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AG 23-086 - CHILDREN AND YOUTH JUSTICE CENTERRETURN TO: Victoria Banks EXT: 2604 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM . ORIGINATING DEPT./DIV: CD/CS . ORIGINATING STAFF PERSON: Patti Spaulding-Klewin EXT: 2651 3. DATE REQ. BY: 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 0 HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL ❑ OTHER PROJECT NAME: Leadership, Intervention and Change (LILAC) NAME OF CONTRACTOR: Children and Youth Justice Center ADDRESS: 300 Elliott Ave W, Suite 360 Seattle, WA 98119 TELEPHONE 206-696-7504 E-MAIL: RSottile@ccyj.org FAX: SIGNATURENAME: Rachel SOttIIe TITLE EXHIBITS AND ATTACHMENTS: A SCOPE, WORK OR SERVICES 9 COMPENSATION IR INSURANCE REQUIREMENTS/CERTIFICATE is ALL OTHER REFERENCED EXHIBITS A PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS TERM: COMMENCEMENT DATE: 01/01/2023 COMPLETION DATE: 12/31 /2024 TOTAL COMPENSATION $ 16,000.00 (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 RETAINAGE: RETAINAGE AMOUNT: ONO IFYES, $ PAID BY. ❑ CONTRACTOR ❑ CITY ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDE ❑ PURCHASING: PLEASE CHARGE TO: 001-7300-083-562-10-410 0. DOCUMENT/CONTRACT REVIEW A PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ® LAW 1. COUNCIL APPROVAL (IF APPLICABLE) 2. CONTRACT SIGNATURE ROUTING A SENT TO VENDOR/CONTRACTOR INITIAL / DATE REVIEWED SJB 01/09/2023 JE 1/20/23 - lots of updates needed COMMITTEE APPROVAL DATE: N/A DATE SENT: 2/6/23 INITIAL / DATE APPROVED COUNCIL APPROVAL DATE: 11 /15/2022 DATE REC'D: 3/28/23 ❑ 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 / DATE SIGNED W�r�AVDEPARTMENATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNEDAG# ;OMMENTS: \pproved Council budget 11/15/2022 .ots of comments. Also see my comments in the King Co, Public Health Services template for my thoughts on several provisions that also appear in this agreement - JE 1120/23 7 /7l11 '7 CITY OF CITY HALL 4! Federal Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederal way com HUMAN SERVICES AGREEMENT FOR LEADERSHIP, INTERVENTION, AND CHANGE (LING) This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Children and Youth Justice Center, 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: CHILDREN AND YOUTH JUSTICE CENTER: I CITY OF FEDERAL WAY: Rachel Sottile Patti Spaulding-Klewin 300 Elliott Ave W, Suite 360 33325 8th Ave. S. Seattle, WA 98119 Federal Way, WA 98003-6325 206-696-7504 (telephone) (253) 835-2651 (telephone) RSottile(a_),ccyj.org Patti.Spaulding-Klewin@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. 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 HUMAN SERVICES AGREEMENT - 1 - 10/2022 CITY OF CITY HALL Fe d e ra f Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com 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-Approgriation of Funds. If sufficient funds are not appropriated or allocated for payment under this Agreement for any future fiscal period, the City will not be obligated to make payments for Services or amounts incurred after the end of the current fiscal period, and this Agreement will terminate upon the completion of all remaining Services for which funds are allocated. No penalty or expense shall accrue to the City in the event this provision applies. 5. INDEMNIFICATION. 5.1 A ene 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. 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. HUMAN SERVICES AGREEMENT - 2 - 10/2022 clrY of CITY HALL ,� .. Fe d e ra I Way Feder l Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www.cityoffederalway com 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 Liabili . 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. 10. INDEPENDENT CONTRACTOR. The Parties intend that the Agency shall be an independent contractor and that the HUMAN SERVICES AGREEMENT - 3 - 10/2022 1 [rrr of CITY HALL �`T 33325 Avenue South Federal Way, WA 98003-6325 Fe d e ra 11111ay (253) 835-7000 www cityoffederalway com 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 CITY of CITY HALL 4 Feder Fe d e ra 11lllay 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 ,� Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 535-7000 www oWffederaiway com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: DATE: CHILDREN AND YOUTH JUSTICE CENTER: By:6�4 PrintedName: �e Title: Rer 4 + CF-- 0 DATE: f4e,0144 lj i � , ��23 STATE OF WASHINGTON ) ss. COUNTY OF i h� ATTEST: *#Wa�&km phanie Courtney, CMC, Ci Clerk APPROVED AS TO FORM: yan Call, Ci Attorney On this day personally appeared before me R- dig) to me known to be the - f) of ; „en Yaf6 Tu!Phi-,e Cehfer- 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 16 0101 day of 20" Notary's signature Notary's printed name$}- LARRY STOTT 11 Notary ublic in and for the State of Washington. NotaryPublic My commission expires l_ rf 2021C State of Washington Commission k 22009636 My Comm. Expires Apr 9, 2026 HUMAN SERVICES AGREEMENT - 6 - 10/2022 CITY OF Federal Project Services Summary CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www ciryoffederalway. com EXHIBIT A SERVICES The. Agency shall provide intervention services to young people who are group or gang -involved to support them in managing crises, re-engaging in secondary education, and connecting with employment opportunities, counseling, treatment, and other wraparound services. 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 — 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 10 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total JAN. — APRIL — JULY — OCT. — MARCH JUNE SEPT. DEC. 2023 1. Case Management 11 12 11 1 12 46 2.Youth Services 4 3 3 3 13 2024 1. Case Management 11 1 12 11 12 46 HUMAN SERVICES AGREEMENT - 7 - 10/2022 4S CITY OF AN Federal CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www c iyoffederalway com 2.Youth Services 4 3 3 3 13 1. Case Management units of service are measured by number of times participants' individual intervention plans are reviewed on a 30-60-day cycle. 2. Youth Services units of service are measured by the number of goals met on participants' individual intervention plans. C. Outcome Measure(s) Outcome 1: Enrolled youth will decrease gang activity/association Indicator: Progress made on Individualized Intervention Plans and/or graduation from program services. Intervention plans can include: decreased association with gang members, completion of probation, completion of court -ordered program, enrollment in school, improvement school attendance, securing employment, participation in prosocial activities, enrollment/Participation in Mental Health/Substance use programs Target: 50% Outcome 2: Enrolled youth will improve school attendance Indicator: Progress made on Individualized Intervention Plans and/or graduation from program services. Intervention plans can include: decreased association with gang members, completion of probation, completion of court -ordered program, enrollment in school, improvement school attendance, securing employment, participation in prosocial activities, enrollment/Participation in Mental Health/Substance use programs Target: 45% Outcome 3: Enrolled youth will obtain employment Indicator: Progress made on Individualized Intervention Plans and/or graduation from program services. Intervention plans can include: decreased association with gang members, completion of probation, completion of court -ordered program, enrollment in school, improvement school attendance, securing employment, participation in prosocial activities, enrollment/Participation in Mental Health/Substance use programs Target: 60% 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 Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www 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 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 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 Proiect Budget CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. cityoffederalway com EXHIBIT B COMPENSATION The Agency shall apply the following funds to the project. The total amount of compensation pursuant to this Agreement shall not exceed Sixteen Thousand and 00/100 Dollars ($16,000.00). City of Federal Way Funds 2023 2024 City of Federal Way General Fund: $8,000.00 $8,000.00 Total City of Federal Way Funds: $9,000.00 $8,000.00 Reimbursement Requests and Service Unit Report forms shall be submitted no less frequently than quarterly and are due on the following dates: 1 stQuarter: 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 $2,000.00 2nd Qtr $2,000.00 3rd Qtr $2,000.00 4th Qtr $2,000.00 2024 1 st Qtr $2,000.00 2nd Qtr $2,000.00 3rd Qtr $2,000.00 4th Qtr $2,000.00 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 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffedera/way. com City of Federal Way Human Services Contract for 2023-2024 General Fund Authorized Signatures for Invoices I authorize w e the following individuals to sign invoices and quarterly reports on behalf of: ON fV/� QAA' Id r (CC y S)(Contracting Agency), for the following: I.INL Authorizing Signature: (must be signed by person who signs the contract, generally, Executive Director) Additional Authorized Signature: Additional Authorized Signature: (Program Title). [4;ICiA-CA Bomb t?veSlc(e (Printed Name) (Title) ( agnalure) (Date) (Printed Name) (Title) (Signature) (Date) (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. 0" OF Federal Way 33325 8th Avenue South, Federal Way, WA 98003 ©New Vendor ❑ Update Form To add your business to our vendor file, or update information, please complete this form and mail to 33325 8`h Ave South Federal Way. WA 98003 or fax #253-835-2509 or email accountsriavable(rvcitvotfedcralway.com Business Informadon (as shown on your federal tax return) 1. Business Name: DBA 2. Contact Name: 3. Business Address: {�y[ / I ! I f v�— UV SIL 4. Remit To Address r (if different): 5. Phone #: ' 0C* 49b—L g_Fax #- 6. Will you provide suppplies or service to the City of Federal Way?? ❑ 7. City of Federal Way Staff/Department Contact Name: 1- qJ1 I (For office use only) VN#: JJi ( t Se e VJA- 1-1 K1 City stare zp cote E-Mail: r (] T � ics X Service`s! IL vf,. 11,4,i _,-. — i r? f i it Ifi Business Type Please Check appropriare has for federal tar rlrxcsi rattan a ersoudea entered on tune 1 ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Government Agency ❑Trust state O�N on -Profit tir«enTr, Exempt payce co&> ao ✓ �L q r�]S Federal ID/EIN # (9 digits) ❑ Sole Proprietor Federal ID # (9 digits) or Social Security Number If you are not a corporation, is your Business subject to 1099 reporting? State of Washington U. B. I. # ❑ Yes ❑ No ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) > Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for US federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. ❑ Other (see inArlrl:tions)> Exemptions (codes apply only to certain entitles, not individuals; see instruction) Exempt payee code (if any) Exemption from FATCA reporting code (if any) Certification: Under penalties ofpetjury, I certify that: I . The number shown on this form is my correct taxpayer identification number (or i am waiting for a number to be issued to me): and 2. 1 am not subject to backup witholding because: (a)1 am exempt from backup rvathhoidinF, or (b) I have not been notified by the m Internal Revenue Service (IRS) that lasubje t to backup withholding as a result of a failure to rgx;rt all interest or dividends. or (c) the iRS has noti6to;d me that I am no Ionger subject to backup witholding; and 3. I am a US citizen or other U.S. person ((Jefined below): and 4. The FATCA codc(s) entered on this form (if airy) indicating that I am exempt from FATCA reporting is correct. The tnternit Revenue Service dots not requirc your consent to any rovtstnn of this document other than the certiricition rrqaired to avoid backup wElirtnll Sift qa�� Here Si attire of U.S. > Date> 2 1_93 Zl�� For information call: 253.835.2525 or Fax: 253.835.2509 or e-mail: accourltsp iyable aicityoli deralway.com Rev 1 2021 StateFarm ME STATE FARM FIRE AND CASUALTY COMPANY ❑ A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED FEB 22 2023 P Sox2�r5 Booming on IL 61702-2915 Addl Insured -Section II Only M-15-2585-FB3C F U 001225 3123 CITY OF FEDERAL WAY 33325 STH AVE S FEDERAL WAY WA 98003-6300 Illlllllllll1- 'III II'llh1lllll-Ill-IIIIIIII'-I1II-IIIIII1.1-I'll Office Policy Policy Number 98-GV-2627-0 Policy Period Effective Date Expiralion Date 12 Months OCT 1 2022 OCT 1 2023 The poll y period bep0ir�s and ends at 12:01 am standard time ate premises on. Named Insured CENTER FOR CHILDREN AND YOUTH JUSTICE Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholderwritten notice in compliance with the policy provisions or as required by law. Entity: NON-PROFIT Reason for Declarations: Endorsement Premium Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Your policy is amended FEB 22 2023 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4860 ADDED None Prepared MAR 16 2023 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009611 290 Al Continued on Reverse Side of Page N Page 1 of 6 c�nsnc. a nc v� ann wivevi..i DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy (dumber 98-GV-2627-0 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coveragge A - Buildings Coverage B - Business Personal Business Personal Property Property 001 300 ELLIOTT AVE W STE 360 No Coverage $ 111,400 25% SEATTLE WA 98119-4138 " As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEWES) Cov A - Inflation Coverage Index Cov B - Consumer Price Index: SECTION 1- DEDUCTIBLES N/A 296.3 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy Prepared MAR 16 2023 © Copyright, State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009611 Continued on Next Page Page 2 of 6 StateFarm DECLARATIONS (CONTINUED) Office PoIicy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 M SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES g The coverages and corresponding limits shown below apply separately to each described premises shown in these 8 Declarations, sinless indicated by "See Schedule," If a coverage does not have a corresponding limit shown below, NC9 but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared MAR 16 2023 ® Copyright, State Farm Mutual Automobile Insuranae Company,2000 CMP-4000 Includes copyrighted material of Insurance Sorviaes Office, Ino„ with its permission, OO9612 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIQNS OF QQVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared MAR 16 2023 © Copyright, State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009612 Continued on Next Page Page 4 of 6 i StateFarm WW a DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 SECTION 11- LIABILITY LIMIT OF s COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $5,000,000 General Aggregate $5,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements than apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS 6ND ENDORSEMENTS CMP-4102 Businessowners Coverage Form CMP-4860 *Al Design Person Org CMP-4247.2 Amendatory Endorsement FE-6999.3 Terrorism Insurance Cov Notice CMP-4779 Employers Liability CMP-4854 Lenders Loss Payable CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703.1 Utility Interruption Loss Incm CMP-4705.2 Loss of Income & Extra Expnse Prepared 16 2023 © Copyright, State FarmMutual Automobile Insurance Company, 2008 MAR CMP-16 2 Includes copyrighted material of Insurance Services Office, Inc„ with its permission. 009613 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy NumMr 98-GV-2627-0 CMP-4746.1 Hired'Auto Liability CMP-4797 Add] Insd Controlling Interest CMP-4786 Add[ Insd Owners Lessee Sched CMP-4787 Waiver of Trans Rgt of Recov CMP-4572 Amendment of Premium Cond CMP-4561.4 Policy Endorsement FE-3661 Actual Cash Value Endorsement FD-6007 Inland Marine Attach Dec * New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended, In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. * M.�� — Secretary President Prepared MAR 16 2023 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009613 290 N Page 6 of 6 ` StateFarrn STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS P Ca{ c913 8po;rr,+r';r'nr11L 61702-2915 Named Insured M-15-2585-FB3C F U CENTER FOR CHILDREN AND YOUTH JUSTICE ATTACHING INLAND MARINE 11 INLAND MARINE ATTACHING DECLARATIONS Policy Number 98-GV-2627.0 PollcyPeriod Effective Date Exppiration Data 12 Months OCT 1 2022 ON 1 2023 The pollGyperiod begins and ends at12:01 am standard time attrte premises location. Automatic Renewal - If the policy parlod is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienhalder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8724 Inland Marine Conditions FE-8744.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared 16 2023 ©Copyright State Farm Mutual Automobile Insurance Company, 2008 MAR MAR 1 7 Includes copyrighted material of Insurance Services Office, Inc„ with its permission. 0096114 530-666 a.2 05-31-2011 10113232c' 98-GV-2627-0 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-8744.1 Inland Marine Computer Prop Loss of Income and Extra Expense LIMIT OF INSURANCE S 25,000 $ 25,000 DEDUCTIBLE AMOUNT 500 Prepared OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY MAR 16 2023 U Copyright State Farm Mutual Automobile Insurance Company, 20011 FD-6007 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 009614 ANNUAL PREMIUM Included Included 530-666 a.2 05-31.2911 103233c1 98-GV-2627-0 009615 CMP-4860 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. srrt aµ CMP-4860 ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION A{ This endorsement modifies insurance provided under the following: K-Al BUSINESSOWNERS COVERAGE FORM SCHEDULE s 98-GV-2627-0 Policy Number: Lb No Named Insured: CENTER FOR CHILDREN AND YOUTH Name And Address Of Additional Insured Person Or Organization: CITY OF FEDERAL WAY 33325 8TH AVE S FEDERAL WAY WA 98003-6300 SECTION II — WHO IS AN INSURED of SECTION II -- LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Premises And Ongoing Operations Your acts or omissions or the acts or omissions of those acting on your behalf: (1) In connection with your premises; or (2) In the performance of your ongoing operations; or b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products -completed opera- tions hazard". 2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provid- ed by you. There will be no refund of premium in the event this endorsement is cancelled, All other policy provisions apply. CMP-4860 ®, Copyright, State Farm Mutual Automobile Insurance Company. 2006 Includes copyrighted material of Insurance Services Cff ce, Inc., with Its permission. 98-GV-2627-0 009615 3/29123, 9:36 AM Washington State Department of Revenue Washington State Department of Revenue < Business Lookup License Information: Entity name: CHILDREN AND YOUTH JUSTICE CENTER Business name: CHILDREN AND YOUTH JUSTICE CENTER Entity type: Nonprofit Corporation UBI #: 602-587-980 Business ID: 001 Location ID: 0002 Location: Active Location address: Mailing address: 300 ELLIOTT AVE W STE 360 SEATTLE WA 98119-4138 300 ELLIOTT AVE W STE 360 SEATTLE WA 98119-4138 New search Back to results https://secure.dor.wa.gov/gtounauth/—/#3 1/4 3/29/23, 9:36 AM Excise tax and reseller permit status: Secretary -of -State status: Washington State Department of Revenue Click here Click -here Endorsements held at this to License # Count Details Federal Way Nonprofit Business Endorsements Endorsements held at this to License # C Governing People May include governing people not registered with Secretary o(State Governing people AUSTIN, PEPPER BRIDGE, JON DANIELSON, BENJAMIN DEANE, SHAWNA INSLEE, DAVINA Status Expiration da First issuance Active Oct-31-2023 Nov-08-2022 Status Expiration da- First issuance Filter https://secure.dor.wa.gov/gtounauth/—t#3 2/4 3/29/23, 9:36 AM Governing people --MALENG, MARK--- SHAIKH, SARAH SHAPIRO, EVAN SHIN, DAN SOTTILE, RACHEL TEMPLE, JEN VOEGTLEN, BARNEY WELLS, MEGAN Registered Trade Names Registered trade names Washington State Department of Revenue Title First issued CENTER FOR CHILDREN AND YOUTH Active Jun-05-2006 JUSTICE View Additional Locations https://secure.dar.we.gov/gteunauth/—,N3 3/4 3129/23, 9:36 AM Washington State Department of Revenue The Business Lookup information is updated nightly. Search date and time: 3/29/2023 9:36:28 AM Contact us How are we doing? Take our survey! Don't see what you expected? Check if your browser is supported hftps:/tsecure.dor.wa gov/gteunauth/—/#3 4/4 3/29/23, 12:21 PM Corporations and Charities System ii,e5�j�t��nd Charities Filing System 1=I11.710:*'R 1►1161.L51rM6101'J CHILDREN AND YOUTH JUSTICE CENTER 602 587 980 WA NONPROFIT CORPORATION ACTIVE 300 ELLIOTT AVE W STE 360, SEATTLE, WA, 98119-4138, UNITED STATES 300 ELLIOTT AVE W STE 360, SEATTLE, WA, 98119-4138, UNITED STATES 02/28/2024 UNITED STATES, WASHINGTON 02/23/2006 tittps://ccfs. sos.wo.govWBusinessSearch/Busi nessl nfonnation Business Name: UBI Number: Business Type: Business Status: Principal Office Street Address: Principal Office Mailing Address: Expiration Date: jurisdiction: Formation/ Registration Date: 114 3129123, 12:27 PM PERPETUAL JUVENILE JUSTICE AND FOSTER CARE SYSTEMS REFORM R 20-4457248 REGISTERED AGENT INFORMATION CHILDREN AND YOUTH JUSTICE CENTER Corporations and Charities System Period of Duration: Inactive Date: Nature of Business: Charitable Corporation: Nonprofit EIN: Most Recent Gross Revenue is less than $500,000: Has Members: Public Benefit Designation: Host Home: Registered Agent Name: https://ccfs.sos.we.gov/#/BusinessSearch/Businesslnfonnafon 2/4 3/29/23, 12:21 PM Corporations and Charities System Street Address: 300 ELLIOTT AVE W STE 360, SEATTLE, WA, 98119-4138, UNITED STATES Mailing Address: 300 ELLIOTTAVE W STE 360, SEATTLE, WA, 98119-4138, UNITED STATES GOVERNORS Tilde Governors Type Entity Name Flrst Name Last Name GOVERNOR INDIVIDUAL BENJAMIN DANIELSON GOVERNOR INDIVIDUAL JON BRIDGE GOVERNOR INDIVIDUAL MARK MALENG GOVERNOR INDIVIDUAL RACHEL SOTTILE GOVERNOR INDIVIDUAL DAVINA INSLEE GOVERNOR INDIVIDUAL BARNEY VOEGTLEN GOVERNOR INDIVIDUAL SARAH SHAIKH GOVERNOR INDIVIDUAL DAN SHIH GOVC RNOR INDIVIDUAL EVAN SHAPIRO GOVERNOR INDIVIDUAL JEN TEMPLE GOVERNOR INDIVIDUAL MEGAN WELLS GOVERNOR INDIVIDUAL PEPPER AUSTIN https://ccfs.sos.wa.gov!#/BusinessSearch/Businaminformaton 314 3/29/23, 12:21 PM Corporations and Charities System Title Governors Type Entity Name First Name Last Name GOVERNOR INDIVIDUAL Back SHAWNA DEANE Filing History Name History Print Return to Business Search https://ccfs.sos.wa gov/#/BusinessSearch/Businesslnfonnation 414 StateFartr A M"I", STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS P x 291rlgror15 g�oomBa: IL 61702-2915 Addl Insured -Section II Only AT2 003560 3125 M-15-2585-FB3C F U CITY OF FEDERAL WAY 33325 8TH AVE S FEDERAL WAY WA 98003-6325 ��III�"�1111111111111�1�11�111�'�'Il�l'1�1111111��111��111���11� Office Policy Policy Number 98-GV-2627-0 Policy Period Effective Date Expiration Date 12 Months OCT 1 2023 OCT 1 2024 The policy period begins and ends at 12:01 am standard time atthe premises location. Named Insured CENTER FOR CHILDREN AND YOUTH JUSTICE Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: NON-PROFIT NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record $ 694.00 Prepared AUG 07 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 024333 294 Al Continued on Reverse Side of Page Page 1 of 7 N 530-606 a.2 05-31-2011 1olf3231c1 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coveragge A - Coverage B - Business Buildings Business Personal Personal Property Property 001 300 ELLIOTT AVE W STE 360 No Coverage $ 114,800 25% SEATTLE WA 98119-4138 *As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to inflation Coverage. SECTION I - INFLATION COVERAGE INDEX ES Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 305.1 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared AUG 07 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 024333 Continued on Next Page Page 2 of 7 StateFarm RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 MIL SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared AUG re 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission 024334 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 [InniAhori7pri RiicinaSc r:arri I Ica e c .,,,r% Valuable Papers And Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared AUG 07 2023 M Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includas copyrighted material of Insurance Services Office, Inc., with its permission 024334 Continued on Next Page Page 4 of 7 StateFarm m RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $5,000,000 General Aggregate $5,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4102 Businessowners Coverage Form FE-6999.3 "Terrorism Insurance Cov Notice CMP-4247.2 Amendatory Endorsement CMP-4779 Employers Liability CMP-4854 Lenders Loss Payable CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703.1 Utility Interruption Loss Incm CMP-4705.2 Loss of Income & Extra Expnse CMP-4746.1 Hired Auto Liability Prepared AUG re 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission 024335 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 CMP-4797 Addl Insd Controlling Interest CMP-4786 Addl Insd Owners Lessee Sched CMP-4860 Al Design Person Org CMP-4787 Waiver of Trans Rgt of Recov CMP-4572 Amendment of Premium Cond CMP-4561.4 Policy Endorsement FE-3661 Actual Cash Value Endorsement FD-6007 Inland Marine Attach Dec * New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared AUG 07 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 024335 Continued on Next Page Page 6 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FEDERAL WAY Policy Number 98-GV-2627-0 M NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and farms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage 0 forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Prepared AUG 07 2023 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission 024336 294 N Page 7 of 7 98-GV-2627-0 024336 STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS P 604 2915 Policy Number 98-GV-2627-0 13 oomington IL 61702-2915 Named Insured Policy Period Effective Date Expiration Date M-15-2585-FI33C F U 12 Months OCT 1 2023 OF 1 2024 The poll y period begins and ends at 12:01 am standard CENTER FOR CHILDREN AND YOUTH time attfie premises location. JUSTICE ATTACHING INLAND MARINE Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amountis included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8724 Inland Marine Conditions FE-8744.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared © AUG re 2023 Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 024337 530-666 a.2 05-31-2011 1o1f32320 98-GV-2627-0 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER FE-8744.1 Prepared AUG 07 2023 FD-6007 COVERAGE Inland Marine Computer Prop Loss of Income and Extra Expense LIMIT OF INSURANCE 25,000 25,000 DEDUCTIBLE AMOUNT OTHER LIMITS AND EXCLUSIONS MAYAPPLY - REFER TO YOUR POLICY © Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 500 ANNUAL PREMIUM Included Included 024337 530-606 a.2 05-31-2611 1o1F3233c1