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AG 23-109 - CATHOLIC COMMUNITY SERVICES - VOLUNTEER SERVICESRETURN TO: Victoria Banks EXT: 2604 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: CD/CS 2. ORIGINATING STAFF PERSON: Patti Spaulding-Klewin EXT: 2651 3. DATE REQ. BY: 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT 11 HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION A CONTRACT AMENDMENT (AG#): AG 23-109 ❑ INTERLOCAL ❑ OTHER_ 5. PROJECT NAME: Volunteer Services 6. NAME OF CONTRACTOR: Catholic Community Services of Western Washington ADDRESS: 100 23rd Avenue South, Seattle, WA 98144 TELEPHONE 206-328-5308 E-MAIL: be1ha116ccsww'org FAX: SIGNATURE NAME: Bill Hallerman TITLE 7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES A PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: 01/01/2023 COMPLETION DATE:. 12/31/2024 9. TOTAL COMPENSATION $ 20.000.00 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES N NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ®YES 0 NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY RETAINAGE: RETAINAGE AMOUNT: 0 RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED ❑ PURCHASING: PLEASE CHARGE TO: 001-7300-083-562-10-410 10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED A PROJECT MANAGER SJB 08/17/2023 ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) 0 LAW JE 8/24/23 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: N/A COUNCIL APPROVAL DATE: 11/15/2022 12. CONTRACT SIGNATURE ROUTING A SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) INITIAL! DATE SIGNED DEPARTMENT Z Ml,�C rAW WI GNATORY (MAYOR OR DIRECTOR) a ❑ CITY CLERK 0 ❑ ASSIGNED AG# AG# COMMENTS: Some changes and comments included in the document to be addressed - JE 8/24/23 2/2017 CITY OF CITY HALL Aw% Fe d e ra y 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www crtyoffederaMay. com AMENDMENT NO. 1 TO HUMAN SERVICES AGREEMENT FOR VOLUNTEER SERVICES This Amendment ("Amendment No. I") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Catholic Community Services of Western Washington a Washington nonprofit corporation ("Contractor"). The City and Contractor (together "Parties"), for valuable consideration and by mutual consent of the Parties, agree to amend the original Agreement for Volunteer Services ("Agreement") dated effective March 10, 2023, as follows: 1. AMENDED SERVICES. The Services, as described in Exhibit A and as referenced by Section 2 of the Agreement, shall be amended to include, in addition to the Services and terms required under the original Agreement and any prior amendments thereto, those additional services described in Exhibit A-1 attached hereto and incorporated by this reference ("Additional Services"). 2. GENERAL PROVISIONS. All other terms and provisions of the Agreement, together with any prior amendments thereto, not modified by this Amendment, shall remain in full force and effect. Any and all acts done by either Party consistent with the authority of the Agreement, together with any prior amendments thereto, after the previous expiration date and prior to the effective date of this Amendment, are hereby ratified as having been performed under the Agreement, as modified by any prior amendments, as it existed prior to this Amendment. The provisions of Section 13 of the Agreement shall apply to and govern this Amendment. The Parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. [Signature page follows] AMENDMENT - 1 - 4/2023 ` CITY OF CITY HALL ��. Fe d e ra l Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cifyoffederafway. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: By: _ ( 7�-� J' rrell, Mayor DATE: G CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON: By: Printed Name: kill Title: V be TZ'<< Date: l 11 l -,.3 STATE OF WASHINGTON ) II ) ss. COUNTY OF ATTEST: q 6 - fiklwll�an - SkJpOanie Courtney, , City Clerk APPROVED AS TO FORM: 5J.yan Call, Ci Attorney On this day personally appeared before me _61L` PPr&1-fR-MA0-) to me known to be the Iit CE PkES! ZXAf' of Catholic Community Services of Western Washington 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 they were 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 rt� day of CSC 7�`1TJ rt.�� 2023. Notary's signature Notary taPubli D EDW M Public -MAHON Notary's printed name A-Tr.� - V-{� No State of Washington Notary Public in and for the State of Washington. Commission # 20101984 M commission exires � . My Comm. Expires Dec 19, 2027 y p AMENDMENT - 2 - 4/2023 CITY Of Federal Way EXHIBIT A-1 ADDITIONAL SERVICES CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederaMoy. com The Contractor shall do or provide the following in addition to Services in previous Exhibits: Project Services Summary The Agency shall provide volunteers to match with low-income elders and adults with chronic illnesses or disabilities to assist them in remaining independent in their homes in the City of Federal Way. Volunteers will assist with chore services and'in-home care to include companionship, light housework, or other simple tasks. The Agency shall ensure that services provided with funding under this Agreement are made available to Federal Way residents. Performance Measures B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: 1st Quarter Jan.— March 2nd Quarter April— June 3rd Quarter July— Sept. 4th Quarter Oct. — Dec. Total 2023 1. Chore Services/In-Home Care 74 75 74 75 298 2024 1. Chore Services/In-Home Care 74 75 74 75 298 Units of service are measured by the number of 60-minutes sessions provided to Federal Way residents. AMENDMENT - 3 - 4/2023 10/10/23, 8:05 AM Washington State Department of Revenue Washington State Department of Revenue A < Business Lookup License Information: New search Back to results Entity name: CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON Business name: CATHOLIC COMMUNITY SERVICES Entity type: Nonprofit Corporation LIBI #: 601-098-379 Business ID: 001 Location ID: 0020 Location: Active Location address: 33515 13TH PL S STE C FEDERAL WAY WA 98003-6358 Mailing address: 1001 NJ ST TACOMA WA 98403-2125 Excise tax and reseller permit status: Click here Secretary of State status: Click here Endorsements Endorsements held at this locatit License # Count Details Expiration date First issuance d: Federal Way Nonprofit 16-100168-kZ I Jul-31-2024 Jul-26-2016 Business Governing People May include governing people not registered with Secretary o/State Governing people HAGELIN, REV. BRADLEY REICHERT, MICHAEL Registered Trade Names Filter Registered trade names Status First issued CATHOLIC CHARITIES HOME CARE Active Nov-18-2019 CATHOLIC COMMUNITY SERVICES Active Jul-07-1992 CATHOLIC COMMUNITY SERVICES NORTHWEST Active Jul-07-1992 hftps://secure.dor.wa.gov/gteunauth/—/#3 1 /2 10/10/23, 8:05 AM Washington State Department of Revenue Registered trade names Status CATHOLIC COMMUNITY SERVICES SNOHOMISH Active CATHOLIC COMMUNITY SERVICES SOUTHWEST Active CATHOLIC COMMUNITY SERVICES SW Active CATHOLIC COMMUNITY SERVICES, KING COUNTY Active CCS Active CCS - NORTHWEST Active CCS - SOUTHWEST NATIVITY HOUSE Active Active View Additional Locations First issued Jul-07-1992 Jul-07-1992 Jul-14-2022 Jul-15-2019 Jul-07-1992 Jul-07-1992 Jul-07-1992 Aug-30-2017 The Business Lookup information is updated nightly. Search date and time: 10/10/2023 8:04:57 AM Contact us How are we doing? Take our survey! Don't see what you expected? Check if your browser is supported https://secure.dor.wa.gov/gteunauth/—,/#3 2/2 10/10/23, 8:06 AM Corporations and Charities System ;i ;r stand Charities Filing System BUSINESS INFORMATION Business Name: CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON UBI Number: 601 098 379 Business Type: WA NONPROFIT CORPORATION Business Status: ACTIVE Principal Office Street Address: 100 23RD AVE S, SEATTLE, WA, 98144-2302, UNITED STATES Principal Office Mailing Address: 100 23RD AVE S, SEATTLE, WA, 98144-2302, UNITED STATES Expiration Date: 07/31/2024 Jurisdiction: UNITED STATES, WASHINGTON Formation/ Registration Date: 07/25/1988 Period of Duration: PERPETUAL Inactive Date: Nature of Business: CHARITABLE, TO MINISTER TO THE NEEDS OF INDIVIDUALS AND FAMILIES IN WESTERN WASHINGTON Charitable Corporation: hftps://ccfs.sos.wa.gov/*/BusinessSearch/Businesslnformation 1/2 10110123, 8:06 AM Corporations and Charities System 91-1585652 El REGISTERED AGENT INFORMATION TIMOTHY MAY Nonprofit EIN: Most Recent Gross Revenue is less than $500,000: 100 23RD AVE S, SEATTLE, WA, 98144-2302, UNITED STATES 100 23RD AVE S, SEATTLE, WA, 98144-2302, UNITED STATES GOVERNORS Title GOVERNOR GOVERNOR Back Governors Type INDIVIDUAL INDIVIDUAL Entity Name Has Members: Public Benefit Designation: Host Home: Registered Agent Name: First Name MICHAEL REV, BRADLEY Street Address: Mailing Address: Last Name REICHERT HAGELIN Filing History Name History Print Return to Business Search https://ccfs.sos.wa.gov/*/BusinessSearch/Businessinformation 2/2 RETURN 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 ❑ REAL ESTATE DOCUMENT ❑ ORDINANCE ❑ CONTRACT AMENDMENT (AG#): ❑ OTHER . PROJECT NAME: Volunteer Services ON HUMAN SERVICES / CDBG ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ RESOLUTION ❑ INTERLOCAL NAME OF CONTRACTOR: Catholic Community Services of Western Washington ADDRESS: 100 23rd Avenue South, Seattle, WA 98144 TELEPHONE 206-328-5308 E-MAIL: billhall@ccsww.org FAX; SIGNATURE NAME: Bill HallermanTITLE EXHIBITS AND ATTACHMENTS: A SCOPE, WORK OR SERVICES 11 COMPENSATION A INSURANCE REQUIREMENTS/CERTIFICATE ® ALL OTHER REFERENCED EXHIBITS A PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS TERM: COMMENCEMENT DATE: 01101/2023 COMPLETION DATE: 12/31 /2024 TOTAL COMPENSATION $ 20,000.00 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE -ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES N NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED 10YES ONO IFYES, RETAINAGE: RETAINAGE AMOUNT: 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 ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) 2 LAW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED SJB 11/22/2022 KVA 11/28/22 1. COUNCILAPPROVAL(IF APPLICABLE) COMMITTEE APPROVAL DATE: N/A COUNCIL APPROVAL DATE: 11/15/2022 2. CONTRACT SIGNATURE ROUTING 9 SENT TO VENDOR/CONTRACTOR DATE SENT: 12/30/22 DATE REC'D: 4/7/23 ❑ 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.) IMTI / DATE SIGNED LA DEPARTMENT 1. GNATORY (MAYOR OR DIRECTOR) CITY CLERK C ❑ ASSIGNED AG# el —0-? �)"%' 1 ca ,OMMENTS: 1pproved Council budget 11/15/2022 CITY OF CITY HALL Fe d e ra Inlay 8th Avenue South Feder Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway. com HUMAN SERVICES AGREEMENT FOR VOLUNTEER SERVICES This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Catholic Community Services of Western 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: CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON: Bill Hallerman 100 23rd Ave S Seattle, WA 98144 206-328-5308 (telephone) The Parties agree as follows: CITY OF FEDERAL WAY: Patti Spaulding-Klewin 33325 8th Ave. S. Federal Way, WA 98003-6325 (253) 835-2651 (telephone) Patti. Spaulding-Klewin@cityo .com 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 Federal Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cltyoffederalway.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 -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. 5. INDEMNIFICATION. 5.1 Agency Indemnification. The Agency agrees to release, indemnify, defend,, and hold the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, taxes, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation expenses to or by any and all persons or entities, including, without limitation, their respective agents, licensees, or representatives arising from, resulting from, or in connection with this Agreement or the performance of this Agreement, except for that portion of the claims caused by the City's sole negligence. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Agency and the City, the Agency's liability hereunder shall be only to the extent of the Agency's negligence. Agency shall ensure that each subcontractor shall agree to defend and indemnify the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers to the extent and on the same terms and conditions as the Agency pursuant to this paragraph. The City's inspection or acceptance of any of Agency's work when completed shall not be grounds to avoid any of these covenants of indemnification. 5.2 Industrial Insurance Act Waiver. It is specifically and expressly understood that the Agency waives any immunity that may be granted to it under the Washington State industrial insurance act, Title 51 RCW, solely for the purposes of this indemnification. Agency's indemnification shall not be limited in any way by any limitation on the amount of damages, compensation or benefits payable to or by any third party under workers' compensation acts, disability benefit acts or any other benefits acts or programs. The Parties further acknowledge that they have mutually negotiated this waiver. 5.3 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 4SClrr OF CITY HALL Fe d e ra WayFeder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www ciiyoifederalway. 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 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. 10. INDEPENDENT CONTRACTOR. The Parties intend that the Agency shall be an independent contractor and that the HUMAN SERVICES AGREEMENT - 3 - 10/2022 CITY OF �. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www ciryoffederalway. 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 EAI[PLQYER. 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 CiiY OF CITY HALL "'S Fe d a ra 11�Vay Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cltyoffederalway 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 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: ATTEST: , CMC, City Clerk 1•_ell, DATE: f: D- Y Ryan Call, City Atta ey CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON: By: Printed Name: ` to.r.�— Title: lJ`cse —Q✓ DATE: ��/ 23 STATE OF WASHINGTON ) ss. COUNTY OF rl O this day personally appeared before me// to me known to be the ! U � $1 �� of e'f Zt)141 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 "/ Y"— day of 202�3 �1�/IIRfR/AA. ##t y C 00""'. Notary's signature (V c�—J e'`�$$1i�''•'s} Notary's printed name • s NOTARY Notary Public in and for the State of Washington. ., a.— My commission expires P IC UBLI 6 . ,. HUMAN SERVICES AGREEMENT - 6 - 10/2022 4! CITY OF Federal Pro'ect Services Summar CITY HALL Way g�� 33325 8th Avenue South �V11�1■ Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com EXHIBIT A SERVICES The Agency shall provide volunteers to match with low-income elders and adults with chronic illnesses or disabilities to assist them in remaining independent in their homes in the City of Federal Way. Volunteers will assist with chore services and in -home care to include companionship, light housework, or other simple tasks. The Agency shall ensure that services provided with funding under this Agreement are made available to Federal Way residents. Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of Federal Way residents with Human Services funds: 1st 2nd 3rd 4tn Quarter Quarter Quarter Quarter Total JAN. — APRIL — JULY — OCT. — MARCH JUNE SEPT. DEC. No. of unduplicated Federal Way persons assisted in 2023 3 3 4 4 14 No. of unduplicated Federal Way persons assisted in 2024 3 3 4 4 14 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: 1st 2nd 3rd 4tn Quarter Quarter Quarter Quarter Total JAN. — APRIL — JULY — OCT. — MARCH JUNE SEPT. DEC. 2023 1. Chore Services/In-Home Care 70 70 70 70 280 2024 1. Chore Services/In-Home Care 70 70 70 70 280 Units of service are measured by the number of 60-minutes sessions. HUMAN SERVICES AGREEMENT - 7 - 10/2022 CITY OF vm�'� Federal Way C. Outcome Measure(s) Outcome 1: Participants feel more able to perform routine tasks Indicator: Surveys show improvement in performing routine tasks Target: 75% Outcome 2: Individuals and/or families will improve health Indicator: Improved health indicators on standardized survey Target: 75% Records CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway. com 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 Afto ,S�� Federal CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cayoffederal way 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- Scbedule The Agency shall collect and report client information to the City quarterly and annually on a Service Unit Report to be provided by the City in the format requested by the City. The Agency shall submit an Annual Demographic Data Report. The agency shall collect and retain the data requested on this form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted annually no later than January 15 in the format requested by the City. The Agency shall implement and track at least one measurable outcome for the program as presented in the application. Changes to the outcome presented in the application must be approved by the City prior to implementation. The Agency shall report the results of its outcome measure(s) annually on the Annual Outcome Data Report to be submitted by January 15 in the format requested by the City. Public Information In all news releases and other public notices related to projects funded under this Agreement, the Agency will include information identifying the source of funds as the City of Federal Way Human Services General Fund Program. HUMAN SERVICES AGREEMENT - 9 - 10/2022 CITY OF Federal Project Budget CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cltyoflederalway. 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 Twenty Thousand and 00/100 Dollars ($20,000.00). City of Federal Way Funds 2023 2024 City of Federal Way General Fund: $10,000.00 $10,000.00 Total City of Federal Way Funds: $10,000.00 $10,000.00 Reimbursement Requests and Service Unit Report forms shall be submitted no less frequently than quarterly and are due on the following dates: 1 st Quarter: April 15 or within 10 days of notice to proceed, whichever is later; 2nd Quarter: July 15; 3rd Quarter: October 15; and 4th Quarter: Final Reimbursement Request and Service Unit Report forms due January 8; Demographic Data Report and Annual Outcome Data Report due January 15. The Agency shall submit payment requests in the format requested by the City. Payment requests shall include a copy of the Service Unit Report. Estimated Quarterly Payments: 2023 1st Qtr $2,500.00 2nd Qtr $2,500.00 3rd Qtr $2,500.00 4th Qtr $2,500.00 2024 1 st Qtr $2,500.00 2nd Qtr $2,500.00 3rd Qtr $2,500.00 4th Qtr $2,500.00 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 CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON Management Protocol 10.0 Catholic Community Services of Western Washington Updated August 1, 2021 The CCSWW Management Protocol has been established in accordance with the By -Laws and Articles of Incorporation of Catholic Community Services of Western Washington (CCS) to ensure the proper function of Catholic Community Services of Western Washington -and the due authorization of all actions taken by employees for the benefit of, and in the name of, the Corporation. Corporate Officers and others designated by the CCSWW President (designees*) are responsible for ensuring that all business transactions within their agency/system meet all the requirements outlined in this protocol. Corporate Officers and designees will receive a letter authorizing their actions/responsibilities under this protocol. MOU — Memorandum of Understanding MOA — Memorandum of Agreement The following individuals are named by position in the Management Protocol: Michael Reichert ....................... CCSWW President Irene Ward ........ _.._ __._..................... CCSWW Executive Vice President and Chief of Operations Tim May ................................ _ ___ CCSWW Vice President and Chief Financial Officer Kim Williams_________________________________ CCSWW Vice President and Director of Human Resources Jean Strafford ....................................... CCSWW Chief Accounting Officer Kevin Lovejoy_....................................... CCSWW Assistant Chief of Operations Kristin Tan............................................. CCSWW In -House Legal Counsel Rosemary Zilmer ................... .............. CCSWW Vice President of Fund Development Agency/System Directors Mike Curry ........................................... CCSWW Agency Director Bill Hallerman_____________________________ _CCSWW Vice President and Agency Director Peter Nazzal -------------------- __�_ ____ CCSWW Vice President and Director of Long Term Care System Will Rice _ CCSWW Vice President and Agency Director Mary Stone Smith____ ... ..... __....... _______ CCSWW Vice President and Director of Family Behavioral Health System The implementation goals of the protocol are highlighted below: 1. Ensure that actions taken in the name of CCS are in compliance with our stated mission and objectives and the teachings of the Roman Catholic Church as interpreted and proclaimed by the Roman Catholic Archbishop of Seattle; 2. Ensure that CCS's existence and benefits are maintained; Page 1 of 18 Arthur J. Gallagher Risk Management Services, LLC 777 108th Avenue NE, Suite 200 Bellevue WA 98004 MDG2023 00061701 01 III City x� City of Federal Way 33325 8th Ave. S. Federal Way, WA 98003 We are providing you with a Certificate of Insurance confirming our client's coverage. Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving digital copies of certificates via e-mail in the future. Or, do you no longer require a certificate of insurance for our client? Please contact us at COI.UpdateMyEmail@AJG.com and provide the following information for processing- 1. Confirmation that a certificate of insurance is no longer required; or 2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery 3. Insured Code: CORPOFT-01 4. This Certificate Number: 526363498 To learn more about the Insurance and Risk Management Services offered by Gallagher, please visit us at www.ajg.com/us/about-us/how-we-work/core-360. Gallagher does not share your e-mail as detailed in our privacy policy found at https:// www.ajg.com/us/privacy-policy/. `4CQ CERTIFICATE OF LIABILITY INSURANCE 7715/2023 TE(MWDD/VYYY) 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: It 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 endorsementfst. PRODUCER Arthur J. Gallagher Risk Management Services, LLC 777 108th Ave NE #200 Bellevue WA 98004 INSURED CORPOFr-01 Co oration of the Catholic Archbishop of Seattle Catholic Community Services of Western Washington 100 23rd Ave. S Seattle WA 98144 GIAUT -- Ahlai Narcisse PUNITON Nf�k>sl1= _ . Arc N • 425-58fi-1028 _ EORHL Ahlai Narcisse ajg,com INSURERS AFFORINNGCOVERAGE _ RAIC0 _ INSURER A: Underwriters at Lf d's London 15792 INSURERS: Old Republic Union Insurance Comeany 31143 INSURER C : Zurich American Insurance Company 16535 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:526363498 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. ;LTR TYPE OF INSURANCE INSD ADDL WVDJ POLICY NUMBER MMfODNYYVI fMP9k&RYXVP`1 LIMITS A X COMMERCIAL GENERAL LIABILITY Y BP1023023 7/1/2023 7/1/2024 EACH OCCURRENCE S11000,000 PREMISES tgq q=rRtNQ1 $ 1,000,000 CLAIMS -MADE FKOCCUR X Lkuor Liability - MED EXP (Any oneperson) $ Nil PERSONAL & ADV INJURY $ 1.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: X POLICYD M LOC GENERALAGGREGATE $1,000,000 PRODUCTS - COMP/OP AGG $1,000.000 $ OTHER: A AUTOMOBILE X LIABILITY ANY AUTO BP1023023 7/1/2023 7/1/2024 EBMBIN£ Si MOLEIJM $1,000,000 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLYPXAUTOS I BODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLYAUTOS ONLY PR FAERTYDAMAGE (Per acciden0 $ B UMBRELLA LIAR ��X OCCUR 8223000785428 7/112021 7/1/2024 EACH OCCURRENCE $ 5,000,000 X $5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTIONS f $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORIPARTNERIEXECUTIVE OFFICEFUMEMEIEREXCLUDED? N/A EWS8741411-02 7/1/2023 711/2024 X OTH- STATUTE EA E.L. EACH ACCIDENT $ 1,000.000 E.L. DISEASE - EA EMPLOYEE $ 1.000,000 (Mandatary io NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 I 0ESCRiPVDN OF OPERATIONS! LOCATIONS! 4EHfCLES (ACORD 101, Add11fonal Remarks Schadule, may be attached if mom space Is required) Limits shown are inclusive of defense and insured retention. Coverage for Additional Insureds IS restricted to the amount of insurance required by contract or permit. Retention under policy #BP1023023 (A XV, Non -Admitted) is $500,000 for Liability. The applicable location maintenance deductible that applies to this. Certificate Is $0 for Liability. Coverage only extends for maims directly arising out of the Human Services Agreement for Federal Way Day Center between Catholic Community Services and the City of Federal Way. Cityy of Federal Way 33325 Sth Ave. S. Federal Way WA 98003 L,fAN%.LLLA I IVIY 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 r� U 1958-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED ASSURED: Corporation of Catholic Archbishop of Seattle Policy Number: BP1023023 Effective Date: July, 01 2023 Endorsement No. 14 CERTIFICATES OF INSURANCE ENDORSEMENT * r*L CERTIFICATES OF INSURANCE It is hereby understood and agreed that holders of Certificates of Insurance issued against this Policy that are shown as Additional ASSUREDS are added to this Policy pursuant to the terms of this Policy as described in GENERAL POLICY DEFINITION 1. Where Certificates of Insurance are requested for Additional ASSUREDS who do not fall within GENERAL POLICY DEFINITION 1, prior agreement of Underwriters and subsequent endorsement of this Policy is required GENERAL POLICY DEFINITION 1. ASSURED is stated as follows ASSURED means not only the NAMED ASSURED as stated on the Declaration Page, but also includes any past, present or future: agencies, subsidiaries, affiliates, institutions and societies owned by or operated by the NAMED ASSURED, officials, members of boards or commissions, trustees, directors, officers, partners, volunteers, student teachers, or employees of the NAMED ASSURED while acting within the scope of their duties as such, and any person, organization, trustee or estate to whom the NAMED ASSURED is obligated by virtue of a written contract or agreement to provide insurance such as is offered by this policy, but only in respect of operations by or on behalf of the NAMED ASSURED. GENERAL POLICY CONDITION 20. WAIVER OF SUBROGATION is stated as follows — 20. WAIVER OF SUBROGATION: This policy shall not be invalidated if the ASSURED, by written agreement, has waived or shall waive its right of recovery from any party for loss or damage covered hereunder; provided that any such waiver is made prior to the occurrence of said loss or damage. MORTGAGORS, LOSS PAYEES & LENDER LOSS PAYEES: It is understood and agreed that GENERAL POLICY CONDITION 12. of this policy is deleted and replaced with the following: 12. MORTGAGORS, CREDITORS & LOSS PAYEES: Where required by written contract, the interest of any mortgagor, creditor or loss payee on property covered by this policy is included as if a separate endorsement were attached hereto to the extent of the amount Except as amended in this Endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this Endorsement is attached. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED ASSURED: Corporation of Catholic Archbishop of Seattle Policy Number: BP1023023 Effective Date: July 01, 2023 of mortgage, loan or interest in property held by the ASSURED as of the date of loss subject to the limits of liability set forth in this policy. PRIMARY NON-CONTRIBUTORY: It is also agreed that, only where required by written contract between the NAMED ASSURED and the Certificate holder, this insurance shall be considered primary to any insurance held by the Certificate holder and theirs shall be excess. MUNICIPALITY PERMITS: Further, where required by written contract or evidenced in the insurance requirements of a permit issued by a municipality at the request of the NAMED ASSURED, that municipality shall be added to this policy as an Additional ASSURED but only as respects liabilities arising out of the subject matter of the written contract or issued permit and then only for liabilities arising from actions by or on behalf of the NAMED ASSURED. Except as amended in this Endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this Endorsement is attached. E DATE (MMIDD/YYYY) ACCAR"_ n CERTIFICATE OF LIABILITY INSURANCE 7/5/2022 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 CONTACT NAME: Stephen Emi Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 777 108th Ave NE, #200 Nu EKtL 425-454-3386 a+c Noy 425-451-3716 Bellevue WA 98004 Au ss; Ste hen EM a' .com INSURED Corporation of the Catholic Archbishop of Seattle Catholic Community Services of Western Washington 100 23rd Ave. S Seattle WA 98144 INSU ,FFORDING COVERAGE NAIC # lO d's London 15792 on Insurance Company 31143 Insurance COmoanv 16535 rnvcoAr_cc rCDTII=U ATC AIIIIIARFR•9A0AF70Ri RFVISION NIIMRFR- 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. fNSR I LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMI POLICY EXP YYY LIMITS A X COMMERCIAL GENERAL LIABILITY BP1023022 7/1/2022 7/1/2023 EACH OCCURRENCE $1,000.000 _ CLAIMS -MADE 1_V_7 OCCUR EREYQgg LLa occurrence $ 1,000,000 MED EXP An one person) s Nil PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP/OP AGG $ 1,000 000 X POLICY P LOC $ OTHER: A AUTOMOBILE LIABILITY BP1023022 7/1/2022 7/1/2023 (Eaaaddert rrL) LE IT Ea xl $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Par accident $ $ B UMBRELLA LIAB I X OCCUR 8222000785428 7/1/2022 7/1/2023 EACH OCCURRENCE S5,000,000 AGGREGATE X EXCESS LIAB CLAIMS -MADE $ 5,000,000 DED I I RETENTIONS S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNER/EXECUTIVE EWS8741411-01 7/1/2022 7/1/2023 X PER OT1-1- TT, ER _ $ 1,000,000 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE OFFICER/MEMBEREXCLUDED? ❑ (Mandatory in NH) N /A S 1,000,000 E.L DISEASE - POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below $ 1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Limits shown are inclusive of defense and insured retention. Coverage for Ad0onal Insureds is restricted to the amount of insurance required by contract or permit. Retention under policy #BP1023022 (A XV, NDn-Admitted) is $250,000 tar Liability. The appticable location maintenance deductible that applies to this Certificate is $0 for Liability. Coverage only extends for daims directly arising out of Catholic Community Services Contract Agreements with The City of Federal Way for Volunteer Chore Services and Emergency Assistance, for the term of the certificate. r'FRTIFIrOTF Hr1I Dr-P CANCELLATION City of Federal Way 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 U 1988-2015 ACUKD GUKPUKA I IUN. All rights reservea. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED ASSURED: Corporation of Catholic Archbishop of Seattle Policy Number: BP1023021 Effective Date: July 01, 2021 Authority Ref No: B0356JA281 N21 of mortgage, loan or interest in property held by the ASSURED as of the date of loss subject to the limits of liability set forth in this policy. PRIMARY NON-CONTRIBUTORY: It is also agreed that, only where required by written contract between the NAMED ASSURED and the Certificate holder, this insurance shall be considered primary to any insurance held by the Certificate holder and theirs shall be excess. MUNICIPALITY PERMITS: Further, where required by written contract or evidenced in the insurance requirements of a permit issued by a municipality at the request of the NAMED ASSURED, that municipality shall be added to this policy as an Additional ASSURED but only as respects liabilities arising out of the subject matter of the written contract or issued permit and then only for liabilities arising from actions by or on behalf of the NAMED ASSURED. Except as amended in this Endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this Endorsement is attached. CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www.cltyoffederaAaay corn 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: the following: Authorizing Signature: (must be signed by person who signs the contract, generally, Executive Director) Additional Authorized Signature: Additional Authorized Signature: (Printed Name) (Contracting Agency), for (Program Title). (Title) (Signature) (Date) r ti SRO u.� (Printed Name) (Title) (Signature) Jonathan Prociv 10 a3 (Date) Program Manager ;,(Pl.'nted Na } (Title) 4/5/23 gnature) (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. 10/13/22, 8:52 AM Corporations and Charities System if �ess`Ar�?A*?,.�and Charities Filing System BUSINESS INFORMATION Business Name: CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON UBI Number: 601 098 379 Business Type: WA NONPROFIT CORPORATION Business Status: ACTIVE Principal Office Street Address: 100 23RD AVE S, SEATTLE, WA, 98144-2302, UNITED STATES Principal Office Mailing Address: 100 23RD AVE S, SEATTLE, WA, 98144-2302, UNITED STATES Expiration Date: 07/31/2023 Jurisdiction: UNITED STATES, WASHINGTON Formation/ Registration Date: 07/25/1988 Period of Duration: PERPETUAL Inactive Date: Nature of Business: CHARITABLE, TO MINISTER TO THE NEEDS OF INDIVIDUALS AND FAMILIES IN WESTERN WASHINGTON Charitable Corporation: 0 https://ccfs.sos.wa.gov/#/BusinessSearch/BusinessInformation 1 /2 10/13M, 8:52 AM Corporations and Charities System FEIN Number: GSIl�i i•� �•7:'ii� REGISTERED AGENT INFORMATION TIMOTHY MAY 100 23RD AVE S, SEATTLE, WA, 98144-2302, UNITED STATES 100 23RD AVE 5, SEATTLE, WA, 98144-2302, UNITED STATES GOVERNORS Title Governors Type GOVERNOR INDIVIDUAL GOVERNOR INDIVIDUAL Bark Gross Revenue exceed $500,000: Has Members: Public Benefit Designation: Host Home: Registered Agent Name: Entity Name First Name MICHAEL REV. BRADLEY Street Address: Mailing Address: Last Name REICHERT HAGELIN Filing History Name History Print Return to Business Search https://ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation 212 4/7/23, 1:18 PM Washington State Department of Revenue Washington State Department of Revenue < Business Lookup License Information: Entity name: CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON Business name: CATHOLIC COMMUNITY SERVICES Entity type: Nonprofit Corporation UBI #: 601-098-379 Business ID: 001 Location ID: 0020 Location: Active Location address: 33515 13TH PL S STE C FEDERAL WAY WA 98003-6358 Mailing address: 1001 NJ ST TACOMA WA 98403-2125 New search Back to results hftps://secure.dor.wa.gov/gteunauth/—/#5 1/4 4/7/23, 1:18 PM Excise tax and reseller permit status: Secretary of State status: Endorsements Endorsements held at this to License # Count Federal Way Nonprofit 16-100168-0( Business Washington State Department of Revenue Click here Click here Details Status Expiration da• First issuance Active Jul-31-2023 Jul-26-2016 Governing People May include governing people not registered with Secretary of State Governing people HAGELIN, REV. BRADLEY REICHERT, MICHAEL Registered Trade Names Filter Kegistered trace names Status First issued CATHOLIC CHARITIES HOME CARE Active Nov-18-2019 CATHOLIC COMMUNITY SERVICES Active Jul-07-1992 hftps://secure.dor.wa.gov/gteunauth/—/#5 2/4 4/7/23, 1:18 PM Washington State Department of Revenue Registered trade names Status CATHOLIC COMMUNITY SERVICES Active NORTHWEST CATHOLIC COMMUNITY SERVICES Active SNOHOMISH CATHOLIC COMMUNITY SERVICES Active SOUTHWEST CATHOLIC COMMUNITY SERVICES SW Active CATHOLIC COMMUNITY SERVICES, KING Active COUNTY CCS Active CCS - NORTHWEST Active CCS - SOUTHWEST Active CCS SW-LONGVIEW Active NATIVITY HOUSE Active View Additional Locations First issued Jul-07-1992 Jul-07-1992 Jul-07-1992 Jul-14-2022 Jul-15-2019 Jul-07-1992 Jul-07-1992 Jul-07-1992 Jul-15-2022 Aug-30-2017 https://secure.dor.wa.gov/gteunauth/_/#5 3/4 4/7/23. 1:18 PM Washington State Department of Revenue The Business Lookup information is updated nightly. Search date and time: 4/7/2023 1:18:05 PM Contact us How are we doing? Take our survey! Don't see what you expected? Check if your browser is supported hftps://secure.dor.wa.gov/gteunauth/—/#5 4/4