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AG 17-038
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: EMERGENCY HUMAN SERVICES 6. NAME OF CONTRACTOR: _S . L� ADDRESS: " 3q S i 33I S1 , E -MAIL: rt)nic. '6vt nei ° A1Sf .CO77) SIGNATURE NAME: 00 h ee5Y1i 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 $_43,200.00 (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: $ o _ * - V'. &w( cc_i ; occuerlie- !�j � y�(I\ qg TELEPHONE 253 - $38 - 8919 v FAX: TITLE 'r Q, WtSldlIVA .- IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ RETAINAGE: RETAINAGE AMOUNT: PAID BY: ❑ CONTRACTOR ❑ CITY ❑ RETAINAGE BY (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED ❑ PURCHASING: PLEASE CHARGE TO: 001 - 7300 - 083 - 562 -10 -410 10. DOCUMENT /CONTRACT REVIEW ArPROJECT MANAGER DIRECTOR ❑ RISK MANAGEMENT OF APPLICABLE) ❑ LAW 11. COUNCIL APPROVAL (IF APPLICABLE) 12. CONTRACT SIGNATURE ROUTING K SENT TO VENDOR/CONTRACTOR ATTACH: SIGNATURE AUTHORITY, ❑ LAW DEPARTMENT % eS1CiNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# ❑ SIGNED COPY RETURNED COMMENTS: Akt. clurt, Mary dtot AL / DATE RE IEWED INITIAL' / DATE APPROVED —0yc. (llo1ll' COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: DATE SENT: L/i . /ao 1- DATE RECD: 3/q /ao,a- INSURANCE CERTIFICATE, LICENSES, EXHIBITS INITIAL / DATE SIGNED taWAIEVAff AP' AG# I O 8 DATE SENT: 03 -14-n Federal Way HUMAN SERVICES AGREEMENT FOR EMERGENCY HUMAN SERVICES CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederahvay. com This Human Services Agreement ( "Agreement ") is made between the City of Federal Way, a Washington municipal corporation ( "City "), and Society of St. Vincent de Paul Council, of Seattle -King County, 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: SOCIETY OF ST. VINCENT DE PAUL COUNCIL, OF SEATTLE -KING COUNTY Joseph Roni 3939 SW 331st Street Federal Way, WA 98023 (253) 838 -8919 (telephone) roniconsulting@msn.com The Parties agree as follows: 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 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 Vecferal Way CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835 -7000 www. cityoffederalway coin 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 fmal invoice by the date indicated on Exhibit B. If the Agency's fmal 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 44CITT OF •., Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederal way 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 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www. cityoffederalway. com 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. EQUAL OPPORTUNITY EMPLOYER. In all services, programs, activities, hiring, and employment made possible by or resulting from this Agreement or any subcontract, there shall be no discrimination by Agency or its subcontractors of any level, or any of those entities' employees, agents, sub - agencies, or representatives against any person because of sex, age (except minimum age and retirement provisions), race, color, religion, creed, national origin, marital status, or the presence of any disability, including sensory, mental or physical handicaps, unless based upon a bona fide occupational qualification in relationship to hiring and employment. This requirement shall apply to, but not be limited to, the following: employment, advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. Agency shall comply with and shall not violate any of the terms of Chapter 49.60 RCW, Title VI of the Civil Rights Act of 1964, the Americans With Disabilities Act, Section 504 of the Rehabilitation Act of 1973, 49 CFR Part 21, 21.5 and 26, or any other applicable federal, state, or local law or regulation regarding non - discrimination. 13. GENERAL PROVISIONS. 13.1 Interpretation and Modification. This Agreement, together with any attached Exhibits, contains all of the agreements of the Parties with respect to any matter covered or mentioned in this Agreement and no prior statements or agreements, whether oral or written, shall be effective for any purpose. Should any language in any Exhibits to this Agreement conflict with any language in this Agreement, the terms of this Agreement shall prevail. The respective captions of the Sections of this Agreement are inserted for convenience of reference only and shall not be deemed to modify or otherwise affect any of the provisions of this Agreement. Any provision of this Agreement that is declared invalid, inoperative, null and void, or illegal shall in no way affect or invalidate any other provision hereof and such other provisions shall remain in full force and effect. Any act done by either Party prior to the effective date of the Agreement that is consistent with the authority of the Agreement and compliant with the terms of the Agreement, is hereby ratified as having been performed under the Agreement. No provision of this Agreement, including this provision, may be amended, waived, or modified except by written agreement signed by duly authorized representatives of the Parties. 13.2 Assignment and Beneficiaries. Neither the Agency nor the City shall have the right to transfer or assign, in whole or in part, any or all of its obligations and rights hereunder without the prior written consent of the other Party. If the non- HUMAN SERVICES AGREEMENT - 4 - 4/2015 Federal Way CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835 -7000 www cityoffederalway 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 Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway.. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: Jim/ ell, ayor DATE: ,3/// SOCIETY OF ST. VINCENT DE PAUL COUNCIL, OF SEATTLE -KING Q6UNTY: By: Printed Name: /c f Title: DATE: 7 -17 STATE OF WASHINGTON ) ss. COUNTY OF KING ATTEST: IVI,Ia, erk, Stephanie Courtneyi MC APPROVED AS TO FORM: Aret ng -City Attorney, J. Ryan Call On this da personally appeared before me IV , r , , to me known to be the Ex €0kL- D i rec,-6r of 3oc i c-1 j of St. t), nciA,-1 de Qcwl o a iC. (Gin() nl� 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 C/1-1- Notary's signature Notary's printed name Notary Publi n and for the State o Washin on. My commission expires O? ` Dal ` HUMAN SERVICES AGREEMENT , 201\. 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 emergency services 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: 1st Quarter JAN. — MARCH 2nd Quarter APRIL — JUNE 3rd Quarter JULY — SEPT. 4th Quarter OCT. — DEC. Total No. of unduplicated Federal Way persons assisted in 2017 100 100 100 100 400 No. of unduplicated Federal Way persons assisted in 2018 100 100 100 100 400 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. Financial Aid /Households Served 30 30 30 30 120 2. Home Visits 30 30 30 30 120 2018 1. Financial Aid /Households Served 30 30 30 30 120 2. Home Visits 30 30 30 30 120 HUMAN SERVICES AGREEMENT 1 HSA Exh 1/2017 CITY oc � Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com C. Definition of Services 1. Financial Aid /Households Served: Number of households assisted to help avoid eviction and /or power shut -off, or provide homeless shelter in a motel. 2. Home Visits: Completion of a home visit conducted by two volunteers. A home visit includes an assessment completed with the household to address goals and other needs. D. Performance Measure(s) Outcome to be reported: 1. Individuals and /or families will have secure housing. 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: • personnel costs: payroll for actual salary and fringe benefit costs. • staff travel: documentation of mileage charges for private auto use must include: a) destination and starting location, and b) purpose of trip; and • 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 Vecleral Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway.. com 9. Documentation of client income. The Agency agrees to use the HUD Income Guidelines to report income of clients served under this Agreement. Income guidelines may be adjusted periodically by HUD. 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 4CITY OF ..- Federal Way EXHIBIT B COMPENSATION CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com 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 Forty -Three Thousand Two Hundred and 00 /100 Dollars ($43,200.00). A. City of Federal Way Funds 2017 2018 City of Federal Way General Fund: $21,600.00 $21,600.00 Total City of Federal Way Funds: $21,600.00 $21,600.00 B. Line Item Budget 2017 2018 Personnel Services (detail below) Office or Operating Supplies Rent & Utilities Communications Travel and Training Other (specify): Direct Assistance $21,600.00 $21,600.00 Client Travel Administration (Overhead) Total City of Federal Way Funds: $21,600.00 $21,600.00 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 CITY oc � Federal Way Estimated Quarterly Payments: 2017 1st Qtr $5,400.00 2nd Qtr $5,400.00 3rd Qtr $5,400.00 4th Qtr $5,400.00 2018 1st Qtr $5,400.00 2nd Qtr $5,400.00 3rd Qtr $5,400.00 4th Qtr $5,400.00 CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway 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 ` CITY OF 44. Federal Way CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835 -7000 www cityoffederalway 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: Society of St. Vincent de Paul Council, of Seattle -King County (Contracting Agency), for the following: Emergency Human Services (Program Title). Authorizing Signature: (must be signed by person who signs the contract, generally, Executive Director) 4'7 (Printed Name) (Title) (Signature- (Date) Additional Authorized Signature: Additional Authorized Signature: 071,5,10.11-11 v,v/ COnir - -E Vic ProJ,4d„f #/ SV BOG/' (Printed Name) (Title) 414 7 frE,,e,a4 ' ?17 ign ure) gervt--c--) as (Date) V iRG I M/ R- , .' Dlll; rn dF f -kPida g nal) SOG /,%r (Print d Name) (Title) d $'l Y /& 5 q)�c.�. 3/7/17 (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. Li h 4. ( I v We'll Be There. Hereby Certify: 1) I am the President of the Board of Directors of the Society of St. Vincent de Paul Council of Seattle /King County - A Washington nonprofit corporation. 2) In executive session at its regular meeting on march 15, 2011, the Board of Directors of the Society voted to offer the position of Executive Director to Mr. Ned Delmore 3) Ned Delmore accepted the offer and began employment as Executive Director of the Society on April 4, 2011. 4) In accordance with the formal bylaws and Executive limitations the Executive Director has the authority to enter into contracts on behalf of the Society. Dated in Seattle on this S day of Mal , 20 /..S- 1) S G1 n Morford, Board President o)the Society of St. Vincent de Paul Council of Seattle /King County St. Vincent de Paul of Seattle I King County 5950 4th Avenue South 1 Seattle, WA 981081 P: 206-767-9975! F: 2061767 -6439 www.svdpseattle.org St. Vincent de Paul of Seattle King County Board of Directors Updated March 2017 OFFICERS d W W z 0 x a d z (206) 930 -6005 H jmorf1933 @comcast.net 2016 -2019 (Second) John Morford z o 0 a a rmuhlebach@comcast.net (206) 660 -6902 Richard Muhlebach 2014 -2017 (First) 1st Vice President curranpm8 @gmail.com (206) 601 -6114 2014 -2017 (First) g U 8 d 2nd Vice President & Secretary defrancoinsurance. com g (206) 723-1680 2017 -2020 (First) Jim DeFranco 0 CI o H atsean47 @gmail.com (206- 306 -4362) o o o O U Fr. John Madigan Spiritual Advisor PRECINCT REPRESENTATIVES W H W z PRECINCT 2016 -2019 (Second) (425) 433 -8684 H rohrbach @nwlink.com Bob Rohrbach East King County poison @fusion3.net 0 cn 0 I-, a Northeast Seattle west_dennis@comcast.net 206 - 465 -3318 2015 -2018 (First) Dennis West Central Seattle 2015 -2018 (Second) (206) 383 -8216 C Chuck Secrest Northwest Seattle bo 0 cti at (425) 605 -6376 (0) jbaumann 2015 -2018 (First) Joe Baumann Northeast King County (253) 838 -8919 H roniconsulting @msn.com 2014 -2017 (First) 0 South King County South Seattle 0 bO al d *Terms are three years. No person may serve more than two consecutive three year terms. Administration - St. Vincent De Paul Seattle /King County Council Staff DEPARTMENT NAME PHONE FAX CELL EMAIL /Executive Director Deputy Director (206) 767 -9975 (206) Ned Delmore ext 1105 767 -6439 (206) 767 -9975 (206) Steve Knipp ext 1123 767 -6439 Director of Finance (206) 767 -9975 (206) (Tax ID Number Eddie Roldan ext 1101 767 -6439 91 -0583891) Director of Marketing & Communications (Brochures & Publicity Help) Director of Development Human ResourcesNolunteer Coordinator Marketing & Communications Specialist nedd @svdpseattle.org stevek @svdpseattle.org eddier @svdpseattle.org Jim (206) 767 -9975 (206) 206-909 - jimm@svdpseattle.org McFarland ext 1104 767 -6439 0839 Donna (206) 767 -9975 206) 767 - donnaw@svdpseattle.org Whitford ext 1132 6439 Tammy (206) 767 -9975 (206) tammyh @svdpseattle.org Haney ext. 1134 767 -6439 Danielle (206) 767 -9975 (206) 206-909 - daniellej@svdpseattle.org Johnston ext 1100 767 -6439 6296 oo co rn ai v 0 CD o � cv ) N O to V A ▪ -0 o o ^x U to pa x a w ct w O co ▪ v ■ 0 U a) ▪ a) cn V ✓ O .r Cn v .5 March 2017 Email nedd @svdpseattle.org stevek @svdpseattle.org eddier @svdpseattle.org jimm @svdpseattle.org donnaw @svdpseattle.org stephanier@svdpseattle.org thomasw@svdpseattle.org tammyh @svdpseattle.org verak @svdpseattle.org michael.j @svdpseattle.org parken @svdpseattle.org luisr @svdpseattle.org peterr @svdpseattle.org Store Operations Helpline Center Hours: Mon -Fri 8:00 AM -3:00 PM (Office is open 7:OOam- 3:30pm) (206) 767 -6449 lisab @svdpseattle.org judyh @svdpseattle.org chrisk @svdpseattle.org Case Management mariam @svdpseattle.org Up 0 CL; V) r6.)) v 47) 03 v Royh @svdpseattle.org tessak@svdpseattle.org Food Bank - -- Desk Ext 1124 erikm @svdpseattle.org Dispatch / Trucking X RI w rn Cr) cr VD 1 N. 1 0 N 206 - 392 -0005 206 - 392 -0005 206 - 392 -0005 Cell - FOR INTERNAL SVdP USE ONLY 206 -819 -0582 206- 227 -5608 206- 940 -1759 ON o rn o O N .-+ °O w ,.0 O N 206 - 390 -1063 206 -755 -8497 Ch n 0 �0 O N 253 - 218 -9425 253 - 278 -0105 peterbroach @gmail,com 206 - 489 -7547 206 - 412 -5880 M 0 ,..0 M 206 -883 -3551 425 -737 -3346 Phone in O X Ext 1123 Ext 1101 Ext 1104 Ext 1132 Ext 1107 Ext 1121 Ext 1134 Ext 1118 Ext 1108 Ext 1122 Ext 1100 206 - 743 -5351 r, M X W ao O X W Ext 1110 in Cr) X W Ext 1141 Ext 1129 N. N X W Ext 1103 z Ned Delmore Steve Knipp Eddie Roldan Jim McFarland Donna Whitford Stephanie Ragland Thomas Wagner Tammy Haney Vera Kovalevich Michael Jones Parke Nietfeld VACANT Peter Roach Lisa Barrientes ,s as Chris Kelsh Maria Moody Betsabe Roy Harrington Tessa Keating, LJCSW Erik Maus Title Executive Director Deputy Director /Human Resources Director of Finance Director of Marketing & Communications Director of Donor Development Director of Vincentian Support /Spirituality Director of Vincentian Support /Formation Human Resources Manager Staff Accountant Accounting Assistant Grants Manager Administrative Coordinator IT Specialist Helpline Manager Helpline Representative Helpline Representative Case Manager Case Management Coordinator Case Manager /Veterans Program Support Social Worker Food Bank Manager Thrift Stores Email Email carinah @svdpseattle.org carolynb @svdpseattle.org mariaj @svdpseattle.org carrollt@svdpseattle.org demeciaa@svdpseattle.org Assistant Manager Carina Hoefer Carolyn Bradbury 253- 223 -3558 s., a H O I, s. et U Demecia Alcazar Fax 206 - 364 -8532 206 - 246 -7389 425 - 228 -7027 425- 483 -3857 253- 277 -0214 Phone 206 - 364 -8495 206 - 243 -6370 425 - 226 -9426 425 - 483 -9497 253 - 277 -0211 Address 13555 Aurora Ave N Seattle, WA 98133 13445 1st Ave. S. Seattle, WA 98168 575 Rainier Ave N Renton, WA 98057 7304 NE Bothell Way Kenmore, WA 98028 310 Central Ave. N Kent, WA 98032 Email estherm@svdpseattle.org albal @sdvpseattle.org joshp @svdpseattle.org Manager Esther Mcodingo VACANT Alba Lopez Josh Proctor VACANT Store Aurora Burien Rainier Kenmore Centro Rendu - 310 Central Ave. N., Kent, WA 98032 & 575 Rainier Ave. N., Renton, WA 98057 — (253) 499 -4245 Email miryar @svdpseattle.org susanam @svdpseattle.org laurat @svdpseattle.org mariaj @svdpseattle.org davidl @svdpseattle.org X W In N -.4 N L0 tn N Cell - -- FOR INTERNAL SVdP USE ONLY 253- 394 -1433 253- 223 -3558 206- 962 -9905 206 -858 -2495 (Work) 509 - 840 -3020 (Personal) 206 - 307 -7178 (Work) 206 - 930 -7499 (Personal) a O 253 - 499 -4243 ext, 101/126 (Kent) 253- 499 -9772 ext. 135 (Renton) 206 - 508 -4766 ext. 141 (Renton) 253 - 499 -1054 ext. 100 (Kent) 253 - 499 -4284 ext, 116 (Kent) a E tt z Mirya Roach Susana Manriquez Laura Tafolla Maria Jimenez David Lujano a F Chief Program Director Plaza Comuitaria Program Administrator Intake & Hispanic Outreach Specialist Case Management Program Coordinator Youth Outreach & Family Case Manager bU 4 v 206 - 734 -2126 206 - 778 -2387 206 - 778 -2216 206 - 778 -2387 m z b0 0 x AC ® RR� CERTIFICATE OF LIABILITY INSURANCE 5 /DATE(M 6 D/Y rl) 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 Artex Risk Solutions, Inc. (CB) Two Pierce Place Itasca IL 60143 -3141 CONTACT NAME: Christian Brothers Services PHONE 800- 807 -0300 FAX NOL 630 - 378 -2508 (A/C Ito Fry: E-MAIL A DDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A:Pennsylvania Manufacturers Assoc In 12262 INSURED CHRIBRO -14 Brothers of the Christian Schools & Affiliates Loc #1134002 SOC SVDP COUNCIL OF SEATTLE /KING CNTY 1205 Windham Parkway Romeoville IL 60446 -1679 INSURER B :Old Republic Insurance Company 24147 INSURER C : 6/15/2017 INSURER D: $2,000,000 INSURERE: INSURER F : X COVERAGES CERTIFICATE NUMBER: 1989815935 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. ILNSR R TYPE OF INSURANCE ADDL SUBR LW POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMBS A x COMMERCIAL GENERAL LIABILITY Y 821600 0578617 6/15/2016 6/15/2017 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X OCCUR DAMAGE O RENTED PREMISES (Ea oxunence) S Induded MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY S Induded GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PET PER: LOC GENERAL AGGREGATE SN/A PRODUCTS - COMP /OP AGG $induded $ B AUTOMOBILE X X LIABILITY ANY AUTO AUTOS OWNED HIRED AUTOS X SCHEDULED NON -OWNED AUTOS Y MWTB 21543 6/15/2016 6/15/2017 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LAB -' OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below Y / N _ N / A J PEATUTE I OOT E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) Only the General Liability Coverage will apply on a Primary and Non - Contributory basis (per attached endorsement) if required by fully executed written contract. Certificate Holder is added as Additional Insured (per attached endorsement) for General Liability and Automobile coverages solely, strictly and specifically with regards to: Use of Various Parish Facilities by Society of Saint Vincent De Paul Council of Seattle /King County Conferences: Christ The King, Our Lady of Fatima, St Alphonsus, St Anne, St Benedict, St John The Evangelist, St Luke, Assumption, Blessed Sacrament, Our Lady of the Lake, St Bridget, St Catherine, St Mark, St Matthew, St Patrick, Blessed Rosalie Rendu, See Attached... CERTIFICATE HOLDER CANCELLATION Archdiocese of Seattle C/O Property Const Services 710 9th Avenue Seattle WA 98104 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZg? REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACORO� AGENCY CUSTOMER ID: CHRIBRO -14 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Artex Risk Solutions, Inc. (CB) NAMED INSURED Brothers of the Christian Schools & Affiliates Loc #1134002 SOC SVDP COUNCIL OF SEATTLE/KING CNTY 1205 Windham Parkway Romeoville IL 60446 -1679 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER- 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Immaculate Conception, Sacred Heart, St James, St Joseph, St Mary, St Therese, Holy Family, Holy Rosary, Our Lady of Guadalupe, Our Lady of Lourdes,St Edward, St George, St John Vianney, St Paul, St Peter, Mary Queen of Peace, Our Lady of Sorrows, Sacred Heart, St Anthony, St Joseph, St Louise, St Madeleine Sophie, St Monica, Blessed Teresa of Calcutta, Holy Family, Holy Innocents, St Brendan, St John Vianney, St Jude, Holy Spirit, St Benadette, St Francis of Assisi, St John The Baptist, St Philomena, Teresa, and St Vincent De Paul, Mission and Activities in Individual Parish Locations. Coverage includes Sexual Misconduct and Review Board/Victim Outreach limited coverage $250,000, each claim and in the aggregate, in total and annually. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PENNSYLVANIA MANUFACTURERS' ASSOCIATION INSURANCE COMPANY Attaching to and forming part of Policy No. 821600 0578617 Named Insured: THE RELIGIOUS AND CHARITABLE RISK POOLING TRUST OF THE BROTHERS OF THE CHRISTIAN SCHOOLS AND AFFILIATES Effective date of this endorsement is June 15, 2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under SECTION 11 INSURING AGREEMENT C, GENERAL LIABILITY COVERAGE defined within the Coverage Agreement SECTION 1: Schedule Name of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHEN YOU HAVE AGREED IN A WRITTEN CONTRACT FOR THAT PERSON OR ORGANIZATION TO BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY. Designated Location(s) Of Covered Operations If no entry appears above, information required to complete this endorsement will be shown in the Certificate of Coverage as applicable to this endorsement. Section II Insuring Agreement C - Name of Insured Amended A Who Is An Insured defined in the General Insurance Agreement is amended to include as an Additional Insured the person(s) or organization(s) shown in the Schedule above but only with respect to liability in the performance of the Named Insured's ongoing operations for the Additional Insured(s) at the Location(s) designated in the Schedule above for "bodily injury" or "property damage ", caused in whole or in part, by the Named Insured's acts or omissions which takes place after the execution of a written agreement with the Additional Insured(s). B For the coverage provided by this endorsement: the following paragraph is added to Section IV — General Conditions, Section II, Insuring Agreement C- General Liability. This insurance is primary insurance as respects to this coverage to the additional insured person or organization. where the written contract or written agreement requires that this insurance be primary and noncontributory . In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured C. Who Is An Insured is also amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, with respect to liability for "bodily injury" or "property damage" caused, in whole or in part by the "Named Insured's work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard ". The most we will pay is the amount of insurance required by the written contract or the amount of applicable limits of insurance under this policy; whichever is Tess. This Insurance does not apply to any claims or suits seeking damages, including defense, arising out of, directly or indirectly, from any actual or alleged participation in any act of sexual misconduct, sexual harassment, sexual molestation, sexual abuse or any claim sexual in nature, physical or mental, of any person. Except as amended in this endorsement. this insurance is subject to all coverage terms. clauses and conditions in the policy to which this endorsement is attached and only applies to the extent permitted by law. THIS FORM APPLIES IN STATES WHICH USE: CA 00 01 (03 -10) AND CA 00 01 (03 -06) IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): All persons or organizations as required by contract or agreement With respect to LIABILITY COVERAGE, Who Is An Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured ". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: 1. You; 2. an "employee" of yours; or 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees ". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and /or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and /or limits required by the contract or agreement. PCA 001 03 06 MWTB 21543 Religious and Charitable Risk Pooling Trust 06/15/2016 - 06/15/2017 THIS FORM APPLIES IN STATES WHICH USE: CA 00 01 (10 -13) IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): All persons or organizations as required by contract or agreement With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured ". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: 1. You; 2. an "employee" of yours; or 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees ". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and /or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and /or limits required by the contract or agreement. PCA 001 10 13 MWTB 21543 Religious and Charitable Risk Pooling Trust 06/15/2016- 06/15/2017