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Home My WebLink AboutAG 21-075 - DAWN - DOMESTIC ABUSE WOMEN'S NETWORKRETURN TO: Brittany Julius EXT: 253-326-1227 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: CD/CS 2. ORIGINATING STAFF PERSON: Brittany Julius EXT: 253-326-1227 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 A PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT 09 HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL ❑ OTHER 5. PROJECT NAME: Community Advocates NAME OF CONTRACTOR: DAWN - Domestic Abuse Women's Network ADDRESS: 221 W. Gowe Street, Kent, WA 98032 TELEPHONE (253) 893-1605 E-MAIL: FAX: SIGNATURENAME: Angela Dannenbrina TITLE 7. EXHIBITS AND ATTACHMENTS: A SCOPE, WORK OR SERVICES A COMPENSATION ICI INSURANCE REQUIREMENTS/CERTIFICATE A ALL OTHER REFERENCED EXHIBITS © PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: January 1, 2021 COMPLETION DATE: December 31, 2022 9. TOTAL COMPENSATION $ 18,000.00 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ 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: 001-7300-083-562-10-410 10. DOCUMENT/CONTRACT REVIEW ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) 0 LAW INITIAL / DATE REVIEWED SJB 02/17/2020 DK 03-02-2021 INITIAL / DATE APPROVED 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: 11/10/2020 COUNCIL APPROVAL DATE: 11/17/2020 12, CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I 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 ❑ LAW DEPARTMENT S~ 4 VrNATORY (MAYOR OR DIRECTOR) 07 ❑ CITY CLERK fi ❑ ASSIGNED AG# AG CR1-- cri5 COMMENTS: ` Feder r o CITY HALL 8th Avenue South Federal Way, WA 98003-6325 Federal Way (253) 835-7000 www. cityoffederalway. com HUMAN SERVICES AGREEMENT FOR COMMUNITY ADVOCATES This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and DAWN - Domestic Abuse Womeds Network, a Washington public benefit corporation ("Agency"). The City and Agency (together "Parties") are located and do business at the below addresses which shall be valid for any notice required under this Agreement: DAWN - DOMESTIC ABUSE WOMEN'S NETWORK: Angela Dannenbring 221 W. Gowe Street Kent, WA 98032 (253) 893-1605 (telephone) The Parties agree as follows: CITY OF FEDERAL WAY: Brittany Julius 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, 2021 and terminating on December 31, 2022 ("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 Agency. 2. SERVICES. The Agency 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 to the City's satisfaction, within the time period prescribed by the City and pursuant to the direction of the Mayor or his or her designee. The Agency 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, including but not limited to obtaining a City of Federal Way business registration. 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 Agency 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. TERNUNATION. 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 Agency 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 Agency 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 Agency only for the approved activities and in accordance with the procedures as specified in Exhibit B. The Agency shall be solely responsible for the payment of any taxes imposed by any lawful jurisdiction resulting from this Agreement. HUMAN SERVICES AGREEMENT - 1 - 12/2020 ` CITY OF CITY HALL Fe d e ra f Way Feder l Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. crryoflederalway corn 4.2 Method of Payment. On a quarterly_ basis, the Agency shall submit to the City an invoice for payment on a form provided by the City 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 and reports. The City will use the quantity of Services actually delivered, as reported on the Agency's reports, as a measure of satisfactory performance under this Agreement. The City shall review the Agency's reports to monitor compliance with the performance measures set forth in Exhibit A. Should the Agency 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 Agency's control impact its ability to meet its service unit goals and the Agency has shown reasonable efforts to overcome these circumstances to meet its goals. If the City objects to all or any portion of the invoice, it shall notify the Agency 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 Agency shall submit its final invoice by the date indicated on Exhibit B. If the Agency's final invoice 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 Agency 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 Non -A ro riation 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 A enc Indemnification. The Agency agrees to release, indemnify, defend, and hold the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, taxes, 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 in connection with this Agreement or the performance of this Agreement, except for that portion of the claims caused by the City's sole negligence. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Agency and the City, the Agency's liability hereunder shall be only to the extent of the Agency's negligence. Agency shall ensure that each subcontractor shall agree to defend and indemnify the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers to the extent and on the same terms and conditions as the Agency pursuant to this paragraph. The City's inspection or acceptance of any of Agency's work when completed shall not be grounds to avoid any of these covenants of indemnification. 5.2 Industrial Insurance Act Waiver. It is specifically and expressly understood that the Agency waives any immunity that may be granted to it under the Washington State industrial insurance act, Title 51 RCW, solely for the purposes of this indemnification. Agency'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. The Parties further acknowledge that they have mutually negotiated this waiver. 5.3 City Indemnification. The City agrees to release, indemnify, defend and hold the Agency, 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, HUMAN SERVICES AGREEMENT - 2 - 12/2020 ` CITY OF CITY HALL Fe d e ra f Way Feder 8th Avenue South Federal Way, WA 9803-6325 (253) 835-7000 www cilyoffederalway com 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 Agency agrees to carry insurance for liability which may arise from or in connection with the performance of the services or work by the Agency, 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. Minimum Limits. The Agency agrees to carry as a minimum, the following insurance, in such forms and with such carriers who have a rating that is satisfactory to the City: a. Commercial general liability insurance covering liability arising from premises, operations, independent contractors, products -completed operations, stop gap liability, personal injury, bodily injury, death, property damage, products liability, advertising injury, and liability assumed under an insured contract with limits no less than $1,000,000 for each occurrence and $2,000,000 general aggregate. b. Workers' compensation and employer's liability insurance in amounts sufficient pursuant to the laws of the State of Washington; C. Automobile liability insurance covering all owned, non -owned, hired and leased vehicles with a minimum combined single limits in the minimum amounts required to drive under Washington State law per accident for bodily injury, including personal injury or death, and property damage. 6.2. No Limit of Liability. Agency's maintenance of insurance as required by the agreement shall not be construed to limit the liability of the Agency to the coverage provided by such insurance, or otherwise limit the City's recourse to any remedy available at law or in equity. The Agency'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 Agency's insurance and shall not contribute with it. 6.3. additional Insured Verification. The City shall be named as additional insured on all commercial general liability insurance policies. Concurrent with the execution of this Agreement, Agency shall provide certificates of insurance for all commercial general liability policies attached hereto as Exhibit C and incorporated by this reference. At the City's request, Agency shall furnish the City with copies of all insurance policies and with evidence of payment of premiums or fees of such policies. If Agency's insurance policies are "claims made," Agency shall be required to maintain tail coverage for a minimum period of three (3) years from the date this Agreement is actually terminated or upon project completion and acceptance by the City. 6.4 Survival. The provisions of this Section shall survive the expiration or termination of this Agreement. 7. CONFIDENTIALITY. All information regarding the City obtained by Agency in performance of this Agreement shall be considered confidential subject to applicable laws. Breach of confidentiality by the Agency may be grounds for immediate termination. All records submitted by the City to the Agency will be safeguarded by the Agency. The Agency will fully cooperate with the City in identifying, assembling, and providing records in case of any public records disclosure request. 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 Agency while performing the Services shall belong to the City upon delivery. The Agency 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 HUMAN SERVICES AGREEMENT - 3 - 12/2020 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www ciryotfederalway corn expiration or termination of this Agreement all originals and copies of any such work product remaining in the possession of Agency -shall be delivered to the City. 9. BOOKS AND RECORDS. The Agency 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 Agency shall be an independent contractor and that the Agency 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 Agency 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. Agency 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 Agency's own risk, and Agency 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 Agency 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 Agency, shall not be deemed to convert this Agreement to an employment contract. 11. CONFLICT OF INTEREST. It is recognized that Agency 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 Agency's ability to perform the Services. Agency agrees to resolve any such conflicts of interest in favor of the City. Agency confirms that Agency 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 Agency's selection, negotiation, drafting, signing, administration, or evaluating the Agency's performance. 12. EQUAL OPPORTUNM EMPLQYER. 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 Agency 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. Agency 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. 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, HUMAN SERVICES AGREEMENT - 4 - 12/2020 ` Feder CITY OF CITY HALL Federal Way 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www W yoffedera Iwdy com inoperative, nuiI 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 Assi mient and Beneficiaries. Neither the Agency nor the City shall have the right totransfer 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 Agency 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. Adherenceto completion dates set forth in the description of the Services is essential to the Agency'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 Agrcement, 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, Ding County, Washington, unless the parties agree in writing to an alternative process. If the Ding 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, 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 Agency 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 HUMAN SERVICES AGREEMENT - 5 - 12/2020 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253)835-7000 www. ci fyoffederahvay. corn 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 - 12/2020 ` CITY OF CITY HALL Federal Way 33325 8tr Avenue South Federal Way, WA 98003 6325 (253) 835-7000 www cityoffederalway com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: Jim Fr, Mayor DATE: S h A;�-/ DAWN - DOMESTIC ABUSE WOMEN'S NETWORK: By: jpaf�4 Printed Name: f'1�1r Title: & ecc6VQ„_- DATE: I ,-/ `- -Z 1 STATE OF WASHINGTON ) ) ss. COUNTY OF Pkftcx ) ATTEST: hanie Courtney, CMC,yl ity Clerk APPROVED AS TO FORM: Z-t�- 40r J. Ryan Call, City Attorney On this day personally appeared before me krA&A L to me known to be the C t U of D A l n! 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 , 207A. FRUTHDELN UL' `NCODARRIUS Notary's signature y PUbiic Notary's printed name non Iln �vrrrie r Washrn[�tnnNumber 189542 otary Public in and for the State of Washington. lssiOrl EVIrasM commission ex firesrRY Cr,'0,tiy p 6 l 10 ld' Z0jS � _ HUMAN SERVICES AGREEMENT - 7 - 12/2020 CITY OF FederaI V EXHIBIT A SERVICES Project Summary CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cifyoflederahvay.. corn The Agency shall provide children's domestic violence response team, and immigrant, mental health, and legal services to survivors in the City of Federal Way. The Agency shall ensure that services provided with funding under this Agreement are made available to Federal Way residents. Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of Federal Way residents with Human Services funds: 1st god 3rd 4tn Quarter Quarter Quarter Quarter Total JAN. — APRIL — JULY — OCT. — MARCH JUNE SEPT. DEC. No. of unduplicated Federal Way persons assisted in 2021 5 5 6 6 22 No. of unduplicated Federal Way persons assisted in 2022 5 5 6 6 22 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: 1st 2nd 3rd 4tn Quarter Quarter Quarter Quarter Total JAN. — APRIL — JULY — OCT. — MARCH JUNE SEPT. DEC. 2021 1. Case Management 31 31 31 31 124 2. Crisis Line 12 12 13 13 50 2022 1. Case Management 31 31 31 31 124 HUMAN SERVICES AGREEMENT - 8 - 12/2020 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253)835-7000 wwv cdyoffederalway. com 2. Crisis Line 1 1 12 12 13 13 50 C. Definition of Services 1. Case Management — Provide DV -focused advocacy support following the mobile advocacy mode. 2. Crisis Line - Provides a 24/7 crisis and advocacy line staffed by trained DV advocates who are skilled in crisis management, resourcing, and trauma -informed supportive listening. D. Performance Measure(s) 90% of clients surveyed state that they feel safer, know about more resources available in the community, and feel more empowered and hopeful for their futures. Records A. Project Files The Agency 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. HUMAN SERVICES AGREEMENT - 9 - 12/2020 ` CITY OF CITY HALT Federal Feder l Avenue Soutn 003 Federal Way, WA 98003-I �/ (253) 835-7000 www.ci"ffederalway com 9. Documentation of client income. The Agency agrees to use the HUD Income Guidelines to report income of clients served under this Agreement. Income giiideIInes may be adjusted periodically by HUD. King County FY 2020 Income Limits Summary Median FY 2020 Income Income 1 2 3 4 5 6 7 8 King Limit Person Persons Persons Persons Persons Persons Persons Persons County Category Extremely Low (30%) $25,100 $28,650 $32,250 $35,800 $38,700 $41,550 $44,400 $47,300 Income Limits Very Low $113,300 (50%) $41,800 $47,800 $53,750 $59,700 $64,500 $69,300 $74,050 $78,850 Income Limits Low (80%) $66,700 $76,200 $85,750 $95,250 $102,900 $110,500 $118,150 $125,750 Income Limits The Agency agrees to use updated Income Guidelines which will be provided by the City. Reports and Re orting Schedule The Agency shall collect and report client information to the City quarterly and annually on a Service Unit Report to be provided by the City in the format requested by the City. The Agency shall submit an Annual Demographic Data Report. The agency shall collect and retain the data requested on this form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted annually no later than January 15 in the format requested by the City. The Agency shall implement and track at least one measurable outcome for the program as presented in the application. Changes to the outcome presented in the application must be approved by the City prior to implementation. The Agency shall report the results of its outcome measure(s) annually on the Annual Outcome Data Report to be submitted by January 15 in the format requested by the City. Public Information In all news releases and other public notices related to projects funded under this Agreement, the Agency will include information identifying the source of funds as the City of Federal Way Human Services General Fund Program. HUMAN SERVICES AGREEMENT - 10 - 12/2020 CITY OF �. Federal Way EXHIBIT B COMPENSATION Pro'rect Budget CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. crryoffederahvay.. com The Agency shall apply the following funds to the project. The total amount of compensation pursuant to this Agreement shall not exceed Eighteen Thousand and 00/100 Dollars ($18,000.00). City of Federal Way Funds 20211 2022 City of Federal Way General Fund: $9,000.001 $9,000.00 Total City of Federal Way Funds: $9,000.001 $9,000.00 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 6; Demographic Data Report and Annual Outcome Data Report due January 15. The Agency shall submit payment requests in the format requested by the City. Payment requests shall include a copy of the Service Unit Report. Estimated Quarterly Payments: 2021 1 st Qtr $2,250.00 2nd Qtr $2,250.00 3rd Qtr $2,250.00 4th Qtr $2,250.00 2022 1` Qtr $2,250.00 2nd Qtr $2,250.00 3rd Qtr $2,250.00 4th Qtr $2,250.00 Quarterly payment requests shall not exceed the estimated payment without prior written approval from the City. 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 - 12/2020 DOMEABU-01 TBREWSTE CERTIFICATE OF LIABILITY INSURANCE DATE 4119/20 1 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER PLC Insurance LLC 19401 40th Ave W, Suite 440 Lynnwood, WA 98036 INSURED Domestic Abuse Women's Network PO Box 1449 Kent, WA 98035 rari►►mir21r9421-4 ral= r1dI211`6701119=0 IIII IIT, 1:7:111Gs (AICC.NNo, Ext): (425 712-3664 ` F IC, No): (425) 712-3786 E-MAIL.... plc(d)PIcins.com INSURERS: INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVE Philadelphia Insurance Co I ,I ATA I.91.7. I:1III I15 I ; I : I;i1 18058 v THIS IS TOCERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ` TYPE OF INSURANCE A DJNSSUER WVDPOLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE ❑ X OCCUR IPHPK2223860 1/1/2021 1/1/2022 1r pREMGETORENT0 S 100,000 MED EXP (Any oneperson) S 5,000 PERSONAL & ADV INJURY $ 1,000,000 .GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY %?f LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 2,000,000 WA STOP GAP $ 1,000,000 OTHER_ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 BODILY &URY JPerperson)S ANY AUTO PHPK2223860 1/1/2021 1/1/2022 BODILY INJURY Per accident $ OWNED X SCHEDULED AIURRTEEO��S ONLY AUTOS PerOacEcRdent AMAGE $ pp X AUTO5 ONLY X AUOS ONFCY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROP RIETOR/PARTNER/EXECU I IVE PER OTH- T E.L. EACH ACCIDENT $ E.L, DISEASE -EA EMPLOYEE $ QFI"ICER/MEMBER EXCLUDED? ❑ {Mandatory In NH) NIA E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Insurance City of Federal Way 33325 8th Ave. S. Federal Way, WA 98003 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0aull. -&1141 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD < Business Lookup License Information - Entity name•. DAWN - DOMESTIC ABUSE WOMEN'S NETWORK Business name: DAWN - DOMESTIC ABUSE WOMEN'S NETWORK Entity type: Nonprofit Corporatior UBI It. 600-464.802 Business ID: 0D1 Location ID. 0001 Location: Active Location address: 221 W GOWE ST KENT WA 96032-5809 Mailing address: 221 W GOWE ST KENT WA 98032-M Excise tar and rescuer permit statue C ck here Secretary or State status: CCck here %ex.rOW1 .Sacs r:e's-M !TY 01' Federal Way CITY HALL 33325 8th Avenue South Federal Way. WA 98003-6325 (253) 835.7 ' w+9 v.: !i 53�1+e+Jvin A t Ay, ro m City of Federal Way Human Services Contract for 2021-2022 General Fund Authorized Signatures for Invoices I authorize the following individu als to sign invoices and quarterly reports on behalf o 12 �tiA P __�.L -D( ty-':'_S—�Aki-t,)Di(IL (Contracting Agency), for r� Vb'� the following: 'i :{'irE�'�r •l,t: !- I� (Program Title). f ' �� Authorizing l Signature: (must be signed by (Printed ame) itieJ person who signs the contract, generally, Executive Director) ig arre) (Date) Additional Authorized , i �r Signature: ! r.�'.[1� CG1' r{ Gt�.I !f _� O iiC r t-u or `N�— (Printed !Name) (Title) /rJ / j ? , Signaturs) (Date) Additional Authorized Signature: (Printed Name) (Title) (Signature) (Date) Note: 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. DAWN Job Description Position: Executive Director Reports to: Board Chair/Board of Directors Department: Administrative Position Summary; Location: Kent, WA Classification: Exempt Hours/Shifts: Mon -Fri 8am-5pm The Executive Director is a visionary leader and community diplomat, responsible for positioning Domestic Abuse Women's Network (DAWN) as a nationwide model for supporting survivors of domestic violence. The Executive Director will lead DAWN in achieving excellence by ensuring continued organization sustainability and expansion of programs and services, while connecting with civil and corporate leaders to develop large scale support for domestic violence survivors via policy and systemic change. Managing the Leadership Team, the Executive Director strategically manages all arms of this rapidly growing organization, ensuring all departments operate to peak efficiency. The Executive Director will secure high-level partnerships with legislators, service -providers, law enforcement, educational institutions, business leaders, community groups and more. The Executive Director has a deep understanding and commitment to social justice and is responsible for DAWN's overall operational excellence. This leader seamlessly manages high -stakes, confidential, social service issues with the mission to lead and inspire DAWN and the team to bring peace to all. Responsibilities include, but are not limited to: • Lead the organization and overall strategy and execution of DAWN operations, partnerships, and programs and services; oversee all program development and implementation; support mission and vision as set by the Board of Directors; creates strategic development plan for short-term and long-term growth. • Principles and practices of financial planning, P&L, budgeting, expenditure control, reporting, and long- and short-term fundraising. Presents pertinent information to Board to fulfill fiduciary and policy responsibilities. • Lead and manage Leadership team - Finance and Operations Director, Advocacy and Programs Director, Partnerships and Fundraising Director; cultivates and oversees organization's capacity, data and outreach including strategic analysis, goals, operations plan and methods for achieving them, objectives, responsibilities, and priorities. • Grow revenue through energetic fundraising efforts —corporate, in -kind, and individual donations; attend speaking engagements, sponsor events and drives, cultivate donors, enhance community visibility, lead other funding initiatives. • Leader responsible for setting priorities, rapid decision -making, delegating, consensus building, facilitating, and conducting large and small meetings; identify and rectify high level issues. • Maintain knowledge of applicable laws, regulations and processes governing non-profit organizations, responsible for interpretation and implementation of required laws, Page 1 DAWN is an equal opportunity employer. We do not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, ancestry, age, marital or veteran status, disability, gender identity, sexual orientation, or any protected status. Domestic Abuse Women's Network (DAWN) © 2019 All Rights Reserved. DAWN Job Description ris i^'c. cinnsr p-a_e regulations, and processes. Develop, review and approve comprehensive administrative procedures and systems. Work with Board to support board functions; engage board to activate personal and professional networks to support revenue efforts; strengthen existing community partnerships and seek new ones; expertly networked. Analyze trends and ensure completion of annual reports, annual independent audit/financial review, IRS requirements, grant and fundraising requirements. Acquire, renew, and authorize via written or verbal process new and renewed agency contracts in conjunction with the Director of Finance and Operations. • Maintain DAWN's public image, standards, and ethical practices; Present the DAWN mission, vision and initiatives within the community. Establish clear performance objectives for our organization. Provides principles of supervision and personnel management to include coaching and managing staff, developing high-performance teams of volunteers and staff, setting and achieving objectives, and managing a budget of relevant scale. Knowledge, Skills and Abilitie, Proven record of accomplishment of fundraising for a nonprofit organization or business development for a business enterprise, with annual outcomes exceeding over one million dollars. • Maintain a strong commitment to DAWN's mission and values Superb written and verbal communication skills Skilled public relations expert and experienced public speaker Strong time management and organizational skills Excellent management and team building skills • Respect confidentiality and adapt to a stressful environment • Adhere to company policies & standard operating procedures • Must possess the ability to make sound judgments relating to crisis situations Some travel required (evening/weekend flexibility) Education/Experience: • Bachelor's degree in a relevant discipline, master's degree preferred; equivalent of ten years leadership experience considered • Experience leading a nonprofit organization • At least five years of fiduciary responsibility in management required • Experience in understanding and presenting P&L statements required; knowledge of non-profit accounting techniques and standards a plus • Proficiency in data collection and reporting. Microsoft Word, Excel, Outlook - Osnium, Basecamp, InfoNet and nonprofit systems knowledge a plus • Twenty hours of recent annual Domestic Violence Training preferred • Current CPR/First Aid and HIV/AIDS training preferred or ability to secure within one month of employment Page 2 DAWN is an equal opportunity employer. We do not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, ancestry, age, marital or veteran status, disability, gender identity, sexual orientation, or any protected status. Domestic Abuse Women's Network (DAWN) © 2019 All Rights Reserved. DAWN Job Description 4s, r15,1r. for [ome%tic pes_e • Must provide own transportation; possess a valid Washington State driver's license, proof of auto insurance and a clean driving record • Must be able to pass Washington State criminal background check and drug test About DAWN: Located in King County, DAWN focuses its resources and expertise on empowering families and communities to be free from violence. We serve more than 5,000 survivors of domestic violence each year in our programs. Our Center for Peaceful Communities offers an environment for clients to feel safe as they seek our services. In addition, our training facility provides education, ongoing support, and opportunities for those interested in more peaceful communities. Page 3 DAWN is an equal opportunity employer. We do not discriminate in hiring or employment on the basis of race, color, religion, sex, national origin, ancestry, age, marital or veteran status, disability, gender identity, sexual orientation, or any protected status. Domestic Abuse Women's Network (DAWN) © 2019 All Rights Reserved. 4/23/2021 Corporations and Charities System BUSINESS INFORMATION Business Name: DAWN - DOMESTIC ABUSE WOMEN'S NETWORK UBI Number: 600 464 802 Business Type: WA PUBLIC BENEFIT CORPORATION Business Status: ACTIVE Principal Office Street Address: 221 W GOWE ST, KENT, WA, 98032-5809, UNITED STATES Principal Office Mailing Address: PO BOX 1449, KENT, WA, 98035-1449, UNITED STATES Expiration Date: 11/30/2021 Jurisdiction: UNITED STATES, WASHINGTON Formation/ Registration Date: 11/17/1980 Period of Duration: PERPETUAL Inactive Date: Nature of Business: CHARITABLE, NON PROFIT PROVIDING SHELTER AND OTHER RESOURCES TO DOMESTIC VIOLENCE VICTIMS REGISTERED AGENT INFORMATION Registered Agent Name: CORPORATION SERVICE COMPANY Street Address: 300 DESCHUTES WAY SW STE 208 MC-CSC1, TUMWATER, WA, 98501, UNITED STATES Mailing Address: 300 DESCHUTES WAY SW STE 208 MC-CSC1, TUMWATER, WA, 98501, UNITED STATES GOVERNORS Title GOVERNOR Governors Type INDIVIDUAL Entity Name First Name JENNIFER Last Name DAVIS https://ccfs.sos.wa.gov/#/BusinessSearch/Businesslnformation 1/1 4/18/2021 EXECUTIVE DIRECTOR: Angela Dannenbring — DAWN Home Get Help Give Help Community Support DAWN 1 V Make a Donation Our Impact Our Team Spring Fundraiser EXECUTIVE DIRECTOR: Angela Dennenbrinq Angela's motto: "When the whole world is silent, even one voice becomes powerful." Angela was born in South Dakota. She is the oldest daughter of two brothers from a small town of Chamberlain, South Dakota. Angela spent most of her childhood and adolescence experiencing the world of dance, sports, school organizations, and community volunteer work. After High School, Angela attended Northern State University and graduated with a major in Psychology. Following graduation, Angela entered into group home and residential services serving individuals disabilities and mental health disorders. Early in her career, she had an opportunity to join a crisis response team. During this time, Angela was in awe of the wrap around care provided to individuals in crisis. She learned so many people needed assistance having their voice heard; and her passion was for serving others and being that voice. With a love of Psychology, and assisting others, Angela went on to graduate school where she focused her studies and received her Masters in Counseling, Human Resources, and Organizational Dynamics. Once graduated, Angela worked with children, adolescents, and adults experiencing family, mental health, or relationship crisis in Minnesota, New Mexico, and South Dakota. Experiencing a holistic approach to assisting families in need helped to stoke Angela's innate curiosity and love for advocacy. Discovering a passion for service and non-profit work, Angela began her career journey through various avenues of non-profit and human services organizations; through roles that served mental health, trauma response, survivors, workforce development,transitional living and re-entry, and providing expert testimony to bring children and adults to safety when needed. Angela's career provided a natural progression form direct care provider, to program ENG ► executive roles; lending opportunity to be the voice SAFETY EX T https://www.dawnrising.org/directors/blog-post-title-one-jndxw . 1 /2 WM9 Request for Taxpayer Give Form to the Form Identification Number and Certification requester. Do not (Rev. October2018) Department of the Treasury send to the IRS. Internal Revenue Service ► Go to www.lrs gov/FormV19 for Instructions and the latest Information. 1 Name (as shown on your Income tax returns). Name Is required on this line; do not leave this line blank. Dt�-C}iC -P-butv �1vL'.i,-x i-1' ]. 2 Business name/dlsregarded entity name, if different from above 3 Check appropriate box for federal tax classification of the person whose name Is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not Individuals; see a C ❑ IndlvlduaVsole proprietor or ElC Corporation ElS Corporation ElPartnership ❑ Trustlestate Instructions on page 3): 0 m 0 single -member LLC Exempt payee code Of any) p ❑ Umlted liability company. Enter the tax classification (C=C corporation, S--S corporation, P=Partnership) ► Note: Check the appropriate box In the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting w LLC If the LLC Is classlfled as a single -member LLC that Is disregarded from the owner unless the owner of the LLC Is code fan y) a - another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that - Is disregarded from the owner should check the appropriate box for the tax classification of Its owner. ❑ Other (see Instructions) ► ¢4 VEm to accwnfsm abroad ouWde Me U.S.) 5 Address (number, street, and apt. or suite no.) See Instructions. Requester's name and address (optional) PO Erov- J L -i f Cn 6 City, state, and ZIP code 0 ,. J 7 List accouht number(s) here (apttonal) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number n �� backup withholding. For individuals, this is generally your social security number (SHowever, fora resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other _ entities, It is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Fmpioyer Identification number Number To Give the Requester for guidelines on whose number to enter. 0 Ma Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. Sign signature of Here U.S. person ► fi�L�'L !, Date ► 7• I General Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (iTIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an Information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-8 (Rev. 10-2018) CITY OF Federal Way 33325 8th Avenue South, Federal Way, WA 98003 ❑New Vendor [Update Form To add your business to our vendor file, or update information. Please complete this form and mail or fax it to the address/fax number below. Business Information Business Name: [k Contact Name: 1J ]il Location Address: Mailing Address (if different): Phone #: (As � ) 4; �i_ (For office use only) VN#:. tif-�wov-k. CITY/STATE ! I CITY/STATE Fax #: f ] - E-Mail: Business a Please Check Dire Corporation ❑ - - - - - _ - Federal ID # (9 digits) Partnership ❑ - - _ _ _ _ _ Federal ID # (9 digits) Government Agency ❑ - - - - - - - Federal ID # (9 digits) Non -Profit / r I C/0) Z Z? _ - - Federal ID # (9 digits) Sole Proprietor ❑ - - - - - - - Federal ID # (9 digits) or Social Security Number What is the official name registered with the I.RS. for the above number? If you are not a corp=tipn, is your Business subject to 1099 reporting? ❑ Yes State of Washington U.B.I. # LPp O q U L4 60-2 Federal Way,Business License #: Will you provide supplies or services to the City of Federal Way? f ❑ Supplies Services City of Federal Way Staff/Department Contact Name: 6fi /'" j;�i u _ Zip Code Zip Code Signature (US Person including a l Date: i US resident alien) lj �� N 9- 1 P "1 _ Z 1 For information call: 253.835.252 or Fax: 253.835.2509 or E-mail: Accountspayable@cityoffederalway.com L