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Home My WebLink AboutQuilcene Historical Museum $51,000- 102323b AGREEMENT FOR 2024 HOTEL -MOTEL FUNDING FOR TOURISM SERVICES S QUILCENE HISTORICAL MUSEUM This Agreement is by and between JEFFERSON COUNTY (hereinafter known as "COUNTY" and the QUILCENE HISTORICAL MUSEUM (hereinafter known as "MUSEUM"). WHEREAS, the MUSEUM is a non-profit corporation of the State of Washington; and WHEREAS, the COUNTY desires to promote tourism by documenting, preserving and displaying County heritage for the benefit of its residents and to encourage tourist interest in Jefferson County, as authorized by Chapter 67.28 RCW and Jefferson County Code Chapter 3.25; and WHEREAS, the Jefferson County Lodging Tax Advisory Committee reviewed and recommended funding the lodging tax proposal by the Quilcene Historical Museum to promote, operate and maintain the museum as a cultural resource and tourism destination, and to provide information to tourists and residents about the local area; IN CONSIDERATION of the mutual covenants and agreements herein it is agreed by the parties as follows: SECTION 1: SERVICES TO BE PERFORMED The MUSEUM shall use its capabilities and utilize up to $51,000 of funding provided under this agreement to continue and update the ongoing performance of the following tourism promotion services consistent with the Itemized List of Proposed Tourism Promotion Services and Lodging Tax Budget a copy of which is incorporated herein and attached hereto as Exhibit A: SECTION 2: RESPONSIBILITIES OF THE QUILCENE HISTORICAL MUSEUM On or before January 31; April 30; July 31; October 31, 2024; and January 31, 2025, provide to the COUNTY: see Exhibit C, attached hereto and incorporated; • A quarterly report of the use, services, programs and activities of the MUSEUM under this Agreement for the prior quarter; • A quarterly financial statement detailing revenues, expenses and cash balances for the prior quarter; and for the final quarter report, the financial statement shall also include a detailed financial statement for all 2024. 2. On or before January 31, 2024 (OR upon execution of this agreement) and July 31, 2024, provide to the COUNTY: • A billing statement requesting payment of Hotel -Motel Funding for the current half year. 3. For a minimum of six (6) years, maintain documented proof of payments made, contracts executed, and other expenditures authorized under this Agreement. Upon reasonable notice, provide access to County or State representatives to audit those records. Page: 1 of 13 Quilcene Historical Museum 4. Funding provided by this Agreement may only be expended on the services described in Section 1 of this Agreement. Any monies used for other services or purposes shall be refunded to Jefferson County. Any monies under -expended of the total funding allocated under this Agreement shall be refunded to Jefferson County by January 31, 2025. 5. By February 2811 of each year provide the following information on Exhibit B, attached hereto and incorporated by reference for the previous year. a. Each festival, event, or tourism facility owned and/or operated by the MUSEUM. b. The amount of lodging tax revenue allocated for expenditure (whether actually expended or not) by the MUSEUM on each festival, event or tourism facility. c. Estimated number of tourists served at each festival, event or tourism facility. ("Tourist" includes persons traveling more than 50 miles to the location of the event, festival or facility and overnight stays in the area). d. Estimated lodging stays. ("Lodging" refers to commercial lodging such as hotels, motels, resorts, bed and breakfasts, or commercial campgrounds). e. Measurements that demonstrate the impact of increased tourism attributable to the event, festival or facility. SECTION 3: RESPONSIBILITY OF JEFFERSON COUNTY 1. The COUNTY will provide the MUSEUM funding from Hotel -Motel Tax receipts to be used in support of their responsibilities as defined under this agreement. Said funding is in the sum of $51,000 for 2024. Semi-annual payments of $25,500 will be made in the first and third quarter of 2024. Payments are to be predicated on submittal of reports defined in Section 2. Payment will be made by the COUNTY upon receipt of an invoice on the next available billing cycle. SECTION 4: TERM This Agreement shall be for a term of one year, commencing on January 1, 2024 and ending on December 31, 2024, except for the reports referenced in Section 2, due January 31, 2025 and February 28, 2025. All activities performed pursuant to this Agreement within its term and prior to its execution are hereby ratified. SECTION 5: ASSIGNMENT Either party to the agreement shall not assign this Agreement, except by signed amendment. SECTION 6: MODIFICATION This Agreement may be modified by mutual written agreement executed by both parties. Page: 2 of 13 Quilcene Historical Museum SECTION 7: TERMINATION The Agreement may be terminated, in whole or in part, by the County upon thirty (30) days written notice in the event expected or actual revenue from the Hotel -Motel Tax is reduced or limited in any way, or for non-performance of duties under this Agreement, or for any reason. The MUSEUM may terminate this Agreement upon thirty (30) days written notice to the COUNTY. In the event of termination under this clause, the County shall be liable to pay only for services rendered prior to the effective date of termination. If termination covers a period for which payment has already been made, the MUSEUM shall refund to the COUNTY a pro -rated share of the payment based upon the balance of time remaining in the paid period, unless otherwise negotiated. SECTION 8: HOLD HARMLESS The MUSEUM shall indemnify and hold the COUNTY, and its officers, employees, agents and volunteers (and their marital communities) harmless from and shall process and defend at its own expense, including all costs, attorney fees and expenses relating thereto, all claims, demands, or suits at law or equity arising in whole or in part, directly or indirectly, from the MUSEUM's negligence or breach of an of its obligations under this Agreement; provided that nothing herein shall require the MUSEUM to indemnify the COUNTY against and hold harmless the COUNTY from claims, demands or suits based solely upon the conduct of the COUNTY, its officers, employees, agents and volunteers (and their marital communities), and; provided further that if the claims or suits are caused by or result from the concurrent negligence of: (a) the MUSEUM's agents or employees; and , (b) the COUNTY, its officers, employees agents and volunteers (and their marital communities), this indemnity provision with respect to claims or suits based upon such negligence, and or the costs to the COUNTY of defending such claims and suits, etc., shall be valid and enforceable only to the extent of the MUSEUM's negligence, or the negligence of the MUSEUM's agents or employees. The MUSEUM specifically assumes potential liability for actions brought against the COUNTY by the MUSEUM's employees, including all other persons engaged in the performance of any work or service required of the MUSEUM under this Agreement and, solely for the purpose of this indemnification and defense, the MUSEUM specifically waives any immunity under the state industrial insurance law, Title 51 RCW. The MUSEUM recognize that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation. SECTION 9: INSURANCE The MUSEUM shall obtain and keep in force during the term of the Agreement, or as otherwise required, the following insurance: A. Commercial General Liability Insurance. The MUSEUM shall maintain commercial general liability coverage on a form acceptable to Jefferson County Risk Management for bodily injury, personal injury, and property damage, with a limits of not less than in the amount of at least $1 million per occurrence, for bodily injury, including death, and property damage. Page: 3 of 13 Quilcene Historical Museum B. Worker's Compensation (Industrial Insurance). The MUSEUM 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. SECTION 10: INDEPENDENT CONTRACTOR The MUSEUM and the COUNTY agree that the MUSEUM is an independent contractor with respect to the services provided pursuant to this agreement. Nothing in this agreement shall be considered to create the relationship of employer and employee between the parties hereto. Neither the MUSEUM nor any employee of the MUSEUM shall be entitled to any benefits accorded County employees by virtue of the services provided under this agreement. The COUNTY shall not be responsible for withholding or otherwise deducting federal income tax or social security or for contributing to the state industrial insurance program, otherwise assuming the duties of an employer with respect to the MUSEUM, or any employee, representative, agent or contractor of the MUSEUM. The MUSEUM shall be responsible for all applicable withholdings, deductions, state industrial insurance, tax reports, business licenses, registrations, and all other obligations of an independent organization. SECTION 11: COMPLIANCE WITH LAWS The MUSEUM shall comply with all Federal, State, and local laws and ordinances applicable to the work to be done under this Agreement. This Agreement shall be interpreted and construed in accord with the laws of the State of Washington and venue shall be in Jefferson County, Washington. SECTION 12: DISCRIMINATION PROHIBITED The MUSEUM with regard to the project to be completed under this agreement, will not discriminate on the grounds of age, sex, marital status, sexual orientation, race, creed, color, national origin, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with a disability, unless based upon a bona fide occupational qualification in the selection and retention of employees, materials, supplies, contractors or subcontractors. SECTION 13: INTEGRATED AGREEMENT This agreement together with attachments or addenda represents the entire and integrated agreement between the County and the MUSEUM and supersedes all prior negotiations, representations, or agreements written or oral. This agreement may be amended only by written instrument signed by both the County and the MUSEUM. SIGNATURES ON THE FOLLOWING PAGE Page: 4 of 13 Quilcene Historical Museum Yd APPROVED and signed this �`3 day of Ccb 2023 Attest: eeallaway. Gl rGf�CaroCMC Clerk of the Board Approved as to,Form: 10/ 8 2023 Philip C. Hunsucker, Chief Civil Deputy Prosecutor 3N COUNTY F COMMISSIONERS Chair QUILCENE HISTORICAL SOCIETY I /VQ�zo�.3 Authorized Official Page: 5 of 13 Quilcene Historical Museum EXHIBIT A Itemized List of Proposed Tourism Promotion Services and Lodging Tax Budget I. Itemized list of Propose! Towism Promotion Sorvicts Organization for Event) Name_ QWko!M Mistontal Museum - Worthington P*!* 1044,(2022 Expense Q92:: C: 4 # 1. Nukof Evynt 5r11:POt & wwwmtwn 66112 :..•; ; i t'. v i 19r:S4 !knace. e■Auts, newsimers, in+ wfoom trochures. corwerrwces, atipnt mateoiaK. SaVOjes L Cu it e a=rv7 Ptr+lr+ershMts� CalYberatlo++a 66115 ,' ! - 5 lVrt S l,p FAM tours. Winare Low, QWb&ei, OAa Oudcene ;air qudcona Akonrw, TCC,, OPTr_, OP'v€! tOfV"Ipc PenwyAAa "to" R+.reAul, State $teWonad. h National mambwt.*%M Ci,wmbm of Commerce, bom' City, gay Scouts. CWC0fw S(rrtsn i5,trt*n Club. eiucatranal 8 scf►aiarshq 04olcene t3oaster Club. Chridren praiyams & ovwntL. tcKdl Farm, & 5eafoad pradr,cves. FArmof Varfiets. Co 6 ev' grOUp tours. `►1i0,,r *r%4 town & educaWn, Area kotajs, 1qr r0 mistarecal Societr...-O CO.. tibrary, 'OvSf-K r.rustwn mob-sk" & Sodsl K$d* tsP, P%ww 66118 S 1.4w domains. arias mains► %)ok r. errrrarcenrcrrt with lets to iaWa jo4fig rli"wig and events, video tele,:orrfrtronnell 4- Spatial Ev*nts, Promoboins, Marletesg 661?0 ,,-7 11 i 19.J5 i $ 33,40U Martir" Maria .4ds & Noanotron, Rental POnf,3j4 p,ict,;+t. MuWUm Seaaon C%Xfwr wit P71diCtt}(4n Her,dtag.? +Liar - `t*t4rar+ Fesm°al Apnll, QK Aiuxrvv Reunion erhdeis {i MI, '90r% loin Pali3Out" Rib« Trek dune!. Worttt,rgton Wrw(lri op-n }souse tc%y: +acne MY5QPt , iC ON-iry Strrtrrnet ReadrrK Program t Jy Aii1, Ket+'itir Pubkr T►..aerr laVW, 'hare & spirts TakWng Gai*,,A&Ag1 worthwvton Park Grcn arid otr lkc f M"*e Night O-A Fam TOO Quids)IX Mown {Sept€. Cunene Ft srivai `h'a7.Awid 15WA 0601tem Cl ster R.rr 15001t '+ of1hrn;turr park karrctrcv.'onust Ir:r<tl, Dote" irpprecwtor Canner Novl, t-0,,ikanr Fiber -sh6wp 40 WWI- festkal loctl S. prof4*4ional servicm Projects 66122 5 i l.CS'a 5 64,r7[iC Atcyssi,omng i Vit, ')tji His" orotett, History ' i " re pu6ttaoons. profcss*onai wrmev,* foiilows rlltwf e(wice fOtwatoom & Tread / coeNylr cr% poxtage, copies, O#tk• C01INV"mr / Conwimfon 1 Nteeto* LMice Erpensas P(okVarn I1As1,OVr -program Trawl Wire Expense. Adm slraticA POstagi. A&ft0istr7tbon Orrntrr'+g ♦nd C opyM ndmin TOW OAC Funding fd"aread fiFs12: r_ : "fi_r 5 J(J 100 661 J • 1.+J .. _. J •�r.7.I $ 800 66265 _t 5 EGGS 5 6w 662L67 a UCU 5 GOO 66269 2w 5 2i�q Page 6 of 13 Quilcene Historical Museum Exhibit B Jurisdiction Lodging Tax Reporting Form — To Be Submitted to Jefferson County Administrator's Office No Later than February 28th of each Year Lodging Tat Reporting Form Organ -at-- receitzng fi'Ming to pro=te feV-twat-. spee3al ewnt-- and -mlawd a..^ai u : through tour - elated fzcile owned or 4soasored by non-profit organezatsons or the local jurisdiction are requned to co®ple4* ties form. fcw EACH actas-rty 1 Orprumn x Name: g.,� Year Spatasa Type (Check Ore): :41(ei;3 i iGlfcj(6} 0 Local tuEsdicrina. 'Esp., 3 ActnityNaw # Actrtity Itpe (Check One): EcentFestaal* Q Fawn,* ®lfadrrg• 5 Acdatty Stet Date`: 6 ActivdvEnd Date*: ' Total Cosa of 4cmvty: S 8 Am= Requested: S 9 Amamt Awarded: S 10 OvmnAtreodmce* a) Protected* b) AnWO c) xe+bodology (Check One)_ ()Duva Co=e Okdirea Comma' ORaptesentame Suarey' O1af,umgsurtey* 05tnnr�muei£ ate' Othff ieaplain3: 11 Number of Atoms s Ule Trashed 5 C� lines w ]dare` a) Pmjectea* b) Acrje* 11d na Couw* `�..J\ Repa2T�ame Survw* 1Q:�a1 sun pv* i i srucurrei £mrame* J Diber (explarn; 12 Number of Anendep- V, ho Tmvied fr= Amber state ar Couttry-* a) Pro3aated4 b) Actual' c) Metbodol ev (Owl ow):Data Cams• 0 kd.- Corns• oR p¢t;aaaat'e Su ,,- 0 hf-1 Spey* (D St -d E_-mwre' 006. (.pl.� ,See Lodging Tax Yearn- Reporting Definitions LLstrurtions Name of Lhdicrdual Who Pt pmd Repast Pbaoe =: E-Mxl A ddresi RETURN THIS FORM TO: leffier-<m Covwv AArar istrator's Office 1820 Ieffemon Street P.O. Box 1210 Part Townsend. W A 9836E )efibocc: ic,o.)efier--am.aa.a 13 Nombet of ME Who SWk (¢-anqIs m U4ajd Atrammairnon;` a; P-leded* b) Actual* c) Medwdajov (Check One): CUM Cam* :nr Corot* OR4teseQ le Sines' -,kM3115=ev* () Savrrured£L- * 00-It. ; 14 Nucabe of ryrAee= IXIw Sun at Ot mw# n Prid ALLcmmaeci;ar - a) PnollK'�d* b) AL=0 c, Sieftdalags tChar Cm@I: i ]:1111 i COME+ SrATea" Sam £a -=ail$* 0 Cibm {evIa Rj: 15 Number cf 33dLWPWNib* ap Pnld* b'I Attaal* c xedsodojagr (Cantu onei: C-lect cocmr* 0 ad — C ouW— Q:1� Styver'* Scr=wed E:�=M- 0tK t: DEAADL.LNE: Februury 28tk of Earl Reporting I ear Page 7 of 13 Quilcene Historical Museum LTAC Yearly Reporting Definitions/Instructions Activity Type: Event/Festival: Short-term activity occurring between specific dates (e.g., 4th of July celebration, local marathon) Facility: Municipally -owned facility that operates some or all of the year (e.g., county historical museum, convention center) Marketing: Activity that provides information to encourage visitors to an area; is typically a year-round activity but may also operate for less than a full year. Activity Date: Activity beginning and ending dates. Actual: Persons estimated to have actually participated in event/festival or visiting a facility. For marketing activity, enter the number of persons estimated to have actually visited area as result of marketing activity. Projected: Persons expected to participate in event/festival or visiting a facility. For marketing activity, enter the number of persons expected to visit area as result of marketing activity. Methodology: Select the methodology used to estimate the actual number of visitors/participants. Direct Count: Actual count of visitors using methods such as paid admissions or registrations, clicker counts at entry points, vehicle counts or number of chairs filled. A direct count may also include information collected directly from businesses, such as hotels, restaurants or tour guides, likely to be affected by an event. Indirect Count: Estimate based on information related to the number of visitors such as raffle tickets sold, redeemed discount certificates, brochures handed out, police requirements for crowd control or visual estimates. Representative Survey: Information collected directly from individual visitors/ participants. A representative survey is a highly structured data collection tool, based on a defined random sample of participants, and the results can be reliably projected to the entire population attending an event and includes margin of error and confidence level. Informal Survey: Information collected directly from individual visitors or participants in a non-random manner that is not representative of all visitors or participants. Informal survey results cannot be projected to the entire visitor population and provide a limited indicator of attendance because not all participants had an equal chance of being included in the survey. Structured Estimate: Estimate produced by computing known information related to the event or location. For example, one jurisdiction estimated attendance by dividing the square footage of the event area by the international building code allowance for persons Q square feet). Other: (please describe) Overall Attendance: Total projected and estimated actual attendance recorded for event, facility or resulting from marketing activity. Total Attendees Traveling 50 miles or more: Total: Total projected and estimated actual number of visitors traveling more than 50 miles to attend event or facility. For marketing organizations, report visitors traveling more than 50 miles to visit area. Of total, attendees who traveled from another state or country: Of the total projected and estimated actual number of visitors traveling more than 50 miles to attend -event or facility or visit area, report projected and estimated actual number of visitors who traveled from another state or country. Attendees who stayed overnight: Paid Accommodations: Total projected and estimated actual number of visitors staying in paid lodging establishments such as hotels, motels, bed and breakfasts, etc. Unpaid Accommodations: Total projected and estimated actual number of visitors staying in unpaid accommodations such as family and friends. Paid Lodging Nights: Total projected and estimated actual number of paid lodging nights. One Lodging night = one or more persons occupying one room for one night. Page 8 of 13 Quilcene Historical Museum EXHIBIT C 1't QUARTER Organization: Contact person: Mailing Address: Phone Number/Email: 1. LTAC Funds received from the County 1st QTR: Due by April 301h to afmcknightgco.iefferson.wa.us ORGANIZATION Amount Received Overspent Refund TOTAL 151 Awarded (+) Required QTR by JeffCo From Underspent LTAC JeffCo (_) of LTAC FUNDS funds SPENT 2. LTAC funds spent by your organization 1st QTR (include 200 word limit regarding activities and funds spent with an itemized statement and supporting documentation ie: invoices paid, receipts from payment,): 3. LTAC funds balance remaining 1st QTR: 4. Please attach your organization's report for all revenue, marketing, services, programs and activities of the prior quarter. This report and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed and other expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be able to provide access to County or State representatives to audit those records. Page 9 of 12 Quilcene Historical Museum EXHIBIT C 2"d QUARTER atmckni�ht�ico jetterson.�e �.us Organization: Contact person: Mailing Address: Phone Number/Email: 1. LTAC Funds received from the County 2d QTR: Due by July 3111 to ORGANIZATION Total Total Overspent Refund TOTAL TOTAL 2°d Amount Received (+) Required I" QTR QTR Awarded Underspent LTAC LTAC by JeffCo From (-) of LTAC FUNDS FUNDS JeffCo funds SPENT SPENT 2. LTAC funds spent by your organization 2" QTR (include 200 word limit regarding activities and funds spent with an itemized statement and supporting documentation ie: invoices paid, receipts from payment,): 1. LTAC funds balance remaining 2"d QTR: 2. Please attach your organization's report for all revenue, marketing, services, programs and activities of the prior quarter. This report and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed and other expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be able to provide access to County or State representatives to audit those records. Page 10 of 12 Quilcene Historical Museum EXHIBIT C 3" QUARTER Organization: Contact person: Mailing Address: Phone Number/Email: 1. LTAC Funds received from the County 3rd QTR: Due by October 315t to afmcknightPco.jefferson.wa.us ORGANIZATION Total Total Overspent Refund TOTAL TOTAL 2"d TOTAL Amount Received (T) Required I't QTR QTR 3rd QTR Awarded From Underspent LTAC LTAC LTAC b JeffCo y JeffCo (') of LTAC FUNDS FUNDS FUNDS funds SPENT SPENT SPENT L. L i AL Tunas spent Dy your organization Tu QTR (include 200 word limit regarding activities and funds spent with an itemized statement and supporting documentation ie: invoices paid, receipts from payment,): 2. LTAC funds balance remaining 3rd QTR: 3. Please attach your organization's report for all revenue, marketing, services, programs and activities of the prior quarter. This report and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed and other expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be able to provide access to County or State representatives to audit those records. EXHIBIT C 41h QUARTER Due by January 3Is' to afmcknightgco.iefferson.wa.us Organization: Page 11 of 12 Quilcene Historical Museum Contact person: Mailing Address: Phone Number/Email: 1. LTAC Funds received from the County 4th QTR: ORGANIZATION Total Total Overspent Refund TOTAL TOTAL TOTAL TOTAL Amount Received (+) Required I" QTR 2°d QTR 3rd QTR 4`t' QTR Awarded Underspent LTAC LTAC LTAC LTAC by JeffCo From (-) of LTAC FUNDS FUNDS FUNDS FUNDS JeffCo funds SPENT SPENT SPENT SPENT 2. LTAC funds spent by your organization 4th QTR (include 200 word limit regarding activities and funds spent with an itemized statement and supporting documentation ie: invoices paid, receipts from payment,): 3. LTAC funds balance remaining 4th QTR: 4. Please attach your organization's report for all revenue, marketing, services, programs and activities of the prior quarter. This report and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW Chapter 42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed and other expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be able to provide access to County or State representatives to audit those records. Page 12 of 12 Quilcene Historical Museum Consent Agenda Commissioners Office JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners FROM: Adiel McKnight, Executive Assistant DATE: C)Dfcktjr,�O , 2023 SUBJECT: AGREEMENT re: 2024 Hotel Motel (Lodging Tax) Grant Funding; In the Amount of $51,000; Quilcene Historical PIAS-e'�.►ry► STATEMENT OF ISSUE: This agreement provides grant funding for 2024 to certain non-profit agencies for the promotion of tourism and ongoing preservation of Jefferson County's heritage. The Lodging Tax Advisory Committee met on September 19, 2023 and reviewed request for proposals. This funding has been budgeted from the Hotel Motel (Lodging Tax) Fund, and approved by the Board of County Commissioners on October 2, 2023. FISCAL IMPACT: Quilcene Historical MuSetim $51,000 RECOMMENDATION: Approve and sign the agreement. REVIEWED BY: Ito Z3 Mark McCaul , County Administrator Date: CONTRACT REVIEW FORM (INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: Quilcene Historical Museum Contract For: Quilcene Historical Museum COUNTY DEPARTMENT: county Administrator Contact Person: Adiel McKnight Contact Phone: 102 Contact email: afmcknight@oo.jefferson.wa.us AMOUNT: $51,000 Revenue: Expenditure: Matching Funds Required: Sources(s) of Matching Funds Fund # Term: 2024 Clear Form Contract No: LTAC OHM PROCESS: Exempt from Bid Process Cooperative Purchase Competitive Sealed Bid Small Works Roster Vendor List Bid RFP or RFQ Munis Org/Obj 12555730/411103 Other: APPROVAL STEPS: STEP I: DEPARTMENT CERTIFIES COMP ANC H J 3. 0 AND CHAPTER 42.23 RCW. CERTIFIED: ❑ N/A:F Sig ure Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT B E 70YY FEDERAL, STATE, OR LOCAL AGENCY. CERTIFIED: ❑ N/A: a 1' 10 • /,3 Signature JDate STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche): $51,000 125 Electronically approved by Risk Management on 10/17/2023. STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche): Electronically approved as to form by PAO on 10118/2023. County standard LTAC grant language. STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY(IF REQUIRED). STEP 6: CONTRACTOR SIGNS STEP 7: SUBMIT TO BOCC FOR APPROVAL