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HomeMy WebLinkAboutOWL 360 ins ex 072924 - 012224 - 0 '/24 24 'r2 Grant Agreement by and Between Jefferson County and OWL 360: Youth and Young Adult Housing For Affordable Housing/Homelessness Services Grant Funding WHEREAS. RCW 36.22.178 authorizes a recording fee surcharge to provide funding for affordable housing services; and WHEREAS, RCW 36.22.179 authorizes a recording fee surcharge to provide funding for homeless housing and assistance; and WHEREAS, RCW 36.22.1791 authorizes an additional surcharge for local homeless housing and assistance; and WHEREAS, RCW 82.14.530 authorizes the use of SHB 1590 sales tax revenues tosupport affordable housing; and WHEREAS, RCW 82.14.540 authorizes the use of SHB 1406 sales tax revenues to support affordable housing; and WHEREAS, RCW 36.22.250 authorizes the use of SSB 5386 sales tax revenues to support affordable and homeless housing; and WHEREAS, on August 28, 2023 the Board of County Commissioners approved funding levels and authorized the release of a Request for Proposals for the funds collected pursuant to the above cited RCW's; and WHEREAS, on December 4, 2023 the Board of County Commissioners approved the Housing Fund Board's recommendation for 2024 funding; NOW, THEREFORE, Jefferson County, a political subdivision of the State of Washington, hereinafter referred to as "County," and Recipient, a non-profit corporation is Washington State (Recipient), in consideration of the mutual benefits, terms, and conditions hereinafter specified, do hereby agree as follows: 1. Grant Commitment. A 100% grant of funds is hereby made to Recipient for the project described in Section 2. The approved maximum amount of the grant shall be$149,270, all coming from Fund 148. The grant shall be available upon the submission of appropriate invoices pursuant to Section 3. 2. Project Description, Schedule and Budget. a. The scope of work for the Project is described in Exhibit A, attached. b. The Project begins on January 1, 2024 and shall be completed by December 31, 2024. c. The budget for the Project is described in Exhibit B, attached. 3. Payment. Expenses incurred on the Project, as described in Section 2, by the Project's consultants, contractors, suppliers, or Recipient's staff shall be submitted to the County Administrator's Office by Recipient using a detailed invoice. Each detailed invoice shall show individual items followed by the total amount incurred and the amount eligible for reimbursement under this grant. Recipient may submit such invoices to the County once per month during the course of the Project for work completed. All invoices shall be submitted no later than 30 days after project completion. The county shall review and approve invoice payments. Payments will be limited to the monies that are available under the grant as described in Section 1. Such invoices, once approved, will be paid using the County's normal bill paying process and cycle. 4. Compliance with Laws. Recipient shall, in completing its project under this Grant Agreement, faithfully observe and comply with all federal, state, and local laws, ordinances, and regulation, applicable to the work to be completed under this Grant Agreement. 5. Indemnity. The Contractor shall defend, indemnify and hold the County, its officers, officials, employees, agents and volunteers (and their marital communities) harmless from any claims, injuries, damages, losses or suits, including attorney's fees, arising out of or resulting from the acts, errors or omissions of the Contractor in performance of this Agreement, except for injuries and damages caused by the sole negligence of the County. Should a court of competent jurisdiction determine this Agreement is subject to RCW 4.24.115 if liability for damages occurs arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Contractor and the County, its officers, officials, employees, agents and volunteers (and their marital communities) the Contractor's liability, including the duty and cost to defend, shall be only for the Contractor's negligence. It is further specifically understood that the indemnification provided constitutes the Contractor's waiver of immunity under Industrial Insurance, Title 51 RCW, solely for the purposes of this indemnification. This waiver has been mutually negotiated by the parties. This section shall survive the expiration or termination of this Agreement. 6. Required Insurance Coverages. a. Commercial General Liability. 1) 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. 2) The commercial general liability insurance coverage shall contain no limitations on the scope of the protection provided and include the following minimum coverage: �. Broad form property damage, with no employee exclusion; ii. Person injury liability, including extended bodily injury; iii.. Broad form contractual/commercial liability,including completed operations and product liability coverage; iv. Premises - operations liability (M&C); v. Independent contractors and subcontractors;and, vi. Blanket contractual liability. 3) Recipient's commercial general liability policy shall include employer's liability coverage. 4) The County and its elected officials, officers and employees shall be named as an additional insured party under this insurance policy. b. 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. c. 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 form Recipient. 1) 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. 2) This coverage shall extend to any contractor or subcontractor that does not have their own workers' compensation and employer's liability insurance. 7. 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. 8. General Insurance Requirements. a. Insurance coverage shall be evidenced by one of the following methods: 1) Certificate of insurance; or, 2) Self-insurance through an irrevocable Letter of Credit from a qualified financial institution. b. 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. c. 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. d. 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. e. 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. f. All deductibles in Recipient's insurance policies shall be assumed by and be at the sole risk of Recipient. g. Any judgments for which the County may be 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. h. Any coverage for third party 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. i. 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. j. Recipient shall provide a copy of all insurance policies specified in this Agreement. k. 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. I. 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. m. 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. n. 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. o. 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. p. 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. q. 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. r. 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. s. The County shall be named as an "additional insured" on all insurance policies required by this Agreement. t. Recipient shall furnish the County with properly executed certificates of insurance that, at a minimum, shall include: 1) The limits of coverage; 2) The project name and agreement number to which it applies; 3) 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 4) 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. 9. Independent Contractor. Recipient and the County agree that Recipient is an independent contractor with respect to the project to be completed pursuant to this Grant Agreement. Nothing in this Grant Agreement shall be considered to create the relationship of employer and employee between the parties hereto.Neither Recipient nor any employee of Recipient, nor any subcontractor of Recipient shall be entitled to any benefits accorded to County employees by virtue of their services on the project to be completed under this Grant 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, or otherwise assuming the duties of an employer with respect to Recipient, or any employee, representative of agent of Recipient, or any contractor of Recipient. 10. Subcontracting Requirements. a. Recipient Owns Contract Performance. Recipient is responsible for meeting all terms and conditions of this Agreement including standards of service, quality of materials and workmanship, costs and schedules. Failure of a subcontractor to perform is no defense to a breach of this Agreement. Recipient assumes responsibility for all liability for the actions and quality of services performed by any subcontractor. b. Subcontractor Disputes. Any dispute arising between Recipient and any subcontractors or between subcontractors must be resolved with involvement of any kind on the part of the County and without detrimental impact on the delivery of contracted goods and services. 11. Legal and Regulatory Compliance. While performing under this Agreement, Recipient, subcontractors,and their employees are required to comply with all applicable local, state and federal laws, codes, ordinances and regulations, including but not limited to: a. Applicable regulations of the Washington State Department of Labor and Industries, including WA-DOSH Safety Regulation; and b. State and Federal Anti-Discrimination Laws. 12. Termination. a. Termination by the County. 1) Should Recipient default in providing or providing services under this g materially breach any of its provisions, the County may terminate this Agreement upon ten (10) days written notice to Recipient. 2) Recipient shall have the right and opportunity to cure any such material breach within the ten (10) day period. 3 The Countymay terminate this Agreement upon immediate notice to Recipient. Recipient will be reimbursed for services expended up to the date of termination. 4) This Agreement may be terminated or amended, in whole or in part, by the County upon thirty (30) days written notice in the event expect ed or actual revenue in Funds 148 and/or 149 is reduced or limited in any way. b. Termination by Recipient. 1) Should the County, its staff, employees, agents and/or representatives default in the performance of this Agreement or materially breach any of its provisions, Recipient, at its option, may terminate this Agreement by giving ten (10) days written notice to the County representative. 2) The County shall have the right and opportunity to cure any such material breach within the ten (10) day period. c. Termination Without Cause. This Agreement may be terminated without cause at any time by either party subject to a sixty (60) day advance written notice of such termination to the other party. 13. No Harassment or Discrimination. Recipient and any contractors/subcontractors will not discriminate against any person in the performance of work under this agreement or in the selection and retention of employees or procurement of materials or supplies on the basis of age, sex, marital status, sexual orientation, religion, 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 guide dog or service animal by a person with a disability, unless based on a bonafide occupational qualification. 14. Contract Expiration. This contract will run until the project is complete and until the County has made all payments required under this Grant Agreement, except that the project must be completed no later than the date listed in Paragraph 2.b. above, unless extended by mutual agreement. 15. Failure to Appropriate. Recipient acknowledges that the County may only appropriate monies in the current year and in a manner consistent with Paragraph 1.Above. The County agrees to appropriate monies to fund this grant unless emergency circumstances prevent the County from doing so. Any monies to be paid by the County to Recipient for this grant are subject to appropriation by the County Commission. 16. Integrated Agreement. This Grant Agreement represents the entire and integrated agreement between the County and Recipient and supersedes all prior negotiations, representation, or agreements written or oral. 17. Modification of this Agreement. This Agreement may be amended or supplemented only by a writing that is signed by duly authorized representatives of all parties. 18. No Assignment. Recipient shall not sell, assign, or transfer any rights obtained by this Agreement without the express written consent of the County. 19. Severability. Provided it does not result in a material change in the terms of this Agreement, if any provision of this Agreement or the application of this Agreement to any person or circumstance shall be invalid, illegal, or unenforceable to any extent, the remainder of this Agreement and the application of this Agreement shall not be affected and shall be enforceable to the fullest extent permitted by law. 20. No Third-party Beneficiaries. The parties do not intend, and nothing in this Agreement shall be construed to mean,that any provision in this Agreement is for the benefit of any person or entity who is not a Party. 21. Controlling Law. It is understood and agreed that this Agreement is entered into in the State of Washington. This Agreement shall be governed by and construed in accordance with the laws of the United State, the State of Washington and the County of Jefferson, as if applied to transactions entered into and to be performed wholly within Jefferson County, Washington between Jefferson County residents. No party shall argue or assert that any state law other than Washington law applies to the governance or construction of this Agreement. (SIGNATURES APPEAR ON THE FOLLOWING PAGE) IN WITNESS WHEREOF, te parties have caused this Grant Agreement to be executed this r2t.W day of fr 2tOi'l 2024. Jefferson County Owl 360 Board of Commissioners �.,/: G �` 2's Signature Date ve/. 6 o" 020A 4-74&9 1 Printed Name/Title Grade By: j212 y Kate ean, Chair ate .r�,a,,�GpMM SOD Cp SEAL: 2 2': s y V� tV • Co: ',r.0• ''S gSHING ATTEST: Oa k) (',, a i/2 Z/Z y Carolyn Gallaway, CMC Date Clerk fV.he Board Approved as to form only: 0- C M r 01/18/2024 Philip C. Hunsucker Date Chief Civil Deputy Prosecuting Attorney • EXHIBIT A - SCOPE OF WORK PROJECT DESCRIPTION • Name of Project: Youth and Young Adult Housing • Amount requested: $149,270 from Fund 148 Provide a brief description of the Project or Program: OWL360 is expanding opportunities for young adults by increasing our housing footprint and associated sustainable livingservices from 6 housingunits at Pfeiffer House to 11 units (currently negotiating a Master Lease agreement for a Port Townsend property, hereafter referred to as Parliament House). OWL360 will use Parliament House as additional transitional housing with corresponding support services for young adults(ages 18-25 and their children) who are homeless, at risk of homelessness, fleeing domestic violence with no subsequent safe residence identified and lacking the resources needed to obtain such housing in our community. OWL360 serves residents who are at 50% AMI and meet the Commerce guidelines. Parliament House can house up to 10 people and will provide residents with basic needs support, mental health services, extensive resource connections, peer counseling, and case care to further increase young adults' sustainable living skills. OWL360 has proven history that young adults DO successfully transition into permanent housing after safe and supportive services like those available at Pfeiffer House. OWL360 will model the programs at Parliament House after those at Pfeiffer House. Specify the Project or Program goals and expected outcomes. Specify the methods by which the Project or Program will be measured and assessed: OWL360's goal is to use Parliament House as subsidized transitional housing for youth and young adults (ages 18-25 and their children) who are homeless, at risk of homelessness, fleeing domestic violence with no subsequent safe residence identified and lack of the resources needed to obtain such housing in our community. Requested funds assist in the operational cost of Parliament House and OWL360's Pfeiffer House. Costs include utilities, facilities renovations and maintenance, insurance, general administrative costs, and salaries and benefits for two OWL360 program staff. Together, OWL360's sustainable living programs provide new housing (Parliament House) and existing housing units (Pfeiffer House), plus supportive care for residents of both locations, wait-listed individuals, and any additional youth and young adults (walk- ins or connected via OWL360 outreach efforts) who are in need of supportive services. The Pfeiffer House and Parliament House contribute to the goal of increased housing availability for youth and young adults in Jefferson County. Eligible youth are those who are unhoused or living in unsafe or unsustainable situations. For those selected to live at either housing option, OWL360 will provide them with consistent case care,which includes life skills, resources, workforce development and advocacy to build agency for the participating youth. OWL360 staff also provides outreach to assist with transitions for youth and young adults towards long term sustainable independent living. Outcome Measures: • Parliament House: 3,650 days of residential youth living in 2024 (5 room unit for up to 10 people multiplied by 365 nights),plus sustainable living support services. • Pfeiffer House: 4,380 days of residential youth living in 2024 (6 one-bedroom apartments for up to 12 people multiplied by 365 nights), plus sustainable living support services. Specify the number of units of housing to be created or number of individuals who will be served by the Project or Program: Between Parliament House and Pfeiffer House OWL360 will have a total of 11 living units. It is anticipated that the programs can serve up to 30 people. This number is based on an expectation around the ability of participants to transition into permanent housing as availability arises in our community due to the ongoing placement support provided by OWL360 staff. EXHIBIT B—BUDGET Budget Categories Program _ Proposal Justification Priority Salaries $130,000 $86,800 2 FTE Case Care/ 1 Housing outreach program staff members Benefits $0 $14,000 Benefits and taxes for 2 1 FTE Rental Subsidies Utilities $17,900 $17,900 Parliament House 1 $5,000 Administration office Insurance $7,100 $7,100 Pfeiffer House 1 Food/Supplies $2,000 Furnishings/Equipment $1,000 Repair/Maintenance $9,000 $8,000 Parliament House— Renovations Transportation $1,000 (explain) Subtotal $168,000 $145,800 Admin (10% max) $16,800 $14,580 TOTAL: $184,800 $160,380 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 employee is dedicated to this Project or Program): Position Salary Benefits FTE Case Care $32,200 $7,000 .62 Case Care/Program Manager $54,600 $7,000 .875 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS CONSENT AGENDA REQUEST TO: Jefferson County Board of Commissioners FROM: Carolyn Gallaway, Clerk of the Board DATE: January 22,2024 SUBJECT: AGREEMENT re: 2024 Affordable Housing/Homelessness Grant Funding; Youth and Young Adult Housing; In the Amount of$149,270; County Administrator; Owl 360 STATEMENT OF ISSUE: On December 4, 2023 the Board of County Commissioners approved the Housing Fund Board's 2024 funding recommendations for Affordable Housing Fund 148, Homeless Housing Fund 149, 1590 and 5386 Funds. One of the recommendations was for Owl 360 to receive $149,270 for Youth and Young Adult Housing. ANALYSIS: The attached Grant Agreement will provide $149,270 in funds approved by the Board of County Commissioners on December 4, 2023. FISCAL IMPACT: $149,270 from Fund 148. RECOMMENDATION: Approve the attached Grant Agreement. REVIEWED BY: g/2/i Mark McCauley ounty Administrator Date CONTRACT REVIEW FORM Clear Form (INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: OWL 360 Contract No: Owl 360 Youth 2024 Contract For: Youth and Young Adult Housing Term: 01/01/24 to 12/31/24 COUNTY DEPARTMENT: County Administrator Contact Person: Carolyn Gallaway Contact Phone: 360-385-9122 Contact email: carolyn@co Jefferson.wa us AMOUNT: $149,270 PROCESS: Exempt from Bid Process Revenue: Cooperative Purchase Expenditure: $149,270 Competitive Sealed Bid Matching Funds Required: Small Works Roster Sources(s)of Matching Funds Vendor List Bid Fund# 148 ✓ RFP or RFQ Munis Org/Obj Other: APPROVAL STEPS: STEP 1: DEPARTMENT CERTIFIES COMPLIAN9 WITH JCC 3.55.080 AND CHAPTE 42.23 RCW. CERTIFIED: ❑ N/A:1=1 (4` i( rIC44N-G �/I7/2'Y Si ature 1 Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL AGENCY. �' CERTIFIED: El N/A: El (�` �c signature I Date STEP 3: RISK MANAGEMENT REVIEW (will he added electronically through Laserfiche): Electronically approved by Risk Management on 1/18/2024. STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche): Electronically approved as to form by PAO on 1/18/2024. Standard COA grant language previously approved by the PAO. 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 1 RTRYAN° TURNER SPECIALTY RT Specialty is a division of RSG Specialty,LLC.RSG Specialty,LLC is a Delaware limited liability company and a subsidiary of Ryan Specialty,LLC. In California:RSG Specialty Insurance Services,LLC(License#0G97516). September 21, 2023 RECEIVED Bick Insurance Agency LLC 16720 116th Ave SE#B3 FEB 0 1 2024 Renton,WA 98058 • JEFFERSON COUNTY COMMISSIONERS Attn: John Bick Re: Pfeifer HouseOWL 360 DBA Pfeifer.House-0100251968-0 Submission#:23028772E Enclosed is an endorsement changing the above policy as follows: Please see attached carrier endorsement. Also note the enclosed invoice for the additional premium charge of$2,491.24. Feel free contact us if you have any questions or require further assistance. Best Regards, Amanda Bolin Brokerage Assistant RT Specialty amanda.bolin@rtspecialty.com THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY DECLARATIONS CHANGES Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100251968-0 09/20/2023 12:01AM at the Named Insured OWL 360 address shown on the Declarations Additional Premium: Return Premium: $2,440 Policy Change Number: 1 This endorsement modifies insurance provided under the following: ALL COVERAGE FORMS The following item(s): Named Insured Insured's Mailing Address Policy Number Company Effective/Expiration Date Insured's Legal Status/Business of Insured X Retroactive Date Premium Basis Additional Interested Parties X Coverage Form and Endorsements X Exposures Deductibles X Covered Property/Located Description Classification/Class Codes Rates X Description of Operations Broker of Record Increase/Decrease in Policy Values Company Fee Amendment Location Address Extended Reporting Period Endorsement is(are)changed as shown {See Additional Pages(s)}: The above amendments result in a change in the premium as shown above. If this box is checked,any additional premium shown above is considered non-refundable as of the effective date of the endorsement. POLICY CHANGES ENDORSEMENT DESCRIPTION Amend Exposure for Class Code:44471.05-Long Term Care-Group Homes to: 15 Beds Amend Forms: AHL2058-0117-Limitation of Coverage A to Designated Location(s)-(General Liability) AHL2059-1019-Limitation of Coverage to Designated Location(s)-(Professional Liability-Claims Made) Add Form:AHL2054-0920-Separate Retroactive Date and Termination Date for Each Location Amend Description of Business and Retroactive Date to: RETROACTIVE DATE Professional Liability: Refer to Form:AHL2054-0920-Separate Retroactive Date and Termination Date for Each Location at 12:01AM at the address of the named insured as shown above. ADF4004 0721 Page 1 of 2 General Liability: Refer to Form:AHL2054-0920-Separate Retroactive Date and Termination Date for Each Location at 12:01AM at the address of the named insured as shown above. THIS INSURANCE DOES NOT APPLY TO INJURY OR DAMAGE WHICH OCCURS BEFORE THE APPLICABLE RETROACTIVE DATE, SHOWN ABOVE. DESCRIPTION OF BUSINESS Description of Operations: Social Service Agency-2 Locations Business Type: Signed By: • 1. (Authorized Representative) ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. ADF4004 0721 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. LIMITATION OF COVERAGE A TO DESIGNATED LOCATION(S) - (GENERAL LIABILITY) Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100251968-0 09/20/2023 12:01AM at the Named Insured OWL 360 address shown on the Declarations Additional Premium: Return Premium: $0 $0 Policy Change Number: 1 This endorsement modifies insurance provided under the following: ALLIED HEALTH GENERAL LIABILITY COVERAGE SCHEDULE Designated Location(s): 711 Taylor St, Port Townsend,WA 98368 319 Fir Street, Port Townsend,WA 98368 SECTION I-COVERAGES,COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 1. Insuring Agreement,part b. (1) is deleted and replaced with the following: b.This insurance applies to "bodily injury"or"property damage" only if: (1)The"bodily injury"or"property damage" is caused by an "occurrence"that takes place at a Designated Location identified in the Schedule above, and the"bodily injury"or"property damage"also takes place at a Designated Location; ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AHL2058 0117 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITATION OF COVERAGE TO DESIGNATED LOCATION(S) - (PROFESSIONAL LIABILITY - CLAIMS MADE) Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100251968-0 09/20/2023 12:01AM at the Named Insured OWL 360 address shown on the Declarations Additional Premium: Return Premium: $0 $0 Policy Change Number: 1 This endorsement modifies insurance provided under the following: ALLIED HEALTH PROFESSIONAL LIABILITY COVERAGE SCHEDULE Designated Location(s): 711 Taylor St, Port Townsend,WA 98368 319 Fir Street, Port Townsend,WA 98368 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this policy) SECTION I — COVERAGES, PROFESSIONAL LIABILITY, 1. Insuring Agreement, part a. is deleted and replaced with the following: a. We will pay, in excess of the Deductible shown in the Declarations,those sums any"insured" becomes legally obligated to pay as"damages"and "defense costs"arising out of"bodily injury" because of a "health care incident" that takes place at a Designated Location identified in the Schedule above. However,we will have no duty to defend the"insured"against any"suit"seeking"damages"for"bodily injury"to which this insurance does not apply. We may, at our discretion, investigate any"health care incident" and settle any"claim" or"suit"that may result. But: (1)The amount we will pay for"damages"is limited as described in Section III—LIMITS OF INSURANCE AND DEDUCTIBLE; and (2) Our right and duty to defend ends when we have used up the applicable Limit of Insurance in the payment of judgments, settlements or"defense costs". In such case,we shall have the right to withdraw from further defense, payment or settlement of any "claim" by tendering control of such "claim" to you. You agree to accept such tender as a condition of this Policy. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AHL2059 1019 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SEPARATE RETROACTIVE DATE AND TERMINATION DATE FOR EACH LOCATION Attached To and Forming Port of Policy Effective Date of Endorsement Named Insured 0100251968-0 09/20/2023 12:01AM at the Named Insured OWL 360 address shown on the Declarations Additional Premium: Return Premium: $0 $0 Policy Change Number: 1 This endorsement modifies insurance under the following: ALLIED HEALTH PROFESSIONAL LIABILITY COVERAGE ALLIED HEALTH GENERAL LIABILITY COVERAGE The Retroactive Date(s) shown on the Declarations Page Is(are)amended as shown below: SCHEDULE OF LOCATIONS, RETROACTIVE DATES AND TERMINATION DATES Location: Professional Liability General Liability Termination Date: Retroactive Date: Retroactive Date: 711 Taylor St, Port Townsend,WA 98368 07/29/2023 07/29/2023 319 Fir Street, Port Townsend,WA 98368 09/20/2023 09/20/2023 All dates shown in the Schedule above are effective at 12:01 AM at the address of the"named insured" shown on the Declarations. Each Location shown in the Schedule above is added to this Policy, however,this insurance shall not apply to any injury or damage: 1. arising directly or indirectly out of, related to,or, in any way involving the ownership, maintenance or use of any Location after its Termination Date;or 2. that takes place at the Location after its Termination Date. The Limit of Insurance shown on the Declarations Page applies to all injury or damage that takes place on or subsequent to the Retroactive Date(s)and prior to the Termination Date(s), if applicable,shown above at each Location in the Schedule above, or the end of the"policy period",whichever is earlier. For the purposes of determining the applicable Retroactive Date, all injury or damage logically or causally connected by any common fact, circumstance, situation,transaction, event,service,advice or decision will be deemed to have first taken place at the time the first of such injury or damage took place. All such injury or damage will be deemed to be the same injury or damage even though the nature and extent of any resulting injury or damage may change and even though the resulting injury or damage may be continuous, progressive,cumulative,changing or evolving, and even though the resulting injury or damage may be or may involve a continuous or repeated exposure to substantially the same general harm. Under no circumstances shall more than one Retroactive Date apply to any related injury or damage. All "claims" based upon such related injury or damage shall be deemed to constitute a single "claim"and be subject to a single Each Claim Limit of Insurance. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AHL2054 0920 Page 1 of 1 ACC0REP® E(MM/DD/YYYY) �•--' CERTIFICATE OF LIABILITY INSURANCE DAT02/07/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: John Bick Bick Insurance Agency PHONE FAX 16720 116th Ave SE Ste B3 (A/C,NO,EXT):425-228-6090 (A/C,No):425-307-6229 E-MAIL Renton WA 98058-5277 ADDRESS: jbick@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Kinsale 38920 INSURER B: Owl 360 dba:Pfeifer House INSURER C: loc Pfeiffer House and Parliament INSURER D: 711 Taylor Street INSURER E: Port Townsend WA 98328 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea Occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y Y 0100251968-1 07/29/2023 07/29/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PROJECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS SCHEDULED BODILY IN URY(Per accident)$ ONLY AUTOS J HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ EXECUTIVE OFFICER/MEMBER N/A EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 3,000,000 A PROFESSIONAL LIABILITY 0100251968-1 07/29/2023 07/29/2024 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Jefferson County is listed as additional insureds CERTIFICATE HOLDER CANCELLATION Jefferson County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1820 Jefferson St DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED R ENT/1TIVE9 Port Townsend WA 98368 �� �p� ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved -n , ,,