Loading...
AG 20-884 - El Centro de la Raza RETURN TO: Sarah Bridgeford EXT: 2650 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: CD/CS Sarah Brid Weford 2650 Q 1/30/2 020 2. ORIGINATING STAFF PERSON: S. g EXT: 3. DATE RE BY:. ,, 4. TYPE OF DOCUMENT(CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT(E.G.,RFB,RFP,RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ilk! PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT A HUMAN SERVICES/CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT(E G BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT(AG#):......................... ❑ INTERLOCAL ❑ OTHER 5. PROJECT NAME: After School and Summer Learning Program 6. NAME OF CONTRACTOR: El centro de la Raza .................... ...... ........ ........, ..._ ADDRESS: 1607 S 341st Place,Fed..ral Way,WA 96003 TELEPHONE 206-957-4629 m m._.w,. E-MAIL:grants@elcentrodelaraza.org FAX: --------------------- _-- ...... SIGNATURE NAME.. ... . .... .... .TIT . . LE 7. EXHIBITS AND ATTACHMENTS:I I SCOPE,WORK OR SERVICES A COMPENSATION ESI INSURANCE REQUIREMENTS/CERTIFICATE CJ ALL OTHER REFERENCED EXHIBITS IJ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: July 1,2020 COMPLETION DATE: June 30,2021 9. TOTAL COMPENSATION$$35,892 00 _ (INCLUDE EXPENSES AND SALES TAX,IF ANY) (IF CALCULATED ON HOURLY&. B:1f)8 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:❑ A ® ......................................................................................................,..,........,,,,........._._._ CONTRACTOR❑CITY RETAINAGE: RETAINAGE AMOUNT: ❑RETAINAGE AGREEMENT(SEE CONTRACT) OR ❑RETAINAGE BOND PROVIDED ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT/CONTRACT REVIEW INITIAL/DATE REVIEWED INITIAL/DATE APPROVED ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW 11. COUNCIL APPROVAL(IF APPLICABLE) COMMITTEE APPROVAL DA I 1 T COUNCIL APPROVAL DATE:all 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: 06/30/2020 DATE REC'D:10/07/2020 ❑ 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/D TE SIGNED ❑ LAW DEPARTMENT " zo ' td,N ORRYK MAYOR OR DIRECTOR ❑ CLt ❑ ASSIGNED AG# A ❑ SIGNED COPY RETURNED DATE SENT: COMMENTS: Insurance provided on 10/712020 _ „.. ..- W .. .._— 1 ze­ f ` � Leg 2/2017 CITY OF CITY HALL 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 (253) 835-7000 www.cityoffederalway.com HUMAN SERVICES AGREEMENT FOR AFTER SCHOOL AND SUMMER LEARNING PROGRAM This Human Services Agreement("Agreement")is made between the City of Federal Way,a Washington municipal corporation("City"), and El Centro de la Raza,a Washington public benefit 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: ww D �.._. ------------- . EL CENTRO E LA RAZA: CITY OF FEDERAL WAY: Estela Ortega Sarah Bridgeford 1607 S 341St Place 33325 8th Ave. S. Federal Tay, WA 99 0033 Federal Way,WA 98003-6325 (206) 957-46�_ (253) 835-2650 (telephone) eortega,elcentrodelaraza.or Sarah.Bridgeford(a-)Cityoffederalway.com The Parties agree as follows: 1. TERM. The term of this Agreement shall be for a period commencing on July 1,2020 and terminating on June 30, 2021 ("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.Additionally,the Agency shall perform in accordance with the provisions of the Services Contract between the City and the Washington State Department of Commerce ("Services Contract"), which is Exhibit C, attached here to and incorporated by this reference, to the same standards of professional practice previously stated.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(3 0)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 - 3/2017 CITY CrrY HALL &16, 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 m (253) 835-7000 c vcllyo(federalway.coin 4.2 M ethod of Payment.On a quarterly basis,the Agency shall submit to the City an invoice for payment on a form provided by the City along with supporting documentation for costs claimed in the invoice and all reports as required by this Agreement. Payment shall be made on a quarterly basis by the City only after the Services have been performed and within forty-five (45) days after the City's receipt and approval of a complete and correct invoice, supporting documentation, and reports. The City will use the quantity of Services actually delivered, as reported on the Agency's reports, as a measure of satisfactory performance under this Agreement. The City shall review the Agency's reports to monitor compliance with the performance measures set forth in Exhibit A. Should the Agency fail to meet the performance measures for each quarter,the City reserves the right to adjust payments on a pro rata basis at any time during the term of this Agreement.Exceptions may be made at the discretion of the City's Human Services Manager in cases where circumstances beyond the Agency's control impact its ability to meet its service unit goals and the Agency has shown reasonable efforts to overcome these circumstances to meet its goals.If the City objects to all or any portion of the invoice,it shall notify the Agency and reserves the option to pay only that portion of the invoice not in dispute.In that event,the Parties will immediately make every effort to settle the disputed portion. 4.3 Final Invoice. The Agency shall submit its final invoice by the date indicated on Exhibit B. If the Agency's final invoice,supporting documentation,and reports are not submitted by the last date specified in Exhibit B,the City shall be relieved of all liability for payment to the Agency of the amounts set forth in said invoice or any subsequent invoice;provided, however,that the City may elect to pay any invoice that is not submitted in a timely manner. 4.4 Budget.The Agency shall apply the funds received from the City under this Agreement in accordance with the line item budget set forth in Exhibit B.The Agency shall request in writing prior approval from the City to revise the line item budget when the cumulative amount of transfers from a line item in any Project/Program Exhibit is expected to exceed ten percent(10%)of that line item.Supporting documents are necessary to fully explain the nature and purpose of the revision,and must accompany each request for prior approval.All budget revision requests in excess of 10%of a line item amount shall be reviewed and approved or denied by the City in writing. 4.5 Non-A,pp,ropriation 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 T)idustrial Insurance Act Waiyq. 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 - 3/2017 CITY OF CITY HALL &, 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 (253)835-7000 wwv cayoffederalway.co®rr 5.3 ChY In pmnification.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 cant'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 cant'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 l iniit of Limul��d 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 lnsu,red 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 Agencywhile performing the Services shall belong to the Cityupon 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 - 3/2017 CITY OF CITY HALL 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 7 (253) 835-7000 cityoffederalway.corn 9. BOOKS AND RECORDS. The Agency agrees to maintain books, records, and documents which sufficiently and properly reflect all direct and indirect costs related to the performance of the Services and maintain such accounting procedures and practices as may be deemed necessary by the City to assure proper accounting of all funds paid pursuant to this Agreement. These records shall be maintained for a period of six(6)years after the termination of this Agreement and may be subject,at all reasonable times,to inspection,review or audit by the City,its authorized representative,the State Auditor,the Department of Commerce,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 mayprovide 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 OPPO'RTL'WITY 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 Assig nxnent 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 - 3/2017 CITY" OF C17Y HALL 33325 8th Avenue South Federal Way,WA 98003-6325 A", Federal Way (253)835-7000 .cityoffederalway.corn 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 Corn Nance 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 - 3/2017 Mrv' OF CITY HALL 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 (253)835-7000 www atWffederalway com IN WITNESS, the Parties execute this Agreement below, effective the last date written below.. CITY OF FEDERAL WAY: ATTEST: Jim Fe Mayor S...�� �. dphanie Courtney, CMC, y Clerk APPROVED AS TO FORM: DATE: li-"�I/5X 0 J. Ryan Call, City Attorney EL CENTRO DE LA RAZA: By: _ �4- Printed Name: Title: RxeLw 1 DATE: FI L-�-t STATE OF WASHINGTON ) ) ss. COUNTY OF....... � %+rl . On this day personally appeared before me to me known to be the Cy eG of -,L- tZNTR-o D� Rm 2+� 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 AV boS'1' 20SV Notary's signature F Notary's printed name Nota P t a0 Public in and for the M w f Washington. tc o My commission expires � f , HUMAN SERVICES AGREEMENT - 6 - 3/2017 CITY OF CITY HALL 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 (253)835-7000 www cityoffederalway com EXHIBIT A SERVICES Proiect Summary The Agency shall provide after school and summer learning services that are designed to provide academic support and be culturally relevant to Latino, Spanish speaking youth. Services will be provided to 6th, 7th, and 8th grade youth from the City of Federal Way. Services will include,but not be limited to, academic tutoring, technology training, cultural enrichment, restorative justice, and trauma informed case management for students and families. 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: Jul-Sep Oct-Dec Jan-Mar Apr-Jun Total No. of unduplicated Federal Way persons assisted in 9 9 9 9 36 7/1/2020-6/30/2021 B.Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: Jul-Sep Oct-Dec Jan-Mar Apr-Jun Total 7/l/2020-6/30/2021 1. Attendance 25 _.... . 25 25 25 100 C.Definition of Services 1. Attendance: The number of youth who attend per session. Youth will be counted for each session they attend and may be duplicated(counted more than once over the period of the agreement). D.Performance Measure(s) Outcomes to ��� _---- m. ( ) be reported: 1. Improved positive approaches toward learning/increased school connection: At least 75% of participants will improve connection to learning and school as measured by attendance, surveys, and observation. 2. Improved attention skills and increased self-confidence: at least 75% of students will improve attention skills as measured by attendance, surveys, and observation. 3. Grade level achievement and/or semesterLade, �m ��srovc tac tit in at least one core HUMAN SERVICES AGREEMENT - 7 - 3/2017 CITY OF ClW HALL 33325 8th Avenue South 4% Federal Way Federal Way,WA 98003-6325 00:!4 w (253)835-7000 www.cityoffederalway.com C...... subject: 75% ofptricipants will achieve as measured by grades. E. Service and Performance Documentation and Recordkeeping The Agency shall document service performance, as well as related expenses,to reflect that funding for Expanded Learning and Career Development is being provided from the Department of Commerce via a contract with the City of Federal Way. Each requires distinct and separate documentation to identify how funds are used and that the use if consistent with the Grant Agreement and this Agreement. Records A.Project Files The Agency shall maintain files for this project containing the following items: 1. Notice of Grant Award. 2. Motions,resolutions, or minutes documenting Board or Council actions. 3. A copy of this Agreement with the Scope of Services. 4. Correspondence regarding budget revision requests. 5. Copies of all invoices and reports submitted to the City for this project. 6. Bills for payment with supporting documentation. 7. Copies of approved invoices and warrants. 8. Records documenting that costs reimbursed with funding provided under this Scope are allowable. Such records include,but are not limited to: for personnel costs,payroll for actual salary and fringe benefit costs. for staff travel, documentation of mileage charges for private auto use must include: a) destination and starting location, and b)purpose of trip; and for copy machine use,postage,telephone use, and office supplies when these costs are shared with other programs and no invoice is available, log sheets or annotated invoices. 9. Documentation of client address; residency verified via King County Parcel Viewer,. HUMAN SERVICES AGREEMENT - 8 - 3/2017 CITY OF CITY HALL 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 (253) 835-7000 www.cityoffederalway.com 10„ 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. King County FY 2019 Income Limits Summary (effective 412 412 0 1 9) FY 2019 Median Income Income 1 2 3 4 5 6 7 8 King County Limit Person Persons Persons Persons Persons Persons Persons Persons Category Extremely Low (30%) $23,250 $26,600 $29,900 I $33,200 $35,900 $38,550 $41,200 $43,850 Income Limits Very Low $108,600 (50%) $38,750 $44,300 $49,850 III $55,350 $59,800 $64,250 $68,650 $73,100 Income Limits .........., ............................................—...........—................................ ..........,,........ Low (80%) 61,800 $70,600 $79,450 $88,250 $95,350 $102,400 $109,450 $116,500 Income Limits The Agency agrees to use updated Income Guidelines which will be provided by the City. Reports and Reporting Sclledule 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 June 30 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 June 30 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 and the Washington State Department of Commerce. HUMAN SERVICES AGREEMENT - 9 - 3/2017 CITY of CITY HALL 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 (253) 835-7000 wwwo"fWeralmycom EXHIBIT B COMPENSATION Prowec�d Wit, The Agency shall apply the following funds to the project in accordance with the Line Item Budget Summary, detailed below. The total amount of reimbursement pursuant to this Agreement shall not exceed Thirty-Five Thousand Eight Hundred Ninety-Two Dollars and 00/100. ($35,892.00). A. City of Federal Way Funds 7/1/2020- 6/30/2021 City of Federal Way(Dept. of Commerce $35,892.00 Funds): ..Total City of Federal Way Funds $35,892.00 B. Line Item Budget 7/1/20-6/30/21 Personnel Services detail below $30,000.00 nt $5,892.00 Total C... .......e............. ... --- ity of Federal Way Funds $35,892.00 C. Personnel Detail Position Title e Position Full Time Annual Salary 7/1/20—6/30/21 _.. _...... ..............fits Equivalent and Benefits Program Coordinator 0.28 FTE for 1 year $71,651.00 $20,500.00 (Full-time salaried _position) �..... Program Instructor $26/hr+ 50%benefits $33,572.00 $9,500.00 (Part-time hourly for 1 year. position) Total: .....,. ...... . ..................� __..m.. .................................$105,223.00 $30,000.00 Report forms shall be submitted no less frequently than quarterly and are due on the following dates: July 1, 2020-June 30, 2021: July-September: October 15; and October-December: January 6; January-March: April 15; and April-June: Final Reimbursement Request and Service Unit Report forms due June 15; Demographic Data Report and Annual Outcome Data Report with supporting documentation due June 30. 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 - 10 - 3/2017 tl F CITY HALL 33325 8th Avenue South Federal Way Federal Way,WA 98003-6325 (253)835-7000 atyoffederalway com Estimated Quarterly Payments. July 1,2020-June 30,2021 1St Qtr $8,973.00 2nd Qtr $8,973.00 3rd Qtr $8,973.00 4th Qtr $8,973.00 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 - 11 - 3/2017 OP ID:SR Al DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE E08/17/2020 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 endorsements. PRODUCER CONTACT NAME: Sprague Israel Giles PHONEFAX ww 1501 Fourth Avenue,Suite 730 .,.__------------ -.-.-.-.- -.------ {AIC Noyes .............. Seattle,WA 98101-3225 EMAIL John M.Policar PRODLtcttt ---- ---- — ELCEN 1 --- ,,,,.--- .....---- -------- ......... a�,.... .. ......_. ,..,�.��........._ INSURER(S)AFFORDING COVERAGE NAIC# INSURED EI Centro de la Raza&ECR INSURER A:Massachusetts Bay Ins Co 2524 16th Avenue South ..ER --..._c Fi INSURER Financial 41840 Seattle,WA 98144-5104 URE -......- INSURER C INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY ...TYPE OF INSURANCE POLICYEFF I POLICYEXP LIMITS LTR SURANCE INSR WVO ,.,-,,,....„„...,,�,-,,,„POLICY NUMBER {MM/DDM'Y,Y,�.W(MMI®D_IYYYX,)., GENERAL LIABILITY EACH OCCURRENCE $ 1,000 00 .... .. -i.1AWAC3E"I"CY`RE1d PEU A ! X COMMERCIAL GENERAL LIABILITY X ZD2A513644-05 01/01/2020;01/01/2021 PR EMISES ,Eaocrurrenr..e) , $ .... 10,000 r P f I X / MED EXP(Any p one erson CLAIMS-MADE OCCUR } S 10,00 ........... ERSONAL&ADV INJURY t$ 1.,000,00 ENERALAGGREGATE $ 2,000,00 . ,....,.,. -.-.- ...... ..... ...-. GEN'L AGGREGATE LIMIT APPLIES PER: .PRODUCTS-COMP/OP AGG $ 1666,000 000 I POL.IC'Y PR LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000' ------. (Ea accident) B X ANY AUTO IAW2A513636-05 01/01/2020 01/01/2021 - -- -er _—. BODILY ODILY INJURY(Per person) $ ALL OWNED AUTOS B ..� ®��� BODILY INJURY(Per accident) $ OS _ PROPERTY DAMAGE � SCHEDULED AUT $ X HIRED AUTOS (PER ACCIDENT) X.. NONOWNEDAUTOS Comp Ded $ 50 X Phys Damage .$75,000 Coll Ded $ 1,00 UMBRELLA LIAB ;OCCUR ! .EACH OCCURRENCE $ EXCESS LIAB ',CLAIMS-MADE AGGREGATE $ .....-I_-RETENTION ------ .......... ...,,..... ,,._,.. __�.,_ _ ... ,®,,.... _ DEDUCTIBLE j $ $ 1 $ WORKERS COMPENSATIONWC STAIU- OTH- AND EMPLOYERS'LIABILITY T(,�RV MITS_ X YIN J ER ..... A ANY PROPRIETOR/PARTNERIEXECUTIVE ZD2A513644-05 01/01/2020 01/01/2021 E-L.EACH ACCIDENT S1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA .. (Mandatory In NH) WA STOP GAP E.L..DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,0003000 DESCRIPTION OF OPERATIONS f LOCA'T'IONS I VEHICLES lAttach ACORD 101 Additfonai Remarks Schedule,if more space is required) The C t.4�r of Federal'Way i additional insured if required b��{{Written contracmt or a reement,subject to the General Liability ad a�itional insured provision eniorsement. Re: Human Services Agreement-After School 8r Summer Learning Program CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Federal Way ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Sarah Bridgeford AUTHORIZED REPRESENTATIVE 33325 8th Avenue South Federal Way,WA 98003-6325 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Form - Request for Taxpayer Give Form to the (Rev.October 2018) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name(as shown on your income tax return),Nanne is required on this hrre„do not leave this line blank. EI Centro de la Raza 2 Su Sines a name/dkrr,Tardod entity name,if different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check onlyone of the 4 Exemptions codes apply onlyto following seven boxes. certain entities, individuals;see CIO CL instructions on page 3): C ❑ Individuaysole proprietor or ElC Corporation ElS Corporation ElPartnership ElTrust/estate a single-member LLC Exempt payee code(if any) ai c Q. o 0 ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)11- 2 2 Note:Check the approlofmie bort an the pone above for the torx classillcaVon of tate single-member owrnef. Do nor check Exemption from FATCA reporting m LLC if,the LLC is cla rifled as a single-marnber LLC that is dicoragarded frorn the owner unless the owner of the.LLC Isco (if an ano heo LLC Ihal is not dnsre�garded frorn the owner for tD S..federal tax pwrpos erwase„.Olha single-muembef LLC that Y) a o is d'Isrog anied frorn trim owner sNr utd check the'apfrropra�te box for the tax Classif c0oan 01its owner, w OU7 F;] _(^ ) ( V.•uo 4. -rao 76,an•d Ift U.Sa ." Other arae instructions 111- 501(c)( ) (AV 0 y Address Irwuml'uou',street and apt.. ... .. -.- . - - a 5.m or suite no.)See instructions. Requester's name and address topi onaI) a> 2524 16th Ave South rn . ,--_ 6 Cily,state,and ZIP c_ode Seattle,WA 98144 ,76_5t account numhaar(s)here(optional) Taxpayer on Number TI Entr�a your TIN in he a p a)ar box.The ITIN provided must match the name given on Brae 1 to avoid Social socnurityITnumber w backup withholding.For ind'lvidtusts,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a Iryaeldern n„ Note:If the account is In more than one name,see the Instructions for line 1.Also see What Name and mea lir"cut'on fraurrrber E ..W�. later. r Number To Give the Requester for guidelines on whose number to enter. 9 1�=9 9 9 2 7 Certifititatl Under penalties of perjury,I certify that. 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.1 am not subject to backup withholding because:(a)I am exempt frorru backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS')that I am sub(ect to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.1 am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have fa lod to report aV i ntorost and dividends on your tax return.For real estate transa0bons,Item 2'does not apply,For mortgage interest paid, acgdsition or abandonment of secured property,cancellation of debt,contributions to an individual retirerlleM arrangememl(IRA),arid,generally,payments ofher than Intemost and dnvideutds:,you are not required to sign the cal dnfucation„but you must provide your correct TIN.See the instrudioris for Part It,latel. Sign signature of Here U.S.poison► � Date 0, General Instructions •Form 1099-DIV(dividends,including those from stocks or utuat funds) Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments .Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. •Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption .Form 1099-A(acquisition or abandonment of secured property) taxpayer Identification number(ATIN),or employer identification number (EIN),to roport on an information return the amourit paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. I/yolu do not return Form W-9 to the requestor with a TIN,;you might •Form 1099-INT(interest earned or paid) be slubjcrt to backup withholding,Sive What is backup withholding, later. Cat.No.10231X Form W-9(Rev.10-2018) OP ID:SR A R� DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/17/2020 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 CONTACT NAME Sprague Israel Giles PHONE FAX 1501 Fourth Avenue,Suite 730 .._. _._._ 1 Nom......... Seattle,WA 9 81 01-3225 E-MAIL ADDRESS ...... .... m John M.Policar PRODUCI�R . CUSTQMIERIDC ELCEN-1 ® ......... ......... ......... ......... INSURER(S)AFFORDING COVERAGE NAIC q INSURED EI Centro de la Raza 8 ECR INSURER A.Massachusetts Bay Ins Co 2524 16th Avenue South _ m Seattle,WA 98144-5104 tNsuReg B Allmerlca Financial 141840 INSURER C: l INSURER D. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBED: 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. ........_ 1L Sf� ' Y EFF TYPE OF INSURANCEJUS R� POLICY NUMBER ..(MMIOD/YYYY MMIDCY EXP LIMITS GENERAL LIABILITY 1 EACH OCCURRENCE S 1,000,00 Cu MAVE Tu raENTE A X� COMMERCIAL GENERAL LIABILITY X ZD2A513644-05 01/01/2020 01/01/2021 PREMISES(Eaoccurrence) S 10,00 _ .... T CLAIMS-MADE I X OCCUR MED EXP(Any one person) 5 10,00 ...�. a {PERSONAL 8 ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: J PRODUCTS-COMP/OP AGG S 2,000,00 ,......... ....._._. POLICY PF - JLSC'C' S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,00 ------- (Ea accident) B X ANY AUTO AW2AS13636-05 01/01/2020 01/01/2021 _ __ --- BODILY INJURY(Per person) f S ALL OWNED AUTOS --............................... BODILY INJURY(Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE S X HIREDAUTOS ( ) _ PER ACCIDENT X NON-OWNED AUTOS Comp Ded 5 50 mm .,. X Phys Damage 1$75,000 (Coll Ded �5 1,00 UMBRELLA LIABOCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE $ ----- D ......._.EDUCTIBLE ........_. ............... ---- ---. S .... ....... RETENTION S WORKERS COMPENSATION TORY LIMITS X !..OF AND EMPLOYERS'LIABILITY - -- - A ANYPROPRIETOR/PARTNER/EXECUTIVE WA STOP GAP 01/01/2020 01/01/2021 E L.DISEASE�EDA EMPLQYEFiiS �1.),000 OO YFN ACI OFFICERIMEMBER EXCLUDED? NIAA, ---- (Mandatory in NH) ,000 00 If as,describe under IfASE POLICY LIMIT ESCRIPTIONOFOPERATIONSbelow E..L DISE S 1,000,00 DESCRIPTION OF OPERATIONS$LOCATIONS I VEHICLES(At'tach ACORD 101,Additional Remarks Schedule,if more space is required) The Citi(of Federal Way is additional insured if required by writtencontract or a�(�reenlent,subject to the General Liability ad,t3itional!insured provision endorsement. Re: Human Services Agreement-After School&Summer Learning Program CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Federal Way ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Sarah Bridgeford 33325 8th Avenue South ArnE AUTHORIZED REPRESENT Federal Way,WA 98003-6325 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUMMARY OF COVERAGES 1, Additional Ins__ured by _._ Contract,Agreement or Permit Included 2. Addttion,.rl Insured-.�ri Primary and Non-Contributory Included 3...... Blank . S Included Blanket Waiver of Subrogation w �4. Bodily Injury RedefinedInclude Broad Form Property Damage Borrowed Equipment, Customers GGoods& Use of Elevators Included 6. Knowledge of Occurrence Included _ _._._... ... .. ........ .. ..w- - 7. Liberalization Clause Included . ...... __ _.... ................ �.. .�_.m. —_ ..._� 8, Medical Payments– Extended Reporting Period _ mmm y ..m Included ,9.'... Newly Acquired or Formed O rganizationsCovered until end of policy period Included . _ _-- ........ ___ �._.­­ 10, Non-owned Watercraft51 ft. .. _ �... ...... ..m.... 11. Supplementary Payments Increased Limits Bail Bonds $2,500 Loss o ----- ___ Lf Earn.._ ....�. ,,,,, ... ings $1000 .._ ... ....._-_ _ ... ._- . ..... -.. 12. Unintentional Failure to Disclose Hazards Included 13, Unintentional Failure to Notifyncluded This endorsement amends coverages provided under the Commercial General Liability Coverage Part through new coverages, higher limits and broader coverage grants. 1. Additional Insured by Contract, Agreement or (1) "Your work" for the additional insured(s) Permit designated in the contract, agreement or The following is added to SECTION II – WHO IS permit; AN INSURED: (2) Premises you own, rent, lease or occupy; Additional Insured by Contract, Agreement or or Permit (3) Your maintenance, operation or use of a. Any person or organization with whom you equipment leased to you. agreed in a written contract, written agreement b. The insurance afforded to such additional or permit that such person or organization to insured described above: add an additional insured on your policy is an (1) Only applies to the extent permitted by additional insured only with respect to liability law; and for "bodily injury', "property damage', or "personal and advertising injury" caused, in (2) Will not be broader than the insurance whole or in part, by your acts or omissions, or which you are required by the contract, the acts or omissions of those acting on your agreement or permit to provide for such behalf, but only with respect to: additional insured. 421-2915 06 15 Indudes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 4 (3) Applies on a primary basis if that is advertising injury" involved the rendering required by the written contract, written of or failure to render any professional agreement or permit. services by or for you. (4) Will not be broader than coverage d. With respect to the insurance afforded to provided to any other insured. these additional insureds, the following is (5) Does not apply if the "bodily injury', added to SECTION III — LIMITS OF "property damage" or "personal and INSURANCE: advertising injury" is otherwise excluded The most we will pay on behalf of the from coverage under this Coverage Part, additional insured for a covered claim is the including any endorsements thereto. lesser of the amount of insurance: c. This provision does not apply: 1. Required by the contract, agreement or (1) Unless the written contract or written permit described in Paragraph a.; or agreement was executed or permit was 2. Available under the applicable Limits of issued prior to the "bodily injury", "property Insurance shown in the Declarations. damage", or "personal injury and This endorsement shall not increase the advertising injury". applicable Limits of Insurance shown in the (2) To any person or organization included as Declarations. an insured by another endorsement 2. Additional Insured — Primary and Non- issued by us and made part of this Contributory Coverage Part. The following is added to SECTION IV — (3) To any lessor of equipment: COMMERCIAL GENERAL LIABILITY (a) After the equipment lease expires; or CONDITIONS, Paragraph 4.Other insurance: (b) If the "bodily injury', "property Additional Insured — Primary and Non- damage", "personal and advertising Contributory injury" arises out of sole negligence of If you agree in a written contract, written the lessor agreement or permit that the insurance provided to (4) To any: any person or organization included as an (a) Owners or other interests from. whom Additional Insured under SECTION II — WHO IS land has been leased which takes AN INSURED, is primary and non-contributory, place after the lease for the land ex- the following applies: pres; or If other valid and collectible insurance is available (b) Managers or lessors of premises if: to the Additional Insured for a loss covered under Coverages A or B of this Coverage Part, our (i) The occurrence takes place after obligations are limited as follows: you cease to be a tenant in that a. Primary Insurance premises; or (ii) The "bodily injury", "property This insurance is primary to other insurance damage", "personal injury" or that is available to the Additional Insured "advertising injury" arises out of which covers the structural alterations, new con- Additional Insured as a Named Insured. We struction or demolition operations will not seek contribution from any other performed by or on behalf of the insurance available to the Additional Insured manager or lessor. except: (5) To "bodily injury", "property damage" or (1) For the sole negligence of the Additional "personal and advertising injury" arising Insured; out of the rendering of or the failure to (2) When the Additional Insured is an render any professional services. Additional Insured under another primary This exclusion applies even if the claims liability policy; or against any insured allege negligence or (3) when b. below applies. other wrongdoing in the supervision, hiring, employment, training or monitoring If this insurance is primary, our obligations are of others by that insured, if the not affected unless any of the other insurance "occurrence" which caused the "bodily is also primary. Then, we will share with all injury"or"property damage"or the offense that other insurance by the method described which caused the "personal and in c. below. 421-2915 06 15 Includes copyrighted material of Insurance Services Office, Inc.,with its perYnission. Page 2 of 4 b, Excess Insurance insurer contributes equal amounts until it has (1) This insurance is excess over any of the paid its applicable limit of insurance or none of other insurance, whether primary, excess, the loss remains, whichever comes first. If any contingent or on any other basis: of the other insurance does not permit contribution by equal shares, we will contribute (a) That is Fire, Extended Coverage, by limits. Under this method, each insurer's Builder's Risk, Installation Risk or share is based on the ratio of its applicable similar coverage for"your work"; limit of insurance to the total applicable limits (b) That is Fire insurance for premises of insurance of all insurers rented to the Additional Insured or 3. Blanket Waiver of Subrogation temporarily occupied by the Additional Insured with permission of the owner; The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY (c) That is insurance purchased by the CONDITIONS, Paragraph 8. Transfer Of Rights Additional Insured to cover the Of Recovery Against Others To Us: Additional Insured's liability as a tenant for "property damage" to We waive any right of recovery we may have premises rented to the Additional against any person or organization with whom you Insured or temporarily occupied by the have a written contract that requires such waiver Additional with permission of the because of payments we make for damage under owner; or this coverage form. The damage must arise out of your activities under a written contract with that (d) If the loss arises out of the person or organization. This waiver applies only to maintenance or use of aircraft, "autos" the extent that subrogation is waived under a or watercraft to the extent not subject written contract executed prior to the "occurrence" to Exclusion g. of SECTION I — or offense giving rise to such payments. COVERAGE A — BODILY INURY AND PROPERTY DAMAGE 4. Bodily Injury Redefined LIABILITY. SECTION V — DEFINITIONS, Definition 3. "bodily (2) When this insurance is excess, we will injury" is replaced by the following: have no duty under Coverages A or B to 3. "Bodily injury" means bodily injury, sickness or defend the insured against any"suit"if any disease sustained by a person including death other insurer has a duty to defend the resulting from any of these at any time. "Bodily insured against that "suit". If no other injury" includes mental anguish or other insurer defends, we will undertake to do mental injury resulting from "bodily injury". so, but we will be entitled to the insured's 5. Broad Form Property Damage — Borrowed rights against all those other insurers. Equipment, Customers Goods, Use of (3) When this insurance is excess over other Elevators Insurance, we will pay only our share of a. SECTION I—COVERAGES, COVERAGE A— the amount of the loss, if any, that BODILIY INJURY AND PROPERTY exceeds the sum of: DAMAGE LIABILITY, Paragraph 2. (a) The total amount that all such other Exclusions subparagraph j. is amended as insurance would pay for the loss in the follows: absence of this insurance; and Paragraph (4) does not apply to "property (b) The total of all deductible and self damage" to borrowed equipment while at a insured amounts under all that other jobsite and not being used to perform insurance. operations. We will share the remaining loss, if any, Paragraphs (3), (4) and (6) do not apply to with any other insurance that is not "property damage"to "customers goods" while described in this Excess Insurance on your premises nor do they apply to the use provision and was not bought specifically of elevators at premises you own, rent, lease to apply in excess of the Limits of or occupy. Insurance shown in the Declarations of b. The following is added to SECTION V — this Coverage Part. DEFINTIONS: c. Method Of Sharing 24, "Customers goods" means property of If all of the other insurance permits your customer on your premises for the contribution by equal shares,we will follow this purpose of being: method also. Under this approach each 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 4 a. worked on; or 10. Non-Owned Watercraft b. used in your manufacturing process. SECTION I — COVERAGES, COVERAGE A c. The insurance afforded under this provision is BODILY INJURY AND PROPERTY DAMAGE excess over any other valid and collectible LIABILITY, Paragraph 2. Exclusions, property insurance (including deductible) subparagraph g.(2) is replaced by the following: available to the insured whether primary, g. Aircraft, Auto Or Watercraft excess, contingent (2) A watercraft you do not own that is: 6. Knowledge of Occurrence (a) Less than 51 feet long; and The following is added to SECTION IV — (b) Not being used to carry persons or COMMERCIAL GENERAL LIABILITY property for a charge; CONDITIONS, Paragraph 2. Duties in the Event of Occurrence, Offense, Claim or Suit: This provision applies to any person who, with your consent, either uses or is e. Notice of an "occurrence", offense, claim or responsible for the use of a watercraft. "suit" will be considered knowledge of the insured if reported to an individual named 11. Supplementary Payments Increased Limits insured, partner, executive officer or an SECTION I — SUPPLEMENTARY PAYMENTS "employee" designated by you to give us such COVERAGES A AND B, Paragraphs 1.b. and a notice. 1.d, are replaced by the following: 7. Liberalization Clause 1.b.Up to $2,500 for cost of bail bonds required The following is added to SECTION IV — because of accidents or traffic law violations COMMERCIAL GENERAL LIABILITY arising out of the use of any vehicle to which CONDITIONS: the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Liberalization Clause 1.d.All reasonable expenses incurred by the If we adopt any revision that would broaden the insured at our request to assist us in the coverage under this Coverage Form without investigation or defense of the claim or "suit", additional premium, within 45 days prior to or including actual loss of earnings up to $1000 a during the policy period, the broadened coverage day because of time off from work. will immediately apply to this Coverage Part. 12. Unintentional Failure to Disclose Hazards 8, Medical Payments — Extended Reporting Period The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY a. SECTION I—COVERAGES, COVERAGE C— CONDITIONS, Paragraph 6. Representations: MEDICAL PAYMENTS, Paragraph 1. Insuring Agreement, subparagraph a.(3)(b) We will not disclaim coverage under this Coverage is replaced by the following: Part if you fail to disclose all hazards existing as of the inception date of the policy provided such (b) The expenses are incurred and reported failure is not intentional. to us within three years of the date of the accident;and 13. Unintentional Failure to Notify b. This coverage does not apply if COVERAGE The following is added to SECTION IV — C— MEDICAL PAYMENTS is excluded either COMMERCIAL GENERAL LIABILITY by the provisions of the Coverage Part or by CONDITIONS, Paragraph 2. Duties in the Event endorsement. of Occurrence, Offense, Claim or Suit: 9. Newly Acquired Or Formed Organizations Your rights afforded under this policy shall not be SECTION II —WHO IS AN INSURED, Paragraph prejudiced if you fail to give us notice of an "occurrence", offense, claim or"suit", solely due to 3.a. is replaced by the following: your reasonable and documented belief that the a. Coverage under this provision is afforded until "bodily injury" or"property damage" is not covered the end of the policy period. under this policy. ALL OTHER TERMS, CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED. 421-2915 06 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 4