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2018/06/18 - Briefing Packet
BOARD OF MASON COUNTY COMMISSIONERS DRAFT BRIEFING MEETING AGENDA 411 North Fifth Street, Shelton WA 98584 Week of June 18, 2018 Monday, June 18, 2018 Commission Chambers 9:00 A.M. Executive Session — RCW 42.30.110 (1)(i) Litigation 9:15 A.M. Closed Session — RCW 42.30.140 (4) Labor Discussion 9:30 A.M. Community Services — Dave Windom 10:00 A.M. BREAK 10:15 A.M. Support Services — Frank Pinter 11:15 A.M. Public Works — Jerry Hauth Utilities & Waste Management 11:45 A.M. Juvenile Court Services - Jim Madsen Commissioner Discussion — as needed Briefing Agendas are subject to change,please contact the Commissioners'office for the most recent version. Last printed 06/14/18 at 11:26 AM If special accommodations are needed,contact the Commissioners'office at ext.419,Shelton#360-427-9670;Belfair #275-4467,Elma#482-5269. MASON COUNTY COMMISSIONER BRIEFING INFORMATION FOR WEEK OF June 18, 2018 In the spirit of public information and inclusion, the attached is a draft of information for Commissioner consideration and discussion at the above briefing. This information is subject to change, additions and/or deletion and is not all inclusive of what will be presented to the Commissioners. We have changed the packet format so that it is an interactive document. Please click on the agenda item which then takes you to the cover sheet of that section in the document. To get back to the agenda, hit your "home" key on the keyboard. Please see draft briefing agenda for schedule. CO 1851 MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Casey Bingham DEPARTMENT: Public Health EXT: 562 BRIEFING DATE: 018/18 PREVIOUS BRIEFING DATES: If this is a follow-up briefing, please provide only new information ITEM. Approval of State of Washington Health Care Authority (HCA) Access to Baby and Child Dentistry (ABCD) contract K2751. Background: This contract provides funding to perform functions in the Access to Baby& Child Dentistry (ABCD)program. Some of these functions are: Providing Family Orientation to the Program, Connecting enrolled families with qualified and ABCD certified dentist, addressing family barriers to accessing oral health care. This contract is to for 7/1/2018 to 6/60/2018 and is for$38,200. This is an ongoing contract that has been budgeted for the 2018 budget year. This contract has no matching requirements. RECOMMENDED OR REQUESTED ACTION- Move ,amendment 2 CLH?8253 Consolidated Contract to the Action Agenda. Briefing Summary 6/13/2018 PROFESSIONAL SERVICES HCA Contract Number: K2751 Washington State CONTRACT gfor Health Care .A�Uthority` ABCD DENTAL SERVICES Contractor/Vendor Contract Number: Mason County THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and the (Contractor). CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA) Mason County Public Health CONTRACTOR ADDRESS I Street City State Zip Code P 0 BOX 1666, SHELTON,WA 98564 CONTRACTOR CONTACT CONTRACTOR TELEPHONE--] CONTRACTOR E-MAIL ADDRESS Lydia Buchheit 360-427-9670x545 lydiab@co.mason.wa.us Is Contractor a Subrecinient under this Contract? CFDA NUMBER(S): FFATA Form Reauired ❑YES ®NO 93.778 ®YES ONO HCA PROGRAM HCA DIVISION/SECTION ABCD Dental Program Clinical Quality and Care Transformation (CQCT) HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS Janice Tadeo, Dental Program Manager Health Care Authority 626 8th Avenue SE Health Services and Management PO Box 42702 Clinical Quality and Care Transformation (CQCT) Health Care Services Olympia, WA 98504 HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS (360) 725-1583 Jan ice.Tadeo(a.hca.wa.gov CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT July 1, 2018 June 30, 2020 $38,200.00 PURPOSE OF CONTRACT: Provide `Access to Baby and Child Dentistry' (ABCD) services to detect and prevent early childhood dental decay by engaging dentists in seeing birth to six (6) year old Medicaid eligible children and engaging local public health departments in outreach and case management. The parties signing below warrant that they have read and understand this Contract, and have authority to execute this Contract. This Contract will be binding on HCA only upon signature by HCA. CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Lydia Buchheit HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED James W. Gayton Contracts Administrator Washington State Health Care Authority Page 1 of 53 Contract#2751 TABLE OF CONTENTS Recitals..............................................................................................................................................4 1. STATEMENT OF WORK (SOW) .................................................................................................4 2. DEFINITIONS..............................................................................................................................4 3. SPECIAL TERMS AND CONDITIONS.........................................................................................6 3.1 PERFORMANCE EXPECTATIONS......................................................................................7 3.2 TERM....................................................................................................................................8 3.3 COMPENSATION .................................................................................................................8 3.4 INVOICE AND PAYMENT.....................................................................................................9 3.5 CONTRACTOR and HCA CONTRACT MANAGERS..........................................................10 3.6 KEY STAFF ........................................................................................................................11 3.7 LEGAL NOTICES................................................................................................................11 3.8 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE...........................12 3.9 INSURANCE.......................................................................................................................12 4. GENERAL TERMS AND CONDITIONS..................................................................................... 13 4.1 ACCESS TO DATA.............................................................................................................13 4.2 ADVANCE PAYMENT PROHIBITED..................................................................................14 4.3 AMENDMENTS...................................................................................................................14 4.4 ASSIGNMENT ....................................................................................................................14 4.5 ATTORNEYS' FEES ...........................................................................................................14 4.6 CHANGE IN STATUS .........................................................................................................14 4.7 CONFIDENTIAL INFORMATION PROTECTION................................................................14 4.8 CONFIDENTIAL INFORMATION SECURITY.....................................................................15 4.9 CONFIDENTIAL INFORMATION BREACH - REQUIRED NOTIFICATION........................15 4.10 CONTRACTOR'S PROPRIETARY INFORMATION............................................................16 4.11 COVENANT AGAINST CONTINGENT FEES.....................................................................16 4.12 DEBARMENT .....................................................................................................................17 4.13 DISPUTES..........................................................................................................................17 4.14 ENTIRE AGREEMENT .......................................................................................................18 4.15 FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA)...................18 4.16 FORCE MAJEURE .............................................................................................................18 4.17 FUNDING WITHDRAWN, REDUCED OR LIMITED............................................................18 4.18 GOVERNING LAW .............................................................................................................19 4.19 HCA NETWORK SECURITY ..............................................................................................19 4.20 INDEMNIFICATION ............................................................................................................19 4.21 INDEPENDENT CAPACITY OF THE CONTRACTOR........................................................20 4.22 INDUSTRIAL INSURANCE COVERAGE............................................................................20 Washington State Health Care Authority Page 2 of 53 Contract#2751 4.23 LEGAL AND REGULATORY COMPLIANCE ......................................................................20 4.24 LIMITATION OF AUTHORITY.............................................................................................20 4.25 NO THIRD-PARTY BENEFICIARIES..................................................................................20 4.26 NONDISCRIMINATION.......................................................................................................21 4.27 OVERPAYMENTS TO CONTRACTOR .............................................:................................21 4.28 PAY Equity..........................................................................................................................21 4.29 PUBLICITY .........................................................................................................................22 4.30 RECORDS AND DOCUMENTS REVIEW............................................................................22 4.31 REMEDIES NON-EXCLUSIVE ...........................................................................................22 4.32 RIGHT OF INSPECTION ....................................................................................................23 4.33 RIGHTS IN DATA/OWNERSHIP.........................................................................................23 4.34 RIGHTS OF STATE AND FEDERAL GOVERNMENTS......................................................24 4.35 SEVERABILITY...................................................................................................................24 4.36 SITE SECURITY.................................................................................................................24 4.37 SUBCONTRACTING...........................................................................................................24 4.38 SUBRECIPIENT..................................................................................................................25 4.39 SURVIVAL ..........................................................................................................................26 4.40 TAXES................................................................................................................................27 4.41 TERMINATION ...................................................................................................................27 4.42 TERMINATION PROCEDURES .........................................................................................28 4.43 WAIVER..............................................................................................................................29 4.44 WARRANTIES ....................................................................................................................29 Attachments Attachment 1: Federal Compliance, Certifications and Assurances Attachment 2: Federal Funding Accountability and Transparency Act (FFATA) Data Collection Form Schedules Schedule A: Statement of Work (SOW) ABCD Dental Services Exhibits Exhibit A: ABCD Quarterly Outreach and Case Management Report Exhibit B: ABCD Quarterly Outreach and Coordination of Care Report Exhibit C: ABCD Yearly Budget Tool Washington State Health Care Authority Page 3 of 53 Contract#2751 Contract K2751 for ABCD Dental Services Recitals The state of Washington, acting by and through the Health Care Authority (HCA), is entering into a contract that is exempt from procurement. HCA has determined that entering into a contract with Mason County Public Health in accordance with its authority under chapters 39.26 and 41.05 RCW. HCA has determined that entering into a Contract with Mason County Public Health will meet HCA's needs and will be in the State's best interest. NOW THEREFORE, HCA awards to Mason County Public Health this Contract, the terms and conditions of which will govern Contractor's providing to HCA the services to detect and prevent early childhood dental decay by engaging dentists in seeing birth to six (6) year old Medicaid eligible children and engaging local public health departments or organizations in outreach and case management. IN CONSIDERATION of the mutual promises as set forth in this Contract, the parties agree as follows: 1. STATEMENT OF WORK (SOW) The Contractor will provide the services and staff as described in Schedule A: Statement of Work. 2. DEFINITIONS "Authorized Representative" means a person to whom signature authority has been delegated in writing acting within the limits of his/her authority. "Breach" means the unauthorized acquisition, access, use, or disclosure of Confidential Information that compromises the security, confidentiality, or integrity of the Confidential Information. "Business Associate" means a Business Associate as defined in 45 CFR 160.103, who performs or assists in the performance of an activity for or on behalf of HCA, a Covered Entity, that involves the use or disclosure of protected health information (PHI). Any reference to Business Associate in this DSA includes Business Associate's employees, agents, officers, Subcontractors, third party contractors, volunteers, or directors. "Business Days and Hours" means Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific Time, except for holidays observed by the state of Washington. "Centers for Medicare and Medicaid Services" or "CMS" means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs. Washington State Health Care Authority Page 4 of 53 Contract#2751 "CFR" means the Code of Federal Regulations. All references in this Contract to CFR chapters or sections include any successor, amended, or replacement regulation. The CFR may be accessed at http://www.ecfr.gov/cqi-bin/ECFR?paqe=browse. "Confidential Information" means information that may be exempt from disclosure to the public or other unauthorized persons under chapter 42.56 RCW or chapter 70.02 RCW or other state or federal statutes or regulations. Confidential Information includes, but is not limited to, any information identifiable to an individual that relates to a natural person's health, (see also Protected Health Information); finances, education, business, use or receipt of governmental services, names, addresses, telephone numbers, social security numbers, driver license numbers, financial profiles, credit card numbers, financial identifiers and any other identifying numbers, law enforcement records, HCA source code or object code, or HCA or State security information. "Contract" means this Contract document and all schedules, exhibits, attachments, incorporated documents and amendments. "Contractor" means its employees and agents. Contractor includes any firm, provider, organization, individual or other entity performing services under this Contract. It also includes any Subcontractor retained by Contractor as permitted under the terms of this Contract. "Covered entity" means a health plan, a health care clearinghouse or a health care provider who transmits any health information in electronic form to carry out financial or administrative activities related to health care, as defined in 45 CFR 160.103. "Data" means information produced, furnished, acquired, or used by Contractor in meeting requirements under this Contract. "Effective Date" means the first date this Contract is in full force and effect. It may be a specific date agreed to by the parties; or, if not so specified, the date of the last signature of a party to this Contract. "HCA Contract Manager" means the individual identified on the cover page of this Contract who will provide oversight of the Contractor's activities conducted under this Contract. "Health Care Authority" or "HCA" means the Washington State Health Care Authority, any division, section, office, unit or other entity of HCA, or any of the officers or other officials lawfully representing HCA. "Overpayment" means any payment or benefit to the Contractor in excess of that to which the Contractor is entitled by law, rule, or this Contract, including amounts in dispute. "Proprietary Information" means information owned by Contractor to which Contractor claims a protectable interest under law. Proprietary Information includes, but is not limited to, information protected by copyright, patent, trademark, or trade secret laws. Washington State Health Care Authority Page 5 of 53 Contract#2751 "Protected Health Information" or "PHI" means individually identifiable information that relates to the provision of health care to an individual; the past, present, or future physical or mental health or condition of an individual; or past, present, or future payment for provision of health care to an individual, as defined in 45 CFR 160.103. Individually identifiable information is information that identifies the individual or about which there is a reasonable basis to believe it can be used to identify the individual, and includes demographic information. PHI is information transmitted, maintained, or stored in any form or medium. 45 CFR 164.501. PHI does not include education records covered by the Family Educational Rights and Privacy Act, as amended, 20 USC 1232g(a)(4)(b)(iv). "RCW" means the Revised Code of Washington. All references in this Contract to RCW chapters or sections include any successor, amended, or replacement statute. Pertinent RCW chapters can be accessed at: http://apps.leg.wa.gov/rcw/. "Statement of Work" or"SOW" means a detailed description of the work activities the Contractor is required to perform under the terms and conditions of this Contract, including the deliverables and timeline, and is Schedule A hereto. "Subcontractor" means a person or entity that is not in the employment of the Contractor, who is performing all or part of the business activities under this Contract under a separate contract with Contractor. The term "Subcontractor" means subcontractor(s) of any tier. "Subrecipient" means a contractor operating a federal or state assistance program receiving federal funds and having the authority to determine both the services rendered and disposition of program. See OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, "Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for additional detail. "USC" means the United States Code. All references in this Contract to USC chapters or sections shall include any successor, amended, or replacement statute. The USC may be accessed at http://uscode.house.gov/ "WAC" means the Washington Administrative Code. All references to WAC chapters or sections will include any successor, amended, or replacement regulation. Pertinent WACs may be accessed at: http://app.leg.wa.gov/wac/. 3. SPECIAL TERMS AND CONDITIONS a) "ABCD" means Access to Baby and Child Dentistry, a program designed to detect and prevent early childhood dental decay by engaging dentists in seeing birth to six (6) year old Medicaid eligible children and engaging local public health departments in outreach and case management. b) "ABCD Coordinators Group" means the Contractors. c) "ABCD Dental Champion" means a participating dentist(s) who has/have been identified by the University of Washington in each local program to deliver the University of Washington designed training to newly recruited dentists and assist Washington State Health Care Authority Page 6 of 53 Contract#2751 the local ABCD coordinator and the local dental society in recruiting dentists to participate. d) "Case Management" means identifying barriers to early oral health care for Medicaid eligible children and assisting families in addressing those barriers; preparing families for their child's first visit to the dentists by providing a family orientation and assisting them in making that first appointment; and following-up to insure that appointments were made and kept, and that the families understand the need for future visits and home care. e) "Client" means Medicaid eligible Clients ages birth through six (6) years of age. f) "GMS" means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. g) "Confidential Information" means information that is exempt from disclosure to the public or other unauthorized persons under Chapter 42.56 RCW or other federal or state laws. Confidential information includes, but is not limited to, Personal Information. h) "Family Orientation" means educating the family of Medicaid children on the need for early, preventive dental care, and dental office etiquette, including the need to make and keep dental appointments. i) "Health Care Authority or "FICA" means the agency designated by the Washington Legislature as the Single State Agency that oversees Washington State's medical assistance programs, including Medicaid, and its employees and authorized agents. j) "Health Coalition" means a group of health care providers and community organizations that meet to collaborate for a common cause. k) "Local Programs" means the constellation of local partners who deliver this program in a county or group of counties. 1) "Outreach" means identifying families with Medicaid eligible children and linking them with dental care through a variety of methods, including but not limited to partnerships with other organizations who work with low-income families, earned media, and referral services. m) "Personal Information" means information identifiable to any person, including, but not limited to, information that relates to a person's name, health, finances, education, business, use or receipt of governmental services or other activities, addresses, telephone numbers, Social Security Numbers, driver license numbers, other identifying numbers, and any financial identifiers. n) "Steering Committee" means a smaller subset of the bigger Health Coalition tasked with working on specific causes that identified by the Health Coalition. 3.1 PERFORMANCE EXPECTATIONS Expected performance under this Contract includes, but is not limited to, the following: Washington State Health Care Authority Page 7 of 53 Contract#2751 3.1.1 Knowledge of applicable state and federal laws and regulations pertaining to subject of contract; 3.1.2 Use of professional judgment; 3.1.3 Collaboration with HCA staff in Contractor's conduct of the services; 3.1.4 Conformance with HCA directions regarding the delivery of the services; 3.1.5 Timely, accurate and informed communications; 3.1.6 Regular completion and updating of project plans, reports, documentation and communications; 3.1.7 Regular, punctual attendance at all meetings; and 3.1.8 Provision of high quality services. Prior to payment of invoices, HCA will review and evaluate the performance of Contractor in accordance with Contract and these performance expectations and may withhold payment if expectations are not met or Contractor's performance is unsatisfactory. 3.2 TERM 3.2.1 The initial term of the Contract will commence on July 1, 2018, or date of last signature, whichever is later, and continue through June 30, 2020, unless terminated sooner as provided herein. 3.2.2 This Contract may be extended through June 30, 2028 in whatever time increments HCA deems appropriate. No change in terms and conditions will be permitted during these extensions unless specifically agreed to in writing. 3.2.3 Work performed without a contract or amendment signed by the authorized representatives of both parties will be at the sole risk of the Contractor. HCA will not pay any costs incurred before a contract or any subsequent amendment(s) is fully executed. 3.3 COMPENSATION 3.3.1 The Maximum Compensation payable to Contractor for the performance of all things necessary for or incidental to the performance of work as set forth in Schedule A: Statement of Work is $38,200.00, and includes any allowable expenses. Source(s) of Funds. The above maximum amount payable under this Contract, for the service to be provided is based on the amounts(s) of funding from the following sources: Washington State Health Care Authority Page 8 of 53 Contract#2751 a) 50% is allotted under this Contract from federal funds received by HCA under the United States Department of Health & Human Services Medical Assistance Program, Title XIX of the Social Security Act, Catalog of Federal Domestic Assistance #93.778; and b) 50% is allotted under this Contract from GF-S (General Fund-State) funds. If indicated on page one (1) of this Agreement the Contractor is a sub-recipient for purposes of this Contract, and as such, shall comply with the terms and conditions listed in Section 4.37, Sub-recipients. Funding Stipulations. a) The Contractor shall cooperate in supplying any information to HCA that may be needed to verify accuracy of reimbursable billings. b) The Contractor shall not use funds payable under this Contract for lobbying activities of any nature. The Contractor certifies that no state or federal funds payable under this Contract shall be paid to any person or organization to influence, or attempt to influence, either directly or indirectly, an officer or employee of an state or federal agency, or an officer or member of any state or federal legislative body or committee, regarding the award, amendment, modification, extension, or renewal of a state or federal contract or grant. c) The Contractor shall not pay Consultants and/or Billing Agents, or Subcontractors on either a contingent, or percentage basis, for work performed as a result of this Contract. 3.3.2 Contractor's compensation for services rendered will be based on the rates in accordance with the Exhibits. 3.3.3 Federal funds disbursed through this Contract were received by HCA through OMB Catalogue of Federal Domestic Assistance (CFDA) Number: 93.788, Contractor agrees to comply with applicable rules and regulations associated with these federal funds and has signed Attachment 1: Federal Compliance, Certification and Assurances, attached. 3.4 INVOICE AND PAYMENT 3.4.1 Contractor must submit accurate invoices to the following address for all amounts to be paid by HCA via e-mail to: Acctspay(�hca.wa.gov. Include the HCA Contract number in the subject line of the email. 3.4.2 Invoices must describe and document to RCA's satisfaction a description of the work performed, the progress of the project, and fees. All invoices will be reviewed and must be approved by the Contract Manager or his/her designee prior to payment. Washington State Health Care Authority Page 9 of 53 Contract#2751 3.4.3 Contractor must submit properly itemized invoices to include the following information, as applicable: 3.4.3.1 HCA Contract number K2751; 3.4.3.2 Contractor name, address, phone number; 3.4.3.3 Description of Services; 3.4.3.4 Date(s) of delivery; 3.4.3.5 Net invoice price for each item; 3.4.3.6 Applicable taxes; 3.4.3.7 Total invoice price; and 3.4.3.8 Payment terms and any available prompt payment discount. 3.4.4 HCA will return incorrect or incomplete invoices to the Contractor for correction and reissue. The Contract Number must appear on all invoices, bills of lading, packages, and correspondence relating to this Contract. 3.4.5 In order to receive payment for services or products'provided to a state agency, Contractor must register with the Statewide Payee Desk at http://des.wa.gov/services/ContractingPurchasing/BusinessNendorPay/Pages/defa ult.aspx. Payment will be considered timely if made by HCA within thirty (30) calendar days of receipt of properly completed invoices. Payment will be directly deposited in the bank account or sent to the address Contractor designated in its registration. 3.4.6 Upon expiration of the Contract, any claims for payment for costs due and payable under this Contract that are incurred prior to the expiration date must be submitted by the Contractor to HCA within sixty (60) calendar days after the Contract expiration date. HCA is under no obligation to pay any claims that are submitted sixty-one (61) or more calendar days after the Contract expiration date ("Belated Claims"). HCA will pay Belated Claims at its sole discretion, and any such potential payment is contingent upon the availability of funds. 3.5 CONTRACTOR AND HCA CONTRACT MANAGERS 3.5.1 Contractor's Contract Manager will have prime responsibility and final authority for the services provided under this Contract and be the principal point of contact for the HCA Contract Manager for all business matters, performance matters, and administrative activities. 3.5.2 HCA's Contract Manager is responsible for monitoring the Contractor's performance and will be the contact person for all communications regarding contract performance and deliverables. The HCA Contract Manager has the authority to accept or reject the services provided and must approve Contractor's invoices prior to payment. Washington State Health Care Authority Page 10 of 53 Contract#2751 3.5.3 The contact information provided below may be changed by written notice of the change (email acceptable) to the other party. CONTRACTOR Health Care Authority Contract Manager Information Contract Manager Information Name: Lydia Buchheit Name: Janice Tadeo Title: Title: Dental Program Manager P O Box 1666, Shelton, P.O. Box 45506 Address: WA 98564 Address: Olympia, WA 98504-5506 Phone: 360-427-9670x545 Phone: 360/725-1583 Email: lydiab@co.mason.wa.us Email: janice.tadeo@hca.wa.gov 3.6 KEY STAFF 3.6.1 Except in the case of a legally required leave of absence, sickness, death, termination of employment or unpaid leave of absence, Key Staff must not be changed during the term of the Statement of Work (SOW) from the people who were described in the Response for the first SOW or those Key Staff initially assigned to subsequent SOWS, without the prior written approval of HCA until completion of their assigned tasks. 3.6.2 During the term of the Statement of Work (SOW), HCA reserves the right to approve or disapprove Contractor's Key Staff assigned to this Contract, to approve or disapprove any proposed changes in Contractor's Key Staff, or to require the removal or reassignment of any Contractor staff found unacceptable by HCA, subject to HCA's compliance with applicable laws and regulations. Contractor must provide a resume to HCA of any replacement Key Staff and all staff proposed by Contractor as replacements for other staff must have comparable or greater skills for performing the activities as performed by the staff being replaced. 3.7 LEGAL NOTICES Any notice or demand or other communication required or permitted to be given under this Contract or applicable law is effective only if it is in writing and signed by the applicable party, properly addressed, and either delivered in person, or by a recognized courier service, or deposited with the United States Postal Service as first-class mail, postage prepaid certified mail, return receipt requested, to the parties at the addresses provided in this section. 3.7.1 In the case of notice to the Contractor: Mason County Public Health P O Box 1666, Shelton, WA 98564 Washington State Health Care Authority Page 11 of 53 Contract#2751 3.7.2 In the case of notice to HCA: Attention: Contracts Administrator Health Care Authority Division of Legal Services Post Office Box 42702 Olympia, WA 98504-2702 3.7.3 Notices are effective upon receipt or four (4) Business days after mailing, whichever is earlier. 3.7.4 The notice address and information provided above may be changed by written notice of the change given as provided above. 3.8 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE Each of the documents listed below is by this reference incorporated into this Contract. In the event of an inconsistency, the inconsistency will be resolved in the following order of precedence: 3.8.1 Applicable Federal and State of Washington statutes and regulations; 3.8.2 Recitals 3.8.3 Special Terms and Conditions; 3.8.4 General Terms and Conditions; 3.8.5 Attachment 1: Federal Compliance, Certifications and Assurances,- 3.8.6 ssurances,3.8.6 Attachment 2: Federal Funding Accountability and Transparency Act(FFA TA) Data Collection Form 3.8.7 Schedule A: Statement of Work,- 3.8.8 ork;3.8.8 Exhibits A: ABCD Quarterly Outreach and Case Management Report, Exhibit B: ABCD Quarterly Outreach and Coordination of Care Report and Exhibit C: ABCD Yearly Budget Tool; and 3.8.9 Any other provision, term or material incorporated herein by reference or otherwise incorporated. 3.9 INSURANCE Contractor must provide insurance coverage as set out in this section. The intent of the required insurance is to protect the State should there be any claims, suits, actions, costs, damages or expenses arising from any negligent or intentional act or omission of Contractor or Subcontractor, or agents of either, while performing under the terms of this Washington State Health Care Authority Page 12 of 53 Contract#2751 Contract. Contractor must provide insurance coverage that is maintained in full force and effect during the term of this Contract, as follows: 3.9.1 Commercial General Liability Insurance Policy - Provide a Commercial General Liability Insurance Policy, including contractual liability, in adequate quantity to protect against legal liability arising out of contract activity but no less than $1 million per occurrence/$2 million general aggregate. Additionally, Contractor is responsible for ensuring that any Subcontractors provide adequate insurance coverage for the activities arising out of subcontracts. 3.9.2 Business Automobile Liability. In the event that services delivered pursuant to this Contract, involve the use of vehicles, owned, either hired, or non-owned by the Contractor, automobile liability insurance is required covering the risks of bodily injury (including death) and property damage, including coverage for contractual liability. The minimum limit for automobile liability is $1,000,000 per occurrence, using a Combined Single Limit for bodily injury and property damage. 3.9.3 Professional Liability Errors and Omissions — Provide a policy with coverage of not less than $1 million per claim/$2 million general aggregate. 3.9.4 The insurance required must be issued by an insurance companyhes authorized to do business within the state of Washington, and must name HCA and the state of Washington, its agents and employees as additional insured's under any Commercial General and/or Business Automobile Liability policy/ies. All policies must be primary to any other valid and collectable insurance. In the event of cancellation, non-renewal, revocation or other termination of any insurance coverage required by this Contract, Contractor must provide written notice of such to HCA within one (1) Business day of Contractor's receipt of such notice. Failure to buy and maintain the required insurance may, at HCA's sole option, result in this Contract's termination. Upon request, Contractor must submit to HCA a certificate of insurance that outlines the coverage and limits defined in the Insurance section. If a certificate of insurance is requested, Contractor must submit renewal certificates as appropriate during the term of the contract. 4. GENERAL TERMS AND CONDITIONS 4.1 ACCESS TO DATA In compliance with RCW 39.26.180 (2) and federal rules, the Contractor must provide access to any data generated under this Contract to HCA, the Joint Legislative Audit and Review Committee, the State Auditor, and any other state or federal officials so authorized by law, rule, regulation, or agreement at no additional cost. This includes access to all information that supports the findings, conclusions, and recommendations of the Contractor's reports, including computer models and methodology for those models. Washington State Health Care Authority Page 13 of 53 Contract#2751 4.2 ADVANCE PAYMENT PROHIBITED No advance payment will be made for services furnished by the Contractor pursuant to this Contract. 4.3 AMENDMENTS This Contract may be amended by mutual agreement of the parties. Such amendments will not be binding unless they are in writing and signed by personnel authorized to bind each of the parties. 4.4 ASSIGNMENT 4.4.1 Contractor may not assign or transfer all or any portion of this Contract or any of its rights hereunder, or delegate any of its duties hereunder, except delegations as set forth in Section 4.37, Subcontracting, without the prior written consent of HCA. Any permitted assignment will not operate to relieve Contractor of any of its duties and obligations hereunder, nor will such assignment affect any remedies available to HCA that may arise from any breach of the provisions of this Contract or warranties made herein, including but not limited to, rights of setoff. Any attempted assignment, transfer or delegation in contravention of this Subsection 4.4.1 of the Contract will be null and void. 4.4.2 HCA may assign this Contract to any public agency, commission, board, or the like, within the political boundaries of the State of Washington, with written notice of thirty (30) calendar days to Contractor. 4.4.3 This Contract will inure to the benefit of and be binding on the parties hereto and their permitted successors and assigns. 4.5 ATTORNEYS' FEES In the event of litigation or other action brought to enforce the terms of this Contract, each party agrees to bear its own attorneys' fees and costs. 4.6 CHANGE IN STATUS In the event of any substantive change in its legal status, organizational structure, or fiscal reporting responsibility, Contractor will notify HCA of the change. Contractor must provide notice as soon as practicable, but no later than thirty (30) calendar days after such a change takes effect. 4.7 CONFIDENTIAL INFORMATION PROTECTION 4.7.1 Contractor acknowledges that some of the material and information that may come into its possession or knowledge in connection with this Contract or its performance may consist of Confidential Information. Contractor agrees to hold Confidential Information in strictest confidence and not to make use of Confidential Information Washington State Health Care Authority Page 14 of 53 Contract#2751 for any purpose other than the performance of this Contract, to release it only to authorized employees or Subcontractors requiring such information for the purposes of carrying out this Contract, and not to release, divulge, publish, transfer, sell, disclose, or otherwise make the information known to any other party without HCA's express written consent or as provided by law. Contractor agrees to implement physical, electronic, and managerial safeguards to prevent unauthorized access to Confidential Information. 4.7.2 Contractors that come into contact with Protected Health Information may be required to enter into a Business Associate Agreement with HCA in compliance with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, as modified by the American Recovery and Reinvestment Act of 2009 ("ARRA"), Sec. 13400 — 13424, H.R. 1 (2009) (HITECH Act) (HIPAA). 4.7.3 HCA reserves the right to monitor, audit, or investigate the use of Confidential Information collected, used, or acquired by Contractor through this Contract. Violation of this section by Contractor or its Subcontractors may result in termination of this Contract and demand for return of all Confidential Information, monetary damages, or penalties. 4.7.4 The obligations set forth in this Section will survive completion, cancellation, expiration, or termination of this Contract. 4.8 CONFIDENTIAL INFORMATION SECURITY The federal government, including the Centers for Medicare and Medicaid Services (CMS), and the State of Washington all maintain security requirements regarding privacy, data access, and other areas. Contractor is required to comply with the Confidential Information Security Requirements set out in this Contract and appropriate portions of the Washington OCIO Security Standard, 141.10 (https://ocio.wa.gov/policies/141-securing information-technology-assets/1 411 0-securing-information-technology-assets). 4.9 CONFIDENTIAL INFORMATION BREACH — REQUIRED NOTIFICATION 4.9.1 Contractor must notify the HCA Privacy Officer (HCAPrivacyOfficer(a)hca.wa.gov) within five Business days of discovery of any Breach or suspected Breach of Confidential Information. 4.9.2 Contractor will take steps necessary to mitigate any known harmful effects of such unauthorized access including, but not limited to, sanctioning employees and taking steps necessary to stop further unauthorized access. Contractor agrees to indemnify and hold HCA harmless for any damages related to unauthorized use or disclosure of Confidential Information by Contractor, its officers, directors, and employees, Subcontractors or agents. Washington State Health Care Authority Page 15 of 53 Contract#2751 4.9.3 If notification of the Breach or possible Breach must (in the judgment of HCA) be made under the HIPAA Breach Notification Rule, or RCW 42.56.590 or RCW 19.254.010, or other law or rule, then: 4.9.3.1 HCA may choose to make any required notifications to the individuals, to the U.S. Department of Health and Human Services Secretary (DHHS) Secretary, and to the media, or direct Contractor to make them or any of them. 4.9.3.2 In any case, Contractor will pay the reasonable costs of notification to individuals, media, and governmental agencies and of other actions HCA 4.9.3.3 Reasonably considers appropriate to protect HCA Clients (such as paying for regular credit watches in some cases). 4.9.3.4 Contractor will compensate HCA Clients for harms caused to them by any Breach or possible Breach. 4.9.4 Any breach of this clause may result in termination of the Contract and the demand for return or disposition of all Confidential Information. 4.9.5 Contractor's obligations regarding Breach notification survive the termination of this Contract and continue for as long as Contractor maintains the Confidential Information and for any breach or possible breach at any time. 4.10 CONTRACTOR'S PROPRIETARY INFORMATION Contractor acknowledges that HCA is subject to Chapter 42.56 RCW, the Public Records Act, and that this Contract will be a public record as defined in chapter 42.56 RCW. Any specific information that is claimed by Contractor to be Proprietary Information must be clearly identified as such by Contractor. To the extent consistent with Chapter 42.56 RCW, HCA will maintain the confidentiality of Contractor's information in its possession that is marked Proprietary. If a public disclosure request is made to view Contractor's Proprietary Information, HCA will notify Contractor of the request and of the date that such records will be released to the requester unless Contractor obtains a court order from a court of competent jurisdiction enjoining that disclosure. If Contractor fails to obtain the court order enjoining disclosure, HCA will release the requested information on the date specified. 4.11 COVENANT AGAINST CONTINGENT FEES Contractor warrants that no person or selling agent has been employed or retained to solicit or secure this Contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, excepting bona fide employees or bona fide established agents maintained by the Contractor for the purpose of securing business. HCA will have the right, in the event of breach of this clause by the Contractor, to annul this Contract without liability or, in its discretion, to deduct from the contract price or Washington State Health Care Authority Page 16 of 53 Contract#2751 consideration or recover by other means the full amount of such commission, percentage, brokerage or contingent fee. 4.12 DEBARMENT By signing this Contract, Contractor certifies that it is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded in any Washington State or Federal department or agency from participating in transactions (debarred). Contractor agrees to include the above requirement in any and all subcontracts into which it enters, and also agrees that it will not employ debarred individuals. Contractor must immediately notify HCA if, during the term of this Contract, Contractor becomes debarred. HCA may immediately terminate this Contract by providing Contractor written notice, if Contractor becomes debarred during the term hereof. 4.13 DISPUTES The parties will use their best, good faith efforts to cooperatively resolve disputes and problems that arise in connection with this Contract. Both parties will continue without delay to carry out their respective responsibilities under this Contract while attempting to resolve any dispute. When a genuine dispute arises between HCA and the Contractor, regarding the terms of this Contract or the responsibilities imposed herein and it cannot be resolved between the parties' Contract Managers, either party may initiate the following dispute resolution process. 4.13.1 The initiating party will reduce its description of the dispute to writing and deliver it to the responding party (email acceptable). The responding party will respond in writing within five (5) Business days (email acceptable). If the initiating party is not satisfied with the response of the responding party, then the initiating party may request that the HCA Director review the dispute. Any such request from the initiating party must be submitted in writing to the HCA Director within five (5) Business days after receiving the response of the responding party. The HCA Director will have sole discretion in determining the procedural manner in which he or she will review the dispute. The HCA Director will inform the parties in writing within five (5) Business days of the procedural manner in which he or she will review the dispute, including a timeframe in which he or she will issue a written decision. 4.13.2 A party's request for a dispute resolution must: 4.13.2.1 Be in writing; 4.13.2.2 Include a written description of the dispute; 4.13.2.3 State the relative positions of the parties and the remedy sought; 4.13.2.4 State the Contract Number and the names and contact information for the parties; 4.13.3 This dispute resolution process constitutes the sole administrative remedy available under this Contract. The parties agree that this resolution process will precede any action in a judicial or quasi-judicial tribunal. Washington State Health Care Authority Page 17 of 53 Contract#2751 4.14 ENTIRE AGREEMENT HCA and Contractor agree that the Contract is the complete and exclusive statement of the agreement between the parties relating to the subject matter of the Contract and supersedes all letters of intent or prior contracts, oral or written, between the parties relating to the subject matter of the Contract, except as provided in Section 4.44 Warranties. 4.15 FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA) 4.15.1 This Contract is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how federal funds are spent. 4.15.2 To comply with the act and be eligible to enter into this Contract, Contractor must have a Data Universal Numbering System (DUNS®) number. A DUNS® number provides a method to verify data about your organization. If Contractor does not already have one, a DUNS® number is available free of charge by contacting Dun and Bradstreet at www.dnb.com. 4.15.3 Information about Contractor and this Contract will be made available on www.uscontractorregistration.com by HCA as required by P.L. 109-282. HCA's Attachment 1: Federal Funding Accountability and Transparency Act Data Collection Form, is considered part of this Contract and must be completed and returned along with the Contract. 4.16 FORCE MAJEURE A party will not be liable for any failure of or delay in the performance of this Contract for the period that such failure or delay is due to causes beyond its reasonable control, including but not limited to acts of God, war, strikes or labor disputes, embargoes, government orders or any other force majeure event. 4.17 FUNDING WITHDRAWN, REDUCED OR LIMITED If HCA determines in its sole discretion that the funds it relied upon to establish this Contract have been withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding after the effective date of this contract but prior to the normal completion of this Contract, then HCA, at its sole discretion, may: 4.17.1 Terminate this Contract pursuant to Section 4.41.3, Termination for Non-Allocation of Funds; 4.17.2 Renegotiate the Contract under the revised funding conditions; or 4.17.3 Suspend Contractor's performance under the Contract upon five (5) Business days' advance written notice to Contractor. HCA will use this option only when HCA Washington State Health Care Authority Page 18 of 53 Contract#2751 determines that there is reasonable likelihood that the funding insufficiency may be resolved in a timeframe that would allow Contractor's performance to be resumed prior to the normal completion date of this Contract. 4.17.3.1 During the period of suspension of performance, each party will inform the other of any conditions that may reasonably affect the potential for resumption of performance. 4.17.3.2 When HCA determines in its sole discretion that the funding insufficiency is resolved, it will give Contractor written notice to resume performance. Upon the receipt of this notice, Contractor will provide written notice to HCA informing HCA whether it can resume performance and, if so, the date of resumption. For purposes of this subsection, "written notice" may include email. 4.17.3.3 If the Contractor's proposed resumption date is not acceptable to HCA and an acceptable date cannot be negotiated, HCA may terminate the contract by giving written notice to Contractor. The parties agree that the Contract will be terminated retroactive to the date of the notice of suspension. HCA will be liable only for payment in accordance with the terms of this Contract for services rendered prior to the retroactive date of termination. 4.18 GOVERNING LAW This Contract is governed in all respects by the laws of the state of Washington, without reference to conflict of law principles. The jurisdiction for any action hereunder is exclusively in the Superior Court for the state of Washington, and the venue of any action hereunder is in the Superior Court for Thurston County, Washington. Nothing in this Contract will be construed as a waiver by HCA of the State's immunity under the 11th Amendment to the United States Constitution. 4.19 HCA NETWORK SECURITY Contractor agrees not to attach any Contractor-supplied computers, peripherals or software to the HCA Network without prior written authorization from RCA's Chief Information Officer. Unauthorized access to HCA networks and systems is a violation of HCA Policy and constitutes computer trespass in the first degree pursuant to RCW 9A.52.110. Violation of any of these laws or policies could result in termination of the contract and other penalties. Contractor will have access to the HCA visitor Wi-Fi Internet connection while on site. 4.20 INDEMNIFICATION Contractor must defend, indemnify, and save HCA harmless from and against all claims, including reasonable attorneys' fees resulting from such claims, for any or all injuries to persons or damage to property, or Breach of its confidentiality and notification obligations under Section 4.7 Confidential Information Protection and Section 4.8 Confidentiality Washington State Health Care Authority Page 19 of 53 Contract#2751 Breach-Required Notification, arising from intentional or negligent acts or omissions of Contractor, its officers, employees, or agents, or Subcontractors, their officers, employees, or agents, in the performance of this Contract. 4.21 INDEPENDENT CAPACITY OF THE CONTRACTOR The parties intend that an independent contractor relationship will be created by this Contract. Contractor and its employees or agents performing under this Contract are not employees or agents of HCA. Contractor will not hold itself out as or claim to be an officer or employee of HCA or of the State of Washington by reason hereof, nor will Contractor make any claim of right, privilege or benefit that would accrue to such employee under law. Conduct and control of the work will be solely with Contractor. 4.22 INDUSTRIAL INSURANCE COVERAGE Prior to performing work under this Contract, Contractor must provide or purchase industrial insurance coverage for the Contractor's employees, as may be required of an "employer" as defined in Title 51 RCW, and must maintain full compliance with Title 51 RCW during the course of this Contract. 4.23 LEGAL AND REGULATORY COMPLIANCE 4.23.1 During the term of this Contract, Contractor must comply with all local, state, and federal licensing, accreditation and registration requirements/standards, necessary for the performance of this Contract and all other applicable federal, state and local laws, rules, and regulations. 4.23.2 While on the HCA premises, Contractor must comply with HCA operations and process standards and policies (e.g., ethics, Internet/email usage, data, network and building security, harassment, as applicable). HCA will make an electronic copy of all such policies available to Contractor. 4.23.3 Failure to comply with any provisions of this section may result in Contract termination. 4.24 LIMITATION OF AUTHORITY Only the HCA Authorized Representative has the express, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this Contract. Furthermore, any alteration, amendment, modification, or waiver or any clause or condition of this Contract is not effective or binding unless made in writing and signed by the HCA Authorized Representative. 4.25 NO THIRD-PARTY BENEFICIARIES HCA and Contractor are the only parties to this contract. Nothing in this Contract gives or is intended to give any benefit of this Contract to any third parties. Washington State Health Care Authority Page 20 of 53 Contract#2751 4.26 NONDISCRIMINATION During the performance of this Contract, the Contractor must comply with all federal and state nondiscrimination laws, regulations and policies, including but not limited to: Title VII of the Civil Rights Act, 42 U.S.C. §12101 et seq.; the Americans with Disabilities Act of 1990 (ADA), 42 U.S.C. §12101 et seq., 28 CFR Part 35; and Title 49.60 RCW, Washington Law Against Discrimination. In the event of Contractor's noncompliance or refusal to comply with any nondiscrimination law, regulation or policy, this Contract may be rescinded, canceled, or terminated in whole or in part under the Termination for Default sections, and Contractor may be declared ineligible for further contracts with HCA. 4.27 OVERPAYMENTS TO CONTRACTOR In the event that overpayments or erroneous payments have been made to the Contractor under this Contract, HCA will provide written notice to Contractor and Contractor shall refund the full amount to HCA within thirty (30) calendar days of the notice. If Contractor fails to make timely refund, HCA may charge Contractor one percent (1%) per month on the amount due, until paid in full. If the Contractor disagrees with HCA's actions under this section, then it may invoke the dispute resolution provisions of Section 4.13 Disputes. 4.28 PAY EQUITY 4.28.1 Contractor represents and warrants that, as required by Washington state law (Laws of 2017, Chap. 1, § 147), during the term of this Contract, it agrees to equality among its workers by ensuring similarly employed individuals are compensated as equals. For purposes of this provision, employees are similarly employed if (i) the individuals work for Contractor, (ii) the performance of the job requires comparable skill, effort, and responsibility, and (iii) the jobs are performed under similar working conditions. Job titles alone are not determinative of whether employees are similarly employed. 4.28.2 Contractor may allow differentials in compensation for its workers based in good faith on any of the following: (i) a seniority system; (ii) a merit system; (iii) a system that measures earnings by quantity or quality of production; (iv) bona fide job- related factor(s); or (v) a bona fide regional difference in compensation levels. 4.28.3 Bona fide job-related factor(s)" may include, but not be limited to, education, training, or experience, that is: (i) consistent with business necessity; (ii) not based on or derived from a gender-based differential; and (iii) accounts for the entire differential. 4.28.4 A "bona fide regional difference in compensation level" must be (i) consistent with business necessity; (ii) not based on or derived from a gender-based differential; and (iii) account for the entire differential. Washington State Health Care Authority Page 21 of 53 Contract#2751 4.28.5 Notwithstanding any provision to the contrary, upon breach of warranty and Contractor's failure to provide satisfactory evidence of compliance within thirty (30) days of HCA's request for such evidence, HCA may suspend or terminate this Contract. 4.29 PUBLICITY 4.29.1 The award of this Contract to Contractor is not in any way an endorsement of Contractor or Contractor's Services by HCA and must not be so construed by Contractor in any advertising or other publicity materials. 4.29.2 Contractor agrees to submit to HCA, all advertising, sales promotion, and other publicity materials relating to this Contract or any Service furnished by Contractor in which RCA's name is mentioned, language is used, or Internet links are provided from which the connection of RCA's name with Contractor's Services may, in RCA's judgment, be inferred or implied. Contractor further agrees not to publish or use such advertising, marketing, sales promotion materials, publicity or the like through print, voice, the Web, and other communication media in existence or hereinafter developed without the express written consent of HCA prior to such use. 4.30 RECORDS AND DOCUMENTS REVIEW 4.30.1 The Contractor must maintain books, records, documents, magnetic media, receipts, invoices or other evidence relating to this Contract and the performance of the services rendered, along with accounting procedures and practices, all of which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Contract. At no additional cost, these records, including materials generated under this Contract, are subject at all reasonable times to inspection, review, or audit by HCA, the Office of the State Auditor, and state and federal officials so authorized by law, rule, regulation, or agreement [See 42 USC 1396a(a)(27)(B); 42 USC 1396a(a)(37)(B); 42 USC 1396a(a)(42(A); 42 CFR 431, Subpart Q; and 42 CFR 447.202]. 4.30.2 The Contractor must retain such records for a period of six (6) years after the date of final payment under this Contract. 4.30.3 If any litigation, claim or audit is started before the expiration of the six (6) year period, the records must be retained until all litigation, claims, or audit findings involving the records have been resolved. 4.31 REMEDIES NON-EXCLUSIVE The remedies provided in this Contract are not exclusive, but are in addition to all other remedies available under law. Washington State Health Care Authority Page 22 of 53 Contract#2751 4.32 RIGHT OF INSPECTION The Contractor must provide right of access to its facilities to HCA, or any of its officers, or to any other authorized agent or official of the state of Washington or the federal government, at all reasonable times, in order to monitor and evaluate performance, compliance, and/or quality assurance under this Contract. 4.33 RIGHTS IN DATA/OWNERSHIP 4.33.1 HCA and Contractor agree that all data and work products (collectively "Work Product") produced pursuant to this Contract will be considered a work for hire under the U.S. Copyright Act, 17 U.S.C. §101 et seq, and will be owned by HCA. Contractor is hereby commissioned to create the Work Product. Work Product includes, but is not limited to, discoveries, formulae, ideas, improvements, inventions, methods, models, processes, techniques, findings, conclusions, recommendations, reports, designs, plans, diagrams, drawings, Software, databases, documents, pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, and/or sound reproductions, to the extent provided by law. Ownership includes the right to copyright, patent, register and the ability to transfer these rights and all information used to formulate such Work Product. 4.33.2 If for any reason the Work Product would not be considered a work for hire under applicable law, Contractor assigns and transfers to HCA, the entire right, title and interest in and to all rights in the Work Product and any registrations and copyright applications relating thereto and any renewals and extensions thereof. 4.33.3 Contractor will execute all documents and perform such other proper acts as HCA may deem necessary to secure for HCA the rights pursuant to this section. 4.33.4 Contractor will not use or in any manner disseminate any Work Product to any third party, or represent in any way Contractor ownership of any Work Product, without the prior written permission of HCA. Contractor shall take all reasonable steps necessary to ensure that its agents, employees, or Subcontractors will not copy or disclose, transmit or perform any Work Product or any portion thereof, in any form, to any third party. 4.33.5 Material that is delivered under this Contract, but that does not originate therefrom ("Preexisting Material"), must be transferred to HCA with a nonexclusive, royalty- free, irrevocable license to publish, translate, reproduce, deliver, perform, display, and dispose of such Preexisting Material, and to authorize others to do so. Contractor agrees to obtain, at its own expense, express written consent of the copyright holder for the inclusion of Preexisting Material. HCA will have the right to modify or remove any restrictive markings placed upon the Preexisting Material by Contractor. Washington State Health Care Authority Page 23 of 53 Contract#2751 4.33.61 Contractor must identify all Preexisting Material when it is delivered under this Contract and must advise HCA of any and all known or potential infringements of publicity, privacy or of intellectual property affecting any Preexisting Material at the time of delivery of such Preexisting Material. Contractor must provide HCA with prompt written notice of each notice or claim of copyright infringement or infringement of other intellectual property right worldwide received by Contractor with respect to any Preexisting Material delivered under this Contract. 4.34 RIGHTS OF STATE AND FEDERAL GOVERNMENTS In accordance with 45 C.F.R. 95.617, all appropriate state and federal agencies, including but not limited to the Centers for Medicare and Medicaid Services (CMS), will have a royalty-free, nonexclusive, and irrevocable license to reproduce, publish, translate, or otherwise use, and to authorize others to use for Federal Government purposes.. (i) software, modifications, and documentation designed, developed or installed with Federal Financial Participation (FFP) under 45 CFR Part 95, subpart F; (ii) the Custom Software and modifications of the Custom Software, and associated Documentation designed, developed, or installed with FFP under this Contract; (iii) the copyright in any work developed under this Contract; and (iv) any rights of copyright to which Contractor purchases ownership under this Contract. 4.35 SEVERABILITY If any provision of this Contract or the application thereof to any person(s) or circumstances is held invalid, such invalidity will not affect the other provisions or applications of this Contract that can be given effect without the invalid provision, and to this end the provisions or application of this Contract are declared severable. 4.36 SITE SECURITY While on HCA premises, Contractor, its agents, employees, or Subcontractors must conform in all respects with physical, fire or other security policies or regulations. Failure to comply with these regulations may be grounds for revoking or suspending security access to these facilities. HCA reserves the right and authority to immediately revoke security access to Contractor staff for any real or threatened breach of this provision. Upon reassignment or termination of any Contractor staff, Contractor agrees to promptly notify HCA. 4.37 SUBCONTRACTING 4.37.1 Neither Contractor, nor any Subcontractors, may enter into subcontracts for any of the work contemplated under this Contract without prior written approval of HCA. HCA has sole discretion to determine whether or not to approve any such subcontract. In no event will the existence of the subcontract operate to release or reduce the liability of Contractor to HCA for any breach in the performance of Contractor's duties. Washington State Health Care Authority Page 24 of 53 Contract#2751 4.37.2 Contractor is responsible for ensuring that all terms, conditions, assurances and certifications set forth in this Contract are included in any subcontracts. 4.37.3 If at any time during the progress of the work HCA determines in its sole judgment that any Subcontractor is incompetent or undesirable, HCA will notify Contractor, and Contractor must take immediate steps to terminate the Subcontractor's involvement in the work. 4.37.4 The rejection or approval by the HCA of any Subcontractor or the termination of a Subcontractor will not relieve Contractor of any of its responsibilities under the Contract, nor be the basis for additional charges to HCA. 4.37.5 HCA has no contractual obligations to any Subcontractor or vendor under contract to the Contractor. Contractor is fully responsible for all contractual obligations, financial or otherwise, to its Subcontractors. 4.38 SUBRECIPIENT 4.38.1 General If the Contractor is a subrecipient (as defined in 45 CFR 75.2 and 2 CFR 200.93) of federal awards, then the Contractor, in accordance with 2 CFR 200.501 and 45 CFR 75.501, shall: 4.38.1.1 Maintain records that identify, in its accounts, all federal awards received and expended and the federal programs under which they were received, by Catalog of Federal Domestic Assistance (CFDA) title and number, award number and year, name of the federal agency, and name of the pass-through entity; 4.38.1.2 Maintain internal controls that provide reasonable assurance that the Contractor is managing federal awards in compliance with laws, regulations, and provisions of contracts or grant agreements that could have a material effect on each of its federal programs; 4.38.1.3 Prepare appropriate financial statements, including a schedule of expenditures of federal awards; 4.38.1.4 Incorporate OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 audit requirements into all agreements between the Contractor and its Subcontractors who are subrecipients; 4.38.1.5 Comply with any future amendments to OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 and any successor or replacement Circular or regulation; 4.38.1.6 Comply with the applicable requirements of OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 and any future amendments Washington State Health Care Authority Page 25 of 53 Contract#2751 to OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, and any successor or replacement Circular or regulation; and 4.38.1.7 Comply with the Omnibus Crime Control and Safe streets Act of 1968, Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title. II of the Americans with Disabilities Act of 1990, Title IX of the Education Amendments of 1972, The Age Discrimination Act of 1975, and The Department of Justice Non-Discrimination Regulations, 28 C.F.R. Part 42, Subparts C.D.E. and G, and 28 C.F.R. Part 35 and 39. (Go to http://o'p.gov/about/offices/ocr.htm for additional information and access to the aforementioned Federal laws and regulations.) 4.38.2 Single Audit Act Compliance If the Contractor is a subrecipient and expends $750,000 or more in federal awards from any and/or all sources in any fiscal year, the Contractor shall procure and pay for a single audit or a program-specific audit for that fiscal year. Upon completion of each audit, the Contractor shall: 4.38.2.1 Submit to the Authority contact person the data collection form and reporting package specified in OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, reports required by the program- specific audit guide (if applicable), and a copy of any management letters issued by the auditor; 4.38.2.2 Follow-up and develop corrective action for all audit findings; in accordance with OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, prepare a "Summary Schedule of Prior Audit Findings." 4.38.3 Overpayments 4.38.3.1 If it is determined by HCA, or during the course of a required audit, that Contractor has been paid unallowable costs under this or any Program Agreement, Contractor shall refund the full amount to HCA as provided in Section 4.27 Overpayments to Contractors. 4.39 SURVIVAL The terms and conditions contained in this Contract that, by their sense and context, are intended to survive the completion, cancellation, termination, or expiration of the Contract will survive. In addition, the terms of the sections titled Confidential Information Protection, Confidential Information Breach — Required Notification, Contractor's Proprietary Information, Disputes, Overpayments to Contractor, Publicity, Records and Documents Review, Rights in Data/Ownership, and Rights of State and Federal Governments will survive the termination of this Contract. The right of HCA to recover any overpayments will also survive the termination of this Contract. Washington State Health Care Authority Page 26 of 53 Contract#2751 4.40 TAXES HCA will pay sales or use taxes, if any, imposed on the services acquired hereunder. Contractor must pay all other taxes including, but not limited to, Washington Business and Occupation Tax, other taxes based on Contractor's income or gross receipts, or personal property taxes levied or assessed on Contractor's personal property. HCA, as an agency of Washington State government, is exempt from property tax. Contractor must complete registration with the Washington State Department of Revenue and be responsible for payment of all taxes due on payments made under this Contract. 4.41 TERMINATION 4.41.1 TERMINATION FOR DEFAULT In the event HCA determines that Contractor has failed to comply with the terms and conditions of this Contract, HCA has the right to suspend or terminate this Contract. HCA will notify Contractor in writing of the need to take corrective action. If corrective action is not taken within five (5) Business days, or other time period agreed to in writing by both parties, the Contract may be terminated. HCA reserves the right to suspend all or part of the Contract, withhold further payments, or prohibit Contractor from incurring additional obligations of funds during investigation of the alleged compliance breach and pending corrective action by Contractor or a decision by HCA to terminate the Contract. In the event of termination for default, Contractor will be liable for damages as authorized by law including, but not limited to, any cost difference between the original Contract and the replacement or cover Contract and all administrative costs directly related to the replacement Contract, e.g., cost of the competitive bidding, mailing, advertising, and staff time. If it is determined that Contractor: (i) was not in default, or (ii) its failure to perform was outside of its control, fault or negligence, the termination will be deemed a "Termination for Convenience." 4.41.2 TERMINATION FOR CONVENIENCE When, at HCA's sole discretion, it is in the best interest of the State, HCA may terminate this Contract in whole or in part by providing ten (10) calendar days' written notice. If this Contract is so terminated, HCA will be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. No penalty will accrue to HCA in the event the termination option in this section is exercised. 4.41.3 TERMINATION FOR NONALLOCATION OF FUNDS If funds are not allocated to continue this Contract in any future period, HCA may immediately terminate this Contract by providing written notice to the Contractor. Washington State Health Care Authority Page 27 of 53 Contract#2751 The termination will be effective on the date specified in the termination notice. HCA will be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. HCA agrees to notify Contractor of such non-allocation at the earliest possible time. No penalty will accrue to HCA in the event the termination option in this section is exercised. 4.41.4 TERMINATION FOR WITHDRAWAL OF AUTHORITY In the event that the authority of HCA to perform any of its duties is withdrawn, reduced, or limited in any way after the commencement of this Contract and prior to normal completion, HCA may immediately terminate this Contract by providing written notice to the Contractor. The termination will be effective on the date specified in the termination notice. HCA will be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. HCA agrees to notify Contractor of such withdrawal of authority at the earliest possible time. No penalty will accrue to HCA in the event the termination option in this section is exercised. 4.41.5 TERMINATION FOR CONFLICT OF INTEREST HCA may terminate this Contract by written notice to the Contractor if HCA determines, after due notice and examination, that there is a violation of the Ethics in Public Service Act, Chapter 42.52 RCW, or any other laws regarding ethics in public acquisitions and procurement and performance of contracts. In the event this Contract is so terminated, HCA will be entitled to pursue the same remedies against the Contractor as it could pursue in the event Contractor breaches the contract. 4.42 TERMINATION PROCEDURES 4.42.1 Upon termination of this Contract, HCA, in addition to any other rights provided in this Contract, may require Contractor to deliver to HCA any property specifically produced or acquired for the performance of such part of this Contract as has been terminated. 4.42.2 HCA will pay Contractor the agreed-upon price, if separately stated, for completed work and services accepted by HCA and the amount agreed upon by the Contractor and HCA for (i) completed work and services for which no separate price is stated; (ii) partially completed work and services; (iii) other property or services that are accepted by HCA; and (iv) the protection and preservation of property, unless the termination is for default, in which case HCA will determine the extent of the liability. Failure to agree with such determination will be a dispute within the meaning of Section 4.13 Disputes. HCA may withhold from any amounts due the Contractor such sum as HCA determines to be necessary to protect HCA against potential loss or liability. Washington State Health Care Authority Page 28 of 53 Contract#2751 4.42.3 After receipt of notice of termination, and except as otherwise directed by HCA, Contractor must: 4.41.3.1 Stop work under the Contract on the date of, and to the extent specified in, the notice; 4.42.3.2 Place no further orders or subcontracts for materials, services, or facilities except as may be necessary for completion of such portion of the work under the Contract that is not terminated; 4.42.3.3 Assign to HCA, in the manner, at the times, and to the extent directed by HCA, all the rights, title, and interest of the Contractor under the orders and subcontracts so terminated; in which case HCA has the right, at its discretion, to settle or pay any or all claims arising out of the termination of such orders and subcontracts; 4.42.3.4 Settle all outstanding liabilities and all claims arising out of such termination of orders and subcontracts, with the approval or ratification of HCA to the extent HCA may require, which approval or ratification will be final for all the purposes of this clause; 4.42.3.5 Transfer title to and deliver as directed by HCA any property required to be furnished to HCA; 4.42.3.6 Complete performance of any part of the work that was not terminated by HCA; and 4.42.3.7 Take such action as may be necessary, or as HCA may direct, for the protection and preservation of the records related to this Contract that are in the possession of the Contractor and in which HCA has or may acquire an interest. 4.43 WAIVER Waiver of any breach of any term or condition of this Contract will not be deemed a waiver of any prior or subsequent breach or default. No term or condition of this Contract will be held to be waived, modified, or deleted except by a written instrument signed by the parties. Only the HCA Authorized Representative has the authority to waive any term or condition of this Contract on behalf of HCA. 4.44 WARRANTIES 4.44.1 Contractor represents and warrants that it will perform all services pursuant to this Contract in a professional manner and with high quality and will immediately re- perform any services that are not in compliance with this representation and warranty at no cost to HCA. 4.44.2 Contractor represents and warrants that it shall comply with all applicable local, State, and federal licensing, accreditation and registration requirements and standards necessary in the performance of the Services. Washington State Health Care Authority Page 29 of 53 Contract#2751 4.44.3 Any written commitment by Contractor within the scope of this Contract will be binding upon Contractor. Failure of Contractor to fulfill such a commitment may constitute breach and will render Contractor liable for damages under the terms of this Contract. For purposes of this section, a commitment by Contractor includes: (i) Prices, discounts, and options committed to remain in force over a specified period of time; and (ii) any warranty or representation made by Contractor to HCA or contained in any Contractor publications, or descriptions of services in written or other communication medium, used to influence HCA to enter into this Contract. Approved as to Form: This contract format was approved by the Office of the Attorney General. Approval on file. Washington State Health Care Authority Page 30 of 53 Contract#2751 ATTACHMENT 1 FEDERAL COMPLIANCE, CERTIFICATIONS, AND ASSURANCES In the event federal funds are included in this agreement,the following sections apply: I. Federal Compliance and II. Standard Federal Assurances and Certifications. In the instance of inclusion of federal funds, the Contractor may be designated as a sub-recipient and the effective date of the amendment shall also be the date at which these requirements go into effect. I. FEDERAL COMPLIANCE - The use of federal funds requires additional compliance and control mechanisms to be in place. The following represents the majority of compliance elements that may apply to any federal funds provided under this contract. For clarification regarding any of these elements or details specific to the federal funds in this contract, contact the Health Care Authority. a. Source of Funds:This agreement is being funded partially or in full through Cooperative Agreement number, the full and complete terms and provisions of which are hereby incorporated into this agreement can be found by reference. Federal funds to support this agreement are identified by the Catalog of Federal Domestic Assistance (CFDA) number 93.778. The sub-awardee is responsible for tracking and reporting the cumulative amount expended under HCA Contract No.K2751 b. Period of Availability of Funds: Pursuant to 45 CFR 92.23, Sub-awardee may charge to the award only costs resulting from obligations of the funding period specified, unless carryover of unobligated balances is permitted, in which case the carryover balances may be charged for costs resulting from obligations of the subsequent funding period. All obligations incurred under the award must be liquidated no later than 90 days after the end of the funding period. c. Single Audit Act: A sub-awardee (including private, for-profit hospitals and non-profit institutions) shall adhere to the federal Office of Management and Budget (OMB) Super Circular 2 CFR 200.501 and 45 CFR 75.501. A sub-awardee who expends $750,000 or more in federal awards during a given fiscal year shall have a single or program-specific audit for that year in accordance with the provisions of OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501. d. Modifications: This agreement may not be modified or amended, nor may any term or provision be waived or discharged, including this particular Paragraph, except in writing, signed upon by both parties. 1. Examples of items requiring Health Care Authority prior written approval include, but are not limited to, the following: i. Deviations from the budget and Project plan. ii. Change in scope or objective of the agreement. iii. Change in a key person specified in the agreement. iv. The absence for more than three months or a 25% reduction in time by the Project Manager/Director. v. Need for additional funding. vi. Inclusion of costs that require prior approvals as outlined in the appropriate cost principles. vii. Any changes in budget line item(s) of greater than twenty percent (20%) of the total budget in this agreement. 2. No changes are to be implemented by the Sub-awardee until a written notice of approval is received from the Health Care Authority. e. Sub-Contracting: The sub-awardee shall not enter into a sub-contract for any of the work performed under this agreement without obtaining the prior written approval of the Health Care Authority. If sub-contractors are approved by the Health Care Authority, the subcontract, shall contain, at a minimum, sections of the agreement pertaining to Debarred and Suspended Vendors, Lobbying certification, Audit requirements, and/or any other project Federal, state, and local requirements. f. Condition for Receipt of Health Care Authority Funds: Funds provided by Health Care Authority to the sub-awardee under this agreement may not be used by the sub-awardee as a match or cost- sharing provision to secure other federal monies without prior written approval by the Health Care Authority. Washington State Health Care Authority Page 31 of 53 Contract#2751 g. Unallowable Costs: The sub-awardees' expenditures shall be subject to reduction for amounts included in any invoice or prior payment made which determined by HCA not to constitute allowable costs on the basis of audits, reviews, or monitoring of this agreement. h. Citizenship/Alien Verification/Determination:The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 (PL 104-193) states that federal public benefits should be made available only to U.S. citizens and qualified aliens. Entities that offer a service defined as a "federal public benefit" must make a citizenship/qualified alien determination/verification of applicants at the time of application as part of the eligibility criteria. Non-US citizens and unqualified aliens are not eligible to receive the services. PL 104-193 also includes specific reporting requirements. i. Federal Compliance: The sub-awardee shall comply with all applicable State and Federal statutes, laws, rules, and regulations in the performance of this agreement, whether included specifically in this agreement or not. j. Civil Rights and Non-Discrimination Obligations During the performance of this agreement, the Contractor shall comply with all current and future federal statutes relating to nondiscrimination. These include but are not limited to: Title VI of the Civil Rights Act of 1964 (PL 88-352), Title IX of the Education Amendments of 1972 (20 U.S.C. §§ 1681-1683 and 1685-1686), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), the Age Discrimination Act of 1975 (42 U.S.C. §§ 6101- 6107), the Drug Abuse Office and Treatment Act of 1972 (PL 92-255), the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290dd-3 and 290ee-3), Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), and the Americans with Disability Act(42 U.S.C., Section 12101 et seq.) http://www.hhs.gov/ocr/civilrights FICA Federal Compliance Contact Information Federal Grants and Budget Specialist Health Care Policy Washington State Health Care Authority Post Office Box 42710 Olympia, Washington 98504-2710 I. CIRCULARS `COMPLIANCE MATRIX' -The following compliance matrix identifies the OMB Circulars that contain the requirements which govern expenditure of federal funds. These requirements apply to the Washington State Health Care Authority (HCA), as the primary recipient of federal funds and then follow the funds to the sub-awardee, x. The federal Circulars which provide the applicable administrative requirements, cost principles and audit requirements are identified by sub-awardee organization type. II. OMB CIRCULAR ENTITY TYPE ADMINISTRATIVE COST AUDIT REQUIREMENTS REQUIREMENTS PRINCIPLES State. Local and Indian Tribal OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 Governments and Governmental Hospitals Non-Profit Organizations and Non-Profit Hospitals Colleges or Universities and Affiliated Hospitals For-Profit Organization Definitions: "Sub-recipient";means the legal entity to which a sub-award is made and which is accountable to the State for the use of the funds provided in carrying out a portion of the State's programmatic effort under a sponsored project.The term may include institutions of higher education, for-profit corporations or non-U.S. Based entities. Washington State Health Care Authority Page 32 of 53 Contract#2751 "Sub-award and Sub-granf'are used interchangeably and mean a lower tier award of financial support from a prime awardee (e.g.,Washington State Health Care Authority)to a Sub-recipient for the performance of a substantive portion of the program. These requirements do not apply to the procurement of goods and services for the benefit of the Washington State Health Care Authority. IV. STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES - Following are the Assurances, Certifications, and Special Conditions that apply to all federally funded (in whole or in part) agreements administered by the Washington State Health Care Authority. CERTIFICATIONS 1. CERTIFICATION REGARDING Covered Transactions" in all lower tier covered DEBARMENT AND SUSPENSION transactions (i.e., transactions with sub-grantees and/or contractors) and in all solicitations for lower The undersigned (authorized official signing for the tier covered transactions in accordance with 45 contracting organization) certifies to the best of his CFR Part 76. or her knowledge and belief, that the contractor, defined as the primary participant in accordance with 45 CFR Part 76, and its principals: 2. CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or The undersigned (authorized official signing for the voluntarily excluded from covered transactions contracting organization) certifies that the by any Federal Department or agency; contractor will, or will continue to, provide a drug- free workplace in accordance with 45 CFR Part 76 b) have not within a 3-year period preceding this by: contract been convicted of or had a civil judgment rendered against them for a) Publishing a statement notifying employees commission of fraud or a criminal offense in that the unlawful manufacture, distribution, connection with obtaining, attempting to obtain, dispensing, possession or use of a controlled or performing a public (Federal, State, or local) substance is prohibited in the grantee's transaction or contract under a public workplace and specifying the actions that will transaction; violation of Federal or State be taken against employees for violation of antitrust statutes or commission of such prohibition; embezzlement, theft, forgery, bribery, falsification or destruction of records, making b) Establishing an ongoing drug-free awareness false statements, or receiving stolen property; program to inform employees about (1) The dangers of drug abuse in the c) are not presently indicted or otherwise workplace; criminally or civilly charged by a governmental (2) The contractor's policy of maintaining a entity (Federal, State, or local)with commission drug-free workplace; of any of the offenses enumerated in paragraph (3)Any available drug counseling, (b) of this certification; and rehabilitation, and employee assistance programs; and d) have not within a 3-year period preceding this (4) The penalties that may be imposed upon contract had one or more public transactions employees for drug abuse violations (Federal, State, or local) terminated for cause occurring in the workplace; or default. c) Making it a requirement that each employee to Should the contractor not be able to provide this be engaged in the performance of the contract certification, an explanation as to why should be be given a copy of the statement required by placed after the assurances page in the contract. paragraph (a) above; The contractor agrees by signing this contract that d) Notifying the employee in the statement it will include, without modification, the clause titled required by paragraph (a), above, that, as a "Certification Regarding Debarment, Suspension, condition of employment under the contract, In eligibility, and Voluntary Exclusion--Lower Tier the employee will— Washington State Health Care Authority Page 33 of 53 Contract#2751 (1) Abide by the terms of the statement; and Title 31, United States Code, Section 1352, entitled (2) Notify the employer in writing of his or her "Limitation on use of appropriated funds to conviction for a violation of a criminal drug influence certain Federal contracting and financial statute occurring in the workplace no later than transactions," generally prohibits recipients of five calendar days after such conviction; Federal grants and cooperative agreements from using Federal (appropriated) funds for lobbying the e) Notifying the agency in writing within ten Executive or Legislative Branches of the Federal calendar days after receiving notice under Government in connection with a SPECIFIC grant paragraph (d)(2) from an employee or or cooperative agreement. Section 1352 also otherwise receiving actual notice of such requires that each person who requests or receives conviction. Employers of convicted employees a Federal grant or cooperative agreement must must provide notice, including position title, to disclose lobbying undertaken with non-Federal every contract officer or other designee on (nonappropriated) funds. These requirements whose contract activity the convicted employee apply to grants and cooperative agreements was working, unless the Federal agency has EXCEEDING $100,000 in total costs (45 CFR Part designated a central point for the receipt of 93). such notices. Notice shall include the identification number(s) of each affected grant; The undersigned (authorized official signing for the contracting organization) certifies, to the best of his f) Taking one of the following actions, within 30 or her knowledge and belief, that: calendar days of receiving notice under paragraph (d)(2),with respect to any employee (1) No Federal appropriated funds have been paid who is so convicted— or will be paid, by or on behalf of the (1) Taking appropriate personnel action undersigned, to any person for influencing or against such an employee, up to and attempting to influence an officer or employee including termination, consistent with of any agency, a Member of Congress, an the requirements of the Rehabilitation officer or employee of Congress, or an Act of 1973, as amended; or employee of a Member of Congress in (2) Requiring such employee to participate connection with the awarding of any Federal satisfactorily in a drug abuse contract, the making of any Federal grant, the assistance or rehabilitation program making of any Federal loan, the entering into approved for such purposes by a of any cooperative agreement, and the Federal, State, or local health, law extension, continuation, renewal, amendment, enforcement, or other appropriate or modification of any Federal contract, grant, agency; loan, or cooperative agreement. g) Making a good faith effort to continue to (2) If any funds other than Federally appropriated maintain a drug-free workplace through funds have been paid or will be paid to any implementation of paragraphs (a), (b), (c), (d), person for influencing or attempting to (e), and (f). influence an officer or employee of any agency, a Member of Congress, an officer or For purposes of paragraph (e) regarding agency employee of Congress, or an employee of a notification of criminal drug convictions, Authority Member of Congress in connection with this has designated the following central point for Federal contract, grant, loan, or cooperative receipt of such notices: agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Legal Services Manager Lobbying Activities," in accordance with its WA State Health Care Authority instructions. (If needed, Standard Form-LLL, PO Box 42700 "Disclosure of Lobbying Activities," its Olympia, WA 98504-2700 instructions, and continuation sheet are included at the end of this application form.) 3. CERTIFICATION REGARDING LOBBYING (3) The undersigned shall require that the language of this certification be included in the Washington State Health Care Authority Page 34 of 53 Contract#2751 award documents for all subcontracts at all tiers Failure to comply with the provisions of the law (including subcontracts, subcontracts, and may result in the imposition of a civil monetary contracts under grants, loans and cooperative penalty of up to $1,000 for each violation and/or agreements) and that all sub-recipients shall the imposition of an administrative compliance certify and disclose accordingly. order on the responsible entity. This certification is a material representation of fact By signing the certification, the undersigned upon which reliance was placed when this certifies that the contracting organization will transaction was made or entered into. Submission of comply with the requirements of the Act and will not this certification is a prerequisite for making or allow smoking within any portion of any indoor entering into this transaction imposed by Section facility used for the provision of services for children 1352, U.S. Code. Any person who fails to file the as defined by the Act. required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 The contracting organization agrees that it will for each such failure. require that the language of this certification be included in any subcontracts which contain 4. CERTIFICATION REGARDING PROGRAM provisions for children's services and that all sub- FRAUD CIVIL REMEDIES ACT(PFCRA) recipients shall certify accordingly. The undersigned (authorized official signing for the The Public Health Services strongly contracting organization) certifies that the encourages all recipients to provide a smoke- statements herein are true, complete, and accurate free workplace and promote the non-use of to the best of his or her knowledge, and that he or tobacco products. This is consistent with the she is aware that any false, fictitious, or fraudulent PHS mission to protect and advance the statements or claims may subject him or her to physical and mental health of the American criminal, civil, or administrative penalties. The people. undersigned agrees that the contracting organization will comply with the Public Health 6. CERTIFICATION REGARDING Service terms and conditions of award if a contract DEBARMENT, SUSPENSION, AND OTHER is awarded. RESPONSIBILITY MATTERS INSTRUCTIONS FOR CERTIFICATION 5. CERTIFICATION REGARDING 1) By signing and submitting this proposal, the ENVIRONMENTAL TOBACCO SMOKE prospective contractor is providing the Public Law 103-227, also known as the Pro- certification set out below. Children Act of 1994 (Act), requires that smoking 2) The inability of a person to provide the not be permitted in any portion of any indoor facility certification required below will not necessarily owned or leased or contracted for by an entity and result in denial of participation in this covered used routinely or regularly for the provision of transaction. The prospective contractor shall health, day care, early childhood development submit an explanation of why it cannot provide services, education or library services to children the certification set out below. The certification under the age of 18, if the services are funded by or explanation will be considered in connection Federal programs either directly or through State or with the department or agency's determination local governments, by Federal grant, contract, loan, whether to enter into this transaction. However, or loan guarantee. The law also applies to failure of the prospective contractor to furnish a children's services that are provided in indoor certification or an explanation shall disqualify facilities that are constructed, operated, or such person from participation in this maintained with such Federal funds. The law does transaction. not apply to children's services provided in private 3) The certification in this clause is a material residence, portions of facilities used for inpatient representation of fact upon which reliance was drug or alcohol treatment, service providers whose placed when the department or agency sole source of applicable Federal funds is Medicare determined to enter into this transaction. If it is or Medicaid, or facilities where WIC coupons are later determined that the prospective contractor redeemed. knowingly rendered an erroneous certification, in addition to other remedies available to the Washington State Health Care Authority Page 35 of 53 Contract#2751 Federal Government, the department or knowledge and information of a participant is agency may terminate this transaction for not required to exceed that which is normally cause of default. possessed by a prudent person in the ordinary 4) The prospective contractor shall provide course of business dealings. immediate written notice to the department or 10) Except for transactions authorized under agency to whom this contract is submitted if at paragraph 6 of these instructions, if a any time the prospective contractor learns that participant in a covered transaction knowingly its certification was erroneous when submitted enters into a lower tier covered transaction with or has become erroneous by reason of a person who is suspended, debarred, changed circumstances. ineligible, or voluntarily excluded from 5) The terms covered transaction, debarred, participation in this transaction, in addition to suspended, ineligible, lower tier covered other remedies available to the Federal transaction, participant, person, primary Government, Authority may terminate this covered transaction, principal, proposal, and transaction for cause or default. voluntarily excluded, as used in this clause, have the meanings set out in the Definitions 7. CERTIFICATION REGARDING and Coverage sections of the rules DEBARMENT, SUSPENSION, AND OTHER implementing Executive Order 12549. You may RESPONSIBILITY MATTERS -- PRIMARY contact the person to whom this contract is COVERED TRANSACTIONS submitted for assistance in obtaining a copy of those regulations. 1) The prospective contractor certifies to the best 6) The prospective contractor agrees by of its knowledge and belief, that it and its submitting this contract that, should the principals: proposed covered transaction be entered into, a) Are not presently debarred, suspended, it shall not knowingly enter into any lower tier proposed for debarment, declared covered transaction with a person who is ineligible, or voluntarily excluded from debarred, suspended, declared ineligible, or covered transactions by any Federal voluntarily excluded from participation in this department or agency; covered transaction, unless authorized by b) Have not within a three-year period preceding Authority. this contract been convicted of or had a civil 7) The prospective contractor further agrees by judgment rendered against them for submitting this contract that it will include the commission of fraud or a criminal offense in clause titled "Certification Regarding connection with obtaining, attempting to obtain, Debarment, Suspension, Ineligibility and or performing a public (Federal, State or local) Voluntary Exclusion -- Lower Tier Covered transaction or contract under a public Transaction," provided by HHS, without transaction; violation of Federal or State modification, in all lower tier covered antitrust statutes or commission of transactions and in all solicitations for lower tier embezzlement, theft, forgery, bribery, covered transactions. falsification or destruction of records, making 8) A participant in a covered transaction may rely false statements, or receiving stolen property; upon a certification of a prospective participant c) Are not presently indicted for or otherwise in a lower tier covered transaction that it is not criminally or civilly charged by a debarred, suspended, ineligible, or voluntarily governmental entity (Federal, State or excluded from the covered transaction, unless local) with commission of any of the it knows that the certification is erroneous. A offenses enumerated in paragraph (1)(b)of participant may decide the method and this certification; and frequency by which it determines the eligibility d) Have not within a three-year period of its principals. Each participant may, but is not preceding this contract had one or more required to, check the Non-procurement List(of public transactions (Federal, State or local) excluded parties). terminated for cause or default. 9) Nothing contained in the foregoing shall be 2) Where the prospective contractor is unable to construed to require establishment of a system certify to any of the statements in this certification, of records in order to render in good faith the such prospective contractor shall attach an certification required by this clause. The explanation to this proposal. Washington State Health Care Authority Page 36 of 53 Contract#2751 CONTRACTOR SIGNATURE REQUIRED SIGNATURE OF AUTHORIZED TITLE CERTIFYING OFFICIAL Please also print or type name: ORGANIZATION NAME: (if applicable) DATE Washington State Health Care Authority Page 37 of 53 Contract#2751 Attachment 2 Federal Funding Accountability and Transparency Act(FFATA) Data Collection Form This Contract is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how federal funds are spent. To comply with the act and be eligible to enter into this contract, your organization must have a Data Universal Numbering System (DUNS®) number. A DUNS® number provides a method to verify data about your organization. If you do not already have one, you may receive a DUNS® number free of charge by contacting Dun and Bradstreet at www.dnb.com. Required Information about your organization and this contract will be made available on USASpending.gov by the Washington State Health Care Authority (HCA) as required by P.L. 109-282. As a tool to provide the information, HCA encourages registration with the Central Contractor Registry (CCR) because less data entry and re-entry is required by both HCA and your organization. You may register with CCR on-line at https://www.uscontractorregistration.com/. Contractor must complete this form and return it to the Health Care Authority (HCA). CONTRACTOR 1. Legal Name 2. DUNS Number 3. Principle Place of Performance 3a. City 3b. State 3c. Zip+4 3d. Country 4. Are you registered in CCR (https://www.uscontractorregistration.com/)? DYES (skip to page 2. Sign, date and return) ❑NO 5. In the preceding fiscal year did your organization: a. Receive 80% or more of annual gross revenue from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative agreements; and b. $25,000,000 or more in annual gross revenues from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative agreements; and c. The public does not have access to information about the compensation of the executives through periodic reports filled with the IRS or the Security and Exchange Commission per 2 CFR Part 170.330 ❑ NO (skip the remainder of this section - Sign, date and return) ❑ YES (You must report the names and total compensation of the top 5 highly compensated officials of your organization). Name Of Official Total Compensation 1. 2. 3. 4. 5. Note: "Total compensation" means the cash and noncash dollar value earned by the executive during the sub-recipient's past fiscal year of the following for more information see 17 CFR 229.402 (c)(2)). Washington State Health Care Authority Page 38 of 53 Contract#2751 Schedule A: Statement of Work (SOW) The Contractor shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: A. In accordance with deadlines in Exhibit A, ABCD Quarterly Outreach and Case Management Report, develop and implement an ABCD action plan in accordance with the ABCD program principles and submit corresponding budget, using Exhibit C, ABCD Yearly Budget Too/. The ABCD program principles are outlined below. 1. Provide outreach and recruitment of Apple Health/Medicaid-eligible Clients, ages birth to six (6), in collaboration with other organizations, including, but not limited to: a) Contact no less than ten (10%) of Client list provided by HCA to the Contractor; i. HCA shall provide the Contractor's contact name identified on page 1, a list that shall include the following data elements: Client ID, Name, Address, and Telephone Number of Clients who have not gone to the dentist, as well the Client's caregiver name and preferred spoken language. HCA shall securely transmit Client information and the Contractor shall be responsible for notifying the Dental Program Manager within five (5) business days prior to the beginning of the quarter if they have not received this information. b) Provide outreach by attending, visiting or working with the below, but not limited to the following: i. County Health Fairs; ii. SmileMobile locations (a mobile clinic serving dental needs to children by the Washington Dental Service Foundation); iii. Women, Infants, and Children WIC offices (a federal assistance program of the Food and Nutrition Services of the United States Department of Agriculture; iv. Head Start facilities (a federal program that promotes the school readiness of children under five from low-income families); v. Early Learning Regional Coalitions (that are a not-for-profit alliance of employers and community subsidized before and after school child care); and vi. Day Care facilities throughout the state of Washington. c) Provide care coordination, including: i. Provide family orientation; including but not limited to, sharing information about the value of a child going to the dentist, what activities will occur in the dentist's office; Washington State Health Care Authority Page 39 of 53 Contract#2751 ii. Connect families with an ABCD certified dentist who accepts Apple Health/Medicaid, and providing information including, but not limited to, names and referrals to dentists, sharing information about interpreters and transportation benefits, and following up after an appointment, if appropriate; iii. Assisting in scheduling dental appointments for eligible children and council on the importance of keeping the appointment; and iv. Identify and address family barriers to accessing oral health care. 2. Convene Health Coalition/ABCD Steering Committee or participate in a Coalition or Steering Committee focused on health care, access or early learning with ABCD semi- annually. a) Invite the ABCD program manager with ARCORA Foundation and the Health Care Authority Dental program administrator. 3. Coordinate with the local ABCD Dental Champions to: a) Identify and recruit dental providers who will take Apple Health/Medicaid Clients through the ABCD Program; b) Maintain a list of active ABCD providers who accept Apple Health/Medicaid Clients birth to six (6) years and monitor provider availability to accept new Clients birth to six (6) years into their practice; c) Support current ABCD providers by communicating program changes and policy updates through in-person meetings and written communication; d) Provide or assist in providing new ABCD provider trainings to providers as needed; e) Assure certification process is completed; f) Provide Apple Health/Medicaid billing training assistance to ABCD offices/or providers or arrange for billing assistance; g) Update dental society (or local dentists/study clubs in counties without a society) on the ABCD Program and encourage their continued recruitment of new Apple Health/Medicaid providers; and h) Support the Dental Champion(s) participation in meetings and activities necessary to effectively conduct Apple Health/Medicaid provider outreach, recruitment and training, including financial support of attendance in development day. 4. Identify and recruit primary care medical providers to participate in Apple Health/Medicaid, secure their training in preventive oral health techniques and build their role in referring Apple Health/Medicaid-eligible children to the ABCD Program. This may include oral health education, fluoride treatments, etc. Washington State Health Care Authority Page 40 of 53 Contract#2751 5. Participate in all three (3) statewide ABCD Coordinators group meetings to remain current with ABCD policies, practices and opportunities. 6. Participate in statewide ABCD Champion Development Day meeting to remain current with any new clinical practices and opportunities. As well as meeting and networking with other champions to discuss roadblocks and program success stories. 7. Identify an ABCD Coordinator within the contracting organization who will develop and maintain a desk manual that outlines the expected ABCD contractual deliverables and how the contractor meets each deliverable. The Coordinator will utilize this manual to fulfill the contractual requirements. If the Contractor's Coordinator leaves, the contractor is responsible to notify the Health Care Authority within two weeks, of the coordinators departure or as soon as possible and share the Contractor's developed work plan that outlines how the expected contract deliverables will be met. The Contractor will share with HCA the contact information of the newly hired or appointed Coordinator and coordinate with HCA to assure a smooth transition of the expected contracted work deliverables. 8. Each quarter complete and submit the following via email: 1) Community Outreach and Coordination Care summary which shall include; a) Exhibit A, ABCD Quarterly Outreach and Case Management Report for the specific quarter; and b) Exhibit B, ABCD Quarterly Outreach and Coordination of Care Report. 2) Each year complete and submit via email the Exhibit C, ABCD Yearly Budget Tool, as applicable to the requirements, contained in Exhibit A. 3) A fully completed invoice that correlates with dollar values for completed deliverables outlined in Exhibit A: a) Exhibit templates are available on the ABCD website http://abcd-dental.org/for- coordinators/; and b) Reports and billing must be submitted no later than one month after each quarter end date, unless otherwise mutually agreed by both parties. Washington State Health Care Authority Page 41 of 53 Contract#2751 Exhibit A ABCD Quarterly Outreach & Case Management Report Year One 2018 - 2019 • 1St Quarter Report Please complete and submit report electronically to: Janice Tadeo, Dental Program Administrator Division of Health Care Services, Washington State Health Care Authority PO Box 45506, Olympia, WA 98504-5506 Phone: (360) 725-1583 Email: Ja nice.Tadeo(a-),HCA.WA.GOV Organization: Mason County Public Health ABCD Contact Person: Lydia Buchheit Phone: 360-427-9670x545 I diab co.mason.wa.us 1st Quarter Report Due: 10/31/18 7/11/18 - 9/30/18 Brief description (for events, provide date Maximum held/attended/ for staff assignments, provide name $$ available and title) - no more than 100 words (complete Exhibit for this A. and attach supporting document if providing Performance Category Yes/No deliverable additional detail) Allocate staff and review contract to plan and Include attached budget (Exhibit C) and copy of your create the year 1 action plan. $1,470 plan. Community and Provider Outreach $2,140 Complete Exhibit B Coordinate Care $665 Complete Exhibit B Provide outcome information such as minutes, copies of Convene Health Coalition/ABCD Steering information provided or list of items provided, examples of committee or participate in a Coalition or type of Organizations attended, what were outcomes or Steering Committee Focused on Health Care, next steps for ABCD. Access or Early Learning with ABCD as a *Send invitation and report back any concerns/issues to Quarterly Agenda Item. NCA Dental Program Administrator & ABCD $500 Administrator Washington State Health Care Authority Page 42 of 53 Contract#2751 Exhibit A ABCD Quarterly Outreach & Case Management Report Year One 2018 - 2019 - 2nd Quarter Report Please complete and submit report electronically to: Janice Tadeo, Dental Program Administrator Division of Health Care Services, Washington State Health Care Authority PO Box 45506, Olympia, WA 98504-5506 Phone: (360) 725-1583 Email: Janice.Tadeo(cDHCA.WA.GOV Organization: Mason County Public Health ABCD Contact Person: Lydia Buchheit Phone: 360-427-9670x545 lydiab@co.mason.wa.us 2nd Quarter Report Due: 01/30/19 10/1/18 - 12/31/18 Brief description (for events, provide date Maximum held/attended/ for staff assignments, provide name $$ available and title) - no more than 100 words (complete Exhibit for this A and attach supporting document if providing Performance Category Yes/No deliverable additional detail) Attend and participate in ABCD Coordinator/Program Meeting $1,470 Community and Provider Outreach $500 Complete Exhibit B Coordinate Care $2,140 Complete Exhibit B Provide outcome information such as minutes, copies of Convene Health Coalition/ABCD Steering information provided or list of items provided, examples of committee or participate in a Coalition or type of Organizations attended, what were outcomes or Steering Committee Focused on Health Care, next steps for ABCD. Access or Early Learning with ABCD as a *Send invitation and report back any concerns/issues to Quarterly Agenda Item. I-ICA Dental Program Administrator & ABCD $665 Administrator Washington State Hf are Authority Page 43 of 53 Contract#2751 Exhibit A ABCD Quarterly Outreach & Case Management Deport Year One 2018 - 2019 • 3rd Quarter Report Please complete and submit report electronically to: Janice Tadeo, Dental Program Administrator Division of Health Care Services, Washington State Health Care Authority PO Box 45506, Olympia, WA 98504-5506 Phone: (360) 725-1583 Email: Janice.Tadeo(5-).HCA.WA.GOV Organization: Mason County Public Health ABCD Contact Person: Lydia Buchheit Phone: 360-427-9670x545 lydiab@co.mason.wa.us 3rd Quarter Report Due: 04/30/19 1/11/19 - 3/31/19 Brief description (for events, provide date Maximum held/attended/for staff assignments, provide name $$ available and title) - no more than 100 words (complete Exhibit for this A and attach supporting document if providing Performance Category Yes/No deliverable additional detail) Attend and participate in ABCD Coordinator/Program Meeting $500 Community and Provider Outreach $2,625 Com tete Exhibit B Coordinate Care $1,150 Complete Exhibit B Provide outcome information such as minutes, copies of Convene Health Coalition/ABCD Steering information provided or list of items provided, examples of committee or participate in a Coalition or type of Organizations attended, what were outcomes or Steering Committee Focused on Health Care, next steps for ABCD. Access or Early Learning with ABCD as a *Send invitation and report back any concerns/issues to Quarterly Agenda Item. HCA Dental Program Administrator & ABCD $500 Administrator Washington State Health Care Authority Page 44 of 53 Contract#2751 Exhibit A ARCD Quarterly Outreach & Case Management Deport Year One 2018 - 2019 • 4th Quarter Report Please complete and submit report electronically to: Janice Tadeo, Dental Program Administrator Division of Health Care Services, Washington State Health Care Authority PO Box 45506, Olympia, WA 98504-5506 Phone: (360) 725-1583 Email: Janice.TadeoOHCA.WA.GOV Organization: Mason County Public Health ABCD Contact Person: Lydia Buchheit Phone: 360-427-9670x545 lycliab@co.mason.wa.us 4th Quarter Report Due: 07/31/2019 4/1/19- 6/30/19 Brief description (for events, provide date Maximum held/attended/for staff assignments, provide name $$ available and title) - no more than 100 words (complete Exhibit for this A and attach supporting document if providing Performance Category Yes/No deliverable additional detail) Contact at least 10% of client list $1,470 Complete Exhibit B Attend and participate in ABCD Coordinator/Program Meeting $500 Community and Provider Outreach $2,140 Complete Exhibit B Coordinate Care $665 Complete Exhibit B Washington State HE are Authority Page 45 of 53 Contract#2751 Exhibit A ABCD Quarterly Outreach & Case Management Report Year Two 2019 - 2020 • 1st Quarter Report Please complete and submit report electronically to: Janice Tadeo, Dental Program Administrator Division of Health Care Services, Washington State Health Care Authority PO Box 45506, Olympia, WA 98504-5506 Phone: (360) 725-1583 Email: Jan ice.Tadeo(o),HCA.WA.GOV Or anizatiom Mason County Public Health ABCD Contact Person: Lydia Buchheit Phone: 360-427-9670x545 lydiab@co.mason.wa.us 1st Quarter Report Due: 10/31/19 7/1/19 - 9/30/19 Brief description (for events, provide date Maximum held/attended/for staff assignments, provide name $$ available and title) - no more than 100 words (complete Exhibit for this A and attach supporting document if providing Performance Category Yes/No deliverable additional detail) Allocate staff and review contract to plan and Include attached budget (Exhibit C) and copy of your create the year 2 action plan. $1,470 plan. Community and Provider Outreach $2,140 Complete Exhibit B Coordinate Care $665 Complete Exhibit B Provide outcome information such as minutes, copies of Convene Health Coalition/ABCD Steering information provided or list of items provided, examples of committee or participate in a Coalition or type of Organizations attended, what were outcomes or Steering Committee Focused on Health Care, next steps for ABCD. Access or Early Learning with ABCD as a 'Send invitation and report back any concerns/issues to Quarterly Agenda Item. HCA Dental Program Administrator & ABCD $500 Administrator Washington State Health Care Authority Page 46 of 53 Contract#2751 Exhibit A ARCD Quarterly Outreach & Case Management Report Year Two 2019 - 2020 - 2nd Quarter Report Please complete and submit report electronically to: Janice Tadeo, Dental Program Administrator Division of Health Care Services, Washington State Health Care Authority PO Box 45506, Olympia, WA 98504-5506 Phone: (360) 725-1583 Email: Janice.TadeoCa)HCA.WA.GOV Organization: Mason County Public Health ABCD Contact Person: Lydia Buchheit Phone: 360-427-9670x545 lydiab@co.mason.wa.us 2nd Quarter Report Due: 01/31/2020 10/11/19- 12/31/19 0/1/19- 12/31/19 Brief description (for events, provide date Maximum held/attended/ for staff assignments, provide name $$ available and title) - no more than 100 words (complete Exhibit for this A and attach supporting document if providing Performance Category Yes/No deliverable additional detail) Contact at least 10% of client list $1,470 Complete Exhibit B Attend and participate in ABCD Coordinator/Program Meeting $500 Community and Provider Outreach $2,140 Complete Exhibit B Coordinate Care $665 Complete Exhibit B Washinaton State Hf are Authority Page 47 of 53 Contract#2751 Exhibit A ABCD Quarterly Outreach & Case Management Deport Year Two 2019 - 2020 • 3rd Quarter Report Please complete and submit report electronically to: Janice Tadeo, Dental Program Administrator Division of Health Care Services, Washington State Health Care Authority PO Box 45506, Olympia, WA 98504-5506 Phone: (360) 725-1583 Email: Janice.Tadeo(a)HCA.WA.GOV Organization: Mason County Public Health ABCD Contact Person: Lydia Buchheit Phone: 360-427-9670x545 lydiab@co.mason.wa.us 3rd Quarter Report Due: 04/30/20 11/11/20 - 3/31/20 /1/20 - 3/31/20 Brief description (for events, provide date Maximum held/attended/ for staff assignments, provide name $$ available and title) - no more than 100 words (complete Exhibit for this A and attach supporting document if providing Performance Category Yes/No deliverable additional detail) Attend and participate in ABCD Coordinator/Program Meeting $500 Community and Provider Outreach $2,625 Complete Exhibit B Coordinate Care $1,150 Complete Exhibit B Provide outcome information such as minutes, copies of Convene Health Coalition/ABCD Steering information provided or list of items provided, examples of committee or participate in a Coalition or type of Organizations attended, what were outcomes or Steering Committee Focused on Health Care, next steps for ABCD. Access or Early Learning with ABCD as a *Send invitation and report back any concerns/issues to Quarterly Agenda Item. HCA Dental Program Administrator & ABCD $500 Administrator Washington State Health Care Authority Page 48 of 53 Contract#2751 Exhibit A ARCD Quarterly Outreach & Case Management Report Year Two 2019 - 2020 • 4th Quarter Report Please complete and submit report electronically to: Janice Tadeo, Dental Program Administrator Division of Health Care Services, Washington State Health Care Authority PO Box 45506, Olympia, WA 98504-5506 Phone: (360) 725-1583 Email: Janice.Tadeo(LDHCA.WA.GOV Organization: Mason County Public Health ABCD Contact Person: Lydia Buchheit Phone: 360-427-9670x545 I diab@co.mason.wa.us 4th Quarter Report Due: 07/31/2020 4/1/20- 6/30120 Brief description (for events, provide date Maximum held/attended/for staff assignments, provide name $$ available and title) - no more than 100 words (complete Exhibit for this A and attach supporting document if providing Performance Category Yes/No deliverable additional detail) Contact at least 10% of client list $1,470 Complete Exhibit B Attend and participate in ABCD Coordinator/Program Meeting $500 Community and Provider Outreach $2,140 Complete Exhibit B Coordinate Care $665 Complete Exhibit B Washinoton State Hi are Authority Page 49 of 53 Contract#2751 Exhibit B ABCD Quarterly Outreach and Coordination of Care Report COORDINATE CARE Family Orientation How Many Haw Location & Date How provided: in-person/phone/email/mail/etc. Clients Contacted from List (10%) How Many How provided: in-person/phone/email/mail/etc. Assisted Client w/Initial Dental Appts. & Provided Follow-Up Flow Many If applicable Referrals To Dental Home How Many Barriers to Care Identified interpreter services/transportation/etc. How Many Washington State Health Care Authority Page 50 of 53 Contract#2751 COMMUNITY OUTREACH Type of Outreach/Place Date How many reached Examples: County health fairs/coordination w/Smile Mobile/WIC offices/Headstart/Early Learning Centers/Day Cares. WORK WITH CHAMPION/RECRUIT PROVIDERS Activity How Many Notes New Providers Certified Provider Trainings Held How Many Place and Date Provider Recruitment How Many Place and Date Washinoton State Hi are Authority Page 51 of 53 Contract#2751 Exhibit C ABC® Yearly Budget Taal 2018-2020 Yearly Expenses (estimated) Year One Year Two July 1 2018 July 1 2019 EXPENSES to To r =: June 30, 2019 June 30, 2020 Staffing/Salary & Benefits— add a column to identify % and hours per week for each year Program Coordinator (x hrs/week = .X FTE) Outreach Staff (x hrs/week = .X FTE) Program Manager (x hrs/week = .X FTE) Support Staff (clerical, IT, finance, communications/per staff, other x hrs/week = .X FTE) Administration (x hrs/week (.X FTE) Salary & Benefits Subtotal Operating Expenses Advertising/Marketing (print, broadcast ads; cable TV time, movie ads, weekly newspaper, billboards, social media) Office Equipment (Copier, Fax) Meeting Expenses (steering committee room, food, etc.) Postage Printing (Outside Vendors) Professional Services Office Supplies Operating Supplies Telephone ABCD Certification Training/dentists and staff (room, audiovisuals, food, thank you to participating families, promotion, etc.) Travel (Per Diem, Transportation, Mileage/airfare, accommodations as required) for 3x annual ABCD Coordinators meeting — 2 Seattle, 1 Central WA; and for 1 x annual Dental Washington State Health Care Authority Page 52 of 53 Contract#2751 Cont. Champion(s) travel/expenses to Development Day, Seattle (Coordinator- participation in this meeting optional but recommended Computer Support/Tech Services Rent/Insurance/Janitorial/Maintenance Utilities Operating Expenses Subtotal Indirect Costs TOTAL EXPENSES FUNDING SOURCES Year One Year Two Other Funding (United Way, Grants, Community Development Block Grant, etc.) Agency Funds and/or In-Kind Current Health Care Authority Contract TOTAL FUNDING Washington State H are Authority Page 53 of 53 Contract#2751 Attachment B MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Dave Windom DEPARTMENT: MCCS EXT: 260 BRIEFING DATE: June 18, 2018 PREVIOUS BRIEFING DATES: June 4, 2018 If this is a follow-up briefing, please provide only new information ITEM: Reclassification Request EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): Previously briefed. Reduce two management positions from Level 34 to 33 and raise two positions from Level 32 to 33. Raise the finance manager by one level. BUDGET IMPACTS: See enclosed RECOMMENDED OR REQUESTED ACTION: Approve ATTACHMENTS: Excel spreadsheet Briefing Summary 6/14/2018 Budgeted 1/1/18 Proposed 7/1/2018 Reclass Mason\CaseyB Mason\CaseyB HOURS REPORTED 1,712.00 HOURS REPORTED 1,712.00 SALARY DIST. 73,456 SALARY DIST. 75,291 MEDICAL AID(L&I 284.36 MEDICAL AID(L&I 284.36 FICA 5,619.38 FICA 5,759.76 RETIREMENT 8,376.63 RETIREMENT 8,585.88 T-RETIREMENT 0.00 T-RETIREMENT 0.00 MEDICAL BENEFI' 14,472.00 MEDICAL BENEFr 14,472.00 UNEMPLOYMENT 200.00 UNEMPLOYMENT 200.00 102,408.37 104,593.01 -2184.6336 Mason\DLR 0 Mason\DLR 0 HOURS REPORTED 1,689.30 HOURS REPORTED 1,692.00 SALARY DIST. 82,997 SALARY DIST. 75,606 MEDICAL AID(L&I 284.36 MEDICAL AID(L&I 284.36 FICA 6,349.27 FICA 5,783.86 RETIREMENT 9,464.65 RETIREMENT 8,621.81 T-RETIREMENT 1,040.00 T-RETIREMENT 1,040.00 MEDICAL BENEFr 14,472.00 MEDICAL BENEFr 14,472.00 UNEMPLOYMENT 200.00 UNEMPLOYMENT 200.00 114,807.28 106,008.02 8799.2516 Total Budgetary Savings 6,614.62 We start collecting the 3%technology when Smartgov is implemented.That fee will go into a restricted fund. Budgeted 1/1/18 Proposed 7/1/2018 Reclass PAC Manager Before PAC Manager After There is savings in the budget to cover PAC manager from filling Jahanel permit tech 2 position with Nicole as a permit tech 1. HOURS REPORTED 1,703.00 HOURS REPORTED 1,708.00 SALARY DIST. 70,376 SALARY DIST. 72,576 MEDICAL AID(L&I 284.36 MEDICAL AID(L&I 284.36 The new planner position vs clerical- What should happen for now-We fill clerical position and change Marissa planner bars line to Kell's planner line. FICA 5,383.76 FICA 5,552.06 RETIREMENT 8,025.40 RETIREMENT 8,276.28 T-RETIREMENT 1,040.00 T-RETIREMENT 0.00 MEDICAL BENEFr 14,472.00 MEDICAL BENEFr 14,472.00 UNEMPLOYMENT 200.00 UNEMPLOYMENT 200.00 99,781.52 101,360.70 -1579.1792 Planning Manager Before Planning Manager After HOURS REPORTED 1,696.00 HOURS REPORTED 1,768.00 SALARY DIST. 78,471 SALARY DIST. 73,488 MEDICAL AID(L&I 284.36 MEDICAL AID(L&I 284.36 FICA 6,003.03 FICA 5,621.83 RETIREMENT 8,948.52 RETIREMENT 8,380.28 T-RETIREMENT 1,040.00 T-RETIREMENT 1,040.00 MEDICAL BENEFr 14,472.00 MEDICAL BENEFr 14,472.00 UNEMPLOYMENT 200.00 UNEMPLOYMENT 200.00 0.00 109,418.91 0.00 103,486.47 5932.4409 Total Budgetary Savings 4353.2617 Mason County Support Services Department Budget Management 411 North 5 th Street Commissioner Administration Emergency Management Shelton, WA 98584 Facilities, Parks&Trails 360.427.9670 ext. 419 Human Resources Information Services Labor Relations Risk Management MASON COUNTY COMMISSIONER BRIEFING ITEMS FROM SUPPORT SERVICES June 18, 2018 • Specific Items for Review o Review of 2019 Budget Guidelines—Frank o Non-Represented Employee Salary Resolution —Frank o Review and authorization for take home vehicle list—Dawn o Review proposed budget supplement- Frank • Commissioner Discussion J:\DLZ\Briefing Items\2018\2018-06-18.docx RESOLUTION NO.3Y"fF 2018 BUDGET SUPPLEMENTAL/BUDGET TRANSFER REQUESTS-NOTICE OF HEARING WHEREAS,by reason of conditions which could not be reasonably foreseen at the time of making the budget for the year 2018, it is necessary to make provision for Supplemental/Budget Transfers to the budget as required by RCW 36.40.100,and RCW 36.40.195 for the following: Supplemental Request: $644,255 to Current Expense Non-Departmental(Fund 001.300)Revenue for Road Fund Internal Allocation Fees $34,000 to Belfair Sewer(Fund 413)Revenue for Belfair Sewer Feasibility Study from City of Bremerton $38,650 to Current Expense Sheriffs Office(Fund 001.205)Revenue from various private contracts $7,000 to Current Expense Support Services(Fund 001.090)Revenue from WA State Archives digital imaging grant $2,500 to Current Expense Juvenile Services(Fund 001.171)Revenue from 1DAI grant increase $24,565 to Current Expense Therapeutic Court(Fund 001.256)for funding from DSHS $104,737 to Current Expense Non-Departmental(Fund 001.300)for funding from Department of Commerce Grant $231,334.50 to REET 2(Fund 351)for funding from Recreation and Conservation Office Grant $506,000 to County Roads(Fund 105)for funding from Recreation and Conservation Office Grant and increased grant funding $290,000 to Skokomish Flood Zone(Fund 192)for increased funding from Mason Conservation District $207,235 to Storm Drain System Development (Fund 480) for revenue to be received from Department of Ecology Grant TOTAL:$2,090,276.50 Budget Transfers: $30,000 from Landfill Reserve(Fund 428)Ending Fund Balance to $30,000 Landfill Reserve(Fund 428)Misc.Contracted Professional Services $66,000 from Belfair Sewer(Fund 413)Ending Fund Balance to $66,000 Belfair Sewer(Fund 413)Professional Services/Misc. $2,050 from Auditor's 0&M(Fund 104)Ending Fund Balance to $1,907.50 Auditor's 0&M(Fund 104)Medical/Dental/Vision/Life, $142.50 Auditor's 0&M(Fund 104)Reserve for Technology $31,950 from Current Expense Ending Fund Balance(Fund 001.320)to $6,500 Auditor(Fund 001.030)Medical/Dental/Vision/Life $8,000 Human Resources/Risk Management(Fund 001.057)Medical/Dental/Vision/Life $6,100 Clerk(Fund 001.070)Medical/Dental/Vision/Life $5,050 Treasurer(Fund 001.260)Various Salaries and Benefits $3,600 Commissioners(Fund 001.080)State Retirement $2,700 Assessor(Fund 001.020)Medical/Dental/Vision/Life $50,000 from Veterans Assistance(Fund 190)Transfers Out to $50,000 Mental Health Tax(Fund 164)Transfers In $50,000 from Veterans Assistance(Fund 190)Transfers Out to $50,000 Community Support Services(Fund 117)Transfers In $4,940 eliminate transfer from Law Library(Fund 160)Transfers Out to $4,940 Support Services(Fund 001.090)Transfers In $4,940 from Law Library(Fund 160)Ending Fund Balance to $4,940 Law Library(Fund 160)Various Salary and Benefits $6,830.47 from Facilities&Grounds(Fund 001.055)Transfers Out to $6,830.47 Historical Preservation(Fund 116)Transfers in $10,000 from Facilities&Grounds(Fund 001.055)Transfers Out to $10,000 Community Support Services(Fund 117)Transfers In $55,090 from Current Expense Ending Fund Balance(Fund 001.320)to $34,403 Sheriff(Fund 001.205)Enterprise Payments $20,687 Sheriff(Fund 001.205)ER&R Upfit/Downfits $1,380.16 from Sheriff Special Funds(Fund 140)Ending Fund Balance to $1,380.16 Sheriff Special Funds-SAR Van Tires $107,831 from Current Expense Ending Fund Balance(Fund 001.320)to $34,528 Auditor(Fund 001.030)Various Salary&Benefit Lines $31,003 Treasurer(Fund 001.260)Various Salary&Benefit Lines $42,300 Clerk(Fund 001.070)Various Salary&Benefit Lines $70,000 from Current Expense Ending Fund Balance(Fund 001.320)to $70,000 Non Departmental(Fund 001.300)Accrued Leave Lines $311,000 from County Roads(Fund 105)Ending Fund Balance to $311,000 County Roads Professional Services THEREFORE,BE IT RESOLVED BY THE Board of Mason County Commissioners: That the 26'day of June,2018 at the hour of 6:30 p.m.,in the Mason County Commissioners Chambers in Courthouse Building I,411 North Fifth Street,Shelton,Washington,is hereby fixed as the time and place for a public hearing upon the matter of Budget Supplemental/Transfer Requests to the 2018 Budget as follows: Supplemental Request: $644,255 to Current Expense Non-Departmental(Fund 001.300)Revenue for Road Fund Internal Allocation Fees $34,000 to Belfair Sewer(Fund 413)Revenue for Belfair Sewer Feasibility Study from City of Bremerton $38,650 to Current Expense Sheriffs Office(Fund 001.205)Revenue from various private contracts $7,000 to Current Expense Support Services(Fund 001.090)Revenue from WA State Archives digital imaging grant $2,500 to Current Expense Juvenile Services(Fund 001.171)Revenue from JDAI grant increase $24,565 to Current Expense Therapeutic Court(Fund 001.256)for funding from DSHS $104,737 to Current Expense Non-Departmental(Fund 001.300)for funding from Department of Commerce Grant $231,334.50 to REET 2(Fund 351)for funding from Recreation and Conservation Office Grant $506,000 to County Roads(Fund 105)for funding from Recreation and Conservation Office Grant and increased grant funding $290,000 to Skokomish Flood Zone(Fund 192)for increased funding from Mason Conservation District $207,235 to Storm Drain System Development (Fund 480) for revenue to be received from Department of Ecology Grant TOTAL:$2,090,276.50 Budget Transfers From: $30,000 from Landfill Reserve(Fund 428)Ending Fund Balance $66,000 from Belfair Sewer(Fund 413)Ending Fund Balance $2,050 from Auditor's 0&M(Fund 104)Ending Fund Balance $31,950 from Current Expense Ending Fund Balance(Fund 001.320) $50,000 from Veterans Assistance(Fund 190)Transfers Out $50,000 from Veterans Assistance(Fund 190)Transfers Out $4,940 eliminate transfer from Law Library(Fund 160)Transfers Out $4,940 from Law Library(Fund 160)Ending Fund Balance $6,830.47 from Facilities&Grounds(Fund 001.055)Transfers Out $10,000 from Facilities&Grounds(Fund 001.055)Transfers Out $55,090 from Current Expense Ending Fund Balance(Fund 001.320) $1,380.16 from Sheriff Special Funds(Fund 140)Ending Fund Balance $107,831 from Current Expense Ending Fund Balance(Fund 001.320) $70,000 from Current Expense Ending Fund Balance(Fund 001.320) $311,000 from County Roads Ending Fund Balance(Fund 105) TOTAL:$802,011.63 Budget Transfers To: $30,000 Landfill Reserve(Fund 428)Misc.Contracted Professional Services $66,000 Belfair Sewer(Fund 413)Professional Services/Misc. $1,907.50 Auditor's O&M(Fund 104)Medical/Dental/Vision/Life, $142.50 Auditor's O&M(Fund 104)Reserve for Technology $6,500 Auditor(Fund 001.030)Medical/Dental/Vision/life $8,000 Human Resources/Risk Management(Fund 001.057)Medical/Dental/Vision/Life $6,100 Clerk(Fund 001.070)Medical/Dental/Vision/Life $5,050 Treasurer(Fund 001.260)Various Salaries and Benefits $3,600 Commissioners(Fund 001.080)State Retirement $2,700 Assessor(Fund 001.020)Medical/Dental/Vision/Life $50,000 Mental Health Tax(Fund 164)Transfers In $50,000 Community Support Services(Fund 117)Transfers In $4,940 Support Services(Fund 001.090)Transfers In $4,940 Law Library(Fund 160)Various Salary and Benefits $6,830.47 Historical Preservation(Fund 116)Transfers In $10,000 Community Support Services(Fund 117)Transfers In $34,403 Sheriff(Fund 001.205)Enterprise Payments $20,687 Sheriff(Fund 001.205)ER&R Upfit/Downfits $1,380.16 Sheriff Special Funds—SAR Van Tires $34,528 Auditor(Fund 001.030)Various Salary&Benefit Lines $31,003 Treasurer(Fund 001.260)Various Salary&Benefit Lines $42,300 Clerk(Fund 001.070)Various Salary&Benefit Lines $70,000 Non Departmental(Fund 001.300)Accrued leave Lines $311,000 County Road(Fund 105)Professional Services TOTAL:$802,011.63 The Clerk of the Board is hereby authorized,empowered,and directed to cause notice of such hearing to be published as provided by law. DATED this 12"of June,2018 ATTEST: BOARD OF COUNTY COMMISSIONERS MASON COUNTY,WASHINGTON ss ewry,Clerk of the / Board RandylAeatherlin,Chair APPROVED AS TO FORM: ;,- — Terri Drexler,Commissioner Tim Whitehead,Chief DPA CC: Auditor—Financial Services Kevin Shutty,Co issioner Publish 2x 6/14&6/21 bill to Commissioners, 411 North 51"Street,Shelton PUBLIC WORKS MONDAY JUNE 18,2018— BRIEFING ITEMS FROM P1IBLIC WORKS (For Commissioners Meeting June 26,2018) Items for this meeting are due to Diane Zoren on Wednesday,June 13,2018 4.0 CORRESPONDENCE AND ORGANIZATIONAL BUSINESS (None) 8.0 APPROVAL OF ACTION ITEM • FEMA Project 701-4, Satsop Cloquallum Road, mitigation project. (Requesting approval at the June 19, 2018 Commission Meeting) • Set Hearing with Hearings Examiner for Road Vacation No. 396 9.0 OTHER BUSINESS (None) 10.0 PUBLIC HEARINGS AND ITEMS SET FOR A CERTAIN TIME (None) DISCUSSION ITEMS: • Recycling Material Values Attendees: Commissioners: Public Works: Other Dept.: Press: Public: _Randy Neatherlin _Jerry Hauth List below: List below List Below: _Kevin Shutty _John Huestis _Terri Drexler _Bart Stepp Others-List below: MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: John Huestis, PE, Deputy Director/County Engineer DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: June 18, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing,please provide only new information.) ITEM: Approval of Project 701-4 Satsop-Cloquallum Mitigation (FEMA PW 35 — DR 4253 Satsop-Cloquallum Road Repair) EXECUTIVE SUMMARY: Project 701-4 is a mitigation project in result of an emergency repair to Satsop-Cloquallum Rd. During a declared event in December 2016, the existing roadway was undercut by the Satsop River. Maintenance crews immediately mobilized to the site, armored the bank with large boulders, saving the roadway. As a mitigation requirement of WDFW, this project provides installation of piling and large woody debris to soften the hard embankment. BUDGET IMPACTS: The preliminary estimated cost of the project is $206,000. FEMA and State Emergency Management funds will cover 86.5%. RECOMMENDED OR REQUESTED ACTION: Recommend the Board authorize the Chair to sign all pertinent documents and Public Works to advertise, set bid opening date/time, award contract and any change orders. Contract award will be announced during a regular meeting of the Board. Attachments: Vicinity Map Briefing Summary r SATSOP - CLOQUALLUM MITIGATION PROJECT 701-4 Sei MP 7.7 ------------------- a, mow; -Id— t W SATSOP CLOQUALLUQ/ 1 Y r N.: SRU"�F •" .. CC 1� 31- -- M/ d I � H3o�lt Ilrxrdsp�qt I i i ahuys-' / 5kn6omich � r 'r � t / I Indianof Z t / / - Rrvrnalinn f' / / � I I P 1i / Jh - / N3rt / / •• S1-1.1(r nd , Island Indian 1 _ Rrtirre atian GOOSE , t_- / PRAIRIE rr iCoat, I tri b�atc� 101_ / L pnp = n 16 004— S` n o = )AMS A-NE Z Y G Mcc1 -y„�eSources:Esri, HE l Fey',": an,METI, 0 1.25 2.5 5 7.5 10 E dia,©O.� PROJECT LOCATION ii, hep Miles MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: John Huestis, PE, Deputy Director/County Engineer and Phil Franklin, ROW Agent DEPARTMENT: Public Works EXT: 450 BRIEFING DATE: June 18, 2018 PREVIOUS BRIEFING DATES: (If this is a follow-up briefing, please provide only new information) ITEM: Road Vacation Request No. 396 - Set Hearing Date EXECUTIVE SUMMARY: Public Works is requesting to vacate a portion of W Cloquallum Road no longer needed due to road realignment under CRP#1916. An Engineer's Report has been prepared for the Hearing Examiner and Public Works recommends vacation subject to retaining existing easements in favor of Centuryl-ink Telecommunications Company, and in accordance with RCW 36.87.170 retaining an easement in favor of Mason County for any other utilities present in the vacated right-of-way. RECOMMENDED OR REQUESTED ACTION: Recommend the Board approve and execute the resolution setting a hearing date with the Hearings Examiner for Wednesday, July 25, 2018 to consider public comment on the proposed vacation of a portion of W Cloquallum Road. ATTACHMENTS: Engineer's Report Resolution — Notice of Intent to Vacate Briefing Summary 6/12/2018 MASON COUNTY DEPARTMENT of PUBLIC WORKS 100 W PUBLIC WORKS DRIVE SHELTON, WASHINGTON 98584 MEMORANDUM DATE: June 13, 2018 TO: Mason County Hearings Examiner FROM: Phil Franklin, Right of Way Agent, for John Huestis, PE, Deputy Director/County Engineer Cc: Loretta Swanson, Technical Services Manager SUBJECT: ENGINEER'S REPORT— ROAD VACATION FILE NO. 396 Vacation of a portion of W. Cloquallum Road, County Road #10000 Background: Mason County Public Works recently completed county road project, (CRP 1916), on W Cloquallum Road between mile post 5.85 and 6.60. This project included realignment of the road to improve driving conditions for the traveling public. As a result of the project,there is now a strip of right of way associated with the old road alignment that is no longer necessary for maintaining W Cloquallum Road. Public Works proposes to vacate this strip of right of way and turn it back to the underlying property owner, Green Diamond Resources Company. Vacating the unused portion of an original right-of-way alignment is common practice in most road projects unless there is a purpose for retaining (such as the need to maintain a slope) or the property is very small and of little or no value. In this case, Public Works has determined the following: 1. The road is presently in use by the public but not located within the proposed vacation area. 2. The proposed vacation area is not deemed necessary to preserve for the County road system. 3. The selected portion of Cloqullum Road, to be vacated, is a Class A Road and the right-of-way is an easement. No compensation is required for Class A Roads with the exception of the administrative costs of the vacation action. In this instance, Public Works is initiating the proposed vacation and will absorb the cost of vacation. 4. Centuryl-ink Telecommunications has buried fiber within the proposed vacation area and an easement is to be reserved in accordance with RCW 36.87.170 in favor of Mason County for any utilities present in the vacated right-of-way. Both Centuryl-ink and Green Diamond Resources have been notified of the proposed vacation and may wish to take additional steps outside the county process to document utility occupation within this strip of land. 5. The public will benefit by this action as it will clear title, add the vacated area to the tax rolls and relieve the county of any liability associated with this strip of land. Public Notice Public notice is to be provided as required by RCW 36.87.050, both by posting at the site and by publishing in the county official newspaper. Page 1 of 2 Recommendation Public Works recommends the vacation of the portion of old and unused right of way laying north of the now currently re-aligned W Cloquallum Road and adjacent to Assessor's Parcel #41903-00-01000 that lays north and northeast of W. Cloquallum Road. The recommended vacation is subject to an existing easement in favor of Centuryl-ink and in accordance with RCW 36.87.170, retaining an easement in favor of Mason County for any utilities present in the vacated right of way. Hearing Examiner Options 1. Find that this vacation meets the standards established by state law and recommend the vacation be granted as petitioned and/or as recommended by the County Engineer. 2. Find that this vacation fails to meet the standards established by state law and recommend the vacation be denied. 3. Finding that only part of the vacation as petitioned or recommended by the County Engineer complies with the law, develop recommendations to grant the compliant portion and deny the other. Attachments: • Exhibit A- Legal Description • Exhibit 61 and B2 Plans of Road Project showing area to be vacated • Exhibit C Aerial picture showing old right of way to be vacated Page 2 of 2 EXHIBIT A All that portion of Bargain and Sale Deed granted to Simpson Resource Company recorded June 28, 2002 under Auditors File No. 1758700, being a portion of the North half of Section 3, Township 19 North, Range 4 West, W.M., Mason County Washington, excepting therefrom the Southeast quarter of the Northeast quarter, lying Northerly and Easterly of the following described line: BEGINNING at a point shown as new Right-of-Way on the official map of Cloquallum Road, County Road Project No. 1916, on file in the office of the Mason County Engineer, Mason County, Washington, said point being radial to Engineers Station 26+00 and 80.00 feet left; thence westerly to a point radial to Engineers Station 26+00 and 45.00 feet left said point being on curve to the left; thence Northwesterly along the arc of said curve to the left having a radius of 880.00 feet and a central angle of 6° 51' 45"a distance of 105.40 feet to a point radial to Engineers Station 25+00 and 45.00 feet left;thence Easterly 5.00 feet to a point radial to Engineers Station 25+00 and 50.00 feet left, said point being on a curve to the left; thence Northwesterly along the arc of said curve to the left having a radius of 885.00 feet and a central angle of 12° 00' 34"a distance of 185.50 feet to a point radial to Engineers Station 23+25 and 50.00 feet left; thence Northeasterly 20.00 feet to a point radial to Engineers Station 23+25 and 70.00 feet left, said point being on a curve to the left; thence Northwesterly along the are of said curve to the left having a radius of 905.00 feet and a central angle of 27° 06' 32"a distance of 428.19 feet to a point radial to Engineers Station 19+30 and 70.00 feet left;thence Southwesterly 20.00 feet to a point radial to Engineers Station 19+30 and 50.00 feet left, said point being on a curve to the left; thence Northwesterly along the arc of said curve to the left having a radius of 885.00 feet and a central angle of 12° 52' 49" a distance of 198.95 feet to a point radial to Engineers Station 17+42.63 and 50.00 feet left and the West line of the Northwest Quarter of Section 3; thence Northerly along the West line of the Northwest Quarter of Section 3 to the existing Right-of Way as shown on said official map of Cloquallum Road, County Road Project No. 1916, on file in the office of the mason County Engineer, Mason County, Washington. SEC770N 3, TDl�91/SH/Y /9 NDrQTh; RANGE 4 *EST 0141 -- --- � . BASIS OF BEARING N,s1R.IGrn.si•R PARE coDRDRurt snml swn.tu.R.o a�(rl0 EAOCR ' (t01 D.00D0)EAOY GLCeAt POalAMAO Srai[l K,R01G,MO pai,a'f2 51.Ow1 ARE GAq. EXHIBIT B PAGE#2 h ' r 34.M.P.y � �i%fir_:•':I � �..'. y"`I� _ �� `` .aoDR G uta. .,,�� ❑ ,`A � .F - --A�t �••� -•—.—.—,_ - .. .. -- - ?mac_ — — — — — — — —— — .— -- -- -------- r ..i � _ —t=l_1—•-1 ♦�-:A �.. — �• �ryj- ..,_.i�;M-----A_'--'�'".�._ I n 5- 3110 s ur Ir a'[a31m ,rte ------------------- 3 1 - ... ------------- —---------------- Z ---Z _ V/ Greenish Yellow highlighted area P°J $ LEGEND denotes old right of way to be vacated wrR[n PORER -- E.- ------- ASING--- - - EOSIWG EDGE Q 11A. I LfAOE PpE 1--A-tw-i-ti CHNIQ Oi OwfASW � SEANCE Ppf Y-i-1-F-:-y SE n[�II n9[A PO51 R110E - Eua1aW WlKR1 00 00 a�" �•�., OWNERSHIP ----- - L_.._ T,.m. -!.:•a.,,. ASLWRO ASSESSONO R T RAT PMC/l RHaaT O)MAY iEIIP.CplaT. E4KA'S RN1C Scale 1' = 100' a p,AOro REOpAO[rnw,AY 1910 V 10000 OOD, —Oil 1G TO-Tom/- ^EY""OEl' 0 9E vAc,tEn EASEUEMr X[M 011..00 IILS01a1Et GOVAN 1916-10000-OOOa 1401 1.11 E- 1 NDpt.ROLND LL t ROY P. IOIf-10000-000E 310 .W .M 3]E 01 1 DAiE e. —1S:p6 w-E a, —�•..'•---__y RIGHT OF WAY s"E'mE MASON COUNTY PUBLIC WORKS 1. P COUNTY ROAD NO.)._omg %Y•�. 100 WEST PUBLIC WORKS DRIVE COUNTY ENGINEER ` ? ' CL UALLUM 5.85-6.60 SHELTON,WASHINGTON 98584 (360)427-9670 - COUNTY ROAD PROJECT 2 90, ROADREAL104MENT 01 Mason County SVA GIS Paue 1 of 1 Mason County WA GIS EXHIBIT C �5�!Py' .1 E f •. i Pat W4' �.r f i• ;Y, -� fl Imo '' i�I !. i �..J •y f ! :;'�i� �cr[� ��. 1a 1!"• t�.��*„� I �a�'•r° •� fes- ` J ,f-,Y 10 ✓ ;. Old Right of Way to oe Reli is C , r��f ♦ r i. �� r 1, O = ght of be!ljamf 14.— O ,t 4 i r 01, �t� -w.• � ♦- ( �,y � !,� ! r�. it �•. ,.� .'s�r_�! � '�J '��� r} ' . ; � •'r: O(d R t W vy Sw 10 AV. f or Of r !' •I.r� LI� ,i i•> . 1.r..•r. _ r r '� .. T ..�° i-EEK RD i0;`• littDs:HL,is.co.mason.wa.us/mason/ sit i')nt Q RESOLUTION NO. VACATION FILE NO.396 NOTICE OF INTENT TO VACATE SETTING TIME AND PLACE FOR HEARING ON SAID VACATION RCW 36.87 IN THE MATTER OF THE VACATION OF A PORTION OF W CLOQUALLUM ROAD WHEREAS, NOTICE IS HEREBY GIVEN that the Mason County Public Works Department is requesting for the vacation of the following right of way: A portion of the old right-of-way located along W. Cloquallum Road. The right of way to be vacated is located North and East of the newly relocated Cloquallum Road between Milepost 6.30 and 6.46 along Assessor's Parcel #41903-00-01000 which is described in the brief legal as, N '/2 Section EX. SE 1/4, in Township 19 Section 3 Range 4 WWM. WHEREAS, the Board of Mason County Commissioners did set a date for public hearing on the matter before the Hearing Examiner on the matter and directed Public Works to prepare notice thereof for posting and publication. NOW THEREFORE, BE IT RESOLVED that said hearing has been set for Wednesday, July 25, 2018 at 1:00 p.m. in the Commission Chambers, Mason County Courthouse Building I, 411 North Fifth Street, Shelton, Washington, at which time and place any taxpayer may appear to hear the County Engineer's report, and be heard either for or against the vacation of said portion of W. Cloquallum Road. DATED this day of 2018. BOARD OF COUNTY COMMISSIONERS MASON COUNTY, WASHINGTON ATTEST: Melissa Drewry, Clerk of the Board Randy Neatherlin, Chair APPROVED AS TO FORM: Terri Drexler, Vice Commissioner Tim Whitehead, Ch. DPA Assessor Auditor Kevin Shutty, Commissioner County Engineer Petitioner Post no later than 7/5/18 (20 days prior to hearing at each terminus of the county road or portion thereof proposed to be vacated or abandoned.) Vacation File No. 396 JOURNAL—Publish 2t: 7/5/18—7/12/18 (Bill Public Works) 1 MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Bart Stepp, Deputy Director/ Utilities and Waste Management DEPARTMENT: Public Works EXT: 652 BRIEFING DATE: June 18, 2018 PREVIOUS BRIEFING DATE: June 4, 2018, April 16 & 23, 2018 ITEM: Recycle Material Values EXECUTIVE SUMMARY: The County has a contract with Mason County Garbage Co. Inc. to haul and service blue box recycling containers at our solid waste facilities. This contract expires in August 2020. Historically China has been the main consumer of our mixed waste paper materials. They are no longer accepting mixed waste paper which has led to a drastic change in prices for mixed waste paper. Due to the drop in prices Mason County Garbage Co. Inc. has asked for an amendment to the contract for an additional surcharge to pay for the costs of paper recycling. The Board discussed this on April le & 23rd and requested that the Solid Waste Advisory Committee (SWAC) discuss this issue and make a recommendation to the board on how to proceed. The SWAC discussed this at the May 16"' meeting and has the following recommendation: 1) Continue providing mixed waste paper recycling in the blue box program. 2) Complete an amendment with Mason County Garbage Co. Inc. to add a surcharge for hauling paper so Mason County Garbage Co. Inc. does not lose money. 3) Have a surcharge cap in the amendment. If prices exceed the cap the County would place the paper in the Eells Hill solid waste containers and avoid paying the surcharge. 4) The surcharge amendment would be reviewed at the end of 2018 or earlier to determine if it was still needed. 5) Send out a press release stating that the County may be forced to dispose of mixed waste paper in the landfill if the surcharge exceeds the cap or if recycling facilities stop accepting mixed waste paper. The average monthly cost for us to recycle mixed waste paper currently is $158.76/ton. In comparison the cost for us to landfill solid waste with Republic is $55.71/ton and operational costs are around $35/ton for a total cost of $90.71/ton. Mason County Garbage indicated at the 5/16/18 SWAC meeting the surcharge based on current pricing would be $79/haul. I propose that we cap the surcharge at $110/haul. Above that pricing we would have Mason County Garbage Co. Inc. just dispose of the paper at Eells Hill. Briefing Summary Cost Impact to the County: A surcharge of $79/haul would increase annual recycling costs to the County by about $17,500. Solid Waste Fund #402 can handle that increase in 2018 without increasing tipping fees but tipping fees would probably need an adjustment above CPI in 2019 to account for the surcharges. If surcharges for other materials were required the increase would be larger. RECOMMENDED OR REQUESTED ACTION: Approve SWAC recommendations to create surcharge with cap for Mason County Garbage Co. Inc. If pricing exceeds the cap or recycling facilities stop recycling paper, then the County would dispose of the mixed waste paper into Eells Hill containers for landfill disposal. If commodity prices increase then the County would resume recycling of mixed waste paper. Briefing Summary Attachment B MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jim Madsen DEPARTMENT: Juvenile Court Services EXT: 332 BRIEFING DATE: 06/18/18 PREVIOUS BRIEFING DATES: If this is a follow-up briefing, please provide only new information ITEM: Juvenile Probation Counselor Vacancy EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): Juvenile Court Services is losing a Juvenile Probation Counselor position on 6/29/18 which currently is supervising 10 offender youth and 46 dependency youth. Our department would like to fill the position as soon as possible to ensure the least amount of disruption to the youth and families. BUDGET IMPACTS: There are not any financial impacts of hiring this position. All funding for this position is already accounted for in the approved Juvenile Court Services budget. RECOMMENDED OR REQUESTED ACTION: Allow Juvenile Court Services to simultaneously post for bidding purposes within the union contract as well as internally within the county system. ATTACHMENTS: N/A Briefmg Summary 6/13/2018 MASON COUNTY BRIEFING ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Jim Madsen DEPARTMENT: Juvenile Court Services EXT: 332 BRIEFING DATE: 6/18/18 PREVIOUS BRIEFING DATES: If this is a follow-up briefing, please provide only new information ITEM: Juvenile Detention Alternatives Initiative (JDAI) Grant 2018-2019. EXECUTIVE SUMMARY: (If applicable, please include available options and potential solutions): The Juvenile Detention Alternatives Initiative is a nationwide initiative created by the Annie E. Casey Foundation that reduces detention populations by ensuring juvenile courts are only detaining offenders that need to be detained. These funds enable the county to provide staff support and the creation of alternative programming in lieu of detention. There are no matching funds requirements for this grant. BUDGET IMPACTS: This grant provides $24,500 of revenue for Juvenile Court Services to provide programming, purchase supplies and equipment, and pay a portion of staff salary and benefits. RECOMMENDED OR REQUESTED ACTION: Approve Contract Number I-501-00812, Juvenile Detention Alternatives Initiative Grant Application. ATTACHMENTS: Contract Number I-501-00812, Juvenile Detention Alternatives Initiative Grant Application. Briefing Summary 6/13/2018 Mason County GRANT QUESTIONNAIRE Date: Office/Department: Juvenile Court Services Contact Person: Jim Madsen/Paula Thale 1) Name of Grant/Program Juvenile Detention Alternatives Initiative Grant 2) New Grant ❑ Renewing Grant ❑ Term (# of years) 3) Is the grant unchanged, and does not require Current Expense funding? Y XX N 41) How will this grant benefit the County's citizens? This Interagency Agreement between Mason County Juvenile Court and the Administrative Office of the Courts provides funds to develop, implement and buy supplies for programs used in lieu of detention services. 5) Is this a program grant or an equipment grant? Program Grant 6) Is this a "one-time only grant" or is it renewable? If renewable, how long is grant anticipated to last? Renewable grant that is anticipated to continue in the future. 7) If this is a new grant how will the grant support a current program OR how will the program change? 8) Does this grant require up front funds? Y N XX If so, what is the source of the up-front funds needed to cover costs prior to initial and continuing reimbursements being received? 9) How many employees (new or current) will be paid by the grant? N -o- C 1 a. If this grant requires new hire(s) and grant ends, how will unemployment costs be funded? Page 1 rev. 3-11 10) Will the grant require matching funds; i.e., in-kind, cash, Employment Security, Social Security, FICA, PERS, etc? Y N xx If so, what? 11) Would the grant allow for an annual COLA in salary, increase in medical insurance premiums or increases in any personnel benefits? Y xx 12) What fund would support a cash match (if required)? 13) If required what is the TOTAL cost of the match over the life of the grant? 14) What fund would support the administration of the grant? 15) Will the grant allow for the County cost allocation plan to be funded? Y 16) Would the grant require the county to provide office space and/or additional equipment to administer the program? If so, what are the requirements? No additional resources will be needed. 17) Would the program require use of a county vehicle or personal vehicle? Y xx N 18) If so, would the grant provide for the cost of the automobile and/or liability insurance? Y xx N 19) Would the grant require activities by other county offices/departments? (i.e. legal review, technology services assistance, new BARS numbers.) Y N xx If so, what activities? 20) Would acceptance and completion of the grant project in any way OBLIGATE the County to create/enact new ordinance or policies? Y N xx If so, what obligations? 21) Does this grant project include any activities that may fall outside the county's standard policies (personnel policies on travel, hours of work, training required, reimbursement for meeting refreshments, paying for meeting space, etc.?) No additional nrtivitiPs are needed Page 2 rev. 3-11 22)6 Will outside consultants be solicited to work on the grant and if so, is a process in place for appropriate selection and oversight of consultant activities? Y N XX If so, what is the funding source for consultant fees? 23) For a program grant, how would the program be funded after the grant expires? (It should be understood that once grant funding ends, either the program ceases OR the funding for the program needs to be absorbed within the department's or office's existing budget) OR justification must be provided that the program has been and will continue to save or benefit taxpayers. The program %Nowld r� o 24) Please provide (attached to questionnaire) a synopsis of the grant or a copy of the fact sheet. Please feel free to submit additional information as needed. Official signature of requesting office/department: Jim Madsen 6/13/18 Elected Official/Department Head Date Approved by: Chair, Board of County Commissioners Date Page 3 OFFICE OF JUVENILE JUSTICE(OJJ) CONTRACT NUMBER FOR OJJ USE ONLY Deparonealotwial Juvenile Detention Alternatives I-501-00812 DATE STAMP 9 Health Services Transforming lives Initiative Grant Application Please read all instructions carefully. PROGRAM AREA For assistance,contact the Department of Social and Health Services (DSHS)Office of Juvenile Justice at(360)902-7526 or FAX(360)902-7527 1. APPLICANT: DO NOT USE PERSON'S NAME AGENCY NAME TELEPHONE NUMBER FAX NUMBER Mason County Juvenile Court Services 360-427-9670 360-427-7785 STREET ADDRESS CITY STATE ZIP CODE 426 W. Cedar Street Shelton WA 98584 MAILING ADDRESS CITY STATE ZIP CODE PO BOX 368 Shelton WA 98584 2. IMPLEMENTING AGENCY: ENTER AGENCY,DEPARTMENT OR CONTRACTOR DIRECTLY IMPLEMENTING THE PROJECT DO NOT USE PERSON'S NAME NAME TELEPHONE NUMBER Mason County Juvenile Court Services 360-427-9670 STREET ADDRESS FEDERAL EMPLOYER IDENTIFICAITON NUMBER OR SOCIAL SECUIRTY NUMBER(MANDATORY FOR 426 W.Cedar Street FEDERAL TAX PURPOSES) CITY STATE ZIP CODE 91-60013554 Shelton WA 98584 3. PROJECT TITLE: ENTER BRIEF,DESCRIPTIVE PROJECT TITLE(LIMITED TO THREE LINES) JDAI Implementation Plan in Mason County,WA 4. APPLICANTS AGREEMENT The applicant is applying for a grant award in the amount shown in the proposed BUDGET SUMMARY(Section 8 of this application)for the purposes identified in this application. By signing and submitting this application,the applicant agrees that this document,together with the GENERAL TERMS AND CONDITIONS AND CERTIFICATIONS(Attachment A of this application),becomes an offer to contract with Washington State Department of Social and Health Services(DSHS or the Department)which,if accepted,binds the applicant to the following: The applicant agrees that this offer becomes a binding contract when a copy of this page is signed by the OJJ Director and returned to the applicant together with an Approved Budget and Special Conditions form provided,however: a. In the event any budget category amount differs from the amount shown in Section 8 of this application,as modified by the Approved budget and Special Conditions,that amount shall be considered to be a counteroffer. The Department shall consider the counteroffer accepted by the applicant unless rejected in writing within 30 days after the date of mailing of such counteroffer by the Office of Juvenile Justice(hereinafter referred to as OJJ) to the applicant b. Upon acceptance of this offer/counteroffer,the applicant shall be referred to as the"Contractor"and the Contractor agrees to accept and abide by the special terms and conditions. NAME AND TITLE OF AUTHORIZED OFFICER(PERSON WITH LEGAL AUTHORITY: COUNTY COMMISSIONERS'CHAIRMAN OF THE BOARD,MAYOR,CITY/TOWN MANAGER,AGENCY DIRECTOR) Mason County Commissioners APPLICANT'S SIGNATURE DATE ACCEPTANCE OF OFFER COUNTEROFFER FOR DSHS OJJ CONTRACTING OFFICER'S SIGNATURE DATE ❑Acceptance ❑ Non-acceptance 5. PROJECT DIRECTOR: PERSON IN DIRECT CHARGE OF PROJECT(DAY-TO-DAY OPERATIONS AND PREPARATION OF REQUIRED PROGRESS REPORTS) NAME TELEPHONE NUMBER Jim Madsen 360-427-9670 ext.332 STREET ADDRESS FAX NUMBER 426 W. Cedar Street 360427-7785 CITY STATE ZIP CODE E-MAIL ADDRESS Shelton WA 98584 'amesma co.mason.wa.us 6. FINANCIAL OFFICER: PERSON IN CHARGE OF FISCAL MATTERS(ACCOUNTING,FUNDS MANAGEMENT,EXPENDITURE,VERIFICATIONS,FINANCIAL REPORTS NAME TELEPHONE NUMBER Paula Thale 360-427-9670 ext.338 STREET ADDRESS FAX NUMBER 426 e.Cedar Street 360-427-7785 CITY STATE ZIP CODE E-MAIL ADDRESS Shelton WA 98584 paulatco.mason.waxs Omission of any required information or certification may be cause for denial of the application. The Department shall take a final approval/disapproval action on all applications within 90 days of receipt by the Department of a conforming application,together with all required certifications. The Department shall not consider an application conforming unless the applicant has completed all items in accordance with instructions and has submitted the necessary certifications. The applicant must submit two signed completed applications to: OFFICE OF JUVENILE JUSTICE,DEPARTMENT OF SOCIAL AND HEALTH SERVICES,PO BOX 45828,OLYMPIA WA 98504-5828. DSHS 05-180C(REV.05/2018) Page 1 JDAI GRANT APPLICATION AGENCY NAME DATE Mason County Juvenile Court Services 06/07/2018 PROJECT TITLE JDAI 7. PROJECT PERIOD A project period is one year and may not exceed one year except by prior agreement with the Department. Proposed project period is from July 1,2018 to June 30.2019 8. BUDGET SUMMARY The proposed project budget is shown below. If the proposal is accepted for contracting,the budget on the Approved Budget and Special Conditions form supersedes the proposed budget shown below. The following items are allowable costs under this contract: • Travel(JDAI Quarterly Meetings,State and National Conferences,Model Site Visits) • Local Coordination to implement the eight(8)JDAI strategies • Detention Alternatives Programs • Data Collection and Analysis • Indirect(up to 10%of direct charges), as noted below. BUDGET CATEGORIES A. Personnel $18,000 Enter the category totals from Section 10. B. Supplies $500 BUDGET DETAILS. The sum of categories A- F is entered as TOTAL DIRECT CHARGES. If C. Other services and charges $1,500 indirect costs are claimed,enter the amount in G. These may not exceed ten(10)percent of D. Capital outlay/equipment $500 the TOTAL DIRECT CHARGES. Add TOTAL DIRECT CHARGES and INDIRECT CHARGES, E. Travel $3,200 and enter the sum on TOTAL PROJECT COSTS line. F. Contractual services $800 TOTAL DIRECT CHARGES G. Indirect charges TOTAL PROJECT COST $24,500 SOURCE OF FUNDS 1. Federal % 1.May not exceed amount approved by the 2. Match % Washington State Partnership Council on Juvenile Justice. 2.Must be funds specifically appropriated for project in applicant's budget Project income must be applied to project operational costs or deducted from the grant award. It is important that all anticipated project income be included in the budget. % TOTAL PROJECT FUNDS % 9. PROJECT SUMMARY: GIVE A BRIEF NARRATIVE SUMMARY OF THE PROJECT. Mason County Juvenile Court Services has opened our completed Intervention Center space and begun using the space for alternative to detention programming.During this grant cycle it is our goal to build upon this success and grow our alternatives.We also plan to focus in on what we really are using our secure for detention facility for and if we can better serve the youth being sentinced to detention in our Intervention Center.We plan to develop a data informed sanctions grid to reduce disparities and implent a tiered warrant system to reduce unnecessary warrant arrests. DSHS 05-180C(REV. 05/2018) Page 2 JDAI GRANT APPLICATION AGENCY NAME DATE Mason County Juvenile Court 06/07/2018 PROJECT TITLE JDAI 10. BUDGET DETAILS: CATEGORY A. PERSONNEL This category is for services rendered by all personnel employed by the project. Costs incurred include salaries,benefits, uniforms,and special clothing. SALARIES AND WAGES: Payment for personal services rendered in accordance with rates, hours,terms and conditions as authorized by law or stated in employment contracts. OVERTIME,HAZARDOUS DUTY, ETC. PERSONAL BENEFITS: FICA, retirements,insurance,etc. UNIFORMS AND CLOTHING: Only uniforms for special clothing required by the nature of the employment and paid for by the employer may be listed. NOTE: Project funds may not be used to pay a percentage of the compensation of any person who was employed by the implementing agency before the project starting date without prior specific authorization from the Department separate from the grant approval. Specific authorization is not required if a person currently employed by the applicant or the implementing agency is transferred from his/her prior position to the project if the transfer creates a personnel vacancy to be filled by hiring a new employee. PERCENT OF LIST POSITION TITLES ANNUAL SALARY TIME TO ITEM TOTAL PROJECT Program Support Specialist 22.5% $18,000 CATEGORY TOTAL % $18,000 JUSTIFICATION AND EXPLANATION: Justify all positions in terms of days and/or hours required to perform the GOALS,OBJECTIVES,AND TASKS set forth. Calculate fringe benefits for each position or class of positions. Salary and benefits for approximately 22.5% of the Program Supports Specialist position. Position is used to collect and analyze data as well as provide detention alternative programming in the Intervention Center. DSHS 05-180C(REV.05/2018) Page 3 JDAI GRANT APPLICATION AGENCY NAME DATE Mason County Juvenile Court 06/07/2018 PROJECT TITLE JDAI 10. BUDGET DETAILS: CATEGORY B. SUPPLIES This category is for articles and commodities which are consumed or materially altered when used. The following are types of supplies. OFFICE SUPPLIES: For example,office stationery,forms,small items of equipment,and maps,films,books,periodicals,and tapes. OPERATING SUPPLIES: For example,chemicals,drugs,medicines,laboratory supplies,cleaning and sanitation supplies,fuel, household and institutional supplies,and clothing. Food for Steering Committee meetings is permitted as outlined under 8.Budget Summary on Page 2. REPAIR AND MAINTENANCE SUPPLIES: For example,building materials and supplies,paints and painting supplies,plumbing supplies,electrical supplies,motor vehicle repair materials and supplies,other repair and maintenance supplies,and small tools. ITEMIZED LISTING DESCRIPTION OF THE ITEM UNIT UNIT COST ITEM TOTAL Office and Operating Supplies $500 CATEGORY TOTAL $500 10. BUDGET DETAILS: CATEGORY C. OTHER SERVICES AND CHARGES This category is for services other than PERSONNEL which are required in the administration of the project. Such services may be provided by some agency of the government unit or by private business organizations. The following are types of services and charges classified under this category. COMMUNICATION: For example,telephone,telegraph,and postage. TRANSPORTATION: For example,freight and express charges,and messenger service. ADVERTISING PUBLIC UTILITY SERVICE PRINTING AND BINDING REPAIRS AND MAINTENANCE INSURANCE RENTALS: For example,buildings,and equipment and machinery. MISCELLANEOUS: For example,tuition and other training fees,dues,subscriptions and memberships,and taxes. ITEMIZED LISTING UNIT UNIT COST ITEM TOTAL ORD OR WORDS DESCRIBING THE COST ITEM, I.E.,POSTAGE Copier $100 Equipment Revolving Rental(ER&R)Vehicle Lease $200 Cell Phone 12 $60 $720 Case Load Pro software rental 12 40 $480 CATEGORY TOTAL $1,500 DSHS 05-180C (REV.05/2018) Page 4 JDAI GRANT APPLICATION AGENCY NAME DATE Mason County Juvenile Court 06/07/2018 PROJECT TITLE JDAI 10. BUDGET DETAILS: CATEGORY D. CAPITAL OUTLAY/EQUIPMENT This category is for nonexpendable outlays which result in the acquisition of,rights to,or additions to fixed assets,other than structures. The following are some of the types of charges under this category. NOTE: Exclude small tools. MACHINERY AND EQUIPMENT: For example,communications equipment(typewriter,microcomputer),janitorial;laboratory,office furniture and equipment,heavy duty work equipment,and other machinery and equipment. ITEMIZED LISTING DESCRIBE THE COST ITEM UNIT UNIT COST ITEM TOTAL Office furniture and equipment $500 CATEGORY TOTAL $500 10. BUDGET DETAILS: CATEGORY E. TRAVEL Travel costs are for domestic travel. Contractors may follow their own established rate for staff travel as long as the rate does not exceed the allowable state rate. The allowable state rate for mileage will be used. Airfare should be the lowest coach fare. ITEMIZED LISTING UNIT UNIT COST ITEM TOTAL 2 staff to National Conference $2,000 1 staff to Fall Coordinator Conference $1,000 Travel to 4 statewide quarterly JDAI meetings $200 CATEGORY TOTAL $3200 DSHS 05-180C(REV. 05/2018) Page 5 FDA[GRANT APPLICATION AGENCY NAME DATE Mason County Juvenile Court 06/07/2018 PROJECT TITLE JDAI 10. BUDGET DETAILS: CATEGORY F. CONTRACTUAL SERVICES The following types of personal services may be contracted: EVALUATION/RESEARCH LEGAL ACCOUNTING MEDICAL AND HEALTH SERVICES AUDITING SOCIAL SERVICES ITEMIZED LISTING UNIT UNIT COST ITEM TOTAL Interpreter/Translation services 16 $50 $800 CATEGORY TOTAL $800 10. BUDGET DETAILS: CATEGORY G. INDIRECT CHARGES Indirect costs may not exceed 10%of the total direct charges. Indirect costs include costs of operating the agency which are not directly attributed to this project(e.g.,maintaining physical plan,depreciation,receptionist,agency administration salaries,etc.) ITEMIZED LISTING DESCRIBE THE COST ITEM UNIT UNIT COST ITEM TOTAL N/A CATEGORY TOTAL N/A DSHS 05-180C (REV. 05/2018) Page 6 JDAI GRANT APPLICATION AGENCY NAME DATE Mason County Juvenile Court 06/07/2018 PROJECT TITLE JDAI 11. STATEMENT OF WORK AND IMPLEMENTATION PLAN The contractor agrees to perform the following minimum statement of work. 1. Each jurisdiction will have a JDAI Coordinator to participate in monthly Coordinator calls with the State Coordinator. 2. Submit the AECF-JDAI Quarterly Report and annual Results Report,no later than 30 days after the end of each quarter to include: • Detention Population Report • Alternative Programs Report • Detention Referrals Screened Report • Detention Risk Assessment Instrument Override Report 3. Attend JDAI Quarterly Meetings,State and National JDAI Conferences(as held/applicable). 4. Conduct regular Stakeholder or Steering Committee meetings each year. 5. Conduct a Detention Self-Inspection as identified by the Local and State JDAI Coordinator or as directed by local management. 6. Submit quarterly progress and financial reports to the Office of Juvenile Justice on reporting forms provided by OJJ. 7. Submit a Racial and Ethnic Disparities Reduction Plan to include local data identifying.the target population,objectives regarding specific changes to policy and practice with identified outcomes,and any technical assistance needed in order to implement proposed objectives. A Racial and Ethnic Disparities Reduction Plan template will be provided for sites to use at their discretion. Attach the County JDAI Implementation Plan to include a minimum of three(3)goals for the contract period July 1,2018 through June 30,2019. It is expected that implementation plans will include objectives,strategies,and tasks targeted at achieving the identified goals as well as the timeframe and responsible party for completion of the tasks. Please also identify which of the eight(8)Core Strategies is being addressed within each goal. An Implementation Plan Template will be provided for sites to use at their discretion. Attached DSHS 05-180C(REV. 05/2018) Page 7 Racial and Ethnic Disparities Reduction Plan Fiscal Year: 2018-2019 County: Mason Total Admissions to Detention 2015 2016 2017 American Indian or Alaska Native 13 29 7 Asian 0 3 4 Black or African American 3 6 2 Hispanic 18 21 6 White 137 97 61 Unknown/Other 0 0 0 Total 171 157 80 Population Totals for Ages 10 — 17 Years 2015 2016 2017 American Indian or Alaska Native 265 302 Asian 115 125 Black or African American 92 114 Hispanic 668 852 White 3539 4086 Unknown/Other 0 0 Total 4575 5479 Rates of Admission 2015 2016 2017 American Indian or Alaska Native 49.05 96.20 23.17 Asian 0 24 32 Black or African American 32.60 52.63 17.54 Hispanic 26.94 24.64 7.04 White 38.71 22.27 14.68 Unknown/Other 0 0 0 Total Top Demographic Group(s) to Focus Efforts Towards: Native American and Black or African American. Top Offense Reasons Resulting in Detention for Identified Group(s) 2015 2016 2017 Ex: Native American PV: Runaway(55) DV Assaults (43) DV Assaults(35) DV Assaults (23) PV:Truancy(22) PV:Truancy(32) Black or African FTA Warrant (1) New Charge (2) Probation Violation: (2) American Civil (1) FTA Warrant (2) Court Ordered (1) NFTA (4) Native American FTA Warrant (5) Probation Violation (15) New Charge (2) NFTA(5) FTA Warrant (5) Court Ordered (3) New Charge (7) NFTA (4) Probation Violation (1) NFTA (1) List Policies that Govern Detention Admission for Top Offense Reasons Lack of sanction grid and current warrant system. Racial Impact Assessments to be conducted on all identified policies by November 1st, 2018. Amended Racial and Ethnic Disparities Reduction Plans due by January 1st, 2019 are to include: • Steps to make policy and practice changes in response to completed Racial Impact Assessments • Deadlines identified for when changes are to be fully implemented • Resource or Technical Assistance needs to be identified MASON COUNTY IMPLEMENTATION PLAN 2018-2019 Grant Cycle , GOAL 1: Creation and Implementation of Sanction Grid OBJECTIVE STRATEGY TASK TIMELINE RESP. PARTY RESP. CORE COMMITTEE STRATEGY/ELEMENT Create and implement a Reducing Racial sanctions rid that Work with administration and Begin by learning about what g other counties use as their Jim Madsen Disparities appropriately responds to risk probation staff to develop a grid Alternatives To Detention level and safetyconcerns, that everyone a upon and grid.Then building that out Spring 2019 Madison Larsen y agrees p to utilize alternatives and Mike Dunn Special Detention Cases retains accountability and that best serves our population. services we have locally. Use of Accurate Data reduces disparity. Collaboration GOAL 2: Create and Implement a Tiered Warrant System OBJECTIVE STRATEGY TASK TIMELINE RESP. PARTY RESP. CORE COMMITTEE STRATEGY/ELEMENT Reduce the amount of Work with local law enforcement Begin by convening a team Alternatives to Detention warrant arrests and bookings Madison Larsen and court administration to of key stakeholders to share Summer Jim Madsen Special Detention Cases into detention. develop tiered warrant system data and the benefits of a 2018 Use of Accurate Data and procedures. tiered warrant system. Mike Dunn Collaboration GOAL 3: Full Implementation of Intervention Center OBJECTIVE STRATEGY TASK TIMELINE RESP. PARTY RESP. CORE COMMITTEE STRATEGY/ELEMENT Full use of the intervention Present current alternative Summer Jim Madsen Alternatives to Detention center and alternative Implement alternatives into our sanction Special Detention Cases rid development. options to stakeholders and 2018— Madison Larsen programming. g P brainstorm future needs. Spring 2019 Mike Dunn Use of Accurate Data Collaboration 1 Modified 513112018