AG 19-180 - WCIA RETURN TO: EXT:
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: L'CLx_0
ORIGINATING STAFF PERSON: CLO co-k 1 EXT: 3. DATE REQ.BY:
TYPE OF DOCUMENT(CHECK ONE):
❑ CONTRACTOR SELECTION DOCUMENT(E.G.,RFB,RFP,RFQ)
❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT
❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT
❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES/CDBG
❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT(E.G.BOND RELATED DOCUMENTS)
❑ ORDINANCE �❑ RESOLUTION
Ip
❑ CONTRACT AMENDMENT(AG#): INTERLOCAL
❑ OTHER
PROJECT NAME: � re.CYY�'.Xhr+ 1„Q C�Y +}�QY1
NAME OF CONTRACTOR:I:l_?L Z 1"�► ` ix11�vCYan 9.e7 +
ADDRESS:�.C} TELEPHOI C::
E-MAIL: FAX:
SIGNATURE NAME: TITLE
EXHIBITS AND ATTACHMENTS:❑ SCOPE,WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL
OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
TERM: COMMENCEMENT DATE: f 19 COMPLETION DATE: �2 1311 ao 1
TOTAL COMPENSATION$ (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 ONO IF YES,$ PAID BY:ElCONTRACTOR❑CITY
RETAINAGE: RETAINAGE AMOUNT: ElRETAINAGE AGREEMENT(SEE CONTRACT) OR ❑RETAINAGE BOND PROVIDE
❑ PURCHASING: PLEASE CHARGE TO:
0. DOCUMENT/CONTRACT REVIEW INITIAL/DATE REVIEWED INITIAL/DATE APPROVED
❑ PROJECT MANAGER
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
❑ LAWr� '11014
1. COUNCIL APPROVAL(IF APPLICABLE) SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE:
SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE:
2. CONTRACT SIGNATURE ROUTING
❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D:
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE,LICENSES,EXHIBITS
❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I MONTH PRIOR TO EXPIRATION DATE
(Include dept.support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.)
INITIAL/DATE SIGNED
❑ LAW DEPARTMENT
V SIGNATORY(MAYOR OR DIRECTOR)
9TY CLERK~ 41450 No
ASSIGNED AG# AG -110
SIGNED COPY RETURNED DATE SENT: l
� I
;OMMENTS:
0
1
InnIR
INTERLOCAL AGREEMENT: CREATING PRE-MEMBERSHIP CONDITIONS
BETWEEN WASHINGTON CITIES INSURANCE AUTHORITY AND
CITY OF FEDERAL WAY
THIS AGREEMENT, made pursuant CHAPTER 39.34 RCW, is made and entered into
in the State of Washington by and among Washington Cities Insurance Authority, a quasi-
municipal corporation organized and existing of the Constitution and laws of the State of
Washington, Chapter 48.62 RCW, hereinafter referred to as WCIA, and the CITY OF
FEDERAL WAY, a municipal corporation existing under the Constitution and laws of the State
of Washington, hereinafter referred to as "Entity" who are the parties signatory to this
Agreement. Washington Cities Insurance Authority and the CITY OF FEDERAL WAY are
sometimes referred to herein as "parties".
RECITALS
WHEREAS, the CITY OF FEDERAL WAY desires and is committed to taking all
steps necessary to become a Full Member of WCIA, as membership is defined by WAC 200-
100-020 (17(a), (b), (c)) as now exists or hereinafter is amended and as defined by the
foundational Interlocal Agreement creating Washington Cities Insurance Authority, and;
WHEREAS, the CITY OF FEDERAL WAY has applied for membership in WCIA and
is committed to becoming a Full Member, if approved for membership by WCIA, on the date of
January 1, 2020 at 12:01 a.m. and;
WHEREAS, WCIA is desirous and committed to taking and completing all necessary
steps to evaluate the CITY OF FEDERAL WAY for Full Membership in WCIA and to prepare
the CITY OF FEDERAL WAY for Full Membership in WCIA starting on the date of January
1, 2020 at 12:01 a.m., and;
WHEREAS, it appears economically feasible and mutually beneficial for the parties to
this Agreement to take all steps reasonably necessary to evaluate the CITY OF FEDERAL
WAY for Full Membership in WCIA and to prepare said entity for Full Membership on the date
of January 1, 2020 at 12:01 a.m.;
NOW, THEREFORE, for and in consideration of all the mutual benefits, covenants and
agreements contained herein, the parties hereto agree as follows:
I. Covenants.
a. The CITY OF FEDERAL WAY hereby formally applies to Washington Cities
Insurance Authority to become a Full Member of WCIA to participate in its joint
self insurance and risk sharing programs and receive its full membership benefits
including orientation, risk management training, and consulting services and all
other support services offered to Full Members of WCIA starting on the date of
January 1, 2020 at 12:01 a.m., if so approved by the governing body of WCIA.
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b. The Entity hereby agrees to give all necessary written notice to any insuring or
self insuring pooling organization to which the Entity is currently a member or
subscriber that it intends to end its current liability insuring or self insuring Entity
membership so as to allow the Entity to become a Full Member of WCIA on the
effective date cited above, if so approved by WCIA.
c. The Entity agrees to provide full and open access to its records and claim history
so as to allow WCIA to properly evaluate the entity's risk profile for prospective
membership in WCIA.
d. The Entity agrees to accept and complete all recommended pre-membership
orientation, risk management training, and consulting services as specified by
WCIA and to reimburse WCIA the reasonable cost of any such services provided
within sixty (60) days of being billed for the same if the Entity's full membership
in WCIA is rejected or if the Entity declines to sign the "appendix" to the
foundation Interlocal Agreement creating WCIA when offered Full Membership.
e. The Entity agrees that if its Full Membership in WCIA is approved by its
governing body it will, through its authorized officer, sign via appendix the
foundational Interlocal Agreement creating WCIA and thereby become a full
participating Member of WCIA as of the effective date of January 1, 2020 at
12:01 a.m. Thereafter, the Entity agrees to be fully bound by all of the terms and
conditions and benefits of full WCIA membership including, but not limited to
those specified in the Interlocal Agreement creating WCIA, the WCIA Bylaws
and Joint Protection Program documents.
f. WCIA agrees to perforin a full, fair and prompt evaluation of the Entity of CITY
OF FEDERAL WAY's qualifications for membership with WCIA and to deliver
a final decision accepting or rejecting the Entity for membership no later than
sixty(60) days prior than the proposed effective date of membership stated above.
At the same time, if WCIA accepts the Entity for membership, it will state in its
acceptance the proposed initial assessment the Entity will be required to pay for
the Entity's initial membership.
g. WCIA agrees to provide all necessary orientation, risk management training and
consulting services to the CITY OF FEDERAL WAY and its officers,
employees and elected officials as necessary to prepare the CITY OF FEDERAL
WAY for Full Membership in WCIA.
h. This pre-membership agreement shall become effective on the date that it has
been signed by both parties authorized representatives as indicated below.
II. Amendments.
This Agreement may be amended at any time only by the written approval of all the
parties signatory to it.
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III. Ap-reenient Complete.
The foregoing constitutes the full and complete agreement of the parties. There are no
oral understandings or agreements not set forth in writing herein.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement by signature
of the au ed offic' s thereof on the date indicated below their signatures.
r'
For an�4))i bel f of the City of Federal Way
Da this y�day of '� �"1- , 20J.
For and on behalf of Washington Cities
Insurance Authority
Ann Bennett, Executive Director of WCIA
Dated this /Z qday of , 201.
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