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AG 23-273 - VALLEY CITIES COUNSELING AND CONSULTATIONRETURN TO: Kim Bachrach EXT: 2654 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: CD/Community Services 2. ORIGINATING STAFF PERSON: Kim Bachrach EXT: 2654 3. DATE REQ. BY: 12/13/2023 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 N HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL ❑ OTHER 5. PROJECT NAME: School Based Mental Health Program - ARPA Human Services Grant 6. NAME OF CONTRACTOR: Valley Cities Counseling and Consultation ADDRESS: 325 W Gowe Street Kent, WA 96032 TELEPHONE 206-408-5274 E_M.AIL. sali@valleycities.org FAX: SIGNATURE NAME: Shekh All TITLE 7. EXHIBITS AND ATTACHMENTS: A SCOPE, WORK OR SERVICES A COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE A ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: July 1, 2023 COMPLETION DATE: December 31,2026 9. TOTAL COMPENSATION $ 150,000.00 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLEEXPENSEAYES ONO IF YES, MAXIMUM DOLLAR AMOUNT: $150,000.00 IS SALES TAX OWED 10YES ONO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED 9 PURCHASING: PLEASE CHARGE TO: 001-1600-990-518-10-410 10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL/ DATE APPROVED ® PROJECT MANAGER SJB 12/4/2023 ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) LAW JE 12/13/23 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: 7/11/2023 COUNCIL APPROVAL DATE: 9/5/2023 12. CONTRACT SIGNATURE ROUTING M SENT TO VENDOR/CONTRACTOR DATE SENT: 12/14/2023 DATE REC'D: 1/5/2024 ❑ 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 art 9,DEPARTMENT l U-SrGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ❑g ❑ ASSIGNED AG# AG# 23-273 COMMENTS: 2/2017 CITY OF CITY HALL 33325 1 Feder F� d ra I Way8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com HUMAN SERVICES AGREEMENT FOR SCHOOL BASED MENTAL HEALTH PROGRAM This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Valley Cities Counseling and Consultation, 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: VALLEY CITIES COUNSELING AND CONSULTATION: Shekh Ali 325 W Gowe Street Kent, WA 98032 (206) 408-5182 (telephone) sal i The Parties agree as follows: CITY OF FEDERAL WAY: Kim Bachrach 33325 8th Ave. S. Federal Way, WA 98003-6325 (253) 835-2654 (telephone) 1. TERM. The term of this Agreement shall be for a period commencing on January 1, 2024, and terminating on December 31, 2026 ("Term"). Funding for the second, third, and fourth years 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 and a Unique Business Identifier (UBI) and a Unique Entity Identifier (UEI). 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. ARPA HUMAN SERVICES AGREEMENT - 1 - 8/2023 CITY OF CITY HALL �- 33325 8th Avenue South Federal Way, WA 98003-6325 Federal Way (253) 835-7000 www. cityoffederalway com 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 not less than quarterly basis, the Agency shall submit to the City an invoice for payment on a form provided by the City along with supporting documentation for costs claimed in the invoice and all reports as required by this Agreement. Payment shall be made by the City only after the Services have been performed and within forty-five (45) days after the City's receipt and approval of a complete and correct invoice, supporting documentation, 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 Community 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 Budget. The Agency shall apply the funds received from the City under this Agreement in accordance with the line item budget set forth in Exhibit B. The Agency shall request prior approval in writing from the City to revise the line item budget when the cumulative amount of transfers from or to a line item is expected to exceed ten percent (10%) of that line item. The Agency must provide supporting documents to fully explain the nature and purpose of the revision with each request for prior approval. All budget revision requests in excess of 10% of a line item amount shall be reviewed and approved or denied by the City in writing. 4.5 Non -Appropriation ofFunds. 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 ARPA HUMAN SERVICES AGREEMENT - 2 - 8/2023 CITY OF �L Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) $35-7000 www ciryoflederalway com 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. 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 ARPA HUMAN SERVICES AGREEMENT - 3 - 8/2023 CITY of CITY HALL Fe d e ra I Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www ciryofTederalway com 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 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. ARPA HUMAN SERVICES AGREEMENT - 4 - 8/2023 CITY OF �� Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway. com 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. ARPA HUMAN SERVICES AGREEMENT - 5 - 8/2023 CITY OF CITY HALL 4S Feder 8th Avenue South Federal Way, WA 98003-6325 Federa f Way (253) 835-7000 www.ciryoffederalway 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 maybe 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 maybe 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. 14. DEBARMENT AND SUSPENSION. 14.1 Debarment and Suspension. Contractor certifies that, except as noted below, the firm, association, or corporation or any person in a controlling capacity associated therewith or anyposition involving the administration of federal funds; is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; has not been suspended, debarred, voluntarily excluded or determined ineligible by any ARPA HUMAN SERVICES AGREEMENT - 6 - 8/2023 4 33325CITY OF CITY HALL �South A Federal t!1lay Feder 8th Avenue 8003 Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com federal agency within the past three (3) years; does not have a proposed debarment pending; and has not been indicted, convicted, or had a civil judgment rendered against said person, firm, association or corporation by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past three (3) years (Executive Orders 12549 and 12689, "Debarment and Suspension"). 14.2 Subcontract Approval Required. The Contractor shall not subcontract any portion of this Contract without City approval. Said approval must be sought in writing by the Contractor prior to executing a subcontract. The request for approval shall include Certification regarding Debarment and Suspension and verification of Labor and Industries eligibility. If the City approves in writing any subcontract, this Section shall nevertheless continue in full force and effect. Any subcontract without prior approval shall be void and not reimbursable under this contract. 14.3 Verification of Subcontractor's Eli ig hility. — 24 C.F.R. § 5. The Contractor shall maintain records documenting that the Contractor, all subcontractors, and consultants have been determined not to be currently debarred, suspended, denied participation, or declared ineligible to participate in federal government funded programs. [Signature page follows] ARPA HUMAN SERVICES AGREEMENT - 7 - 8/2023 CITY OF CITY HALL `� Fed a ra I Way Feder. Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cllyoffederalway. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: Jim FerrV14or or I DATE: I VALLEY CITIES COUNSELING AND CONSULTATION: By: Printed Name: Title: C&D DATE: a 2,Z Z O STATE OF WASHINGTON ) ATTEST: ph nie Courtney, CM gity Clerk APPROVED AS TO FORM: 9J.yan Call, CiVy Attorney ss. COUNTY OF Yam; ) On this day personally appeared before me to me known to be the 0 of Valley Cities Counseling and Consultation 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 Dn A day of 20 �, ',,,j11111 t�� Ioa M. ' P� t ic5� '''•,, Notary's signature ��•eXre h *0" , ���,,,..••....,�.,� ■.� Notary s printed n Notary Public in and for the State of Washington. rMy commission expires 12,14 VV. Offt f'�i►.. Exn�ros �a►► ARPA HUMAN SERVICES AGREEMENT - 8 - 8/2023 CITY OF Federal Pro'ect Services Summary CITY HALL ■ �{ ■�� 33325 8th Avenue South �v Federal Way, WA 98003-6325 (253) 835-7000 www cityo/federalway. com EXHIBIT A SERVICES The Agency shall provide school -based mental health treatment, including one on one and group therapy, to young people in the City of Federal Way. The Agency shall ensure that services provided with funding under this Agreement are made available and delivered 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 ARPA funds: 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total JAN. — APRIL — JULY — OCT. — MARCH JUNE SEPT. DEC. No. of unduplicated Federal Way persons assisted in 2024 8 8 0 8 24 No. of unduplicated Federal Way persons assisted in 2025 8 8 0 8 24 No. of unduplicated Federal Way persons assisted in 2026 8 8 0 8 24 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 NNE SEPT. DEC. 2024 Therapy sessions 64 64 35 64 227 2025 Therapy sessions 64 64 35 64 227 2026 ARPA HUMAN SERVICES AGREEMENT - 9 - 8/2023 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www ciryoffederalway com therapy sessions 64 64 35 1 64 227 Units of service are measured by the number of 30-90 minute one on one or group therapy sessions conducted. C. Outcome Measure(s) Outcome 1: Client reported treatment plan progess Outcome 1 Indicator: Self reported client survey every, 6 months or clinician observation Target: 50% of students 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. Records documenting that costs reimbursed with funding provided under this Scope are allowable. Such records include, but are not limited to: • for personnel costs, payroll for actual salary and fringe benefit costs. ■ for staff travel, documentation of mileage charges for private auto use must include: a) destination and starting location, and b) purpose of trip; and It for copy machine use, postage, telephone use, and office supplies when these costs are shared with other programs and no invoice is available, log sheets or annotated invoices. 9. Documentation of client address; residency verified via King County Parcel Viewer. 10. 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. ARPA HUMAN SERVICES AGREEMENT - 10 - 8/2023 CITY Way 41 CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com King County FY 2023 Income Limits Summary (Effective June 15, 2023) Median FY 2023 I� Income 0 Limit 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons County Category Extremely Low -30% $28,800 $32,900 $37,000 $41,100 $44,400 $47,700 $51,000 $54,300 Income Limits Very Low $146,500 -50% $47,950 $54,800 $61,650 $68,500 $74,000 $79,500 $84,950 $90,450 Income Limits Low 80% $70,650 $80,750 $90,850 $100,900 $109,000 $117,050 $125,150 $133,200 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 not less than quarterly. Required reports shall be submitted together on a form and format to be provided by the City. Required reports are the reimbursement request, service unit report with narrative, demographic data report, and outcomes reports. The Agency shall submit a Demographic Data Report not less than quarterly. The agency shall collect and retain the data requested on the City provided form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted not less than quarterly 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 and detailed above in this Exhibit A. Changes to the outcome(s) presented in the application must be approved by the City prior to implementation. The Agency shall report the results of its outcome measure(s) not less than quarterly on the Outcome Data Report 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 ARPA Funds. ARPA HUMAN SERVICES AGREEMENT - 11 - 8/2023 CITY OF Federal Proiect laud. -et 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 in accordance with the Line Item Budget Summary, detailed below. The total amount of compensation pursuant to this Agreement shall not exceed One Hundred Fifty Thousand and 00/100 Dollars ($150,000.00). A. City of Federal Way Funds 2024 2025 2026 City of Federal Way ARPA Funds: $50,000.00 $50,000.00 $50,000.00 Total City of Federal Way Funds: $50,000.00 1 $50,000.00 $50,000.00 B. Line Item Budget 2024 2025 2026 Personnel Services detail below $33 566.67 $33,566.67 $35,266.67 Other (specify): Direct Aid to Clients $16,433.33 $16,433.33 $14 733.33 Total City of Federal Way Funds: $50,000.00 $50,000.00 $50 000.00 C. Personnel Detail Position Title Position Full Time E uivalent Annual Salary and Benefits Annual ARPA Funds Clinician 1 FTE $84,500.00 $28,900.00 Total: $ $28 900.00 Reimbursement Requests with supporting documentation for the billing period, Service Unit Report, Demographics Data Report, and Outcomes Data Report shall be submitted no less frequently than quarterly and are due on the 15t' of the month after the reporting period ends, but not less than the following dates: 1 st Quarter: April 15; 2nd Quarter: July 15; 3rd Quarter: October 15; and 4th Quarter: Reimbursement Request, Service Unit Report, Demographic Data Report, and Outcomes Data Report forms are due January 6. The first quarter of reporting is the 1 st quarter of 2024. The first Reimbursement Requests, Service Unit Report forms, Demographics Data Report shall be submitted on April 15, or within ten (10) days of notice to proceed, whichever is later. Services are to be delivered throughout each contract year. If the Agency anticipates expenditures will exceed the estimated quarterly or monthly payments for the corresponding billing period, the Agency shall request prior approval in writing from the City. Estimated Quarterly Payments are $10,713.00. If the Agency submits monthly reports, Estimated Monthly Payments are $3,571.00. ARPA HUMAN SERVICES AGREEMENT - 12 - 8/2023 CITY OF CITY HALL Fe d e ra I Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com 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. Conditions of Funding The Agency agrees it will meet the specific funding conditions identified for the Agency and acknowledges payment to the Agency will not be made unless the funding conditions are met. If the Agency's performance is behind the agreed upon numbers stated above by June 2024, the City reserves the right to deny additional award of funds beyond 2024 and re -distribute any remaining funding that otherwise would have been available to the Agency to other agencies, programs, or projects as the City sees fit. ARPA HUMAN SERVICES AGREEMENT - 13 - 8/2023 CITY OF CITY HALL I � 33325 8th Avenue South ra aV Federal Way, WA 98003-6325 ,] (253) 835-7000 www cityoffederahvay com EXHIBIT C CERTIFICATE OF INSURANCE ARPA HUMAN SERVICES AGREEMENT - 14 - 8/2023 Client#: 709605 VALLECIT ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/22/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTAc' NAME: Deb Schluckebier USI Insurance Services NW HC PHONE 206 441-6300 610-362-8530 NC. No Ext : Q Nc 601 Union Street, Suite 1000 EErEss: deb.schluckebier@usi.corrl Seattle, WA 98101 206 441-6300 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Indemnity Insurance Co. 118058 INSURED Valley Cities Counseling & Consultation 325 W. Gowe Street Kent, WA 98032 INSURER B : INSURER C : INSURER D : INSURER E INSURER F : COVERAGES CERTIFICATE NIIMRFR- PF=VLCInN kit IMRPP- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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 NSR WVD POLICY NUMBER MMIDDY� MMIDDY/YEYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X CLAIMS -MADE OCCUR X PHPK2567123 06/30/2023 06/30/202 EACH OCCURRENCE $1 DDO 000 DAMAGE TO RENTED PREMISES Ea occurrence $100 000 X MED EXP (Any one person) $20 000 Retro: 01/28/1987 X WA Stop Gap PERSONAL & ADV INJURY $1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECT ❑ LOG GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $3,000,000 WA Stop Ga $$1M/$lM/$1M OTHER: A AUTOMOBILE LIABILITY PHPK2567123 06/30/2023 06/30/202 COM6INEOSINGLELIMIT Iaacciaant $1,000,000 X BODILY INJURY (Per person) ANY AUTO $ AUNSCHED TOS ONLY AUTOSULED $ BODILY INJURY (Per accident) X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY $ PROPERTY DAMAGE Per aczidenl A X UMBRELLA LIAB X OCCUR PHUB868552 36/30/2023 06130/2024 EACH OCCURRENCE s5,000,000 AGGREGATE $5 00O 000 EXCESS LIAB CLAIMS -MADE DED I X RETENT1oNM 000 PER OTH- $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below _ PHPK2567123 A Professional Liab 06/30/2023 06/30/2024 $1,000,000 Per Incident Claims -Made $3,000,000 Aggregate Retro: 01 /28/1987 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Federal Way is additional insured as respects their interest in the operations of the Named Insured. Evidence of Insurance for Professional Liability. CERTIFICATE HOLDER CANCELLATION City of Federal Way 33325 8th Ave S PO BOX 9718 Federal Way, WA 98063-0000 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 0 ACORD 25 (2016103) 1 of 1 #S40493431/M40480431 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SNKZR This page has been left blank intentionally. POLICY NUMBER: PHPK2567123 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Federal Way Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement applicable Limits of Declarations. shall not increase the Insurance shown in the CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Pagelo of 74 W"9 Request for Taxpayer Give Form to the Form (Rev. October2018) Identification Number and Certification requester. Do not laepartment of the Treasury send to the IRS. Internal Revenue Service ► Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). dame is required on this line; do not leave this line blank. Valley Cities Counseling and Consultation 2 Business name/disregarded entity name, if different from above M 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the p y 4 Exemptions codes I onlyto followinevn boxes. certain entities(not individuals; see a cp ❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate instructions on page 3): airA single -member LLC Exempt payee code (if any) ao .j�, '� ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► o` Note: Check the appropriate box fn the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting w LLC if the LLC is classified as a single -member LLC that Is disregarded from the owner unless the owner of the LLC Is LLC that Is disregarded code ( if any) a o another not from the owner for t1.S. 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. m 0 Other (see instructions)► Non -Profit Organization Under 501 (c)(3) (Applies to accounts mNnrahred wWde the U.S.) N 5 Address (number, street, and apt. or suite na.) See instructions. Requester's name and address (optional) cD 325 West Gowe Street 6 City, state, and ZIP code Kent, WA 98032 7 Llst account number(s) here (optional} Identification Number Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other _ IE entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. F-7-1 a0mnin"N"IMM Under penalties of perjury, I certify that: 1. 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 withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that 1 am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, Rem 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividend you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. %alyrl Signature of Here U.S. person ► Date ► tt] 7� ��, f 'Zf`17 `x, General instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to wwwJrs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number pT1N), adoption taxpayer Identification number (ATIN), or employer identification number (EIN), to report on an Information return the amount paid to you, or other amount reportable on an Information return, Examples of Information returns Include, but are not limited to, the following. • Form 1000ANT pnt®roat ®@mod or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only If you are a U.S. person Qncluding a resident alien), to provide your correct TIN, I( you (1p not evturri Funn W-9 W flu+ rr:griPSMr with a TIN, you might f i o --,,vb )ci ro bra:-kol: withholding. SoP) Whlt 10 backup withholding, !a 1,q Irf3 M W■9 (Ftrv,1®=g11t 6) Washington State Department of Revenue < Business Lookup License Information: New search Back to results Entity name: VALLEY CITIES COUNSELING AND CONSULTATION PUBLIC BENEFIT I Business VALLEY CITIES COUNSELING & CONSULTATION name: Entity type: Nonprofit Corporation UBI #: 171-004-959 Business ID: 001 Location ID: 0014 Location: Active Location address: 33405 8TH AVE S UNIT 200 FEDERAL WAY WA 98003-6639 Mailing address: 325 W GOWE ST KENT WA 98032 Excise tax and reseller permit status: Click here Secretary of State status: Click here Endorsements Endorsements held a License # Count Details Status Expiratior First issua View Additional Locations The Business Lookup information is updated nightly. Search date and time: 5/31/2023 7:12:01 PM Contact us How are we doing? Take our survey! Don't see what you expected? Check if your browser is supported VALLEY CITIES COUNSELING AND CONSULTATION Unique Entity ID Y2EDA95JBLC3 CAGE:'NCAGE 4HY35 Physical Address 325 W Gowe ST Kent, Washington 98032-5892, United States Reg istrotion Status Expiration Dote Active Registration Feb 9, 2024 Purpose of Registration Federal Assistance Awards Only MailingAddreSS 325 West Gowe ST. Kent, Washington 98032-5892, United States BUSINESS INFORMATION Business Name: VALLEY CITIES COUNSELING AND CONSULTATION PUBLIC BENEFIT UBI Number: 171 004 959 Business Type: WA NONPROFIT CORPORATION Business Status: ACTIVE Principal Office Street Address: 325 W GOWE ST, KENT, WA, 98032-5892, UNITED STATES Principal Office Mailing Address: 325 W GOWE ST, KENT, WA, 98032-5892, UNITED STATES Expiration Date: 08/31/2024 Jurisdiction: UNITED STATES, WASHINGTON Formation/ Registration Date: 08/13/1964 Period of Duration: PERPETUAL Inactive Date: Nature of Business: CHARITABLE, NON PROFIT BEHAVIORAL HEALTH Charitable Corporation: Rr Nonprofit EIN: 91-6063183 Most Recent Gross Revenue is less than $500,000: El Has Members: El Public Benefit Designation: R Host Home: REGISTERED AGENT INFORMATION Registered Agent Name: SHEKH ALI Street Address: 2704 I ST NE, AUBURN, WA, 98002-2411, UNITED STATES Mailing Address: 325 W GOWE ST, KENT, WA, 98032-5892, UNITED STATES GOVERNORS Title Governors Type Entity Name First Name Last Name GOVERNOR INDIVIDUAL DAN MCDOUGALL-TRAECY CITY OF CITY HALL Federal Way Feder l Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www crryoffederalway com City of Federal Way Human Services Contract for 2023-2026 ARPA Authorized Signatures for Invoices I authorize the following individuals to sign invoices and quarterly reports on behalf of: \ O0'kjEM C/ b e,S (Contracting Agency), for the following: 0 1 Authorizing Signature: (must be signed by person who signs the contract, generally, Executive Director) .H. {-�+ l� �i+ (Program Title). 4��, 41A . el-�j 'Liek 1� (Printed Name) (Signature Additional Authorized Signature: (Printed Name) P(ft?Jj4,4r4 i, C.Zid Additional Authorized Signature: (Signature) (Title) 44 6 Z. ( ate) r-C r-1 D 1 ru 6Cei (Title/) / 01 / 02 1 a o (Date) CA (Printed Name) (Title) (Signature) (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.