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AG 23-059 - UKRAINIAN COMMUNITY CENTER OF WASHINGTONRETURN 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, REP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT L HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL ❑ OTHER 5. PROJECT NAME: Refugee Assistance Program 6. NAME OF CONTRACTOR: Ukrainian Community Center of Washing on ADDRESS: rj O ' 7W TELEPHONE E-MAIL- FAX: SIGNATURE E: TITLE . t 7. EXHIBITS AND ATTACHMENTS: SCOPE, WORK OR SERVICES A COMPENSATION ® INSURANCE REQUIREMENTS/CERTIFICATE A ALL OTHER REFERENCED EXHIBITS IN PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: 01/01/2023 COMPLETION DATE: 12/31/2024 9. TOTAL COMPENSATION $ 32,000.00 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES (ENO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ®YES IDNO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAbE BOND PROVIDED ❑ PURCHASING: PLEASE CHARGE TO: 001-7300-083-562-10-410 10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED ® PROJECT MANAGER SJB 12/14/2022 ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) a LAW KVA 12121/2022 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: N/A COUNCIL APPROVAL DATE: 11/15/2022 12. CONTRACT SIGNATURE ROUTING ® SENT TO VENDOR/CONTRACTOR DATE SENT: 12/30/22 DATE RECD:1/30/23 ❑ 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 SIGNED kWDEPARTMENT SIGNATORY (MAYOR OR DIRECTOR) {/ CITY CLERK ❑ ASSIGNED AG# G -p COMMENTS: Approved Council budget 11/15/2022 2/2017 CITY OF CITY HALL �F Federal Way eder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway. com HUMAN SERVICES AGREEMENT FOR REFUGEE ASSISTANCE PROGRAM (RAP) This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Ukrainian Community Center of Washington, a Washington 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: UKRAINIAN COMMUNITY CENTER OF I CITY OF FEDERAL WAY: WASHINGTON: Oleg Pynda Patti Spaulding-Klewin 17701 108th Ave SE, 336 33325 8th Ave. S. Renton, WA 98055 Federal Way, WA 98003-6325 425-430-8229 (telephone) (253) 835-2651 (telephone) opynda(a-uccwa.org Patti.Spaulding-Klewin(a_),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 -AN `Federal � ���� 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com 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 -Appropriation of Funds. If sufficient funds are not appropriated or allocated for payment under this Agreement for any future fiscal period, the City will not be obligated to make payments for Services or amounts incurred after the end of the current fiscal period, and this Agreement will terminate upon the completion of all remaining Services for which funds are allocated. No penalty or expense shall accrue to the City in the event this provision applies. 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 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, 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 4 33325Federal Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway 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. 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. HUMAN SERVICES AGREEMENT - 3 - 10/2022 Cfxr of CITY HALL Fe d e ra I Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www ciryoffederalway com 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 OPPORTUNITY EMPLOYER. In all services, programs, activities, hiring, and employment made possible by or resulting from this Agreement or any subcontract, there shall be no discrimination by 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, 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 4! CITY OF As Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway. com 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 full force and effect. Failure or delay of the City to declare any breach or default immediately upon occurrence shall not waive such breach or default. Failure of the City to declare one breach or default does not act as a waiver of the City's right to declare another breach or default. This Agreement shall be made in, governed by, and interpreted in accordance with the laws of the State of Washington. If the Parties are unable to settle any dispute, difference or claim arising from this Agreement, the exclusive means of resolving that dispute, difference, or claim, shall be by filing suit under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an 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 4 33325� .. Federal Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www c1tyoffederalway. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: DATE: UKRAINIAN COMMUNITY CENTER OF WASHINGTON: By: U Printed Name: Title: G'iYL Gil �I✓e ��e� DATE: STATE OF WASHINGTON ) ATTEST: Stepro LrS ey, C , City Clerk PTO FORM: 'A P 3 Ryan Call, City ss. COUNTY OF On this day personally appeared before me �C I I" YI dO to me known to be the x e cru t i Lle 0J R F C Kok of 64, g a i h/oy, GDP u Y G tee? 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 J l-) Z4 a ,L? 20A-e A II�NIMI if i ial�r .•`'� p, D1k1r ,1 Notary's signature •`� i5QFiRes',�R�¢`G•; Notary's printed name R v� Notary Public in and for the State f Washington. :o N0 y �+ My commission expires // / a 0 PUBLIC '...... n nuti'�► HUMAN SERVICES AGREEMENT - 6 - 10/2022 4! CITY OF AN Federal Project Services Summary CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www crtyoffederalway. com EXHIBIT A SERVICES The Agency shall provide intensive case management and cultural orientation workshops for low-income Ukrainian and Russian speaking refugees _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 2nd 3rd 4th Quarter Quarter Quarter Quarter Total JAN. - APRIL - NLY - OCT. - MARCH JUNE SEPT. DEC. No. of unduplicated Federal Way persons assisted in 2023 10 10 10 10 40 No. of unduplicated Federal Way persons assisted in 2024 10 10 10 10 40 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: 1st 2nd 3rd 4th Quarter Quarter Q Quarter Q Quarter Total JAN. - APRIL - NLY - OCT. - MARCH NNE SEPT. DEC. 2023 1. Case Management 10 10 10 10 40 2. Support Groups 1 0 1 0 2 2024 1. Case Management 10 10 10 10 40 2. Support Groups 1 0 1 0 2 HUMAN SERVICES AGREEMENT - 7 - 10/2022 CITY OF CITY HALL 8th Avenue South Fe d e ra I Way Federal Way, WA 98003-6325 (253) 835-7000 wwwo"flederafway com 1. Case Management units of service are measured by the number of individuals enrolled in one-on-one counseling sessions 2. Support Groups units of service are measured by the number of group sessions provided to newly arrived refugees and immigrants C. Outcome Measure(s) Outcome 1: Increased self-sufficiency Indicator: Progress toward meeting participant centered goals as outlined in Individual Service Plan and measured at regular intervals Target: 90% Outcome 2: Increased community resource knowledge Indicator: Participant satisfaction and reported knowledge on pre and post -questionnaires Target: 90% 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 '4SCITY OF ,Federal CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www ciiyoffederalway. 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 Persons Persons Persons County Category Extremely Low (30%) $27,200 $31,050 $34,950 $38,800 $41,950 $45,050 $48,150 $51,250 Income Limits Very Low $134,600 (50%) $45,300 $51,800 $58,250 $64,700 $69,900 $75,100 $80,250 $85,450 Income Limits Low (80%) $66,750 $76,250 $85,800 $95,300 $102,950 $110,550 $118,200 $125,800 Income Limits The Agency agrees to use updated Income Guidelines which will be provided by the City. Reports and Reportintz 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 Way EXHIBIT B COMPENSATION Project Budget CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. ciryoffederalway com The Agency shall apply the following funds to the project. The total amount of compensation pursuant to this Agreement shall not exceed Thirty -Two Thousand -and 00/100 Dollars ($32,000.00). City of Federal Way Funds 2023 2024 City of Federal Way General Fund: $16,000.00 $16,000.00 Total City of Federal Way Funds: $16,000.00 $16,000.00 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 1 st Qtr $4,000.00 2nd Qtr $4,000.00 3rd Qtr $4,000.00 4th Qtr $4,000.00 2024 1 st Qtr $4,000.00 2nd Qtr $4,000.00 3rd Qtr $4,000.00 4th Qtr $4,000.00 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 CITY OF .L Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 WNW 0 10flederahva}, com City of Federal Way Human Services Contract for 2022-2023General Fund Authorized Signatures for Invoices I authorize the following individuals to sign invoices and quarterly reports on behalf of: [ate '�Crlr� fO"P 10A (Contracting Agency), for the following �L '� � e i � C I (rrogram Title). Authorizing O� f C r Yx Signature: g (must be signed by (Printed Name) (Title) person who signs the contract, generally, Executive Director) G (Si ature)-l" (Date) Additional Authorized Signature: i 1 j'LCi r f l C i uC� f rL� !'K (Printe Name) (T } ( nature) tDatel Additional Authorized Signature: (Printed Name) (Signature) (Title) (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. UKRAINIAN COMMUNITY CENTER OF WASHINGTON BYLAWS Article I Name Section 1: The name of this corporation shall be the Ukrainian Community Center of Washington, Incorporated, and shall hereinafter be referred to as the Center. Article II Classification Section 1: The Center is non -political body. Section 2: The Center is a tax exempt, service giving corporation, aimed at serving the following general purposes, i.e., to build among diverse ethnic communities in the Washington state a sense of solidarity and friendship through various activities of common interest, especially in the areas of educational, vocational, social and cultural activities. Article III Governing Board Section 1: The corporate power of the Center shall be vested in a Board of Directors consisting of seven (7) voting members. Section 2: Annually, the Board shall select, by majority vote, a Chair, a Secretary, and a Treasurer, who shall serve as officers of the Board. Section 3: A Nominating Committee of two (2) Directors and a representative from the community at large appointed by the Chair shall nominate to the Board persons to fill each class annually as well as persons to fill vacancies that occur on the Board. Nominees shall be approved by majority vote of the Board. Section 4: Any member of the Board of Directors may be removed from the Board for good cause by a two-thirds (2/3) vote of the Board of Directors. Section 5: Four (4) members of the Board shall constitute a quorum for conducting business. All contracts, agreements, grant proposals and legal instruments must be approved by an absolute majority (four members) of the Board of Directors. Section 6: The Board shall have the authority to appoint committees and task forces it deems necessary. The standing committees of the Board shall be the Nominating Committee, and the Finance Committee. Section 7: A Nominating Committee shall nominate to the Board an Executive Director. Nominee shall be approved by majority vote of the Board. Article IV ties of the Officers Section 1: The Chair shall preside over all meetings of the Board. In the event of his or her absence, the Board may name another director to preside. In cases of a tie vote, the Chair shall have the deciding vote. Section 2: The Executive Director shall sign all contracts, proposals, agreements, and legal documents which have been approved by the Board of Directors and which ordinarily require the signature of the presiding officer. The Executive Director shall not serve as a voting member on the Board of Directors. Section 3: The Secretary shall keep accurate minutes of all meetings of the Board of Directors, and shall write and sign all official correspondence of the Board. The Secretary shall be responsible for informing directors of regularly scheduled and special meeting of the Board. Section 4: The Treasurer, in accordance with generally accepted accounting procedures, shall oversee the financial affairs of the Center. The Treasurer shall chair the Finance Committee of the Board, and shall present a financial statement to the Board at each regularly scheduled meeting. Section 5: Directors shall serve without compensation while serving on the Board of Directors. However a reasonable fee may be paid to directors for attending regular and special meetings. Section 6: The salaries of the officers, if any, shall be fixed from time to time by resolution of the Board of Directors. In all cases, any salaries received by officers of this corporation shall be reasonable and given in return for services actually rendered to or for the corporation. Article V Meetings Section 1. Meetings of the Board of Directors shall be open to the public, except when personnel matters are discussed and acted upon. Section 2: The Board of Directors shall set the date, time, and location of their regular meeting and must meet no less than once three month. Special meetings may be called by the Chair or by any director. The Board shall be given at least three days notice of special meetings. Section 3: No director may vote by proxy at regularly scheduled or special meeting of the Board of directors. In emergency situations, the Chair may direct the Secretary to poll the Directors by telephone. The proposed action and telephone vote tally shall be recorded in the minutes of the next regularly scheduled meeting of the Board. Section 4: All proceedings of the Board and its committees shall be governed by Robert's Rules of Order, Newly Revised. Article VI Finances Section 1: The Board of Directors shall annually establish a Finance Committee of no less than three (3) directors, chaired by the Treasurer. Section 2: The Finance Committee, in cooperation with staff, shall develop the annual budget for the Center, and recommend it to the Board Section 3: The Finance Committee, in cooperation with staff, shall arrange for an annual audit of the books of the Center. Section 4: The Finance Committee shall propose a fund raising strategy annually to the Board. Article VII IRC 501(c)(3) TAX EXEMPTION PROVISIONS Section 1: No substantial part of the activities of this corporation shall be the carrying on of propaganda, or otherwise attempting to influence legislation [except as otherwise provided by Section 501(h) of the Internal Revenue Code], and this corporation shall not participate in, or intervene in (including the publishing or distribution of statements), any political campaign on behalf of, or in opposition to, any candidate for public office. Notwithstanding any other provisions of these Bylaws, this corporation shall not carry on any activities not permitted to be carried on (a) by a corporation exempt from federal income tax under Section 501(c) (3) of the Internal Revenue Code, or (b) by a corporation, contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code. Section 2: No part of the net earnings of this corporation shall inure to the benefit of, or be distributable to, its members, directors or trustees, officers, or other private persons, except that the corporation shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes of this corporation. Section 3: Upon the dissolution of this corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed for one or more exempt purposes within the meaning of Section 510(c)(3) of the Internal Revenue Code or shall be distributed to the federal government, or to a state or local government, for a public purpose. Such distribution shall be made in accordance with all applicable provisions of the laws of this state. Article VIII Amendments Section 1: Any of these by-laws may be revoked, amended, or revised by majority vote of the Board of Directors provided the Board has received at least thirty days notice of any proposed changes. Date: March 14, 1999 A� �_V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/22/2022 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 Liberty Mutual Insurance NA E.I:T PO SOX 188065 PHo" o xt : 800-962-7132 FAX No: 800-845-3666 Fairfield, OH 45018 E-MAIL ADDRESS, Business5ervicefMLibertvMutual.com INSURED Ukrainian Community Center Of Washington 17701 108th Ave SE Ste 336 Renton WA 98055 I INSURER(S) AFFORDING COVERAGE I NAIC # INSURER A : INSURER B : INSURER C : COVERAGES CERTIFICATE NUMBER: F,7R17Rar, 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 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 - ADDL SUER POLICY EFF POLICY EXP LTR . TYPE OF INSURANCE aa POLICY NUMBER MMJDDIYYYY MWDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY BLA57738883 4/30/2022 4/30/2023 EACH OCCURRENCE $1 000 000 CLAIMS -MADE �✓ OCCUR E6Ra accigrenral ED DAMAGE PREMISES $ 1 000 000 MED EXP JApy oneperson) $ 15 000 PERSONAL & ADV INJURY $1 000 000 .IF, 1AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ❑ jERC"T F LOC PRODUCTS - COMP/OP AGG $ 2 000 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea c.o. $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per acdderlt $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ WORXERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y / N BLA57738883 4/30/2022 4/30/2023 SEATUTE OTH E.L. EACH ACCIDENT $ 1 00O 000 0FFICERIMEMBEREXCLUDED7 NIA (Mandatary In NH) It yss, descntre under DESCRIPTION OF OPERATIONS below Stop Gap E.L. DISEASE - EA EMPLOYEE $ 1.000000 EL. DISEASE- POLICY LIMIT $ 1 000 000 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 if required by written contract or written agreement subject to General Liability Blanket Additional Insured Provision. City of Federal Way 33325 8th Ave S Federal Way WA 98003 LW-111 C LENA R EFCI N Lui I, 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 _I Travis Shane�--� @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 67817645 1 57738883 1 22-23 GL WC I Travis Shane 1 4/22/2022 12:03:42 PM (EDT) I Page 1 of 1 10/14/22, 1:22 PM Corporations and Charities System eriessCArt wand Charities Filing System BUSINESS INFORMATION Business Name: UKRAINIAN COMMUNITY CENTER OF WASHINGTON UBI Number: 601 885 258 Business Type: WA NONPROFIT CORPORATION Business Status: ACTIVE Principal Office Street Address: 13470 MARTIN LUTHER KING JR WAY S, SEATTLE, WA, 98178-5210, UNITED STATES Principal Office Mailing Address: 17701 108TH AVE SE # 336, RENTON, WA, 98055-6448, UNITED STATES Expiration Date: 06/30/2023 UNITED STATES, WASHINGTON 06/19/1998 PERPETUAL CHARITABLE, SOCIAL El https://ccfs.sos.wa.gov/#/BusinessSearch/Businesslnformation Jurisdiction: Formation/ Registration Date: Period of Duration: Inactive Date: Nature of Business: Charitable Corporation- 1/3 10/14/22, 1:22 PM Corporations and Charities System 91-1923155 G 1-1 REGISTERED AGENT INFORMATION OLEG PYNDA FEIN Number: Gross Revenue exceed $500,000: Has Members: Public Benefit Designation: Host Home: Registered Agent Name: Street Address: 13470 MARTIN LUTHER KING JR WAY S, SEATTLE, WA, 98178-5210, UNITED STATES Mailing Address: 17701 108TH AVE SE # 336, RENTON, WA, 98055-6448, UNITED STATES GOVERNORS Title Governors Type GOVERNOR INDIVIDUAL GOVERNOR INDIVIDUAL GOVERNOR INDIVIDUAL GOVERNOR INDIVIDUAL GOVERNOR INDIVIDUAL Entity Name First Name Last Name YU RIY ZAR E M BA PETRO MARTYNYUK BINNI THOMAS IGOR BURDA SVETLANA MARCHUK https://ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation 2/3 10/14/22, 1:22 PM Title GOVERNOR GOVERNOR Back Corporations and Charities System Governors Type Entity Name First Name Last Name INDIVIDUAL LILIYA MILYAN INDIVIDUAL IRYNA LABAZ Filing History —Name Historl Print Return to Business Search https://ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation 3/3 Q a 0 0 N {A C m U z z yO `<`' T Y E O di E .w _/ m J LU E m cin fl. d C# m W C) 0 R N to w C m R I' 0 R V 0 J ll� z S2 LU H 00 r- J � Z o0 rn a a � LU J �a m LU Ln d L M M f0 0 R u 0 J M M LU Ln Ln LU Ln > O a co dl = a co Q z O 0 ~ LU i M M t 7 ems+ DI O m 3 0 v ai U a� Vl to a L Q N Q! r u N = O � N N M •= N IA Q LL Q m M � N O O O O L_ M •C W N 7 N > m }+ v o V1 Q C N E lC a a� 0 a� � N c o s s t v v cc V V C L4 o, ++ d � 4A u ++ u a i R t O a Q 4-0 w a Z oC = N ��'' Z Gi Z Ln Z R N C = Z Z Q m w ( = Q �P } O LU v .c i � m oc J O oc M Ln 9 QQ CQ C � u u W LL. m �01 U� m J G G G N m W (A L LI N N N L m c d m 0 m 3 `o N U N fA cQ L 00 00 Qi fl1 f'I) fY'1 +� I` > O > O _ ++ Z Z c a- +r c� U L W VI _0 W m -^ i.L O O Qa Ln Q O O 16 J M N Ol L^ N 7 > cu > N O Vf +, U Q 41 U Q In N m M N O � s � H N E w 1- m Z w z U � H d Z F— c O W Z a cn Q cn cc 3 O i *' v IA m3 L. au = 0 3 Y O M W G a) ^ — a- a� � a IA a ,vA 0' 3 o � L t � N p V) >h C V S u II AeC,11oO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDIMIN- ) `. 03/14/2023 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 REPRESENT'A IVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain POUGIes may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER . E: Liberty Mutual Insurance PHONE 800-962-7132 FAX N . 800-845-3666 jwr. No PO Box 188065 AooREss. BusinessSmice@LjbertyMutual.com INSURERM AFFORDING COVERAGE NAICII Fairfield OH 45018 INSURERA, The Ohio Casualty Insurance Company 24074 INSURED INSURER B: American Fire and Casualty Company 24066 Ukrainian Community Center Of WashingtDn INSURERC: 17701 108th Ave Se 336 INSURER D : INSURER E : Renton WA 98055 INSURER F : I'.AVFRAC:FFi f_FRTICIf_ATF MIIRmia;=p- n9AnnRRR90 DMnCInM rri 180Cn.'IMc_na 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 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. DISIR TYPE OF INSURANCE ADDL UBR VFVD� POLICY NUMBER Pin EFF PGLICY E7IP LIW B }( COMMERCIALGENERALLIABILRY CLAIMS -MADE FXOCCUR X X BLA57738883 04/30/2023 04/3012024 EACH OCCURRENCE S 1.000,000 S 1,0D0,0W MED EXP one S 15,000 PERSONAL& ADV INJURY S 1,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: X POLICY JEC �X LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG S 2,000,000 $ AUTOMOBILELIABIUITtt ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBJNED SINGLE LIMIT $ BODILY INJURY (Per person) t i BODILY INJURY (Per ( ) PROPERTY DAMAGE Per n{ S S A X UMBRELLALIAB ExCESSLIAB X OCCUR CLAIMS -MADE X X US057738883 03/14/2023 04/30/2023 EACH OCCURRENCE S 1,000,DOO AGGREGATE S 1,000,000 DED X1 RETENTIONS 10,000 s ' WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY YIN iER ANYPROPRIETOR/PARTNER/EXECUTiVE OFFICERIMEMBEREXCLUDED7 ❑ (Mandatory In NH) If M dosedba under DESCRIPTION OF OPERATIONS below NIA 3TATl1TE DTH EL. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMB S I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required) City of Federal Way is Additional Insured if required by written contract or written agreement subject to General Liability Blanket Additional Insured Provision. vLrs 11Vp%.0 iIC rILILUCR LaAN L'CLLAI ILIre SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Federal Way ACCORDANCE WITH THE POLICY PROVISIONS. 33325 8th Ave S AUTHORIZED REPRESENTATIVE Federal Way WA 98003 _ Curtis Luken -- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD