Loading...
AG 17-034II RETURN TO: Sarah Bridgeford EXT: 2651 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: CD /CS 2. ORIGINATING STAFF PERSON: _SARAH BRIDGEFORD EXT: 2651 3. DATE REQ. BY: 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 x HUMAN SERVICES / CDBG ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ RESOLUTION ❑ INTERLOCAL 5. PROJECT NAME: EMPLOYMENT AND TRAINING SERVICES 6. NAME OF CONTRACTOR: UGET SOUND RAINING CENTER ADDRESS: E -MAIL: SIGNATURE NAME: TELEPHONE FAX: TITLE 7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS /CERTIFICATE X ALL OTHER REFERENCED EXHIBITS X PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS 8. TERM: COMMENCEMENT DATE: 01/01/2017 COMPLETION DATE: 12/31/2018 9. TOTAL COMPENSATION $_10,000.00 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY RETAINAGE: RETAINAGE AMOUNT: ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT /CONTRACT REVIEW ❑ PROJECT MANAGER C✓'DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW 11. COUNCIL APPROVAL (IF APPLICABLE) ❑ RETAINAGE BY (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED 001- 7300 - 083 - 562 - 10-410 INITIAL / DATE REVIEWED O).t 111 (ik COMMITTEE APPROVAL DATE: INITIAL / DATE APPROVED COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING % SENT TO VENDOR/CONTRACTOR DATE SENT{ $, 20th— DATE REC'D: g/ ( /7,31-4- 14 ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS INITIAL / DATE S GNED ❑0 L EPARTMENT SIW f GNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# ❑ SIGNED COPY RETURNED COMMENTS: 17 AG - F1 af DATE SENT: 03-OR -I l CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www cityofederalway com HUMAN SERVICES AGREEMENT FOR EMPLOYMENT AND TRAINING SERVICES This Human Services Agreement ( "Agreement ") is made between the City of Federal Way, a Washington municipal corporation ( "City "), and Puget Sound Opportunities Industrialization Center, a Washington nonprofit corporation ( "Agency "). The City and Agency (together "Parties ") are located and do business at the below addresses which shall be valid for any notice required under this Agreement: PUGET SOUND OPPORTUNITIES INDUSTRIALIZATION CENTER: Marisol Tapia 270 SW 43rd Street, Bldg. 3 Renton, WA 98057 (425) 656 -5950 (telephone) marisolt @pstrainingcenter.com CITY OF FEDERAL WAY: Sarah Bridgeford 33325 8th Ave. S. Federal Way, WA 98003 -6325 (253) 835 -2651 (telephone) (253) 835 -2609 (facsimile) Sarah.Bridgeford@cityoffederalway.com The Parties agree as follows: 1. TERM. The term of this Agreement shall be for a period commencing on January 1, 2017 and terminating on December 31, 2018 ( "Term "). Funding for the second year of the Agreement is contingent upon satisfactory Agreement performance during the first year of the Agreement term and upon funding availability. This Agreement may be extended for additional periods of time upon the mutual written agreement of the City and the Agency. 2. SERVICES. The Agency shall perform the services more specifically described in Exhibit A, attached hereto and incorporated by this reference ( "Services "), in a manner consistent with the accepted professional practices for other similar services within the Puget Sound region in effect at the time those services are performed to the City's satisfaction, within the time period prescribed by the City and pursuant to the direction of the Mayor or his or her designee. The Agency warrants that it has the requisite training, skill, and experience necessary to provide the Services and is appropriately accredited and licensed by all applicable agencies and governmental entities, including but not limited to obtaining a City of Federal Way business registration. Services shall begin immediately upon the effective date of this Agreement. Services shall be subject, at all times, to inspection by and approval of the City, but the making (or failure or delay in making) such inspection or approval shall not relieve the Agency of responsibility for performance of the Services in accordance with this Agreement, notwithstanding the City's knowledge of defective or non - complying performance, its substantiality or the ease of its discovery. 3. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days' written notice at its address set forth above. The City may terminate this Agreement immediately if the Agency fails to maintain required insurance, breaches confidentiality, or materially violates Section 12, and such may result in ineligibility for further City agreements. 4. COMPENSATION. 4.1 Amount. In return for the Services, the City shall pay the Agency an amount not to exceed a maximum amount and according to a rate or method as delineated in Exhibit B, attached hereto and incorporated by this reference. The City shall reimburse the Agency only for the approved activities and in accordance with the procedures as specified in Exhibit B. The Agency shall be solely responsible for the payment of any taxes imposed by any lawful jurisdiction resulting from this Agreement. HUMAN SERVICES AGREEMENT - 1 - 4/2015 CITY OF ,"�.... Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www crtyof ederafway com 4.2 Method of Payment. On a quarterly basis, the Agency shall submit to the City an invoice for payment on a form provided by the City along with supporting documentation for costs claimed in the invoice and all reports as required by this Agreement. Payment shall be made on a quarterly basis by the City only after the Services have been performed and within forty -five (45) days after the City's receipt and approval of a complete and correct invoice, supporting documentation, and reports. The City will use the quantity of Services actually delivered, as reported on the Agency's reports, as a measure of satisfactory performance under this Agreement. The City shall review the Agency's reports to monitor compliance with the performance measures set forth in Exhibit A. Should the Agency fail to meet the performance measures for each quarter, the City reserves the right to adjust payments on a pro rata basis at any time during the term of this Agreement. Exceptions may be made at the discretion of the City's Human Services Manager in cases where circumstances beyond the Agency's control impact its ability to meet its service unit goals and the Agency has shown reasonable efforts to overcome these circumstances to meet its goals. If the City objects to all or any portion of the invoice, it shall notify the Agency and reserves the option to pay only that portion of the invoice not in dispute. In that event, the Parties will immediately make every effort to settle the disputed portion. 4.3 Final Invoice. The Agency shall submit its final invoice by the date indicated on Exhibit B. If the Agency's final invoice, supporting documentation, and reports are not submitted by the last date specified in Exhibit B, the City shall be relieved of all liability for payment to the Agency of the amounts set forth in said invoice or any subsequent invoice; provided, however, that the City may elect to pay any invoice that is not submitted in a timely manner. 4.4 Budget. The Agency shall apply the funds received from the City under this Agreement in accordance with the line item budget set forth in Exhibit B. The Agency shall request 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/Program 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. 4.5 Non - Appropriation of Funds. If sufficient funds are not appropriated or allocated for payment under this Agreement for any future fiscal period, the City will not be obligated to make payments for Services or amounts incurred after the end of the current fiscal period, and this Agreement will terminate upon the completion of all remaining Services for which funds are allocated. No penalty or expense shall accrue to the City in the event this provision applies. 5. INDEMNIFICATION. 5.1 Agency Indemnification. The Agency agrees to release, indemnify, defend, and hold the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, taxes, losses, fines, fees, penalties expenses, attorney's fees, costs, and /or litigation expenses to or by any and all persons or entities, including, without limitation, their respective agents, licensees, or representatives arising from, resulting from, or in connection with this Agreement or the performance of this Agreement, except for that portion of the claims caused by the City's sole negligence. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Agency and the City, the Agency's liability hereunder shall be only to the extent of the Agency's negligence. Agency shall ensure that each subcontractor shall agree to defend and indemnify the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers to the extent and on the same terms and conditions as the Agency pursuant to this paragraph. The City's inspection or acceptance of any of Agency's work when completed shall not be grounds to avoid any of these covenants of indemnification. 5.2 Industrial Insurance Act Waiver. It is specifically and expressly understood that the Agency waives any immunity that may be granted to it under the Washington State industrial insurance act, Title 51 RCW, solely for the purposes of this indemnification. Agency's indemnification shall not be limited in any way by any limitation on the amount of damages, compensation or benefits payable to or by any third party under workers' compensation acts, disability benefit acts or any other benefits acts or programs. The Parties further acknowledge that they have mutually negotiated this waiver. HUMAN SERVICES AGREEMENT - 2 - 4/2015 CITY OF ,�.. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www cityoffederalway corn 5.3 City Indemnification. The City agrees to release, indemnify, defend and hold the Agency, its officers, directors, shareholders, partners, employees, agents, representatives, and subcontractors harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, losses, fines, fees, penalties expenses, attorney's fees, costs, and /or litigation expenses to or by any and all persons or entities, including without limitation, their respective agents, licensees, or representatives, arising from, resulting from or connected with this Agreement to the extent solely caused by the negligent acts, errors, or omissions of the City. 5.4 Survival. The provisions of this Section shall survive the expiration or termination of this Agreement with respect to any event occurring prior to such expiration or termination. 6. INSURANCE. The Agency agrees to carry insurance for liability which may arise from or in connection with the performance of the services or work by the Agency, their agents, representatives, employees or subcontractors for the duration of the Agreement and thereafter with respect to any event occurring prior to such expiration or termination as follows: 6.1. Minimum Limits. The Agency agrees to carry as a minimum, the following insurance, in such forms and with such carriers who have a rating that is satisfactory to the City: a. Commercial general liability insurance covering liability arising from premises, operations, independent contractors, products - completed operations, stop gap liability, personal injury, bodily injury, death, property damage, products liability, advertising injury, and liability assumed under an insured contract with limits no less than $1,000,000 for each occurrence and $2,000,000 general aggregate. b. Workers' compensation and employer's liability insurance in amounts sufficient pursuant to the laws of the State of Washington; c. Automobile liability insurance covering all owned, non - owned, hired and leased vehicles with a minimum combined single limits in the minimum amounts required to drive under Washington State law per accident for bodily injury, including personal injury or death, and property damage. 6.2. No Limit of Liability. Agency's maintenance of insurance as required by the agreement shall not be construed to limit the liability of the Agency to the coverage provided by such insurance, or otherwise limit the City's recourse to any remedy available at law or in equity. The Agency's insurance coverage shall be primary insurance as respect the City. Any insurance, self - insurance, or insurance pool coverage maintained by the City shall be excess of the Agency's insurance and shall not contribute with it. 6.3. Additional Insured, Verification. The City shall be named as additional insured on all commercial general liability insurance policies. Concurrent with the execution of this Agreement, Agency shall provide certificates of insurance for all commercial general liability policies attached hereto as Exhibit C and incorporated by this reference. At the City's request, Agency shall furnish the City with copies of all insurance policies and with evidence of payment of premiums or fees of such policies. If Agency's insurance policies are "claims made," Agency shall be required to maintain tail coverage for a minimum period of three (3) years from the date this Agreement is actually terminated or upon project completion and acceptance by the City. 6.4 Survival. The provisions of this Section shall survive the expiration or termination of this Agreement. 7. CONFIDENTIALITY. All information regarding the City obtained by Agency in performance of this Agreement shall be considered confidential subject to applicable laws. Breach of confidentiality by the Agency may be grounds for immediate termination. All records submitted by the City to the Agency will be safeguarded by the Agency. The Agency will fully cooperate with the City in identifying, assembling, and providing records in case of any public records disclosure request. 8. WORK PRODUCT. All originals and copies of work product, including plans, sketches, layouts, designs, design specifications, records, files, computer disks, magnetic media or material which may be produced or modified by Agency while performing the Services shall belong to the City upon delivery. The Agency shall make such data, documents, and files available to the City and shall deliver all needed or contracted for work product upon the City's request. At the expiration or termination of this Agreement all originals and copies of any such work product remaining in the possession of Agency shall be delivered to the City. HUMAN SERVICES AGREEMENT - 3 4/2015 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www cityoffederalway corn 9. BOOKS AND RECORDS. The Agency agrees to maintain books, records, and documents which sufficiently and properly reflect all direct and indirect costs related to the performance of the Services and maintain such accounting procedures and practices as may be deemed necessary by the City to assure proper accounting of all funds paid pursuant to this Agreement. These records shall be maintained for a period of six (6) years after the termination of this Agreement and may be subject, at all reasonable times, to inspection, review or audit by the City, its authorized representative, the State Auditor, or other governmental officials authorized by law to monitor this Agreement. 10. INDEPENDENT CONTRACTOR. The Parties intend that the Agency shall be an independent contractor and that the Agency has the ability to control and direct the performance and details of its work, the City being interested only in the results obtained under this Agreement. The City shall be neither liable nor obligated to pay Agency sick leave, vacation pay or any other benefit of employment, nor to pay any social security or other tax which may arise as an incident of employment. Agency shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the Services and work and shall utilize all protection necessary for that purpose. All work shall be done at Agency's own risk, and Agency shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. The Agency shall pay all income and other taxes due except as specifically provided in Section 4. Industrial or any other insurance that is purchased for the benefit of the City, regardless of whether such may provide a secondary or incidental benefit to the Agency, shall not be deemed to convert this Agreement to an employment contract. 11. CONFLICT OF INTEREST. It is recognized that Agency may or will be performing services during the Term for other parties; however, such performance of other services shall not conflict with or interfere with Agency's ability to perform the Services. Agency agrees to resolve any such conflicts of interest in favor of the City. Agency confirms that Agency does not have a business interest or a close family relationship with any City officer or employee who was, is, or will be involved in the Agency's selection, negotiation, drafting, signing, administration, or evaluating the Agency's performance. 12. EOUAL OPPORTUNITY EMPLOYER. In all services, programs, activities, hiring, and employment made possible by or resulting from this Agreement or any subcontract, there shall be no discrimination by Agency or its subcontractors of any level, or any of those entities' employees, agents, sub - agencies, or representatives against any person because of sex, age (except minimum age and retirement provisions), race, color, religion, creed, national origin, marital status, or the presence of any disability, including sensory, mental or physical handicaps, unless based upon a bona fide occupational qualification in relationship to hiring and employment. This requirement shall apply to, but not be limited to, the following: employment, advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. Agency shall comply with and shall not violate any of the terms of Chapter 49.60 RCW, Title VI of the Civil Rights Act of 1964, the Americans With Disabilities Act, Section 504 of the Rehabilitation Act of 1973, 49 CFR Part 21, 21.5 and 26, or any other applicable federal, state, or local law or regulation regarding non - discrimination. 13. GENERAL PROVISIONS. 13.1 Interpretation and Modification. This Agreement, together with any attached Exhibits, contains all of the agreements of the Parties with respect to any matter covered or mentioned in this Agreement and no prior statements or agreements, whether oral or written, shall be effective for any purpose. Should any language in any Exhibits to this Agreement conflict with any language in this Agreement, the terms of this Agreement shall prevail. The respective captions of the Sections of this Agreement are inserted for convenience of reference only and shall not be deemed to modify or otherwise affect any of the provisions of this Agreement. Any provision of this Agreement that is declared invalid, inoperative, null and void, or illegal shall in no way affect or invalidate any other provision hereof and such other provisions shall remain in full force and effect. Any act done by either Party prior to the effective date of the Agreement that is consistent with the authority of the Agreement and compliant with the terms of the Agreement, is hereby ratified as having been performed under the Agreement. No provision of this Agreement, including this provision, may be amended, waived, or modified except by written agreement signed by duly authorized representatives of the Parties. 13.2 Assignment and Beneficiaries. Neither the Agency nor the City shall have the right to transfer or assign, in whole or in part, any or all of its obligations and rights hereunder without the prior written consent of the other Party. If the non- HUMAN SERVICES AGREEMENT - 4 - 4/2015 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www crtyoffederalway com assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. Subject to the foregoing, the rights and obligations of the Parties shall inure to the benefit of and be binding upon their respective successors in interest, heirs and assigns. This Agreement is made and entered into for the sole protection and benefit of the Parties hereto. No other person or entity shall have any right of action or interest in this Agreement based on any provision set forth herein. 13.3 Compliance with Laws. The Agency shall comply with and perform the Services in accordance with all applicable federal, state, local, and city laws including, without limitation, all City codes, ordinances, resolutions, regulations, rules, standards and policies, as now existing or hereafter amended, adopted, or made effective. If a violation of the City's Ethics Resolution No. 91 -54, as amended, occurs as a result of the formation or performance of this Agreement, this Agreement may be rendered null and void, at the City's option. 13.4 Enforcement. Time is of the essence of this Agreement and each and all of its provisions in which performance is a factor. Adherence to completion dates set forth in the description of the Services is essential to the Agency's performance of this Agreement. Any notices required to be given by the Parties shall be delivered at the addresses set forth at the beginning of this Agreement. Any notices may be delivered personally to the addressee of the notice or may be deposited in the United States mail, postage prepaid, to the address set forth above. Any notice so posted in the United States mail shall be deemed received three (3) days after the date of mailing. Any remedies provided for under the terms of this Agreement are not intended to be exclusive, but shall be cumulative with all other remedies available to the City at law, in equity or by statute. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. Failure or delay of the City to declare any breach or default immediately upon occurrence shall not waive such breach or default. Failure of the City to declare one breach or default does not act as a waiver of the City's right to declare another breach or default. This Agreement shall be made in, governed by, and interpreted in accordance with the laws of the State of Washington. If the Parties are unable to settle any dispute, difference or claim arising from this Agreement, the exclusive means of resolving that dispute, difference, or claim, shall be by filing suit under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative process. If the King County Superior Court does not have jurisdiction over such a suit, then suit may be filed in any other appropriate court in King County, Washington. Each party consents to the personal jurisdiction of the state and federal courts in King County, Washington and waives any objection that such courts are an inconvenient forum. If either Party brings any claim or lawsuit arising from this Agreement, each Party shall pay all its legal costs and attorney's fees and expenses incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, however nothing in this paragraph shall be construed to limit the Parties' rights to indemnification under Section 5 of this Agreement. 13.5 Execution. Each individual executing this Agreement on behalf of the City and Agency represents and warrants that such individual is duly authorized to execute and deliver this Agreement. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original and with the same effect as if all Parties hereto had signed the same document. All such counterparts shall be construed together and shall constitute one instrument, but in making proof hereof it shall only be necessary to produce one such counterpart. The signature and acknowledgment pages from such counterparts may be assembled together to form a single instrument comprised of all pages of this Agreement and a complete set of all signature and acknowledgment pages. The date upon which the last of all of the Parties have executed a counterpart of this Agreement shall be the "date of mutual execution" hereof. [Signature page follows] HUMAN SERVICES AGREEMENT - 5 - 4/2015 CITY OF "k Federal Way CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835-7000 www cilyoffederalway cam IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: Jim ys 'ell, ayor DATE: 3 PUGET SO INDUST By: 24_7 PPORTUNITIES Prn " d am JOse rte- ke_ Ti e: \reS U,( �� l ( I DATE: STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) ATTEST: erk, Stephanie Court APPROVED AS TO FORM: nzC Pk 0 CMC Acting City Attorney, J. Ryan Call On this day personally appeared before me `.bscfM D`�xlc� , to me known to be the presi a ent / C.0 of t'ua of . ,'id ON:9 ,-i 1i a Irdwlr-ia/ ce ver 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 94�xj d, if any, is the corporate seal of said corporation. iosmii '11N1, °d ; Zvi lAGJ 1 .. e • 41 : • fficial seal this 9.-1-- day of o c' `� Notary's signature =" NOTARY N PUBLIC z � -. .,`®® s .1.:',;(% kip C'J..a. �,,FOF wpksvo,� Notary's printed n /Va Kl7sfin - to Notary Public in and for the Sta e of Washington. My commission expires 01 HUMAN SERVICES AGREEMENT - 6 - 4/2015 CITY OF ,�... Federal Way EXHIBIT A SERVICES Project Summary CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com The Agency shall provide a comprehensive set of employment services to low- income individuals, including refugees and immigrants, in the City of Federal Way. The Agency shall ensure that services provided with funding under this Agreement are made available to Federal Way residents. Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of Federal Way residents with Human Services funds: B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: 1" Quarter JAN.— MARCH 2"d Quarter APRIL — JUNE 3rd Quarter JULY — SEPT. 4th Quarter OCT. — DEC. Total No. of unduplicated Federal Way persons assisted in 2017 8 8 8 7 31 No. of unduplicated Federal Way persons assisted in 2018 8 8 8 7 31 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: HUMAN SERVICES AGREEMENT 1 HSA Exh 1/2017 1st Quarter JAN. — MARCH 2nd Quarter APRIL— JUNE 3rd Quarter JULY— SEPT. 4th Quarter OCT.- DEC. Total 2017 1. Case Management Hours 47 47 47 47 188 2. Employment Service Hours 72 72 72 72 288 3. Training Hours 60 60 60 60 240 2018 1. Case Management Hours 47 47 47 47 188 2. Employment Service Hours 72 72 72 72 288 3. Training Hours 60 60 60 60 240 HUMAN SERVICES AGREEMENT 1 HSA Exh 1/2017 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www.cityoffederalway.com C. Definition of Services 1. Case Management: Hours of case management provided to clients. 2. Employment Service Hours: Hours of employment services provided to clients. 3. Training Hours: Class and training hours provided to clients. D. Performance Measure(s) Outcome(s) to be reported: 1. Increased academic success. 2. Improved access to health care. 3. Improved self - sufficiency. Records A. Project Files The Agency shall maintain files for this project containing the following items: 1. Notice of Grant Award. 2. Motions, resolutions, or minutes documenting Board or Council actions. 3. A copy of this Agreement with the Scope of Services. 4. Correspondence regarding budget revision requests. 5. Copies of all invoices and reports submitted to the City for this project. 6. Bills for payment with supporting documentation. 7. Copies of approved invoices and warrants. 8. Records documenting that costs reimbursed with funding provided under this Scope are allowable. Such records include, but are not limited to: • for personnel costs, payroll for actual salary and fringe benefit costs. • for staff travel, documentation of mileage charges for private auto use must include: a) destination and starting location, and b) purpose of trip; and ■ 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. HUMAN SERVICES AGREEMENT - 2 HSA Exh 1/2017 CITY OF '.. Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 wwwv crtyoffederalway com 9. Documentation of client income. The Agency agrees to use the HUD Income Guidelines to report income of clients served under this Agreement. Income guidelines may be adjusted periodically by HUD. The Agency agrees to use updated Income Guidelines which will be provided by the City. King County FY 2016 Income Limits Summary Median Income King County FY 2016 Income Limit Category 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons $90,300 Extremely Low (30 %) Income Limits $19,000 $21,700 $24,400 $27,100 $29,300 $32,580 $36,730 $40,890 Very Low (50 %) Income Limits $31,650 $36,150 $40,650 $45,150 $48,800 $52,400 $56,000 $59,600 Low (80 %) Income Limits $48,550 $55,450 $62,400 $69,300 $74,850 $80,400 $85,950 $91,500 Reports and Reporting Schedule The Agency shall collect and report client information to the City quarterly and annually on a Service Unit Report to be provided by the City in the format requested by the City. The Agency shall submit an Annual Demographic Data Report. The agency shall collect and retain the data requested on this form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted annually no later than January 15 in the format requested by the City. The Agency shall implement and track at least one measurable outcome for the program as presented in the application. Changes to the outcome presented in the application must be approved by the City prior to implementation. The Agency shall report the results of its outcome measure(s) annually on the Annual Outcome Data Report to be submitted by January 15 in the format requested by the City. Public Information In all news releases and other public notices related to projects funded under this Agreement, the Agency will include information identifying the source of funds as the City of Federal Way Human Services General Fund Program. HUMAN SERVICES AGREEMENT - 3 HSA Exh 1/2017 CITY OF Federal Way EXHIBIT B COMPENSATION CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www cityofederalway. corn 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 Agreement shall not exceed Ten Thousand and 00 /100 Dollars ($10,000.00). A. City of Federal Way Funds 2017 2018 City of Federal Way General Fund: $5,000.00 $5,000.00 Total City of Federal Way Funds: $5,000.00 $5,000.00 B. Line Item Budget 2017 2018 Personnel Services (detail below) $3,906.00 $3,906.00 Office or Operating Supplies $39,544.00 $987.00 Rent & Utilities $1,064.00 $1,064.00 Communications Case Manager 0.025 Travel and Training $987.00 Instructor Other (specify): Direct aid to clients $30.00 $30.00 Client Travel $142,579.80 Administration (Overhead) Total City of Federal Way Funds: $5,000.00 $5,000.00 C. Personnel Detail Position Title Position Full Time Equivalent Annual Salary and Benefits HS Funds Case Manager 0.025 $39,544.00 $987.00 Case Manager 0.025 $43,699.72 $987.00 Case Manager 0.025 $39,184.00 $987.00 Instructor 0.040 $20,152.08 $945.00 Total: $142,579.80 $3,906.00 Reimbursement Requests and Service Unit Report forms shall be submitted no less frequently than quarterly and are due on the following dates: 1st Quarter: April 15 or within 10 days of notice to proceed, whichever is later; 2nd Quarter: July 15; 3rd Quarter: October 15; and 4th Quarter: Final Reimbursement Request and Service Unit Report forms due January 8; Demographic Data Report and Annual Outcome Data Report with supporting documentation due January 15. The Agency shall submit Reimbursement Requests in the format requested by the City. Reimbursement Requests Invoices shall include a copy of the Service Unit Report and any supporting documents for the billing period. HUMAN SERVICES AGREEMENT - 4 - HSA Exh 1/2017 '4CITY OF & Federal Way Estimated Quarterly Payments: 2017 1st Qtr $1,250.00 2nd Qtr $1,250.00 3rd Qtr $1,250.00 4th Qtr $1,250.00 2018 1st Qtr $1,250.00 2nd Qtr $1,250.00 3rd Qtr $1,250.00 4th Qtr $1,250.00 CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www clfyoffederalway com Expenses must be incurred prior to submission of quarterly reimbursement requests. Proof of expenditures must be attached to the reimbursement request for invoice to be approved. Quarterly reimbursement requests shall not exceed the estimated payment without prior written approval from the City. Estimated quarterly payments are contingent upon meeting or exceeding the above performance measure(s) for the corresponding quarter. This requirement may be waived at the sole discretion of the City with satisfactory explanation of how the performance measure will be met by year -end on the Service Unit Report. Conditions of Funding The Agency agrees that it will meet the specific funding conditions identified for the Agency and acknowledges that payment to the Agency will not be made unless the funding conditions are met. HUMAN SERVICES AGREEMENT 5 HSA Exh 1/2017 Puget Sound Training Center Helping people turn success into reality PUGET SOUND OIC, INC DBA Puget Sound Training Center 268 -270 SW 43rd St- Bldg. #3 Renton, WA 98057 February 28, 2017 This is to certify that per the Puget Sound Training Center Succession Plan approved by the PSTC Board of Directors in 2010, Joseph P. Drake has the authority to act out the following duties as President and CEO: 1. Has the authority to enter into contracts on behalf of the agency and has the authority to sign contracts. 2. Contact and follow -up on other DVR locations for new CRP contracts and present to DVR Counselor for additional clients. 3. Check and open all incoming mail and send the mail to the finance department for proper distribution. 4. Contact and follow -up on all internal and external inquiries that require the attention of the CEO /President. 5. Oversee and manage all pertinent responsibilities that need executive administrative action. 6. Prepare and complete all SDOR, SDOP and AFT reports related to the services provided for DVR /CRP clients and forward those reports to the Program Manager. 7. In a large binder keep in a secure place all pertinent medical records and reports of all the DVR /CRP clients. 8. Keep in contact with employer, maintain and build new partnership opportunities with local unions and employers. Sincerely, Ron Newton Board Chair Puget Sound Training Center Helping people turn success into reality Puget Sound Training Center Succession Plan Using Best Practices in Succession Planningl as a resource, the leadership team agreed on the following roadmap for Puget Sound Training Center (PSTC). Some of the strategies will be initiated now, some at a future date: 1. Analysis (initiate now): • Scanning the environment to determine what challenges will impact the agency in the next 2 -4 years. • Determining the key positions for succession planning. • Defining core competencies for the key positions. 2. Development (begin to initiate now): • Use the Nine -Box Grid for Talent Management2 to assess potential of current staff members. • Create development plans for current staff members with potential. • Begin identifying external talent for key positions and take steps to begin relationship building. 3. Selection (initiate at a future date): • Ensuring that internal candidates with potential are ready as the transition approaches. ■ Updating the scan for external candidates. • Involve agency leadership team and Board in selection process. 4. Transition (initiate at a future date): • Defining the on- boarding process for candidates for key positions. • Ensure the Board and successors agree on a plan for their first year including metrics, milestones and the engagement of agency leadership team. ■ Determining the need and identifying a coach for successors during their first year. 5. Contingency Plan (initiate now): C 1 Souce: Forbes Magazine, Best Practices in Succession Planning, Stephen A. Miles and Nathan Bennett, 11- 09 -07. Source: The General Electric- McKinsey Nine -Box Matrix.vv Developed by Puget Sound Training Center Leadership Team I Reviewed July 14, 2016. Page 1 • Each member of the leadership team will define essential duties / tasks associated with their position that must be completed in a one -month period. • Essential duties / tasks will be documented so that in case of an emergency, these duties / tasks can be fulfilled by other members of the leadership team. Analysis The PSTC leadership team identified three key positions for succession planning: • CEO / President • Senior Program Manager • Financial Manager In defining the core competencies for these position, a distinction was made between core competencies that must be embedded in potential candidates (competencies they can already demonstrate) versus those that can be learned on the job (competencies they can develop). For the purpose of succession planning, the focus will be on embedded core competencies. Following are the core competencies for the three key positions: 1. CEO / President a. Practical working knowledge of every level of agency operations. b. Involved community leader, inspires confidence and trust. c. Strong commitment, vision and leadership skills. d. Ability to inspire others to work at their highest level. e. Ability to envision agency operations two to five years from the current date. f. Solid theoretical training / experience in management. g. Proven record of innovative and effective staff development. h. Diplomatic and effective in all negotiations. i. Experience in fundraising and financial management. 2. Senior Program Manager a. Demonstrated management and administrative experience. b. Highly effective in promoting a positive, productive work environment. c. Reputation for excellence and high quality service to clients. d. Well organized and skilled in setting priorities, designing and executing work plans. e. Work effectively both as a team member and independently. f. Highly effective in motivating and supervising employees. g. Strength in creative problem solving and in handling conflict. h. Able to balance the priorities of the agency with the needs of staff. i. Experience and training in basic office systems. j• Developed by Puget Sound Training Center Leadership Team I Reviewed July 14, 2016. Page 2 3. Financial Manager a. Professional reputation for prudent fiscal management. b. Experience in auditing, payroll and preparation of corporate taxes. c. Highly successful in establishing, streamlining and automating accounting systems. d. Thoroughly familiar with all accounting procedures and legal financial guidelines for non - profit organizations. e. Effective team member who functions well under pressure. f. Commitment to professional development and growth in financial services. g. Thorough and well organized in completing projects. h. Knowledge of banking relationships and safeguards. i. Strength in recognizing, analyzing and solving problems. Development The PSTC leadership team will be assessing the potential of each current staff member. Based on this assessment, a development plan will be created for each person on staff with their input. Develop plans will address both professional development in the agency and potential for candidacy for the key positions identified. These plans will be completed at the end of the current performance review period (June 2011). The leadership team will also scan the external environment for potential future candidates for the three key positions. Contingency Plans The intent of the contingency plans is to provide a list of major duties for each of the three key positions that would need to be performed if the person in the position had to be away from work for a one -month period. The remaining members of the leadership team would perform these duties to maintain stability and performance in the agency. Following are the major duties for each of the three key positions: CEO / President 1. Has the authority to enter into contracts on behalf of the agency and has the authority to sign contracts. 2. Contact and follow -up on other DVR locations for new CRP contracts and present to DVR Counselor for additional clients. 3. Check and open all incoming mail and send the mail to the finance department for proper distribution. 4. Contact and follow -up on all internal and external inquiries that require the attention of the CEO / President. Developed by Puget Sound Training Center Leadership Team I Reviewed July 14, 2016. Page 3 5. Oversee and manage all pertinent responsibilities that need executive administrative action. 6. Prepare and complete all SDOR, SDOP and AFT reports related to the services provided for DVR /CRP clients and forward those reports to the Program Manager. 7. In a large binder keep in a secure place all pertinent medical records and reports of all the DVR /CRP clients. 8. Keep in contact with employer, maintain and build new partnership opportunities with local unions and employers. Senior Program Manager 1. Supervises and oversees all program staff to support agency programs. 2. Research and pursue contract/grant opportunities with foundations, government and other CBO's. 3. Recruits, hires and evaluates staff performance according to PSTC core values and contract requirements 4. Researches and recommends proposed staff positions; develops job descriptions and salary ranges. 5. Conduct new employee orientations to inform new employees of agency mission /values, performance standards, policies and procedures, compensation and benefits. 6. Encourages ongoing professional development for staff 7. Coordinate, recommend and register staff for workshops and trainings as needed 8. Provides on -site training to new employees and ensures that all staff are properly trained. 9. Conduct progressive employee performance evaluation and development 10. Provides administration for the overall personnel functions. 11. Engage in open and regular communication with staff in other functional areas (job development, contract requirements, training, volunteer and finance) to maintain rapport, mutual support and consistent integration of activities. 12. Communicate clearly, effectively and in a timely manner any information necessary for other staff members to complete their duties. 13. Works to promote staff cohesion and build staff morale. 14. Manages all functions of agency operations 15. Monitors progress toward contract goals and is responsible for program outcomes. 16. Compiles statistics and generates reports as required 17. Handles client complaints in a fair and equitable manner under established procedures 18. Ensures organization meets all contract requirements and outcomes. Developed by Puget Sound Training Center Leadership Team I Reviewed July 14, 2016. Page 4 19. Maintains official records and documents in accordance with federal, state, local and contractual regulations. 20. Coordinate and collaborate with community organizations, public agencies, Financial Manager Notations in red indicate the importance of the item. Vendor files are located in the second drawer of the file cabinet. All checks must be signed by the President / CEO. 1. Monthly Staff Payroll Processing Procedure. Due the last business day of the month. 2. Building Office Rent 3. Utilities: Pay by the due date on the monthly billing. Vendor: Puget Sound Energy. 4. Insurance Expense. All must be paid before the last business day of the month. 5. Telephone. Must be paid by the due date on the billing invoice. Vendor: Qwest. 6. Forklift Manuals. Due by the end of the month. Vendor: Amerigas. 7. Credit Cards. All credit cards must be paid by the last business day of the month. a. American Express b. Capitol One Visa 8. Consultant Services. Must be paid by the last business day of the month. 9. Copier Leasing. Vendor: Toshiba. 10. Forklift Fuel. Must be paid by the last business day of the month. Vendor: Amerigas Developed by Puget Sound Training Center I eadership Team I Reviewed July 14, 2016. Page 5 Puget Sound Training Center -Staff Roster- Responsibilities 00 Ql Ql ri V1/1 4-, U co 4-, ' _c C -0 O C 1 C U CO 1 O N N ; E c bA m N ' O N U N L +, C +, a) C O C s D +, W +, a) E C E cu 0-', O = .3 O U 00)) N C z Q co v L b0 Q N 0 C >� C f) C O fl- C 0 +, 0 = 4, (o !z 4 ! c0 (o i v C a Ly C N 0 O L s- 1- U) OS a) +, W Q > C NN O = N -0 Q, O > 5 E U O .o a) < financial statements, QuickBooks data entry. Position /Title Print Name Executive Director Joseph P. Drake Samantha Nelson ++ +J 4-, C c c 'v I a) 0) N N N CI) ' a) N L L L Q i I? a L!1 Ln 111 p r I r-I O O 0 1 N • N • 0 r-I • 0 ,+ •O c0 - }' I bO N i c ``- C : U O (6 (0 C N O 4 0 a) Q 0) E •- CU (a U C o) c cu N 4, U 7 co co co C C E O c a ° -C E c tan E 'I N +, CO O C 174) u co Q Q N C U N C .O t a) D 1^ co co vWi N 4_, N U a) N > 2 Q N O Q v Q 0) vi a1 U O N 0 c a) a) 0 c CO 4-+ C a) v bO co co E a) co U c a) a) U co +, 0) N a) L Q c 0) N 0) L C. LCD 0 N O 0) bb > C v) C LE a) CO 0 c a) O O L 0 •, Q. L C E v Q) O CU U CO L . 0 - CO N •- O N E. - co co v "O N L 1 L E 0) -0 , co . - bO ' t c0 4 ±, 3 , N E - N C a) C (0 N CO co_ (O Q .(7) U .- -E c -2 (0 a) (O E 0" N Q) N N N N N < CI. E L L (L0 a) a) b0 (0 (0 OL L C C O C 4J N a) co cu N 5/) U CO 0 C 0) 0 Tagwo Ahmed Case Manager Carmen Sanchez case management, and career advancement. Lll O O N C. O N N cu a) O a' = L N O C N O '5_ v 4- 0- N 1v C , CO Y >• N 0 C CO O tin +, +, C C 1 a) 0 ' CO 0 oo 0 N D : C CU as c -o c aJ 1 0 CO 0 - +, (0 N (A CO : L C U -0 Q Q .Lvi 0 U 0 •—J N t L bO ! L C CO C O CO Q O 'L Q a) a) 0 U cu O co U .� L C i a) (0 (.9 CO (0 1 H Q Lc') 0 O N O 0 b0 C r1 O N O Teach computer technology and warehouse training to O 4-, 7 N c L CO L O ' f0 . Y U L N N (0 UJ — (0 E >.. c0 N N — Y Z N 4-, CO a 0 (0 n Staff Roster, updated July 7, 2016 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835-7000 www cdyoffederalway corn City of Federal Way Human Services Contract for 2017 -2018 General Fund Authorized Signatures for Invoices I authorize the following individuals to sign invoices and quarterly reports on behalf of: Puget Sound Opportunities Industrialization Center (Contracting Agency), for the following: Employment & Training Services Authorizing Signature: (must be signed by person who signs the contract, generally, Executive Director) Additional Authorized Signature: Additional Authorized Signature: (Printed ame) (Program Title). &LiJ /6.0 (Title) kn12 ill, 7-091 c� (Printed Name) (Signature) enic2Rz r�sn �1ar1� (Title) (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. PUGET -3 OP ID: RH 1 CORD' �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 07/06/2016 (HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS '.ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. MPORTANT: If the certificate holder is an ADDITIONAL INSURED, the he terms and conditions of the policy, certain policies may require an endorsement. : ertificate holder in lieu of such endorsement(s). policy(ies) must be endorsed. If SUBROGATION 15 WAIVED, subject to A statement on this certificate does not confer rights to the CONTACT Ruth Hubbard, CISR, CPIW, DAE NAME: )DUCER B INSURANCE AGENCY 12 Bronson Way North ). Box 796 iton, WA 98057 -0796 :h Hubbard, CISR, CPIW, DAE (I. PHONE FAX Ext) :425- 255 -2486 (A/c, No): 425 - 235 -8674 . E-MAIL rhubbard.hubin0l @insuremail.net INSURER(S) AFFORDING COVERAGE NAIC If INSURER A: American States Insurance Co COMMERCIAL GENERAL LIABILITY URED Puget Sound Training Center Puget Sound OIC Inc dba 268 -270 SW 43rd St, Ste 3 -D &E Renton, WA 98057 INSURER B : INSURERC: CLAIMS -MADE INSURER D : OCCUR INSURER E : $ 10,000 INSURER F : IVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 4DICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS :ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL k , X SUER ii , POLICY NUMBER 01C136564770 POLICY EFF MM /DD/Y 07/25/2016 POLICY EXP MMIDD/YYYY 07/25/2017 LIMITS EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES ETOMRRENTED PSES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT X PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 01XS16571440 07/25/2016 07/25/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENT ON $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N N / A 01C136564770 WA STOP GAP 07/25/2016 07/25/2017 OTH- I STATUTE I X ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 CRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) tificate holder is named as an additional insured as respects to their rest in all operations of the named insured subject to policy terms and ditions. Form CG7635 attached. RTIFICATE HOLDER CANCELLATION CITYFED al Ways 33325 8th Ave S Federal Way, WA 98003 -6325 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 © 1988-2014 ACORD CORPORATION. All rights reserved.