AG 23-034 - LUTHERAN COMMUNITY SERVICES NORTHWESTRETURN 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 19 HUMAN SERVICES / CDBG
❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
❑ ORDINANCE ❑ RESOLUTION
❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL
❑ OTHER
5. PROJECT NAME: Culturally Attuned Counseling at Refugees Northwest
6. NAME OF CONTRACTOR: Lutheran Community Services Northwest
ADDRESS: 4040 S 198th Street, Ste. 300, Seatac, WA 98188 TELEPHONE 206-901-1685
E-MAIL:Ikfoumier@lcsnw.org FAX:
SIGNATURE NAME: David ❑Uea TITLE
7. EXHIBITS AND ATTACHMENTS: A SCOPE, WORK OR SERVICES A COMPENSATION N INSURANCE REQUIREMENTS/CERTIFICATE 10 ALL
OTHER REFERENCED EXHIBITS R 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 $ 30.000.00 (INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑ YES O.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 INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
M PROJECT MANAGER SJB 12/14/2022
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
A LAW KVA 12/21/2022
11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: N/A COUNCIL APPROVAL DATE: 11/15/2022
12. CONTRACT SIGNATURE ROUTING
9 SENT TO VENDOR/CONTRACTOR DATE SENT: 12/30/22 DATE REC'D: 2/15/23
❑ 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 1 DATE IGNED
ALAW DEPARTMENT 71 Y
90r NATORY (MAYOR OR DIRECTOR)
❑ CITY CLERK
❑ ASSIGNED AG# AG# 3 b
COMMENTS:
Approved Council budget 11/15/2022
?:f2017
CITY OF CITY HALL
Fe d e ra f a� 33325 Avenue South
Federall Way, WA 9$003.6325
(253) 835-7000
www aryorloderalmw con)
HUMAN SERVICES AGREEMENT
FOR
CULTURALLY ATTUNED COUNSELING AT REFUGEES NORTHWEST
This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and Lutheran Community Services Northwest, a foreign nonprofit 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:
LUTHERAN COMMUNITY SERVICES CITY OF FEDERAL WAY:
NORTHWEST:
David Duea Patti Spaulding-Klewin
4040 S 188th St, Suite 300 1 33325 8th Ave. S.
SeaTac, WA 98188 Federal Way, WA 98003-6325
206-901-1685 (telephone) (253) 835-2651 (telephone)
jkfPatti.Sliauldin,-Klewinfic_cityoffederalway.com
The Parties agree as follows:
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 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. 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 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 - 10/2022
` CITY OF CITY HALL
33325
�� Fe d e ra I Way Feder 8th Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
ivww crtyollederahvay con;
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-- ropriation 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 Agency 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 Cite 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, 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.
HUMAN SERVICES AGREEMENT - 2 - 10/2022
CITY OF CITY HALL
44�, Fe d e ra I Way Feder l Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www aryoffederalway com
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 $2,000,000 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
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 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. ROOKS 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.
HUMAN SERVICES AGREEMENT - 3 - 10/2022
CITY OF CITY HALL
Fe d e ra I ay Feder 8th Avenue South
8135- p OA 98003-6325
(2 3)
wwwrllyortexclorahvaycorn
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. EOiTAL OPPORTUNIETY 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 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 Intewretation 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 Agency 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.
HUMAN SERVICES AGREEMENT - 4 - 10/2022
CITY OF CITY HALL
Fe d e ra I Way Feder Avenue South
Federal
Way, WA 98003-6325
�1 (253) 835-7000
www ciryoffederalway corn
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. Adherence to 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 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 fall 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 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, 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 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 - 5 - 10/2022
CITY OF CITY HALL
44�1Federal Wa 33325 Avenue South
400 Federall Way, WA 98003-6325
(253) 835-7000
www clryoffederahvay com
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY:
Ji ell, ayor
DATE: Alp'
LUTHERAN COMMUNITY SERVICES
NORTHWEST:
go
Printed Name: , = L D,A `—
Title: -p- c S j d -� C C U
DATE: Z1/`11 Z 3
STATE OF WASHINGTON )
) ss.
COUNTY OF PT &Ce )
ATTEST:
SVh Courtney, CMC, nitClerk
APPROVED AS TO FORM:
�r. pyarniCall, City Attorney
QQ this day ersonally appeared before e to me known to be the
-CStC� of `Jl� _ 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 f ` day of - , y R- _ , 2(}�,3
SYM �'��4 Notary's signature cF��
'� �ti�as3r+�r Notary's printed name EISll-e
or f�'•,� �i Notary Public in and for the S ate a Washington.
My commission expiresit, 0io
'1+1 AV
I
����aaa;�
HUMAN SERVICES AGREEMENT - 6 - 10/2022
,� CIT
Federal Way
EXHIBIT A
SERVICES
Pro iect Services Summar2,
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003 6325
(253) 835-7000
www cityoffederalway com
The Agency shall provide individual and group outpatient counseling for adult refugees, immigrants, and
asylum seekers. Counseling will be provided at Refugees Northwest, a program of Lutheran Community
Services Northwest. 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
2nd
3rd
4tn
Quarter
Quarter
Quarter
Quarter
Total
JAN. —
APRIL —
JULY —
OCT. —
MARCH
NNE
SEPT.
DEC.
No. of unduplicated Federal Way
persons assisted in 2023
2
3
2 3
10
No. of unduplicated Federal Way
persons assisted in 2024
2
3
2 3
101
B. Units of Service
The Agency agrees to provide, at minimum, the following units of service by quarter:
1st
god
3rd
4th
Quarter
Quarter
Quarter
Q
Quarter
Total
JAN. —
APRIL —
JULY —
OCT. —
MARCH
JUNE
SEPT.
DEC.
2023
1. Counseling
2
3
2
3
10
2024
1. Counseling
21
2 1
3 1
10
Units of service are measured by the number of individuals served 60 minute sessions.
HUMAN SERVICES AGREEMENT - 7 - 10/2022
CITY OF CITY HALL
�� 33325 Sth Avenue South
FederalY Federal Way, WA 98003-6325
(253) 835-7000
mm crtyoffederahvay com
C. Outcome Measure(s)
Outcome: Sustained or improved mental health symptoms.
Indicator: LOTUS Assessment data at intake, every 180 days after admission, annually, and at
discharge
Target: 80%
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 - 8 - 10/2022
CITY OF
Federal
CITY HALL
■ � 1�� 33325 8th Avenue South
■IfI■r1■ Federal Way, WA 98003-6325
(253) 835-7000
w~ cityoffederalway 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 guidelines may be adjusted periodically by
HUD.
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 i Persons
Persons
Persons
County
Cate or)
Extremely
Low
(30%)
$27,200
$31,050
$34,950 1 $38,800
$41,950
$45,050 $48,150
$51,250
Income
Limits
Very Low
j
$1349600
(50%)
$45,300
$51,800
$58,250 $64,700
$69,900
$75,100
$80,250
$85,450
Income
Limits
Low
$66,750
$76,250
$85,800 1 $95300
$102,950
$110,550
$118,200
$125,800
Income
I
Limits
-
— -
—
The Agency agrees to use updated Income Guidelines which will be provided by the City.
Reports and Reporting 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 - 9 - 10/2022
CITY OF
Federal
Project Budget
CITY HALL
Way 33325 Sth Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
MVW Cq4) federalwayrom
EXHIBIT B
COMPENSATION
The Agency shall apply the following fiends to the project. The total amount of compensation pursuant to this
Agreement shall not exceed Thirty Thousand and 00/100 Dollars ($30,000.00).
City of Federal Way Funds 2023 2024
City of Federal Way General Fund: $15,000.00 $15,000.00
Total City of Federal Way Funds: $15,000.00 _ $15,000.00
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 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:
2023
1st Qtr
$3,750.00
2nd Qtr
$3,750.00
3rd Qtr
$3,750.00
4th Qtr
$3,750.00
2024
1 st Qtr
$3,750.00
2nd Qtr
$3,750.00
3rd Qtr
$3,750.00
4th Qtr
$3,750.00
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 - 10 - 10/2022
ClITY OF CITY HALL
Federal Way Federal3325 h y, WA South003
Federal Way, WA 98003-6325
(253) 835-7000
www alyollederalway com
City of Federal way
2023-2024 Human Services General Fund
Authorized Signatures for Invoices
I audwrize the following individuals to sign invoices and quarterly reports on behalf of:
Lutheran Communily Services Northwest _
(Contracting Agency), for
the following: CuNurall%-Attuned Counseling far Refugees orthwest_ (Program Title).
Authorizing
Signature:
(must be signed by
person who signs
the contract
generally,
Executive Director)
Additional
Authorized
Signature:
Additional
Authorized
Signature:
David ❑uea President and CEO
(Printed Name) (Title)
(Signature) (Date)
Mary_Watko _ Grants Accountant Supervisor
(Printed Name) (Title)
Signature)l (Date)
Vikki Bailey
(Printed Name)
-
t�k (t
(Signature)
Grants Accountant
(Tale)
.)-[.2/2
(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.
UUGU01Y1I CI IVUIUNC IU. JDr IJCDU-UUrL-'+I.UC-DI.�L-:7ULLVOL4JDr 1
LUTH ERAN
Community
Services
NORTHWEST
Resolution from the Minutes of the February 12, 2022 Meeting of the board of Directors of
Lutheran Community Services Northwest
Resolution 22-02-02
In accordance with Board policies, the Board of Directors of Lutheran Community Services
Northwest recognizes the authority of its CEO to sign all contracts; agreements; leases, deeds,
and titles; funding agreements (including but not limited to United Way); certifications; funding
proposals and applications; other legal documents; and federal, state, and local reports and
filings. It further recognizes the authority of the CEO to delegate these responsibilities at his
Uor, u5luncu by: discretion.
0t�i- u��j C-�Q-a- o 64"& aw'tk" 2/12/2022
-,er.oerrcarsn.
Lisa Kraft Date
Secretary
LCSNW Board of Directors
Ac"RLY CERTIFICATE OF LIABILITY INSURANCE
4% �-
DATE(M92D/YYYY)
o7/z/ozz
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed_
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT Brittany Wagner
NAME:
Brown & Brown of Washington, Inc.
a eNN E (253)396-5500 arc No
EMAIL Brittany.Wagner@bbrown.com
ADDRESS:
2106 Pacific Ave
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite 501
INSURER A: Alliance of Nonprofits for Insurance, Risk Retention Group
10023
Tacoma WA 98402
INSURED
INSURER B :
INSURER C :
Lutheran Community Services NW
INSURER D :
4040 S 188th St #300
INSURER E :
INSURERF:
SeaTac WA 98188
COVERAGES CERTIFICATE NUMBER: 2022-2023 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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
LTR
TYPE OF INSURANCE
AVUL=13IR
NSp
D
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICYEXP
M/ MDD/YYYY
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE OCCUR
DAMA
PREMISES Fa occurrence
S 500,000
MED EXP (Any one person)
$ 20,000
X
Professional Liability
PERSONAL & ADV INJURY
s 1,000,000
A
2022-40171
07/31/2022
07/31/2023
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 3,000,000
POLICY ❑ j,T LOC
PRODUCTS - COMP/OP AGO
S 3,000,000
s
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE UMfr
fEa accident
$ 1,000,000
BODILY INJURY (Per person)
$
ANYAUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
2022-40171
07/31/2022
07/31/2023
BODILY INJURY (Per accidenl)
$
PROPERTY DAMAGE
Peraccident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
S 5,000,000
AGGREGATE
$ 5,000,000
A
EXCESS LIAR
CLAIMS MADE
2022-40171-UMB
07/31/2022
07/31/2023
DED I XRETENTIONS 10,000
S
AOFFICER/MEMBER
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
EXCLUDED?
(Mandatory In NH)
NIA
2022-40171- WA Stop Gap
07/31/2022
07131/2023
PER OTH-
STATUTE I ER
E.L EACH ACCIDENT
$ 1,000,000
E.L. DISEASE- EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L DISEASE - POLICY LIMIT
$ 1,000,000
A
Property
CWB0020775-01 - 40171
07/31/2022
07/31/2023
Employee Dishonesty
$500,000
Deductible
$5,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder is additional insured per attached forms and endorsements.
CERTIFICATE HOLDER CANCELLATION
City of Federal Way ATTN:Patti Spaulding-Klewin
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
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
10/13/22, 10:38 AM Corporations and Charities System
rssCgr ? t' as and Charities Filing System
BUSINESS INFORMATION
LUTHERAN COMMUNITY SERVICES NORTHWEST
602128 998
FOREIGN NONPROFIT CORPORATION
ACTIVE
4040 S 188TH ST STE 300, SEATAC, WA, 98188-5070, UNITED STATES
4040 S 188TH ST STE 300, SEATAC, WA, 98188-5070, UNITED STATES
06/30/2023
UNITED STATES, OREGON
06/19/2001
PERPETUAL
NONPROFIT HUMAN SERVICES
https://ccfs.sos.wa.gov/#/BusinessSearch/Businesslnformation
Business Name:
UBI Number:
Business Type:
Business Status:
Principal Office Street Address:.
Principal Office Mailing Address:
Expiration Date:
Jurisdiction:
Formation/ Registration Date:
Period of Duration:
Inactive Date:
Nature of Business:
Charitable Corporation:
1 /2
10113/22. 10:38 AM
Corporations and Charities System
FEIN Number:
93-0386860
Gross Revenue exceed $500,000:
LI
REGISTERED AGENT INFORMATION
Registered Agent Name:
DAN JOHNSTON
Street Address;
4040 S 188TH ST STE 300, SEATAC, WA, 98188-5070, UNITED STATES
Mailing Address:
4040 S 188TH ST STE 300, SEATAC, WA, 98188-5070, UNITED STATES
GOVERNORS
Title
Governors Type
Entity Name First Name
Last Name
GOVERNOR
INDIVIDUAL
DAViD
DUEA
GOVERNOR
INDIVIDUAL
HEIKE
LAKE
Back
F:ling History FNameHfstory 1 Print 1 Return to Business Search
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11/8/22, 12:36 PM Washington State Department of Revenue
Washington State Department of Rev�� �-lC
< Business Lookup
License Information:
Entity name: LUTHERAN COMMUNITY SERVICES NORTHWEST
Business name: LUTHERAN COMMUNITY SERVICES NORTHWEST
Entity type: Nonprofit Corporation
UBI #: 602-128-998
Business ID: 001
Location ID: 0001
Location: Active
Location address: 4040 S 188TH ST # 300
SEATAC WA 98188-5070
Mailing address: 4040 S 188TH ST # 300
SEATAC WA 98188-5070
n
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Excise tax and reseller permit status:
Secretary of State status:
Endorsements
Endorsements held at this to License #
Burien Nonprofit Business 04287
Federal Way General
Business - Non -Resident
SeaTac General Business
Tukwila General Business -
Non -Resident
Washington State Department of Revenue
Click here
Click here
Count Details
Governing People May include governing people not registered with Secretary of State
Governing people
DUEA, DAVID
LAKE, HEIKE
Registered Trade Names
Ranictararl trarla nnmac
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0
Status
Expiration da
First issuance
Active
Jun-30-2023
Aug-27-2004
Active
Jun-30-2023
Apr-22-2021
Active Jun-30-2023 Jun-12-2019
Active Jun-30-2023 May-04-2021
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Washington State Department of Revenue
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ACT FOR KIDS (A.C.T.)
Active
Aug-06-2001
ADVOCATE HOME NETWORK
Active
Aug-06-2001
DIVORCE LIFELINE
Active
Aug-06-2001
FAMILIES FOR KIDS RECRUITMENT
Active
Aug-06-2001
RESOURCES
HOMEHELPERS HOMECARE
Active
Aug-06-2001
LUTHERAN COMMUNITY SERVICES
Active
May-11-2021
NORTHWEST
PARENTLINE
Active
Aug-06-2001
SAFET-SEXUAL ASSAULT AND FAMILY
Active
Aug-06-2001
TRAUMA RESPONSE CENTER
SENIOR MEDIA SERVICES
Active
Aug-06-2001
SENIOR SCENE NEWSPAPER
Active
Aug-06-2001
WHERE TO TURN: A GUIDE TO
Active
Aug-06-2001
COMMUNITY RESOURCES FOR OLDER
ADULTS IN TACOMA/PIERCE COUNTY
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