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HomeMy WebLinkAboutCAG2023-647 - Original - Living Well Kent Collaborative - SLFRF: Organizational Development - 01/01/2024 FOR CITY OF KENT OFFICIAL USE ONLY Sup/Mgr: Agreement Routing Form Dir Asst: 0/,/ • For Approvals,Signatures and Records Management Dir/Dep: KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms. J W A S H I N G T O N (Print on pink or cherry colored paper) (optional) Originator: Department: KateLynn Jennings for Christine Horn Parks, Recreation &Community Services Date Sent: Date Required: > 12/13/2023 12/20/2023 0 Q Authorized to Sign: Date of Council Approval: QDirector or Designee Mayor N/A Budqet Account Number: Grant?V]Yes E]No B30021.64190.4792 Budget?V1 Yes E]No Type: Federal Vendor Name: Category: Living Well Kent Collaborative Contract Vendor Numb el Sub-Category: _ 2010643 Original 0 Organizational Development-SLFRF Project Name: E 0 The grant funds will generate additional capacity to weather current and future financial hardship. Project Details: C G1 Agreement Am $85,000 Basis for Selection of Contracto=Other *Memo to Mayor must be attached i Start Date:l 1/1/2024 Termination Date: 6/30/2025 Q Local Business?r7es17No* If meets requirements per KCC3.70.100,pleosecomplete"VendorPurchase-Locol Exceptions"form onCityspace. Business License Verification:171 Yes Dn-Process Exempt(KCC 5.01.045) Notice required prior to disclosure? Contract Number: E]YesONo CAG2023-647 Comments: p1 C 3 0 �1 N •> i Date Received by City Attorney: 12/18/23 C C1 Date Routed to the Mayor's Office: 12/20/23 in Date Routed to the City Clerk's Office: 12/21/23 adccW22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements rev.200821 City of Kent - SURF - Grant Recipient Agreement Grantee Living Well Kent Collaborative Program Title Organizational Development Grant Amount$ $85,000 Agreement Period From: January 1, 2024 To June 30, 2025 SAM Identifying number: DTD7HL15Z883 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 10605 SE 240th St. Suite#232, Kent, Washington, 98031, 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 June 30, 2025, 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: Shamso Issak Title: Mayor Title: Executive Director Signature: �JQXI�. Signature: `Shawso..L(n- /—,if Date: 12/21/2023 Date: 12/15/2023 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 June 30, 2025, 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 2023-2025 11.5 N N G r 0 N PARKS, RECREATION S COMMUNITY SERVICES Scope and Schedule of Work Agency: Living Well Kent Collaborative Program: Organizational Development Contact: Pooja Kumar, Grant Manager Phone: (907) 227-6992 Email: pooja@livin wellkent.or Project Description Living Well Kent (LWK) is a non-profit organization that serves the community from and a location within a qualified census tract and faced significant challenges due to the Outcomes: pandemic's social and economic impacts which increased the demand for services and shifting operational and organizational needs. Through this Scope of Work, LWK is addressing the unique needs of their local communities to build a strong, resilient, and equitable recovery for residents of Kent and for the sustainability of the organization. To be able to address increased demand for services and operational needs brought on by the pandemic, the grant funds will generate additional capacity to weather current and future financial hardship. Living Well Kent (LWK) is a Black and People of Color led, and governed organization created by and for refugees and immigrants in the city of Kent whose mission is to provide public spaces and initiatives that encourage healthier lifestyles and better living. Community priorities inform our programs and currently include food access, health and wellness, early learning, and youth empowerment. Outcomes: • Enhanced credibility and image among stakeholders. • Increase in annual grant revenue. • Retention of existing funders and more diversification of funding. • Improved perspectives of Black and People of Color refugees and immigrants in community-wide investments. • Overall, more proactive direction-setting, decision-making and problem- solving. Consultant shall provide the following deliverables during the Agreement: Deliverables EXAMPLES— Completion Date Leadership and supervisory development, to peruse prospective grown initiatives and Jan 2024 community-wide growth opportunities, resulting in transformational impact for BIPOC refugees and immigrants in Kent. Onboarding 0.5 Grants Manager trained to oversee and coordinate programmatic and June 2024 financial reporting, track, and contract deliverables, monitor progress toward outcomes, and work with programs to meet contract compliance. Strategic planning to identify and increase capacity to peruse additional grant and November 2024 funding opportunities. Proposed Costs and Payment Terms Salaries/Wages $65,000 Administration $10,000 Professional Services $10,000 Payment Terms — Administration and operations including staff salaries and benefits invoiced monthly. Equipment and supplies invoiced upon incurring them; copies of receipts attached to invoice. Website Design, safety planning, and all workshops and training invoiced as costs are incurred, but no more than monthly. Contract Administration - The Consultant shall notify the City, in writing, within ten (10) days of any changes in agency leadership. - 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 monthly reporting, staff may perform desktop and at least 2 onsite monitoring visits 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 measure. 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. Deliverable and Progress Report — Data from this form will be used to track progress toward meeting the goals stipulated in the Scope of Work. The Progress Report should include updates regarding deliverables, any successes and challenges the organization is experiencing, or any significant changes to the program model or budget. It shall be submitted monthly, 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. It shall be submitted monthly, 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. Report Due Date Service Unit Report and Reimbursement 15th day following each quarter Request Final Reimbursement Request July 30, 2025 40 Attachment A ARPA KEN• T WASH IN G T O N PARKS, RECREATION & Request for Payment & Progress Report COMMUNITY SERVICES From: To: Christine Horn Agency: Email: CHorn@kentwa.gov Address: Phone: (253) 856-5063 Email: Phone: Program Reporting Period Program name Organizational Development Costs incurred from to Reimbursement Request Award Amount Request This Quarter Total Requested to Date Balance Remaining 85,000.00 PERFORMANCE MEASURES —KENT FUNDED SERVICE UNITS Deliverable Description Target Actual Completion Completion Date Date Leadership and supervisory development, to peruse prospective grown initiatives and community-wide growth Jan 2024 opportunities, resulting in transformational impact for BIPOC refugees and immigrants in Kent. Onboarding 0.5 Grants Manager trained to oversee and coordinate programmatic and financial reporting, track, and contract deliverables, monitor progress toward June 2024 outcomes, and work with programs to meet contract compliance. Strategic planning to identify and increase capacity to November 2024 peruse additional grant and funding opportunities. Sec. 5: NARRATIVE Page 1 of 3 The narrative should include progress on deliverables and describe how funds were utilized. Please include information about your successes and/or any challenges or barriers you are facing in meeting the deliverables. 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 Page 2 of 3 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 3 of 3 Grant Recipient Agreement— Exhibit 3 COST CERTIFICATION I certify that: 1. 1 have authority and approval from the governing body on behalf of Living Well Kent Collaborative ("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 January 01, 2024 through June 30, 2025. 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. Shamso Issak Slawso If ak Printed Name Signature Executive Director 12/15/2023 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 FIR 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. Shamso Issak Jlawlr0 /,fsak Printed Name Signature Executive Director 12/15/2023 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. Shamso Issak �hawfo Irsah Printed Name Signature Executive Director 12/15/2023 Title Date Exhibit 6 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 EXHIBIT 7 DECLARATION CITY OF KENT NON-DISCRIMINATION POLICY The City of Kent (City) is committed to conform to Federal and State laws regarding equal opportunity. As such all contractors, subcontractors, consultants, vendors, and suppliers who perform work with relation to this Agreement shall comply with the regulations of the City's equal employment opportunity policies. The City of Kent and its contractors are subject to and will comply with the following: • Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits discrimination on the basis of race, color, national origin); • 49 C.F.R. Part 21 (entitled Non-discrimination In Federally-Assisted Programs Of The Department Of Transportation-Effectuation Of Title VI Of The Civil Rights Act Of 1964); • 28 C.F.R. section 50.3 (U.S. Department of Justice Guidelines for Enforcement of Title VI of the Civil Rights Act of 1964). • Ch. 49.60 RCW (Washington Law Against Discrimination) The preceding statutory and regulatory cites hereinafter are referred to as "the Acts and Regulations". The following statements specifically identify the requirements the City deems necessary for any contractor, subcontractor, or supplier on this specific Agreement to adhere to. An affirmation of all of the following is required for this Agreement to be valid and binding. If any contractor, subcontractor, or supplier willfully misrepresents themselves with regard to the directives outlined below, 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 statements 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 I, the prime contractor, will provide a written statement to all new employees and subcontractors indicating commitment as an equal opportunity employer. 4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of women and minorities. 5. During the performance of this contract, the contractor, for itself, its assignees, and successors in interest (hereinafter referred to as the "contractor") agrees as follows: EEO COMPLIANCE DOCUMENTS - 1 of 5 A. Compliance with Regulations: The contractor, subcontractor, consultant, vendor, and supplier (hereinafter "Contractor") will comply with all Acts and the Regulations relative to non-discrimination, including those applicable to Federally- assisted programs of the U.S. Department of Transportation, State-assisted programs through the Washington State Department of Transportation, and generally under Washington's Law Against Discrimination, Ch. 49.60 RCW, as they may be amended from time to time, which are herein incorporated by reference and made a part of this contract. B. Non-discrimination: The contractor, with regard to the work performed by it during the contract, will not discriminate on the grounds of race, color, or national origin in the selection and retention of subcontractors, including procurements of materials and leases of equipment. The contractor will not participate directly or indirectly in the discrimination prohibited by the Acts and the Regulations, including employment practices when the contract covers any activity, project, or program set forth in Appendix B of 49 CFR Part 21. C. Solicitations for Subcontracts, Including Procurements of Materials and Equipment: In all solicitations, either by competitive bidding, or negotiation made by the contractor for work to be performed under a subcontract, including procurements of materials, or leases of equipment, each potential subcontractor or supplier will be notified by the contractor of the contractor's obligations under this contract and the Acts and the Regulations relative to non-discrimination on the grounds of race, color, or national origin. D. Information and Reports: The contractor will provide all information and reports required by the Acts and Regulations and directives issued pursuant thereto and will permit access to its books, records, accounts, other sources of information, and its facilities as may be determined applicable to contractor's contract by the City or the Washington State Department of Transportation to be pertinent to ascertain compliance with such Acts and Regulations and instructions. Where any information required of a contractor is in the exclusive possession of another who fails or refuses to furnish the information, the contractor will so certify to the City or the Washington State Department of Transportation, as appropriate, and will set forth what efforts it has made to obtain the information. E. Sanctions for Noncompliance: In the event of a contractor's noncompliance with the non-discrimination provisions of this contract, the City will impose such contract sanctions as it or the Washington State Department of Transportation may determine to be appropriate, including, but not limited to: a. withholding payments to the contractor under the contract until the contractor complies; and/or b. cancelling, terminating, or suspending a contract, in whole or in part. F. Incorporation of Provisions: The contractor will include the provisions of paragraphs (A) through (F) above in every subcontract, including procurements of materials and leases of equipment, unless exempt by the Acts and Regulations and directives issued pursuant thereto. The contractor will take action with respect to any subcontract or procurement as the City or the Washington State Department of Transportation may direct as a means of enforcing such provisions including sanctions for noncompliance. Provided, that if the contractor becomes involved in, or is threatened with litigation by a subcontractor, or supplier because of such EEO COMPLIANCE DOCUMENTS - 2 of 5 direction, the contractor may request the City to enter into any litigation to protect the interests of the City. In addition, the contractor may request the United States to enter into the litigation to protect the interests of the United States. 6. During the performance of this contract, the contractor, for itself, its assignees, and successors in interest agrees to comply with the following non-discrimination statutes and authorities; including but not limited to: Pertinent Non-Discrimination Authorities: i. Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits discrimination on the basis of race, color, national origin); and 49 CFR Part 21. ii. The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. § 4601), (prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal or Federal-aid programs and projects); iii. Federal-Aid Highway Act of 1973, (23 U.S.C. § 324 et seq.), (prohibits discrimination on the basis of sex); iv. Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended, (prohibits discrimination on the basis of disability); and 49 CFR Part 27; V. The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits discrimination on the basis of age); vi. Airport and Airway Improvement Act of 1982, (49 USC § 471, Section 47123), as amended, (prohibits discrimination based on race, creed, color, national origin, or sex); vii. The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage and applicability of Title VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973, by expanding the definition of the terms "programs or activities" to include all of the programs or activities of the Federal-aid recipients, sub-recipients and contractors, whether such programs or activities are Federally funded or not); viii. Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on the basis of disability in the operation of public entities, public and private transportation systems, places of public accommodation, and certain testing entities (42 U.S.C. §§ 12131-12189) as implemented by Department of Transportation regulations at 49 C.F.R. parts 37 and 38; ix. The Federal Aviation Administration's Non-discrimination statute (49 U.S.C. § 47123) (prohibits discrimination on the basis of race, color, national origin, and sex); X. Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations, which ensures Non-discrimination against minority populations by discouraging programs, policies, and activities with disproportionately high and adverse human health or environmental effects on minority and low-income populations; xi. Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and resulting agency guidance, national origin discrimination includes discrimination because of Limited English proficiency (LEP). To ensure EEO COMPLIANCE DOCUMENTS - 3 of 5 compliance with Title VI, you must take reasonable steps to ensure that LEP persons have meaningful access to your programs (70 Fed. Reg. at 74087 to 74100); xii. Title IX of the Education Amendments of 1972, as amended, which prohibits you from discriminating because of sex in education programs or activities (20 U.S.C. 1681 et seq). xiii. Washington Law Against Discrimination (Ch. 49.60 RCW) 7. The submission of the final invoice for this contract will constitute a reaffirmation that the preceding statements were complied with during the course of the contract's performance. By signing below, I agree to fulfill the five requirements referenced above. stawso lssak By: Shamcn Iccak(Dar 1 5,90) 10-11,PST For: Living Well Kent Collaborative Title: Executive Director Date: 12/15/2023 EEO COMPLIANCE DOCUMENTS - 4 of 5 CITY OF KENT ADMINISTRATIVE POLICY NUMBER: 1.2 EFFECTIVE DATE: October 20, 2022 SUBJECT: INCLUSIVE CONTRACTING SUPERSEDES: January 1, 1998 APPROVED BY Dana Ralph, Mayor POLICY: Equal employment opportunity and non-discrimination in contracting 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. Further, all contractors, subcontractors, consultants, suppliers, grantees, or subgrantees of the City, regardless of the value of the Agreement, are required to sign the City's Non-Discrimination Policy Declaration, prior to commencing performance. 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 coordinate with the City's Title VI coordinator, and perform 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 - 5 of 5 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. A�" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/11/2023 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). PRODUCER CONTACT DougJones NAME:HOE FAX StateFarm Doug Jones (PA ICNNo Ext: 253 850 3226 A/c No), 124 4th Ave S Suite 210 A Ress: doug.jones.srat@statefarm.com INSURER(S)AFFORDING COVERAGE NAIC# Kent WA 980325821 INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURER B: LIVING WELL KENT COLLABORATIVE INSURER C: 10605 SE 240TH ST#232 INSURER D: INSURER E: KENT WA 980314903 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 ADD SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE � OCCUR PREMISES (E.occurrence) ccurrrence) $ 300,000 MED EXP(Any one person) $ 5,000 A Y Y 98-CK-U326-2 08/30/2023 08/30/2024 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRO- POLICY JECT X LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 543 4170-A28-47A 07/28/2023 01/28/2024 Ea accident $ ANY AUTO BODILY INJURY(Per person) $ 1,000,000 A OWNED SCHEDULED N N BODILY INJURY Per accident) $ 1,000,000 AUTOS ONLY X AUTOS HIRED NON-OWNED AUTOS ONLY AUTOS ONLY Per accident $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER $ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N O ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF KENT ACCORDANCE WITH THE POLICY PROVISIONS. 400 W GOWE ST AUTHORIZED REPRESENTATIVE KENT WA 98032-6019 _ sq— This form was system-generated on 10/11/2023 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 2005 155279 205 01-19-2023 KR POIIC No. 98 CKU326 2 194B—FACD CMP-4786 y Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4786 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 98 CKU326 2 Named Insured: LIVING WELL KENT COLLABORATIVE 10605 SE 240TH ST STE 232 KENT WA 98031-4903 Name And Address Of Additional Insured Person Or Organization: CITY OF KENT 400 W GOWE ST KENT WA 98032 6019 1. SECTION II — WHO IS AN INSURED of b. Products-Completed Operations SECTION II — LIABILITY is amended to in- "Your work" performed for that additional clude, as an additional insured, any person insured and included in the "products- or organization shown in the Schedule, but completed operations hazard". only with respect to liability for "bodily in- 2. Any insurance provided to the additional in- jury", "property damage", or "personal and sured shall only apply with respect to a claim advertising injury" caused, in whole or in made or a "suit" brought for damages for part, by: which you are provided coverage. a. Ongoing Operations 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- (1) Your acts or omissions; or ance. Any insurance carried by the additional insured shall be noncontributory with respect (2) The acts or omissions of those acting to coverage provided by you. on your behalf; There will be no refund of premium in the event in the performance of your ongoing opera- this endorsement is cancelled. tions for that additional insured; or All other policy provisions apply. CMP-4786 1006104 137713.1 10-23-2013 ©,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. KR PolicyNo. 98 CKU326 2 194B—FACD CMP-4787 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 98 CKU326 2 Named Insured: LIVING WELL KENT COLLABORATIVE 10605 SE 240TH ST STE 232 KENT WA 98031-4903 Name And Address Of Person Or Organization: CITY OF KENT 400 W GOWE ST KENT WA 98032 6019 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715.1 11-19-2013 ©,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Last updated by Shamso Issak on Jun 27,2023 at 02:36 PM LIVING WELL KENT COLLABORATIVE �!1_SAM*Gov° LIVING WELL KENT COLLABORATIVE Unique Entity ID CAGE/NCAGE Purpose of Registration DTD7HL15Z883 87D14 Federal Assistance Awards Only Registration Status Expiration Date Active Registration Jun 26,2024 Physical Address Mailing Address 10605 SE 240TH ST 10605 SE 240TH ST SE Kent,Washington 98031-4903 #232 United States Kent,Washington 98031-4903 United States Doing Business as Division Name Division Number LIVING WELL KENT COLLABOR Livingwell Kent (blank) Congressional District State/Country of Incorporation URL Washington 09 Washington/United States www.livingwelikent.org Registration Dates Activation Date Submission Date Initial Registration Date Jun 28,2023 Jun 27,2023 Nov 23,2018 Entity Dates Entity Start Date Fiscal Year End Close Date May 1,2015 Dec 31 Immediate Owner CAGE Legal Business Name (blank) (blank) Highest Level Owner CAGE Legal Business Name (blank) (blank) Executive Compensation Registrants in the System for Award Management(SAM)respond to the Executive Compensation questions in accordance with Section 6202 of P.L.110-252,amending the Federal Funding Accountability and Transparency Act(P.L.109-282).This information is not displayed in SAM.It is sent to USAspending.gov for display in association with an eligible award.Maintaining an active registration in SAM demonstrates the registrant responded to the questions. Proceedings Questions Registrants in the System for Award Management(SAM.gov)respond to proceedings questions in accordance with FAR 52.209-7,FAR 52.209-9, or 2.C.F.R.200 Appendix XII.Their responses are displayed in the responsibility/qualification section of SAM.gov.Maintaining an active registration in SAM.gov demonstrates the registrant responded to the proceedings questions. Active Exclusions Records? No I authorize my entity's non-sensitive information to be displayed in SAM public search results: Yes Business Types Entity Structure Entity Type Organization Factors Corporate Entity(Tax Exempt) Business or Organization (blank) Profit Structure Non-Profit Organization Aug 29,2023 10:56:28 PM GMT https:11samgov/entity1DTD7HL15Z8831coreData?status—Active Page l of 2 Last updated by Shamso Issak on Jun 27,2023 at 02:36 PM LIVING WELL KENT COLLABORATIVE Socio-Economic Types Check the registrant's Reps&Certs,if present,under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small business concern.Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration. Accepts Credit Card Payments Debt Subject To Offset No No EFT Indicator CAGE Code 0000 871314 EFT Indicator CAGE Code 8714 (blank) Electronic Business 24604 104TH AVE SE Shamso A Issak,Executive Director #102 Kent,Washington 98030 United States Government Business 24604104TH AVE SE Shamso A Issak,Executive Director #102 Kent,Washington 98030 United States Past Performance 9. 24604104TH AVE SE Claudia Cortes,Operations Director Suite 102 Kent,Washington 98030 United States NAICS Codes Primary NAICS Codes NAICS Title This entity does not appear in the disaster response registry. Aug 29,2023 10:56:28 PM GMT https:11samgov/entity1DTD7HL25Z8831coreData?status—Active Page 2 of 2 OWIAI—c Signature: Merin�a�ansonn( e7c15,202�309:•25PST) Signature: Email: mhanson@kentwa.gov Email: phuynh@kentwa.gov Signature: Juli arascondola(Dec 16,20231250 PST) Email: jparascondola@kentwa.gov H HS_LWK_OrganizationalDevSLFRF_121323 Final Audit Report 2023-12-16 Created: 2023-12-13 By: KateLynn Jennings(kjennings@kentwa.gov) Status: Signed Transaction ID: CBJCHBCAABAAi7rkN76Vdty7Y_13ZLdRoYGIXwg07NhD "HHS_LWK_OrganizationalDevSLFRF_121323" History "; Document created by KateLynn Jennings (kjennings@kentwa.gov) 2023-12-13-9:40:09 PM GMT-IP address: 146.129.252.126 Document emailed to mhanson@kentwa.gov for signature 2023-12-13-9:42:16 PM GMT Email viewed by mhanson@kentwa.gov 2023-12-15-5:25:16 PM GMT-IP address:73.11.236.7 Signer mhanson@kentwa.gov entered name at signing as Merina Hanson 2023-12-15-5:25:44 PM GMT-IP address:73.11.236.7 ca Document e-signed by Merina Hanson (mhanson@kentwa.gov) Signature Date:2023-12-15-5:25:46 PM GMT-Time Source:server-IP address:73.11.236.7 Document emailed to Phung Huynh (phuynh@kentwa.gov)for signature 2023-12-15-5:25:48 PM GMT 3 Email viewed by Phung Huynh (phuynh@kentwa.gov) 2023-12-15-5:34:47 PM GMT-IP address: 104.47.64.254 Document e-signed by Phung Huynh (phuynh@kentwa.gov) Signature Date:2023-12-15-5:36:11 PM GMT-Time Source:server-IP address: 146.129.252.126 Document emailed to shamso@livingwellkent.org for signature 2023-12-15-5:36:14 PM GMT Email viewed by shamso@livingwellkent.org 2023-12-15-6:11:49 PM GMT-IP address: 104.47.55.254 EY Signer shamso@livingwellkent.org entered name at signing as Shamso Issak 2023-12-15-6:15:56 PM GMT-IP address: 174.165.81.199 Powered by r � Adobe T Acrobat Sign E= Document e-signed by Shamso Issak (shamso@livingwellkent.org) Signature Date:2023-12-15-6:15:58 PM GMT-Time Source:server-IP address: 174.165.81.199 Document emailed to Julie Parascondola Qparascondola@kentwa.gov)for signature 2023-12-15-6:16:01 PM GMT Email viewed by Julie Parascondola (jarascondola@kentwa.gov) 2023-12-16-8:49:58 PM GMT-IP address:76.22.106.188 E= Document e-signed by Julie Parascondola Qparascondola@kentwa.gov) Signature Date:2023-12-16-8:50:10 PM GMT-Time Source:server-IP address:76.22.106.188 Agreement completed. 2023-12-16-8:50:10 PM GMT Powered by r � Adobe � � T Acrobat Sign