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AG 16-099I I RETURN TO: Sarah Bridgeford EXT: 2651 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: COMMUNITY DEVELOPMENT /COMMUNITY SERVICES 2. ORIGINATING STAFF PERSON: SARAH BRIDGEFORD 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E. ❑ PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT b REAL ESTATE DOCUMENT ❑ ORDINANCE ❑ CONTRACT AMENDMENT (AG #):_16 -099 _ ❑ OTHER EXT: 2651 3. DATE REQ. BY: 12/10/16 G., RFB, RFP, RFQ) ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ MAINTENANCE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ RESOLUTION ❑ INTERLOCAL 5. PROJECT NAME: PARKVIEW HOMES XII ACQUISITION OF PERMANENT HOUSING 6. NAME OF CONTRACTOR: PARKVIEW SERVICES ADDRESS: 17544 MIDVALE AVE, LL, SHORELINE, WA 98133 TELEPHONE 206 -542 -6610 E -MAIL: MARCAPARKVIEWSERVICES.ORG FAX: SIGNATURE NAME: MARC COTE TITLE EXECUTIVE DIRECTOR 7. EXHIBITS AND ATTACHMENTS: I 1 SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS /CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS 8. TERM: COMMENCEMENT DATE: JANUARY 1, 2016 COMPLETION DATE: JUNE 30, 2017 9. TOTAL COMPENSATION $ $60,000 (odd 410,0x) (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATT CH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ CITY ❑ PURCHASING: PLEASE CHARGE TO: 119 - 7300 - 963 - 594 -41 -410 10. DOCUMENT /CONTRACT REVIEW ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW 11. COUNCILAPPROVAL(IFAPPLICABLE) 12. CONTRACT SIGNATURE ROUTING SENT TO VENDOR/CONTRACTOR DATE SENT: /, DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICA E, LICENSES, EXHIBITS INITIAL / DAM S GNED ZJ�L 1NIR PAID BY: ❑CONTRACTOR ❑ / DATE ' VIEWED INITIAL / DATE APPROVED j� illa% -., COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: ❑ LAW DEPARTMENT /p ❑ /CHIEF OF STAFF SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# ❑ SIGNED COPY RETURNED COMMENTS: 1 11 AG - itrocict k DATE SENT: 01- 25 - n- 11/9 Vecleral Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway.. com AMENDMENT NO. 1 TO CDBG CAPITAL PROJECTS CONTRACT FOR ACQUISITION OF PERMANENT HOUSING This Amendment ( "Amendment No. 1 ") is made between the City of Federal Way, a Washington municipal corporation ( "City "), and Parkview Services, a Washington non - profit organization ( "Contractor "). The City and Contractor (together "Parties "), for valuable consideration and by mutual consent of the Parties, agree to amend the original Agreement for Acquisition of Permanent Housing ( "Agreement ") dated effective January 1, 2016, as follows: 1. AMENDED COMPENSATION. The amount of compensation, as referenced by Section 4 of the Agreement, shall be amended to change the total compensation the City shall pay the Contractor and the rate or method of payment, as delineated in Exhibit B -1, attached hereto and incorporated by this reference. The Contractor agrees that any hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate for the Term. Except as otherwise provided in an attached Exhibit, the Contractor shall be solely responsible for the payment of any taxes imposed by any lawful jurisdiction as a result of the performance and payment of this Agreement. 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. AMENDMENT [Signature page follows] - 1 1/2015 Priecferal 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 By: DATE: I 4'Z O 7 PARKVIEW SERVICES By: i/1 a... Printed Name: Marc Cote Title: Executive Director DATE: 01/03/d-0 / 7— STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) ATTEST: h. ie Courtney, CMC, Clerk APPROVED AS TO FORM: Acting City Attorney, J. Ryan Call On this day personally appeared before me Marc Cote, to me known to be the Exeutive Director of Parkview Services 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 ,3rd day of Jar 1G(.4. U4 v Lf , 20a Notary's signature 4/ /kg / U/ P Notary's printed name /id Notary P�iblic in and for the State of Washington. My commission expires MONIQUE PATZER STATE OF WASHINGTON NOTARY PUBLIC MY COMMISSION EXPIRES 10 -21 -17 AMENDMENT 2 1/2015 CITY OF Federal Way EXHIBIT B -1 ADDITIONAL COMPENSATION CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway. com 1. Total Compensation: In return for the Services, the City shall pay the Contractor an additional amount not to exceed Ten Thousand and 00 /100 Dollars ($10,000.00). The total amount payable to Contractor pursuant to the original Agreement, all previous Amendments, and this Amendment shall be an amount not to exceed Sixty Thousand and 00 /100 Dollars ($60,000.00). 2. Method of Compensation: The City shall reimburse the Agency for satisfactory completion of the requirements specified in the Contract, payable in the following manner: the sum, not to exceed Sixty Thousand and 00 /100 Dollars ($60,000.00), shall be paid upon submission of invoices and supporting documentation by the Agency. Funds disbursed for acquisition shall not exceed Sixty Thousand and 00 /100 Dollars ($60,000.00) and shall be fully invoiced no later than the End Date. AMENDMENT 3 1/2015 • ARKSERV ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/03/2016 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 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 Propel Insurance Seattle Commercial Insurance 925 4th Ave, Suite 3200 Seattle, WA 98104 CONTACT Kira Preston NAME: PHONE 800 499 -0933 FAx 866 577 -1326 (A/C, No, Ext): I (A/C, No): E-MAIL ESS: kira• preston @propelinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Philadelphia Indemnity Ins Comp 18058 INSURED Parkview Services 17544 Midvale Avenue N Suite LL Shoreline, WA 98133 -3992 INSURER B: PHPK1525197 INSURER C: 08/01/2017 INSURER D : $1,000,000 INSURER E: PREMISES (EaEaxurrence) INSURER F : $5,000 $1 ,000,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MDD/YYYY) M/ POLICY EXP (MM/DD/YYYY) UMW A GENERAL X UABILITY COMMERCIAL GENERAL LIABILITY X PHPK1525197 08/01/2016 08/01/2017 EACH OCCURRENCE $1,000,000 $100,000 PREMISES (EaEaxurrence) MED EXP (Any one person) $5,000 $1 ,000,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY GENERAL AGGREGATE $3,000,000 PRODUCTS - COMP/OP AGO $3,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES J RE T PER: X LOC A $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS ^ X X SCHEDULED AUTOS NO - AUTN OS OWNED PHPK1525197 08/01/2016 08/01/2017 (Ea accidentSINGLE LIMIT $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X PHUB549522 08/01/2016 08/01/2017 EACH OCCURRENCE $1,000,000 $1,000,000 AGGREGATE $ DED X RETENTION $10000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 0 yes, describe under DESCRIPTION OF OPERATIONS below Y/N N/A PHPK1525197 WA STOP GAP ONLY 08/01/2016 08/01/2017 w RYUMITS OTH- ER E.L. EACH ACCIDENT $1,000,000 $1 ,000,000 $1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 0 more space is required) Loc# 59 - 33402 33rd Place SW; Federal Way, WA Building # 1 33402 33rd Place SW CERTIFICATE HOLDER CANCELLATION City of Federal Way, Its Officials, Employees, and Volunteers PO Box 9718 Federal Way, WA 98063 -9718 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 • 7r1-04A- ACORD 25 (2010/05) 1 of 1 #S2323655/M2311166 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KKPOO This page has been left blank intentionally. POLICY NUMBER: PHPK1525197 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 Its Officials, Employees, and Volunteers 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. CG 20 26 0413 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 shall not increase the applicable Limits of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 9 I I RETURN TO: Cynthia Ricks - Maccotan EXT: 2651 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: COMMUNITY DEVELOPMENT /COMMUNITY SERVICES 2. ORIGINATING STAFF PERSON: _CYNTHIA RICKS - MACCOTAN EXT: 2651 3. DATE REQ. BY: 5/25/16 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ REAL ESTATE DOCUMENT ❑ ORDINANCE ❑ CONTRACT AMENDMENT (AG #): ❑ OTHER ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ MAINTENANCE AGREEMENT 0 HUMAN SERVICES / CDBG ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ RESOLUTION ❑ INTERLOCAL 5. PROJECT NAME: PARKVIEW HOMES XII ACQUISITION OF PERMANENT HOUSING 6. NAME OF CONTRACTOR: PARKVIEW SERVICES ADDRESS: 17544 MIDVALE AVE, LL,_SHORELINE, WA 98133 TELEPHONE 206 -542 -6610 E -MAIL: MARC(2 PARKVIEWSERVICES.ORG FAX: SIGNATURE NAME: MARC COTE TITLE EXECUTIVE DIRECTOR 7. EXHIBITS AND ATTACHMENTS: LI SCOPE, WORK OR SERVICES ❑ COMPENSATION ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ INSURANCE REQUIREMENTS /CERTIFICATE ❑ ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS 8. TERM: COMMENCEMENT DATE: JANUARY.1, 2016 COMPLETION DATE: JUNE 30, 2017 9. TOTAL COMPENSATION $ $50,000 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT /CONTRACT REVIEW ROJECT MANAGER DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW 11. COUNCIL APPROVAL (IF APPLICABLE) / D E REV EWE COMMITTEE APPROVAL DATE: INITIAL / DATE APPROVED �- c- 3'131(l COUNCIL APPROVAL DATE: 12. C TRACT SIGNATURE ROUTING S NT TO VENDOR/CONTRACTOR DATE SENT: 4 L 2,9 I I (v DATE REC'D: % /SI zo I % TTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES C , EXHIBITS LAW DEPARTMENT CHIEF OF STAFF ❑ SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# ❑ SIGNED COPY RETURNED COMMENTS: ciffor *Is -14Avetipuirf. Form riot* be-61e.. 'lGrF use . 11/9 4.4‘.., Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway corn CDBG CAPITAL PROJECTS CONTRACT FOR ACQUISITION OF PERMANENT HOUSING This CDBG Capital Projects Contract ( "Contract ") is made between the City of Federal Way, a Washington municipal corporation ( "City "), and Parkview Services, a Washington non - profit organization ( "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 Contract: PARKVIEW SERVICES: Marc Cote 17544 Midvale Ave. N Suite Lower Level Shoreline, WA 98133 (206) 542 -6610 (telephone) (206) 745 -1009 (facsimile) marc@parkviewservices.org CITY OF FEDERAL WAY: Cynthia Ricks- Maccotan 33325 8th Ave. S. Federal Way, WA 98003 -6325 (253) 835 -2461 (telephone) (253) 835 -2609 (facsimile) cynthia.ricks-maccotan@cityoffederalway.com WHEREAS, the City is an entitlement City applicant for Community Development Block Grant ( "CDBG ") funds (Catalogue of Federal Domestic Assistance -CFDA 14.218) under the Housing and Community Development Act of 1974 (the "Act "), as amended, Pub. L. No. 93 -383, 88 Stat. 633 (1974), and anticipates receiving CDBG funds for the purpose of carrying out eligible community development and housing activities under the Act, under regulations promulgated by the Department of Housing and Urban Development ( "HUD "), at 24 CFR § 570, et seq. and per adopted City ordinances, policies and procedures; and WHEREAS, the City desires to contract with the Agency for the performance of certain eligible activities described within this Contract; and WHEREAS, it is appropriate and mutually desirable that the Agency be designated by the City to undertake the aforementioned eligible activities, so long as the requirements of the Act, HUD regulations, and state and local laws are adhered to, as provided for herein; and WHEREAS, the purpose of this Contract is to provide for cooperation between the City and the Agency, as the parties to this Contract, in the provision of such eligible activities; and WHEREAS, the parties are authorized and empowered to enter into this Contract pursuant to the Act, RCW 35.21.730 to 735, and/or by the Constitution and the enabling laws of the State of Washington. NOW THEREFORE, for and in consideration of the terms and conditions provided in this Contract, the parties mutually covenant and agree as follows: 2016 CDBG CAPITAL AGREEMENT - 1 - 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederatway.. com INDEX TO CONTRACT SECTIONS I. Scope of Contract II. Duration of Contract III. Compensation and Method of Payment IV. Budget V. Internal Control and Accounting System VI. Maintenance of Records VII. Monitoring and Reporting Requirements VIII. Evaluations and Inspections IX. Corrective Action X. Assignment XI. Termination XII. Future Support XIII. Hold Harmless and Indemnification XIV. Insurance Requirements XV. Nondiscrimination and Equal Employment Opportunity XVI. Section 504 and Americans with Disabilities Act XVII. Accessibility XVIII. Environmental Review XIX. Labor Standards XX. Volunteers XXI. Acquisition and Relocation XXII. Public Ownership I. SCOPE OF CONTRACT XXIII. Reversion of Assets XXIV. Property Management Standards XXV. Additional Local Requirements XXVI. Subcontracts and Purchases XXVII. Conflict of Interest XXVIII. Political Activity Prohibited XXIX. Equipment Purchase, Maintenance, and Ownership XXX. Notices XXXI. Proprietary Rights XXXII. Contract Amendments XXXIII. Entire Contract/Waiver of Default XXXIV. Miscellaneous Provisions XXXV. Supplanting XXXVI. Attorney's Fees & Costs XXXVII. Drug -Free Workplace Certification and Other Federal Requirements XXXVIII. Constitutional Prohibition XXXIX. Compliance with Health Insurance Portability Accountability Act of 1996 (HIPAA) XL. Confidentiality XLI. Debarment and Suspension XLII. General Provisions A. Scope. The Agency shall use the funds provided herein only to perform the activities authorized by this Contract and as set forth in the Project Scope of Services, which is attached as "Exhibit A" and hereby incorporated by this reference ( "Services "). The Contract between the Parties shall consist of the Capital Contract for 2013 and 2014 CDBG Funds; the federal, state, and local program requirements; and each and every project exhibit, appendix and attachment. This Contract supersedes any and all former Contracts regarding projects attached as Exhibits to this Contract. In the event that there is a difference between any of the language contained in this Contract and any of the language contained in the Exhibits to this Contract, the language in this Contract shall control, unless the Parties affirmatively agree to the contrary in writing. B. Mandatory Certifications. The Agency certifies that it shall comply with the provisions of Section XV., "Nondiscrimination and Equal Employment Opportunity," Section XVI., "Section 504 and Americans with Disabilities Act," Section XXVII., "Conflict of Interest," and Section XXVIII., "Political Activity Prohibited," of this Contract. 2016 CDBG CAPITAL AGREEMENT - 2 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederatway. com C. Program Benefit — 24 C.F.R. 570.208(a). Activities undertaken by this Contract must predominantly benefit low and moderate income persons. At least seventy percent (70 %) of the persons served by these activities must be low or moderate income persons as defined in "Exhibit A ". The following requirements apply: 1. The Agency shall ascertain household income of persons applying for and receiving assistance to assure compliance with the income limits defined in "Exhibit A "; and shall maintain records pursuant to Section VI(G) of this Contract; or 2. If the activity exclusively serves a clientele, which by federal regulation is "presumed" to be low and moderate income, individual income verification is not required. Persons eligible for this presumption are specified in Section VI(G)(3) of this Contract. In this case, the Agency shall maintain appropriate data to validate the presumption, as provided in Section VI(G)(3); or 3. If the activity is such that it is not feasible to identify and record beneficiaries, the total population of the area from which the beneficiaries are drawn must be predominantly low and moderate income. In this case, the Agency shall maintain substantiation data as required by Section VI(G)(4) of this Contract. 4. The benefit to low and moderate income beneficiaries must be in the form of a free or reduced cost service. If beneficiaries are charged for services, the charges to low and moderate income beneficiaries, and to all other beneficiaries, shall be as specified in the Exhibit(s), if applicable. Changes to the structure of charges during the term of this Contract (and, in the case of a facility project, for five years thereafter) must preserve an identical discount for low and moderate income beneficiaries, and the change must be approved by the City. 5. The low and moderate income limits in effect at the time of execution of this Contract are specified in "Exhibit A ". These limits are revised periodically by HUD. It is the Agency's responsibility to use any revised limits when they take effect. Revisions will be announced by and can be obtained from the City. D. Contact Person. The City and the Agency shall each designate a contact person for each Project/Program Exhibit incorporated in this Contract. All correspondence, reports, and invoices shall be directed to the designated contact person. This provision does not, however, supplant or override Section XXX. "Notices." E. Federal Funds. The term "federal funds" as used herein means CDBG funds under this Contract. F. Compliance with Laws. Agency shall comply with and perform the Services in accordance with all applicable federal, state, and City laws including, without limitation, all City codes, ordinances, resolutions, standards and policies, as now existing or hereafter adopted or amended. G. Requirements of 24 CFR 570. Agency agrees to comply with the requirements of Title 24 of the Code of Federal Regulations, Part 570 (the U.S. Housing and Urban Development regulations concerning Community Development Block Grants (CDBG)) including subpart K of these regulations, except that (1) the Agency does not assume the City's environmental responsibilities described in 24 CFR 570.604 and (2) Agency does not assume the City's responsibility for initiating the review process under the provisions of 24 CFR Part 52. H. Independent Contractor. Nothing contained in this Contract is intended to, or shall be construed in any manner, as creating or establishing the relationship of employer /employee between the parties. The Agency shall at all times remain an "independent contractor" with respect to the services to be performed under this Contract. The City shall be exempt from payment of all Unemployment Compensation, FICA, retirement, life and/or medical insurance and Workers' Compensation Insurance, as the Agency is an independent contractor. I. Uniform Administration Requirements. Agency shall comply with the policies, guidelines and requirements of OMB Circular Nos. A -122 "Cost Principles for Non - Profit Organizations ", A -133 "Audits for Institutions of Higher Education and Other Nonprofit Institutions ", A -87 for "Cost Principles for State, Local, and 2016 CDBG CAPITAL AGREEMENT 3 5/2016 A4•.- Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com Indian Tribal Governments ", and 24 CFR Part 84, Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals, and Other Non - Profit Organizations identified at 24 CFR 570.502(b), Applicability of Uniform Administrative Requirements. J. Warranty. 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 being registered to do business in the City of Federal Way by obtaining a City of Federal Way business registration. K. Taxes and Licenses. The Agency shall pay throughout the term of this Contract, all applicable taxes, and all licenses. II. DURATION OF CONTRACT The terms of this Contract shall be in effect from the Start Date (as defined in the Exhibit(s), or the date of execution of this Contract, whichever is earlier), until the Termination Date specified in each Exhibit, unless extended to a later date or terminated earlier, pursuant to the terms and conditions of the Contract. The City shall furnish the Agency with a written notice to proceed. No work on a project shall occur without prior written approval from the City. Costs incurred prior to the date written notice to proceed was given or after the termination date will not be reimbursed. III. COMPENSATION AND METHOD OF PAYMENT The Agency's compensation will be from the 2013 and 2014 programs for Community Development Block Grant ( "CDBG ") funds, CFDA 14.218, under the Housing and Community Development Act of 1974 ( "HCD Act "), Public Law 93 -383, as amended and under regulations promulgated by the U.S. Department of Housing and Urban Development (HUD) at 24 CFR Part 570, and Agency will receive the CDBG funds for the purpose of carrying out eligible community development and housing activities under the Act. The City shall reimburse the Agency only for the approved activities specified in each Exhibit after the Services have been performed. The reimbursement amount shall not exceed the amount specified in each Exhibit. The Agency shall provide the Services in a manner consistent with the accepted practices for other similar Services, 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. Reimbursements will be payable in the following manner: A. Start Date and End Date. Start Dates and End Dates for individual projects shall be specified in each Exhibit. Costs incurred before the Start Date will not be reimbursed. Costs incurred after the End Date will not be reimbursed. B. Compensation and Contract Performance. The City will use the quantity of Services actually delivered, as reported on the Agency's reports, as a measure of satisfactory Contract performance. 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 Contract. C. Eligible Costs. All costs incurred must be reasonable and of a nature which clearly relate to the specific purposes and end product of the Contract under which the services are being performed. Care must be taken by all concerned in incurring costs to assure that expenditures conform to these general standards and the following criteria for eligibility of costs. To be eligible for reimbursement, costs must: 1. Be necessary and reasonable for proper and efficient execution of the contractual requirements and in accordance with an approved budget. 2016 CDBG CAPITAL AGREEMENT 4 5/2016 A. Vecleral Way Agency. CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cifyoffedera/way com 2. Be no more liberal than policies, procedures, and practices applied uniformly to other activities of the 3. Be accorded consistent treatment through application of account policy and procedures approved and /or prescribed herein. 4. Not be allowable under or included as costs of any other federal, state, local or other agency- financed programs in either prior or current periods. 5. Be net of all applicable credits such as purchase discounts, rebates or allowances, sales of publication or materials, or other income or refunds. 6. Be fully documented. D. Submission of Invoices, Supporting Documentation and Reports. On a quarterly basis, the Agency shall submit an invoice, supporting documentation for eligible costs (as defined in subsection C above) claimed in the invoice and all reports as specified in each Project Exhibit or the City may not process the invoice. Supporting documentation for eligible costs claimed in the invoice include but is not limited to, purchase orders and bills. The City shall pay the Agency within forty -five (45) days following the City's approval of a complete and correct invoice, supporting documentation and reports. Payment by the City shall not constitute approval of the services for which payment is requested. The City does not, by making such payment, waive any rights it may have pursuant to this Contract to require satisfactory performance of the services promised herein. The City reserves the right to demand and recover reimbursements made for ineligible costs. E. Final Invoice for Projects. The Agency shall submit its final invoice for each Project Exhibit by January 8, 2017. The Agency shall submit all outstanding reports for each Project Exhibit providing funding for Capital Projects by January 15, 2017. If the Agency's final invoices, supporting documentation, and reports are not submitted by the last date specified in this subsection, 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. F. Return of Unspent City Funds. On or before the End Date specified in each Project Exhibit, for individual projects covered by this Contract, the Agency shall transfer to the City any unexpended and unencumbered funds provided under this Contract that are on hand and any accounts receivable attributable to the use of City funds. G. Nonprofit Corporations. If the Agency is a nonprofit corporation, costs for which the Agency requests reimbursement shall comply with, unless otherwise provided in the Exhibit(s), the policies, guidelines and requirements of OMB Circular No. A -122, "Cost Principles for Non - Profit Organizations," and the sections of 24 CFR Part 84, Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals, and Other Non - Profit Organizations, identified at 24 CFR 570.502 (b), Applicability of Uniform Administrative Requirements. H. Excess Federal Funds. CDBG funds on hand shall not exceed $5,000 if retained beyond three (3) days unless written approval is received from the City. Any reimbursement in excess of the amount required shall be promptly returned to the City. I. Program Income. The Agency shall report all CDBG Program Income, as defined in 24 CFR Part 570.504(c) generated under this Contract for the purposes specified herein or generated through the project(s) funded under this Contract. Program Income is to be returned to the City unless the City specifies that it may be retained by 2016 CDBG CAPITAL AGREEMENT 5 - 5/2016 CITY os 44h. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com the Agency. If the City authorizes the Agency to retain the Program Income to continue or benefit a project(s), the Agency shall comply with all provisions of this Contract in expending the funds. This duty to repay the City shall not be diminished or extinguished by the prior termination of the Contract pursuant to the Duration of Contract or the Termination Section. IV. BUDGET The Agency shall apply the funds received from the City under this Contract in accordance with the line item budget set forth in each Project Exhibit. The Agency shall request in writing prior approval from the City to revise the line item budget when the cumulative amount of transfers from a line item in any Project Exhibit is expected to exceed ten percent (10 %) of that line item. Supporting documents are necessary to fully explain the nature and purpose of the revision, and must accompany 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. V. INTERNAL CONTROL AND ACCOUNTING SYSTEM The Agency shall establish and maintain a system of accounting and internal controls, which complies with applicable, generally accepted accounting principles, and governmental accounting and financial reporting standards. VI. MAINTENANCE OF RECORDS A. Scope of Records. The Agency shall maintain accounts and records, including personnel, property, financial, and programmatic records and other such records as may be deemed necessary by the City to ensure proper accounting for all Contract funds and compliance with this Contract, including all records specified in "Exhibit A ". This requirement includes complete copies of all contracts, subcontracts, and agreements with third parties into which the Agency enters in the performance under this Contract; and all correspondence, reports, and other documentation pertaining to such contracts, subcontracts, and agreements. B. Time for retention of Records. Records required to be maintained in subsection A, above, shall be maintained for a period of six (6) years after the Termination Date, unless a different period for records retention is specified in the Project Exhibit. C. Location of Records/Notice to City. The Agency shall inform the City in writing of the location, if different from the Agency address listed on page one of this Contract, of the aforesaid books, records, documents, and other evidence and shall notify the City in writing of any changes in location within ten (10) working days of any such relocation. D. Federal Exceptions to Retention Requirements. Exceptions to the six (6) year retention period are as follows: (1) Records that are the subject of audit findings, litigation, or claims shall be retained until such findings, litigation or claims have been resolved; and (2) The retention period for real property and equipment records starts from the date of the disposition, replacement or transfer at the direction of the City. E. Financial Management Records. Financial records shall identify adequately the source and application of funds for activities within this Contract, in accordance with the provisions of 24 CFR Part 85.20 and the U. S. Office of Management and Budget ( "OMB ") Circular A -87 for governmental agencies, 24 CFR Part 84.21 and OMB Circular A -122 for Nonprofit Corporations. These records shall contain information pertaining to grant awards and authorizations, obligations, unobligated balances, assets, liabilities, outlays, and income. 2016 CDBG CAPITAL AGREEMENT 6 5/2016 Ab*m• CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cftyoffederalway com F. Beneficiary Records. The Agency agrees to maintain racial, ethnic, disability status, single head of household, household income, and gender data showing the extent to which these categories of persons have participated in, or benefited from, the activities carried out under this Contract if required in a Project Exhibit. G. Program Benefit Records — 24 CFR § 570.506(b). As applicable, the following categories of records shall be maintained, for the discrete activities which are assisted in whole or in part with funding under this Contract (or for all the Agency's activities if funding under this Contract is not specifically allocated to particular activities) for the purpose of documenting that a majority of the beneficiaries are persons of low- or moderate - income: 1. Records specifying by dollar amount, family size, and household income limits used to determine income level; 2. For service activities serving individual clients without regard to their residence location within the City, records documenting: (a) manner in which each client's income is determined in all cases; (b) determination that each individual client's income is or is not within low- or moderate - income limits; (c) date determination was made; and (d) tabulation of the individual determinations. 3. For a service or facility which exclusively serves a class of beneficiaries, the members of which are presumed to be low- or moderate - income eligible absent general evidence to the contrary (abused children, battered spouses, senior citizens, adults meeting the Bureau of the Census' Current Population Reports definition of "severely disabled," homeless persons, illiterate persons, persons living with AIDS and migrant farm workers), records documenting: (1) that the facility exclusively serves the eligible class; and (2) there is no generally available data indicating specific population served is not predominantly low- or moderate - income. 4. For a service or facility which offers benefits uniformly without regard to income to all persons residing within a delineated area, records establishing: (1) boundaries of the service area; (2) the income characteristics of families and unrelated individuals in the service area; and (3) if the percent of low- and moderate - income persons in the service area is less than fifty -one (51) percent, data showing that the area qualifies under the exception criteria set forth at 24 CFR § 570.208(a)(1)(ii). H. Records of Program Operations, Management And Evaluation. Agency shall maintain all records of: 1. Operating policies and procedures; 2. Employee qualifications, training, and evaluation; 3. Principal operations data: work units completed; clients served, classified by client and service characteristics; staff hours utilized; etc. 4. Self- evaluation of services, programs. and employment practices for compliance with 504 and ADA requirements. I. Property Records. Agency shall maintain all records identifying any real and personal property acquired or improved in whole or in part with funds under this Contract (OMB Circular A -110) as follows: 1. Itemized inventory of real property recording legal and common descriptions and address, date of acquisition and /or improvements, cost of acquisition and /or improvements, and CDBG - funded share of cost; 2. Itemized inventory of all non - expendable personal property recording full identification, current location, date and cost of acquisition, and CDBG - funded share of cost; 3. Complete records of any authorized disposition of real or non - expendable personal property including how and to whom disposed, date, amount of disposition proceeds, market value at time of disposition and how determined, intended use, and any conditions governing use following disposition; 2016 CDBG CAPITAL AGREEMENT - 7 5/2016 CITY OF � Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com 4. At the termination of this Contract, a record of the total purchase cost of all remaining unused expendable personal property. J. Additional Requirement for Acquisition or Improvement of Real Property Projects. 1. For construction contracts over $100,000, records documenting compliance with the bonding requirements of 24 CFR § 85.36 (h). 2. Flood Insurance, Flood Disaster Protection Act of 1973; and Federal Insurance Administration Notice in Federal Register Vol. 24, No. 133, July 13, 1989. a. Record of determination whether the assisted project is located within a designated flood plain or flood hazard area. b. If the project is within such area: (1) Evidence of current participation in the National Flood Insurance Program; and (2) Evidence of flood insurance coverage in force on all significant project structures. 3. Lead -Based Paint — Records required to document compliance with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801, et seq.), as amended and the Residential Lead -Based Paint Hazard Reduction Act of 1992 (42 U.S.C. §§ 4851, et seq.), and the implementing regulations 24 CFR § 35. 4. Labor Standards — Records required to document compliance with all requirements of Davis -Bacon and Related Acts (40 U.S.C. §§ 3141 and 3142); Contract Work Hours and Safety Standards Act (40 U.S.C. § 3701, et seq.); Copeland Act (18 U.S.C. § 874); US Secretary of Labor Regulations (29 CFR §§ 3, 5, 6, and 7). 5. Real Property Acquisition and Relocation — Records required to document compliance with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. §§ 4601, et seq., as amended; and the implementing regulations 49 CFR § 24. The agency shall consult the City for complete instruction prior to undertaking any action which may result in displacement of persons as defined at 49 CFR § 24.2(g). K. Procurement Records. Agency shall maintain records of: 1. Agency's adopted code of conduct governing officers' and employees' actions in contracting and purchasing; 2. Agency's standard operating procedures for authorizing and executing purchases and contract procurements of various sizes and types; 3. Agency's individual purchases or contracts over $10,000 as required by the OMB Circular A -110; 4. Agency's procurement procedures utilized and the bases for supplier selection/contract award. L. Records Regarding Remedy of Past Discrimination. The Agency shall maintain documentation of the affirmative action measures the Agency has taken to overcome prior discrimination if a court or HUD has found that the Agency has previously discriminated against persons on the grounds of race, color, national origin or sex in administering a program or activity funded in whole or in part with CDBG funds pursuant to 24 CFR Part 121. M. Personal Information — Notice of Security Breach 1. If the Agency maintains computerized or other forms of data that includes personal information owned by the City, the Agency shall notify the City of any breach of the security of the data immediately following discovery if the personal information was, or is reasonably believed to have been, acquired by an unauthorized person in accordance with RCW 42.56.590 (2). 2016 CDBG CAPITAL AGREEMENT 8 5/2016 CITY OF 4 �. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway. corm 2. The Agency shall provide all information requested by the City including the following in accordance with RCW 42.56.590 and any other applicable federal, state and local statute: a. Circumstances associated with the breach; b. Actions taken by the Agency to respond to the breach; and c. Steps the Agency shall take to prevent a similar occurrence. This information shall be provided in a format requested by the City. 3. The City may at its sole discretion, require the Agency to contact the appropriate law enforcement agency and to provide the City a copy of the report of the investigation conducted by the law enforcement agency. 4. The Agency shall be responsible for notifying individuals whose personal information may have become available to unauthorized users through a security breach. The Agency shall also be responsible for any cost associated with notifying the affected individuals. This notification may be by written notice or electronic notice in accordance with RCW 42.56.590 (7). 5. If the Agency demonstrates that the cost of providing notice would exceed $250,000, or that the potentially affected persons exceeds 500,000, or the Agency does not have sufficient contact information, substitute notice shall consist of the following in accordance with RCW 42.56.590 (7), (c): a. E -mail notice when the Agency has an e-mail address for the subject persons; b. Conspicuous posting of the notice on the Agency's web site page, if the Agency maintains one; and c. Notification to major County -wide media. 6. For purpose of this section, "personal information" means the same as defined in RCW 42.56.590: a. An individual's first name or first initial and last name in combination with any one of the following data elements, when either the name or the data elements are not encrypted: social security number; driver's license number or Washington identification card number; or b. Account number or credit or debit card number, in combination with any required security code; access code, or password that would permit access to an individual's financial account. VII. MONITORING AND REPORTING REQUIREMENTS A. Monitoring. Agency understands and agrees that it will be monitored by the City and HUD from time to time to assure compliance with all terms and conditions of this Contract and all applicable local, state, and federal laws, regulations, and promulgated policies. Monitoring by the City under this Contract shall include, but not be limited to: (1) on -site inspections by City staff, (2) quarterly performance reviews, and (3) an annual evaluation. B. Program Reporting. Projects qualifying to meet the national objective to serve low- and moderate - income persons (under Section I(C)) shall submit a demographic report providing income, race, and head of household information for the beneficiaries of the CDBG Project, which shall cover a one year period extending back from the date of the report. If the facility is and remains occupied during the project, this report is due thirty (30) days after the date the project was closed. If the facility is first occupied or reoccupied after the close of the project, the report is due one year from the date of the last project closing. C. Fiscal Reporting Responsibilities. The Agency shall provide fiscal statements or reports as may be required from time to time by the City, which statements or reports, or both, must indicate the status of all accounts 2016 CDBG CAPITAL AGREEMENT - 9 - 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cilyoffederalway.com and funds being used to perform under this Contract. The Agency shall maintain proper documentation and records of all expenditures incurred pursuant to the terms of this Contract in a manner as will facilitate auditing by either HUD or the City. D. Nonprofit Corporations. The Agency shall provide the City with a copy of its IRS Form 990 (Return of Organization Exempt from Tax) when requested if the Agency is a nonprofit corporation. 1. Audit. The Agency shall have an independent audit conducted of its financial statement and conditions, which shall comply with the requirements of generally accepted auditing standards "GAAS "; Government Accountability Office (GAO) Standards for Audits of Governmental Organizations, Programs, Activities, and Functions; and OMB Circulars A -21, A -87, A -102, A -122 and A -133, as amended, and as applicable. 2. Copy of Audit Report. The Agency shall provide the City a copy of the audit report including any management letter or official correspondence submitted by the auditor, its response and corrective action plan for all findings and reportable conditions contained in its audit. These documents shall be submitted not later than six months subsequent to the end of the Agency's fiscal year. 3. Catalog of Federal Domestic Assistance. The Catalog of Federal Domestic Assistance (CFDA) number for the CDBG Program is 14.218. 4. Additional Audit or Review Requirements. Additional audit or review requirements may be imposed on the City, and the Agency shall be required to comply with any such requirements. VIII. EVALUATIONS AND INSPECTIONS A. Right of Access to Facilities for Inspection of Records. The Agency shall provide right of access to its facilities to the City and /or federal agencies or officials at all reasonable times in order to monitor and evaluate the activities funded under this Contract. The City shall give advance notice to the Agency in the case of fiscal audits to be conducted by the City. B. Time for Inspection and Retention. The records and documents with respect to all matters covered by this Contract shall be subject at all times to inspection, review, or audit by the City and /or federal /state officials so authorized by law during the performance of this Contract and six (6) years after the Termination Date, unless a different period is specified in the Project Exhibit or a longer retention period is required by law. C. Agreement to Cooperate. The Agency agrees to cooperate with the City or its agent in the evaluation of the Agency's performance under this Contract and to make available all information reasonably required by any such evaluation process. The results and records of said evaluations shall be maintained and disclosed in accordance with RCW Chapter 42.17 or RCW 42.56 as hereafter amended. IX. CORRECTIVE ACTION A. Default by Agency. If the City determines that a breach of Contract has occurred because the Agency failed to comply with any material terms or conditions of this Contract or the Agency has failed to provide in any manner the work or Services agreed to in "Exhibit A" attached hereto, and if the City deems said breach to warrant corrective action, the following sequential procedure will apply: 1. The City shall notify the Agency in writing of the nature of the breach. 2. The Agency shall submit a plan describing the specific steps being taken to correct the specified deficiencies (the "Corrective Action Plan "). The Corrective Action Plan shall be submitted to the City within ten (10) business days from the Agency's receipt of the City's notice under this Section. The Corrective Action Plan shall 2016 CDBG CAPITAL AGREEMENT - 10 - 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com specify the proposed completion date for bringing the Contract into compliance, which completion date shall not be more than thirty (30) days from the date the City receives the Agency's Corrective Action Plan, unless the City, in its sole discretion, specifies in writing an extension in the number of days to complete the corrective actions. 3. The City shall notify the Agency, in writing, within ten (10) business days of receipt of the Plan, of the City's determination as to the sufficiency of the Plan. The determination of sufficiency of the Plan will be at the sole discretion of the City. B. Termination of Contract. In the event that the Agency does not respond within the appropriate time with a Corrective Action Plan, or the Agency's Corrective Action Plan is determined by the City to be insufficient, the City may commence termination of this Contract in whole or in part pursuant to Section XI.B; C. City Withholding of Payment. The City may withhold any payment owed the Agency or prohibit the Agency from incurring additional obligations of funds until the City is satisfied that corrective action has been taken or completed; and D. No Waiver of Other Remedies. Nothing herein shall be deemed to affect or waive any rights the Parties may have pursuant to Section XI or other remedies authorized by law. X. ASSIGNMENT The Agency shall not assign any portion of this Contract or transfer or assign any claim arising pursuant to this Contract without the prior written consent of the City. Additional terms for City consent to such Assignment may be described in a Project Exhibit. Said consent must be sought in writing by the Agency not less than forty-five (45) business days prior to the date of any proposed assignment. The Agency shall deliver to the City with its request for consent to such assignment, such information regarding the proposed assignee, including the proposed assignee's mission, description of the proposed assignee's legal status, and financial and management capabilities as is reasonably available to the Agency. Within thirty (30) days after such request for consent to such assignment, City may reasonably request additional available information on the proposed assignee. If the City shall give its consent to any assignment, this Section shall nevertheless continue in full force and effect. Any assignment without prior City consent shall be void. XI. TERMINATION A. Termination for Convenience. 1. This Contract may be terminated by the City without cause, in whole or in part, prior to the Termination Date specified in Project Exhibits, immediately upon written notice to the Agency of the termination. The Agency may cancel this Contract only by written notice provided thirty (30) days before the intended cancellation. 2. In addition to the foregoing, if expected or actual funding is withdrawn, reduced, or limited in any way prior to the Termination Date set forth in "Exhibit A ", the City may, upon written notification to the Agency, immediately terminate this Contract in whole or in part. 3. If the Contract is terminated as provided above: (1) the City shall be liable only for payment in accordance with the terms of this Contract for Services rendered prior to the effective date of termination; (2) the Mayor's determination of such compensation shall be binding and conclusive; and, (3) the Agency shall be released from any obligation to provide such further Services pursuant to the Contract as are affected by the termination. 2016 CDBG CAPITAL AGREEMENT - 11 - 5/2016 CITY OF .14■. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com B. Termination for Cause. 1. The City may terminate this Contract, in whole or in part, immediately upon written notice to the Agency in the event: (1) the Agency materially breaches any duty, obligation, or service required pursuant to this Contract and such breach has not been cured by a Corrective Action Plan acceptable to the City; or (2) the duties, obligations, or Services required herein become impossible, illegal, or not feasible. 2. If the City terminates the Contract pursuant to this section, the Agency shall be liable for damages, including any additional costs of procurement of similar Services from another source. 3. If the termination results from acts or omissions of the Agency, including but not limited to misappropriation, nonperformance of required Services, or fiscal mismanagement, the Agency shall return to the City immediately, any funds, misappropriated or unexpended, which have been paid to the Agency by the City. 4. If the Contract is terminated as provided in this Subsection: (1) the City shall be liable only for payment in accordance with the terms of this Contract for Services rendered prior to the effective date of termination; and (2) the Agency shall be released from any obligation to provide such further Services pursuant to the Contract as are affected by the termination. C. Waiver. Nothing herein shall limit, waive, or extinguish any right or remedy provided by this Contract at law or in equity that either party may have in the event that the obligations, terms, and conditions set forth in this Contract are breached by the other party. XII. FUTURE SUPPORT The City makes no commitment to support the Services contracted for herein and assumes no obligation for future support of the activity contracted herein except as expressly set forth in this Contract. XIII. HOLD HARMLESS AND INDEMNIFICATION A. Agency is an Independent Agency. In providing Services under this Contract, the Agency is an Independent Agency, and neither it, nor its officers, agents or employees are employees of the City for any purpose. The Agency shall be responsible for all federal and/or state tax, industrial insurance, and Social Security liability that may result from the performance of and compensation for these Services and shall make no claim of career service or civil service rights which may accrue to a City employee under state or local law. The City assumes no responsibility for the payment of any compensation, wages, benefits, or taxes by or on behalf of the Agency, its employees, and/or others by reason of this Contract. The Agency shall protect, indemnify, and save harmless the City, its officers, agents, and employees from and against any and all claims, costs, and /or losses whatsoever occurring or resulting from (1) the Agency's failure to pay any such compensation, wages, benefits, or taxes, and/or (2) the supplying to the Agency of work, Services, materials, or supplies by Agency employees or other suppliers in connection with or support of the performance of this Contract. B. Agency Agreement to Repay. The Agency further agrees that it is financially responsible for and will repay the City all indicated amounts following an audit exception which occurs due to the negligence, intentional act, and /or failure, for any reason, to comply with the terms of this Contract by the Agency, its officers, employees, agents, and /or representatives. This duty to repay the City shall not be diminished or extinguished by the prior termination of the Contract pursuant to the Duration of Contract or the Termination Sections. 2016 CDBG CAPITAL AGREEMENT - 12 - 5/2016 `CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com C. Agency Indemnification of City. 1. Agency Indemnification of City. The Agency shall protect, defend, indemnify, and save harmless the City, its officers, employees, and agents from any and all costs, claims, judgments, and /or awards of damages, arising out of, or in any way resulting from, the negligent acts or omissions of the Agency, its officers, employees, and /or agents, in its performance and /or non - performance of its obligations under this Contract. The Agency agrees that its obligations under this subparagraph extend to any claim, demand, and /or cause of action brought by, or on behalf of, any of its employees or agents. For this purpose, the Agency, by mutual negotiation, hereby waives, as respects to the City only, any immunity that would otherwise be available against such claims under the Industrial Insurance provisions of RCW, Title 51. In the event the' City incurs any judgment, award, and/or cost arising there from including attorneys' fees to enforce the provisions of this article, all such fees, expenses, and costs shall be recoverable from the Agency. Claims shall include, but not be limited to, assertions that use or transfer of software, book, document., report, film, tape, or sound reproduction or material of any kind, delivered hereunder, constitutes an infringement of any copyright, patent, trademark, trade name, and /or otherwise results in unfair trade practice. 2. The Agency agrees not to perform any acts that include, but are not limited to, use or transfer of software, book, document, report, film, tape, or sound reproduction or material of any kind, delivered hereunder, that constitutes an infringement of any copyright, patent, trademark, trade name, and /or otherwise results in unfair trade practice. The Agency agrees to indemnify the City for any harm resulting from unfair trade practices. 3. The provisions in this section shall survive the termination and/or duration of the contract term. 4. Nothing contained within this provision shall affect and/or alter the application of any other provision contained within this Contract. XIV. INSURANCE REQUIREMENTS — GENERAL A. Insurance Required. By the date of execution of this Contract, the Agency shall procure and maintain for the duration of this Contract, insurance against claims for injuries to persons or damages to property which may arise from, or in connection with, the performance of work hereunder by the Agency, its agents, representatives, and/or employees. The Agency shall pay the costs of such insurance. The Agency shall furnish separate certificates of insurance and policy endorsements as evidence of compliance with the insurance requirements of this Contract. The Agency is responsible for ensuring compliance with all of the insurance requirements stated herein. Failure by the Agency, its agents, employees, officers, Agency, providers, and /or provider subcontractors to comply with the insurance requirements stated herein shall constitute a material breach of this Contract. Each insurance policy shall be written on an "occurrence" form; except that insurance on a "claims made" form may be acceptable with prior City approval. If coverage is approved and purchased on a "claims made" basis, the Agency warrants continuation of coverage, either through policy renewals or the purchase of an extended discovery period, if such extended coverage is available, for not less than three years from the date of Contract termination, and /or conversion from a "claims made" form to an "occurrence" coverage form. Nothing contained within these insurance requirements shall be deemed to limit the scope, application and/or limits of the coverage afforded by said policies, which coverage will apply to each insured to the full extent provided by the terms and conditions of the policy(ies). Nothing contained in this provision shall affect and/or alter the application of any other provision contained within this Contract. B. Risk Assessment by Agency. By requiring such minimum insurance, the City shall not be deemed or construed to have assessed the risks that may be applicable to the Agency under this Contract, nor shall such 2016 CDBG CAPITAL AGREEMENT - 13 - 5/2016 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway corn minimum limits be construed to limit the limits available under any insurance coverage obtained by the Agency. The Agency shall assess its own risks and, if it deems appropriate and/or prudent, maintain greater limits and /or broader coverage. C. Minimum Scope of Insurance. Coverage shall be at least as broad as: 1. General Liability. Insurance Services Office form number (CG 00 01) covering COMMERCIAL GENERAL LIABILITY. 2. Professional Liability, Errors, and Omissions Coverage. In the event that Services delivered pursuant to this Contract either directly or indirectly involve or require professional services, Professional Liability, Errors, and Omissions coverage shall be provided. "Professional Services ", for the purpose of this Contract section, shall mean any Services provided by a licensed professional or those Services that require a professional standard of care. 3. Automobile Liability. Insurance Services Office form number (CA 00 01) covering BUSINESS AUTO COVERAGE, symbol 1 "any auto"; or the appropriate coverage provided by symbols 2, 7, 8, or 9. 4. Workers' Compensation. Workers' Compensation coverage, as required by the Industrial Insurance Act of the State of Washington, as well as any similar coverage required for this work by applicable federal or "Other States" state law. 5. Stop Gap /Employers Liability. Coverage shall be at least as broad as the protection provided by the Workers' Compensation policy Part 2 (Employers Liability) or, in states with monopolistic state funds, the protection provided by the "Stop Gap" endorsement to the general liability policy. 6. Property Insurance. Insurance Services Office form number (CP 00 10) covering BUILDING AND PERSONAL PROPERTY COVERAGE FORM and Insurance Services Office form number (CP 10 30) CAUSES OF LOSS — SPECIAL FORM or project appropriate equivalent. 7. National Flood Insurance. The use of CDBG funds for acquisition or construction purposes in identified special flood hazard areas shall be subject to Contractor mandatory purchase of flood insurance as required by Section 102(a) of the Flood Disaster Protection Act of 1973 (Pub L. 93 -237). D. Minimum Limits of Insurance — Capital Projects: The Agency shall maintain limits no less than the following, for: 1. Commercial General Liability: $1,000,000 combined single limit per occurrence for bodily injury, personal injury and property damage and $2,000,000 in the Aggregate. 2. Automobile Liability: $1,000,000 combined single limit per accident for bodily injury and property damage. 3. Professional Liability, Errors & Omissions: $1,000,000, Per Claim and in the Aggregate. 4. Workers Compensation: Statutory requirements of the State of Residency. 5. Stop Gap or Employers Liability Coverage: $1,000,000. 6. Property Insurance: One hundred percent replacement value of funded structure. E. Deductibles and Self - Insured Retentions. Any deductibles or self - insured retentions must be declared to, and approved by, the City. The deductible and/or self - insured retention of the policies shall not apply to the Agency's liability to the City and shall be the sole responsibility of the Agency. 2016 CDBG CAPITAL AGREEMENT - 14 - 5/2016 CITY OF �. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www atyoffederalway corn F. Other Insurance Provisions. All liability insurance policies required in this Contract except Professional and Workers Compensation are to contain, or be endorsed to contain, the following provisions: 1. The City, its officers, officials, employees, and agents are to be covered as additional insureds as respects liability arising out of activities performed by or on behalf of the Agency in connection with this Contract. Such coverage shall include Products - Completed Operations. 2. The Agency's insurance coverage shall be primary insurance as respects the City, its officers, officials, employees, and agents. Any insurance and /or self - insurance maintained by the City, its officers, officials, employees, or agents shall not contribute with the Agency's insurance or benefit the Agency in any way. 3. The Agency' s insurance shall apply separately to each insured against whom claim is made and/or lawsuit is brought, except with respect to the limits of the insurer' s liability. G. Acceptability of Insurers. Unless otherwise approved by the City, insurance is to be placed with insurers with a Bests' rating of no less than A: VIII, or, if not rated with Bests, with minimum surpluses the equivalent of Bests' surplus size VIII. Professional Liability, Errors, and Omissions insurance may be placed with insurers with a Bests' rating of B +VII. Any exception must be approved by the City. If, at any time, the foregoing policies shall fail to meet the above requirements, the Agency shall, upon notice to that effect from the City, promptly obtain a new policy, and shall submit the same to the City, with appropriate certificates and endorsements, for approval. H. Verification of Coverage. The Agency shall furnish the City with certificates of insurance and endorsements required by this Contract. The certificates and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificates and endorsements for each insurance policy are to be on forms approved by the City prior to the commencement of activities associated with the Contract. The City reserves the right to require complete, certified copies of all required insurance policies at any time. XV. NON - DISCRIMINATION AND EQUAL EMPLOYMENT OPPORTUNITY A. Non - discrimination. During the performance of this Contract, the Agency shall not discriminate nor tolerate harassment on the basis of age, color, creed, national origin, marital status, race, religion, sex, sexual orientation, or the presence of any mental, physical or sensory, disability in the employment, application for employment, the administration or delivery of services, or any other benefits under this Contract. B. Compliance with Applicable Laws. The Agency shall comply fully with all applicable federal, state and local laws, ordinances, executive orders and regulations that prohibit such discrimination. These laws include, but are not limited to, RCW Chapter 49.60; Titles VI and VII of the Civil Rights Act of 1964, 42 U.S.C. 2000(a) et seq.; the Americans with Disabilities Act, 42 U.S.C. 12101 et seq.; and the Restoration Act of 1987. The Agency shall further comply fully with any affirmative action requirements set forth in any federal regulations; statutes or rules included or referenced in the contract documents. C. Fair Housing Protections. The Agency shall comply with the federal Fair Housing Act, Public Law 90- 284 (42 USC 3601 et seq.) The Agency shall take necessary and appropriate actions to prevent discrimination in any housing - related project under this contract, which includes rental housing projects and /or projects that include residential real estate - related transactions, as required by the Federal Fair Housing Act as amended (42 USC 3601) and the Washington State Law Against Discrimination (RCW Chapter 49.60). Residential real estate - related transactions include the making or purchasing of loans or the provision of financial assistance secured by real estate, or the making or purchasing of loans or financial assistance for the purchasing, constructing, improving, repairing or 2016 CDBG CAPITAL AGREEMENT - 15 - 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway. com maintaining of a dwelling. Rental housing includes any dwelling which is intended for occupancy as a residence for one or more families by lease, sublease or by grant for a consideration of the right to occupy premises not owned by the occupant. D. Additional Federal Nondiscrimination Requirements. The Agency shall comply with all applicable federal laws prohibiting discrimination, including the following: 1. Presidential Executive Order 11063 as amended and implementing regulations at 24 CFR Part 107; 2. Section 109 of the HCD Act of 1974, as amended (42 USC 5301); 3. The Americans with Disabilities Act (42 USC 1213; 47 USC 155, 201, 218 and 225); and 4. Section 504 of the Rehabilitation Act of 1973 and regulations at 24 CFR Part 8. E. Prohibited Discriminatory Actions. 1. Except where expressly authorized by federal law, the Agency may not, under any program or activity to which this Contract may apply, directly or through contractual or other arrangements, discriminate on the grounds of age, color, creed, familial status, marital status, nationality, religion, race, sex, sexual orientation, or the presence of any, physical, mental or sensory disability. Discriminatory actions may include but are not limited to the following: a. Denying any person access to facilities, Services, financial aid or other benefits provided under the program or activity. b. Denying any person Services due to limited English proficiency. c. Providing any person with facilities, Services, financial aid or other benefits, which are different, or are provided in a different form from that provided to others under the program or activity. d. Subjecting any person to segregated or separate treatment in any facility or in any matter or process related to receipt of any service or benefit under the program or activity. e. Restricting in any way access to or in the enjoyment of any advantage or privilege enjoyed by others in connection with facilities, Services, financial aid or other benefits under the program or activity. f. Treating any person differently from others in determining whether the person satisfies any admission, enrollment, eligibility, membership, or other requirement or condition which individuals must meet in order to be provided any facilities, Services or other benefit provided under the program or activity. g. Denying any person any opportunity to participate in a program or activity as an employee. h. Failing to design and construct facilities for first occupancy after January 26, 1993 that are readily accessible to and usable by individuals with disabilities and failure to remove architectural and communication barriers that are structural in nature in existing facilities, where such removal can be accomplished without difficulty and expense. 2. The Agency shall not utilize criteria or methods of administration which have the effect of subjecting individuals to discrimination on the basis of age, color, familial status, nationality, race, religion, sex, or sexual orientation; or mental, physical, or sensory disability; or have the effect of defeating or substantially impairing accomplishment of the objectives of the program or activity with respect to individuals of a particular age, color, familial status, nationality, race, religion, sex, or sexual orientation; or the presence of any mental, physical, or sensory disability. 2016 CDBG CAPITAL AGREEMENT - 16 - 5/2016 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com 3. The Agency, in determining the site or location of housing or facilities provided in whole or in part with funds under this Contract, may not make selections of such site or location which have the effect of excluding individuals, denying them benefits, or subjecting them to discrimination on the grounds of age, sex, marital status, familial status, religion, race, creed, color, sexual orientation, nationality, or the presence of any sensory, mental or physical disability; or which have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the HCD Act or of the HUD Regulations. F. Employment Projections. In all solicitations under this Contract, the Agency shall state that all qualified applicants will be considered for employment. The words "equal opportunity employer" in advertisements shall constitute compliance with this Section. G. Record - Keeping Requirements and Site Visits. The Agency shall maintain, for at least six years after completion of all work under this Contract, the following: 1. Records of employment, employment advertisements, application forms, and other pertinent data, records and information related to employment, applications for employment or the administration or delivery of services or any other benefits under this Contract; and 2. Records, including written quotes, bids, estimates or proposals submitted to the Agency by all businesses seeking to participate on this Contract, and any other information necessary to document the actual use of and payments suppliers in this Contract, including employment records. The City may visit, at any time, the site of the work and the Agency's office to review the foregoing records. The Agency shall provide all assistance requested by the City during such visits. In all other respects, the Agency shall make the foregoing records available to the City for inspection and copying upon request. If this Contract involves federal funds, the Agency shall comply with all record keeping requirements set forth in any federal rules, regulations or statutes included or referenced in the contract documents. H. Sanctions for Violations. Any violation of the mandatory requirements of the provisions of this Section shall be a material breach of contract for which the Agency may be subject to damages, withholding payment and any other sanctions provided for by the Contract and by applicable law. I. No Conflict with Federal Requirements. As indicated by HUD Notice CPD 04 -10, a faith -based organization's exemption from the federal prohibition on employment discrimination on the basis of religion, set forth in 42 U.S.C. 2000e -1(a), is not forfeited when the organization receives HUD funding. Faith -based organizations, like any other entity participating in a HUD - funded program, must, however, comply with all the statutory requirements of that particular HUD - funded program. Both the CDBG and HOME Programs contain statutory provisions imposing non - discrimination requirements on all agencies or subgrantees. Religious organizations that believe that certain non - discrimination statutory requirements are substantially burdensome may be entitled to protection under the Religious Freedom Restoration Act [42 U.S.C.4000bb- 3,4000bb -2(1)] which applies to all federal law and its implementation. Agencies, subgrantees, or contractors should be aware that anti- discrimination provisions of Section 109 of the Housing and Community Development Act of 1974, Section 282 of the HOME Investment partnership Act may pose questions of conformance with Title VII of the Civil Rights Act of 1964 and future court rulings could define more specifically the application of these laws to faith -based organizations. In the event that a provision of this Contract is deemed to be in actual conflict with federal law, the conflicting provision in this Contract shall not apply. XVI. SECTION 504 AND AMERICANS WITH DISABILITIES ACT If the Agency is a nonprofit corporation, the Agency warrants and represents that it has completed a 504 /ADA Self- Evaluation Questionnaire for all programs and Services offered by the Agency (including any 2016 CDBG CAPITAL AGREEMENT - 17 - 5/2016 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 anew cityoffederatway com Services not subject to this Contract) and has evaluated its Services, programs and employment practices for compliance with Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 701 et seq. and the Americans with Disabilities Act of 1990 (ADA) 42 U.S.C. 12101 et seq.. The Agency warrants and represents that it has completed a 504 /ADA Assurance of Compliance and shall submit it to the City. Such Assurance of Compliance is attached to this Contract and is incorporated herein by this reference. XVII. ACCESSIBILITY Any buildings or other facilities designed, constructed, or altered with federal funds pursuant to this Contract are subject to the requirements of the Architectural Barriers Act of 1968 (42 U.S.C. § 4151, et seq.) and shall comply with the Uniform Federal Accessibility Standards (Appendix A to 24 CFR § 40.1, et seq. for residential structures, and Appendix A to 41 CFR § 101 -19, et seq. for general type buildings). When applicable, certain multifamily housing units designed and constructed for first occupancy after March 13, 1991, with assistance provided under this Contract, must comply with the Fair Housing Accessibility Guidelines, 24 CFR § 100.1, et seq., as amended. XVIII. ENVIRONMENTAL REVIEW A. National Environmental Policy Act - The City retains environmental review responsibility for purposes of fulfilling requirements of the National Environmental Policy Act as implemented by HUD Environmental Review Procedures (24 CFR § 58.1, et seq.). The City may require the Agency to furnish data, information, and assistance for the City's review and assessment in determining whether an Environmental Impact Statement must be prepared. The Agency shall be solely responsible for the cost of compliance with all such federal laws and authorities including the cost of preparing plans, studies, reports, and the publication of notices that may be required. B. Other Federal Environmental Laws. 1. Historic Preservation. Activities affecting property listed in or found to be eligible for inclusion in the National Register of Historic Places will be subject to requirements set forth in HUD Environmental Review Procedures at 24 CFR § 58.1, et seq. The Agency shall meet the historic preservation requirements of Pub. L. No. 89 -665 (16 U.S.C. § 470(i)), and the Archaeological and Historic Preservation Act of 1974, Pub. L. No. 93 -291 (16 U.S.C. § 469a -1), and Executive Order 11593, including the procedures prescribed by the Advisory Council on Historic Preservation in the regulations at 36 CFR § 801, et seq. 2. Architectural Barriers. Any facility constructed pursuant to this Contract shall comply with design requirements of the Architectural Barriers Act of 1968 (42 U.S.C. §§ 4151, et seq.), and the Uniform Federal Accessibility Standards (US Government Printing Office, 1985- 494 -187). 3. National Flood Insurance. When applicable, the use of CDBG funds for acquisition or construction purposes in identified special flood hazard areas shall be subject to Agency mandatory purchase of flood insurance as required by Section 102(a) of the Flood Disaster Protection Act of 1973 (Pub. L. No. 93 -237, 42 U.S.C. § 2414 and 42 U.S.C. §§ 4001 - 4128). 4. Lead -Based Paint. Whenever funds under this Contract are used directly or indirectly for construction, rehabilitation, or modernization of residential structures, the Agency shall comply, at its sole expense, with the HUD Lead -Based Paint regulations (24 CFR § 35) issued pursuant to the Lead -Based Paint Poisoning Prevention Act, as amended (42 U.S.C. §§ 4801, et seq.) and the Residential Lead -Based Paint Hazard Reduction Act of 1992 (42 U.S.C. §§ 4851, et seq.), with regard to lead -based paint, and with any and all applicable federal, state, and local laws, regulations, or standards hereafter enacted or issued with regard to lead -based paint. Without limiting the foregoing, the Agency shall remove or cover, prior to the date for completion of the work funded hereunder and in compliance with all applicable, laws, regulations, and in conformity with guidelines issued by 2016 CDBG CAPITAL AGREEMENT - 18 - 5/2016 CITY OF deral Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffedera!way com HUD, all lead -based paint with lead content above the threshold established by HUD on surfaces affected by the work funded under this Contract. The Agency shall defend, indemnify, and hold harmless the City from any liability, loss, damage, or expense, including costs and attorneys' fees, relating in any way to lead -based paint at the property or the abatement or disposal thereof. This provision shall survive expiration and satisfaction of this Contract, whether by payment, forgiveness, foreclosure, or otherwise. 5. Other. Clean Air Act as amended, 42 U.S.C. § 7401, et seq.; Water Pollution Control Act, 33 U.S.C. §§ 1367, et seq., as amended; Environmental Protection Agency regulations, 40 CFR §§ 1.1, et seq. C. State Environmental Policy Act. Agencies which are branches of government under RCW 43.21C.030 retain responsibility for fulfilling the requirements of the State Environmental Policy Act, Chapter 43.21 C RCW and the regulations and ordinances adopted thereunder. If the Agency is not a branch of government under RCW 43.21 C.030, the City may require the Agency to furnish data, information, and assistance, as necessary, to enable the City to comply with the State Environmental Policy Act. D. Satisfaction of Environmental Requirements. 1. Limitations on Activities Pending Clearance. Pursuant to 24 CFR § 58.22(a), the Agency shall not commit assistance under this Contract until HUD has approved the City's Request for Release of Funds (RROF) and the related certification from the City. In addition, until the RROF has been approved by HUD, neither the City nor the Agency may commit non -HUD funds on or undertake an activity or project under a program listed in § 58.1(b) if the activity or project would have an adverse environmental impact or limit the choice of reasonable alternatives. Provided; however, that an option agreement, self -Help Homeownership Opportunity Program funds, and relocation assistance may be excluded from the limitation above per 24 CFR § 58.22(d), (e) and (f) respectively. 2. Notice to Proceed. Project execution under this Contract, by either the City or the Agency, shall not proceed until satisfaction of all applicable requirements of the national and state environmental policy acts. A written notice to proceed will not be issued by the City until all such requirements are complied with. XIX. LABOR STANDARDS — 24 CFR § 570.603 A. The Agency shall require that project construction contractors and subcontractors pay their laborers and mechanics at wage rates in accordance with the Davis -Bacon Act, as amended (40 U.S.C. §§ 3141 and 3142), and that they comply with the Copeland Act (18 U.S.C. § 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§ 3701, et seq.); provided that this section shall not apply to rehabilitation of residential property only if such property contains not less than eight (8) units. In addition to complying with these federal labor standards, the Agency shall further require that all project construction contractors comply with all applicable state and local public works bidding and contracting regulations, specifically including, without limitation, the prevailing wage provisions set forth in Ch. 39.12 RCW and all regulations adopted by the State of Washington Department of Labor and Industries. B. The Agency shall require that project construction contractors and subcontractors comply with Federal Labor Standards Provisions (HUD form 4010) and the Davis -Bacon wage determinations (attached as "Exhibit B" and "Exhibit C ", respectively, if applicable). For construction contracts, a copy of the Federal Labor Standards Provisions (HUD form 4010) and the current Davis -Bacon wage determinations must be included in all construction bid specs and /or contracts over $2,000. XX. VOLUNTEERS - 24 CFR § 70 If the Agency or the Contractor /Subcontractor uses volunteers to perform services on a federally- assisted construction project, it shall ensure that work is performed without promise, expectation or receipt of compensation 2016 CDBG CAPITAL AGREEMENT - 19 - 5/2016 CITY OF ,..,� Federal Way CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835 -7000 www cityoffederalway com for services rendered. Volunteer files shall include: (1) the name and address of the agency sponsoring the project; (2) a description of the project; and (3) the number of volunteers and the hours donated to the project. XXI. ACQUISITION AND RELOCATION A. Any acquisition of real property for any activity assisted under this Contract shall comply with the Federal Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. §§ 4601, et seq. (hereinafter the "Uniform Act" and the government -wide regulations applicable to all federally- assisted projects, effective April 2, 1989, at 49 CFR §§ 34.1, et seq. B. Implementation of any project provided for in this Contract will be undertaken so as to minimize involuntary displacement of persons, businesses, nonprofit organizations, or farms to the greatest extent feasible. C. Any displacement of persons, businesses, nonprofit organizations, or farms occurring as the result of acquisition of real property assisted under this Contract shall comply with the Uniform Act, and the regulations at 49 CFR §§ 24.1, et seq., required by federal CDBG regulations at 24 CFR § 570.606. The Agency shall comply with the regulations pertaining to costs of relocation and written policies, as specified by the City of Kent's Displacement Policy. XXII. PUBLIC OWNERSHIP For Agencies which are not municipal corporations organized under the laws of the State of Washington, it may become necessary to grant the City a property interest where the subject project calls for the acquisition, construction, reconstruction, rehabilitation, or installation of publicly -owned facilities and improvements. XXIII. REVERSION OF ASSETS — 24 CFR § 570.505. Any real property under the Agency's control that was acquired or improved in whole or in part with CDBG funds in excess of $25,000 must be either: A. Used to meet one of the national objectives set forth in 24 CFR § 570.208 of the CDBG regulations until five (5) years after expiration of the Contract, or such longer period of time as determined by the City. For Acquisition or improvement of real property projects, the Agency and the City shall execute a Community Facility Covenant Agreement (attached as "Exhibit D" if applicable); or B. Disposed of in a manner that results in the City being reimbursed in the amount of the current fair market value of the property, less any portion attributable to expenditures of non -CDBG funds for acquisition of, and improvements to, the property. Such reimbursement is not required after the period of time specified in Paragraph (A) above. XXIV. PROPERTY MANAGEMENT STANDARDS A. The Agency shall meet the following procedural requirements for all property acquired in whole or in part with CDBG funds: 1. Property records shall be maintained accurately and provide for a description of the property; manufacturer's serial number or other identification number; acquisition date and cost; source of the property; percentage of CDBG funds used in the purchase of property; and location, use, and condition of the property; 2. A physical inventory of property taken and the results of that inventory are reconciled with the property records at least once every two (2) years to verify the existence, current utilization, and continued need for the property; and 2016 CDBG CAPITAL AGREEMENT - 20 - 5/2016 1441%.‘.... CITY OF Federal Way u7, CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway. com 3. A control system shall be in effect to ensure adequate safeguards to prevent loss, damage, or theft of the property which shall be investigated and fully documented. B. The disposition of real property acquired in whole or in part with CDBG funds shall be at no less than its current appraised fair market value (or for a lease, at the current market value), except that such property may be disposed of for a lesser value, including by donation, if the disposition at the lesser value is for a use which qualifies under one of the criteria set forth in 24 CFR § 570.208 for meeting the national objectives and is permissible under state and local law. Where the disposition is for a lesser value, the recipient shall maintain documentation that the use meets one of the national objectives pursuant to 24 CFR § 570.208. XXV. ADDITIONAL LOCAL REQUIREMENTS A. Promissory Note, Deed of Trust and Covenant — In acquisition, rehabilitation, and construction projects, the City shall enter into a deed of trust or leasehold agreement with the Agency to secure and protect the City's and the public's interest in the property. The Agency agrees that funding provided under this Contract for the acquisition, construction, improvement and /or rehabilitation of real property owned by the Contractor is a loan from the City to the Agency. The Agency agrees to promptly execute a promissory note, deed of trust and covenant (if applicable), in a format approved by the City, if required in a Project Exhibit. The Agency agrees that for real property, which is leased by the Agency and assisted under this Contract, the Agency shall obtain a covenant from the owner of the real property in a form approved by the City, if required in any Project Exhibit. B. Adequate Value — In acquisition projects, the City shall require evidence through a property appraisal, title search, or other means to ensure that there is adequate value so as to secure the City's financial interest. C. City Ordinance, Codes, and Regulations — In acquisition and construction projects, the Agency shall comply with all applicable City ordinances, codes, and regulations. D. Additional Public Information — For all construction projects, the Agency shall erect a sign to City specifications at the construction site, which identifies the source of funds, except that this requirement may be waived for construction projects of $5,000 or less. XXVI. SUBCONTRACTS AND PURCHASES A. Subcontract Defined. "Subcontract" shall mean any contract between the Agency and a subcontractor or between subcontractors that is based on this Contract, provided that the term "subcontract" does not include the purchase of (1) support services not related to the subject matter of this Contract, or (2) supplies. B. Amendment Required. The Agency shall not subcontract any portion of this Contract without the prior amendment to this Contract as outlined in Section XXXII. Said amendment must be sought in writing by the Agency not less than forty -five (45) business days prior to the date of any proposed subcontract. If the City shall give its consent to any subcontract by completing an amendment, this Section shall nevertheless continue in full force and effect. Any subcontract without prior amendment to this Contract, shall be void and not reimbursable under this contract. C. Verification of Subcontractor's Eligibility — 24 CFR § 5. The Agency shall maintain records documenting that the Agency, 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. Verification of eligibility shall be accomplished by signing the Certification Regarding Debarment and Suspension, which is attached and incorporated as "Exhibit E ". 2016 CDBG CAPITAL AGREEMENT - 21 - 5/2016 CITY os Federal Way CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835 -7000 • www cityoffederalway. com D. Procurement Requirements. In awarding contracts pursuant to this Contract, the Agency shall comply with all applicable requirements of local and state law for awarding contracts, including but not limited to procedures for competitive bidding, contractor's bonds, and retained percentages (Ch. 60.28 RCW, Ch. 39.12 RCW, and Ch. 39.04 RCW). In addition, the Agency shall comply with the requirements of the U.S. Office of Management and Budget ( "OMB ") Circular A -110, Attachment 0, relating to "Procurement Standards," and with Executive Order 11246 regarding nondiscrimination in bid conditions for projects over $10,000. Where federal standards differ from local or state standards, the stricter standards shall apply. If the Agency is a nonprofit corporation, it agrees to comply with procurement requirements specified in 24 CFR Part 84.40 through .48 or as otherwise provided in the Project Exhibit. The regulations at 24 CFR Part 85.36 (b) through (g) and 24 CFR Part 84.40 through .48, require that all goods and Services, irrespective of cost, be procured using a competitive process. E. Buy American Requirements - ARRA of 2009 - Division A - Title XVI § 1605. 1. General. None of the funds used to purchase goods pursuant to this Contract may be used for a project or the construction, alteration, maintenance, or repair of a public building or public work unless all of the iron, steel, and manufactured goods used in the project are produced in the United States. 2. Waiver of Buy American Requirement. Subsection (1) shall not apply in any case or category of cases in which the City finds that: a. Applying subsection (1) would be inconsistent with the public interest; b. Iron, steel, and the relevant manufactured goods are not produced in the United States in sufficient and reasonable available quantities and of a satisfactory quality; or c. Inclusion of iron, steel, and manufactured goods produced in the United States will increase the cost of the overall project by more than 25 percent. F. Failure to Comply is Default. Failure by the Agency to require compliance with the above terms and conditions in subcontracts shall constitute a breach of this Contract. XXVII. CONFLICT OF INTEREST A. The Agency agrees to abide by the provision of 24 CFR §§ 84.42 and 570.611, which include (but are not limited to) the following: 1. The Agency shall maintain a written code or standards of conduct that shall govern the performance of its officer, employees or agents engaged in the award and administration of contracts supported by Federal funds; and 2. No employee, officer or agent of the Agency shall participate in the selection or in the award, or administration of a contract supported by Federal funds if a conflict of interest, real or apparent, would be involved. 3. No covered persons who exercise or have exercised any functions or responsibilities with respect to CDBG- assisted activities, or who are in a position to participate in a decision - making process or gain inside information with regard to such activities, may obtain a financial interest in any contract, or have a financial interest in any contract, subcontract, or agreement with respect to the CDBG- assisted activity, either for themselves or those with whom they have business or immediate family ties, during their tenure or for a period of (1) year thereafter. For purposes of this paragraph, a "covered person" includes any person who is an employee, agent, consultant, officer, or elected or appointed official of the City, the Agency or any designated public Agency. B. Agency Covenants. The Agency covenants that no officer, employee, consultant, elected or appointed official, or agent of the Agency who exercises any functions or responsibilities in connection with the activities 2016 CDBG CAPITAL AGREEMENT - 22 - 5/2016 CITY OF A Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com funded in whole or in part under this Contract, herein, or any other person who exercises any functions or responsibilities in connection with the activities funded herein, shall have any personal financial interest, direct or indirect, in this Contract, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. Any interest on the part of the Agency or his employees must be disclosed to the City. The Agency shall take appropriate steps to assure compliance with this provision. C. Current and Former City employees. The Agency acknowledges that, for one year after leaving City employment, a former City employee may not have a financial or beneficial interest in a contract or a grant that was planned, authorized or funded by a City action in which the former City employee participated during City employment. The Agency shall identify, at the time of offer, current or former City employees involved in the preparation of proposals or the anticipated performance of work if awarded the Contract. Failure to identify current or former City employees involved in the transaction may result in the City's denying or terminating the Contract. After Contract award, the Agency is responsible for notifying the City's Project Manager of current or former City employees who may become involved in the Contract any time during the term of the Contract. D. Non - Disclosure is Grounds for Termination. Violation of this Section shall constitute a material breach of this Contract and grounds for termination pursuant to Section XI, as well as any other right or remedy provided in this Contract or law. XXVIII. POLITICAL ACTIVITY PROHIBITED A. No Partisan Activity. None of the funds, materials, property, or Services provided directly or indirectly under this Contract shall be used for any partisan political activity or to further the election or defeat of any candidate for public office. B. Certification Regarding Lobbying. The Agency certifies, to the best of its knowledge and belief, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the Agency, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the Agency shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 3. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 USC 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. XXIX. EQUIPMENT PURCHASE, MAINTENANCE, AND OWNERSHIP A. Equipment over $5,000. The Agency agrees that any equipment purchases, in whole or in part, with Contract funds at a cost of $5,000 per item or more, when the purchase of such equipment is reimbursable as a Contract budget item, is upon its purchase or receipt the property of the City and/or federal government. 2016 CDBG CAPITAL AGREEMENT - 23 - 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederahvay com B. Maintenance of Equipment. The Agency shall be responsible for all such property, including the proper care and maintenance of the equipment. C. Equipment Returned. The Agency shall ensure that all such equipment shall be returned to the City and /or federal government upon termination of this Contract unless otherwise agreed upon by the Parties. D. Right of Access. The Agency shall admit the City's designee to the Agency's premises for the purpose of marking such property with City property tags. E. Maintenance of Records. The Agency shall establish and maintain inventory records and transaction documents (purchase requisitions, packing slips, invoices, receipts) of equipment purchased with Contract funds. F. Disposition of Equipment. If the Agency ceases to use equipment purchased in whole or in part with CDBG funds for the purpose described in this Contract, or if the Agency wishes to dispose of such equipment, the disposition shall be determined under the provisions of 24 CFR Part 570.502(b)(3)(vi), if the Agency is a nonprofit corporation and 24 CFR Part 570.502(a) and 24 CFR Part 85.32(e) if the Agency is a municipal corporation or an agency of the State of Washington. The Agency agrees that it will contact the City for instructions prior to disposing of, surplusing, encumbering or transferring ownership of any equipment purchased in whole or in part with federal funds. XXX. NOTICES Whenever this Contract provides for notice to be provided by one Party to another, such notice shall be in writing; and directed to the Chief Executive Officer of the Agency and Mayor of Federal Way. 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. XXXI. PROPRIETARY RIGHTS The Parties to this Contract hereby mutually agree that if any patentable or copyrightable material or article should result from the work described herein, all rights accruing from such material or article shall be the sole property of the Agency. The Agency agrees to and does hereby grant to the City, irrevocable, nonexclusive, and royalty -free license to reproduce, publish or otherwise use, and to authorize others to use, the work for governmental purposes, according to law, any material or article and use any method that may be developed as part of the Services under this Contract. The foregoing license shall not apply to existing training materials, consulting aids, checklists, and other materials and documents of the Agency, which are modified for use in the performance of this Contract. XXXII. CONTRACT AMENDMENTS Either party may request changes to this Contract. Proposed changes, which are mutually agreed upon, shall be incorporated by written amendments to this Contract. Budget revisions approved by the City pursuant to Section IV are not required to be incorporated by written amendment. XXXIII. ENTIRE CONTRACT/WAIVER OF DEFAULT The Parties agree that this Contract is the complete expression of the terms hereto and any oral or written representations or understandings not incorporated herein are excluded. Both Parties recognize that time is of the essence in the performance of the provisions of this Contract. 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. 2016 CDBG CAPITAL AGREEMENT - 24 - 5/2016 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com XXXIV. MISCELLANEOUS PROVISIONS A. Severability. If any term or provision of this Contract or an application of any term or provision to any person or circumstance is invalid or unenforceable, the other terms or provisions of this Contract, or the application of the term or provision to persons or circumstances other than those as to which it is held invalid or unenforceable, shall not be affected and will continue in full force. B. Cumulative Remedies. No provision of this Contract precludes the City from pursuing any other remedies for the Agency's failure to perform its obligations. C. No Third Party Rights. This Contract is for the benefit of the named Parties and the City of Federal Way only, and no other third party shall have any rights thereunder. XXXV. SUPPLANTING If the Agency is a nonprofit corporation providing public (human) Services under this Contract with CDBG funds and the Agency received non - federal funds from the City ( "local funds ") to provide the same Services as those funded herein during the preceding calendar year, the Agency must use the funds provided herein to pay for units of service this year that are over and above the level of service provided with local funds during the previous year. XXXVI. ATTORNEY'S FEES AND COSTS In the event either of the Parties defaults on the performance of any of the terms of this Contract or either Party places the enforcement of this Contract in the hands of an attorney or files a lawsuit, each Party shall pay all of its own attorneys' fees, costs and expenses. The venue for any dispute related to this Contract shall be King County, Washington. XXXVII. DRUG FREE WORKPLACE CERTIFICATION AND OTHER FEDERAL REQUIREMENTS A. Drug -Free Workplace Certification. The Agency certifies that it is in compliance with the Drug -Free Workplace Act of 1988 (42 USC 701) and regulations set forth at 24 CFR part 24, subpart F. B. Other Federal Requirements. The absence of mention in this Contract of any other federal requirements, which apply to the award, and /or expenditure of the federal funds made available by this Contract is not intended to indicate that those federal requirements are not applicable to Agency activities. The Agency shall comply with all other federal requirements relating to the expenditure of federal funds, including but not limited to: the Hatch Act (5 USC. Chapter 15) regarding political activities. XXXVIII. CONSTITUTIONAL PROHIBITION Funds Not Used for Religious Purposes. In accordance with the First Amendment of the United States Constitution, Article 1, Section 11 of the Washington State Constitution, and separation of church and state principles, as a general rule, funds received under this Contract may not be used for religious activities. Except where otherwise allowed by Federal law, the following restrictions and limitations apply to the use of CDBG funds: A. An Agency may not engage in inherently religious activities, such as worship, religious instruction or proselytization, as part of the assistance funded under this Contract. If the Agency conducts religious activities, the activities must be offered separately, in time and location, from the assistance funded under this Contract, and participation must be voluntary for the beneficiaries of the assistance. B. In performing under this Contract, the Agency shall not discriminate a program beneficiary or prospective program beneficiary on the basis of religion or religious belief. 2016 CDBG CAPITAL AGREEMENT - 25 - 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway.. com XXXIX. COMPLIANCE WITH THE HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT OF 1996 Terms used in this section shall have the same meaning as those terms in the Privacy Rule, 45 CFR Parts 160 and 164. A. Obligations and Activities of the Agency. 1. The Agency agrees not to use or disclose protected health information other than as permitted or required by law. 2. Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of the protected health information that it creates, receives, maintains, or transmits on behalf of the covered entity as required by CFR Title 45, Section 164, Subpart C. 3. The Agency agrees to mitigate, to the extent practicable, any harmful effect that is known to the Agency of a use or disclosure of protected health information by the Agency in violation of the requirements of this Contract. 4. The Agency agrees to report to the City any use or disclosure of protected health information not allowed under this Contract, or security incident, within two days of the Agency's knowledge of such event. 5. The Agency agrees to ensure that any agent, including a subcontractor, to whom it provides protected health information received from, or created or received by the Agency on behalf of the City, agrees to the same restrictions and conditions that apply through this Contract to the Agency with respect to such information. 6. The Agency agrees to make available protected health information in accordance with 45 CFR § 164.524. 7. The Agency agrees to make available protected health information for amendment and incorporate any amendments to protected health information in accordance with 45 CFR § 164.526. 8. The Agency agrees to make available the information required to provide an accounting of disclosure in accordance with 45 CFR 164 § 528. B. Effect of Termination. 1. Except as provided in paragraph B.2. of this section, upon termination of this Contract, for any reason, the Agency shall return or destroy all protected health information received from the City, or created or received by the Agency on behalf of the City. This provision shall apply to protected health information that is in the possession of subcontractors or agents of the Agency. The Agency shall retain no copies of the protected health information. 2. In the event the Agency determines that returning or destroying the protected health information is infeasible, the Agency shall provide to the City notification of the conditions that make return or destruction infeasible. Upon notification that return or destruction of protected health information is infeasible, the Agency shall extend the protections of the Contract to such protected health information and limit further uses and disclosure of such protected health information to those purposes that make the return or destruction infeasible, for so long as the Agency maintains such protected health information. XL. CONFIDENTIALITY The Agency agrees that all information, records, and data collected in connection with this Contract shall be protected from unauthorized disclosure in accordance with applicable state and federal law. 2016 CDBG CAPITAL AGREEMENT - 26 - 5/2016 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway. com XLI. DEBARMENT AND SUSPENSION Agency certifies that, except as noted below, the firm, association or corporation or any person in a controlling capacity associated therewith or any position 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 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. ") XLII. GENERAL PROVISIONS A. Successors in Interest. Subject to Section X., Assignment, 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. B. Governing Law. This Contract shall be made in, governed by, and interpreted in accordance with the laws of the State of Washington. C. Authority. Each individual executing this Contract on behalf of the City and Agency represents and warrants that such individuals are duly authorized to execute and deliver this Contract on behalf of the Agency or the City. D. Captions. The respective captions of the sections of this Contract are inserted for convenience of reference only and shall not be deemed to modify or otherwise affect any of the provisions of this Contract. E. Counterparts. This Contract may be executed in any number of counterparts, which counterparts shall collectively constitute the entire Contract. F. Compliance with Ethics Code. If a violation of the City's Ethics Resolution No. 91 -54, as amended, occurs as a result of the formation and /or performance of this Contract, this Contract may be rendered null and void at the City's option. G. Equal Opportunity to Draft. The Parties have participated and had an equal opportunity to participate in the drafting of this Contract and the Exhibits, if any, attached. No ambiguity shall be construed against any Party upon a claim that that Party drafted the ambiguous language. [Signature page follows] ., K 1 rt... 2016 CDBG CAPITAL AGREEMENT - 27 - 5/2016 � Vecleral Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffedera!way com IN WITNESS, the Parties execute this Contract below, effective the last date written below. CITY OF FEDERAL WAY vri rv4 Jim Ferrell, Mayor DATE: 7/a /1)4, PARKVIEW SERVICES Marc Cote, Executive Director DATE: O SO l ZJ t / 2i D/ lb STATE OF WASHINGTON ) ////'' ) ss. COUNTY OF kf/7 ATTEST: Ji;uL (PLC Jae 1 rk, Stephanie Courtney, C VIC L./ APPROVED AS TO FORM: City Attorney, On this day personally appeared before me Marc Cote, to me known to be the Executive Director of PARKVIEW SERVICES that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that he /she was authorized to execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation. GIVEN my hand and official seal this day ofj-1 , 20/ i Notary's signature j'/1//4 Notary's printed name Df>l'.` , . ZPy —� Notary Public in and for the State of Washington. My commission expires /%O ' c / ' MONIQUE PATZER STATE OF WASHINGTON NOTARY PUBLIC MY COMMISSION EXPIRES 10 -21 -17 2016 CDBG CAPITAL AGREEMENT - 28 - 5/2016 CITY OF Federal Way EXHIBIT A PROJECT SCOPE CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com Project No.: Start Date: January 1, 2016 Project Title: Acquisition of Permanent Housing End Date: June 30, 2017 Federal Way Contract No.: Termination Date: June 30, 2037 Agency Contact Person: Marc Cote Telephone: (206) 542 -6610 E -mail: marc @parkviewservices.org FAX: (206) 745 -1009 PARKVIEW SERVICES (hereinafter referred to as the "Agency ") shall acquire a single - family residence and operate housing on real property located at 33402 33rd Place SW, within the City of Federal Way. The real property and improvements thereon are hereinafter referred to as the "Premises ". The Agency agrees to perform all those activities described in this Project Exhibit ( "Exhibit ") beginning on January 1, 2016, ( "Start Date ") and completing on or before June 30, 2017, ( "End Date "). The Agency also agrees to perform all those housing operations and management activities described in this Exhibit for a period of 20 years beginning no later than July 1, 2017, ( "Operations Start Date ") and terminating on June 30, 2037, ( "Termination Date "). The period between the Operations Start Date and the Termination Date is the "Compliance Period." All such activities shall be provided in a manner which fully complies with all applicable federal, state, and local laws, statutes, rules, and regulations, as are now in effect or hereafter may be amended. I. Project Requirements A. Work Statement. The Agency shall acquire and improve the Premises substantially in compliance with the Agency's application(s) as approved by the City of Federal Way Community Development (hereinafter referred to as the "City ") and any plans and /or specifications (hereinafter referred to as the "Project ") submitted to and approved by the City. The Agency shall finance and develop the Project substantially in accordance with the following Sources and Uses Statement. B. Records. 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 Scope and the City's notice to proceed on this project. 4. Correspondence regarding budget revision requests. 5. Copies of all invoices and reports submitted to the City for this project. 6. Bills for payment. 7. Copies of approved invoices and warrants. 8. Records documenting that costs reimbursed with funding provided under this Scope are allowable in accordance with OMB Circular A -87 for local governments and A -122 for nonprofit organizations. Such records include, but are not limited to: o for personnel costs, payroll time sheets for actual salary and fringe benefit costs. Time sheets must be signed by a supervisor and annotated to document percent of time charged against this project. Direct salaries and wages of employees chargeable to more than one grant program or other cost objective(s) must be supported by time distribution records. Timesheets should contain an after the fact determination of the actual activity of each employee and be 2016 CDBG CAPITAL AGREEMENT - 29 - 5/2016 Vecleral Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com annotated to document the time charged to the project if daily hours being paid for by the respective CDBG award are not noted. o for staff travel, documentation of mileage charges for private auto use must include: a) destination and starting location, and b) purpose of trip; and o 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 the solicitation process used to select vendors and subcontractors with original purchase orders and subcontracts. 10. Documentation required by this Contract if any funds provided under this Scope are used to acquire equipment. 11. The Agency shall ensure that services provided with funding under this Contract are made available to Federal Way residents. 12. Documentation of client income. The Agency shall screen all clients served with funds provided under this Contract and maintain records documenting that at least 51% of the total number of clients served do not have a gross annual family income in excess of the limits specified in the below Income Guidelines for Moderate Income Households (80% and below of median) with the applicable number of Persons Per Household. The definition of family shall include all persons living in the same household who are related by birth, marriage or adoption and includes dependent children living away from home. Adjusted gross income as defined by the Internal Revenue Service Form 1040 shall be used to determine persons' or households' income. The following methods may be used to determine income eligibility: a) IRS income tax return; b) Client income certification on a form approved by the City; or c) Documentation of qualification for participation in a "means- tested" federal or state program at least as restrictive as CDBG with regard to Income Guidelines. King County FY 2016 Income Limits Summary Median FY 2016 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 %) $19,000 $21,700 $24,400 $27,100 $29,300 $32,580 $36,730 $40,890 Income Limits Very Low $90,300 (50 %) $59,600 Income $31,650 $36,150 $40,650 $45,150 $48,800 $52,400 $56,000 0 Limits Low (80 %) $48,550 $55,450 $62,400 $69,300 $74,850 $80,400 $85,950 $91,500 Income Limits Income guidelines may be adjusted periodically by HUD. The Agency agrees to use updated Income Guidelines which will be provided by the City. 2016 CDBG CAPITAL AGREEMENT - 30 - 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffedera!way com Record Retention Period All records required by this Scope shall be retained by the Agency for the period of time specified in the Contract in Section VI. The period of time shall commence on January 1 of the year following the year in which the final invoice was paid. II. Project Budget The Agency shall apply the following funds to the project in accordance with the Line Item Budget Summary. The total amount of reimbursement pursuant to this Scope shall not exceed $50,000.00. A. City of Federal Way Funds Date City of Federal Way Community Development Block Grant $50,000.00 Total City of Federal Way Funds: $50,000.00 B. Line Item Budget Date Acquisition $50,000.00 Construction 7/15/2016 Professional Fees 9/30/2016 Construction Mgt. /Developer Fees 10/1/2016 Other Development Costs (specify below): Total City of Federal Way Funds: $50,000.00 A. The City shall reimburse the Agency for satisfactory completion of the requirements specified in the Contract and this Exhibit, payable in the following manner: the sum, not to exceed $50,000, shall be paid upon submission of invoices and supporting documentation by the Agency as set forth in Section VI.B. of this Exhibit. Funds disbursed for acquisition, site improvement, or construction activities shall not exceed $50,000 and shall be fully invoiced no later than End Date. B. In addition to funding provided under this Contract, the Agency shall secure other public and /or private funding totaling $350,000.00, which shall be sufficient to fully fund total project costs. Total project costs shall be $400,000.00. The City shall not advance funds under this Contract until the Agency has secured commitments for all other financing necessary to meet total project costs. Evidence of these commitments shall be received by this office no later than July 31, 2016. C. The Agency shall expend City and other project - committed funds only for purposes directly related to this project. Unless otherwise agreed to in writing by the City, the expenditure of all such funds shall be strictly in accordance with the development budget as set forth in the approved application. III. Project Milestones Task Date Acquisition 6/30/2016 Rehabilitation start 7/15/2016 Rehabilitation finish 9/30/2016 Occupancy 10/1/2016 Proof of meeting accomplishments or milestones shall be submitted with each voucher for reimbursement. 2016 CDBG CAPITAL AGREEMENT - 31 - 5/2016 ` CITY OF f. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com Milestones may be amended from time to time with the prior approval of the City through a Contract amendment. IV. Acquisition Requirements A. Acquisition Activities. When using City funds to purchase property, the Agency shall follow sound standard business practices to ensure that public dollars are appropriately spent. At a minimum, the following steps shall be taken: 1. Purchase no property in which a board member or staff person has any financial interest; 2. Obtain a Member of Appraisal Institute (MAI), Senior Residential Appraiser (SRA), or Residential Member (RM) appraisal which complies with the Uniform Standards of Professional Appraisal Practices. If the original appraisal exceeds $2,000,000 or involves income property, obtain a review appraisal. The City may waive the review appraisal requirement on a case -by -case basis; 3. Submit a copy of the appraisal(s) and purchase agreement to City of Federal Way Community Services Office prior to requesting reimbursement for the cost of the real property acquisition; 4. Purchase American Land Title Association (ALTA) extended title insurance naming the City as beneficiary; 5. Have the closing documents prepared by an attorney or escrow officer; 6. Review the Cost Settlement Statement to ensure that all following costs are eligible subsequent to closing or possession, whichever is first: recording fees, transfer taxes, documentation stamps, title certificates, other evidence of title, boundary surveys, penalty costs and charges for repayment of any preexisting recorded mortgage entered into in good faith encumbering the real property, and the pro rata portion of any prepaid real property taxes and other charges such as water, sewer, and garbage allocable to the period; and 7. Submit a copy of the Cost Settlement Statement when requesting funds for the real property acquisition. B. Tenant Notification and Relocation 1. The Agency shall at all times comply with all applicable federal, state, and local laws, statutes, rules and regulations relating to notification to and relocation of those persons and households residing at the Premises prior to acquisition by the Agency. The Agency shall be solely responsible for the cost of all relocation benefits required by law. At no time shall the City be responsible for the cost of such benefits. 2. Consultation with City staff is required for any Project that involves acquisition of a building with existing residential and /or commercial tenants to determine tenant notification and, if applicable, relocation assistance requirements. The Agency shall implement notification and relocation consistent with the directions of the City staff, whose role is to ensure that the Agency complies with all federal and local relocation requirements. 3. Consultation with the City staff shall be required for any project that involves demolition and/or conversion of any housing units, including unoccupied units, to determine whether additional requirements will apply under Section 104(d) of the Housing and Community Development Act of 1974, as amended ( "Barney Frank Amendment "). C. Procurement Process 1. If funds under this Contract will be used to reimburse costs of contractor or consultant services, the Agency shall utilize and document an open and competitive solicitation process. The specific requirements for solicitation shall be determined based on the amount of expenditure and whether federal funds are being used. The City shall approve the specific solicitation methods and /or procedures to be followed when procuring consultants or contractors for the project and the bid specifications prior to advertisement. 2016 CDBG CAPITAL AGREEMENT - 32 - 5/2016 CITY OF ''�... Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffedera!way com 2. Wage Rate Requirements. For projects that include construction activities being reimbursed by the City, state prevailing wage rates shall apply unless federal funds mandate use of federal prevailing wage rates. The Agency shall consult with the King City Housing and Community Development Program to determine applicable regulations. If federal prevailing wage rate regulations apply, the Agency shall comply with Davis - Bacon and related Acts set forth at 29 CFR Part 5 and shall consult with the City to establish applicable Davis - Bacon wage rates and reporting requirements. D. Property Construction Standards 1. At a minimum, the Premises shall be improved to comply with Section 8 Housing Quality Standards defined in 24 CFR 982.401. 2. If the Project's construction costs exceed $25,000 per unit, improvements to the Premises shall meet the current edition of the Model Energy Code published by the Council of American Building Officials. All substantially rehabilitated housing shall meet applicable local codes, rehabilitation standards, ordinances, and zoning codes in addition to the cost - effectiveness standards defined in 24 CFR part 39. 3. The Premises shall meet the accessibility requirements in the regulations referenced in 24 CFR 5.105(a), which implement the Fair Housing Act and Section 504 of the Rehabilitation Act of 1973. E. Security Interest 1. To secure the performance of this Contract, including this Exhibit, the Agency shall, for each unit, execute an Affordable Housing Covenant Agreement ( "Covenant "); a Promissory Note ( "Note ") in the total principal amount of $50,000, and a respective Deed of Trust securing said Note and shall obtain an ALTA extended title insurance policy naming the City as beneficiary. If at any time during the term of the Contract, the Agency fails to provide, to Qualified Tenants within the Premises, housing and any services as defined in Section VI of this Exhibit or fails to perform any of the terms or conditions of the Contract, the Agency shall be deemed to be in breach of the Contract and in default of the Covenant, Note, and Deed of Trust and the City shall be entitled to the principal sum of $50,000, or the value of said unit. The terms and conditions of the Covenant, Note, and Deed of Trust are incorporated herein in full by this reference and any default under the Covenant, Note, and /or Deed of Trust shall, at the option of the City, constitute a default under this Contract. Upon default the City shall be entitled to the proportionate share of the Net Appreciated Value, if any, on the property, as defined in the executed Promissory Note. 2. The City's loan to the Agency shall be a non - recourse loan. Nothing, however, shall diminish the Agency's liability for damages or deficiencies resulting from, theft, waste, fraud, material misrepresentation, and misuse of rents. F. Compliance with Federal Environmental Review 1. Notwithstanding any provision of this Contract, the parties hereto agree and acknowledge that this Contract does not constitute a commitment of funds or site approval, and that such commitment of funds or approval shall occur only upon satisfactory completion of environmental review and receipt by the City of a release of funds from the U.S. Department of Housing and Urban Development (HUD) under 24 CFR Part 58. The parties further agree that the provision of any funds to the project shall be conditioned upon the City's determination to proceed with, modify, or cancel the project based on the results of a subsequent environmental review. The Agency shall not spend any funds on physical or choice - limiting actions, including property acquisition, demolition, movement, rehabilitation, conversion, repair, or construction prior to the environmental clearance. Violation of this provision may result in the denial of any funds under the Contract. 2016 CDBG CAPITAL AGREEMENT - 33 - 5/2016 CITY OF :'.,.. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cttyoffederalway com 2. The Agency shall perform all the required mitigation measures referenced in the Environmental Review Record provided by the department. The Agency shall certify its compliance with environmental mitigation measures with each voucher request and shall submit a final account of compliance with all mitigation V. Housing Operations Requirements A. Tenant Population, Income, and Rents 1. The Agency shall operate the Premises as permanent housing for up to six persons with developmental disabilities. The total number of housing units at the Premises is six. The total number of regulated units is six. These units shall be occupied by "Qualified Tenants ", defined as households whose gross annual incomes do not exceed the percent of area median income listed for the regulated units in the table below. The table below provides target numbers at each income level defined by its upper limit for each unit size in the project. For new construction, the Agency shall follow the guidelines in the table to income qualify tenants for the unit size at initial occupancy and change of tenancy following a vacancy. In projects already occupied at the time of acquisition, the Agency shall follow the guidelines in the table to income qualify tenants for each unit size at change of occupancy following a vacancy. (Non - regulated units listed in the table below are not subject to the rent restrictions of this contract.) 2. Rents for the units will be set at an affordable level for Qualified Tenants and will assume occupancy of one to two people per bedroom. The affordable rent level including a utility allowance is defined as no greater than 30 percent of the maximum Qualified Tenant income for the unit. The amount of the utility allowance will be calculated annually by the King City Housing Authority. In no case shall rent including a utility allowance exceed Fair Market Rent for the unit size, as published annually by HUD. All Units in the Project Bedroom size: Tenant income level: Beds Total Extremely low — 30% AMI 6 6 Non - regulated units 0 0 Total Project units 6 6 Tenant income levels shall be determined by using the Seattle- Everett Primary Metropolitan Statistical Area Median income (PMSA median income), adjusted for family size, which is estimated annually by HUD. If at any time, HUD no longer estimates PMSA median income, the benefit standard shall be based on a program selected by the City at its sole discretion. 3. Rents shall not be increased more than once annually, and the Agency shall provide written notice to tenants at least 30 days prior to implementing any increase. Rent may be reduced at any time on a temporary or permanent basis if there is a loss of household income. Changes in the method of determining rent or modifications in the rent schedule for the Premises shall be approved in writing by the City, in advance of notification to tenants. 4. The Agency shall certify household income, and household size and composition, and shall verify household employment and sources of income at each tenant's initial occupancy. Thereafter, tenant incomes shall be certified annually. To determine the tenant's income, the Agency shall use the tenant's adjusted gross income as defined by the Internal Revenue Services for federal income tax reporting. 2016 CDBG CAPITAL AGREEMENT - 34 - 5/2016 ` CITY OF 4W 4 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com 5. Tenants, living at the Premise prior to acquisition by the Agency, with incomes exceeding the limits set forth in Subsection V.A. above shall not be subject to the income requirements set forth in Subsection V.A. and shall continue to pay market rents in the units until turnover. As vacancies occur, the unit shall be rented to Qualified Tenants and the rents shall be subject to the rent restrictions set forth in Subsection V.B. No later than one calendar year after the End Date, the Premises shall be fully occupied with Qualified Tenants and /or Tenants living at the Premises prior to the acquisition by the Agency. Full occupancy is defined as a vacancy rate of less than or equal to 95 percent. 6. If at any time during the course of this Contract, the Agency determines that it is no longer feasible to house Qualified Tenants within the Premises, the Agency shall inform the City that it desires to negotiate with the City for the purpose of serving an alternative population within the Premises. The City may, at its sole option, agree to negotiate this matter with the Agency and all public agencies that have provided funding. Such negotiation shall not waive or otherwise affect the City's rights of recourse under this agreement or otherwise at law. The negotiation period shall not exceed 180 days unless circumstances warrant an extension, and the City agrees in writing to such extension. B. Services Provided to Tenants 1. The Agency or a service partner under a Memorandum of Understanding shall provide supportive services to Qualified Tenants, including but not limited to the following: a. Support and training services provided by Puget Sound Regional Services or other similar organization that are funded by the Developmental Disabilities Administration (DDA). 2. The services to be provided for Qualified Tenants as well as the primary provider of such services shall be described in the Management Plan for the Premises, as defined in Subsection V.C., below. C. Management and Operation of the Premises 1. The Agency shall develop and provide for approval by the City a copy of a comprehensive management plan ( "Management Plan ") for the Premises prior to invoicing or, at the discretion of the City, no later than the End Date. The Management Plan shall address, but not be limited to, a description of the physical plant, the tenant population, tenant selection, tenant termination, the housing program and services, service providers, and the maintenance and operation of the Premises. The Management Plan shall not conflict with the Housing and Community Development Act of 1974, and the National Affordable Housing Act of 1990, as amended. If an independent party or property management firm manages the property, the Agency shall provide a copy of the agreement between the Agency and property management firm. See Section VI of this Contract for more detail. 2. During the period of compliance, the Agency agrees to provide the City access to the property for periodic inspections to ensure compliance with the terms of this Contract. Except in the case of an emergency or abandonment, at least 48 hours advance notice of such access shall be given to the tenant. D. Tenant Protections 1. The Agency shall offer a lease to tenants of permanent housing, which indicates a term and the amount of rent to be paid. 2. The following lease terms are prohibited: a. Agreement by the tenant to be sued, to admit guilt or to a judgment in favor of the owner in a lawsuit brought in connection with the lease; b. Agreement by the tenant that the owner may take, hold or sell personal property of household members without notice to the tenant and a court decision on the rights of the parties; c. Agreement by the tenant not to hold the owner or the owner's agents legally responsible for any action or failure to act, whether intentional or negligent; 2016 CDBG CAPITAL AGREEMENT - 35 - 5/2016 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com d. Agreement by the tenant that the owner may institute a lawsuit without notice to the tenant; e. Agreement by the tenant that the owner may evict the tenant or household members without instituting a civil court proceeding in which the tenant has the opportunity to present a defense, or before a court decision on the rights of the parties; f. Agreement by the tenant to waive any right to a trial by jury; g. Agreement by the tenant to waive the tenant's right to appeal or otherwise challenge in court a court decision in connection with the lease; and h. Agreement by the tenant to pay attorneys' fees or other legal costs even if the tenant wins in a court proceeding by the owner against the tenant. The tenant, however, may be obliged to pay costs if the tenant loses. 3. Tenant selection policies shall be adopted with criteria that: a. Are consistent with the purpose of providing housing for very low- income and low- income persons; b. Are reasonably related to program eligibility and the applicants' ability to perform the obligations of the lease; c. Provide for the selection of tenants from a written waiting list in the chronological order of their application, insofar as is practicable; and d. Give prompt written notification to any rejected applicant of the grounds for any rejection. 4. The Agency may not terminate the tenancy or refuse to renew the lease of a tenant of rental housing except for serious or repeated violation of the terms and conditions of the lease; for violation of federal, state, or local law; or other good cause. Nothing in this Section is intended to reduce the required timeframe otherwise specified in state or local law for providing notice of such termination. VI. Special Requirements A. Operating and Replacement Reserves 1. The Agency shall, by the Operations Start Date, establish separate accounts for operating and replacement reserves and shall capitalize each account with an initial deposit, in the amount specified in the project operating budget approved by the City or in an amount not less than the amount required by a permanent lender or Low Income Housing Tax Credit investor. The Agency shall also make deposits annually as specified in the approved operating pro forma. In the event of a transfer of the property, all maintained operating and replacement accounts shall be transferred to the accounts of the new owner. 2. The Agency shall conduct a capital needs assessment on all the properties covered by this contract. The capital needs assessment shall be conducted by a professional firm having prior experience in this field. At a minimum, the assessment shall identify the condition of the improvements, determine any deferred maintenance, indicate the remaining useful life of building components, and the anticipated projected costs, and schedule for those replacements. The assessment methodology must be approved by the City. The Agency shall then reallocate their reserves accordingly. The Agency shall conduct its first assessment ten years from the Start Date and every ten years thereafter. B. Reports 1. The Agency shall submit an annual report to the City's Community Services Office within 30 days of the close of each calendar year, beginning no later than the year of the End Date. At a minimum, the Agency shall report the rents and utility allowances; the income, size, ethnicity, and composition of tenant households; and, if applicable, information regarding the homeless and /or special needs households served. 2. In addition, the Agency shall provide annually to the City's Community Services Office the following information pertaining to the Premises and the Agency: 2016 CDBG CAPITAL AGREEMENT - 36 - 5/2016 CITY OF '.. Federal Way flow; CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com a. Annual operating statements for the Premises detailing all forms of income, expenses, and cash b. Annual account statements for separate replacement and operating Reserves, including year -end balances and withdrawal and deposit activity; c. An audited financial statement provided on each July 1 for the full period of contract compliance with the first statement due on July 1 of the year following the End Date and the subsequent statements due each July 1 thereafter; d. The federal form 990, at the time it is required by the federal government; e. The annual report of activities and a list of names and addresses of current board members and officers; and f. Additional reports that the City may from time to time reasonably require. 3. City staff shall make periodic visits to the Agency to examine contract files, including but not limited to individual tenant files and source documentation used to verify household income and demographic information. 4. The Agency shall retain records covering individual tenant income verifications and project rents for the most recent five -year period, and shall retain such records for six years after the Termination Date. C. Conflict of Interest 1. No officer, consultant, elected or appointed official, employee, or agent of the City who exercises any functions or responsibilities in connection with the planning and carrying out of the City's Community Development Block Grant Program, or who is in a position to participate in a decision making process or gain inside information with regard to the activities of that program, may obtain a financial interest or benefit from any activity assisted by any housing assistance program of the City's, or have a financial interest in any contract, subcontract, or agreement with respect to City- assisted housing activity of any kind, either for themselves or those with whom they have business or immediate family ties, during their tenure or for one year thereafter. 2. The Agency agrees that it will incorporate into every subcontract required to be in writing and made pursuant to this Agreement the following provisions: The Contractor covenants that no person who presently exercises any functions or responsibilities in connection with the City's CDBG program has any personal financial interest, direct or indirect, in this Contract. The Contractor further covenants that s/he presently has no interest and will not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of services hereunder. The Contractor further covenants that in the performance of this Contract, no person having any conflicting interest will be employed. Any interest on the part of the Contractor or the Contractor's employees must be disclosed to the City. 2016 CDBG CAPITAL AGREEMENT - 37 - 5/2016 CITY OF �. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www otyoffederahvaycom EXHIBIT B FAIR LABOR STANDARDS ACT (HUD FORM 4010) Not Applicable - this contract is not for construction. 2016 CDBG CAPITAL AGREEMENT - 38 - 5/2016 CITY OF '•... Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com EXHIBIT C DAVIS — BACON WAGE DETERMINATION FORM Not Applicable - this contract is not for construction. 2016 CDBG CAPITAL AGREEMENT - 39 - 5/2016 �CITY OF . Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederatway com EXHIBIT D COMMUNITY FACILITY COVENANT AGREEMENT This contract is not for construction. There is no need for a community facility covenant agreement. 2016 CDBG CAPITAL AGREEMENT - 40 - 5/2016 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cttyoffederalway com EXHIBIT E CERTIFICATION RE: DEBARMENT AND SUSPENSION SA.M Search Results List of records matching your search for : Record Status: Active DUNS Number: 937921828 Functional Area: Entity tiIanagement, Performance Information ENTITY PARKVIEW SERVICES Status:Active DUNS: 937921828 +4: CAGE Code: 5LKU2 DoDAAC: Expiration Date: May 20, 2017 Has Active Exclusion ?: No Delinquent Federal Debt ?: No Address: 17544 MIDVALE AVE N City: SHORELINE State /Province: WASHINGTON ZIP Code: 98133 -4921 Country: UNITED STATES 2016 CDBG CAPITAL AGREEMENT - 41 - 5/2016 4CITY OF ., Federal Way LENDER: BORROWER: CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www dtyoffederatway com PROMISSORY NOTE City of Federal Way — CDBG Capital Project Acquisition of Permanent Housing City of Federal Way, a Municipal corporation 33325 8t11 Avenue South Federal Way, WA 98003 PARKVIEW SERVICES, a Washington non - profit corporation 17544 Midvale Ave. N Suite Lower Level Shoreline, WA 98133 PROPERTY 33402 33rd Place Southwest ADDRESS: Federal Way, WA 98023 PRINCIPAL AMOUNT: $50,000.00 LOAN DATE: May 31, 2016 DUE DATE: The earlier of "Default Date" or June 30, 2036 In consideration for the mutual undertakings and covenants contained in this Promissory Note (the "Note "), Lender (also referred to hereinafter as the "City ") and Borrower agree as follows: 1. Purpose for Loan. Borrower has been allocated funds through Lender's Community Development Block Grant ( "CDBG ") Capital Project Program ( "Program ") to acquire and improve real property (the "Property ") to provide permanent housing for persons with developmental disabilities. The program is funded by CDBG funds that have been made available to the City. City is prepared to fund the loan upon Borrower's execution of the "Loan Documents," which include this Promissory Note, an affordability Covenant, a Deed of Trust and a Closing Statement. 2. Promise to Pay. For value received, on or before the Due Date, or at Lender's option upon sale or other conveyance of all or any portion of the Property, Borrower, including its assigns and successors, promises to pay Lender in lawful money of the United States of America, at Lender's principal place of business, or such other place as Lender may designate in writing from time to time, the Principal Amount listed above and as shall have been advanced by Lender to or on behalf of Borrower under this Note, plus interest as provided in this Note. 3. Interest Rate. The unpaid Principal Amount shall bear interest at the rate of One Percent (1 %) compounded per annum (the "Effective Interest Rate ") unless or until there is a breach, default or violation under the Contract, the Deed of Trust, the Covenant Agreement or this Promissory Note. After such breach, default, or violation, the obligation shall bear interest at PROMISSORY NOTE 5/2016 CDBG CAPITAL PROJECT - PARKVIEW SERVICES 2016 Page 1 CITY OF '�... Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www crtyoffederatway com Twelve Percent (12 %) per annum or the highest rate allowed by applicable law, whichever is less. 4. Payments. No payments will be required to be made on the Principal Amount unless or until a Default occurs. In the event of Default, the entire unpaid balance of the Principal Amount as of the date of Default shall immediately become due and payable and interest on the unpaid balance shall commence to accrue at the "Default Interest Rate" on the date of Default. 5. Pre - Payments. Borrower may prepay this Note in full or in part at any time, without penalty. All payments received on this Note shall first be applied against accrued and unpaid interest and "Costs and Fees" owed to Lender under this Note, and the balance against unpaid Principal Amount. Borrower expressly assumes all risks of loss or delay in the delivery of any payments made by mail, and no course of conduct or dealing shall affect Borrower's assumption of these risks. 6. Loan Account. All advances made to or on behalf of Borrower under this Note shall be charged to a loan account in Borrower's name on Lender's books ( "Loan Account ") and Lender shall debit to Borrower's Loan Account the amount of each advance, and credit the amount of each repayment made by Borrower as described in Section 5 above. 7. Default. Upon the occurrence of any of the following events ( "Events of Default "), Lender, at its option, and without notice to Borrower, may declare the entire unpaid Principal Amount to be immediately due and payable: a. The Borrower sells the Property or conveys the Property in lieu foreclosure, or forfeits the Property in foreclosure, bankruptcy or other insolvency proceeding; b. The Borrower makes, or is deemed to have made, any materially incorrect, false, fraudulent or misleading representation, warranty or certificate to the Lender or makes, or is deemed to have made, any materially incorrect, false, fraudulent, or misleading representation in any statement or application to Lender in connection with Lender's consideration of Borrower's Program application; c. The Borrower defaults under the terms of this Note or the Deed of Trust granted in connection herewith; d. Formal charges are filed against the Borrower under any federal, state or municipal statute, law or ordinance for which forfeiture of the Property is a potential penalty, or the Property is in fact so seized or forfeited; e. The Borrower fails to maintain the Property, commits waste upon the Property or allows the Property to become a nuisance; f. The Borrower (1) makes an assignment for the benefit of creditors, (2) consents to the appointment of a custodian, receiver or trustee for itself or for a substantial part of its assets or (3) commences, consents to the commencement or continuation of, or has commenced upon it, voluntarily or involuntarily, any proceeding under any bankruptcy, insolvency or similar laws of any jurisdiction; or g. The Borrower defaults under the deed of trust executed in connection with this Note, it being understood and agreed that this Note and the deed of trust shall be interpreted and construed as a single integrated agreement between Lender and Borrower. PROMISSORY NOTE 5/2016 CDBG CAPITAL PROJECT — PARKVIEW SERVICES 2016 Page 2 CITY OF CITY HALL Fe d e ra I Way 33325 8th Avenue South Federal Way, WA 980038003 -6325 (253) 835 -7000 www crtyoffederalway corn The term "Default Date" shall mean the date on which an Event of Default has occurred or the date Borrower is no longer entitled to cure the Event of Default under the terms of this Note. 8. Default Interest Rate. Upon the occurrence of any Event of Default, the unpaid Principal Amount balance shall bear interest at the per annum interest rate for judgments provided by Washington law until the Note is satisfied in full. 9. Security. This Note is secured by and relates to a deed of trust of even date encumbering the Property. 10. Default Remedies. Upon the occurrence of any Event of Default, Lender shall have and may exercise any one or more of the rights and remedies provided in this Note and the deed of trust relating to this Note. The remedies provided in this Note and Deed of Trust are cumulative to the full extent provided by law. 11. Sale of Property. Except as otherwise contemplated in the Contract, in the event of a sale or transfer of the Property (excluding transfers of interest, if any, that are allowed by the Contract), the Borrower additionally agrees to pay the Lender an amount equal to Lender's proportionate share of the net appreciated value, if any, of the Property. The Lender's proportionate share is calculated by dividing the principal amount of this Note by the actual total development costs of the Project. Lender's estimated proportionate share is 100 percent of the net appreciated value of the Property. Net appreciated value shall be calculated as follows: a. In the case of a sale of the Property, the greater of the sales price of the Property or the appraised value thereof at the time of sale as determined at Borrower's expense by an appraiser satisfactory to Lender; b. Less, as approved by Lender, the original principal of any funds secured by liens against the Property, including the funds referred to herein; c. Less the amount of cash that Borrower has invested in the Property from sources other than the funds referenced in (b) above. This deduction shall include only sums attributable to direct expenditures for acquisition, development and /or capital improvements to the Property and shall not include ongoing maintenance expenditures or indirect expenditures such as real property taxes or legal fees related to the ongoing operation of the Property; and d. Less the actual reasonable costs of sale (if sold), such as appraisal, real estate commissions, real property excise tax, escrow fees, recording fees, and title insurance premiums. 12. Costs and Fees. Borrower agrees to pay all of Lender's costs incurred in the collection, modification, review, monitoring, or termination of this Note, including actual attorney fees and those incurred in any foreclosure, bankruptcy, or other similar insolvency proceeding. 13. No Waiver. Acceptance by Lender of any payment in an amount less than the amount then due shall be deemed an acceptance on account only, and Lender's acceptance of any such partial payment shall not constitute a waiver of Lender's right to receive the entire amount due. 14. Consent. Borrower hereby jointly and severally (i) waives presentment for payment, demand, notice of non - payment, notice of protest or protest of this Note, (ii) waives Lender's diligence in collection or bringing suit, and (iii) waives consent to any and all extensions of time, renewals, waivers or modifications as may be granted by Lender with respect to payment or any PROMISSORY NOTE 5/2016 CDBG CAPITAL PROJECT - PARKVIEW SERVICES 2016 Page 3 CITY F O Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www cityoffederalway corn other provisions of this Note. The liability of the Borrower under this Note shall be absolute and unconditional, without regard to the liability of any other party. 15. Governing Law and Venue. This Note shall be interpreted, construed and governed by, and in accordance with, the laws of the State of Washington. Venue for any action commenced by Borrower or Lender to interpret or enforce this Note or the deed of trust shall be in the Superior Court of the State of Washington, For King County, at the Maleng Regional Justice Center, Kent, Washington. 16. Assignment. Except as otherwise provided in the Contract, the Borrower may not sell, assign or transfer this Note without the written authorization of the Lender. 17. Entire Agreement. Except as otherwise expressly provided in this Note, this Note and the deed of trust constitute the entire agreement of the Borrower and the Lender relating to its subject matter. ORAL AGREEMENTS OR ORAL COMMITMENTS TO LOAN MONEY, EXTEND CREDIT, OR TO FORBEAR FROM ENFORCING REPAYMENT OF A DEBT ARE NOT ENFORCEABLE UNDER WASHINGTON LAW. [Signatures located on following page.] PROMISSORY NOTE 5/2016 CDBG CAPITAL PROJECT - PARKVIEW SERVICES 2016 Page 4 CITY OF Federal Way Agreed to and accepted by: LENDER: CITY OF FEDERAL WAY Jim Ferrell, Mayor / GdNiu/L 7//1/,a/.0 APPROVED AS TO FORM: 0 160(City Attorney,. Auto BORROWER: PARKVIEW SERVICES By: g1 Marc Cote, Executive Director STATE OF WASHINGTON ) ) ss. COUNTY OF CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 wwwdtyoffederatway corn ATTEST: AI '/ // /" /A . t, • erk, Stephanie Courtney, C C On this day personally appeared before me Marc Cote, to me known to be the Executive Director of PARKVIEW SERVICES that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that he /she was authorized to execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation. GIVEN my hand and official seal this day of j{).-Al , 2016. Notary's signature f� G Notary's printed name q Notary Pulhlic in and for the State of Washington. My commission expires )C / l i0 00-4g-%/ MONIQUE PAT;' STATE OF WASHING I ON NOTARY PUBLIC MY COMMISSION EXPIRES 10 -21 -17 PROMISSORY NOTE CDBG CAPITAL PROJECT — PARKVIEW SERVICES 2016 MONIQUE PATZER STATE OF WASHINGTON NOTARY PUBLIC MY COMMISSION EXPIRES 1u -21 -17 5/2016 Page 5 CITY OF ti Federal Way City of Federal Way 2016 CDBG Capital Projects Contract Contract Checklist Please return the following to: Cynthia Ricks - Maccotan City of Federal Way 33325 8th Avenue S Federal Way, WA 98003 CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835 -7000 www cltyoffederalway corn Two signed and notarized copies of the 2016 CDBG Capital lAte Projects contract with the City of Federal Way Documentation that the person signing the contract is authorized to do so. This may be from: Board minutes, articles of incorporation, agency bylaws, etc. A signed Authorized Signatures for Invoices form � �I G' Required insurance certificate(s) as outlined in Section XIV � �/� Insurance Requirements — General Insurance of the contract 11, A Contracts will not be executed by the City of Federal Way until all of the required items have been received. Contact Cynthia Ricks - Maccotan at 253 - 835 -2651 or cynthia.ricks- maccotan (cr�cityoffederalway.com if you have any questions. PCV-*Vi ecv set ✓�CeS 17544 Midvale Ave N., Ste LL Shoreline, WA 98133 marc @parkviewservices.org www.parkviewservices.org Marc Cote Executive Director Ph: 206.542.6610 Cell: 206.334.0731 Fx: 206.745.1009 Nay amity of Federal Way tG Capital Projects Contract Authorized Signatures for Invoices CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835 -7000 www cityoffederalway corn I authorize the following individuals to sign invoices and quarterly reports on behalf of: ?Aij{vIfs SakVicES for 'p the following: T QY Authorizing Signature: (must be signed by person who signs the contract, generally, Executive Director) Mgt" , r CQ (Printed Name) (Signature) (Contracting Agency), (Program Title). Pc Lj W-e J)Ivec (Title) D6 13© /24)16 (Date) Additional Authorized Signature: Additional Authorized Signature: (Printed Name) (Title) (Signature) (Date) (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. Par-kView 5. e1-ViC.e,5 09/02/2014 17544 Midvale Ave N, Suite LL Shoreline, WA 98133 -4921 PH: 206.542.6644 FX: 206.542.6608 or 877.751.6381 The Board of Directors of Parkview Services in accordance with its bylaws hereby approves the following regarding Parkview Homes XII: 1. The submittal of applications for funding to: a. The Department of Commerce Housing Trust Fund in the amount of $ 401,000. b. King County Housing Finance Program in the amount of $401,000. c. A Regional Coalition for Housing in the amount of $190,000. 2. A commitment of funding from Parkview Services in the amount of $6.000. 3. Marc Cote, Executive Director, can sign all funder contracts, purchase and sale agreements, and vouchers for funding. So passed on this 914 day of September, 2015. Todd Pietzsch, B . and V' sident Marc Cote, Executive Director www.parkviewservices.org r We create inclusive housing solutions to promote stability opportunity and community. POLICY CHANGE DOCUMENT POLICY NO.: PHPK1370990 Philadelphia Indemnity Insurance Company' 104165 Bratrud Middleton Ins Brokers Inc dba Pr NAMED INSURED Parkview Services MAILING ADDRESS 17544 Midvale Ave N Ste LI Shoreline, WA 98133 -4921 POLICY PERIOD: FROM 08/01/2015 TO 08/01/2016 at 12:01 A.M. Standard Time at your mailing address shown above. CHANGE EFFECTIVE 05/30/2016 CHANGE # 7 DESCRIPTION In consideration of the premium reflected, the policy is amended as indicated below: Added: Location 57, Bldg 1; 33402 33rd PI SW, Federal Way, WA 98023 Building limit $245,000; $10,000 Deductible; 100% Co -ins; Replacement Cost Blanket limit has been amended GL Class 63010 DWELLING -1 FAM (LESSOR'S RISK) Premium Basis 1 Dwelling Per attached schedules Added: Additional Insureds: King County Housing and Community Development Program 401 5th Ave Ste 500 Seattle, WA 98104 The State of Washington Deptartment of Commerce Path ID 9823818 Total Annual Total Prorate Additional /Return Premium $ 439.00 ADDITIONAL Additional /Return Premium $ 76.00 ADDITIONAL COUNTERSIGNED BY (Date) (Authorized Representative) 06/10/2016 Issue Date Insurance Policy Page 1 of 2 • POLICY CHANGE DOCUMENT POLICY NO.: PHPK1370990 1 CHANGE EFFECTIVE 05/30/2016 CHANGE # 7 DESCRIPTION (Continued) PO Box 48300 Olympia, WA 98504 City of Federal Way Its Officials, Employees, and Volunteers PO Box 9718 Federal Way, WA 98063 Form CG2026- Additional Insured - Designated Person or Organization applies With respect to 57, 33402 33rd PI SW, Federal Way, WA 98023 Per attached schedule 06/10/2016 Issue Date Insurance Policy Page 2 of 2 • • Philadelphia Indemnity Insurance Company Locations Schedule Policy Number: PHPK1370990 Prems. Bldg. No. No. Address 0001 0001 103 N 168th St Shoreline, WA 98133 -5208 0002 0001 10355 Wallingford Ave N Seattle, WA 98133 -9439 0003 0001 10706 Beardslee PI Bothell, WA 98011 -3220 0004 0001 1114 15th Ave E Seattle, WA 98112 -3301 0005 0001 11219 SE 213th St Kent, WA 98031 -2148 0006 0001 1150 Sunset Blvd NE # 322 Renton, WA 98056 -2987 0007 0001 11545 30th Ave NE Seattle, WA 98125 -6860 0008 0001 11939 SE 167th St Renton, WA 98058 -5335 0009 0001 12001 5th Ave NE Seattle, WA 98125 -4907 0010 0001 12219 Bel Red Rd D -201 Bellevue, WA 98005 -2472 0011 0001 130 S 170th St Burien, WA 98148 -1622 0012 0001 13517 1st Ave NE Seattle, WA 98125 -3020 0013 0001 13736 Meridian Ave N Seattle, WA 98133 -7228 0014 0001 14010 Courtland PI N Seattle, WA 98133 -7126 0015 0001 14150 SE 17th PI B -7 Bellevue, WA 98007 -6056 0016 0001 14480 NE 31st St J204 Bellevue, WA 98007 -7672 Page 1 of 4 • • Philadelphia Indemnity Insurance Company Locations Schedule Policy Number: PHPK1370990 Prems. Bldg. No. No. Address 0017 0001 14529 Ashworth Ave N Shoreline, WA 98133 -6223 0018 0001 14616 SE 263rd St Kent, WA 98042 -8117 0019 0001 14757 NE 32nd St B -102 Bellevue, WA 98007 0020 0001 15744 Wallingford Ave N Shoreline, WA 98133 -6012 0021 0001 1642 N 197th PI Shoreline, WA 98133 -3709 0022 0001 16329 Linden Ave N Shoreline, WA 98133 -5619 0023 0001 1808 N 165th St Shoreline, WA 98133 -5502 0024 0001 16738 Fremont Ave N Shoreline, WA 98133 -5242 0025 0001 18100 15th Ave NE # 113 Shoreline, WA 98155 -3817 0026 0001 18100 15th Ave NE # 316 Shoreline, WA 98155 -3819 0027 0001 18833 SE 262nd St Covington, WA 98042 -8415 0028 0001 19141 3rd Ave NW Shoreline, WA 98177 -3010 0029 0001 19584 23rd Ave NE Shoreline, WA 98155 -1202 0030 0001 20105 14th Ave NE Shoreline, WA 98155 -1114 0031 0001 2044 NW 60th St Seattle, WA 98107 -3114 0032 0001 213 155th Ave SE Bellevue, WA 98007 -5301 Page 2 of 4 • • Philadelphia Indemnity Insurance Company Locations Schedule Policy Number: PHPK1370990 Prems. Bldg. No. No. Address 0033 0001 216 NE 185th St Shoreline, WA 98155 -2100 0034 0001 2350 NE 128th St Seattle, WA 98125 -4229 0035 0001 2530 NE 204th St Shoreline, WA 98155 -1428 0036 0001 2509 Edmonds Ave NE Renton, WA 98056 -2204 0037 0001 2721 NE 144th St Seattle, WA 98125 -3570 0038 0001 2804 NE 115th St Seattle, WA 98125 -6747 0039 0001 2915 14th St SE Auburn, WA 98092 -6426 0040 0001 305 NW 199th St Shoreline, WA 98177 -2551 0041 0001 30648 9th Ave S Federal Way, WA 98003 -4117 0042 0001 3412 S 253rd St Kent, WA 98032 -5663 0043 0001 3512 NE 140th St Seattle, WA 98125 -3721 0044 0001 500 N 141st St Seattle, WA 98133 -6823 0045 0001 550 N 78th St Seattle, WA 98103 -4706 0046 0001 610 N 204th St Shoreline, WA 98133 -3051 0047 0001 616 N 180th St Shoreline, WA 98133 -4338 0048 0001 814 Hiawatha PI S Seattle, WA 98144 -2821 Page 3 of 4 • • Philadelphia Indemnity Insurance Company Locations Schedule Policy Number: PHPK1370990 Prems. Bldg. No. No. Address 0049 0001 8205 1st PI SE Lake Stevens, WA 98258 -3351 0050 0001 8209 1st PI SE Lake Stevens, WA 98258 -3351 0051 0001 8217 5th Ave NE # 201 Seattle, WA 98115 -4161 0052 0001 828 N 153rd PI Shoreline, WA 98133 -6107 0053 0001 9814 15th Ave NE Seattle, WA 98115 -2216 0054 0001 17544 Midvale Ave N Ste LI Shoreline, WA 98133 -4921 0055 0001 825 93rd St SE Everett, WA 98208 -3748 0056 0001 8305 NE 183rd St Kenmore, WA 98028 -2838 0057 0001 33402 33rd PI SW Federal Way, WA 98023 -2753 Page 4 of 4 • • Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK1370990 Additional Insured Snohomish County Its officers, elected officials, agents and employees Attn: HSD Contracts 3000 Rockefeller Ave MS 305 Everett, WA 98201 -4046 CG2026 - General Liability Additional Insured Department of Commerce PO Box 42525 1011 Plum St SE Olympia, WA 98504 -2525 CG2018 - WA - Loc #49 CG2018 - WA - Loc #50 Additional Insured Navarre +Pollowitz and Associates LLC PO Box 65206 Seattle, WA 98155 -9206 CG2026 - General Liability Additional Insured Washington Homeownership Resource Center 17544 Midvale Ave N Ste LI Shoreline, WA 98133 -4921 CG2026 - General Liability Additional Insured King County Housing and Community Development Program 401 5th Ave Ste 500 Seattle, WA 98104 -2377 CG2026 - WA - Loc #1 Page 1 of 8 • • Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK1370990 Additional Insured King County Housing and Community Development Program 401 5th Ave Ste 500 Seattle, WA 98104 -2377 CG2026 - WA - Loc #3 CG2026 - WA - Loc #5 CG2026 - WA - Loc #6 CG2026 - WA - Loc #8 CG2026 - WA - Loc #10 CG2026 - WA - Loc #11 CG2026 - WA - Loc #15 CG2026 - WA - Loc #16 CG2026 - WA - Loc #17 CG2026 - WA - Loc #18 CG2026 - WA - Loc #19 CG2026 - WA - Loc #20 CG2026 - WA - Loc #21 CG2026 - WA - Loc #22 CG2026 - WA - Loc #23 CG2026 - WA - Loc #24 CG2026 - WA - Loc #25 CG2026 - WA - Loc #26 CG2026 - WA - Loc #28 Page 2 of 8 • • Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK1370990 Additional Insured King County Housing and Community Development Program 401 5th Ave Ste 500 Seattle, WA 98104 -2377 CG2026 - WA - Loc #29 CG2026 - WA - Loc #30 CG2026 - WA - Loc #32 CG2026 - WA - Loc #33 CG2026 - WA - Loc #35 CG2026 - WA - Loc #36 CG2026 - WA - Loc #39 CG2026 - WA - Loc #40 CG2026 - WA - Loc #42 CG2026 - WA - Loc #46 CG2026 - WA - Loc #47 CG2026 - WA - Loc #48 CG2026 - WA - Loc #52 CG2026 - WA - Loc #56 CG2026 - WA - Loc #57 Page 3 of 8 • • Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK1370990 Additional Insured Snohomish County its officers, elected officials, agents and employees Attn: HSD Contracts 3000 Rockefeller Ave MS 305 Everett, WA 98201 -4046 CG2026 - General Liability RE: Contract Additional Insured The State of Washington Department of Commerce PO Box 48300 Olympia, WA 98504 -8300 CG2026 - WA - Loc #54 RE: Agreement # S16- 32401 -001 CG2026 - WA - Loc #56 CG2026 - WA - Loc #57 Additional Insured Washington State Housing Finance Commission 1000 2nd Ave Ste 2700 Seattle, WA 98104 -3601 CG2026 - WA - Loc #54 Page 4 of 8 • • Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK1370990 Additional Insured WA Dept of Financial Institutions PO Box 41200 Olympia, WA 98504 -1200 CG2026 - WA - Loc #54 Additional Insured City of Bellevue Attn: Housing Planner 450 110th Ave NE PO Box 90012 Bellevue, WA 98004 -5514 CG2018 - WA - Loc #56 Additional Insured City of Clyde Hill Attn: City Administrator 9605 NE 24th St Clyde Hill, WA 98004 -2141 CG2018 - WA - Loc #56 Additional Insured Town of Hunts Point Attn: Town Administrator 3000 Hunts Point Rd Hunts Point, WA 98004 -1121 CG2018 - WA - Loc #56 Page 5 of 8 • • Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK1370990 Additional Insured City of Issaquah Planning Department Attn: Housing Planner PO Box 1307 Issaquah, WA 98027 -0051 CG2018 - WA - Loc #56 Additional Insured City of Kenmore Department of Planning and Community Development, Attn: Planning Director 18120 68th Ave NE PO Box 82607 Kenmore, WA 98028 -2701 CG2018 - WA - Loc #56 Additional Insured City of Medina Attn: City Manager PO Box 144 Medina, WA 98039 -0144 CG2018 - WA - Loc #56 Page 6 of 8 • • Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK1370990 Additional Insured City of Mercer Island City Attorney's Office 9611 SE 36th St Mercer Island, WA 98040 -3732 CG2018 - WA - Loc #56 Additional Insured City of Newcastle Planning Department Attn: Planning Director 12835 Newcastle Way Unit 200 Newcastle, WA 98056 -1316 CG2018 - WA - Loc #56 Additional Insured City of Sammamish Planning Department Attn: Housing Planner /Planning Director 801 228th Ave SE Sammamish, WA 98075 -9509 CG2018 - WA - Loc #56 Page 7 of 8 • • Philadelphia Indemnity Insurance Company Additional Insured Schedule Policy Number: PHPK1370990 Additional Insured City of Woodinville Department of Planning and Community Development Attn: Planning Director 17301 133rd Ave NE Woodinville, WA 98072 -8563 CG2018 - WA - Loc #56 Additional Insured Town of Yarrow Point Attn: Town Clerk /Treasurer 4030 95th Ave NE Yarrow Point, WA 98004 -1358 CG2018 - WA - Loc #56 Additional Insured City of Federal Way Its Officials, Employees, and Volunteers PO Box 9718 Federal Way, WA 98063 CG2026 - WA - Loc #57 Page 8 of 8 • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 001 001 103 N 168th St Shoreline, WA 98133 -5208 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent# 104165 002 001 10355 Wallingford Ave N Seattle, WA 98133 -9439 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 001 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 002 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 001 001 BUILDING BKT #01 08/01/2016 (X) 002 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 003 001 10706 Beardslee PI Bothell, WA 98011 -3220 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 004 001 1114 15th Ave E Seattle, WA 98112 -3301 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 003 001 BUILDING BKT #O1 SPECIAL BKT #01 10,000 004 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 004 001 BUSINESS PERS PROPERTY BKT #02 SPECIAL BKT #02 10,000 004 001 BUSINESS INCOME-BASIC (2) BKT #03 SPECIAL BKT #03 72 HR. OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 003 001 BUILDING BKT #01 08/01/2016 (X) 004 001 BUILDING BKT #01 08/01/2016 (X) 004 001 BUSINESS PERS PROPERTY BKT #02 08/01/2016 (X) (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) 004 001 08/01/2016 BKT #03 Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 005 001 11219 SE 213th St Kent, WA 98031 -2148 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 007 001 11545 30th Ave NE Seattle, WA 98125 -6860 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 005 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 007 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 005 001 BUILDING BKT #01 08/01/2016 (X) 007 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 008 001 11939 SE 167th St Renton, WA 98058 -5335 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 009 001 12001 5th Ave NE Seattle, WA 98125 -4907 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 008 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 009 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 008 001 BUILDING BKT #01 08/01/2016 (X) 009 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 011 001 130 S 170th St Burien, WA 98148 -1622 DWELLING -1 FAM (LESSOR'S RISK) PC 04 FRAME 012 001 13517 1st Ave NE Seattle, WA 98125 -3020 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent# 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. • Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 011 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 012 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 011 001 BUILDING BKT 4t01 08/01/2016 (X) 012 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 013 001 13736 Meridian Ave N Seattle, WA 98133 -7228 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME 014 001 14010 Courtland PI N Seattle, WA 98133 -7126 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent# 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 013 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 014 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. No. No. 013 001 BUILDING 014 001 BUILDING Coverage Agreed Value Replacement Cost Inflation Amount Expiration Date Incl. Stock Guard BKT #01 08/01/2016 (X) BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 017 001 14529 Ashworth Ave N Shoreline, WA 98133 -6223 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 018 001 14616 SE 263rd St Kent, WA 98042 -8117 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent# 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 017 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 018 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 017 001 BUILDING BKT #01 08/01/2016 (X) 018 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 020 001 15744 Wallingford Ave N Shoreline, WA 98133 -6012 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 021 001 1642 N 197th PI Shoreline, WA 98133 -3709 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 020 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 021 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 020 001 BUILDING BKT #01 08/01/2016 (X) 021 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 022 001 16329 Linden Ave N Shoreline, WA 98133 -5619 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 023 001 1808 N 165th St Shoreline, WA 98133 -5502 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 022 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 023 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. No. No. 022 001 BUILDING 023 001 BUILDING Coverage Agreed Value Replacement Cost Inflation Amount Expiration Date Incl. Stock Guard BKT #01 08/01/2016 BKT #01 08/01/2016 (X) (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 024 001 16738 Fremont Ave N Shoreline, WA 98133 -5242 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 027 001 18833 SE 262nd St Covington, WA 98042 -8415 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 024 001 BUILDING BKT #01 SPECIAL BKT #O1 10,000 027 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 024 001 BUILDING BKT #01 08/01/2016 (X) 027 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 028 001 19141 3rd Ave NW Shoreline, WA 98177 -3010 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 029 001 19584 23rd Ave NE Shoreline, WA 98155 -1202 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 028 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 029 001 BUILDING BKT #O1 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 028 001 BUILDING BKT #01 08/01/2016 (X) 029 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 031 001 2044 NW 60th St Seattle, WA 98107 -3114 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME 032 001 213 155th Ave SE Bellevue, WA 98007 -5301 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 031 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 032 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 031 001 BUILDING BKT #01 08/01/2016 (X) 032 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 033 001 216 NE 185th St Shoreline, WA 98155 -2100 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 034 001 2350 NE 128th St Seattle, WA 98125 -4229 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 033 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 034 001 BUILDING BKT #01 SPECIAL, BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 033 001 BUILDING BKT #01 08/01/2016 (X) 034 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 035 001 2530 NE 204th St Shoreline, WA 98155 -1428 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent # 104165 036 001 2509 Edmonds Ave NE Renton, WA 98056 -2204 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 035 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 036 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 035 001 BUILDING BKT #01 08/01/2016 (X) 036 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 037 001 2721 NE 144th St Seattle, WA 98125 -3570 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME 038 001 2804 NE 115th St Seattle, WA 98125 -6747 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent# 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 037 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 038 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 037 001 BUILDING BKT #01 08/01/2016 (X) 038 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 039 001 2915 14th St SE Auburn, WA 98092 -6426 DWELLING -1 FAM (LESSOR'S RISK) PC 04 FRAME 040 001 305 NW 199th St Shoreline, WA 98177 -2551 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 039 001 BUILDING BKT #O1 SPECIAL BKT #01 10,000 040 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 039 001 BUILDING BKT #01 08/01/2016 (X) 040 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 041 001 30648 9th Ave S Federal Way, WA 98003 -4117 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME 042 001 3412 S 253rd St Kent, WA 98032 -5663 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. No. No. Coverage 041 001 BUILDING 042 001 BUILDING Limit of Causes of (1) Insurance Loss Form Coinsurance(2) Deductible BKT #01 SPECIAL BKT #01 10,000 BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 041 001 BUILDING BKT #01 08/01/2016 (x) 042 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 043 001 3512 NE 140th St Seattle, WA 98125 -3721 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME 044 001 500 N 141st St Seattle, WA 98133 -6823 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent# 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 043 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 044 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. No. No. 043 001 BUILDING 044 001 BUILDING Coverage Agreed Value Replacement Cost Inflation Amount Expiration Date Incl. Stock Guard BKT #O1 08/01/2016 (X) BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 045 001 550 N 78th St Seattle, WA 98103 -4706 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME 046 001 610 N 204th St Shoreline, WA 98133 -3051 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 045 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 046 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 045 001 BUILDING BKT #01 08/01/2016 (X) 046 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 047 001 616 N 180th St Shoreline, WA 98133 -4338 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 049 001 8205 1st PI SE Lake Stevens, WA 98258 -3351 DWELLING -1 FAM (LESSOR'S RISK) PC 04 FRAME Agent# 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 047 001 BUILDING BKT #O1 SPECIAL BKT #01 10,000 049 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 047 001 BUILDING BKT #01 08/01/2016 (X) 049 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 050 001 8209 1st PI SE Lake Stevens, WA 98258 -3351 DWELLING -1 FAM (LESSOR'S RISK) PC 04 FRAME 052 001 828 N 153rd PI Shoreline, WA 98133 -6107 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME Agent# 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 050 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 052 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 050 001 BUILDING BKT #01 08/01/2016 (X) 052 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 053 001 9814 15th Ave NE Seattle, WA 98115 -2216 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent # 104165 054 001 17544 Midvale Ave N Ste LI Shoreline, WA 98133 -4921 OFFICE PC 03 FRAME COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 053 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 054 001 BUSINESS PERS PROPERTY BKT #02 SPECIAL BKT #02 10,000 054 001 BUSINESS INCOME-BASIC (1) BKT #03 SPECIAL BKT #03 72 HR. OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 053 001 BUILDING BKT #01 08/01/2016 (X) 054 001 BUSINESS PERS PROPERTY BKT #02 08/01/2016 (X) (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) 054 001 08/01/2016 BKT #03 Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 055 001 825 93rd St SE Everett, WA 98208 -3748 DWELLING -1 FAM (LESSOR'S RISK) PC 03 FRAME 056 001 8305 NE 183rd St Kenmore, WA 98028 -2838 DWELLING -1 FAM (LESSOR'S RISK) PC 04 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 055 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 056 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Replacement Cost Inflation No. No. Coverage Amount Expiration Date Incl. Stock Guard 055 001 BUILDING BKT #01 08/01/2016 (X) 056 001 BUILDING BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services DESCRIPTION OF PREMISES: Prem. Bldg. No. No. Location, Fire Protection /Construction and Occupancy 057 001 33402 33rd PI SW Federal Way, WA 98023 -2753 DWELLING -1 FAM (LESSOR'S RISK) PC 02 FRAME Agent # 104165 COVERAGES PROVIDED: Insurance at the described premises applies only for coverages for which a limit of insurance is shown or for which an entry is made. Prem. Bldg. Limit of Causes of (1) No. No. Coverage Insurance Loss Form Coinsurance(2) Deductible 057 001 BUILDING BKT #01 SPECIAL BKT #01 10,000 BOILER & MACHINERY PROPERTY ELITE OPTIONAL COVERAGES: Prem. Bldg. No. No. 057 001 BUILDING Coverage Agreed Value Replacement Cost Inflation Amount Expiration Date Incl. Stock Guard BKT #01 08/01/2016 (X) OPTIONAL COVERAGES: APPLIES TO BUSINESS INCOME ONLY Prem. Bldg. Agreed Value Agreed Value Monthly Limit of Maximum Period of Extended Period of No. No. Date Amount Indemnity(Fraction) Indemnity Indemnity (Days) Deductible Exceptions: (1) EQ (if shown) = Earthquake (2) Coinsurance %, Extra Expense %, Limits on Loss Payment or Value Reporting Form Symbol (5) 10% or $5,000 minimum • • Philadelphia Indemnity Insurance Company COMMERCIAL PROPERTY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Named Insured: Parkview Services COMMERCIAL PROPERTY COVERAGE PART — BLANKET STATEMENT OF VALUES Agent # 104165 Blanket Limit of Co- No. Blanket Description Insurance Insurance 001 Blanket Building $ 9,428,246 100% 002 Blanket BPP $ 121,100 100% 003 Blanket BI /EE $ 125,000 100% • • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent # 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums Prem./ Prod./ Ops. Comp. Ops. WA PREM NO. 001 HEALTH CARE FACIL - HANDICAP -NFP 44434 2,370 89.537 INCL 212 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 002 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,950 89.537 INCL 175 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 003 HEALTH CARE FACIL - HANDICAP -NFP 44434 2,880 98.259 INCL 283 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 004 CAMP -N /PROFIT 41422 300 0.484 INCL 145 INC: CAMPER DAY PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 004 HEALTH CARE FACIL - HANDICAP -NFP 44434 4,410 89.537 INCL 395 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 005 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 INC: DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 006 HEALTH CARE FACIL- HANDICAP -NFP 44434 891 98.259 INCL 88 INC. AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT • • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent # 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums Prem./ Prod./ Ops. Comp. Ops. WA PREM NO. 007 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,740 89.537 INCL 156 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 008 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,910 98.259 INCL 188 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 009 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 104.518 INCL 105 INC. DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 010 HEALTH CARE FACIL - HANDICAP -NFP 44434 662 98.259 INCL 65 INC. AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 011 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,450 98.259 INCL 142 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 012 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,540 89.537 INCL 138 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 013 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,740 89.537 INCL 156 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT • • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent # 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums Prem./ Prod./ Ops. Comp. Ops. WA PREM NO. 014 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,480 89.037 INCL 133 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 015 HEALTH CARE FACIL - HANDICAP -NFP 44434 642 98.259 INCL 63 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 016 HEALTH CARE FACIL - HANDICAP -NFP 44434 942 98.259 INCL 93 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 017 HEALTH CARE FACIL- HANDICAP -NFP 44434 2,540 89.537 INCL 227 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 018 HEALTH CARE FACIL - HANDICAP -NFP 44434 ],900 98.259 INCL 187 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 019 HEALTH CARE FACIL - HANDICAP -NFP 44434 889 98.259 INCL 87 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 020 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,860 89.937 INCL 167 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT 1 • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent # 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums PremJ Prod./ Ops. Comp. Ops. WA PREM NO. 021 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 104.518 INCL 105 INC DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 022 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 104.518 INCL 105 INC. DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 023 HEALTH CARE FACIL - HANDICAP -NFP 44434 3,140 89.537 INCL 281 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 024 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 104.518 INCL 105 INC: DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 025 HEALTH CARE FACIL - HANDICAP -NFP 44434 685 98.259 INCL 67 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 026 HEALTH CARE FACIL - HANDICAP -NFP 44434 934 98.259 INCL 92 INC] AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 027 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 INC] DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT • • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent # 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums Prem./ Prod./ Ops. Comp. Ops. WA PREM NO. 028 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,380 89.537 INCL 124 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 029 HEALTH CARE FACIL - HANDICAP -NFP 44434 2,000 98.259 INCL 197 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 030 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,010 98.259 INCL 99 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 031 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,930 89.537 INCL 173 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 032 HEALTH CARE FACIL - HANDICAP -NFP 44434 2,310 98.259 INCL 227 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 033 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 INC DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 034 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 104.518 INCL 10S INC: DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent# 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums Prem./ Prod./ Ops. Comp. Ops. WA PREM NO. 035 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 INC. DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 036 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,880 98.259 INCL 185 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 037 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 104.518 INCL 105 INC: DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 038 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,570 89.537 INCL 141 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 039 HEALTH CARE FACIL- HANDICAP -NFP 44434 2,610 98.259 INCL 256 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 040 HEALTH CARE FACIL - HANDICAP -NFP 44434 2,290 89.537 INCL 205 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 041 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 INC: DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT • • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent # 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums Prem./ Prod./ Ops. Comp. Ops. WA PREM NO. 042 HEALTH CARE FACIL - HANDICAP -NFP 44434 2,060 98.259 INCL 202 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 043 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,880 89.537 INCL 168 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 044 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,710 89.537 INCL 153 INC: AR EA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 045 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,250 89.537 INCL 112 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 046 HEALTH CARE FACIL - HANDICAP -NFP 44434 2,030 89.537 INCL 182 INC. AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 047 HEALTH CARE FACIL - HANDICAP -NFP 44434 2,250 89.537 INCL 201 INC AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 048 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,392 89.537 INCL 125 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT • • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent # 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums Prem./ Prod./ Ops. Comp. Ops. WA PREM NO. 049 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 TNC DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 050 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 INC. DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 051 HEALTH CARE FACIL - HANDICAP -NFP 44434 947 89.537 INCL 85 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 052 HEALTH CARE FACIL- HANDICAP -NFP 44434 1,920 89.537 INCL 172 INC: AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 053 HEALTH CARE FACIL - HANDICAP -NFP 44434 5,420 89.537 INCL 485 INC- AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 054 BLDG /PREMS- OFFICE -NOC -NFP 6122/ 6,089 164.942 INCL 1,004 INC- AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 055 HEALTH CARE FACIL - HANDICAP -NFP 44434 1,603 98.259 INCL 158 INC. AREA PROD /COMP OP SUBJ TO GEN AGG LIMIT • • Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1370990 Agent # 104165 Classifications Code No. Premium Basis Rates Prem./ Prod./ Ops. Comp. Ops. Advance Premiums Prem./ Prod./ Ops. Comp. Ops. WA PREM NO. 056 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 TNC DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA PREM NO. 057 DWELLING -1 FAM (LESSOR'S RISK) 63010 1 100.499 INCL 100 INC. DWELLING PROD /COMP OP SUBJ TO GEN AGG LIMIT WA SPECIAL EVENTS COVERAGE 48558 120 120 FLAT CHARGE WA LIABILITY DELUXE 44444 INCL