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City Council Meeting - Council - Agenda - 4/4/2023
^*4 KENT CITY COUNCIL AGENDA • Tuesday, April 4, 2023 1--7KENT 7:00 PM WASH I NGTON Chambers 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: 894 3424 6787 Passcode: 503761 Mayor Dana Ralph Council President Bill Boyce Councilmember Brenda Fincher Councilmember Zandria Michaud Councilmember Satwinder Kaur Councilmember Toni Troutner Councilmember Marli Larimer Councilmember Les Thomas ************************************************************** COUNCIL MEETING AGENDA - 7 P.M. 1. CALL TO ORDER/FLAG SALUTE 2. ROLL CALL 3. AGENDA APPROVAL Changes from Council, Administration, or Staff. 4. PUBLIC COMMUNICATIONS A. Public Recognition 1. Employee of the Month 2. Recognition of Kent 101 Graduates 3. Proclamation for Sexual Assault Awareness Month 4. Proclamation for National Public Safety Telecommunicators Week 5. Presentation from the Greater Kent Historical Society B. Community Events 5. REPORTS FROM COUNCIL AND STAFF A. Mayor Ralph's Report and Chief Administrative Officer's Report City Council Meeting City Council Regular Meeting April 4, 2023 B. Councilmembers' Reports 6. PUBLIC HEARING 7. PUBLIC COMMENT The Public Comment period is your opportunity to speak to the Council and Mayor on issues that relate to the business of the city of Kent or to agenda items Council will consider at this meeting. Comments that do not relate to the business of the city of Kent are not permitted. Additionally, the state of Washington prohibits people from using this Public Comment period to support or oppose a ballot measure or candidate for office. Public Comment may be provided orally at the meeting, or submitted in writing, either by emailing the City Clerk by 4 p.m. on the day of the meeting at CityClerkCa@kentwa.gov or delivering the writing to the City Clerk at the meeting. If you will have difficulty attending the meeting by reason of disability, limited mobility, or any other reason that makes physical attendance difficult, and need accommodation in order to provide oral comment remotely, please contact the City Clerk by 4 p.m. on the day of the meeting at 253-856-5725 or CityClerk@kentwa._gov. When called to speak during the meeting, please state your name and city of residence for the record. You will have up to three minutes to provide comment. Please address all comments to the Mayor and Council as a whole. The Mayor and Council may not be in a position to answer questions during the meeting. Alternatively, you may email the Mayor and Council at Mayor@KentWA.aov and CityCouncil@KentWA.gov. Emails are not read into the record. S. CONSENT CALENDAR A. Approval of Minutes City Council Meeting - City Council Regular Meeting - Mar 21, 2023 7:00 PM B. Payment of Bills - Approve C. Medical, Stop Loss and Wellness Vendor Contracts - Authorize D. Washington State Department of Commerce Mill Creek / 76th Avenue South Flood Plain Stabilization, Habitat Enhancement Project $980,000 Grant - Authorize E. Washington State Department of Commerce Mill Creek / 76th Avenue South Flood Plain Stabilization, Habitat Enhancement Project $1,950,000 Grant - Authorize F. James Street Stormwater Improvements - King County Flood Control District Sub-Regional Opportunity Fund acceptance - Authorize G. Excused Absence for Councilmember Larimer - Approve 9. OTHER BUSINESS 10. BIDS A. 2023 Paint Line Striping and Raised Pavement Markings Replacement Bid - Award City Council Meeting City Council Regular Meeting April 4, 2023 11. EXECUTIVE SESSION AND ACTION AFTER EXECUTIVE SESSION 12. 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. 4.A.3 PROCLAMATION WHEREAS, By definition, sexual violence is any unwanted sexual contact - either in person or online - including sexual assault, harassment, and abuse; and WHEREAS, Sexual Assault Awareness Month calls attention to the impact of sexual violence in communities across the state and nation, raising public awareness and educating communities on how to prevent it; and c 0 WHEREAS, In Washington State, 45% of women and 22% of men report having experienced sexual violence in their lifetime; and c U a� WHEREAS, Rape is among the most underreported crimes for many reasons, U including victims'fear of being disbelieved or further traumatized within the legal system. Additional barriers, such as language, immigration a status, gender bias, and systemic racism further oppress and silence victims; and c 0 WHEREAS, 41% of Americans have been personally subjected to harassing behavior online, and people from historically oppressed groups are more likely to experience online harassment, mirroring inequities we see elsewhere in L society; and 3 a WHEREAS, Negative impacts of sexual violence trauma on adults, youth, and children include fear, concern for safety, physical and mental health y conditions, including symptoms of post-traumatic stress disorder, a injury, and missed work or school; and x WHEREAS, Working together as a community, we can alleviate the trauma of sexual in violence by ensuring supportive resources are available to all survivors, `o while standing up to and actively disrupting harmful attitudes and c behaviors that contribute to sexual violence. 2 Now, therefore, I, Dana Ralph, Mayor of Kent, join advocates and communities throughout King County in taking action to prevent sexual o violence by standing with survivors and proclaiming April 2023, to be a c Sexual Assault Awareness Month In Kent Washington. Together, we commit to a safer future for all children, young people, adults, and families in our community. E E In witness whereof, I have hereunto set my hand this 4th day of April 2023. 0 Mayor Dana Ral h ICEN• T W A S H I N O T O N Packet Pg. 4 4.A.4 PROCLAMATION Whereas, Valley Com staff are essential first responders. They play a critical role in effectively coordinating emergency services to ensure the health and safety of our residents, businesses and visitors 24- hours a day, seven days a week; and 0 Whereas, Valley Com call receivers and dispatchers are important first responders who endure long hours, abnormal schedules, and .2 stressful work situations daily. Their ability to remain calm under a pressure has saved the lives of countless Kent residents, -- employees and visitors; and, Whereas, the city of Kent honors the men and women who play a vital role c in the protection of our community members, businesses and visitors; and 0 Whereas, Valley Com has been successfully serving the public safety E communication needs of the city of Kent since 1977. a� NOW, THEREFORE, I, Mayor Dana Ralph, do hereby proclaim the week of M April 9-15, 2023 as U) National Public Safety Telecom municators Week a in Kent Washington and urge all our residents pay tribute to our 911 call 0 receivers, dispatchers, support staff and managers and to recognize the z substantial contributions they have made to our health, safety, welfare and o quality of life. c 0 In witness whereof, I have hereunto set my hand and caused to be affixed the E seal of the city of Kent this 4th day of April 2023. U 0 L Q. 0 V Mayor Da ha R Iph E E 0 U KENT W A S H I N G T O N Packet Pg. 5 5.A ri CA reipioOrt'! rt K"FW of department highl ghts Cn ithe n- 0 • During the month of March, the City Clerk's ) ADMINISTRATION office processed 115 contracts and 0 conducted three bid/RFP openings. Administration • The Records Management Administrator o • We continue to spend a significant amount has been hard at work assisting staff with of time reviewing proposed legislation. the proper retention destruction and With just under one month left in session, transfer of records to the state archives. o we have many bills we are weighing in on, • The Clerk's Office continues to receive a0. providing both feedback and testimony. record number of requests for public �, Recent activity includes: records. During the month of March alone, o The Senate capital budget proposal was the Clerk's Office closed out more than 714 2 released and $250,000 was included for requests for public records and processed 0 East Hill Neighborhood Park. 209 body worn camera videos totaling o The Mayor testified in support of SB nearly 6,000 minutes of footage. cc 5536 on possession of controlled In March, the Clerk's Office started substances. providing one-on-one records management •E o Councilmember Troutner and Julie a Stormes testified in support of SB 5606 and public records training to newly-hired a on street racing; and the committee police officers. later approved the bill. Communications o Kim Komoto and Christina Schuck Kent 101 Spring session is a wrap Thank you testified virtually on HB 1080 on body to every department for sharing how they help serve Kent and make it such a great place to Q worn camera footage. live. Graduation for the class will be held at • Interviews for the position of Human the April 4 Council meeting. We are looking Resources Director were conducted the week of March 20. We are hoping to have forward to continuing the class this Fall! �. an announcement about a new director soon. • As we head into spring, our community Current Planning events will be ramping up. Stay tuned and Last week, Sam Alcorn was promoted from c keep an eye out for fun, informative things planner to senior planner. This well-deserved to come. recognition reflects his professionalism, Clerk's Office teamwork and personal qualities which • The Teams remote meeting room located in support the City's mission and core values. E the Centennial Center first floor conference Unfortunately, ECD also learned that planner U room, is now up and running and is being Jonathan Kesler has accepted a senior planner utilized by the City's boards and position with the City of Snoqualmie, where he commissions. will have more opportunities to focus on his passion for historic preservation. While this is Page 1 of 10 Packet Pg. 6 5.A a loss for the City of Kent team, we are happy for the many contributions she made in for Jonathan's new opportunity to advance his Customer Service. career in a unique Western Washington city Accounting and Reporting that is just up the road. Amazon Prime Business account set up is As a result of these changes, two planner being finalized and the conversion will be positions are vacant and should be open by complete in mid-April. Account clean-up the time of this publication. The planning team and inactivation will be complete by April 3. is excited to add new talent and perspectives An email was sent out to all affected users to serve our customers and the community and all department liaisons on March 24. in and keep Kent's many exciting projects Please continue to reach out to moving forward together. accounting@kentwa.gov or Building Services accountspayable@kentwa.gov regarding • Inspection volumes dropped slightly during 13th period adjustments and year-end 0 the month of March with 537 inspections closing questions. E conducted as of March 24. Plan reviewers Tax and License o stayed busy with 110 reviews during the Finance personnel recently attended the month. This despite all staff attending 20- Quarterly Operations Committee meeting a 30 hours of continuing education classes for the FileLocal agency, along with early in March through ICC. All courses representatives from five other Washington were taken remotely which saved an cities. The FileLocal platform allows o average of 2 1/2 hours of driving daily, over businesses to apply for or renew their a staff attending classes in person at the business license online. This was the first Lynnwood Convention Center. in-person meeting for FileLocal since the • Building Services hired a new inspector, RJ start of the COVID-19 pandemic. w Petersen, to replace a colleague who left The 2023 Quarterly B&O tax return is 0 a� the city in January. A second inspector will available on the City's website for those r arrive the first of April, as well as a new who file paper returns. Quarter 1, 2023 plans examiner - this will help maintain and Annual 2022 B&O tax returns are due next day service for inspections and also by May 1. E reduce timelines for application review. a 4- a� Benefits Budget • Gathering information for State Risk • The Budget Book has been completed, Management Reporting o submitted to GFOA, and sent to the • Working with CVS on system configuration printers. Printed copies will be distributed for AFSCME CBA changes to departments by mid-April. • Secure 2.0 change requirements a Customer Service assessment • An unusually high volume of leak Labor adjustment applications were received in Non-represented Salary Survey project the month of March. Some of the Standby Pay meeting with Legal and adjustment requests were for issues Finance E caused by very cold temperatures in Updating and standardizing MWI and II job 2 February. So far, 36 applications have been descriptions in Utilities approved and a total of $171,908.90 will Meeting with PW regarding take-home be adjusted. vehicles in Water E Rio Petroff, Financial Services Supervisor, Recruiting U • will be working her last day in Customer Five employees starting on April 3: Jeremy Service on March 31. We wish her lots of Henke- Traffic Signal Technician (Public luck on her move to Texas and thank her Works), Joey Lenzmeier- Assistant City Attorney (Law), Brett Minson- Plans Page 2 of 10 Packet Pg. 7 5.A Examiner (ECD), Matthew Pereira-Walker- the defendant responded by punching the MW2 in Signs (Public Works), and Adrian teenager in the head multiple times and Rojas-Media- Police Officer (PD) ripping out her earring. The jury found the • Promotions effective April 1: Sam Alcorn- defendant not guilty of Assault in the Sr. Planner and Ian Beckstrom- SCADA Fourth Degree. Technician. Julie Stormes, the City's lead Senior • Oral board interviews for Parking Prosecutor, testified on March 21 in Enforcement Assistant on April 3. support of SB 5606, a bill to deter street • Interviews during the week of 3/27 for racing. Its passage would allow law in Payroll Supervisor and Civil Engineering enforcement officers to impound vehicles Designer 2 and interviews the week of April used in illegal street races. Additionally, 3 for Custodian and Data/Systems once a vehicle has been impounded twice, c Engineer. the vehicle is subject to forfeiture upon 0 conviction for illegal racing. The bill would E also explicitly authorize jurisdictions to 0 Information Technology Projects prosecute individuals with aiding and SCADA System Upgrade - to upgrade or abetting when they organize illegal street a • race events. replace the current Supervisory Control In March, prosecutors covered one and Data Acquisition (SCADA) system in order to ensure that the SCADA Platform is community court calendar with 98 cases Q using the latest supported operating across 59 defendants. There were 22 FTAs: @ systems, databases, and software, with 10 of which were mandatory appearances, physical and virtual servers capable of which resulted in warrants being issued. supporting the SCADA system and its Continued to assist accesso ShoWare staff 2 associated alarming system for the next to procure building improvements including decade while meetin anew marquee. g necessar y goals for . Assisted the Police Department in ;a system security and outage redundancy. u • Corrections Camera Upgrade - Replace the structuring an agreement with Vine Maple 9 jail's internal analog cameras and migrate Place to expand the community immersion a to the digital capture, storage and program for new recruits.Continued to assist Public Works in a retention of the OnSSI system. Which will finalizing the Lower Russell Road Levee then be integrated with the Jail Controller project. � and intercom. Assisted Parks in kicking off the Kent East Information Technology operational support for March 19, 2023 to March 28, 2023 Hill Operations Center (KEHOC) project and Q Number of tickets opened - 147 explored alternatives for project building • and financing. Y) • Number of tickets closed - 270 Assisted the HR and IT Departments with �. agreements to extend Workday support services. `o • One criminal case went to trial in March. • Advised the IT Department regarding The defendant was charged with Assault in contract terms for replacing the the Fourth Degree under allegations that department's records management system, `o she used more force than was reasonably Tiburon. necessary to defend herself against a • Assisted the Clerk's Office on various public E- teenager. The defendant had intercepted records requests. E an elderly person who was alleged to have • Assisted the HR Department in a number of E shoplifted from a local store. Affronted by sensitive employment and labor related U the defendant's physical aggression toward matters. the elderly thief, a teenage woman • Assisted City departments in reviewing and intervened and a fight ensued. The negotiating contract terms for a number of teenager had pushed the defendant, and Page 3 of 10 Packet Pg. 8 5.A contracts related to construction, Adaptive Recreation Spring registration technological, and development projects. opened, and in many cases, closed on • Assisted outside counsel on a number of March 15. Except for one program, every cases currently in litigation. class filled within 30 minutes. Most • Worked with staff to acquire the property programs also have waitlisted participants! rights necessary to complete various Kent Parks runs one of the largest Adaptive projects throughout the City. programs in Western Washington. • Matt Dusk Sings Sinatra played to a 92% PARKS, RECREATION, ' capacity audience of 329 people on Friday, in COMMUNITY SERVICES March 17 at 7:30 pm at the Kent-Meridian PAC. The crowd enthusiastically enjoyed Recreation and Cultural Services the performance as evidenced by two c • Our newest program, "Lu Fitness for Kids," standing ovations, as well as verbal 0 has been a big success. Lu is a state-of- feedback and comments on social media. E the-art gaming system which combines Ray on My Mind, part concert and part 0- exercise, education, and video games. It theatrical production, closed the 2022- n projects the games onto a blank wall and 2023 Spotlight Series on Saturday, March a with the use of balls, kids interact, score 25 with a show celebrating the songs and points, learn, solve problems, build life story of Ray Charles. As of Thursday, coordination, work as teams, and achieve March 23, 286 tickets had been sold. o successes. We just finished up our sold-out The Student Art Walk is underway through winter session and are now promoting two March 31 with artwork by local students on spring offerings. Future Lu opportunities display in the Centennial Gallery, as well as include an adaptive program and a at Kent Station and in downtown w birthday party package coming in the fall. businesses. The gallery is free and open to 0 a� • Youth-Teen Staff, in partnership with the public during regular city business r Meeker Middle School Afterschool All-stars hours - 8 am to 5 pm, Monday through (a nationwide organization funded by the Friday. Sixteen schools and 17 businesses T Arnold Schwarzenegger Foundation), have participated in this year's Student Art E been teaching middle schoolers how to Exhibit. a cook healthy, and mainly from scratch, The next Centennial Gallery exhibit will a entrees and snacks. Teens are anxious to feature paintings and textile artwork from L) participate in this two-hour, twice a week Renee Hazen and Leslie Barber from April 3 cooking program. It's particularly through May 23. noteworthy that this performance-based The 2023 Kent Summer Art Exhibit will Q program requires that participants must be return to the Centennial Center Gallery, passing all their classes!! Staff recently June through August. The deadline for U) organized and challenged the teens to an artwork submissions was March 15 and a a "Iron Chef Leftover," competition. They record number of artists applied. We � formed two teams and gave the teens full received a total of 894 artwork submissions `o access to all the leftover ingredients in the from 125 artists, up from 582 artworks refrigerator! Displaying teamwork, from 73 artists in 2022. Two professional creativity, and their developing skills of artist jurors are currently reviewing the `o_ mixing and matching ingredients, both applications and will select approximately teams ended up creating amazing tasting 60 pieces for inclusion in the show. 'r_ soups. The winning presentation was a The deadline for the 2023 Downtown Mural E chicken noodle soup that incorporated all Project was March 31. Two artists will be E the non-traditional vegetables they could chosen to create murals for two mural U chop or grind! Everybody won as both locations in Kent's historic downtown. New teams proudly consumed their final hot and murals will replace the inaugural artworks healthy concoctions on an icy cold day. for 2021 at 403 W. Meeker Street and 314 West Meeker Street. Page 4 of 10 Packet Pg. 9 5.A • Softball Tournament season kicked-off on area was conducted, and a 12-year-old and March 25 and 26 as Kent continues to be a a 14-year-old juvenile were located in the destination for local, regional, and national backyard to a residence off of West Valley sports events. A women's 23 team softball HWY. Both juveniles were booked into tournament was the opening event held at juvy. Hogan Park @ Russell Road. Kent Parks On March 16, at 8:03 pm, officers were Sports Complexes create community dispatched to a threat with a weapon at connections and provide significant Arterra Townhomes. The suspect had economic benefits to the city through hotel pointed a gun at the resident over a in stays, restaurant visits and local shopping snapchat based dispute with his daughters. late March through late September. Officers responded to the suspect's • The 2022-2023 Senior Center Winter Snow location, she exited the apartment and was c Sports program has ended after a hugely detained without force. A search warrant 0 successful season. The Senior Activity was granted, and officers cleared the E Center offered 11 trips hosting 465 very apartment finding the referenced gun. The o enthusiastic participants. The Nordic skiing suspect was booked for Assault 2. and snowshoeing trips traversed over On March 17, at 1:15 pm, an officer was a 1,750 miles of snow-covered trails in dispatched to the East Hill Village Self Washington State this season. The Storage located at 10223 SE 256t" St participants were not ready for the season regarding a burglary. During the early o to end and are already looking forward to morning hours on multiple days, the a next year. suspect(s) broke into at least 12 different units and took different items. The issue a) began when one tenant began sharing his .2 code with others. Video surveillance 0 Staff Changes - Hiring/Retirement/ captured the incidents. Recruitment/ Leaves/Promotions • On March 17 at 4:35 pm, officers were Corrections Officer Ryan Armstrong dispatched to Driftwood Apartments for a T resigned March 27. report of sounds of someone throwing E Significant crime activities/arrests -0 /investigations rocks at the gym windows. Officer Lind a • On March 13, at 10:25 am, officers were located two suspects coming out of the dispatched to a residential burglary in south side of the gym. One male had dark progress in the 21000 block of 119t" Ave objects in his hand, and he kept trying to SE. The victim was working at the put his hands back into his waistband Southcenter Mall when the suspects stole despite being told not to. A struggle to 0 her vehicle, drove to her residence and control the male ensued during which one began ransacking and stealing items of officer fell backwards trying to take the value. While this was occurring, the suspect to the ground. The officer hit his victim's daughter arrived home and saw head on the hard dirt and the heavier four suspects exit the residence, get into suspect landed on the officers head. After -, the victim's vehicle and flee the area. a bit more struggle the male was placed • On March 15, at 4:02 pm officers located into handcuffs. The officer was transported E an occupied stolen vehicle at the Old to Covington ER. Both suspects were o booked into the Kent Jail for various Fishing Hole and placed terminators by the tires. PA announcements were used, and offenses. c the vehicle took off east on Frager Rd with On March 17, at 10:44 pm, officers pulled E two flat tires. Officers were not able to over a recklessly speeding Challenger. The G p driver blew a 0.367 on a Portable Breath U pursue the vehicle because of the state's Tester. He was arrested and booked into current pursuit laws. Officers then located Kent Jail. the vehicle on Frager Rd. close to West On March 23, at 5:27 am, officers were Valley HWY unoccupied. A search of the dispatched to an alarm at the M&J Food Page 5 of 10 Packet Pg. 10 5.A Mart located at 427 E Smith St. Three DV call. The protected party on a No suspects were actively breaking into the Contact Order came to the location after business. When the suspects were being invited by the respondent. The challenged, two suspects ran from the Protected party was assaulted by the store and got into a vehicle driven by the respondent's sister. The respondent was third. The vehicle ended up in a creek. One arrested for DV NCO violation after she suspect was taken into custody. showed texts where all day the two had • On March 24, at 8:54 pm, officers communicated over food being delivered responded to a two-car collision at 681" Ave and child custody. A half hour later, the in S/S 196t" St. The injuries were significant. protected party returned to the apartment One vehicle was traveling west on S 1961" and destroyed the resident's doorknob as St with the green light in his favor. The she wouldn't answer the phone. The c other involved was travelling south on 68t" protected party was now arrested for DV 0 Ave S at a high rate of speed, running the Malicious Mischief. E red light. A T-bone collision occurred and On March 27 at 11:30 am, officers o the sole occupant of the vehicle traveling attempted a traffic stop on a vehicle that south was severely injured. He was fled eastbound on Kent-Kangley Rd from a transported to Harborview Medical Center 104th Ave SE. Officers did not pursue due in critical condition. The sole occupant of to the state's current pursuit laws. A few the vehicle travelling west did not sustain minutes later the same vehicle collided o any injuries. with the Sterling Ridge Apartments sign at a • On March 25, at 8:41 am, officers were the front entrance. The driver fled into an dispatched to a burglary report that apartment at the complex. The apartment occurred at the Great Wall Mall. A suspect was surrounded, and the driver was w drove through the front doors of the mall, identified as having an Assault 1 DV 0 a� continued through the main hall until it warrant, and several others, out of Pierce r reached the ATM machine. The suspects County. He eventually surrendered, with used the vehicle to clear a path and to the assistance of Auburn negotiators, and T dislodge the ATM machine. Two suspects taken into custody. E loaded up the ATM machine and drove back On March 27, at 10:17 pm, officers were a out of the mall the way they came. The dispatched to multiple reports of 15-20 vehicle was recovered in the 11200 block gunshots and a car wrecked into a fence in of SE 200t" St with the ATM in the back. It the area of 461" Ave S and S 216t" St. As c was a reported stolen vehicle out of officers arrived in the area, they heard Renton. more shots being fired. The officers Q • On March 25, at 3:31 pm, officers were located the vehicle in the fence and a male dispatched to a stabbing that occurred exiting the vehicle. He was detained and within a residence located in the 24800 claimed he was shot at by 2 males in a a block of 961" Ave S. The victim was doing black Cadillac. Officers located casings at laundry and sitting on the couch when he that scene and a black sideview mirror on `o was stabbed in the ear by his girlfriend's the roadway. As the investigation adult daughter. The suspect admitted to continued, officers located casings in the stabbing the victim but would not disclose park to the north. The detained male had `o_ why. denied shooting and claimed this was a • On March 26, at 12:06 am, a family was dispute over a car purchase. A female then E home in the 10200 block of SE 243 St drove up claiming the male had shot her E when two males broke into the house by house up. Officers located casings at her c smashing the rear glass door. They house as well as the Cadillac with bullet U demanded money and eventually ran out holes in it, a flat tire and a missing side through the backyard. view mirror cover. She claimed the male • On March 26, at 12:29 am, officers shot her house then fled but she denied responded to Pembrooke Apartments for a knowing who shot at him. Page 6 of 10 Packet Pg. 11 5.A • On March 27, at 2:20 am, officers were Environmental dispatched to a report of a moving van NPDES Annual Report and Storm Water with a small fire in the back at Days Inn. Management Plan (SWMP): staff completed Officers did a stop on the vehicle and two the 2023 SWMP and NPDES annual report people exited. The van was stolen out of to be submitted to the WA Department of Renton. The suspects had bragged about Ecology by March 31. Both documents will having a stolen van for an extended period be posted on the city website by May 1st of time. The male suspect was booked for a The SWMP reports on how the city will $25,000 DV Assault 4 warrant and Vehicle manage stormwater programs, projects in Trespass. The 8-month pregnant female and activities required by the NPDES was released, and her information was permit in 2023. passed along to resources to try and get Cross Connection Control: updated EPA c her off the streets. Guidance for Water Utility Service Line 0 Major emphasis patrol Inventories - all systems will be required E • On March 20, KPD conducted a joint to compile an inventory for both current or o operation with Liquor and Cannabis Board historical lead levels or pipe materials used officers to conduct compliance checks at in the water distribution system, including a alcohol retailers, targeting sales of alcohol service lines belonging to private property a) to minors. Eight retailers were visited. The owners and vacant/abandoned properties. co-owner of one retailer (a bar) sold The purpose is to avoid partial o 0. alcohol to a minor and was cited. replacements during utility work, such as Events and awards water main projects. Complete inventory is • Officer Mello was commended for his due Oct 24, 2024. dedication to his fellow officers and the Planet Protectors Summit: The Planet w agency by foregoing precious vacation time Protector Summit was Tuesday, March 28 0 a� to be an acting sergeant. Officer Mello at Green River College. There were 478 r embodies the values of the Kent Police students who attended from five schools Department and the City of Kent, showing within the Kent School District. service, professionalism, and integrity. Mayor's Homeless Task force/On-Call E Garbage Contract: the UPLIFT team a PUBLIC WORKS continues to clean designated areas of Kent a Survey removing litter and dumping from right-of- L) • Land Survey field staff have provided way areas. The team has removed roughly staking for 761h Ave. Improvements and 580 bags of trash since the program began the Railroad Flashing Beacon Crossings last November. o. projects. The Assistant City Surveyor is Community Programs/Events overseeing the boundary and lot line TeamUp2CleanUp: updating the new poster elimination work for the Kent East Hill for the Saturday, May 6 event. Volunteers a Operations Center (KEHOC). The City will continue to register at the same Surveyor has written multiple legal website, www.kentwa.gov/talkingtrash, `o descriptions for West Hill Reservoir and is and then will have an option to register for mapping the easements for the Mill Creek litter or graffiti removal. Rehabilitation Project. • Adopt-A-Street/Spot: 1st quarter numbers: o • Public Works GIS staff updated the storm & Volunteers: 193; Bags removed: 208; sewer asset as-builts from multiple CIP and Volunteer hours: 277 Private Development projects completed in • Next 2023 Recycle Collection Event E 2022. Staff continue fulfilling public records o June 3 - Kent Phoenix Academy c requests, calculating impervious surfaces o Mini-event Friday, April 21 at the Kent U for billing services and providing support to Library from 1:00 - 4:00 pm PW Operations. The PW GIS Supervisor is Mini-event recyclable items will helping resolve issues with the Laserfiche include paint, document shredding, migration for Public Works. and TVs and electronics. Page 7 of 10 Packet Pg. 12 5.A Design 6MG1 Reservoir Recoating and Vent • 2023 Watermain Upgrades: contract was Replacement: prep for coating the tank has advertised March 28. Work zone for James begun and we continue tracking to turn the St storm will have EB traffic detoured and tank over to the water department 5/1/23. allow for WB traffic. Outreach with residents/commuters/businesses is being coordinated with the communications team. PSE gas intends to relocate gas main behind curb to sidewalk. in • HSIP - 108th Ave SE & SE 264th St - Compact Roundabout: construction fund obligation documents sent to WSDOT for c processing, returned and resubmitted. Lumen notified that existing maintenance 2022 Asphalt Overlays: work is resuming E permit covers work needed to resolve after seasonal weather suspension. o conflicts. Relocating j-boxes on 196t" is scheduled to n • HSIP - Road Diet Locations: 90% review begin April 3. Planing and paving on 196t" a comments received March 10 and work to to follow j-box relocations later in week, a) incorporate is in process - working to weather permitting. reconcile conflicting comments. • 761" Avenue South - North Segment: West o • Washington Ave Pumpstation: 90% review half of roadway and driveways have been 0. comments are being incorporated. completed. Continue working on stairs and Coordinating site access with operations. ramp. NE quadrant pavement and driveway Advertisement expected end of April. placement work scheduled for this week. w • Reith Road - vicinity S 253rd St to SR 516: SE quadrant scheduled for following week. 0 a� Preparing documents for SEPA. • 2022 Sanitary Sewer CIPP Lining: working r Geotechnical explorations complete - on a revision adding two locations; 98 LF analysis of data has started. on SE 239t" line and 343 LF in alley • East Valley Highway - S 212th St to S between 1st and 2nd Ave off of James in E 196th St: PSRC notified City that early North Park. Pictures below of broken pipe a funds are available for construction of the discovered 144 ft downstream of manhole ; project. City has responded desire to 4756, south of E James St on 8" line accept early construction funds. Design is between Kennebeck and Clark Ave. complete. Final design review in progress with comments due April 7. Updating `'.?t; - provisions and preparing right-of-way for certification and obligation documents. • Meeker Street Bridge Painting and Deck �. Repair: core team kick off scheduled for early April. Full PMP kickoff to follow. Team `o to evaluate project schedule then prepare public outreach plan in preparation for discussion about traffic impacts. `o_ Construction • S 240t" Street and Russell Road TIB • West Hill Reservoir: placed curb and gutter Sidewalk Improvements: crews have on 38t". Preparing for asphalt paving. completed installing the new storm lines on E Organizing and preparing for start-up and SE 240t". Curb installation began week of c testing schedule. Target date to begin 3/27 as well as sidewalk and driveways. U filling tank currently 4/19. • Rectangular Rapid Flashing Beacon Crossing Improvements: site #1 - 104t" Ave SE: crews pouring traffic curb this week, with asphalt patching scheduled this Page 8 of 10 Packet Pg. 13 5.A week also. Site #2 - SE 240t" St: crews and pruned the trees at the 640 Zone tank, have completed center island. Currently Kent Springs upper, Seven Oaks well and working on ADA ramps on shoulder at Clark Springs. sidewalk, with concrete scheduled for 3/28. • The Sidearm crews dug out and rebuilt the Site #'s 3 & 4 - Central Ave N: placing traffic circle at SE 224t" St advanced warning PCMS boards this week. • Wetland Mitigation crews planted at the Downey site, transplanted plants at the GRNRA nursery and collected water bugs. ' Water/Sewer in • Water staff continued the water main c cleaning in the Kent East hill area. We are currently working with Columbia Basin c ti Waterworks testing our large water meters 0 that are 3-inch in size and above. There E are 61 meters on the testing list this year. o We also continue to work with development _ contractors and water purity samples for Q Streets newly constructed water mains before they a • Street Maintenance cleaned the sidewalks are tied to the water system. on S 196t" St and on S 212t" St, prepared • Sewer staff continued line cleaning on the o for pouring and poured new sidewalks at Kent East hill in the area of 1081" Ave SE 0 Kent Kangley Rd, W Smith St and at from SE 269t" PI to Kent Kangley Rd. Video W Washington Ave, poured concrete around inspections are underway for storm lines in Lo the round-about at SE 224t" St, backfilled front of Public Works Operations for a w new sidewalks at SE 2401" St, unloaded and sidewalk project at Frager Rd and W o pressure washed the sanders and plows. Meeker St and sewer lines at 114t" Ave SE r • Signs and Markings updated the and SE 270t" St. Staff are also collecting information into the Geographic measurements for cleanouts to be installed 2 Information System (GIS), installed bases in drop manholes. E and signs on SE 236t" St, 3rd Ave S, State Source, Supply and Pumpstations a Ave N and on 132nd Ave SE, installed signs Source and Supply staff met with the Fire ; on 2nd Ave N and on 124t" Ave SE, Department to discuss the training scope, U fabricated signs and located for sign conducted maintenance of Cal-Valves by replacement, set foundations for flashing GC Systems, ran offline wells, repaired the signs on Reith Rd, performed walk thru for eastern fence line at Clark Springs, Q Poulsbo RV and performed sign conducted the fill planning for the West Hill maintenance at various locations Citywide. Reservoir, worked on the 2022 Water Un • Solid Waste cleaned up debris in several Quality Report and began the annual �. locations including along 116t" Ave SE, S Fluoride Saturator cleaning. 260t" St and on 76t" Ave S SCADA staff conducted conduit locates and `o • Water Vegetation cleared debris, line prepared for the pump install at GRNRA trimmed and pruned trees at the East Hill North, performed Program Logistic well, Scenic Hill sites, West Hill sites, Kent Controller (PLC) at Seven Oaks, PLC o POD #3, the 640 Zone tank, Seven Oaks program commissioning at the Frager well and Kent Springs upper, gallery and Pumpstation, repaired the NaF (Sodium trails. Fluoride) speed control at Clark Springs, E • Street Vegetation staff repaired the plant worked with consultants on SCADA c bed irrigation near W James St, sprayed upgrades and reviewed design for U the plant beds on James Hill, performed Washington Ave. walk thru for Poulsbo RV, cleared debris, Pumpstation crews backfilled the trench, litter and replanted shrubs within planted installed the entry switch on hatches, traffic islands Citywide and cleared debris started up the grinder, commission and Page 9 of 10 Packet Pg. 14 5.A grouting at the Frager pumpstation, inventory orders and hauled spoils as time replaced the mechanical seal on pump #1 and equipment were available. at Victoria Ridge pumpstation and Fleet staff worked on receiving, ordering performed the yearly maintenance of and setting up new vehicles for service, tubing, oil and filter change at GRNRA built new vehicles for Storm, Signs and South. Cross Connection, made repairs to the Storm Drainage/Vegetation Vactor and the mowers for Spring weather, • Storm crews repaired the catch basin at purchased items for upcoming builds, Kimberly Ave, hauled Vactor spoils and prepared vehicles for auction and in conducted site maintenance for the Vactor. scheduled and nonscheduled repairs. Performed control structure and permeable pavement inspections and repairs at ### various locations Citywide, crews also 0 performed National Pollutant Discharge E Elimination System (NPDES) assessing on o Lakeside Blvd E, S 228t" St, S 212t" St, 68tn Ave S and on S 220t" St and pumping on S a 212t" St, 84t" Ave S, 64t" Ave S and on 68t" 0 Ave S, cleaned culverts and dug out ditches at 116t" Ave S and SE 212t" PI. o • Wetland Maintenance worked on fence a repairs at Bridges wetland at 124t" Ave SE and at Jamie Lane wetland at 116t" Ave SE. Inspected wetlands for transient activity w and removed litter as necessary at Birk on 0 S 260t" St, Maplewood Grove on 108tn Ave r SE, Redondo on 27t" Ave S, Signal Electric on 3rd Ave S, 72nd Ave diversion channel on 72�d Ave S, Horseshoe Bend on 80tn Ave S, E the GRNRA bike path, South Tower, the a 196t" Corridor wetland on S 196t" St and at a ShoWare Center on W James St. • Holding Pond crews removed trees and treated stumps with herbicide at Mack Park on 112t" Ave SE, repaired the fence at a Mcann Meadows on 1015t Ct SE, Sun Meadows on SE 277t" PI, Jamie Lane on 115t" PI SE and at Canary Hill on SE 255t" a Pl, treated stumps with herbicide at Orme on SE 256t" St and prepared equipment `o and vehicles for mowing season. Fleet/Warehouse • The Warehouse crew continued to assist o with CDL training, maintained the shops yard, keeping it clean and free of litter and debris, cleaned and maintained the wash E rack, washed and vacuumed motor pool c vehicles, issued personal protection U equipment (PPE) and motor pool vehicles to staff and hydrant meters and public notice boards to contractors, repaired small equipment as needed, received parts and Page 10 of 10 Packet Pg. 15 Pending Approval Kent City Council • City Council Regular Meeting KENT Minutes WAS M IN G 7 0 N March 21, 2023 Date: March 21, 2023 Time: 7:00 p.m. Place: Chambers 1. CALL TO ORDER/FLAG SALUTE Mayor Ralph called the meeting to order. c 2. ROLL CALL Attendee Name Title Status Arrived C Dana Ralph Mayor Present > Bill Boyce Council President Present ° Q. Brenda Fincher Councilmember Present Q- a Satwinder Kaur Councilmember Present Marli Larimer Councilmember Present a Toni Troutner Councilmember Present 0 Les Thomas Councilmember Present Zandria Michaud Councilmember Present c N 3. AGENDA APPROVAL N L A. I move to approve the agenda as presented. 4- 0 RESULT: MOTION PASSES [UNANIMOUS] r MOVER: Bill Boyce, Council President c SECONDER: Les Thomas, Councilmember AYES: Boyce, Fincher, Kaur, Larimer, Troutner, Thomas, Michaud c 4. PUBLIC COMMUNICATIONS as A. Public Recognition Q as i. Appointments to the Parks Commission = Mayor Ralph recognized Miriam Alvarez-Pintor and Suzanne Smith as her recommended appointments to the Parks Commission and requested the council confirm the appointments. H. Appointment to the Land Use and Planning Board Mayor Ralph recognized Bryan Kesterson as her recommendation to the Land Use and Planning Board and recommended Council confirm the appointment. B. Community Events Council President Boyce provided upcoming events at the accesso ShoWare Packet Pg. 16 Kent City Council City Council Regular Meeting March 21, 2023 Minutes Kent, Washington Center and invited the public to attend events. Councilmember Fincher invited the public to attend upcoming Spotlight Series events. C. Public Safety Report Chief Rafael Padilla presented the Public Safety Report by starting with providing backgrounds on new Kent Police Officers Uriah Daschofsky, Officer Megan Martinez, Officer Stefan Carson, and Officer James Quidachay. Mayor Ralph swore the officers in. w Chief Padilla presented Commander Andy Grove with the Chief's Award for Professional Excellence for his outstanding and tireless work on the — Community Immersion Law Enforcemenet Program in 2021 and 2022. This i work is instrumental in improving community relations with police on an 0- institutional level that will enable the Kent Police Department to better serve a the community for decades to come. a Community Educations Unit and Neighborhood /response Team to address o problem of stolen vehicles. Grant funding to obtain Clubs to give away to Kent residents. N 4 giveaway events giving over 500 Clubs so far. Future giveaway dates are N planned. N L R Chief Padilla announced upcoming events: April 22nd 10-2 drug take back day o May 10t" @ 6 p.m. Community Meeting at Meridian Elementary r March 291" @ 8 a.m. Coffee with the Chief at Cutter's Point Coffee S. REPORTS FROM COUNCIL AND STAFF c A. Mayor Ralph's Report and Chief Administrative Officer's Report 2 aD Mayor Ralph advised there is no executive session this evening and the Chief Administrative Officer's report is in today's agenda packet. a a� Mayor Ralph serves on the Regional Policy Council that recently received an update on the King County Veterans, Seniors and Human Services levee that is coming up for renewal. Mayor Ralph talked about the recent Hwy 167 master planning meeting. Mayor Ralph talked about attending both the KSARC and Communities in Schools fundraising events. Mayor Ralph closed out her report by providing an update on the current Legislative Session. ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Page 2 of 6 Packet Pg. 17 Kent City Council City Council Regular Meeting March 21, 2023 Minutes Kent, Washington B. Councilmembers' Reports Council President Boyce serves as the chair of the Operations and Public Safety Committee and provided an overview of today's agenda items. Boyce serves as the Chair of the Public Issues Committee that recently received a presentation from Candice Bock on legislative items. Councilmember Michaud serves as the Council liaison on the Human Services Commission that recently received an overview of the King County Crisis Care levy. Additionally, the Commission received an update on the Co- w responder model. 4- Councilmember Larimer serves on the Advisory Council for Aging and 0 Disability Services the recently received briefings on the King County o Regional Homeless Authority whose mission is to reduce homelessness in all a 39 cities. Larimer provided statistics on the work of the Authority. a Councilmember Troutner serves on the Regional Transit Committee that a received presentations on Metro Connects and Metro's support for regional o planning. There was a briefing on the progress of the Rapid Ride K and R M lines. o N Troutner discussed her testimony to the Legislature on the illegal street L racing bill. 4- 0 Councilmember Thomas serves as the Chair of the Puget Sound Regional Fire Authority that is adding the City of Tukwila Fire Department to the PSRFA. Councilmember Fincher serves as the chair of the Public Works Committee and provided a recap of recent agenda items. a Fincher serves on the Kent Arts Commission. Fincher provided information on the upcoming Spotlight Series events and the Summer Art Exhibits. Fincher a welcomed all artists to submit art for the Downtown Mural Project. a 6. PUBLIC HEARING None 7. PUBLIC COMMENT Phil Peretti, a resident of the Phoenix Court Apartments, provided public comment regarding the installation of a fence around the apartments without a gate. S. CONSENT CALENDAR ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Page 3 of 6 Packet Pg. 18 Kent City Council City Council Regular Meeting March 21, 2023 Minutes Kent, Washington RESULT: APPROVED [UNANIMOUS] MOVER: Bill Boyce, Council President SECONDER: Les Thomas, Councilmember AYES: Boyce, Fincher, Kaur, Larimer, Troutner, Thomas, Michaud A. Approval of Minutes i. Council Workshop - Workshop Regular Meeting - Mar 7, 2023 5:00 PM ii. City Council Meeting - City Council Regular Meeting - Mar 7, 2023 7:00 y PM w B. Payment of Bills - Approve 4- MOTION: I move to approve the payment of bills received through 2/28/23 and paid on 2/28/23 and approve the checks o issued for payroll 2/16/23-2/28/23 and paid on 3/3/23, all a audited by the Operations and Public Safety Committee on a 3/7/23. C. Accept the 84th Avenue South (East Valley Highway) Slump o Repair Project as Complete - Accept MOTION: I move to accept the 84th Avenue South (East Valley o N Highway) Slump Repair Project as complete and release N retainage to Active Construction, Inc. upon receipt of standard N releases from the State and the release of any liens. D. Appointments to the Parks Commission - Confirm o N MOTION: I move to confirm the appointment of Miriam Alvarez- Pintor and Suzanne Smith each to an initial three-year term on the Kent Parks and Recreation Commission from March 21, 2023 through March 20, 2026. c �a E. Appointment to the Land Use and Planning Board - Confirm 0 MOTION: I move to confirm the Mayor's appointment of Bryan a Kesterson to the Land Use and Planning Board to fill a vacancy for a term ending December 31, 2024. F. Resolution - Washington State Puget Sound Acquisition and Restoration Grant Application - Adopt MOTION: I move to adopt Resolution No. 2059, authorizing the submission of an application for grant funding through the Washington State Puget Sound Acquisition and Restoration grant program, in the amount of $300,000, for the Lower Russell Road Levee Setback Habitat Area A Project. G. Neighborhood Parking Restrictions Ordinance - Adopt ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Page 4 of 6 Packet Pg. 19 Kent City Council City Council Regular Meeting March 21, 2023 Minutes Kent, Washington MOTION: I move to adopt Ordinance No. 4459, amending Chapter 9.38 of the Kent City Code to add no parking zones and other parking prohibitions on various City streets. H. Consultant Services Agreement with KBA, Inc. for Railroad Quiet Zone BNSF Railroad Crossing Improvements - Authorize MOTION: I move to authorize the Mayor to sign the Consultant Services Agreement with KBA, Inc. in the amount of $148,153.00, subject to final terms and conditions acceptable to the Public Works Director and City Attorney. w I. Funding Agreement with King County Metro for a Non- c Motorized Access Grant - James, Smith, and Meeker Streets 4- Sidewalks - Authorize 0 7i MOTION: I move to authorize the Mayor to sign a funding o agreement with the King County Metro Transit Department, in a the amount of $175,000, subject to final terms and conditions a acceptable to the City Attorney and the Public Works Director. a 0 9. OTHER BUSINESS R ti None. N 0 N 10. BIDS N L A. 2023 Asphalt Overlays - Award 4- Public Works Director, Chad Bieren provided an overview of the 2023 Asphalt ° N Overlays project and recommended awarding ICON Materials. 2 MOTION: I move to award the 2023 Asphalt Overlays Project to ICON Materials in the amount of $2,872,117.50 and authorize the Mayor to sign all necessary documents, subject to final c terms and conditions acceptable to the City Attorney and Public a Works Director. a RES LTU : MOTION PASSES [UNANIMOUS] MOVER: Brenda Fincher, Councilmember SECONDER: Satwinder Kaur, Councilmember AYES: Boyce, Fincher, Kaur, Larimer, Troutner, Thomas, Michaud 11. EXECUTIVE SESSION AND ACTION AFTER EXECUTIVE SESSION None. 12. ADJOURNMENT Mayor Ralph adjourned the meeting. ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Page 5 of 6 Packet Pg. 20 Kent City Council City Council Regular Meeting March 21, 2023 Minutes Kent, Washington ......................... Meeting ended at 7:51 p.m. K�lvy A. Kot to- City Clerk as c 0 0 L 0. CL CQ G a 0 0 r� M N 0 N Irz L C� C 4- 0 N N r 7 C N C,1 C r d V t� Q N d r+ 7 C ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Page 6 of 6 Packet Pg. 21 8.B KENT WASH IN G T O N DATE: April 4, 2023 TO: Kent City Council SUBJECT: Payment of Bills - Approve MOTION: I move to approve the payment of bills received through 3/15/2023 and paid on 3/15/2023, and approve the checks issued for payroll 3/1/2023-3/15/2023 and paid on 3/20/2023, all audited by the Operations and Public Safety Committee on 3/21/2023. SUMMARY: Approval of payment of the bills received through: 03/15/23 and paid 03/15/23 Approval of checks issued for Vouchers: Date Document Numbers Amount 03/15/23 Wire Transfers 9604 9626 $2,992,609.78 03/15/23 Regular Checks 768110 768460 $3,154,125.83 03/15/23 Payment Plus 104897 104934 $115,117.01 Void Checks $0.00 Void Payment Plus $0.00 03/15/23 Use Tax Payable $9,511.34 Total Accounts Payable: $6,271,363.96 Approval of checks issued for Payroll: 3/1/23-3/15/23 and paid 03/20/23 Date Document Numbers Amount 03/20/23 Checks $2,343,545.67 Voids and Reissues $0.00 03/20/23 Advices FR&P 463533 463540 $7,205.82 Total Payroll: $2,350,751.49 BUDGET IMPACT: None. 03/21/23 Operations and Public Safety Committee MOTION PASSES Packet Pg. 22 8.B RESULT: MOTION PASSES [UNANIMOUS]Next: 4/4/2023 7:00 PM MOVER: Les Thomas, Councilmember SECONDER: Satwinder Kaur, Councilmember AYES: Boyce, Fincher, Kaur, Larimer, Michaud, Thomas, Troutner Packet Pg. 23 8.0 1�# KENT DATE: April 4, 2023 TO: Kent City Council SUBJECT: Medical, Stop Loss and Wellness Vendor Contracts - Authorize MOTION: I move to authorize the Mayor to approve renewal of the following contracts: • Medical plan with Kaiser Permanente for one year • Stop Loss Insurance with LifeWise for one year • Wellness platform with Vitality Group for 3 years and 9 months with the option to renew automatically for a successive period of 1 year each, all subject to approval of final terms and conditions acceptable to the Interim Human Resources Director and the City Attorney. SUMMARY: Medical The City contracts with Kaiser Permanente for the City's fully insured health maintenance organization plan (HMO). The renewal has a 4.9% rate increase for 2023. Stop Loss The City contracts with LifeWise Assurance Company for our individual and aggregate stop loss insurance coverage. The best offer received for 2023 was from LifeWise with a 10.5% 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 exceeding this amount are reimbursed to the City under this policy. Wellness Employee health and well-being continues to be a priority for the City. Vitality's Wellness platform offers a solid plan design and meets the functionality needs of our employees and is critical for our Wellness Program. The renewal has a 4.3% increase ($1,686 annual increase) Packet Pg. 24 8.0 Staff recommends these renewals 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. Kaiser Permanente - $484,789 for a 1-year contract LifeWise - $1,189,290 for a 1-year contract Vitality - $40,622 for a 3-year and 9 months contract SUPPORTS STRATEGIC PLAN GOAL: Sustainable Services - Providing quality services through responsible financial management, economic growth, and partnerships. ATTACHMENTS: 1. Kaiser - Agreement 2023 (PDF) 2. LifeWise - Amendment 2023 (PDF) 3. Vitality SOW 3 April 2023 to December 2026 (PDF) 03/21/23 Operations and Public Safety Committee MOTION PASSES RESULT: MOTION PASSES [UNANIMOUS]Next: 4/4/2023 7:00 PM MOVER: Toni Troutner, Councilmember SECONDER: Satwinder Kaur, Councilmember AYES: Boyce, Fincher, Kaur, Larimer, Michaud, Thomas, Troutner Packet Pg. 25 8.C.a KAISER PERMANENTEO Kaiser Foundation Health Plan of Washington A nonprofit health maintenance organization a� N 0 t r� 7 Group Medical Coverage Agreement Q L Kaiser Foundation Health Plan of Washington("KFHPWA")is a nonprofit health maintenance organization,duly O registered under the laws of the State of Washington,furnishing health care coverage on a prepayment basis.The c Group identified below wishes to purchase such coverage. This Group Medical Coverage Agreement("Group Agreement")sets forth the terms under which that coverage will be provided,including the rights and responsibilities of the contracting parties;requirements for enrollment and eligibility;and benefits to which those w enrolled under this Group Agreement are entitled. 0 c The Group Medical Coverage Agreement between KFHPWA and the Group consists of the following: • Standard Provisions U) • Evidence of Coverage 0. 0 City of Kent,#0036900 M 0 This Group Agreement will continue in effect until terminated or renewed as herein provided for and is effective January 1,2023. 0 0 LO M M N O N r C N E N N L Q d M Y c d E t v r Q COB5710036900 1 Packet Pg. 26 8.C.a 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 N received on or before the due date and is subject to a grace period of 10 days.Premiums are subject to change o by KFHPWA upon 30 days written notice. Premium rates will be revised as a part of the annual renewal process. Q KFHPWA reserves the right to re-rate this benefit package if the demographic characteristics change by more than 15%. i c 3. Dissemination of Information. V Unless the Group has accepted responsibility to do so,KFHPWA will disseminate information describing `o benefits set forth in the EOC attached to this Group Agreement. m 4. Identification Cards. w KFHPWA will furnish cards,for identification purposes only,to all Members enrolled under this Group c Agreement. d 5. Administration of Group Agreement. vi KFHPWA may adopt reasonable policies and procedures to help in the administration of this Group Agreement. c This may include,but is not limited to,policies or procedures pertaining to benefit entitlement and coverage -J determinations. c .r 6. Modification of Group Agreement. M Except as required by federal and Washington State law,this Group Agreement may not be modified without 0 agreement between both parties. No oral statement of any person shall modify or otherwise affect the benefits,limitations and exclusions of this c Group Agreement,convey or void any coverage,increase or reduce any benefits under this Group Agreement or M be used in the prosecution or defense of a claim under this Group Agreement. M N 7. Indemnification. N KFHPWA agrees to indemnify and hold the Group harmless against all claims,damages,losses and expenses, including reasonable attorney's fees,arising out of KFHPWA's failure to perform,negligent performance or willful misconduct of its directors,officers,employees and agents of their express obligations under this Group Agreement. Q The Group agrees to indemnify and hold KFHPWA harmless against all claims,damages,losses and expenses, including reasonable attorney's fees,arising out of the Group's failure to perform,negligent performances or 2 willful misconduct of its directors,officers,employees and agents of their express obligations under this Group Y Agreement. c d The indemnifying party shall give the other party prompt notice of any claim covered by this section and t provide reasonable assistance(at its expense). The indemnifying party shall have the right and duty to assume U the control of the defense thereof with counsel reasonably acceptable to the other party.Either party may take Q 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. 2 Packet Pg. 27 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, N benefits,limitations,exclusions or provisions will go into effect as required by the governmental agency. All o 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 Q services and other benefits terminate the first of the month following 30 days after receipt of non-acceptance. 10. Grandfathered Health Plan. L For any coverage identified in an EOC as a"grandfathered health plan"under the Patient Protection and r_ Affordable Care Act(a/k/a the ACA),Group must immediately inform KFHPWA if this coverage does not V meet(or no longer meets)the requirements for grandfathered status including but not limited to any change in `o its contribution rate to the cost of any grandfathered health plan(s)during the plan year. Group represents that, for any coverage identified as a"grandfathered health plan"in the applicable EOC,Group has not decreased its contribution rate more than five percent(5%)for any rate tier for such grandfathered health plan when N compared to the contribution rate in effect on March 23,2010 for the same plan.Health Plan will rely on c Group's representation in issuing and/or continuing any and all grandfathered health plan coverage — d 11. Confidentiality. vi Each party acknowledges that performance of its obligations under this Group Agreement may involve access c to and disclosure of data,procedures,materials,lists, systems and information,including medical records, _J employee benefits information,employee addresses,social security numbers,e-mail addresses,phone numbers c and other confidential information regarding the Group's employees(collectively the"information").The v� information shall be kept strictly confidential and shall not be disclosed to any third party other than: (i) M representatives of the receiving party(as permitted by applicable state and federal law)who have a need to 0 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 c them,(ii)pursuant to court order or(iii)to a designated public official or agency pursuant to the requirements of M 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 N requirements,so that the other party may object to the request and/or seek an appropriate protective order N against such request.Each party shall maintain the confidentiality of medical records and confidential patient and employee information as required by applicable law. E a� a� 12. HIPAA. Q Definition of Terms.Terms used,but not otherwise defined,in this section shall have the same meaning as those terms have in the Health Insurance Portability and Accountability Act of 1996("HIPAA"). M Y 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 y the Group or the Group's business associates are in compliance with HIPAA standards for electronic E transactions. The Group shall indemnify KFHPWA for any breach of this section by the Group. U r 13. Termination of Entire Group Agreement. Q 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 3 Packet Pg. 28 8.C.a of the premium due date. The Group's failure to accept the revised premiums provided as part of the annual 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 N misrepresentation,fraud or omission of information by the other party in performance of its responsibilities o under this Group Agreement. Q 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. L c d. Federal or State Law.KFHPWA may terminate this Group Agreement in the event there is a change in V federal or state law that no longer permits the continued offering of the coverage described in this Group `0 Agreement. m 14. Withdrawal or Cessation of Services. w 0 m 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's clinical,financial or administrative capacity to service the covered Members would be vi exceeded. 0 J b. KFHPWA may determine to cease to offer the Group's current plan and replace the plan with another plan c offered to all covered Members within that line of business that includes all of the health care services v� covered under the replaced plan and does not significantly limit access to the services covered under the M replaced plan.KFHPWA may also allow unrestricted conversion to a fully comparable KFHPWA product. 0 13 m 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. c U) M 15. Limitation on Enrollment. The Group Agreement will be open for applications for enrollment as described in the group master application. N Subject to prior approval by the Washington State Office of the Insurance Commissioner,KFHPWA may limit N enrollment,establish quotas or set priorities for acceptance of new applications if it determines that KFHPWA's capacity,in relation to its total enrollment,is not adequate to provide services to additional persons. E a� a� 16. Acceptance of Group Agreement The Group agrees as having accepted the terms and conditions of this Group Agreement and any amendments Q issued during the term of this Group Agreement,upon receipt by KFHPWA of any amount of premium payment. M Y c d E t v r Q 4 Packet Pg. 29 8.C.a YourN O t Kaiser Foundation Health Plan of N Washington O Evidence of Coverage 0 y N O J Q O R v d O O LO M M . • N KAISER PERMAN ELATE® E O L Q d Y c aD E t r r Q Packet Pg. 30 8.C.a KAISER PERMANENTE® Kaiser Foundation Health Plan of Washington A nonprofit health maintenance organization a� N �L O Q N V L 2023 Evidence of Coverage O U L O S a) 3.1 N O J O_ O U) R v d O O LO M M N O N r C N E N N L Q d Y c m E t v r r Q CA-1888a23 1 COB571-0036900 Packet Pg. 31 8.C.a Important Notice Under Federal Health Care Reform Kaiser Foundation Health Plan of Washington("KFHPWA")recommends each Member choose a Network Personal Physician. This decision is important since the designated Network Personal Physician provides or arranges for most of the Member's health care. The Member has the right to designate any Network Personal Physician who participates in one of the KFHPWA networks and who is available to accept the Member or the Member'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, N or toll-free in Washington, 1-888-901-4636. p z For children,the Member may designate a pediatrician as the primary care provider. Q The Member does not need Preauthorization from KFHPWA or from any other person (including a Network W Personal Physician) to access obstetrical or gynecological care from a health care professional in the KFHPWA L network who specializes in obstetrics or gynecology. The health care professional, however, may be required to r_ comply with certain procedures, including obtaining Preauthorization for certain services, following a pre-approved C) treatment plan, or procedures for obtaining Preauthorization. For a list of participating health care professionals `o 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. Women's health and cancer rights 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. vi • Surgery and reconstruction of the other breast to produce a symmetrical appearance. c • Prostheses. Ja • Treatment of physical complications of all stages of mastectomy,including lymphedemas. c .r These services will be provided in consultation with the Member and the attending physician and will be subject to M the same Cost Shares otherwise applicable under the Evidence of Coverage(EOC). m Statement of Rights Under the Newborns' and Mothers' Health Protection Act Carriers offering group health coverage generally may not,under federal law,restrict benefits for any hospital length c LO 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 mother's or newborn's attending provider,after consulting with the mother,from discharging the mother or newborn c earlier than 48 hours(or 96 hours as applicable).In any case,carriers may not,under federal law,require that a N r 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 E the 48-hour(or 96-hour)stay is treated in a manner less favorable to the mother or newborn than any earlier portion L of the stay. Q For More Information `m M KFHPWA will provide the information regarding the types of plans offered by KFHPWA to Members on request. Y Please call Kaiser Permanente Member Services at(206) 63 0-463 6 in the Seattle area,or toll-free in Washington, 1- 888-901-4636. E z U r Q 2 COB571-0036900 Packet Pg. 32 8.C.a Table of Contents I. Introduction...................................................................................................................................................6 II. How Covered Services Work........................................................................................................................6 A. Accessing Care.........................................................................................................................................6 B. Administration of the EOC. .....................................................................................................................9 C. Assignment...............................................................................................................................................9 N D. Confidentiality..........................................................................................................................................9 0 E. Modification of the EOC..........................................................................................................................9 F. Nondiscrimination....................................................................................................................................9 Q G. Preauthorization.......................................................................................................................................9 0 H. Recommended Treatment. .....................................................................................................................10 L I. Second Opinions....................................................................................................................................10 r_ 0 J. Unusual Circumstances..........................................................................................................................10 V L K. Utilization Management.........................................................................................................................10 c III. Financial Responsibilities...........................................................................................................................11 > A. Premium.................................................................................................................................................11 w B. Financial Responsibilities for Covered Services....................................................................................11 c C. Financial Responsibilities for Non-Covered Services............................................................................11 IV. Benefits Details............................................................................................................................................12 AnnualDeductible.........................................................................................................................................12 N 0 Coinsurance...................................................................................................................................................12 0. LifetimeMaximum.......................................................................................................................................12 0 Out-of-pocket Limit......................................................................................................................................12 Pre-existing Condition Waiting Period.........................................................................................................12 0 13 Acupuncture..................................................................................................................................................13 AdvancedCare at Home................................................................................................................................13 0 AllergyServices............................................................................................................................................15 Q Ambulance....................................................................................................................................................15 `h Cancer Screening and Diagnostic Services...................................................................................................15 N 0 Circumcision.................................................................................................................................................16 N r ClinicalTrials................................................................................................................................................16 Dental Services and Dental Anesthesia.........................................................................................................16 4E) a) Devices,Equipment and Supplies(for home use).........................................................................................17 Diabetic Education,Equipment and Pharmacy Supplies ..............................................................................18 Q Dialysis(Home and Outpatient)....................................................................................................................18 N Drugs-Outpatient Prescription.....................................................................................................................19 Y EmergencyServices......................................................................................................................................22 c GenderHealth Services.................................................................................................................................22 d E Hearing Examinations and Hearing Aids......................................................................................................23 HomeHealth Care.........................................................................................................................................23 r Hospice..........................................................................................................................................................24 Q Hospital-Inpatient and Outpatient...............................................................................................................25 Infertility(including sterility)........................................................................................................................25 InfusionTherapy...........................................................................................................................................26 Laboratoryand Radiology.............................................................................................................................26 3 COB571-0036900 Packet Pg. 33 ManipulativeTherapy...................................................................................................................................27 Maternityand Pregnancy...............................................................................................................................27 MentalHealth and Wellness..........................................................................................................................28 Naturopathy...................................................................................................................................................29 NewbornServices.........................................................................................................................................29 NutritionalCounseling..................................................................................................................................30 Nutritional Thera 30 N 0 ObesityRelated Services...............................................................................................................................30 Z On the Job Injuries or Illnesses.....................................................................................................................31 Q Oncology.......................................................................................................................................................31 y Optical(vision)..............................................................................................................................................31 L OralSurgery..................................................................................................................................................32 0 OutpatientServices.......................................................................................................................................32 t� L Plastic and Reconstructive Surgery...............................................................................................................32 0 Podiatry.........................................................................................................................................................33 c PreventiveServices.......................................................................................................................................33 w Rehabilitation and Habilitative Care(massage,occupational,physical and speech therapy,pulmonary and cardiac rehabilitation)and Neurodevelopmental Therapy.....................................................................34 ReproductiveHealth......................................................................................................................................35 SexualDysfunction.......................................................................................................................................36 c SkilledNursing Facility.................................................................................................................................36 —J a Sterilization...................................................................................................................................................36 Substance Use Disorder.................................................................................................................................37 U) TelehealthServices.......................................................................................................................................39 0 Temporomandibular Joint(TMJ)..................................................................................................................40 TobaccoCessation.........................................................................................................................................40 0 Transplants....................................................................................................................................................40 LO UrgentCare...................................................................................................................................................41 M V. General Exclusions......................................................................................................................................41 N VI. Eligibility,Enrollment and Termination...................................................................................................43 N A. Eligibility. ..............................................................................................................................................43 c a� B. Application for Enrollment....................................................................................................................44 E a� C. When Coverage Begins..........................................................................................................................45 L a� D. Eligibility for Medicare..........................................................................................................................46 Q E. Termination of Coverage. ......................................................................................................................46 F. Continuation of Coverage Options.........................................................................................................46 cv VII. Grievances....................................................................................................................................................47 Y VIII. Appeals.........................................................................................................................................................48 c d IX. Claims...........................................................................................................................................................49 E X. Coordination of Benefits.............................................................................................................................50 U Definitions.....................................................................................................................................................50 r Order of Benefit Determination Rules...........................................................................................................52 Q Effect on the Benefits of this Plan.................................................................................................................53 Right to Receive and Release Needed Information.......................................................................................53 Facilityof Payment.......................................................................................................................................54 Rightof Recovery.........................................................................................................................................54 4 COB571-0036900 Packet Pg. 34 8.C.a Effectof Medicare.........................................................................................................................................54 XI. Subrogation and Reimbursement Rights..................................................................................................54 XII. Definitions....................................................................................................................................................56 a� N �L O Q N V L O U L O 13 C N N O J O_ O U) R v 13 d O CO LO M M N O N r C N E N N L Q d Y c m E t v r r Q 5 COB571-0036900 Packet Pg. 35 8.C.a KFHPWA believes this plan is a"grandfathered health plan"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 N Agreement between Kaiser Foundation Health Plan of Washington("KFHPWA")and the Group. The benefits were 0 approved by the Group who contracts with KFHPWA for health care coverage.This EOC is not the Group medical t coverage agreement itself.In the event of a conflict between the Group Medical Coverage Agreement and the EOC, < Q the EOC language will govern. 0 The provisions of the EOC must be considered together to fully understand the benefits available under the EOC. L Words with special meaning are capitalized and are defined in Section XII. r_ 0 c.� Contact Kaiser Permanente Member Services at 206-630-4636 or toll-free 1-888-901-4636 for benefits questions. `0 c II. How Covered Services Work A. Accessing Care. 1. Members are entitled to Covered Services from the following: Your Provider Network is KFHPWA's Core Network(Network). Members are entitled to Covered vi Services only at Network Facilities and Network Providers,except for Emergency services and care c pursuant to a Preauthorization. _J 0. 0 Benefits under this EOC will not be denied for any health care service performed by a registered nurse v� licensed to practice under chapter 18.88 RCW,if first,the service performed was within the lawful scope of M such nurse's 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 Personal Physicians,specialists,women's health care providers and KFHPWA- c designated Specialists is available by contacting Member Services or accessing the KFHPWA website at M www.kp.org/wa.Information available online includes each physician's location,education,credentials, and specialties.KFHPWA also utilizes Health Care Benefit Managers for certain services.To see a list of N Health Care Benefit Managers,go to hqps://healLhy.kaiselpermanente.org/washinaton/sLipport/forms n/support/forms and C14 click on the"Evidence of coverage"link. a� E 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 Q 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 Y 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 y www.wa.kaiserpermanente.org/html/public/services/traveling E t U KFHPWA will not directly or indirectly prohibit Members from freely contracting at any time to obtain Q 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. 6 COB571-0036900 Packet Pg. 36 8.C.a 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 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.ore/wa.The change will be made within 24 hours of the receipt of the request if the selected physician's caseload permits. If a personal physician accepting new Members is not available in your area, N contact Kaiser Permanente Member Services,who will ensure you have access to a personal physician by o contacting a physician's office to request they accept new Members. Q To find a personal physician,call Member Services or access the KFHPWA website at www.kp.org/wa to view physician profiles.Information available online includes each physician's location,education, W credentials,and specialties. M c For your personal physician,choose from these specialties: C) • Family medicine `o • Adult medicine/internal medicine • Pediatrics/adolescent medicine(for children up to 18) Be sure to check that the physician you are considering is accepting new patients. If our choice does not feel right after a few visits you can change our personal physician at an time for Y g �Y g Y P p Y Y any reason.If you don't choose a physician when you first become a KFHPWA member,we will match vi you with a physician to make sure you have one assigned to you if you get sick or injured. c J In the case that the Member's personal physician no longer participates in KFHPWA's network,the c Member will be provided access to the personal physician for up to 60 days following a written notice v� offering the Member a selection of new personal physicians from which to choose. M V 3. Specialty Care Provider Services. Unless otherwise indicated in Section 11.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 c operated by Kaiser Permanente. LO M KFHPWA-designated Specialist. N Preauthorization is not required for services with KFHPWA-designated Specialists at facilities owned and N 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 E 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, Q neurology,obstetrics and gynecology,occupational medicine,oncology/hematology,ophthalmology, optometry,orthopedics,otolaryngology(ear,nose and throat),physical therapy, smoking cessation, 2 speech/language and learning services,substance use disorder and urology. Y 4. Hospital Services. d Non-Emergency inpatient hospital services require Preauthorization.Refer to Section IV. for more E information about hospital services. U M r 5. Emergency Services. Q 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. 7 COB571-0036900 Packet Pg. 37 8.C.a Members are covered for Emergency care and Medically Necessary urgent care anywhere in the world.If you think you are experiencing an emergency,go immediately to the nearest emergency care facility or call 911. Go to the closest urgent care center for an illness or injury that requires prompt medical attention but is not an emergency.Examples include,but are not limited to minor injuries,wounds,and cuts needing stiches;minor breathing issues;minor stomach pain.If you are unsure whether urgent care is your best option,call the consulting nurse helpline for advice at 1-800-297-6877 or 206-630-2244. m N If you need Emergency care while traveling and are admitted to a non-network hospital,you or a family p member must notify us within 24 hours after care begins,or as soon as is reasonably possible.Call the notification line listed on the back of your KFHPWA Member ID card to help make sure your claim is Q accepted.Keep receipts and other paperwork from non-network care.You'll need to submit them with any claims for reimbursement after returning from travel. U) M L Access to non-Emergency care across the Core network service area:your Plan provides access to all r_ providers in the Core Network,including many physicians and services at Kaiser Permanente medical C) facilities and Core Network facilities across the state.Find links to providers at kp.org/wa/diregM or `o contact Member Services at 1-888-901-4636 for assistance. c m 6. Urgent Care. w Inside the KFHPWA Service Area,urgent care is covered at a Kaiser Permanente medical center,Kaiser c Permanente urgent care center or Network Provider's office.Outside the KFHPWA Service Area,urgent — care is covered at any medical facility.Refer to Section IV.for more information about urgent care. vi For urgent care during office hours,you can call your personal physician's office first to see if you can get c a same-day appointment.If a physician is not available or it is after office hours,you may speak with a _J licensed care provider anytime at 1-800-297-6877 or 206-630-2244. You may also check c kp.org/wa/directory or call Member Services to find the nearest urgent care facility in your network. v� M 7. Women's Health Care Direct Access Providers. 0 Female Members may see a general and family practitioner,physician's assistant,gynecologist,certified nurse midwife,licensed midwife,doctor of osteopathy,pediatrician,obstetrician or advance registered nurse practitioner who is unrestricted in your KFHPWA Network to provide women's health care services c directly,without Preauthorization,for Medically Necessary maternity care,covered reproductive health M services,preventive services(well care)and general examinations,gynecological care and follow-up visits for the above services.Women's health care services are covered as if the Member's Network Personal N Physician had been consulted,subject to any applicable Cost Shares. If the Member's women's health care N 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 E KFHPWA providers,contact Member Services or view the Provider Directory located at www.kp.org/wa. L 8. Travel Advisory Service. Q Our Travel Advisory Service offers recommendations tailored to your travel outside the United States. Nurses certified in travel health will advise you on any vaccines or medications you need based on your 2 destination,activities,and medical history.The consultation is not a covered benefit and there is a fee for a Y KFHPWA Member using the service for the first time.Travel-related vaccinations and medications are usually not covered.Visit kp.org/wa/travel-service for more details. y E t 9. Process for Medical Necessity Determination. U Pre-service,concurrent or post-service reviews may be conducted. Once a service has been reviewed, Q additional reviews may be conducted. Members will be notified in writing when a determination has been made. First Level Review: 8 COB571-0036900 Packet Pg. 38 8.C.a 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 Member's medical record,and consultation with qualified health professionals and multidisciplinary health care team members.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 health care team when more clarity is needed to make an informed medical necessity decision.The reviewer may consult with a N board-certified consultative specialist and such consultations will be documented in the review text.If the 0 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. Q Second Level(Practitioner)Review: M L The practitioner reviews the treatment plan and discusses,when appropriate,case circumstances and r_ management options with the attending(or referring)physician.The reviewer consults with the health care C) team when more clarity is needed to make an informed coverage decision.The reviewer may consult with `0 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- N 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. 0 B. Administration of the EOC. KFHPWA may adopt reasonable policies and procedures to administer the EOC.This may include,but is not 0. limited to,policies or procedures pertaining to benefit entitlement and coverage determinations. v� M C. Assignment 0 13 The Member may not assign this EOC or any of the rights,interests,claims for money due,benefits,or obligations here under without prior written consent. 0 0 D. Confidentiality. M 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 N health information held by KFHPWA. The Notice of Privacy Practices is distributed to Members and is c014 available in Kaiser Permanente medical centers,at www.kp.org/wa,or upon request from Member Services. a� E E. 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 Q or defense of a claim under the EOC. m F. Nondiscrimination. 0 Y 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 Member's coverage and will not deny care on the y basis of age,sex,sexual orientation,gender identity,race,color,religion,national origin,citizenship or E immigration status,veteran or military status,occupation or health status. U M r G. Preauthorization. Q Refer to Section IV. or Authorizations&Clinical Review Overview I Kaiser Permanente Washington for more information regarding which services,equipment and facility types 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. 9 COB571-0036900 Packet Pg. 39 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 N the requested information. `0 • Expedited requests—within 2 calendar days o If insufficient information has been provided a request for additional information will be made within Q 1 calendar day.The provider or facility has 2 calendar days to provide the necessary information.A N decision will be made within 2 calendar days of receipt of the information or the deadline for receipt of 0 the requested information. M c 0 H. Recommended Treatment. C) KFHPWA's medical director will determine the necessity,nature and extent of treatment to be covered in each 0 individual case and the judgment will be made in good faith.Members have the right to appeal coverage c 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 N recommended by KFHPWA's medical director do so with the full understanding that KFHPWA has no obligation for the cost,or liability for the outcome,of such care. cd New and emerging medical technologies are evaluated on an ongoing basis by the following committees—the vi Interregional New Technologies Committee,Medical Technology Assessment Committee,Medical Policy 0 Committee,and Pharmacy and Therapeutics Committee. These physician evaluators consider the new J technology's benefits,whether it has been proven safe and effective,and under what conditions its use would be o appropriate. The recommendations of these committees inform what is covered on KFHPWA health plans. M I. Second Opinions. 13 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 c Preauthorization,or when obtained from a KFHPWA-designated Specialist. Coverage is determined by the M 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 c authorize the Member to return to the physician providing the second opinion for any additional treatment. c14 Services,drugs and devices prescribed or recommended as a result of the consultation are not covered unless included as covered under the EOC. E aD aD J. Unusual Circumstances. In the event of unusual circumstances such as a major disaster,epidemic,military action,civil disorder,labor Q disputes or similar causes,KFHPWA will not be liable for administering coverage beyond the limitations of available personnel and facilities. M Y 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 d liability or obligation if Covered Services are delayed or unavailable due to unusual circumstances. t U K. Utilization Management. Q "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. 10 COB571-0036900 Packet Pg. 40 8.C.a 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 m N A. Premium. p The Subscriber is liable for payment to the Group of their contribution toward the monthly premium,if any. Q B. Financial Responsibilities for Covered Services. N 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 M date.Charges will be for the lesser of the Cost Shares for the Covered Service or the actual charge for that r_ service. Cost Shares will not exceed the actual charge for that service. C) L O 1. Annual Deductible. c 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 N received from a Network Provider at a Network Facility,unless the Member has received Preauthorization c or has received Emergency services. — d There is an individual annual Deductible amount for each Member and a maximum annual Deductible vi amount for each Family Unit.Once the annual Deductible amount is reached for a Family Unit in a c calendar year,the individual annual Deductibles are also deemed reached for each Member during that _J same calendar year. c .r Individual Annual Deductible Carryover.Under this EOC,charges from the last 3 months of the prior M year which were applied toward the individual annual Deductible will also apply to the current year :a 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. 0 0 2. Plan Coinsurance. `n M After the applicable annual Deductible is satisfied,Members may be required to pay Plan Coinsurance for M Covered Services. c N r 3. Copayments. Members shall be required to pay applicable Copayments at the time of service. Payment of a Copayment E does not exclude the possibility of an additional billing if the service is determined to be a non-Covered y Service or if other Cost Shares apply. Q 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. Y c C. Financial Responsibilities for Non-Covered Services. E The cost of non-Covered Services and supplies is the responsibility of the Member.The Subscriber is liable for t payment of any fees charged for non-Covered Services provided to the Subscriber and their Dependents at the U time of service.Payment of an amount billed must be received within 30 days of the billing date. Q 11 COB571-0036900 Packet Pg. 41 8.C.a 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 KFHPWA's medical director and as described herein.All Covered Services are subject to case management and utilization management. m N 0 t Annual Deductible Member pays$0 per Member per calendar year or$0 per Family Unit per calendar year Q Coinsurance Plan Coinsurance: Member pays nothing L c 0 0 Lifetime Maximum No lifetime maximum on covered Essential Health Benefits `- 13 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 vi 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 c benefit,charges in excess of Allowed Amount,charges for non-Covered Services Pre-existing Condition No pre-existing condition waiting period 2 13 Waiting Period 0 0 U) M M N O N r C N E N N L Q d M Y c d E t v r Q 12 COB571-0036900 Packet Pg. 42 8.C.a Acupuncture Acupuncture needle treatment. Member pays$10 Copayment Limited to 8 visits per medical diagnosis per calendar year without Preauthorization.Additional visits are covered with m N Preauthorization. 0 z No visit limit for treatment for Substance Use Disorder. Q Exclusions: Herbal supplements; any services not within the scope of the practitioner's licensure W M L Advanced Care at Home V L 0 Advanced Care at Home is a personalized,patient-centered No charge,Member pays nothing program that provides care for patients with certain clinical > conditions in their homes,or at another appropriate care N location such as a family member's home or temporary residence. — d Advanced Care at Home services must be associated with an vi acute episode in which the member is treated for a brief but c severe episode of illness,for conditions that are the result of disease such as,but not exclusive to,congestive heart failure, o pneumonia,upper urinary tract infection or cellulitis. The treatment plan may include restorative care associated with M the acute episode.The duration of an episode of care(which 0 13 includes acute and restorative phases)is limited to a total of 30 days. 0 0 To receive advanced care in the home: LO M • The member must be referred into the advanced care program by the managing provider at a Network c emergency room setting, c14 • Advanced Care at Home requires Preauthorization c a� based on the Member's health status,treatment plan, E and home setting or another appropriate care y location within the Service Area, Lai • The clinical condition must meet inpatient Medical Q Necessity criteria, `m • The Member must consent to receiving advanced 2 M care described in the treatment plan, 1 • The care location,such as the member's residence, must be within 30 minutes ground travel time of an d emergency department,and t • The care location,such as the member's residence, must,have cell service. Q Advanced Care at Home is provided through Medically Home,our Network provider,and will provide the following services in the Member's home or appropriate care location: • Home visits by RNs,physical therapists, 13 COB571-0036900 Packet Pg. 43 8.C.a occupational therapists,speech therapists,respiratory therapists,nutritionist,health aides,and other healthcare professionals in accordance with the Advanced Care at Home treatment plan and the provider's scope of practice and licensure. • Communication devices to allow the Member to contact the medical command center 24 hours a day, N 7 days a week.This includes needed communication o technology to support reliable connection for communication,and a personal emergency response 0 system alert device to contact the medical command Q center if the Member is unable to get to a phone. M L Additional services covered under this benefit include: c • The following equipment necessary to ensure that V you are monitored appropriately in your home:blood `o pressure cuff/monitor,pulse oximeter,scale,and thermometer. > • Mobile imaging and tests such as X-rays, w ultrasounds,and EKGs. w m • Safety items when Medically Necessary,such as E shower stools,raised toilet seats,grabbers,long handled shoehorn,and sock aids. vi • Meals when Medically Necessary while you are w 0 receiving advanced care at home will be provided through our network provider,Medically Home. 0 .r In addition,cost sharing is waived for the following covered M services and items when the services and items are prescribed 0 13 as part of your Advanced Care at Home treatment plan: • Durable Medical Equipment. • Medical Supplies. c • Member transportation to and from Network M facilities when Member transport is Medically Necessary will be arranged by Medically Home c based on the most appropriate mode of c14 transportation which could be ambulance,cabulance or otherwise. E • Physician Assistant and Nurse Practitioner house y calls. Lai • Emergency Department visits associated with this Q benefit. L m 2 The cost share is not waived and will apply to any services Y that are not part of your Advanced Care at Home treatment plan(for example,DME not specified in your Advanced Care E at Home treatment plan). t U 0 For outpatient prescription drug cost shares, see Drugs- Q Outpatient Prescription. Exclusions: Private Duty Nursing;housekeeping or meal services not part of your Advanced Care at Home treatment plan;any care provided by or for a family member;any other services rendered in the home which are not specified in 14 COB571-0036900 Packet Pg. 44 8.C.a your Advanced Care at Home treatment plan Allergy Services Allergy testing. Member pays$10 Copayment m N O Allergy serum and injections. Member pays$10 Copayment Z 0 Q U) Ambulance L c 0 Emergency ambulance service is covered only when: Member pays 20%ambulance coinsurance V L • Transport is to the nearest facility that can treat your 0 condition m • Any other type of transport would put your health or > safety at risk N • The service is from a licensed ambulance. c • The ambulance transports you to a location where you receive covered services. vi Emergency air or sea medical transportation is covered only 0 when: 0. 0 • The above requirements for ambulance service are met,and • Geographic restraints prevent ground Emergency 0 transportation to the nearest facility that can treat 3 your condition,or ground Emergency transportation would put your health or safety at risk c 0 LO M Non-Emergency ground or air interfacility transfer to or from Member pays 20%ambulance coinsurance N a Network Facility where you receive covered services when o N Preauthorized by KFHPWA.Contact Member Services for Hospital-to-hospital ground transfers:No charge; Preauthorization. Member pays nothing E a) a) L Cancer Screening and Diagnostic Services Q Routine cancer screening covered as Preventive Services in Member pays$10 Copayment N accordance with the well care schedule established by Y KFHPWA and the Patient Protection and Affordable Care Act of 2010.The well care schedule is available in Kaiser y Permanente medical centers,at www.kp.org/wa,or upon E t request from Member Services. See Preventive Services for U additional information. Q Diagnostic laboratory and diagnostic services for cancer. See No charge;Member pays nothing Diagnostic Laboratory and Radiology Services for additional information. Preventive laboratory/radiology services are covered as Preventive Services. 15 COB571-0036900 Packet Pg. 45 8.C.a Circumcision Circumcision. Hospital-Inpatient:No charge;Member pays nothing Non-Emergency inpatient hospital services require Preauthorization. Hospital-Outpatient: Member pays$10 N Copayment o t Outpatient Services:Member pays$10 Copayment Q U) Within 60 days of birth:No charge;Member pays L nothing 0 c.� L 0 Clinical Trials c m Notwithstanding any other provision of this document,the Hospital-Inpatient: N Plan provides benefits for Routine Patient Costs of qualified No charge;Member pays nothing c 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 vi Routine patient costs include all items and services consistent c with the coverage provided in the plan(or coverage)that is Outpatient Services: _J typically covered for a qualified individual who is not Member pays$10 Copayment 0. enrolled in a clinical trial. v� M Clinical trials are a phase I,phase II,phase III,or phase IV 0 13 clinical trial that is conducted in relation to the prevention, detection,or treatment of cancer or other life-threatening disease or condition."Life threatening condition"means any c disease or condition from which the likelihood of death is M probable unless the course of the disease or condition is interrupted. N 0 N Clinical trials require Preauthorization. a� E Exclusions: Routine patient costs do not include: (i)the investigational item,device,or service,itself;(ii)items and aD a� 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 Q of care for a particular diagnosis M Y Dental Services and Dental Anesthesia d Dental services(i.e.,routine care,evaluation and treatment) Not covered;Member pays 100%of all charges t including accidental injury to natural teeth. U r Q 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 Copayment 16 COB571-0036900 Packet Pg. 46 Dental problems such as infections requiring emergency treatment outside of standard business hours are covered as Outpatient Services:Member pays$10 Copayment Emergency Services. General anesthesia services and related facility charges for Hospital-Inpatient:No charge;Member pays dental procedures for Members who are under 7 years of age nothing or are physically or developmentally disabled or have a N Medical Condition where the Member's health would be put Hospital-Outpatient: Member pays$10 at risk if the dental procedure were performed in a dentist's Copayment z office. Q General anesthesia services for dental procedures require Preauthorization. M L Exclusions: Dentist's or oral surgeon's fees;dental care,surgery,services and appliances,including:treatment of C V accidental injury to natural teeth,reconstructive surgery to the jaw in preparation for dental implants,dental implants, `o periodontal surgery;any other dental service not specifically listed as covered 3 m Devices,Equipment and Supplies(for home use) c Durable medical equipment: Equipment which can withstand Member pays 20%coinsurance repeated use,is primarily and customarily used to serve a vi medical purpose,is useful only in the presence of an illness or c injury and is used in the Member's home. J Annual Deductible does not apply to strip-based o • Examples of covered durable medical equipment include: blood glucose monitors,test strips,lancets or control v� hospital beds,wheelchairs,walkers,crutches,canes, solutions. M blood glucose monitors,external insulin pumps 0 13 (including related supplies such as tubing,syringe cartridges,cannulae and inserters),oxygen and the rental of equipment to administer oxygen(including tubing, o 0 connectors,and masks),and therapeutic shoes, M modifications and shoe inserts for severe diabetic foot disease.KFHPWA will determine if equipment is made c available on a rental or purchase basis. c14 • Orthopedic appliances:Items attached to an impaired c body segment for the purpose of protecting the segment E or assisting in restoration or improvement of its function. y • Ostomy supplies: Supplies for the removal of bodily Q secretions or waste through an artificial opening. , • Post-mastectomy bras/forms,limited to 2 every 6 `m months.Replacements within this 6-month period are 2 M covered when Medically Necessary due to a change in Y the Member's condition. • Prosthetic devices: Items which replace all or part of an d external body part,or function thereof. t • Sales tax for devices,equipment and supplies. r Q When provided in lieu of hospitalization,benefits will be the greater of benefits available for devices,equipment and supplies,home health or hospitalization. See Advanced Care at Home for durable medical equipment provided in an Advanced Care at Home setting. See Hospice for durable 17 COB571-0036900 Packet Pg. 47 8.C.a medical equipment provided in a hospice setting. 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 N 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 o 0 listed as covered above; same as or similar equipment already in the Member's possession;replacement or repair due Q to loss,theft,breakage from willful damage,neglect or wrongful use,or due to personal preference;structural , modifications to a Member's home or personal vehicle M L ++ r_ Diabetic Education,Equipment and Pharmacy Supplies V L 0 Diabetic education and training. Member pays$10 Copayment m 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 strip-based : shoes,modifications and shoe inserts for severe diabetic foot blood glucose monitors,test strips,lancets or control vi disease. See Devices,Equipment and Supplies for additional solutions. c information. J a 0 Diabetic pharmacy supplies: Insulin,lancets,lancet devices, Preferred generic drugs(Tier 1): Member pays needles,insulin syringes,disposable insulin pens,pen $10 Copayment per 30-days up to a 90-day supply M needles,glucagon emergency kits,prescriptive oral agents 0 13 and blood glucose test strips for a supply of 30 days or less Preferred brand name drugs(Tier 2): Member m per item.Certain brand name insulin drugs will be covered at pays$10 Copayment per 30-days up to a 90-day the generic level. See Drugs—Outpatient Prescription for supply c additional pharmacy information. M Non-Preferred generic and brand name drugs (Tier 3):Not covered;Member pays 100%of all c charges c14 r c a� E Annual Deductible does not apply to strip-based y blood glucose monitors,test strips,lancets or control solutions. Q Note:A Member will not pay more than$35,not m subject to the Deductible,for a 30-day supply of Y insulin to comply with state law requirements.Any cost sharing paid will apply toward the annual d Deductible. E z U 0 Diabetic retinal screening. No charge;Member pays nothing Q Dialysis(Home and Outpatient) Dialysis in an outpatient or home setting is covered for Outpatient Services:Member pays$10 Copayment 18 COB571-0036900 Packet Pg. 48 8.C.a Members with acute kidney failure or end-stage renal disease (ESRD). Dialysis requires Preauthorization. Injections administered by a Network Provider in a clinical Outpatient Services:Member pays$10 Copayment setting during dialysis. N Self-administered injectables. See Drugs—Outpatient Preferred generic drugs(Tier 1): Member pays 0 Prescription for additional pharmacy information. $10 Copayment per 30-days up to a 90-day supply 3 Q Preferred brand name drugs(Tier 2): Member pays$10 Copayment per 30-days up to a 90-day L supply 0 0 Non-Preferred generic and brand name drugs `o (Tier 3):Not covered;Member pays 100%of all 3 charges m Drugs-Outpatient Prescription E d Prescription drugs,supplies and devices for a supply of 30 Preferred generic drugs(Tier 1): Member pays vi days or less including diabetic pharmacy supplies(insulin, $10 Copayment per 30-days up to a 90-day supply c lancets,lancet devices,needles,insulin syringes,disposable J insulin pens,pen needles and blood glucose test strips), Preferred brand name drugs(Tier 2): Member c mental health and wellness drugs, self-administered pays$10 Copayment per 30-days up to a 90-day injectables,medications for the treatment arising from sexual supply M assault,and routine costs for prescription medications 0 13 provided in a clinical trial."Routine costs"means items and Non-Preferred generic and brand name drugs services delivered to the Member that are consistent with and (Tier 3):Not covered;Member pays 100%of all typically covered by the plan or coverage for a Member who charges c is not enrolled in a clinical trial. LO M All drugs,supplies and devices must be obtained at a Annual Deductible does not apply to strip-based N KFHPWA-designated pharmacy except for drugs dispensed blood glucose monitors,test strips,lancets or control N for Emergency services or for Emergency services obtained solutions. c outside of the KFHPWA Service Area,including out of the E E country.Information regarding KFHPWA-designated Note:A Member will not pay more than$35,not a) a) pharmacies is reflected in the KFHPWA Provider Directory subject to the Deductible,for a 30-day supply of or can be obtained by contacting Kaiser Permanente Member insulin to comply with state law requirements.Any Q Services. cost sharing paid will apply toward the annual Deductible. N Prescription drug Cost Shares are payable at the time of Y delivery.Certain brand name insulin drugs are covered at the generic drug Cost Share. d E t Members may be eligible to receive an emergency fill for U certain prescription drugs filled outside of KFHPWA's Q 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 19 COB571-0036900 Packet Pg. 49 8.C.a eligible for emergency fills is available on the pharmacy website at www.kp.oriz/wa/formulary.Members can request an emergency fill by calling 1-855-505-8107. Certain drugs are subject to Preauthorization as shown in the Preferred drug list(formulary)available at www.kp.orgg/wa/formulary. N For outpatient prescription drugs and/or items that are 0 covered under the Drugs—Outpatient Prescription section and 3 obtained at a pharmacy owned and operated by KFHPWA,a Q Member may be able to use approved manufacturer coupons N as payment for the Cost Sharing that a Member owes,as L allowed under KFHPWA's coupon program.A Member will c owe any additional amount if the coupon does not cover the 0 entire amount of the Cost Sharing for the Member's c prescription.When a Member uses an approved coupon for payment of their Cost Sharing,the coupon amount and any additional payment that you make will accumulate to their w Out-of-Pocket Limit.More information is available regarding w m the Kaiser Permanente coupon program rules and limitations at kp.or /g rxcoupons. Injections administered by a Network Provider in a clinical Member pays$10 Copayment U) setting. � a 0 Over-the-counter drugs not included under Reproductive Not covered;Member pays 100%of all charges Health M 0 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 0 Annual Deductible does not apply to strip-based Ln blood glucose monitors,test strips,lancets or control solutions. M N O N Note:A Member will not pay more than$35,not subject to the Deductible,for a 30-day supply of insulin to comply with state law requirements.Any cost-sharing paid will apply toward the annual L Deductible. Q The KFHPWA Preferred drug list is a list of prescription drugs,supplies,and devices considered to have acceptable N efficacy,safety and cost-effectiveness. The Preferred drug list is maintained by a committee consisting of a group of M Y 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 y generally have better scientific evidence for safety and effectiveness and are more affordable than Non-Preferred E drugs.The preferred drug list is available at www.kp.org/wa/formul4a,or upon request from Member Services. U 0 r Members may request a coverage determination by contacting Member Services. Coverage determination reviews Q 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. 20 COB 5 71-0036900 Packet Pg. 50 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. "Standard reference compendia"means the American Hospital Formulary Service—Drug Information;the American Medical Association Drug Evaluation;the N United States Pharmacopoeia—Drug Information,or other authoritative compendia as identified from time to time by the federal secretary of Health and Human Services."Peer-reviewed medical literature"means scientific studies z printed in health care journals or other publications in which original manuscripts are published only after having been Q 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. N M Generic drugs are dispensed whenever available. A generic drug is a drug that is the pharmaceutical equivalent to one W or more brand name drugs. Such generic drugs have been approved by the Food and Drug Administration as meeting C the same standards of safety,purity,strength and effectiveness as the brand name drug. Brand name drugs are c 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. w m 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 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 N prescription for a chronic condition,the Member may request a coordination of medications so that medications for 0 chronic conditions are refilled on the same schedule(synchronized).Cost-shares for the initial fill of the medication c 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 0 serious and/or complex conditions,such as rheumatoid arthritis,hepatitis or multiple sclerosis. Specialty drugs must 3 be obtained through KFHPWA's preferred specialty pharmacy vendor and/or network of specialty pharmacies and are 2 covered at the appropriate cost share above.For a list of specialty drugs or more information about KFHPWA's c specialty pharmacy network,please go to the KFHPWA website at www.kp.org/wa/formulary or contact Member Q Services at 206-630-4636 or toll-free at 1-888-901-4636. M M The Member's Right to Safe and Effective Pharmacy Services: State and federal laws establish standards to assure N safe and effective pharmacy services,and to guarantee Members'right to know what drugs are covered and the coverage limitations.Members who would like more information about the drug coverage policies,or have a question E 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. Q Members who would like to know more about their rights under the law,or think any services received while enrolled i may not conform to the terms of the EOC,may contact the Washington State Office of Insurance Commissioner at N toll-free 1-800-562-6900.Members who have a concern about the pharmacists or pharmacies serving them may call Y the Washington State Department of Health at toll-free 1-800-525-0127. c d Prescription Drug Coverage and Medicare: This benefit,for purposes of Creditable Coverage,is actuarially equal E 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 r in a Medicare Part D plan at a later date;however,the Member could be subject to payment of higher Part D Q 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. 21 COB571-0036900 Packet Pg. 51 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. N 0 z Emergency Services Q Emergency services at a Network Facility or non-Network Network Facility: Member pays$75 Copayment Facility. See Section XII.for a definition of Emergency. L Non-Network Facility: Member pays$125 r_ Emergency services include professional services,treatment Copayment V and supplies,facility costs,outpatient charges for patient `0 observation,medical screening exams required to stabilize a patient,and post stabilization treatment. m w Members must notify KFHPWA by way of the Hospital aa) notification line within 24 hours of any admission,or as soon E thereafter as medically possible. vi If a Member is admitted as an inpatient or to Advanced Care w 0 at Home directly from an emergency department,any _J Emergency services Copayment is waived.Coverage is 0 subject to the hospital services Cost Share. v� M If two or more Members in the same Family Unit require 0 13 Emergency services as a result of the same accident,coverage for all Members will be subject to only one Emergency services Copayment. 00 LO If a Member is hospitalized in a non-Network Facility, M KFHPWA reserves the right to require transfer of the N Member to a Network Facility upon consultation between a N 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. Q Follow-up care which is a direct result of the Emergency must U)i be received from a Network Provider,unless Preauthorization M Y is obtained for such follow-up care from a non-Network c Provider. y E t U Gender Health Services Q Medically Necessary medical and surgical services for gender Hospital-Inpatient:No charge;Member pays affirmation. Consultation and treatment requires nothing Preauthorization. Hospital-Outpatient: Member pays$10 22 COB 5 71-0036900 Packet Pg. 52 8.C.a 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. N 0 z Exclusions: Cosmetic services and surgery not related to gender affirming treatment(i.e.,face lift or calf implants), Q complications of non-Covered Services M L Hearing Examinations and Hearing Aids o V Hearing exams for hearing loss and evaluation are covered Hospital-Inpatient: `o only when provided at KFHPWA-approved facilities. No charge;Member pays nothing c m Cochlear implants or Bone Anchored Hearing System Hospital-Outpatient: w (BAHS)when in accordance with KFHPWA clinical criteria. Member pays$10 Copayment m c Covered services for initial cochlear implants and BAHS Outpatient Services: include diagnostic testing,pre-implant testing,implant Member pays$10 Copayment vi surgery,post-implant follow-up,speech therapy, w 0 programming and associated supplies(such as transmitter cable,and batteries). 0 .r Replacement devices and associated supplies—see Devices, M Equipment and Supplies Section. 0 13 m Hearing aids including hearing aid examinations. Not covered;Member pays 100%of all charges 0 Exclusions: Programs or treatments for hearing loss or hearing care including,but not limited to,externally worn M 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 N 0 N r C N Home Health Care E a) a) L Home health care when the following criteria are met: No charge;Member pays nothing Q • 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 2 for transportation does not constitute inability to leave the Y home. c • The Member requires intermittent skilled home health d care,as described below. z • KFHPWA's medical director determines that such 2 services are Medically Necessary and are most Q appropriately rendered in the Member's home. 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 23 COB 5 71-0036900 Packet Pg. 53 8.C.a 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 the Member's home."Intermittent"means care that is to be rendered because of a medically predictable recurring need for skilled home health care. "Skilled home health care" means reasonable and necessary care for the treatment of an z illness or injury which requires the skill of a nurse or Q therapist,based on the complexity of the service and the , condition of the patient and which is performed directly by an N appropriately licensed professional provider. L c Home health care requires Preauthorization. C V L Exclusions: Private Duty Nursing;housekeeping or meal services; any care provided by or for a family member;any 3 other services rendered in the home which do not meet the definition of skilled home health care above m m Hospice E d Hospice care when provided by a licensed hospice care No charge;Member pays nothing vi program.A hospice care program is a coordinated program of c home and inpatient care,available 24 hours a day. This _J program uses an interdisciplinary team of personnel to 0 provide comfort and supportive services to a Member and any v� family members who are caring for the member,who is M experiencing a life-threatening disease with a limited 0 13 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. 0 In order to qualify for hospice care,the Member's provider M must certify that the Member is terminally ill and is eligible for hospice services. N 0 N Inpatient Hospice Services.For short-term care,inpatient c hospice services are covered with Preauthorization. a) E a� a� Respite care is covered to provide continuous care of the Member and allow temporary relief to family members from Q the duties of caring for the Member for a maximum of 5 consecutive days per 3-month period of hospice care. M Y Other covered hospice services,when billed by a licensed hospice program,may include the following: d • Inpatient and outpatient services and supplies for injury E t and illness. U • Semi-private room and board,except when a private Q room is determined to be necessary. • Durable medical equipment when billed by a licensed hospice care program. Hospice care requires Preauthorization. 24 COB 5 71-0036900 Packet Pg. 54 8.C.a 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 N covered: nothing o • Room and board,including private room when prescribed,and general nursing services. Hospital-Outpatient: Member pays$10 Q • Hospital services(including use of operating room, Copayment anesthesia,oxygen,x-ray,laboratory and radiotherapy services). M • Drugs and medications administered during confinement. o • Medical implants. V L • Withdrawal management services. G c 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 vi recommendation from the attending physician or licensed J health care provider.Alternative care arrangements in lieu of a covered hospital or other institutional care must be c .r determined to be appropriate and Medically Necessary based upon the Member's Medical Condition. Such care is covered M to the same extent the replaced Hospital Care is covered. �a Alternative care arrangements require Preauthorization. Members receiving the following nonscheduled services are c required to notify KFHPWA by way of the Hospital M notification line within 24 hours following any admission,or as soon thereafter as medically possible: acute withdrawal N 0 management services,Emergency psychiatric services, N r Emergency services,labor and delivery and inpatient a� admissions needed for treatment of Urgent Conditions that E cannot reasonably be delayed until Preauthorization can be L obtained. a� Q Coverage for Emergency services in a non-Network Facility `m and subsequent transfer to a Network Facility is set forth in 2 Emergency Services. Y c Non-Emergency hospital services require Preauthorization. E t Exclusions: Take home drugs,dressings and supplies following hospitalization;internally implanted insulin pumps, M artificial larynx and any other implantable device that have not been approved by KFHPWA's medical director Q Infertility(including sterility) General counseling and one consultation visit to diagnose Member pays$10 Copayment 25 COB571-0036900 Packet Pg. 55 8.C.a 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 N heritable disorders;surrogacy o z 3 Q Infusion Therapy ' U) Administration of Medically Necessary infusion therapy in an Member pays$10 Copayment M outpatient setting. 0 c.� Preauthorization is required. `0 c Administration of Medically Necessary infusion therapy in No charge;Member pays nothing > the home setting. N m To receive benefits for the administration of select infusion E medications in the home setting,the drugs must be obtained through KFHPWA's preferred specialty pharmacy and vi administered by a provider we identify. For a list of these c specialty drugs or for more information about KFHPWA's J 0. specialty pharmacy network,please go to the KFHPWA o website at www.kp.org/wa/fonnulary or contact Member Services. M 0 �a Associated infused medications include,but are not limited No charge;Member pays nothing to: 0 • Antibiotics. o LO • Hydration. M • Chemotherapy. • Pain management. cm N r C N Laboratory and Radiology E a� L Nuclear medicine,radiology,ultrasound and laboratory No charge;Member pays nothing Q services,including high end radiology imaging services such ' L as CAT scan,MRI and PET which are subject to N Preauthorization except when associated with Emergency Y services or inpatient services.Please contact Member Urine Drug Screening:No charge,Member pays Services for any questions regarding these services. nothing. Limited to 2 tests per calendar year. Benefits are applied in the order claims are received E Services received as part of an emergency visit are covered as and processed. Emergency Services. r After Allowance:No charge;Member pays nothing Q 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 26 COB 5 71-0036900 Packet Pg. 56 8.C.a request from Member Services. Manipulative Therapy Manipulative therapy of the spine and extremities when in Member pays$10 Copayment accordance with KFHPWA clinical criteria,limited to a total N of 10 visits per calendar year.Preauthorization is not o required. z Q Rehabilitation services,such as massage or physical therapy, provided with manipulations is covered under the Rehabilitation and Habilitative Care(massage,occupational, L physical and speech therapy,pulmonary and cardiac o rehabilitation)and Neurodevelopmental Therapy section. C) L O 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 N m c d Maternity and Pregnancy vi Maternity care and pregnancy services,including care for Hospital-Inpatient:No charge;Member pays J complications of pregnancy and prenatal and postpartum care nothing a are covered for all female Members including dependent c .r daughters. Hospital-Outpatient: Member pays$10 Copayment M Delivery and associated Hospital Care,including home births �a and birthing centers.Home births are considered outpatient Outpatient Services:Member pays$10 Copayment services. LO 0 Members must notify KFHPWA by way of the Hospital notification line within 24 hours of any admission,or as soon thereafter as medically possible. The Member's physician,in c consultation with the Member,will determine the Member's N r length of inpatient stay following delivery. a� E Prenatal testing for the detection of congenital and heritable L disorders when Medically Necessary as determined by Q KFHPWA's medical director and in accordance with Board , of Health standards for screening and diagnostic tests during `m pregnancy. 2 M Y Termination of pregnancy. Hospital-Inpatient:No charge;Member pays nothing d Non-Emergency inpatient hospital services require t Preauthorization. Hospital-Outpatient: Member pays$10 U Copayment Q Outpatient Services:Member pays$10 Copayment Exclusions: Birthing tubs;genetic testing of non-Members;fetal ultrasound in the absence of medical indications 27 COB 5 71-0036900 Packet Pg. 57 8.C.a 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's medical director.Treatment may utilize psychiatric, Hospital-Outpatient: Member pays$10 N psychological and/or psychotherapy services to achieve these Copayment o objectives. z Outpatient Services:Member pays$10 Copayment Q Mental health and wellness services including medical , management and prescriptions are covered the same as for any other condition. Group Visits:No charge;Member pays nothing L c Applied behavioral analysis(ABA)therapy,limited to V outpatient treatment of an autism spectrum disorder or,has a `o developmental disability for which there is evidence that ABA therapy is effective,as diagnosed and prescribed by a > neurologist,pediatric neurologist,developmental pediatrician, w psychologist or psychiatrist experienced in the diagnosis and m treatment of autism.Documented diagnostic assessments, E individualized treatment plans and progress evaluations are required. vi Services for any involuntary court-ordered treatment program � shall be covered only if determined to be Medically c Necessary by KFHPWA's medical director. Services provided under involuntary commitment statutes are covered. M V If a Member is admitted as an inpatient directly from an m emergency department,any Emergency services Copayment is waived. Coverage is subject to the hospital services Cost o Share.Coverage for services incurred at non-Network M Facilities shall exclude any charges that would otherwise be �- excluded for hospitalization within a Network Facility. N Members must notify KFHPWA by way of the Hospital N notification line within 24 hours of any admission,or as soon thereafter as medically possible. E a� Mental health and wellness services rendered to treat mental L a� disorders are covered.Mental Disorders means mental Q disorders covered in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the ui American Psychiatric Association,except as otherwise M Y excluded under Sections IV.or V. Mental Health and Wellness Services means Medically Necessary outpatient y services,Residential Treatment,partial hospitalization E program,and inpatient services provided by a licensed facility U or licensed providers;including advanced practice psychiatric Q 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 28 COB571-0036900 Packet Pg. 58 8.C.a 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.Outpatient specialty services, N including rTMS,ECT,and Esketamine require Preauthorization.Routine outpatient therapy and psychiatry t services with contracted network providers do not require Q Preauthorization. , U) Exclusions:Academic or career counseling;personal growth or relationship enhancement;assessment and treatment L services that are primarily vocational and academic;court-ordered or forensic treatment,including reports and c summaries,not considered Medically Necessary;work or school ordered assessment and treatment not considered C V Medically Necessary;counseling for overeating not considered Medically Necessary;specialty treatment programs `o such as"behavior modification programs"not considered Medically Necessary;relationship counseling or phase of 3 life problems(Z code only diagnoses);custodial care;experimental or investigational therapies,such as wilderness > therapy. w N am c Naturopathy vi Naturopathy. Member pays$10 Copayment c J Limited to 3 visits per medical diagnosis per calendar year c without Preauthorization.Additional visits are covered with v� Preauthorization. M V 13 Laboratory and radiology services are covered only when obtained through a Network Facility. 0 0 Exclusions: Herbal supplements;nutritional supplements;any services not within the scope of the practitioner's Ln M licensure M N O N r Newborn Services a� E Newborn services are covered the same as for any other Hospital-Inpatient: No charge;Member pays L condition.Any Cost Share for newborn services is separate nothing Q from that of the mother. , During the baby's initial hospital stay while the birth N Preventive services for newborns are covered under mother and baby are both confined,any applicable M Preventive Services. Deductible and Copayment for the newborn are Y waived c See Section VI.A.3. for information about temporary d coverage for newborns. Hospital-Outpatient: Member pays$10 U Copayment r Q Outpatient Services: Member pays$10 Copayment 29 COB 5 71-0036900 Packet Pg. 59 8.C.a Nutritional Counseling Nutritional counseling. Member pays$10 Copayment Services related to a healthy diet to prevent obesity are covered as Preventive Services. See Preventive Services for additional information. m N Exclusions:Nutritional supplements;weight control self-help programs or memberships,such as Weight Watchers, Jenny Craig,or other such programs 0 Q Nutritional Therapy L c Medical formula necessary for the treatment of No charge;Member pays nothing C) phenylketonuria(PKU),specified inborn errors of `0 metabolism,or other metabolic disorders. c m Enteral therapy is covered when Medical Necessity criteria is Member pays 20%coinsurance N met and when given through a PEG,J tube or orally,or for an eosinophilic gastrointestinal disorder. d Necessary equipment and supplies for the administration of vi enteral therapy are covered as Devices,Equipment and c Supplies. J a 0 Parenteral therapy(total parenteral nutrition). No charge;Member pays nothing M Necessary equipment and supplies for the administration of 0 13 parenteral therapy are covered as Devices,Equipment and m Supplies. 0 0 Exclusions:Any other dietary formulas,medical foods,or oral nutritional supplements that do not meet Medical M Necessity criteria or are not related to the treatment of inborn errors of metabolism; special diets;prepared foods/meals N 0 N r C N Obesity Related Services aEi a) L Bariatric surgery and related hospitalizations when KFHPWA Hospital-Inpatient:No charge;Member pays criteria are met. nothing Q L Services related to obesity screening and counseling are Hospital-Outpatient: Member pays$10 covered as Preventive Services. Copayment Y c Obesity related services require Preauthorization. Outpatient Services: Member pays$10 Copayment d E t U 0 Exclusions:All other obesity treatment and treatment for morbid obesity including any medical services,drugs or Q 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 30 COB571-0036900 Packet Pg. 60 8.C.a 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 N Outpatient Services:Not covered;Member pays t 100%of all charges Q U) Exclusions: Confinement,treatment or service that results from an illness or injury arising out of or in the course of L any employment for wage or profit including injuries,illnesses or conditions incurred as a result of self-employment j_ 0 c.� L 0 Oncology m Radiation therapy,chemotherapy,oral chemotherapy. Radiation Therapy and Chemotherapy: N Member pays$10 Copayment c See Infusion Therapy for infused medications. — d Oral Chemotherapy Drugs: vi Preferred generic drugs(Tier 1): Member pays c $10 Copayment per 30-days up to a 90-day supply _J 0. 0 Preferred brand name drugs(Tier 2): Member v) pays$10 Copayment per 30-days up to a 90-day M supply 3 m Non-Preferred generic and brand name drugs (Tier 3):Not covered;Member pays 100%of all c charges Ln M M N O Optical(vision) N r c a� Routine eye examinations and refractions,limited to once Routine Exams: Member pays$10 Copayment E every 12 months. L Exams for Eye Pathology: Member pays$10 Q Eye and contact lens examinations for eye pathology and to Copayment monitor Medical Conditions,as often as Medically `0 Necessary. N M Y Contact lenses or framed lenses for eye pathology when Frames and Lenses: Not covered;Member pays Medically Necessary. 100%of all charges E t One contact lens per diseased eye in lieu of an intraocular Contact Lenses or Framed Lenses for Eye M lens is covered following cataract surgery provided the Pathology: No charge;Member pays nothing Q 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 31 COB571-0036900 Packet Pg. 61 8.C.a surgery,is covered only once within a 12-month period and only when needed due to a change in the Member's 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 N 0 z Oral Surgery Q 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 M cheeks,lips,tongue,gums,roof,and floor of the mouth;and r_ incision of salivary glands and ducts. Hospital-Outpatient: Member pays$10 V Copayment `0 KFHPWA's medical director will determine whether the care or treatment required is within the category of Oral Surgery or Outpatient Services:Member pays$10 Copayment > Dental Services. w m Oral surgery requires Preauthorization. E d Exclusions: Care or repair of teeth or dental structures of any type;tooth extractions or impacted teeth; services vi related to malocclusion; services to correct the misalignment or malposition of teeth; any other services to the mouth, c facial bones,or teeth which are not medical in nature J 0. 0 Outpatient Services M .a Covered outpatient medical and surgical services in a Member pays$10 Copayment provider's office,including chronic disease management and treatment arising from sexual assault. See Preventive Services o for additional information related to chronic disease c`Vi management. N O See Hospital-Inpatient and Outpatient for outpatient hospital N r medical and surgical services,including ambulatory surgical centers. E a) a) L Q Plastic and Reconstructive Surgery L 2 Plastic and reconstructive services: Hospital-Inpatient:No charge;Member pays Y • Correction of a congenital disease or congenital anomaly. nothing • Correction of a Medical Condition following an injury or resultingfrom sure which has produced a major effect Hospital-Outpatient: Member pays$10 E surgery p J p• P pY E on the Member's appearance,when in the opinion of Copayment KFHPWA's medical director such services can r reasonably be expected to correct the condition. Outpatient Services:Member pays$10 Copayment Q • 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 32 COB571-0036900 Packet Pg. 62 8.C.a 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. m Exclusions: Cosmetic services including treatment for complications resulting from cosmetic surgery;cosmetic o surgery;complications of non-Covered Services t Q Podiatry N M L Medically Necessary foot care. Member pays$10 Copayment o V Routine foot care covered when such care is directly related `o to the treatment of diabetes and,when approved by KFHPWA's medical director,other clinical conditions that > effect sensation and circulation to the feet. w m Exclusions:All other routine foot care d vi Preventive Services o J Q. 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 M upon request from Member Services. �a m Screening and tests with A and B recommendations by the U.S.Preventive Services Task Force(USPSTF). LO Services,tests and screening contained in the U.S.Health Resources and Services Administration Bright Futures c guidelines as set forth by the American Academy of N r Pediatricians. a� E Services,tests,screening and supplies recommended in the L U.S.Health Resources and Services Administration women's Q preventive and wellness services guidelines. L Immunizations recommended by the Centers for Disease N M Control's Advisory Committee on Immunization Practices. Y Flu vaccines are covered up to the Allowed Amount when provided by a non-Network Provider. d E t Preventive services include,but are not limited to,well adult M and well child physical examinations;immunizations and Q vaccinations;pap smears;routine mammography screening; routine prostate screening;and colorectal cancer screening for Members who are age 45 or older or who are under age 45 and at high risk. 33 COB571-0036900 Packet Pg. 63 8.C.a 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 N Network Provider,non-network providers may provide these services without Cost Share when Preauthorized. 0 Z 3 Services provided during a preventive services visit,including Q laboratory services,which are not in accordance with the KFHPWA well care schedule are subject to Cost Shares.Eye L refractions are not included under preventive services. c 0 0 Exclusions: Those parts of an examination and associated reports and immunizations that are not deemed Medically `o Necessary by KFHPWA for early detection of disease;all other diagnostic services not otherwise stated above 3 m Rehabilitation and Habilitative Care(massage, aNi occupational,physical and speech therapy,pulmonary and cardiac rehabilitation)and Neurodevelopmental Therapy vi 0 Rehabilitation services to restore function following illness, Hospital-Inpatient: No charge;Member pays _J injury or surgery,limited to the following restorative nothing c therapies: occupational therapy,physical therapy,massage therapy and speech therapy. Services are limited to those Outpatient Services: Member pays$10 Copayment M necessary to restore or improve functional abilities when 0 13 physical,sensori-perceptual and/or communication impairment exists due to injury,illness or surgery. Group visits(occupational,physical,speech therapy or learning services): c Outpatient services require a prescription or order from a Member pays one half of the office visit Copayment M physician that reflects a written plan of care to restore and applicable Plan Coinsurance function and must be provided by a rehabilitation team that N may include a physician,nurse,physical therapist, N occupational therapist,massage therapist or speech therapist. Preauthorization is not required. E aD a� Habilitative care includes Medically Necessary services or devices designed to help a Member keep,learn,or improve Q skills and functioning for daily living. Services may include: occupational therapy,physical therapy,and speech therapy 2 when prescribed by a physician.Examples include therapy for Y a child who is not walking or talking at the expected age. These services may include physical and occupational y therapy,speech-language pathology and other services for E people with disabilities in a variety of inpatient and/or U outpatient settings. Q Neurodevelopmental therapy to restore or improve function including maintenance in cases where significant deterioration in the Member's condition would result without the services,is limited to the following therapies: 34 COB571-0036900 Packet Pg. 64 8.C.a 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. N N .` O Services with mental health diagnoses are covered with no Z limit. Q Non-Emergency inpatient hospital services require Preauthorization. L c Cardiac rehabilitation is covered up to a total of 36 visits per Member pays$10 Copayment C� cardiac event when clinical criteria is met. `0 c Group visits(occupational,physical,speech > Limited to a combined total of 60 inpatient days and 60 therapy or learning services): N outpatient visits per calendar year for all Rehabilitation and Member pays one half of the office visit Copayment Habilitative care. and applicable Plan Coinsurance vi Pulmonary rehabilitation is covered when clinical criteria is Member pays$10 Copayment 0 met. a 0 Preauthorization is required after initial visit. Group visits(occupational,physical,speech therapy or learning services): M Member pays one half of the office visit Copayment 3 Limited to a combined total of 60 inpatient days and 60 and applicable Plan Coinsurance outpatient visits per calendar year for all Rehabilitation and 0 Habilitative care. o Ln M M Exclusions: Specialty treatment programs;inpatient Residential Treatment services;specialty rehabilitation programs c including"behavior modification programs";recreational,life-enhancing,relaxation or palliative therapy; r implementation of home maintenance programs E aD a� L Reproductive Health Q Medically Necessary medical and surgical services for Hospital-Inpatient:No charge;Member pays N reproductive health,including consultations,examinations, nothing M procedures and devices,including device insertion and Y removal. Hospital-Outpatient:No charge;Member pays d nothing E See Maternity and Pregnancy for termination of pregnancy U services Outpatient Services:No charge;Member pays r nothing Q 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,and maternity 35 COB571-0036900 Packet Pg. 65 8.C.a 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 N and,when available,picked up in the provider's office. o z Q Sexual Dysfunction N M L One consultation visit to diagnose sexual dysfunction Member pays$10 Copayment o conditions. C) L 0 13 Specific diagnostic services,treatment and prescription drugs. TNot covered;Member pays 100%of all charges m Exclusions: Diagnostic testing and medical treatment of sexual dysfunction regardless of origin or cause;devices, N equipment and supplies for the treatment of sexual dysfunction d Skilled Nursing Facility N 0 J Skilled nursing care in a skilled nursing facility when full- No charge;Member pays nothing 0. time skilled nursing care is necessary in the opinion of the 0 attending physician,limited to a total of 30 days per condition per calendar year. M 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- Q term restorative occupational therapy,physical therapy and speech therapy. M N O Skilled nursing care in a skilled nursing facility requires N r Preauthorization. a� E Exclusions: Personal comfort items such as telephone and television;rest cures;domiciliary or Convalescent Care L a� Q Sterilization M FDA-approved female sterilization procedures,services and No charge;Member pays nothing Y supplies. E Non-Emergency inpatient hospital services require Preauthorization. r Q Vasectomy. No charge;Member pays nothing Non-Emergency inpatient hospital services require Preauthorization. 36 COB571-0036900 Packet Pg. 66 8.C.a 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 N organized individual and group counseling;and/or o prescription drugs unless excluded under Sections IV.or V. Outpatient Services:Member pays$10 Copayment Q Substance use disorder means a substance-related or addictive disorder listed in the most current version of the Diagnostic Group Visits:No charge;Member pays nothing N and Statistical Manual of Mental Disorders(DSM).For the L purposes of this section,the definition of Medically o Necessary shall be expanded to include those services t� necessary to treat a substance use disorder condition that is `0 having a clinically significant impact on a Member's emotional,social,medical and/or occupational functioning. Substance use disorder services are limited to the services aNi rendered by a physician(licensed under RCW 18.71 and E RCW 18.57),a psychologist(licensed under RCW 18.83),a substance use disorder treatment program licensed for the vi service being provided by the Washington State Department 0 0 of Social and Health Services(pursuant to RCW 70.96A),a _J master's level therapist(licensed under RCW 18.225.090),an 0 advance practice psychiatric nurse(licensed under RCW 18.79)or,in the case of non-Washington State providers, M those providers meeting equivalent licensing and certification 0 requirements established in the state where the provider's practice is located. 0 The severity of symptoms designates the appropriate level of M care and should be determined through a thorough assessment completed by a licensed provider who recommends treatment N based on medical necessity criteria. N r c Court-ordered substance use disorder treatment shall be covered only if determined to be Medically Necessary. 44)) L Preauthorization is required for outpatient,intensive Q outpatient,and partial hospitalization services. Preauthorization is required for Residential Treatment and Y non-Emergency inpatient hospital services provided at out-of- state facilities. 4) d E Preauthorization is not required for Residential Treatment and U non-Emergency inpatient hospital services provided in-state. Q Member is given two days of treatment and is then subject to medical necessity review for continued care.Member or facility must notify KFHPWA within 24 hours of admission, or as soon as possible.Member may request prior authorization for Residential Treatment and non-Emergency 37 COB571-0036900 Packet Pg. 67 8.C.a inpatient hospital services.Members may contact Member Services to request Preauthorization. Withdrawal Management Services for Alcoholism and Emergency Services Network Facility: Member Substance Use Disorder. pays$75 Copayment m Withdrawal management services means the management of Emergency Services Non-Network Facility: o symptoms and complications of alcohol and/or substance Member pays$125 Copayment t withdrawal. The severity of symptoms designates the 3 appropriate level of care and should be determined through a Hospital-Inpatient: No charge;Member pays Q thorough assessment completed by a licensed provider who nothing recommends treatment based on medical necessity criteria. L c Outpatient withdrawal management services means the C V symptoms resulting from abstinence are of mild/moderate `o severity and withdrawal from alcohol and/or other drugs can be managed with medication at an outpatient level of care by > an appropriately licensed clinician. Subacute withdrawal w management means symptoms associated with withdrawal m from alcohol and/or other drugs can be managed through E medical monitoring at a 24-hour facility or other outpatient facility. vi Preauthorization is required for outpatient withdrawal � management and subacute withdrawal management services. 0. 0 "Acute withdrawal management services"means the - symptoms resulting from abstinence are so severe that 0 withdrawal from alcohol and/or drugs require medical 3 management in a hospital setting or behavioral health agency (licensed and certified under RCW 71.24.037),which is c needed immediately to prevent serious impairment to theLO Member's health. M Coverage for acute withdrawal management services is N provided without Preauthorization.If a Member is admitted r 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 Q within 24 hours of any admission,or as soon thereafter as i medically possible. N M Member is given no less than two days of treatment, Y excluding weekends and holidays,in a behavioral health agency that provides inpatient or residential substance abuse E treatment;and no less than three days in a behavioral health agency that provides withdrawal management services prior r to conducting a medical necessity review for continued care. Q Member or facility must notify KFHPWA within 24 hours of admission,or as soon as possible.Members may request Preauthorization for Residential Treatment and non- Emergency inpatient hospital services by contacting Member Services. 38 COB571-0036900 Packet Pg. 68 8.C.a 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. N Exclusions: Experimental or investigational therapies,such as wilderness programs or aversion therapy;facilities and t treatment programs which are not certified by the Department of Social Health Services Q Telehealth Services L c Telemedicine No charge;Member pays nothing V Services provided by the use of real-time interactive audio 0 and video communications or store and forward technology between the patient at the originating site and a Network > Provider at another location.Audio-only communication N requires an Established Relationship. Store and forward c technology means sending a Member's medical information — from an originating site to the provider at a distant site for later review.The provider follows up with a medical vi diagnosis for the Member and helps manage their care. c Services must meet the following requirements: • Be a Covered Service under this EOC. o .r • The originating site is qualified to provide the service. M • If the service is provided through store and forward :a technology,there must be an associated office visit between the Member and the referring provider. • Is Medically Necessary. 0o LO M Telephone Services and Online(E-Visits) No charge;Member pays nothing �� Scheduled telephone visits with a Network Provider are c covered. N r c a� Online(E-Visits):A Member logs into the secure Member aEi site at www.kp.org/wa and completes a questionnaire.A L KFHPWA medical provider reviews the questionnaire and Q provides a treatment plan for select conditions,including L prescriptions. Online visits are not available to Members N during in-person visits at a KFHPWA facility or pharmacy. Y More information is available at https://wa.kaiserpermanente.org/httnl/public/services/e-visit. y E z U Exclusions:Fax and e-mail;telehealth services with non-contracted providers;telehealth services in states where Q prohibited by law;all other services not listed above 39 COB571-0036900 Packet Pg. 69 8.C.a 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: • Medically Necessary orthognathic procedures for the Hospital-Outpatient: Member pays$10 treatment of severe TMJ disorders which have failed Copayment N non-surgical intervention. • Radiology services. Outpatient Services:Member pays$10 Copayment t • TMJ specialist services. 3 Q • Fitting/adjustment of splints. N U) Non-Emergency inpatient hospital services require L Preauthorization. c 0 c.� TMJ appliances. See Devices,Equipment and Supplies for Member pays 20%coinsurance `0 additional information. c m > w 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, or severe obstructive sleep E apnea;hospitalizations related to these exclusions vi 0 Tobacco Cessation a 0 Individual/group counseling and educational materials. No charge;Member pays nothing M 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- c designated mail order service M Other approved pharmacy products: c Preferred generic drugs(Tier 1): Member pays N $10 Copayment per 30-days up to a 90-day supply E Preferred brand name drugs(Tier 2): Member y pays$10 Copayment per 30-days up to a 90-day supply Q `m Non-Preferred generic and brand name drugs (Tier 3):Not covered;Member pays 100%of all Y charges d E t U M Transplants Q 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 40 COB 5 71-0036900 Packet Pg. 70 8.C.a 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 N excision fees.Donor costs for a covered organ recipient o are limited to procurement center fees,travel costs for a z surgical team and excision fees. 3 • Follow-up services for specialty visits. Q • Rehospitalization. � • Maintenance medications during an inpatient stay. L c Transplant services must be provided through locally and V nationally contracted or approved transplant centers. All `o transplant services require Preauthorization. Contact Member Services for Preauthorization. > w Exclusions: Donor costs to the extent that they are reimbursable by the organ donor's insurance;treatment of donor aa) complications; living expenses except as covered under Section II.K.Utilization Management d vi Urgent Care c J a Inside the KFHPWA Service Area,urgent care is covered at a Network Emergency Department: Member pays 0 Kaiser Permanente medical center,Kaiser Permanente urgent $75 Copayment care center or Network Provider's office. M Network Urgent Care Center: Member pays$10 13 Outside the KFHPWA Service Area,urgent care is covered at Copayment any medical facility. 0 0 See Section XII.for a definition of Urgent Condition. Network Provider's Office: Member pays$10 M Copayment M N O N r Non-Network Provider: Member pays$125 Copayment E a) a) L Q V. General Exclusions m In addition to exclusions listed throughout the EOC,the following are not covered: M Y 1. Benefits and related services,supplies and drugs that are not Medically Necessary for the treatment of an y illness,injury,or physical disability,that are not specifically listed as covered in the EOC,except as required by t federal or state law. U r 2. Services Related to a Non-Covered Service: When a service is not covered,all services related to the non- Q 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 41 COB571-0036900 Packet Pg. 71 8.C.a 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. N 0 5. Services to the extent benefits are"available"to the Member as defined herein under the terms of any vehicle, homeowner's,property or other insurance policy,except for individual or group health insurance,pursuant to Q medical coverage,medical"no fault"coverage,personal injury protection coverage or similar medical coverage ' contained in said policy.For the purpose of this exclusion,benefits shall be deemed to be"available"to the W Member if the Member receives benefits under the policy either as a named insured or as an insured individual L under the policy definition of insured. r_ 0 c.� 6. Services or care needed for injuries or conditions resulting from active or reserve military service,whether such `0 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 N not be interpreted to interfere with or preclude coordination of benefits under Tri-Care. c 7. Services provided by government agencies, except as required by federal or state law. vi 8. Services covered by the national health plan of any other country. c J 9. Experimental or investigational services. c .r KFHPWA consults with KFHPWA's medical director and then uses the criteria described below to decide if a M particular service is experimental or investigational 0 13 m a. A service is considered experimental or investigational for a Member's condition if any of the following statements apply to it at the time the service is or will be provided to the Member: c 1) The service cannot be legally marketed in the United States without the approval of the Food and Drug M Administration("FDA")and such approval has not been granted. 2) The service is the subject of a current new drug or new device application on file with the FDA. N 3) The service is the trialed agent or for delivery or measurement of the trialed agent provided as part of a N qualifying Phase I or Phase II clinical trial,as the experimental or research arm of a Phase III clinical trial. E 4) The service is provided pursuant to a written protocol or other document that lists an evaluation of the service's safety,toxicity or efficacy as among its objectives. 5) The service is under continued scientific testing and research concerning the safety,toxicity or efficacy Q of services. 6) The service is provided pursuant to informed consent documents that describe the service as N experimental or investigational,or in other terms that indicate that the service is being evaluated for its Y safety,toxicity or efficacy. 7) The prevailing opinion among experts,as expressed in the published authoritative medical or scientific y literature,is that(1)the use of such service should be substantially confined to research settings,or(2) E further research is necessary to determine the safety,toxicity or efficacy of the service. U M r b. The following sources of information will be exclusively relied upon to determine whether a service is Q experimental or investigational: 1) The Member's medical records. 2) The written protocol(s)or other document(s)pursuant to which the service has been or will be provided. 42 COB 5 71-0036900 Packet Pg. 72 8.C.a 3) Any consent document(s)the Member or Member's representative has executed or will be asked to 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 Member's illness or injury. 6) Regulations,records,applications and any other documents or actions issued by,filed with or taken by, N the FDA or other agencies within the United States Department of Health and Human Services,or any 0 state agency performing similar functions. Q 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. W M L 10. Hypnotherapy and all services related to hypnotherapy. r_ 0 c.� 11. Directed umbilical cord blood donations. `0 c 12. Prognostic(predictive)genetic testing and related services,unless specifically provided in Section IV.Testing for non-Members. w m 13. Autopsy and associated expenses. cd VI. Eligibility,Enrollment and Termination vi 0 A. Eligibility. _J In order to be accepted for enrollment and continuing coverage,individuals must reside or work in the Service c Area and meet all applicable requirements set forth below,except for temporary residency outside the Service v� Area for purposes of attending school,court-ordered coverage for Dependents or other unique family M arrangements,when approved in advance by KFHPWA.KFHPWA has the right to verify eligibility. 0 m 1. Subscribers. Bona fide employees as established and enforced by the Group shall be eligible for enrollment.Please c contact the Group for more information. M 2. Dependents. c The Subscriber may also enroll the following: N r c a� a. The Subscriber's legal spouse. E a� a� b. The Subscriber's state-registered domestic partner(as required by Washington state law)or if Q specifically included as eligible by the Group,the Subscriber's non-state registered domestic partner. , State-registered domestic partners will be extended the same rights as spouses. `m M C. Children who are under the age of 26. Y c "Children"means the children of the Subscriber,spouse or eligible domestic partner,including adopted E 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. M r Q Eligibility may be extended past the Dependent's limiting age as set forth above if the Dependent is 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 43 COB 5 71-0036900 Packet Pg. 73 8.C.a 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 Subsection F. After 3 weeks of age,no benefits are available unless the newborn child qualifies as a Dependent and is enrolled. N 0 B. Application for Enrollment. Application for enrollment must be made on an application approved by KFHPWA.The Group is responsible Q for submitting completed applications to KFHPWA. KFHPWA reserves the right to refuse enrollment to any person whose coverage under any medical coverage M agreement issued by Kaiser Foundation Health Plan of Washington Options,Inc. or Kaiser Foundation Health r- Plan of Washington has been terminated for cause. C) L 0 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. N am 2. New Dependents. c 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. vi 0 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 0. additional Dependent. v� M 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. c Ln M 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 N claims. N r c 3. Open Enrollment. E KFHPWA will allow enrollment of Subscribers and Dependents who did not enroll when newly eligible as 4) described above during a limited period of time specified by the Group and KFHPWA. Q 4. Special Enrollment. a. KFHPWA will allow special enrollment for persons: Y 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: y • Cessation of employer contributions. E t • Exhaustion of COBRA continuation coverage. U • Loss of eligibility,except for loss of eligibility for cause;or Q 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. 44 COB 5 71-0036900 Packet Pg. 74 8.C.a 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. N 2) Cessation of Dependent status(reaches maximum age).Application for coverage must be made o within 30 days of the cessation of Dependent status. 3) Death of an employee under whose coverage they were a Dependent.Application for coverage Q 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 W within 30 days of the termination or reduction in number of hours worked. L 5) Leaving the service area of a former plan.Application for coverage must be made within 30 days r_ of leaving the service area of a former plan. C) 6) Discontinuation of a former plan.Application for coverage must be made within 30 days of the `o discontinuation of a former plan. m c. KFHPWA will allow special enrollment for individuals who are eligible to be a Subscriber and their N 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. vi 3) Adoption or placement for adoption.Application for coverage for the Subscriber and Dependents c other than the adopted child must be made within 60 days of the adoption or placement for adoption. c 4) Eligibility for premium assistance from Medicaid or a state Children's Health Insurance Program (CHIP),provided such person is otherwise eligible for coverage under this EOC.The request for M special enrollment must be made within 60 days of eligibility for such premium assistance. 0 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. c 6) Applicable federal or state law or regulation otherwise provides for special enrollment. LO M C. When Coverage Begins. N 0 N 1. Effective Date of Enrollment. • Enrollment for a newly eligible Subscriber and listed Dependents is effective on the date eligibility E requirements are met,provided the Subscriber's application has been submitted to and approved by y 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 1st Q of the month following date eligibility requirements are met.Please contact the Group for more information. • Enrollment for newborns is effective from the date of birth. Y • 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 E the child. t U 2. Commencement of Benefits for Persons Hospitalized on Effective Date. Q 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. 45 COB571-0036900 Packet Pg. 75 8.C.a 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. N .` 0 The Group is also responsible for providing KFHPWA with a prospective timely notice of Members' Z ineligibility for Medicare Advantage coverage under the Group,as well as providing a prospective notice to its Q 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 M required timeframe will also need to be provided. r- 0 c.� E. Termination of Coverage. `0 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. > w 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 vi continuation coverage as described in Subsection F.below,coverage will terminate at the end of the 0 month during which the loss of eligibility occurs,unless otherwise specified by the Group. J a 0 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. M Coverage of a Member may be terminated upon 10 working days written notice for: .0 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 another Member's identification card or number to obtain care to which a person is not entitled. c Ln M c. Premium Payments.Nonpayment of premiums or contribution for a specific Member by the Group. M N O Individual Member coverage may be retroactively terminated upon 30 days written notice and only in the N 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 E coverage for nonpayment of premiums or contributions by the Group as described above. y L In no event will a Member be terminated solely on the basis of their physical or mental condition provided Q they meet all other eligibility requirements set forth in the EOC. `m Any Member may appeal a termination decision through KFHPWA's appeals process. Y c F. Continuation of Coverage Options. E t 1. Continuation Option. U A Member no longer eligible for coverage(except in the event of termination for cause,as set forth in Q 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. 46 COB 5 71-0036900 Packet Pg. 76 8.C.a 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., • Such leave is in compliance with the Group's established leave of absence policy that is consistently applied to all employees, m • The Group's leave of absence policy is in compliance with the Family and Medical Leave Act when applicable,and ° z • The Group continues to remit premiums for the Subscriber and Dependents to KFHPWA. Q 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 0 dispute,a Subscriber may continue uninterrupted coverage through payment of monthly premiums directly c to the Group. Coverage may be continued for the lesser of the term of the strike,lock-out or other labor V dispute,or for 6 months after the cessation of work. O 13 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. m c The Group is responsible for immediately notifying each affected Subscriber of their rights of self-payment under this provision. vi 4. Continuation Coverage Under Federal Law. J This section applies only to Groups who must offer continuation coverage under the applicable provisions Q. 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 M employees who are leaving employment to serve in the United States Armed Forces. 3 Upon loss of eligibility,continuation of Group coverage may be available to a Member for a limited time c after the Member would otherwise lose eligibility,if required by COBRA.The Group shall inform Q Members of the COBRA election process and how much the Member will be required to pay directly to the Group. M N O Continuation coverage under COBRA or USERRA will terminate when a Member becomes covered by N r Medicare or obtains other group coverage,and as set forth under Subsection E. aa) E 5. KFHPWA Group Conversion Plan. L 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 Q group health plan,may convert to an individual KFHPWA group conversion plan.If coverage under the N EOC terminates,any Member covered at termination(including spouses and Dependents of a Subscriber M who was terminated for cause)may convert to a KFHPWA group conversion plan. Coverage will be Y retroactive to the date of loss of eligibility. d 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. Q Persons wishing to purchase KFHPWA's individual and family coverage should contact KFHPWA. VILGrievances - 47 COB 5 71-0036900 Packet Pg. 77 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 N be resolved in this way. p z Step 2: If the Member is still not satisfied,they should call or write to Member Services at PO Box 34590, Q 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 W think would be a fair resolution to the problem.An appropriate representative will investigate the Member's M concern by consulting with involved staff and their supervisors,and reviewing pertinent records,relevant plan C policies and the Member Rights and Responsibilities statement.This process can take up to 30 days to resolve C) after receipt of the Member's written or verbal statement. `o 13 c 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 N mental disabilities that impede their ability to request review or participate in the review process. c d vi Members are entitled to appeal through the appeals process if/when coverage for an item or service is denied due to c 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 c of the following:a denial,reduction,or termination of,or a failure to provide or make payment(in whole or in part) a) for,a benefit,including any such denial,reduction,termination,or failure to provide or make payment that is based M on a determination of a Member's eligibility to participate in a plan,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. c KFHPWA will comply with any new requirements as necessary under federal laws and regulations.Assistance is M 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 N information about your appeals process is available by contacting KFHPWA's Member Appeal Department at the N address or telephone number below. c a) E 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 Q a request for an appeal either orally or in writing to KFHPWA's Member Appeal Department,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 Y should be directed to KFHPWA's Member Appeal Department,P.O.Box 34593, Seattle,WA 98124-1593,toll- free 1-866-458-5479. d E A party not involved in the initial coverage determination and not a subordinate of the party making the initial U coverage determination will review the appeal request. KFHPWA will then notify the Member of its Q determination or need for an extension of time within 14 days of receiving the request for appeal.Under no circumstances will the review timeftame exceed 30 days without the Member's written permission. 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. 48 COB571-0036900 Packet Pg. 78 8.C.a There is an expedited/urgent appeals process in place for cases which meet criteria or where delay using the standard appeal review process will seriously jeopardize the Member's 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 KFHPWA's Member Appeal Department toll-free 1-866-458-5479. The nature of the patient's condition will be 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 believes the member's condition meets the definition of expedited,the request will be N processed as expedited. 0 z The request for an expedited/urgent appeal will be processed and a decision issued no later than 72 hours after Q receipt of the request. 0 The Member may also request an external review at the same time as the internal appeals process if it is an M urgent care situation or the Member is in an ongoing course of treatment. r_ 0 c.� If the Member requests an appeal of a KFHPWA decision denying benefits for care currently being received, `0 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. N m The U.S.Department of Health and Human Services has designated the Washington State Office of the Insurance Commissioner's Consumer Protection Division as the health insurance consumer ombudsman.The Consumer Protection Division Office can be reached by mail at Washington State Insurance Commissioner, vi Consumer Protection Division,P.O.Box 40256,Olympia,WA 98504-0256 or at toll-free 1-800-562-6900. c More information about requesting assistance from the Consumer Protection Division Office can be found at _J http://www.insurance.wa.,_o�v/your-insurance/health-insurance/appeal/. 0. 2. Next Level of Appeal M If the Member is not satisfied with the decision regarding medical necessity,medical appropriateness,health 0 13 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 c controlled by KFHPWA.KFHPWA will notify the Member of the name of the external independent review M 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 N independent review will be conducted at no cost to the Member.Once a decision is made through an N independent review organization,the decision is final and cannot be appealed through KFHPWA. a� E If the Member requests an appeal of a KFHPWA decision denying benefits for care currently being received, a� 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 Q review period. A request for a review by an independent review organization must be made within 180 days after the date of Y the initial appeal decision notice. c d IX. Claims U Claims for benefits may be made before or after services are obtained.KFHPWA recommends that the provider Q 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. 49 COB 5 71-0036900 Packet Pg. 79 8.C.a 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 N claims: 0 0 • Immediate request situations—within 1 business day. • Concurrent urgent requests—within 24 hours. Q • Urgent care review requests—within 48 hours. N • Non-urgent preservice review requests—within 5 calendar days. 0 • Post-service review requests—within 30 calendar days. c 0 Timeframes for pre-service and post-service claims can be extended by KFHPWA for up to an additional 15 days. V L Members will be notified in writing of such extension prior to the expiration of the initial timeframe. 0 c �X. Coordination of Benefits 6 > 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 governs the order in which each plan will pay a claim for benefits.The plan N that pays first is called the primary plan. The primary plan must pay benefits according to its policy terms without 0 regard to the possibility that another plan may cover some expenses.The plan that pays after the primary plan is the 0. secondary plan.In no event will a secondary plan be required to pay an amount in excess of its maximum benefit 0 plus accrued savings. M If the Member is covered by more than one health benefit plan,and the Member does not know which is the primary plan,the Member or the Member's provider should contact any one of the 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. o Ln M All health plans have timely claim filing requirements.If the Member or the Member's provider fails to submit the �� Member's claim to a secondary health plan within that plan's claim filing time limit,the plan can deny the claim.If c the Member experiences delays in the processing of the claim by the primary health plan,the Member or the N r Member's 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. E W a� L If the Member is covered by more than one health benefit plan,the Member or the Member's provider should file all Q the Member's claims with each plan at the same time.If Medicare is the Member's primary plan,Medicare may , submit the Member's claims to the Member's secondary carrier. `m M Definitions. Y c A. A plan is any of the following that provides benefits or services for medical or dental care or treatment.If d separate contracts are used to provide coordinated coverage for Members of a Group,the separate contracts t are considered parts of the same plan and there is no COB among those separate contracts.However,if U COB rules do not apply to all contracts,or to all benefits in the same contract,the contract or benefit to Q 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, 50 COB571-0036900 Packet Pg. 80 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 N federal governmental plans;unless permitted by law. p z Each contract for coverage under Subsection 1. or 2. is a separate plan.If a plan has two parts and COB Q 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 L 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 C) provision to certain benefits, such as dental benefits,coordinating only with similar benefits,and may apply `o another COB provision to coordinate other benefits. m C. The order of benefit determination rules determine whether this plan is a primary plan or secondary plan N when the Member has health care coverage under more than one plan. c When this plan is primary,it determines payment for its benefits first before those of any other plan without considering any other plan's benefits.When this plan is secondary,it determines its benefits after those of vi another plan and must make payment in an amount so that,when combined with the amount paid by the c 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 c combined with what the primary plan paid,totals 100%of the allowable expense.In addition,if this plan is a) secondary,it must calculate its savings(its amount paid subtracted from the amount it would have paid had M it been the primary plan)and record these savings as a benefit reserve for the covered Member. This 0 13 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. 0 0 D. Allowable Expense.Allowable expense is a health care expense,coinsurance or copayments and without M 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 N considered an allowable expense and a benefit paid.An expense that is not covered by any plan covering coi the Member is not an allowable expense. a� E The following are examples of expenses that are not allowable expenses: 4) L 1. The difference between the cost of a semi-private hospital room and a private hospital room is not an Q 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 Y 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 y allowable expense. E t U 3. If a Member is covered by two or more plans that provide benefits or services on the basis of Q 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. 51 COB571-0036900 Packet Pg. 81 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. m N Order of Benefit Determination Rules. 0 When a Member is covered by two or more plans,the rules for determining the order of benefit payments are as follows: Q 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. M c B. (1)Except as provided below(subsection 2),a plan that does not contain a coordination of benefits C) provision that is consistent with this chapter is always primary unless the provisions of both plans state that `0 the complying plan is primary. m (2)Coverage that is obtained by virtue of membership in a Group that is designed to supplement a part of a N basic package of benefits and provides that this supplementary coverage is excess to any other parts of the c 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. vi 0 C. A plan may consider the benefits paid or provided by another plan in calculating payment of its benefits _J only when it is secondary to that other plan. 0. .r D. Each plan determines its order of benefits using the first of the following rules that apply: M 0 13 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 c beneficiary and,as a result of federal law,Medicare is secondary to the plan covering the Member as a M 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 N Member as an employee,member,policyholder,Subscriber or retiree is the secondary plan and the N other plan is the primary plan. a� E 2. Dependent child covered under more than one plan.Unless there is a court decree stating otherwise, 0 a) when a dependent child is covered by more than one plan the order of benefits is determined as follows: Q a) For a dependent child whose parents are married or are living together,whether or not they have ever been married: N_ • The plan of the parent whose birthday falls earlier in the calendar year is the primary plan;or 0 Y • If both parents have the same birthday,the plan that has covered the parent the longest is the primary plan. E b) For a dependent child whose parents are divorced or separated or not living together,whether or E not they have ever been married: U i. If a court decree states that one of the parents is responsible for the dependent child's health Q 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; 52 COB 5 71-0036900 Packet Pg. 82 8.C.a iii. If a court decree states that both parents are responsible for the dependent child's health care 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 dependent child's health care expenses or health care coverage,the order of benefits for the child are as follows: • The plan covering the custodial parent,first; N • The plan covering the spouse of the custodial parent,second; `0 • The plan covering the non-custodial parent,third;and then • The plan covering the spouse of the non-custodial parent,last. Q c) For a dependent child covered under more than one plan of individuals who are not the parents of rn the child,the provisions of Subsection a)or b)above determine the order of benefits as if those 0 individuals were the parents of the child. c 0 3. Active employee or retired or laid-off employee.The plan that covers a Member as an active V L employee,that is,an employee who is neither laid off nor retired,is the primary plan. The plan 0 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 N 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 N under a right of continuation provided by state or other federal law is covered under another plan,the 0 plan covering the Member as an employee,member, Subscriber or retiree or covering the Member as a 0. Dependent of an employee,member,Subscriber or retiree is the primary plan and the COBRA or state 0 .r 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 M apply if the rule under Section D.1 can determine the order of benefits. �a m 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 c period of time is the secondary plan. M M 6. If the preceding rules do not determine the order of benefits,the allowable expenses must be shared N 0 equally between the plans meeting the definition of plan.In addition,this plan will not pay more than it N r would have paid had it been the primary plan. a� E Effect on the Benefits of this Plan. y When this plan is secondary,it must make payment in an amount so that,when combined with the amount paid by Q 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 `m 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. Y c Right to Receive and Release Needed Information. d Certain facts about health care coverage and services are needed to apply these COB rules and to determine benefits t payable under this plan and other plans.KFHPWA may get the facts it needs from or give them to other M organizations or persons for the purpose of applying these rules and determining benefits payable under this plan Q 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. 53 COB571-0036900 Packet Pg. 83 8.C.a 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 N maximum amount of payment necessary to satisfy the intent of this provision.KFHPWA may recover excess 0 payment from any person to whom or for whom payment was made or any other issuers or plans. Q Questions about Coordination of Benefits?Contact the State Insurance Department. U) Effect of Medicare. L Medicare primary/secondary payer guidelines and regulations will determine primary/secondary payer status,and r_ will be adjudicated by KFHPWA as set forth in this section.KFHPWA will pay primary to Medicare when required V by federal law.When Medicare,Part A and Part B or Part C are primary,Medicare's allowable amount is the highest `0 allowable expense. m When a Network Provider renders care to a Member who is eligible for Medicare benefits,and Medicare is deemed N to be the primary bill payer under Medicare secondary payer guidelines and regulations,KFHPWA will seek Medicare reimbursement for all Medicare covered services. — d XI. Subrogation and Reimbursement Rights vi 0 The benefits under this EOC will be available to a Member for injury or illness caused by another party,subject to _J the exclusions and limitations of this EOC. If KFHPWA provides benefits under this EOC for the treatment of the c injury or illness,KFHPWA will be subrogated to any rights that the Member may have to recover compensation or U) damages related to the injury or illness and the Member shall reimburse KFHPWA for all benefits provided,from M any amounts the Member received or is entitled to receive from any source on account of such injury or illness, 0 13 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; 0 • Any Workers' Compensation or disability award or settlement; M • Medical payments coverage under any automobile policy,premises or homeowners'medical payments coverage or premises or homeowners' insurance coverage;and N 0 • Any other payments from a source intended to compensate an Injured Person for injuries resulting from an N r accident or alleged negligence. E This section more fully describes KFHPWA's subrogation and reimbursement rights. L a� "Injured Person"under this section means a Member covered by the EOC who sustains an injury or illness and any Q spouse,dependent or other person or entity that may recover on behalf of such Member including the estate of the `m Member and,if the Member is a minor,the guardian or parent of the Member.When referred to in this section, " U) KFHPWA's Medical Expenses"means the expenses incurred and the value of the benefits provided by KFHPWA Y under this EOC for the care or treatment of the injury or illness sustained by the Injured Person. d If the Injured Person's injuries were caused by a third-party giving rise to a claim of legal liability against the third t party and/or payment by the third party to the Injured Person and/or a settlement between the third party and the U Injured Person,KFHPWA shall have the right to recover KFHPWA's Medical Expenses from any source available Q 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 acknowledges KFHPWA's right of reimbursement.This right of reimbursement attaches when this KFHPWA has provided benefits for injuries or 54 COB 5 71-0036900 Packet Pg. 84 8.C.a illnesses caused by another party and the Injured Person or the Injured Person's representative has recovered any amounts from a third party or any other source of recovery.KFHPWA's right of reimbursement is cumulative with and not exclusive of its subrogation right and KFHPWA may choose to exercise either or both rights of recovery. In order to secure KFHPWA's recovery rights,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 extent of the plan's 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. N 0 KFHPWA's subrogation 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. Q 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 M uninsured/underinsured motorist funds,KFHPWA's Medical Expenses are secondary,not primary. C 0 c.� The Injured Person and their agents shall cooperate fully with KFHPWA in its efforts to collect KFHPWA's Medical `0 Expenses.This cooperation includes,but is not limited to,supplying KFHPWA with information about the cause of 3 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 w or reimbursement.The Injured Person shall provide periodic updates about any facts that may impact KFHPWA's right to reimbursement or subrogation as requested by KFHPWA,and shall inform KFHPWA of any settlement or — other payments relating to the Injured Person's injury.The Inured Person and their agents shall permit KFHPWA p Y g J j rY• J g at KFHPWA's option,to associate with the Injured Person or to intervene in any legal,quasi-legal,agency or any vi other action or claim filed. 0 J The Injured Person and their agents shall do nothing to prejudice KFHPWA's subrogation and reimbursement 0. rights.The Injured Person shall promptly notify KFHPWA of any tentative settlement with a third party and shall v� not settle a claim without protecting KFHPWA's interest. The Injured Person shall provide 21 days advance notice M to KFHPWA before there is a disbursement of proceeds from any settlement with a third party that may give rise to 0 a claim for subrogation or reimbursement.If the Injured Person fails to cooperate fully with KFHPWA in recovery of KFHPWA's Medical Expenses,and such failure prejudices KFHPWA's subrogation and/or reimbursement rights,the Injured Person shall be responsible for directly reimbursing KFHPWA for 100%of KFHPWA's Medical c Expenses. LO To the extent that the Injured Person recovers funds from any source that in any manner relate to the injury or illness N giving rise to KFHPWA's right of reimbursement or subrogation,the Injured Person agrees to hold such monies in N trust or in a separate identifiable account until KFHPWA's subrogation and reimbursement rights are fully c determined and that KFHPWA has an equitable lien over such monies to the full extent of KFHPWA's Medical E Expenses and/or the Injured Person agrees to serve as constructive trustee over the monies to the extent of (D KFHPWA's Medical Expenses.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 Q funds without regard to KFHPWA's rights of subrogation or reimbursement will be personally liable to KFHPWA for the amounts so distributed. N M Y 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 y apportionment of such collection costs between KFHPWA and the Injured Person.This reduction will be made only r if each of the following conditions has been met: (i)KFHPWA receives a list of the fees and associated costs before U settlement and(ii)the Injured Person's attorney's actions were directly related to securing recovery for the Injured Q 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. 55 COB571-0036900 Packet Pg. 85 8.C.a 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 N same services or supplies;and the charges are within the general range of charges made o by other providers in the same geographical area for the same services or supplies. t Members shall be required to pay any difference between a non-Network Provider's Q charge for services and the Allowed Amount,except for Emergency services,including , post stabilization and for ancillary services provided by a non-Network provider at a U) Network Facility.For more information about balance billing protections,please visit: L https://health. .k�rpermanente.oriz/washin tg on/support/fonns and click on the"Billing W forms"link. C V L Convalescent Care Care furnished for the purpose of meeting non-medically necessary personal needs 3 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 w medication. N am c Copayment The specific dollar amount a Member is required to pay at the time of service for certain Covered Services. vi Cost Share The portion of the cost of Covered Services for which the Member is liable.Cost Share � includes Copayments,coinsurances and Deductibles. 0. Covered Services The services for which a Member is entitled to coverage in the Evidence of Coverage. M 13 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 00 actuarial guidelines.In general,the actuarial determination measures whether the M expected amount of paid claims under KFHPWA's prescription drug coverage is at least �- as much as the expected amount of paid claims under the standard Medicare prescription N drug benefit. 0 r c Deductible A specific amount a Member is required to pay for certain Covered Services before benefits are payable. 4) L 0 Dependent Any member of a Subscriber's family who meets all applicable eligibility requirements, Q is enrolled hereunder and for whom the premium has been paid. m T) Emergency The emergent and acute onset of a medical,mental health or substance use disorder M Y 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 y exists that requires immediate medical attention,if failure to provide medical attention E t would result in serious impairment to bodily function or serious dysfunction of a bodily U organ or part,or would place the Member's health,or if the Member is pregnant,the Q 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, 56 COB571-0036900 Packet Pg. 86 8.C.a 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 and chronic disease management and pediatric services,including oral and vision care. Established Member must have had at least one in-person appointment or at least one real-time Relationship interactive appointment using both audio and visual technology in the past year,with the N provider providing audio only telemedicine or with a provider employed at the same o medical group,at the same clinic,or by the same integrated delivery system operated by z KFHPWA. Or the Member was referred to the provider providing audio-only Q telemedicine by a provider who they have had an in-person appointment within the past , year. M L Evidence of Coverage The Evidence of Coverage is a statement of benefits,exclusions and other provisions as c set forth in the Group Medical Coverage Agreement between KFHPWA and the Group. 0 V L 0 Family Unit A Subscriber and all their Dependents. 3 m Group An employer,union,welfare trust or bona-fide association which has entered into a w Group Medical Coverage Agreement with KFHPWA. 0 c Hospital Care Those Medically Necessary services generally provided by acute general hospitals for admitted patients. vi 0 KFHPWA-designated A specialist specifically identified by KFHPWA. _J Specialist 0 .r Medical Condition A disease,illness or injury. M 13 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 c services,as determined by KFHPWA's medical director according to generally accepted M 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. N In order to be Medically Necessary,services and supplies must meet the following N 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 E supply which can be safely provided to the Member; (c)are for the diagnosis or 4) treatment of an actual or existing Medical Condition unless being provided under KFHPWA's schedule for preventive services; (d)are not for recreational,life-enhancing, Q 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 0 Y adversely affecting the Member's condition or the quality of health services rendered; (f) as to inpatient care,could not have been provided in a provider's office,the outpatient y department of a hospital or a non-residential facility without affecting the Member's E condition or quality of health services rendered;(g)are not primarily for research and U data accumulation;and(h)are not experimental or investigational.The length and type Q of the treatment program and the frequency and modality of visits covered shall be determined by KFHPWA's medical director.In addition to being medically necessary,to be covered,services and supplies must be otherwise included as a Covered Service and not excluded from coverage. 57 COB571-0036900 Packet Pg. 87 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 N Foundation Health Plan of Washington or otherwise designated by KFHPWA,or with r 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 Q Physician Washington Permanente Medical Group,P.C.,or contracted with KFHPWA to provide U) primary care services to Members and is selected by each Member to provide or arrange L for the provision of all non-emergent Covered Services,except for services set forth in c the EOC which a Member can access without Preauthorization.Network Personal V Physicians must be capable of and licensed to provide the majority of primary health `o care services required by each Member. m Network Provider The medical staff,clinic associate staff and allied health professionals employed by w 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, vi psychologists,physical therapists and other professionals engaged in the delivery of c healthcare services who are licensed or certified to practice in accordance with Title 18 _J Revised Code of Washington. c 0 Out-of-pocket Expenses Those Cost Shares paid by the Subscriber or Member for Covered Services which are M applied to the Out-of-pocket Limit. 0 13 am Out-of-pocket Limit The maximum amount of Out-of-pocket Expenses incurred and paid during the calendar 2 year for Covered Services received by the Subscriber and their Dependents within the 00 same calendar year.The Out-of-pocket Expenses which apply toward the Out-of-pocket M Limit are set forth in Section IV. M N Plan Coinsurance The percentage amount the Member is required to pay for Covered Services received. N r c Preauthorization An approval by KFHPWA that entitles a Member to receive Covered Services from a E specified health care provider. Services shall not exceed the limits of the y 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 Q Preauthorization for specialty care provider services. Private Duty Nursing The hiring of a nurse by a family or Member to provide long term and/or continuous one Y (or 24-hour nursing on one care with or without oversight by a home health agency.The care may be skilled, care) supportive or respite in nature. t Residential Treatment A term used to define facility-based treatment,which includes 24 hours per day,7 days U per week rehabilitation.Residential Treatment services are provided in a facility Q 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. 58 COB571-0036900 Packet Pg. 88 Service Area Washington counties of Benton,Columbia,Franklin,Island,King,Kitsap,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. m Urgent Condition The sudden,unexpected onset of a Medical Condition that is of sufficient severity to 0 require medical treatment within 24 hours of its onset. Q 0 L r- �O♦ V L O d d O J Q. O r.+ M V 13 d O O LO M M N O N r C N E N N L Q d M Y c d E t v r Q 59 COB571-0036900 Packet Pg. 89 8.C.a Notice of Nondiscrimination Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. ("Kaiser Permanente")comply with applicable Federal and Washington state civil rights laws and do not O N discriminate,exclude people,or treat them differently on the basis of race,color,national origin,age, L- disability,sex,sexual orientation,gender identity,or any other basis protected by applicable federal, state,or local law.We also: O Q • Provide free aids and services to people with disabilities to communicate effectively with us, y r such as: v cv L — Qualified sign language interpreters O — Written information in other formats(large print,audio,accessible electronic formats,and U L other formats) 0 — Assistive devices(magnifiers,Pocket Talkers,and other aids) d • Provide free language services to people whose primary language is not English,such as: y — Qualified interpreters d c — Information written in other languages If you need these services,contact Member Services at 1-888-901-4636(TTY 711). N If you believe that Kaiser Permanente has failed to provide these services or discriminated in another O J way on the basis of race,color,national origin,age,disability,sex,sexual orientation,or gender identity, Q you can file a grievance with our Civil Rights Coordinator by writing to P.O. Box 35191,Mail Stop: 0 RCR-A35-03,Seattle,WA 98124-5191 or calling Member Services at the number listed above.You can file U) a grievance by mail,phone,or online at kp.org/wa/feedback. If you need help filing a grievance,our Civil v Rights Coordinator is available to help you. m You can also file a civil rights complaint with: • The U.S. Department of Health and Human Services,Office for Civil Rights electronically through p LO the Office for Civil Rights Complaint Portal,available at https://ocrportal.hhs.gov/ocr/portal/lobby.isf,or by mail or phone at: U.S. Department of C 1 Health and Human Services,200 Independence Avenue SW.,Room 509F,HHH Building, p Washington,DC 20201, 1-800-368-1019,800-537-7697(TDD) r Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.htmi aa)i E • The Washington State Office of the Insurance Commissioner,electronically through the Office of the Insurance Commissioner Complaint portal available at https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status,or by phone at Q 800-562-6900,360-586-0241(TDD).Complaint forms are available at https://fortress.wa.gov/oic/onlineservices/cc/pub/complaintinformation.aspx N Y c m E t 2022-XB-7_ACA_Notice_Taglines Vim° KAISER PERMANEWE® Q 60 COB571-0036900 Packet Pg. 90 8.C.a Multi-language Interpreter Services English:ATTENTION:If you speak a language other than English,language assistance services,free of charge,are available to you. Call 1-888-901-4636(TTY 711). N N Espan"ol(Spanish):ATENCI6N:Si habla espanol,tiene disponibles servicios de ayuda con el idioma sin cargo. i- Hame al 1-888-901-4636(TTY 711). 7 L�3t(Chinese) rTAZK 1-888-901-4636 Q (TTY 711) y r v Tieng Viet(Vietnamese):CHID N:N6u quy vi n6i tieng Viet,quy vi co the six dung dich vu ho trd ng6n ngix i mien phi c6a chung t6i.Xin goi so"1-888-901-4636(TTY 711). 0 a> 12�1 (Korean):J�jl:a�-�t 1�1'1 RL h}-$-o}Al o-T, 111°j 7,l a M til Z -q--7- A]� ��t-q L 1-888-901-4636(TTY 711)-Li ---,-i 91 oIA�h1 o. C PYCCKHN(Russian):BHNMAHNE! ECAm Bbi roBopmTe n0-pycCKW,BaM AOCTynHbi 6ecnnaTHbie ycnyr" j nepeBO,ALIMKa.3BOHHTe no Homepy 1-888-901-4636(TTY 711). N d Tagalog:PAUNAWA:Kung nagsasalita ka ng Tagalog,maaari kang gumamit ng mga serbisyo ng tulong sa S wika nang walang bayad.Tumawag sa 1-888-901-4636(TTY 711). d 3.1 YKpaIHCbKa(Ukrainian):YBAfA!FIKLL�0 BN p03MOBAACTe yKpaIHCb K0M MOBOK),BaM AOCTynHI 6e3KOWTOBHi y nocnyrL1 nepeKnaAy.Tene4)OHYt Te 3a HoMepoM 1-888-901-4636(TTY 711). 00 J a 0- Fil€U1S2S (Khmer)' CiSf3PSSi5Gt5OMwli5o PSSf3Si5t5Scii5S312iiSjS31tSF3 0 fi l 91[i 1S5' FUO 1-888-901-4636(TTY 711)`l U) R S ao(Japanese):;±'Z*EX : *f40)H*AaZ0)aap 1�— N � 1�L\LLif-d-z to v 1-888-901-4636(TTY 711) J�Z. f&�'�<tE t Lxo hOYC'r(Amharic)*07AML.Ff 4"�S74,fi 5V35�A"40�h0 4+C?-P h7H frig AACWv PqC A-: o WY 1-888-901-4636(TTY 711),P,9aA-r: Q M Oromiffa(Oromo):XIYYEEFFANNAA:Afaan dubbattu Oroomiffa yoo We,tajaajila gargaarsa afaanii, kanfaltiidhaan ala,ni argama. 1-888-901-4636(TTY 711)irraatti bilbilaa. N 0 N IIRQ(Punjabi):f4*rrc7 t�:4-5F ifrT�$��t�c�,3T-!gT$T��!oAjo3cTraFoNu3QLfKkikiZ-6i � 1-888-901-4636(TTY 711)`�qFF-q�I E N .ULl_«JJ&�sy>�a g:JJI o rsl oJl uL r�1s�a_yJl a;JJI u ti aS151:olwl:(Arabic)ZeyJl W (TTY 711) 1-888-901-4636 P9�1 �J�31 Q Deutsch(German):ACHTUNG:Wenn Sie Deutsch sprechen,stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur VerfOgung. Rufnummer: 1-888-901-4636(TTY 711). to (Lao):1L$c)sl-)e): ccaiz�ava3ri�z�v�n�a����c�n�c��r�����Fc��vc���i:2�nccrien�a�.Fen 1-888-901-4636(TTY 711). E t v R r XB0001444-58-22 Q 61 COB571-0036900 Packet Pg. 91 8.C.b AMENDMENT NO. 14 To be attached to and made part of Policy WA 518212 issued to City of Kent as Policyholder. m N It is hereby agreed the Policy shall be amended as follows: 0 a Effective January 1, 2023: c� The following Section has been replaced: O Section 1, Declarations. o c a� a� The following Rider renews for the 2023 Policy Year: as Specific Advance Funding Rider. O J Q O r N fC v N O O LO All other terms and conditions of the contract remain unchanged. M N O N C N E C d E Q d N LifeWise Assurance Company Name and Title of Officer J Signature of Officer E Rick Grover President and Chief Executive Officer Q Date of Signature LifeWise Assurance Company 1. Sign and return copy to LifeWise Assurance Company. 2. Retain copy with Your Policy. PSL-500 WA AM (9-18) Amendment Packet Pg. 92 8.C.b This Declarations for Policy Number WA 518212 apply to the Policy Term January 1, 2023 through December 31, 2023 in its entirety. SECTION 1 — DECLARATIONS IF A. POLICY INFORMATION N 0 1. Policy Number WA 518212 a 2. Policyholder City of Kent 3. Policy Term January 1, 2023 through December 31, 2023 i c 4. Covered Underlying Plan City of Kent's Health Plan ° U L 5. Claim Administrator Premera Blue Cross ° c a� B. SPECIFIC BENEFIT SCHEDULE > For all Eligible Losses except those to which a Special Risk Limitation applies: c 1. Covered Loss Basis Covered Services Incurred from January 1, 2010 through December 31, 2023 and Paid from vi January 1, 2023 through December 31, 2023. 0 J If an Eligible Claim Expense is denied by the Covered Underlying Plan and that denial is o subsequently reversed by an Independent Review Organization (IRO),the date such Eligible in Claim Expense was originally denied by the Covered Underlying Plan will be considered the "Paid"date under the above referenced Policy. W 2. Covered Services include Medical o 0 Prescription Drug .LOM. M 3. Number of Covered Units o N Composite 701 m 4. Specific Deductible per Participant $200,000 c (Please note: Specific deductible per Participant shall not exceed the lesser of 5%of expected claims or$100,000). Q 5. Specific Payable Percentage (in excess of Specific Deductible) 100% N 6. Maximum Specific Benefit in excess of the Specific Deductible _ J Per Policy Term Unlimited r c Per Lifetime Unlimited E c� Q PSL-500 WA(9-18) 1 Packet Pg. 93 8.C.b C. AGGREGATE BENEFIT SCHEDULE For all Eligible Losses except those to which a Special Risk Limitation applies: 1. Covered Loss Basis Covered Services Incurred from January 1, 2010 through December 31, 2023 and Paid from N January 1, 2023 through December 31, 2023. o t If an Eligible Claim Expense is denied by the Covered Underlying Plan and that denial is subsequently reversed by an Independent Review Organization (IRO),the date such Eligible Q Claim Expense was originally denied by the Covered Underlying Plan will be considered the "Paid"date under the above referenced Policy. cLa c 2. Covered Services include v Medical o Prescription Drug c a� 3. Number of Covered Units N Composite 701 a� 4. Aggregate Payable Percentage in excess of Deductible 100% vi 5. Aggregate Corridor 200% J (Please note: Aggregate Corridor will never be less than 120%of expected claims). o r N 6. Minimum Aggregate Deductible _ The greater of: :a A. $29,344,420.80; or B. The sum of Aggregate Monthly Factors, multiplied by the corresponding number of c Covered Units used to calculate premium in the first month of the Policy Term, multiplied LO by the number of months in the Policy Term, multiplied by 95%. M 7. Annual Aggregate Deductible c N Is equal to the greater of A or B,where: A=The sum of the Monthly Aggregate Deductible Amounts applicable to each Policy Month E in the Policy Term c B =The Minimum Aggregate Deductible °' E Please Note:Annual Aggregate Deductible cannot be finalized until the Monthly Aggregate Q Deductible Amounts are calculated for each Policy Month of the Policy Term. N 8. Aggregate Monthly Factor per Covered Unit Composite $3,488.40 J r c 9. Maximum Aggregate Eligible Loss per Participant $200,000 E 10. Maximum Aggregate Benefit per Policy Term $1,000,000 Q PSL-500 WA(9-18) 2 Packet Pg. 94 8.C.b D. PREMIUM Specific Monthly Premium Rate Composite $155.28 m Specific Rate Guarantee Period 12 Months ^' 0 Aggregate Monthly Premium Rate Per Covered Unit Composite $0.02 a Aggregate Rate Guarantee Period 12 Months i c The Specific Monthly Premium Rate and the Aggregate Monthly Premium Rate apply only to this 0 Policy Term. L 0 c E. SPECIAL RISK LIMITATIONS > Retirees Included Yes c a� Other: Yes vi Lasered Individual N 0 J Member ID: 600156808-02 a Specific Deductible: $300,000 0 Paid Claims between$200,000 and $300,000 are not eligible under the Aggregate Benefit. N F. AFFILIATE 0 Name Covered Underlying Plan c None M N O N C N >_ C d E Q d N J r C N E L V cC Q PSL-500 WA(9-18) 3 Packet Pg. 95 8.C.c • KENT - SOW - 3 TIM STATEMENT OF WORK-PROGRAM LAUNCH This KENT-SOW-3 effective as of April 1,2023("SOW Effective Date")is entered into pursuant to and incorporates N herein by reference the terms and conditions of the Vitality Master Services Agreement(the"Agreement")by and between o The Vitality Group, LLC("TVG")and CITY OF KENT,AWASHINGTONMUNICIPF('�Gu&torner").Services performed under this SOW will be 0 provided in accordance with and subject to the terms and conditions of this SOW,the Agreement and any applicable ' Amendments. Q 1. SCOPE OF WORK AND SCHEDULE. c This SOW shall cover and define all services to be provided by TVG as described under Section 3 of this SOW. U L 0 2. DEFINITIONS. c a� All capitalized terms not otherwise defined herein shall have the meaning ascribed to such term in the Agreement. > a� 2.1 "Program Launch"means the first day the Vitality Services will be accessible by eligible persons. as 2.2. "Vitality Bucks"means the currency that is provided to a Member to be redeemed for Vitality Rewards. If Member spends Vitality Bucks,the Member's Vitality Points do not change. 0 J CL 2.3. "Vitality Champ"means Customer's employee who are interested in promoting healthy living within the workplace. o Their role is to help other employees engage in the Vitality Program using tools provided. 2.4. "Vitality Program"means an incentive based wellness program which incorporates Vitality Points,Vitality Status and Vitality Rewards into a meaningful tool for the benefit of the Customer and Members. 2.5. "Vitality Points"means the unit that is earned by Members for participating in the Vitality Program. c LO M 2.6. "Vitality Program Year"means the rolling twelve month period your Vitality Program Year will begin and end twelve months later. 04 0 N 2.7. "Vitality Rewards"means the benefits available to Members according to an earned Vitality Status. 2.8."Vitality Status"means the threshold levels that Members may achieve by engagement in the Vitality 0 Program. 0 0 r M N O 3. DESCRIPTION OF SERVICES. L Q Below is a high level description of the"Vitality Services."Full requirements will be detailed throughout this SOW. Q M 3.1. TVG shall provide Vitality Services,which shall include,but not be limited to the following components. 0 3.1.1. A suite of health and wellness-oriented activities,clinical goals/measures,educational programs,and other objectives for members to pursue("Engagements"). 3.1.2. Health risk assessments and other or similar tool(s)to identify a member's current health and wellness levels, > conditions,activities, risks,and related factors. 3.1.3. A designated wellness strategy manager to assist in leading a standard ninety day implementation and building Customer's strategy for running a wellness portal. 3.1.4. A points based incentive structure to encourage members to pursue Engagements. 3.1.5. Various"Vitality Rewards"which members may qualify for through engagement in the Vitality Program,which a may include Earn Apple Watch with Apple Watch fulfillment. ................................................................................................................................................................................. Agency-Vitality SOW#3 1 8.C.c • TM KENT - SOW - 3 4. RESPONSIBILITIES OF TVG. 4.1. Program Launch. TVG shall accurately implement and launch the Vitality Program on April 1, 2019 N (the"Program Launch Date")in accordance with the program selection of this SOW. However,in the event that 0 Customer has not satisfied the obligations of Section 4 of KENT-SOW- 1 TVG may in its sole discretion delay the Program Launch Date to the first day of the following month. Q 4.2. On Going. Effective upon Program Launch,TVG shall provide a designated wellness strategy manager throughout the p 9 p 9 9Y 9 9 � term of this SOW.The designated wellness strategy manager shall be responsible for: c 4.2.1. Developing with Customer an annual strategy engagement and roadmap including specific objectives and goals U prior to the start of each Vitality Program Year. o c 4.2.2. Leading and scheduling a monthly call to discuss engagement strategy,communication plans,troubleshoot escalated issues and any updates on the Vitality Program a� 4.2.3. Providing and assisting in the review of the standard monthly,quarterly and annual reports.' a� 4.2.4. Provideing training prior to Program Launch on: 4.2.4.1. The Vitality Information Portal o 4.2.4.2. Vitality Champs _J a 0 4.2.5. Up to once a month,if requested,attending via teleconference a monthly Vitality Champ ongoing training session y 4.2.6. Delivering a monthly client newsletter to Customer a� 5. RESPONSIBILITIES OF CUSTOMER. 0 5.1. Ongoing. Effective upon Program Launch, Customer shall provide a designated point of contact throughout the term LO of this SOW.The designated point of contact shall be responsible for: m N 5.1.1. Develop with TVG an annual strategy engagement and roadmap c N L 5.1.2. Regularly attend TVG standard trainings2 5.1.3. Reasonably cooperating with the TVG wellness strategy manager to promote engagement and use of the U Vitality Program using TVG provided tools such as: o 5.1.3.1.Attending monthly teleconferences with TVG call to discuss engagement strategy,communication plans, troubleshoot escalated issues and any updates on the Vitality Program N 5.1.3.2. Developing regular communications using the TVG provided communication center. In the event Customer N creates non-standard communication materials,Customer agrees to seek TVG approval prior to distribution. 5.1.3.3. Using the C-Suite Tool Kit to promote engagement and communication at the executive level Q- Q 5.1.3.4.Vitality Champ recruitment,training and use including a monthly call with TVG and a Vitality Champ r� 5.1.3.5.Sponsoring TVG approved activities with allocated additional Vitality Points 5.1.3.6. Informing and educating any new hires of the Vitality Program using TVG provided materials y If at the end of any quarter,fewer than fifty(50)eligible employees have completed the Vitality Health Review,certain standard reports may > not be available due to privacy and security concerns. :: c 2 All trainings are subject to change as the program evolves,Customer will be provided adequate notice prior to any new training to best equip E Customer to get the full value of the Vitality Program c� Q ....................................................................................................................................................................... Agency-Vitality SOW#3 2 Packet Pg. 97 KENT - S $�E TM 5.1.4. Provide TVG an ongoing,accurate Eligibility File no less frequently than once permonth3 5.1.4.1. In the event an Eligibility File contains errors, it shall be the Customer's responsibility to review the TVG provided error reports and make all appropriate changes N 5.1.5. Provide TVG with reasonable notice of any business changes such as changes to the&Suite, main contacts, t Human Resources or Benefits Department as well as any changes to business entity structure to enable the wellness strategy manager and Customer to update and modify any objectives,goals or overall strategy as Q required. r 6. TERM 6.1. The Services described in this SOW shall commence April 1,2023 and continue until December 31,2026 � 0 ("Renewal Term"). Following the Renewal Term,a new SOW shall be automatically generated to renew c� for a successive period of one(1)year each(each a"Renewal Terri'). o 6.2. During any Renewal Term,either Party may terminate this SOW with ninety(90)days written notice.The termination shall be effective the last day of the month following the ninety(90)day notice period > a� c a� vi O J Q O r R 7. VITALITY PROGRAM SELECTIONS and COMPENSATION SCHEDULE 0 a� 7.1. Customer shall provide TVG with a minimum of ninety(90)days'notice in the event Customer chooses to change any oc of their Vitality Program selections as shown below.Any change to Vitality Program offering may only occur at the M renewal of each Vitality Program Year and be agreed to in an amendment to this SOW m 7.2. After Renewal Term, Once per year,all fees outlined below are subject to change with ninety(90)days written notice to c Customer.Any changes to the PEPM Administration Fee will be limited to the percentage increase in the Consumer Price Index-Urbai ci over a corresponding time period. E a� a� 7.3. In the event Customer requests any work, reports or integrations be done by TVG or with the support of TVG outside o of what is contained herein,additional fees may apply. Program Selection Charge Basis(If Applicable) Amount o N NAtality Program a Activate Q • Elevate "' Members shall be: Per Employee Per Month $ 5.06 0 0 En ooyees Only (PEPW Administration Fee ;, Employees and eligible dependents(no children) Employees and eligible dependents(with children) w c a� 3 The Customer shall provide TVG,on a regular basis,an electronic file in a format specified by TVG("Digibility File")of all members along with E such information as is reasonably required to enable TVG to verify the identity of r w-bers and administer the Vitality Program.The Customer's updating of its Eligibility File shall serve as notice to TVG of any additions,changes,deletions or modifications to the list of members and TVG f° shall be entitled to rely on the accuracy and completeness of the enrollment and eligibility data in providing the Vitality Program In no event shall Q TVG be required to revise the eligibility retroactively. 4 If an employee had access for at least one day at any pant during the calendar month,the full PEPM will be owed. Agency-Vitality buvvg.s Packet Pg. 98 8.C.c KENT -Im a� N O t 3 Member Education Sessions5: Q 2 included following Program Launch Travel and expenses only r c additional in the first Vitality Program Year $850/visit plus travel and expenses Varies v `o additional in the subsequent Vitality Program Years $850/visit plus travel and expenses > Add-On Vitality Rewards: Mall: Customer shall be responsible for O No Mall funding any items purchased in the Mall Varies Q Low Mall via a reimbursement on each bill. o Q Standard Mall a 0 Vitality Squares Vitality Squares is included in the y Administration Fee N/A - U Vitality HealthyFood V�alrrert Vitality HeaIthyF is included in the N/A Nutrisavi Admnistration Fee c LO M Welliness Rebates: Customer shall be responsible for funding c any Rebates redeetred via a 04 rein-burserrent on each bill. d No Wellness Rebates E ®SniJdng Cessation Up to$200/Rebate Redeemed'a ©Wight Loss Up to$200/Rebate Redeemedsb Vanes o Rebate/Subsi per verified workouts 0 GO M N O N L Q Q M 0 N SA Member Education Session includes use of a TVG employee for a business day.Sites within a close proximity that can be traveled to within the time frame > allotted may,at TVG's discretion,be considered one site.Customer may exchange an on-site visit for a business day of up to four(4)Member education a� webinars.A webinar is an hour long session which may be recorded during the session and distributed after. Reasonable time for meals and short breaks must E be provided for TVG employees. All Member educations,whether done via recorded webinar or onsite must be agreed and approved by TVG at time of U scheduling.Travel expenses are not included and will be charged to Customer by TVG at cost. Q 60 Members may earn each rebate once per lifetime. ................................................................................................................................................................................. Agency-Vitality SOW#3 4 8.C.c TM Active Rewards: Customer shall be responsible for Not Offered funding the total value of any gift Varies 4 cards redeemed via a o ® Offered reimbursement on each bill. a Earn Apple Watch Earn Apple Watch Administration Fee Not Offered PEPM c ® Offered EE-Only In addition, Customer shall be 0 Varies ® Offered EE+Spouses responsible for funding the -L_°0 discounted monthly Apple Watch payments earned by Members" > Biometric Screenings Submission: Integrated Partner B aTietric Screener No Charge N/A v; 0 J ®Devate Integrated Non-Partner Biometric Screener One-Tirre Set Up Fee 9a $2,000 OrrCoing Maintenance Fee $3,500/Year y ®Activate Integrated Non-Partner B m-dric Screener One-Tirre Set Up Fee9b $3,500 Cn-Gang Mair-tenanoe Fee $4,500/Year Paper form Member submission $3/Form Varies c LO M INTENDING TO BE BOUND,this SOW has been duly executed by the authorized representatives of the parties set forth below. c N L CUSTOMER THE MTALJTY GROUP,LLC E E 0 U By: w�,,,,.,,,,� 0 Name: Name: M N O Title: Title: 04 L Q Dated: Dated: Q M O N 7A Member's monthly Apple Watch payments will be lowered in accordance with his or her qualifying activity during the previous month.Customer will be responsible for the amount by which each Member's monthly Apple Watch payment has been lowered.These charges will be applied to the Vitality Rewards cost section on each monthly invoice. > BEarn Apple Watch allows Members the opportunity to pay for an Apple Watch over a twenty-four month period(the"Apple Watch Repayment Period").Members can lower C their monthly payment for as long as this SOW is active.Upon termination of this SOW,TVG may charge Customer an Earn Apple Watch termination fee that will be 4) calculated based on i)the total amount remaining in each Apple Watch Repayment Period;ii)ongoing administration costs and;iii)expected bad debt.Alternatively,if Customer ends the Earn Apple Watch benefit,but does not terminate this SOW,Customer may elect to continue paying the Earn Apple Watch Administration Fee and allowing Earn Apple Watch Members to earn monthly discounts until the Apple Watch Repayment Period has ended or been settled on all Member Apple Watches. Q 90 Fee applies for set-up of a one time file feed in TVG's standard file format. Agency-Vitality SOW#3 5 Packet Pg. 100 8.D KENT WASH IN G T O N DATE: April 4, 2023 TO: Kent City Council SUBJECT: Washington State Department of Commerce Mill Creek / 76th Avenue South Flood Plain Stabilization, Habitat Enhancement Project $980,000 Grant — Authorize MOTION: I move to accept grant funds in the amount of $980,000 from the Washington State Department of Commerce for the Mill Creek / 761" Avenue South Flood Plain Stabilization, Habitat Enhancement Project, amend the budget, authorize expenditure of funds, authorize the Mayor to sign all necessary documents, subject to final terms and conditions acceptable to the City Attorney and Public Works Director, and to ratify all prior acts consistent with this motion. SUMMARY: The City was successful in receiving a $980,000 grant from the Washington State Department of Commerce for the Mill Creek / 76th Avenue South Flood Plain Stabilization, Habitat Enhancement project. Funds awarded under this grant will be used for capital expenditures to improve habitat and protect against flooding in an urbanized reach of Mill Creek adjacent to 76th Avenue South. This flood plain stabilization and habitat project includes replacement of creek culverts to improve fish passage and habitat, including restoration of vegetation and channel capacity, and creation of flood plain areas to reduce flood risk. The project is located between 22011 and 22408 76th Avenue S. BUDGET IMPACT: Provides $980,000 in revenue to the project account 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. ATTACHMENTS: 1. Dept of Commerce Grant Contract (PDF) 03/20/23 Public Works Committee MOTION PASSES Packet Pg. 101 8.D RESULT: MOTION PASSES [UNANIMOUS]Next: 4/4/2023 7:00 PM AYES: Brenda Fincher, Satwinder Kaur, Marli Larimer Packet Pg. 102 8.D.a . ►. Washington State Department of wwiv commerce N a L U Grant to = City of Kent L through L w The Local and Community Projects Program E O U w O r c a� For Flood Plain Stabilization, Habitat Enhancement 0 Cn 0 Start date: July 1 , 2019 0 LO M a+ V R L O U c cv ,L^ V V L N E E O U O Q E V Y Q Packet Pg. 103 8.D.a Contents FACESHEET................................................................................................................................................1 DECLARATIONS ..........................................................................................................................................2 Q ADDITIONAL RECITALS..............................................................................................................................2 co SPECIAL TERMS AND CONDITIONS.........................................................................................................3 1. GRANT MANAGEMENT...................................................................................................................3 aYi m L 2. COMPENSATION .............................................................................................................................3 C) 3. CERTIFICATION OF FUNDS PERFORMANCE MEASURES.........................................................3 4. PREVAILING WAGE LAW................................................................................................................4 5. DOCUMENTATION AND SECURITY ..............................................................................................4 6. BASIS FOR ESTABLISHING REAL PROPERTY VALUES FOR ACQUISITIONS OF REAL PROPERTY PERFORMANCE MEASURES............................................................................................4 a� E 7. EXPENDITURES ELIGIBLE FOR REIMBURSEMENT....................................................................5 E 0 8. BILLING PROCEDURES AND PAYMENT.......................................................................................5 V 18 9. SUBCONTRACTOR DATA COLLECTION.......................................................................................6 0 c 10. CERTIFIED PROJECT COMPLETION REPORT AND FINAL PAYMENT......................................6 E E 11. INSURANCE.....................................................................................................................................6 a 12. ORDER OF PRECEDENCE.............................................................................................................8 p 13. REDUCTION IN FUNDS...................................................................................................................8 r 14. OWNERSHIP OF PROJECT/CAPITAL FACILITIES........................................................................9 Cn c 15. CHANGE OF OWNERSHIP OR USE FOR GRANTEE-OWNED PROPERTY ...............................9 a� 16. CHANGE OF USE FOR LEASED PROPERTY PERFORMANCE MEASURE ...............................9 E 17. SIGNAGE, MARKERS AND PUBLICATIONS..................................................................................9 Cu 18. HISTORICAL AND CULTURAL ARTIFACTS...................................................................................9 LO 19. REAPPROPRIATION......................................................................................................................10 tn M 20. TERMINATION FOR FRAUD OR MISREPRESENTATION ..........................................................10 0 21. APPLICABILITY OF COPYRIGHT PROVISIONS TO ARCHITECTURAL/ENGINEERING DESIGN m w WORK.....................................................................................................................................................11 0 22. FRAUD AND OTHER LOSS REPORTING ....................................................................................11 V c 23. PUBLIC RECORDS ACT................................................................................................................11 P 0 GENERAL TERMS AND CONDITIONS.....................................................................................................12 L 24. DEFINITIONS..................................................................................................................................12 25. ACCESS TO DATA.........................................................................................................................12 E 0 26. ADVANCE PAYMENTS PROHIBITED...........................................................................................12 U 18 0 27. ALL WRITINGS CONTAINED HEREIN..........................................................................................12 a 28. AMENDMENTS...............................................................................................................................12 0 29. AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, ALSO REFERRED TO AS THE "ADA" 28 CFR PART 35................................................................................13 E t 30. ASSIGNMENT.................................................................................................................................13 31. ATTORNEYS' FEES.......................................................................................................................13 Q 32. AUDIT..............................................................................................................................................13 i Packet Pg. 104 8.D.a 33. BREACHES OF OTHER STATE CONTRACTS.............................................................................14 34. CONFIDENTIALITY/SAFEGUARDING OF INFORMATION..........................................................14 35. CONFLICT OF INTEREST .............................................................................................................14 36. COPYRIGHT PROVISIONS ...........................................................................................................15 Q t 37. DISPUTES ......................................................................................................................................15 38. DUPLICATE PAYMENT..................................................................................................................16 ;c a� 39. GOVERNING LAW AND VENUE ...................................................................................................16 U 40. INDEMNIFICATION ........................................................................................................................16 = 41. INDEPENDENT CAPACITY OF THE GRANTEE...........................................................................16 42. INDUSTRIAL INSURANCE COVERAGE.......................................................................................17 L 43. LAWS..............................................................................................................................................17 m 44. LICENSING, ACCREDITATION AND REGISTRATION.................................................................17 45. LIMITATION OF AUTHORITY........................................................................................................17 E 46. NONCOMPLIANCE WITH NONDISCRIMINATION LAWS............................................................17 U 4- 47. PAY EQUITY...................................................................................................................................17 r c 48. POLITICAL ACTIVITIES .................................................................................................................18 49. PUBLICITY......................................................................................................................................18 50. RECAPTURE..................................................................................................................................18 0 51. RECORDS MAINTENANCE...........................................................................................................18 °r 52. REGISTRATION WITH DEPARTMENT OF REVENUE.................................................................18 CCnn c 53. RIGHT OF INSPECTION................................................................................................................18 0 a� 54. SAVINGS ........................................................................................................................................18 __ 55. SEVERABILITY...............................................................................................................................19 Cu 56. SITE SECURITY.............................................................................................................................19 Lo 57. SUBGRANTING/SUBCONTRACTING...........................................................................................19 Q M 58. SURVIVAL.......................................................................................................................................19 r 59. TAXES.............................................................................................................................................19 L w 60. TERMINATION FOR CAUSE .........................................................................................................19 0 U 61. TERMINATION FOR CONVENIENCE ...........................................................................................20 c 62. TERMINATION PROCEDURES.....................................................................................................20 P 63. TREATMENT OF ASSETS.............................................................................................................21 L 64. WAIVER..........................................................................................................................................21 E ATTACHMENT A- SCOPE OF WORK......................................................................................................22 E 0 ATTACHMENT B - CERTIFICATION OF THE AVAILABILITY OF FUNDS TO COMPLETE THE U 0 PROJECT....................................................................................................................................................24 ., a ATTACHMENT C- CERTIFICATION OF THE PAYMENT AND REPORTING OF PREVAILING WAGES ....................................................................................................................................................................26 r c ATTACHMENT D - CERTIFICATION OF INTENT TO ENTER THE LEADERSHIP IN ENERGY AND ENVIRONMENTAL DESIGN (LEED) CERTIFICATION PROCESS..........................................................28 R a Packet Pg. 105 8.D.a FACE SHEET Grant Number: 20-96627-1 Project Name: Flood Plain Stabilization, Habitat Enhancem, y m Washington State Department of Commerce Q Local Government Division Community Assistance and Research Unit ti 1. GRANTEE 2. GRANTEE Doing Business As (optional) City of Kent N/A 220 4TH AVE S Kent, WA 98032-5895 = 3. GRANTEE Representative 4. COMMERCE Representative Susanne Smith Mara Isaacson, Grant Manager (253) 856-5553 PO Box 42525, Olympia, WA 98504 spsmith@kentWA.gov (360) 742-7665 mara.isaacson@commerce.wa.gov L 5. Grant Amount 6. Funding Source 7. Start Date 8. End Date $980,000.00 Federal: State:X Other: N/A: July 1, 2019 June 30, 2025, 0 contingent on reappropriation; V 4- June 30, 2023 if funds are not 0 reappro riated. 9. Federal Funds (as applicable) Federal Agency CFDA Number E N/A N/A N/A 10. Tax ID# 11. SWV# 12. UBI# 13. DUNS# o N/A SW V0000552-00 173-000-002 N/A a; 14. Grant Purpose Cn The purpose of this performance-based Grant Agreement is to provide funding for a legislatively approved project that c furthers the goals and objectives of the Local and Community Projects Program as described in Attachment A—Scope of Work (the "Project'). S U) COMMERCE, defined as the Washington State Department of Commerce, and the GRANTEE, as defined above, f° acknowledge and accept the terms of this Grant and attachments and have executed this Grant on the date below to start as of the date and year referenced above. The rights and obligations of both parties to this Grant are governed by this c Grant and the following other documents incorporated by reference: Grant Terms and Conditions including Attachment M "A"—Scope of Work, Attachment"B"—Certification of Availability of Funds to Complete the Project, Attachment"C"— Certification of the Payment and Reporting of Prevailing Wages, Attachment"D"—Certification of Intent to Enter LEED Process. c 0 FOR GRANTEE FOR COMMERCE v c R ,L^ V V Signature Mark K. Barkley, Assistant Director E Local Government Division E 0 Print Name v Date 0 .. Q. a� Title APPROVED AS TO FORM o c a� Date Steve Scheele, Assistant Attorney General t ca 6/15/2022 Q Date 1 Packet Pg. 106 8.D.a DECLARATIONS m GRANTEE INFORMATION Q t GRANTEE Name: City of Kent ti Grant Number: 20-96627-078 State Wide Vendor Number: SWV0000552-00 L PROJECT INFORMATION V Project Name: Flood Plain Stabilization, Habitat Enhancement } Project City: Kent Project State: Washington Project Zip Code: 98032 a� GRANT AGREEMENT INFORMATION E O Grant Amount: $980,000.00 U Appropriation Number: SHB 1102 SL Section 1042 (2020 Regular Session) o r c Re-appropriation Number(if applicable): SHB 1080 SL Section 1041 (2021 Regular Session) E L Grant End Date: June 30, 2025, contingent on reappropriation; June 30, 2023, if funds are not reappropriated. o Biennium: 2021-2023 r Biennium Close Date: June 30, 2023 Cn c PROJECT PURPOSE O Improve habitat and protect against flooding in an urbanized reach of Mill Creek. c t CU ADDITIONAL SPECIAL TERMS AND CONDITIONS GOVERNING THIS AGREEMENT LO Grant End Date: In the event funds for the project are reappropriated, the contract end date will be M extended pursuant to the reappropriation and consistent with Special Term and Condition 19. Depending on the reappropriation, a contract amendment may be required. L ADDITIONAL RECITALS o U WHEREAS, the GRANTEE previously received funding for this project and COMMERCE is administering the funding through Commerce Grant Number CD18-96616-113. a� L E E O U O r.+ Q d r-+ C d E t v R a Packet Pg. 107 8.D.a SPECIAL TERMS AND CONDITIONS N GENERAL GRANT STATE FUNDS Q THIS GRANT AGREEMENT, entered into by and between the GRANTEE and COMMERCE, as defined ti on the Face Sheet of this Grant Agreement, WITNESSES THAT: a� m WHEREAS, COMMERCE has the statutory authority under RCW 43.330.050 (5)to cooperate with and provide assistance to local governments, businesses, and community-based =_ organizations; and WHEREAS, COMMERCE is also given the responsibility to administer state funds and programs L which are assigned to COMMERCE by the Governor or the Washington State Legislature; and c9 m WHEREAS, the Washington State Legislature has made an appropriation to support the Local and Community Projects Program, and directed COMMERCE to administer those funds; and E 0 WHEREAS, the enabling legislation also stipulates that the GRANTEE is eligible to receive w funding for design, acquisition, construction, or rehabilitation. ° r c a� NOW, THEREFORE, in consideration of covenants, conditions, performances, and promises hereinafter E contained, the parties hereto agree as follows: Q. m 1. GRANT MANAGEMENT o The Representative for each of the parties shall be responsible for and shall be the contact person for all communications and billings regarding the performance of this Grant. Cn The Representative for COMMERCE and their contact information are identified on the Face c Sheet of this Grant. The Representative for the GRANTEE and their contact information are identified on the Face Sheet of this Grant. N c� 2. COMPENSATION COMMERCE shall pay an amount not to exceed the awarded Grant Amount as shown on the Face o Sheet of this Grant Agreement, for the capital costs necessary for or incidental to the performance of M work as set forth in the Scope of Work. U 0 3. CERTIFICATION OF FUNDS PERFORMANCE MEASURES A. The release of state funds under this Grant Agreement is contingent upon the GRANTEE ° certifying that it has expended or has access to funds from non-state sources as set forth in ATTACHMENT B (CERTIFICATION OF THE AVAILABILITY OF FUNDS TO COMPLETE THE L PROJECT), hereof. Such non-state sources may consist of a combination of any of the following: C9 i) Eligible Project expenditures prior to the execution of this Grant Agreement. ii) Cash dedicated to the Project. a, iii) Funds available through a letter of credit or other binding loan commitment(s). E iv) Pledges from foundations or corporations. 0 v) Pledges from individual donors. v vi) The value of real property when acquired solely for the purposes of this Project, as ° established and evidenced by a current market value appraisal performed by a licensed, professional real estate appraiser, or a current property tax statement. COMMERCE will o not consider appraisals for prospective values of such property for the purposes of calculating the amount of non-state matching fund credit. 0 vii) In-kind contributions, subject to COMMERCE'S approval. ca Q Packet Pg. 108 8.D.a B. The GRANTEE shall maintain records sufficient to evidence that it has access to or has N expended funds from such non-state sources, and shall make such records available for COMMERCE's review upon reasonable request. Q 4. PREVAILING WAGE LAW ti The Project funded under this Grant may be subject to state prevailing wage law(Chapter 39.12 Y RCW). The GRANTEE is advised to consult the Industrial Statistician at the Washington Department of Labor and Industries to determine whether prevailing wages must be paid. COMMERCE is not v responsible for determining whether prevailing wage applies to this Project or for any prevailing wage — payments that may be required by law. 5. DOCUMENTATION AND SECURITY The provisions of this section shall apply to capital projects performed by nonprofit organizations and public benefit corporations that involve the expenditure of over$250,000 in state funds. Additionally, Commerce reserves the right to review all state-funded projects and to require that projects performed by other entity types comply with this section. Projects for which the grant award or E legislative intent documents specify that the state funding is to be used for design only are exempt E from this section. v A. Deed of Trust. This Grant shall be evidenced by a promissory note and secured by a deed of 0 trust or other appropriate security instrument in favor of COMMERCE (the "Deed of Trust"). The Deed of Trust shall be recorded in the County where the Project is located, and the original E returned to COMMERCE after recordation within ninety(90) days of Grant Agreement execution. The Deed of Trust must be recorded before COMMERCE will reimburse the GRANTEE for any Project costs. The amount secured by the Deed of Trust shall be the amount of the Grant as set o forth on the Face Sheet, hereof. B. Term of Deed of Trust. The Deed of Trust shall remain in full force and effect for a minimum period of ten (10) years following the later of: (1)final payment of state funds to the GRANTEE c under this grant; or(2)the date when the facility improved or acquired with grant funds, or a a� distinct phase of the project, is made useable to the public for the purpose intended by the c Legislature. Upon satisfaction of the ten-year term requirement and all other grant terms and U) conditions, COMMERCE shall, upon written request of the GRANTEE, take appropriate action to reconvey the Deed of Trust. C. Title Insurance. The GRANTEE shall purchase an extended coverage lender's policy of title c insurance insuring the lien position of the Deed of Trust in an amount not less than the amount of LO M the grant. D. Covenant. If the project will be partially funded by a loan and the term of said loan is less than the U commitment period under this grant contract, COMMERCE may require that GRANTEE record or cause to be recorded a covenant in a superior lien position ahead of the lender's security 0 instrument that restricts use of the facility or property for the purpose(s)stated elsewhere in this v contract for at least the term of the commitment period E. Subordination. COMMERCE may agree to subordinate its deed of trust upon request from a private or public lender. Any such request shall be submitted to COMMERCE in writing, and COMMERCE shall respond to the request in writing within thirty(30) days of receiving the a) request. E E 0 6. BASIS FOR ESTABLISHING REAL PROPERTY VALUES FOR ACQUISITIONS OF REAL U PROPERTY PERFORMANCE MEASURES o When all or part of the grant is used to fund the acquisition of real property, before funds are Q. disbursed, the GRANTEE shall procure and provide to COMMERCE evidence establishing the p value of the real property eligible for reimbursement: A. GRANTEE purchases of real property from an independent third-party seller shall be evidenced by a current appraisal prepared by a licensed Washington State commercial real E estate appraiser, or a current property tax statement. ca B. GRANTEE purchases of real property from a subsidiary organization, such as an affiliated a LLC, shall be evidenced by a current appraisal prepared by a licensed Washington State Packet Pg. 109 8.D.a commercial real estate appraiser or the prior purchase price of the property plus holding N costs, whichever is less. a, Q 7. EXPENDITURES ELIGIBLE FOR REIMBURSEMENT Payments to the Grantee shall be made on a reimbursement basis only. The GRANTEE may be ti reimbursed for the following eligible costs related to the activities identified in the SCOPE OF WORK Y shown on Attachment A. L U A. Real property, and costs directly associated with such purchase, when purchased or acquired — solely for the purposes of the Project; B. Design, engineering, architectural, and planning; +, C. Construction management and observation (from external sources only); D. Construction costs including, but not limited to, the following: Site preparation and improvements; Permits and fees; Labor and materials; E Taxes on Project goods and services; 0 Capitalized equipment; v Information technology infrastructure; and o Landscaping. F. Other costs authorized through the legislation. E L 8. BILLING PROCEDURES AND PAYMENT COMMERCE shall reimburse the GRANTEE for eligible Project expenditures, up to the maximum o payable under this Grant Agreement. When requesting reimbursement for expenditures made, the GRANTEE shall submit to COMMERCE a signed and completed Invoice Voucher(Form A-19), that Cn documents capitalized Project activity performed for the billing period. The GRANTEE can submit all r- Invoice Vouchers and any required documentation electronically through COMMERCE's Contracts a� Management System (CMS), which is available through the Secure Access Washington (SAW) c portal. N c� The GRANTEE shall evidence the costs claimed on each voucher by including copies of each invoice received from vendors providing Project goods or services covered by the Grant Agreement. The c GRANTEE shall also provide COMMERCE with a copy of the cancelled check or electronic funds LO M transfer, as applicable, that confirms that they have paid each expenditure being claimed. The cancelled checks or electronic funds transfers may be submitted to COMMERCE at the time the U voucher is initially submitted, or within thirty(30) days thereafter. 0 The voucher must be certified (signed) by an official of the GRANTEE with authority to bind the v GRANTEE. The final voucher shall be submitted to COMMERCE within sixty(60) days following the completion of work or other termination of this Grant Agreement, or within fifteen (15)days following the end of the state biennium unless Grant Agreement funds are reappropriated by the Legislature in accordance with Section 19, hereof. E If GRANTEE has or will be submitting any of the invoices attached to a request for payment for partial E 0 reimbursement under another grant contract, GRANTEE must clearly identify such grant contracts in U the transmittal letter and request for payment. o Q. Each request for payment must be accompanied by a Project Status Report, which describes, in p narrative form, the progress made on the Project since the last invoice was submitted, as well as a report of Project status to date. COMMERCE will not release payment for any reimbursement request received unless and until the Project Status Report is received. After approving the Invoice E Voucher and Project Status Report, COMMERCE shall promptly remit a warrant to the GRANTEE. ca Q Packet Pg. 110 8.D.a COMMERCE will pay GRANTEE upon acceptance of services provided and receipt of properly N completed invoices, which shall be submitted to the Representative for COMMERCE not more often than monthly. Q t Payment shall be considered timely if made by COMMERCE within thirty(30) calendar days after ti receipt of properly completed invoices. Payment shall be sent to the address designated by the Y GRANTEE. L COMMERCE may, in its sole discretion, terminate the Grant or withhold payments claimed by the v GRANTEE for services rendered if the GRANTEE fails to satisfactorily comply with any term or condition of this Grant. }, c No payments in advance or in anticipation of services or supplies to be provided under this Agreement shall be made by COMMERCE. L Duplication of Billed Costs E The GRANTEE shall not bill COMMERCE for services performed under this Grant Agreement, and 0 COMMERCE shall not pay the GRANTEE, if the GRANTEE is entitled to payment or has been or will v be paid by any other source, including grants, for that service. o r c Disallowed Costs E E The GRANTEE is responsible for any audit exceptions or disallowed costs incurred by its own organization or that of its subgrantees. 0 9. SUBCONTRACTOR DATA COLLECTION GRANTEE will submit reports, in a form and format to be provided by COMMERCE and at intervals as agreed by the parties, regarding work under this Grant performed by subcontractors and the c portion of Grant funds expended for work performed by subcontractors, including but not necessarily 0 limited to minority-owned, woman-owned, and veteran-owned business subcontractors. c "Subcontractors" shall mean subcontractors of any tier. N c� 10. CERTIFIED PROJECT COMPLETION REPORT AND FINAL PAYMENT The GRANTEE shall complete a Certified Project Completion Report when activities identified in the c SCOPE OF WORK shown on Attachment A are complete. LO M The GRANTEE shall provide the following information to COMMERCE: U A. A certified statement that the Project, as described in the SCOPE OF WORK shown on Attachment A, is complete and, if applicable, meets required standards. o B. A certified statement of the actual dollar amounts spent,from all funding sources, in completing the v project as described in the SCOPE OF WORK shown on Attachment A. C. Certification that all costs associated with the Project have been incurred and accounted for. Costs are incurred when goods and services are received and/or Grant work is performed. D. A final voucher for the remaining eligible funds, including any required documentation. a) E The GRANTEE will submit the Certified Project Completion Report together with the last Invoice E 0 Voucher for a sum not to exceed the balance of the Grant Amount. U 0 11. INSURANCE Q. A. Insurance Requirements for Reimbursable Activities 0 The GRANTEE will maintain appropriate insurance coverage throughout any period in which reimbursable activities are conducted. The intent of the required insurance is to protect the state of E Washington should there be any claims, suits, actions, costs, damages or expenses arising from any loss, or negligent or intentional act or omission of the GRANTEE, or Subgrantee, or agents of either, a while performing under the terms of this Grant. Packet Pg. 111 8.D.a B. Additional Insurance Requirements During the Term of the Grant a, Q The GRANTEE shall provide proof to COMMERCE of the following insurance coverage as applicable: m ti Commercial General Liability Insurance Policy. Provide a Commercial General Liability Insurance Policy, including contractual liability, written on an occurrence basis, in adequate quantity to protect against legal liability related to this Grant but no less than $1,000,000 per L occurrence. Additionally, the GRANTEE is responsible for ensuring that any v Subgrantee/subcontractor provide adequate insurance coverage for the activities arising out of g subgrants/subcontracts. Commercial General Liability Insurance coverage shall be maintained in }, full force and effect during the term of this Grant and throughout the commitment period described in Special Terms and Conditions Section 5, 15, and 16. m U Property Insurance. The GRANTEE shall keep the property insured in an amount sufficient to aD permit such insurance to be written at all times on a replacement cost basis. Such insurance shall E cover the following hazards, as applicable: o • Loss or damage by fire and such other risks; v w • Loss or damage from leakage or sprinkler systems now or hereafter installed in any building on the premises; • Loss or damage by explosion of steam boilers, pressure vessels, oil or gasoline storage tanks or similar apparatus now or hereafter installed in a building or building on the Q. premises. p Property Insurance coverage shall be maintained in full force and effect during the term of this Grant and throughout the commitment period described in Special Terms and Conditions Section 5, 15, and 16. c 0 Professional Liability, Errors and Omissions Insurance. If GRANTEE will be providing any professional services to be reimbursed under this Grant, the GRANTEE shall maintain N Professional Liability or Errors and Omissions Insurance with minimum limits of no less than $1,000,000 per occurrence to cover all activities by the GRANTEE and licensed staff employed or under contract to the GRANTEE. The state of Washington, its agents, officers, and employees c need not be named as additional insureds under this policy. M Fidelity Insurance. Every officer, director, employee, or agent who is authorized to act on behalf U of the GRANTEE for the purpose of receiving or depositing funds into program accounts or issuing financial documents, checks, or other instruments of payment for program costs shall be o insured to provide protection against loss: v A. The amount of fidelity coverage secured pursuant to this Grant shall be $2,000,000 or the R highest of planned reimbursement for the Grant period, whichever is lowest. Fidelity insurance secured pursuant to this paragraph shall name COMMERCE as beneficiary. B. Subgrantees/subcontractors that receive $10,000 or more per year in funding through this Grant shall secure fidelity insurance as noted above. Fidelity insurance secured by E Subgrantees/subcontractors pursuant to this paragraph shall name the GRANTEE and the E GRANTEE's fiscal agent as beneficiary. U C. Fidelity Insurance coverage shall be maintained in full force and effect during the term of this c Grant. Q. a� 0 The insurance required shall be issued by an insurance company authorized to do business within the state of Washington. The insurance shall name the state of Washington, its agents, officers, and E employees as additional insureds under the insurance policy. All policies shall be primary to any other valid and collectable insurance. The GRANTEE shall instruct the insurers to give COMMERCE thirty (30) calendar days advance notice of any insurance cancellation or modification. a Packet Pg. 112 8.D.a The GRANTEE shall provide to COMMERCE copies of insurance instruments or certifications from N the insurance issuing agency. The copies or certifications shall show the insurance coverage, the designated beneficiary, who is covered, the amounts, the period of coverage, and that COMMERCE a will be provided thirty(30) days advance written notice of cancellation. m During the term of the Grant, the GRANTEE shall submit renewal certificates not less than thirty(30) calendar days prior to expiration of each policy required under this section. m L U Professional Liability, Errors and Omissions Insurance. The GRANTEE shall require that any = contractors providing professional services that are reimbursable under this Grant maintain Professional Liability or Errors and Omissions Insurance. The GRANTEE shall require such contractors to maintain minimum limits of no less than $1,000,000 per occurrence. The state of L Washington, its agents, officers, and employees need not be named as additional insureds under these policies. U L GRANTEES and Local Governments that Participate in a Self-Insurance Program. E Self-Insured/Liability Pool or Self-Insured Risk Management Program —With prior approval from o COMMERCE, the GRANTEE may provide the coverage above under a self-insured/liability pool or - self-insured risk management program. In order to obtain permission from COMMERCE, the GRANTEE shall provide: (1) a description of its self-insurance program, and (2) a certificate and/or letter of coverage that outlines coverage limits and deductibles. All self-insured risk management E programs or self-insured/liability pool financial reports must comply with Generally Accepted Q. Accounting Principles (GAAP) and adhere to accounting standards promulgated by: 1) Governmental o Accounting Standards Board (GASB), 2) Financial Accounting Standards Board (FASB), and 3)the Washington State Auditor's annual instructions for financial reporting. GRANTEE's participating in c joint risk pools shall maintain sufficient documentation to support the aggregate claim liability cn information reported on the balance sheet. The state of Washington, its agents, and employees need c not be named as additional insured under a self-insured property/liability pool, if the pool is prohibited 0 from naming third parties as additional insured. 9 U) cc GRANTEE shall provide annually to COMMERCE a summary of coverages and a letter of self insurance, evidencing continued coverage under GRANTEE's self-insured/liability pool or self-insured risk management program. Such annual summary of coverage and letter of self insurance will be LO provided on the anniversary of the start date of this Agreement. r 12. ORDER OF PRECEDENCE L In the event of an inconsistency in this Grant, the inconsistency shall be resolved by giving c precedence in the following order: v • Applicable federal and state of Washington statutes and regulations • Declarations page of this Grant Agreement • Special Terms and Conditions m • General Terms and Conditions U • Attachment A—Scope of Work E • Attachment B—Certification of the Availability of Funds to Complete the Project E • Attachment C—Certification of the Payment and Reporting of Prevailing Wages U • Attachment D—Certification of Intent to Enter the Leadership in Energy and Environmental c Design (LEED) Certification Process Q. a� 0 13. REDUCTION IN FUNDS In the event state funds appropriated for the work contemplated under this Grant Agreement are withdrawn, reduced, or limited in any way by the Governor or the Washington State Legislature during E the Grant Agreement period, the parties hereto shall be bound by any such revised funding limitations as implemented at the discretion of COMMERCE, and shall meet and renegotiate the Grant a Agreement accordingly. Packet Pg. 113 8.D.a 14. OWNERSHIP OF PROJECT/CAPITAL FACILITIES COMMERCE makes no claim to any real property improved or constructed with funds awarded under Q this Grant Agreement and does not assert and will not acquire any ownership interest in or title to the capital facilities and/or equipment constructed or purchased with state funds under this Grant ti Agreement; provided, however, that COMMERCE may be granted a security interest in real property, Y to secure funds awarded under this Grant Agreement. This provision does not extend to claims that COMMERCE may bring against the GRANTEE in recapturing funds expended in violation of this U Grant Agreement. —_ 15. CHANGE OF OWNERSHIP OR USE FOR GRANTEE-OWNED PROPERTY }, A. The GRANTEE understands and agrees that any and all real property or facilities owned by the GRANTEE that are acquired, constructed, or otherwise improved by the GRANTEE using state funds under this Grant Agreement, shall be held and used by the GRANTEE for the purpose or purposes stated elsewhere in this Grant Agreement for a period of at least ten (10) years from the later of: (1)the date the final payment is made hereunder; or(2)the date when the facility E improved or acquired with grant funds, or a distinct phase of the project, is made useable to the E public for the purpose intended by the Legislature. v B. This provision shall not be construed to prohibit the GRANTEE from selling any property or o properties described in this section; Provided, that any such sale shall be subject to prior review and approval by COMMERCE, and that all proceeds from such sale shall be applied to the E purchase price of a different facility or facilities of equal or greater value than the original facility and that any such new facility or facilities will be used for the purpose or purposes stated elsewhere in this Grant Agreement. o C. In the event the GRANTEE is found to be out of compliance with this section, the GRANTEE shall repay to the state general fund the principal amount of the grant as stated on the Face Sheet, hereof, plus interest calculated at the rate of interest on state of Washington general obligation c bonds issued most closely to the effective date of the legislation in which the subject facility was a� authorized. Repayment shall be made pursuant to Section 50 (Recapture provision). c U) 16. CHANGE OF USE FOR LEASED PROPERTY PERFORMANCE MEASURE A. The GRANTEE understands and agrees that any facility leased by the GRANTEE that is constructed, renovated, or otherwise improved using state funds under this Grant Agreement c shall be used by the GRANTEE for the purpose or purposes stated elsewhere in this Grant LO M Agreement for a period of at least ten (10) years from the later of: (1)the date the final payment is made hereunder; or(2)the date when the facility improved or acquired with grant funds, or a U distinct phase of the project, is made useable to the public for the purpose intended by the Legislature. 0 B. In the event the GRANTEE is found to be out of compliance with this section, the GRANTEE shall v repay to the state general fund the principal amount of the grant as stated on the Face Sheet, hereof, plus interest calculated at the rate of interest on state of Washington general obligation bonds issued most closely to the effective date of the legislation in which the subject facility was authorized. Repayment shall be made pursuant to Section 50 (Recapture Provision). a) E 17. SIGNAGE, MARKERS AND PUBLICATIONS E 0 If, during the period covered by this Grant Agreement, the GRANTEE displays or circulates any U communication, publication, or donor recognition identifying the financial participants in the Project, o any such communication or publication must identify"The Taxpayers of Washington State" as a Q- participant. o 18. HISTORICAL AND CULTURAL ARTIFACTS Prior to approval and disbursement of any funds awarded under this Contract, GRANTEE shall E cooperate with COMMERCE to complete the requirements of Governor's Executive Order 21-02 or ca GRANTEE shall complete a review under Section 106 of the National Historic Preservation Act, if a applicable. GRANTEE agrees that the GRANTEE is legally and financially responsible for compliance Packet Pg. 114 8.D.a with all laws, regulations, and agreements related to the preservation of historical or cultural N resources and agrees to hold harmless COMMERCE and the state of Washington in relation to any claim related to such historical or cultural resources discovered, disturbed, or damaged as a result of Q the project funded by this Contract. m ti In addition to the requirements set forth in this Contract, GRANTEE shall, in accordance with Y Governor's Executive Order 21-02 as applicable, coordinate with Commerce and the Washington State Department of Archaeology and Historic Preservation ("DAHP"), including any recommended v consultation with any affected tribe(s), during Project design and prior to construction to determine the — existence of any tribal cultural resources affected by Project. GRANTEE agrees to avoid, minimize, or mitigate impacts to the cultural resource as a continuing prerequisite to receipt of funds under this }, Contract. ° ,L^ V The GRANTEE agrees that, unless the GRANTEE is proceeding under an approved historical and cultural monitoring plan or other memorandum of agreement, if historical or cultural artifacts are discovered during construction, the GRANTEE shall immediately stop construction and notify the E local historical preservation officer and the state's historical preservation officer at DAHP, and the ° Commerce Representative identified on the Face Sheet. If human remains are uncovered, the v GRANTEE shall report the presence and location of the remains to the coroner and local enforcement o immediately, then contact DAHP and the concerned tribe's cultural staff or committee. E The GRANTEE shall require this provision to be contained in all subcontracts for work or services related to the Scope of Work attached hereto. m 0 In addition to the requirements set forth in this Contract, GRANTEE agrees to comply with RCW 27.44 regarding Indian Graves and Records; RCW 27.53 regarding Archaeological Sites and Resources; RCW 68.60 regarding Abandoned and Historic Cemeteries and Historic Graves; and c WAC 25-48 regarding Archaeological Excavation and Removal Permits. a� c Completion of the requirements of Section 106 of the National Historic Preservation Act shall U) substitute for completion of Governor's Executive Order 21-02. In the event that the GRANTEE finds it necessary to amend the Scope of Work the GRANTEE may c be required to re-comply with Governor's Executive Order 21-02, or Section 106 of the National LO M Historic Preservation Act. r U ° L 19. REAPPROPRIATION c A. The parties hereto understand and agree that any state funds not expended by the BIENNIUM v CLOSE DATE listed on the Declarations page will lapse on that date unless specifically reappropriated by the Washington State Legislature. If funds are so reappropriated, the state's obligation under the terms of this Grant Agreement shall be contingent upon the terms of such reappropriation. U B. In the event any funds awarded under this Grant Agreement are reappropriated for use in a future m biennium, COMMERCE reserves the right to assign a reasonable share of any such E reappropriation for administrative costs. ° v 4- 20. TERMINATION FOR FRAUD OR MISREPRESENTATION ° In the event the GRANTEE commits fraud or makes any misrepresentation in connection with the Grant application or during the performance of this Grant Agreement, COMMERCE reserves the right to terminate or amend this Grant Agreement accordingly, including the right to recapture all funds c disbursed to the GRANTEE under the Grant. E E ca Q Packet Pg. 115 8.D.a 21. APPLICABILITY OF COPYRIGHT PROVISIONS TO ARCHITECTURAL/ENGINEERING DESIGN N WORK The "Copyright Provisions", Section 36 of the General Terms and Conditions, are not intended to Q apply to any architectural and engineering design work funded by this grant. m ti 22. FRAUD AND OTHER LOSS REPORTING Contractor/Grantee shall report in writing all known or suspected fraud or other loss of any funds or other property furnished under this Contract immediately or as soon as practicable to the Commerce v Representative identified on the Face Sheet. —_ 23. PUBLIC RECORDS ACT }, Notwithstanding General Terms and Conditions Section 34, COMMERCE is a public agency subject to the Public Records Act, Chapter 42.56 RCW (the "PRA"). Under the PRA, all materials relating to the conduct of government or the performance of any governmental or proprietary function prepared, owned, used, or retained by COMMERCE or its functional equivalents are considered public records. The PRA requires that public records responsive to a public records request be promptly produced unless the PRA or an "other statute" exempts such records from production. This Agreement is not 0 intended to alter COMMERCE's obligations under the PRA. The parties agree that if COMMERCE v receives a public records request for files that may include confidential information under General o Terms and Conditions Section 34, COMMERCE will notify the other party of the request and of the date that the records will be released to the requester unless GRANTEE obtains a court order E enjoining disclosure. If the GRANTEE fails to obtain the court order enjoining disclosure, COMMERCE may release the requested information on the date specified. If the GRANTEE obtains a court order from a court of competent jurisdiction enjoining disclosure pursuant to the PRA, o COMMERCE shall maintain the confidentiality of the information per the court order. Cn c 0 c U) c� 0 LO M a+ V R L 0 U c cv ,L^ V V L a) E E 0 V O Q E V Y Q Packet Pg. 116 8.D.a GENERAL TERMS AND CONDITIONS F GENERAL GRANT Q STATE FUNDS m 24. DEFINITIONS As used throughout this Grant, the following terms shall have the meaning set forth below: A. "Authorized Representative" shall mean the Director and/or the designee authorized in writing to v act on the Director's behalf. B. "COMMERCE" shall mean the Department of Commerce. g C. "GRANTEE" shall mean the entity identified on the Face Sheet performing service(s) under this Grant, and shall include all employees and agents of the GRANTEE. D. "Personal Information" shall mean information identifiable to any person, including, but not limited to, information that relates to a person's name, health, finances, education, business, use or m receipt of governmental services or other activities, addresses, telephone numbers, social a� security numbers, driver license numbers, other identifying numbers, and any financial identifiers. E E. "State" shall mean the state of Washington. E F. "Subgrantee/subcontractor" shall mean one not in the employment of the GRANTEE, who is v performing all or part of those services under this Grant under a separate Grant with the c GRANTEE. The terms "subgrantee/subcontractor" refers to any tier. G. "Subrecipient" shall mean a non-federal entity that expends federal awards received from a pass- through entity to carry out a federal program, but does not include an individual that is a beneficiary of such a program. It also excludes vendors that receive federal funds in exchange for goods and/or Q. services in the course of normal trade or commerce. 0 H. "Vendor" is an entity that agrees to provide the amount and kind of services requested by a; COMMERCE; provides services under the grant only to those beneficiaries individually determined to be eligible by COMMERCE and, provides services on a fee-for-service or per-unit basis with c contractual penalties if the entity fails to meet program performance standards. o I. "Grant" and "Agreement" and "Contract" shall mean the entire written agreement between COMMERCE and the GRANTEE, including any attachments, exhibits, documents, or materials N incorporated by reference, and any amendments executed by the parties. 25. ACCESS TO DATA In compliance with RCW 39.26.180, the GRANTEE shall provide access to data generated under this M Grant to COMMERCE, the Joint Legislative Audit and Review Committee, and the Office of the State -- Auditor at no additional cost. This includes access to all information that supports the findings, U conclusions, and recommendations of the GRANTEE's reports, including computer models and the L methodology for those models. o U 26. ADVANCE PAYMENTS PROHIBITED No payments in advance of or in anticipation of goods or services to be provided under this Grant shall be made by COMMERCE. U L 27. ALL WRITINGS CONTAINED HEREIN E This Grant contains all the terms and conditions agreed upon by the parties. No other understandings, E oral or otherwise, regarding the subject matter of this Grant shall be deemed to exist or to bind any of v the parties hereto. c Q. 28. AMENDMENTS o This Grant may be amended by mutual agreement of the parties. Such amendments shall not be binding unless they are in writing and signed by personnel authorized to bind each of the parties. E ca Q AAG Approved -CAR DA GRANT AGREEMENT—VER 3 Packet Pg. 117 8.D.a 29. AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, ALSO N REFERRED TO AS THE "ADA" 28 CFR PART 35 Q The GRANTEE must comply with the ADA, which provides comprehensive civil rights protection to individuals with disabilities in the areas of employment, public accommodations, state and local government services, and telecommunications. a� rl- 30. ASSIGNMENT L Neither this Grant, nor any claim arising under this Grant, shall be transferred or assigned by the v GRANTEE without prior written consent of COMMERCE. 31. ATTORNEYS' FEES c Unless expressly permitted under another provision of the Grant, in the event of litigation or other L action brought to enforce Grant terms, each party agrees to bear its own attorney's fees and costs. U L 32. AUDIT E A. General Requirements E COMMERCE reserves the right to require an audit. If required, GRANTEEs are to procure audit U services based on the following guidelines. c r c The GRANTEE shall maintain its records and accounts so as to facilitate audits and shall ensure that subgrantees also maintain auditable records. E Q- The GRANTEE is responsible for any audit exceptions incurred by its own organization or that of its subgrantees. COMMERCE reserves the right to recover from the GRANTEE all disallowed costs resulting from Cn the audit. o Responses to any unresolved management findings and disallowed or questioned costs shall be included with the audit report. The GRANTEE must respond to COMMERCE requests for information or corrective action concerning audit issues within thirty(30) days of the date of request. ,n 0 LO B. State Funds Requirements In the event an audit is required, if the GRANTEE is a state or local government entity, the Office of the State Auditor shall conduct the audit. Audits of non-profit organizations are to be conducted by a certified public accountant selected by the GRANTEE. 0 U The GRANTEE shall include the above audit requirements in any subcontracts. c R L In any case, the GRANTEE's records must be available for review by COMMERCE. m U L C. Documentation Requirements m The GRANTEE must send a copy of the audit report described above no later than nine (9) E months after the end of the GRANTEE's fiscal year(s) by sending a scanned copy to 0 v comacctoffice(c)commerce.wa.gov or a hard copy to: — Department of Commerce o ATTN: Audit Review and Resolution Office 1011 Plum Street SE PO Box 42525 E Olympia WA 98504-2525 ca In addition to sending a copy of the audit, when applicable, the GRANTEE must include: a AAG Approved -CAR DA GRANT AGREEMENT-VER 3 Packet Pg. 118 8.D.a • Corrective action plan for audit findings within three (3) months of the audit being N received by COMMERCE. a • Copy of the Management Letter. m If the GRANTEE is required to obtain a Single Audit consistent with Circular A-133 requirements, a copy must be provided to COMMERCE; no other report is required. m L 33. BREACHES OF OTHER STATE CONTRACTS V GRANTEE is expected to comply with all other contracts executed between GRANTEE and the State of Washington. A breach of any other agreement entered into between GRANTEE and the State of Washington may, in COMMERCE's discretion, be deemed a breach of this Agreement. ,L^ V 34. CONFIDENTIALITY/SAFEGUARDING OF INFORMATION U A. "Confidential Information" as used in this section includes: °' 1. All material provided to the GRANTEE by COMMERCE that is designated as "confidential" by E COMMERCE; G 2. All material produced by the GRANTEE that is designated as "confidential" by COMMERCE; , and r 3. All personal information in the possession of the GRANTEE that may not be disclosed under state or federal law. "Personal information" includes but is not limited to information related to a person's name, health, finances, education, business, use of government services, Q. addresses, telephone numbers, social security number, driver's license number and other o identifying numbers, and "Protected Health Information" under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). c B. The GRANTEE shall comply with all state and federal laws related to the use, sharing, transfer, cn sale, or disclosure of Confidential Information. The GRANTEE shall use Confidential Information 0 solely for the purposes of this Grant and shall not use, share, transfer, sell or disclose any a� Confidential Information to any third party except with the prior written consent of COMMERCE or as may be required by law. The GRANTEE shall take all necessary steps to assure that N c� Confidential Information is safeguarded to prevent unauthorized use, sharing, transfer, sale or disclosure of Confidential Information or violation of any state or federal laws related thereto. Upon request, the GRANTEE shall provide COMMERCE with its policies and procedures on LO confidentiality. COMMERCE may require changes to such policies and procedures as they apply to this Grant whenever COMMERCE reasonably determines that changes are necessary to prevent unauthorized disclosures. The GRANTEE shall make the changes within the time period L specified by COMMERCE. Upon request, the GRANTEE shall immediately return to 0 COMMERCE any Confidential Information that COMMERCE reasonably determines has not v been adequately protected by the GRANTEE against unauthorized disclosure. C. Unauthorized Use or Disclosure. The GRANTEE shall notify COMMERCE within five (5) working L days of any unauthorized use or disclosure of any confidential information, and shall take necessary steps to mitigate the harmful effects of such use or disclosure. U am 35. CONFLICT OF INTEREST E E Notwithstanding any determination by the Executive Ethics Board or other tribunal, COMMERCE v may, in its sole discretion, by written notice to the GRANTEE terminate this Grant Agreement if it is — found after due notice and examination by COMMERCE that there is a violation of the Ethics in Public Service Act, Chapters 42.52 RCW and 42.23 RCW; or any similar statute involving the GRANTEE in the procurement of, or performance under this Grant Agreement. c Specific restrictions apply to contracting with current or former state employees pursuant to chapter E E 42.52 of the Revised Code of Washington. The GRANTEE and their subcontractor(s) must identify any person employed in any capacity by the state of Washington that worked on this Grant, or any matter related to the project funded under this Grant or any other state funded project, including but a not limited to formulating or drafting legislation, participating in grant procurement, planning and AAG Approved -CAR DA GRANT AGREEMENT—VER 3 Packet Pg. 119 8.D.a execution, awarding grants, or monitoring grants, during the 24 month period preceding the start date N of this Grant. Any person identified by the GRANTEE and their subcontractors(s) must be identified Q individually by name, the agency previously or currently employed by,job title or position held, and separation date. If it is determined by COMMERCE that a conflict of interest exists, the GRANTEE may be disqualified from further consideration for the award of a Grant. In the event this Grant Agreement is terminated as provided above, COMMERCE shall be entitled to pursue the same remedies against the GRANTEE as it could pursue in the event of a breach of the Grant Agreement by the GRANTEE. The rights and remedies of COMMERCE provided for in this =_ clause shall not be exclusive and are in addition to any other rights and remedies provided by law. The existence of facts upon which COMMERCE makes any determination under this clause shall be an issue and may be reviewed as provided in the "Disputes" clause of this Grant Agreement. L 36. COPYRIGHT PROVISIONS Unless otherwise provided, all Materials produced under this Grant shall be considered "works for W hire" as defined by the U.S. Copyright Act and shall be owned by COMMERCE. COMMERCE shall E be considered the author of such Materials. In the event the Materials are not considered "works for c hire" under the U.S. Copyright laws, the GRANTEE hereby irrevocably assigns all right, title, and v 4- interest in all Materials, including all intellectual property rights, moral rights, and rights of publicity to G r COMMERCE effective from the moment of creation of such Materials. a� E "Materials" means all items in any format and includes, but is not limited to, data, reports, documents, pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, m and/or sound reproductions. "Ownership" includes the right to copyright, patent, register and the o ability to transfer these rights. Cn For Materials that are delivered under the Grant, but that incorporate pre-existing materials not c produced under the Grant, the GRANTEE hereby grants to COMMERCE a nonexclusive, royalty-free, irrevocable license (with rights to sublicense to others) in such Materials to translate, reproduce, 9 distribute, prepare derivative works, publicly perform, and publicly display. The GRANTEE warrants N and represents that the GRANTEE has all rights and permissions, including intellectual property f° rights, moral rights and rights of publicity, necessary to grant such a license to COMMERCE. 0 The GRANTEE shall exert all reasonable effort to advise COMMERCE, at the time of delivery of M Materials furnished under this Grant, of all known or potential invasions of privacy contained therein r and of any portion of such document which was not produced in the performance of this Grant. The U GRANTEE shall provide COMMERCE with prompt written notice of each notice or claim of infringement received by the GRANTEE with respect to any Materials delivered under this Grant. v COMMERCE shall have the right to modify or remove any restrictive markings placed upon the Materials by the GRANTEE. L 37. DISPUTES Except as otherwise provided in this Grant, when a dispute arises between the parties and it cannot `m be resolved by direct negotiation, either party may request a dispute hearing with the Director of E COMMERCE, who may designate a neutral person to decide the dispute. G v The request for a dispute hearing must: c • be in writing; Q- a� • state the disputed issues; o • state the relative positions of the parties; • state the GRANTEE's name, address, and Grant number; and • be mailed to the Director and the other party's (respondent's) Grant Representative within three (3)working days after the parties agree that they cannot resolve the dispute. Q AAG Approved -CAR DA GRANT AGREEMENT-VER 3 Packet Pg. 120 8.D.a The respondent shall send a written answer to the requestor's statement to both the Director or the N Director's designee and the requestor within five (5)working days. Q The Director or designee shall review the written statements and reply in writing to both parties within ten (10)working days. The Director or designee may extend this period if necessary by notifying the parties. Y a� m L The decision shall not be admissible in any succeeding judicial or quasi-judicial proceeding. v The parties agree that this dispute process shall precede any action in a judicial or quasi-judicial tribunal. c L Nothing in this Grant shall be construed to limit the parties' choice of a mutually acceptable alternate dispute resolution (ADR) method in addition to the dispute hearing procedure outlined above. U a) E 38. DUPLICATE PAYMENT E COMMERCE shall not pay the GRANTEE, if the GRANTEE has charged or will charge the State of U Washington or any other party under any other Grant, subgrant/subcontract, or agreement, for the - same services or expenses. The GRANTEE certifies that work to be performed under this contract does not duplicate any work to be charged against any other grant, subgrant/subcontract, or E agreement. L Q 39. GOVERNING LAW AND VENUE This Grant shall be construed and interpreted in accordance with the laws of the state of Washington, m and the venue of any action brought hereunder shall be in the Superior Court for Thurston County. Cn 40. INDEMNIFICATION o To the fullest extent permitted by law, the GRANTEE shall indemnify, defend, and hold harmless the state of Washington, COMMERCE, agencies of the state and all officials, agents and employees of the state, from and against all claims for injuries or death arising out of or resulting from the performance of the contract. "Claim" as used in this contract, means any financial loss, claim, suit, action, damage, or expense, including but not limited to attorneys fees, attributable for bodily injury, ,n sickness, disease, or death, or injury to or the destruction of tangible property including loss of useLO resulting therefrom. r The GRANTEE's obligation to indemnify, defend, and hold harmless includes any claim by U GRANTEE's agents, employees, representatives, or any subgrantee/subcontractor or its employees. 0 GRANTEE expressly agrees to indemnify, defend, and hold harmless the State for any claim arising c) out of or incident to GRANTEE'S or any subgrantee's/subcontractor's performance or failure to c perform the Grant. GRANTEE'S obligation to indemnify, defend, and hold harmless the State shall L not be eliminated or reduced by any actual or alleged concurrent negligence of State or its agents, agencies, employees and officials. U a) The GRANTEE waives its immunity under Title 51 RCW to the extent it is required to indemnify, E defend and hold harmless the state and its agencies, officers, agents or employees. 0 v 41. INDEPENDENT CAPACITY OF THE GRANTEE 0 The parties intend that an independent contractor relationship will be created by this Grant. The GRANTEE and its employees or agents performing under this Grant Agreement are not employees or o agents of the state of Washington or COMMERCE. The GRANTEE will not hold itself out as or claim to be an officer or employee of COMMERCE or of the state of Washington by reason hereof, nor will the GRANTEE make any claim of right, privilege or benefit which would accrue to such officer or employee under law. Conduct and control of the work will be solely with the GRANTEE. Q AAG Approved -CAR DA GRANT AGREEMENT—VER 3 Packet Pg. 121 8.D.a 42. INDUSTRIAL INSURANCE COVERAGE N The GRANTEE shall comply with all applicable provisions of Title 51 RCW, Industrial Insurance. If Q the GRANTEE fails to provide industrial insurance coverage or fails to pay premiums or penalties on behalf of its employees as may be required by law, COMMERCE may collect from the GRANTEE the full amount payable to the Industrial Insurance Accident Fund. COMMERCE may deduct the amount owed by the GRANTEE to the accident fund from the amount payable to the GRANTEE by COMMERCE under this Grant Agreement, and transmit the deducted amount to the Department of L Labor and Industries, (L&I) Division of Insurance Services. This provision does not waive any of L&I's v rights to collect from the GRANTEE. 43. LAWS c The GRANTEE shall comply with all applicable laws, ordinances, codes, regulations and policies of L local and state and federal governments, as now or hereafter amended. U L 44. LICENSING, ACCREDITATION AND REGISTRATION E The GRANTEE shall comply with all applicable local, state, and federal licensing, accreditation and E registration requirements or standards necessary for the performance of this Grant Agreement. Lj w 0 45. LIMITATION OF AUTHORITY Only the Authorized Representative or Authorized Representative's delegate by writing (delegation to be made prior to action) shall have the express, implied, or apparent authority to alter, amend, i modify, or waive any clause or condition of this Grant Agreement. Furthermore, any alteration, Q. amendment, modification, or waiver or any clause or condition of this Grant Agreement is not effective or binding unless made in writing and signed by the Authorized Representative. 46. NONCOMPLIANCE WITH NONDISCRIMINATION LAWS Cn During the performance of this Grant, the GRANTEE shall comply with all federal, state, and local o nondiscrimination laws, regulations and policies. In the event of the GRANTEE's non-compliance or refusal to comply with any nondiscrimination law, regulation or policy, this Grant may be rescinded, canceled or terminated in whole or in part, and the GRANTEE may be declared ineligible for further Grants with COMMERCE. The GRANTEE shall, however, be given a reasonable time in which to cure this noncompliance. Any dispute may be resolved in accordance with the "Disputes" procedure ,n set forth herein. The funds provided under this contract may not be used to fund religious worship, LO exercise, or instruction. No person shall be required to participate in any religious worship, exercise, or instruction in order to have access to the facilities funded by this grant. L 47. PAY EQUITY o The GRANTEE agrees to ensure that"similarly employed" individuals in its workforce are c) compensated as equals, consistent with the following: c a. Employees are "similarly employed" if the individuals work for the same employer, the performance of the job requires comparable skill, effort, and responsibility, and the jobs are performed under similar working conditions. Job titles alone are not determinative of whether U employees are similarly employed; m b. GRANTEE may allow differentials in compensation for its workers if the differentials are based in E good faith and on any of the following: o v (i)A seniority system; a merit system; a system that measures earnings by quantity or quality — of production; a bona fide job-related factor or factors; or a bona fide regional difference in Q. compensation levels. o (ii)A bona fide job-related factor or factors may include, but not be limited to, education, training, or experience that is: Consistent with business necessity; not based on or derived from a gender-based differential; and accounts for the entire differential. E (iii)A bona fide regional difference in compensation level must be: Consistent with business necessity; not based on or derived from a gender-based differential; and account for the entire differential. a AAG Approved -CAR DA GRANT AGREEMENT-VER 3 Packet Pg. 122 8.D.a This Grant Agreement may be terminated by COMMERCE, if COMMERCE or the Department of N Enterprise services determines that the GRANTEE is not in compliance with this provision. Q 48. POLITICAL ACTIVITIES Political activity of GRANTEE employees and officers are limited by the State Campaign Finances and Lobbying provisions of Chapter 42.17a RCW and the Federal Hatch Act, 5 USC 1501 - 1508. Y a� m L No funds may be used for working for or against ballot measures or for or against the candidacy of v any person for public office. 49. PUBLICITY c The GRANTEE agrees not to publish or use any advertising or publicity materials in which the state of L Washington or COMMERCE's name is mentioned, or language used from which the connection with the state of Washington's or COMMERCE's name may reasonably be inferred or implied, without the U prior written consent of COMMERCE. E E E 50. RECAPTURE 0 U In the event that the GRANTEE fails to perform this Grant in accordance with state laws, federal laws, c and/or the provisions of this Grant, COMMERCE reserves the right to recapture funds in an amount to compensate COMMERCE for the noncompliance in addition to any other remedies available at law or in equity. L Q Repayment by the GRANTEE of funds under this recapture provision shall occur within the time period specified by COMMERCE. In the alternative, COMMERCE may recapture such funds from payments due under this Grant. Cn 51. RECORDS MAINTENANCE o The GRANTEE shall maintain books, records, documents, data and other evidence relating to this Grant and performance of the services described herein, including but not limited to accounting procedures and practices that sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Grant. GRANTEE shall retain such records for a period of six years following the date of final payment. AtLO no additional cost, these records, including materials generated under the Grant, shall be subject at all reasonable times to inspection, review or audit by COMMERCE, personnel duly authorized by COMMERCE, the Office of the State Auditor, and federal and state officials so authorized by law, regulation or agreement. 0 U If any litigation, claim or audit is started before the expiration of the six (6)year period, the records c shall be retained until all litigation, claims, or audit findings involving the records have been resolved. L c� m 52. REGISTRATION WITH DEPARTMENT OF REVENUE U If required by law, the GRANTEE shall complete registration with the Washington State Department m of Revenue. E 0 c) 53. RIGHT OF INSPECTION At no additional cost, the GRANTEE shall provide right of access to its facilities to COMMERCE, or any Q. of its officers, or to any other authorized agent or official of the state of Washington or the federal o government, at all reasonable times, in order to monitor and evaluate performance, compliance, and/or quality assurance under this Grant. E 54. SAVINGS In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after the effective date of this Grant and prior to normal completion, COMMERCE may terminate the a Grant under the "Termination for Convenience" clause, without the ten calendar day notice AAG Approved -CAR DA GRANT AGREEMENT—VER 3 Packet Pg. 123 8.D.a requirement. In lieu of termination, the Grant may be amended to reflect the new funding limitations N and conditions. Q 55. SEVERABILITY The provisions of this Grant are intended to be severable. If any term or provision is illegal or invalid for any reason whatsoever, such illegality or invalidity shall not affect the validity of the remainder of the Grant. L U 56. SITE SECURITY While on COMMERCE premises, GRANTEE, its agents, employees, or subcontractors shall conform in all respects with physical, fire or other security policies or regulations. L 57. SUBGRANTING/SUBCONTRACTING m Neither the GRANTEE nor any subgrantee/subcontractor shall enter into subgrants/subcontracts for U any of the work contemplated under this Grant Agreement without obtaining prior written approval of E E COMMERCE. In no event shall the existence of the subgrant/subcontract operate to release or reduce E the liability of the GRANTEE to COMMERCE for any breach in the performance of the GRANTEE's Lj duties. This clause does not include Grants of employment between the GRANTEE and personnel - assigned to work under this Grant. r c as Additionally, the GRANTEE is responsible for ensuring that all terms, conditions, assurances and E L certifications set forth in this agreement are carried forward to any subgrants/subcontracts. Every Q. subgranUsubcontract shall include a term that COMMERCE and the State of Washington are not liable for claims or damages arising from a subgrantee's/subcontractor's performance of the subgranUsubcontract. GRANTEE and its subgrantees/subcontractors agree not to release, divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal information without Cn the express written consent of COMMERCE or as provided by law. o 58. SURVIVAL The terms, conditions, and warranties contained in this Grant that by their sense and context are intended to survive the completion of the performance, cancellation or termination of this Grant shall so survive. 0 LO 59. TAXES All payments accrued on account of payroll taxes, unemployment contributions, the GRANTEE's income or gross receipts, any other taxes, insurance or expenses for the GRANTEE or its staff shall be the sole responsibility of the GRANTEE. 0 U 60. TERMINATION FOR CAUSE c In the event COMMERCE determines the GRANTEE has failed to comply with the conditions of this Grant in a timely manner, COMMERCE has the right to suspend or terminate this Grant. Before m suspending or terminating the Grant, COMMERCE shall notify the GRANTEE in writing of the need to U take corrective action. If corrective action is not taken within 30 calendar days, the Grant may be (D terminated or suspended. E 0 c) In the event of termination or suspension, the GRANTEE shall be liable for damages as authorized by c law including, but not limited to, any cost difference between the original Grant and the replacement Q. or cover Grant and all administrative costs directly related to the replacement Grant, e.g., cost of the o competitive bidding, mailing, advertising and staff time. c COMMERCE reserves the right to suspend all or part of the Grant, withhold further payments, or E prohibit the GRANTEE from incurring additional obligations of funds during investigation of the alleged compliance breach and pending corrective action by the GRANTEE or a decision by f° COMMERCE to terminate the Grant. A termination shall be deemed a "Termination for Convenience" a AAG Approved -CAR DA GRANT AGREEMENT—VER 3 Packet Pg. 124 8.D.a if it is determined that the GRANTEE: (1)was not in default; or(2)failure to perform was outside of N his or her control, fault or negligence. Q The rights and remedies of COMMERCE provided in this Grant are not exclusive and are, in addition to any other rights and remedies, provided by law. ti 61. TERMINATION FOR CONVENIENCE Except as otherwise provided in this Grant, COMMERCE may, by ten (10) business days written L notice, beginning on the second day after the mailing, terminate this Grant, in whole or in part. If this v Grant is so terminated, COMMERCE shall be liable only for payment required under the terms of this Grant for services rendered or goods delivered prior to the effective date of termination. c 62. TERMINATION PROCEDURES L Upon termination of this Grant, COMMERCE, in addition to any other rights provided in this Grant, may require the GRANTEE to deliver to COMMERCE any property specifically produced or acquired 2 for the performance of such part of this Grant as has been terminated. The provisions of the E E "Treatment of Assets" clause shall apply in such property transfer. E 0 U COMMERCE shall pay to the GRANTEE the agreed upon price, if separately stated, for completed c work and services accepted by COMMERCE, and the amount agreed upon by the GRANTEE and COMMERCE for(i) completed work and services for which no separate price is stated, (ii) partially E completed work and services, (iii)other property or services that are accepted by COMMERCE, and i (iv)the protection and preservation of property, unless the termination is for default, in which case the Q. AUTHORIZED REPRESENTATIVE shall determine the extent of the liability of COMMERCE. Failure m to agree with such determination shall be a dispute within the meaning of the "Disputes" clause of this Grant. COMMERCE may withhold from any amounts due the GRANTEE such sum as the AUTHORIZED REPRESENTATIVE determines to be necessary to protect COMMERCE against Cn potential loss or liability. o The rights and remedies of COMMERCE provided in this section shall not be exclusive and are in addition to any other rights and remedies provided by law or under this Grant Agreement. After receipt of a notice of termination, and except as otherwise directed by the AUTHORIZED ,n REPRESENTATIVE, the GRANTEE shall: LO M 1. Stop work under the Grant on the date, and to the extent specified, in the notice; 2. Place no further orders or subgrants/subcontracts for materials, services, or facilities except as may be necessary for completion of such portion of the work under the Grant that is not 0 terminated; c) 3. Assign to COMMERCE, in the manner, at the times, and to the extent directed by the c AUTHORIZED REPRESENTATIVE, all of the rights, title, and interest of the GRANTEE under the orders and subgrants/subcontracts so terminated, in which case COMMERCE has the right, at its m discretion, to settle or pay any or all claims arising out of the termination of such orders and U L subgrants/subcontracts; m 4. Settle all outstanding liabilities and all claims arising out of such termination of orders and E subcontracts, with the approval or ratification of the AUTHORIZED REPRESENTATIVE to the 0 v extent AUTHORIZED REPRESENTATIVE may require, which approval or ratification shall be — final for all the purposes of this clause; .• 5. Transfer title to COMMERCE and deliver in the manner, at the times, and to the extent directed o by the AUTHORIZED REPRESENTATIVE any property which, if the Grant had been completed, would have been required to be furnished to COMMERCE; 6. Complete performance of such part of the work as shall not have been terminated by the E AUTHORIZED REPRESENTATIVE; and 7. Take such action as may be necessary, or as the AUTHORIZED REPRESENTATIVE may direct, f° for the protection and preservation of the property related to this Grant, which is in the possession a of the GRANTEE and in which COMMERCE has or may acquire an interest. AAG Approved -CAR DA GRANT AGREEMENT—VER 3 Packet Pg. 125 8.D.a 63. TREATMENT OF ASSETS Q Title to all property furnished by COMMERCE shall remain in COMMERCE. Title to all property furnished by the GRANTEE,for the cost of which the GRANTEE is entitled to be reimbursed as a direct item of cost under this Grant, shall pass to and vest in COMMERCE upon delivery of such property by the GRANTEE. Title to other property, the cost of which is reimbursable to the GRANTEE under this Grant, shall pass to and vest in COMMERCE upon (i) issuance for use of such property in the L performance of this Grant, or (ii) commencement of use of such property in the performance of this v Grant, or (iii) reimbursement of the cost thereof by COMMERCE in whole or in part, whichever first occurs. A. Any property of COMMERCE furnished to the GRANTEE shall, unless otherwise provided herein or approved by COMMERCE, be used only for the performance of this Grant. L B. The GRANTEE shall be responsible for any loss or damage to property of COMMERCE that results from the negligence of the GRANTEE or which results from the failure on the part of the GRANTEE 2 to maintain and administer that property in accordance with sound management practices. E E C. If any COMMERCE property is lost, destroyed or damaged, the GRANTEE shall immediately notify E COMMERCE and shall take all reasonable steps to protect the property from further damage. U D. The GRANTEE shall surrender to COMMERCE all property of COMMERCE prior to settlement c upon completion, termination or cancellation of this Grant a� All reference to the GRANTEE under this clause shall also include GRANTEE'S employees, E agents or subgrantees/subcontractors. Q. m 64. WAIVER Waiver of any default or breach shall not be deemed to be a waiver of any subsequent default or breach. Any waiver shall not be construed to be a modification of the terms of this Grant unless Cn stated to be such in writing and signed by Authorized Representative of COMMERCE. o 0 c U) c� 0 LO M a+ V R L yr O U c cv ,L^ V V L a) E E O V 0 Q E V Y Q AAG Approved -CAR DA GRANT AGREEMENT—VER 3 Packet Pg. 126 8.D.a m ATTACHMENT A- SCOPE OF WORK Q Funds awarded under this grant will be used for capital expenditures to improve habitat and protect against flooding in an urbanized reach of Mill Creek. This flood plain stabilization and habitat project includes replacement of five creek culverts to allow increased fish passage and restoration of vegetation and channel capacity; and creation of flood plain areas to reduce flood risk. L U The location of the project is a section between 22011 and 22408 of 76th Ave S., Kent, WA 98032 g Project activities will include and not be limited to: • Construction m This project is expected to begin in spring 2023 and is expected to be complete by December 2024 a) E Costs related to the work will only be reimbursed to the extent the work is determined by Commerce to be E within the scope of the legislative appropriation. U w 0 CERTIFICATION PERFORMANCE MEASURE a� The GRANTEE, by its signature, certifies that the declaration set forth above has been reviewed and E L approved by the GRANTEE's governing body as of the date and year written below. Q. m 0 m Cn c 0 GRANTEE c U) c� TITLE 0 LO DATE r U L O U c cv ,L^ V V L a) E E O U 0 Q E V Y Q 22 Packet Pg. 127 8.D.a m Q m ti a� L U c ,L^ V d V L O U 4- 0 r c a� E L Q V/ O U) LO M a+ V R L a O U c cv ,L^ V V L N E E O U 4- 0 Q E V Y Q 23 Packet Pg. 128 8.D.a ATTACHMENT B - CERTIFICATION OF THE AVAILABILITY OF FUNDS TO COMPLETE THE PROJECT > Q t Type of Funding Source Description Amount Grant Washington State Department of Commerce $980,000.00 Y Other Grants P L Washington State Department of Commerce v Grant#1 CD18-96616-113 $1,950,000.00 - King County Flood Control District I $205,902.00 Total Other Grants $2,155,902.00 L Other Loans m Loan #1 $ aD Total Loans $0.00 E Other Local Revenue 0 U Source#1 City of Kent $14,642,390.00 c Total Local Revenue $14,642,390.00 Other Funds Source#1 I $ f° a Total Other Funds $0.00 0 Total Project Funding $17,778,292.00 m r Cn CERTIFICATION PERFORMANCE MEASURE c a� The GRANTEE, by its signature, certifies that project funding from sources other than those provided by E t this Grant Agreement and identified above has been reviewed and approved by the GRANTEE's CU governing body or board of directors, as applicable, and has either been expended for eligible Project expenses, or is committed in writing and available and will remain committed and available solely and Ln specifically for carrying out the purposes of this Project as described in elsewhere in this Grant c LO Agreement, as of the date and year written below. The GRANTEE shall maintain records sufficient to evidence that it has expended or has access to the funds needed to complete the Project, and shall make such records available for COMMERCE's review upon reasonable request. L w c 0 U c GRANTEE P C9 a� L TITLE 0 E E 0 DATE v 0 w a a� 0 r c a� E R a 24 Packet Pg. 129 8.D.a m Q m ti a� L U c ,L^ V d V L O U 4- 0 r c a� E L Q V/ O U) LO M a+ V R L a O U c cv ,L^ V V L N E E O U 4- 0 Q E V Y Q 25 Packet Pg. 130 8.D.a ATTACHMENT C- CERTIFICATION OF THE PAYMENT AND REPORTING OF PREVAILING WAGES N m CERTIFICATION PERFORMANCE MEASURE Q m The GRANTEE, by its signature, certifies that all contractors and subcontractors performing work on the Project shall comply with prevailing wage laws set forth in Chapter 39.12 RCW, as applicable on the date Y a� the appropriation becomes effective, including but not limited to the filing of the"Statement of Intent to L Pay Prevailing Wages" and "Affidavit of Wages Paid" as required by RCW 39.12.040. The GRANTEE v shall maintain records sufficient to evidence compliance with Chapter 39.12 RCW, and shall make such M records available for COMMERCE's review upon request. c If any state funds are used by the GRANTEE for the purpose of construction, applicable State Prevailing L Wages must be paid. U L The GRANTEE, by its signature, certifies that the declaration set forth above has been reviewed and E E approved by the GRANTEE's governing body as of the date and year written below. E 0 U w O r c a� E L GRANTEE 0 Q. m 0 m TITLE U) c 0 DATE c t U) c� 0 LO M a+ V R L 0 U c cv ,L^ V V L a) E E 0 V 0 Q E V Y Q 26 Packet Pg. 131 8.D.a m Q m ti a� L U c ,L^ V d V L O U 4- 0 r c a� E L Q V/ O U) LO M a+ V R L a O U c cv ,L^ V V L N E E O U 4- 0 Q E V Y Q 2/ Packet Pg. 132 8.D.a ATTACHMENT D - CERTIFICATION OF INTENT TO ENTER THE LEADERSHIP IN ENERGY AND N ENVIRONMENTAL DESIGN (LEED) CERTIFICATION PROCESS Q t CERTIFICATION PERFORMANCE MEASURE ti The GRANTEE, by its signature, certifies that it will enter into the Leadership in Energy and Y a� Environmental Design certification process, as stipulated in RCW 39.35D, as applicable to the Project L funded by this Grant Agreement. The GRANTEE shall, upon receipt of LEED certification by the United v States Green Building Council, provide documentation of such certification to COMMERCE. M The GRANTEE, by its signature, certifies that the declaration set forth above has been reviewed and approved by the GRANTEE's governing body or board of directors, as applicable, as of the date and year written below. U L IF EXEMPT: DO NOT SIGN E E 0 U w O r c GRANTEE E L Q TITLE m 0 m DATE Cn c 0 c U) c� 0 LO M a+ V R L 0 U c cv ,L^ V V L a) E E 0 V 0 Q E V Y Q 28 Packet Pg. 133 8.E KENT DATE: April 4, 2023 TO: Kent City Council SUBJECT: Washington State Department of Commerce Mill Creek / 76th Avenue South Flood Plain Stabilization, Habitat Enhancement Project $1,950,000 Grant - Authorize MOTION: I move to accept grant funds in the amount of $1,950,000 from the Washington State Department of Commerce for the Mill Creek / 76t" Avenue South Flood Plain Stabilization, Habitat Enhancement Project, amend the budget, authorize expenditure of funds, authorize the Mayor to sign all necessary documents, subject to final terms and conditions acceptable to the City Attorney and Public Works Director, and to ratify all prior acts consistent with this motion. SUMMARY: The City was successful in receiving a $1,950,000 grant from the Washington State Department of Commerce for the Mill Creek / 76t" Avenue South Flood Plain Stabilization, Habitat Enhancement project. Funds awarded under this grant can be used for land acquisition, design, and construction phases of an urbanized reach of Mill Creek adjacent to 76t" Avenue S. located between 22011 and 22408 76th Avenue S. The project includes flood plain stabilization and habitat improvements to Mill Creek at 76t" Avenue South by replacing culverts to improve fish passage and restoration of habitat through using native vegetation; and improving floodplain areas to reduce flood risk. This project will serve as a benefit to the public by stabilizing the area to protect against flooding and improving the surrounding habitat. BUDGET IMPACT: Provides $1,950,000 in revenue to the project account 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. Packet Pg. 134 8.E ATTACHMENTS: 1. Dept of Commerce Grant Contract (PDF) 03/20/23 Public Works Committee MOTION PASSES RESULT: MOTION PASSES [UNANIMOUS]Next: 4/4/2023 7:00 PM AYES: Brenda Fincher, Satwinder Kaur, Marli Larimer Packet Pg. 135 8.E.a .�►. Washington State Department of L 'v4a&'w Commerce Cn a Grant to City of Kent L U through L The Local and Community Projects Program E O U O a-. C N For Mill Creek Flood Control Project - Flood plain stabilization and habitat improvements to an urbanized reach of Mill Creek. U) 0 Start date: 1/19/2018 y 0 LO M r V O L O U r c c� /L^ V V L cd E E O U O N C N E t v R r r Q Washington State Department of Commerce - Ver.06_09_22 www.commerce.wa.gov Packet Pg. 136 8.E.a TABLE OF CONTENTS FaceSheet........................................................................................................................ 1 Special Terms and Conditions.......................................................................................... 2 1. Grant Management ................................................................................... 2 2. Compensation ........................................................................................... 2 Cn 3. Certification of Funds Performance Measures.......................................... 2 4. Prevailing Wage Law................................................................................. 3 5. Documentation and Security ..................................................................... 3 Q 6. Basis for Establishing Real Property Values for Acquisitions of Real Property....4 7. Expenditures Eligible for Reimbursement .................................................4 8. Billing Procedures and Payment ...............................................................4 9. Subcontractor Data Collection...................................................... 5 10. Insurance................................................................................................... 5 L) 11. Order of Precedence................................................................................. 7 12. Reduction in Funds ................................................................................... 7 13. Ownership of Project/Capital Facilities...................................................... 7 a, 14. Change of Ownership or Use for GRANTEE-Owned Property ................. 7 E 15. Change of Use for Leased Property Performance Measure ..................... 8 0 16. Modification to the Project Budget............................................................. 8 0 17. Signage, Markers and Publications........................................................... 8 18. Historical and Cultural Artifacts ................................................................. 9 E 19. Reappropriation......................................................................................... 9 20. Termination for Fraud or Misrepresentation .............................................. 9 �. 21. Fraud and Other Loss Reporting............................................................. 10 0 22. Public Records Act.................................................................................. 10 ' 23. Applicability of Copyright Provisions to Architectural/En ineerin Design Work 10 pp Y9� 9 g in c 0 r a� General Terms and Conditions......................................................................................... 1 N 1. Definitions.................................................................................................. 1 2. Access to Data .......................................................................................... 1 3. Advance Payments Prohibited .................................................................. 1 0 LO 4. All Writings Contained Herein ................................................................... 1 5. Amendments ............................................................................................. 1 6. Americans with Disabilities Act (ADA)....................................................... 2 7. Assignment................................................................................................ 2 c 8. Attorney's Fees ......................................................................................... 2 v 9. Audit.......................................................................................................... 2 10. Breaches of Other State Contracts ..................................................3 11. Confidentiality/Safeguarding of Information............................................... 3 12. Conflict of Interest ..................................................................................... 3 a, 13. Copyright Provision ...................................................................................4 E 14. Disputes ....................................................................................................4 0 15. Duplicate Payment .................................................................................... 5 0 16. Governing Law and Venue........................................................................ 5 �. 17. Indemnification .......................................................................................... 5 0 18. Independent Capacity of the Grantee........................................................ 5 19. Industrial Insurance Coverage .................................................................. 5 20. Laws.......................................................................................................... 6 E 21. Licensing, Accreditation and Registration ................................................. 6 U 22. Limitation of Authority................................................................................ 6 a 23. Noncompliance with Nondiscrimination Laws ........................................... 6 24. Pay Equity..................................................................................6 Packet Pg. 137 8.E.a 25. Political Activities....................................................................................... 7 26. Publicity..................................................................................................... 7 27. Recapture.................................................................................................. 7 28. Records Maintenance ............................................................................... 7 c� 29. Registration with Department of Revenue................................................. 7 Cn 30. Right of Inspection............................................................ ..........7 31. Savings...................................................................................................... 8 32. Severability................................................................................................ 8 Q 33. Site Security .............................................................................................. 8 34. Subgranting/Subcontracting ...................................................................... 8 35. Survival...................................................................................................... 8 36. Taxes......................................................................................................... 8 37. Termination for Cause............................................................................... 8 38. Termination for Convenience .................................................................... 9 39. Termination Procedures............................................................................ 9 0 40. Treatment of Assets ................................................................................ 10 a� 41. Waiver..................................................................................................... 10 E E O U Attachment A, Scope of Work; Attachment B, Budget; Attachment C, Availability of Funds; Attachment D Certification of Prevailing Wages; Attachment E, Certification of LEED E E L CU N O y fC O LO M r V fC L O U r c R ,Ln V V L d E E O U O Q O C O E L v R r Q Packet Pg. 138 8.E.a FACE SHEET Grant Number: 18-96616- Washington State Department of Commerce Local Government Division Community Capital Facilities Unit M L GRANTEE 2.GRANTEE Doing Business As(optional) 3 c d City of Kent Q 440 W Gowe Kent,Washington 98032 Y 3.Grantee Representative 4.COMMERCE Representative L Susanne P. Smith Katrina Perez V (253)856-5553 Project Manager P.O.Box 42525 spsmith@kentwa.gov (360)688-6127 1011 Plum Street SE Fax 360-586-5880 Olympia,WA 98504-2525 `m katrina.perez@commerce.wa.gov E E 5.Grant Amount 6.Funding Source 7.Start Date 8.End Date V $1,950,000.00 Federal: ❑ State: ® Other: ❑ N/A: ❑ 1/19/2018 6/30/2023,contingent on p reappropriation, 6/30/2023 if funds are not d reappropriated E 9.Federal Funds(as applicable) Federal Agency CFDA Number Q. d N/A N/A N/A G m 10.Tax ID# 11.SWV# 12.UBI# 13.DUNS# 91-6001254 SWV0000552-00 173-000-002 N/A c 0 14.Grant Purpose c The purpose of this performance-based contract is to provide funding for flood plain stabilization and habitat improvements to an y urbanized reach of Mill Creek as described in Attachment A—Scope of Work(the"Project"). COMMERCE,defined as the Department of Commerce,and the GRANTEE,as defined above,acknowledge and accept the terms c of this Grant and attachments and have executed this Grant on the date below to start as of the date and year referenced above. The M rights and obligations of both parties to this Grant are governed by this Grant and the following other documents incorporated by reference: Grant Terms and Conditions including Attachment"A"—Scope of Work,Attachment"B"—Budget,Attachment"C"— Certification of Availability of Funds to Complete the Project,Attachment"D"—Certification of the Payment and Reporting of Prevailing Wages,Attachment"E"—Certification of Intent to Enter LEED process. V FOR GRANTEE FOR COMMERCE c /L^ V d Dana Ralph,Mayor Mark K.Barkley,Assistant Director m E E Date Date 0 V 0 APPROVED AS TO FORM Q. d � � c d Dawn Cortez,Assistant Attor General E Washington State Office of the Attorney Genera! Date:1//23/2023 r Q Packet Pg. 139 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS THIS CONTRACT, entered into by and between City of Kent ("GRANTEE"), a unit of local government, c and the Washington State Department of Commerce ("COMMERCE"), WITNESSES THAT: Cn L WHEREAS, COMMERCE has the statutory authority under RCW 43.330.050 (5)to cooperate with and provide assistance to local governments, businesses, and community-based organizations; and a WHEREAS, COMMERCE is also given the responsibility to administer state funds and programs which are assigned to COMMERCE by the Governor or the Washington State Legislature; and WHEREAS, the Washington State Legislature has, in Laws of 2018, Chapter 2, Section 10004, reappropriated in Laws of 2019, Chapter 413, Section 1024, and Laws of 2021,Chapter 332, c� Section 1024, made an appropriation to support the Local and Community Projects Program, and = directed COMMERCE to administer those funds; and a� U L WHEREAS, the GRANTEE intends to complete the Project, which will result in flood plain m stabilization and habitat improvements to an urbanized reach of Mill Creek; and E 0 WHEREAS, the enabling legislation stipulates that the GRANTEE is eligible to receive funding for o the Project; and +. c a� Additionally, the GRANTEE has received an appropriation for grant activities relating to current E project in Laws of 2019, Chapter 413, Section 1042, which has not yet been administered; and Q. a� WHEREAS, the Project is one component of a larger multiphase project, which will result in 76t" Avenue South being raised above the FEMA flood elevation. This final phase is the most a significant as it replaces deficient culverts and expands creek channel capacity. U) c 0 NOW, THEREFORE, in consideration of covenants, conditions, performances, and promises hereinafter a� contained, the parties hereto agree as follows: S N R 1. GRANT MANAGEMENT m The Representative for each of the parties shall be responsible for and shall be the contact person for Q all communications and billings regarding the performance of this Grant. r The Representative for COMMERCE and their contact information are identified on the Face Sheet of this Grant. c The Representative for the GRANTEE and their contact information are identified on the Face �j Sheet of this Grant. c� L 2. COMPENSATION a� COMMERCE shall pay an amount not to exceed $1,950,000.00 for the capital costs necessary for or incidental to the performance of work as set forth in the Scope of Work. E 0 U 3. CERTIFICATION OF FUNDS PERFORMANCE MEASURES o A. The release of state funds under this contract is contingent upon the GRANTEE certifying that it has expended or has access to funds from non-state sources as set forth in ATTACHMENT C o (CERTIFICATION OF THE AVAILABILITY OF FUNDS TO COMPLETE THE PROJECT), hereof. Such non-state sources may consist of a combination of any of the following: i) Eligible Project expenditures prior to the execution of this contract. U 0 ii) Cash dedicated to the Project. Q Packet Pg. 140 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS iii) Funds available through a letter of credit or other binding loan commitment(s). c iv) Pledges from foundations or corporations. Cn c� v) Pledges from individual donors. vi) The value of real property when acquired solely for the purposes of this Project, as established and evidenced by a current market value appraisal performed by a licensed, Q professional real estate appraiser, or a current property tax statement. COMMERCE will not consider appraisals for prospective values of such property for the purposes of ti calculating the amount of non-state matching fund credit. vii) In-kind contributions, subject to COMMERCE'S approval. U B. The GRANTEE shall maintain records sufficient to evidence that it has access to or has expended funds from such non-state sources, and shall make such records available for COMMERCE'S review upon reasonable request. U L d E 4. PREVAILING WAGE LAW E 0 The Project funded under this Grant may be subject to state prevailing wage law (Chapter 39.12 v RCW). The GRANTEE is advised to consult the Industrial Statistician at the Washington Department 0 of Labor and Industries to determine whether prevailing wages must be paid. COMMERCE is not responsible for determining whether prevailing wage applies to this Project or for any prevailing wage E payments that may be required by law. Q. a� 5. DOCUMENTATION AND SECURITY o a� The provisions of this section shall apply to capital projects performed by nonprofit organizations and public benefit corporations that involve the expenditure of over$250,000 in state funds. Additionally, U) Commerce reserves the right to review all state-funded projects and to require that projects o performed by other entity types comply with this section. Projects for which the grant award or legislative intent documents specify that the state funding is to be used for pre-design or design only are exempt from this section. A. Deed of Trust. This Grant shall be evidenced by a promissory note and secured by a deed of trust or other appropriate security instrument in favor of COMMERCE (the "Deed of Trust"). The Q Deed of Trust shall be recorded in the County where the Project is located, and the original returned to COMMERCE after recordation within ninety(90) days of contract execution. The Deed of Trust must be recorded before COMMERCE will reimburse the GRANTEE for any Project costs. The amount secured by the Deed of Trust shall be the amount of the grant as set forth in Section 2, hereof. C) r c B. Term of Deed of Trust. The Deed of Trust shall remain in full force and effect for a minimum period of ten (10)years following the later of: (1)final payment of state funds to the GRANTEE a� under this grant; or(2)the date when the facility improved or acquired with grant funds, or a U, L distinct phase of the Project, is made useable to the public for the purpose intended by the m E Legislature. Upon satisfaction of the ten-year term requirement and all other grant terms and E conditions, COMMERCE shall, upon written request of the GRANTEE, take appropriate action to 0 U reconvey the Deed of Trust. o C. Title Insurance. The GRANTEE shall purchase an extended coverage lender's policy of title o insurance insuring the lien position of the Deed of Trust in an amount not less than the amount of the grant. E D. Covenant. If the project will be partially funded by a loan and the term of said loan is less than the commitment period under this grant contract, COMMERCE may require that GRANTEE record or r Q Packet Pg. 141 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS cause to be recorded a covenant in a superior lien position ahead of the lender's security c instrument that restricts use of the facility or property for the purpose(s) stated elsewhere in this contract for at least the term of the commitment period Cn a� E. Subordination. COMMERCE may agree to subordinate its deed of trust upon request from a private or public lender. Any such request shall be submitted to COMMERCE in writing, and > COMMERCE shall respond to the request in writing within thirty(30) days of receiving the Q request. coo ti 6. BASIS FOR ESTABLISHING REAL PROPERTY VALUES FOR ACQUISITIONS OF REAL �c PROPERTY PERFORMANCE MEASURES a0i L When all or part of the grant is used to fund the acquisition of real property, before funds are v_ disbursed, the GRANTEE shall procure and provide to COMMERCE evidence establishing the value of the real property eligible for reimbursement as follows: L a. GRANTEE purchases of real property from an independent third-party seller shall be m evidenced by a current appraisal prepared by a licensed Washington State commercial E real estate appraiser, or a current property tax statement. U b. GRANTEE purchases of real property from a subsidiary organization, such as an affiliated LLC, shall be evidenced by a current appraisal prepared by a licensed E Washington State commercial real estate appraiser or the prior purchase price of the E property plus holding costs, whichever is less. Q. a� 7. EXPENDITURES ELIGIBLE FOR REIMBURSEMENT a� The GRANTEE may be reimbursed, at the rate set forth elsewhere in this contract, for Project f° U) expenditures corresponding to activities described in the Scope of Work in the following cost c categories: c A. Real property, and costs directly associated with such purchase, when purchased or acquired w solely for the purposes of the Project; B. Design, engineering, architectural, and planning; c M C. Construction management and observation (from external sources only); r D. Construction costs including, but not limited to, the following: Site preparation and improvements; 0 Permits and fees; Labor and materials; Taxes on Project goods and services; Capitalized equipment; Information technology infrastructure; and Landscaping. E 0 8. BILLING PROCEDURES AND PAYMENT v COMMERCE shall reimburse the GRANTEE for one-hundred percent (100%) of eligible Project 0 expenditures, up to the maximum payable under this contract. When requesting reimbursement for o expenditures made, the GRANTEE shall submit to COMMERCE a signed and completed Invoice Voucher(Form A-19), that documents capitalized Project activity performed— by budget line item— for the billing period. E z The GRANTEE shall evidence the costs claimed on each voucher by including copies of each invoice U received from vendors providing Project goods or services covered by the contract. The GRANTEE Q Packet Pg. 142 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS shall also provide COMMERCE with a copy of the cancelled check or electronic funds transfer, as c applicable, that confirms that they have paid each expenditure being claimed. The cancelled checks or electronic funds transfers may be submitted to COMMERCE at the time the voucher is initially Cn submitted, or within thirty (30)days thereafter. The voucher must be certified (signed) by an official of the GRANTEE with authority to bind the W GRANTEE. The final voucher shall be submitted to COMMERCE within sixty (60)days following the Q completion of work or other termination of this contract, or within fifteen (15) days following the end of the state biennium unless contract funds are reappropriated by the Legislature in accordance with ti Section 19, hereof. If GRANTEE has or will be submitting any of the invoices attached to a request for payment for partial reimbursement under another grant contract, GRANTEE must clearly identify such grant contracts in c) the transmittal letter and request for payment. Each request for payment must be accompanied by a Project Status Report, which describes, in 4) narrative form, the progress made on the Project since the last invoice was submitted, as well as a `m report of Project status to date. COMMERCE will not release payment for any reimbursement E request received unless and until the Project Status Report is received. After approving the Invoice 0 Voucher and Project Status Report, COMMERCE shall promptly remit a warrant to the GRANTEE. v 0 COMMERCE will pay GRANTEE upon acceptance of services provided and receipt of properly completed invoices, which shall be submitted to the Representative for COMMERCE not more often E than monthly. 0 Payment shall be considered timely if made by COMMERCE within thirty (30)calendar days after Q- a� receipt of properly completed invoices. Payment shall be sent to the address designated by the o GRANTEE. c� COMMERCE may, in its sole discretion, terminate the Grant or withhold payments claimed by the U) GRANTEE for services rendered if the GRANTEE fails to satisfactorily comply with any term or 0 condition of this Grant. No payments in advance or in anticipation of services or supplies to be provided under this w Agreement shall be made by COMMERCE. Duplication of Billed Costs 0 The GRANTEE shall not bill COMMERCE for services performed under this Agreement, and M COMMERCE shall not pay the GRANTEE, if the GRANTEE is entitled to payment or has been or will be paid by any other source, including grants, for that service. L Disallowed Costs 0 The GRANTEE is responsible for any audit exceptions or disallowed costs incurred by its own organization or that of its subgrantees. cLa 9. SUBCONTRACTOR DATA COLLECTION a� GRANTEE will submit reports, in a form and format to be provided by Commerce and at intervals as agreed by the parties, regarding work under this Grant performed by subcontractors and the portion E of Grant funds expended for work performed by subcontractors, including but not necessarily limited 0 to minority-owned, woman-owned, and veteran-owned business subcontractors. "Subcontractors" v shall mean subcontractors of any tier. 0 a m 0 10. INSURANCE m A. Insurance Requirements for Reimbursable Activities E z The GRANTEE will maintain appropriate insurance coverage throughout any period in which r reimbursable activities are conducted. The intent of the required insurance is to protect the state of Q Packet Pg. 143 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS Washington should there be any claims, suits, actions, costs, damages or expenses arising from any c loss, or negligent or intentional act or omission of the GRANTEE, or Subgrantee, or agents of either, while performing under the terms of this Grant. Cn B. Additional Insurance Requirements During the Term of the Grant c The GRANTEE shall provide proof to COMMERCE of the following insurance coverage as applicable: > a Commercial General Liability Insurance Policy. Provide a Commercial General Liability Insurance Policy, including contractual liability, written on an occurrence basis, in adequate ti quantity to protect against legal liability related to this Grant but no less than $1,000,000 per occurrence. Additionally, the GRANTEE is responsible for ensuring that any Subgrantees provide adequate insurance coverage for the activities arising out of subgrants. Commercial General v Liability Insurance coverage shall be maintained in full force and effect during the term of this —_ Grant and throughout the commitment period described in Special Terms and Conditions Section 5, 14, and 15. L Property Insurance. The GRANTEE shall keep the property insured in an amount sufficient to m E permit such insurance to be written at all times on a replacement cost basis. Such insurance shall E cover the following hazards, as applicable: 0 • Loss or damage by fire and such other risks; o • Loss or damage from leakage or sprinkler systems now or hereafter installed in any building on the premises; E • Loss or damage by explosion of steam boilers, pressure vessels, oil or gasoline storage tanks or similar apparatus now or hereafter installed in a building or building on the premises. a� Property Insurance coverage shall be maintained in full force and effect during the term of this Grant and throughout the commitment period described in Special Terms and Conditions Section in 5, 14, and 15 0 r a� c Fidelity Insurance. Every officer, director, employee, or agent who is authorized to act on behalf of the GRANTEE for the purpose of receiving or depositing funds into program accounts or issuing financial documents, checks, or other instruments of payment for program costs shall be insured to provide protection against loss: co 0 LO A. The amount of fidelity coverage secured pursuant to this Grant shall be$2,000,000 or the highest of planned reimbursement for the Grant period, whichever is lowest. Fidelity insurance secured pursuant to this paragraph shall name COMMERCE as beneficiary. L B. Subgrantees that receive $10,000 or more per year in funding through this Grant shall secure c fidelity insurance as noted above. Fidelity insurance secured by Subgrantees pursuant to v this paragraph shall name the GRANTEE and the GRANTEE's fiscal agent as beneficiary. L Fidelity Insurance coverage shall be maintained in full force and effect during the term of this Grant. L d The insurance required shall be issued by an insurance company authorized to do business within E the state of Washington. The insurance shall name the state of Washington, its agents, officers, and o employees as additional insureds under the insurance policy. All policies shall be primary to any other c) valid and collectable insurance. The GRANTEE shall instruct the insurers to give COMMERCE thirty o (30) calendar days advance notice of any insurance cancellation or modification. a m The GRANTEE shall provide to COMMERCE copies of insurance instruments or certifications from the insurance issuing agency. The copies or certifications shall show the insurance coverage, the designated beneficiary, who is covered, the amounts, the period of coverage, and that COMMERCE will be provided thirty (30)days advance written notice of cancellation. r r Q Packet Pg. 144 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS During the term of the Grant, the GRANTEE shall submit renewal certificates not less than thirty (30) c calendar days prior to expiration of each policy required under this section. Professional Liability, Errors and Omissions Insurance for Contractors. The GRANTEE Cn shall require that any contractors providing professional services that are reimbursable under this Grant maintain Professional Liability or Errors and Omissions Insurance. The GRANTEE shall require such contractors to maintain minimum limits of no less than $1,000,000 per occurrence. Q The state of Washington, its agents, officers, and employees need not be named as additional insureds under these policies. ti GRANTEES and Local Governments that Participate in a Self-Insurance Program. Self-Insured/Liability Pool or Self-Insured Risk Management Program—With prior approval from 9), COMMERCE, the GRANTEE may provide the coverage above under a self-insured/liability pool t) or self-insured risk management program. In order to obtain permission from COMMERCE, the GRANTEE shall provide: (1) a description of its self-insurance program, and (2) a certificate and/or letter of coverage that outlines coverage limits and deductibles. All self-insured risk U L management programs or self-insured/liability pool financial reports must comply with Generally Accepted Accounting Principles GAAP and adhere to accounting standards promulgated b 1 E p 9 p ( ) 9 p 9 Y� ) E Governmental Accounting Standards Board (GASB), 2) Financial Accounting Standards Board 0 U (FASB), and 3)the Washington State Auditor's annual instructions for financial reporting. o GRANTEE's participating in joint risk pools shall maintain sufficient documentation to support the aggregate claim liability information reported on the balance sheet. The state of Washington, its E agents, and employees need not be named as additional insured under a self-insured E property/liability pool, if the pool is prohibited from naming third parties as additional insured. Q. a� GRANTEE shall provide annually to COMMERCE a summary of coverages and a letter of self o insurance, evidencing continued coverage under GRANTEE's self-insured/liability pool or self- insured risk management program. Such annual summary of coverage and letter of self f° U) insurance will be provided on the anniversary of the start date of this Agreement. c 0 r 11. ORDER OF PRECEDENCE c In the event of an inconsistency in this Grant, the inconsistency shall be resolved by giving precedence in the following order: • Applicable federal and state of Washington statutes and regulations o • Special Terms and Conditions M • General Terms and Conditions • Attachment A—Scope of Work L • Attachment B— Budget c • Attachment C—Certification of the Availability of Funds to Complete the Project �j • Attachment D—Certification of the Payment and Reporting of Prevailing Wages • Attachment E—Certification of Intent to Enter the Leadership in Energy and Environmental Design (LEED) Certification Process a� L 12. REDUCTION IN FUNDS In the event state funds appropriated for the work contemplated under this contract are withdrawn, o reduced, or limited in any way by the Governor or the Washington State Legislature during the v contract period, the parties hereto shall be bound by any such revised funding limitations as o implemented at the discretion of COMMERCE, and shall meet and renegotiate the contract accordingly. o 13. OWNERSHIP OF PROJECT/CAPITAL FACILITIES E COMMERCE makes no claim to any real property improved or constructed with funds awarded under this contract and does not assert and will not acquire any ownership interest in or title to the capital r Q Packet Pg. 145 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS facilities and/or equipment constructed or purchased with state funds under this contract; provided, c however, that COMMERCE may be granted a security interest in real property, to secure funds awarded under this contract. This provision does not extend to claims that COMMERCE may bring Cn against the GRANTEE in recapturing funds expended in violation of this contract. c 14. CHANGE OF OWNERSHIP OR USE FOR GRANTEE-OWNED PROPERTY a A. The GRANTEE understands and agrees that any and all real property or facilities owned by the GRANTEE that are acquired, constructed, or otherwise improved by the GRANTEE using state ti funds under this contract, shall be held and used by the GRANTEE for the purpose or purposes stated elsewhere in this contract for a period of at least ten (10)years from the later of: (1)the date the final payment is made hereunder; or(2)the date when the facility improved or acquired v with grant funds, or a distinct phase of the Project, is made usable to the public for the purpose —_ intended by the Legislature. a� B. This provision shall not be construed to prohibit the GRANTEE from selling any property or U L properties described in this section; Provided, that any such sale shall be subject to prior review m and approval by COMMERCE, and that all proceeds from such sale shall be applied to the E purchase price of a different facility or facilities of equal or greater value than the original facility U and that any such new facility or facilities will be used for the purpose or purposes stated — elsewhere in this contract. c C. In the event the GRANTEE is found to be out of compliance with this section, the GRANTEE shall E repay to the state general fund the principal amount of the grant, plus interest calculated at the rate of interest on state of Washington general obligation bonds issued most closely to the Q- a� effective date of the legislation in which the subject facility was authorized. Repayment shall be o made pursuant to Section 27 (Recapture provision)of the General Terms and Conditions. 15. CHANGE OF USE FOR LEASED PROPERTY PERFORMANCE MEASURE c A. The GRANTEE understands and agrees that any facility leased by the GRANTEE that is constructed, renovated, or otherwise improved using state funds under this contract shall be used c by the GRANTEE for the purpose or purposes stated elsewhere in this contract for a period of at E least ten (10)years from the later of: (1)the date the final payment is made hereunder; or(2)the date when the facility improved or acquired with grant funds, or a distinct phase of the Project, is made usable to the public for the purpose intended by the Legislature. o B. In the event the GRANTEE is found to be out of compliance with this section, the GRANTEE shall repay to the state general fund the principal amount of the grant, plus interest calculated at the rate of interest on state of Washington general obligation bonds issued most closely to the effective date of the legislation in which the subject facility was authorized. Repayment shall be c made pursuant to Section 27 (Recapture provision)of the General Terms and Conditions. C) r 16. MODIFICATION TO THE PROJECT BUDGET c�a L A. Notwithstanding any other provision of this contract, the GRANTEE may, at its discretion, make modifications to line items in the Project Budget(Attachment B), hereof, that will not increase the L line item by more than fifteen percent(15%). B. The GRANTEE shall notify COMMERCE in writing (by email or regular mail)when proposing any o budget modification or modifications to a line item in the Project Budget (Attachment B,) hereof, v that would increase the line item by more than fifteen percent(15%). Conversely, COMMERCE o may initiate the budget modification approval process if presented with a request for payment under this contract that would cause one or more budget line items to exceed the 15 percent o (15%)threshold increase described above. m C. Any such budget modification or modifications as described above shall require the written E approval of COMMERCE (by email or regular mail), and such written approval shall amend the U r r Q Packet Pg. 146 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS Project Budget. Each party to this contract will retain and make any and all documents related to c such budget modifications a part of their respective contract file. D. Nothing in this section shall be construed to permit an increase in the amount of funds available Cn for the Project, as set forth in Section 2 of this contract. 3 c 17. SIGNAGE, MARKERS AND PUBLICATIONS > a If, during the period covered by this contract, the GRANTEE displays or circulates any communication, publication, or donor recognition identifying the financial participants in the Project, ti any such communication or publication must identify"The Taxpayers of Washington State" as a participant. L 18. HISTORICAL AND CULTURAL ARTIFACTS v Prior to approval and disbursement of any funds awarded under this Contract, GRANTEE shall a� cooperate with COMMERCE to complete the requirements of Governor's Executive Order 21-02 or U GRANTEE shall complete a review under Section 106 of the National Historic Preservation Act, if m E applicable. GRANTEE agrees that the GRANTEE is legally and financially responsible for compliance E with all laws, regulations, and agreements related to the preservation of historical or cultural 0 U resources and agrees to hold harmless COMMERCE and the state of Washington in relation to any — claim related to such historical or cultural resources discovered, disturbed, or damaged as a result of the project funded by this Contract. r- In addition to the requirements set forth in this Contract, GRANTEE shall, in accordance with Q. Governor's Executive Order 21-02 as applicable, coordinate with Commerce and the Washington State Department of Archaeology and Historic Preservation ("DAHP"), including any recommended consultation with any affected tribe(s), during Project design and prior to construction to determine the a existence of any tribal cultural resources affected by Project. GRANTEE agrees to avoid, minimize, U) or mitigate impacts to the cultural resource as a continuing prerequisite to receipt of funds under this o Contract. a� c The GRANTEE agrees that, unless the GRANTEE is proceeding under an approved historical and cultural monitoring plan or other memorandum of agreement, if historical or cultural artifacts are discovered during construction, the GRANTEE shall immediately stop construction and notify the local historical preservation officer and the state's historical preservation officer at DAHP, and the Q LO Commerce Representative identified on the Face Sheet. If human remains are uncovered, the GRANTEE shall report the presence and location of the remains to the coroner and local enforcement immediately, then contact DAHP and the concerned tribe's cultural staff or committee. L c The GRANTEE shall require this provision to be contained in all subcontracts for work or services �j related to the Scope of Work attached hereto. c� L In addition to the requirements set forth in this Contract, GRANTEE agrees to comply with RCW a� 27.44 regarding Indian Graves and Records; RCW 27.53 regarding Archaeological Sites and L Resources; RCW 68.60 regarding Abandoned and Historic Cemeteries and Historic Graves; and WAC 25-48 regarding Archaeological Excavation and Removal Permits. E 0 Completion of the requirements of Section 106 of the National Historic Preservation Act shall v substitute for completion of Governor's Executive Order 21-02. 0 a m In the event that the GRANTEE finds it necessary to amend the Scope of Work the GRANTEE may be required to re-comply with Governor's Executive Order 21-02 or Section 106 of the National Historic Preservation Act. E z U 19. REAPPROPRIATION r Q Packet Pg. 147 8.E.a SPECIAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS A. The parties hereto understand and agree that any state funds not expended by June 30, 2023 will c lapse on that date unless specifically reappropriated by the Washington State Legislature. If L funds are so reappropriated, the state's obligation under the terms of this contract shall be Cn contingent upon the terms of such reappropriation. ° B. In the event any funds awarded under this contract are reappropriated for use in a future biennium, COMMERCE reserves the right to assign a reasonable share of any such Q reappropriation for administrative costs. co ti 20. TERMINATION FOR FRAUD OR MISREPRESENTATION In the event the GRANTEE commits fraud or makes any misrepresentation in connection with the Grant application or during the performance of this contract, COMMERCE reserves the right to c) terminate or amend this contract accordingly, including the right to recapture all funds disbursed to the GRANTEE under the Grant. a� U L 21. FRAUD AND OTHER LOSS REPORTING E Grantee shall report in writing all known or suspected fraud or other loss of any funds or other o property furnished under this Contract immediately or as soon as practicable to the Commerce v Representative identified on the Face Sheet. o 22. PUBLIC RECORDS ACT E Notwithstanding General Terms and Conditions Section 11, COMMERCE is a public agency subject to the Public Records Act, Chapter 42.56 RCW (the "PRA"). Under the PRA, all materials relating to Q- a� the conduct of government or the performance of any governmental or proprietary function prepared, o owned, used, or retained by COMMERCE or its functional equivalents are considered public records. The PRA requires that public records responsive to a public records request be promptly produced unless the PRA or an "other statute" exempts such records from production. This Agreement is not c intended to alter COMMERCE's obligations under the PRA. The parties agree that if COMMERCE ° receives a public records request for files that may include confidential information under General c Terms and Conditions Section 11, COMMERCE will notify the other party of the request and of the E date that the records will be released to the requester unless GRANTEE obtains a court order enjoining disclosure. If the GRANTEE fails to obtain the court order enjoining disclosure, COMMERCE may release the requested information on the date specified. If the GRANTEE obtains c a court order from a court of competent jurisdiction enjoining disclosure pursuant to the PRA, M COMMERCE shall maintain the confidentiality of the information per the court order. r ° L 23. APPLICABILITY OF COPYRIGHT PROVISIONS TO ARCHITECTURAL/ENGINEERING DESIGN WORK ° U The "Copyright Provisions", Section 13 of the General Terms and Conditions, are not intended to apply to any architectural and engineering design work funded by this grant. a� L d E E O U O N C N E t v R r r Q Packet Pg. 148 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS 1. DEFINITIONS L As used throughout this Grant, the following terms shall have the meaning set forth below: U) g g 9 cn A. "Authorized Representative" shall mean the Director and/or the designee authorized in writing to act on the Director's behalf. B. "COMMERCE" shall mean the Department of Commerce. Q C. "Grant" and "Agreement" and "Contract" shall mean the entire written agreement between ti COMMERCE and the GRANTEE, including any exhibits, attachments, documents, or materials Y incorporated by reference, and any amendments executed by the parties. L D. "GRANTEE" shall mean the entity identified on the face sheet performing service(s) under this v Grant, and shall include all employees and agents of the GRANTEE. E. "Personal Information" shall mean information identifiable to any person, including, but not limited to, information that relates to a person's name, health, finances, education, business, use or receipt of governmental services or other activities, addresses, telephone numbers, social E security numbers, driver license numbers, other identifying numbers, and any financial identifiers. o U F. "State" shall mean the state of Washington. o G. "Subgrantee/subcontractor" shall mean one not in the employment of the GRANTEE, who is performing all or part of those services under this Grant under a separate Grant with the E GRANTEE. The terms "subgrantee/subcontractor" refers to any tier. Q. H. "Subrecipient" shall mean a non-federal entity that expends federal awards received from a pass- p through entity to carry out a federal program, but does not include an individual that is a ar beneficiary of such a program. It also excludes vendors that receive federal funds in exchange for goods and/or services in the course of normal trade or commerce. ) 0 I. "Vendor" is an entity that agrees to provide the amount and kind of services requested by COMMERCE; provides services under the grant only to those beneficiaries individually S determined to be eligible by COMMERCE and, provides services on a fee-for-service or per-unit basis with contractual penalties if the entity fails to meet program performance standards. ?� 2. ACCESS TO DATA o LO In compliance with RCW 39.26.180, the GRANTEE shall provide access to data generated under this Grant to COMMERCE, the Joint Legislative Audit and Review Committee, and the Office of the State Auditor at no additional cost. This includes access to all information that supports the findings, conclusions, and recommendations of the GRANTEE's reports, including computer models and the c methodology for those models. v r c c� 3. ADVANCE PAYMENTS PROHIBITED No payments in advance of or in anticipation of goods or services to be provided under this Grant L shall be made by COMMERCE. 4. ALL WRITINGS CONTAINED HEREIN o U This Grant contains all the terms and conditions agreed upon by the parties. No other o understandings, oral or otherwise, regarding the subject matter of this Grant shall be deemed to exist a or to bind any of the parties hereto. o 5. AMENDMENTS This Grant may be amended by mutual agreement of the parties. Such amendments shall not be binding unless they are in writing and signed by personnel authorized to bind each of the parties. r Q Packet Pg. 149 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS 6. AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, also referred to L as the "ADA" 28 CFR Part 35 c9 U) The GRANTEE must comply with the ADA, which provides comprehensive civil rights protection to individuals with disabilities in the areas of employment, public accommodations, state and local c government services, and telecommunications. Q 7. ASSIGNMENT ti Neither this Grant, nor any claim arising under this Grant, shall be transferred or assigned by the Y GRANTEE without prior written consent of COMMERCE. ° a� L 8. ATTORNEYS' FEES v Unless expressly permitted under another provision of the Grant, in the event of litigation or other action brought to enforce Grant terms, each party agrees to bear its own attorneys' fees and costs. L d 9. AUDIT E E A. General Requirements ° U COMMERCE reserves the right to require an audit. If required, GRANTEEs are to procure audit ° services based on the following guidelines. The GRANTEE shall maintain its records and accounts so as to facilitate audits and shall ensure that subgrantees also maintain auditable records. Q- a� The GRANTEE is responsible for any audit exceptions incurred by its own organization or that of its subgrantees. COMMERCE reserves the right to recover from the GRANTEE all disallowed costs resulting from U) c the audit. ° r a� Responses to any unresolved management findings and disallowed or questioned costs shall be included with the audit report. The GRANTEE must respond to COMMERCE requests for information or corrective action concerning audit issues within thirty(30)days of the date of request. m B. State Funds Requirements M In the event an audit is required, if the GRANTEE is a state or local government entity, the Office of the State Auditor shall conduct the audit. Audits of non-profit organizations are to be L conducted by a certified public accountant selected by the GRANTEE. 0 The GRANTEE shall include the above audit requirements in any subcontracts. v r c In any case, the GRANTEE's records must be available for review by COMMERCE. /L^ V C. Documentation Requirements L The GRANTEE must send a copy of the audit report described above no later than nine (9) m months after the end of the GRANTEE's fiscal year(s) by sending a scanned copy to E E auditreview(a)-commerce.wa.gov or a hard copy to: 0 Department of Commerce o ATTN: Audit Review and Resolution Office a 1011 Plum Street SE 0 PO Box 42525 Olympia WA 98504-2525 E In addition to sending a copy of the audit, when applicable, the GRANTEE must include: U 0 • Corrective action plan for audit findings within three (3) months of the audit being a received by COMMERCE. Packet Pg. 150 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS • Copy of the Management Letter. L If the GRANTEE is required to obtain a Single Audit consistent with Circular A-133 requirements, Cn a copy must be provided to COMMERCE; no other report is required. 3 c 10. BREACHES OF OTHER STATE CONTRACTS > a GRANTEE is expected to comply with all other contracts executed between GRANTEE and the State of Washington. A breach of any other agreement entered into between GRANTEE and the State of ti Washington may, in COMMERCE's discretion, be deemed a breach of this Agreement. Y m as 11. CONFIDENTIALITY/SAFEGUARDING OF INFORMATION �j A. "Confidential Information" as used in this section includes: 1. All material provided to the GRANTEE by COMMERCE that is designated as "confidential" U by COMMERCE; E 2. All material produced by the GRANTEE that is designated as"confidential" by COMMERCE; E and c) 3. All personal information in the possession of the GRANTEE that may not be disclosed under ° state or federal law. "Personal information" includes but is not limited to information related to a� a person's name, health, finances, education, business, use of government services, E addresses, telephone numbers, social security number, driver's license number and other identifying numbers, and "Protected Health Information" under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). as B. The GRANTEE shall comply with all state and federal laws related to the use, sharing, transfer, sale, or disclosure of Confidential Information. The GRANTEE shall use Confidential Information ) solely for the purposes of this Grant and shall not use, share, transfer, sell or disclose any $ Confidential Information to any third party except with the prior written consent of COMMERCE or as may be required by law. The GRANTEE shall take all necessary steps to assure that Confidential Information is safeguarded to prevent unauthorized use, sharing, transfer, sale or disclosure of Confidential Information or violation of any state or federal laws related thereto. Upon request, the GRANTEE shall provide COMMERCE with its policies and procedures on m confidentiality. COMMERCE may require changes to such policies and procedures as they apply M to this Grant whenever COMMERCE reasonably determines that changes are necessary to -- prevent unauthorized disclosures. The GRANTEE shall make the changes within the time period specified by COMMERCE. Upon request, the GRANTEE shall immediately return to COMMERCE any Confidential Information that COMMERCE reasonably determines has not c been adequately protected by the GRANTEE against unauthorized disclosure. v r c C. Unauthorized Use or Disclosure. The GRANTEE shall notify COMMERCE within five (5)working days of any unauthorized use or disclosure of any confidential information, and shall take necessary steps to mitigate the harmful effects of such use or disclosure. L am 12. CONFLICT OF INTEREST E E Notwithstanding any determination by the Executive Ethics Board or other tribunal, COMMERCE v may, in its sole discretion, by written notice to the GRANTEE terminate this contract if it is found after o due notice and examination by COMMERCE that there is a violation of the Ethics in Public Service a Act, Chapters 42.52 RCW and 42.23 RCW; or any similar statute involving the GRANTEE in the o procurement of, or performance under this contract. c Specific restrictions apply to contracting with current or former state employees pursuant to chapter 42.52 of the Revised Code of Washington. The GRANTEE and their subcontractor(s) must identify any person employed in any capacity by the state of Washington that worked on this Grant, or any ;o matter related to the project funded under this Grant or any other state funded project, including but a not limited to formulating or drafting legislation, participating in grant procurement, planning and Packet Pg. 151 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS execution, awarding grants, or monitoring grants, during the 24 month period preceding the start date L of this Grant. Any person identified by the GRANTEE and their subcontractors(s) must be identified 0 individually by name, the agency previously or currently employed by,job title or position held, and Cn separation date. If it is determined by COMMERCE that a conflict of interest exists, the GRANTEE may be disqualified from further consideration for the award of a Grant. In the event this contract is terminated as provided above, COMMERCE shall be entitled to pursue Q the same remedies against the GRANTEE as it could pursue in the event of a breach of the contract coo by the GRANTEE. The rights and remedies of COMMERCE provided for in this clause shall not be exclusive and are in addition to any other rights and remedies provided by law. The existence of facts upon which COMMERCE makes any determination under this clause shall be an issue and may L be reviewed as provided in the "Disputes" clause of this contract. v 13. COPYRIGHT PROVISIONS a� U Unless otherwise provided, all Materials produced under this Grant shall be considered "works for E hire" as defined by the U.S. Copyright Act and shall be owned by COMMERCE. COMMERCE shall E be considered the author of such Materials. In the event the Materials are not considered "works for o hire" under the U.S. Copyright laws, the GRANTEE hereby irrevocably assigns all right, title, and v interest in all Materials, including all intellectual property rights, moral rights, and rights of publicity to ° COMMERCE effective from the moment of creation of such Materials. _ W "Materials" means all items in any format and includes, but is not limited to, data, reports, documents, pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, Q. and/or sound reproductions. "Ownership" includes the right to copyright, patent, register and the W 0 ability to transfer these rights. a, c� For Materials that are delivered under the Grant, but that incorporate pre-existing materials not U) produced under the Grant, the GRANTEE hereby grants to COMMERCE a nonexclusive, royalty-free, o irrevocable license (with rights to sublicense to others) in such Materials to translate, reproduce, distribute, prepare derivative works, publicly perform, and publicly display. The GRANTEE warrants c and represents that the GRANTEE has all rights and permissions, including intellectual property w rights, moral rights and rights of publicity, necessary to grant such a license to COMMERCE. The GRANTEE shall exert all reasonable effort to advise COMMERCE, at the time of delivery of Materials furnished under this Grant, of all known or potential invasions of privacy contained therein ,LO and of any portion of such document which was not produced in the performance of this Grant. The GRANTEE shall provide COMMERCE with prompt written notice of each notice or claim of infringement received by the GRANTEE with respect to any Materials delivered under this Grant. L COMMERCE shall have the right to modify or remove any restrictive markings placed upon the 0 0 Materials by the GRANTEE. C) r c 14. DISPUTES t9 Except as otherwise provided in this Grant, when a dispute arises between the parties and it cannot W be resolved by direct negotiation, either party may request a dispute hearing with the Director of E COMMERCE, who may designate a neutral person to decide the dispute. E The request for a dispute hearing must: v • be in writing; ° • state the disputed issues; m • state the relative positions of the parties; • state the GRANTEE's name, address, and Contract number; and c be mailed to the Director and the other party's (respondent's) Grant Representative within E • three (3)working days after the parties agree that they cannot resolve the dispute. ° The respondent shall send a written answer to the requestor's statement to both the Director or the Q Director's designee and the requestor within five (5)working days. Packet Pg. 152 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS The Director or designee shall review the written statements and reply in writing to both parties within L ten (10)working days. The Director or designee may extend this period if necessary by notifying the 0 parties. Cn a� The decision shall not be admissible in any succeeding judicial or quasi-judicial proceeding. c a� The parties agree that this dispute process shall precede any action in a judicial or quasi-judicial Q tribunal. co Nothing in this Grant shall be construed to limit the parties' choice of a mutually acceptable alternate dispute resolution (ADR) method in addition to the dispute hearing procedure outlined above. Y m a� L 15. DUPLICATE PAYMENT v COMMERCE shall not pay the GRANTEE, if the GRANTEE has charged or will charge the State of Washington or any other party under any other Grant, subgrant/subcontract, or agreement, for the same services or expenses. The GRANTEE certifies that work to be performed under this contract E does not duplicate any work to be charged against any other grant, subgrant/subcontract, or E agreement. o U 16. GOVERNING LAW AND VENUE c This Grant shall be construed and interpreted in accordance with the laws of the state of Washington, and the venue of any action brought hereunder shall be in the Superior Court for Thurston County. Q. 17. INDEMNIFICATION p To the fullest extent permitted by law, the GRANTEE shall indemnify, defend, and hold harmless the state of Washington, COMMERCE, agencies of the state and all officials, agents and employees of U) the state, from and against all claims for injuries or death arising out of or resulting from the o performance of the contract. "Claim" as used in this contract, means any financial loss, claim, suit, action, damage, or expense, including but not limited to attorneys'fees, attributable for bodily injury, _ sickness, disease, or death, or injury to or the destruction of tangible property including loss of use w resulting therefrom. The GRANTEE's obligation to indemnify, defend, and hold harmless includes any claim by co GRANTEE's agents, employees, representatives, or any subgrantee/subcontractor or its employees. LO M GRANTEE expressly agrees to indemnify, defend, and hold harmless the State for any claim arising out of or incident to GRANTEE'S or any subgrantee's/subcontractor's performance or failure to L perform the Grant. GRANTEE'S obligation to indemnify, defend, and hold harmless the State shall not be eliminated or reduced by any actual or alleged concurrent negligence of State or its agents, agencies, employees and officials. The GRANTEE waives its immunity under Title 51 RCW to the extent it is required to indemnify, defend and hold harmless the state and its agencies, officers, agents or employees. L 18. INDEPENDENT CAPACITY OF THE GRANTEE E The parties intend that an independent contractor relationship will be created by this Grant. The v GRANTEE and its employees or agents performing under this Contract are not employees or agents ,- of the state of Washington or COMMERCE. The GRANTEE will not hold itself out as or claim to be ° an officer or employee of COMMERCE or of the state of Washington by reason hereof, nor will the GRANTEE make any claim of right, privilege or benefit which would accrue to such officer or o employee under law. Conduct and control of the work will be solely with the GRANTEE. m 19. INDUSTRIAL INSURANCE COVERAGE z U The GRANTEE shall comply with all applicable provisions of Title 51 RCW, Industrial Insurance. If the GRANTEE fails to provide industrial insurance coverage or fails to pay premiums or penalties on Q Packet Pg. 153 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS behalf of its employees as may be required by law, COMMERCE may collect from the GRANTEE the L full amount payable to the Industrial Insurance Accident Fund. COMMERCE may deduct the amount c9 owed by the GRANTEE to the accident fund from the amount payable to the GRANTEE by Cn COMMERCE under this Contract, and transmit the deducted amount to the Department of Labor and Industries, (L&I) Division of Insurance Services. This provision does not waive any of L&I's rights to collect from the GRANTEE. Q 20. LAWS ti The GRANTEE shall comply with all applicable laws, ordinances, codes, regulations and policies of local and state and federal governments, as now or hereafter amended. L U 21. LICENSING, ACCREDITATION AND REGISTRATION The GRANTEE shall comply with all applicable local, state, and federal licensing, accreditation and registration requirements or standards necessary for the performance of this Contract. `m E 22. LIMITATION OF AUTHORITY o Only the Authorized Representative or Authorized Representative's delegate by writing (delegation to v be made prior to action) shall have the express, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this Contract. Furthermore, any alteration, amendment, modification, or waiver or any clause or condition of this contract is not effective or binding unless E made in writing and signed by the Authorized Representative. Q. a� 23. NONCOMPLIANCE WITH NONDISCRIMINATION LAWS a� During the performance of this Grant, the GRANTEE shall comply with all federal, state, and local nondiscrimination laws, regulations and policies. In the event of the GRANTEE's non-compliance or U) refusal to comply with any nondiscrimination law, regulation or policy, this Grant may be rescinded, �00 canceled or terminated in whole or in part, and the GRANTEE may be declared ineligible for further Grants with COMMERCE. The GRANTEE shall, however, be given a reasonable time in which to cure this noncompliance. Any dispute may be resolved in accordance with the"Disputes" procedure cyv set forth herein. The funds provided under this contract may not be used to fund religious worship, exercise, or o instruction. No person shall be required to participate in any religious worship, exercise, or instruction in order to have access to the facilities funded by this grant. 24. PAY EQUITY 0 The GRANTEE agrees to ensure that"similarly employed" individuals in its workforce are compensated as equals, consistent with the following: cLa t9 a. Employees are "similarly employed" if the individuals work for the same employer, the W performance of the job requires comparable skill, effort, and responsibility, and the jobs are performed under similar working conditions. Job titles alone are not determinative of whether E employees are similarly employed; 0 b. GRANTEE may allow differentials in compensation for its workers if the differentials are v based in good faith and on any of the following: 0 (i)A seniority system; a merit system; a system that measures earnings by quantity or Q- m quality of production; a bona fide job-related factor or factors; or a bona fide regional o difference in compensation levels. m (ii)A bona fide job-related factor or factors may include, but not be limited to, education, z training, or experience that is: Consistent with business necessity; not based on or r derived from a gender-based differential; and accounts for the entire differential. a Packet Pg. 154 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS (iii)A bona fide regional difference in compensation level must be: Consistent with L business necessity; not based on or derived from a gender-based differential; and c9 account for the entire differential. Cn a� ° This Contract may be terminated by COMMERCE, if COMMERCE or the Department of Enterprise services determines that the GRANTEE is not in compliance with this provision. Q 25. POLITICAL ACTIVITIES ti Political activity of GRANTEE employees and officers are limited by the State Campaign Finances Y and Lobbying provisions of Chapter 42.17a RCW and the Federal Hatch Act, 5 USC 1501 - 1508. L No funds may be used for working for or against ballot measures or for or against the candidacy of v any person for public office. — 26. PUBLICITY i am The GRANTEE agrees not to publish or use any advertising or publicity materials in which the state of E Washington or COMMERCE's name is mentioned, or language used from which the connection with ° the state of Washington's or COMMERCE's name may reasonably be inferred or implied, without the c) prior written consent of COMMERCE. o 27. RECAPTURE E In the event that the GRANTEE fails to perform this Grant in accordance with state laws, federal laws, and/or the provisions of this Grant, COMMERCE reserves the right to recapture funds in an amount to compensate COMMERCE for the noncompliance in addition to any other remedies available at law o or in equity. Repayment by the GRANTEE of funds under this recapture provision shall occur within the time U) period specified by COMMERCE. In the alternative, COMMERCE may recapture such funds from o payments due under this Grant. 28. RECORDS MAINTENANCE The GRANTEE shall maintain books, records, documents, data and other evidence relating to this Grant and performance of the services described herein, including but not limited to accounting o procedures and practices that sufficiently and properly reflect all direct and indirect costs of any M nature expended in the performance of this Grant. r ° GRANTEE shall retain such records for a period of six years following the date of final payment. At no additional cost, these records, including materials generated under the Grant, shall be subject at v all reasonable times to inspection, review or audit by COMMERCE, personnel duly authorized by COMMERCE, the Office of the State Auditor, and federal and state officials so authorized by law, regulation or agreement. a� If any litigation, claim or audit is started before the expiration of the six (6)year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved. E O 29. REGISTRATION WITH DEPARTMENT OF REVENUE v If required by law, the GRANTEE shall complete registration with the Washington State Department ° of Revenue. m 0 30. RIGHT OF INSPECTION c m At no additional cost, the GRANTEE shall provide right of access to its facilities to COMMERCE, or E any of its officers, or to any other authorized agent or official of the state of Washington or the federal U government, at all reasonable times, in order to monitor and evaluate performance, compliance, Q and/or quality assurance under this Grant. Packet Pg. 155 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS c L 31. SAVINGS (7 In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after the effective date of this Grant and prior to normal completion, COMMERCE may terminate the c Grant under the "Termination for Convenience" clause, without the ten calendar day notice Q requirement. In lieu of termination, the Grant may be amended to reflect the new funding limitations and conditions. *� co ti 32. SEVERABILITY a� The provisions of this Grant are intended to be severable. If any term or provision is illegal or invalid �j for any reason whatsoever, such illegality or invalidity shall not affect the validity of the remainder of = the Grant. a� U L 33. SITE SECURITY E While on COMMERCE premises, GRANTEE, its agents, employees, or subcontractors shall conform o in all respects with physical, fire or other security policies or regulations. v 0 34. SUBGRANTING/SUBCONTRACTING Neither the GRANTEE nor any subgrantee/subcontractor shall enter into subgrants/subcontracts for any of the work contemplated under this contract without obtaining prior written approval of Q. COMMERCE. In no event shall the existence of the subgrant/subcontract operate to release or p reduce the liability of the GRANTEE to COMMERCE for any breach in the performance of the ar GRANTEE's duties. This clause does not include Grants of employment between the GRANTEE and personnel assigned to work under this Grant. U) c 0 r Additionally, the GRANTEE is responsible for ensuring that all terms, conditions, assurances and certifications set forth in this agreement are carried forward to any subgrants/subcontracts. Every subgrant/subcontract shall include a term that COMMERCE and the State of Washington are not liable for claims or damages arising from a subgrantee's/subcontractor's performance of the subgrant/subcontract. GRANTEE and its subgrantees/subcontractors agree not to release, divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal information without , the express written consent of COMMERCE or as provided by law. r 35. SURVIVAL L c The terms, conditions, and warranties contained in this Grant that by their sense and context are 0 intended to survive the completion of the performance, cancellation or termination of this Grant shall v c so survive. ca /L^ V 36. TAXES L All payments accrued on account of payroll taxes, unemployment contributions, the GRANTEE's E income or gross receipts, any other taxes, insurance or expenses for the GRANTEE or its staff shall o be the sole responsibility of the GRANTEE. v 0 37. TERMINATION FOR CAUSE a m In the event COMMERCE determines the GRANTEE has failed to comply with the conditions of this o Grant in a timely manner, COMMERCE has the right to suspend or terminate this Grant. Before suspending or terminating the Grant, COMMERCE shall notify the GRANTEE in writing of the need to take corrective action. If corrective action is not taken within 30 calendar days, the Grant z may be terminated or suspended. r r Q Packet Pg. 156 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS In the event of termination or suspension, the GRANTEE shall be liable for damages as authorized by L law including, but not limited to, any cost difference between the original Grant and the replacement 0 or cover Grant and all administrative costs directly related to the replacement Grant, e.g., cost of the Cn competitive bidding, mailing, advertising and staff time. c a� COMMERCE reserves the right to suspend all or part of the Grant, withhold further payments, or Q prohibit the GRANTEE from incurring additional obligations of funds during investigation of the alleged compliance breach and pending corrective action by the GRANTEE or a decision by ti COMMERCE to terminate the Grant. A termination shall be deemed a "Termination for Convenience" Y if it is determined that the GRANTEE: (1)was not in default; or(2)failure to perform was outside of his or her control, fault or negligence. v The rights and remedies of COMMERCE provided in this Grant are not exclusive and are, in addition to any other rights and remedies, provided by law. L d 38. TERMINATION FOR CONVENIENCE E E Except as otherwise provided in this Grant, COMMERCE may, by ten (10) business days written Lj notice, beginning on the second day after the mailing, terminate this Grant, in whole or in part. If this o Grant is so terminated, COMMERCE shall be liable only for payment required under the terms of this Grant for services rendered or goods delivered prior to the effective date of termination. E 39. TERMINATION PROCEDURES Q. a� Upon termination of this Grant, COMMERCE, in addition to any other rights provided in this Grant, o may require the GRANTEE to deliver to COMMERCE any property specifically produced or acquired for the performance of such part of this Grant as has been terminated. The provisions of the U) "Treatment of Assets" clause shall apply in such property transfer. o r a� COMMERCE shall pay to the GRANTEE the agreed upon price, if separately stated, for completed = work and services accepted by COMMERCE, and the amount agreed upon by the GRANTEE and w COMMERCE for(i) completed work and services for which no separate price is stated, (ii) partially completed work and services, (iii) other property or services that are accepted by COMMERCE, and (iv)the protection and preservation of property, unless the termination is for default, in which case the c AUTHORIZED REPRESENTATIVE shall determine the extent of the liability of COMMERCE. Failure M to agree with such determination shall be a dispute within the meaning of the "Disputes" clause of this Grant. COMMERCE may withhold from any amounts due the GRANTEE such sum as the AUTHORIZED REPRESENTATIVE determines to be necessary to protect COMMERCE against potential loss or liability. v r The rights and remedies of COMMERCE provided in this section shall not be exclusive and are in i addition to any other rights and remedies provided by law or under this contract. c9 After receipt of a notice of termination, and except as otherwise directed by the AUTHORIZED REPRESENTATIVE, the GRANTEE shall: E 1. Stop work under the Grant on the date, and to the extent specified, in the notice; o 2. Place no further orders or subgrants/subcontracts for materials, services, or facilities except as v may be necessary for completion of such portion of the work under the Grant that is not o terminated; Q- 3. Assign to COMMERCE, in the manner, at the times, and to the extent directed by the o AUTHORIZED REPRESENTATIVE, all of the rights, title, and interest of the GRANTEE under the orders and subgrants/subcontracts so terminated, in which case COMMERCE has the right, at its discretion, to settle or pay any or all claims arising out of the termination of such orders and z subgrants/subcontracts; U 4. Settle all outstanding liabilities and all claims arising out of such termination of orders and Q subcontracts, with the approval or ratification of the AUTHORIZED REPRESENTATIVE to the Packet Pg. 157 8.E.a GENERAL TERMS AND CONDITIONS GENERAL GRANT STATE FUNDS extent AUTHORIZED REPRESENTATIVE may require, which approval or ratification shall be L final for all the purposes of this clause; c9 5. Transfer title to COMMERCE and deliver in the manner, at the times, and to the extent directed Cn by the AUTHORIZED REPRESENTATIVE any property which, if the Grant had been completed, would have been required to be furnished to COMMERCE; 6. Complete performance of such part of the work as shall not have been terminated by the Q AUTHORIZED REPRESENTATIVE; and co 7. Take such action as may be necessary, or as the AUTHORIZED REPRESENTATIVE may direct, for the protection and preservation of the property related to this Grant, which is in the possession of the GRANTEE and in which COMMERCE has or may acquire an interest. L U 40. TREATMENT OF ASSETS Title to all property furnished by COMMERCE shall remain in COMMERCE. Title to all property furnished by the GRANTEE, for the cost of which the GRANTEE is entitled to be reimbursed as a `m direct item of cost under this Grant, shall pass to and vest in COMMERCE upon delivery of such E property by the GRANTEE. Title to other property, the cost of which is reimbursable to the o GRANTEE under this Grant, shall pass to and vest in COMMERCE upon (i) issuance for use of such v property in the performance of this Grant, or (ii) commencement of use of such property in the 0 performance of this Grant, or (iii) reimbursement of the cost thereof by COMMERCE in whole or in = a� part, whichever first occurs. E A. Any property of COMMERCE furnished to the GRANTEE shall, unless otherwise provided herein or approved by COMMERCE, be used only for the performance of this Grant. o B. The GRANTEE shall be responsible for any loss or damage to property of COMMERCE that results from the negligence of the GRANTEE or which results from the failure on the part of the U) GRANTEE to maintain and administer that property in accordance with sound management o practices. r a� C. If any COMMERCE property is lost, destroyed or damaged, the GRANTEE shall immediately S notify COMMERCE and shall take all reasonable steps to protect the property from further w damage. D. The GRANTEE shall surrender to COMMERCE all property of COMMERCE prior to settlement upon completion, termination or cancellation of this Grant c All reference to the GRANTEE under this clause shall also include GRANTEE'S employees, M agents or subgrantees/subcontractors. 41. WAIVER c O Waiver of any default or breach shall not be deemed to be a waiver of any subsequent default or C) breach. Any waiver shall not be construed to be a modification of the terms of this Grant unless stated to be such in writing and signed by Authorized Representative of COMMERCE. a� L d E E O U O N C N E t v R r r Q Packet Pg. 158 8.E.a Attachment A Scope of Work L Cn Funds awarded under this grant shall be used by City of Kent for land acquisition, design, and the construction phases of an urbanized reach of Mill Creek located in a section between 22011 and 22408 76th Ave S Kent, WA 98032. Q This will include, but not be limited to, providing flood plain stabilization and habitat improvements to Mill ti Creek at 76th Ave South by replacing five deficient culverts to allow increased fish passage and Y restoration of vegetation and channel capacity; and creation of floodplain areas to reduce flood risk. L U This project will serve as a benefit to the public by stabilizing the area to protect against flooding and - improving the surrounding habitat. a� U This project is anticipated to be completed by December 2024. E Costs related to the work will only be reimbursed to the extent the work is determined by Commerce to be o within the scope of the legislative appropriation. U 0 c a� E Q. a� 0 CERTIFICATION PERFORMANCE MEASURE U) The GRANTEE, by its signature, certifies that the Scope of Work set forth above has been reviewed and o approved by the GRANTEE's governing body as of the date and year written below. c N R t0 O GRANTEE U*) r TITLE c O U r DATE cOa /L^ V V L d E E O U O N C N E t v R r r Q Packet Pg. 159 8.E.a Attachment B Budget L C9 Cn a� c a� Line Item Amount Q Architecture & Engineering $1,500,000.00 Site Acquisition $1,411,202.00 ti Construction $13,367,090.00 Construction Management $1,500,000.00 L Total Contracted Amount: $17,778,292.00 v a� CERTIFICATION PERFORMANCE MEASURE m E The GRANTEE, by its signature, certifies that the Project Budget set forth above has been reviewed and o approved by the GRANTEE's governing body or board of directors, as applicable, as of the date and year v written below. o c O E r L GRANTEE TITLE o r a� c t DATE to 0 LO M r V fC L O U r c R ,Ln V V L d E E O U O Q O C O E L v R r Q Packet Pg. 160 8.E.a Attachment C Certification of the Availability of Funds to Complete the Project L C9 Cn a� c a� Non-State Funds Amount Total Q King County Flood Control District $205,902.00 to City of Kent $14,642,390.00 Total Non-State Funds $14,848,292.00 $14,848,292.00 Y m State Funds L State Capital Budget $1,950,000.00 v 2019-2021 Local Community Projects 20-96627-078 $980,000.00 Total State Funds $2,930.000.00 a� Total Non-State and State Sources $17,778,292.00 `m E E O CERTIFICATION PERFORMANCE MEASURE cU O The GRANTEE, by its signature, certifies that project funding from sources other than those provided by c this contract and identified above has been reviewed and approved by the GRANTEE's governing body E E or board of directors, as applicable, and has either been expended for eligible Project expenses, or is committed in writing and available and will remain committed and available solely and specifically for carrying out the purposes of this Project as described in elsewhere in this contract, as of the date and p year written below. The GRANTEE shall maintain records sufficient to evidence that it has expended or +? has access to the funds needed to complete the Project, and shall make such records available for N COMMERCE'S review upon reasonable request. 0 r a� c t y fC GRANTEE to 0 LO M TITLE �a L O DATE v r c ,Ln V V L d E E O U O Q O C O E L v R r Q Packet Pg. 161 8.E.a Attachment D Certification of the Payment and Reporting of Prevailing Wages L U) CERTIFICATION PERFORMANCE MEASURE c a� The GRANTEE, by its signature, certifies that all contractors and subcontractors performing work on the Q Project shall comply with prevailing wage laws set forth in Chapter 39.12 RCW, as applicable on the date the Project appropriation becomes effective, including but not limited to the filing of the "Statement of Intent to Pay Prevailing Wages" and "Affidavit of Wages Paid" as required by RCW 39.12.040. The ;c GRANTEE shall maintain records sufficient to evidence compliance with Chapter 39.12 RCW, and shall make such records available for COMMERCE'S review upon request. U If any state funds are used by the GRANTEE for the purpose of construction, applicable State Prevailing Wages must be paid. i am The GRANTEE, by its signature, certifies that the declaration set forth above has been reviewed and E approved by the GRANTEE's governing body as of the date and year written below. o U O C N E R GRANTEE aQi 0 a� c� TITLE U) c 0 r a� DATE N R t0 O M r V O L O U r c c� /L^ V V L d E E O U O N C N E t v R r r Q Packet Pg. 162 8.E.a Attachment E Certification of Intent to Enter the L Leadership in Energy and Environmental Design (LEED) Certification Process Cn a� CERTIFICATION PERFORMANCE MEASURE a The GRANTEE, by its signature, certifies that it will enter into the Leadership in Energy and Environmental Design certification process, as stipulated in RCW 39.35D, as applicable to the Project ti funded by this contract. The GRANTEE shall, upon receipt of LEED certification by the United States ;c Green Building Council, provide documentation of such certification to COMMERCE. U The GRANTEE, by its signature, certifies that the declaration set forth above has been reviewed and = approved by the GRANTEE's governing body or board of directors, as applicable, as of the date and year written below. i m E E O U O GRANTEE E TITLE aQi 0 a� c� DATE in c 0 r a� c N C I � O � L O U r c c� /L^ V V L d E E O U O N C N E t v R r r Q Packet Pg. 163 8.F KENT WASH IN G T O N DATE: April 4, 2023 TO: Kent City Council SUBJECT: James Street Stormwater Improvements — King County Flood Control District Sub-Regional Opportunity Fund acceptance — Authorize MOTION: I move to accept the King County Flood Control District Sub- Regional Opportunity Fund Allocation, in the amount of $225,308, for James Street stormwater improvements, amend the budget, authorize expenditure of funds, and authorize the Mayor to sign all necessary documents, subject to final terms and conditions acceptable to the City Attorney and Public Works Director. SUMMARY: The King County Flood Control District (District) collects an annual levy from properties within King County. Through the District's Sub-Regional Opportunity Fund, 10% of the levy collected within each jurisdiction is granted back to the jurisdiction to be used for stormwater or habitat projects with a flood-related nexus. This year the city of Kent was allocated $225,308 from this fund. These funds will increase the capacity of existing stormwater conveyance infrastructure along James Street near Mill Creek. This project will reduce the duration of standing water over the eastbound lanes on James Street by adding drainage facilities to reduce clogging, thus enabling eastbound lanes of traffic to be reopened more quickly following flood events. This project will be bid in 2023 with construction anticipated in summer 2023. BUDGET IMPACT: Provides $225,308 for the project 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. ATTACHMENTS: 1. 2023_SROF_Application (PDF) 2. Ado pted_AppendixG_2023_SROF_AllocationsandProjects (PDF) Packet Pg. 164 8.F 03/20/23 Public Works Committee MOTION PASSES RESULT: MOTION PASSES [UNANIMOUS]Next: 4/4/2023 7:00 PM AYES: Brenda Fincher, Satwinder Kaur, Marli Larimer Packet Pg. 165 8.F.a ATTACHMENT A KING COUNTY King County Water and Land Resources Division FLOOD CONTROL River and Floodplain Management D I S T R I C T 2023 Sub-Regional Opportunity Fund Project Application Application Due Date: October 7, 2022 Jurisdiction: City of Kent c Do you wish to forego the receipt of your Opportunity Fund allocation this year, allowing it to accruefor a a future ear? ❑ Yes ®'No Would you prefer to apply your Opportunity Funds toward an existing project on the District's 6-year Q CIP? VNo ❑ Yes Project name = Location ' U_ If you are deferring use of these funds for a future year, do you have a specific project that you are N saving up for? ❑ Yes Q'No c If yes, give the project name and estimated cost and timeline: E 0 > 0 L 0- APPLICANT NAME: Melissa Dahl E ADDRESS: 1400 West Gowe Street Kent, WA 98032 r PHONE: 256-856-6511 E-MAIL: I Mdahl@Kentwa.gov f° 3 If you answered "Yes"to either of the first two questions above, stop here and submit this form. E 0 SCOPE OF WORK ' (Please complete only one application per project.) L r U) PROJECT TITLE: James Street Storm Drainage SROF REQUEST: $224,790 Improvement Project E 1) Short description of proposed project: Due to seasonal flooding from Mill Creek, an additional inlet and conveyance system will be installed to move flooded waters from James Street to the James o Street Stormwater Pump Station. Project start date: Spring 2023 Project end date: Winter 2024 0 2) Type of ❑ Feasibility roject Project Eproperty Acquisition Activity Study Design Construction Q Q. Q ElProgrammatic— identify: oI ❑ Other— identify: NI 3) Proposed project location and related body of water: N This project is located on James Street, a principal arterial with over 31,000 average daily trips, between the intersection of State Avenue North and Woodford Avenue North. The project is adjacent to E Mill Creek Middle School, with nearby single family and multi-family homes and businesses. James Street is a Minor Arterial Roadway and a key connection between the East Hill and the industrial valley. r Q Lower Mill Creek is located in proximity of the proposed project area. This watershed originates on the East Hill of Kent and flows through Earthworks Canyon and into the Kent Valley, which is a flat alluvial plain with a high groundwater table. Packet Pg. 166 8.F.a 4) Description of the flooding, stormwater, or linked watershed management problem that this projector activity will address (300 words maximum): The Kent Valley is historically prone to flooding. Over time, erosion from the hills have deposited sediments in the Mill Creek channel, leading to reduced capacity in the creek channel. Reduced storage capacity in the channel, coupled with increasingly significant precipitation events frequently lead to the creek overtopping its banks and impacting nearby roads and properties, including the proposed project area next to James Street, disrupting travel and King County Metro transit along James Street and resulting in property damage. The flooding causes road closures multiple times per Q year, affecting residents, businesses, and adjacent Mill Creek Elementary school. c a as After the storm event passes and the creek recedes back into its channel, a portion of James Street, remains flooded and closed to roadway traffic and transit service due to water and debris, causing a Q hazardous and impassible condition. 3 U- The City previously constructed the James Street Pump station to help convey stranded water to the creek. Even with the pumpstation support, it can take multiple days to drain flood water from James Street. The pump station has capacity to move a greater volume of water if conveyance is improved so that floodwater from the surrounding areas, isolated from the creek, can get to the pump station. o While the pump station has greatly reduced the duration the road is impacted, there are still pockets of E water along the road that delay the full use of the road and continue to impact drivers beyond the window of flooding. 3 E L 5) Description of how the proposed activity will address the problem outlined in Question #4, above o Cn (300 words maximum): as Proposed work increases the capacity of the existing convenance system on James Street. and r will allow for improved effectiveness of the pump station. U) as E Reducing the frequency/longevity of road closures due to flooding will benefit many roadway users. The improved condition will allow James Street to serve as a more durable and sustainable o piece of the transportation network, getting normal transit, traffic and school access back to normal M more quickly. Improvement to the access capacity by the existing pumps should also reduce the risk to Mill Creek elementary school facilities and reduce potential damage or extent of damage to 0 property and businesses. .Q Funding this phase of the project will allow hydrology and hydraulic analysis to better define and ai refine the proposed benefits and make identified improvements within the proposed budget. o i M N O N r+ C d E t V a+ a Packet Pg. 167 8.F.a 6) Describe how the proposed project or activity satisfies the eligibility criteria for at least one of the three categories listed in Section II of the Application Packet (Criteria for Eligible Projects and Activities) (300 words maximum): This project seeks to address both stormwater control improvements and flood control. Flooding resultant from Mill Creek is a systemic issue which the City is seeking to address in projects proposed under the City of Kent's Drainage Master plan. Work proposed under this application will increase conveyance capacity to the existing system that feeds into the pump station. Proposed work v will seek to both improve the existing stormwater infrastructure in place along James Street and improve flood control in a highly trafficked area of the City. Q c u_ c a� E as 0 L Q E 7) Identify the management plan (i.e. flood control, stormwater control, or watershed management) that includes, recommends, supports, or is consistent with implementation of the project or activity (see Application Packet for more information): Flood Control and Stormwater control 3 E L 0 8. SCOPE ACTIVITIES AND TIMELINE (n TASK TITLE RELATED ACTIVITY OUTCOME OR DELIVERABLES TIMELINE as as Task 1: Project City will manage the staff and other Complete administration and December 2024 Administration resources being used to complete the documentation for the project. (Required) project. Submit reimbursement request E forms, backup documentation for billing, and progress reports. Submit a Fiscal c Closeout form and a Closeout Report LO form with the final reimbursement c request. 0 0 Task 2: Project City will oversee full design of new Complete design package including Spring/Summer .Q Design, conveyance system along James Street permits and property rights. 2023 Q- Q Permitting, ROW and will pursue necessary permits and coordination access to the site. O i M Task 3: Bidding City will prepare bid documents Fully constructed and as-built Summer/Fall c and Construction(including estimates, plan sets,traffic stormwater system which will manage 2023 `" control and specifications) and oversee the flooding and reduce road closures. the construction of the proposed E conveyance system. City staff will provide construction management and survey Q support during construction as well as wrap up of the site and final inspection and as-building the final product. Packet Pg. 168 8.F.a Describe the products and means that will The fund from the District will be acknowledge the District for its financial contribution acknowledged when the project is to this project: signed and on the project website. Additional acknowledgements may include social media and/or mention at City Council meetings (which are live streamed and posted on the city website). c R a as U 9. PROJECT BUDGET a ITEM TOTAL How was this cost REQUEST MATCH SOURCE COST calculated? (Amount to be OF MATCH paid by this u_ fund N Task 1: Project Administration $12,000 Roughly 10%of total $15,000 $0.00 N/A project cost E Task 2: Project Design, $45,000 Roughly 25%of the total $45,000 $45,000 City Drainage o Permitting, ROW coordination project Utility a E Task 3: Bidding and $167,790 Roughly 65%of total $167,790 $90,000 City Drainage Construction project cost Utility A 3 E L O TOTAL 1$227,790 1$135,000 Please disregard below if you are applying for more than one project this year. The figures will be i tabulated separately. ALLOCATION (from Table 1 in the Application Packet): 224,790 Difference between Allocation and Request (Note:This amount may not exceed the balance of allocated funds E that you have selected to defer in prior years):$0.00 ti 0 L0 M C O O v 0- 0 I M N O N r+ C d E t V a+ a Packet Pg. 169 8.F.a For Informational Purposes Only. If you plan to partner with other jurisdictions to conduct a project or otherwise intend to use your Opportunity Fund allocation to leverage grant funds or other surface water management funds, please provide us with this information (300 words only): N/A m c a as U a u_ E 0 L Q E SIGNATURE m When signed below and adopted by the King County Flood Control District(District) Board of Supervisors, this 3 Scope of Work is to be added to the Interlocal Agreement between the District and (applicant jurisdiction full name- E e.g the City of Kent the and incorporated therein and made a part thereof according to the terms and conditions of o 0 this Interlocal Agreement. U) ACKNOWLEDGED, i r SIGNATURE >? s- DATE OF SIGNATURE L ! v� Forinfernal Use Orly ti ❑ Project eligible and accepted Date: LO O M I � O ❑ Project ineligible REASON: .Q Q. u_ i O M N O N r+ C d E t V a+ a Packet Pg. 170 8.F.b King County Flood Control District as c 2023 Subregional Opportunity Fund Allocations a Attachment G d c� 11/4/2022 Q Opportunity Project Name Project Description Jurisdiction O Fund Allocation IL Algona $10,000 Flood Management Plan Update Update the 1997 Flood Management Plan. fn Auburn $113,277 DEFERRING Beaux Arts $10,000 2023 Stormwater Annual Clean&Camera 2023 Stormwater Annual Clean&Camera Activities for 2700 to 2900 106th Ave SE (-800LF of pipe) 4) Bellevue $649,873 Upper Kelsey Creek Phase 2 Culvert/Bridge 4) Replacement at Lake Hills Blvd. Existing Kelsey Creek Culverts that cross under Lake Hills Blvd are undersized,unstable and deteriorating,causing an increased risk of flooding in the immediate area.Replace culverts. p Black Diamond $12,951 DEFERRING Q. 1. Blyth Creek Sediment Catchment Basin E Bothell $64,022 Replacement-Ph.III Construction, 2. Parr L. 1.Construct an improved sediment catchment basin system in Blyth Park to address ongoing sediment deposition. 2. Remove invasive reed canarygrass,old beaver dams,and replant stream banks to d Creek Invasive Removal and Replanting address ongoing sediment deposition and flooding of surrounding business park. M Burien $77,580 DEFERRING 3 Carnation $10,000 DEFERRING E Clyde Hill $28,910 Comprehensive Stormwater Plan Update Update the Comprehensive Stormwater Plan for Clyde Hill. L O Covington $32,154 DEFERRING Des Moines $44,642 DEFERRING Duvall $15,894 DEFERRING N d Boise Creek Restoration at Enumclaw Golf Restore Boise Creek at the Enumclaw Golf Course to its historic channel to provide both improved salmonid spawning/riparian habitat and eliminate routine seasonal flooding which damages the course. L. Enumclaw $19,961 +' Course This will add more funds to the existing project. CO) Federal Way $123,096 DEFERRING to Hunts Point $11,477 2023 Stormwater Annual Clean&Camera 2023 Stormwater Annual Clean&Camera Activities for 3614 to 4053 Hunts Point Road (-1,750LF of pipe) N Issaquah $112,569 DEFERRING E Kenmore $51,661 DEFERRING Kent $225,308 James Street Storm Drainage Improvement Due to seasonal flooding from Mill Creek,an additional inlet and conveyance system will be installed to move flooded waters from James Street to the Jame Street Stormwater Pump Station. ~ O 1. Natural Drainage Flood Program 2.Flood v King County $509,186 Hazard Management Planning 3.Shinglemill 1. Address flood/sediment problems that arise in the County 2.Conduct technical analyses,risk assessments,stakeholder engagement,and develop a draft flood hazard management plan;may include Creek Beaver Dam Analogs work on the EIS 3. Complete fatal flaw/feasibility analysis of constructing beaver dam analogs to reduce stream flashiness and improve summer flows for Shinglemill Creek on Vashon Island. N 1.Juanita/High Woodlands Stormwater Retrofit V Kirkland $311,086 Planning 2.North Rose Hill Infiltration Wells 3. O 100th Ave NE Water Quality Treatment 4. 1.Conduct planning for stormwater retrofit facilities in the High Woodlands portion of the Juanita Creek Watershed. 2.Construct water quality treatment followed by infiltration wells on NE 111th Place L 83rd/110th Intersection Flood Reduction a east of 127th Ave NE. 3.Add water quality treatment near intersection of Simonds Rd and 100th Ave NE. 4. Fix flooding by replacing about 320 lineal feet of existing undersized stormwater pipe. Lake Forest Park $34,006 DEFERRING Maple Valley $48,162 DEFERRING to Medina $44,316 DEFERRING G Mercer Island $143,302 Luther Burbank Waterfront Drainage LID a+ Construction Construct an LID system for surface&subsurface water at the Luther Burbank waterfront in coordination with recreational improvements planned for the site. tp Milton $10,000 Stormwater Action Plan Step III Develop a Stormwater Management Action Plan V Newcastle $39,387 DEFERRING Normand Park $18,362 DEFERRING aI North Bend $19,911 DEFERRING Pacific $10,000 DEFERRING Q Redmond $249,097 Evans Creek Relocation Relocate Reach 2 of Evans Creek out of an industrial area and into adjacent floodplain wetlands. N Renton $200,157 Panther Creek Barrier Removal-Talbot Road Replace a deteriorated 42-inch corrugated metal pipe under Talbot Road S with a fish passable culvert to reduce the flood risk due to accumulating debris at the culvert inlet and restore fish passage. M Sammamish $199,764 DEFERRING N O SeaTac $42,075 DEFERRING NI 1.Broadview 12th Ave NW Drainage Seattle $2,255,356 Improvements 2.North Thornton Natural 1. Amendment to add budget to implement drainage improvements to address the highest priority areas of surface water flooding in the west branch of Mohlendorph basin. 2. Install green K Drainage System stormwater infrastructure,conveyance improvements,and stormwater controls to build new storm water infrastructure,and improve water quality in the northern reach of Thornton creek. :a Shoreline $114,674 DEFERRING C Sk komish $10,000 DEFERRING d Sno ualmie $31,260 DEFERRING Q. Tukwila $64,358 S.131st Place Drainage Improvements IThis will add additional funds to an existing project to design drainage improvements to S.131st Place to keep Southgate Creek within its banks during storm events. aI Woodinville $41,940 DEFERRING I -a Yarrow Point $13,652 2023 Stormwater Annual Clean&Camera 12U23 Stormwater Annual Clean&Camera Activities for NE 37th St,NE 37th Place,NE 40th St,NE 41 st St,NE 42nd St,and 91st Ave NE(-6,000LF of pipe) r0) Jurisdiction Totals $6,023,426 Q- O Deferrals 1,247,681 Q Projects 4,775,745 C d E t t� O a -1 - Packet Pg. 171 8.G KENT DATE: April 4, 2023 TO: Kent City Council SUBJECT: Excused Absence for Councilmember Larimer - Approve MOTION: I move to approve an excused absence for Councilmember Larimer for the City Council meeting of April 4, 2023. SUMMARY: Councilmember Larimer is unable to attend the City Council meeting of April 4, 2023, and has requested an excused absence. Packet Pg. 172 10.A 1�# KENT DATE: April 4, 2023 TO: Kent City Council SUBJECT: 2023 Paint Line Striping and Raised Pavement Markings Replacement Bid - Award MOTION: I move to award the 2023 Paint Line Striping and Raised Pavement Markings Replacement Project to Specialized Pavement Marking, LLC in the amount of $342,575.00 and authorize the Mayor to sign all necessary documents, subject to final terms and conditions acceptable to the City Attorney and Public Works Director. SUMMARY: This project consists of installing paint striping over existing lane markings, painting existing traffic curbing and replacing raised pavement markings on various city streets. The bid opening for the 2023 Paint Line Striping and Raised Pavement Markings Replacement Project was held on March 21, 2023, with two bids received. The lowest responsible and responsive bid was submitted by Specialized Pavement Marking, LLC in the amount of $342,575.00. Bid Tab Summary O1. Specialized Pavement Marking, LLC $342,575.00 02. Stripe Rite, Inc. $477,700.00 Engineer's Estimate $390,720.00 BUDGET IMPACT: This project is a budgeted item funded through the street fund. SUPPORTS STRATEGIC PLAN GOAL: Evolving Infrastructure - Connecting people and places through strategic investments in physical and technological infrastructure. ATTACHMENTS: 1. 2023 Paint Line Striping & RPM Replacement Bid Tab (PDF) Packet Pg. 173 10.A.a 2023 Paint Line Striping and RPM Replacement 1 2 Bid Opening: March 21, 2023, 11:00 AM Specialized Pavement Marking, LLC Stripe Rite, Inc. Engineer's Estimate 11095 SW Industrial Way, Suite A 1813 137th Ave E Joe Araucto Disclaimer: These preliminary bid results are provided as a convenience to Tualatin, OR 97062 Sumner, WA 98390 contractors for informational purposes only and do not identify lowest responsible bidder. Bid review by staff and final award pending. TOTAL $342,575.00 $477,700.00 $390,720.00 3 ITEM DESCRIPTION QTY UNIT UNIT TOTAL UNIT TOTAL UNIT TOTAL a NO. PRICE AMOUNT PRICE AMOUNT PRICE AMOUNT 'm c a� 1000 Mobilization 1 LS 8,500.00 $8,500.00 27,655.00 $27,655.00 15,000.00 $15,000.00 E 1005 Painted Double Solid Line 390,000 LF 0.18 $70,200.00 0.22 $85,800.00 0.18 $70,200.00 0 CL 1010 Painted Single Solid Line 580,000 LF 0.10 $58,000.00 0.14 $81,200.00 0.12 $69,600.00 1015 Painted Skip Lane Line 130,000 LF 0.09 $11,700.00 0.16 $20,800.00 0.10 $13,000.00 1020 Painted Dotted Line 12,000 LF 0.10 $1,200.00 0.16 $1,920.00 0.16 $1,920.00 1025 Painted TWLTL Line 100,000 LF 0.14 $14,000.00 0.19 $19,000.00 0.16 $16,000.00 1030 Painted Wide Lane Line 35,000 LF 0.24 $8,400.00 0.24 8,400.00 0.22 $7,700.00 � 1035 Painted Bike Lane Line 140,000 LF 0.22 $30,800.00 0.24 $33,600.00 0.22 $30,800.00 .2- L 1040 Painting Traffic Curb 12,500 LF 1.05 $13,125.00 3.33 $41,625.00 3.00 $37,500.00 N 1045 Raised Pavement Marker Type 1 100 HUND 295.00 $29,500.00 555.00 $55,500.00 400.00 $40,000.00 = J 1050 Raised Pavement Marker Type 2 100 HUND 395.00 $39,500.00 555.00 $55,500.00 450.00 $45,000.00 = 1055 RPM Lane Line Removal at Ramsay Way 100 LF 4.50 $450.00 12.00 $1,200.00 25.00 $2,500.00 n 1060 Project Temporary Traffic Control 1 LS 51,250.00 $51,250.00 40,000.00 $40,000.00 35,000.00 $35,000.00 N 1065 SPCC Plan 1 LS 950.00 $950.00 500.00 $500.00 1,500.00 $1,500.00 CD 1070 Minor Change 1 CALC 5,000.00 $5,000.00 5,000.00 $5,000.00 5,000.00 $5,000.00 U) M CONSTRUCTION CONTRACT TOTALI $342,575.00 $477,700.00 $390,720.00 'm T c a� E a� M a a� a a otS a� c .Q •L co a) c J C n M N O N r.+ C G1 E t V Q Packet Pg. 174