area running along 68th Ave.
S
Planned Activities Culturally responsive legal assistance
9
Project Name World Relief: Paradise Parking Plot Community Garden
Target Area City of Kent
Goals Supported Opportunity to Meet Basic Needs
Needs Addressed Opportunity to Meet Basic Needs
Funding CDBG: $14,453
Description Public Services: This project provides a community
garden for new Americans to prevent food insecurity.
Target Date 12/31/2021
Estimate the number It is estimated that 32 individuals will benefit.
and type of families
that will benefit from
the proposed activities
Location Description City of Kent
Planned Activities Community Gardening & Classes to prevent food
insecurity
10
Project Name
YWCA: Anita Vista Transitional Housing
Target Area City of Kent & Kent R/ECAP
Goals Supported Prevent Homelessness
Needs Addressed Homeless Prevention
Funding CDBG: $20,000
Description Public Service: Project provides transitional housing to
domestic violence survivors and their children.
Target Date 12/31/2021
Estimate the number It is estimated that 14 individuals will benefit.
and type of families
that will benefit from
the proposed activities
Location Description City of Kent
Planned Activities Transitional housing to domestic violence survivors
and their children
11
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Project Name City of Kent: Home Repair Program-Minor Home
Repair
Target Area City of Kent & Kent R/ECAP
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Maintain Affordable Housing
Goals Supported
Affordable Housing
Needs Addressed
Funding CDBG: $690,815
Description Capital: Low/moderate-income homeowners in Kent
receive minor home repairs
Target Date 12/31/2021
Estimate the number It is estimated that 100 households will benefit.
and type of families
that will benefit from
the proposed activities
Location Description City of Kent
Planned Activities Minor home maintenance and rehabilitation
12
Project Name East Hill Capital Project
Target Area City of Kent
Goals Supported Support Economic Viability
Needs Addressed Support Economic Viability: Poverty
Funding CDBG: $50,000
Description Funds will be invested on the East Hill of Kent, a
Racially/Ethnically Concentrated Area of Poverty
(R/ECAP). City staff will work with residents to respond
to emerging needs and plan for future use of funds.
Funds will be used to mitigate poverty.
Target Date 12/31/2021
Estimate the number TBD
and type of families
that will benefit from
the proposed activities
Location Description City of Kent –East Hill
Planned Activities Poverty mitigation activities
13
Project Name Planning & Administration
Target Area City of Kent
Goals Supported Planning and Administration
Needs Addressed Planning and Administration
Funding CDBG: $227,917
Description City uses funds to administer the CDBG program, to
monitor sub-recipients, and to deliver strategies
outlined in the 2020-2024 Consolidated Plan.
Target Date 12/31/2021
Buubdinfou;!3132`DECH.Bdujpo!Qmbo!!)3697!;!3132!Dpnnvojuz!Efwfmpqnfou!Cmpdl!Hsbou!Boovbm!Bdujpo!Qmbo!.!Bvuipsj{f*
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Estimate the number N/A
and type of families
that will benefit from
the proposed activities
Location Description City of Kent
Planned Activities Planning and administration activities to carry out the
CDBG program.
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AP-50 Geographic Distribution - 91.420, 91.220(f)
Description of the geographic areas of the entitlement (including areas
of low-income and minority concentration) where assistance will be
directed
Historically, low/moderate-income households were dispersed throughout the City, and
CDBG funds were distributed accordingly. Data now indicates that the East Hill of Kent
has the highest concentration of poverty in the City. The federal government categorizes
the East Hill as a Racially or Ethnically Concentrated Area of Poverty (R/ECAP). A R/ECAP
is defined as a census tract that is majority non-White and has a poverty rate greater
than 40% or is three times the average census tract poverty rate for the metro/micro
area, whichever threshold is lower. (Kent is the only City in the CDBG Consortium that
includes a R/ECAP; cities in the Consortium include Auburn, Bellevue, and Federal Way.)
Neighborhoods with high concentrations of poverty can serve as a tipping point to a
family’s ability to reach positive outcomes; therefore, the City will work will residents and
nonprofits in the East Hill Area to develop a strategy for investing in East Hill beginning
in 2021. The City will begin with an investment of five percent (5%) of its HUD allocation
in 2021 and could increase its investment as opportunities arise between 2022-2024.
Geographic Distribution
Target Area Percentage of Funds
City of Kent 95%
3
East Hill 5%
Rationale for the priorities for allocating investments geographically
Because low/moderate-income families reside throughout Kent, investments will be
dispersed widely. A 5% portion of the City’s funds will be targeted on the East Hill to
address the high concentration of poverty in that area.
Discussion
According to the American Community Survey (2019), the poverty rate in Kent is 13.4
%. This rate was determined before the pandemic struck; therefore, it is a low estimate.
According to YCHARTS, the unemployment rate ranged from a low of 3.2% in January
2020 when rumblings of the COVID-19 virus first started to a high of 19.3% in May
2020 when the area experienced a full-fledged pandemic. When the 2020-2024
Consolidated Plan was drafted in 2020, poverty in pockets throughout the City was just
over 20%, and just over half of the students in the Kent School District qualified for free
and reduced lunches. Economic disadvantage and poverty associated with the pandemic
led to increased dependence on public assistance and forced many households to use
public services for basic needs, including food, utility assistance, rental assistance,
medical services, childcare, etc. Housing costs continue to rise in Kent. According to the
apartment web service, Rent Café, the average cost for an apartment in Kent is $1,565
(average one-bedroom size), and this represents a 3% increase from the average cost
over a year.
Buubdinfou;!3132`DECH.Bdujpo!Qmbo!!)3697!;!3132!Dpnnvojuz!Efwfmpqnfou!Cmpdl!Hsbou!Boovbm!Bdujpo!Qmbo!.!Bvuipsj{f*
3
This percentage does not include households receiving home repair assistance.
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Additionally, the East Hill of Kent is defined by the federal government as a R/ECAP. This
high poverty rate justifies targeted investment on the East Hill.
AP-75 Action Plan Barriers to Affordable Housing – 91.420, 91.220(j)
Introduction
Actions it planned to remove or ameliorate the negative effects of public
policies that serve as barriers to affordable housing such as land use
controls, tax policies affecting land, zoning ordinances, building codes,
fees and charges, growth limitations, and policies affecting the return on
residential investment:
In 2021, the City is planning to adopt a Housing Action Plan that identifies actionable
code amendments that will increase overall residential building capacity. The plan
assesses housing needs including affordability at all income levels and adopts strategies
to improve housing outcomes. Draft strategies include strengthening partnerships,
increasing access to homeownership, and adjusting development regulations. It is
anticipated that implementation will begin in late 2021 and continue with nearer and
longer-term steps as resources allow.
Discussion:
Economic and Community Development staff presented the Housing Action Plan to the
Kent Cultural Diversity Initiative Group and is seeking comments from under-served
communities. Human Services Division staff is also collaborating with Economic and
Community Development staff on identifying opportunities for non-profit affordable
housing developers to work in Kent.
AP-85 Other Actions - 91.420, 91.220(k)
Introduction
The City is actively involved in many initiatives and ongoing commitments to improve the
life of Kent residents.
The City is actively engaged with refugee and immigrant communities by staffing
and facilitating the Kent Cultural Diversity Initiative Group (KC-DIG).
In 2020, the City hired a Race and Equity Manager, who began concentrating on
racial justice issues facing the City on a full-time basis in 2021.
The City’s Human Services Division hired consultants to work with the Kent Human
Services Commission and staff to prioritize and direct 2021-2022 human services
investments using a racial equity lens. A consultant was also hired to evaluate the
2021-2022 human services funding cycle.
In 2016, the City appointed a Cultural Communities Advisory Board to advise the
Mayor and City Council on how to engage with and provide culturally responsive
services to the cultural communities residing in Kent.
Buubdinfou;!3132`DECH.Bdujpo!Qmbo!!)3697!;!3132!Dpnnvojuz!Efwfmpqnfou!Cmpdl!Hsbou!Boovbm!Bdujpo!Qmbo!.!Bvuipsj{f*
The CDBG Coordinator participates in the King County Climate Equity Community
Task Force, where frontline racial and ethnic communities collaborated and
developed the Sustainable and Resilient Communities section of the 2020
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Strategic Climate Action Plan (SCAP). The Task Force recommended that the King
County Council to adopt this new section of the SCRAP.
The CDBG Coordinator is on the board of Communities Rise, which
fosters movements to build power in communities impacted by systemic
oppression.
Kent’s Human Services Manager has been actively involved in regional discussions
about governance in the Seattle/King County homelessness system. In August of
2018 the City of Seattle and King County partnered with Future Laboratories to
launch a community-driven process of listening, and ultimately, designing a
stronger regional response. A key part of the process going forward will be to
design with equity in mind, building a system that is responsive to the needs of
those who are at the highest risk for prolonged or multiple episodes of
homelessness. While service systems are traditionally built with the input of
“experts” as the guiding voices, delivering services that are effective means the
input of people utilizing those services must be understood as the primary data
source.
Actions planned to address obstacles to meeting underserved needs
Staff will continue to play a leadership role in emergency and COVID-19 service
coordination.
Staff will administer and manage CDBG Coronavirus (CDBG-CV ) grants (total of
$1,530,361), which are provided to organizations assisting individuals and families
impacted by COVID-19.
Human Services Division staff will continue to work with Economic Development
Division staff on outreach and engagement and provide recommendations on best
practices to ensure culturally responsive service to under-served communities.
Staff will continue to work with The Seattle Foundation and King County on the
Communities of Opportunity Grant which provides funds to organizations whose
activities reduce inequities in the areas of health, housing, and economic
opportunities.
Staff will continue to participate on the King County Refugee Housing Task Force,
which is led by DSHS, Office of Immigrant and Refugee Assistance. This
stakeholders’ group works collaboratively to influence policies, resources, and the
public’s interest to increase affordable housing for refugees.
The City will continue to provide educational support to the Kent School District to
improve outcomes for students.
Kent’s Human Services Manager will continue to participate in regional discussions
about governance in the Seattle/King County homelessness system.
Actions planned to foster and maintain affordable housing
Buubdinfou;!3132`DECH.Bdujpo!Qmbo!!)3697!;!3132!Dpnnvojuz!Efwfmpqnfou!Cmpdl!Hsbou!Boovbm!Bdujpo!Qmbo!.!Bvuipsj{f*
The City will continue its long-term collaboration and participation on Boards,
committees, funding review teams; etc., to foster and maintain affordable housing for
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the South County Region. Through sub-regional efforts, City staff and stakeholders will
engage in discussions with elected officials and Land Use and Planning Board members
about the impact that affordable housing has on the long-term viability of the
community. As part of the South King Housing and Homelessness Partnership project,
staff will review opportunities to implement strategies recommended by the Regional
Affordable Housing Task Force.
Additionally, in 2020 the state legislature gave counties and cities authority to impose a
1/10 of one percent sales tax for affordable housing. Kent was one of eight city councils
that chose to impose it within their city limits and then the county imposed it countywide
(minus the eight cities). The eight cities are Bellevue, Issaquah, Snoqualmie, North
Bend, Renton, Kent, Covington, and Maple Valley. State law places the same
requirement on every county and city that imposes the tax: spend 60% of the proceeds
to construct affordable housing and 40% on human services. City staff is currently
working on some options and recommendations on implementation for city council
consideration.
Actions planned to reduce lead-based paint hazards
No actions are planned.
Actions planned to reduce the number of poverty-level families
Actions to reduce the number of poverty level families maintaining relationships with
local training schools, encouraging business to hire low-income residents and outreach to
increase opportunities for low-income residents to obtain livable wage jobs. The City also
collaborates with the Financial Empowerment Network. Based on homelessness research,
it is evident the City must prioritize economic stability to reduce inflow into
homelessness. Research data and coordination will help guide the City’s planning
process.
Actions planned to develop institutional structure
In 2018, the City hired a consultant to evaluate its Parallel Human Services Application
process (PAP). PAP was piloted in 2017-2018 and extended to 2019-2020. The purpose
was to use a streamlined application process to increase funds to under-served and
under-resourced organizations that received a disproportional percentage of human
services funds but provided a great deal of services to Kent residents. We used lessons
learned from the Parallel Application pilot to simplify the human services and CDBG-CV
application process and to increase investments to Ethnic Community-Based
Organizations and under-served residents.
Actions planned to enhance coordination between public and private
housing and social service agencies
The City was instrumental in developing relationships between public and private housing
and social service agencies and will continue to collaborate with these entities, including
the Homeless Forum (a monthly meeting of housing and support service providers),
South King Council of Human Services, South King County Housing Development Group,
and the King County Housing Development Consortium. The South King County Housing
Buubdinfou;!3132`DECH.Bdujpo!Qmbo!!)3697!;!3132!Dpnnvojuz!Efwfmpqnfou!Cmpdl!Hsbou!Boovbm!Bdujpo!Qmbo!.!Bvuipsj{f*
and Homelessness Partnership will be a key driver of enhancing coordination in this area
25
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in 2021 as well.
Discussion
The City will diligently engage in actions to support its residents and the goals of the
Five-Year Consolidated Plan.
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Program Specific Requirements
AP-90 Program Specific Requirements - 91.420,
91.220(l)(1,2,4)
Introduction
The City of Kent will use CDBG funds to benefit low/moderate-income residents. The full
amount allowable by regulation will be used for Public Services and Planning and
Administration. The balance of funds will be used for housing rehabilitation services and
micro-enterprise. The City will not receive program income from prior years.
Community Development Block Grant Program (CDBG)
Reference 24 CFR 91.220(l)(1)
Projects planned with all CDBG funds expected to be available during the year are
identified in the Projects Table. The following identifies program income that is available
for use that is included in projects to be carried out.
1. The total amount of program income that will have been received
before the start of the next program year and that has not yet been
reprogrammed0
2. The amount of proceeds from section 108 loan guarantees that will be
used during the year to address the priority needs and specific
objectives identified in the grantee's strategic plan.0
3. The amount of surplus funds from urban renewal settlements0
4. The amount of any grant funds returned to the line of credit for which
the planned use has not been included in a prior statement or plan 0
5. The amount of income from float-funded activities0
Total Program Income:0
Other CDBG Requirements
1. The amount of urgent need activities0
2. The estimated percentage of CDBG funds that will be used for
activities that benefit persons of low and moderate income. Overall
Benefit - A consecutive period of one, two or three years may be used
to determine that a minimum overall benefit of 70% of CDBG funds is
used to benefit persons of low and moderate income. Specify the years
covered that include this Annual Action Plan. 100.00%
Discussion
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All CDBG funds will be used to benefit low/moderate-income individuals and households.
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For Immediate
Publication/Release
Posted on City of Kent Web
Page
January 14, 2021
PUBLIC NOTICE
CITY OF KENT
Department of Parks, Recreation & Community Services
Human Services Division
NOTICE OF SECOND PUBLIC HEARING REGARDING THE COMMUNITY
DEVELOPMENT BLOCK GRANT (CDBG)
2021 ANNUAL ACTION PLAN
In accordance with 24 CFR 91.105, notice is hereby given that the City of Kent will hold
its second public hearing on January 21, 2021 to receive comments from Kent residents,
low/moderate-income persons, non-governmental organizations (AKA nonprofits), and
other interested parties regarding the development of the City’s CDBG 2021 Annual
Action Plan for Housing and Community Development. Comments will be received by the
Kent Human Services Commission and/or CDBG Program staff.
The 2021 Annual Action Plan outlines the City’s proposed use of 2021 Community
Development Block Grant (CDBG) funds awarded to the City by the U.S. Department of
Housing and Urban development (HUD) under Title 1 of the Housing and Community
Development Act of 1974 as amended, known as the Community Development Block
Grant (CDBG) Program. The Plan also identifies the objectives and strategies that will
guide the City’s investments. The City’s Program Year for investing these funds runs
from January 1, 2021 to December 31, 2021. In PY 2020, the City received $1,139,685
in CDBG funds and estimates that it will receive the same amount or less in 2021.
COMMUNITY PARTICIPATION PROCESS
All interested persons are invited to attend a public hearing to provide comments and
recommendations to the City on how CDBG funds should be invested in 2021. This is an
opportunity for residents, stakeholders, non-profit organizations and others to influence
the Annual Action Plan before the initial written draft is completed.
DATE/TIME OF PUBLIC HEARING
Thursday, January 21, 2021 3:00 p.m.
Virtual Hearing Link: https://cityofkent.zoom.us/j/96234547881
A draft copy of the 2021 CDBG Annual Action Plan can be found on the City’s web site at
the followingaddress: http://www.kentwa.gov/residents/human-social-services.
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Written comments will be accepted and may be mailed or e-mailed to:
Dinah R. Wilson, Senior CDBG Program Coordinator
th
Ave. South, Kent, WA 98032
City of Kent, 220 4
E-mail: drwilson@kentwa.gov
The comment period will remain open for 30 days from the date that this notice was posted
on the City’s website.
ADA Information:
This notice is available in alternate formats for individuals with disabilities upon request.
Reasonable accommodations at the public hearing such as sign language interpretation
or alternate formats for printed material are available for individuals with disabilities with
a minimum of four (4) days advance notice. Please call (253) 856-5070 directly, email
drwilson@kentwa.gov, or:
For TDD call (253) 856-5499
For Braille Relay Service call 1-800-833-6385
For Hearing Impaired Relay Service call 1-800-833-6388
Merina Hanson, Housing & Human Services Director
Housing and Human Services Division | Parks, Recreation & Community Services
Department
__________________________________________
Signature
1/14/2021__________________________________Date
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CERTIFICATIONS
In accordance with the applicable statutes and the regulations governing the consolidated plan regulations,
the jurisdiction certifies that:
Affirmatively Further Fair Housing --The jurisdiction will affirmatively further fair housing.
Uniform Relocation Act and Anti-displacement and Relocation Plan -- It will comply with the
acquisition and relocation requirements of the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970, as amended, (42 U.S.C. 4601-4655) and implementing regulations at 49
CFR Part 24. It has in effect and is following a residential anti-displacement and relocation assistance
plan required under 24 CFR Part 42 in connection with any activity assisted with funding under the
Community Development Block Grant or HOME programs.
Anti-Lobbying --To the best of the jurisdiction's knowledge and belief:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with the
awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement;
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this
Federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form-LLL,
"Disclosure Form to Report Lobbying," in accordance with its instructions; and
3. It will require that the language of paragraph 1 and 2 of this anti-lobbying certification be included in
the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
Authority of Jurisdiction --The consolidated plan is authorized under State and local law (as applicable)
and the jurisdiction possesses the legal authority to carry out the programs for which it is seeking funding,
in accordance with applicable HUD regulations.
Consistency with plan --The housing activities to be undertaken with Community Development Block
Grant, HOME, Emergency Solutions Grant, and Housing Opportunities for Persons With AIDS funds are
consistent with the strategic plan in the jurisdiction’s consolidated plan.
Section 3 -- It will comply with section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C.
1701u) and implementing regulations at 24 CFR Part 135.
____________________________ _________
Signature of Authorized Official Date
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________Mayor__________________
Title
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Specific Community Development Block Grant Certifications
The Entitlement Community certifies that:
Citizen Participation -- It is in full compliance and following a detailed citizen participation plan that
satisfies the requirements of 24 CFR 91.105.
Community Development Plan -- Its consolidated plan identifies community development and housing
needs and specifies both short-term and long-term community development objectives that that have been
developed in accordance with the primary objective of the CDBG program (i.e., the development of
viable urban communities, by providing decent housing and expanding economic opportunities, primarily
for persons of low and moderate income) and requirements of 24 CFR Parts 91 and 570.
Following a Plan -- It is following a current consolidated plan that has been approved by HUD.
Use of Funds -- It has complied with the following criteria:
1. Maximum Feasible Priority. With respect to activities expected to be assisted with CDBG
funds, it has developed its Action Plan so as to give maximum feasible priority to activities which
benefit low- and moderate-income families or aid in the prevention or elimination of slums or
blight. The Action Plan may also include CDBG-assisted activities which the grantee certifies
are designed to meet other community development needs having particular urgency because
existing conditions pose a serious and immediate threat to the health or welfare of the community,
and other financial resources are not available (see Optional CDBG Certification).
2. Overall Benefit. The aggregate use of CDBG funds, including Section 108 guaranteed loans,
during program year(s) 2021, shall principally benefit persons of low and moderate income in a
manner that ensures that at least 70 percent of the amount is expended for activities that benefit
such persons during the designated period.
3. Special Assessments. It will not attempt to recover any capital costs of public improvements
assisted with CDBG funds, including Section 108 loan guaranteed funds, by assessing any
amount against properties owned and occupied by persons of low and moderate income,
including any fee charged or assessment made as a condition of obtaining access to such public
improvements.
However, if CDBG funds are used to pay the proportion of a fee or assessment that relates to the
capital costs of public improvements (assisted in part with CDBG funds) financed from other
revenue sources, an assessment or charge may be made against the property with respect to the
public improvements financed by a source other than CDBG funds.
In addition, in the case of properties owned and occupied by moderate-income (not low-income)
families, an assessment or charge may be made against the property for public improvements
financed by a source other than CDBG funds if the jurisdiction certifies that it lacks CDBG funds
to cover the assessment.
Excessive Force -- It has adopted and is enforcing:
1. A policy prohibiting the use of excessive force by law enforcement agencies within its
jurisdiction against any individuals engaged in non-violent civil rights demonstrations; and
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2. A policy of enforcing applicable State and local laws against physically barring entrance to or
exit from a facility or location which is the subject of such non-violent civil rights demonstrations
within its jurisdiction.
Compliance with Anti-discrimination laws -- The grant will be conducted and administered in
conformity with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d) and the Fair Housing Act (42
U.S.C. 3601-3619) and implementing regulations.
Lead-Based Paint -- Its activities concerning lead-based paint will comply with the requirements of 24
CFR Part 35, Subparts A, B, J, K and R.
Compliance with Laws -- It will comply with applicable laws.
_____________________________ _____________
Signature of Authorized Official Date
________Mayor__________________
Title
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PARKS, RECREATION AND COMMUNITY SERVICES
DEPARTMENT
Julie Parascondola
220 Fourth Avenue South
Kent, WA 98032
253-856-5100
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Adjustment to the 2019 Community Development Block Grant
Budget to Accept Third Round of CARES Act Coronavirus
Funds (CDBG-CV) - Authorize
MOTION: Authorize the Mayor to adjust the 2019 CDBG budget, accept
$859,720 in federal funds awarded to the City through the third round of
CARES Act funds (CDBG-CV) for coronavirus relief and authorize the Mayor
to execute the appropriate certifications and agreements, subject to final
terms and conditions acceptable to the Parks Director and City Attorney.
SUMMARY: The Department of Housing and Urban Development (HUD)
informed the City that it will receive an additional $859,720. (Round 3) in
Community Development Block Grant Coronavirus funds (CDBG-CV). These
funds are awarded through The Coronavirus Aid, Relief, and Economic Security
Act (H.R. 748), also known as the CARES Act. All funds must be used to
prevent, prepare for, and respond to the coronavirus. To accept these funds,
the City amended its 2019 CDBG Action Plan and must adjust its 2019 CDBG
budget.
Funds will be allocated to non-profit organization (sub-recipients) to provide
coronavirus relief to Kent residents. The City will use a streamlined process to
select these organizations, with the Kent Human Services Commission
submitting final funding recommendations to Council for approval. Priority
areas of funding include, but is not exclusive to:
· Rental/utility assistance
· Hotel/motel vouchers for those needing temporary shelter
· Food assistance
· Legal assistance for those facing evictions and/or for other legal needs
· Financial literacy and emergency assistance payments on behalf of
unemployed and under-employed residents for food, childcare, healthcare,
etc.
· Assistance for students who need tutors
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· Digital literacy for under-served populations
· Micro-enterprise assistance
· Healthcare assistance (behavioral and for COVID-related services)
· Housing support, including furniture for tenants moving into and
maintaining rental housing
BUDGET IMPACT: As described.
SUPPORTS STRATEGIC PLAN GOAL:
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
ATTACHMENTS:
1. 2019_ CDBG_ Amend2-Exhibit1 (PDF)
2. 2019_ CDBG_ Amend2-Exhibit2 (PDF)
3. Exhibit (PDF)
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POLICE DEPARTMENT
Rafael Padilla, Police Chief
220 Fourth Avenue South
Kent, WA 98032
253-852-2121
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: INFO ONLY: Request for Proposal for a Police Data Collection
Consultant
SUMMARY: Police Chief, Rafael Padilla will present the Council with an update on
the status of seeking proposals for a police data collection consultant.
SUPPORTS STRATEGIC PLAN GOAL:
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
ATTACHMENTS:
1. Data Collection RFP (PDF)
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Kent Police Department
Request for Proposal (RFP)
Race and Equity Data Collection
Prepared by Rafael Padilla
City of Kent Police Department
th
232 4 Avenue South
Kent, WA 9032
Phone: 253-856-5890 Fax: 253-856-6802
Email: Policechief@kentwa.gov
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R EQUEST FOR P ROPOSALS
________ _____, 2021
Advertised Date
Race and Equity Data Collection for the Kent Police Department
Request for Proposal Title:
City of Kent Police Department
Requesting Dept./Div.:
RFP Number: ___________________
February ____, 2021
Due Date:
RFP Coordinator: ____________________, _______________
________@kentwa.gov; (253) 856-_____
The City of Kent, Washington (“City”) requests proposals for a subject matter expert to assist the Kent
Police Department in developing data collection and data analytics capabilities that will allow the Kent
Police Department to determine whether its policies and practices result in discriminatory enforcement
practices or the provision of services in a discriminatory manner as more fully described within the RFP..
Should the City elect to accept any proposal, the City anticipates entering into a consultant contract with
the successful Proposer in the form provided for within the RFP.
Proposals shall be delivered and received, regardless of the delivery method, through February ____,
2021, up to 4:00 p.m., as shown on the clock on the east wall of the City Clerk’s Office, at the following
location:
By mail to: City of Kent Police Department
Attn: ________________
220 Fourth Avenue South
Kent, WA 98032
By hand-delivery to: City of Kent
City Clerk’s Office
th
220 4Avenue South
Kent, WA 98032
By email to: ____________@KentWA.gov
If a Proposer wishes to deliver a proposal in-person, due to impacts from COVID-19, the Proposer shall
call the City Clerk at (253) 856-5725 to schedule a time to drop-off the proposal.
P ROPOSERS MUST COMPLETE AND SIGN THE FORM BELOW (T YPE OR P RINT)
Company Name
Address City/State /Postal Code
SignatureAuthorized Representative/Title (Print name and title)
EmailPhone Fax
Company Headquarters Located in State/Province of
RFP – Race and Equity Data Collection Services for the Kent Police Department
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R EQUEST FOR P ROPOSALS
City of Kent Police Department
ACE AND E QUITY D ATA C OLLECTION
R
I. Opportunity
The City of Kent Police Department (the “City”) invites and requests proposals for its Kent Police Race and
Equity Data Collection project.
II. Overview
The City wishes to retain a subject matter expert to assist its Police Department in developing data collection
and data analytics capabilities that permit the Police Department to determine whether its policies and
practices result in discriminatory enforcement practices or the provision of services in a discriminatory
manner. If a Proposer intends to subcontract any work should it be awarded the RFP, the proposal must be
accompanied by background materials and references for any proposed subcontractor.
By submitting a proposal in response to this Request for Proposals (“RFP”), Proposer(s) agrees in advance
that if it is the successful Proposer, it agrees to the terms provided for in the City’s standard Consultant
Services Agreement attached and incorporated as Exhibit B, and will perform its services according to the
terms and conditions outlined in that agreement. In no event is a Proposer to submit its own standard
contract terms and conditions in response to this RFP. Proposers may submit exceptions as allowed in the
Certifications and Assurances document attached and incorporated as Exhibit A. The City will review
requested exceptions and accept or reject the same at its sole discretion. Be specific with any exception
noted.
The successful Proposer shall comply with and perform the services in accordance with all applicable federal,
state, county and City laws including, without limitation, all City codes, ordinances, standards and policies,
as now existing or hereafter adopted or amended.
III. Proposals
All proposals should be prepared simply, and provide straightforward and concise descriptions of the
Proposer’s capabilities to satisfy the requirements of this RFP. Emphasis should be on completeness and
clarity of content. Efficiency is a critical component of this RFP and all Proposers are advised to propose a
process that will make efficient use of limited City resources in executing any proposal that may be selected
through this RFP process. Should a contract result from this RFP process, all work must be completed within
90 days from the effective date of that resulting contract.
Proposals shall include a signature line, with name and title of signatory, in either PDF or Word document 8
½” x 11” format, and if submitted it hard-copy as opposed to electronically, it shall include ____ (__) copies.
All proposals must include the following:
1. Summary of Proposer’s background to include:
a. Organization name, address, telephone number, and email address (if available);
b. Name and telephone number of contact person;
c. Legal formation of Proposer (e.g., sole proprietor, partnership, corporation);
d. Date Proposer’s company was formed;
e. Description of Proposer’s company in terms of size, range and types of services
offered, and clientele;
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f. A list of Proposer’s principal officers, along with their respective experience and
background as it pertains to data collection services (e.g., President, Chairman, Vice
President, Secretary, Chief Operating Officer, Chief Financial Officer, General
Managers);
g. Proposer’s federal employee identification number (FEIN);
h. Evidence of legal authority to conduct business in Washington (e.g., the number of
Proposer’s state unified business identifier);
i. Evidence of an established track record for providing services and/or deliverables that
are the subject of this RFP; and
j. A statement of what specifically qualifies the Proposer to perform the race and equity
data collection services sought.
2. Summary of Proposer’s financial position to include:
a. A statement as to whether the Proposer or its parent company (if any) has ever filed
for bankruptcy or any form of reorganization under the bankruptcy code; and
b. A statement as to whether the Proposer or its parent company (if any) has ever
received any sanctions or is currently under investigation by any regulatory or
government entity.
3. A proposed data collection process that includes:
a. Conducting an assessment of current best practices by law enforcement and
government entities, including identifying policies and procedures and leading data
collection and analysis technology systems being utilized;
b. Conducting an assessment of current data collection capabilities of the Police
Department to determine gaps or shortcomings;
c. Facilitating stakeholder discussions to capture input from community members,
elected officials, police command staff, and City administration to gather data to
answer the following questions:
i. What question(s) are we attempting to answer utilizing the data?
ii. What data needs to be collected to answer those questions?
iii. How should the Police Department deliver a report regarding the data and to
whom?
iv. Estimate the cost of implementation of the program
The Police Department will assist the selected Proposer in identifying possible
participants for each stakeholder group.
4. Proposer’s proposed outcome that includes:
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a. Summary of timeline and work to be completed;
b. Methodology of how the work will be performed, incorporating the provisions outlined
in Section III.3. above;
c. Quality control measures that will be utilized to ensure accuracy of the work; and
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d. Details of who will perform the work, their qualifications including resumes, as well as
a list of related work experience of each individual who will perform the work.
5. A reporting process that includes the production of at least the following deliverables:
a. A written report that incorporates the successful Proposer’s research results for items
in Sections III.3.a. – III.3.c. above; and
b. Presentation of the report to participating stakeholders, with a question and answer
session to follow.
6. A statement of the fee proposed to compensate Proposer for implementing its proposal and
supplying the City with the requested services and deliverables, which should incorporate the
following:
a. Brief summary of the total cost of the proposal;
b. A detailed list of any and all expected costs or expenses related to the proposed
project; and
c. Summary and explanation of any other contributing expenses to the total cost.
7. A list of 2 professional references for similar or related work performed in the past 24 months,
including names, addresses, and phone numbers, and identify how each reference will be able
to comment upon Proposer’s ability to successfully perform the services Proposer proposes in
its response to this RFP.
By submitting a proposal, Proposer agrees that City of Kent Police Department may contact
all submitted references to obtain any and all information regarding Proposer's performance
history.
8. A statement that the Proposer can meet the insurance requirements contained in Exhibit C
to the RFP.
9. Return of the signed Certifications and Assurances, attached as Exhibit A.
All costs incurred to develop and prepare proposals, and to otherwise participate in this RFP process, are
entirely the responsibility of the Proposer and shall not be chargeable to the City.
All proposals become the property of the City and are subject to public disclosure laws.
IV. Method of Selection
Submittals will be evaluated using the following criteria. These criteria represent the primary factors for
consideration. Selection of the proposal the City believes best fits its needs will be based on a number of
factors including, but limited to:
1. Proposer’s related experience, performance history, and ability to timely deliver the services
requested;
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2. Proposer’s ability to provide and deliver qualified personnel having the knowledge and skills
required to execute the requested services effectively and efficiently;
3. Overall cost anticipated to implement the proposal;
4. Information contained within the submitted proposal; and
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5. Proposer’s performance during the interview prior to award, if the City elects to conduct such
an interview.
In evaluating the proposals, cost will not be the sole factor, but it will have a significant impact on wether
the City is able to proceed with any particular proposal. The City may consider any factors it deems necessary
and proper for best value including, but not limited to, price, quality of service, response to this request,
experience, staffing, and general reputation. Following the review process, the City, at the City’s sole
discretion, may select the Proposer(s) best able to meet the City’s needs.
The City reserves the right to determine the completeness of all proposals. Late or incomplete proposals
may not be considered. The City reserves the right to reject any and all proposals submitted or to cancel
this RFP at any time. The City reserves the right to waive any irregularities in the submittal and evaluation
process.
The City reserves the right to request additional information from each Proposer and to request additional
oral interviews.
V. Schedule -Tentative
The City’s proposed schedule for review of the proposal submittals and final selection of the successful
Proposer is as follows:
January ___, 2021 RFP Packages are available on city Web page, Kent Reporter, mailed, emailed
or picked up.
February ___, 2021 Deadline for submittal of written questions to the Police Department via an
email to ________@KentWA.gov
February ____, 2021 City will post all RFP questions, and the City’s responses, to the City’s
procurement website: https://www.kentwa.gov/doing-business/bids-
procurement
February ___, 2021 RFP submittal deadline: 4:00 pm
February ___ - ___, 2021 RFP reviews
March ___, 2021 Oral Interviews-if needed; interviews are optional and will be scheduled at the
sole discretion of the City and its Police Department
March ___, 2021 Consultant contract(s) awarded.
All Proposers will be notified of the City’s decision once a successful Proposer is selected.
VI. Submittal
The City prefers that proposals be submitted by email to _____________@KentWA.gov, but proposals may
also be submitted by mail or other delivery service. Only one delivery method shall be utilized; duplicate
proposals shall not be sent by other means.
Regardless of the delivery method chosen, all proposals shall be delivered and must be received by 4:00
p.m. on February _____, 2021. Late proposals may result in a proposal being rejected.
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US Mail Delivery:
If submitting a proposal by mail, a total of ___ copies of the entire proposal in printed form must be submitted
in a sealed envelope or box with the following words clearly marked on the outside of the envelope:
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Proposal Due Date: February ____, 2021
envelope. Mailed proposals
The name of the Proposer and its address must also be clearly indicated on the
should be addressed as follows:
City of Kent Police Department
Attention: ___________
220 Fourth Ave. S.
Kent, WA 98032
Email Delivery:
If submitting a proposal by email, emailed proposals must be in MS Wordor PDF format. They must include
subject line and be sent to the following email
“Race and Equity Data Collection Services – RFP” in the
address:____________@KentWa.gov.
Hand-Delivery:
If hand-delivering a proposal, and due to impacts from COVID-19, the Proposer shall call the City Clerk at
(253) 856-5725 to schedule a time to drop-off the proposal. Hand-delivered proposals shall be delivered to:
City of Kent
City Clerk’s Office
220 Fourth Avenue South
Kent, WA 98032
Proposal Questions:
Proposers should submit any questions regarding the RFP via e-mail directly to the RFP Coordinator,
___________________, Police __________, at __________@KentWA.gov. The cut off for all questions is
February ____, 2021, at ______ p.m.
VII. General RFP Provisions
Revisions to RFP through Addenda. In the event it becomes necessary to revise any part of this RFP,
addenda shall be created and distributed to all known potential Proposers providing an accurate e-mail
address. City staff are prohibited from speaking with Proposers about the project during the solicitation.
Please direct all questions to the identified RFP Coordinator.
Costs to Propose. The City is not liable for any cost incurred by a Proposer in responding to this RFP or
during the RFP review process.
COVID-19 Pandemic. All proposals must be submitted with the current COVID-19 pandemic in mind and
include the costs the successful Proposer, as the selected consultant, will incur in timely performing the
work while complying with all federal, state, and local job site requirements, including social distancing,
sanitation measures, and required personal protective equipment. Once a contract is executed, the
successful Proposer will not be excused for delay, and no change order will issue for increased costs or
additional time, due to the Proposer’s requirement to meet COVID-19 mitigation measures established by
any federal or state agency or official and required as of the date of RFP opening. Should a federal or state
agency or official impose subsequent mitigation measures that are not reasonably foreseeable, the City will
agree to negotiate in good faith the impact those measures have on the ultimate contract work.
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Most Favorable Terms. The City reserves the right to make an award without further discussion of the
proposal submitted. Therefore, the proposal should be submitted initially on the most favorable terms that
the Proposer can propose. There will be no best and final offer procedure. The City does reserve the right
to contact a Proposer for clarification of its proposal during the evaluation process. In addition, if the
Proposer is selected as the apparent successful Proposer, the City reserves the right to enter into contract
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negotiations with the apparent successful Proposer, which may include discussion regarding the terms of
the proposal. Contract negotiations may result in incorporation of some or all of the Proposer’s proposal
submission. The Proposer should be prepared to accept this RFP for incorporation into a contract resulting
from this RFP. It is also understood that the proposal will become part of the official procurement file.
Acceptance Period. Proposals must provide 60 days for acceptance by the City from the due date for
receipt of proposals.
Rejection of Proposals and Waiver of Informalities. The City reserves the right at its sole discretion to
reject any or all proposals that the City receives without penalty, and to waive irregularities and informalities
with respect to any proposal.
Contract and General Terms and Conditions. The apparent successful Proposer will be expected to enter
into a contract that is substantially the same as the sample contract and its specific and general terms and
conditions attached as Exhibit B. In no event is a Proposer to submit its own standard contract terms and
conditions in response to this solicitation. A Proposer may submit exceptions as allowed in the Certifications
and Assurances section, Exhibit A to this solicitation. The City will review requested exceptions and accept
or reject the same at its sole discretion.
No Obligation to Contract. This RFP does not obligate the City to contract for services specified herein.
Participation in this RFP and /or submission of a proposal does not confer any legal right or entitlement to
Proposers, nor create any obligation thereto on the part of the City.
Commitment of Funds. The Mayor or the Mayor’s delegate are the only individuals who may legally commit
the City to the expenditure of funds for a contract resulting from this RFP. No cost chargeable to the proposed
contract may be incurred before receipt of a fully executed contract.
Insurance Coverage. The selected Proposer(s) shall, at its own expense, obtain and keep in force
insurance coverage that shall be maintained in full force and effect during the term of the contract in the
types and amounts required by Exhibit C. At the time any contract is executed, the selected Proposer(s)
shall furnish evidence of such coverage, in the form of a Certificate of Insurance and an additional insured
endorsement.
Equal Opportunity Employer. The City is an Equal Opportunity Employer and does not discriminate
against individuals or firms because of their race, color, creed, marital status, religion, age, sex, national
origin, sexual orientation, or the presence of any mental, physical or sensory handicap in an otherwise
qualified handicapped person.
Compliance with Applicable Laws. In addition to these nondiscrimination compliance requirements, the
vendor ultimately awarded a contract shall comply with federal, state and local laws, statutes, regulations
and ordinances relative to the execution of the services. This requirement includes, but is not limited to,
protection of public and employee safety and health; disabilities; environmental protection; waste reduction
and recycling; the protection of natural resources; permits; fees; taxes; and similar subjects; and social
distancing, personal protective equipment, and sanitation requirements in response to the current COVID-
19 pandemic.
Public Records. All submitted proposals and evaluation materials become public information and may be
reviewed by anyone requesting to do so at the conclusion of the evaluation, negotiation, and award process.
This process is concluded when a signed contract is completed between the City and the selected Proposer.
Temporary Waiver of Right to Submit Public Records Request. By electing to participate in this RFP
process, the Proposer agrees not to make a public records request for any documents or information
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submitted by any other Proposer who responds to this RFP, and to the extent allowed by law, waives its
right to make such a request until contract execution is complete.
Conditional Proposal Invalid. A response from a Proposer that indicates that any of the information
requested by the City in this RFP will be provided only if the Proposer is selected as the apparently successful
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Proposer is not acceptable, and, at the City’s sole discretion, such response may disqualify the proposal
from consideration.
VIII. Exhibits
Exhibit A – Certifications and Assurances
Exhibit B – Sample Consultant Services Contract
Exhibit C – Insurance Requirements
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Exhibit A
To the RFP for Race and Equity Data Collection Services for the Kent Police Department
CERTIFICATIONS AND ASSURANCES
I/we make the following certifications and assurances as a required element of the proposal to which it is attached,
understanding that the truthfulness of the facts affirmed here and the continuing compliance with these
requirements are conditions precedent to the award or continuation of the related contract(s):
1. I/we declare that all answers and statements made in the proposal are true and correct.
2. The prices and/or costs data have been determined independently, without consultation, communication,
or agreement with others for the purpose of restricting competition. However, I/we may freely join with
other persons or organizations for the purpose of presenting a single proposal.
3. The attached proposal is a firm offer for a period of 60 days following the due date for receipt of proposals,
and it may be accepted by the City of Kent, Washington without further negotiation (except where
obviously required by lack of certainty in key terms) at any time within the 60-day period.
4. In preparing this proposal, I/we have not been assisted by any current or former employee of the City of
Kent whose duties relate (or did relate) to this proposal or prospective contract, and who was assisting
in other than his or her official, public capacity. (Any exceptions to these assurances are described in full
detail on a separate page and attached to this document.)
5. I/we understand that the City of Kent will not reimburse me/us for any costs incurred in the preparation
of this proposal. All proposals become the property of the City of Kent, and I/we claim no proprietary
right to the ideas, writings, items, or samples, unless so stated in this proposal.
6. Unless otherwise required by law, the prices and/or cost data which have been submitted have not been
knowingly disclosed by the Proposer and will not knowingly be disclosed by him/her prior to opening,
directly or indirectly, to any other Proposer or to any competitor.
7. I/we agree that submission of the attached proposal constitutes acceptance of the solicitation contents
and the attached sample contract and general terms and conditions. If there are any exceptions to these
terms, I/we have described those exceptions in detail on a page attached to this document.
8. No attempt has been made or will be made by the Proposer to induce any other person or firm to submit
or not to submit a proposal for the purpose of restricting competition.
9. I/we grant the City of Kent the right to contact references and others, who may have pertinent information
regarding the Proposer's prior experience and ability to perform the services contemplated in this
procurement.
Signature of Proposer
Title Date
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EXHIBIT A – Certifications and Assurances
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Exhibit B
Sample Consultant Services Agreement
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
\[Insert Consultant's Company Name\]
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter
the "City"), and \[Insert Consultant's Co. Name\] organized under the laws of the State of \[Insert State Co.
Formed Under\], located and doing business at \[Insert Consultant's Address and Phone Number\] (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:
\[Insert Detailed Description of Work Consultant will be Performing\]
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 \[Type either "within" or "by" depending on deadline in next form field\] \[Insert
either a date specific or enter # of days, weeks, months, years, etc.\].
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to exceed
\[Insert maximum dollar amount to be paid for services. You may type out the dollar amount
and place the numerical dollar amount in parentheses or you may just enter the numerical
dollar amount, plus applicable Washington State sales tax,\], for the services described in this
Agreement. This is the maximum amount to be paid under this Agreement for the work
described in Section I above, and shall not be exceeded without the prior written authorization
of the City in the form of a negotiated and executed amendment to this agreement. The
Consultant agrees that the hourly or flat rate charged by it for its services contracted for
herein shall remain locked at the negotiated rate(s) for a period of one (1) year from the
effective date of this Agreement. The Consultant's billing rates shall be as delineated in
Exhibit \[Insert the Exhibit # that lists the rate to be charged\].
B. The Consultant shall submit \[Enter monthly or quarterly\] payment invoices to the City for
work performed, and a final bill upon completion of all services described in this Agreement.
The City shall provide payment within forty-five (45) days of receipt of an invoice. If the City
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objects to all or any portion of an invoice, it shall notify the Consultant and reserves the option
to only pay that portion of the invoice not in dispute. In that event, the parties will
immediately make every effort to settle the disputed portion.
C. 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
Consultant’s services under this Agreement will be performed.
C. The Consultant has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained the Consultant’s services, or the Consultant is engaged in an independently
established trade, occupation, profession, or business of the same nature as that
involved under this Agreement.
D. The Consultant is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal Revenue
Service and the state Department of Revenue.
E. The Consultant has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by the
Consultant’s business, and has obtained a Unified Business Identifier (UBI) number
from the State of Washington.
F. The Consultant maintains a set of books dedicated to the expenses and earnings of its
business.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party thirty (30) days written notice at its address set forth on the signature block of this
Agreement. After termination, the City may take possession of all records and data within the Consultant’s
possession pertaining to this project, which may be used by the City without restriction. If the City’s use of the
Consultant’s records or data is not related to this project, it shall be without liability or legal 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 disaster or acts of government (“force majeure event”). Performance that is prevented or
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
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protective equipment requirements that may be required under federal, state, or local law in response to
the current pandemic.
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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
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 Consultant’s liability accruing from that obligation shall be only to the extent of the Consultant's
negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION
PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF IMMUNITY UNDER INDUSTRIAL
INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES
FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER.
In the event 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
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having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the Consultant’s part, then
the Consultant shall pay all the City’s costs for defense, including all reasonable expert witness fees and
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reasonable attorneys’ fees, plus the City’s legal costs and fees incurred because there was a wrongful refusal
on the Consultant’s part.
The provisions of this section shall survive the expiration or termination of this Agreement.
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 \[Insert Exhibit #\] attached and incorporated
by this reference.
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
City’s request. The Consultant acknowledges that the City is a public agency subject to the Public Records
Act codified in Chapter 42.56 of the Revised Code of Washington. As such, the Consultant agrees to
cooperate fully with the City in satisfying the City’s duties and obligations under the Public Records Act. The
City’s use or reuse of any of the documents, data, and files created by 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
dispute, difference or claim arising from the parties’ performance of this Agreement, the exclusive means
of resolving that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules
and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in
writing to an alternative dispute resolution process. In any claim or lawsuit for damages arising from the
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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.
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D. Written Notice. All communications regarding this Agreement shall be sent to the parties at
the addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written
notice hereunder shall become effective three (3) business days after the date of mailing by registered or
certified mail, and shall be deemed sufficiently given if sent to the addressee at the address stated in this
Agreement or such other address as may be hereafter specified in writing.
E. Assignment. Any assignment of this Agreement by either party without the written consent
of the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment,
the terms of this Agreement shall continue in full force and effect and no further assignment shall be made
without additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement
shall be binding unless in writing and signed by a duly authorized representative of the City and 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 agrees to cooperate fully with the City in satisfying the City’s duties
and obligations under the Public Records Act.
J. City Business License Required. Prior to commencing the tasks described in Section I,
Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the
Kent City Code.
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K. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any
number of counterparts, each of which shall constitute an original, and all of which will together constitute
this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page
to the other by fax or email and that signature shall have the same force and effect as if the Agreement
bearing the original signature was received in person.
IN WITNESS, the parties below execute this Agreement, which shall become effective on
the last date entered below. All acts consistent with the authority of this Agreement and prior
to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed
to have applied.
CONSULTANT: CITY OF KENT:
By: By:
(signature) (signature)
Print Name: Print Name: Dana Ralph
Its: Its: Mayor
(title)
DATE:
DATE:
NOTICES TO BE SENT TO:NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
\[Insert Contact Name\] \[Insert Name of City Rep. to Receive Notice\]
\[Insert Company Name\] City of Kent
\[Insert Address\] 220 Fourth Avenue South
\[Address - Continued\] Kent, WA 98032
\[Insert Telephone Number\] (telephone) (253) \[Insert Phone Number\] (telephone)
(253) \[Insert Fax Number\] (facsimile)
\[Insert Fax Number\] (facsimile)
APPROVED AS TO FORM:
Kent Law Department
ATTEST:
Kent City Clerk
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DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City’s equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City’s sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of sex,
race, color, national origin, age, or the presence of all sensory, mental or physical disability.
3. During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
By: __________________________________________
For: _________________________________________
Title: ________________________________________
Date: ________________________________________
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CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and state
laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal
employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
Any contractor, subcontractor, consultant or supplier who willfully disregards the City’s
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City’s equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
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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: ________________________________________
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EXHIBIT C
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.
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 and shall cover liability
arising from premises, operations, independent contractors,
products-completed operations, personal injury and
advertising injury, and liability assumed under an insured
contract. The Commercial General Liability insurance shall be
endorsed to provide the Aggregate Per Project Endorsement
ISO form CG 25 03 11 85. The City shall be named as an
insured under the Consultant’s Commercial General Liability
insurance policy with respect to the work performed for the
City using ISO additional insured endorsement CG 20 10 11
85 or a substitute endorsement providing equivalent
coverage.
2. Cyber Liability insurance naming the City as an Additional
Insured.
Minimum Amounts of Insurance
Consultant shall maintain the following insurance limits:
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1. Commercial General Liability insurance shall be written with
limits no less than $1,000,000 each occurrence, $2,000,000
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general aggregate. Coverage may be in the form of an
underlying GL policy combined with an Umbrella/Excess
policy in order to meet the limits required.
2. Cyber Liability insurance shall be written with limits no less
than $2,000,000 per occurrence and $2,000,000 aggregate.
Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability
insurance:
1. The Consultant’s insurance coverage shall be primary insurance as
respect the City. Any Insurance, self-insurance, or insurance pool
coverage maintained by the City shall be excess of the Consultant’s
insurance and shall not contribute with it.
2. The Consultant’s insurance shall be endorsed to state that coverage shall
not be cancelled by either party, except after thirty (30) days prior
written notice by certified mail, return receipt requested, has been given
to the City.
3.The City of Kent shall be named as an additional insured on all policies
(except Professional Liability) as respects work performed by or on behalf
of the Consultant and a copy of the endorsement naming the City as
additional insured shall be attached to the Certificate of Insurance. The
City reserves the right to receive a certified copy of all required insurance
policies. The Consultant’s Commercial General Liability insurance shall
also contain a clause stating that coverage shall apply separately to each
insured against whom claim is made or suit is brought, except with
respects to the limits of the insurer’s liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not
less than A:VII.
E. Verification of Coverage
Consultant shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of
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the Consultant before commencement of the work.
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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.
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PUBLIC WORKS DEPARTMENT
Chad Bieren, PE - Interim Public Works Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5600
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: King County Flood Control District Sub-Regional Opportunity
Fund: Accept and Reallocate Funds for the Lake Fenwick
Aerator Improvements - Authorize
MOTION: Authorize the Mayor to accept 2021 King County Flood Control
District Sub-Regional Opportunity Funds, in the amount of $312,367, for
the Lake Fenwick Aerator Improvements project and reallocate 2019 Sub-
Regional Opportunity Funds, in the amount $197,147, from the Kent
Airport Levee to the Lake Fenwick Aerator Improvements project.
SUMMARY: The King County Flood Control District collects an annual levy from
-Regional Opportunity
Fund, ten percent of the levy collected within each jurisdiction is redistributed to
the jurisdictions for use in stormwater or habitat projects.
In 2018 and 2020, -Regional
Opportunity Funds were allocated to the Lake Fenwick Aerator Improvements. In
County Flood Control District Sub-Regional Opportunity Funds to the Kent Airport
Levee project. Since that time, the District has prioritized other levee reaches in
their work plan, including the Lower Russell Levee and Signature Pointe Levee, and
has not moved forward on the Kent Airport Levee project. This request is to
reallocate the 2019 Sub-Regional Opportunity Funds ($197,147) and the 2021 Sub-
Regional Opportunity Funds (two agreements, $172,367 and $140,000, for a total
of $312,367) to the Lake Fenwick Aerator Project.
As the city has completed designs on a retrofit of the existing Lake Fenwick Aerator
Improvements, the next phase of work is construction. Funding from the Sub-
Regional Opportunity Fund will be used to construct the aerator improvements,
reduce the risk of future harmful algae b
of impaired water bodies, and improve the recreational experience at Lake Fenwick
Park. Lake Fenwick is a valuable and important natural resource for Kent, and this
critical project helps protect a key resource for the community.
BUDGET IMPACT: Funding from the King County Sub-Regional Opportunity Funds
will supplement previously budgeted funds for the project. The total project cost is
estimated to be approximately $1,400,000-$1,500,000.
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SUPPORTS STRATEGIC PLAN GOAL:
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
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PUBLIC WORKS DEPARTMENT
Chad Bieren, PE - Interim Public Works Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5600
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: INFO ONLY: Construction Standards Update
SUMMARY: This is an update to information provided at the Council Workshop on
November 17, 2020. Over the past several years, Public Works has collaborated
with departments throughout the City to update the 2009 Kent Design and
Construction Standards. The 2021 Kent Design and Construction Standards were
created from this effort.
The purpose of the standards is (to the extent practicable) to set forth the
minimum requirements for specific and consistent construction of, and
improvements to: public and private streets, water utilities, sewer utilities and
storm water utilities; placement and operation of any utilities in rights-of-way; and
all excavation and grading in the City.
These Standards include procedures for inspection, acceptance, warranty and
varia
and improvement of City streets and utilities.
The 2021 Kent Design and Construction Standards have been submitted for SEPA
and to the Department of Commerce, the State Department of Health, the Master
Builder Association, the Land Use and Planning Board and the King County
Industrial Waste Program for review and comments.
The Legal department is drafting a new ordinance which will repeal ordinance 3927
and amend Chapter 6.02
SUPPORTS STRATEGIC PLAN GOAL:
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
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PUBLIC WORKS DEPARTMENT
Chad Bieren, PE - Interim Public Works Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5600
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: INFO ONLY: Traffic Safety Update
SUMMARY: Staff will provide an update on measures taken to address traffic
safety throughout the City.
SUPPORTS STRATEGIC PLAN GOAL:
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
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PUBLIC WORKS DEPARTMENT
Chad Bieren, PE - Interim Public Works Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5600
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: INFO ONLY: Transportation Impact Fees
SUMMARY: Staff will present information about a proposed update to
Transportation Impacts Fees and its relation to the 2021 Transportation Master
Plan.
SUPPORTS STRATEGIC PLAN GOAL:
Evolving Infrastructure - Connecting people and places through strategic investments in physical
and technological infrastructure.
Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
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FINANCE DEPARTMENT
Paula Painter, Finance Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5264
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Payment of Bills - Authorize
MOTION: Authorize the payment of bills.
SUMMARY:
BUDGET IMPACT:
SUPPORTS STRATEGIC PLAN GOAL:
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
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FINANCE DEPARTMENT
Paula Painter, Finance Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5264
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Investment Advisory Agreement with Public Financial
Management, LLC - Authorize
MOTION: Authorize the Mayor to sign a contract with Public Financial Asset
Management, LLC to serve as the investment advisor and manager of the
-term investments, subject to final terms and conditions
acceptable to the Finance Director and City Attorney.
SUMMARY:
At the end of 2016, PFM Asset Management, LLC (PFM) was engaged to manage
-term investment portfolio which at that time totaled $25 million.
Since then the portfolio has grown to approximately $125 million. The annual fee
structure is based on the size of the portfolio as is as follows:
Average Assets Under Management Fees
Initial $25 Million 10 basis points (0.10%)
Next $25 Million 8 basis points (0.08%)
Next $50 Million 7 basis points (0.07%)
Above $100 Million 6 basis points (0.06%)
With the current size of the portfolio, the annual fee is approximately $92,000
increase the size of the portfolio in 2021
short-term investment portfolio managed by the Local Government Investment Pool
to the long-term portfolio managed by PFM. Historically, we have seen significantly
higher returns on investments for those held in the long-term portfolio.
Under this contract, the fee structure remains the same. It is anticipated that with
an additional $70 million invested with PFM, the annual cost will increase by
approximately $42,000 totally $134,000 annually. This amount will vary based on
the size of the portfolio.
BUDGET IMPACT: An increase in expenditures of approximately $42,000 annually
which will be offset by additional investment income (revenue). These amounts will
vary based on the size of the portfolio.
SUPPORTS STRATEGIC PLAN GOAL:
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Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
ATTACHMENTS:
1. PFM Kent Contract Final Draft (PDF)
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INVESTMENT ADVISORY AGREEMENT
THIS AGREEMENT, entered into as of the day of December, 2020 (the “Agreement”), by
and between CITY OF KENT, WASHINGTON, a Washington municipality (hereinafter the
"Client"), and PFM ASSET MANAGEMENT LLC, a Delaware limited liability company with an
office in Portland, Oregon (hereinafter the "Advisor").
W I T N E S S E T H
WHEREAS, the Client has funds available for investment purposes (the “Initial Funds”) for
which it intends to conduct an investment program; and
WHEREAS, the Client desires to avail itself of the experience, sources of information,
advice, assistance and facilities available to the Advisor; to have the Advisor undertake certain
duties and responsibilities; and to perform certain services as investment advisor on behalf of the
Client, as provided herein; and
WHEREAS, the Advisor is willing to provide such services on the terms and conditions
hereinafter set forth;
NOW, THEREFORE, in consideration of the premises and mutual covenants herein
contained, the parties hereto, intending to be legally bound, agreed as follows:
1. SERVICES OF ADVISOR.
The Client hereby engages the Advisor to serve as investment advisor under the terms of this
Agreement with respect to the Initial Funds and such other funds as the Client may from time to
time assign by written notice to the Advisor (collectively the "Managed Funds"), and the Advisor
accepts such engagement. In connection therewith, the Advisor will provide investment research
and supervision of the Managed Funds investments and conduct a continuous program of
investment and evaluation of the Managed Funds assets. The Advisor shall continuously monitor
investment opportunities and evaluate investments of the Managed Funds. The Advisor shall
furnish the Client with statistical information and reports with respect to investments of the
Managed Funds. The Advisor shall place all orders for the purchase, sale, loan or exchange of
portfolio securities for the Client’s account with brokers or dealers recommended by the Advisor
and/or the Client, and to that end the Advisor is authorized as agent of the Client to give instructions
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to the custodian designated by the Client (the “Custodian”) as to deliveries of securities and
payments of cash for the account of the Client. In connection with the selection of such brokers and
dealers and the placing of such orders, the Advisor is directed to seek for the Client the most
favorable execution and price, the determination of which may take into account, subject to any
applicable laws, rules and regulations, whether statistical, research and other information or
services have been or will be furnished to the Advisor by such brokers and dealers.
Both the Client and the Advisor agree on the following explicit roles in the conduct of investment
decisions, and Advisor’s authority to implement those decisions. The Advisor shall have no
discretionary authority under this Agreement. The Advisor shall make investment
recommendations to the Client, in accordance with the Client’s written Investment Policy
Statement. The Client agrees to evaluate the Advisor’s recommendations, and to either accept,
reject, or modify the investment recommendations. The Client is not limited to the Advisor’s
recommendations in the choice of investment decisions regarding the investments for the Managed
Funds or the allocation of the Managed Funds among those recommended investments, and Advisor
may assist in the implementation of some or all investment decisions, without responsibility,
however, for assuring compliance with the Investment Policy Statement as to investments directed
by the Client that have not been recommended by the Advisor. The Client authorizes the Advisor
to follow any written instructions provided by the agent designated by the Client for communicating
those instructions with regard to investments and allocation of investments within the Managed
Funds. Such written instructions may be sent by first class mail, fax, electronic mail or otherwise.
The Custodian shall have custody of cash, securities and other assets of the Client. The Advisor
shall not take possession of or act as custodian for the cash, securities or other assets of the Client
and shall have no responsibility in connection therewith. Authorized investments shall include only
those investments which are currently authorized by the Investment Policy Statement, state
investment statutes and applicable covenants and as supplemented by such other written
instructions as may from time to time be provided by the Client to the Advisor. The Advisor shall
be entitled to rely upon the Client’s written advice with respect to anticipated drawdowns of
Managed Funds. The Advisor will observe the instructions of the Client with respect to
broker/dealers who are approved to execute transactions involving the Managed Funds and in the
absence of such instructions will engage broker/dealers which the Advisor reasonably believes to
be reputable, qualified and financially sound.
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2. COMPENSATION.
(a) For services provided by the Advisor pursuant to this Agreement, the Client shall pay the
Advisor an annual fee, in monthly installments, based on the daily net assets under management
according to the schedule below:
Average Assets Under Management Fees
Initial $25 million 10 basis points (0.10%)
8 basis points(0.08%)
Next $25 million
Next $50 million 7 basis points (0.07%)
Above $100 million6 basis points(0.06%)
“Daily net assets” is defined to include the amortized value of securities, accrued interest and cash
or any money market fund balance.
The minimum annual fee is $25,000, to be applied in equal monthly installments.
(b) The Advisor will bill the Client monthly for service performed under this Agreement,
said bill to include a statement indicating the basis upon which the fee was calculated. The Client
shall pay to the Advisor the amount payable pursuant to this Agreement not later than on the 30th
day of the month following the month during which the Advisor's statement was rendered.
(c) Assets invested by the Advisor under the terms of this Agreement may from time to time
be invested in (i) a money market mutual fund managed by the Advisor or (ii) a local government
investment pool managed by the Advisor (either, a “Pool”), or in individual securities. Average
daily net assets subject to the fees described in this section shall not take into account any funds
invested in the Pool. Expenses of the Pool, including compensation for the Advisor and the Pool
custodian, are described in the relevant prospectus or information statement and are paid from the
Pool.
(d) If and to the extent that the Client shall request the Advisor to render services other than
those to be rendered by the Advisor hereunder, such additional services shall be compensated
separately on terms to be agreed upon between the Advisor and the Client.
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3. EXPENSES.
(a) The Advisor shall furnish at its own expense all necessary administrative services, office
space, equipment, clerical personnel, telephone and other communication facilities, investment
advisory facilities, and executive and supervisory personnel for managing the Managed Funds.
(b) Except as expressly provided otherwise herein, the Client shall pay all of its own
expenses including, without limitation, taxes, commissions, fees and expenses of the Client’s
independent auditors and legal counsel, if any, brokerage and other expenses connected with the
execution of portfolio security transactions, insurance premiums, and fees and expenses of the
Custodian.
4. REGISTERED ADVISOR; DUTY OF CARE.
The Advisor hereby represents it is a registered investment advisor under the Investment
Advisers Act of 1940, as amended. The Advisor shall immediately notify the Client if at any time
during the term of this Agreement it is not so registered or if its registration is suspended. The
Advisor agrees to perform its duties and responsibilities under this Agreement with reasonable care.
The federal securities laws impose liabilities under certain circumstances on persons who act in
good faith. Nothing herein shall in any way constitute a waiver or limitation of any rights which
the Client may have under any federal securities laws. The Client hereby authorizes the Advisor to
sign I.R.S. Form W-9 on behalf of the Client and to deliver such form to broker-dealers or others
from time to time as required in connection with securities transactions pursuant to this Agreement.
5. ADVISOR’S OTHER CLIENTS.
The Client understands that the Advisor performs investment advisory services for various
other clients which may include investment companies, commingled trust funds and/or individual
portfolios. The Client agrees that the Advisor, in the exercise of its professional judgment, may
give advice or take action with respect to any of its other clients which may differ from advice
given or the timing or nature of action taken with respect to the Managed Funds. The Advisor shall
not have any obligation to purchase, sell or exchange any security for the Managed Funds solely
by reason of the fact that the Advisor, its principals, affiliates, or employees may purchase, sell or
exchange such security for the account of any other client or for itself or its own accounts.
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6. TERM.
This Agreement may be terminated by the Client any time, on not less than thirty (30) days’
written notice to the Advisor. The Advisor may terminate this Agreement immediately upon any
material breach of its terms by the Client, or at any time after one year upon thirty (30) days’ written
notice to the Client.
7. FORCE MAJEURE.
The Advisor shall have no liability for any losses arising out of the delays in performing or
inability to perform the services which it renders under this Agreement which result from events
beyond its control, including interruption of the business activities of the Advisor or other financial
institutions due to acts of God, acts of governmental authority, acts of war, terrorism, civil
insurrection, riots, labor difficulties, or any action or inaction of any carrier or utility, or mechanical
or other malfunction.
8. DISCIPLINARY ACTIONS.
The Advisor shall promptly give notice to the Client if the Advisor shall have been found to
have violated any state or federal securities law or regulation in any final and unappealable
judgment in any criminal action or civil suit in any state or federal court or in any disciplinary
proceeding before the Securities and Exchange Commission (“SEC”) or any other agency or
department of the United States, any registered securities exchange, the Financial Industry
Regulatory Authority, or any regulatory authority of any State based upon the performance of
services as an investment advisor.
9. INDEPENDENT CONTRACTOR.
The Advisor, its employees, officers and representatives shall not be deemed to be employees,
agents (except as to the purchase or sale of securities described in Section 1), partners, servants,
and/or joint ventures of the Client by virtue of this Agreement or any actions or services rendered
under this Agreement.
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10. BOOKS.
The Advisor shall maintain records of all transactions in the Managed Funds. The Advisor
shall provide the Client with a monthly statement showing deposits, withdrawals, purchases and
sales (or maturities) of investments, earnings received, and the value of assets held on the last
business day of the month. The statement shall be in the format and manner that is mutually agreed
upon by the Advisor and the Client. The Advisor shall provide the Client with the necessary data
to complete the Deposits and Investments Footnote in the Client’s CAFR as required in GASB 40
and GASB 72. The data shall include market and book values sorted and subtotaled by investment
type and maturity by years and include the percentage of the portfolio. The Advisor will also
provide a list of securities sorted by type, and percentage of the portfolio and include ratings by
Moody’s and S&P. In addition, the Advisor will provide the Fair Value Measurements by security
as required in GASB 72. As accounting standards change, the Advisor shall provide the data in
accordance with updated accounting standards issued by GASB, and communicated by the Client
to the Advisor. The Advisor shall provide such information to the City no later than February 28 of
each year, and the Client agrees to provide the format needed for such information no later than
February 1 of each year.
11. THE ADVISOR’S BROCHURE AND BROCHURE SUPPLEMENT.
The Advisor warrants that it has delivered to the Client prior to the execution of this
Agreement the Advisor's current SEC Form ADV, Part 2A (brochure) and Part 2B (brochure
supplement). The Client acknowledges receipt of such brochure and brochure supplement prior to
the execution of this Agreement.
12. MODIFICATION.
This Agreement shall not be changed, modified, terminated or discharged in whole or in part,
except by an instrument in writing signed by both parties hereto, or their respective successors or
assigns.
13. SUCCESSORS AND ASSIGNS.
The provisions of this Agreement shall be binding on the Advisor and its successors and
assigns, provided, however, that the rights and obligations of the Advisor may not be assigned
without the consent of the Client.
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14. NOTICE.
Written notices required under this Agreement shall be sent by regular mail, certified mail,
overnight delivery or courier, and shall be deemed given when received at the parties’ respective
addresses shown below. Either party must notify the other party in writing of a change in address.
Client’s Address
City of Kent, Washington
th
Ave. S.
220 4
Kent, WA 98032
Attn: Finance Department
Advisor’s Address With copy to:
PFM Asset Management LLC PFM Asset Management LLC
650 NE Holladay Street 1735 Market Street
rd
Suite 1600 43Floor
Portland, OR 97232 Philadelphia, PA 19103
Attn: Luke Schneider Attn: Controller
15. APPLICABLE LAW.
This Agreement shall be construed, enforced, and administered according to the laws of the
State of Washington. The Advisor and the Client agree that, should a disagreement arise as to the
terms or enforcement of any provision of this Agreement, each party will in good faith attempt to
resolve said disagreement prior to filing a lawsuit.
16. EXECUTION AND SEVERABILITY.
Each party to this Agreement represents and warrants that the person or persons signing this
Agreement on behalf of such party is authorized and empowered to sign and deliver this Agreement
for such party. The invalidity in whole or in part of any provision of this Agreement shall not void
or affect the validity of any other provision.
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17. PARTICIPATION IN AGREEMENT.
With the consent of the Advisor, this Agreement may be extended for use to other Washington
public agencies and other similar eligible entities. Any such use by other such entities must be in
accordance with applicable Washington state law, including RCW 39.34.030, and any ordinance,
charter or procurement rules and regulations of such respective entity.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by
their authorized representatives as of the date set forth in the first paragraph of this Agreement.
PFM ASSET MANAGEMENT LLC
By:
Name:
Title:
CITY OF KENT, WASHINGTON
By:
Name:
Title:
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FINANCE DEPARTMENT
Paula Painter, Finance Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5264
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Authorize the Use of accessoShoWare Center Operating Fund
Balance to Purchase Scoreboard - Authorize
MOTION: Authorize the use of the accessoShoWare operating fund balance
for the purchase of a scoreboard in the amount of $300,000.
SUMMARY: As part of the accessoShoWare Center Sales, Marketing and
Operational Management Services Agreement with the City, SMG has committed to
contribute $500,000 to the Events Center to be used for the purchase of a new
scoreboard. The estimated cost of a new scoreboard is $800,000.
The scoreboard, which also includes the video and control room equipment, was
now 14 years later and the manufacturer, Daktronics, no longer has replacement
parts for it. There are issues with the scoreboard, and we can longer find parts for
replace their scoreboard after 12 years. A replacement cycle of 12-14 years is
typical for this piece of equipment.
Since the accessoShoWare Center opened in 2009, admissions tax for the
accessoShoWare Center and the Thunderbirds have been transferred from the
these funds have been accumulating in fund balance which currently nears $3.0
million. $545,000 of the current fund balance is CARES funding reserved for
reopening expenses, which leaves approximately $2.4 million in fund balance. The
City would like to use approximately $300,000 of the accessoShoWare operating
fund balance to pay for the remaining cost of the scoreboard.
The Finance Department plans to come back to Council in the future with a proposal
for the future use of the accessoShoWare operating fund balance.
BUDGET IMPACT: $300,000 of fund balance
SUPPORTS STRATEGIC PLAN GOAL:
Innovative Government - Delivering outstanding customer service, developing leaders, and
fostering innovation.
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Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
Inclusive Community - Embracing our diversity and advancing equity through genuine community
engagement.
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FINANCE DEPARTMENT
Paula Painter, Finance Director
220 Fourth Avenue South
Kent, WA 98032
253-856-5264
DATE: February 9, 2021
TO: Kent City Council - Committee of the Whole
SUBJECT: Ordinance Providing Business Licensing Exemption for Parks
Performers - Adopt
MOTION: Adopt Ordinance No. 4392, amending Chapter 5.01 of the Kent
City Code to provide a business licensing exemption for vendors whose
sole business activity is accepting a contract with the City to perform or
provide a service to the Recreation and Cultural Services Division of the
Parks Department.
SUMMARY: Under the Kent City Code, a business license is required for any vendor
who enters into a contract with the City, regardless of whether the vendor
physically steps foot within the City. This requirement poses significant challenges
for many of the contracts within the Recreation and Cultural Services Division of the
Parks and Community Services Department, who contract with several small non-
profit organizations and touring artists as part of its programming.
program costs significantly, as these costs would have to be added to each contract
the City enters into. In addition, the business licensing process creates additional
paperwork for the performers who tend to be unfamiliar with licensing requirements
and many of whom would simply decline the work. These artists are touring for
multiple months, stopping in a different city for only a few nights. It simply does
not make logistical sense for them to take the time to apply for a business license
and pay a business license fee for a few hours of work before they move on to a
different city.
This ordinance provides for an exemption from the business licensing requirements
for vendors that are contracting with the City as part of an event or program
Services Division. In addition, it makes a housekeeping change to move an already
existing exemption for businesses owned by minors into the revised exemptions
section of the code.
BUDGET IMPACT: None
SUPPORTS STRATEGIC PLAN GOAL:
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Thriving City - Creating safe neighborhoods, healthy people, vibrant commercial districts, and
inviting parks and recreation.
Sustainable Services - Providing quality services through responsible financial management,
economic growth, and partnerships.
ATTACHMENTS:
1. Business License Exemption Rec and Cultural (PDF)
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ORDINANCE NO. 4392
AN ORDINANCE of the City Council of the
City of Kent, Washington, amending sections
5.01.040 and 5.01.045 of the Kent City Code to: (i)
provide a business licensing exemption for vendors
who contract with the City as part of an event or
program facilitated by, or for a service provided to,
the Recreation and Cultural Services Division of the
City’s Parks Department, and (ii) to make a
housekeeping change to group an existing
exemption with this new exemption within section
5.01.045 of the Kent City Code.
RECITALS
A. The Recreation and Cultural Services Division of the City’s
Parks and Community Services Department contracts with several small
non-profit organizations and touring artists as part of its programming.
B. Requiring business licenses and associated fees for these types
of vendors adds significant programming costs as the business license fees
would necessarily be built into the project cost billed back to the City.
Furthermore, due to the additional paperwork, and lack of familiarity with
licensing requirements, many of the touring artists would simply decline to
work with the City. These artists are touring for multiple months on the
road, stopping in a different city for only a few nights. It simply does not
make logistical sense for them to take the time to apply for a business
1 Amend KCC 5.01.040, 5.01.045 -
Re: Business License Exemptions
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license and pay a business license fee for a few hours of work before they
move on to a different city.
C. If not exempted from the business licensing requirements,
these small contracts would require significant additional City expense by
raising the cost of each contract, and could deter potential cultural services
vendors from working with the City.
D. This ordinance provides the necessary exemption from the
business licensing requirements for vendors that contract with the City as
part of an event or program facilitated by, or for a service provided to, the
City’s Recreation and Cultural Services Division, and moves the current
exemption for businesses owned by minors into the revised exemptions
section of the Kent City Code.
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF KENT,
WASHINGTON, DOES HEREBY ORDAIN AS FOLLOWS:
ORDINANCE
SECTION 1. – Amendment – KCC 5.01.040. Section 5.01.040 of the
Kent City Code, entitled “General business license required”, is hereby
amended as follows:
Sec. 5.01.040. General business license required. Except as
provided in KCC 5.01.045, it is unlawful for any business to operate in the
city without having first obtained a general business license for the current
calendar year or unexpired portion thereof and paid the fees prescribed in
this chapter. A business with premises, primary places of business, or main
offices outside the city limits must be licensed before conducting business
within the city limits.
2 Amend KCC 5.01.040, 5.01.045 -
Re: Business License Exemptions
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SECTION 2. – Amendment – KCC 5.01.045. Section 5.01.045 of the
Kent City Code, entitled “Threshold exemption”, is hereby amended as
follows:
Sec. 5.01.045. Exemptions. To the extent set forth in this section,
the following persons and businesses shall be exempt from the registration,
license and/or license fee requirements as outlined in this chapter:
A. Any person or business whose annual value of products, gross
proceeds of sales, or gross income of the business in the city is equal to or
less than $2,000 and who does not maintain a place of business within the
city. The exemption does not apply to regulatory license requirements or
activities that require a specialized permit.
B. Any person or business whose sole business activity conducted within
the city is accepting or executing a contract or grant agreement with the city
as part of an event or program facilitated by, or for a service provided to,
the recreation and cultural services division of the parks and community
services department.
C. A business solely owned and operated by a person under the age of
18 years shall not be required to have a business license.
SECTION 3. – Severability. If any one or more section, subsection,
or sentence of this ordinance is held to be unconstitutional or invalid, such
decision shall not affect the validity of the remaining portion of this ordinance
and the same shall remain in full force and effect.
SECTION 4. – Corrections by City Clerk or Code Reviser. Upon
approval of the city attorney, the city clerk and the code reviser are
authorized to make necessary corrections to this ordinance, including the
3 Amend KCC 5.01.040, 5.01.045 -
Re: Business License Exemptions
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correction of clerical errors; ordinance, section, or subsection numbering; or
references to other local, state, or federal laws, codes, rules, or regulations.
SECTION 5. – Effective Date. This ordinance shall take effect and be
in force thirty days from and after its passage, as provided by law.
February 16, 2021
DANA RALPH, MAYOR Date Approved
ATTEST:
February 16, 2021
KIMBERLEY A. KOMOTO, CITY CLERK Date Adopted
February 19, 2021
Date Published
APPROVED AS TO FORM:
ARTHUR “PAT” FITZPATRICK, CITY ATTORNEY
4 Amend KCC 5.01.040, 5.01.045 -
Re: Business License Exemptions
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