AG 22-037 - MSMRETURN TO: EXT:
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: FWCC
2. ORIGINATING STAFF PERSON: Trisha Plucknett
EXT: 6921 3. DATE REQ. BY:
4. 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
❑ ORDINANCE
❑ CONTRACT AMENDMENT (AG#):
0 OTHER MOU
❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
❑ RESOLUTION
71=I19rMele
5. PROJECT NAME: Memorandum of Understanding City of Federal Way and MSM and Mandy Ma
6. NAME OF CONTRACTOR: Multicultural Self -Sufficiency Movement
ADDRESS: h ' 1 0 W1 V TELEPHONE
E-MAIL: FAX:
SIGNATURE NAME: 1r TITLE
7. EXHIBITS AND ATTACHMENTS:11 SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE R ALL
OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
8. TERM: COMMENCEMENT DATE: upon execution
COMPLETION DATE: December 31, 2024
9. TOTAL COMPENSATION $ N/A (INC-LUDE 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: ❑ CONTRACTOR ❑ CITY
RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE TO: NI"
10. DOCUMENT/CONTRACT REVIEW
❑ PROJECT MANAGER
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
IN LAW
11. COUNCIL APPROVAL (IF APPLICABLE)
INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
DS 2/14/22
JE 2/16/22
COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE:
12. CONTRACT SIGNATURE ROUTING
❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D:
❑ 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.)
/ INITIAL / DATE SIGNED
CVLAW DEPARTMENT 2
SIGNATORY (MAYOR OR DIRECTOR) p"� 1
CITY CLERK
ASSIGNED AG# AG# '"
COMMENTS:
Can you please review before we have the MOU signed for another two year agreement?
2/2017
Memorandum of Understanding
City of Federal Way and MSM and Mandy Ma
THIS MEMORANDUM OF UNDERSTANDING (MOU), dated effective when signed by all parties, defines
the respective responsibilities of the City of Federal Way ("City"), Multicultural Self -Sufficing Movement
(MSM) a Washington non-profit corporation, in connection with the senior meal program at the Federal Way
Community Center.
Background
A. The MSM desires to enter an agreement for use of space at the Federal Way Community Center for a
twice weekly meal program from the effective date of this agreement until December 31, 2024.
B. The City of Seattle has provided funding for a congregate meal program to MSM to serve an unmet
need in the community. The congregate meal program is donation based and provides warm nutritious
meals to low-income seniors.
C. The City of Federal Way will provide space at the Federal Way Community Center located at 876 S
333rd Street, Federal Way, WA 98003, for the purpose of offering an ethnic low-income congregate
meal program provided by The Senior Meal Providers.
D. MSM has permission to use the community rooms and kitchen or other space designated by the Federal
Way Community Center on Tuesdays and continued use on Thursdays. Time of use for MSM is from
8:00 a.m. until 1:00 p.m. both days.
E. No party shall be responsible for events that are unforeseeable and beyond its reasonable control, such
as acts of God, weather delays or government restrictions.
F. This MOU may be terminated by either party with 30-days' written notice.
NOW, THEREFORE, the parties agree as follows:
I. City Responsibilities. The City agrees to provide the following:
• Dining areas and kitchen facilities on the days outlined above.
■ Tables, chairs, and appropriate kitchen equipment.
• MSM will be notified ten days in advance of any schedule changes or conflicts that may result in
canceled or reduced space.
■ Changes or conflicts that may result in canceled or reduced space will not exceed two dates per
month with the exception of holidays and our annual closure week
II. Multicultural Self -Sufficiency Movement (MSM). MSM agrees to the following:
• MSM acknowledges that this agreement is for temporary use of space at the Federal Way
Community Center on Tuesdays and will develop an alternative location for continuation of services
in 2025. It is understood that a request may be made at the end of this term to continue the meal
program at the Federal Way Community Center.
■ Provide a congregate meal program on Tuesdays and Thursdays at the Federal Way Community
Center on the days and times provided above.
• MSM is only allowed entrance to facility during designated times on Tuesdays and Thursdays from
8:00 a.m. until 1:00 p.m., including the kitchen and meeting spaces.
• Qualified cooks who hold current required permits and training.
• All food is to be purchased and provided by the MSM at their sole expense.
• All paper and plastic products including, but not limited to plates, napkins and utensils are to be
purchased and provided by MSM at their sole expense.
• MSM is responsible for cleaning the community rooms, kitchen and all equipment after each day of
use. This includes emptying all trash in the community rooms and kitchen and placing in the rolling
dumpster outside the back door of the kitchen.
• MSM is solely responsible for managing its inventory of food to ensure safety and freshness.
• MSM is solely responsible for any fines they may incur due to violations of health codes.
■ MSM will provide and maintain a comprehensive general liability insurance policy with limits of
Two Million dollars ($2,000,000) per occurrence specifically naming the City of Federal Way
additionally insured. This policy shall include personal injury, bodily injury, or property claims of
MSM services and its agents.
• MSM will report any damage or malfunctioning equipment to designated Federal Way Community
Center staff upon discovery.
• MSM will agree to repair or replace at their expense any damaged equipment caused by misuse by
the The Senior Meal Providers.
• MSM will only use the designated refrigerator storage space that has been assigned to them and
properly store items in non -spill, odor resistant containers.
• MSM will assist in paying for quarterly kitchen cleanings, limited to no more than the amount of
$500.00 per quarter.
• This MOU sets forth the intent of the parties herein.
[Signature page follows]
IN WITNESS, the Parties execute this MOU below, effective the last date written below.
CITY OF FEDERAL WAY:
Ja utton, P s 151re r
DATE: Q
ATTEST:
HQAA41W "
ity iherk, Stephanie C ney. CMC
APPROVED AS TO FORM:
M
)Jan Call, City A torney
MULTICULTURAL SELF-SUFFICIENCY MOVEMENT:
By:
Printed Name: 4-eCt✓
Title:
DATE: :3Z r I
STATE OF WASHINGTON )
ss.
COUNTY OF
On this day personally appeared before me 1 , to me known to be the
��^`,�( of J that executed the foregoing
instrument, and acknowledged the said instrument to be the fre6 and voI tary act and deed of said corporation,
for the uses and purposes therein mentioned, and on oath stated that he sh as 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 LkA 20XV.
,�`>>�►►►111111
P PVC 11Oil Notary's signature
�e��',,,,,,NKW *,;�'�► h�� Notary's printed name r
►�.� 4PT�� Notary Public in and for the tat ! Washington.
a My commission expires
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2/14/22, 12:12 PM Corporations and Charities System
BUSINESS INFORMATION
Business Name:
MULTICULTURAL SELF-SUFFICIENCY MOVEMENT
UBI Number:
601 737 885
Business Type:
WA NONPROFIT CORPORATION
Business Status:
ACTIVE
Principal Office Street Address:
3820 STEILACOOM BLVD SW, LAKEWOOD, WA, 98499, UNITED STATES
Principal Office Mailing Address:
3820 STEILACOOM BLVD SW, LAKEWOOD, WA, 984994552, UNITED STATES
Expiration Date:
09/30/2022
Jurisdiction:
UNITED STATES, WASHINGTON
Formation/ Registration Date:
09/11/1996
Period of Duration:
PERPETUAL
Inactive Date:
Nature of Business:
CHARITABLE, TO PROVIDE CRITICAL INTEGRATION AND EMPOWERMENT SERVICES THAT WILL LEAD TO A PATH OF
SELF SUFFICIENCY FOR CULTURALLY, LINGUISTICALLY, AND ECONOMIC DISENFRANCHISED MEMBER OF OUR
SOCIETY, INCLUDING LOW INCOME, LIMITED ENGLISH PROFICIENT PERSONS, IMMIGRANTS, REFUGEES, AND PERSONS
WITH DIVERSE RACIAL AND ETHNIC BACKGROUNDS.
Charitable Corporation:
FEIN Number:
Gross Revenue exceed $500,000:
Has Members:
Public Benefit Designation:
Host Home:
REGISTERED AGENT INFORMATION
Registered Agent Name:
MANDY H MA
Street Address:
3820 STEILACOOM BLVD SW, LAKEWOOD, WA, 984994552, UNITED STATES
Mailing Address:
GOVERNORS
Title
Governors Type
GOVERNOR
INDIVIDUAL
GOVERNOR
INDIVIDUAL
GOVERNOR
INDIVIDUAL
GOVERNOR
INDIVIDUAL
Entity Name First Name
Last Name
MANDY
MA
JAE
YANG
PETER
RHEE
NANCY
SEONG
https://ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation 1/1
-�►cvR - ' CERTIFICATE OF LIABILITY INSURANCE DATE 01115/202 YY)
Q111512423
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 pollcy(les) must be endorsed. If SUBROGATIONI5 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
AMR INSURANCE LLC/PHS NAMEl
PHONE (866) 467-8730 FAX
52811642 (A/C, No, Ext): (A/C, No):
The Hartford Business Service Center
3600 Wiseman Blvd E-MAIL
San Antonio, TX 78251 ADDRESS;
INSURERS) AFFORDING COVERAGE NAIC#
INSURED
MANDY MA DBA: MULTICULTURAL SELF-SUFFICIENCY
MOVEMENT
3820 STEILACOOM BLVD SW
LAKEWOOD WA 98499-4552
INSURER A: Hartford Casualty Insurance Company
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: KtVItiWN NUIMMIZ11:
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.
Ng AD L SUBR DLICY EFF POLICY EXP LIMITS
TYPE OF INSURANCE POLICY NUMBER ruurnnrvvvv� rrufNfnnfv vvn
III
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$1.000.000
DAMAGE TO RENTED
$300,000
CLAIMS -MADE
PREMISES occurrence)
MED EXP (Any one person)
$10,000
X
General Liability
A
X
52 SBA GQ0201
02/12/2023
02/12/2024
PERSONAL & ADV INJURY
$1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OPAGG
$2,000,000
POLICY ❑ PRO [j] LOC
JECT
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE
LIABILITY
BODILY INJURY (Per person)
ANY AUTO
I. I
BODILY INJURY (Per accident)
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED NON -OWNED
PROPERTY DAMAGE
AUTOS AUTOS
(PpracCldenty
OCCUR
EACH OCCURRENCE
UMBRELLA LIAR
AGGREGATE
EXCESS LIAR CLAIMS-
MADE
DED RETENTION $
WO COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY
ANY Y/N
T
E.L. EACH ACCIDENT
$1,000,000
A
PROPRIETORIPARTNERIEXECUTIVE
N/A
52 SBA G00201
02/12/2023
02/12/2024
E.L. DISEASE -EA EMPLOYEE
$1,0001000
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE - POLICY LIMIT
$1,000,000
(Mandatory In NH)
If yea, describe under
OF SC RIPT N F PER [ON S below
Each Claim
$5,000
A
EMPLOYMENT PRACTICES
52 SBA GQ0201
02/12/2023
02/12/2024
Limit
Aggregate Limit
$5,000
LIABILITY
DESCRIPTION
OF OPERATIONS IL0CATION5/VEHICLES
(ACORD
101. Ad OfIGnal Remarks Schadula,
may be attached
If more apace
is required)
Those
usual to the insured's Operations.
Certificate
holder is an additional Insured
per the Business
Liability
Coverage Form S80008
attached to this
policy.
CFRTIFIcaTE
HOLDER
CANCELLATION
City of Federal Way
PO BOX 9718
FEDERAL WAY WA 98063
ACORD 25 (2016103)
SHOULD ANY OF THE ABOVE DESCRIBED POLKGILS bt UANko t.LLtu
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
U (uea"7 cf, �r�v��
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
THE HARTFORD
BUSINESS SERVICE CENTER
THE 3600 WISEMAN BLVD
HARTFORD SAN ANTONIO TX 78251
SP 01 004003 41048 H 16 ASNGLP
III IIIIII III111'1111111ii111"11111111111111111111111111111111111
City of Federal Way
PO BOX 9718
FEDERAL WAY WA 98063
January 15, 2023
N
Account Information:
MANDY MA DBA:
Policy Holder Details : MULTICULTURAL SELF-
SUFFICIENCY MOVEMENT
0 Contact Us
Need Help?
Chat online or call us at
(866) 467-8730.
We're here Monday - Friday.
Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any
questions or concerns.
Sincerely,
Your Hartford Service Team
WLTRO05