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AG 17-07911 RETURN TO: Sarah Bridgeford EXT: 2651 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM . ORIGINATING DEPT./DIV: CD /CS ORIGINATING STAFF PERSON: SARAH BRIDGEFORD TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E. ❑ PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ REAL ESTATE DOCUMENT ❑ ORDINANCE x CONTRACT AMENDMENT (AG #):_17 -079_ ❑ OTHER EXT: _2651 3. DATE REQ. BY:_8/7/2017 G., RFB, RFP, RFQ) ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ MAINTENANCE AGREEMENT x HUMAN SERVICES / CDBG ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ RESOLUTION ❑ INTERLOCAL . PROJECT NAME: VOLUNTEER CHORE SERVICES NAME OF CONTRACTOR: CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON ADDRESS: TELEPHONE E -MAIL: FAX: SIGNATURE NAME: TITLE . EXHIBITS AND ATTACHMENTS: x SCOPE, WORK OR SERVICES X COMPENSATION X INSURANCE REQUIREMENTS /CERTIFICATE X ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS . TERM: COMMENCEMENT DATE: _01/01/2017 COMPLETION DATE: 12/31/2018 TOTAL COMPENSATION $_ 0) — 1�",;14c c-( ? 0. r yr ,G or,—K4 ,ND 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: (INCLUDE EXPENSE ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDE x PURCHASING: PLEASE CHARGE TO: 001 - 7300 - 083 - 562 -10 -410 0. DOCUMENT /CONTRACT REVIEW INI / DA E REVIEWED INITIAL / DATE APPROVED ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ L A W 3 A u3 z t 7 1. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: 2. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: a J m, - DATE REC'D: ///9 /aU t 91 ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) ❑ LAW DEPARTMENT iyBI NNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# ❑ SIGNED COPY RETURNED ;OMMENTS: INITIAL / DATE SIGNED Oc 2.617 AG# DATE SENT: 16-15-- AT- CIT F Y OF eral Wa , ed Way AMENDMENT NO. #1 TO HUMAN SERVICES AGREEMENT FOR VOLUNTEER CHORE SERVICES CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityofederalwoy com This Amendment ( "Amendment No. 1") is made between the City of Federal Way, a Washington municipal corporation ( "City "), and Catholic Community Services of Western Washington, a Washington non - profit corporation ( "Contractor "). The City and Contractor (together "Parties "), for valuable consideration and by mutual consent of the Parties, agree to amend the original Agreement for Volunteer Chore Services ( "Agreement ") dated effective 1/1/2017, as follows: 1. AMENDED SERVICES. The Services, as described in Exhibit A and as referenced by Section 2 of the Agreement, shall be amended to include, in addition to the Services and terms required under the original Agreement and any prior amendments thereto, those additional services described in Exhibit A -1 attached hereto and incorporated by this reference ( "Additional Services "). 2. AMENDED COMPENSATION. The amount of compensation, as referenced by Section 4 of the Agreement, shall be amended to change the total compensation the City shall pay the Contractor and /or the rate or method of payment, as delineated in Exhibit B -1, attached hereto and incorporated by this reference. The Contractor agrees that any hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate for the Term. Except as otherwise provided in an attached Exhibit, the Contractor shall be solely responsible for the payment of any taxes imposed by any lawful jurisdiction as a result of the performance and payment of this Agreement. 3. GENERAL PROVISIONS. All other terms and provisions of the Agreement, together with any prior amendments thereto, not modified by this Amendment, shall remain in full force and effect. Any and all acts done by either Party consistent with the authority of the Agreement, together with any prior amendments thereto, after the previous expiration date and prior to the effective date of this Amendment, are hereby ratified as having been performed under the Agreement, as modified by any prior amendments, as it existed prior to this Amendment. The provisions of Section 13 of the Agreement shall apply to and govern this Amendment. The Parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. [Signature page follows] AMENDMENT 1 3/2017 Vecferal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: ATTEST: DATE: I 4* .47 9 CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON: By: iaef Printed Name: B 111 / (/'6 1J Title: UGvC— /II'44 Date: Obd j STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) j*intubt. S ph nie Courtney, CMC, Clerk APPROVED AS TO FORM: /°\//iL4- r J. Ryan Call, City Attorney On this day personally appeared before me I -,` I1 th7, vwnct?.1 , to me known to be the ViCt.Residkielk of CaAti ic t nu-1; rv) (k_S 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 d * , C. C44 i f / 1, . .bwoN F�A4�41 // OS • % V • (I U 4ust.`� `O /�i ''s -08.19 0 - ,, /1 WASH I C day of Notary's Notary's signature printed name Lie j,. Q/ ( 0 . CJ4e k'> Notary Public in and for the State of Washington. My commission expires 1,1(1 ZPJ / of , 201 AMENDMENT 2 3/2017 4A■.- Vecferal Way EXHIBIT A -1 ADDITIONAL SERVICES CITY HALL 33325 8th Avenue South Federal Way. WA 98003 -6325 (253) 835 -7000 www crryoffederalway com The Contractor shall do or provide the following in addition to Services in previous Exhibits: Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of residents by city with Human Services funds annually: 2017 QUARTER 1st 2nd 3rd 4th Annual Total City of SeaTac: Number of unduplicated Clients 0 0 1 0 1 2018 QUARTER 1st 2nd 3rd •th Annual Total City of SeaTac: Number of unduplicated Clients 0 0 1 0 1 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter annually: 2017 QUARTER City of SeaTac Performance Measures 1st 2nd 3rd 4th Annual Total 1. Service Hours 12 12 24 24 48 2018 QUARTER City of SeaTac Performance Measures 1st 2nd 3rd 4th Annual Total 1. Service Hours 12 12 12 12 48 C. Definition of Services 1. Chore services are measured by the hours of assistance provided to clients within each jurisdiction by the volunteers with whom they are matched. AMENDMENT 3 3/2017 CITY OF ,�.. Federal Way EXHIBIT B -1 ADDITIONAL COMPENSATION CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www crtyofederalway com 1. Total Compensation: In return for the Additional Services, the City shall pay the Contractor an additional amount not to exceed Two Thousand and 00 /100 Dollars ($2,000.00). The total amount payable to Contractor pursuant to the original Agreement, all previous Amendments, and this Amendment shall be an amount not to exceed Sixty -Seven Thousand and 00 /100 Dollars ($67,000.00). 2. Estimated Quarterly Payments: 2017 3rd Qtr $8,625.00 4th Qtr $8,625.00 2018 lst Qtr $8,375.00 2 "d Qtr $8,375.00 3`d Qtr $8,375.00 4t" Qtr $8,375.00 AMENDMENT - 4 3/2017 ACC 0120 CERTIFICATE OF LIABILITY INSURANCE L.---- DATE (MM /DD /YYYY) 6/23/2017 6/23/2017 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 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 777 108th Ave NE, #200 Bellevue WA 98004 CONTACT NAME: Stephen Erni PHONE 425 - 454.3386 Mt, N„), 425 - 451 -3716 (A/C, No. Fxt)• ADDARESS: Stephen_Erni @ajg.com INSURER(S) AFFORDING COVERAGE NAIC a INSURERA:Underwriters at Lloyd's London INSURER B:OId Republic Union Insurance Company 15792 31143 INSURED CORPOFT -01 Corporation of the Catholic Archbishop of Seattle Catholic Community Services of Western Washington 100 23rd Ave. S Seattle WA 98144 INSURER c :State National Insurance Company, Inc 12831 INSURER D : 7/1/2018 INSURER E : 81,000,000 INSURER F: 81,000,000 CERTIFICATE NUMBER: 5249664 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 I5 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AWL INSD SUBR WVD POUCY NUMBER POLICY EFF (MMIDDIYYYY) POUCY EXP (MMIDDIYYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY Y 8P1023017 7/1/2017 7/1/2018 EACH OCCURRENCE 81,000,000 AMAGE 10 PREM PREMISES (Ea RENTED 81,000,000 CLAIMS -MADE X OCCUR MED EXP (An one person) END PERSONAL & ADV INJURY 81,000,000 GENERAL AGGREGATE 81,000,000 GE X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG 81,000,000 8 A AUTOMOBILE X X UABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON OWNED AUTOS ONLY BP1023017 7/1/2017 7/1/2018 COMBINED SINGLE LIMIT (Ea accident) 81000,000 , BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) 8 8 B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 821600 0785428 7/1/2017 7/1/2018 EACH OCCURRENCE 85,000,000 AGGREGATE 85,000,000 8 DED RETENT ON 8 A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER /EXECUTIVE l l OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA BP1023017 NDE- 0864512 -17 7/1/2017 7/1/2017 7/1/2018 7/1/2018 X STATUTE ER E.L. EACH ACCIDENT 81,000,000 E.L. DISEASE - EA EMPLOYEE 81,000,000 E.L. DISEASE - POLICY LIMIT 81,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Limits shown are inclusive of defense and insured retention. Coverage only extends for claims directly arising out of the Human Services Agreement for Federal Way Day Center between Catholic Community Services and the City of Federal Way. CERTIFICATE HOLDER CANCELLATION City of Federal Way 33325 8th Ave. S. Federal Way WA 98003 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 ACORD 25 (2016/03) 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT attaching to and forming part of Policy No. BP 1023017 NAMED ASSURED: Corporation of the Catholic Archbishop of Seattle Effective date of this endorsement: July 01, 2017 Endorsement No. 14 GENERAL POLICY CONDITIONS ENDORSEMENT — INCLUDING PRIMARY NON - CONTRIBUTORY CERTIFICATES OF INSURANCE: It is hereby understood and agreed that holders of Certificates of Insurance issued against this Policy that are shown as Additional ASSUREDS are added to this Policy pursuant to the terms of this Policy as described in GENERAL POLICY DEFINITION 1. Where Certificates of Insurance are requested for Additional ASSUREDS who do not fall within GENERAL POLICY DEFINITION 1, prior agreement of Underwriters and subsequent endorsement of this Policy is required GENERAL POLICY DEFINITION 1. ASSURED is stated as follows - 1. ASSURED means not only the NAMED ASSURED as stated on the Declaration Page, but also includes any past, present or future: agencies, subsidiaries, affiliates, institutions and societies owned by or operated by the NAMED ASSURED, officials, members of boards or commissions, trustees, directors, officers, partners, volunteers, student teachers, or employees of the NAMED ASSURED while acting within the scope of their duties as such, and any person, organization, trustee or estate to whom the NAMED ASSURED is obligated by virtue of a written contract or agreement to provide insurance such as is offered by this policy, but only in respect of operations by or on behalf of the NAMED ASSURED. GENERAL POLICY CONDITION 20. WAIVER OF SUBROGATION is stated as follows — 20. WAIVER OF SUBROGATION: This policy shall not be invalidated if the ASSURED, by written agreement, has waived or shall waive its right of recovery from any party for loss or damage covered hereunder; provided that any such waiver is made prior to the occurrence of said loss or damage. MORTGAGORS, LOSS PAYEES & LENDER LOSS PAYEES: It is understood and agreed that GENERAL POLICY CONDITION 12. of this policy is deleted and replaced with the following: 12. MORTGAGORS, CREDITORS & LOSS PAYEES: Where required by written contract, the interest of any mortgagor, creditor or loss payee on property covered by this policy is included as if a separate endorsement were attached hereto to the extent of the amount of mortgage, loan or interest in property held by the ASSURED as of the date of loss subject to the limits of liability set forth in this policy. PRIMARY NON - CONTRIBUTORY: It is also agreed that, only where required by written contract between the NAMED ASSURED and the Certificate holder, this insurance shall be considered primary to any insurance held by the Certificate holder and theirs shall be excess. 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. ENDORSEMENT attaching to and forming part of Policy No. BP 1023017 NAMED ASSURED: Corporation of the Catholic Archbishop of Seattle Effective date of this endorsement: July 01, 2017 MUNICIPALITY PERMITS: Further, where required by written contract or evidenced in the insurance requirements of a permit issued by a municipality at the request of the NAMED ASSURED, that municipality shall be added to this policy as an Additional ASSURED but only as respects liabilities arising out of the subject matter of the written contract or issued permit and then only for liabilities arising from actions by or on behalf of the NAMED ASSURED. Except as amended in this Endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this Endorsement is attached. Arthur J. Gallagher Risk Management Services, Inc. 777 108th Ave NE, #200 Bellevue, WA 98004 5591 2 AB 0.400 111111111111" 111111 "111IIIIIIiltiuu 11111111111iIiIn11111 II CITY OF FEDERAL WAY 33325 8TH AVE S FEDERAL WAY, WA 98003 -6325 C -5591 I I 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. ❑ PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ REAL ESTATE DOCUMENT ❑ ORDINANCE ❑ CONTRACT AMENDMENT (AG #): ❑ OTHER G, RFB, RFP, RFQ) ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ MAINTENANCE AGREEMENT x HUMAN SERVICES / CDBG ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ RESOLUTION ❑ INTERLOCAL 5. PROJECT NAME: VOLUNTEER CHORE SERVICES 6. NAME OF CONTRACTOR: _CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON ADDRESS: ID0 2,51Do� Av€ t �-hmilWQ, WA coil TELEPHONE .!4;'3'28- (p55,3 E -MAIL: h0�\tdun \t 1 +L1,Ka p FAX: N/A- TITLE SIGNATURE NAME: Mao* N� TITLE Vt rtiu . A 1 'kKpm 7. EXHIBITS AND ATTACHMENTS: x SCOPE, WORK OR SERVICES X COMPENSATION X 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 $_65,000 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ 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 ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: INITIAL / DATE APPROVED COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING SENT TO VENDOR/CONTRACTOR DATE SENT: 1.17COA /(p DATE REC'D: ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ DEPARTMENT SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# ❑ SIGNED COPY RETURNED COMMENTS: INITIAL / DATE I NED AG# DATE SENT: 4., Vecferal Way HUMAN SERVICES AGREEMENT FOR VOLUNTEER CHORE SERVICES CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com This Human Services Agreement ( "Agreement ") is made between the City of Federal Way, a Washington municipal corporation ( "City "), and Catholic Community Services of Western Washington, a Washington nonprofit corporation ( "Agency "). The City and Agency (together "Parties ") are located and do business at the below addresses which shall be valid for any notice required under this Agreement: CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON: Hollianne Monson 100 23rd Avenue South Seattle, WA 98144 (206) 328 -6853 (telephone) holliannemo@ccsww.org 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) 832 -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 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 cityoffederalway. 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 (1 0%) 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 1 0% 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 com 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 Vecleral Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www crtyoffederalway. 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 FE ERAL WAY: Jim F`, . yor DATE: S if A CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON: By: Printed Name: 671 Title: �� e-t s-) D -its DATE: Li 1 l? STATE OF WASHINGTON ) ss. COUNTY OF KING On this day personally appeared before me ^✓ of (Mho `1 L C wy1/YI.U'D inst men , and acknowledged the said instrument to be the the uses and purposes therein mentioned, and on oath stated and that the seal affixed, if any, is the corporate seal of said bi GIVEN my hand and official seal this ta, C. 0443 III, � i A r 2 N� / D // V .\G . 0 /I�1, Op WASN \ ""-�w EVA ATTEST: a 'e Courtney, CMC, lerk APPROVED AS TO FORM: !) YL OWE J. Ryan Call, City Attorney , to me known to be the CAS that executed the foregoing �ee and voluntary act and deed of said corporation, for that he /she was authorized to execute said instrument corporation. day of Notary's signature Notary's printed name Nota Public in and for the Sat of Washington. My commission expires / /( ?MI HUMAN SERVICES AGREEMENT 6 1-tG% Ie c 4/2015 Federal Way EXHIBIT A SERVICES Project Summary CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityofrederalway com The City of Federal Way, along with the cities of Auburn, Covington, Renton, and SeaTac, have entered into a Memorandum of Understanding to make the most efficient use of their resources by cooperating to provide joint application and funding for human services. It is the City's responsibility to enter into an agreement with the Agency on behalf of the cities which are party to said Memorandum of Understanding. The Agency shall provide free chore assistance to low- income seniors and adults living with disabilities to help them remain living independently in their own homes for the cities listed below. The Agency shall ensure that services provided with funding under this Agreement are made available to the participating cities' residents. Performance Measures A. Number Served The Agency agrees to serve, at minimum, the following unduplicated number of residents by city with Human Services funds annually: QUARTER 1St 2nd 3rd 4th Annual Total City of Auburn: Number of unduplicated Clients 3 3 3 .2 11 QUARTER 1St 2nd 2nd 3rd 4th Annual Total City of Covington: Number of unduplicated Clients 4 1 2 2 2 7 QUARTER 1St 2nd 3rd 4th Annual Total City of Federal Way: Number of unduplicated Clients 4 4 4 3 15 QUARTER 1St 2nd 3rd 4th Annual Total City of Renton: Number of unduplicated Clients 3 3 3 4 13 QUARTER 1st 2nd 3rd 4th Annual Total City of SeaTac: Number of unduplicated Clients 3 3 2 2 10 HUMAN SERVICES AGREEMENT 1 HSA Exh 1/2017 CITY OF 4.- Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www crtyoffederalway com B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter annually: QUARTER City of Auburn Performance Measures 1st 2nd 3rd 4th Annual Total 1. Service Hours 126 126 126 127 505 QUARTER City of Covington Performance Measures 1St 2nd 3rd 4th Annual Total 1. Service Hours 57 57 58 58 230 QUARTER City of Federal Way Performance Measures 1st 2nd 3rd 4th Annual Total 1. Service Hours 189 189 189 189 756 QUARTER City of Renton Performance Measures 1St 2nd 3rd 4th Annual Total 1. Service Hours 175 175 175 176 701 QUARTER City of SeaTac Performance Measures 1st 2nd 3rd 4th Annual Total 1. Service Hours 120 120 120 121 481 C. Definition of Services 1. Chore services are measured by the hours of assistance provided to clients within each jurisdiction by the volunteers with whom they are matched. D. Outcome(s) Outcome(s) to be reported: 1. Individuals and /or families will have access to services that increase self - sufficiency. 2. Individuals and /or families improve health (physical /dental /mental). 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 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. HUMAN SERVICES AGREEMENT 2 HSA Exh 1/2017 EY OF Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www crtyoffederalway. com 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. 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 (on the dates outlined in Exhibit B) and annually on a Service Unit Report to be provided by the City in the format requested by the City. The Agency shall also submit a quarterly Narrative Report describing the program's accomplishments and explaining any variance in quarterly service units that is more than twenty -five percent over or under the quarterly goal. 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. HUMAN SERVICES AGREEMENT - 3 - HSA Exh 1/2017 Federal Way EXHIBIT B COMPENSATION CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederalway com Project Budget In return for the services in Exhibit A, the City shall pay the Agency shall an amount not to exceed Sixty -Five Thousand and 00 /100 Dollars ($65,000.00) for the two year term of the agreement. Funds shall be applied to the project in accordance with the Annual Budget and Expenses detailed for each City. Annual Budget and Expenses by City: City of Auburn Personnel $ 6,000 Nonpersonnel $ 0 Covington Personnel $ 4,000 Nonpersonnel $ 0 City of Federal Way Personnel $ 9,000 Nonpersonnel $ 0 City of Renton Personnel $ 7,500 Nonpersonnel $ 0 City of SeaTac Personnel $ 6,000 Nonpersonnel $ 0 Total: $32,500 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 Pecleral Way Estimated Quarterly Payments: 2017 1st Qtr $8,125.00 2nd Qtr $8,125.00 3rd Qtr $8,125.00 4th Qtr $8,125.00 2018 1St Qtr $8,125.00 2nd Qtr $8,125.00 3rd Qtr $8,125.00 4th Qtr $8,125.00 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 invoices 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 Program Accomplishment 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 4/3/2017 Corporations: Registration Detail - WA Secretary of State CATHOLK COMMUNITY SERVICES OF WESTERN WASHINGTON UBI Number 601098379 Category PBC Actve /Inactive Active State Of Incorporation WA WA Filing Date 07/25/1988 Expiration Date 07/31/2017 Inactive Date Duration Perpetual Charity This corporation Is also a charity. View Info a Ihttp: / /www.sos.wa.Rov /charities /search detailasox?chanly id =6891 Registered Agent Information Agent Name PETER BERNAUER Address 10023RD AVES City SEATTLE State WA ZIP 981442302 Special Address Information Address City State Zip Gareming Persons (as defined in RCW2395.105(12) (htt1/ /app. leg. wragov/ NCW /wpdefaulLaslvt?citrt23.9s.iosl) Title Name Address Governor ADDITIONAL NAMES ON FILE, Governor REICHERT, MICHAEL Governor BERNAUER, PETER Governor FREEMEAN, FRANK Governor WARD, IRENE https://www.sos.wa.gov/corps/search_detail.aspx?ubi=601098379 1/1 Management Protocol 5.0 (Formerly Known as Legal Protocol) Catholic Community Services of Western Washington Updated August 1, 2016 The CCSWW Management Protocol has been established in accordance with the By -Laws and Articles of Incorporation of Catholic Community Services of Western Washington (CCS) to ensure the proper function of Catholic Community Services of Western Washington and the due authorization of all actions taken by employees for the benefit of, and in the name of, the Corporation. Corporate Officers and others designated by the CCSWW President (Designees *) are responsible for ensuring that all business transactions within their agency /system meet all of the requirements outlined in this protocol. Corporate Officers and Designees will receive a letter authorizing their actions /responsibilities under this protocol. For purposes of this protocol, the Corporate Officers are named below: Michael Reichert CCSWW President Irene Ward CCSWW Executive Vice President and Chief of Operations Peter Bernauer CCSWW Vice President and Chief Financial Officer Bill Hallerman CCSWW Vice President and Agency Director Denny Hunthausen CCSWW Vice President and Agency Director Peter Nazzal CCSWW Vice President and Director of Long Term Care System Will Rice CCSWW Vice President and Agency Director Mary Stone Smith CCSWW Vice President and Director of Family Behavioral Health System Josephine Tamayo Murray CCSWW Vice President for Public Policy Kim Williams CCSWW Vice President and Director of Human Resources Rosemary Zilmer CCSWW Vice President of Fund Development The implementation goals of the protocol are highlighted below: 1. Ensure that actions taken in the name of CCS are in compliance with our stated mission and objectives and the teachings of the Roman Catholic Church as interpreted and proclaimed by the Roman Catholic Archbishop of Seattle; 2. Ensure that CCS's existence and benefits are maintained; 3. Ensure that CCS is acting lawfully and has adequate assets and insurance to cover any problems and risks which may arise in relationship to the actions taken and for the protection of the persons acting on behalf of CCS; and 4. Ensure that appropriate policies and procedures are in place to ensure effective and efficient functioning of the organization. * For purposes of the CCS Management Protocol, "Designees" referred to in this document must be named by the President of CCS. A. Contracts and Program Agreements Corporate Officers or Designees, as appointed by the President, are responsible for the evaluation Page 1 of 10 1 of all new and revised contracts, as well as any contracts being renewed. Contracts are legal instruments between CCS and other legal entities which bind CCS in any way to perform services, purchase goods, etc. Contracts are evaluated to ensure they meet the mission of CCS and that they are fiscally sound. The contract review process outlined in this protocol applies not only to CCS contracts but also to contracts which apply to separate legal entities affiliated with CCS. When completing a Contract Review Cover Sheet for contracts associated with these entities, identify the correct legal entity that is party to the contract. Contracts fall into two (2) categories. They include those contracts which must be approved by the CFO and reviewed by Retained Counsel prior to being signed and those which can be reviewed and approved by Agency /System staff without any approval from CCSWW staff. At the initiation of the contract review process, a complete copy of all contracts will be forwarded to the CCSWW Operations Coordinator. This requirement extends to all contracts regardless of whether or not they must be approved by the CFO and reviewed by Retained Counsel. Those contracts which can be reviewed and approved by Agency /System staff without any approval from CCSWW staff are forwarded to the CCSWW office as an "FYI" only. The following is a summary of both contract approval processes: • Contracts needing approval by CCSWW staff prior to being signed The following types of contracts must be submitted to the CCSWW Office and approved by the CFO and reviewed by Retained Counsel prior to being signed: • New contracts with new funders (new contracts with current funders do not need to be reviewed by CCSWW); ■ Contracts for new services not currently done elsewhere in the organization —this applies even if the funder is not new; • New leases; • All construction contracts; • Agreements for LLC's; • Agreements that require Corporate Resolution; ■ Agreements that require a Certificate of Action of the President; • Any amendments to the above. These contracts cannot be signed until they are approved by the CFO and reviewed by Retained Counsel. During the review of contracts for new agency services, the contract will also be forwarded to our insurer, Arthur J. Gallagher, to ensure coverage. Any problems arising from the final review will be coordinated between the Corporate Officer, the Regional Chief of Operations or Operations Director and the CCSWW office. (If there are any service related concerns in a contract, these should be submitted to the Executive Vice President for review /discussion prior to initiation of the general contract review process.) • Contracts which can be approved by Agency /System Directors or Designees The following types of contracts will be reviewed by Agency /System Directors, or designees, and will be forwarded to the CCSWW Operations Coordinator as an "FYI" only: Page 2 of 10 Pecferal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.cityoffederalway.com City of Federal Way Human Services Contract for 2017 -2018 General Fund Authorized Signatures for Invoices authorize the following individuals to sign invoices and quarterly reports on behalf of: Catholic Community Services of Western Washington (Contracting Agency), for the following: Volunteer Chore Services (Program Title). Authorizing Signature: 1951 t ( (must be signed by (Printed Name) person who signs the contract, generally, Executive Director) Cl��/ (Signature) eke U(Title) g//7//7 (Date) Additional Authorized Signature: Additional Authorized Signature: (Printed Name) (Title) (Signature) (Date) (Printed Name) (Title) (Signature) (Date) Note: It is the responsibility of the contractor to inform the City of Federal Way if they wish to add a name to or delete names from this list. 1 ® A� o CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/30/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 777 108th Ave NE, #200 Bellevue WA 98004 CT NAME: A Stephen Erni PHONE 425 -454 -3386 FAX 425 -451 -3716 (arc, No Rd): 425-454-3386 Not: E- MAIL ADDRESS: Stephen_Erni @ajg.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Underwriters at Lloyd's London 15792 INSURED CORPOFT -01 Corporation of the Catholic Archbishop of Seattle Catholic Community Services LP 310; 100 23rd Ave. S Seattle WA 98144 INSURERB:Old Republic Union Insurance Compan 31143 INSURER C :State National Insurance Company, I 12831 INSURER D : $1,000,000 INSURER E : $1,000,000 INSURER F : •959944064 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL -SUBR INSD WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY BP1023016 7/1/2016 7/1/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $Nil PERSONAL 8 ADV INJURY $1,000,000 GE X GENERAL AGGREGATE $1,000,000 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $1,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALLOSVNED HIRED AUTOS X SCHEDULED NON -OWNED AUTOS BP1023016 7/1/2016 7/1/2017 (Ea aB tleD) INGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 821600 0785428 7/1/2016 7/1/2017 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED RETENTION $ A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A BP1023016 NDE- 0864110 -16 7/1/2016 7/1/2016 7/1/2017 7/1/2017 X PER STATUTE H ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1 000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Limits shown for insurer A & B are inclusive of defense and insured retention Coverage only extends for claims directly arising out of Catholic Community Services Contract Agreements with The City of Federal Way for Volunteer Chore Services and Emergency Assistance, for the term of the certificate. CERTIFICATE HOLDER CANCELLATION City of Federal Way SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT attaching to and forming part of Policy No. BP1023016 NAMED ASSURED: Corporation of the Catholic Archbishop of Seattle Effective date of this endorsement: July 01, 2016 Endorsement No. 14 GENERAL POLICY CONDITIONS ENDORSEMENT — INCLUDING PRIMARY NON - CONTRIBUTORY CERTIFICATES OF INSURANCE: It is hereby understood and agreed that holders of Certificates of Insurance issued against this Policy that are shown as Additional ASSUREDS are added to this Policy pursuant to the terms of this Policy as described in GENERAL POLICY DEFINITION 1. Where Certificates of Insurance are requested for Additional ASSUREDS who do not fall within GENERAL POLICY DEFINITION 1, prior agreement of Underwriters and subsequent endorsement of this Policy is required GENERAL POLICY DEFINITION 1. ASSURED is stated as follows - 1. ASSURED means not only the NAMED ASSURED as stated on the Declaration Page, but also includes any past, present or future: agencies, subsidiaries, affiliates, institutions and societies owned by or operated by the NAMED ASSURED, officials, members of boards or commissions, trustees, directors, officers, partners, volunteers, student teachers, or employees of the NAMED ASSURED while acting within the scope of their duties as such, and any person, organization, trustee or estate to whom the NAMED ASSURED is obligated by virtue of a written contract or agreement to provide insurance such as is offered by this policy, but only in respect of operations by or on behalf of the NAMED ASSURED. GENERAL POLICY CONDITION 20. WAIVER OF SUBROGATION is stated as follows — 20. WAIVER OF SUBROGATION: This policy shall not be invalidated if the ASSURED, by written agreement, has waived or shall waive its right of recovery from any party for loss or damage covered hereunder; provided that any such waiver is made prior to the occurrence of said loss or damage. MORTGAGORS, LOSS PAYEES & LENDER LOSS PAYEES: It is understood and agreed that GENERAL POLICY CONDITION 12. of this policy is deleted and replaced with the following: 12. MORTGAGORS, CREDITORS & LOSS PAYEES: Where required by written contract, the interest of any mortgagor, creditor or loss payee on property covered by this policy is included as if a separate endorsement were attached hereto to the extent of the amount of mortgage, loan or interest in property held by the ASSURED as of the date of loss subject to the limits of liability set forth in this policy. PRIMARY NON - CONTRIBUTORY: It is also agreed that, only where required by written contract between the NAMED ASSURED and the Certificate holder, this insurance shall be considered primary to any insurance held by the Certificate holder and theirs shall be excess. 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. • ENDORSEMENT attaching to and forming part of Policy No. BP1023016 NAMED ASSURED: Corporation of the Catholic Archbishop of Seattle Effective date of this endorsement: July 01, 2016 MUNICIPALITY PERMITS: Further, where required by written contract or evidenced in the insurance requirements of a permit issued by a municipality at the request of the NAMED ASSURED, that municipality shall be added to this policy as an Additional ASSURED but only as respects liabilities arising out of the subject matter of the written contract or issued permit and then only for liabilities arising from actions by or on behalf of the NAMED ASSURED. Except as amended in this Endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this Endorsement is attached.