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HomeMy WebLinkAboutAG 23-270 - KING COUNTY SEXUAL ASSUALT RESOURCE CENTERRETURN TO: Kim Bachrach EXT: 2654 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: CD/Community Services 2. ORIGINATING STAFF PERSON: Kim Bachrach EXT: 2654 3. DATE REQ. BY:12/6/23 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 9 HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL ❑ OTHER 5. PROJECT NAME: ARPA Human Services Grant 6. NAME OF CONTRACTOR: King County Sexual Assault Resource Center ADDRESS: PO Box 300 Renton, WA 98057 TELEPHONE (425) 282-0354 E-MAIL.: mstone@kcsarc.org FAX: SIGNATURE NAME: Ellen TITLE CEO 7. EXHIBITS AND ATTACHMENTS: A SCOPE, WORK OR SERVICES A COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ® ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: October 1, 2023 COMPLETION DATE: December 31, 2026 9. TOTAL COMPENSATION $ 150,000 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: BYES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ 150,000 IS SALES TAX OWED ®YES ONO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED 2 PURCHASING: PLEASE CHARGE TO: 001-1800-990-518-10-410 10. DOCUMENT/CONTRACT REVIEW INITIAL/DATE REVIEWED INITIAL/DATE APPROVED ❑ PROJECT MANAGER SJB 11/27/2023 ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) R LAW JE 12/13/23 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCILAPPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING © SENT TO VENDOR/CONTRACTOR DATE SENT: 10113/2023 DATE REC'D: 12/22/2023 ❑ 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 A DEPARTMENT --L_ GNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# COMMENTS: CITY OF CITY HALL A% Fed a ra I Way33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www.crq offederafway com HUMAN SERVICES AGREEMENT FOR BETTER IN COMMUNIDAD This Human Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and King County Sexual Assault Resource Center, 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: KING COUNTY SEXUAL ASSAULT RESOURCE CENTER: Kate Krug PO Box 300 Renton, WA 98057 (425) 282-0354 (telephone) The Parties agree as follows: CITY OF FEDERAL WAY: Kim Bachrach 33325 8th Ave. S. Federal Way, WA 98003-6325 (253) 835-2654 (telephone) Kim. B achrach(acityoffederalway. com 1. TERM. The term of this Agreement shall be for a period commencing on October 1, 2023, and terminating on December 31, 2026 ("Term"). Funding for the second, third, and fourth years of the Agreement is contingent upon satisfactory Agreement performance during the first year of the Agreement term and upon funding availability. This Agreement may be extended for additional periods of time upon the mutual written agreement of the City and the Agency. 2. SERVICES. The Agency shall perform the services more specifically described in Exhibit A, attached hereto and incorporated by this reference ("Services"), in a manner consistent with the accepted professional practices for other similar services within the Puget Sound region in effect at the time those services are performed to the City's satisfaction, within the time period prescribed by the City and pursuant to the direction of the Mayor or his or her designee. The Agency warrants that it has the requisite training, skill, and experience necessary to provide the Services and is appropriately accredited and licensed by all applicable agencies and governmental entities, including but not limited to obtaining a City of Federal Way business registration and a Unique Business Identifier (UBI) and a Unique Entity Identifier (UEI). 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. ARPA HUMAN SERVICES AGREEMENT - 1 - 8/2023 CITY OF A%,S* Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com 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. 4.2 Method of Payment. On a not less than 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 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 Community 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. hi 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 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 prior approval in writing from the City to revise the line item budget when the cumulative amount of transfers from or to a line item is expected to exceed ten percent (10%) of that line item. The Agency must provide supporting documents to fully explain the nature and purpose of the revision with each request for prior approval. All budget revision requests in excess of 10% of a line item amount shall be reviewed and approved or denied by the City in writing. 4.5 Non -Appropriation of Funds. If sufficient funds are not appropriated or allocated for payment under this Agreement for any future fiscal period, the City will not be obligated to make payments for Services or amounts incurred after the end of the current fiscal period, and this Agreement will terminate upon the completion of all remaining Services for which funds are allocated. No penalty or expense shall accrue to the City in the event this provision applies. 5. INDEMNIFICATION. 5.1 Agency Indemnification. The Agency agrees to release, indemnify, defend, and hold the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, taxes, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation expenses to or by any and all persons or entities, including, without limitation, their respective agents, licensees, or representatives arising from, resulting from, or in connection with this Agreement or the performance of this Agreement, except for that portion of the claims caused by the City's sole negligence. Should a court of competent ARPA HUMAN SERVICES AGREEMENT - 2 - 8/2023 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cilyoffederalway com 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. 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 $2,000,000 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 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 ARPA HUMAN SERVICES AGREEMENT - 3 - 8/2023 Alt Federal Way 4 CITY OF CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cilyoffederalway com 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 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 ARPA HUMAN SERVICES AGREEMENT - 4 - 8/2023 CITY OF CITY HALL 33325 4S Feder Federal Way8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway. com 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 Parry 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 Assigmnent 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 -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. ARPA HUMAN SERVICES AGREEMENT 5 - 8/2023 clrr of CITY HALL �S Feder 8th Avenue South Federal Way, WA 98003-6325 Fed ra Way (253) 835-7000 www cityoffederalway com 13.4 Enforcement. Time is of the essence in 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 maybe 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 maybe 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] ARPA HUMAN SERVICES AGREEMENT - 6 - 8/2023 CITY OF CITY HALL Fe d e ra I Way Feder 8ih Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: Jim Fe yr ATTEST: VA Ad �V Ste h ie vurtney 'CMC, City Clerk A RO AS TO FORM: DATE: ) 2- J. R Call, City AWrney KING COUNTY SEXUAL ASSAULT RESOURCE CENTER: By: (YC,�� L o r-rcA \ r') Printed Name: mc o t t-C w1C- VLru C-j Title: (TUL-) _ DATE: �C-1-1 -2- STATE OF WASHINGTON ) ss. COUNTY OF tj On this day personally appeared before me (A3 W -ram inG lC.r to me known to be the C ED of King County Sexual Assault Resource Center 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 they were 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 21 r"' day of yccLh^ 6yr , 20�3 Notary's signature Notary's printed name Notary Public Notary blic in d for the State of Washington. State of Washington My commission expires / Z5/"�-1 ABIGAIL BARGMAN � COMMISSION# 23029424 MY COMMISSION EXPIRES August 28, 2027 ARPA HUMAN SERVICES AGREEMENT - 7 - 8/2023 CITY OF , Federal `Nay EXHIBIT A SERVICES Project Services Summary CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www.cityoflederalway com The Agency shall provide culturally relevant sexual assault prevention and intervention programming for Lantinx youth in the City of Federal Way through their Better in Comunidad program. Better in Comunidad will deepen awareness and knowledge of the dynamics of sexual assault and mental health as well as empower youth to confidentially continue conversations with their community. This intervention program will refer participants to additional services at King County Sexual Assault Resource Center including therapy, legal advocacy, and client care as needed. The Agency shall ensure that services provided with funding under this Agreement are made available and delivered 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 ARPA funds: 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total JAN. - APRIL - JULY - OCT. - MARCH JUNE SEPT. DEC. No. of unduplicated Federal Way ersons assisted in 2023 N/A N/A N/A 5 5 No. of unduplicated Federal W4y persons assisted in 2024 5 6 5 6 22 No. of unduplicated Federal Way persons assisted in 2025 4 5 4 5 18 No. of unduplicated Federal Way persons assisted in 2026 4 5 4 5 18 B. Units of Service The Agency agrees to provide, at minimum, the following units of service by quarter: 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter Total JAN. - APRIL - JULY - OCT. - MARCH NNE SEPT. DEC. 2023 1. Service Hours N/A N/A N/A 57 57 2024 ARPA HUMAN SERVICES AGREEMENT - 8 - 8/2023 CITY OF Federal CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway. com 1. Service Hours 83 83 83 83 331 2025 1. Service Hours 67 67 66 66 266 2026 1. Service Hours 67 67 66 66 266 Units of service are measured by the hours of client therapy, legal advocacy, client care, and general advocacy services. C. Outcome Measure(s) Outcome 1: Youth report an increased ability to identify next steps or make decisions/plan for the future. Outcome 1 Indicator: Pre/post satisfaction surveys Target: 80% of youth in the general program Outcome 2: Youth report that they are better able to manage their mental health symptoms. Outcome 2 Indicator: Pre/post satisfaction surveys Target: 80% of youth enrolled in therapy services only 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 is 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. ARPA HUMAN SERVICES AGREEMENT - 9 - 8/2023 CITY OF !, Federal CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cltyofiederalway.. 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 2023 Income Limits Summary (Effective June 15, 2023) Median FY 2023 Income Income Limit 1 Person 2 Persons 3 Persons 4 Persons 5 Persons 6 Persons 7 Persons 8 Persons King County Category Extremely Low -30% $28,800 $32,900 $37,000 $41,100 $44,400 $47,700 $51,000 $54,300 Income Limits Very Low $146,500 -50% $47,950 $54,800 $61,650 $68,500 $74,000 $79,500 $84,950 $90,450 Income Limits Low -80% $70,650 $80,750 $90,850 $100,900 $109,000 $117,050 $125,150 $133,200 Income Limits The Agency agrees to use updated Income Guidelines which will be provided by the City. Reports and Reporting Schedule The Agency shall collect and report client information to the City not less than quarterly. Required reports shall be submitted together on a form and format to be provided by the City. Required reports are the reimbursement request, service unit report with narrative, demographic data report, and outcomes reports. The Agency shall submit a Demographic Data Report not less than quarterly. The agency shall collect and retain the data requested on the City provided form from the persons served through this contract. Data should be tracked in an ongoing manner and submitted not less than quarterly 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 and detailed above in this Exhibit A. Changes to the outcome(s) presented in the application must be approved by the City prior to implementation. The Agency shall report the results of its outcome measure(s) not less than quarterly on the Outcome Data Report 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 fiends as the City of Federal Way ARPA Funds. ARPA HUMAN SERVICES AGREEMENT - 10 - 8/2023 CITY OF Federal Pro 0ect Budget CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. cifyoffederalway com EXHIBIT B COMPENSATION The Agency shall apply the following funds to the project in accordance with the Line Item Budget Summary, detailed below. The total amount of compensation pursuant to this Agreement shall not exceed One Hundred Fifty Thousand and 00/100 Dollars ($150,000.00). A. City of Federal Way Funds 2023 2024 2025 2026 Cit of Federal WayARPA Fund: $9,187.00 $53,063.00 $43,875.00 $43,875.00 Total Cityof Federal Way Funds: $9,187.00 $53'063.00 $43,875.00 $43,875.00 B. Line Item Budget 2023 2024 ` 2025 2026 Personnel Services detail below) $8,136.00 $40,679.54 $32 543.63 $32,543.63 Office or Operating Supplies $87.00 $275.00 $275.00 $275.00 Travel and Training $25.00 $125.00 $100.00 $100.00 Administration (Overhead) $939.00 $11 983.46 $10 956.37 $10 956.37 Total City of Federal Way Funds: $9,187.00 $53 063.00 $43,875.00 $43,875.00 C. Personnel Detail Position Title Position Full Time Annual Salary and Benefits Total ARPA Funds Legal Advocate -Equivalent - 0.15 $95,397.64 $50,083.76 General Advocate 0.14 0.10 $55,453.32 $26,783.95 Therapist $105,814.26 $37,034.99 Total: 0.39 $256 665.22 $113.,902.71 Reimbursement Requests with supporting documentation for the billing period, Service Unit Report, Demographics Data Report, and Outcomes Data Report shall be submitted no less frequently than quarterly and are due on the 15ffi of the month after the reporting period ends, but not less than the following dates: 1st Quarter: April 30; 2nd Quarter: July 31; 3rd Quarter: October 31; and 4th Quarter: Reimbursement Request, Service Unit Report, Demographic Data Report, and Outcomes Data Report forms are due January 10. The first quarter of reporting is the 4th quarter of 2023. The first Reimbursement Requests, Service Unit Report forms, Demographics Data Report shall be submitted on January 10, or within ten (10) days of notice to proceed, whichever is later. Services are to be delivered throughout each contract year. If the Agency anticipates expenditures will exceed the estimated quarterly or monthly payments for the corresponding billing period, the Agency shall request prior approval in writing from the City. Estimated Quarterly Payments are $10,713.00. If the Agency submits ARPA HUMAN SERVICES AGREEMENT - 11 - 8/2023 CITY OF CITY HALL Federal Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cityoffederalway com monthly reports, Estimated Monthly Payments are $3,571.00. Quarterly payment 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 it will meet the specific funding conditions identified for the Agency and acknowledges payment to the Agency will not be made unless the funding conditions are met. If the Agency's performance is behind the agreed upon numbers stated above by June 2024, the City reserves the right to deny additional award of funds beyond 2024 and re -distribute any remaining funding that otherwise would have been available to the Agency to other agencies, programs, or projects as the City sees fit. ARPA HUMAN SERVICES AGREEMENT - 12 - 8/2023 'S AN C, � ITY Way EXHIBIT C CERTIFICATE OF INSURANCE CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www cidyoffederalway com ARPA HUMAN SERVICES AGREEMENT - 13 - 8/2023 KINGCOU-04 RIAMEA CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 912912023 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 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 AssuredPartners of Washington, LLC 1325 4th Ave Suite 2100 Seattle, WA 98101 INSURED King County Sexual Assault Resource Center PO Box 300 Renton, WA 98057 CERTIFICATE NUMBER: ja/c Lua, Ext): (800) 429-4144 MR k% INSURERIS) AF INSURER A: Philadelphia Inc INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : REVISION NUMBER: 1 336-7081 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 TYPE OF INSURANCE ADDL BUBR POLICY NUMBER POLICY EFFQQQ= POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE �X OCCUR X IPHPK2609709 9/30/2023 9/3012024 DAMAGE Tq RENTED $ 100,000 MED EXP (Any one ers S 5,000 PERSONAL & ADV INJURY $ 1,000,000 EN'LAGGREGAT LIMIT APPLIES PER: X POLICY�JEC LOC AGGREGATEGENERAL S 2,000,000 PRODUCTS -COMP/OPAGO $ 2,000,000 WA STOP GAP $ 1,06000 OTHER A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) S ANY AUTO IPHPK2609709 9/30/2023 9/30/2024 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S X derynl AMAGE S AU & ONLY X AUUTOS ONLYa $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE S 4,000,000 EXCESS LIAB CLAIMS -MADE IPHUB884117 9/3012023 9/30/2024 DIED I X I RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A IPHPK2609709 9130/2023 9/30/2024 I PER T X I OTH- IER E.L. EACH ACCIDENT 1,000,000 S E.L DISEASE - EA EMPLOYEE S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 7,000,000 $ A Professional Liabili PHPK2609709 :13012023 9/30/2024 Each Incident 1,000,000 A Professional Liabili IPHPK2609709 9/3012023 9/30/2024 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is Tquiredl Human Services Agreement for Sexual Assault Victim Svcs to residents of the City of Federal Way. The City is included as Additional Insured as respects the named insured operations as sexual assault and education Svc per attached policy forms CG20260413 & PIGLDHS1011 attached. Coverage is primary and non-contributory perform attached PIGL0050712. City of Federal Way Attn: Sarah Bridgeford 33326 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 King County Sexual Assault Resource Center King County Sexual Assault Resource Center Board of Directors Retreat and November Meeting Minutes November 3, 2023, 12:00 — 5:00 pm DWT Seattle Attending: Laurie Anderson, Marnix Brinkoff, Angela Bultemeier, Tiffiny Evans, Dennis Higgins, Lisa Holderman, Tara Lee, Marta Lowe, Carl Morris, John Rheinberger, Alexa Rudin, Lisa Schaures, Diana Schuetz, Marilyn Sherron, Grace Thompson, Dana Ulrich, Lauren Venezia, Susan Warwick, Brittany Weede, and Lu Yang. Staff: Kate Krug, Mary Ellen Stone, Karen Sharp, Larraine Lynch, Veena Gonugunta, and Ashley Nguyen. Guests: Christine Martin, Kristy Gilmore, and Alexis Osborne. Absent: Bobbe Bridge and Jesse Franklin. Welcome: Marilyn and Christine provided an overview of the agenda and established the goals for the day. Client story: Kristy, a KCSARC Empowered Voices member and former KCSARC client, was in conversation with Larraine, Chief Program Officer. Kristy shared her story and experience with KCSARC support. KCSARC origins and current connections: Mary Ellen provided an overview of the movement and KCSARC origins. Board members spent time discussing how they became connected to KCSARC. Year in review and year ahead: Mary Ellen reviewed the 2023-2026 Strategic Plan and Q3 Dashboard. Angela will begin the planning process next spring about moving the strategic plan forward with Kate. Lu and Veena reviewed the 2024 budget draft. Budget Board calls can be scheduled for questions. The Board will vote to approve the 2024 budget at the December meeting. Onboarding Kate as our new CEO: Dennis and Susan from the Transition Committee reviewed upcoming onboarding milestones and support needed from each member of the Board. How do we connect more people to KCSARC?: Lisa S and Karen from the Board Development Committee introduced an exercise to create plans for connecting and expanding KCSARC's network, including potential Board members. November Board Meeting Consent calendar: The October Board minutes were distributed. Marta Lowe motioned to approve the October minutes. Angela seconded the motion. Board members voted, and the motion passed. Finance: Marilyn presented the 990 with edits. Lisa S. motioned to approve, and Diana Schuetz seconded the motion. Board members voted, and the motion passed. Governance: Veena presented a motion to give Kate signing authority. Lauren Venezia motioned to approve, and Susan seconded the motion. Board members voted, and the motion passed. Executive session: The Board moved into executive session. 24/7 Sexual Assault Resource Line www.kcsarc.org Tel 425.226.5062 888.99.VOICE PO Box 300 1 Renton, WA 98057 Fax 425.235.7422 King County Sexual Assault Resource Center The Board adjourned at 5:00 pm. Respectfully submitted Alexa Rudin Secretary 24/7 Sexual Assault Resource Line www.kcsarc.org TeL 425.226.5062 888.99.VOICE PO Box 300 1 Renton, WA 98067 Fax 425.235.7422 KING COUNTY SEXUAL ASSAULT RESOURCE CENTER Unique Entity ID JWJBZSA7KJN4 CAGE'NCAGE 6Wi45 Physical Address 707 S Grady WAY STE 300 Renton, Washington 9� 8057-3245, United States Registration Status Expiration hate Active Registration Jan 11, 2024 Purpose of Registration Federal Assistance Awards Only MailingAddress P.O. BOX300 Renton, Washington 9805T-0300, United States Form W=9 Request for Taxpayer Give Form to the (Rev. October2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Intemal Revenue Service No. Go to wwwJrs.gov/FonmW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this fine; do not leave this line blank KING COUNTY SEXUAL ASSAULT RESOURCE CENTER 2 Business narn0disregarded 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 only one of the following seven boxes. ❑ Individual/sole proprietor or 0 C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate single -member LLC ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ► Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. I. J Other (see ;nslruo,"sons) ► 5 Address (number, street, and apt. or suite no.) See instructions. PO BOX 3000 6 City, state, and ZIP code RENTON, WA 9857 7 List account number(s) here (optionaQ 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) N/A (Applies to accounts malntalned outside the U.S.) Requester's name and address (optional) ■io-= I axpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Lsocial security number backup withholding. For individuals, 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 TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. F-7-1 Certification 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 from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject 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 failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Signature of Here U.S. person Do - General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest eamed or paid) Date ► . � [ J�✓� Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) CITY OF �. Federal Way 33325 8" Avenue South, Federal Way, WA 98003 ❑✓ New Vendor ❑ Update Form To add your business to our vendor file, or update information, please complete this form and mail to 33325 8" Ave South Federal Way. WA 98003 or fax #253-835-2509 or email accountsnavablela.citvoffederalway.com Businass In(grnration (as shown on your ffedoW tax return) (For office use only) VN#: 1. Business Name: KING COUNTY SEXUAL ASSAULT RESOURCE CENTER DBA 2. Contact Name: 3. Business Address: PO BOX 300 RENTON 98057 City State Zip Cade 4. Remit To Address (if different): City/State 7.i Cade 5. Phone#: 425-226-5062 Fax 9: E-Mail: FINANCEGa7KCSAC.ORG 6. Will you provide suppplies or service to the City of Federal Way? ❑ Supplies ❑✓ Services 7. City of Federal Way Staff/Department Contact Name: KIM BACHRACH Business Zkpe(Please Check appropriate hos for federal tar clrtss! Icanon of nerronlentin, entered on line 1) 0 C Corporation ❑ S Corporation ❑ Partnership ❑ Government Agency ❑ Trust/Estate 0 Non -Profit (if..ipt, E,,o payee code) 91-0967255 Federal HNEIN # (9 digits) ❑ Sole Proprietor Federal ID # (9 digits) or Social Security Number If you are not a corporation, is your Business subject to 1099 reporting? ❑ Yes State of Washington U. B.1. # 600354301 ❑ No ❑ Limited liability company. Enter the tax classification (C--C corporation, S=S corporation, P=Partnership) > Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for US federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. ❑ Other (see instructions) - Exemptions (codes apply only to certain entitles, not individuals; see instruction) Exempt payee code (if any) Exemption from FATCA reporting code (if any) Certification: Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me); and 2. I am not subject to backup witholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Intemal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report al] interest or dividends, or (c) the IRS has notified me that I am no longer sul,ject to backup witholding; and 3. 1 am a US 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. The Internal Revenue Service does not require vour consent to anv proxisinrt oT ibis documcns other IhAn ttte certification required to avoid backup withholdin r _tiHere Sienature of U.S. person>�� I-'f Date> 2-1 For information call: 253.835.2525 or Fax: 253.835.2509 or e-mail: accountspavable a citvoffederaiway.coni Rev 12021 CITY OF �'FederalFQ�ral 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 2023-2026 ARPA Authorized Signatures for Invoices I authorize the following individuals to sign invoices and quarterly reports on behalf of: L 1 hi G C 0tiTy ge)(Dr, A5- iqUZ 1 "UO�]E eE?kontracting Agency), for the following '9E-TT� r- 1 N C't-t L) Al 1'A A:D (Program Title). Authorizing Signature: (must be signed by person who signs the contract, generally, Executive Director) Additional Authorized Signature: Additional Authorized Signature: (Printed Name) (Title) 1A, (Date) 'Pe Av��NA �tor��Ct�� 1 Cr-�o (Printed Name) (Title) cs TIC- z ; 2-6-Z—a (Si a t7rer (Date) LA'r-cA(M - L-YNCq CT0 (Printed Name) (Title) -7 z� tore) (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.