AG 22-136 - KING COUNTYRETURN TO: Sarah Bridgeford EXT: 2650
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT./DIV: CD/CS
2. ORIGINATING STAFF PERSON: Sarah Bridgeford EXT: 2650 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 M. HUMAN SERVICES / CDBG
❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
❑ ORDINANCE ❑ RESOLUTION
❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL
A OTHER Agenda Bill and Staff Report $ Grant Contract (ILA)
5. PROJECT NAME: King County Unmet Needs Funding
6. NAME OF CONTRACTOR:
ADDRESS: TELEPHONE
E-MAIL: FAX:
SIGNATURE NAME: TITLE
7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL
OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
8. TERM: COMMENCEMENT DATE: 8/16/22 COMPLETION DATE: 12131/22
9. TOTAL COMPENSATION $ 100,000 (INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑ YES [ENO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED ®YES ONO IF YES, $. PAID BY: ❑ CONTRACTOR ❑ CITY
RETAINAGE: RETAINAGE AMOUNT: 0 RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE TO:
10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
A PROJECT MANAGER SJB 11/1812022
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
11 LAW KVA 11/28/22
11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE:
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 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/ DA E IGNED
❑ LAW DEPARTMENT
A SIGNATORY (MAYOR OR DIRECTOR)
❑ CITY CLERK
❑ ASSIGNED AG#
COMMENTS:
Will go to PRHSPS on 11/8/2022 and Council on 11/15/2022
L-9
King County
Developmental Disabilities and Early Childhood Supports Division
Department of Community and Human Services
401 Fifth Avenue, Suite 500
Seattle, WA 98104
206-263-9105
TTY Relay: 711
November 17, 2022
Mayor Jim Ferrell
City of Federal Way
33325 8th Ave S.
Federal Way, WA 98003
Jim.Ferrellecityoffederalway com
RE: 2022 One -Time COVID Unmet Needs Funding
Dear Mayor Ferrell,
On behalf of City of Federal Way, you have agreed to accept County one-time funding totaling
$100,000 to support City of Federal Way's COVID-19 relief and recovery efforts, as described in
the attached Additional Terms. This one-time funding was included by King County
Councilmember Pete von Reichbauer, District 7, in Ordinance #19479.
This letter serves as the agreement between your organization and the Developmental
Disabilities and Early Childhood Supports Division (DDECSD) in the King County Department of
Community and Human Services (DCHS) and is effective for the period set forth in Section I of
the Additional Terms, unless otherwise terminated or extended by DCHS.
To acknowledge your acceptance of DCHS' terms, please sign and date on page 6. Before
you can receive compensation for these services, we will need to receive the following from you:
1. King County Substitute W-9 Form. Either affirm the attached W-9 remains accurate or
submit an updated Substitute KC-W9.
• To avoid delays in processing your award, please ensure the following sections
of the KC-W9 are fully completed: Physical Address, Remit Address, Tax
Reporting Name and Address and Tax Identification Number/Social
Security Number.
2. The name of the person authorized to endorse and deposit checks for your organization.
3. The mailing address to which the check should be sent (if different from remit address
on KC W-9).
Please send these materials, along with any questions you may have, to Libby Brockman,
Program Manager at Libby. Brockman ❑+r7_-,kingcounty.gov. Please feel free to contact her with any
questions.
Please see Section V in the enclosed Additional Terms for instructions on Billing and
Compensation.
DocuSign Envelope ID: FB586142-2BD6-4C09-9AA8-9993D4107126
City of Federal Way, Contract number #6325147
November 17, 2022
Page 2 of 7
This award is conditioned upon your compliance with applicable State and County laws, and the
terms and conditions stated below_ Please note that future considerations of additional funding
in years to come will be based in part on the receipt of the data and narrative reports within the
timeframe specified above.
We look forward to working with you to support emergency assistance that will address unmet
need related to or resulting from the COVID-19 pandemic.
Sincerely,
Da uSign" 6y:
ag�ri�r�ma�
DDECS Division Director
Cc: The Honorable Metropolitan King County Councilmember Pete von Reichbauer, District 7
Leo Flor, Department Director, DCHS
Christian Diaz, Chief Financial Officer, DCHS
Reginald Cole, Contracts and Operations Manager, DDECSD, DCHS
Libby Brockman-, Program Manager, DDECSD, DCHS
Enclosures:
Additional Terms
KC-W9
City of Federal Way, Contract number #6325147
November 17, 2022
Page 3 of 7
Additional Terms:
Agreement Period:
The period of this agreement shall be between August 16, 2022 through December 31, 2022,
and may be extended at increments DCHS deems necessary.
Purpose
DCHS seeks to support the King County community's path toward stabilization and recovery by
addressing the inequitable impacts of the pandemic. The purpose of this funding is to support
emergency assistance that will address unmet needs and/or lost revenue related to or resulting
from the COVID-19 pandemic.
Accordingly, the Contractor shall use the funds provided pursuant to this agreement to provide
services, funding, or other types of support that promote recovery from or response to the
impacts of the COVID-19 pandemic on King County communities.
In order for DCHS to determine the extent by which this purpose has been fulfilled, the
Contractor shall provide a written report following the end of the agreement period (as described
further below).
III. Reporting Requirements
A written report shall be due on January 16, 2023 upon completion of the project, in which you
provide a description of how these funds were used to benefit your organization and/or
residents of King County to address COVID-19 pandemic relief and recovery efforts. The report
shall include:
A. The number of participants served;
B. Aggregated demographic data elements such as race, ethnicity, zip code, gender
identity, and age group; and
C. Narrative responses about program implementation, successes, and challenges.
At the completion of your project, please complete your report at
htti)s://www.surveymonkey.com/r/CovidUnmetNeeds and please inform Libby Brockman at
Libb .Brockman kin count ❑v, or 206-477-9028.
IV. Program Deliverables
In order to further DCHS' goals of addressing the impacts of COVID-19 within the community,
the Contractor shall use the funds in furtherance of the purpose outlined in Section II and fulfill
the reporting requirements as described in Section III. In doing so, the Contractor shall follow
the deliverable schedule described below.
Deliverable
Accurate signed invoice
Written report with data elements &
narrative response
Due by
Within 30 days of a reement execution
January 16, 2023
City of Federal Way, Contract number #6325147
November 17, 2022
Page 4 of 7
V. Billing & Compensation
a. Compensation
1. The total amounts of payment to the Contractor for this Exhibit shall not exceed
$100,000, unless otherwise approved by King County in writing.
b. Billing Invoice Package
1. The Contractor shall submit a billing invoice that consists of a signed invoice
statement, which shall be provided by King County, along with other reporting
requirements as stated above.
2. The funds provided hereunder may be used for expenses incurred in addressing
negative impacts from the COVID-19 pandemic beginning on January 1, 2022
and through December 31, 2022.
3. The Contractor shall maintain supporting documentation that details expenditures
consistent with the Purpose and will make this documentation available upon
request.
4. The Contractor may send the invoices electronically to Libby Brockman at
Libby.Brockman@kingcounty.gov.
VI. No Employment Relationship
King County and the Contractor are creating an independent contractor relationship with this
Agreement. The Contractor shall not be considered an employee of the County for any purpose.
The Contractor is exclusively responsible for all self-employment and income taxes, and/or
other tax obligations which may arise as a consequence of payment and performance of the
services under this Agreement. The County will report all income to the Contractor on IRS Form
1099. For more information, the IRS website hosts a "Self -Employed Individuals Tax Center'
with guidance on tax obligations for independent contractors.
VII. Representations and Warranties:
A. Contractor represents and warrants that neither it nor any subcontractors are
presently debarred, suspended, or proposed for debarment by the U.S. Government-
B. Contractor shall notify King County in the event it, or a subcontractor, is debarred,
suspended, or proposed for debarment by any Federal department or agency.
Debarment status can be verified at.https://www.sam.gov/.
C. Contractor represents and warrants that neither it nor anyone involved in this
transaction was employed by the County in the past year.
D. Contractor shall identify at the time of offer current or former County employees
involved in the preparation of proposals or the anticipated performance of work.
Failure to identify current or former County employees involved in this transaction
may result in the County's denying or terminating this Agreement. After award, the
Contractor is responsible for notifying the County's Project Manager of current or
former County employees who may become involved in the Agreement any time
during the term of this Agreement.
City of Federal Way, Contract number #6325147
November 17, 2022
Page 5 of 7
E. Contractor shall comply with applicable provisions of King County Code (KCC) 3.04
Employee Code of Ethics. Failure to comply with such requirements constitutes a
material breach of this Letter of Agreement and may result in termination.
F. Pursuant to KCC 3.04.060, the Contractor shall not willfully attempt to secure
preferential treatment in its dealings with the County by offering any valuable
consideration, thing of value or gift, whether in the form of services, loan, thing or
promise, in any form to any County official or employee. If Contractor is found to
have violated the prohibition found in this paragraph, its current contracts with the
County will be cancelled and it shall not be able to bid on any county contract for a
period of two years.
Vill. Indemnification
The Contractor shall protect, defend, indemnify, and save harmless King County, its officers,
employees, and agents from any and all costs, claims, judgments, and/or awards of damages,
arising out of, or in any way resulting from, the negligent acts or omissions of the Contractor, its
officers, employees, subcontractors and/or agents, in its performance and/or nonperformance of
its obligations under this Agreement. The obligations under this paragraph extend to any claim,
demand, and/or cause of action brought by, or on behalf of, any of its employees or agents. For
this purpose, it, by mutual negotiation, hereby waives, as respects King County only, any
immunity that would otherwise be available against such claims under the Industrial Insurance
provisions of Title 51 of the Revised Code of Washington (RC1N).
IX. Maintenance of Records 4. ,
The Contractor shall maintain accounts and records, including personnel, property, financial,
and programmatic records and other such records as may be deemed necessary by the County
to ensure proper accounting for all funds and compliance with this Agreement.
The Contractor agrees to cooperate with the County or its agent in the evaluation of the
Contractor's performance under this Contract and to make available all information reasonably
required by any such evaluation process. The results and records of said evaluations shall be
maintained and disclosed in accordance with RCVV Chanter 42.56.
X. Equipment Ownership
A. The Contractor agrees that any equipment purchased, in whole or in part, with
Contract funds at a cost of $5,000 per item or more, when the purchase of such
equipment is reimbursable as a Contract budget item, is upon its purchase or receipt
the property of the County and/or federal/state government. The Contractor shall be
responsible for all such property, including the proper care and maintenance of the
equipment.
B. The Contractor shall ensure that all such equipment will be returned to the County or
federal/state government upon termination of this Contract unless otherwise agreed
upon by the parties.
XI. Additional Conditions
City of Federal Way, Contract number #6325147
November 17, 2022
Page 6 of 7
A. The Contractor shall not discriminate against any employee or applicant for
employment or employee benefits as provided in KCC 12.16.050 and in King County
Ordinance 14823. Failure to abide by this requirement may result in disqualification
from bidding on King County contracts, remedies allowed by this agreement, other
remedies allowable or provided for by law or rule.
B. The Contractor shall not use any of the funds provided under this Agreement for any
partisan political activity or to further the election or defeat of any candidate for public
office.
C. The County makes no commitment to support the services contracted for herein and
assumes no obligation for future support of the activity contracted herein except as
expressly set forth in this Agreement.
XII. Signature
The parties acknowledge this Letter of Agreement is the complete expression of the terms, and
any oral or written representations or understandings not incorporated herein are excluded.
IN WITNESS WHEREOF, the parties hereby agree to the terms and conditions of this
Agreement:
Jim Fern ayor DatdF
City ofgVderal Way
The attached W-9 is correct ❑ We will submit an updated KC W-9 form
Individual authorized to endorse and deposit checks for your organization:
Mailing address to which the check should be sent (if different from remit address on your KC
W-9):
City of Federal Way, Contract number #6325147
November 17, 2022
Page 7 of 7
KC W-9:
Request for Taxpayer Identification number and Give form to King County.
KING COUNTY Certification I Do not send to IRS.
SUBSTITUTE W-9
Name (as shown on Invoice)
C j4tl oC- Feder& l l>v
Business -Type
❑ Association 0 C-Corporation ❑ S-Corporation ❑ Disregarded Entity
❑ Division 0 Government ❑ Individual
❑ Limited Liability Company: Enter tax classification (C=C-Corporation, S=S-Corporation, P=PartnershipJ10-
❑ Non Profit ❑ Partnership ❑ Sole Proprietor ❑ Trust/Estate
Business Registration Information
Enter where you are registered to do business and the corresponding State Registration Number
State: w ASW t �'%Trv/Registration Number: &01- 2-M — 933
Purchasing Location Information
Physical Address
333 25 S5 % v4lPe . Sou�� Faek l Wail ai , &eu,4 qz&6 3
City , State, and Zip
Remittance Information
Remit Address (if different than above)
City, State, and Zip
Tax Reporting Name and Tax Identification Number or Social Security Number
Enter your Tax reporting Name and address. The Tax Identification number provided must match the name
given on the "Tax Reporting Name" line. For individuals, this is your social security number (SSN).
Tax Reporting Name
�;3Z5 Filk f�J2 Svt1'i I�
Tax (R�eportingAddress
- P-Jef t f q- (IL 4 Od
Tax Reporting City, StAte, and Zip
Tax Identification Number, Emolover Identification Number or Social Secrnty Number (enter numbers only):
11111 q I & I 25 I C>o
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct tax reporting name and identification number
2. 1 am a U.S. citizen, U.S. person or U.S. Business Entity.
3. 1 am not subject to backup withholding due to failure to report interest and dividend income
4. 1 am exempt from FATCA reporting.
Certification instructions. If you are not a U.S. citizen, U.S. person or U.S. Business Entity, you must cross
out item 2 above. Y Nwill need to prov a a commjpleted Ki ounly W9 form as well as a c pyy of your W-B.
Sign Here ► " L'�+l� ] 7c ✓ T_�
Print Name of Signer Date Signed
Version: 3 King County Substitute W9 Dated 6/1/2018