HomeMy WebLinkAboutBayside - 1590 Vince's Village Phase 1 $512,671FUNDING FOR
AFFORDABLE AND SUPPORTIVE
HOUSING & HOMELESS HOUSING
AND ASSISTANCE FUNDS
REQUEST FOR PROPOSALS
Page 1 of 19
Threshold Requirements:
The project meets eligibility requirements under Senate Bill 5386 and House Bill 1590 and RCW
82.14.530
A. AFFORDABLE AND SUPPORTIVE HOUSING OR 1590 FUNDS
Funding for Affordable and Supportive Housing in accordance With House Bill 1590
and RCW 82. 14.530
1. Development (and first year operations): A minimum of sixty percent of this fund must be used
for the following eligible uses:
o Constructing affordable housing, which may include new units of affordable
housing within an existing structure, and facilities providing housing -related
services,
solely for eligible households (as defined below); or
o Constructing mental and behavioral health -related facilities; or
o Funding the operations and maintenance costs of new units of affordable housing
and facilities where housing -related programs are provided, or newly constructed
evaluation and treatment centers.
2. Operations: The remaining proceeds shall be used for the operation, delivery and evaluation of
mental and behavioral health treatment programs and services or housing- related services.
3. No more than ten percent of the proceeds may be used to supplant existing local funds.
4. For purposes of this provision, "eligible households" means persons within any of the
following population groups whose income is at or below sixty percent of median income:
o Persons with mental illness
o Veterans
o Senior citizens
o Homeless (or at -risk of being homeless) families with children
o Unaccompanied homeless youth or young adults
o Persons with disabilities
o Domestic violence survivors
B. HOMELESS HOUSING AND ASSISTANCE FUNDS OR 5386 FUNDS
The activity is included in the most recent local homeless plan outlined in SSB 5386 ESSHB
2163 and ESSHB 1570
Who is Efi ible for Services under these Funds?
Persons meeting the definition of homeless under the legislation and persons at -risk of
homelessness such as:
Persons being evicted within a week from a private dwelling unit or leaving an
institution, such as a mental health or substance abuse treatment facility or a
jail/prison, with no subsequent residence identified and lacking the resources
needed to obtain housing.
Persons fleeing domestic or family violence with no subsequent safe
residence identified and lacking the resources needed to obtain such
housing.
Page 2 of 19
• Persons living on the streets or in emergency shelter but are spending a short time
(up to 30 consecutive days) in a hospital or other institution.
• Persons who would otherwise be living on the streets or in an emergency shelter.
• Households who are very low-income.
Eli ible uses:
a. Rental and furnishing of dwelling units for the use of homeless persons.
b. Costs of developing affordable housing for homeless persons, and services for
formerly homeless individuals and families residing in transitional housing or
permanent housing and still at risk of homelessness.
c. Operating subsidies for transitional housing or permanent housing serving
formerly homeless families or individuals.
d. Services to prevent homelessness, such as emergency eviction prevention
programs including temporary rental subsidies to prevent homelessness.
e. Temporary services to assist persons leaving state institutions and other state
programs to prevent them from becoming or remaining homeless.
f. Outreach services for homeless individuals and families
g. Development and management of local homeless plans including homeless census
data collection; identification of goals, performance measures, strategies, and costs
and evaluation of progress towards established goals.
h. Rental vouchers payable to landlords for persons who are homeless or below
thirty percent of the median income or in immediate danger of becoming
homeless.
i. Other activities to reduce and prevent homelessness as identified for funding in the
local plan.
j. Acquisition, construction or rehabilitation of housing projects or units within
housing project that are affordable to very low-income households.
k. Supporting building, operation and maintenance costs of housing projects or unites
eligible to receive housing trust funds, that are affordable to very low-income
household, and that require a supplement to income to cover ongoing operating
expenses.
1. Rental assistance vouchers for housing units that are affordable to very low-income
households.
in. Operating costs for emergency shelters and licensed overnight youth shelters.
II. The applicant has capacity to deliver the Program or Project
Please provide a brief description of previous experience providing similar program
services or development initiatives.
I1I. The project or program meets priorities and aligns with the Five -Year Plan
Please provide a brief description how the project aligns with Jefferson County's
Homeless Crisis and Housing Response and 5 Year Plan, available at
www.co.jefferson.wa.us — Government — Boards & Commissions F-Z — Housing Fund
Board
Any proposal that does not meet all threshold requirements
will not be evaluated.
Selection Criteria
We will rank responses according to the criteria described below. All responsive proposals
Page 3 of 19
received by the time and date specified in this RFP shall be evaluated by the RFP Evaluation
Panel based on the following criteria and weights:
Evaluation Criteria
Max. Points
A. Approach — Completeness of Proposal and Readiness
5
B. Impact
10
C. Budget — Feasible Financial Plan
5
TOTAL
j 20
Submission Requirements
All proposals must include the following elements. We reserve the right to disqualify any
incomplete proposals.
(a) Approach — Completeness of Proposal and Readiness (5 Points)
Your application should describe how you will approach this assignment and complete
the purpose of the proposal.
The proposal will be evaluated based on the clarity of proposal, completeness of the
submission including required certifications and documentation and readiness to begin
the Program or Project if funding is awarded.
Please answer the following questions in your application:
■ Is the Project or Program ready to use the funding now or are there actions to be
taken before the Project or Program can begin? If so, what are those actions?
■ Will the requested funds fully fund the Project or Program? If not, how does the
organization intend to fill the gap?
■ Could the Project or Program be scaled (include the per unit cost of the Project or
Program)?
■ Have additional funds been requested or will be requested. Identify the sources for
those requests and the status of the requests.
(b) Impact (10 Points)
Please answer the following questions as relevant to your project:
• How would the project contribute to positive movement in Commerce's Homeless
System Performance Measure, including total project entries, length of time
homeless, exits to permanent housing, returns to homelessness, and system
prioritization. (current link)
• What other funds, donors, or community support are involved with the project? Will
these funds leverage other funds? Identify other sources of funds that would be
leveraged with the requested funds and/or how these funds will be used to leverage
other funds.
• How many new units will be brought online. How many existing units will be
preserved? What services will be funded and howis sustainability achieved?
• How many individuals will be served by these funds?
Page 4 of 19
• Will these funds serve any special populations such as youth or domestic violence
survivors?
• How does this project serve marginalized populations and address risk of harm and barriers to
housing stability?
What is your plan for continuous improvement in order to serve historically underserved
populations?
(c) Budget — A Feasible Financial Plan (5 Points)
Identify whether you are a 501(c) (3), for -profit, PHA or government agency.
Please provide the following if applicable:
• Program or Project Budget which includes a complete breakdown of all
funding sources already received or committed for this Program or Project
Please include any budget narrative that is descriptive or helpful to explain any part
of your proposed expenditures in your budget(s).
• Current operating budget for the organization requesting the funding
• Operating Pro Forma for ten years.
PROPOSAL EVALUATION AND SELECTION PROCESS
General
The following procedure will be used to evaluate the proposals and select finalists. All complete
eligible proposals received within the established deadline will be evaluated by the RFP
Screening Panel, meaning scored by each HFB member. The combined totals guide funding
awards, and the HFB will approach the specific awards through a lens of equity, diversity and
inclusion.
RFP Screening Panel
The Housing Fund Board will be the RFP Screening Panel. All HFB members will disclose any potential
connections and recuse themselves from any conflict of interest, not scoring any conflicted applications.
Board service will be disclosed but is not per se a conflict.
Proposal Evaluation
Applicants whose proposal is being considered for an award may be invited to make an oral
presentation of their proposal to the HFB. The HFB reserves the right to recommend funding
for multiple contracts under this RFP or recommend funding for a portion of the requested
amount at their discretion.
FUNDING PERIOD
Jefferson County Homelessness Program Funding Instructions
The HFB is requesting proposals for Affordable Housing and Homeless Housing and
Page 5 of 19
Assistance Funds for the period l/l/26 through 12/31/26.
Funding must be requested and used within each funding cycle. Each proposal requires the
annual budget for the Project.
If possible, the HFB would like to arrange small (non -meeting) field trips of all awarded
projects during the year or by March, 2026. If a field trip is impossible due to safety or
privacy concerns, a presentation at a regular HFB meeting can replace the field trip.
Proposal Deadline: 10/15/25 by 4pm
All responses to this Request for Proposal should be submitted on the provided application
form. Please submit an electronic PDF version of the proposal e-mailed to Carolyn
Gallaway at Carolyn@co.jefferson.wa.us
The following should be in the subject line: "Proposal — Affordable and Homeless Housing
Funds."
If electronic submission is not possible, lilease contact County Administrator's office at 360-
385-9100 for accommodation.
It is very important that a our application is complete, sired. is for an eli ible activity and
conforms to all program requirements. Applications not meeting &11 the requirements will
not receive consideration for funding.
Proposals MUST be received by 4pm on 10/15/25. Late 7ro osals will not be accepted.
Submittals made in an incorrect format will not be considered.
All responses to this Request for Proposal should be submitted on the provided application
form.
REQUEST FOR PROPOSAL TIMELINE FOR FUNDS
Date
Activity
8/29/25
RFP to be posted on the County website
9/3/25
RFP first publication in paper
9/10/25
Questions from applicants at 2:30 PM
Zoom Meeting: https://us06web.zoom.us/i/91098454388 THIS LINK MAY
CHANGE
RFP second publication in paper
9/10/25
10/15/25
Proposals must be submitted by 4:00 pm
10/17/25
Proposals opened and distributed to HFB
10/20/25
Technical questions for applicants will be sent once with a return
date of 1 weekday, or during the October 22111 HFB meeting
10/29/25
Presentation of proposals to HFB at Special Meeting at 2:30 p.m.
11/3/25
HFB Recommendation to BOCC for approval
November
Contracts to County Prosecutor and Risk Manager for approval
Contracts to Providers and returned to BOCC for signatures
December
Page 6 of 19
Note , All dates are subject to change
Definitions:
Definition of Area Median Income for Jefferson Coun
Affordable housing program eligibility is always determined by one's income. Each
household's income is compared to the income of all other households in the area. This is
accomplished through a statistic established by the government called the Area Median
Income, most often referred to as AMI. The AMI is calculated and published each year by
HUD.
In Jefferson County, HUD calculates the Sixty Percent (60%) Area Median Income ("AMI")
for a family of four as $58,980. Sixty Percent (60%) AMI for an individual is $41,280. Link:
https://www.huduser.gov/portal/datasets/home-
datasets/files/HOME_IncomeLmts_State_WA_2025.pdf
Period of Performance: Funding under this grant program is allocated for a 12-month
period. The period of performance for services solicited under this RFP begins 1/l/26 and
ends 12/31/26. Initial funding is not an assurance or guarantee of ongoing operational
funding after the contract period. Proposers are cautioned not to assume a commitment of
future funding based on the receipt of funds in prior years.
Guidine Principles for all Applicants:
• Be as specific as possible in stating goals, measures of success, objectives, expected
results, deliverables, etc. It is expected that there will be considerably more requests
for funds than there are funds available. Therefore conciseness and clan of
description are essential.
• The program must provide services only within Jefferson County boundaries.
• Applicants that have received prior Affordable Housing and/or Homeless
Housing and Assistance Funds must be current on all required reporting to be
eligible to receive funds.
• Grantees will be required to submit a progress report midway through the grant period
and a closeout report at the end of the funding period will be required no later than
2/l/27, or, alternatively small group field trips with HFB members touring awarded
projects by March 21, 2026. Failure to submit timely reports/progress data will result
in holding or non-payment of funds. These reports should include a comparison of
outcomes to date with those initially proposed, and the total number of individuals
served in the contract period. A fiscal and programmatic monitoring visit may be
conducted by the County during any project year. Provider will make all documents
and required files available for review.
• Reimbursement of costs will be addressed in the grant agreement.
• Jefferson County reserves the right to negotiate additional terms to the grant
agreement it deems necessary and appropriate to ensure compliance with funding
requirements as outlined in SB 5386/HB 1590, RCW 82.14.530, and RCW 82.14.540.
• Funding in previous years does not assure additional awards in this funding cycle.
A sample contract may be found on Laserfiche at the following path:
httns:Htest.co. o efferson.wa.us/WeblinkExternal/Browse.asi)x?id=10141412&dbid=0&re
o=Jefferson
www.co.'efferson.wa.us — Jefferson - Board of Commissioners - Boards & Committees - Housing
Fund Board - RFP 2026
Insurance Requirement: Awardees will be required to meet all the County's insurance
Page 7 of 19
requirements, which are included as AttachmentA to this 5386/1590 RFP.
APPLICATION REQUIREMENTS
Complete all parts of the application form and answer all questions on the application.
Incomplete applications will not be accepted and will not receive funding consideration.
All responses to this Request for Proposal should be submitted on the provided application
form on an electronic PDF with a backup identical copy in Microsoft Word or equivalent.
Responses to this RFPs should be e-mailed to Carolyn Gallaway at
carolyn(a)co jefferson.wa.us. Carolyn will confirm receipt of application.
It is very important that your application is complete, signed, is for an eligible activity, and
conforms to all program requirements. Applications not meeting all the requirements will not
receive consideration for funding.
Proposal Deadline: 10/15/25 by 4pm
Proposals MUST be received by 4pm on 10/15/25. Late proposals will not be accepted.
Submittals made in an incorrect format will not be considered.
Page 8 of 19
FUNDING FOR
AFFORDABLE AND SUPPORTIVE
HOUSING & HOMELESS HOUSING
AND ASSISTANCE FUNDS
APPLICATION
Proposals must be RECEIVED: 10/15/25 at 4pm
JEFFERSON COUNTY
THROUGH THE COUNTY & CITY OF PORT TOWNSEND
HOUSING FUND BOARD
Page 9 of 19
Application
AFFORDABLE AND SUPPORTIVE
HOUSING & HOMELESS HOUSING
AND ASSISTAN(-.F FUNDS
For use from January 1, 2026 to December 31, 2026
GENERAL INFORMATION —It is understood that if awarded funding for this period, there is no guarantee of
future funding beyond this award.
We estimate the available funding for this period to be approximately �160,000 for 5386 Homeless Housing and
Assistance (operating) funds; $780,000 for 1590 Affordable and Supportive Housing development funds; and first
year operating funds; and $520,000 for 1590 Affordable and Supportive Housing operating funds. Note that 1590
operating funds may be used for all housing -related services.
Page 10 of 19
Name of Project or Program Vince's Village —Phase 1
Requested total amount for this application: $512,671
Area of the County to be served: East Jefferson
Name of Applicant/Agency: Bayside Housing & Services
Contact Person: Gary Keister
Address: PO Box 927
State: WA Zip: 98339
Phone Number: (360) 881-7148 X601
E-mail: j gary@baysidehousing.org
Title:
City:
Federal Tax ID #: 47-1798297
Executive Director
Port Hadlock
Fax Number:
CERTIFICATION by Authorized Agency Representative (Board President, CEO .or another person authorized to
bind the agency in a contract).��'�� ` 6�--
Name of Authorized Agency Representative (print): J� : �v G�vS 1 h S v V "Qs
Title: Executive Director
• Applicant certifies that these funds will be used as described in this application unless a change has been
mutually agreed upon between Contractor and Jefferson County Board of County Commissioners. Substantive
amendment requests will also require the approval of the Housing Fund Board ("HFB").
• Applicant certifies that the information in this application is true and correct.
• Applicant certified that it has no outstanding obligations to the County with respect to housing funds.
of Ahthorilked Agency Representative
l0 lS- 0�
Dat
Page 11 of 19
SPECIFIC INFORMATION
Please separately tab each section of the application submission as to Project or Program Description, Capacity,
Alignment, Approach, Impact of Funds, Budget.
PROJECT DESCRIPTION
Name of Project or Program (please include HMIS name/number if applicable):
Vince's Village —Phase 1
• Amount requested: _$512,671
• Provide a brief description of the Project or Program: (LIMIT 200 WORDS)
Vince's Village — Phase 1 involves the construction of a 32-unit affordable multifamily apartment building
Located at 177710th St. in Port Townsend as a development project by Bayside Housing & Services
(BHS). It would allow a substantial increase in capacity for the BHS Permanent Supportive Housing
(PSH) program and also offer much needed housing affordable to people in the 50% AMI income
bracket. We were awarded $8.6 million in state funding in early 2024, but since then construction costs
for both materials and labor have risen 4.8% (Consumers Price Index). Estimates from contractors have
come in over the amount of our existing funding. Cuts have been made wherever possible, but certain
cuts, though offering relief in the near term, would compromise building quality and add to long-term
operating and maintenance costs. One example is roofing material. Asphalt shingles would be a less
expensive option ($7/sf vs. $16/sf) but would not have near the lifespan and energy efficiency of a steel
roof. We are seeking supplemental funding to compensate for the rise in building costs and to maintain
the structural integrity of a building we have committed as affordable housing for the next 40 years.
• Specify the Project or Program goals and expected outcomes. Specify the measures of success by which the
Project or Program will be assessed. (LIMIT 300 WORDS)
• Creation of 32 Affordable Housing Units, accomplished and available for occupancy by scheduled date for
completion and in accord with Final Development Budget.
• Set Sustainable Unit Rental Costs to be no higher than 30% of income of individuals or families who earn at 50%
AMI or lower.
• Achieve Sustainable Facility Operating and Maintenance Costs to meet annual projected costs so as to not
impact other budgetary requirements such as provision of services.
• Offer Individualized Case Management Services to all PSH program participants who reside thereto prepare them
for integration into the community and long-term housing stability.
• Enrich the Local Economy with the creation of 75-100 high -wage construction jobs and purchases of materials
from local sources..
Specify the number of units of housing to be created or number of individuals who will be served by the Project or
Program.
This building will provide 32 rental apartment units that could potentially at full occupancy house 72 people.
Threshold Requirements:
Page 12 of 19
• Identify the specific eligible use(s) under 5386 and/or 1590 for which the Project or Program qualifies, as
listed on pages two through four of the RFP. If you are submitting for both operating and development
funds, please submit separate budgets for each.
5386 Operating Funds:
1590 Development Funds: Constructing affordable housing, which may include new units of
affordable housing within an existing structure, and facilities providing housing -related services.
1590 Operating Funds:
• Provide a brief description of recent, relevant and successful experiences in delivering similar programs
and/or projects.
Bayside Housing & Services (BHS) has operated in Jefferson County since 2016 when it began
offering Transitional Housing with case management services in Bayside Tower at the Old Alcohol
Plant Inn in Port Hadlock. We currently offer 20 rooms there dedicated to that use. We have also
developed 2 Tiny Shelter Villages (Pat's Place in Port Townsend and Peter's Place in Port Hadlock)
that offer a combined 25 units of Transitional Housing along with communal cooking and hygiene
facilities at each village. We purchased the 16-unit Hadlock Motel and renovated the rooms to create
studio units where we operate our first Permanent Supportive Housing program at Woodley Place.
Briefly describe how the project aligns with the priorities and objectives of the Five -Year Homeless
Housing Plan and the community outreach conducted for the project or program. (LIMIT 400 WORDS)
Objectives 1 and 2: BHS identifies program participants through the Coordinated Entry process in which
we participate in partnership with OIyCAP. Upon referral (or via online self -application) people are
entered into the HMIS database and followed up with a detailed interview process. Phase 1 of Vince's
Village will provide 19 new units dedicated to Permanent Supportive Housing (PSH) for people with a
history of chronic homelessness accompanied by physical and/or mental health disabilities. An
additional 13 units will be available for rental by people with incomes beneath 50% AMI.
Objective 3: BHS operates over 60 units of housing linked with case management services available to
people experiencing homelessness or unstably housed. The added new units of PSH at Vince's Village
allow expansion of our PSH program to a new location. The 13 units of low-income affordable housing
will be available for program participants when they have progressed through our Transitional Housing
program and are ready for permanent housing.
Objective 5: BHS designs and operates trauma -informed and client -centered programs to address the
circumstances and background of each program participant. This standard guides our case
management training and is based not merely on a policy of non-discrimination and inclusiveness based
on race, gender or ethnicity, but extends to developing culturally sensitive services for the diverse
population we serve. Past program participants have ranged in age from infancy to 92 and included
BIPOC community members and those identifying as LGBTQ+.
Objective 6: Vince's Village Phase 2 will increase the local affordable housing supply by 32 units sized
as studios, 1 BR and 2 BR. This directly addresses a serious local shortage that often delays final
movement beyond temporary housing solutions for those experiencing homelessness to long-term
permanent housing solutions.
Page 13 of 19
A. APPROACH - Comxfleteness of Proposal and Readiness (5 Points) (LIMIT 400 WORDS)
BHS is working with SMR Architects, the firm responsible for design of Vince's Village Phase 1. As a
result of weekly consultations, architectural plans have been developed for the property and have been
furnished to the City of Port Townsend for review and permitting. Construction estimates have been
offered by one general contractor and are in process for two additional construction companies. The
final set of construction plans will be produced in early 2026 aligning with the selection of the general
contractor. Ground -breaking for construction will take place in Spring of 2026 on a lot owned by BHS at
177710th St. in Port Townsend. The building process will take place over one year's time until
completion in Spring 2027.
Our primary source of funding is an $8,600,000 grant from the Housing Trust Fund administered by WA
Dept. of Commerce that we were awarded in January 2024. $500,000 of those funds went toward
covering the cost of the land where this project is located. Since then, inflation and other factors have
increased building expenses and we are assessing strategies to overcome this situation which will keep
this project on schedule and within budget. A reduction in the number of units would be an option of
last resort, and an outcome we want to avoid.
B. IMPACT OF FUNDS - Leveraue of Other Funds and Number of Persons Assisted
10 Points (LIMIT 400 WORDS)
Phase 1 of Vince's Village wilt provide 32 units of new affordable housing for Jefferson County. The 6
studios, 201-Bedroom apartments & 6 2-Bedroom apartments could house as many as 72 County
residents who are unhoused or in search of permanent housing. The 19 units designated for PSH have
been awarded project -based vouchers from the Apple Health & Homes program that will provide rent
subsidy support up to the full HUD standard for Jefferson County.
There is a second phase of Vince's Village being planned. It would be sited on the same property and
would consist of another 32-unit multifamily apartment building. We are currently applying for funding
for that project from WA Dept. of Commerce/Housing Trust Fund and will be making an application for
9% Low Income Housing Tax Credits from the Washington State Housing Finance Commission.
Construction of Phase 2 would commence upon completion of Phase 1.
C. PROJECT OR PROGRAM BUDGET — A Feasible Financial Plan (5 Points
BUDGET FORMS
Funding period begins January 1, 2025, and ends December 31, 2025. Please use the attached budget
templates. If you need additional space, you may insert rows. "Proposal" refers to the funds requested from
these funds that will be applied to this specific Project or Program. Blank spaces are provided for additional
categories. Justification for budget items must be specific, and that same specificity should be reflected in
subsequent billings. A maximum 10% Administration fee is allowed for projects if needed, however
Administration fees are not allowed for Capital Projects.
CAPITAL BUDGET FOR REAL ESTATE DEVELOPMENT USES
Financing Categories
Estimate
Basis of Estimate
Total Acquisition Costs
$
Construction
$
Construction Fees
$
Page 14 of 19
Financing Fees and
$
Char -es,
Guarantees and Reserves
$
Developers Fee
$
Construction inflation
$362,324
Consumer price index of inflation (4.8%); 1/2024 equivalency of
costs, Jan 2024-Se t 2025
9/2025 $8M estimate would be $7,637,676
Increase in sales tax
$33,733
(9.4%) due to cost
increase
Cost differential for metal
$106,650
11,850 square ft roof, asphalt shingle cost $7/sq ft, metal roof cost
roof
$16/sq ft
Sales tax increase due to
$9,964
different material cost
Subtotal
$
TOTAL
$512,671
SOURCES
Financing Categories
Estimator
Indicate if Committed or Application has been made. If not made
indicate date application is to be submitted
WA State Department of Commerce
Private Loan
$
$
Jefferson Counf � Funds
Public Sources (State or
Federal Funds)
$8,600,000
Foundations
$
Donations
$
Low Income Housing
Tax Credits (indicate 9%
or 4%
$
Historic Tax Credits
$
New Market Tax Credits
$
Ga if an
$
TOTAL
$
Please include any budget narrative that is descriptive or helpful to explain any part of your proposed
expenditures in your capital budget(s). (LIMIT 300 WORDS)
PROGRAM OPERATING BUDGET
[DATES]
Budget Categories
Program
Proposal
Justification
Priority
Salaries
$
$
Benefits
$
$
Rental Subsidies
$
$
Utilities
$
$
Insurance
$
$
Food/Supplies
$
$
Furnishings/Equipment
$
$
Repair/Maintenance
$
$
Transportation (explain)
$
$
$
Page 15 of 19
Subtotal
$
$
Administration (10% max)
$
$
TOTAL
$
$
If your Project or Program includes salaries and benefits, please list position(s) and FTE to be paid by these funds
(FTE should be that percentage of time the em to ee is dedicated to this Project or Program):
Position Salary Benefits FTE
FUNDING SOURCES FOR THE PROGRAM in 2025
Funding Sources
Awards
2025
Awards
2026
Indicate if Committed or
Application has been made.
Public Sources
(State or Federal
Funds
$
$
Private Donations
$
Foundation Grants
$
$
United Campaigns
$
$
Other
$
$
Other
$
$
TOTAL
$
$
Please include any budget narrative that is descriptive or helpful, to explain any part of your proposed
expenditures. For instance, if you are requesting furnishings or appliances specifically for housing included in your
Project or Program, what are the items you are requesting? (LIMIT 300 WORDS)
ATTACHMENT A
Required Insurance Coverages
1. Commercial General Liability.
• Recipient shall maintain commercial general liability coverage on a form acceptable to
Jefferson County Risk Management for bodily injury, personal injury, and property damage, in
an amount not less than two million dollars per occurrence ($2,000,000) and an aggregate of
not less than four million dollars ($4,000,000), for bodily injury, including death, and property
damage.
• The commercial general liability insurance coverage shall contain no limitations on the scope
of the protection provided and include the following minimum coverage:
o Broad form property damage, with no employee exclusion;
o Person injury liability, including extended bodily injury;
o Broad form contractual/commercial liability, including completed operations and
product liability coverage;
o Premises — operations liability (M&C);
Page 16 of 19
o Independent contractors and subcontractors; and,
o Blanket contractual liability.
■ Recipient's commercial general liability policy shall include employer's liability coverage.
• The County and its elected officials, officers and employees shall be named as an additional
insured party under this insurance policy.
2. Automobile Liability.
■ Recipient shall maintain business automobile Liability insurance on a form acceptable to
Jefferson County Risk Management with a limit of not less than a combined single limit of
$1,000,000 each occurrence. Coverage shall include owned, hired, and non -owned
automobiles.
Workers' Compensation (Industrial Insurance). Recipient shall maintain workers' compensation
insurance at its own expense, as required by Title 51 RCW, for the term of this Agreement and
shall provide evidence of coverage to Jefferson County Risk Management, upon request. If the
County incurs any cost to enforce the provisions of this subsection, all costs and fees shall be
recoverable from Recipient.
o Recipient shall provide Workers' Compensation and Employer's Liability on a state
approved policy form providing benefits as required by law with employer's liability limits
no less than $1,000,000 per accident or disease.
o This coverage shall extend to any contractor or subcontractor that does not have their own
workers' compensation and employer's liability insurance.
o Recipient expressly waives by mutual negotiation all immunity and limitations on liability,
with respect to the County, under any industrial insurance act, disability benefit act, or
other employee benefit act of any jurisdiction, which would otherwise be applicable in case
of such claim.
4. General Insurance Requirements.
• Insurance coverage shall be evidenced by one of the following methods:
o Certificate of insurance; or,
o Self-insurance through an irrevocable Letter of Credit from a qualified financial institution.
• Any deductibles or self -insured shall be declared to and approved by the County prior to the
approval of this Agreement by the County. At the option of the County, the insurer shall reduce
or eliminate deductibles or self -insured retention, or Recipient shall procure a bond
guaranteeing payment of losses and related investigations, claim administration and defense
expenses.
• Failure of Recipient to take out or maintain any required insurance shall not relieve Recipient
from any liability under this agreement, nor shall the insurance requirements be construed to
conflict with or otherwise limit the obligations concerning indemnification of the County.
Page 17 of 19
• Recipient's insurers shall have no right of recovery or subrogation against the County
(including its employees and other agents and agencies), it being the intention of the parties
that the insurance policies so affected shall protect all the parties and shall be primary coverage
for all losses covered by the above described insurance.
• Insurance companies issuing Recipient's insurance policy or policies shall have no recourse
against the County (including its employees and other agents and agencies) for payment of any
premiums or for assessments under any form of insurance policy.
• All deductibles in Recipient's insurance policies shall be assumed by and be at the sole risk of
Recipient.
• Any judgments for which the County maybe liable, in excess of insured amounts required by this
agreement, or any portion thereof, may be withheld from payment due, or to become due, to
Recipient until Recipient shall furnish additional security covering such judgment as may be
determined by the County.
• Any coverage for third parry liability claims provided to the County by a "Risk Pool" created
pursuant to Ch. 48.62 RCW shall be non-contributory with respect to any insurance policy
Recipient shall provide to comply with this Agreement.
• The County may, upon Recipient's failure to comply with all provisions of this Agreement
relating to insurance, withhold payment or compensation that would otherwise be due to
Recipient.
• Recipient shall provide a copy of all insurance policies specified in this Agreement.
• Written notice of cancellation or change in Recipient's insurance required by this Agreement shall
reference the project name and agreement number and shall be mailed to the County at the
following address: Jefferson County Risk Management, P.O. Box 1220, Port Townsend, WA
98368.
• Recipient's liability insurance provisions shall be primary and noncontributory with respect to
any insurance or self-insurance or self-insurance programs covering the County, its elected and
appointed officers, officials, employees and agents.
• Any failure to comply with reporting provisions of the insurance policies shall not affect coverage
provided to the County, its officers, officials, employees or agents.
• Recipient's insurance shall apply separately to each insured against whom claim is made or suit is
brought, except with respect to the limits of the insurer's liability.
• Recipient shall include all subcontractors as insured under its insurance policies or shall furnish
separate certificates and endorsements for each subcontractor. All insurance coverage for
subcontractors shall be subject to all the requirements stated in this Agreement. The insurance
limits mandated for any insurance coverage required by this Agreement are not intended to be an
indication of exposure nor are they limitations on indemnification.
Page 18 of 19
• Recipient shall maintain all required insurance policies in force from the time services commence
until services are completed. Certificates, insurance policies, and endorsements expiring before
completion of services will be promptly replaced.
• Recipient shall place insurance with insurers listed to business in the State of Washington and
having A.M. Best Company ratings of no less than A-, with the exception that excess and
umbrella coverage used to meet the requirements for limits of liability or gaps in coverage need
not be place with insurers or re -insurers licensed in the State of Washington.
• Certificates of insurance as required by this Agreement shall be delivered to the County within
fifteen (15) days of execution of the Agreement. To the extent a certificate lists or refers to any
endorsements solely by name. description or number it shall be the responsibility of Recipient to
obtain and provide to Jefferson County Risk Management a full and complete copy of the texts of
such endorsements.
• The County shall be named as an "additional insured" on all insurance policies required by this
Agreement.
• Recipient shall furnish the County with properly executed certificates of insurance that, at a
minimum, shall include:
o The limits of coverage;
o The project name and agreement number to which it applies;
o The certificate holder as Jefferson County, Washington and its elected officials,
officers, employees and agents with the address of Jefferson County Risk Management,
P.O. Box 1220, Port Townsend, WA 98368; and
o A statement that the insurance policy shall not be cancelled or allowed to expire except
on thirty (30) days prior written notice to the County.
Page 19 of 19