Loading...
HomeMy WebLinkAbout2017 Public Services Community Development Block Grant - Contract 2017 PUBLIC SERVICES COMMUNITY DEVELOPMENT BLOCK GRANT SUB - RECIPIENT AGREEMENT BETWEEN MASON COUNTY AND COMMUNITY ACTION COUNCIL OF LEWIS, MASON AND THURSTON COUNTIES This AGREEMENT is made between Mason County, Washington ( herein called the COUNTY) and Community Action Council of Lewis, Mason and Thurston Counties ( herein called SUB- RECIPIENT) for the 2017 Public Services Community Development Block Grant ( herein called PROJECT) . COUNTY and SUB- RECIPIENT are collectively referred to as " PARTIES" to the AGREEMENT. As the Washington State Department of COMMERCE ( COMMERCE ) is authorized by the federal Department of Housing and Urban Development ( HUD ) to provide funds to units of the COUNTY selected to undertake and carry out PROJECTS under the Washington State Community Development Block Grant ( CDBG ) Program in compliance with all applicable local , state, and federal laws, regulations and policies; and As the COUNTY has applied for and received a CDBG award , contract number 17-62210 -010 ( CFDA 14 . 228 ) , to fund the PROJECT with Federal Award Identification Number B-17- DC-53 -0001 ; and As it benefits the COUNTY to engage the SUB - RECIPIENT to accomplish the Scope of Work and the objectives of the local CDBG PROJECT; The PARTIES agree that : 1 . SCOPE OF SERVICES A . COUNTY Responsibilities The COUNTY is responsible for administration of the CDBG contract, and ensuring CDBG funds are used in accordance with all program requirements [ ( 24 CFR 570 . 501 ( b ) ] and its CDBG contract with COMMERCE referenced above . The COUNTY will provide such assistance and guidance to the SUB - RECIPIENT as may be required to accomplish the objectives and conditions set forth in this AGREEMENT. The COUNTY is responsible for completing the following tasks to accomplish the objectives of the PROJECT: Principal Tasks • Execute contract with COMMERCE • Execute sub- recipient AGREEMENT • Establish administrative and other record keeping systems • Process and submit payment requests and CDBG Beneficiary Reports • Formulate and implement a sub- recipient monitoring plan and conduct on -site review • Ensure grant activities are completed • Conduct a final public hearing • Complete the grant close- out process with COMMERCE B . SUB - RECIPIENT Responsibilities The SUB - RECIPIENT will complete in a satisfactory and proper manner as determined by the COUNTY the tasks and activities as detailed in " Exhibit A Scope - of-Work" to accomplish the objectives of the PROJECT. The SUB - RECIPIENT will periodically meet with the COUNTY to review the status of these tasks . Principal Tasks • Provide referrals for a minimum of 6 , 000 individuals in Mason and Lewis counties of which a minimum of 3 , 060 must meet HUD' s 51 % income qualification . • Provide direct services and referrals for a minimum of 300 child victims . • Formulate and submit required reports and payment requests to COUNTY in an accurate and timely manner. 2 . TIME OF PERFORMANCE The effective date of this AGREEMENT will be the date the PARTIES sign and complete execution of this AGREEMENT through 6/30/2018 and will be in effect for the time period during which the SUB - RECIPIENT remains in control of CDBG funds or other CDBG assets as defined and required by COMMERCE and/or HUD . 3 . AGREEMENT REPRESENTATIVES Each party to this AGREEMENT shall have a representative . Each party may change its representative upon providing written notice to the other party . The PARTIES' representatives are as follows : A . SUB- RECIPIENT: John Walsh, CEO Community Action Council of Lewis, Mason and Thurston Counties 420 Golf Road Lacey, WA 98503 360-438 - 1100 johnw@caclmt . org DUNS#096245428 B . COUNTY: Jessica Sweet, Financial Analyst Mason County 411 N . 5th Street Shelton , WA 98584 360-427-9670 Ext . 644 jsweet@co . mason . wa . us 4 . BUDGET The COUNTY will pass through to the SUB- RECIPIENT no more than $ 99, 289 in CDBG funds for eligible incurred costs and expenses for the PROJECT according to the following budget . PROJECT Budget Element Budgeted Amount 05 Public Services $ 99 , 289 Indirect Cost Rate : _% Federally Approved Indirect Rate, or 10% de minimis rate, or fill out " N/A" declining to charge indirect The COUNTY may require a more detailed budget breakdown, and the SUB-RECIPIENT will provide such supplementary budget information in a timely fashion in the form and content prescribed by the COUNTY. Indirect Cost Rate if the SUB- RECIPIENT chooses to charge Indirect under this grant, the SUB - RECIPIENT shall provide their indirect cost rate that has been negotiated between their entity and the Federal Government . If no such rate exists, a de minimis indirect cost rate of 10% of modified total direct costs ( MTDC ) will be used . " Modified Total Direct Costs ( MTDC)" shall mean all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel , and up to the first $ 25 , 000 of each subaward ( regardless of the period of performance of the subawards under the award ) . MTDC excludes equipment, capital expenditures, and rental costs . Any amendments to this AGREEMENT' s Budget must first be determined by the COUNTY as consistent with its CDBG contract with COMMERCE and then approved in writing by the COUNTY and the SUB- RECIPIENT. 5 . PAYMENT The COUNTY shall reimburse the SUB - RECIPIENT in accordance with the payment procedures outlined in the CDBG Management Handbook, Financial Management Section for all allowable expenses agreed upon by the PARTIES to complete the Scope of Service . Reimbursement under this AGREEMENT will be based on billings, supported by appropriate documentation of costs actually incurred . It is expressly understood that claims for reimbursement will not be submitted in excess of actual , immediate cash requirements necessary to carry out the purposes of the AGREEMENT. Funds available under this AGREEMENT will be utilized to supplement rather than supplant funds otherwise available . It is understood that this AGREEMENT is funded in whole or in part with CDBG funds through the Washington State CDBG Program as administered by COMMERCE and is subject to those regulations and restrictions normally associated with federally-funded programs and any other requirements that the State may prescribe . 6 . PERFORMANCE MONITORING The COUNTY will monitor the performance of the SUB- RECIPIENT by tracking PROJECT progress, reviewing payment requests for applicable costs, managing the timely pass-through of CDBG funds, overseeing compliance with CDBG requirements, and ensuring recordkeeping and audit requirements are met . Substandard performance as determined by the COUNTY will constitute noncompliance with this AGREEMENT . If action to correct such substandard performance is not taken by the SUB- RECIPIENT within a reasonable period of time after being notified by the COUNTY, contract suspension or termination procedures will be initiated . 7 . SPECIAL CONDITIONS A. Withholding Payment : In the event the SUB- RECIPIENT has failed to perform any obligation under this AGREEMENT within the times set forth in the AGREEMENT, the COUNTY may, upon written notice, withhold from amounts otherwise due and payable to SUB - RECIPIENT, without penalty, until such failure to perform is cured or otherwise adjudicated . Withholding under this clause shall not be deemed a breach entitling SUB - RECIPIENT to termination or damages, provided that the COUNTY promptly gives notice in writing to the SUB - RECIPIENT of the nature of the default or failure to perform , and in no case more than 10 days after it determines to withhold amounts otherwise due . A determination of the Administrative Office set forth in a notice to the SUB - RECIPIENT of the action required and/or the amount required to cure any alleged failure to perform shall be deemed conclusive under this clause, without prejudice to any other remedy under the AGREEMENT, to take all or any of the following actions : ( 1 ) cure any failure or default, ( 2 ) to pay any amount so required to be paid and to charge the same to the account of the SUB- RECIPIENT, ( 3 ) to set off any amount so paid or incurred from amounts due or to become due the SUB - RECIPIENT . In the event the SUB - RECIPIENT obtains relief upon a claim under the Disputes clause, no penalty or damages shall accrue to SUB- RECIPIENT by reason of good faith withholding by the COUNTY under this clause . B . Labor Standards : SUB - RECIPIENT agrees to comply with all applicable state and federal requirements, including but not limited to those pertaining to payment of wages and working conditions, in accordance with RCW 39 , 12 . 040, the Prevailing Wage Act; the Americans with Disabilities Act of 1990; the Davis- Bacon Act; and the Contract Work Hours and Safety Standards Act providing for weekly payment of prevailing wages, minimum overtime pay, and providing that no laborer or mechanic shall be required to work in surroundings or under conditions which are unsanitary, hazardous, or dangerous to health and safety as determined by regulations promulgated by the Federal Secretary of Labor and/or the State of Washington . C . Waiver of Noncompetition : SUB- RECIPIENT irrevocably waives any existing rights which it may have , by contract or otherwise , to require another person or corporation to refrain from submitting a proposal to or performing work or providing supplies to the COUNTY, and SUB - RECIPIENT further promises that it will not in the future , directly or indirectly, induce or solicit any person or corporation to refrain from submitting a bid or proposal to or from performing work or providing supplies to the COUNTY. D . Ownership of Items Produced : All writings, programs, data , public records or other materials prepared by SUB - RECIPIENT and/or its consultants or sub- contractors, in connection with performance of this AGREEMENT, shall be the sole and absolute property of COUNTY . E . E-verify : The E -Verify contractor program for Mason County applies to contracts of $ 100, 000 or more and subcontracts for $ 25 , 000 or more if the primary contract is for $ 100, 000 or more . SUB - RECIPIENT represents and warrants that it will , for at least the duration of the AGREEMENT, register and participate in the status verification system for all newly hired employees . The term "employee " as used herein means any person that is hired to perform work for Mason County . As used herein , "status verification system : means the Illegal Immigration Reform and Immigration Responsibility Act of 1996 that is operated by the United States Department of Homeland Security, also known as the E-Verify Program , or any other successor electronic verification system replacing the E-Verify Program . SUB- RECIPIENT agrees to maintain records of such compliance and , upon request of the COUNTY, to provide a copy of each such verification to the COUNTY . SUB- RECIPIENT further represents and warrants that any person assigned to perform services hereunder meets the employment eligibility requirements of all immigration laws of the State of Washington . SUB - RECIPIENT understands and agrees that any breach of these warranties may subject SUB - RECIPIENT to the following : ( a ) termination of the AGREEMENT and ineligibility for any Mason County contract for up to three ( 3 ) years, with notice of such cancellation/termination being made public . In the event of such termination/cancellation , SUB - RECIPIENT would also be liable for any additional costs incurred by the COUNTY due to contract cancellation or loss of license or permit . SUB - RECIPIENT will review and enroll in the E-Verify program through this website : www . uscis . gov F . Disputes : Differences between SUB - RECIPIENT and COUNTY, arising under and by virtue of the AGREEMENT Documents, shall be brought to the attention of COUNTY at the earliest possible time in order that such matters may be settled or other appropriate action promptly taken . Except for such objections as are made of record in the manner hereinafter specified and within the time limits stated , the records, orders, rulings, instructions, and decisions of the Administrative Officer shall be final and conclusive . G . Notice of Potential Claims : Subrecipient shall not be entitled to additional compensation which otherwise may be payable, or to extension of time for ( 1 ) any act or failure to act by the Administrative Officer or COUNTY, or ( 2 ) the happening of any event or occurrence , unless Subrecipient has given COUNTY a written Notice of Potential Claim within ten ( 10 ) days of the commencement of the act, failure, or event giving rise to the claim, and before final payment by COUNTY . The written Notice of Potential Claim shall set forth the reasons for which Subrecipient believes additional compensation or extension of time is due, the nature of the cost involved , and insofar as possible, the amount of the potential claim . Subrecipient shall keep full and complete daily records of the work performed , labor and material used , and all costs and additional time claimed to be additional . H . Detailed Claim : Subrecipient shall not be entitled to claim any such additional compensation, or extension of time, unless within thirty ( 30 ) days of the accomplishment of the portion of the work from which the claim arose, and before final payment by COUNTY, Subrecipient has given COUNTY a detailed written statement of each element of cost or other compensation requested and of all elements of additional time required , and copies of any supporting documents evidencing the amount or the extension of time claimed to be due . I . Arbitration : Other than claims for injunctive relief brought by a party hereto ( which may be brought either in court or pursuant to the arbitration provision ) , and consistent with the provisions hereinabove, any claim , dispute or controversy between the PARTIES under, arising out of, or related to the AGREEMENT or otherwise, including issues of specific performance, shall be determined by arbitration in Shelton , Washington, under the applicable American Arbitration Association (AAA ) rules in effect on the date hereof, as modified by the AGREEMENT. There shall be one arbitrator selected by the PARTIES within ten ( 10 ) days of the arbitration demand , or if not, by the AAA or any other group having similar credentials . Any issue about whether a claim is covered by this AGREEMENT shall be determined by the arbitrator . The arbitrator shall apply substantive law and may award injunctive relief, equitable relief ( including specific performance ), or any other remedy available from a judge, including expenses, costs and attorney fees to the prevailing party and pre -award interest, but shall not have the power to award punitive damages . The decision of the arbitrator shall be the sole and exclusive remedy between them regarding any dispute presented or pled before the arbitrator. At the request of either party made no later than forty-five ( 45 ) days after the arbitration demand , the PARTIES agree to submit the dispute to nonbinding mediation , which shall not delay the arbitration hearing date; provided , that either party may decline to mediate and process with arbitration . J . Venue and Choice of Law : In the event that any litigation should arise concerning the construction or interpretation of any of the terms of the AGREEMENT, the venue of such action of litigation shall be in the courts of the State of Washington in and for the County of Mason . Unless otherwise specified herein, this AGREEMENT shall be governed by the laws of Mason County and the State of Washington . K . Communication : Subrecipient will not communicate directly with COMMERCE concerning this PROJECT without COUNTY' s prior approval . 8 . GENERAL CONDITIONS A . General Compliance The SUB - RECIPIENT agrees to comply with : • The requirements of Title 24 of the Code of Federal regulations, 570 ( HUD regulations concerning CDBG ) ; and • All other applicable Federal , State and Local laws, regulations, and policies, governing the funds provided under this AGREEMENT. B . CDBG National Obiective The SUB - RECIPIENT certifies the activities carried out under this AGREEMENT meet a CDBG Program National Objective defined in 24 CFR 57002080 C . Independent Contractor Nothing contained in this AGREEMENT is intended to, or will be construed in any manner, as creating or establishing the relationship of employer/employee between the PARTIES . The SUB - RECIPIENT will at all times remain an " independent contractor" with respect to the services to be performed under this AGREEMENT. The COUNTY will be exempt from payment of all Unemployment Compensation , FICA, retirement, life and/or medical insurance and Workers' Compensation Insurance, as the SUB - RECIPIENT is an independent contractor . D . Indemnification To the fullest extent permitted bylaw, SUB - RECIPIENT will hold harmless, defend and indemnify the COUNTY and its departments, elected and appointed officials, employees, agents and volunteers, from any and all claims, actions, suits, charges and judgments whatsoever that arise out of the SUB - RECIPIENT' s performance or nonperformance of the services or subject matter called for in this AGREEMENT. This indemnification obligation of the SUB- RECIPIENT shall not apply in the limited circumstance where the claim, damage, loss, or expense is caused by the sole negligence of COUNTY . This indemnification obligation of the SUB - RECIPIENT shall not be limited in any way by the Washington State Industrial Insurance Act, RCW Title 51, or by application of any other workmen ' s compensation act, disability benefit act or other employee benefit act, and the SUB- RECIPIENT hereby expressly waives any immunity afforded by such acts . The foregoing indemnification obligations of the SUB- RECIPIENT are a material inducement to COUNTY to enter into the AGREEMENT, are reflected in SUB - RECIPIENT' s compensation , and have been mutually negotiated by the PARTIES . SUB- RECIPIENT' s initials acknowledging indemnity terms : E . Workers' Compensation The SUB - RECIPIENT will provide Workers' Compensation Insurance Coverage for all of its employees involved in the performance of this AGREEMENT. F . Insurance and Bonding The SUB- RECIPIENT will carry sufficient insurance coverage to protect contract assets from loss due to theft, fraud and/or undue physical damage , and as a minimum will purchase a blanket fidelity bond covering all employees in an amount equal to cash advances from the COUNTY as detailed in " Exhibit B Insurance Requirements . " The SUB- RECIPIENT shall furnish the COUNTY with properly executed certificate of insurance or a signed policy endorsement as " Exhibit C Certificate of Insurance" which shall clearly evidence all insurance required in this section prior to commencement of services . The certificates will , at a minimum , list limits of liability and coverage . The certificate will provide that the underlying insurance contract will not be cancelled or allowed to expire except on thirty ( 30 ) days prior written notice to the COUNTY . G . Funding Source Recognition The SUB - RECIPIENT will insure recognition of the roles of COMMERCE, the WA State CDBG program , and the COUNTY in providing services through this AGREEMENT . All activities, facilities and items utilized pursuant to this AGREEMENT will be prominently labeled as to funding source . In addition , the SUB - RECIPIENT will include a reference to the support provided herein in all publications made possible with funds made available under this AGREEMENT. H . Amendments The COUNTY or SUB- RECIPIENT may amend this AGREEMENT at any time provided that such amendments make specific reference to this AGREEMENT, and are executed in writing, signed by a duly authorized representative of each organization , and approved by the COUNTY' s governing body . Such amendments will not invalidate this AGREEMENT, nor relieve or release the COUNTY or SUB- RECIPIENT from its obligations under this AGREEMENT . I . Suspension or Termination In accordance with 2 CFR 200 . 33 &9, the COUNTY may suspend or terminate this AGREEMENT if the SUB - RECIPIENT materially fails to comply with any terms of this AGREEMENT, which include ( but are not limited to ) the following : 1 . Failure to comply with any of the rules, regulations or provisions referred to herein , or such statues, regulations, executive orders, and HUD guidelines, policies or directives as may become applicable at any time; 2 . Failure, for any reason , of the SUB - RECIPIENT to fulfill in a timely and proper manner its obligations - under this AGREEMENT . 3 . Ineffective of improper use of funds provided under this AGREEMENT; or 4 . Submission by the SUB- RECIPIENT to the COUNTY of reports that are incorrect or incomplete in any material respect . In accordance with 2 CFR 200 . 339, this AGREEMENT may also be terminated by either the COUNTY or the SUB- RECIPIENT, in whole or in part, by setting forth the reasons for such termination , the effective date, and , in the case of partial termination , the portion to be terminated . However, if in the case of a partial termination , the COUNTY determines that the remaining portion of the award will not accomplish the purpose for which the award was made , the COUNTY may terminate the award in its entirety . 9 . ADMINISTRATIVE REQUIREMENTS A . Financial Management 1 . Accounting Standards The SUB- RECIPIENT agrees to comply with 2 CFR 200 and agrees to adhere to the accounting principles and procedures required therein , utilize adequate internal controls, and maintain necessary source documentation for all costs incurred . 2 . Cost Principles The SUB- RECIPIENT will administer its program in conformance with 2 CFR 200 . These principles will be applied for all costs incurred whether charged on a direct or indirect basis . 3 . Duplication of Costs The SUB - RECIPIENT certifies that work to be performed under this AGREEMENT does not duplicate any work to be charged against any other contract, subcontract or other source . Be Documentation and Record Keeping 1 . Records to Be Maintained The SUB - RECIPIENT will maintain all records required by the Federal regulations specified in 24 CFR 570 . 506 that are pertinent to the activities to be funded under this AGREEMENT and those records described in the CDBG Management Handbook . Such records will include but not be limited to : a . Records providing a full description of each activity undertaken ; b . Records demonstrating that each activity undertaken meets one of the National Objectives of the CDBG program ; c . Records required to determine the eligibility of activities; d . Records required to document the acquisition , improvement, use or disposition of real property acquired or improved with CDBG assistance ; e . Records documenting compliance with the civil rights components of the CDBG program ; f. Financial records as required by 24 CFR 570 . 502, and 2 CFR 200 . 333 ; g . Labor standards records required to document compliance with the Davis Bacon Act, the provisions of the Contract Work Hours and Safety Standards Act, and all other applicable Federal, State and Local laws and regulations applicable to CDBG -funded construction PROJECTS; and h . Other records necessary to document compliance with Subpart K of 24 CFR 570 . 2 . Access to Records and Retention The grantee, the Washington State Department of COMMERCE, and other authorized representatives of the state and federal governments shall have access to any books, documents, papers and records of the SUB- RECIPIENT that are directly pertinent to this AGREEMENT for the purposes of making audit, examination , excerpts and transcriptions . All such records and all other records pertinent to this AGREEMENT and work undertaken under this AGREEMENT will be retained by the SUB - RECIPIENT for a period of six years after final audit of the COUNTY' s CDBG PROJECT, unless a longer period is required to resolve audit findings or litigation . In such cases, the COUNTY will request a longer period of record retention . 3 . Audits and Inspections All SUB- RECIPIENT records with respect to any matters covered by this AGREEMENT will be made available to the COUNTY, COMMERCE , and duly authorized officials of the state and federal government, at anytime during normal business hours, as often as deemed necessary, to audit, examine, and make excerpts or transcripts of all relevant data . Any deficiencies noted in audit reports must be fully cleared by the SUB- RECIPIENT within 30 days after receipt by the SUB - RECIPIENT . Failure of the SUB- RECIPIENT to comply with the above audit requirements will constitute a violation of this AGREEMENT and may result in the withholding of future payments . The SUB - RECIPIENT that expends $ 750, 000 or more in a fiscal year in federal funds from all sources hereby agrees to have an annual agency audit conducted in accordance with current COUNTY policy concerning SUB- RECIPIENT audits and 2 CRF 200 . 501 . The Catalog of Federal Domestic Assistance ( CFDA ) number is 14 . 228 . C . Reporting 1 . Program Income The SUB- RECIPIENT will report annually all program income ( as defined at 24 CFR 570 . 500 ( a ) ) generated by activities carried out with CDBG funds made available under this AGREEMENT. The use of program income by the SUB - RECIPIENT will comply with the requirements set forth at 24 CFR 57005040 2 . Periodic Reports The SUB- RECIPIENT, at such times and in such forms as the COUNTY may require, will furnish the COUNTY such periodic reports as it may request pertaining to the work or services undertaken pursuant to this AGREEMENT, the costs and obligations incurred or to be incurred in connection therewith , and any other matters covered by this AGREEMENT. D . Use and Reversion of Assets The use and disposition of real property and equipment under this AGREEMENT will be in compliance with the requirements of 2 CFR 200 . 311 and 313 , 24 CFR 570 . 502, 570 . 503 , 570 , 504, as applicable, which include but are not limited to the following : 1 . The SUB - RECIPIENT will transfer to the COUNTY any CDBG funds on hand and any accounts receivable attributable to the use of funds under this AGREEMENT at the time of expiration , cancellation, or termination . 2 . Real property under the SUB- RECIPIENT' s control that was acquired or improved , in whole or in part, with funds under this AGREEMENT in excess of $ 25, 000 will be used to meet one of the CDBG National Objectives pursuant to 24 CFR 570 . 208 until ten ( 10 ) years after the contract between COMMERCE and the COUNTY is closed . If the SUB - RECIPIENT fails to use CDBG -assisted real property in a manner that meets a CDBG National Objective for this 10-year period of time, the SUB - RECIPIENT will pay the COUNTY an amount equal to the current fair market value of the property less any portion of the value attributable to expenditures of non - CDBG funds for acquisition of, or improvement to, the property after the CDBG program ' s approval . Such payment will constitute program income to the COUNTY . The SUB - RECIPIENT may retain real property acquired or improved under this AGREEMENT after the expiration of the ten -year period . 3 . In cases in which equipment acquired , in whole or in part, with funds under this AGREEMENT is sold , the proceeds will be program income . Equipment not needed by the SUB - RECIPIENT for activities under this AGREEMENT will be ( a ) transferred to the COUNTY for CDBG - eligible activities as approved by the CDBG program or ( b ) retained after compensating the COUNTY . 10 . PERSONNEL AND PARTICIPANT CONDITIONS A . Civil Rights Title VI of the Civil Rights Act of 1964 : Under Title VI of the Civil Rights Act of 1964, no person will, on the grounds of race, color, creed , religion , sex or national origin , be excluded from participation in , be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance . Section 109 of the Housing and Community Development Act of 1974 : No person in the United States will on the grounds of race, color, creed , religion , sex or national origin be excluded from participation in , be denied benefits of, or be subjected to discrimination under any program or activity funded in whole or in part with funds made available under this title . Age Discrimination Act of 1975 , as Amended No person will be excluded from participation , denied program benefits, or subjected to discrimination on the basis of age under any program or activity receiving federal funding assistance . (42 U . S . C . 610 et . seq . ) Section 504 of the Rehabilitation Act of 1973 , as Amended No otherwise qualified individual will , solely by reason or his or her disability, be excluded from participation ( including employment ), denied program benefits, or subjected to discrimination under any program or activity receiving Federal funds . ( 29 U . S . C . 794) Public Law 101-336 , Americans with Disabilities Act of 1990 Subject to the provisions of this title , no qualified individual with a disability will , by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity . B . Section 3 of the Housing and Community Development Act of 1968 Compliance in the Provision of Training, Employment, and Business Opportunities : 1 . The work to be performed under this AGREEMENT is on a PROJECT assisted under a program providing direct federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended , 12 U . S . C . 1701u . Section 3 requires that to the greatest extent feasible opportunities for training and employment be given lower- income residents of the PROJECT area ; and contracts for work in connection with the PROJECT be awarded to business concerns which are located in , or owned in substantial part, by persons residing in the area of the PROJECT. 2 . The PARTIES to this contract will comply with the provisions of said Section 3 and the regulations set forth in 24 CFR 135 , and all applicable rules and orders of HUD and COMMERCE issued thereunder prior to the execution of this contract . The PARTIES to this contract certify and agree that they are under no contractual or other disability that would prevent them from complying with these provisions . 3 . The SUB - RECIPIENT will send to each labor organization or representative of workers with which he has a collective bargaining AGREEMENT or other contract or understanding, if any, a notice advising the said labor organization or workers' representative of his commitments under this Section 3 clause and will post copies of the notice in conspicuous places available to employees and applicants for employment or training . 4 . The SUB - RECIPIENT will include this Section 3 clause in every subcontract for work in connection with the PROJECT and will , at the direction of the applicant, or recipient of federal financial assistance, take appropriate action pursuant to the subcontract upon a finding that the subcontractor is in violation of regulations issued by the Secretary of HUD, 24 CFR 135 . The SUB - RECIPIENT will not subcontract with any subcontractor where it has notice or knowledge that the latter has been found in violation of regulations under 24 CFR 135 and will not let any subcontract, unless the subcontractor has first provided it with a preliminary statement of ability to comply with the requirements of these regulations . 5 . Compliance with the provisions of Section 3 , the regulations set forth in 24 CFR 135, and all applicable rules and orders of HUD and COMMERCE issued hereunder prior to the execution of the contract, will be a condition of the federal financial assistance provided to the PROJECT, binding upon the applicant or recipient for such assistance, its successors, and assigns . Failure to fulfill these requirements will subject the applicant, or recipient, its consultants and subcontractors, its successors and assigned to those sanctions specified by the grant or loan AGREEMENT or contract through which federal assistance is provided , and to such sanctions as are specified by 24 CFR 135 . C . Conduct 1 . Assignability The SUB- RECIPIENT will not assign or transfer any interest in this AGREEMENT without the prior written consent of the COUNTY thereto ; provided , however, that claims for money due or to become due to the SUB- RECIPIENT from the COUNTY under this contract may be assigned to a bank, trust company, or other financial institution without such approval . Notice of any such assignment or transfer will be furnished promptly to the COUNTY and COMMERCE . 2 . Conflict of Interest No member of the COUNTY' s governing body and no other public official of such locality, who exercises any functions or responsibilities in connection with the planning or carrying out of the PROJECT, will have any personal financial interest, direct or indirect, in this AGREEMENT; and the SUB - RECIPIENT will take appropriate steps to assure compliance . The SUB- RECIPIENT agrees to abide by the provisions of 2 CFR 200 , 318 and 24 CFR 570 . 611 , which includes maintaining a written code or standards of conduct that will govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds . The SUB - RECIPIENT covenants that its employees have no interest and will not acquire interest, direct or indirect, in the study area or any parcels therein or any other interest which would conflict in any manner or degree with the performance of services hereunder . The SUB - RECIPIENT further covenants that in the performance of this AGREEMENT, no person having such interest will be employed . 3 . Certification Regarding Debarment Suspension Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions a . The lower tier contractor certifies, by signing this contract that neither it nor its principals is presently debarred , suspended , proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency . b . Where the lower tier contractor is unable to certify to any of the statements in this contract, such contractor will attach an explanation to this contract . D . Copyright If this AGREEMENT results in any copyrightable material or inventions, the COUNTY and/or COMMERCE reserves the right to royalty-free , non - exclusive and irrevocable license to reproduce, publish or otherwise use and to authorize others to use, the work or materials for governmental purposes . E . Religious Activities The SUB - RECIPIENT agrees that funds provided under this AGREEMENT will not be utilized for inherently religious activities prohibited by 24 CFR 570 . 200 (j ) , such as worship, religious instruction , or proselytization . 11 . SEVERABILITY If any provision of this AGREEMENT is held invalid , the remainder of this AGREEMENT will not be affected thereby and all other parts of this AGREEMENT will nevertheless be in full force and effect . 12 . PERFORMANCE WAIVER The COUNTY' s failure to act with respect to a breach by the SUB- RECIPIENT does not waive its right to act with respect to subsequent or similar breaches . The failure of the COUNTY to exercise or enforce any right or provision will not constitute a waiver of such right or provision . 13 . ENTIRE AGREEMENT This AGREEMENT constitutes the entire AGREEMENT between the COUNTY and the SUB - RECIPIENT for the use of funds received under this AGREEMENT and it supersedes all prior communications and proposals, whether electronic, oral, or written between the COUNTY and the SUB - RECIPIENT with respect to this AGREEMENT . The attachments to this AGREEMENT are identified as follows : Exhibit A Scope- of-Work and Budget Exhibit B Insurance Requirements Exhibit C Certificate of Insurance Exhibit D Sample Forms and Instructions IN WITNESS WHEREOF, the COUNTY and the SUB - RECIPIENT have executed this AGREEMENT as of the date and year last written below . BOARD OF COUNTY COMMISSIONERS COMMUNITY TION COUNCIL OF WIS, MASON COUNTY, WASHINGTON MASON a d T URSTON COUM IE r Randy Neathoflin , Chair John als CE0 Date : I lu ZO « Date : Approved As To Form : Tim White ead, ief D 'f EXHIBIT A SCOPE -OF -WORK The Community Action Council of Lewis , Mason and Thurston Counties ( CAC ) will be responsible for completing the tasks and activities below as well as others as detailed throughout this AGREEMENT , Washington Department of Commerce' s ( Commerce) Community Development Block Grant (CDBG ) Management Handbook and other guides as required to provide referral and direct services in compliance with the CDBG program and Mason County' s (COUNTY) policies and procedures . It is the CAC ' s responsibility to review , understand , implement and adhere to all requirements as this Scope- of-Work is a summary , not an exhaustive list . SUB- RECIPIENT will : 1 . Conduct participant eligibility screening for Lewis and Mason county residents to determine program eligibility in compliance with CDBG requirements . 2 . Provide referrals for a minimum of 6 , 000 individuals in Mason and Lewis counties of which a minimum of 3 , 060 must meet current HUD ' s low- middle income qualifications . 3 . Provide Children ' s Justice and Advocacy Center direct services and referrals for a minimum of 300 eligible residents of Mason and Lewis counties . Services include ; resource referrals , advocacy , support case coordination , child forensic interviews , technical assistance for victims of child abuse , and consultation and case support for victims of other crimes . 4 . Collect , track and report PROJECT data in a manner consistent with the requirements detailed in this AGREEMENT , COMMERCE ' s CDBG Management Handbook and other guides as . applicable . SUB. RECIPIENT must ensure that the services provided to eligible individuals under this PROJECT are not reported to any other funding entities for the purpose of meeting contractual obligations . 3 . Voucher Requests and Reports : A . Formulate and submit a Washington State Voucher Distribution request (form A19 ) to COUNTY on a quarterly basis due September 15 , January 15 , April 15th and July 15 . Submission to include one digital copy in WORD e - mailed to Jessica Sweet and one copy that has been printed , signed and either scanned and e - mailed or sent by U . S . mail or hand delivery . Signed and certified timesheets must be maintained by the SUB - RECIPIENT . County will be responsible for submitting completed requests to COMMERCE . See " Exhibit E Sample Forms and Instructions . " B . Formulate and submit a CDBG Quarterly Beneficiary Reporting Form and a CDBG Project Status Report to COUNTY on a quarterly basis due September 15 , January 15 , April 15th and July 15 . A digital or hard copy is acceptable e- mailed or delivered to Jessica Sweet . County will be responsible for submitting completed forms and reports to COMMERCE . See Exhibit E Sample Forms and Instructions Jessica Sweet Mason County 411 N . 5th Street Shelton , WA 98584 Isweet ( co . mason . wa . us 4 . Participate in PROJECT meetings , including a grant start- up meeting , as scheduled by COUNTY . 5 . Participate and support on -site compliance reviews conducted by COUNTY per CDBG requirements . 6 . Assist COUNTY with all aspects of program administration and requirements including grant close - out process as requested . 7 . Assist with preparation of 2018 Public Services Grant application as requested by COUNTY . EXHIBIT B Budget 1 . The approved project budget for the SUB - RECIPIENT of $ 99 , 289 allows for reimbursement requests for staff salaries and benefits . The SUB - RECIPIENT cannot use Community Development Block Grant ( CDBG ) funds from this AGREEMENT for travel , equipment , contracted services , materials/supplies , other and/or indirect expenses . 2 . Staff charging time to the CDBG grant must record actual hours worked on a timesheet . Timesheets are to be signed , certifying that the hours charged are for time spent providing CDBG grant- related services . 3 . Signed and certified timesheets must be maintained by the SUB - RECIPIENT . 4 . Financial policies , practices and processes must adhere to the requirements detailed in this AGREEMENT , COMMERCE ' s CDBG Management Handbook and other guides as well as applicable Mason County' s ( COUNTY) policies and procedures . 5 . SUB - RECIPIENT will provide COUNTY with a copy of the annual A- 133 compliant audit within nine months of the end of CAC' s fiscal year. EXHIBIT C INSURANCE REQUIREMENTS 1 . MINIMUM Insurance Requirements : A . Commercial General Liability Insurance using Insurance Services Office " Commercial General Liability" policy form CG 00 01 , with an edition date prior to 2004 , or the exact equivalent . Coverage for an additional insured shall not be limited to its vicarious liability . Defense costs must be paid in addition to limits . Limits shall be no less than $ 1 , 000 , 000 per occurrence for all covered losses and no less than $2 , 000 , 000 general aggregate . B . Workers ' Compensation on a state- approved policy form providing statutory benefits as required by law with employer' s liability limits no less than $ 1 , 000 , 000 per accident for all covered losses . C . Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including owned , non - owned and hired autos , or the exact equivalent . Limits shall be no less than $ 1 , 000 , 000 per accident , combined single limit . If SUB - RECIPIENT owns no vehicles , this requirement may be satisfied by a non- owned auto endorsement to the general liability policy described above . If SUB - RECIPIENT or SUB - RECIPIENT ' s employees will use personal autos in any way on this project , SUB - RECIPIENT shall obtain evidence of personal auto liability coverage for each such person . D . Excess or Umbrella Liability Insurance ( Over Primary) if used to meet limit requirements , shall provide coverage at least as broad as specified for the underlying coverages . Such policy or policies shall include as insureds those covered by the underlying policies , including additional insureds . Coverage shall be " pay on behalf" , with defense costs payable in addition to policy limits . There shall be no cross liability exclusion precluding coverage for claims or suits by one insured against another. Coverage shall be applicable to COUNTY for injury to employees of SUB - RECIPIENT , subcontractors or others involved in the Work . The scope of coverage provided is subject to approval of COUNTY following receipt of proof of insurance as required herein . 2 . Certificate of Insurance : A certificate of insurance is attached hereto as " Exhibit D Certificate of Insurance . " 3 . Basic Stipulations : A . SUB- RECIPIENT agrees to endorse third party liability coverage required herein to include as additional insureds COUNTY , its officials , employees and agents , using ISO endorsement CG 20 10 with an edition date prior to 2004 . [ if this is a construction contract , ISO endorsement 20 37 also is required . ] SUB - RECIPIENT also agrees to require all SUB - RECIPIENT s , subcontractors , and anyone else involved in this Contract on behalf of the SUB - RECIPIENT (hereinafter " indemnifying PARTIES " ) to comply with these provisions . B . SUB- RECIPIENT agrees to waive rights of recovery against COUNTY regardless of the applicability of any insurance proceeds , and to require all indemnifying PARTIES to do likewise . C . All insurance coverage maintained or procured by SUB- RECIPIENT or required of others by SUB - RECIPIENT pursuant to this Contract shall be endorsed to delete the subrogation condition as to COUNTY, or must specifically allow the named insured to waive subrogation prior to a loss . D . All coverage types and limits required are subject to approval , modification and additional requirements by COUNTY. SUB- RECIPIENT shall not make any reductions in scope or limits of coverage that may affect COUNTY' s protection without COUNTY ' s prior written consent . E . Proof of compliance with these insurance requirements , consisting of endorsements and certificates of insurance shall be delivered to COUNTY prior to the execution of this Contract . If such proof of insurance is not delivered as required , or if such insurance is canceled at any time and no replacement coverage is provided , COUNTY has the right , but not the duty , to obtain any insurance it deems necessary to protect its interests . Any premium so paid by COUNTY shall be charged to and promptly paid by SUB- RECIPIENT or deducted from sums due SUB - RECIPIENT . F . It is acknowledged by the PARTIES of this Contract that all insurance coverage required to be provided by SUB- RECIPIENT or indemnifying party , is intended to apply first and on a primary non - contributing basis in relation to any other insurance or self-insurance available to COUNTY . G . SUB - RECIPIENT agrees not to self- insure or to use any self- insured retentions on any portion of the insurance required herein and further agrees that it will not allow any indemnifying party to self- insure its obligations to COUNTY . If SUB- RECIPIENT ' s existing coverage includes a self- insured retention , the self- insured retention must be declared to the COUNTY . The COUNTY may review options with SUB - RECIPIENT , which may include reduction or elimination of the self- insured retention , substitution of other coverage , or other solutions . H . SUB - RECIPIENT will renew the required coverage annually as long as COUNTY , or its employees or agents face an exposure from operations of any type pursuant to this Contract . This obligation applies whether or not the Contract is canceled or terminated for any reason . Termination of this obligation is not effective until COUNTY executes a written statement to that effect . EXHIBIT CERTIFICATE OF INSURANCE DATE (MMIDD/YYYY) A� t7 CERTIFICATE OF LIABILITY INSURANCE 1 /8/2018 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 CONTACT NAME: (OR) Heffernan Insurance Brokers PHONE FAX 5100 SW Macadam , Suite 440 Arc No Ext : 503-226-1320 A/c No : 503-226-1478 EMAIL Portland OR 97239 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA : Philadelphia Indemnity Insurance Company 18058 INSURED COMMACT-08 INSURER B Community Action Council of Lewis, Mason & Thurston Counties INSURERC : 3020 Willamette Dr. NE INSURERD : Lacey WA 98516 INSURER E : INSURERF : COVERAGES CERTIFICATE NUMBER: 1662793430 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y PHPK1720952 10/1 /2017 10/mala EACH OCCURRENCE $ 1 ,000,000 DAMAGE RENTED CLAIMS-MADE OCCUR PREM SESOEa occurrence) $ 1 ,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1 ,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,0001000 X POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OPAGG $ 2,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY PHPK1720952 10/1 /2017 10/1/2018 COMBINED SINGLE LIMIT $ Ea accident 1 000 000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident $ A UMBRELLA LIAB X OCCUR PHUB602795 10/1 /2017 10/1 /2018 EACH OCCURRENCE $ 1 ,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 ,000,000 DED X RETENTION $ m000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIEiOR/PARTNERIEXECUTIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability PHPK1720952 10/1/2017 10/1 /2018 Aggregate $2,0002000 Ea. Professional incd $1 ,0003000 Crime Limit $250,000 Ded. $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached if more space is required) Re : As per contract or agreement on file with insured . Mason County, its officials , employees and agents are included as an additional insured on General Liability policy per the attached endorsement, if required . Waiver of Subrogation is included on General Liability policy per the attached endorsement, if required . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mason County ACCORDANCE WITH THE POLICY PROVISIONS. attn : Todd Parker 411 N . 5th Street AUTHORIZE D RERESENTATIVE Shelton , WA 98584 © 1988 -2015 ACORD CORPORATION . All rights reserved . ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD PkGLD- HS ( 10/ 11 ) K. Key and Lock Replacement — Janitorial Services Client Coverage SECTION I — COVERAGES , SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended to include the following : We will pay for the cost to replace keys and locks at the "clients" premises due to theft or other loss to keys entrusted to you by your "client , 13 up to a $ 10 , 000 limit per occurrence and $ 10 , 000 policy aggregate . We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners , members , officers , "employees" , "managers" , directors , trustees , authorized representatives or any one to whom you entrust the keys of a "client" for any purpose commit, whether acting alone or in collusion with other persons . The following , when used on this coverage , are defined as follows : a . " Client" means an individual , company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services . b . " Employee " means : ( 1 ) Any natural person : (a) While in your service or for 30 days after termination of service ; ( b) Who you compensate directly by salary, wages or commissions ; and (c) Who you have the right to direct and control while performing services for you ; or (2 ) Any natural person who is furnished temporarily to you : (a) To substitute for a permanent " employee " as defined in Paragraph ( 1 ) above , who is on leave ; or ( b ) To meet seasonal or short-term workload conditions ; while that person is subject to your direction and control and performing services for you . (3 ) " Employee " does not mean : (a) Any agent, broker, person leased to you by a labor leasing firm , factor, commission merchant , consignee , independent contractor or representative of the same general character; or ( b ) Any "manager, " director or trustee except while performing acts coming within the scope of the usual duties of an "employee . " c . " Manager" means a person serving in a directorial capacity for a limited liability company. L . Additional Insureds SECTION II - WHO IS AN INSURED is amended as follows : 1 . If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office , Inc. , with its permission . © 2011 Philadelphia Indemnity Insurance Company PI - GLD- HS ( 10/ 11 ) Coverage Part , Paragraph 3 . a . is deleted in its entirely and replaced by the following : a . Coverage under this provision is afforded until the end of the policy period . 2 . Each of the following is also an insured : a . Medical Directors and Administrators — Your medical directors and administrators , but only while acting within the scope of and during the course of their duties as such . Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient . b . Managers and Supervisors — Your managers and supervisors are also insureds , but only with respect to their duties as your managers and supervisors . Managers and supervisors who are your "employees" are also insureds for " bodily injury" to a co - "employee" while in the course of his or her employment by you or performing duties related to the conduct of your business . This provision does not change Item 2 . a . ( 1 ) (a ) as it applies to managers of a limited liability company. c . Broadened Named Insured — Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured , if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance . d . Funding Source — Any person or organization with respect to their liability arising out of: ( 1 ) Their financial control of you ; or (2 ) Premises they own , maintain or control while you lease or occupy these premises . This insurance does not apply to structural alterations , new construction and demolition operations performed by or for that person or organization . e . Home Care Providers — At the first Named Insured 's option , any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled . f. Managers , Landlords , or Lessors of Premises — Any person or organization with respect to their liability arising out of the ownership , maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions : This insurance does not apply to : ( 1 ) Any "occurrence" which takes place after you cease to be a tenant in that premises ; or (2 ) Structural alterations , new construction or demolition operations performed by or on behalf of that person or organization . g . Lessor of Leased Equipment — Automatic Status When Required in Lease Agreement With You — Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy . Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office , Inc . , with its permission . © 2011 Philadelphia Indemnity Insurance Company PkGLMS ( 10/ 11 ) organization is an insured only with respect to liability for " bodily injury , " " property damage" or " personal and advertising injury' caused , in whole or in part, by your maintenance , operation or use of equipment leased to you by such person or organization . A person 's or organization ' s status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends . With respect to the insurance afforded to these additional insureds , this insurance does not apply to any "occurrence" which takes place after the equipment lease expires . h . Grantors of Permits — Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision : ( 1 ) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own , rent or control and to which this insurance applies : (a) The existence , maintenance , repair, construction , erection , or removal of advertising signs , awnings , canopies , cellar entrances , coal holes , driveways , manholes , marquees , hoist away openings , sidewalk vaults , street banners or decorations and similar exposures ; ( b) The construction , erection , or removal of elevators ; or (c) The ownership , maintenance , or use of any elevators covered by this insurance . L Vendors — Only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business , subject to the following additional exclusions : (1 ) The insurance afforded the vendor does not apply to : (a) " Bodily injury" or " property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement . This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; ( b) Any express warranty unauthorized by you ; (c) Any physical or chemical change in the product made intentionally by the vendor; (d ) Repackaging , except when unpacked solely for the purpose of inspection , demonstration , testing , or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections , adjustments , tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business , in connection with the distribution or sale of the products ; (f) Demonstration , installation , servicing or repair operations , except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office , Inc. , with its permission . © 2011 Philadelphia Indemnity Insurance Company PkGLD - HS ( 10/11 ) (g) Products which , after distribution or sale by you , have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or ( h ) 'Bodily injury" or " property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to : ( i ) The exceptions contained in Sub-paragraphs (d ) or (fl ; or ( ii ) Such inspections , adjustments , tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business , in connection with the distribution or sale of the products . (2) This insurance does not apply to any insured person or organization , from whom you have acquired such products , or any ingredient , part or container, entering into , accompanying or containing . j . Franchisor — Any person or organization with respect to their liability as the grantor of a franchise to you . k. As Required by Contract — Any person or organization where required by a written contract executed prior to the occurrence of a loss . Such person or organization is an additional insured for " bodily injury, " " property damage " or " personal and advertising injury" but only for liability arising out of the negligence of the named insured . The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement . These limits are included within and not in addition to the limits of insurance shown in the Declarations I . Owners , Lessees or Contractors — Any person or organization , but only with respect to liability for " bodily injury , " " property damage " or " personal and advertising injury" caused , in whole or in part , by: ( 1 ) Your acts or omissions ; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract . With respect to the insurance afforded to these additional insureds , the following additional exclusions apply: This insurance does not apply to " bodily injury" or " property damage " occurring after : (a) All work , including materials , parts or equipment furnished in connection with such work , on the project (other than service , maintenance or repairs ) to be performed by or on behalf of the additional insured (s ) at the location of the covered operations has been completed ; or (b) That portion of " your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office , Inc . , with its permission . © 2011 Philadelphia Indemnity Insurance Company PI -GLD- HS ( 10/ 11 ) m . State or Political Subdivisions — Any state or political subdivision as required , subject to the following provisions : ( 1 ) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract . (2) This insurance does not apply to : (a) " Bodily injury, " " property damage " or " personal and advertising injury" arising out of operations performed for the state or municipality; or (b) " Bodily injury" or " property damage" included within the " products -completed operations hazard . " M . Duties in the Event of Occurrence , Claim or Suit SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS , Paragraph 2 . is amended as follows : a . is amended to include : This condition applies only when the "occurrence" or offense is known to : ( 1 ) You , if you are an individual ; (2 ) A partner, if you are a partnership ; or (3 ) An executive officer or insurance manager, if you are a corporation . b . is amended to include : This condition will not be considered breached unless the breach occurs after such claim or "suit" is known to : ( 1 ) You , if you are an individual ; (2 ) A partner, if you are a partnership ; or (3 ) An executive officer or insurance manager, if you are a corporation . N . Unintentional Failure To Disclose Hazards SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS , 6 . Representations is amended to include the following : It is agreed that , based on our reliance on your representations as to existing hazards , if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure . O . Transfer of Rights of Recovery Against Others To Us SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS , 8 . Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office , Inc . , with its permission . © 2011 Philadelphia Indemnity Insurance Company PI -GLD- HS ( 10/ 11 ) m . State or Political Subdivisions — Any state or political subdivision as required , subject to the following provisions : ( 1 ) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit , and is required by contract . (2) This insurance does not apply to : (a ) " Bodily injury, " " property damage " or " personal and advertising injury" arising out of operations performed for the state or municipality; or (b) " Bodily injury" or " property damage" included within the " products -completed operations hazard . " M . Duties in the Event of Occurrence , Claim or Suit SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS , Paragraph 2 . is amended as follows : a . is amended to include : This condition applies only when the "occurrence" or offense is known to : ( 1 ) You , if you are an individual ; (2 ) A partner, if you are a partnership ; or (3) An executive officer or insurance manager, if you are a corporation . b . is amended to include : This condition will not be considered breached unless the breach occurs after such claim or "suit" is known to : ( 1 ) You , if you are an individual ; (2 ) A partner, if you are a partnership ; or (3) An executive officer or insurance manager, if you are a corporation . N . Unintentional Failure To Disclose Hazards SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS , 6 . Representations is amended to include the following : It is agreed that, based on our reliance on your representations as to existing hazards , if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure . O . Transfer of Rights of Recovery Against Others To Us SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS , 8 . Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office , Inc . , with its permission . © 2011 Philadelphia Indemnity Insurance Company PI -GLD - HS ( 10111 ) Recovery Against Others To Us is deleted in its entirety and replaced by the following : If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us . The insured must do nothing after loss to impair them . At our request , the insured will bring "suit" or transfer those rights to us and help us enforce them . Therefore , the insured can waive the insurer' s rights of recovery prior to the occurrence of a loss , provided the waiver is made in a written contract . P . Liberalization SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS , is amended to include the following : If we revise this endorsement to provide more coverage without additional premium charge , we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state . Q . Bodily Injury — Mental Anguish SECTION V — DEFINITIONS , Paragraph 3 . Is deleted in its entirety and replaced by the following : " Bodily injury' means : a . Bodily injury, sickness or disease sustained by a person , and includes mental anguish resulting from any of these ; and b . Except for mental anguish , includes death resulting from the foregoing ( Item a . above) at any time . R. Personal and Advertising Injury — Abuse of Process , Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part , the definition of "personal and advertising injury' is amended as follows : 1 . SECTION V — DEFINITIONS , Paragraph 14 . b , is deleted in its entirety and replaced by the following : b . Malicious prosecution or abuse of process ; 2 . SECTION V — DEFINITIONS , Paragraph 14 . is amended by adding the following : Discrimination based on race , color, religion , sex, age or national origin , except when : a . Done intentionally by or at the direction of, or with the knowledge or consent of: ( 1 ) Any insured ; or (2) Any executive officer, director, stockholder, partner or member of the insured ; b . Directly or indirectly related to the employment, former or prospective employment , termination of employment, or application for employment of any person or persons by an insured ; Page 11 of 12 Includes copyrighted material of Insurance Services Office , Inc . , with its permission . © 2011 Philadelphia Indemnity Insurance Company EXHIBIT E SAMPLE FORMS AND INSTRUCTIONS CDBG PUBLIC SERVICES GRANT QUARTERLY BENEFICIARY REPORT This report is due Oct. 31 (for 1 " Qtr.), Jan 31 (for 2nd Qtr. ) , Apr. 30 (for 3rd Qtr.), July 15 (for 4`h Qtr. ) Instructions follow. Grantee Name : Submission Date : Subrecipient CDBG Contract Number: Name: Reporting ❑ 15t Quarter (July-Sept) ❑ 2nd Quarter (Oct-Dec) ❑ 3 ,d Quarter (Jan-March) ❑ 41h Quarter (Apr-June) Period 2017-2018 THE TOTAL NUMBER OF : 151 Quarter 2"1 Quarter 3rd Quarter 41h Quarter Cumulative PERSONS ASSISTED IN 2017-2018 OF THE TOTAL NUMBER OF PERSONS ASSISTED , THE NUMBER OF PERSONS WITH : NEW OR CONTINUING ACCESS TO SERVICE/ BENEFIT IMPROVED ACCESS TO SERVICE/ BENEFIT RECEIVING A SERVICE/BENEFIT THAT IS NO LONGER SUBSTANDARD 15TQuarter 2"d Quarter 3 .1 Quarter 41h Quarter Cum ulative RACE/ETHNICITY OF BENEFICIARIES # # of # # of # # of # # of # # of Hispanic Hispanic Hispanic Hispanic Hispanic WHITE 0 0 B LA CK/A FRICA N A MERICA N 0 0 ASIAN 0 0 AMERICAN INDIANIALASKAN NATIVE 0 0 NATIVE HAWAIIAN/OTHER PACIFIC 0 0 ISLANDER AMERICAN INDIANIALASKAN NATIVE 0 0 A ND WHITE ASIANANDWHITE 0 0 BLACK/AFRICAN AMERICAN AND WHITE 0 0 AMERICAN INDIANIALASKAN NATIVE 0 0 AND BLA CK/A FRICA N A MERICA N OTHER MULTI- RACIAL 0 0 TOTALS 0 0 0 0 0 0 0 0 0 0 HISPANIC* = Hispanic is an ethnic group and not a racial group . For example : a person can be both Hispanic and White, or Hispanic and Black/African American, but cannot be designated only as Hispanic. BENEFICIARY INCOME DATA % HUD ADJUSTED MEDIAN 1sTQuarter 2"d Quarter 3rd Quarter 41h Quarter Cumulative FAMILY INCOME 0-30% (VERY LOW- INCOME) 0 31 - 50 % ( LOW- INCOME 0 51 - 80 % ( MODERATE INCOME) 0 81 % ANDABOVE 0 TOTALS 0 0 0 0 0 Briefly describe the quarter ' s public services accomplishments : (i . e . , 150 meals provided to senior citizens, drug counseling provided to 25 people, etc .) Signature Date of Signature I certify that all CDBG funds expended for personnel costs are directly attributed to CDBG eligible activities . Printed name, title and phone number of person completing or signing this form: INSTRUCTIONS This report is due on Oct.31 (for 1st Qtr.), Jan 31 (for 2nd Qtr.), Apr. 30 (for 31 Qtr.), and July 15 (for 4' Qtr.) No voucher will be paid unless your quarterly reports are up to date. This form should be completed and signed by the contract subrecipient and sent to the CDBG grantee (county) . Then the CDBG grantee (county) is to review the form and send it to the CDBG project manager. Retain a copy for your records. This form has been updated to calculate totals in each column. To activate the imbedded Excel table in the worksheet, double click on the table area; to close the worksheet, click outside the table area. All section totals must match. Total Number of Persons Assisted : The unduplicated beneficiary count is a count of individuals and not a count of the services received. Unduplicated means each person is counted only once during the calendar year. Only report individuals you maintain written records on. These records must be established at the time the person first receives services from the agency. Since in one quarter an individual may receive any or all of the services listed on your CDBG application' s Project Description and Low- and Moderate Income Benefit table, you must establish the most appropriate one service (I, N or S) to count the beneficiary under. EXAMPLE 1 : Bob visits the food bank in first quarter, and needs rental assistance in the 2nd quarter. While he was served 2 times, from 2 different services over 2 quarters, he is only one individual. His unduplicated cumulative count for the quarterly beneficiary report is one ( 1 ) in the first quarter. Bob is counted only once for the year, the first service he received that year. EXAMPLE 2: Bob, Bill and Jane visit the food bank during the 2nd and 41 quarters . Bill also gets rental assistance in the 2nd quarter. Jane receives job training in the 4d' quarter. The unduplicated count of persons receiving benefit is three (3) . Even though multiple services were provided only 3 persons were actually assisted during the year. Each person would be recorded once, on the first month of recorded assistance. EXAMPLE 3: In the third quarter, Jeff visits the food bank and also meets monthly with a case manager. Jeff would be counted once in the third quarter and year. On the CDBG application' s Project Description and LMI Benefit Table, the food bank is designated as an Improved (I) service and case management services are designated as a New/Continuing (N) service for the agency. So even though Jeff received food bank assistance first, the agency determined his one count is best reported as an (I) service count since that was the most significant service Jeff received that quarter. Race/Ethnicity: Insert the racial group and ethnicity for the unduplicated clients served during this reporting period. When completing this section, if the individual is not Hispanic or Latino, use the first column labeled #Total. If the individual is Hispanic, use the first column to identify race (which gives us a total), then count the individual in the second column, which is a subset of the first column. Income: Insert the unduplicated clients (not households) served whose household income is Very Low Income (0-301/o), Low-Income (31 - 50%) and Moderate-Income (5140%) based on family size, the relevant area median income, and CDBG income limits . The current CDBG income limits for each county are available on the CDBG website at www. commerce.wa. ovg /cdbg under Guidance Materials . For LMI Limited Clientele activities such as a public services targeting one of the `presumed benefit ' groups below, HUD allows us to use and report the following income levels instead of collecting specific household income. Abused Children Very Low Income Illiterate Adults Low Income Battered Spouses Low Income Persons with AIDS Low Income Severely Disabled Adults Low Income Migrant Farm Workers Low Income Elderly Low Income � n.,�oq WASHINGTON STATE DEPARTMENT OF COMMERCE `+, aAGENCY NUMBER IDIS PROJECT NUMBER Commerce Contract Number A19 VOUCHER DISTRIBUTION 1030 17 -62210 =010 AGENCY NAME INSTRUCTION TO VENDOR OR CLAIMANT: DEPARTMENT OF COMMERCE Submit this form to claim payment for materials, merchandise or services. ATTN: CDBG Show complete detail for each item . PO BOX 42525 OLYMPIA, WA 98504-2525 Vendor's Certificate: I hereby certify under perjury that the items and totals listed herein are proper charges for materials, merchandise or services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without VENDOR OR CLAIMANT (Warrant is to be payable to: ) discrimination because of age, sex, marital status, race, creed, color, national origin, handicap, religion or Vietnam era or disabled veterans status. MASON COUNTY By : PO BOX 429 (SIGN IN BLUE INK) SHELTON, WA 985804292 REPORTING PERIOD : (TITLE) ( DATE) Description QUANTITY AMOUNT PREVIOUSLY AMOUNT REMAINING BUDGET REQUESTED THIS INVOICE BALANCE 7578 05 Public Services 99 , 289 . 00 $ 995289 . 00 $ 0 , 00 $ 0 , 00 7579 21A General Admin 35500000 $3 , 500 . 00 $ 0 . 00 $ 0 . 00 $ 0 . 00 $ 0 . 00 $ 0 . 00 TOTAL PAYMENTREQUEST $ 102, 789 . 00 $ 0 . 00 0 . 00 $ 1025789 . 00 Everything below this line is for Dept of Commerce FED TAX ID R PROGRAM APPROVAL DATE DOC DATE CURRENT DOC, NO, REFERENCE DOC NO, VENDOR NUMBER SWV0001 893 - 1 1 ACCOUNT NO. Aso NUMBER VENDOR MESSAGE 33275 CDBG P mt # M SUB TRANS 0 MASTER SUB SUB GL ACCT SUBSID INVOICE CODE D INDEX OBJ OBJ AMOUNT NUMBER 62270320 NZ 5152 17 - 62210 - 010 SIGNATURE OF ACCOUNTING PREPARER FOR PAYMENT DATE WARRANT TOTAL ACCOUNTING APPROVAL FOR PAYMENT DATE