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HomeMy WebLinkAboutAG 23-158 - SEATTLE KING COUNTY DEPARTMENT OF PUBLIC HEALTHRETURN TO: victoria Banks EXT: 2604
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT./DIV: CD/CS
2. ORIGINATING STAFF PERSON: Patti Spaulding-Klewin EXT: 2651 3. DATE REQ. BY:
4. TYPE OF DOCUMENT (CHECK ONE):
❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT
❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT
❑ GOODS AND SERVICE AGREEMENT A HUMAN SERVICES / CDBG
❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
❑ ORDINANCE ❑ RESOLUTION
❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL
❑ OTHER
5. PROJECT NAME: South King County Mobile Medical Program
6. NAME OF _CONTRACTOR: Seattle King County Department of Public Health
ADDRESS: 401 5th Ave #1300, Seattle WA 9e104 TELEPHONE 206-477-6391
E-MAIL: vacrockrell@kingcounty,gov FAX:
SIGNATURE NAME: VaZaSkla CI ockrell TITLE Director
7. EXHIBITS AND ATTACHMENTS:®. SCOPE, WORK OR SERVICES 19 COMPENSATION A INSURANCE REQUIREMENTS/CERTIFICATE © ALL
OTHER REFERENCED EXHIBITS IN PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
8. TERM: COMMENCEMENT DATE: 01/01/2023 COMPLETION DATE: 12/31/2024
9. TOTAL COMPENSATION $ 14,000.00 (INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑ YES A NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED ®YES ONO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY
RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE TO: 001-7300-0e3-552-10-410
10. DOCUMENT/CONTRACT REVIEW INITIAL/DATE REVIEWED INITIAL/DATE APPROVED
❑ PROJECT MANAGER
A DIRECTOR KN/2.10.23
❑ RISKMANAGEMENT (IFAPPLICABLE)
® LAW JE 2/14/23
11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: N/A COUNCIL APPROVAL DATE: 11/15/2022
12. CONTRACT SIGNATURE ROUTING
A SENT TO VENDOR/CONTRACTOR DATE SENT: 4/14/23 DATE REC'D: 7/1023
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE
(Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.)
INITIAL/ DATE SIGNED
DEPARTMENT I
�4eA-W
IGNATORY (MAYOR OR DIRECTOR) W PSI
❑ CITY CLERK a
ElASSIGNED AG# AG# ' rJ
COMMENTS:
Approved Council budget 11/15/2022
This looked really great! Only a few tweaks here and there. JE 2114123
2/2017
C1iY OF CITY HALL
Fed a ra y Feder 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www ciryoffederalway com
HUMAN SERVICES AGREEMENT
FOR
SOUTH KING COUNTY MOBILE MEDICAL PROGRAM
This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and Public Health of Seattle -King County, a Washington county agency ("County"). The City
and County (together "Parties") are located and do business at the below addresses which shall be valid for any
notice required under this Agreement:
PUBLIC HEALTH OF SEATTLE-KING
COUNTY:
Vazaskia Crockrell
401 5th Ave #1300
Seattle, WA 98104
(206) 477-6391 (telephone)
vacro ckrell @kingcounty. go
The Parties agree as follows:
CITY OF FEDERAL WAY:
Patti Spaulding-Klewin
33325-8th Ave. S,
Federal Way, WA 98003-6325
(253) 835-2651 (telephone)
com
1. TERM. The term of this Agreement shall be for a period commencing on January 1, 2023, and terminating
on December 31, 2024 ("Term"). Funding for the second year of the Agreement is contingent upon satisfactory
Agreement performance during the first year of the Agreement term and upon funding availability. This Agreement
may be extended for additional periods of time upon the mutual written agreement of the City and the County.
2. SERVICES. The County shall perform the services more specifically described in Exhibit A, attached hereto
and incorporated by this reference ("Services"), in a manner consistent with the accepted professional practices for
other similar services within the Puget Sound region in effect at the time those services are performed in a
satisfactory manner, within the time period prescribed by the City. The County warrants that it has the requisite
training, skill, and experience necessary to provide the Services and is appropriately accredited and licensed by all
applicable agencies and governmental entities. Services shall begin immediately upon the effective date of this
Agreement. Services shall be subject, at all times, to inspection by and approval of the City, but the making (or
failure or delay in making) such inspection or approval shall not relieve the County of responsibility for performance
of the Services in accordance with this Agreement, notwithstanding the City's knowledge of defective or non-
complying performance, its substantiality or the ease of its discovery.
3. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the
other party thirty (30) days' written notice at its address set forth above. The City may terminate this Agreement
immediately if the County fails to maintain required insurance, breaches confidentiality, or materially violates
Section 12, and such may result in ineligibility for further City agreements.
4. COMPENSATION.
4.1 Amount. In return for the Services, the City shall pay the County an amount not to exceed a
maximum amount and according to a rate or method as delineated in Exhibit B, attached hereto and incorporated by
this reference. The City shall reimburse the County only for the approved activities and in accordance with the
HUMAN SERVICES AGREEMENT - 1 - 1/2023
CITY OF CITY HALL
4 33325Fe d e ra 1 Way Feder 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway com
procedures as specified in Exhibit B. The County shall be solely responsible for the payment of any taxes imposed
by any lawful jurisdiction resulting from this Agreement.
4.2 Method ofPayment. On a quarterly basis, the County shall submit to the City an invoice for payment
on a form provided by the City along with supporting documentation for costs claimed in the invoice and all reports
as required by this Agreement. Payment shall be made on a quarterly basis by the City only after the Services have
been performed and within forty-five (45) days after the City's receipt and approval of a complete and correct
invoice, supporting documentation, and reports. The City will use the quantity of Services actually delivered, as
reported on the County's reports, as a measure of satisfactory performance under this Agreement. The City shall
review the County's reports to monitor compliance with the performance measures set forth in Exhibit A. Should the
County fail to meet the performance measures for each quarter, the City reserves the right to adjust payments on a
pro rata basis at any time during the term of this Agreement. Exceptions may be made at the discretion of the City's
Human Services Manager in cases where circumstances beyond the County's control impact its ability to meet its
service unit goals and the County has shown reasonable efforts to overcome these circumstances to meet its goals. If
the City obj ects to all or any portion of the invoice, it shall notify the County and reserves the option to pay only that
portion of the invoice not in dispute. In that event, the Parties will immediately make every effort to settle the
disputed portion.
4.3 Final Invoice. The County shall submit its final invoice by the date indicated on Exhibit B. If the
County's final invoice, supporting documentation, and reports are not submitted by the last date specified in Exhibit
B, the City shall be relieved of all liability for payment to the County of the amounts set forth in said invoice or any
subsequent invoice; provided, however, that the City may elect to pay any invoice that is not submitted in a timely
manner.
4.4 Buffet. The County shall apply the funds received from the City under this Agreement in accordance
with the line item budget set forth in Exhibit B. The County shall request in writing prior approval from the City to
revise the line item budget when the cumulative amount of transfers from a line item in any Project/Program Exhibit
is expected to exceed ten percent (10%) of that line item. Supporting documents are necessary to fully explain the
nature and purpose of the revision, and must accompany each request for prior approval. All budget revision
requests in excess of 10% of a line item amount shall be reviewed and approved or denied by the City in writing.
4.5 Nan -Appropriation of Funds. If sufficient funds are not appropriated or allocated for payment under
this Agreement for any future fiscal period, the City will not be obligated to make payments for Services or amounts
incurred after the end of the current fiscal period, and this Agreement will terminate upon the completion of all
remaining Services for which funds are allocated. No penalty or expense shall accrue to the City in the event this
provision applies.
5. INDEMNIFICATION.
5.1 County Indemnification. The County represents to the City that the County has competent, trained
staff and where necessary, professional staff to render the services to be performed under this Agreement. The
County agrees to indemnify, defend, and hold the City, its elected officials, officers, employees, agents, and
volunteers harmless from any and all claims, demands, actions, losses and liabilities (including costs, expenses and
all reasonable attorneys' fees) to or by any and all persons or entities, including, without limitation, their respective
agents, licensees, or representatives arising from, resulting from, or in connection with this Agreement to the extent
caused by the negligent acts, errors or omissions of the County, its partners, shareholders, agents, employees, or by
the County's breach of this Agreement.
HUMAN SERVICES AGREEMENT - 2 - 1/2023
CITY OF CITY HALL
Federal Way Feder 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway com
5.2 Industrial Insurance Act Waiver. The County waives any immunity that may be granted to it under the
Washington State industrial insurance act, Title 51 RCW. The County's indemnification shall not be limited in any
way by any limitation on the amount of damages, compensation or benefits payable to or by any third party under
workers' compensation acts, disability benefit acts or any other benefits acts or programs.
5.3 City Indemnification. The City agrees to release, indemnify, defend and hold the County, its officers,
directors, shareholders, partners, employees, agents, representatives, and subcontractors harmless from any and all
claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries,
damages, liabilities, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation expenses to or by
any and all persons or entities, including without limitation, their respective agents, licensees, or representatives,
arising from, resulting from or connected with this Agreement to the extent solely caused by the negligent acts,
errors, or omissions of the City.
5.4 Survival. The -provisions of this Section shall survive the expiration or termination of this Agreement
with respect to any event occurring prior to such expiration or termination.
6. INSURANCE. The County agrees to carry insurance for liability which may arise from or in connection
with the performance of the services or work by the County, their agents, representatives, employees or
subcontractors for the duration of the Agreement and thereafter with respect to any event occurring prior to such
expiration or termination as follows:
6.1. Self -Insurance Program. King County, a charter county government under the constitution of the
State of Washington, hereinafter referred to as "County", maintains a fully funded Self -Insurance program as defined
in King County Code 4.12 for the protection and handling of the County's liabilities including injuries to persons
and damage to property.
The City acknowledges, agrees and understands that the County is self -funded for all of its liability
exposures. The County agrees, at its own expense, to maintain, through its self -funded program, coverage for all of
its liability exposures for this Agreement. The County agrees to provide the City with at least thirty (30) days' prior
written notice of any material change in the County's self -funded program and will provide the City with a
certificate of self-insurance as adequate proof of coverage. The City further acknowledges, agrees and understands
that the County does not purchase Commercial General Liability insurance and is a self -insured governmental entity;
therefore, the County does not have the ability to add the City as an additional insured.
6.2. No Limit of Liability. City's acknowledgement of County's fully funded self-insurance program
shall not be construed to limit the liability of the County to the coverage provided by such program, or otherwise
limit the City's recourse to any remedy available at law or in equity. The County's self-insurance program 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 County's insurance and shall not contribute with it.
6.3. Survival. The provisions of this Section shall survive the expiration or termination of this
Agreement.
7. CONFIDENTIALITY. All information regarding the City obtained by County in performance of this
Agreement shall be considered confidential subject to applicable laws. Breach of confidentiality by the Countymay
be grounds for immediate termination. All records submitted by the City to the County will be safeguarded by the
County. The County will fully cooperate with the City in identifying, assembling, and providing records in case of
any public records disclosure request.
HUMAN SERVICES AGREEMENT - 3 - 1/2023
Federal Way
CITY OF
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www crlyoffederalway com
8. WORK PRODUCT. All originals and copies of work product, including plans, sketches, layouts, designs,
design specifications, records, files, computer disks, magnetic media or material which may be produced or modified
by County while performing the Services shall belong to the City upon delivery. The County shall make such data,
documents, and files available to the City and shall deliver all needed or contracted for work product upon the City's
request. At the expiration or termination of this Agreement all originals and copies of any such work product
remaining in the possession of County shall be delivered to the City.
9. BOOKS AND RECORDS. The County agrees to maintain books, records, and documents which
sufficiently and properly reflect all direct and indirect costs related to the performance of the Services and maintain
such accounting procedures and practices as may be deemed necessary by the City to assure proper accounting of all
funds paid pursuant to this Agreement. These records shall be maintained for a period of six (6) years after the
termination of this Agreement and may be subject, at all reasonable times, to inspection, review or audit by the City,
its authorized representative, the State Auditor, or other governmental officials authorized by law to monitor this
Agreement.
10. INDEPENDENT CONTRACTOR. The Parties intend that the County shall be an independent contractor
and that the County has the ability to control and direct the performance and details of its work, the City being
interested only in the results obtained under this Agreement. The City shall be neither liable nor obligated to pay
County sick leave, vacation pay or any other benefit of employment, nor to pay any social security or other tax which
may arise as an incident of employment. County shall take all necessary precautions and shall be responsible for the
safety of its employees, agents, and subcontractors in the performance of the Services and work and shall utilize all
protection necessary for that purpose. All work shall be done at County's own risk, and County shall be responsible
for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. The
County shall pay all income and other taxes due except as specifically provided in Section 4. Industrial or any other
insurance that is purchased for the benefit of the City, regardless of whether such may provide a secondary or
incidental benefit to the County, shall not be deemed to convert this Agreement to an employment contract.
11. CONFLICT OF INTEREST. It is recognized that County may or will be performing services during the
Term for other parties; however, such performance of other services shall not conflict with or interfere with
County's ability to perform the Services. County agrees to resolve any such conflicts of interest in favor of the City.
County confirms that County does not have a business interest or a close family relationship with any City officer or
employee who was, is, or will be involved in the County's selection, negotiation, drafting, signing, administration, or
evaluating the County's performance.
12. EQUAL OPPORTUNITY EMPLOYER. In all services, programs, activities, hiring, and employment
made possible by or resulting from this Agreement or any subcontract, there shall be no discrimination by County or
its subcontractors of any level, or any of those entities' employees, agents, sub -agencies, or representatives against
any person because of sex, age (except minimum age and retirement provisions), race, color, religion, creed, national
origin, marital status, or the presence of any disability, including sensory, mental or physical handicaps, unless based
upon a bona fide occupational qualification in relationship to hiring and employment. This requirement shall apply
to, but not be limited to, the following: employment, advertising, layoff or termination, rates of pay or other forms of
compensation, and selection for training, including apprenticeship. County shall comply with and shall not violate
any of the terms of Chapter 49.60 RCW, Title VI of the Civil Rights Act of 1964, the Americans With Disabilities
Act, Section 504 of the Rehabilitation Act of 1973, 49 CFR Part 21, 21.5 and 26, or any other applicable federal,
state, or local law or regulation regarding non-discrimination.
HUMAN SERVICES AGREEMENT - 4 - 1/2023
CITY OF CITY HALL
Federal Way Feder 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www crryoffederalway com
13. GENERAL PROVISIONS.
13.1 Interpretation and Modification. This Agreement, together with any attached Exhibits, contains all of
the agreements of the Parties with respect to any matter covered or mentioned in this Agreement and no prior
statements or agreements, whether oral or written, shall be effective for any purpose. Should any language in any
Exhibits to this Agreement conflict with any language in this Agreement, the terms of this Agreement shall prevail.
The respective captions of the Sections of this Agreement are inserted for convenience of reference only and shall
not be deemed to modify or otherwise affect any of the provisions of this Agreement. Any provision of this
Agreement that is declared invalid, inoperative, null and void, or illegal shall in no way affect or invalidate any other
provision hereof and such other provisions shall remain in full force and effect. Any act done by either Party prior to
the effective date of the Agreement that is consistent with the authority of the Agreement and compliant with the
terms of the Agreement, is hereby ratified as having been performed under the Agreement. No provision of this
Agreement, including this provision, may be amended, waived, or modified except by written agreement signed by
duly authorized representatives of the Parties.
13.2 Assignment and Beneficiaries. Neither the County nor the City shall have the right to transfer or
assign, in whole or in part, any or all of its obligations and rights hereunder without the prior written consent of the
other Party. If the non -assigning Party gives its consent to any assignment, the terms of this Agreement shall
continue in full force and effect and no further assignment shall be made without additional written consent. Subject
to the foregoing, the rights and obligations of the Parties shall inure to the benefit of and be binding upon their
respective successors in interest, heirs and assigns. This Agreement is made and entered into for the sole protection
and benefit of the Parties hereto. No other person or entity shall have any right of action or interest in this Agreement
based on any provision set forth herein.
13.3 Compliance with Laws. The County shall comply with and perform the Services in accordance with
all applicable federal, state, local, and city laws including, without limitation, all City codes, ordinances, resolutions,
regulations, rules, standards and policies, as now existing or hereafter amended, adopted, or made effective. If a
violation of the City's Ethics Resolution No. 91-54, as amended, occurs as a result of the formation or performance
of this Agreement, this Agreement may be rendered null and void, at the City's option.
13.4 Enforcement. Time is of the essence in this Agreement and each and all of its provisions in which
performance is a factor. Adherence to completion dates set forth in the description of the Services is essential to the
County's performance of this Agreement. Any notices required to be given by the Parties shall be delivered at the
addresses set forth at the beginning of this Agreement. Any notices may be delivered personally to the addressee of
the notice or may be deposited in the United States mail, postage prepaid, to the address set forth above. Any notice
so posted in the United States mail shall be deemed received three (3) days after the date of mailing. Any remedies
provided for under the terms of this Agreement are not intended to be exclusive, but shall be cumulative with all
other remedies available to the City at law, in equity or by statute. The failure of the City to insist upon strict
performance of any of the covenants and agreements contained in this Agreement, or to exercise any option
conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of
those covenants, agreements or options, and the same shall be and remain in full force and effect. Failure or delay of
the City to declare any breach or default immediately upon occurrence shall not waive such breach or default. Failure
of the City to declare one breach or default does not act as a waiver of the City's right to declare another breach or
default. This Agreement shall be made in, governed by, and interpreted in accordance with the laws of the State of
Washington. If the Parties are unable to settle any dispute, difference or claim arising from this Agreement, the
exclusive means of resolving that dispute, difference, or claim, shall be by filing suit under the venue, rules and
jurisdiction of the King County Superior Court, King County, Washington, unless the Parties agree in writing to an
HUMAN SERVICES AGREEMENT - 5 - 1/2023
CITY OF CITY HALL
Fed ra I ��� Feder 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway com
alternative process. If the King County Superior Court does not have jurisdiction over such a suit, then suit may be
filed in any other appropriate court in King County, Washington. Each Party consents to the personal jurisdiction of
the state and federal courts in King County, Washington and waives any objection that such courts are an
inconvenient forum. If either Party brings any claim or lawsuit arising from this Agreement, each Party shall pay all
its legal costs and attorney's fees and expenses incurred in defending or bringing such claim or lawsuit, including all
appeals, in addition to any other recovery or award provided by law; provided, however, nothing in this paragraph
shall be construed to limit the Parties' rights to indemnification under Section 5 of this Agreement.
13.5 Execution. Each individual executing this Agreement on behalf of the City and County represents and
warrants that such individual is duly authorized to execute and deliver this Agreement. This Agreement may be
executed in any number of counterparts, each of which shall be deemed an original and with the same effect as if all
Parties hereto had signed the same document. All such counterparts shall be construed together and shall constitute
one instrument, but in making proof hereof it shall only be necessary to produce one such counterpart. The signature
and acknowledgment pages from such counterparts may be assembled together to form a single instrument
comprised of all pages of this Agreement and a complete set of all signature and acknowledgment pages. The date
upon which the last of all of the Parties have executed a counterpart of this Agreement shall be the "date of mutual
execution" hereof.
[Signature page follows]
HUMAN SERVICES AGREEMENT - 6 - 1/2023
CITY OF CITY HALL
Fed a ra I Way Feder 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederaiway com
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY:
DATE:
PUBLIC HEAL
KING COU NT I.
12
Printed N ame: J
Title:
DATE: L7
STATE OF WASHINGTON )
) ss.
COUNTY OF KING )
ATTEST:
q�-- &�W-v
S hanie Courtney, CM ity Clerk
APPROVED AS TO FORM:
'Ej)�all, City Att ey
On this day personally appeared before me 11 a-ZaS)61 z1 (r ceCY-4'C l j to me known to be the
%V.t5iCAn �,4u,of that executed the foregoing
instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for
the uses and purposes therein mentioned, and on oath stated that he/she was authorized to execute said instrument
and that the seal affixed, if any, is the corporate seal of said corporation.
GIVEN my hand and official seal this day of , 20�2
Notary's signatu>,e
s printed 1
Notary Public Notary Public in and for the State of Washington.
State E GILLING14 M My commission expires 119(o • ap
7EANIE GILLIhIGHAM
LICENSE # 205344
MY COMMISSION EXPIRES
NOVEMBER 26, 2026
HUMAN SERVICES AGREEMENT - 7 - 1/2023
,�SCITY OF
� Federal
Project Services Summary
CITY HALL
Way 33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway com
EXHIBIT A
SERVICES
The County shall provide free, walk-in dental care and social service referrals to unhoused individuals in the City of
Federal Way. The County shall ensure that services provided with funding under this Agreement are made available
to people residing in Federal Way.
Performance Measures
A. Number Served
The County agrees to serve, at minimum, the following unduplicated number of people residing in Federal Way with
Human Services funds:
1st
2nd
3rd
4th
Quarter
Quarter
Quarter
Quarter
Total
JAN. —
APRIL —
JULY —
OCT. -
MARCH
JUNE
SEPT.
DEC.
No. of unduplicated Federal
Way persons assisted in 2023
7
7
7
7
28
No. of unduplicated Federal
Way persons assisted in 2024
7
7
7
7
28
B. Units of Service
The County agrees to provide, at minimum, the following units of service by quarter:
1st
2nd
3rd
4th
Quarter
Quarter
Quarter
Quarter
Total
JAN. -
APRIL -
JULY -
OCT. -
MARCH
NNE
SEPT.
DEC.
2023
1. Dental Care
7
8
7
8
30
2024
1. Dental Care
7
8
7
8
30
Units of service are measured by the number of dental care visits provided via mobile van.
HUMAN SERVICES AGREEMENT -8- 1/2023
CITY OF
Federal Way
C. Outcome Measure(s)
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway com
Outcome: Dental patients will complete referrals for additional dental treatment.
Indicator: Additional treatment services will be provided by Mobile Medical dentist or
confirmed via referral process and measured monthly for follow-through.
Target: 35%
Records
A. Project Files
The County shall maintain files for this project containing the following items:
1. Notice of Grant Award.
2. Motions, resolutions, or minutes documenting Board or Council actions.
3. A copy of this Agreement with the Scope of Services.
4. Correspondence regarding budget revision requests.
5. Copies of all invoices and reports submitted to the City for this project.
6. Bills for payment with supporting documentation.
7. Copies of approved invoices and warrants.
8. Documentation of client address; residency verified via King County Parcel Viewer.
9. Documentation of client income. The County agrees to use the following HUD Income Guidelines
to report income of clients served under this Agreement.
King County FY 2022 Income Limits Summary
Median
FY 2022
Income
Income
1
2
3
4
5
6
7
8
King
Limit
Person
Persons
Persons
Persons
Persons
Persons
Persons
Persons
County
Cate ory
Extremely
Low
(30%)
$27,200
$31,050
$34,950
$38,800
$41,950
$45,050
$48,150
$51,250
Income
Limits
Very Low
$134,600
(50%)
$45,300
$51,800
$58,250
$64,700
$69,900
$75,100
$80,250
$85,450
Income
Limits
Low
(80%)
$66,750
$76,250
$85,800
$95,300
$102,950
$110,550
$118,200
$125,800
Income
Limits
Income guidelines may be adjusted periodically (annually) by HUD. The County agrees to use
updated Annual Income Guidelines which will be provided by the City.
HUMAN SERVICES AGREEMENT - 9 - 1/2023
CITY OF
�� Federal
Reports and Reporting Schedule
CITY HALL
Way 33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway. com
The County is required to collect all data and submit required forms using an Excel template found and submitted
via Share 1 App (instructions to be provided). Required forms shall be submitted quarterly and/or annually. 1 st, 2nd,
and 3rd quarterly reports are due no later than the 15th of the month following the end of each quarter, i.e.
April 15, July 15, and October 15. 4th quarter reports are due no later than the first week of January in order
to comply with City end -of -year accounting procedures. City staff will communicate official January due
date(s) during the first week of December.
Quarterly Service Unit Report (due with each submittal): Submitted Excel report uploaded through
Share lApp, data from this form will be used to track each program's progress toward meeting the goals
stipulated in the Scope of Services.
Reimbursement Request (due with each submittal): Included as the first page of the Excel form, this form
will serve as the invoicing mechanism for payment to your agency/program. Reimbursement requests
must be signed and uploaded through SharelApp.
Annual Demographics Report (due 4th quarter): Submitted via Excel form, the agency shall collect and
retain data requested on this form from persons served through this Agreement. Data should be tracked
in an ongoing manner and submitted annually in Share lApp by January 15th.
Annual Outcomes Report (due 4th quarter): Submitted via Excel form, data should demonstrate the
program's progress toward Outcomes specified in the Scope of Services. Outcome data shall be submitted
in Share 1 App annually by January 15th. The County shall implement and track at least one measurable outcome for
the program as presented in the application. Changes to the outcome(s) presented in the application must be
approved by the City prior to implementation.
Public Information
In all news releases and other public notices related to projects funded under this Agreement, the County will
include information identifying the source of funds as the City of Federal Way Human Services General Fund
Program.
HUMAN SERVICES AGREEMENT - 10 - 1/2023
CITY OF
Federal Way
EXHIBIT B
COMPENSATION
Project Budget
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cityoffederalway. com
The County shall apply the following funds to the project. The total amount of compensation pursuant to this
Agreement shall not exceed Fourteen Thousand and 00/100 Dollars ($14,000.00).
City of Federal Way Funds
2023
2024
City of Federal Way General Fund:
$7,000.00
$7,000.00
Total City of Federal Way Funds:
$7,000.00
$7,000.00
Reimbursement Requests and Service Unit Report forms shall be submitted no less frequently than quarterly and are
due on the following dates:
1 st Quarter: April 15 or within 10 days of notice to proceed, whichever is later;
2nd Quarter: July 15;
3rd Quarter: October 15; and
4th Quarter: Final Reimbursement Request and Service Unit Report forms due January 8; Demographic Data
Report and Annual Outcome Data Report due January 15.
The Reimbursement Request form, included as the first page of the Excel form, serves as the invoicing mechanism
for payment to your agency/program for service provided pursuant to this agreement. Reimbursement requests must
be signed and uploaded through Share lApp and are due with each submittal as provided in Exhibit A.
Estimated Quarterly Payments:
2023
1st Qtr
$1,750.00
2nd Qtr
$1,750.00
3rd Qtr
$1,750.00
4th Qtr
$1,750.00
2024
1st Qtr
$1,750.00
2nd Qtr
$1,750.00
3rd Qtr
$1,750.00
4th Qtr
$1,750.00
Quarterly payment requests shall not exceed the estimated payment without prior written approval from the City,
proof of which must be provided with any corresponding payment request. Estimated quarterly payments are
contingent upon meeting or exceeding the above performance measure(s) for the corresponding quarter. This
requirement may be waived at the sole discretion of the City with satisfactory explanation of how the performance
measure will be met by year-end on the Service Unit Report.
HUMAN SERVICES AGREEMENT - 11 - 1/2023
CITY of
Federal Way
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
wwwolyoffeder 4vay,com
City of Federal Way
Human Services Contract for 2022-2023General Fund
Authorized Signatures for Invoices
I authorize the fallowing individuals to sign invoices and quarterly reports on behalf of:
kv—tLAx- 51111e V-1624c�Ji� (Contracting Agency), for
the following:
Authorizing
Signature:
(must be signed by
person who signs
the contract,
generally,
Executive Director)
Additional
Authorized
Signaiure:
Additional
Authorized
Signature:
(Program Title).
(Printed Name)— f(Title)
(Printed Name)
(Signature)
(Printed Name)
(Signature)
(Title)
(Date)
(Title)
(Date)
NoW It is the responsibility of the contractor to inform the City of Federal Way if they wish to add a
name to or delete names from this list.
L19
King County
Office of Risk Management Services
Department of Executive Services
500 Fourth Ave #320
Seattle, WA 98104
(206) 263-2250
KING COUNTY CERTIFICATE OF SELF-INSURANCE - 2023
This letter is to certify that King County is fully self -funded for all of its liability exposures. Should an
incident occur involving the negligence of County employees acting in the scope of their employment,
our self -funded program would respond.
King County, charter county government under the constitution of the State of Washington, maintains
a fully funded Self -Insurance program for the protection and handling of the County's liabilities,
including injuries to persons and damage to property.
This letter is also to certify that King County is protected from physical loss under the County's blanket
property insurance policy. The policy is an "All Risk" policy that provides the County with protection
for all County property wherever located.
Please note that this certificate is issued for informational purposes only and neither confers any rights,
nor constitutes an agreement between King County and any other party.
If you have any questions, please do not hesitate to contact the King County Office of Risk Management
Services, Insurance and Contracts group at the phone number above.
Sincerely,
The Office of Risk _14anagement Services
Insurance and Contracts Group
Rev 12/18/2019
Office of the Director
Public Health
401 Fifth Avenue, Suite 1300
Seattle, WA 98104-1818 Seattle & King County ka
206-296-4600 Fax 206-296-0166
7rY Relay; 711
www.kingcounty.gov/health
DELEGATION OF SIGNATURE AUTHORITY
This order delegates to the Chief Administrative Officer (CAO) and others the authority to sign and
administer Contracts, Agreements, Change Orders, Amendments, and Other Instruments.
WHEREAS, Section 320.20 of the King County Charter authorizes the King County Executive to
"...sign, or cause to be signed, on behalf of the County all deeds, contracts and other instruments
and '
WHEREAS, -Section 850 of -the -Charter -provides that powers -and -duties of -a county -officer -may -be -
delegated by that officer to another officer or employee of the County under the control and
supervision of the delegating officer; and
WHEREAS, Executive Order CON 7-3-2 (AEO) delegates authority related to signing and
administering such contracts and other instruments to Department Directors and authorizes them to
further delegate such authority to qualified subordinates; and
NOW, THEREFORE, I, Dr. Faisal Khan, Director of Public Health — Seattle & King County, hereby
delegate the authority to negotiate, sign, administer, and settle contracts, agreements, and other
instruments, including, but not limited to, memoranda of understanding with other government
agencies, permit documents, grant documents, waivers, noncompetitive community service
agreements, amendments and change orders to I.) Division Directors and Deputy Division Directors
in charge of the Administration Division; Environmental Health Services Division, Prevention
Division, Emergency Medical Services Division, Jail Health Services Division, Community Health
Services Division and II.) the Chief of Assessment, Policy Development and Evaluation (APDE), the
Health Services Administrator I in charge of APDE and Chronic Disease and Injury Prevention
subject to the limitations outlined in Executive Order CON 7-3-2 (AEO).
FURTHER, the CAO, the Department Deputy Director, the Deputy Director of the Administrative
Division have authority to sign and administer contracts and other instruments for all divisions in
the Department.
FURTHER, I hereby ratify and confirm actions taken by the CAO-and others identified herein with
respect to signing contracts and agreements in accordance with Executive Order CON 7-3-2 (AEO),
to the extent such actions and delegations were consistent with the requirements set forth above in
this delegation letter.
NOW, THEREFORE, I, Dr. Faisal Khan, Director do hereby order and direct.
Dated this June 9, 2023.
Dr. Faisel Khan, Director, Public Health — Seattle & King County