HomeMy WebLinkAboutCAG2024-576 - Original - ANEW - KSD Student Career Exploration - 12/23/24 FOR CITY OF KENT OFFICIAL USE ONLY
Sup/Mgr: M�
Agreement Routing Form Dir Asst: It�Parks
For Approvals,Signatures and Records Management Dir/Dep:
•
K E N T J ie Parasco
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:
Lori Guilfoyle Parks, Recreation & Community Services
Date Sent: Date Required:
> 12/10/2024 12/20/2024
0
Q Mayor or Designee to Sign. Date of Council Approval:
Q
Q Interlocal Agreement Uploaded to Website 11/16/2021
Budget Account Number: Grant? YesWl NoE]
B30021
Budget?W]Yes E]No Type: Federal
Vendor Name: Category: IM
ANEW Contract
Vendor Number: Sub-Category:
c 2000762 Original
4-0 KSD Student Career Exploration
Project Name: p
cProject Details: High School students, aged 16 - 20, in the Kent School District will engage
in customized Career ExplorationNouth Employment Program camps that
will incorporate RISE Up curriculum.
c
Basis for Selection of Contractor:
Agreement $10Q *Memo to Ma
,QQQ Other
E yor must be attached
i Start Date: � 2�1�2024 Termination Date: 9/30/2026
Q Local Business? Yes Who*If meets requirements per KCC3.70.100,please complete"VendorPurchose-Locol Exceptions"form onCityspace.
Business License Verification: 91 Yes In-ProcessD Exempt(KCC 5.01.045) W1 Authorized Signer Verified
Notice required prior to disclosure? Contract Number:
Yes W1 No CAG2024-576
Comments:
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Date Received:City Attorney:12/20/24 Date Routed:Mayor's Offic 12/20/24 City Clerk's Office 12/23/2
adccW22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements
rev.20221201
City of Kent - SURF - Grant Recipient Agreement
Grantee Apprenticeship and Nontraditional Employment for Women (ANEW)
Program Title KSD Student Career Exploration
Grant Amount$ $100,000
Agreement Period From: December 1,2024 To September 30, 2026
SAM Identifying number. R8F9CEPF9ZCS
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 18338 Andover Park West,Seattle, Washington, 98188,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 other funding,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
ANEW 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.eov/.
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 anyway 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.
ANEW Grant Beneficiary Agreement
Page 2 of 3
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:Karen Dove
Title: Mayor Title:Executive Director
Ka,,�a,,,
SignaturQ Signature:
Date: 12/23/2024 111 Date: Dec 19, 2024
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
ANEW 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).
4^
Exhibit 2
KENT 2024-2026
W n 5 H ry G T O N
PARKS, RECREATION S
COMMUNITY SERVICES Scope and Schedule of Work
Agency: ANEW
Program: KSD Student Career Exploration
Contact: Olivia DeFay, Career Exploration Program Manager
Thenisia Sullivan, RISE UP Program Manager
Liliana Paredes, CPO
Program
Description: High School students, aged 16 - 20, in the Kent School District will engage in
customized Career Exploration/Youth Employment Program camps that will
incorporate RISE Up curriculum. Each 40-hour camp will introduce students to the
construction trades as an alternative post-secondary education/career opportunity.
Students will learn about the various construction trades: what the different ones
are, how much they make, what they do, and how to get into an apprenticeship.
Additionally, students will practice foundational construction skills, build
group/personal projects, and practice work-readiness essential/soft skills such as
emotional intelligence, self advocacy, financial literacy, resume building, interview
practice, etc.
Consultant shall provide the approximate number of City of Kent clients with the following services during the Agreement:
Unduplicated Kent Clients Contracted
to Serve (specify individuals or 45
households)
Service Unit Descriptions and Deliverables Units Contracted to Serve
Service Unit 1: Career Exploration Camp 2
Nine week cohorts during the school year, location to be determined
Service Unit 2: Summer Carer Exploration 2
Two week cohorts during the summer, location to be determined
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 reimbursement request and 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 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. The City and ANEW will co-design the reporting
format.
Service Unit and Narrative Report - Data from the report will be used to track the 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 monthly/quarterly, no later than
the 15th of the month following the end of the month/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/quarterly, no later than the 15th of the
month following the end of the month/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 at the end of contract.
Report Due Date
Service Unit Report and Reimbursement 151h day following each month/quarter
Request
Final Reimbursement Request September 30, 2026
Demographic Data Report September 30, 2026
DEMOGRAPHIC INFORMATION - The following information should be collected and
reported annually.
Number of Households or Persons Assisted (please specify "H" or "P"):
Race Unduplicated Unduplicated
Year to Date Year to Date
All (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
Grant Recipient Agreement— Exhibit 3
COST CERTIFICATION
I certify that:
1. 1 have authority and approval from the governing body on behalf of ANEW
("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 December 1. 2024
through September 30, 2026.
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.
Karen Dove A-.
Printed Name Signature
Executive Director Dec 19,2024
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.
Karen Dove KDa�
Printed Name Signature
Executive Director Dec 19, 2024
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.
Karen Dove A- D
Printed Name Signature
Executive Director Dec 19, 2024
Title Date
AUTNENT"( T_
1.1..111EM.M NT
INFONMATION
GPO
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
031E-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 For Material Chan a Onl
d.loan c. post-award g Y
e.loan guarantee year quarter
I.
loan insurance date of last report
4. Name and Address of Reporting Entity: S. If Reporting Entity in No.4 is Subawardee,Enter Name
❑ Prime ❑ Subawardee and Address of Prime:
Tier ,if known:
Con ressional 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
fit individual,last name,first name,MII: -different from No.IOa)
(last name,first name,MII:
attach Contrnuation 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 alf that apply): ❑ c. commission
❑ a.cash ❑ d.contingent fee
❑ b.in-kind;specify: nature ❑ e.deferred
p value eci❑ f. other;specify:
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-LLL- if necessa
15. Continuation Sheetls)SF-LLL-A attached: ❑Yes ❑No
16. ldmtnahan nqueatad through thb lawn is authorized by title 31 U.S.C.
mn I—This dmib d bbbying activities is a material repia nt ri n Signature:
d fact upon whkh r0' .was placed by the tier above when this
:rtkn was made o,-t—t!inm.rhia dadown is"..led pvm Print Name:
31 U.S.C.135I.M,idorma will be reported to the Cwgms semi-
annudly and will be ariil"br pudk inspection.My person who fails to Title:
file the".bed di lcb shall be subject to a civil penalty d nut kss than
s+o.ago and—t mom than$lw.opo lm each> h ia;m . Telephone No.: Date:
lllFys Authorized iw Ixal Reproduction
standard Form-ca.
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. Identify 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,stair 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 date(s)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 0340046&0046 OMB
CONTINUATION SHEET
Reporting Entity: Page of
Authorized for Local ltgw dWio
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.
By:
For: AN EW
Title: Executive Director
Date: Dec 19., 2024
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 B (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.
Issue Date 5/23/2024 Cert#:0000043437
NON PROFIT INSURANCE PROGRAM
CERTIFICATE OF COVERAGE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES
NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE NPIP COVERAGE AGREEMENT BELOW.THIS CERTIFICATE OF COVERAGE 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 COVERED PARTY,THE COVERAGE AGREEMENT MUST BE ENDORSED. IF SUBROGATION IS
WAIVED,SUBJECT TO THE TERMS AND CONDITIONS OF THE COVERAGE AGREEMENT,CERTAIN COVERAGE MAY REQUIRE AN ENDORSEMENT.A STATEMENT
ON THIS CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENTS.
PROGRAM ADMINISTRATOR COMPANIES AFFORDING COVERAGE
Clear Risk Solutions GENERAL LIABILITY
451 Diamond Drive NPIP/Munich Re.et al.
Ephrata,WA 98823
AUTOMOBILE LIABILITY
COVERED PARTY NPIP/Munich Re.et al.
ANEW PROPERTY
NPIP/Munich Re.et al.
18338 Andover Park West MISCELLANEOUS PROFESSIONAL LIABILITY
Tukwila,WA 98188 NPIP/Munich Re.et al.
COVERAGES
THIS IS TO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED MEMBER NAMED ABOVE FOR THE COVERAGE PERIOD
INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED BY THE NPIP COVERAGE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL
THE TERMS,EXCLUSIONS,AND CONDITIONS OF SUCH COVERAGE AGREEMENT. LIMITS SHOWN BELOW MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LINE OF COVERAGE COVERAGE NUMBER EFF DATE EXP DATE DESCRIPTION LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY NPIP242560721 6/1/2024 6/1/2025 PER OCCURRENCE $2,000,000
OCCURRENCE FORM PER MEMBER AGGREGATE $4,000,000
INCLUDES STOP GAP—EMPLOYERS LIABILITY PRODUCT-COMP/OP $2,000,000
PERSONAL&ADV.INJURY $2,000,000
(LIABILITY IS SUBJECT TO A$350,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $50,000,000
AUTOMOBILE LIABILITY
ANY AUTO NPIP242560721 6/1/2024 6/1/2025 COMBINED SINGLE LIMIT $2,000,000
(LIABILITY IS SUBJECT TO A$350,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE
PROPERTY
NPIP242560721 6/1/2024 6/1/2025 ALL RISK PER OCC EXCL EQ&FL $100,000,000
EARTHQUAKE PER OCC $1,000,000
FLOOD PER OCC $1,000,000
(PROPERTY IS SUBJECT TO A$350,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE NONE
MISCELLANEOUS PROFESSIONAL LIABILITY
NPIP242560721 6/1/2024 6/1/2025 PER CLAIM $2,000,000
(LIABILITY IS SUBJECT TO A$350,000 SIR PAYABLE FROM PROGRAM FUNDS) ANNUAL POOL AGGREGATE $40,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
Regarding Consultant Services Agreement between the City of Kent and ANEW.City of Kent is named as Additional Covered Party regarding this agreement only and is
subject to coverage terms,conditions,and exclusions.Additional Covered Party endorsement is attached.NPIP is primary and non-contributory.
CANCELLATION NOTICE:SHOULD ANY OF THE ABOVE DESCRIBED COVERAGES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE COVERAGE AGREEMENT PROVISIONS.
CERTIFICATE HOLDER AUTHORIZED REPRESENTATIVE
City of Kent
220 Fourth Avenue South
Kent,WA 98032
Coverage Number: NPIP242560721 Effective Date: 6/1/2024
Cert#:0000043437 Issue Date 5/23/2024
ADDITIONAL COVERED PARTY-DESIGNATED PERSON OR ORGANIZATION
(GENERAL LIABILITY)
THIS ENDORSEMENT CHANGES THE COVERAGE AGREEMENT.PLEASE READ IT CAREFULLY
This endorsement modifies Coverage provided under the following:
GENERAL LIABILITY COVERAGE PART
This endorsement changes the Coverage Agreement effective on the inception date of the Coverage Agreement unless
another date is indicated above. Providing the certificate of coverage that this endorsement is attached to has been issued by
and is on file with the Company, the following applies.
SCHEDULE
Person or Organization(Additional Covered Party):
City of Kent
220 Fourth Avenue South
Kent,WA 98032
Description of Activities/Operations/Designated Premises:
Regarding Consultant Services Agreement between the City of Kent and ANEW. City of Kent is named as Additional Covered
Party regarding this agreement only and is subject to coverage terms, conditions, and exclusions.Additional Covered Party
endorsement is attached. NPIP is primary and non-contributory.
A. With respects to the General Liability Coverage Part only,the definition of Covered Party in the Liability Conditions,
Definitions and Exclusions section of this Coverage Agreement is amended to include as a Covered Party the
Person or Organization shown in the above Schedule.Such Person or Organization is a Covered Party only with
respect to liability for Bodily Injury,Property Damage,or Personal and Advertising Injury caused in whole or in
part by your acts or omissions or the acts or omissions of those acting on your behalf:
1. In performance of your ongoing operations;or
2. In connection with your premises owned or rented to you.
B. The Limits of Coverage applicable to the additional Covered Party are those specified in either the:
1. Written contract or written agreement;or
2. Declarations for this Coverage Agreement,
whichever is less. These Limits of Coverage are inclusive and not in addition to the Limits of Coverage shown in the
Declarations.
All other terms and conditions remain unchanged.
OF
Signature: McYin( 1fwlsol? Signature:
Merina Hanson(Dec 10,2024 13:55 PST) Kent Parks(Dec 10,202414:09 PST)
Email: mhanson@kentwa.gov Email: parkscontracts@kentwa.gov
Signature: 4090*
ie Parascon ola(Dec 20,2024 09:32 PST)
Email: jparascondola@kentwa.gov
AN EWSLFRFCareerexploration Final
Final Audit Report 2024-12-20
Created: 2024-12-10
By: Brittany Levens(blevens@kentwa.gov)
Status: Signed
Transaction ID: CBJCHBCAABAA8Vr3YCOs3QV5C-IHOAZGtVf4BFvxnR8Y
"ANEWSLFRFCareerexplorationFinal" History
Document created by Brittany Levens (blevens@kentwa.gov)
2024-12-10-9:45:24 PM GMT
Document emailed to mhanson@kentwa.gov for signature
2024-12-10-9:54:09 PM GMT
Email viewed by mhanson@kentwa.gov
2024-12-10-9:55:04 PM GMT
Signer mhanson@kentwa.gov entered name at signing as Merina Hanson
2024-12-10-9:55:44 PM GMT
ca Document e-signed by Merina Hanson (mhanson@kentwa.gov)
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