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Home My WebLink AboutContract2023 GRANT BENEFICIARY/ARTIST AGREEMENT WITH CHRISTINA CARAVAGLIO RENTON MUNICIPAL ARTS COMMISSION GRANT PROGRAM THIS AGREEMENT, dated for reference purposes only as May 25, 2023, is by and between the City of Renton (the “City”), a Washington municipal corporation, and Christina Caravaglio (“Beneficiary/Artist”), a Sole Proprietor, and sets forth the terms and conditions under which the City will provide a grant to Beneficiary/Artist under the Renton Municipal Arts Commission, Municipal Art Fund, Grant Program (“Program”). The Program is funded through the Renton Municipal Art Fund (RMC 2-8-7.B) (“Fund”), as authorized by the Renton City Council on November 14, 2022 pursuant to RMC 2-8-4.C and 2-8-7.B.3. The City and the Beneficiary/Artist are referred to collectively in this Agreement as the “Parties.” Once fully executed by the Parties, this Agreement is effective as of the last date signed by both parties. RECITALS: WHEREAS, the City of Renton recognizes and acknowledges the importance of, and benefit to the public in, providing visual art and performance in its public works and facilities, and the community as a whole; and, WHEREAS, the City created the Renton Municipal Arts Commission (“Commission”)to advise the Mayor and City Council on artistic and cultural development of the City, and to disburse money budgeted to it for cultural arts performances and other events, art-related programs and activities and support of artists and arts and cultural organizations, as resources allow through the City’s Municipal Art Fund; and, WHEREAS, the Commission established Application Criteria (Exhibit 1), issued a Call for Application (Call for Application” at Exhibit 2), reviewed Applications (“Beneficiary/Artist’s Application” at Exhibit 3), and established a list of Projects awarded from the Fund (“Projects Awarded” at Exhibit 4), each Exhibit is incorporated herein by reference; and WHEREAS, on December 6, 2022, the Commission reviewed the Beneficiary/Artist’s Application and determined that the Beneficiary/Artist is eligible for assistance under this Program and is promoting arts and culture in Renton. CAG-23-315 PAGE 2 OF 15 NOW THEREFORE, in consideration of the mutual covenants and agreements herein, the Parties agree as follows: AGREEMENT 1. Grant Amount and Disbursement. a. Amount. The total amount to be awarded to Beneficiary/Artist under the Program is up to four thousand five hundred and five dollars ($4,505) as a reimbursement for eligible expenses. Except as specifically provided herein, the Beneficiary/Artist shall be solely responsible for payment of any taxes imposed as a result of this Agreement. b. Award Disbursement. i.Reimbursement Request. On a monthly, or no less than quarterly basis during any quarter in which artistic and cultural support is completed, Beneficiary/Artist shall submit reimbursement request(s) in a format acceptable to the City (Exhibit 5) with supporting documentation including, but not limited to, invoices or reports demonstrating expenses for which reimbursement is sought. ii.Effect of Award. Other than as specified, Beneficiary/Artist relinquishes the right to any financial proceeds in association with City’s use or reproductions of PROJECT. iii.Payment. Payment shall be made by City within thirty (30) calendar days after receipt and approval by the appropriate City representative of the invoice. iv.No waiver. Payment for any reimbursement shall not constitute a waiver by the City of any remedies it may have for any breach of this Agreement by the Beneficiary/Artist. v.Tax implications. Grant funds may be taxable. Please consult your financial advisor/tax professional for guidance. If it is required by the IRS, a 1099 form will be issued to the Beneficiary/Artist. 2. Scope and Performance.Beneficiary/Artist agrees to create and install artwork or produce an event as specified in Exhibit 3 “Beneficiary/Artist’s Application” which is attached and incorporated herein. Such scope is hereinafter referred to as “PROJECT.” a. Prior to scheduling the installation or production, Beneficiary/Artist agrees to discuss the contents of the proposed PROJECT with designated City staff to address necessary Council approvals, coordination with affected City departments, compliance with affected City regulations such as signage or event permits, materials to be used, and/or documentation of agreements with Beneficiary/Artist partners such as private property where the PROJECT will be presented. These discussions may result in revision of the PROJECT as proposed. PAGE 3 OF 15 b. The final design will be provided to the City’s Municipal Arts Commission for review, request for further revision as needed, and final confirmation prior to installation or production of the PROJECT. c. Beneficiary/Artistwill be responsible for installing the PROJECT in its approved design at the location identified in Exhibit 3. d. Beneficiary/Artist agrees to create and install PROJECT no later than December 15, 2023. 3. Installation on Private Property. a. According to the Application (Exhibit 3), The PROJECT will be displayed or produced at 16812 116th Ave SE, Renton WA 98057 (parcel # 2823059114) which is not owned by the City or a public entity. b. As noted in Section 2.a of this Agreement, ARTIST will provide the City with documentation of the property owner’s agreement to host the PROJECT including submission of all necessary permit applications to effectuate the PROJECT. Nothing in the Agreement is intended to, nor should be construed to, act as a guarantee that an application for a permit will be granted. c. ARTIST agrees to inform the private property owner(s) of the obligation to consult with CITY’s Community & Economic Development Administrator prior to any removal or alteration of the PROJECT. d. CITY may, at its own discretion, cooperate with the private property owner and ARTIST in the case private property owner has reason to remove or alter the PROJECT in the future, or if the PROJECT is impacted by wear, vandalism, damage, or other reason, to restore or relocate the PROJECT as necessary. 4. Beneficiary/Artist’s Grants and Representations: a. Delivery of PROJECT to City constitutes Beneficiary/Artist’s certification that: i. PROJECT is the original work of Beneficiary/Artist; ii. To the extent others contributed to the PROJECT, Beneficiary/Artist assumes all responsibility and liability for any claims of right to the PROJECT by such others; iii. Beneficiary/Artist owns all rights to PROJECT, including having obtained any rights that Beneficiary/Artist did not originally possess; and iv. if PROJECT contains recognizable images of particular persons, Beneficiary/Artist has obtained appropriate releases. b. Beneficiary/Artist acknowledges that, except for PROJECT to which section 3 of this Agreement applies, the PROJECT will be displayed on City-owned property at [insert address/location] at the discretion of the City. The City retains all right to remove, maintain, restore, relocate, or otherwise alter the PROJECT in the future for any reason. c. Beneficiary/Artist grants to City a non-exclusive license to graphically and electronically reproduce PROJECT, while on display, for any and all future publicity endeavors conducted by City, provided that any such reproduction is credited to PAGE 4 OF 15 Beneficiary/Artist by name. City may use the Beneficiary/Artist’s photograph, other likeness, or biography in connection with the use of PROJECT. 5. Final Report: Together with the final reimbursement request, and in a format acceptable to the City (Exhibit 6), Beneficiary/Artist shall submit a final report detailing outcomes related to budget, activities, objectives, and attendance as first described in the Beneficiary/Artist’s application for the Grant. 6. Scope ofEligible Expenditures: Grant funds disbursed under this Agreementshallonly be used to pay or reimburse eligible expenses as described in the Criteria (Exhibit 1) and in the “Program Call for Applications” (Exhibit 2) a. Reimbursement Defined. “Reimbursement” means grant disbursement to Beneficiary/Artist upon receipt by the City of invoices and documentation demonstrating eligible expenses. b. No Duplication of Payment. No grant funds may be used to pay or reimburse costs for expenditures for which Beneficiary/Artist has received any other funding, whether state, federal or private in nature, for that same expense. 7. Beneficiary/Artist Responsibilities. a. False Statement. The Beneficiary/Artist understands and acknowledges that providing false information in the Application or on any documents submitted to the City or its designees as part of the Beneficiary/Artist’s participation in the Program may constitute fraud, justify termination of this Agreement, trigger the Beneficiary/Artist’s obligation to return funds, and may be subject to civil and/or criminal penalties and/or sanctions. b. No Employee Relationship. The Beneficiary/Artist understands and acknowledges that neither the Beneficiary/Artist nor any officer, employee or agent of the Beneficiary/Artist shall be considered to be an employee of the City, nor entitled to any benefits accorded City employees, by virtue of the services provided under this Agreement. The City shall not be responsible for assuming the duties of an employer with respect to the Beneficiary/Artist or any employee of the Beneficiary/Artist. c. Non-discrimination.During the performance of this Agreement, the Beneficiary/Artist shall comply with all federal and state nondiscrimination laws, including but not limited to, chapter 49.60 RCW, Washington’s Law Against Discrimination, and 42 U.S.C. 12101 et seq., the Americans with Disabilities Act (ADA). In the event of theCompany’s noncompliance or refusal to comply with any nondiscrimination law, regulation, or policy, this Agreement may be rescinded, canceled, or terminated in whole or in part. d. Sole proprietorship or Individual. If the Beneficiary/Artist is a sole proprietorship or if this Agreement is with an individual, the Beneficiary/Artist agrees to notify the City and complete any required form if the Beneficiary/Artist retired under a State of Washington retirement system and PAGE 5 OF 15 agrees to indemnify any losses the City may sustain through the Beneficiary/Artist’s failure to do so. 8. Insurance [Requirement Waived] 9. Records: Maintenance, Access, Disclosure. a. Records Maintained.Beneficiary/Artistshall maintain all records and accounts with respect to all matters covered by this Agreement, including personnel, property, financial, and programmatic records and documents. b. Retention Period. These records shall be maintained for as long as may be required by applicable Washington State records retention laws, but in any case for a period of six (6) years after all funds have been expended or returned to the City, whichever is later, to ensure proper accounting for all funds and compliance with the Agreement. c. Litigation or Audit. If any litigation, claim or audit is started before the expiration of the six (6)year period provided in Section 4(b) above, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved. d. Right of Access.The City, or itsauthorized representatives, shall have the right of access to records (electronic and otherwise) of Beneficiary/Artist in order to conduct audits or other investigations. e. Subject to Disclosure. Beneficiary/Artist acknowledges that records may be subject to disclosure under the Public Records Act, Ch. 42.56 RCW. i. To the full extent the City determines necessary to comply with the Washington State Public Records Act, Beneficiary/Artist shall make a due diligent search of all records in its possession or control relating to this Agreement and the PROJECT, including, but not limited to, e-mail, correspondence, notes, saved telephone messages, recordings, photos, or drawings and provide them to the City for production. ii. In the event Beneficiary/Artist believes said records need to be protected from disclosure, it may, at Beneficiary/Artist’s own expense, seek judicial protection. Beneficiary/Artistshall indemnify, defend, and hold harmless the City for all costs, including attorneys’ fees, attendant to any claim or litigation related to a Public Records Act request for which Beneficiary/Artist has responsive records and for which Beneficiary/Artist has withheld records or information contained therein, or not provided them to the City in a timely manner. iii. Beneficiary/Artist shall produce to the City for distribution any and all records responsive to the Public Records Act request in a timely manner, unless those records are protected by court order. The provisions of this section shall survive the expiration or termination of this Agreement. PAGE 6 OF 15 10. Publications.Any publications produced with funds from this Agreement must display the following language: “This project is being supported, in whole or in part, by a grant from the City of Renton.” 11. Disclaimer by the City.The City expressly disclaims any and all responsibility or liability to Beneficiary/Artist or third persons for the actions of Beneficiary/Artist or third persons resulting in death, bodily injury, property damages, or any other losses resulting in any way from the performance of this Agreement or any other losses resulting in any way from the performance of the Agreement, or any subcontract thereto. This Agreement does not in any way establish an agency relationship between or among the City and/or Beneficiary/Artist. 12. Expenses Incurred in Excess of Program Award Funds. Beneficiary/Artist acknowledges that any expenses incurred in excess of ProgramAward Funds are the Beneficiary/Artist’s sole responsibility and will not be paid by the City. 13. Repayment of Funds. If any funds provided to Beneficiary/Artist were used in a manner that is not consistent or allowable as outlined in this Agreement, Beneficiary/Artistshall return funds to City in the amount determined to be ineligible. Beneficiary/Artist further agrees that it is financially responsible for and will repay the City any and all indicated amounts following an audit exception which occurs due to Beneficiary/Artist’s failure, for any reason, to comply with the terms of this Agreement. This duty to repay the City shall not be diminished or extinguished by the termination of the Agreement. 14. Termination.The City reserves the right to terminate this Agreement at any time, with or without cause by giving ten (10) calendar days’ notice to the Beneficiary/Artist in writing. In the event of such termination or suspension, Beneficiary/Artist waives any right to un- distributed portions of the award. 15. Conflict of Interest. a. Beneficiary/Artist designees, agents, members, officers, employees, consultants, and any other public official who exercises or who has exercised any functions or responsibilities with respect to the Program during his or her tenure, or who is in a position to participate in a decision-making process or gain inside information with regard to the Program, are barred from any interest, direct or indirect, in any grant or proceeds of the Program, or benefit there from, which is part of this Agreement at any time during or after such person's tenure. b. The City’s Code of Ethics and Washington State law prohibit City employees from soliciting, accepting, or receiving any gift, gratuity or favor from any person, firm or corporation involved in a contract or transaction. To ensure compliance with the City’s Code of Ethics and state law, the Beneficiary/Artist shall not give a gift of any kind to City employees or officials. PAGE 7 OF 15 c. Beneficiary/Artist also confirms that Beneficiary/Artist does not have a business interest or a close family relationship with any City officer or employee who was, is, or will be involved in selecting the Beneficiary/Artist, negotiating or administering this Agreement, or evaluating the Beneficiary/Artist’s performance of the Work. 16. Notices: Any notice required under this Agreement will be in writing, addressed to the appropriate party at the address which appears below (as modified in writing from time to time by such party), and given personally, by registered or certified mail, return receipt requested, by facsimile or by nationally recognized overnight courier service. Time period for notices shall be deemed to have commenced upon the date of receipt, EXCEPT facsimile delivery will be deemed to have commenced on the first business day following transmission. Email and telephone may be used for purposes of administering the Agreement, but should not be used to give any formal notice required by the Agreement. CITY OF RENTON Jessie Kotarski Economic Development Manager CED/City of Renton 1055 South Grady Way, 6th Floor Renton, WA 98057 Phone: (425) 430-7271 Email: jkotarski@rentonwa.gov BENEFICIARY/ARTIST Christina Caravaglio Artist 12533 SE 203rd Pl Kent, WA 98031 Phone: (253) 486-5857 Email: ccpatchwork@gmail.com 17. Waiver/Conflict of Terms. a. Any waiver by the Beneficiary/Artist or the City of the breach of any provision of this Agreement by the other party will not operate, or be construed, as a waiver of any subsequent breach by either party or prevent either party from thereafter enforcing any such provisions. b. In the event of any inconsistencies between Beneficiary/Artist proposals and this Agreement, the terms of this Agreement shall prevail. Any exhibits/attachments to this Agreement are incorporated by reference only to the extent of the purpose for which they are referenced within this Agreement. To the extent a Beneficiary/Artist-prepared exhibit conflicts with the terms in the body of this Agreement or contains terms that are extraneous to the purpose for which it is referenced, the terms in the body of this Agreement shall prevail and the extraneous terms shall not be incorporated herein. 18. Modification. This Agreement may only be amended by written agreement signed by both Parties. PAGE 8 OF 15 19. Conflicts. In the event of any inconsistencies between Beneficiary/Artist proposals or Beneficiary/Artist-prepared exhibits and this Agreement, the terms of this Agreement shall prevail. 20. Severability. In the event any term or condition of this Agreement or application thereof to any person or circumstances is held invalid, such invalidity shall not affect other terms, conditions, or applications of this Agreement that can be given effect without the invalid term, condition, or application. To this end, the terms and conditions of the Agreement are declared severable. 21. Governing Laws.Any lawsuit or legal action brought by any party to enforce or interpret this Agreement or any of its terms or covenants shall be brought in the King City Superior Court for the State of Washington at the Maleng Regional Justice Center in Kent, King City, Washington, or its replacement or successor. Beneficiary/Artist hereby expressly consents to the personal and exclusive jurisdiction and venue of such court even if Beneficiary/Artist is a foreign corporation not registered with the State of Washington. 22. Indemnification. To the maximum extent permitted by law,Beneficiary/Artistshall, at its cost and expense, protect, defend, indemnify, and hold harmless the City, its directors, officers, employees, and agents, from and against any and all demands, liabilities, causes of action, costs and expenses (including attorneys’ fees), claims, judgments, or awards of damages, arising out of or in any way resulting from the acts or omissions of Beneficiary/Artist, its directors, officers, employees, or agents, relating in any way to Beneficiary/Artist’s performance or non-performance under the Agreement. Beneficiary/Artist agrees that its obligations under this paragraph extend to any demands, liabilities, causes of action, or claims brought by, or on behalf of, any of its employees or agents. For this purpose, Beneficiary/Artist, by mutual negotiation, hereby waives, as respects the Cityonly, any immunity that would otherwise be available against such claims under any industrial insurance act, including Title 51 RCW, other Worker’s Compensation act, disability benefit act, or other employeebenefit act of any jurisdiction which would otherwise be applicable in the case of such claim. These indemnification obligations shall survive the termination of the Agreement. 23. Complete Agreement. This Agreement sets forth the complete expression of the agreement between the Parties, and any oral representations or understandings not incorporated herein are excluded. The Parties may execute this Agreement in any number of counterparts, each of which shall constitute an original, and all of which will together constitute this one Agreement. Exhibits 1 – Renton Municipal Arts Commission Grant Program – Application Criteria 2 – Renton Municipal Arts Commission Grant Program – Call for Applications 3 – Renton Municipal Arts Commission Grant Program – Beneficiary/Artist’s Application 4 – Renton Municipal Arts Commission Grant Program – Projects Awarded PAGE 9 OF 15 5 – Renton Municipal Arts Commission Grant Program – Reimbursement Request Form 6 – Renton Municipal Arts Commission Grant Program – Final Report Form IN WITNESS WHEREOF, the Parties have voluntarily entered into this Agreement as of the date last signed by the Parties below. CITY OF RENTON By:________________________ BENEFICIARY By:___________________________ C.E. “Chip” Vincent CED Administrator Christina Caravaglio Artist __________________________ Date _____________________________ Date Approved as to legal form: __________________________ M. Patrice Kent Sr. Assistant City Attorney Grant Template: 01.18.2023 (File # 2332 – Award Ref #:2638) ϲͬϮϮͬϮϬϮϯ ϲͬϮϭͬϮϬϮϯ Approved by Patrice Kent via 6/2/2023 email PAGE11OF16 EXHIBIT1: RENTONMUNICIPALARTSGRANTPROGRAM APPLICATIONCRITERIA DEADLINES $SSOLFDWLRQVDUHUHYLHZHG RQDTXDUWHUO\EDVLV $SSOLFDWLRQV0867EH VXEPLWWHGHOHFWURQLFDOO\E\ SPRQWKHGD\RIWKH GHDGOLQHRUWKH\ZLOOQRWEH FRQVLGHUHGLQWKDWTXDUWHU 42FWREHU 4)HEUXDU\ 4$SULO 4²-XO\ GET HELP :HDUHon hand to answer your questions and assist with your application. Call during regular business hours. $UWV#UHQWRQZDJRY 425.. # 6833257)257+($576 ,15(1721 Funding for arts, cultural and heritage projects that serve residents and visitors in 5HQWRQ, Washington We encourage innovative projects by artists and communities that VKRZFDVHFXOWXUDO GLYHUVLW\LQFUHDVHXQGHUVWDQGLQJDQG inspire new forms of creative participation DQGRSSRUWXQLWLHVIRUJURZWKparticularly for under-served groups. +LVWRULFDOO\JUDQWVKDYHEHHQDZDUGHGLQ DPRXQWVEHWZHHQDQG Projects must take place during 20and should be completed by December $UW courtesy of 0DUVKD5ROOLQJHU 20*UDQWGuidelines 3DJH Program Overview Purpose 7KH&LW\RI5HQWRQWKURXJKWKH5HQWRQ0XQLFLSDO$UW &RPPLVVLRQRIIHUVJUDQWVWRLQGLYLGXDOVRUJDQL]DWLRQV DQG FRPPXQLW\JURXSVIRUDUWVDQGFXOWXUHSURMHFWV DQG HYHQWVWKDWVHUYHWKHJHQHUDOSXEOLFLQ5HQWRQ Public Funding = Public Benefit 3URMHFWVVKRXOGSURYLGHSXEOLF EHQHILW ([DPSOHVRI SXEOLFEHQHILW DUH x )UHH SXEOLF SHUIRUPDQFHV H[KLELWLRQV ZRUNVKRSV VFUHHQLQJV RUUHDGLQJV x 6FKRODUVKLSV WR RQJRLQJ IHHEDVHG DUWV HGXFDWLRQDO RU WUDLQLQJ SURJUDPV x 6HUYLFHVWKDWH[SDQGDFFHVVDQG LQFOXVLRQ WR LQGLYLGXDOV ZLWK OLPLWHG SK\VLFDORU (QJOLVK VSHDNLQJ DELOLWLHV **UDQWW$ZDUGVVKDYHHEHHQQXVHGGWR v 3URGXFHRQHWLPHSHUIRUPDQFHVH[KLELWV VSHFLDOHYHQWVRUSURJUDPVWKDWEULQJDUWVRU FXOWXUDOH[SHULHQFHVWR5HQWRQUHVLGHQWV v 3URYLGHRSSRUWXQLWLHVIRULQGHSHQGHQW DUWLVWV WRGHYHORSDQGSUHVHQWQHZZRUNLQ DOO PHGLXPV v ,PSURYHDUWVDQGFXOWXUDORSSRUWXQLWLHVIRU DUWLVWVDQGDXGLHQFHVIURPGLYHUVH FRPPXQLWLHV v 3DUWLFLSDWRU\DQGHGXFDWLRQDORSSRUWXQLWLHV IRU\RXWKPXOWLFXOWXUDOVHQLRUVDQGVSHFLDO SRSXODWLRQV v ,QFUHDVHDFFHVVWRDUWVDQGFXOWXUDOHYHQWV E\SURYLGLQJGLVFRXQWWLFNHWVDQGRUIUHH HGXFDWLRQDOSURJUDPV v 3URMHFWVWKDWDUHQRWORFDWHGLQ5HQWRQ SULPDULO\EHQHILW5HQWRQUHVLGHQWVRUDUHQRW RIIHUHGIUHHRIFKDUJHRUDWUHGXFHGUDWHVWR WKHH[WHQWSRVVLEOH v 3URMHFWVWKDWDUHQRWRSHQWRWKHSXEOLF v 3URMHFWVWKDWKDYHDOUHDG\EHHQFRPSOHWHG v 3URMHFWVWKDWVXSSRUWRURSSRVHDVSHFLILF LQWHUHVWVXFKDVDSDUWLFXODUEXVLQHVV SROLWLFDORUUHOLJLRXVYLHZSRLQWRU RUJDQL]DWLRQ v &DSLWDOFRQVWUXFWLRQSURMHFWV v 3URMHFWVWKDWXVHWKH*UDQWIXQGVWRSURYLGH FDVKDZDUGVWRLQGLYLGXDOV v 3URMHFWVZKLFKSUHFOXGHUHDVRQDEOHDFFHVV E\WKHJHQHUDOSXEOLFVXFKDVLQDORFDWLRQ QRWRSHQWRWKHJHQHUDOSXEOLFRUIRUZKLFK PHPEHUVKLSLVUHTXLUHGRUDGPLVVLRQ FKDUJHVFDQQRWEHUHGXFHGRUZDLYHGIRU DFFHVV )XQGLQJJ5HVWULFWLRQVVLQFOXGH 7KHIROORZLQJW\SHVRISURMHFWVDUH127HOLJLEOHIRU IXQGLQJ Application Review Process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age 3 Funding Generally, the maximum award is $,000 and the minimum award is $500. However, the Arts Commission may recommend greater or lesser amounts. Timing of Projects Projects must take place during and should be completed by December , . Payment 3D\PHQWIRUUHLPEXUVDEOHH[SHQVHVZLOOEHmade at the end of the project. Exceptions may be made, depending on circumstances and City policy. The funding recipient XJMMturn ininvRLFHVDQGDILQDOreport to the $UWV &RPPLVVLRQ for reimbursement. Invoices and final reports are due by December . Checks are normally mailed within 30 days of the invoice dateDQGUHFHLSWRI FRPSOHWHG paperwork. Eligibility Who May Apply x ,QGLYLGXDOVJURXSVRISHRSOHDOODJHV QHLJKERUKRRGRUEXVLQHVVRUJDQL]DWLRQVVHHNLQJ IXQGLQJIRUDQDUWSURMHFWRUFXOWXUDOHYHQW x ,QGHSHQGHQW$UWLVWV$UWVDQG&XOWXUDO RUJDQL]DWLRQVLQFOXGLQJSURIHVVLRQDODQG FRPPXQLW\EDVHGJURXSV x ,56QRWIRUSURILWVWDWXV²F²LVQRW UHTXLUHG x $&LW\RI5HQWRQEXVLQHVVOLFHQVHPD\EHUHTXLUHG Evaluation Criteria Artistic Innovation v Quality and promise of the proposed arts, cultural,and heritage project to meet the cultural needs ofan audience and/or constituent group. v Innovative approach to foster creative and civic participation by 5HQWRQ V diverse residents and visitors, particularly underserved people and communities. v Fills a gap in art, cultural, or heritage offerings andopportunities not regularly available to 5HQWRQresidents and visitors. v 3URSRVHGSURMHFWVPXVWWDNHSODFHLQ5HQWRQ v 3URSRVHGSURMHFWVPXVWVHUYHDQGEHDFFHVVLEOH WRUHVLGHQWVRI5HQWRQ v v 3URSRVHGSURMHFWVPXVWSUHVHQWQHZZRUNVWR WKHSXEOLF 3ULRULW\ZLOOEHJLYHQWRSURMHFWVWKDWLQYROYH 5HQWRQEDVHGDUWLVWVDQGRUJDQL]DWLRQV v 'HPRQVWUDWHGH[SHULHQFHRISURMHFWOHDGHUVWR DFFRPSOLVKWKHVFRSHDQGVFDOHRIWKHSURMHFW v (YLGHQFHRIWKRXJKWIXOSODQQLQJLQFOXGLQJFOHDUO\ DUWLFXODWHGJRDOVDQGSURFHVVIRUHYDOXDWLRQ v 5HDOLVWLFEXGJHWDQGWLPHOLQH Public Access and Benefit Project Feasibility Application Instructions v &RPSOHWHWKHDSSOLFDWLRQDYDLODEOHRQUHQWRQZDJRY UPDFLQFOXGLQJVXSSOHPHQWDOPDWHULDOV v ,QFRPSOHWHDQGRULQDFFXUDWHDSSOLFDWLRQVZLOOUHVXOWLQ UHWXUQRIDSSOLFDWLRQGHOD\LQJIXQGLQJFRQVLGHUDWLRQRU SRWHQWLDOGHQLDORIIXQGLQJFRQVLGHUDWLRQ v 6WDUWWKHDSSOLFDWLRQSURFHVVDVIDULQDGYDQFHDV SRVVLEOHDDWOHDVW WK UHHPRQ WKVE HIRUH\RXU SURMHFWVWDUW RUHYHQWGDWH v 6XEPLWFRPSOHWHGDSSOLFDWLRQWRDUWV#UHQWRQZDJRY v <RXPD\EHDVNHGWRSUHVHQW\RXUSURSRVDOWRWKH$UWV &RPPLVVLRQ v )RUDGGLWLRQDOLQIRUPDWLRQRUFODULILFDWLRQSOHDVHFDOO RUHPDLODUWV#UHQWRQZDJRY $SSOLFDWLRQSDFNHW 7KHDSSOLFDWLRQLVDYDLODEOHDWUHQWRQZDJRYUPDFDQGLV GXHDFFRUGLQJWRWKHVFKHGXOHDERYH3OHDVHFRPSOHWH WKHIRUPLQLWVHQWLUHW\DQGVXEPLWLWDORQJZLWKDOO VXSSOHPHQWDOPDWHULDOVRQOLQH,QFRPSOHWHDSSOLFDWLRQV ZLOOGHOD\IXQGLQJFRQVLGHUDWLRQ$GGLWLRQDOLQIRUPDWLRQRU FODULILFDWLRQPD\EHUHTXHVWHGE\WKH*UDQWV&RPPLWWHH PAGE12OF16 EXHIBIT2: RENTONMUNICIPALARTSGRANTPROGRAM CALLFORAPPLICATIONS 1055 South Grady Way, Renton, WA 98057 | 425-430-6400 | rentonwa.gov | CITY OF RENTON FOR IMMEDIATE RELEASE Sept. 15, 2022 City of Renton Contacts Jessie Kotarski, Economic Development Manager, 425-430-7271 Dave Neubert, Communications Manager, 425-430-6567 Renton Municipal Arts Commission accepting 2023 grant applications Deadline is 4:30 p.m. on Thursday, Oct. 13, 2022 RENTON, WA – Renton Municipal Arts Commission is accepting grant applications from individuals, organizations, and community groups for art, cultural, and heritage projects serving Renton residents and visitors. Renton Arts & Culture Grants stimulate grassroots activity and encourage public interest and participation in the arts. The commission encourages innovative projects depicting Renton's cultural diversity. Projects should increase the understanding of individuals and society and inspire new forms of creative participation and growth opportunities, particularly for underserved groups. Programming funded by these grants includes art exhibits, concerts, dance performances, festivals, workshops, readings, and theater productions. Grants of up to $10,000 are awarded four times a year and applicants are eligible for one grant per calendar year. The application for this round of funding is online. Applications are due by 4:30 p.m. on Oct. 13, 2022. Projects and events scheduled between January and March 2023 are given priority. Application deadlines in 2023 are Feb. 3, April 21, and July 21. Renton Municipal Arts Commission will host two question and answer sessions on Monday, Sept. 26, from 6 to 7 p.m., and Friday, Oct. 7, from 3 to 4 p.m. Both sessions will be held at Renton History Museum. The sessions are an opportunity to meet the grant committee, ask questions, and connect with other applicants. They are casual, and pre-registration is not required. Questions concerning the application process may be directed to Jessie Kotarski, the City of Renton’s Economic Development Manager, at 425-430-7271 or arts@rentonwa.gov. 1055 South Grady Way, Renton, WA 98057 | 425-430-6400 | rentonwa.gov | About the City of Renton The City of Renton, Washington, with a population of 107,500 (2022), is located on the southeast shore of Lake Washington, just south of Seattle. Renton's strong economic base, diverse marketplace, and favorable business climate have attracted nationally recognized companies wishing to provide employees and their families with an outstanding quality of life. Renton is the home of Boeing, PACCAR, IKEA, Super Bowl Champion (2014) Seattle Seahawks, two-time (2016 & 2019) MLS champion and CONCACAF Champion (2022) Seattle Sounders FC (in 2024), and the eternal resting place of rock icon Jimi Hendrix. More information is on our website, in news releases, or on Facebook, Twitter, and Nextdoor. About the Renton Municipal Arts Commission Renton Municipal Arts Commission was created in 1965. The members advise the city government about the artistic and cultural development and serve as stewards of the city's art collection. In addition, the commission strives to support and connect people with arts and culture endeavors in the Renton community. For more information about the Renton Municipal Arts Commission, contact arts@rentonwa.gov or facebook.com/rentonarts. ### PAGE13OF16 EXHIBIT3: RENTONMUNICIPALARTSGRANTPROGRAMBENEFICIARY/ARTIST’SAPPLICATION CAUTION: This email originated from outside the City of Renton. Do not click links, reply or open attachments unless you know the content is safe. From:noreply@yourwpsite.email on behalf of Christy Caravaglio To:Jessie Kotarski Subject:New submission from 2023 Renton Arts Grant Application Date:Saturday, October 8, 2022 4:35:51 PM Attachments:RMAC-Budget-Sheet_Grant-Application-2023.pdf 2023-Renton-application-additional-info.docx.pdf Name of your Organization Christy Caravaglio Contact Person and Title Christy Caravaglio, artist Contact person email address ccpatchwork@gmail.com Organization Address 12533 SE 203rd Pl Kent, WA 98031 United States Map It Phone (253) 486-5857 Have you applied for a Renton arts grant award in the past? Yes Have you received funding in previous years from the Renton Arts Grant Program? Yes Please list the most recent project and the grant amount for which you have previously received funding Maple Valley Highway Fence Project in 2021, $4,500 Select that category best describes your project Public art support Check the one arts discipline that best describes your proposed project: Visual Arts Project or Event Title Twirling Star Project Summary I propose to install temporary yarn art a chain link fence in Renton. This installation will add bright color and joyful pattern to the existing urban environment. Using brightly colored acrylic yarn, I will weave a geometric design onto the fence. Yarn will be simply and securely tied to the fence leaving no permanent effects on the site. It is suitable outdoors in all weather conditions. Expected duration of installation is approximately one year. When the yarn becomes faded, worn, or damaged, the artist will remove it with the consent of arts commission staff. I have identified two possible locations. One is at 17426 Benson Dr. SE, Renton, 98055. This is a “teardown” property, formerly West & Sons Towing across from the Fred Meyer and CVS on Benson & Carr Roads. If we can obtain permission for this fence, art at this location will be highly visible and have a large impact on the community in a busy area that has no other public art. The other location is LQWKH%HQVRQ&RPPXQLW\RQWKHFRUQHURIWK$YH6(DQG6(WK6WDFURVV IURPWKH%HQVRQ%UXLQV%DOOILHOG There are many chain link fences RQWKLVFRUQHU. The one that willbe most accessible, in terms of permission and safety, is the one that encloses the QXUVHU\HPSW\ORWDFURVV IURPWKH(OHYHQ. 7KHEDOOILHOGKRVWVDQXPEHURIFRPPXQLW\HYHQWVLQWKHVSULQJDQGVXPPHU 'ecoration on this fence will soften the atmospherein this active construction area and families will have easy access to interact with the artist duringinstallation. Public art like this can help create a sense of place and a feeling of belonging to that place. Colorful geometric designs appear in a variety of world cultures so a piece like this can be appreciated broadly in a diverse community such as we have in South King County. This project can be done any time. Preferred start date is in the spring. The artist and the arts commission can decide on specific dates. Installation can take place on weekends over the course of a couple of weeks. It will be fun for people to see the project progress gradually Funding Amount 4,505 List the beginning and ending date of your project March 2023-March 2024 The Renton Public Arts Program is committed to broadening the scope of arts programming and connecting with underserved populations in the City of Renton and broader community. Please detail what steps you hope to take to connect with under-served populations in the community. (100 words) This project will be accessible to all. It will be seen by everyone who drives or walks by the location, both of which are used by many, many people. This work will add bright color and joyful pattern to the existing and unsightly chain link fence. One of the things I love about public art is that people can experience it without leaving their daily routines. Since installation will be done on-site, people will have the opportunity to interact with the artist in-person during those hours. Budget RMAC-Budget-Sheet_Grant-Application-2023.pdf Application Certification I agree to the privacy policy. I understand the City of Renton and Washington state limitations placed on use of public funds and certify that the requested funds will be used only for the purposes described in this application or as approved by the RMAC. I understand use of funds is subject to audit by the State of Washington. I have read and understand the criteria by which our application will be evaluated and understand that if our application is selected for funding, we will be required to enter into a binding agreement with the City to ensure completion of the project Name Christina Caravaglio Certification I certify that my statements are true and have approval from my board/agency to apply for this grant. I have read and understand the RMAC Grant Guidelines and will provide all documentation requested by the City in support of this application. I consent to having this website store my submitted information to process this grant application. Upload any supporting documentation, including artist bios, organization overview, description of project partners or other relevant information in support of your application. 2023-Renton-application-additional-info.docx.pdf Renton Public Arts Program Application Upload any supporting documentation, including artist bios, organization overview, description of project partners or other relevant information in support of your application. Christy Caravaglio ccpatchwork@gmail.com October 2023 Artist Statement The goal of my work is to brighten up our daily environments with color and pattern. Inspired by the geometry of traditional and contemporary fiber arts and crafts, I recombine and reimagine motifs into different settings. Soft, colorful yarn contrasts with the hard, gray chain link fences that I often use for installation. And transporting a usually indoor medium to the outdoors changes its accessibility and visibility. Art in public spaces is for everyone. Adding art to unadorned spaces we see everyday and take for granted shows care and love for those places. I like to cause people to see their familiar environment in new ways, creating moments of surprise and joy. Colorful geometric designs appear all over the world. These elements are very human and broadly accessible to every member of the community regardless of age or origin. An important element of my installation work is that I create it in person on-site. I enjoy the process of making, the feel of yarn, the gradual growth of something made by hand. It is meditative to hear the sounds, feel the sun, smell the air where I am placing my art. Not less important is the opportunity to meet the people who walk or drive by. I can really feel the community building aspect of public art in those interactions. While weaving yarn in a public space, I feel a connection to the community. Artist Bio Christy Caravaglio is a fiber artist living in Kent, WA. She grew up in New York State and received a bachelor of fine arts from Alfred University. She worked as a graphic artist for ten years while practicing a lifelong interest in fiber arts (quilting, knitting, stitching.) After becoming a mother, she worked for ten years as a teaching artist and program coordinator in her local elementary schools. Christy’s current yarn installation work blends her past experiences. Inspired by textile art and crafting, she creates yarn installations on chain link fences where public art sparks community development. Christy has received grants and commissions from 4Culture and several cities in Washington including Burien, Edmonds, Renton, Auburn, and Seattle. Work Samples (images of previously completed projects/events) Images of my previous work on similar projects can be seen online at https://www.ccpatchwork.com/ Illustration of proposed design. This panel will repeat along the length of the fence. Changes may be made. WZK:dh'd ŽŵƉůĞƚĞƚŚĞĨŽůůŽǁŝŶŐƚĂďůĞ;ŽƌƐƵďŵŝƚĂƐĞƉĂƌĂƚĞďƵĚŐĞƚͿƚŽĚĞƚĂŝůƚŚĞĐŽƐƚƐŝŶǀŽůǀĞĚŝŶƚŚĞƉƌŽũĞĐƚ͘ dŚĞďƵĚŐĞƚŵƵƐƚƌĞĨůĞĐƚĂĐƚƵĂůĐŽƐƚƐĂƐƐŽĐŝĂƚĞĚǁŝƚŚƚŚĞƉƌŽũĞĐƚ;ƉůĞĂƐĞƐƵďŵŝƚĂǀĂŝůĂďůĞƋƵŽƚĞƐĂŶĚ ĞƐƚŝŵĂƚĞƐŝĨĂǀĂŝůĂďůĞͿ͘ ͗WĞƌƐŽŶŶĞů ;WƌŽũĞĐƚZĞůĂƚĞĚͿ ŵŽƵŶƚ ZĞƋƵĞƐƚĞĚ ĨƌŽŵŝƚǇ DĂƚĐŚŝŶŐ &ƵŶĚƐ /ŶͲ<ŝŶĚ ŽŶĂƚŝŽŶƐ dŽƚĂů ǆƉĞŶĚŝƚƵƌĞEŽƚĞƐ Give details here. Artistic Administration Technical Other dŽƚĂůWĞƌƐŽŶŶĞů ǆƉĞŶĚŝƚƵƌĞƐ ͗/ŵƉůĞŵĞŶƚĂƚŝŽŶ ;ŽƐƚŽĨWƌŽũĞĐƚͿ Supplies/Materials Promotion/Printing Postage Artistic Services Other Professional Services Space/Equipment Rental Travel/Transportation Other dŽƚĂů/ŵƉůĞŵĞŶƚĂƚŝŽŶ ǆƉĞŶĚŝƚƵƌĞƐ dŽƚĂůǆƉĞŶĚŝƚƵƌĞƐ;нͿ WƌŽũĞĐƚdŝƚůĞĂƚĞŽĨĞǀĞŶƚͬ ƉƌŽũĞĐƚƐƚĂƌƚ A Day in Hollywood A Night in Ukraine Feb 17th, 2023 2550 2550 5100 Actors, director, choreographer, and music director pay 1492 1492 2984 Artistic director salary between February and March 2725 2725 5450 Lighting, Costuming, Sound designer, Stage Manager,and Props Designer pay 6767 6767 13534 1638 1638 3276 Costume, props, lighting, sound, and set supplies 1595 1595 3190 Royalties and misc. 3233 3233 6466 10,000 10,000 20,000 PAGE14OF16 EXHIBIT4: RENTONMUNICIPALARTSGRANTPROGRAMPROJECTSAWARDED Applicant ContactInfo Address ProjectorEventTitle Projectdates ProjectSummary FundingRequestGrantCommRecBlackeloneusProductionsLLCDylanDurutylerduru@gmail.com(704)858Ͳ22312101SWSunsetBlvdAptA311Renton,WA98057RoadtoSun 10/22/2021Ͳ8/31/2023RoadtoSunisthestoryofayoungmannamedIcaruswhohasrecentlyconcludedaromanticrelationshipwithawomannamedRose.Icarusstrugglestoovercomethegriefofalostrelationship,buthemustprocessandacceptitbeforeitconsumeshim.Hemustgetpastthefivestagesofgrief.$10,000 $0ChristyCaravaglioChristyCaravaglioccpatchwork@gmail.com(253) 486Ͳ585712533SE203rdPlKent,WA98031TwirlingStar March2023ͲMarch2024Temporaryinstallationofyarnartonapublic,highlyvisiblefenceinRenton.$4,505 $4,505EvergreenCityBalletBethSandersgrants@evergreencityballet.org(425)228Ͳ68001300BronsonWayN.Renton,WA98057TheNutcrackerattheRentonIKEAArtsCenterSept2023ͲDecember20232023productionofTheNutcrackerattheRentonIKEAArtsCenter. $10,000 $0JoseTrejoMayaJoseTrejoMayajdtrejomaya@gmail.com(626) 367Ͳ77563834MontereyAveApt.110Baldwin Park, CA 91706TransparenciesinTime Interactive/multidisciplinarypoetryexhibit;anexposéonMesoamericanloreandmorespecificallyonapreͲColumbiannotionoftime$10,000 $0RentonCivicTheatreBillHuls,CreativeDirectorbill@rentoncivictheatre.org(425)226Ͳ5529507S3rdStRenton,WA98057ADayinHollywoodANightinUkraineFebruary17thͲMarch4th,2023ADayinHollywoodANightinUkrainewontwoTonyawardsin1980.ItistwoindependentoneactshowsthatpayhomagetoincredibleHollywoodͲesquemusicanddance.TommyTunewonbestchoreographyforhisworkinthisshowandRCT'sproductionispullingoutallthestops.ThismusicalisahiddengemandwillbetheperfectproductionforRCT.$10,000 $10,000RentonDowntownPartnershipChristianSwitzerdirector@rentondowntown.com241WilliamsAveSRenton,WA98057RentonDowntownHistoricandMuralWalkingTourJan1,2023ͲOctober31,2023AHistoricWalkingTourofdowntownRenton,includinganartscomponent,discussingthevariousmuralsdowntownalongwiththehistory.Fundingwouldhelpcoverthecostofthetotebags,atreatforattendees,andprintedguides. Three tours in 2023.$3,000 $2,500SongofSeattleChorusSonjaMejlaenderskmmaddie@yahoo.com(206)794Ͳ3271POBox50384Bellevue,WA980152023SpringFlingͲACappellaQuartets&Chorus15ͲAprͲ23 Show/programconceptwillbefreeandnonͲgated,featuringalineͲupof8Ͳ10acappellaquartetsandSongofSeattleChorus,whichisa30Ͳmemberwomen'sacappellachorus.Allperformerswillbepreparingfortheannual5ͲstateNxNWRegionalacappellacompetitionwhichwillbeheldinMay2023inSpokane.AfterathreeͲyearhiatusduetothepandemic,SpringFlingwillgivetheseperformingcompetitorstheopportunitytotakethestage,sharetheircraft,entertaintheaudience,andreceivevaluablefeedbackandfreeadjudicationbytheguestjudge.$2,000 $2,000Totals $49,505 $19,005 PAGE15OF16 EXHIBIT5: RENTONMUNICIPALARTSGRANTPROGRAMREIMBURSEMENTREQUESTFORM Recipientname Mailingaddress ContractNo. DateInvoice#Description Artistic/ Administration Supplies Event Misc Total $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$$ $$$$ Totals $ $ $ $ $ ŽƉŝĞƐŽĨŝŶǀŽŝĐĞƐ͕ƌĞĐĞŝƉƚƐ͕ŽƌŽƚŚĞƌŝƚĞŵƐƚŚĂƚƌĞĨůĞĐƚƉƌŽũĞĐƚĞǆƉĞŶƐĞƐ CompletedFinalReport AttachedIRSFormW9 Amountrequested $ Signature Printedname ǆŚŝďŝƚϱ RENTONMUNICIPALARTSCOMMISSIONGRANTPROGRAM ReimbursementRequestForm Attachedsupportingdocumentationforexpensestodemonstrate,bydate,expenseswereincurred followingtheexecutionofthecontractandnolaterthanDecemberϭϲ,202ϯ.Sufficient documentationincludes: PAGE16OF16 EXHIBIT6: RENTONMUNICIPALARTSGRANTPROGRAMFINALREPORTFORM Renton Municipal Arts Commission Renton City Hall 1055 South Grady Way Renton WA 98057 ͸ ǣ ǣ ǣ ǣ Ǧǣ ǣ ǣ ǣ ȋǤǤ ǡǡǡǡǢ ǡǦ Ǧ ȌǤ ȋȌ ǣ Ǥ ǢǢǡ ǡǢǤNote: These attachments are necessary to document that the project was completed as stated in your application. A requirement of the grant contract is to show that the "credit line" for support from the Renton Municipal Arts Commission used in publicity. Renton Municipal Arts Commission Renton City Hall 1055 South Grady Way Renton WA 98057 ǫǤ Ǥȋ ǣǡ ǡǡǤȌ Ǥǯ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴ ǣRenton Municipal Arts Commission, 1055 S Grady Way, Renton, WA 98057 or arts@rentonwa.gov ȋͶʹͷǦͶ͵ͲǦ͸ͷͺͳ Ȍ For Office Use Only: Approved By: ____________________ Account #: