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HomeMy WebLinkAboutCommunity Health Centers of King County BG0701AGREEMENT Between The CITY OF AUBURN, WASHINGTON AND COMMUNITY HEALTH CENTERS OF KING COUNTY THIS AGREEMENT, entered into this _19th_day of _October , 2007, between the City of Auburn, State of Washington (hereinafter referred to as the "City") and Community Health Centers of King County (hereinafter referred to as the "Agency"). WHEREAS, The City is an entitlement applicant for Community Development Block Grant (CDBG) funds under the Housing and Community Development Act of 1974 (the Act), Pub. L. 93-383 as amended, and will receive CDBG funds for the purpose of carrying out eligible community development and housing activities under the Act and under regulations promulgated by the Department of Housing and Urban Development (HUD) at 24 CFR Part 570; and WHEREAS, The City desires to award certain funds to the Agency for use as described within this Agreement, for the purpose of implementing eligible activities under the Act and HUD regulations; and WHEREAS, It is appropriate and mutually desirable that the Agency be designated by the City to undertake the aforementioned eligible activities, so long as the requirements of the Act, HUD Regulations, State law and local law are adhered to, as provided for herein; and WHEREAS, The purpose of this Agreement is to provide for cooperation between the City and the Agency, in implementing such eligible activities in the manner described herein; and WHEREAS, The Legislature has declared that carrying out the purposes of federal grants or programs is both a public purpose and an appropriate function for a city, town, county, or public corporation; and WHEREAS, the provisions of RCW 35.21.730 through RCW 35.21.755 and RCW 35.21.660 and 35.21.670 and the enabling authority as herein conferred to implement these provisions are hereby construed to accomplish the purpose of RCW 35.21.730 through RCW 35.21.755; NOW, THEREFORE, for and in consideration of payments, covenants, and agreements hereinafter mentioned, to be made and performed by the parties hereto, the parties mutually covenant and agree as provided for in this Agreement. PART I GENERAL CONDITIONS: 1. Scope of Agreement 2. Scope of Project 3. Commencement and Termination of Projects 4. Administration Contract - BG0701 , 5. Compensation and Method of Payment 6. Failure to Perform 7. Operating Budget S. Funding Alternatives and Future Support 9. Amendments 10. Assignment and Subcontracting 11. Hold Harmless and Indemnification 12. Insurance 13. Conflict of Interest 14. Termination 15. Reversion of Assets PART II FEDERAL, STATE AND LOCAL PROGRAM REQUIREMENTS: 1. Procurement Standards 2. Environmental Review 3. Nondiscrimination 4. Labor Standards 5. Property Management 6. Acquisition and Relocation 7. National Flood Insurance 8. Lead-Based Paint Poisoning 9. Administrative Requirements and Cost Principles 10. Other Federal Requirements 11. Non-substitution for Local Funding 12. Public Ownership 13. Public Information 14. Lobbying 15. Religious Organizations PART III EVALUATION AND RECORD KEEPING: 1. Evaluation 2. Audits and Inspections 3. Records 4. Retention of Records 5. Reports PART IV EXHIBITS PART V ACCEPTANCE AND SIGNATURES ATTACHMENTS: ATTACHMENT # 1: General Information ATTACHMENT #2: Project Budget ATTACHMENT #3: Special Conditions ATTACHMENT #4: Records and Reporting ATTACHMENT #5: Project Timeline/Performance Measurements Contract - BG0701 2 PART I. GENERAL CONDITIONS: 1. SCOPE OF AGREEMENT: The Agreement between the parties shall consist of the signature page; the general conditions; the Federal, State and local program requirements; the evaluation and record keeping requirements; each and every proj ect Exhibit and Attachment incorporated into the Agreement; all matters and laws incorporated by reference herein; and any written amendments made according to the general conditions. This Agreement supersedes any and all former agreements applicable to projects governed by this Agreement. 2. SCOPE OF PROJECT: The Agency shall use funds only to perform the activities set forth in the Attachments hereto. In the case of multiple projects, each project shall correspond to a separate set of Attachments. This Agreement maybe amended from time to time, in accordance with the general conditions, for the purpose of adding new projects, amending the scope of work, or for any other lawful purpose. 3. COMMENCEMENT AND TERMINATION OF PROJECTS: A. Upon release ofproject-related funds by HUD pursuant to 24 CFR Part 58, the City shall furnish the Agency with written notice to proceed. No work on a project shall occur prior to the notice to proceed without written approval from the City. Termination dates for individual projects shall be specified in the appropriate Attachments. Costs incurred after the termination date will not be reimbursed. The termination date maybe changed through amendment of this Agreement. B. Upon termination of individual projects covered by this Agreement, the Agency shall transfer to the City any CDBG funds on hand at the time of termination and any accounts receivable attributable to the use of CDBG funds. 4. ADMINISTRATION: The Agency shall appoint a liaison who shall be responsible for overall administration of CDBG funded project(s) and coordination with the City of Auburn's Department of Planning and Community Development. The Agency shall also designate one or more representatives who shall be authorized to sign the Voucher Reimbursement Requests and Program Accomplishments Forms. The names of the liaison and representatives shall be specified in the Attachment(s). 5. COMPENSATION AND METHOD OF PAYMENT: A. The City shall reimburse the Agency only for the activities specified in the Attachments in an amount not to exceed the amount specified on Attachment #1 -- "CDBG APPROPRIATION." Reimbursement shall be based on a CDBG Voucher Reimbursement Request and Program Accomplishments Form submitted and signed by the Agency's authorized representative. Reimbursement is subject to the terms of Section 6 of this Part I. B. The Agency shall submit a properly executed Voucher Reimbursement Request and Program Contract - BG0701 Accomplishments Form as frequently as desired, but at a minimum no later than fifteen (15) working days after the close of each calendar quarter throughout the term of the project. The City will make payment to the Agency not more than forty-five (45) working days after said Reimbursement Request is received and approved by the City. The City will issue a statement of correction in the event that the Voucher Reimbursement Request is erroneous. Payment does not constitute absolute approval. C. Any reimbursement must comply with conditions of Letter of Credit Procedure Regulations 1900.23 (Revised) in that funds on hand should not exceed $5,000 if retained beyond three (3) days and that any reimbursement in excess of the amount required shall be returned to the City. C). FAILURE TO PERFORM: In the event of a failure to comply with any terms or conditions of this Contract or to provide in any manner the activities or other performance as agreed to herein, the City reserves the right, following written notice to the Agency, to withhold all or any part of payment, suspend all or part of the contract, or prohibit the Agency from incurring additional obligations of funds until the City is satisfied that corrective action has been taken or completed as more specifically outlined in the Exhibit(s) and Attachment(s) to this contract. The option to withhold funds is in addition to, and not in lieu of, the City's right to termination as provided in Section 14 of the General Conditions of this Agreement. 7. OPERATING BUDGET: The Agency shall apply the funds received from the City under this Agreement in accordance with the Budget Summary found on Attachment #2. No line item expense thereunder shall cause total expenditures charged to this Agreement to exceed the total amount appropriated to the Agency by the City as indicated in Attachment #1 -- "CDBG APPROPRIATION." S. FUNDING ALTERNATIVES AND FUTURE SUPPORT: A. The Agency shall report all project income generated under this Agreement for the purposes specified herein or generated through the project(s) funded under this Agreement. Income which is not used to continue or benefit such project(s) shall revert to the CDBG Fund for reallocation by the City. The City shall determine whether income is being used to continue or benefit a project or projects authorized by this Agreement. If the City should authorize, the Agency will comply with all provisions of this Agreement in expending such project income. B. The City makes no commitment to future support and assumes no obligation for future support of the activities contracted herein, except as expressly set forth in this Agreement. C. Should anticipated sources of revenue become unavailable to the City for use in the Community Development Block Grant Program, the City shall immediately notify the Agency in writing and the City will be released from all contracted liability for that portion of the Agreement covered by funds not yet received by the City. 9. AMENDMENTS' Either party may request modifications in the scope of permissible activities, terms, or Contract - BG0701 conditions of this Agreement. Proposed modifications which are mutually agreed upon shall be incorporated by written amendment to this Agreement. A written amendment may affect a project or projects authorized by this Agreement or maybe of general application. 1 ~. ASSIGNMENT AND SUBCONTRACTING: A. The Agency shall not assign any portion of this Agreement without the written consent of the City, and it is further agreed that said consent must be sought in writing by the Agency not less than fifteen (15) days prior to the date of any proposed assignment. B. Any work or services assigned or subcontracted hereunder shall be subject to each provision of this Agreement and proper bidding procedures contained herein. The Agency agrees that it is as fully responsible to the City for the acts and omissions of its subcontractors and their employees and agents, as it is for the acts and omissions of its own employees and agents, as provided in paragraph 11.B. 11. HOLD HARMLESS AND INDEMNIFICATION: A. The Agency agrees that it is financially responsible (liable) for any audit exception or other financial loss to the City which occurs due to its negligence or its failure to comply with the terms of this Agreement. B. The Agency further agrees to defend, indemnify and hold harmless the City, its elected and appointed officials, employees and agents from and against any and all claims, demands and/or causes of action of any kind or character whatsoever arising out of or relating to services provided under this Agreement by the Agency, its employees, subcontractors, or agents for any and all claims by any persons for alleged personal injury, death, or damage to their persons or property to the extent caused by the negligent acts, errors or omissions of the Agency, its employees, agents, subcontractors or representatives. In the event that any suit or claim for damages based upon such claim, action, loss, or damages is brought against the City, the Agency shall defend the same at its sole cost and expense; provided that the City retains the right to participate in said suit if any principle of governmental or public law is involved; and if final judgment be rendered against the City and/or its officers, agents, and/or employees or any of them or jointly against the City and the Agency and its respective officers, agents, subcontractors, employees or any of them, the Agency agrees to fully satisfy the same and the Agency shall reimburse the City for any cost and expense which the City has incurred as a result of such claim or suit. The provisions of this section shall survive the expiration or termination of this Agreement. I2. INSURANCE' A. Public Liability Insurance: The Agency shall, at all times during the term of this Agreement, at its cost and expense, carry and maintain general public liability insurance against claims for bodily injury, personal injury, death or property damage occurring or arising out of services provided under this Agreement, which insurance shall cover such claims as maybe occasioned by any act, omission, or negligence of the Agency or its officers, agents, representatives, assigns or servants. The limits of liability insurance, which maybe increased from time to time as deemed necessary by the City with the approval of the Agency which shall not be unreasonably withheld, shall not be less than one million dollars ($1,000,000) combined single limit personal injury and property Contract - BG0701 damage insurance. The insurance required above shall be issued by an insurance company or companies authorized to do business within the State of Washington and must be acceptable to the City. The City shall be specifically named as an additional insured on all such policies, and all such policy or policies shall be primary to any other valid and collectible insurance. B. Building Risk Insurance: The Agency shall cause to be maintained, during the period that any construction work is in progress, All Risk Builder's Insurance (including fire, vandalism, malicious mischief and extended coverage), in an amount not less than the value of destructible contract work in place. C. Proof of Insurance: Certificate or certificates or other evidence satisfactory to the City evidencing the existence and terms and conditions of all insurance required above shall be delivered to the City within five days of the Agency's receipt of the Authorization to Proceed. The policy or policies of insurance required to be maintained in accordance with this Agreement shall not be canceled or given notice ofnon-renewal nor shall the terms or conditions thereof be altered or amended without sixty (60) days written notice being given to the City. 13. CONFLICT OF INTEREST: A. Interest of Officers, Employees, or Agents: No officer, employee, or agent of the City or Agency who exercises any functions or responsibilities in connection with the planning and carrying out of the City of Auburn CDBG Program, or any other person who exercises any functions or responsibilities in connection with the City, shall have any personal financial interest, direct or indirect, in this Agreement, and the Agency shall take appropriate steps to assure compliance. B. Interest of Contractor(s) and Their Employees: The Agency agrees that it will incorporate into every subcontract required to be in writing, and made pursuant to this Agreement, the following or equivalent provisions: The Contractor covenants that no person who presently exercises any functions or responsibilities in connection with the CDBG Program, has any personal financial interest, direct or indirect, in this Contract. The Contractor further covenants that he or she presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of services hereunder. The Contractor further covenants that in the performance of this Contract no person having any conflicting interest shall be employed. Any such interest on the part of the Contractor or the Contractor's employees must be disclosed to the Agency and the City. 14. SUSPENSION AND TERMINATION: A. This Agreement is subject to suspension or termination upon 30 days written notice by the City should: 1. The Agency mismanage or make improper or unlawful use of CDBG funds; 2. The Agency fail to comply with the terms and conditions expressed herein or the applicable regulations and directives of the Federal Government, State, or City; 3. CDBG funds become no longer available from the Federal Government or through the City; Contract - BG0701 4. The Agency fail to carry out activities expressed by this Agreement; or 5. The Agency fail to submit reports or submit incomplete or inaccurate reports in any material respect. B. This Agreement is subject to suspension or termination upon 30 days written notice by the Agency should: 1. The City fail in its commitment under this Agreement to provide funding for services rendered, as herein provided; or 2. CDBG funds become no longer available from the Federal Government or through the City. C. This Agreement maybe suspended or terminated at any time, in whole or in part, upon the written agreement of the City and the Agency. D. Otherwise this Agreement shall terminate on the termination date specified on Attachment #1 attached hereto and shall be subject to extension only by mutual agreement and amendment in accordance with paragraph 9, Amendments, of this Part. E. Upon termination of this Agreement, any unexpended balance of the CDBG funds awarded through this Agreement shall lapse and remain in the City of Auburn's CDBG fund. F. In the event that termination occurs under paragraph A(1) of this section, the Agency shall return to the City all funds which were expended in violation of the terms of this Agreement. 15. REVERSION OF ASSETS: Upon expiration of this Agreement, the Agency shall transfer to the City any City CDBG funds on hand at the time of expiration any accounts receivable attributable to the use of City CDBG funds. In the event that the Agency ceases to use any asset acquired or improved with CDBG funds for the purpose described in this Agreement, within five years following the termination of this agreement, the Agency shall pay to the City the fair market value of the asset less any portion of the value attributable to expenditures of non-CDBG funds. PART II. FEDERAL, STATE AND LOCAL PROGRAM REQUIREMENTS: 1. PROCUREMENT STANDARDS: In awarding contracts pursuant to this Agreement, the Agency shall comply with all applicable requirements of local and State law for awarding contracts, including but not limited to procedures for competitive bidding, contractor's bonds, and RCW60.28.010, which addresses retained percentages. In addition, the Agency shall comply with the requirements of the U.S. Office of Management and Budget Circular A-110 and/or A-102 and/or A-133, as applicable, relating to bonding, insurance and procurement standards; and with Executive Order 11246 regarding nondiscrimination in bid conditions for projects over $100,000. Where Federal standards differ from local or State standards, the stricter standards shall apply. The Federal standard of $100,000 for competitive bidding shall apply only if the applicable State or local standard for competitive bidding is greater than $100,000. Contract - BG0701 2. ENVIRONMENTAL REVIEW: A. National Environmental Policy Act: The City retains environmental review responsibility for purposes of fulfilling requirements of the National Environmental Policy Act as implemented by HUD Environmental Review Procedures (24 CFR Part 58). The City may require the Agency to furnish data, information and assistance for the City's review and assessment in determining whether an Environmental Impact Statement must be prepared. B. Other Federal Environmental Laws: In decision making and action pursuant to NEPA, and otherwise under this Agreement the standards, policies, and regulations of the following laws and authorities shall be followed: The National Historic Preservation Act of 1966 (16 U.S.C. 470 et seq.) as amended, particularly section 106 (16 U.S.C. 470(f)); Executive Order 11593, Protection and Enhancement of the Cultural Environment, May 13, 1971 (36 FR 8921 et seq.), particularly section 2(c); The Reservoir Salvage Act of 1960 (16 U.S.C. 469 et seq.), particularly section 3 (16 U.S.C. 469a- 1), as amended by the Archaeological and Historic Preservation Act of 1974; Flood Disaster Protection Act of 1973 (42 U.S.C. 4001 et seq.) as amended, particularly sections 102(a) and 202(a) (42 U.S.C. 4012a(a) and 4106(a)); Executive Order 11988, Floodplain Management, May 24, 1977 (42 FR 26951 et seq.), particularly section 2(a); Executive Order 11990, Protection of Wetlands, May 24, 1977 (42 FR 26961 et seq.), particularly sections 2 and 5; The Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.) as amended, particularly section 307(c) and (d) (16 U.S.C. 1456(c) and (d)); The Safe Drinking Water Act of 1974 (42 U.S.C. 201, 300(f) et seq., and 21 U.S.C. 349) as amended, particularly section 1424(e) (42 U.S.C. 300h-303(e)); The Endangered Species Act of 1973 (16 U.S.C. 1531 et seq.) as amended, particularly Section 7 (16 U.S.C. 1536); The Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) as amended, particularly section 7(b) and (c) (16 U.S.C. 1278(b) and (c)); The Clean Air Act (42 U.S.C. 7401 et seq.) as amended, particularly section 176(c) and (d) (42 U.S.C. 7506(c) and (d)); and HUD environmental standards (24 CFR Part 51, Environmental Criteria and Standards (44 FR 40860-40866, July 12, 1979). C. State Environmental Policy Act: Agencies which are branches of government under RCW 43.21C.030 retain responsibility for fulfilling the requirements of the State Environmental Policy Act, RCW chap. 43.21C, and regulations and ordinances adopted thereunder. If the Agency is not a branch of government under RCW 43.21 C.030, the City may require the Agency to furnish data, information and assistance as necessary to enable the City to comply with the State Environmental Policy Act. D. Satisfaction of Environmental Requirements: Project execution under this Agreement by either the City or the Agency shall not proceed until satisfaction of all applicable requirements of the National and State Environmental Policy Acts. A written notice to proceed will not be issued by the City until all such requirements are complied with. Contract - BG0701 3. NONDISCRIMINATION: A. General: The Agency shall comply with all Federal, State and local laws prohibiting discrimination on the basis of age, sex, marital status, race, creed, color, national origin or the presence of any sensory, mental or physical handicap. These requirements are specified in RCW chapter 49.60; Section 109 of the Housing and Community Development Act of 1974; Civil Rights Act of 1964, Title VI; Civil Rights Act of 1968, Title VIII; Executive Order 11063; Executive Order 11246; Section 3 of the Housing and Urban Development Act of 1968; Section 504 of the Rehabilitation Act of 1973; and, the Age Discrimination Act of 1975. Specifically, the Agency is prohibited from taking any discriminatory actions defined in the HUD Regulations at 24 CFR 570.602 (b) (1) and shall take such affirmative and corrective actions as are required by the Regulations at 24 CFR 570.602 (b)(4). B. Specific Discriminatory Actions Prohibited: 1. The Agency may not, under any program or activity to which this Agreement may apply, directly or through contractual or other arrangements, on the grounds of race, color, national origin, or sex: (i) Deny any person facilities, services, financial aid or other benefits provided under the program or activity. (ii) Provide any person with facilities, services, financial aid or other benefits which are different, or are provided in a different form from that provided to others under the program or activity. (iii) Subject any person to segregated or separate treatment in any facility or in any matter or process related to receipt of any service or benefit under the program or activity. (iv) Restrict in any way access to, or in the enjoyment of, any advantage or privilege enjoyed by others in connection with facilities, services, financial aid or other benefits under the program or activity. (v) Treat any person differently from others in determining whether the person satisfies any admission, enrollment, eligibility, membership, or other requirement or condition which individuals must meet in order to be provided any facilities, services or other benefit provided under the program or activity. (vi) Deny any person any opportunity to participate in a program or activity as an employee. 2. The Agency shall not utilize criteria or methods of administration which have the effect of subjecting individuals to discrimination on the basis of race, color, national origin, or sex, or have the effect of defeating or substantially impairing accomplishment of the objectives of the program or activity with respect to individuals of a particular race, color, national origin, or sex. 3. The Agency, in determining the site or location of housing or facilities provided in whole or in part with funds under this part, may not make selections of such site or location which have the effect of excluding individuals from, denying them the benefits of, or subjecting them to discrimination on the grounds of race, color, national origin, or sex; or which have the purpose or effect of defeating or substantially impairing the accomplishment of the objectives of the Act or of the HUD Regulations. Contract - BG0701 9 C. Fair Housing: The Agency shall take necessary and appropriate actions to prevent discrimination in Federally assisted housing and lending practices related to loans insured or guaranteed by the Federal government. (Civil Rights Act of 1968, Title VII; Executive Order 11063). D. Employment: 1. In all solicitations under this Agreement, the Agency shall state that all qualified applicants will be considered for employment. The words "equal opportunity employer" in advertisements shall constitute compliance with this section. 2. The Agency shall not discriminate against any employee or applicant for employment in connection with this Agreement because of age, sex, marital status, race, creed, color, national origin, or the presence of any sensory, mental, or physical handicap, except when there is a bona fide occupational limitation. Such action shall include, but not be limited to, the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training. (RCW chap. 49.60; Executive Order 11246 as amended). 3. To the greatest extent feasible, the Agency shall provide training and employment opportunities for lower income residents within the area served by CDBG assisted projects (Section 3, Housing and Urban Development Act of 1968, as amended). E. Contractors and Suppliers: 1. No contractor, subcontractor, union or vendor engaged in any activity under this Agreement shall discriminate in the sale of materials, equipment or labor on the basis of age, sex, marital status, race, creed, color, national origin, or the presence of any sensory, mental, or physical handicap. Such practices include: employment, upgrading, demotion, recruiting, transfer, layoff, termination, pay rate, and advertisement for employment. (RCW chap. 49.60; Executive Order 11246 as amended). 2. All firms and organizations described above shall be required to submit to the Agency certificates of compliance demonstrating that they have, in fact, complied with the foregoing provisions; provided, that certificates of compliance shall not be required from firms and organizations with fewer than 25 employees or on contracts and/or yearly sales of less than $10,000. 3. To the greatest extent feasible, the Agency shall purchase supplies and services for activities under this Agreement from vendors and contractors whose businesses are located in the area served by CDBG funded activities or owned in substantial part by project area residents. (Section 3, Housing and Urban Development Act of 1968, as amended.) 4. CDBG funds shall not be used directly or indirectly to employ, award contracts to, or otherwise engage the services of, or fund any contractor or subrecipient during any period of debarment, suspension, or placement in ineligibility status under the provisions of 24 CFR Part 24. F. Notice: The Agency shall include the provisions of the appropriate subsections A, B, C, D, and E of this section 3 entitled "Nondiscrimination" in every contract or purchase order for goods and services under this Agreement and shall send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding a notice advising the said labor union or worker's representative of the Contract - BG0701 10 commitments made in these subsections. 2. In advertising for employees, goods or services for the activities under this Agreement, the Agency shall comply with Attachment O to OMB Circular A-102 or A-110, as applicable, Procurement Standards, paragraph 9, Contracting with Small and Minority Firms, Women's Business Enterprise and Labor Surplus Area firms. Agencies shall be considered to be in compliance with this provision if at least one of the following steps is taken: (a) advertise in a minority publication in addition to publication of general circulation; (b) utilize a minority contractors bidding center; and (c) utilize the King County Affirmative Action Office Certified Minority/Women's Business Enterprise Directory. 4. LABOR STANDARDS: The Agency shall require that project construction contractors and subcontractors pay their laborers and mechanics at wage rates in accordance with the Davis-Bacon Act, as amended (40 U.S.C. sections 276(a)-276(a)(5)), and that they comply with the Copeland "Anti-Kickback" Act (40 U.S.C. 276(c)) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 et seq.) as prescribed at 29 CFR Parts 1,3,5,6 and 7; provided that this section shall not apply to rehabilitation of residential property designed for residential use by fewer than eight families. 5. PROPERTY MANAGEMENT: A. The Agency agrees that any non-expendable personal property (capital equipment), purchased wholly or in part with project funds at a cost of $300 (three hundred dollars) or more per item, is upon its purchase or receipt the property of the City and/or Federal government. Final ownership and disposition of such property shall be determined under the applicable provisions of Attachment N to the U.S. Office of Management and Budget Circular No. A-102, and/or Attachment N to the U.S. Office of Management and Budget Circular No. A-110. B. The Agency shall be responsible for all such property, including its care and maintenance at the Agency's expense. C. The Agency shall admit the City's property management officer to Agency's premises for the purpose of marking such property, as appropriate, with City property tags. D. The Agency shall meet the following procedural requirements for all such property: 1. Property records shall be maintained accurately and provide for: a description of the property; manufacturer's serial number or other identification number; acquisition date and cost; source of the property; percentage of CDBG funds used in the purchase of property; and location, use, and condition of the property. 2. A physical inventory of property shall be taken and the results reconciled with the property records at least once every two (2) years to verify the existence, current utilization, and continued need for the property. 3. A control system shall be in effect to insure adequate safeguards to prevent loss, damage, or theft of the property. Any such loss, damage or theft of property shall be investigated and fully documented. 4. Adequate maintenance procedures shall be implemented to keep the property in good condition. Contract - BG0701 11 G. ACQUISITION AND RELOCATION: A. Any acquisition of real property by a State Agency for any activity assisted under this Agreement shall comply with the Federal Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (hereinafter referred to as the Uniform Act) (42 U.S.C. 4601 et seq.) and the Regulations at 24 CFR Part 42. B. Implementation of any project provided for in this Agreement will be undertaken so as to minimize involuntary displacement of persons, businesses, nonprofit organizations, or farms to the greatest extent feasible. C. Any displacement of persons, businesses, nonprofit organizations, or farms occurring as the result of acquisition of real property assisted under this Agreement shall comply with the Uniform Act, the Regulations at 24 CFR Part 42, and the City of Auburn's Displacement Policy required by Federal CDBG regulations at 24 CFR 570.305. The Agency shall comply with the Regulations pertaining to costs of relocation and written policies, as specified by 24 CFR 570.602 (c) and (d). 7. NATIONAL FLOOD INSURANCE: To the extent indicated by 24 CFR 570.605, the Agency shall comply with the flood insurance purchase requirements of Section 202(a) of the Flood Disaster Protection Act of 1973. (42 U.S.C. 4001 et seq. and the Federal regulations issued thereunder). The Agency shall comply with the Regulations at 24 CFR section 570.605. 8. LEAD-BASED PAINT POISONING: The Agency shall comply with the HUD Lead-Based Paint Regulations (24 CFR Part 35) issued pursuant to the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. sections 4831 et seq.) requiring prohibition of the use of lead-based paint (whenever funds under this Agreement are used directly or indirectly for construction, rehabilitation, or modernization of residential structures) and notification of the hazards of lead-based paint poisoning to purchasers and tenants of residential structures constructed prior to 1950. 9. ADMINISTRATIVE REQUIREMENTS AND COST PRINCIPLES: A. If the A~encYis a governmental entity, the Agency shall comply with the requirements and standards of OMB Circular A-128, "Audits of State and Local Government," and Circular A- 87, "Principles for Determining Costs Applicable to Grants and Contracts with State, Local and Federally recognized Indian Tribal Governments," and with the following Attachments to OMB Circular No. A-102: 1. Attachment A, "Cash Depositories," except for Paragraph 4 concerning deposit insurance; 2. Attachment B, "Bonding and Insurance;" 3. Attachment C, "Retention and Custodial Requirements for Records;" 4. Attachment G, "Standards for Grantee Financial Management Systems;" 5. Attachment I, "Monitoring and Reporting Program Performance," Paragraph 2; 6. Attachment J, "Grant Payment Requirements;" 7. Attachment N, "Property Management Standards," except for Paragraph 3 concerning the Contract - BG0701 12 standards for real property; 8. Attachment O, "Procurement Standards;" and 9. Attachment P, "Audit Requirements." B. If the Agency is not a governmental entity, the Agency shall comply with the requirements and standards of OMB Circular No. A-133, "Audits of Institutions of Higher Learning and Other Non-Profit Institutions," and No. A-122, "Cost Principles for Non-Profit Organizations," and the following Attachments to OMB Circular No. A-110: 1. Attachment A, "Cash Depositories," except for Paragraph 4 concerning deposit insurance; 2. Attachment B, "Bonding and Insurance;" 3. Attachment C, "Retention and Custodial Requirements for Records;" 4. Attachment H, "Monitoring and Reporting Program Performance," Paragraph 2; 5. Attachment N, "Property Management Standards," except for Paragraph 3 concerning the standards for real property; and 6. Attachment O, "Procurement Standards." 10. OTHER FEDERAL REQUIREMENTS: The absence of mention in this Agreement of any other Federal requirements which apply to the award and expenditure of the Federal funds made available by this Agreement is not intended to indicate that those Federal requirements are not applicable to Agency activities. The Agency shall comply with all other Federal requirements relating to the expenditure of Federal funds, including but not limited to: The Architectural Barriers Act of 1968 (42 U.S.C. 4151), and the Hatch Act (5 U.S.C. Chapter 15). Additionally, the Agency shall comply with the Federal requirements described by 24 CFR Part 570, Sections 600 through 603; Section 605; and Sections 607 through 612. 11. NONSUBSTITUTION FOR LOCAL FUNDING: The CDBG funding made available under this Agreement shall not be utilized by the Agency to reduce substantially the amount of local financial support for community development activities below the level of such support prior to the availability of funds under this Agreement. 12. PUBLIC OWNERSHIP: For Agencies which are not municipal corporations organized under the laws of the State of Washington, it may become necessary to grant the City a property interest where the subject project calls for the acquisition, construction, reconstruction, rehabilitation, or installation of publicly owned facilities and improvements. The Agency shall comply with current City requirements regarding transfer of a property interest sufficient to meet any public ownership requirement imposed bylaw. 13. PUBLIC INFORMATION: A. In all news releases and other public notices related to projects funded under this Agreement, the Agency shall include information identifying the source of funds as the City of Auburn CDBG Program. B. For all construction projects the Agency shall erect a sign to City specifications at the Contract - BG0701 13 construction site, identifying the source of funds, except that this requirement may be waived for construction projects of $100,000 or less. C. The Agency acknowledges that this Agreement and any other information provided by it to the City and/or relevant to the Project(s) described in the Exhibit(s) and Attachment(s) are subject to the Washington State Public Disclosure Act, Chapter 42.17 RCW. 14. LOBBYING' The Agency certifies, to the best of his or her knowledge and belief, that: A. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. B. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. C. The Agency shall require that the language of this certification, or equivalent language, be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 15. RELIGIOUS ORGANIZATIONS: The Agency will comply with all federal requirements concerning religious organizations and the use of Community Development Block Grant funds. All services delivered must be dispensed in a clearly non-sectarian manner, devoid of any religious influence. Contract - BG0701 14 PART III. EVALUATION AND RECORD KEEPING: I. GENERAL: The Agency agrees to maintain records and provide reports as listed in Attachment #4 of this Contract, and as defined in this Part, below. 2. EVALUATION' The Agency agrees to participate with the City in any evaluation project or performance report, as designed by the City or the appropriate Federal Agency, and to make available all information required by any such evaluation process. 3. AUDITS AND INSPECTIONS: The records and documents with respect to all matters covered by this Agreement shall be subject at all times to inspection, review or audit by the City, Federal or State officials so authorized by law during the performance of this Agreement and during the period of retention specified in this Part III. A. Audits: The Agency will provide at or before the contract signing a copy of the Agency's most recent audit. The Agency will provide to the City a copy of the Agency's most recent audit for each year in which a contract for the use of funds exists with the City. Failure to provide such audit will be considered a material breach of the contract and result in a refund to the City of all moneys paid or due under the contract. B. Audit Requirements: Agencies receiving $300,000 or more in federal funds will provide to the City the above required audits conducted in a manner pursuant to OMB Circular A-133. 4. RECORDS: All Agencies receiving Community Development Block Grant funds from the City shall maintain a certified public audit for the City Community Development Block Grant year in which the funds are awarded and through each Community Development Block Grant year or portion thereof, in which the funds are used or a contract exists between the Agency and the City. As required by HUD Regulations, 24 CFR Part 570, the Agency shall compile and maintain the following records: A. Financial Mana eg ment: Such records shall identify adequately the source and application of funds for activities within this Agreement, in accordance with the applicable provisions of Attachment G to the U.S. Office of Management and Budget Circular A-110. These records shall contain information pertaining to grant awards and authorizations, obligations, unobligated balances, assets, liabilities, outlays, and income. Contract - BG0701 15 B. Relocation: Agency record keeping must comply with the Uniform Act implementing regulations at 24 CFR Part 42. Indication of the overall status of the relocation workload and a separate relocation record for each person, business, organization, and farm operation displaced or in the relocation workload must be kept. C. Propert~Acquisition: Agency files must contain a separate acquisition file for each acquisition process documenting compliance with the implementing regulations for the Uniform Act at 24 CFR Part 42. Major requirements include: (a) invitation to owner to accompany appraiser during inspection, (b) at least one property appraisal, (c) statement of basis for determination of just compensation, (d) written offer of just compensation, (e) all documents involving conveyance, (f) settlement cost reporting statement, and (g) notice to surrender possession of premises. D. Equal Opportunity: The Agency shall maintain racial, ethnic, and gender data showing the extent to which these categories of persons have participated in, or benefited from, the activities carried out under this Agreement. The Agency shall also maintain data which records its affirmative action in equal opportunity employment, and its good-faith efforts to identify, train, and/or hire lower-income residents of the project area and to utilize business concerns which are located in or owned in substantial part by persons residing in the area of the project. E. Labor Standards: Records shall be maintained regarding compliance of all contractors performing construction work under this Agreement with the labor standards made applicable by 24 CFR 270.603 and any State labor standards, as applicable. F. Miscellaneous Records: The Agency shall maintain such other records as maybe required by HUD or the City. Such records shall include, but shall not be limited to, a separate and current file for each separate CDBG funded project (as represented by separate Exhibits and Attachments to this Agreement), containing copies of originals of the following: 1. Original Funding Application. 2. Grant Award Letter. 3. Notice to Proceed and/or equivalent written approval from City. 4. Project or program related authorizations, motions, resolutions or meeting minutes of the Agency's governing body. 5. Contract Attachments, Exhibits and any amendments thereto. 6. This Agreement and any amendments thereto. 7. Voucher reimbursement requests and program accomplishment forms. 8. Bills for payment. 9. Approved vouchers and warrants. 10. Where CDBG funds will support Agency staff salary and/or fringe benefit costs, payroll time sheets signed by the employee and the employee's supervisor, annotated to document percent of time charged against the project if less than full time. Contract - BG0701 16 11. Where CDBG funds will be used to offset the cost of communications, travel and office supplies, and where these costs are shared with other programs and no invoice is available, documentation such as log sheets (for copy machine use, odometer readings, etc.). As an alternative, annotated invoices maybe used to document charges as appropriate. 12. In capital projects where CDBG funds will be used to hire physical laborers and/or tradespeople (regardless of Davis-Bacon applicability to the project), hours that these employees worked, and their rate of pay per hour. Additionally, each project file shall include documentation on all persons who have benefited from the project, as follows: residence status (Auburn resident, non-Auburn resident); income status (below 30% of County Median, below 50% of County median, below 80% of County median, above 80% of county median); ethnic status (white, black, American Indian or Alaskan Native, Hispanic, Asian or Pacific Islander); and whether or not beneficiary is a member of a female-headed household. $. RETENTION OF RECORDS: Required records shall be retained for a period of three (3) years after termination of this Agreement, except as follows: (1) Records that are the subject of audit findings shall be retained for three (3) years after such findings have been resolved. (2) Records for nonexpendable property shall be retained for three (3) years after its final disposition. Nonexpendable property is defined in Attachment N to U.S. Office of Management and Budget Circular No. A-102, for governmental entities, and Circular No. A-110 for non-governmental organizations. 6. REPORTS The Agency shall submit such reports as required by the City at such times as required by the City. Notwithstanding any other provision of this Agreement to the contrary, the reports required by the City shall be submitted by the Agency no less than on an annual basis. Such reports shall also be submitted prior to project completion. PART IV. EXHIBITS The following exhibits are incorporated herein by reference A. Original Grant Application as submitted June 30, 2006. B. Environmental Determination. C. Contract Scope of Work, Completion Date, and Contact Information Contract - BG0701 17 PART V. ACCEPTANCE AND SIGNATURES: The parties hereto agree and accept the terms, conditions, covenants and all matters and laws incorporated by reference herein and therefore cause their hands to affix their signatures as evidence to their acceptance of this Agreement before their designated witnesses and/or notaries. CI~T" Y ~F A BUR -- __, i MAYOR A TEST: Danielle Daskam, aniel B. City Clerk COMMUNITY HEALTH C OF HING COUNTY STATE OF WASHINGTON COUNTY OF KING ss ~Yti On this ~,a, day of i ~D~ e..m ~ `2~~ , 2007, before me, the undersigned, a Notary Public in and for the State of Washington, personally appeared Thomas ~1 '(`o nn_ ,(,ZPa~I°~ , to me known to be the Ch~- ~~ ~ ~G v. C~1 ~ ~ ~ 1~-~~- L L.f' of Community Health Centers of King County, the non-profit corporation referenced as Agency within the foregoing instrument, and acknowledged said instrument to be the free and voluntary act and deed of said non-profit corporation for the uses and purposes therein mentioned, and on oath stated that he/she is authorized to execute said instrument on behalf of said non-profit corporation. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the date hereinabove set forth. ,0~,~,,,,~„~ ~ ~ N ARY PUBLIC in and for the State ., .~ ~ _`~ Mgt ''~ ~~ of Washington, residing in COV i rt u~ h -:~ ~. ~~ %",'44 ~ MY COMMISSION expires: 1 0 e~ '%t.~,euc a ~ ~' %~ ©'''~., 9.08 ~-~' .l. -- /,~/ rS-"TSHtM~~~, Contract - BG0701 18 TITLE: Chief Executive Officer ATTACHMENT #I - BGO7O1 Community Development Block Grant Contract General Information PROJECT NO.: BG0601 TITLE: Community Health Centers of King County -Primary Health Care PROJECT SUMMARY: Primary medical and dental care for uninsured and underinsured people in suburban Kinc County including Auburn clients. ELIGIBILITY: 570.201(e) -Health Services (OSM) NATIONAL OBJECTIVE: 570.208(a)(2) - Low/Mod Limited Clientele CDBG APPROPRIATION : $51,464 TYPE OF PROJECT: Public Service PROJECT LOCATION: 126 Auburn Ave, Suite 300, Auburn SPECIAL CONDITIONS: See EXHIBIT #3: Special Conditions TERMINATION DATE: December 31, 2007 CONTACT PERSON: Faith Wimberley TITLE: Grants Manager MAILING ADDRESS: 955 Powell Ave SW Renton WA 98057 PHONE/FAX NUMBER: 425.203.0419 or 425.277.1311 E-MAIL: fwimberley~a,chckc. org PERSON(S) AUTHORIZED TO SIGN VOUCHER REIMBURSEMENT REQUEST AND PROGRAM ACCOMPLISHMENTS FORM: NAME/TITLE Faith Wimberley, Grants Manager SIGNATURE (optional) NAME/TITLE Meredith Vaughn, Director of Planning and Development SIGNATURE Agreement BG - 0701 Community Health Centers ATTACHMENT #2 - BGO7O1 Community Development Block Grant Contract Project Budget PROJECT NO.: BG0701 TITLE: Community Health Centers of Kine County SUMMARY OF TASKS AND COSTS PERSONNEL COSTS Percent of List Employees by Position Title Annual Salary Time to Item Total Project Physician Dentist Fringe Benefits Category Total (Should be the same as No. 1 in Budget Detail)1 $51,464 (continued) 21.7% $31,464 20.3% $20,000 Agreement BG - 0701 Community Health Centers Attachment #2 (continued) Community Development Block Grant Contract BUDGET DETAIL Column A Column B Column C Cost Categories Total Budget Item CDBG Other Non-CDBG Funds Funds -- Personnel Costs 1,666,039 51,464 1,636,029 -- Office/Operating Supplies 120,437 120,437 -- Consultant or Purchased Services 218,237 218,237 -- Construction Contracts/ Real Pro e Ac uisition -- Communications and 51,022 51,022 Advertisements -- Travel and/or Training 17,531 17,531 -- Intra-Agency Support {i.e. administrative overhead -- Capital Outlay -Construction -- Other (Detail) 639,071 639,071 Rent, Utilities, Maintenance Total Project Costs {Note : Column A must equal sum of 2,712,337 51,464 2,682,327 Column B and C Source of Funds Column A Total Column B City of Auburn Column C Other Sources -- City of Auburn CDBG Funds 51,464 51,464 -- City of Auburn General Funds 8,536 8,536 -- Other Funds: 2,652,337 2,652,337 * Medical portion only of Auburn General Funds Grand Total {Note : Column A must equal sum of Column B and C 2,712,337 60,000 2,652,337 Agreement BG - 0701 Community Health Centers Attachment #3 - BG0701 Community Development Block Grant Contract Special Conditions 1. Resolution #3938 In accordance with the legislative intent of the City Council as expressed in PY2006 Annual Action Plan adopted by Resolution #3938, the Agency must: Provide primary health care to low income, uninsured residents at facilities located in Auburn. {CDBG Eligible under 24CFR570.201(e)} 2. Timely Progression of Project: The Agency agrees that it will complete the above project in a timely manner, and comply with the time line as set forth in Attachment #4, Project Time Line. Limitations on Expenditures and Adjustments: In the event that the City receives less CDBG revenues than originally estimated in the CDBG budget ordinance, the Agency will receive a proportionately equal reduction in its appropriation relative to the total decrease in total CDBG revenues. The amount of CDBG funds available to the Agency is stipulated in the "Notice of Grant Award." If the amount CDBG funds available to the Agency is less than appropriated; then the City will notify the Agency in writing when additional CDBG funds become available 4. Termination of the Contract: This Agreement between the CITY OF AUBURN and the AGENCY shall terminate on December 31, 2007. In accordance with the terms of the Agreement, all unspent CDBG funds at the time of termination shall lapse and return to the City of Auburn's CDBG fund. 5. Public Information: The stipulations of Section 13(B) of the Agreement regarding the erection of sign identifying the source of funds is hereby waived. Reversion of Assets: In the event that the activity or use conducted upon the premises acquired or improved by the Agency with the City's CDBG funds changes within twenty (20) years from the date of this Agreement; then the City of Auburn shall be entitled to reimbursement from the Agency. The amount of reimbursement shall be equal to the current market value of the property, less any portion of the value attributable to expenditures from non-CDBG funds for the acquisition or improvement to the property, multiplied by the following ratios for each respective year. No reimbursement is required if the use or ownership of the asset changes after twenty (20) years from above termination date. Ex fired Years Reimbursement Ratio 0 - 5 ears 100% 6 ears 90% 7 ears 80% 8 ears 70% 9 ears 60% 10 ears 50% 11-12 ears 40% 13-14 ears 30% 15-16 ears 20% 17-18 ears 10% 19-20 ears 5% Agreement BG - 0701 Community Health Centers EXHIBIT #4 PROJECT TIME LINE BG0701 Part 1. Schedule by Task Milestones Medical Dental Unduplicated City Clients served: Projected Actual Projected Actual 1st Quarter (1/1/2007 - 3/31/2007) 63 50 2nd Quarter (4/1/2007 - 6/30/2007) 63 50 3ra Quarter (7/1/2007 - 9/30/2007) 63 50 4`~ Quarter (10/1/2007 - 12/31/2007) 63 50 Part 2. CDBG Expenditure Rate CDBG Funds Vouchered 1st Quarter (1/1/2007 - 3/31/2007) 2°a Quarter (4/1/2007 - 6/30/2007) 3`a Quarter (7/1/2007 - 9/30/2007) 4~` Quarter (10/1/2007 - 12/31/2007) Projected Actual $12,866.00 $12,866.00 $12, 866.00 $12,866.00 Agreement BG - 0701 Community Health Centers ATTACHMENT #5 - BG0701 Reporting Requirements and Recordkeeping 1. Reimbursement Schedule: (a) The Agency must submit a request for reimbursement at least once a quarter and may submit such a request on a monthly basis, beginning with the date of this Agreement, and applicable to all costs incurred toward this grant beginning January 1, 2007. (b) Failure to submit a quarterly request for reimbursement in accordance with Part 1, Section 5 of this Agreement may cause the City to consider the Project abandoned and the CDBG funds made available for re-appropriation. Continued failure to request reimbursement and submit required performance reports will cause the City to take corrective action as it deems necessary. (c) The City shall reimburse the Agency for its expenses incurred implementing this Agreement within the forty-five (45) days following the receipt of a Voucher Reimbursement Request. 2. Required Contents of Reimbursement Request: (a) Reimbursement Cover Sheet as supplied, showing Agency name, address, contact information, and budget information; (b) Accomplishments data sheet as supplied for the Agency, showing how the Agency has progressed toward its goals as set forth in Attachment #4. (c) Failure to properly submit a reimbursement request, through the omission of the above-required items or through material omissions within those documents, will cause the request to be returned to the Agency and will cause a delay in the disbursement of funds. Agreement BG - 0701 Community Health Centers MEMORANDUM OF UNDERSTANDING This Memorandum of Understanding is an addendum to the agreement for services between the City of Auburn and Community Health Centers, the original of which was executed on the _19th day of _October , 2007. All other terms and conditions of the agreement for services shall remain in full force and effect except as specifically amended by this Memorandum of Understanding. It is the goal of the City of Auburn to increase the availability of healthcare to its low income residents by 15% between January, 2007 and January, 2010. II. The grant funds provided to the Agency during the 2007 year are provided with the objective of achieving the result of increasing the availability of healthcare to low income residents. III. Agencies receiving funding from the City of Auburn agree to participate in the conceptual development of the One Stop Center and to collaborate with other agencies concerning the delivery of services to clients when the Center is operational. The nature and extent of the collaboration to be determined when the One Stop Center is operational. N. The City of Auburn will utilize the following performance measures in evaluating the effectiveness of reaching this goal. a. Performance Indicators ^ Auburn's children under the age of 19 will have access to healthcare. ^ Auburn babies and children are healthy and have adequate nutrition and prenatal care. ^ The number of sites within Auburn where low income residents can access healthcare will continue to increase. ^ Reduction in the number of emergency room visits ^ Better dissemination of information about the availability of health care to low-income residents throughout the community. Agreement BG - 0701 Community Health Centers Performance Indicators 2002 2004 Goal Uninsured Adults 105 161 137 Per 1000 adults ages 18 - 24 Uninsured Children 78 40 34 Per 1000 children under 18 yrs. Emergency Room Visits 13 13 11 Per 1000 adults ages 18 - 64 Unmet Medical Need 80 124 105 Per 1000 adults ages 18 - 64 Low Birth Weight 6 6 5 Per 100 births No Flu & Pneumococcal Immunization 390 350 298 Per 1000 adults ages 65+ No Childhood Immunization 353 190 162 Per 1000 children under 3 years Teen Pregnancy 23 21 18 Per 1000 females ages 15 - 17 REMAINDER OF PAGE LEFT INTENTIONALLY BLANK Agreement BG - 0701 Community Health Centers f' ' r t OF` UBUR~ ~. :~ ~, --- ` PETER B. LEWIS MAYOR AT ST: Danielle E. Daskam, City Clerk APP D O F R a 'e B. Heid, y Attorney COMMUNITY HEALTH CENTERS STATE OF WASHINGTON ) )ss COUNTY OF KING ) On this IC~~ day of r10 V ~~ ~2.~T , 2007, before me, the undersigned, a Notary Public in and for the State of Washington, personally appeared , to me known to be the Executive Director of COMMUNITY HEALTH CENTERS, the non-profit corporation that executed the within and foregoing instrument, and acknowledged said instrument to be the free and voluntary act and deed of said non-profit corporation for the uses and purposes therein mentioned, and on oath stated that he/she is authorized to execute said instrument on behalf of said non-profit corporation. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the date hereinabove set forth. t ~.ut~t~~~Rr ~ '4'4~ ~ . cs s _• TITLE: Chief Executive Officer ion n ~ NO RY PUBLIC in and for the State of Washington, residing in ~ ~ _ MY COMMISSION expires: ~2. Z o Attachments - BG0701