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HomeMy WebLinkAboutCAG2023-310 - Original - Vine Maple Place - ARPA - Stable Families - 05/18/2023 FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: Agreement Routing Form DirAsst: • For Approvals,Signatures and Records Management Dir/Dep: KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover (optional) W A S H I N G T O N Sheet forms. (Print on pink or cherry colored paper) Originator: Department: KateLynn Jennings for Lori Guilfoyle Parks, Recreation & Community Services Date Sent: Date Required: > 5/9/2023 Soonest possible please O Q Authorized to Sign: Date of Council Approval: Q Mayor or Designee 11/15/2022 Budget Account Number: Grant? YesWl NoE] B30021.64150.4648 Budget?W]Yes EINo Type: N/A Vendor Name: Category: Vine Maple Place Contract Vendor Number: Sub-Category: C 2422839 Original O Project Name: ARPA - Stable Families 3- Project Details: Provide families experiencing homelessness or eviction into safe, stable housing, 0- identifies the tools they need become stable and then to achieve self-sufficiency. C C EO Basis for Selection of Contractor: � Agreement Amount $75,000 Other *Memo to Mayor must be nttnrhPd i Start Date: 5/1/2023 Termination Date: 12/31/2024 Q Local Business? Yes Who*If meets requirements per KCC3.70.100,please complete"VendorPurchose-Locol Exceptions"form onCityspace. Business License Verification: W1 Yes In-ProcessD Exempt(KCC 5.01.045) W]Authorized Signer Verified Notice required prior to disclosure? Contract Numb Yes W1 No CAG2023-310 Comments: H i 3 f0 a1 C C a1 3 O cc a, a, cc Date Received:City Attorney: 5/18/23 Date Routed:Mayor's Office 5/18/23 City Clerk's Office 5/18/23 adccW22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements rev.20221201 City of Kent - SLFRF - Grant Recipient Agreement Grantee Vine Maple Place Program Title Stable Families Grant Amount$ 75,000 Agreement Period From: May 1,2023 To December 31, 2024 SAM Identifying number: ZXGMAM3QQ687 This Agreement is made by and between the City of Kent, a municipal corporation ("the City") and Grantee, a Washington Non-Profit Corporation, located at PO Box 1092, Maple Valley, Washington, 98038, to set forth the terms and conditions under which the City will provide a grant to Grantee under the Program to be used for costs incurred during the Agreement Period. Such grant is provided to Grantee as a beneficiary of the City's Coronavirus State and Local Fiscal Recovery Funds. 1. Scope of Eligible Expenditures. Grant funds may only be used to pay or reimburse eligible expenditures as described in the"Federal Terms" (Exhibit 1),and as detailed in the"Scope of Work"(Exhibit 2). No grant funds may be used to pay or reimburse costs for which Grantee has received any otherfunding,whether state,federal or private in nature,for that same cost. 2. Grantee Responsibilities.Grantee understands and agrees that funds provided under this Agreement may only be used in compliance with section 603(c)of the Social Security Act("the Act"),as added by section 9901 of the American Rescue Plan Act("ARPA"),the U.S. Department of Treasury's("Treasury's")regulations implementing that section,guidance issued by Treasury regarding the foregoing, and any other applicable federal provisions, including those described in the"Federal Terms"(Exhibit 1). 3. Grantee Certifications. Prior to any disbursement of funds authorized by this Agreement, Grantee shall provide the City with: Cost Certification (Exhibit 3), Civil Rights Certification Form (Exhibit 4), the Lobbying Certification Form (Exhibit 5), if applicable, the Lobbying Disclosure Form (Exhibit 6), the City EEO Compliance Documents (Exhibit 7),and proof of meeting the Insurance Requirements (Exhibit 8). 4. Request for Payment. Grantee shall submit a quarterly invoice and Cost Certification (Exhibit 3) for the expenses therein no later than fifteen (15) working days after the close of each calendar quarter throughout the term of the Agreement. S. Maintenance of and Access to Records.Grantee shall maintain all records and accounts with respect to all matters covered by this Agreement, including personnel, property, financial, and programmatic records and documents sufficient to evidence compliance with section 603(c) of the Act, Treasury's regulations implementing that section,and guidance issued by Treasury regarding the foregoing.These records shall be maintained for a period of six (6) years after all funds have been expended or returned to the City, whichever is later, to ensure proper accounting for all funds and compliance with the Agreement.The City,the Treasury Office of Inspector General,and the Government Accountability Office, or their authorized representatives, shall have the right of access to records (electronic and otherwise)of Grantee in order to conduct audits or other investigations.Grantee acknowledges that records may be subject to disclosure under the Public Records Act, Ch.42.56 RCW. 6. Publications. Any publications produced with funds from this Agreement must display the following language:"This project [is being][was]supported,in whole or in part,by federal award number SLFRP3352 awarded to the City of Kent,Washington by the U.S. Department of the Treasury." 7. Disclaimer by the City and United States. The United States has expressly disclaimed any and all responsibility or liability to the City or third persons for the actions of the City or third persons resulting in death, bodily injury,property damages,or any other losses resulting in any way from the performance of this award or any other losses resulting in any way from the performance of the award of Federal funds to the City under section Grant Beneficiary Agreement Page 1 of 3 603(c) of the Act, or any contract or subcontract under such award. The City expressly disclaims any and all responsibility or liability to Grantee or third persons for the actions of Grantee or third persons resulting in death, bodily injury, property damages, or any other losses resulting in any way from the performance of this Agreement or any other losses resulting in any way from the performance of the Agreement, or any subcontract thereto. This Agreement does not in any way establish an agency relationship between or among the United States, the City, and/or Grantee. 8. False Statements. Grantee understands that making false statements or claims in connection with this Agreement may be a violation of federal law and may result in criminal, civil, or administrative sanctions, including fines, imprisonment, civil damages and penalties, debarment from participating in federal or City awards or contracts,and/or any other remedy available by law. 9. Debarment and Suspension Certification. Entities that are debarred, suspended, or proposed for debarment, by the U.S. Government are excluded from receiving federal funds and contracting with the City. Grantee, by signature to this Agreement, certifies that Grantee is not currently debarred, suspended, or proposed for debarment, by any Federal department or agency. Grantee also agrees that it will not enter into a subcontract with a person or entity that is debarred,suspended,or proposed for debarment. Grantee will notify the City if it,or a subcontractor, is debarred, suspended, or proposed for debarment, by any Federal department or agency. Debarment status may be verified at https://www.sam.gov/. 10. Termination. Upon thirty (30) days-notice, the City may terminate this agreement for convenience. Any unspent grant proceeds shall be immediately returned to the City. 11. Repayment of Funds; Recoupment. If Grantee has unspent grant proceeds on hand as of December 31, 2024,Grantee shall return all unspent grant proceeds to the City within ten (10)calendar days. If any funds provided to Grantee were used in a manner that is not consistent or allowable as outlined in this Agreement or in the Federal Terms, Grantee shall return funds to City in the amount determined to be ineligible. Grantee further agrees that it is financially responsible for and will repay the City any and all indicated amounts following an audit exception which occurs due to Grantee's failure,for any reason,to comply with the terms of this Agreement.This duty to repay the City shall not be diminished or extinguished by the termination of the Agreement. 12. Conflict of Interest. Grantee designees,agents, members, officers, employees, consultants, and any other public official who exercises or who has exercised any functions or responsibilities with respect to the Program during his or her tenure,or who is in a position to participate in a decision-making process or gain inside information with regard to the Program,are barred from any interest,direct or indirect,in any grant or proceeds of the Program, or benefit there from,which is part of this Agreement at any time during or after such person's tenure. 13. Governing Laws.This Agreement shall be governed by and construed in accordance with the laws of the State of Washington.The venue for any action hereunder shall be in the Superior Court for King County,Washington, or the U.S. District Court for the Western District of Washington. 14. Indemnification.To the maximum extent permitted by law, Grantee shall,at its cost and expense, protect, defend, indemnify, and hold harmless the City, its directors, officers, employees, and agents, from and against any and all demands, liabilities, causes of action, costs and expenses (including attorneys' fees), claims, judgments, or awards of damages,arising out of or in any way resulting from the acts or omissions of Grantee,its directors,officers, employees, or agents, relating in any way to Grantee's performance or non-performance under the Agreement. Grantee agrees that its obligations underthis paragraph extend to any demands,liabilities,causes of action,or claims brought by,or on behalf of,any of its employees or agents. For this purpose, Grantee,by mutual negotiation,hereby waives, as respects the City only, any immunity that would otherwise be available against such claims under any industrial insurance act, including Title 51 RCW, other Worker's Compensation act, disability benefit act, or other employee benefit act of any jurisdiction which would otherwise be applicable in the case of such claim. These indemnification obligations shall survive the termination of the Agreement. Grant Beneficiary Agreement Page 2of3 15. Insurance. The Recipient shall procure and maintain for the duration of this Agreement, insurance of the types and in the amounts described in Exhibit 8 attached and incorporated by this reference. 16. Counterparts and Signatures by Fax or Email. This Agreement may be executed in any number of counterparts,each of which shall constitute an original,and all of which will together constitute this one Agreement. Further, upon executing this Agreement, either party may deliver the signature page to the other by fax or email and that signature shall have the same force and effect as if the Agreement bearing the original signature was received in person. CITY OF KENT GRANTEE Name: Dana Ralph Name: Michelle Frets Title: Mayor Title: Executive Director - MIG.eUG fSi nature:D Signature: M—17 K-1a sv PST, Date: 05/18/2023 Date:5/17/2023 Exhibits 1—Federal Terms 2—Scope of Work 3—Cost Certification 4—Civil Rights Certification Form 5—Lobbying Certification Form 6—Lobbying Disclosure Form (if applicable) 7—City EEOC Compliance Documents 8—Insurance Requirements Grant Beneficiary Agreement Page 3 of 3 Grant Recipient Agreement— Exhibit 1 FEDERAL TERMS In case of conflict between these Federal Terms and the Agreement, the following order of priority shall be utilized: (1) Federal Terms, and (2) Agreement. 1. Grantee understands and agrees that funds provided under this Agreement may come from a federal source and agrees to comply with any and all additional applicable terms. A. Grantee Capacity. Grantee agrees and confirms that it has the institutional, managerial and financial capacity to ensure proper planning, management and completion of the work detailed in the Scope of Work (Exhibit 2). B. Technical Assistance. If, at any time, Grantee believes its capacity is compromised or Grantee otherwise needs any sort of assistance, it shall immediately notify the City. The City will make best efforts to provide timely technical assistance to Grantee to bring Grantee into compliance. C. Compliance with Act. Grantee understands and agrees that funds provided under the Agreement may only be used in compliance with section 603(c) of the Social Security Act (the "Act"), as added by section 9901 of the American Rescue Plan Act ("ARPA"), the U.S. Department of Treasury's ("Treasury's") regulations implementing that section, and guidance issued by Treasury regarding the foregoing. D. Definitions. The term "Grantee" shall refer to an individual or entity who receives funds from the City, but shall not include a "Subrecipient," as defined in 2 C.F.R. 200.1 and as determined in the City's sole discretion. 2. Agreement Requirements and Incorporated Exhibits. Grantee shall meet the requirements included in the Agreement and in the following attached exhibits, each of which is incorporated into the Agreement by reference: EXHIBIT NAME NUMBER Federal Terms Exhibit 1 Scope of Work Exhibit 2 Cost Certification Exhibit 3 Civil Rights Certification Form Exhibit 4 Lobbying Certification Form Exhibit 5 Lobbying Disclosure Form (if activity occurs) Exhibit 6 City EEO Compliance Documents Exhibit 7 A. Scope of Eligible Expenditures. Grant funds may only be used to pay or reimburse eligible expenditures as described in the Agreement, these Federal Terms (Exhibit 1), and Scope of Work (Exhibit 2). No grant funds may be used to pay or reimburse costs cannot be used for expenditures for which Grantee has received any other funding, whether state, federal or private in nature, for that same expense. B. Grantee Certifications. Prior to any disbursement of funds authorized by this Agreement, Grantee shall provide the City with: Cost Certification (Exhibit 3), Civil Rights Certification Form (Exhibit 4), the Lobbying Certification Form (Exhibit 5), and, if activity occurs, the Lobbying Disclosure Form (Exhibit 6). C. Reports. Grantee shall provide the City with additional information and documentation upon request, including completing any reports deemed necessary for the City to comply with documentation, reporting, or audit requirements. 3. Access to Records. The Treasury Office of Inspector General and the Government Accountability Office, or their authorized representatives, shall have the right of access to records (electronic and otherwise) of Grantee in order to conduct audits or other investigations. 4. Uniform Guidance Compliance. A. Remedial Actions. In the event of Grantee's noncompliance with section 603(c) of the Act, Treasury's regulations implementing that section, guidance issued by Treasury regarding the foregoing, or any other applicable federal laws or regulations, Treasury may take available remedial actions as set forth in 2 C.F.R. 200.339. B. Recoupment. 1. Grantee agrees that it is financially responsible for and will repay the City any and all indicated amounts following an audit exception which occurs due to Grantee's failure, for any reason, to comply with the terms of the Agreement. This duty to repay the City shall not be diminished or extinguished by the termination of the Agreement. 2. In the event of a violation of section 603(c) of the Act, the funds shall be subject to recoupment by the City. 3. Any funds paid to Grantee (1) in excess of the amount to which Grantee is authorized to retain under the terms of the Agreement; (2) that are determined by the Treasury Office of Inspector General to have been misused; (3) are determined by Treasury to be subject to a repayment obligation pursuant to section 603(e) of the Act; or (4) are otherwise subject to recoupment by the City, and have not been repaid by Grantee to the City shall constitute a debt to the City. 4. Any debts determined to be owed the City must be paid promptly by Grantee. A debt is delinquent if it has not been paid by the date specified in the City's initial written demand for payment, unless other satisfactory arrangements have been made or if the City knowingly or improperly retains funds that are a debt. The City will take any actions available to it to collect such a debt. C. Return of Unused Funds. If Grantee has any unspent funds on hand as of the earlier of December 31, 2024, or the termination of this Agreement, Grantee shall return all unspent funds to the City within ten (10) calendar days. 5. Disclaimer. A. The United States expressly disclaims any and all responsibility or liability to Grantee or third persons for the actions of Grantee or third persons resulting in death, bodily injury, property damages, or any other losses resulting in any way from the performance of this award or any other losses resulting in any way from the performance of this grant or any contract, or subcontract under this grant. B. The acceptance of this grant by Grantee does not in any way establish an agency relationship between the United States and Grantee. 6. Protection for Whistleblowers. A. In accordance with 41 U.S.C. § 4712, Grantee may not discharge, demote, or otherwise discriminate against an employee in reprisal for disclosing to any of the list of persons or entities provided below, information that the employee reasonably believes is evidence of gross mismanagement of a federal contract or grant, a gross waste of federal funds, an abuse of authority relating to a federal contract or grant, a substantial and specific danger to public health or safety, or a violation of law, rule, or regulation related to a federal contract (including the competition for or negotiation of a contract) or grant. B. The list of persons and entities referenced in the paragraph above includes the following: 1. A member of Congress or a representative of a committee of Congress; 2. An Inspector General; 3. The Government Accountability Office; 4. A Treasury employee responsible for contract or grant oversight or management; 5. An authorized official of the Department of Justice or other law enforcement agency; 6. A court or grand jury; or 7. A management official or other employee of Grantee, contractor, or subcontractor who has the responsibility to investigate, discover, or address misconduct. C. Grantee shall inform its employees in writing of the rights and remedies provided under this section, in the predominant native language of the workforce. 7. Increasing Seat Belt Use in the United States. Pursuant to Executive Order 13043, 62 FR 19217 (Apr. 18, 1997), Grantee is encouraged to adopt and enforce on-the-job seat belt policies and programs for its their employees when operating company-owned, rented or personally owned vehicles. 8. Reducing Text Messaging While Driving. Pursuant to Executive Order 13513, 74 FR 51225 (October 6, 2009), Grantee is encouraged to adopt and enforce policies that ban text messaging while driving, and to establish workplace safety policies to decrease accidents caused by distracted drivers 9. False Statements. Grantee understands that making false statements or claims in connection with this Agreement may be a violation of federal law and may result in criminal, civil, or administrative sanctions, including fines, imprisonment, civil damages and penalties, debarment from participating in federal or City awards or contracts, and/or any other remedy available by law. 10. Applicable Laws. A. The Agreement shall be governed by and construed in accordance with the laws of the State of Washington. B. Grantee agrees to comply with the requirements of section 603 of the Act, the Treasury's regulations implementing that section, and guidance issued by Treasury regarding the foregoing. Grantee also agrees to comply with all other applicable federal laws, regulations, and executive orders, and Grantee shall provide for such compliance by other parties in any agreements it enters into with other parties relating to this Agreement. C. Federal regulations applicable to this grant may include, without limitation, the following: 1. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, 2 C.F.R. Part 200, including the following: a. Subpart A, Acronyms and Definitions; b. Subpart B, General Provisions; C. Subpart C, Pre-Federal Award Requirements and Contents of Federal Awards; d. Subpart D, Post-Federal Award Requirements; e. Subpart E, Cost Principles; and f. Subpart F, Audit Requirements. 2. Universal Identifier and System for Award Management (SAM), 2 C.F.R. Part 25, pursuant to which the award term set forth in Appendix A to 2 C.F.R. Part 25 is hereby incorporated by reference. 3. Reporting Subaward and Executive Compensation Information, 2 C.F.R. Part 170, pursuant to which the award term set forth in Appendix A to 2 C.F.R. Part 170 is hereby incorporated by reference. 4. OMB Guidelines to Agencies on Governmentwide Debarment and Suspension (Nonprocurement), 2 C.F.R. Part 180, including the requirement to include a term or condition in all lower tier covered transactions (contracts and subcontracts described in 2 C.F.R. Part 180, subpart B) that the award is subject to 2 C.F.R. Part 180 and Treasury's implementing regulation at 31 C.F.R. Part 19. 5. Grantee Integrity and Performance Matters, pursuant to which the award term set forth in 2 C.F.R. Part 200, Appendix XII to Part 200 is hereby incorporated by reference. 6. Governmentwide Requirements for Drug-Free Workplace, 31 C.F.R. Part 20. 7. New Restrictions on Lobbying, 31 C.F.R. Part 21. 8. Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42 U.S.C. §§ 4601-4655) and implementing regulations. 9. Generally applicable federal environmental laws and regulations. C. Statutes and regulations prohibiting discrimination applicable to this award include, without limitation, the following: 1. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d et seq.) and Treasury's Implementing regulations at 31 C.F.R. Part 22, which prohibit discrimination on the basis of race, color, or national origin under programs or activities receiving federal financial assistance; 2. The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§ 3601 et seq.), which prohibits discrimination in housing on the basis of race, color, religion, national origin, sex, familial status, or disability; 3. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794), which prohibits discrimination on the basis of disability under any program or activity receiving federal financial assistance; 4. The Age Discrimination Act of 1975, as amended (42 U.S.C. §§ 6101 et seq.), and Treasury's implementing regulations at 31 C.F.R. Part 23, which prohibit discrimination on the basis of age in programs or activities receiving federal financial assistance; and 5. Title II of the Americans with Disabilities Act of 1990, as amended (42 U.S.C. §§ 12101 et seq.), which prohibits discrimination on the basis of disability under programs, activities, and services provided or made available by state and local governments or instrumentalities or agencies thereto. D. Hatch Act. Grantee agrees to comply, as applicable, with requirements of the Hatch Act (5 U.S.C.§§ 1501-1508 and 7324-7328), which limits certain political activities of federal employees, as well as certain other employees who work in connection with federally funded programs. E. Grantee agrees to comply with the Prohibition on Providing Funds to the Enemy (2 C.F.R. 183). Exhibit 2 KENT 2023-2024 11.5 N N G r 0 N PARKS, RECREATION S COMMUNITY SERVICES Scope and Schedule of Work Agency: Vine Maple Place Program: Stable Families Program Contact: Michelle Frets michellef@vinemapleplace.org Program The onsite Stable Families team moves families experiencing homelessness or Description: eviction into safe, stable housing, identifies the tools they need become stable and then to achieve self-sufficiency, and works with them to heal and build new skills to leave homelessness forever. The Stable Families model weaves together emergency housing, housing stability, employment, livable wage development, behavioral health, financial literacy, parenting support, and all-inclusive child and youth services to help families heal to achieve safety and stability to break the generational cycle of homelessness. Housing Stability: Focused on preventing a homeless episode or quickly housing homeless families in safe, stable housing, then customizing a long-term plan with each family as they build skills and heal, moving toward stability. We provide basic needs, help each family with their move-in costs, and provide monthly rent assistance while they reduce their housing barriers and grow to become stable. Workforce Development: Parents come to VMP out of work or are severely low- income, and this program focuses on helping them obtain and retain employment, a critical pathway to stability. We offer a series of workshops on career path development and a fund to pay for educational supports like housing stipends and class materials, transportation, and training that helps parents upskill and develop a path to a livable-wage income. Financial Literacy: Weekly workshops and one-on-one training in budgeting and credit repair help parents remove financial barriers and create realistic household budgets. Goals are set to decrease debt and increase their stability. Child &Youth Program: Sixty-six percent of our clients are children. Our work with children and youth focuses on children learning the tools they need to heal the parts of their brain most affected by trauma — the prefrontal cortex. Over 65% of children require intensive services to reach age-appropriate development levels. Through this focus, they learn self-regulation, cope with toxic stress, and build their executive functioning skills toward the ability to focus on academic, emotional, and social success. Children receive weekly onsite academic tutoring, mentoring, activities to build social and emotional skills, and behavioral health counseling, ensuring kids don't grow up and repeat the patterns that lead to homelessness. Life Skills, Behavioral Health, and Counseling: Once families are safely housed, we focus on removing emotional and physical stability barriers. Parents and children develop life skills, nurture family bonds, and engage in activities and workshops focused on increasing self-esteem and confidence as they heal from past trauma. Consultant shall provide the approximate number of City of Kent clients with the following services each year of the Agreement: Unduplicated Kent Clients Contracted 41 individuals to Serve Service Unit Descriptions and Deliverables Units Contracted to Serve Service Unit 1: Case Management Services 41 individuals Service Unit 2: Placement(reaching housing stability) 26 individuals Service Unit 3: Employment(employed upon existing the program) 8 Contract Administration - The Consultant shall notify the City, in writing, within ten (10) days of any changes in agency leadership or program personnel. - The Consultant shall provide the City with a current list of its board of directors, general or limited partners, as applicable. - The Consultant shall maintain a City of Kent Business License. - In addition to quarterly and annual reporting, staff may perform desktop or onsite monitoring to ensure contract compliance. Any onsite monitoring will be scheduled with adequate time to prepare for the visit. The Contractor can request a copy of the monitoring form at any time by contacting City of Kent staff. - All records related to the Agreement must be retained for six (6) years plus the current year. Performance Measures The City uses a variety of measures as indicators of satisfactory contract performance. The Consultant will be expected to meet 100% of the performance measures as set forth in the Scope of Work. If the Consultant fails to fulfill the performance measures, payment for services rendered under this Agreement will be reduced by the rate calculated for each service unit. Exceptions may be made if circumstances beyond the Consultant's control impact its ability to fulfill the required units of service and if the Consultant has shown reasonable effort to overcome those circumstances. Exceptions are made at the sole discretion of the City's Human Services Manager. Reporting Requirements and Timeline All data and required forms shall be submitted electronically. Please use Attachment A for reporting. Service Unit and Narrative Report - Data from this form will be used to track each program's progress toward meeting the goals stipulated in the Scope of Work. The narrative should include updates regarding outreach and partnership building, any successes and challenges the program is experiencing, or any significant changes to the program model or budget. It shall be submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 30), along with the Reimbursement Request. Reimbursement Request - This form will be filled out electronically and serve as the invoicing mechanism for payment to your agency/program. Documents supporting expenses should be included. It shall be submitted quarterly, no later than the 15th of the month following the end of the quarter (i.e. April 15, July 15, Oct 15, Jan 10), unless otherwise specified. Demographic Data Report - The agency shall collect and retain the data requested on the Demographics form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted annually (by January 30). Report Due Date Service Unit Report and Reimbursement 151h day following each quarter Request Final Reimbursement Request (4th Qtr.) January 10th, 2024/3anuary 101h, 2025 Demographic Data Report January 30th, 2024/3anuary 301h, 2025 DEMOGRAPHIC INFORMATION - The following information should be collected and reported annually. Number of Households or Persons Assisted (please specify "H" or "P"): Race Undup. Unduplicate Yea r to d Year to Date (All) Date (Hispanic) White Black/African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander American Indian or Alaska Native AND White Asian AND White Black/African American AND White American Indian /Alaska Native AND Black/African American Other Multi-Racial GRAND TOTAL CLIENTS Income Level Unduplicated Year to Date Extremely Low Income 0-30% of MFI Low Income 31-50% of MFI Moderate Income 51-80% of MFI Above Moderate Income 81% + of MFI GRAND TOTAL CLIENTS Homeless * Complete only for individuals & families Unduplicated Quarter Unduplicated who have been assisted with transitional and Year to Date permanent housing 1 2 3 4 Individuals Families Total Homeless Ll Grant Recipient Agreement — Exhibit 3 COST CERTIFICATION I certify that: 1. 1 have authority and approval from the governing body on behalf of Vine Maple Place ("Grantee")to accept proceeds from the City of Kent (the "City") per the Agreement by and between the City and Grantee from the City's allocation of the Coronavirus State Local Fiscal Recovery Fund ("CLFR") as created by the American Rescue Plan Act of 2021, Section 9901 ("ARPA") for eligible expenditures included on the corresponding invoice voucher for report period March 3, 2021 through December 31, 2024. 2. 1 understand that as additional federal guidance becomes available, an amendment to the Contract between the City and Grantee may become necessary and agree to execute necessary amendments. 3. 1 understand the City will rely on this certification as a material representation in processing reimbursements or payment requests. 4. 1 understand the Grantee receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/or sales receipts in a manner consistent with §200.333 Retention requirements for records of 2 CFR 200 Uniform Administrative Requirements,Cost Principles, and Audit Requirements for Federal Awards(Uniform Guidance). Such documentation shall be produced to the City upon request and may be subject to audit by the State Auditor. 5. 1 understand any funds provided pursuant to this certification cannot be used for expenditures for which Grantee has received any other funding whether state, federal or private in nature, for that same expense. I hereby certify that I have read the above certification, and that the information and my statements provided herein by me are true and correct to the best of my knowledge, and by my signature on this document, acknowledge my understanding that any intentional or negligent misrepresentation or falsification of any of the information in this document could subject me to punishment under federal and/or civil liability and/or in criminal penalties,including but not limited to fine or imprisonment or both under Title 18, United States Code, Sec. 1001, et seq. and punishment under federal law. Michelle Frets ltllcheae-Tntf Printed Name Signature Executive Director 5/17/2023 Title Date Grant Recipient Agreement— Exhibit 4 CIVIL RIGHTS CERTIFICATION FORM The funds provided to the grantee named below(hereinafter referred to as the "Grantee") are available under section 603 of the Social Security Act, as added by section 9901 of the American Rescue Plan Act. Grantee understands and acknowledges that: As a condition of receipt of federal financial assistance from the Department of the Treasury, with monies distributed through the City of Kent, Grantee provides the assurances stated herein. The federal financial assistance may include federal grants, loans and contracts to provide assistance to Grantee,the use or rent of Federal land or property at below market value, Federal training, a loan of Federal personnel, subsidies, and other arrangements with the intention of providing assistance. Federal financial assistance does not encompass contracts of guarantee or insurance, regulated programs, licenses, procurement contracts by the Federal government at market value,or programs that provide direct benefits. The Civil Rights Restoration Act of 1987 provides that the provisions of the assurances apply to all of the operations of Grantee's program(s) and activity(ies), so long as any portion of Grantee's program(s) or activity(ies) is federally assisted in the manner prescribed above Grantee certifies the following: 1. Grantee ensures its current and future compliance with Title VI of the Civil Rights Act of 1964, as amended,which prohibits exclusion from participation, denial of the benefits of, or subjection to discrimination under programs and activities receiving federal financial assistance, of any person in the United States on the ground of race, color,or national origin (42 U.S.C. § 2000d et seq.), as implemented by the Department of the Treasury Title VI regulations at 31 CFR Part 22 and other pertinent executive orders such as Executive Order 13166, directives,circulars, policies, memoranda, and/or guidance documents. 2. Grantee acknowledges that Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency," seeks to improve access to federally assisted programs and activities for individuals who, because of national origin, have Limited English proficiency(LEP). Grantee understands that denying a person access to its programs, services, and activities because of LEP is a form of national origin discrimination prohibited under Title VI of the Civil Rights Act of 1964 and the Department of the Treasury's implementing regulations.Accordingly, Grantee shall initiate reasonable steps, or comply with the Department of the Treasury's directives,to ensure that LEP persons have meaningful access to its programs, services, and activities. Grantee understands and agrees that meaningful access may entail providing language assistance services, including oral interpretation and written translation where necessary,to ensure effective communication in Grantee's programs, services, and activities. 3. Grantee agrees to consider the need for language services for LEP persons when Grantee develops applicable budgets and conducts programs,services, and activities. As a resource, the Department of the Treasury has published its LEP guidance at 70 FR 6067. For more information on taking reasonable steps to provide meaningful access for LEP persons, please visit http://www.lep.gov. 4. Grantee acknowledges and agrees that compliance with the assurances constitutes a condition of continued receipt of federal financial assistance and is binding upon Grantee and its successors,transferees, and assignees for the period in which such assistance is provided. 5. Grantee shall comply with Title VI of the Civil Rights Act of 1964,which prohibits Grantees of federal financial assistance from excluding from a program or activity, denying benefits of, or otherwise discriminating against a person on the basis of race, color, or national origin (42 U.S.C. § 2000d et seq.), as implemented by the Department of the Treasury's Title VI regulations, 31 CFR Part 22,which are herein incorporated by reference and made a part of this contract (or agreement).Title VI also includes protection to persons with "Limited English Proficiency" in any program or activity receiving federal financial assistance,42 U.S.C. § 2000d et seq., as implemented by the Department of the Treasury's Title VI regulations, 31 CFR Part 22, and herein incorporated by reference and made a part of this contract or agreement. 6. Grantee understands and agrees that if any real property or structure is provided or improved with the aid of federal financial assistance by the Department of the Treasury,this assurance obligates Grantee,or in the case of a subsequent transfer,the transferee,for the period during which the real property or structure is used for a purpose for which the federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is provided,this assurance obligates the Contractor for the period during which it retains ownership or possession of the property. 7. Grantee shall cooperate in any enforcement or compliance review activities by the Department of the Treasury of the aforementioned obligations. Enforcement may include investigation, arbitration, mediation, litigation, and monitoring of any settlement agreements that may result from these actions. Grantee shall comply with information requests, on-site compliance reviews and reporting requirements. 8. Grantee shall maintain a complaint log and inform the Department of the Treasury of any complaints of discrimination on the grounds of race, color,or national origin, and limited English proficiency covered by Title VI of the Civil Rights Act of 1964 and implementing regulations and provide, upon request, a list of all such reviews or proceedings based on the complaint, pending or completed, including outcome.Grantee also must inform the Department of the Treasury if Contractor has received no complaints under Title VI. 9. Grantee must provide documentation of an administrative agency's or court's findings of non- compliance of Title VI and efforts to address the non-compliance, including any voluntary compliance or other agreements between the Contractor and the administrative agency that made the finding. If Grantee settles a case or matter alleging such discrimination, Grantee must provide documentation of the settlement. If Grantee has not been the subject of any court or administrative agency finding of discrimination, please so state. 10. The United States of America has the right to seek judicial enforcement of the terms of this assurances document and nothing in this document alters or limits the federal enforcement measures that the United States may take in order to address violations of this document or applicable federal law. I hereby certify that I have read and understood the obligations described above,that Grantee is in compliance with the above-described nondiscrimination requirements, and by my signature on this document, acknowledge my understanding that any intentional or negligent misrepresentation or falsification of any information submitted in conjunction with this document could subject me to punishment under federal,civil liability and/or in criminal penalties, including but not limited to fine or imprisonment or both under Title 18, United States Code, Sec. 1001, et seq. and punishment under federal law. Michelle Frets Micheae meets Printed Name Signature Executive Director 5/17/2023 Title Date Grant Recipient Agreement— Exhibit 5 LOBBYING CERTIFICATION FORM The undersigned certifies, to the best of the undersigned's knowledge and belief,that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions, as attached. (3)The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. I hereby certify that I have read the above certification, and that the information and my statements provided herein by me are true and correct to the best of my knowledge, and by my signature on this document, acknowledge my understanding that any intentional or negligent misrepresentation or falsification of any of the information in this document could subject me to punishment under federal and/or civil liability and/or in criminal penalties,including but not limited to fine or imprisonment or both under Title 18, United States Code,Sec. 1001, et seq. and punishment under federal law. Michelle Frets /�J1G�teGGefGtf Printed Name Signature Executive Director 5/17/2023 Title Date Pt. 21, App. B 31 CFR Subtitle A (7-1-06 Edition) APPENDIX B TO PART 21—DISCLOSURE FORM TO REPORT LOBBYING DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB 0348-0046 Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 (See reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a. initial filing b.grant El b.initial award b.material change c. cooperative agreement d.loan c. post-award For Material Change Only: e.loan guarantee year quarter I. loan insurance date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee,Enter Name ❑ Prime ❑ Subawardee and Address of Prime: Tier ,if known: Congressional District,if known: Congressional District,if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number,if applicable: 8. Federal Action Number,if known: 9. Award Amount,if known: $ 10. a. Name and Address of Lobbying Entity b.Individuals Performing Services(including address if fif individual,last name,first name,MII: -different from No.l0a) (last name,first name,MB: attach Connnvalion Sheets SF-LLL-A if necessa. 11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply): $ ❑actual ❑planned ❑ a. retainer ❑ b.one-time fee 12. Form of Payment(check all that apply): ❑ c. commission ❑ a.cash ❑ d.contingent fee ❑ b.in-kind;specify: nature ❑ e.deferred p value ❑ f. other;specify: P N 14. Brief Description of Services Performed or to be Performed and Date(s)of Service,including officer(s),employee(s), or Member(s)contacted,for Payment Indicated in Item 11: attach Continuation Sheets SF-ILL- if necess 15. Continuation Sheet(s)SF-LLL-A attached: ❑Yes ❑No 16. lnb, Ma reque thm%h thn fours is authonzM by title 31 U.S.C. wn 13sx.Thia di:<baare d lobbymn,<ti. is a maredd representnan Signature: d fact upon whkh reliance was placed by the tier above when this sa was made or ant into.rem dN 10 b,equirM pursuant to Print Name: 31 U.S.C.135I.This i4-1m will be mport to the Congms semi- annudly and win be available 1 r publk inspec+ion.My person who fins m Title: fik the repuired dmcb shall be subi—to a civil penalty d not kss than s+o.aao area�t more man loW.000 fur each,t,th W.— Telephone No.: Date: . Authorized for L—I Reproduction Standard Fwm-LLL 262 Office of the Secretary of the Treasury Pt. 21, App. B INSTRUCTIONS FOR COMPLETION OF SF-LLL,DISCLOSURE OF LOBBYING ACTIVITIES This disclosure forth shall be completed by the reporting entity,whether subawardee or prime Federal recipient,at the initiation or receipt of a covered Federal action,or a material change to a previous filing,pursuant to title 31 U.S.C. section 1352.The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress,or an employee of a Member of Congress in connection with a covered Federal action.Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate.Complete all items that apply for both the initial filing and material change report.Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identity the status of the covered Federal action. 3. Identity the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported,enter the year and quarter in which the change occurred.Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address,city, state and zip code of the reporting entity. Include Congressional District, if known.Check the appropriate classification of the reporting entity that designates if if is,or expects to be,a prime or subaward recipient.Identify the tier of the subawardee,e.g.,the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts,subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks"Subawardee",then enter the full name,address,city,stale and zip code of the prime Federal recipient.Include Congressional District,if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name,if known. For example,Department of Transportation,United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action(item 1). If known,enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1(e.g., Request for Proposal(RFP)number;Invitation for Bid(IFB)number;grant announcement number;the contract, grant,or loan award number;the application/proposal control number assigned by the Federal agency). Include prefixes,e.g.,"RFP.DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a)Enter the full name,address,city,state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b)Enter the full names of the individual(s)performing services,and include full address if different from 10(a). Enter Last Name,First Name,and Middle Initial(MI). 11. Enter the amount of compensation paid or reasonably expected to be paid.by the reporting entity(item 4)to the lobbying entity(item 10). Indicate whether the payment has been made(actual)or will be made(p!anned). Check all boxes that apply. If this is a material change report,enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es).Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other,specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed,or will be expected to perform,and the dates)of any services rendered.Include all preparatory and related activity,not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s),or Member(s)of Congress that were contacted. 15. Check whether or not a SF-LLL-A Continuation Sheet(s)is attached. 16. The certifying official shall sign and date the form,print his/her name,title,and telephone number. Public reporting burden for this collection of information is estimated to average 30 mintues per response,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.Send comments regarding the burden estimate or any other aspect of this collection of information,including suggestions for reducing this burden.to the Office of Management and Budget,Paperwork Reduction Project(0348-0046).Washington,D.C.20503. 263 Pt. 21, App. B 31 CFR Subtitle A (7-1-06 Edition) DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB 0348-0046 CONTINUATION SHEET Reporting Entity. Page of Authorized for Local Rqw doclion Standard form-UL•A 264 Grant Recipient Agreement — Exhibit 7 DECLARATION CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The following questions specifically identify the requirements the City deems necessary for any Grantee on this specific Agreement to adhere to. An affirmative response is required on all of the following questions for this Agreement to be valid and binding. If any Grantee willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of contract and it will be at the City's sole determination regarding suspension or termination for all or part of the Agreement; The questions are as follows: 1. I have read the attached City of Kent administrative policy number 1.2. 2. During the time of this Agreement I will not discriminate in employment on the basis of sex, race, color, national origin, age, or the presence of all sensory, mental or physical disability. 3. During the time of this Agreement the Grantee will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the Grantee, will actively consider hiring and promotion of women and minorities. 5. Before acceptance of this Agreement,an adherence statement will be signed by me,the Grantee,that the Grantee complied with the requirements as set forth above. By signing below, I agree to fulfill the five requirements referenced above. MIcheue Tets By: Michelle Frets(May 17,2023 14:59 PDT) For: Vine Maple Place Title: Executive Director Date: 5/17/2023 EEO COMPLIANCE DOCUMENTS - 1 of 3 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998 SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996 CONTRACTORS APPROVED BY Jim White, Mayor POLICY: Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity within their organization and, if holding Agreements with the City amounting to$10,000 or more within any given year, must take the following affirmative steps: 1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 2. Actively consider for promotion and advancement available minorities and women. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works Departments to assume the following duties for their respective departments. 1. Ensuring that contractors,subcontractors,consultants,and suppliers subject to these regulations are familiar with the regulations and the City's equal employment opportunity policy. 2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines. EEO COMPLIANCE DOCUMENTS - 2 of 3 CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT This form shall be filled out AFTER COMPLETION of this project by the Grantee awarded the Agreement. I, the undersigned, a duly represented agent of Company, hereby acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement known as_ that was entered into on the (date), between the firm I represent and the City of Kent. I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part of the before-mentioned Agreement. By: For: Title: Date: EEO COMPLIANCE DOCUMENTS - 3 of 3 EXHIBIT 8 INSURANCE REQUIREMENTS FOR CONSULTANT SERVICES AGREEMENTS Insurance The Consultant shall procure and maintain for the duration of the Agreement, insurance against claims for injuries to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Consultant, their agents, representatives, employees or subcontractors. A. Minimum Scope of Insurance Consultant shall obtain insurance of the types described below: 1. Automobile Liability insurance covering all autos used for the purpose of fulfilling this agreement. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage. 2. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01. The City shall be named as an Additional Insured under the Consultant's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. 3. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of Washington. B. Minimum Amounts of Insurance Consultant shall maintain the following insurance limits: 1. Automobile Liability insurance with a minimum combined single limit for bodily injury and property damage of $1,000,000 per accident. 2. Commercial General Liability insurance shall be written with limits no less than $1,000,000 each occurrence, $2,000,000 general aggregate. EXHIBIT 8 (Continued) C. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Automobile Liability and Commercial General Liability insurance: 1. The Consultant's insurance coverage shall be primary insurance as respect the City. Any Insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Consultant's insurance and shall not contribute with it. 2. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. 3. The City of Kent shall be named as an additional insured on all policies (except Professional Liability) as respects work performed by or on behalf of the Consultant and a copy of the endorsement naming the City as additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all required insurance policies. The Consultant's Commercial General Liability insurance shall also contain a clause stating that coverage shall apply separately to each insured against whom claim is made or suit is brought, except with respects to the limits of the insurer's liability. D. Acceptability of Insurers Insurance is to be placed with insurers with a current A.M. Best rating of not less than ANII. E. Verification of Coverage Consultant shall furnish the City with original certificates and a copy of the amendatory endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the insurance requirements of the Consultant before commencement of the work. F. Subcontractors Consultant shall include all subcontractors as insureds under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to all of the same insurance requirements as stated herein for the Consultant. .4��� DATE(MM/DDIYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 01/27/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ONTACT PRODUCER Ahern Insurance Agency LLC NAME, Michaela Ahern 27116 167th PI SE A//C.No Ext: 253-854-3883 ON FAX No):253-854-4040 #114 E-MAIL michaela.•ahern farmersa enc ADDRESS: g Y•com Covington WA 98042 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Amtrust North America INSURED Vine Maple Place INSURER B: PO Box 1092 INSURER C: Maple Valley WA 98038 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY B COMMERCIAL GENERAL LIABILITY �/ WPP1994224 01/31/2023 01/31/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO TED CLAIMS-MADE FD OCCUR PREMISES (E.occurrence) lccurrrence) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 A'OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 JECT $ A AUTOMOBILE LIABILITY Li WPP1994224 01/31/2023 01/31/2024 COMBINED SINGLE LIMIT $ 1 OOO OOO Ea accident , , ANY AUTO BODILY INJURY(Per person) $ OWNED / SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY Y AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B UMBRELLALIAB OCCUR KMB1025501 01/31/2023 01/31/2024 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WPP1994224 01/31/2023 01/31/2024 I IPER STATUTE OERH WA STOP G 1AP AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ ,OOO,OOO OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Abusive Acts WPP1994224 01/31/2023 01/31/2024 $1,000,000 00 00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Kent is listed as an additional insured and certificate holder. CERTIFICATE HOLDER CANCELLATION City of Kent, Human Resources SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 220 4th Ave S. Kent,WA 98032 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: WPP1994224 00 IL 12 01 11 85 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REA❑ IT CAREFULLY. POLICY CHANGES Policy Change Number : 1 POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY WPP1994224 00 2/14/2023 Wesco Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE Vine Maple Place Chris Foy COVERAGE PARTS AFFECTED General Liability CHANGE $100.00 Additional Premium CG20010413 PRIMARY AND NONCONTRIBUTORY—OTHER INSURANCE CONDITION is added. Change in Tax Premium (Included in Total): Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 Copyright, ISO Commercial Risk Services, Inc., 1983 . Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP1994224 00 FA Cleveland, CH 44114 Named Insured: Vine Maple Place COMMERCIAL COMMON POLICY DECLARATIONS FORMS AND ENDORSEMENTS SCHEDULE Coverage Form Number Edition Date Title CG CG2001 04/13 PRIMARY AND NONCONTRIBUTORY-OTHER INSURANCE CONDITION IL IL1201 11/85 POLICY CHANGES Issued Date: 2/23/2023 ILFORMSCH 0414 Page 2 of 2 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 40 Attachment A ARPA KEN• T WASH IN G T O N PARKS, RECREATION Billing Voucher & Service Report COMMUNITY SERVICES From: Agency Contact To: CITY CONTACT Agency: Email: Address: Phone: Email: Phone: Program Reporting Period Program name Costs incurred from to Reimbursement Request Annual Award Balance Remaining Amt 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr $0.00 PERFORMANCE MEASURES —KENT FUNDED SERVICE UNITS Note: Unduplicated client counts must be reported both quarterly and year-to-date Service Unit Description Contracted to Clients Actually Year to Serve Served Date Total Service Unit/Performance Total 1st 2nd 3rd 4th Contracted 1st 2nd 3rd 4th Measure to Serve Unduplicated # of Kent clients (persons) Service Unit Service Unit Service Unit Sec. 5: NARRATIVE Provide a narrative explanation if you are behind in either progress toward meeting performance measures or projected expenditure rate. Include information about any program or staff changes and how the funds were utilized. Page 1 of 2 By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise, (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812). Agency Authorized Signature Date Print Name Payment Authorization this section to be completed by City of Kent only) Contractual Obligations Met? YES NO Circle one Enter notes if Agency underperformed: Authorized Date:By: Page 2 of 2 Signature: Mein'"Hanson( 8:53PDT) Signature: Email: mhanson@kentwa.gov Email: rlashley@kentwa.gov Signature: Juli arascondola(May 17,202315:07 PDT) Email: jparascondola@kentwa.gov Vine Maple Place-CLFR Grant Recipient Agreement Final Audit Report 2023-05-17 Created: 2023-05-10 By: KateLynn Jennings(kjennings@kentwa.gov) Status: Signed Transaction ID: CBJCHBCAABAAUVjEbq_S_CAY1msXYG5UvzU8n7JLZTjM "Vine Maple Place-CLFR Grant Recipient Agreement" History Document created by KateLynn Jennings (kjennings@kentwa.gov) 2023-05-10-1:29:40 AM GMT-IP address: 146.129.252.126 Document emailed to mhanson@kentwa.gov for signature 2023-05-10-1:39:29 AM GMT Email viewed by mhanson@kentwa.gov 2023-05-10-1:52:54 AM GMT-IP address:73.11.236.7 Signer mhanson@kentwa.gov entered name at signing as Merina Hanson 2023-05-10-1:53:23 AM GMT-IP address:73.11.236.7 Document e-signed by Merina Hanson (mhanson@kentwa.gov) Signature Date:2023-05-10-1:53:25 AM GMT-Time Source:server-IP address:73.11.236.7 C-► Document emailed to Ronald Lashley (rlashley@kentwa.gov)for signature 2023-05-10-1:53:26 AM GMT Email viewed by Ronald Lashley (rlashley@kentwa.gov) 2023-05-10-5:53:57 PM GMT-IP address: 104.47.64.254 a Document e-signed by Ronald Lashley (rlashley@kentwa.gov) Signature Date:2023-05-10-5:59:32 PM GMT-Time Source:server-IP address: 146.129.252.126 �► Document emailed to michellef@vinemapleplace.org for signature 2023-05-10-5:59:33 PM GMT Email viewed by michellef@vinemapleplace.org 2023-05-17-8:57:37 PM GMT-IP address:50.205.194.30 Powered by r � Adobe T Acrobat Sign �'-. New document URL requested by michellef@vinemapleplace.org 2023-05-17-8:57:43 PM GMT-IP address:50.205.194.30 zk Signer michellef@vinemapleplace.org entered name at signing as Michelle Frets 2023-05-17-9:59:37 PM GMT-IP address:50.205.194.30 Z�p Document e-signed by Michelle Frets (michellef@vinemapleplace.org) Signature Date:2023-05-17-9:59:39 PM GMT-Time Source:server-IP address:50.205.194.30 �. Document emailed to Julie Parascondola (jparascondola@kentwa.gov)for signature 2023-05-17-9:59:42 PM GMT Email viewed by Julie Parascondola (jparascondola@kentwa.gov) 2023-05-17-10:07:33 PM GMT-IP address: 104.47.64.254 d� Document e-signed by Julie Parascondola Qparascondola@kentwa.gov) Signature Date:2023-05-17-10:07:47 PM GMT-Time Source:server-IP address: 146.129.252.126 Q Agreement completed. 2023-05-17-10:07:47 PM GMT Powered by r � Adobe T Acrobat Sign