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HomeMy WebLinkAboutPeers Rising Amendment 1i Kittitas County Public Health Public Health Contract/Agreement Review Form 116-Public Health Contract/Agreement Information Contract/Agreement Agency: Peers Rising (Previously KCRCO) _ Contract/Agreement Title: AFS between Kittitas County and Peers Rising Amendment 1 Begin Date: 03.01.26 End Date: 12.31.27 Total $ Amount: See Exhibit B (original Contract) Contract/Agreement #: PHMH-018 Contract/Agreement Summary: The amendment to the AFS is established to clarify allowable costs and billing documents submitted by the contractor for reimbursement to the county. Kittitas County Prosecutor and Auditor Review and Comment: APPROVED A TO FORM: 36 2L Signature o Prosecu ar's ffice Date Signatu f Auditor's Off(cef Date n...l...,+ I..F...w.�+inn Revenue Code(s): 5U I7j . w Expense Code(s): ❑ Agency is not suspended/disbarred Not Checked (reason) Pass Through Information Agency to Pass Through Amount to Pass Through Expense Code: Sub -Contract Approved Date: ADMIN I Version: 0 _Supersedes: 0 Date Adopted: 12/01/2024 1 Modified By: Katie Odiaga I Approval By: Chelsey Loeffers KITTITAS COUNTY AMENDMENT TO: Agreement for Services between Kittitas County and Peers Rising PHMH-018 Amendment 1 This Amendment ("Amendment") is made as of March 1, 2026 by and between Kittitas County (hereinafter "County"), a political subdivision of the State of Washington, and Peers Rising (hereinafter "Contractor"). WHEREAS, the parties entered into an agreement dated January 1, 2026 through December 31, 2027 (the "Agreement"); and WHEREAS, the parties desire to amend the Agreement; NOW, THEREFORE, the parties agree as follows: 1. The Agreement is amended as follows: In Attachment B, Compensation, add the following language: The purchase of supplies, equipment, and materials for daily general activities, including but not limited to arts and crafts, games, food, and supplies for recreational activities are not allowable. Any uses of these funds outside of the listed allowable uses must be approved by Kittitas County in advance of the expenditure, in writing. The Contractor must contact the contract manager in advance for review and approval of any purchases of unclear allowability. In Attachment B, Compensation, under Reimbursement Procedures, add the following language: Contractor must submit the Non Payroll Expenses Invoicing Template with invoices that include non -payroll expenses. Add Attachment I to include the Non Payroll Expenses Invoicing Template (attached) 2. No Other Changes All other terms of the Agreement remain unchanged and in full force and effect. Kittitas County Amendment to: ILA, AGS, InterDept. MOU (8/28/25) Page 1 of 2 IN WITNESS WHEREOF, the parties have executed this Amendment as of the latest date written below. KITTITAS COUNTY BOARD OF COUNTY COMMISSIONER: Cory Wright, Chair Brett Wachsmith, Vice -Chair Laura, Osiadacz, Commissioner Date: Attest: Clerk of the Board ❑ Julie Kjorsvik ❑ Mandy Buchholz Kittitas County Amendment to: ILA, AGS, InterDept. MOU (8/28/25) Page 2 of 2 C] uirr iras County Kittitas County Public Health Public Health Contract/Agreement Review Form Deparr men Today's Date: 12/10/2025 Legal Request #_1 12085 Fund/Department: �_ Agenda Date: Contract/Agreement Information Contract/Agreement Agency: Peers Rising (Previously KCRCO) Contract/Agreement Title: Agreement for Services between Kittitas County and Peers Rising Begin Date: 01/01/2026 End Date: 12/31/2027 Total $ Amount: See Exhibit B Contract/Agreement #: PHMH-018 Contract/Agreement Summary: The agreement for services funds Peers Rising Warmth and Wellness: Resilience and Life Skills Support in Kittitas County Project as recommended by the 1/10th of 1% Mental Health and Chemical Dependency Advisory Board. Kittitas County Prosecutor and Auditor Review and Comment: Signature of Prosecutor' RECEIVE I Date Signature of Auditor's Office Date Budget Information Revenue Code(s): 105 560.313.4000 Expense Code(s): Agency is not suspended/disbarred Pass Through Information Agency to Pass Through Amount to Pass Through Sub -Contract Approved Date: Not Checked (reason) Expense Code: ADMIN I version: 0 1 Supersedes: 0 1 Date Adopted: 12/01/2024 I Modified By: Katie Odiaga I Approval By: Chelsey Loeffers 12/15125, 3:18 PM SAM.gov Entity Information PEERS RISING Active Registration Unique Entity ID CAGE/NCAGE CY39Z6JRAL25 (blank) Physical Address 211 W 3RD AVE Ellensburg, Washington 98926-3026, United States Purpose of Registration Federal Assistance Awards Only Version Current Record BUSINESS INFORMATION Doing Business As (blank) Division Name Peers Rising Congressional District Washington 08 Owner Immediate Owner URL (blank) Division Number (blank) State/Country of Incorporation 14%Jashington, United States CAGE Legal Business Name (blank)(blank) Highest Level (blank) (blank) Mailing Address 110 West 6TH Avenue Pmb 118 Ellensburg, Washington 98926, United States Registration Dates Activation Date May 8, 2025 Submission Date May 7, 2025 Initial Registration Date Feb 1, 2024 Entity Dates May 7, 2026 https://sam.gov/entities/view/CY39Z6J RAL25/coreData?status=Ac1ive&emrKey Va1ue=21736408-1746623032347606 1 /2 12/15/25, 3:1B PM SAM.gov Owner Entity Start Date Sep 29, 2021 Fiscal Year End Close Date Dec 25 Executive Compensation Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of P.L. 110-252. arnending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligibie award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions. SAM SEARCH AUTHORIZATION I authorize my entity's non -sensitive information to be displayed in SAM public search results: Yes ENTITY TYPES Business Types Entity Structure Other Entity Type Business or Organization Profit Structure Non -Profit Organization Organization (blank) Factors Socio-Economic Types Check the registrant's Reps & Certs. if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SSA -certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration. hftpsllsam.gov/entdies/viewiCY39Z6j RAL251coreData?status=Active&emrKeyValue=21736408-1746623032347606 zrz t . e'�k -`'� • f' _— .. - ,fir - 1 ^F - KITTITAS C-01 TT KITTITAS COUNTY AGREEMENT FOR SERVICES PHMH-018 (Prev KCRCO) This Agreement for Services (hereinafter "Agreement") is entered into by and between Kittitas County (hereinafter "County"), a political subdivision of the State of Washington, and Peers Rising (hereinafter "Contractor"). The purpose of this Agreement is as follows: Peers Rising will expand youth prevention and recovery services in Kittitas County through peer -led youth support groups, family life skills workshops, and winter wellness supply distribution. This project reduces stigma, strengthens resilience, and improves access to free behavioral health support for youth ages 12-25 and their families. The term of this Agreement shall be from January V, 2026, through December 315t, 2027, unless the Agreement is terminated early or its term is extended as provided herein. The parties' addresses and points of contact for the administration of this Agreement are as follows: COUNTY 507 N Nan um Street Ste 102 Ellensburg, WA 98926 Kasey Knutson Human Services Manager Human Services Kasey.knutson@co.kittitas.wa.us (509) 962-7515 CONTRACTOR 110 W 6th Ave, PMB 118 Ellensburg, WA 98926 Brandi Amundson Executive Director brandi a peersrisingwa.org (509) 312-8041 This Agreement includes the following, which are attached hereto and hereby incorporated by this reference: Attachment "A": Scope of Work Attachment "B": Compensation Attachment "C": Insurance Requirements Attachment "D": Reporting Attachment "E": General Terms and Conditions Attachment "F": W-9 (Contractor must complete and return to the County for payment) Attachment "G": Retirement Status Form (Contractor must complete and return to the County for payment if Contractor is an individual, as opposed to a corporate business entity) Attachment "H": Subcontracting Kittitas County Agreement For Services (rev. 5/14/25) Page 1 of 24 IN WITNESS WHEREOF, this Agreement has been executed by and on behalf of the parties through their authorized representatives, effective as of the latest date written below. KITTITAS COUNTY BOARD OF COUNTY CO 55IONERS Ch r Vic air nP Date: o' 2� Attest: rd uk r?tlnw Kittitas County Agreement for Services (rev. 5/14/25) Page 2 of 24 CONTRACTOR Signature Eck 1 Printed Name Title r Date: f ^ J ATTACHMENT "A" SCOPE OF WORK in addition to providing all material and labor, the Contractor shall perform the following activities as indicated in your Performance Indicators and Evaluation Workbook for the Warmth & Wellness: Resilience and Life Skills Support in Kittitas County project: 3 Facilitate workshops Expand youth programs Support groups Involvement and coordination of community events a Develop advocacy and awareness campaigns Hire additional staff Expand available services in our three Peers Rising hubs Staff training and Development Coordinate community outreach, engagement, and promotion Provide referrals for behavioral health screenings Implementing early intervention programming Partner with healthcare providers G Expand availability of crisis services Hire Peer Support Specialist Winter supply distribution Direct aid distribution Evaluation and reporting Kittitas Counb/ Agreement for Services (rev. 5/14/25) Page 3 of 24 ATTACHMENT "B" COMPENSATION THE COUNTY WILL NOT PROCESS PAYMENT FOR SERVICES RENDERED UNDER THIS AGREEMENT UNTIL CONTRACTOR SUBMITS A COMPLETED W-9 (SEE ATTACHMENT F ). As full compensation for satisfactory performance of the work described in Attachment "A", and within pay actor the thirty (30) days of receiving Contractor's itemized invoice, voiceh 5346,309 in addition Linn tor$1Z5,754f remaining from the plus any applicable taxes as detailed in Contracto terminated contract, minus amounts billed through that contract prior to termination for the months of October, November, and December 2025. Allowable direct expenses include, but are not limited to, salaries, wages, benefits, direct client services, promotion, outreach activities, supplies, professional development and training, equipment, and subcontracts. Ail expenses must be necessary and directly reiaredto the pe of work as request process outlined Attachment cess for I ne- tem expenses) refer to their approved budget document submitted through the funding que-item contract Any changes or updates to the budget must be approved by Kittitas County through the appointed manager in advance of the expenditure, in writing. Unless otherwise provided herein, Contractor shall be solely responsible for Contractor's travel and related expenses. Any uses of these funds outside of the listed allowable uses must be approved by Kittitas County in advance of the expenditure, in writing. All funding is based on local tax and fee revenue. If local economic conditions result in insufficient funds to compensate at the stated levels, the County reserves the right to renegotiate funding amounts to remain within available revenue balances. The County will notify the Contractor immediately if financial forecasting or actuals indicate such a circumstance_ All funds must be spent by December 31't, 2027. No extension of the funding period will be granted. Reimbursement Procedures A. The Contractor shall submit invoices for services due once a month, which shall be emailed to Katie Odiiaga, Kittitas County Public Health Department, at katie.odia a co•kittit alendsr month in which B. All invoices must be submitted by the last day of the month following the services were delivered. C. The Contactor must provide adequate backup documentation to support costs in each invoice. This includes a general ledger from the financial accounting system detailing transactions and expenditure dates for allowable activities within the period of performance. Payroll expenses must show employee fcan names, hourly rate, number of hours, total pay. and project code. Beneaf the receipt ipt o paymentut should include project code. Non -payroll expenses must include a copy invoice. Payments to subcontractors must be listed as a specific line item per subcontractor. D. All invoices must include invoice date and an invoice number. E. All invoices must also be accompanied by an updated Contractor Spending Form, as provided by Kittitas County, to ensure that billing record keeping matches County records. F. Failure to submit required monthly deliverable reports as outlined in Attachment A: scope of Work may result in delayed reimbursement payments or denial of invoices. Kittitas County Agreement for Services (rev. 5/14/25) Page 4 of 24 G. Kittitas County is not liable for services provided unless the invoice is received on time or prior arrangements are agreed to in writing signed by the County. In no event shall payments under this agreement total more than $346,309 in addition to $125,754 remaining from the terminated contract, minus amounts billed through that contract prior to termination for the months of October, November, and December 2025 Kittitas County Agreement for Services (rev. 5/14/25) Page 5 of 24 ATTACHMENT "C" INSURANCE RE iJIREMENTS Contractor shall secure and maintain in effect at all times during performance of work under this Agreement such insurance as will protect Contractor, its employees, and agents from all claims, losses, harm, costs, liabilities, damages and expenses arising out of Contractor's performance under this Agreement, including but not limited to personal injury (including death) or property damage. All insurance shall be issued by companies admitted to do business in the State of Washington and have a rating of A-, Class VII or better in the most recently published edition of Best's Reports unless otherwise approved by the County. If an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies must comply with Chapter 48.15 RCW and 284-15 WAC. At a minimum, Contractor shall maintain and provide proof of the following selected options: Commercial General Liabilit Insurance Coverage limits not less than: $1,000,000 per occurrence, for all covered losses o $2,000,000 general aggregate $1,000,000 products & completed operations aggregate $1,000,000 personal and advertising injury, each offense to include the County and its officials, employees and agents The policy must be endorsed as additional insureds. Commercial Automobile Liabilit Insurance Automobile Liability for owned, endorsement attached aif pollutants' are to bered, and leased vehicles, ttransported, C endorsement and a Coverage lirnits not less than: $1,000,000 combined single limit 1] Excess or Umbrella Liabilit ■ Contractor shall provide Excess or Umbrella Liability coverage of $5,000,000. This Excess or umbrella Liability coverage shall apply, at a minimum: to both the Commercial General and Automobile Insurance policy coverages. If used to meet limit requirements, coverage must be at least as broad as specified for underlying coverages, and must cover those insured in the underlying policies. ■ This requirement may alternatively be satisfied through Contractor's primary Commercial General and Automobile Liability coverage, or any combination thereof. The policy must be endorsed to include the County and its officials, employees and agents as additional insureds. in addition to policy limits. Coverage shall be "pay on be ,with defense costs payable There shall be no cross liability exclusion precluding coverage for claims or suits by one insured against another. Workers' Com ensation & Em is er's Liabilit p Contractor shall provide Workers Compensation and Employer's Liability insurance on a ired by law with employer s liability state -approved policy form providing benefits as requ limits no less than $1,000,000 per accident or disease. Kittitas County Agreement for Services (rev. 5/14/25) Page 6 of 24 ❑ Professional Li a bili ty I Errors and ❑missions Liabilit p Coverage limits not less than: $1,000,000 each claim Contractor must provide evidence of this coverage on a policy form appropriate to Contractor's profession. Contractor shall furnish to the County a Certificate of Insurance, with endorsement where required above, as evidence that policies providing insurance required by this Agreement are in full force and effect. Contractor's insurance polities required above must apply on a primary non-contributing basis in relation to any other insurance or self-insurance available to the County. Contractor agrees to provide notice to the County at least thirty (30) days prior to cancellation, or any material alteration or non -renewal, of any of the above -required insurance coverages. Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools, machinery, equipment, or motor vehicles owned or utilized by Contractor, or Contractor's agents, employees, suppliers or contractors, as well as to any temporary structures, scaffolding and/or protective fences_ Contractor shall have sole responsibility for ensuring the insurance coverage and limits required herein are also obtained by any subcontractors. NOTE Notwithstanding any other provision(s) of this Agreement, no contract shall form under this Agreement until and unless the following are provided to the County: (1) a copy of the Certificate(s) of Insurance with all required endorsements, properly completed and in the amounts required, and (2) where requested by the County, a copy of the required insurance policies, including all required endorsements. Kittitas County Agreement for Services (rev. 5/14/25) Page 7 of 24 ATTACHMENT "D" REPORTING Contractor shall provide quarterly progress reports using the template provided. Please submit progress reports to the clerk at iheaIthandhumarise rvices co.kitdtas.wa.us. ❑ Quarter 1 (January -March) report due on the last day of April. Quarter 2 (April -June) report due on the last day of July. Quarter 3 (July -September) report due on the last day of October. c Quarter4 (October -December) report due on the last day of January. The report shall include, at a minimum: 1. A narrative of project activities during the reporting period, including progress on the activities outlined in your Scope of Work (Attachment "A"). 2. A narrative of project successes during the reporting period. 3. A narrative of project challenges during the reporting period. 4. A data summary of the following outputs as indicated in your Performance Indicators and Evaluation Workbook (submitted in application process): a. Number of unique individuals exposed to/number of public awareness campaigns and messages b. Number and percentage of unique individuals who have demonstrated improvement in knowledge, attitudes, or beliefs related to prevention and/or promotion c. Number of policies developed and implemented as a result of the grant d. Number of organizational changes made to support improvement e. Number of new staff hired f. Number of unique individuals trained in prevention or behavioral health promotion g. Number of unique individuals trained in trauma -informed care practices h. Number of unique individuals receiving or participating in evidence -based behavioral health - related services as a result of the grant i. Number of unique individuals screened for behavioral health or related interventions j. Number and percentage of unique individuals accessing services after referral k. Number of unique individuals referred to crisis or other behavioral health services for suicide risk, ideation, or behavior I. Number of unique- individuals trained in suicide risk assessment as a result of the grant m. Number of unique individuals screened for suicide ideation as a result of the grant n. Number of unique individuals screened for trauma -related experiences as a result of the grant o_ Number of organizational changes made to support improvement p. Number of new staff hired q_ Number of unique individuals trained in prevention or behavioral health promotion r. Number of unique individuals trained in trauma -informed care practices Kittitas County Agreement for Services (rev. 5/14/25) Page 8 of 24 The County retains the right to request clarification or additional information of the applicant as needed to assess project progress and/or appropriate use of funds. Failure to submit the required reports may result in delayed reimbursement payments, denial of invoices, or contract termination. Contracts, reporting, and invoicing documentation is subject to public disclosure. Please refrain from using individual names in these documents. These documents may be posted to the Kittitas County Public Department's Website at any time to provide transparency in the use of tax funding. Kittitas County Agreement for Services (rev. 5/14/25) Page 9 of 24 ATTACHMENT "E" GENERAL T1 RM5 AND CdNDiTIDNS 1.. 5co a of Contractor's Services: Contractor agrees to provide to the County services as set forth in Attachment "A". No materials, labor, or facilities will be furnished by the County, unless otherwise provided herein. All work performed under this Agreement shall comply with applicable laws and regulations. 2. Accauntin and Ra ment: Compensation to Contractor for services rendered under this Agre ement sha I shall be as set forth in Attachment "B". Where Attachment B' requires payments) by the County, pay be based upon billings, supported unless provided otherwise in Attachment "B by documentation of units of work actually performed and amounts earned, including, where appropriate, the total number of hours for the month and the total dollar payment requested. Unless specifically stated in Attachment "B", the County will not reimburse Contractor for any costs or expenses incurred by Contractor in performance of this Agreement. Where required, the County shall, upon receipt of appropriate documentation, compensate Contractor, no more often than monthly, through the County voucher system, for Contractor's services pursuant to the fee schedule set forth in Attachment "B". In the event Contractor fails to perform any of its obligations under this Agreement within the time specified herein, then the County may withhold all monies due and payable to Contractor until such failure to perform is cured or otherwise adjudicated. The County will not process payment for services rendered under this Agreement until Contractor submits a completed W-9 (See Attachment "E")_ 3. Taxes: Contractor understands and acknowledges that the County will not withhold Federal or State ontractor authorizes income taxes from payments made to Contractor. Where required by State �aee}! Awl I campensation received the County to make withholding for any taxes other than income taxes je.g by Contractor will be reported to the internal Revenue Service at the end of the calendar year in accordance with applicable IRS regulations. It is the responsibility of Contractor to make its necessary estimated tax payments throughout the year, if any, and Contractor is solely liable For any tax obligation arising from Contractor's performance of this Agreement. The County will pay sales and use taxes imposed on goods or services acquired hereunder as required by law. Contractor must pay all other taxes, including but not limited to: business and occupation tax; or taxes based on (2) Contractor's gross or net income, or (2) personal property to which the County does not hold title. The County is exempt from federal excise tax. 4. inde endent Contractor: Contractor's services shall be furnished by Contractor as an independent contractor, and nothing stated herein shall be construed to create a relationship of employer -employee or a guarantee of future employment. Contractor acknowledges that its entire compensation under this Agreement is specified in Attachment "B", and that Contractor is not entitled to any County benefits, including but not limited to: vacations pay, holiday pay, sick leave pay, medical, dental, or other insurance benefits, or any other rights or privileges afforded to Kittitas County employees. S. Assignment and Subcontracting: and Subcontracting: No portion of this Agreement may be assigned or subcontracted to any other individual, firm or entity without the express and prior written approval of the County. The Contractor may only subcontract work contemplated under this agreement if it obtains the prior Kittitas County Agreement for Services (rev. 5/14/25) Page 10 of 24 written approval of the County. If the County approves subcontracting, the Contractor shall maintain written procedures related to subcontracting, as well as copies of all subcontracts and records related to subcontracts. For cause, the County in writing may require the Contractor to amend its subcontracting procedures as they relate to this agreement, prohibit the Contractor from subcontracting with a particular person or entity, or require the Contractor to rescind or amend a subcontract. Every subcontract shall bind the Subcontractor to follow all applicable terms of this agreement. The Contractor is responsible to the County if the Subcontractor fails to comply with any applicable term or condition of this agreement. The Contractor shall appropriately monitor the activities of the Subcontractor to assure fiscal conditions of this agreement. In no event shall the existence of a subcontract operate to release or reduce the liability of the Contractor to the County for any breach in the performance of the Subcontractor's duties. Every subcontract shall include a term that County is not liable for claims or damages arising from a Subcontractor's performance of the subcontract. 6. Right to Review; Maintenance of Records: This Agreement is subject to review by any Federal or State auditor. The County or its designee shall have the right to review and monitor the financial and service components of the work performed under this Agreement by whatever means are deemed expedient by the County. Such review may occur with or without notice, and may include, without limitation, on -site inspection, inspection of all records or other materials which the County deems pertinent, and any and all communications with or evaluation by service recipients under this Agreement. Contractor shall preserve and maintain all records relating to this Agreement for six (6) years after termination or expiration of the Agreement, and upon request shall make them available for review by any Federal or State auditor, the County, and/or any persons authorized by the County. 7. 311lpdification 7.1. This Agreement may be amended by mutual agreement of the parties. Any such amendment shall be in writing and signed by both parties. 7.2 The County may unilaterally amend this Agreement at any time by written notice ("Change Notice") to Contractor, to modify the work to be performed under this Agreement, within the general scope of the Agreement. Such changes may include, but are not limited to, changes in the exact scope of work to be performed (including modification, substitution, addition, or deletion of required tasks) and changes to the schedule of performance. If any such Change Notice causes an increase or decrease to Contractor's cost of, or the time required for, performance of the work, an equitable adjustment in the compensation to Contractor and/or in the schedule for the performance of the work shall be made by the County to reflect such an increase or decrease. Notwithstanding any dispute or delay in arriving at a mutually acceptable equitable adjustment, Contractor shall proceed in accordance with all Change Notices_ Within thirty (30) days after receipt of any Change Notice which, in Contractor's opinion, lacks an adequate adjustment, Contractor must submit to the County a written statement requesting a modified adjustment; otherwise, Contractor will forfeit its right to any such modified adjustment. The County retains the final right to determine adjustments hereunder. 8. Termination 8.1 This Agreement may be terminated at any time by mutual written agreement of the parties. 8.2 The County, by giving written notice, may terminate this Agreement at any time without cause and without further obligation to Contractor except for payment due for deliverables provided and/or services performed prior to the effective date of termination. An equitable adjustment in the contracted price for partially completed tasks will be made by the County, but such adjustment shall not include compensation for loss of anticipated profit on uncompleted work. Kittitas County Agreement for Services (rev. 5/14/25) Page 11 of 24 8.3 If Contractor defaults by failing to perform any of its obligations under this Agreement, or becomes insolvent, is declared bankrupt or commits any act of bankruptcy or insolvency, or makes an assignment for the benefit of creditors, the County may, by written notice to Contractor, terminate the Agreement, and at the County's option, obtain performance of the work elsewhere. if the Agreement gre m ntthiisg is reemterminated troder ❑this tis paragraph, Contractor shall not be entitled to receive any further pay ments obligations hereunder have been fully performed, and any extra cost or damage to the County shaii be deducted from any money due or coming due to Contractor.Furthermore, nru0 eclin the by thevent of CountyEn clnation Linder ompleting thehworlc,is aandp II Contractor shall bear the costs of any extra expense damages sustained, or which may be sustained, by the County. g.4 Termination of this Agreement by any means provided herein shall not excuse any party's performance of its obligations hereunder through the effective date of termination, except that the Coy shall not be obligated to pay for services that have not been performed or deliverables that have not been provide. 9. Indemnification 9.1 To the fullest extent permitted by law, Contractor agrees to indemnify, defend and hold the County and its departments, elected and appointed officials, employees, agents and volunteers, harmless from and against any and all claims, damages, losses and expenses, including but not limited to court costs, attorney's fees and alternative dispute resolution costs, for any personal or bodily injury, sickness, disease or death, for any damage to or destruction of any property (including the loss of use resulting therefrom), and for any other claims, damages, losses, and expenses sustained by the County, which (1) are caused in whole or in part by any act or omission, negligent or otherwise, of Contractor, its employees, agents or volunteers, or Contractor's subcontractors, their employees, agents or volunteers; or (2) are directly or indirectly arising out of, resulting from, or otherwise connected with the performance of this Agreement; or (3) are based upon Contractor's or its subcontractors' use of, presence upon or proximity to the property of the County. This indemnification obligation of Contractor shall not apply in the limited circumstance where the claim, damage, loss or expense is caused by the sole negligence of the County. This indemnification obligation of Contractor shall not o be limited In any way by any other workmen s the Washington State Industrial Insurance Act, RCW Title 51, or by application compensation act, disability benefit act or other employee benefit act, and Contractor hereby expressly waives any immunity afforded by such acts. The foregoing indemnification obligations of Contractor are a material inducement to the County to enter into this Agreement, are reflected in Contractors compensation, and have been mutually negotiated by the parties. 9.2 The County reserves the right, but not the obligation, to participate in the defense of any claim for damages, losses or expenses, and such participation shall not constitute a waiver of Contractor's indemnity obligations contained in any section of this Agreement. 9.3 In the event Contractor enters into subcontracts to the extent allowed under this Agreement, each such subcontractor shall indemnify the County on a basis equal to or exceeding Contractor's indemnity obligations to the County. 1o. Venue and Choice of Law: In the event that any litigation should arise concerning this Agreement, the venue for such action shall be in the Superior e laws of the Court State of State Washington. f Washington in and forthe County of Kittitas. This Agreement shall be governed by t Ikon -A r❑ riation of l unds� If the County does not appropriate sufficient funding for this Agreement 11. for any future fiscal period, the County will not be obligated to make payments for services performed after the end of the last fiscal period for which sufficient funding was appropriated. No penalty or expense shall accrue to the County in the event this provision applies. Kittitas County Agreement for Services (rev. 5/14/25) Page 12 of 24 12. Contractor Commitments Warranties and Representations: Contractor represents and warrants as follows: 12.1 Contractor is duly incorporated, v ilidly existing and in good standing under the laws of t:)e State of Washington, and has all requisite corporate 1x;,ver and authority to enter into and to perform its obk-,a,,ions under this Agreement. 12.2 Contractor has the authority to execute this Agreement, to make the representations and warranties set forth herein, and to perform its obligations hereunder. 12.3 This Agreement has been validly executed by an authorized representative of Contractor and constitutes a valid and legally binding and enforceable obligation of Contractor. 12.4 Contractor holds, or will obtain prior to commencing work under this Agreement, such licenses, permits and other authorizations from federal, state and local governmental authorities, or from any applicable industrial or professional certification or licensing bodies, as are necessary for the lawful performance of its obligations under this Agreement, and will maintain such throughout the term of this Agreement. 12.5 Contractor is not in violation of any applicable law, ordinance or regulation the consequence of which will or may materially affect Contractor's ability to perform its obligations under this Agreement. Contractor is not subject to any order or judgment of any court, tribunal or governmental agency which materially and adversely affects its operations or assets in the State of Washington, or its ability to perform its obligations under this Agreement_ 12.6 Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal or State department or agency. 12.7 None of the representations or warranties in this Agreement, and none of the documents, statements, certificates or schedules furnished by Contractor in connection with the performance of the obligations contemplated under this Agreement, contains or will contain any untrue statement of a material fact or amits or will omit a material fact necessary to make the statements of fact contained therein not misleading. 13. ownership of Items Producers: All writings, pr ogl,oms, data, reports, films, recordings, or other materials prepared by Contractor and/or its consultants or subs .L)ntractors, in connection with the performance of this Agreement, shall be the sole and absolute property of the County. The County will have all rights of ownership therein, including but not limited to the right to use, copyright, trademark, and/or patent, and the ability to transfer any or all ownership rights. 14. Intellectual PropertV Infringement: Contractor will defend and indemnify the County from any claimed action, cause or demand brought against the County, to the extent such action is based on the claim that information and/or materials supplied by Contractor infringe any intellectual property rights of any third party(ies). Contractor will pay all costs and damages attributable to any such claims finally awarded against the County in any action. Such defense and payments are conditioned upon the following: (1) Contractor shall be notified promptly in writing by the County of any notice of such claim; and (2) Contractor shall have the right hereunder, at its option and expense, to obtain for the County the right to continue using the information and/or materials that are the subject of such claim, provided no reduction in performance or loss results to the County. Kittitas County Agreement for Services (rev. 5/14/25) Page 13 of 24 15. Use of County Name and Lo o: Contractor may not use the County's name, logo(s), trademark(s), or as a current or former client, on its website or in any other identifying information, or identify the County marketing or promotional materials without the prior written consent of the County. 16. Disputes: Any dispute between the parties arising under or relating to this Agreement shall be resolved informally if possible. However, in the event such a dispute cannot be so resolved, it shall be adjudicated by a dispute board ("Dispute Board") in the following manner: Each party shall appoint one member to the Dispute Board, the members so appointed shall jointly appoint an additional member to the Dispute Board, and the Dispute Board will evaluate the facts, Agreement terms, and all applicable statutes and rules, and make a determination as to the proper resolution of the dispute. Such determination shall be final and binding on both parties. The cost of resolution will be borne as allocated by the Dispute Board. Alternatively, if agreed to in writing by both parties, the parties may forego the option of establishing a Dispute Board to adjudicate the dispute, and instead pursue arbitration, jointly selecting an arbitrator acceptable to both parties. In the event the parties choose to pursue arbitration, the parties agree that: (1) the fees and expenses of the arbitrator shall be shared equally by both parties to this Agreement, (2) each party shall bear its own costs and attorney fees, (3) arbitration shall be conducted according to the commercial arbitration procedures of the American Arbitration Association, and (4) the arbitrator's decision or award shall be final and binding on both parties. 17. Confidentialit Contractor, its employees, agents and volunteers, and any of Contractor's subcontractors and their employees, agents and volunteers, shall maintain the confidentiality of all information provided by the County or acquired by Contractor in performance of this Agreement, except upon the prior written consent of the Kittitas County Prosecuting Attorney or an order entered by a court after having acquired jurisdiction over the County. Contractor shall immediately provide the County notice of any judicial proceedings seeking disclosure of such information. Contractor agrees to indemnify, defend and hold harmless the County and its departments, elected and appointed officials, employees, agents and volunteers from all loss or expense, including but not limited to settlements, judgments, setoffs, attorneys' fees and costs resulting from Contractor's breach of this provision. Notwithstanding the foregoing, and to the extent that any information obtained by the Contractor hereunder is required to be shared with others by the explicit terms of the Scope of Work, this provision shall not be construed as prohibiting such sharing, provided there are no applicable laws or regulations prohibiting same. 18. Notices: Written notices required or permitted to be provided by one party to the other party under this Agreement may be provided by personal delivery, legal courier service, or certified mail, postage prepaid and return receipt requested. Notice may be provided by regular first class mail if simultaneous notice is provided by email. Notices given by Contractor shall be provided to the County's point of contact listed on page 1 of this Agreement, at the address there listed, and to the department head of the county department for which services under this Agreement are rendered. Notices given by the County shall be provided to Contractor at Contractor's address listed on page 1 of this Agreement. 19. Prevailirr Wage: Where labor to be performed under this Agreement is considered "public work" as defined in RCW 39.04.010, Contractor shall pay the prevailing rate of wages to all workers, laborers, or mechanics greement in accordance with RCW 39.12 and the rules and employed in the performance of work under this A regulations of the Washington State Department of Labor and Industries. The schedule of prevailing wage rates for the applicable locality or localities is determined by the Industrial Statistician of the Department of Labor and Industries. It is Contractor's responsibility to verify the applicable prevailing wage rate. It is understood that Contractor is responsible for obtaining and completing all required government forms relating to prevailing wage and submitting same to the proper authorities. Disputes regarding prevailing wage rates shall be referred for arbitration to the Director of the Department of Labor and Industries. The arbitration decision shall be final and conclusive and binding on all parties involved in the dispute as provided for in RCW 39.12.060. Kittitas County Agreement For Services (rev. 5/14/25) Page 14 of 24 20. Standard of Care: Contractor shall perform its duties hereunder in a manner consistent with that degree of care and skill ordinarily exercised by members of the same profession or industry as Contractor currently practicing or working under similar circumstances. Contractor shall, without additional compensation, correct any of its services not meeting such a standard. 21. Nondiscrimination 21.1 In the performance of this Agreement, Contractor will not discriminate against any employee or applicant for employment on the grounds of age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, 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 e disability; provided that the prohibition against discrimination because of such disability shall not apply if the particular disability prevents the proper performance of the particular worker involved. Contractor shall ensure that applicants are employed, and that employees are treated during employment, without discrimination because of their age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, honorably discharged veteran or military status, orthe 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. Such requirements apply, without limitation, to the following: employment, promotion, demotion, transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and programs for training, including apprenticeships. Contractor shall take such action with respect to this Agreement as may be required to ensure full compliance with local, state and federal laws prohibiting discrimination in employment. 21.2 Contractor will not discriminate against any recipient of any services or benefits provided for under this Agreement on the grounds of age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, 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. 21.3 If any assignment and/or subcontracting has been authorized by the County, said assignment or subcontract shall include appropriate safeguards against discrimination. 22. Waiver: The waiver of any default or breach of this Agreement, or the failure of a party to enforce any provision hereof or to exercise any right or privilege hereunder, shall not be deemed to waive any prior or subsequent default or breach, the enforcement of any provision hereof, or the exercise of any right or privilege hereunder, unless otherwise stated in a writing, signed by the parties hereto. 23. 13ead":nos: The headings of sections and paragraphs of this Agreement are for convenience of reference only and are not intended to restrict, affect, or be of any weight in the interpretation orconstruction of the provisions of such sections or paragraphs. 24. Survival: The provisions of paragraphs 2, 3, 4, 6, 8, 9, 10, 13, 14, 15, 16, 17, 19, 20, 22, 24, and 28 of these General Terms and Conditions shall sure the completion, expiration, termination or cancellation of this survive Agreement for any reason. 25. Complete Agreement: This Agreement constitutes the entire agreement between the parties and supersedes any and all other agreements, understandings, negotiations and discussions, oral or written, express or implied, regarding the work to be performed hereunder. The parties agree that no other representations, inducements, promises, agreements, or warranties relating to this Agreement, oral or otherwise, have been made between the parties. Except as provided elsewhere in this Agreement, no modification or waiver of this Agreement shall be valid or binding unless in writing and signed by the parties. Kittitas County Agreement for Services (rev. 5/14/25) Page 15 of 24 26. Severabili : If any term or condition of this Agreement or the application thereof to any person(s) or circumstances is held invalid, such invalidity shall not affect other terms, conditions or applications which can be given effect without the invalid term, condition or application. To this end, the terms and conditions of this Agreement are declared to be severable. 27. Time: Time is of the essence in the performance of this Agreement unless otherwise agreed between the parties in a signed writing. 28. Construction: This Agreement has been mutually reviewed and negotiated by the parties, and should not be construed against the drafter. 29. A regiment Not for Benefit of Third Parties: This Agreement is entered into solely for the benefit of the parties hereto and vests no rights in, nor is it enforceable by, any third parties. Kittitas County Agreement for Services (rev. 5/14/25) Page 16 of 24 Before you begin. For ATTACHMENT 'T" Request for Taxpayer Give form to the Identification Number and Certification requester. Do not sends the IRS. 'at,on. Go to VA-Av.jrs.gov1FormW9 for instructions and the latest information. Forrr "1-0. A-Vt- •(3v" 2 3 LJ­ 12.-.: 1 t I ' . c , m! t, r i .. ­rifd '.,r I" �t . ' '.r J 2 J F l; c, -, " J�P-, ' F r 713"C" 1 P r! ­.k L; QL N.t,: ;c it ow I for.,:' :1 Qr .z 3b -ol r 11 Fir 01 ls_, Colin- -! Ja� •Ou o z " ;1V 1 6 r -, , i 7 P :Cd,! Ta,p Y"Id,njifiration Nu�mb,, th, CEIN ell our -r. -ir p7jjo!E •r,!­.­,r SSr. ! lr-�W 1, L- . -, o, r For-_ n LLLI ;c! mar, 3r d. r. i rzl!-, I! df 3 or mCrtr Tint - Note: 1 41— 1 also 7T r fC. 17 11r' L, der p-elafties or jr --I to ir, ;t,- jj.jrrttr ��­lo.,.n or 'tFO­ y -;Lxp 3V!lf lj.±nl.l tw ;:.:;j,!C FO t.­'rkj.P b� I --j—derdz. :i RS, a-,c,:. --,,Z to zl,,c qlirj icloinq: :wd I j S !,Zr, or OCh­ j S cl,:ii cd To d dic,j -(j -,x„iripr toz i: :c,r C, 0" •F: -Q L);IC Certification instructions. Yc-; l­ [Vd[ je, -'s cr -,7, iz ­r ,n r?r r-LA r, ar rrel c!• ,�,!-Iion 3i 71 "'1 Ullci Fl iur L, at of Fit,) r i:ln Irr ,r -,t 'r J o 7r Sign sigrlawro 0' Dot, Here I U,S. porn.n General Instructions FuWm dcv,-Jupmon-S =GnP W-9 -1 tf,,if A-& T What's New L '4 "tV s-11,1-1d -?1U-1 n,z;k A-1 I So�q,,j n h n, i I d ;11,. - -.in N of io­K L-Z LOA 11PO ";' :t:' ! 11-­-"';, t Kittitas County Agreement for Services (rev. 5/14/25) Page 17 of Z4 T:-t*Lfp -r hip r,?_Sr. 1j Ica, pig. t pw., -40 4T,,�j K trd is -I S11 I' ,rinirtts 3 1�-L-trli I.Diizi jr— Purpose of Form Paga 2 Form W-9 (Rev- 3-2024) mrsst obtain your earmc! taxpap°r identification number (1 IPl}, which may be roux social secunry number [SSP1}, i di e dentification umber ,denlifgcaton number (MPp. adoption raxpay tATIP4, =a employer identification number IGM to report an an r information return the amaunl pad 10 you. ar ather amount repotabre on an Information retum. Erainples of infomtation returns include, but are not limited to, the fallowing. • Form io99-(NT iinterest earned or paid)_ • Fong 1099-DPI (dividends, including those from stocks or mutual funds). • Form 1099-14iISC (various ryoes of income, prizes, awards. or gross proceeds). • Form 1099-NEC (nonemployee compensation). Form 10g9-e (stock or mutual fund sales and certain other transactions by brokers). • Form 1099-S (proceeds from real estate transactions) - Form 1099-K (merchant card and third -Patty netvrark trartsaclegns}. • Form 1098 (home mortgage interest!. tog&E !student iaan interest). and 1 o98-T (tuition)- * Form log�C (canceled debt). • Form 1099-A (acquisibon or abandonment of secured prope,WY) Use Farm W-9 only if you are a U.S. persan (mcluding a resident alien), to provide your correct 1101. Caution: it you don't return Form W-9 to the rv-Auester with a TiPl. you might be sutKect to backup withholding. See YMat is backup trithhanding, later By signing thr> filled -out form, you: I C�r01PJ that the TIP! you areglv,ng �s correct for you ar wailing for a number to be issued: subject to bac 2 C,. F6fy that you are not kup withholdn9: °r 3- Cla1m exemption From backup withholdng if you are a U-5. exempt payee: and s C4nifri to your na,_for4Kn $talus for purposes of 'rnshitofdint} under ,hapt.r 3 or s of rite Cade fit appi[r able): and 5. Cerb,Ty that PATCA jodefsh entered on this Irting raiyn correct. anySea What rs that you are adiemPtatee. learn kurhsr nkwthe moattw F:iTG4 Repo g- _ (tote: if you are 3 U.S. parson and a req m a th �yorueros e s rm i�aon ;f tr,an Form W-9 ro r-quest your TIN. you it is substantial*i similar to this Form W-9- pefnition a[ a U.& person. For led=raf tax purposes you are considered a U.S. Person if you are: • An vidrviduaf who is a U.S. c t+'-'-n ar U-3- r [dent align: • A aartners lip, corporahan. Ampan . qr ass("ziun created nr organized in tha united States ou under tiro :aivs If t! a Jnired States: • An estate (other than a foreign esMaJ: or • A domestic trust tat defined in Regoatrons section 301.7701-71. Establishing US- status for purposes of chapter 3 and chapter 4 whhliotding. Payments made fo farxgn Pe sons, inclt,d'ing ep�3ds. may distributions. alk ens of irlr_ me. or transfers of sales prcc. be st,rpiact to utth,holding ender r:laptar 3 cv chapter 1 of th - � ad. fsec9cas 1 a-f 1-t174i Undef those reties. if a Form W-9 or other certification of nor;-Fo am—ssbip ipayad gaR rY ppkes pry mplion agent. 'ra:Fsfer??- Wparut . ,,Is tt`at .nav require the payot to=siihhold aaptieable fax from the recrprent owner. trarsf?for. ar parfneripayaa)- 3-a pub- 515- 1,Ph1hholding 7f Tax on Nonr•_>;rdent Aliens arxl Foreign Ertlines. The f9llavarg persons ttuscr provtdle Form `PI-9 to the payor W purposes of Fsrabgshrnq its nor -foregn starers- • Ire (he rase of a des egardad •Yr,(itY vAlft a U.S. o•:rner- Etta U.S. owner of the disr--gwded entity andnoi Medisregardad -Fairy. • in the case if a grantor tr qI vnth a U.S_ grantor or other U.S. o•.vs—r. gersers1ly, the U.3- grantor or alher U 3. aster of the grantor trust and notVta grantor tr'-ist (ola • In the case of a U-S. trust rer than a grantor tr,,sq, the U.S- rust and not the beneticianes of the lust. SaN puu. i' -3for mar-; inforrnalan or provodutg a Ferric ;4 •g ar a cenifieaton of iron -foreign s(alus to avoid :vilhho[dsng. Kittitas County Agreement for Services (rev. 5/14/25) Page 18 of 24 Foreign person- If you are a (orexyn poise" or the U S. branch der foreign bank Ghat has elected;o be treated as a U-3. *on b9n far it_�ulator s Section t.1.1-t 1 1(Al(21fr+I Or 7the' appirca chapter 3 ar a ourposes ). do not use Farm W-9. fnsread. use the appropriate Form W 8 or Form 8233 {s 3e Pub. 5 4 a 1 6re a t(d). or quatifsed fcraigr+ par!$rgn itrF,d arxi°r Rego on kinds. a partnerslnp that is svhaly averted Gy gtrafrfied Fars gn pertse Iha( is treated as a non.,oretgn Parson for pis of whir, 1s45 Withholding. do not Use Farm W-8. fnstcad- use Form W-sal> (or other ceriiflcation of m)rt-foreign stat[as) Nonresident tifien wfto becomes aresident aGer+• var,2faltY• Orgy s ronna5idan( alien individual may Use :he terms of a sax treaty to reduce ❑r eliminate f1.5 trx NtrtJin . Iles of trtcame. Flowerer, roostx tr±aues coftmn a provisian known as a saws ctarrse. Exceptions om taA to specified in the SWIng clause may perms[ ors exempuan has ashennsa continua for -enain types of incarr a even after the tas'� became a U.S. resident align far tax purpose$• If You are a U.S. resident alien who is refying al' an exception contam=d in the swrrg Cause of a tax treat' aff0 n�ent op from U.S. tax an pertain types !:If Incwtta. youmust attach . to Fort W-9 than specif,es the foltovnng fi 1a stems. 1. The treaty country. (1?naraly. this must bo the same treaty under which you claimed exemptton arum tax as a:wrresident alien. 2. The treaty ;article addressing the income. 3. The article number jog localsanl in the tax meaty that contains the saving clause And its axceplaons. ,a. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty amcle. Exampfa. Article 2A Of the rJ•S -China trscome tax up slta rs ar: a.•.a nptan from tax tP+ sCttu}arship income received by a Chnese swele.'a tEmpomnly present in the finned States Seo} [hate stay in th-- studF.rt[ -Anil becomes a resident ales fur lax purjw. ra h 2 of the Unttsd $tat es e,ce ds 5 calendar years. HOw'svef, P�aS p firs; Protccal ore the L.S.•China treat;ppl ;dal-d April �) al�ows s th prou,sions of Ashore 20 to continua .o ay evsn Swdy.',t ` ?comes 3 resident area Of the United Sates, A 7at � first LHho qualifies to- this exception ;under oaragrape _ prmaaoq ante Ls Mytng on ows exrepnon to claim an '-x;m�� •A on Iheir ssh,olar$*p or z?Ucwshrp tneome w+xtki an 4h to rt that s atamenr viat mcludas the rnfxmaton ]bars to iuPPo exemptior.. if you are a nonresederit a&en or a 'o_t90 anurgive the requester the approfiriat? compEc ed Form W-5 or Form 8233 Backup Withholding what is hack[rp :vithholi n99 Persons nraktng =gi n PaYrrwls to you -rtust •rrtd•_r ceRasn rondebons nshhatd and pay to die IRS 2-1'4 of such payments. This :$ called -backup cl- n,, A are �ynents that may t» subject 10 backup withholding rnetud �, trrt are r at limited [a. in(�rasi. W-ax--rript mtcrr;•st. dhiderdsbroker and barter axChzrraesrtada intransactions.:ants ro}�Fu"s rrOneM'Qy°e Pay Pa!r' arid settlement of pUvro-�tt card arw znrrd-p�Y nsttrork transactions, verse paymeMs iron Crsti`j txat operators. Rkal astatr Iras,saCtai:s are not subject to ltaOQUP vnthW6rg5. You Y,:ti not be sttbjea to backup wiftotdue.cl an payments you receive if you g�+a the rs-< , x your cart-vt TIN. r^ak ^ dv pr'oP'tr cartsftcatioris. and !epart all your taxabis ntaast and dratdends Dn your W retum- payments yoga rer-eive , g bat subi�--t to backup trrithho(rl'ing it- - 1. You do oat furnish you TIN to the requester. 2, You do Sot :en:fy lour T01 whir s +quued (See the tl,Struchans far part It for details): 3. The IF1S [eta the requester that you funv5tizd as incorrect T1N: a. Thor IRS keys tau hat you are suWct to backup wilhAolding ra[llm liar fV did of r- ar- ar-d �Gzrtdsl �}dt� suds an you+ ou 5. You do not c:rl'fy la the requester Ihat you are not subfeC1 to backup %vOhoitfing. as descalbed in rt-sm •t under 'fay s+gn,izg fire rrHeC- out farm" aCuve +for repe,Vttk- trtterest and dividend accounts o>^ened after 1983 onty)- Form w-9 tF'v. 3-20241 Certain payees and payments ar9 exempt from backup %Yilhholdtng See Exenrpr wYee code. later, and lha separate irkslructions V the Requester of Fenn W-9 for more rfarmation Sae also Establishiito U.S. status for purposes of chapter 3 and chapter ivithholding, earlier - What Is FATCA Reporting? The Fore ign Acccuni Tax Compha nee Act (FATCAj requl—a panicipa ling Foreign financial institution to report all U.S. account holders that are 3Pectfiact ii-S. persen5. Certain payees are exempt from FATCA reporting. sea F-ramprion from FA TCA reporting cede. later. and the Instructmns for tha Requester of Form 1N-9 for more mformafion- Updating Your Information You must provtde updated information 10 any person to whom you claimed to be an exempt payenz if you are no longer an e'.rempt payee and anticipate receiving reportable payments in the future from this person. For example. you may need to provide updated. informaliOn If you are a C corporaton that elects to be an S corporation. or 0 you are no longer tax exempt In addition, you must famish a new Form `N-9 if the name or TIN changes for the account. for oxampte. rf the grantor of a grantor trust dies_ Penalties Failure to furnish TiN. it you fad to furrvsh your correct TIN [o a requester- you are subject to a penalty of S50 for each such radur= unless your failure is due to reason able cause and not to wilful negfect. Civil penalty for false information ►AIh respect to withlnolding.If you make a fafst 518iemeni •rn[h no reasonable: bass that results in no bacltup withholding. You are subject to a S500 penalty, Criminal penalty for falsifying information. Willfully fals&,dng certifications or affirmations may subjecl you to criminal penalties incltid<ng Ines andfor mPrisonment. Misuse of TiIVs. If trte re-queSter discloses or uses TNs in violation of f•=det-at fav+, ih+ requester may be -subjum to civil and criminal penalties. Specific Instructions Line f you must enter one of 16a following on this line: do not leave this line blank. The name Should match iha name on your tax return. If. Links Form IV-9 ;3 fer a joint air-aunt;other than an accourn mainlasn ed to/ a foreign financial institution ff l)j. list first. and then ctrcia. the name of Itre person of enlny whose-tumbsr you entered in pert i of roan W-9. if you ar= providing Fort W-9 to an FP1 to dOdwment it pin[ aceaunt each notder of the account [hat as a U. S. P?F,90 i rinks[ prowde a Form %V-9- lndivrdetai. C+aPI rr-ey 5nter the name sf'akn 4n your tax r--Wm- If you have changed your fast nanr- without informing Vie Social 3`uny Admintsuation [SSA} of thname change. en.£' your first name. the Pas[ name as shvr n our tour social security card. and your new tw nainf- Note for ITIN app%cant& Enter your uedvidu3t name as it wad catered on your Form W-7 application. line f aL This should also be the -ants ar the name you-nter_d on the Form t0.t4 your feted with yc, u application • sole proprietor. Ent- your individual name as ahov:n on your Farm t t7 0 on flee S Entet four busyness, trade- or 'doing busaress a. 08AI name on line 2- • Partnership. C corporation. S corporation. or LLC, Other titan a disregaded entity. Enter 014 en[e[y', name as shnvm On 'be sn4itis tax return on Una t and any business, trade. or 09A name an We 2. • Other entities. Enter your name 3s shown on mired V.S. federal tat. documents on line 1- This name should match [he Hanna sham On th7 cnanet or other legal document creating the entity. Enter any tlusiness. trade, or DBA name on line 2. • Disregarded enmity. in gen•-MJ. a business entity that has a sir, gtf oviner, including an LLC. and rs not a corporauon. is disregarded as 3n anaty separate from its owner [a dtsrayarclad endtyl-See R.agulauons section 3o 1, 701.2(CM, A disregarded entity should checks tha appropriate W^ for tin` taw classe6calion of its owner. Enter the Ov rcr'= .-tame an line 1. The name of the owner entemd on tine I should rieaer be a disregarded entity The name on line I should be the name shown an the income tax return on .,ihch the income ghoold be reported. For Kittitas County Agreement for Services (rev. 5/14/25) Page 19 of 24 ,X3mpi� if a foreign i.LC tenet -:7YaLt d as d disregarded ent[ty for V'& federal tax purposeO ha_s a Angle amrer That rs a U.S. persm the U.S. osiers narre is requred to fx provided on Una 1- If the direct owner of the entity is also a c6sreq—k'a -tirr. ?sitar them first Myner dial. is not disregarded for federal is Purpose. Ether the disragard--d -MI&I s narne on lira 2. If 'ire swr>¢r ❑f ilre dra'!g Fdrrt Yrl 8 erus'4ad f ro the asn:tas must COMV � an appragr +N-9- This is tees case evert if tta lGrsign person has a U-S. TIN - Line 2 If you We a business name- trade name. 09A naqsP, or disregarded amity name- enter rtan tine 2. Line 3a Chet the appmpoaw bclx on Ere 3a far Me U.S. federal tax dassi5;atirrn of the person vrhose name is anIered on Une 1- Ckck Oink. - one box on tine 3a- Line 3b ChiiECc this box if you aka a pare-'hP (tnclud rLk3 an LiC classiRai as a aartrres5itrp for U.S. lederal lac purposes). tr W. 7r -state Ihat has an; foreign PaMw.- owner or b ra i-_- and you are € rowdin9 this faun to a pwinerstgp. ties[. Or esmte. n % hwh yLxr here an aerrseesl+np mlarsSL 'foV mug[ check the sad or- I*-- 3b f }ou --c v* a form 'U-S (or cff_ rznar; rnderre; frvrn any parro r. wmer. Or bare fi r'r �tabks" bmiym stares orii yodr rM'rxe a Fern 'h 9 ream srry panner. owner. ar berie-ricaany that hras chvsird the b�1< on line 3b- Note- A parUmfstup Ghat pfovkp3 a fora W-9 and cheris Lox 3o may b± ,!garbed tO cornpj{t Sthedulies; K - 2 and K-3 Wool" m S 164 F x more inrof-ration, ere the pan natsiuip instrercibor s :or 5ctaduleS ss-? arid K- 3 (Porn f4esi- If you are r=gwr-j to tv da:M y<su may act rscer.- tt:'tflfLkrrridteon:trC Cir'r M' a-Lorr?C!•nfonriailon r?t1: r•'i .VnSI the IRS x rurrash a ,*fact pave.= 5=t trrnwY to your parnels or bereeackM5-See.lot aiamptc-,= Wr56a`9o.6i'2. Vd672-.for penal— that wrap --ppey- Line 4 Exemptions tf ynre err ems; arrn tacS up m+ditrmtdin3 lw&or FA' :A depora, tg. entav m 1it a ria:e spat= an rev ; amf : cda�s) tftac :rW a"it; to !OU- Eim.fi Pt payee ealr. • Gerrreai4j iisdrndt css Fmdudrrt3 sat-=rnonetorsr are ME ex _met trom baci ispi rwlhf� C e,�cpt as prrsurded Wo[4 - C6tgn� �raeAetnrpf 6CM t-?00M v LhF,oFjing far c rrau: pafrxr ills aselrmq rrtar st end di -:I!,, co�s are not ex mp[ Tram backup withtw 6ng for paym=-at i made in aetde<ment of paym x+t -Ardor thief -party +Y=rrrais::r actlons • a7;-�iQr>31et ti am no[ ipf OVT U= baick` rl wltllho"'ng 'ha rPly'_f.7 if7 attomeys feu s gross fps paid to Ei"nrr�ys. errd ccrprxarbsns ,hat pnw de medical or h, aXth cam servic+s are n xt-MernjpI with respect to pa: +Ww- tits rapOnatr[e are Fxm 09? +dfSC. ih>✓ foliorung oil1 d ntliy 0,1"es titan ? ;' '"rTP[ from bacup vmL hotting Fetter th-- appropriate 00da at the s,Par tin "fle J. f -Ara argasr_dton ex, rMpt fresh tee' ur tj�r sacbaft Sol jal. any IRA or a cusmckal accormt under 5--Vwn 4MtthA-, I ,t :tit account -Owfi s iha egdiusrr Brits ; r sec aasi iff 3 [Ri-7i page 4 Form 4V-9 (]Rev 3-2024) 2-The United Stales or any of its agencies or ins ttumentaliities. 3-A state. ihs ❑isIrict of Columbia- a V-& caommanr:eatth or tertrtcry. or any of their political sub"fiv15sons orinstnim"nnliues. 4-A foreign government or any of iv, Politicall subdMstons aye- s. or instrumentalities- 5 -A corporation. o-A dealer in securities orcommndities required to register in the United States- the District of Columbia. or a U.S. commonweallhor territory. 7-A futures commission merchant registered with the Commodity Futures Trading Commission. 8-A real estate investment trust. 9 -An entity registered at 431I times during the tax year under the Investment Company Act of 19.10. 10-A common trust fund operated by a bank under section 584(al. 11-A financial insttution as defined under section 361. 1--A middleman known in the investment community as a nonrirwe or custodian. 13-A trust exempt from tax under section 664 or described in section 4947, The following Chart Shove$ tyP" of payments that may be exempt The applies to the exempt payees listed from hack up withholding. chart above. 1 through M IF the payment is for .. - THEN the payment is exempt for- .. • Interest and dividend payments All exempt payees except for 7. Exempt payer 1 lhrmugh 3 and 6 • 6roker transactions through t 1 and all C corpcuations 5 corporations must not antes an exempt payee code because thrf are exempt only for sales of non=iversd securities acquired pnw to 2012. • Barter exchange transactions Exempt payees t through 4- and patron a dividends • Payments over 5600 required to Generath{. exempE payers be reported and dir ct sales aver 1 through 5.2 5.5.000 v • payments made in settlement of Exempt pays 1 .yerorxh - payment card or third -party y network tnnsackorm Sae Form 1099-MISC, Miscetlansraus fnfarmaton. and its iris : cl5orr =However. the hall awing paayyments made to a 009wnanon aid r portable on Form I a99•tutl. G are not exempt from+ backup, withhoiding7 medical and heath care payments. attorneys fees. gross prmeeds paid to an attdmaV reportable under seQtron 604dft arcf payments for seances paid by a rod?ra1 rxe'"ve agent;• EXamptiori from FATCA reporting code. The folforrmg code's xfent V payees that am axsrrrpt From reporting under FATCA T codes apply to p?rsr+rrS Submitting this form for accounts marmairted mnsttie of the United Stales by cerEaln foreign financial utstitutiens There or-_ 4 you are only SuOrnIM1tg this form for a=currt yns) hold in Orr_• PJnncd States. you may feave this field blank. Cairutt vfAh the person requesting this form iT sou are uncertain if rile financial itrSLt! 07rr is subiact to these regvirsmerits A requester may indicate;fre a o-9cis at regtaired by prowding you vrdh a Farm W-9 with "Mol AWF Zab&o_' for arty=111ar ind+cationy-_ritered inn the fine fear a FATCA exemption code A --An orgam2aWn exempi from tar under sacuan 5oi(al arany individual retirement plan as defined in s=cdan 701�aXW1 $ _The United States or any Of its agencies of in9lJ`wTm"l;266es C-A s(ate. the District of Columbia. a U.S. commonwealth of temtory or any of their political subdivisionS or instrumantaiilics. t}-A carporariort the static of which is regulafly rndi<d on On-- or more estaDhshed secunties markets. as described m Pf19Ufeaares section I.1s72-t(CA11M. E-A corporal ion that Is a member of the same etxpand e1 adiLate<l group as a corporation described rn Regulations 5r004N 1.1-7? tit Hturl. Kittitas County Agreement for Services (rev. 5/14/25) Page 20 of 24 F -A dea!ar rn sect)6Ues- eorrrmod0es, rr Nsec at;va firrI ref rnsir rt:mfs 6nctudirig national prfnetal cr7dIa3GL5. futures, torvrai[is. erect aptcorus} that s eegistered as st__ unt4er the tatws of t}te UmTCd States or any state- G—A real estate investment trisst. Ff —A requlattd Investman't company as d&'rrd In S.__ S=n 851 or an anOW seared at all tunes Mutiny Ike roes sea sr:dx the tnresttnctn company Act of im, I —A common trust fund as defined in sewn 581fa1. .f—A- bank as defined in section SSIs K-A broker. L-A trust exempt from tax under se. flan E'Ez or de__nb=�i in s_cLon 4947(a)(1 ). M -A tax exempt trust under a sector, ;mil plan or section 457(g) PUUM- !plate: Ybrr may xedo to consult Mth the Gsiartcrdl institution requesting f .tonal t1)deterrmine whether the FATCA code arcVOr Pempt payee elide should be completed. Litre 5 apamT ten[ or vie numbers. Enter your address tnumbe . tree Fa d'11 I of your mforrruttion This is where the requesteruest'_r alrsad has an returns- if this address differs from I" or. a thr rag y fire. enter NJEUV" at If is tap. If a new address is pmo cded. changes i still a our chance the old address Will be tsserJ until the pay 4 Y address in their records. Line 6 Enter your city, state. and ZIP code. Part I. Taxpayer Identification Number (TIN) enter your TIN in the appropriate hoc If you are a resident awn --d you do not hare, and are not slrgrble t0 get. an SSf t, sour TIN vow IRS ipp1 Eder It in Ift2 entry space foe due soda aunty nurrrlxs IS yaV do neat hale an ITltti. see Flow ro ger a INN below. eiffeer if you are a sole arcprietor and you hose an Ertl. -Mu map ecst=r your SSN Of 9N. if you am a srngW_ mernber LLC that s aa-pre"d?d as an entity separate from its frVnel- anW the SSRi (Dr EfR�t enter dews i;i"l El the LLG a clasalfied as a aar,,,oralion or pvtst- _ NOW , :Ylaa: Varna aryd Aturrper Ts, �� t� - ��?stir. Fat�r. fsa' 6 rrif zr daminca,nn of name arid Test onxbirtar�orr%. tires_ Iltlit[' ratefY How to get a TINL If you do, net have a MI. aWY 1 a =e lm v%f i`ato t•� To apply for as SM get scum SS-5. Apia° Card from your tacal SSA oikca or got this foss os'lire al t?i 3 Lisa -rr., 4-.�4g0v Yott may u:sa gaa dw•s Mart by ca.T� �' Forrr. V-i . AppteeaWn for IRS tnddrdual Talpayer Number. to apply for an li V4, or irarsn SS-z- R,�lmmmaro Errs Empi A r Identftaoon Number, to apt>sy roes ar Elf'- eou Can apof (Oran _ anI ire by ac°9 tl+e tPS xaDslt= at .sxn r/xrrElhf. C50 to rite,., ImgovIRmxs tp ;trey. downivad. or':Mt fo A a 4t fag end �g� �. yov cases Ao to tsrens•srs.�r+h"Jtd�farm +mere Form W.I andlor Form SS; crr2 ail to jw wittwt 15 fx� r�s days 1s ww era asked to corr+pletA Forn .�ir3 but rSef cot fa'Je a 1TRl. apply for a TIN acid enter "Appb'd L7e in "ke Spec- For the TV1, sigr'i and date the fQ rro. anc gore rt to the rages estFs. For me -seer and Payments, and �rtmn par mad: -adlI I-_sp-ast r*,nm" *-adabrk- inStri.imenG, yriu W4 3'sreszlty ha-.ve Sr? days to eta TIN arve it no ester "for- yew ar? eruct Io ozyuPDay: g theman n!s dr)?s MY aPPlyts GtiT >:(tom of pa:means you WI It i The teCj !oy 'f4i1 will t>< strbleft to tlaClxUT4 SSr411hO6jClfj. 0`1 a,'1 Stith gal rr+;Jits ur[tit you privida your Mhi :5 0-te r_ }ue't'-c Notes Enierrng -Applied For means Ill at jo•u ha:e already apptr� far a TII or that you imand to apply for one sc V See aisa ar N bb•shrng UL 9 stares for pv poses ❑f cl•*apw 3 Bird cheArer s :nthhdcur S. �rEi�r- fw wFt n ynu may instead b svtKeCt to :rithhvltfirtg under c :aIK?r 3 of of the Code. Caution: Adis►'�jarti U.S. entity that etas a Tore rrvr ores ' the appropriate -orm W-8 Form W-9 (Rev- 3-202.4) Part II. Certification To ?slebliah to [her timthholding agent that you era a U.S P'Mn. [x resideiir afren, sign Form W-8. You may be guested to sign by the y,ithhotding agent even if item 1. 3. or S below indreaL-5 riIJ1 vrnse- Pot a joint actatsnt. only 1hi parson whose Tly is shown rn Part I 0ould sign when :egwred). In the case Of a disr093fdadenW ti10 parson identified on fine- t must sign. exempt payees. see, ExemptPaYe.- code. earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below- 1. Interest, dividend. and barter exchange accounts opened before 1984 and broker accounts considered Active during l9$3- You must gore your correct TIN. but you do not rlavx to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after f9a3 and hroker accounts considered inactive during 19a You must sign the cwtihr alion Or ttackup withhol[irlg 1vd! 3PPly. If you are sub*t to backup withholding and you me rn?rrsty providirrg your c(rreet TIN to the reques car. you must cross out Rem 2 in the Certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. d. Other payments. You must give your correct TIN. but you do not have to sign the tertificalion unless you have been nc)dfi,-d that you hau3 preyitsusly given an incorrect TIN. 'Other payments' mctude payments made in zhn course at the requester's trade or business for rants, royaities. goods (other than hiIL4 for -rearchandrse), medical and health care services (including payments to corporaRors). paym'nts m a nonemptoyee for seivices+ pal mtms made in senigrnent of payment card and Child -party newrork transact+Otls, payments to certain fishing boa! crew rnemban and itsterms-r. and gross proceeds paid W atlomeys (including payments to corpordVerts). 5. Mortgage interest Raid by you, acquisition or ahandonntent al secured property. cancellation of debt. qualified tuition orngrarn payments )under section 529). ABLE accounts (under section 5291A). IRA, CovRsrdetl ESA, Archer N1SA or HSA contributions or distribulions. and pension rfixtributions_ You must 91e yazu-'exyect TIN L but you do not nave to sign the certification. What Name and Number To Give the Requester For this type of account: I Give name and SSN at i Individual The iodual Two or mar= ndmiduals tjanc acoauni) The a tuUt aa•n:t ai die account 3'. other than an act,unt m Lintain=d by rf cor ibo-d.. bin-- th- firs': ndmduai an FR pan &C 3- Two or more U S Persons each howl aF he acaunt Cicint account maintained by an F"Ftl S. Custodial account of a rumor Pr--Cr (Uniform Gift to Pdinors Act) 3 a- The usual revrxabl_ c uings tr�.st 'he {lr7ritar-ti'�c (grantor is also trustee) h- So-called trust account that is neat Tii- aYza-rl °+uner` a legal cr valid trust under slat_= w, 3. Sole Proprietorshipardrsr--9wd-d T^`- errtity owned by an i ndii,•iduat 7 Granter trust filing underClptionaf Tin=,rscoe" Rung 14tethad I. NeeA:gafamdn: 7tC!,cn Kittitas County Agreement for Services (rev. 5/14/25) Page 21 of 24 For this type of account s- oisregarded'nwy no t wontl by r. individual 9. A valid trust estate. car p-:nscan'Se6t 10. Corpomfico r LLC 6--Q --xwaL- status on Fc+rn v-n or Fora 11. Association, club. raki,-cus_e.NuG41e• educational. or Othel tea=x-Ernpt organ©lion 12. Partnership car multi -mink- LLC 13- A broker or r-a6teced mmirnee 1 d-- Accent :76 the DepSrll -'n of Ag�ruias- 01hC 1�r. �e vt s :+:Ci Y .Arty Isueh as .1 stay orloeat go,csrunarrt. school Jezmct. or Prx'nt that receives acincultwal Pit payments (5 Grantor trust firing Farm 1041 or tinder the Optional Flog?- -&*R tnR i xm 1099 rx- Rtoub"or.s season 1.6TtatbltVdiAlir Page 5 Give name, and EIN Of - The aartr Legai �e ty= ltrr:,_rpw a6rin eliz aeganr�aaea The wr:f-e<d+ip The brak=r or rev m EFe auwl -- eit&f The cast ' List first and circle the name of the patsort wlrase number you rumtsh. If only one person on a joint account has an SStd, that person's number must be fumished. Circle the minor's name and Furnish G`1= minors SSN. and -1 rout or DBA-lame. f Any GnGn � YOU may use- either yourtSSN ❑i EIN liril yvu have onej, but the IM eticottrages YOU 3o u5e your SSN. ' Lisr first and cirde the name Of 111? trust- Mare. or pltn4ron trust. to* not fumish the TIN at the pe-rscnA mnte�- umh w r Begat enliry ilseU is roll destgnalad in 3ccaunt tille.f 'Note- The grantor must 950 M'+1d 8 r tin %l`1-9 to the trust," of th3 trust. -' Far more inforrnattari an apBortal N,-49 me#X#s for grantor trusts, sm�- the Insiluctions for Form 1(7-31- Uote: if no name is Ertl d whim m0M I" one name L-1 listed. the number vrnfl be onsidered to t)► th-V o?vte firsanam- listed Secure Your Tax Records From Identity Theta Idenvty that. occurs whorl sosr.'t+rr visas yrxu F :rwnaf rnh-innation' such as your nary-- 5S�_ or n1w r-dctn+auon.:100i t vow permisston to wmrttrr t-aud or iAhar -rwrYs .ter et±- brf rtr*f ruay 35e your !>SN to get a,ob at may ble a ax ---nor •,6^4 rvw SSNI to rani. _ a refund. To reduce your risk: • Protect your SSN& • Ensure your Fmpleyer is p ,T=c un9 ;•o x SS.11. acrid • Be careful when choosing a 1-25A f--I m P`aPM"=- - q your tax recon�s car , Okfted by wM r,W- -Tv dxaatd;+racer, a notice ,`tam llse CFCs_ r �-4xm right away :o them -me and ppn.? nurnAw ormt-ad tin tilt kRS notice -car tat[,+ if yottr tas re- COrdls afe not dur1-,g af:`o- -M t by dens ty tkt[ but ;au lhink you are at «sf ,fit- to ales- car etoien rui s~ ff, cornet- t: s�We erg card a:trnty. of a gtyS11o1ra{� oriel rq Fdenrit4 Thtft Radii- at-SW-3J3"&r-,D r ilobzzr,t"Csm t t 31 For mare CtiorrrMton_ see put? Sri_'+ inert-{ The" 400i rAbw Ica Taxpayers- Page 6 Form W-9 (Rev. 3-2023) V,tprns 01:den try theft vjho ere expenencrng economic humor a systemic problem. or era' seeking help to resoMnq tax problems that have not been resolved through normal channels. may lye eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by cailfng she TAS tall -fro 5 case intake Erie at u+ rr-777-47 is or T y/f6G 800-829-41059. protect yourself from strspfcious emaif%or phishing sche *s6 Phtshirg is the creation arid use of email and wobsites d ig ned mimic legitintat� busrness errimis and vlabsrtes. 'he most common art is sending an armA to a user falsely r_lwrning to be an :stabl[shed )egitimate enterprise in an arerupt to scam the user kKo surrendering private information that will be used for identity [hell. The IRS does not initiate contacts with ta.,(payers via ernaiis. Also. the IRS does not raqu:st personal dewed information through Om a" or ask Ia�cpayers trrr the P911 nutnbers. passwords. or stmlfar secret across mforrralion for Ihewcmsdrt card. bank, or atherftnanctal accaunts. If you receive an unsolicited errtall claiming fo be from the IRS. forrrard Ihts tnessaye t0phisNf;_g4irs 90v. you may also report misuse of the IRS rtarn?, togo. or Other IRS properly to the Treasury Inspector General for Tax Admutistraeon (TIGTA) at 800.366.1 464. You ran forward suspicious ej raits to the Federal Trade Commission at sparn4(xa.gav or report them at wtvW.Rr.govrcarnplarnt. You can contaIf you have been the vvscm tiV. eof identity theft. 7sea %,^vwJdentiryTheh.gw and Pub. 502T. Go to wtw�.irs_govlldentityTheft to team more about identity theft and how to reduce your risk_ Kittitas County Agreement for Services (rev. 5/14/25) Page 22 of 24 Privacy Act {Notice SectiorT 6109 of the Irt_rW 6,8verttrz Cod`= Tequir� you to provide your correct Thf to pe<sar Su�lu&n7j;RdejW xgeuciasj who are regturFd to file:nforrtion rattrsts with d►a H:S to repor: rraerzst. dividends, or na r lair. Otft i troTre paid w )rout 3e p rry V yatr paid: the acqutsrtion or abarrdwMent dF cettrrgd prT'P' IFjP �af3an of debt-. or cnrttnterttOns you m n Arch=r Fl L. r H$A Fts person :affecting twits form uses lhte sriormafion" the form to 5N' :nfnmwtion Wt"s with the 1pa_ r-postnq the above inform4ull. Rowne uses of tins r forn-.abor+ 9174ftXle 4i'''n5 it To the DeVartmentt of J.sstice for tiviI and crmmmA llttgaunr+ard to ohms. states. the Ekhtrict of lort ne C�wfrmbm artd :i.S. cOm mamvdafths used rasrr�r as for use s ri to elf r adrninrstenp.9 Ih- r'r gars. TNe ivfDrsr`j=-r rraV also lea di ta oauntnes under a treaty to federal and star' ages :° e p'rit and comnal is r:x,10 to f taJ law A-np'rees ant and inplf:gence ago -Mies to ��ombat t-ow. orism. you-nu&l =vide your TIN ahather or not you are squired to isle a tar re � j ems, ocs must ger.nd �raAv a ithhofd a perc�enng certain other payments to a payee who dO,�not g" a TiPI 10 the payor. Certain penal lies ma} also apply for Ara•tdng •raIs,_- or frzudutent information_ ATTACHMENT "G" RETIREMENT STATUS FORM ** All Contractors who are individuals must complete and sign ** SECTION 1: CONTRACTOR COMPLETES THIS SECTION: Did you retire from one of the State of Washington Retirement Systems? _ Yes „ No Did you retire before age 65 using the 2008 early retirement factors (ERF)? — Yes _ No Will you be receiving direct compensation for these services? _ Yes No Will you be receiving indirect compensation for these services? — Yes _ No CONTRACTOR (Full name of contractor as in DRS filings -Please Print): Signature: Date: Last Four Digits of Social Security No SECTION 1: COUNTY COMPLETES THIS SECTION: [Use Member Reporting Verification (MRV) to verify the past retirement membership and document below] 1. Has Contractor been a member of a Washington State Retirement System? _ Yes _ No If yes, which system and plan? Teachers' Retirement System (TRS) _ Plan 1 , Plan 2 _ Plan 3 _ School Employees' Retirement System (SERS) _ Plan 2 _ Plan 3 _ Public Employees' Retirement Systems (PERS) _ Plan 1 _ Plan 2 _ Plan 3 _ Public Safety Employees' Retirement System tPSERS) _ Plan 2 _ Law Enforcement Officers' & Fire Fighters' Retirement System (LEOFF) —Plan 1 _ Plan 2 _ Washington State Patrol Retirement System (WSPRS) _ Plan 1 _ Plan 2 _ Judicial Retirement System (JRS) 2. Is Contractor a retiree of a Washington State Retirement System? Yes No 3. Did Contractor retire before age 65 using the 2008 ERF? _ Yes _ No have verified the information above using MRV or by contacting DRS. COUNTY REPRESENTATIVE (Please Print): Signature: Date COUNTY RETAINS THIS FORM Kittitas County Agreement for Services (rev. 5/14/25) Page 23 of 24 ATTACHMENT "H" SUBCONTRACTING The Contractor shall subcontract County funding through this agreement to the following subcontractors in the following approximate amounts. This exhibit constitutes written approval of the subcontracts below. Subcontracting Entity Subcontract Amount 1 Agape Family Therapy PLLC if subcontract agreements and/or actual costs change by more than 10%, the Contractor must immediately notify the County, and the County may require an amendment to this agreement. The County reserves the right to enforce all parts of General Terms and Conditions Section 5 of this agreement. Kittitas County Agreement for Services (rev. 5/14/25) Page 24 of 24 Form (Rev. March 2024) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Go to www.irs.gov/FormW9 for instructions and the latest information. Before you begin. For guidance related to the co a� m a C 0 a;C ao o` CH I CL 0 w r; m 0 a) rn ]os9 of Form W-9, see Put 1 Name or entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the businessldisregaroea entity's name on line 2.) Give form to the requester. Do not send to the IRS. Peers Risinq 2 Business name/disregarded entity name, if different from above, of Form, below, 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes. ❑ Individual/sole proprietor ❑ C corporation ❑ S corporation ❑ Partnership ❑ Trust/estate ❑ LLC. Enter the W ciassiFcation (E - C corporation, S = S corporation, P = Partnership) . . . . Note: Check the "LLC" box above and, in the entry Space, enter the appropriate code (C, 5, ar P) for the tax clarsificatfon of the LLC, unless k is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner. ❑✓ Other (see instructions) Non -Profit Organization 501(C) 3 3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check ❑ this box if you have any foreign partners, owners, or beneficiaries. See instructions . . . . . . 5 Address (number, street, and apt. or suite no.). See instructions. 110 W 6TH AVE PMB 118 6 City, state, and ZIP code ELLENSBURG WA 98926 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any) (Applies to accounts maintained outside the United States.) Requester's name and address (optional) r 7 List account number(s) here (optional) Taxpayer Identification Number (TIN) Social security number Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a - El r resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a or TIN, later. Employer identiTicativn number Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter. M84 - 2 5F4T2 9 I Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Here Signature of U.S. pamn General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. What's New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classificatlan of its owner, Otherwise, it shoUtd check the "LLC" box and enter its appropriate tax classification. Date 1 /30/2026 New line 3b has been added to this form. A flow -through entity is required to complete this line to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when n provides the Form W-9 to another flow -through entity in which it has an ownership interest. This change is intended to provide a flow -through entity with information regarding the sratus of its indirect foreign partners, owners, O beneficiaries, so tnat it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may t>e required to complete Schedutes K-2 and K-3. See the Partnership instructior s for Schedules K-2 and K-3 (Farm 10651. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS is giving you this form because they Cat. No. 10231X Form W-9 (Rev. 3-2024) DATE (MMIDDlYYYY) fccwa CERTIFICATE OF LIABILITY INSURANCE _ olr3orzozs THIS `CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. — -- �— IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL. INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain Policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s . CONTACT PRODUCER yAME P res 1vaCcmrnnn_'+alL�n Custpme an A ent gm �n PHONE FAX Arrterican Underwriters 1 No.11 1 � 3A �87 0429 S TACONIA WAY, TACOMA, WA 98409 EMAIL nrr pr siva.GOm INSURER A; Uniiea =inarniai Casual Cmn a 117711 INSURED INSURER B : PEERS RISING INSURER C ; 110 W 6TH AVE PMB 118 INSURER D ELLENSBURG, WA 98926 INSURERE. - INSURER F : COVERAGES CERTIFICATE NUMBER: 799354885194877319DO13026T204653 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLISUB I POLICY EFF POLICY EXP SR TYPE OF INSURANCE I INSD 1NV0 POLICY NUMBER �IMMIDONYYY1 (M.MID01YYYY), fR I [COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR !+F l QEWL AGGREGATE 7 APPLIES PER: POLICY L._J ject 7 LOC Ty OTHER: AUTOMOBILE LIABILITY ANY AUTO Oyyt,;rp �G�-i@OULED N N A AUyTOS ONLY %� AUTOS aIJT(S ONLY A4n3iNDS ONLV UMBRELLA LIAB QUGUK EXCESS LIAB CLAIMS -MADE DEa RE7EN r:ON 3 WORKERS CAMPE:NSATION YIN I AND EMPLOYERS' LIABILITY A.�rYPROPP.IETOcRJPFAxRTrinRlfiK ECUTIVE N I A 0021362990 1 10i i 3/2025 I 10113/2026 LIMITS i EACH OCCURRENCEAM G A ws 3 Ee MED E. ,An One rsen7 PERSONAL &ADV INJURY GENERALAGGREGATE S PRODIiCTS COAIP4P AGG 1lvGLE LIMTT en 0 donly S 1 7D0 aaDILY iNJUr7Y Per man] a 300ILY INJURY Per ace,deru S RTJ DAMAGE fFer u4cminn1 i EACH OCCURRENCE AGGREGATE S P H- E.L. EACH .ACCIDENT s E.t_ DISEASE • EA 1,S OYE E L DISEASE -POLICY LIMIT $ I [Man&uny In NMI %I"crlbe under , DESCF;II'VON OF OPERATIONS balmy S JA ACORD 101 for additional coverage details 002062990 N N 1/113/2025 10i13l2025 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION - ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PEERS RISING ACCORDANCE WITH THE POLICY PROVISIONS. 'I 10 W 6TH AVE PMB 1 I8 ELLENSBURG, WA 98926 AUTHORIZED REPRESENTATIVE - © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) •4� ��'�� CERTIFICATE OF LIABILITY INSURANCE 01/30/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on +i ro tifinnta dnes not confer rights to the certificate holder in lieu of such endorsement(S). PRODUCER American Underwriters Ins Agcys Inc 6429 South Tacoma Way Tacoma INSURED Peers Rising 110 W 6th Ave Pmb 118 Northcutt, Lavonne _ FAX �fAIC :to :---- INSURE5 AFFOROING COVERAGE NAIII WA 984094004 Ohio SecurityInsurance CompanY 24082 _ IN&t1RERA: SNSURER C- INSURER D: .. -- Ellensburg WA 98926 1 INSURER F . COVERAGES CERTfFICATE NUMBER: 0144906689 REVISION NUMBER: 2016-03 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NSR: A III gRi ROLICYIEFF F61dCP LIMITS TYPEOFINSURANCE H A1g YN • POLICYNU6R I Il[Mll7OrYYYY M GIYYYY 'X! OOMMERCIALGENERAL LIABILITY EACH OCCURRENCE 3 1,000,000 1,t�d,DOD CLAIMS -MADE X ocr:UR I PRE7K1�fy E��--5 -�^ f MED EXP i anz GYM] 5 15,000 A X X BKS63980283 10/26/2025 10126/2026. PERSONAL & ADV 1NJYRY 1,000,000 aeNERALAGGF[EGA"E $ 2,000,000 _ GEIi AGGREGATE VM"' APPUrS PER - X [prOPAGG' S ,00 PR LOC PRODUCT$ •CR,ow POLICY S OTHER - 11161N L1SiINGLELIMIT $ 1,000,000 AUTOMOBILE LIABILITY IEn ii —'i 1 BODILY INJURY (Par person) S ANY AUTO I ---" ii oyy,NEO —'1 SCHEDULED I BKS63980283 10/26/2025 j 10/26/2026 1 BODILY INJURY (Per accident)! S J _— A ONLY AUTOS PROPERTY CA?AA E ' $ _ ! HIRED NON-OAUTOS x... VVNED X LPar accidanil - AUTO$ ONLY AUTOS ONLY i OCCURP-ENGE S UMBRELLA LIAR OCCUR -?ACH ' . _ EXCESS LIAB CLAIMS -MADE .,AGGREGATE S — --- — s DEO RL"7cNT:ONS_ PTA T'E p1LH . $_ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N _T.�_ ` E L EACH ACCIDENT S 1 ,000.000 _ ANYPRCPR:-SiTOFiIa.RRTNERrE:S-C"UTIV= NIA BKS63980283 -Stop Gap 10/26/2025 10/26/2026 1,000,000 A OFFIOERiMEMBER�(CLLiDE37 E L DiSEASt-�A.wMPLO'r`E: 3 (Rtardatory in NH) R 4 describe under E L DISEASE • POLICYL[MIT S 1,000,000 :OLLSCRIp730N OF 0PERdT=pNS derorr I I I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) `"`Proof of Insurance" ' CERTIFICATE HOLDER Peers Rising 110 W 6th Ave Pmb 118 Ellensburg WA 98926 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' r Curtis Luken - 9)1988-2015 ACORD CORPORATION. All rights reserved- ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD STATE OF W SHINGTON Department of Labor & Industries Certificate of Workers' Compensation Coverage WA UBI No_ L&I Account ID Legal Business Name Doing Business As Workers' Comp Premium Status: Estimated Workers Reported (See Description Below) Account Representative Licensed Contractor? January 30, 2026 604 817 226 185,334-00 PEERS RISING PEERS RISING Account is in good standing. Quarterly report received and is being processed. Pending current quarter filing Employer Services Help Line, (360) 902-4817 No What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 1.1 2.050 and -, I . � � 19iCD- Q 0 f+ cc ``Q. CD `r �o C .O d C 0 a X W O T R a c O PIA f . 4 _ E Px W 'v r p , A O Z Oyy s LLF C U C C 0 L d � F. c U � a. U) Q G N ]L � W m �/•+ 0 ti a a s E Q C S xe o is m LU C v S . 4 W O C 0 p C Q Q F