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HomeMy WebLinkAbout2018/01/16 - Regular Packet BOARD OF MASON COUNTY COMMISSIONERS DRAFT MEETING AGENDA Commission Chambers— 9:00 a.m. 411 North Fifth Street, Shelton WA 98584 January 16, 2018 1. Call to Order 2. Pledge of Allegiance 3. Roll Call 4. Correspondence and Organizational Business 4.1 Correspondence 5. Open Forum for Citizen Input (5 minutes per person, 15 minutes time limit) If you wish to address the Commission, raise your hand to be recognized by the Chair. When you have been recognized, please step up to the microphone and give your name and address before your comments.The Mason County Commission is committed to maintaining a meeting atmosphere of mutual respect and speakers are encouraged to honor this principle. 6. Adoption of Agenda Items appearing on the agenda after"Item 10. Public Hearings", may be acted upon before 9:30 a.m. 7. Approval of Minutes— January 1 and January 8, 2018 Briefing Minutes; January 9, 2018 Regular Meeting Minutes. 8. Approval of Action Agenda: All items listed under the"Action Agenda"may be enacted by one motion unless a Commissioner or citizen requests an item be removed from the Action Agenda and considered as a separate item. 8.1 Approval to appoint Jamie Bariekman and Brian Smith to the Planning Advisory Commission for terms ending January 16, 2022. 8.2 Approval of Warrants &Treasure Electronic Remittances Claims Clearing Fund Warrant #s 8054044-8054141 $ 139,420.48 Direct Deposit Fund Warrant #s 46809-47175 $ 604,954.48 Sala[y Clearing Fund Warrant #s 7003329-7003369 $ 957,048.26 Total $1,701,423.22 8.3 Approval to appoint Kathryn Haigh to the Mason County Housing Authority Board for a five year term ending January 16, 2023. 8.4 Approval of 2018 contract renewals for public defense with the Law Offices of Sean Taschner. 8.5 Approval to bind coverage for Mason County's third party liability TankGuard Renewal Policy with AIG effective April 21, 2018 —April 21, 2019 and approval to authorize the Chair to sign the Renewal Warrant Acknowledgement Form. There is no change in the policy as written for the prior year. Agendas are subject to change,please contact the Commissioners' office for most recent version. This agenda was last printed on 01/11/18 10:04 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 COMMISSIONERS' MEETING AGENDA January 16, 2018— PAGE 2 8.6 Approval to authorize the Chair to sign the Sub-recipient agreement with Community Action Council of Lewis, Mason, and Thurston Counties for service provisions under a Public Services of Washington State Community Development Block Grant (CDBG). 8.7 Approval of the updated fee schedule for Mason County Baseball field use. 8.8 Approval of contract CLH18253 between Mason County and the State of Washington Department of Health. This contract supersedes contract C17118. 9. Other Business (Department Heads and Elected Officials) 10. 9:30 a.m. Public Hearings and Items Set for a Certain Time- No Hearings. 11. Board's Reports and Calendar 12. Adjournment J:\AGENDAS\2018\2018-01-16 REG.doc C_1 crl _, MASON COUNTY TO: BOARD OF MASON COUNTY COMMISSIONERS Reviewed: FROM: Jennifer Giraides Ext. 380 DEPARTMENT: Support Services Action Agenda DATE: January 16, 2018 No. 4.1 ITEM: Correspondence 4.1.1 Washington State Liquor and Cannabis Board sent a liquor license application for Deer Creek Store 5881 E. State Route 3, Shelton. 4.1.2 John Campbell sent in an application for the Mason County Transit Authority Board. 4.1.3 Casey Breeze sent in an application for Planning Advisory Commission Board. 4.1.4 Thrive Washington sent a letter regarding the Nurse-Family Partnership Program. Attachments: Originals on file with the Clerk of the Board. cc:CMMRS Neatherlin,Shutty&Drexler Clerk J �N 1•�1� ,q rot', Washington State Liquor and Cannabis Board NOTICE OF LIQUOR LICENSE APPLICATION WASHINGTON STATE LIQUOR AND CANNABIS BOARD License Division - 3000 Pacific, P.O. Box 43075 Olympia,WA 98504-3075 Customer Service: (360) 664-1600 Fax: (360) 753-2710 Website: http://Icb.wa.gov TO: MASON COUNTY COMMISSIONERS RETURN TO: localauthority@sp.lcb.wea.gov RE:ASSUMPTION DATE: 1/05/18 From K.K.SUN INC Dba DEER CREEK STORE APPLICANTS: RRW KIM, INC RECEIVED E® License: 351579 -1F County:23 KIM, ROBERT JAN 0 5 2018 UB I: 604-194-459-001-0001 1983-04-12 Tradename: DEER CREEK STORE KIM, RYUNG-HEE Loc Addr: 5881 E STATE ROUTE 3 1957-08-01 Mason County SHELTON WA 98584 KIM,WHA JIN Commissioners 1952-01-05 Mail Addr: 23416 HWY 99 STE B EDMONDS WA 98026 Phone No.: 425-640-3435 YOUNG KANG Privileges Applied For: GROCERY STORE-BEER/WINE As required by RCW 66.24.010(8), the Liquor and Cannabis Board is notifying you that the above has applied for a liquor license. You have 20 days from the date of this notice to give your input on this application. If we do not receive this notice back within 20 days,we will assume you have no objection to the issuance of the license. If you need additional time to respond,you must submit a written request for an extension of up to 20 days,with the reason(s)you need more time. If you need information on SSN,contact our CHRI desk at(360) 664-1724. YES NO 1. Do you approve of applicant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑ 2. Do you approve of location? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑ 3. If you disapprove and the Board contemplates issuing a license,do you wish to request an adjudicative hearing before final action is taken? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑ (See WAC 314-09-010 for information about this process) 4. If you disapprove,per RCW 66.24.010(8)you MUST attach a letter to the Board detailing the reason(s)for the objection and a statement of all facts on which your objection(s)are based. DATE SIGNATURE OF MAYOR,CITY MANAGER,COUNTY COMMISSIONERS OR DESIGNEE cc:CIAMRS Neatherlin,Shutty&Drexler Clerk t,- RECEIVEU IASOJV COUM COMMISSIONERS 411 NOR771FIMISPREE T JAN 09 2018 SHELTON WA 98584 Fntr 360.427-8437, Vaca 360 4279470, L it 4 19, 275•4467 ot 4811 5269 Mas0i'l County Nv I AM SIFFKING a INTMENT TO A V% IA lZ cn w. Fie VOTIN GPRECINCT. KJ.;,.*Iv;-- WORK PHONE 52 100 AREA IN T114 VA MTS yout") ' Y ------- ------------- --------- - COMMUNITY SERVICE EMPLOYMENT (IF RETIRED.PREVIOUS EAMMN-Cf-I tACTIVITIES OR MCMURIAl") e EQSITM COMPANY:� YRS POSITION -------- -- - -- ----------- - ------ ----------- - in your words, what do you perceive is the role or purpose of the Board.Committee or Counol for which you are applying What interests, skills do you wish to offer the Board,Committee or Council? C, Please list any financial, professional, or voluntary affiliations which may influence or affect your position on this Board (i.e- ueate a potential conflict of interest) viz Your participation is dependent upon attending certain trainings made available by the County during regular business hours (such as open Public Meetings Act and Public Records). The trainings would be at no cost to you Would you be able to attend such trainings? Realisbcally, how much time can you gimme to this P0511,100? Datj OMct Use Only ouaflert'/ IIV Appointment %IA V 5' YX fI_— Dab Term Expire ..,•!ti �K_'�J��!'i... _��.�.•._'4.�. .. ,,* * S;.J'- ,'►!-.�e_.;• Op O Community Service op 1. Member North Mason School Board since 2007. 1 have been re-elected 3 times. My current term expires at the end of 2018. a. President NMSB at least 3 different times the last ending in 2017. b. Legislative Council Washington Association of School Directors(WSSDA) c. Legislative Representative from NMSB Since 2010. 2. Volunteer We The People a. Civic Education program focusing on Constitutional Education. b. Have coached in this program at NMHS. c. Volunteer for Project Citizen: Middle School level We the People Program. 3. Mason Transit Authority. a. I was President for at least one term. b. I suggested the Mason Transit History Project c. This project led to the production of our MTA film by Mark Woytowich. 4. Member Lower Hood Canal Watershed Coalition. a. Was part of a volunteer effort to monitor the Union River b. Helped take water samples in in the Union River 2015-16. 5. Volunteer for Pac NW Salmon Center a. Monitored Summer Chum Runs b. Two years in a row. (This was a couple years ago.) 6. Victor Improvement Club a. Serve As Secretary b. Monthly column for VIC in North Bay Review c. Participate in yearly Flea Mkt. raise$for NMHS scholarships. d. And to other worthy civic organizations. Employment: 1. University of Washington. Assistant/Associate Professor Communication 1968-1995 2. University of Memphis. Full Professor Communication 1995-2005. In your words what is the role and purpose of the board. The chief role of the board is to govern the MTA. This includes: close attention to the public purse, attention to the direction of the institution relative to its mission, regular attendance at meetings. I believe that if a board follows the general philosophy of "Nose In"/"Hands Off" the board can encourage professionalism ! among management and employees. In two phrases I would say the purpose of the board is to Govern and to do that it needs to deliberate well on all matters of concern to the agency. What interests or skills do you wish to offer the Board. The principle skill i bring to the position is institutional memory. I have served under 3 MTA CEO's. I have had experience both in hiring and firing our CEO's. I believe I also bring skills of deliberation, the ability to listen, to respect the minority when I am with the majority and the majority when I am in the minority. Any financial conflicts of interest? 1 am aware of none. y Attending meetings/Trainings./Giving of extra time. record speak for me. I have volunteered for extra set r To: Mason County Commission Page 2 of 2 2018-01-09 04:09:46 (GMT) cc:CMMRS Neatherlin,Shutty&Drexler _ . ..... ... . ......_._-. Clerk )PQWa' b(ainc- . ._ RECEIVED MASON CGQUN'j'1'G'.C)PI1V118.510IV.N1115 JAN 0 9 2018 411 NORTH FIFTH STREET SHELTON WA 95584 _ Mason County Fax 360-427-6437; Voice 360-427-9670,:;Ext..419;275-4467 or 482-5269 - , Commissioners I AM SEEKING APPOINTMENT TO Mason County Planning Advisory Commission N,gh,�il E: Casey Breeze ADDRESS: Grapeview, WA PHONE: 360- CITY/ZIP: VOTING PRECINCT: WORK PHONE: 98546 (OR YOULR'E) Grapevlew E h�Al� . L �--L�4 .com ------------------------- COMMUNITY SERVICE EMPLOYMENT: (IF RETIRED, PREVIOUS EXPERIENCE) (ACTIVIT:ESORMEMBERSHIPS) COMPANY: Shelton Patient Group 8 YRS Srhnnl Roarri n'rprtnr Pos Nn 5, GSD#,4 -- --- POSITION: Own er/Operator COMPANY: YRS POSITION: --------------------------------------------------------------------------------------------- In your words, what do you perceive is the role or purpose of the Board, Committee or Council for which you are applying: I perceive the role of the Committee being to work along with and advise the Mason County Board of Commissioners an issues-relating to zoning, land use,-Comprehensive Plan, rezone requests;B"elfair sign code, etc:......,_ What interests, skills do you wish to offer the Board,Committee, or Council? 1 bring to the table tho nbolety to interact with all walks of people for the good of the Commission and the people o- Mason County. I would bring balance and an objective viewpoint. One of my strengths includes seeing the bigger picture and implementing long-term strategic, visionary, anci airectionalpans for the future. I am passionate about—our rnmmllnity anri tha wnndarfld nonnla in it anri I Will dri ha hiimhlari in canis nn this r.nmmiccinn Please list any financial, professional, or voluntary affiliations which may Influence or affect your position on this Board: (i.e. create a potential conflict of interest) do not foresee any,financial, professional, or voluntary affiliations which may influence or affect my position on this Commission. Your participation is dependent upon attending certain trainings made available by the County during regular business hours (such as Open Public Meetings Act and Public records). The trainings would be alt.no.cost to.you.Would you be able to attend such trainings? Yes Realistically.,how much time can you give to this position? Quarteliy Mexitttly X Weekly D+ y —-^ --- ------— - - ---- --- 117/2018 :. �-gig,` ;� ; Signayate gC.xS•Y?i: :fit'-`x gt't_.l Received Time Jan. 8. 2018 8:07PM No. 0797 cc:CMMRS Neatherlin,Shutty&Drexler Clerk 0Nwsc-Family �E .. THRIVE ����p cE►vE® ■� WASHINGTON '' 1*4"h-7i-p•-�--d JAN 10 2018 January 8,2018 Mason County Commissioners Dear Mason County Commissioners Neatherlin,Shutty,and Drexler: Congratulations on your recent collaboration in forming a regional Nurse-Family Partnership (NFP)program. NFP is a rigorous,evidence based program that can be challenging for rural and small counties to implement and sustain.Joining with a larger county to offer NFP services to an entire region assures equitable access for all vulnerable families and will lead to improved health,child welfare,and economic outcomes for families throughout the region. As a Washington State Nurse Consultant for Nurse-Family Partnership I support and advocate for NFP programs across the state. My priorities are to ensure as many families as possible receive NFP services and that those services are high quality and in fidelity to the NFP model. I am confident that both Lewis and Mason counties will be very well served by becoming part of the program led by Thurston County. Thurston County NFP has a very strong record as a top tier NFP program both in Washington and in the nation.Gretchen Thaller is the lead NFP supervisor and has led her team of nurses to consistently carry high caseloads while serving the most vulnerable families including those with complex social and mental health issues and has achieved excellent quality and fidelity indicators and improved family outcomes. As this partnership proceeds we will be working together to engage community partners in understanding the new regional NFP program and to support this program by referring families for NFP services. I hope to see each of you at community meetings. Please feel free to contact me with questions or thoughts on supporting,sustaining,and growing your regional NFP program. Sincerely, Quen Zorrah PHN MSN IMH-E®(IV-C) Nurse-Family Partnership State Nurse Consultant 206.470.9269 1 quen@thrivewa.org Cc'd Lewis County Board of County Commissioners Mason County Board of County Commissioners Thurston County Board of County Commissioners BOARD OF MASON COUNTY COMMISSIONERS'BRIEFING MINUTES Mason County Commission Chambers,411 North 5th Street,Shelton,WA Week of January 1,2018 Monday,January 1,2018 No briefing due to the New Year Holiday Tuesday,January 2.2018 10:00 A.M. Public Works—John Huestis Commissioners Neatherlin,Drexler and Shutty were in attendance. • Request to move forward the resolution for 2018 bridge limits establishing lane limits for traffic control on eight Mason County bridges was approved. • Interlocal Agreement with WSDOT for electronic speed radar signs and flashing cross walk beacons signs as part of the WSDOT Belfair Area Widening and Safety Improvement project. The maximum County contribution is$21,000. Capital improvements can be purchased from the Road Fund but it was not anticipated in the Road Fund budget. The Commissioners asked staff to look at the Road Fund budget which is first choice to pay from and staff will verify if it was anticipated in the Current Expense Non-Departmental budget. The agreement was approved to place on next week's agenda. • Cmmr.Drexler asked staff to look into a proposal that has been suggested changing federal law allowing an increased truck load limit. Commissioner Discussion Cmmr.Drexler stated she has forwarded information from MRSC regarding authority to sign contracts and interlocal agreements(ILA). The Commissioners have exclusive authority to approve 1LA's and she has asked legal staff to look into the authority to amend ILA's or enforce any terms such as termination of an ILA. Cmmr.Drexler noted there is no outsourcing budget line in the MCSO budget. Cmmr. Shutty informed the Commissioners that the Building Code Council on which he sits,is trying to reform the laws pertaining to treatment facilities which could impact the BHO treatment facility. Cmmr.Neatherlin reviewed the meeting process—he wants to remind the public it's a Commission business meeting and comments should be directed to the Commission;he plans to stick to the agenda;Item 9 is reserved for only Department Heads and Elected Officials and not staff. Continue the Department Head and Elected Official meetings with an agenda that includes items from the Commission and the Department Heads and Elected Officials and hold the meetings on a regular basis. Commissioners Drexler&Shutty will be attending Bob Roger's campaign launch for City Council. 10:30 A.M. Community Development—Dave Windom Commissioners Neatherlin,Drexler and Shutty were in attendance. • Leon Lawson,Dogcon Auto,auto sales facility at Taylor Towne which is a Rural Commercial District 3. A letter has been sent from Mr.Windom regarding an Administrative Determination and outlining the conditions to allow the business to remain at that location. • Discussion of the Nurse Family Partnership program that will now be provided jointly with Thurston County.This has been in discussions since last summer and the services are not what Dave anticipated. Board of Mason County Commissioners'Briefing Meeting Minutes Week of January 1,2018 • Cmmr.Drexler brought up the request to change the 150' set back in the Boating Ordinance. Respectfully submitted, Diane Zoren,Administrative Services Manager BOARD OF MASON COUNTY COMMISSIONERS Randy Neatherlin Terri Drexler Kevin Shutty Chair Commissioner Commissioner BOARD OF MASON COUNTY COMMISSIONERS' BRIEFING MINUTES Mason County Commission Chambers,411 North 5th Street,Shelton,WA Week of January 8,2018 Monday,January 8,2018 9:00 A.M. Planning Advisory Commission Interview Commissioners Neatherlin,Drexler and Shutty interviewed Jamie Bariekman for the Planning Advisory Commission. 9:15 A.M. Community Services—Dave Windom Commissioners Neatherlin,Drexler and Shutty were in attendance. • Request to move forward the Consolidated Contract C 17118 with WA State Department of Health. Discussion of the onsite sewage management program and the need of septic education. Approval to place on next week's agenda. • Dave provided an update on the Steve Fors property that has had code violations including RV's on site. The plan is to have the property cleaned up by this summer. • Maintenance of Mackinaw Road west side of Lake Cushman has been an issue and the County does not have the authority to enforce the Lake Cushman Maintenance Company to maintain the road. • Sign Codes need revisions including the Belfair Sign Code. • Discussion of the policy and process of water/well management for the Comprehensive Plan. Erica Marbet, Squaxin Island Tribe,was also attendance.The policy deals with the legal requirements of the Hirst decision while providing an assurance for builders. Discussion of water rights.Dave reviewed the procedure staff will follow to determine water adequacy. The goal is to not impact the aquifer. • Staffing issues—resignations received from a Permit Technician and a Building Inspector. Dave has submitted a reclass request of a clerical position to a Planning Technician position. • Working on a memorandum of understanding with the Housing Authority. Community Services can provide clerical support but not executive director duties. Cmmr.Drexler asked about Crossroads Housing sharing executive director duties with the Housing Authority. • Cmmr.Drexler asked for a timeline to deal with the 150' setback for buoys on lakes. 10:18 A.M. The Commissioners took a 12 minute break. 10:30 A.M. Public Works—Jerry Hauth Utilities&Waste Management Commissioners Neatherlin,Drexler and Shutty were in attendance. • Jerry informed the Board the Belfair Sewer used registered warrants in December 2017. $39,291.93 of 2017 expenses will come out of the 2018 budget. • Discussion of the use of the 800 Road that is owned by Green Diamond and has traditionally been used as an evacuation route from Skokomish Valley. There is a road use agreement and Green Diamond has requested revisions to the agreement to address liability concerns and maintenance costs. The request is to close the access unless being used in an emergency situation. Emergency responders have a gate key. Staff will meet with Green Diamond later this month and an agreement will be coming to the Commissioners. • Notification of potential road weight restrictions has gone out to the school districts. Staff has met with the school districts and informed them of the permitted routes. • End of 2017 billings from MCSO for the Traffic Diversion funding have been reviewed by CRAB and not all submitted expenses qualified. Staff will be meeting with the Sheriff s office and CRAB so everyone is aware of the rules. • SR 3 flashing signs can be paid by the Road Fund and there is funding available. • Staff is working on the Skokomish Valley dike repairs. Mason County Commissioners Briefing Meeting Minutes Week of January 8,2018 • Parcel in Allyn is bisected by Drum Street and Cmmr.Neatherlin wants to know if that is vacated by order of law. • Brief discussion of a condemnation on Matlock Brady Road which is being worked on. More information is being gathered and will be briefed on. 11:30 A.M. Hood Canal and Pioneer School Districts—Superintendents Shawn Batstone&Martin Brewer Commissioners Neatherlin,Drexler and Shutty were in attendance. • Presentation of information regarding the February 13,2018 bond measure to build a cooperative high school between Hood Canal and Pioneer School Districts. Commissioner Discussion—there was no discussion. BREAK—NOON 2:00 P.M. Public Defense—Peter Jones Commissioners Neatherlin,Drexler and Shutty were in attendance. • Peter briefed on the 2018 Public Defense attorney contracts with Taschner Law Offices with Sean Taschner and Justus Kandoll. Peter has noticed that the Prosecutor's Office is starting to drop some of the DWLS3 cases. A new program is being developed to deal with the DWLS3 cases. 2:15 P.M. Support Services—Frank Pinter Commissioners Neatherlin,Drexler and Shutty were in attendance. • Reminder that January 15 is Martin Luther King,Jr Holiday. • The Commissioners reviewed the process for Mason Transit Authority appointments.The Commissioners agreed to place appointments for John Campbell,Don Progreba and Deborah Peterson on their January 9 agenda. Interviews for the remaining positions will be scheduled on January 22. • The Board agreed to appoint Kathy Haigh to the Housing Authority. • The Board agreed to schedule a 5t'Tuesday meeting in Belfair on January 30. Agenda items are an update from WSDOT on the Belfair Bypass,an update from SCJ Alliance, updates from Community Development on changes to the sign ordinance,process for water adequacy,Lakeland Village plat approval and on-line permitting. • The Board agreed to increase the Parks&Trails fees as recommended by staff. • A public hearing will be scheduled on January 23,6:30 p.m.to consider 2018-2023 Parks &Trails Comprehensive Plan. A public workshop will be held on Wednesday,January 17 at 6 p.m.in Commission Chambers. • Frank reported a bid has been received for a tax title property in Shorecrest that will not be accepted. Frank stated the process needs to be updated to deal with tax title property. • Dawn explained that the CORE 360 training module will be implemented this year to staff. • Underground tank liability insurance renewal was approved to move forward. • The agreement for the Community Action Council grant with Commerce will be placed on next week's agenda. • The Board asked that Mendy Harlow be appointed to serve on the Parks&Trails Advisory Board. • Vehicle Use Policy and the IRS requirements for take-home vehicles was discussed. The County has to report the fringe benefit on employee's W-2. There will be a follow-up at the January 22 briefing. • The Assessor's Office has forwarded 49 applications for the Open Space program. Because the Public Benefit Rating System has not been implemented,Diane will check with Amber on deadlines for the Commissioners to take action on these requests. Mason County Commissioners Briefing Meeting Minutes Week of January 8,2018 • The 2018 Non-Represented Employee salary resolution needs to be corrected because the COLA was incorrectly recorded as 1.02%and it should be 1.2%.This will be placed on tomorrow's agenda so the payroll will be correct. • Frank reported there needs to be a change to the Public Defense salary scale—a salary step was left off. This will be placed on the January 16 agenda. Commissioner Discussion—there was no discussion. Tuesday,January 9,2018 10:00 A.M. Planning Advisory Commission Interview • Commissioners Neatherlin,Drexler and Shutty interviewed Brian Smith for the Planning Advisory Commission. • The Board agreed to appoint Jamie Bariekman and Brian Smith to the Planning Advisory Commission. Respectfully submitted, Diane Zoren,Administrative Services Manager BOARD OF MASON COUNTY COMMISSIONERS Kevin Shutty Terri Drexler Randy Neatherlin Chair Commissioner Commissioner BOARD OF MASON COUNTY COMMISSIONERS' PROCEEDINGS Mason County Commission Chambers, 411 North St" Street, Shelton, WA JANUARY 9, 2018 1. Call to Order—The Chairperson called the regular meeting to order at 9:02 a.m. 2. Pledge of Allegiance —Conley Watson led the flag salute. 3. Roll Call — Present: Commissioner District 1 - Randy Neatherlin; Commissioner District 2 — Kevin Shutty; Commissioner District 3—Terri Drexler. 4. Correspondence and Organizational Business 4.1 Correspondence 4.1.1 Jeff Carey sent in an application for the TIP CAP Board. 4.1.2 Timberland Regional Library sent in their Final 2018 Budget. 4.1.3 Sandy Tarzwell and Dan Ward sent in applications for the Mason Transit Authority Board. 4.1.4 Mason County Sheriff's Deputy Guild sent a letter regarding comments at the December 19, 2017 Budget meeting. 4.1.5 Kathy Haigh sent in an application for the Mason County Housing Authority Board. 5. Open Forum for Citizen Input— 5.1 Cheryl Williams announced the Monthly League of Women Voters meeting will be held January 16th from 12:00-1:30 p.m. in Johnson Library at Olympic College. She said the discussion will be about the budget with Sheriff Casey Salisbury. 6. Adoption of Agenda —Cmmr. Drexler asked to revise the agenda so that Wes Martin could also be appointed to the Mason Transit Authority board under item 8.7. Cmmr. Drexler/Shutty moved and seconded to adopt the revised agenda. Motion carried unanimously. N-aye; S-aye; D-aye. 7. Approval of Minutes—January 2, 2018 Regular meeting minutes Cmmr. Shutty/Drexler moved and seconded to approve the January 2, 2018 Regular meeting minutes. Motion carried unanimously. N-aye; S-aye; D-aye. 8. Approval of Action Agenda: 8.1 Approval of Warrants and Treasurer Electronic Remittances Claims Clearing Fund Warrant #s 8053759-8054043 $ 718,035.06 Direct Deposit Fund Warrant #s $ Salary Clearing Fund Warrant #s $ Approval of Treasurer Electronic Remittances 2017 $ 7,184,251.30 Total $ 7,902,286.36 8.2 Approval of the Resolution establishing load/lane limits for traffic control on eight Mason County Bridges. 8.3 Approval of the Interlocal Agreement (WSDOT Agreement No. GCB2480) associated with WSDOT's Belfair Area Widening and Safety Improvement project and authorize the Public Works Director to execute the agreement. 8.4 Approval to schedule a public hearing on January 23, 2018 at 6:30 p.m. to consider the Parks &Trails Comprehensive Plan. A public workshop will be held on Wednesday, January 17 at 6 p.m. to review the proposed Plan. Both meetings will be held in the Commission Chambers. 8.5 Approval of the resolution amending Resolution 60-17 correcting a clerical error in the Non-Representative Employee Salary Scale. BOARD OF MASON COUNTY COMMISSIONERS' PROCEEDINGS January 9, 2018 - PAGE 2 8.6 Approval to appoint Mendy Harlow to serve on the Mason County Parks &Trails Advisory Board. 8.7 Approval to appoint the following elected officials to serve on the Mason Transit Authority Board: Don Pogreba, Deborah Petersen, John Campbell and Wes Martin. Cmmr. Drexler asked to remove item 8.5 for discussion. Cmmr. moved and seconded to approve action items 8.1 through 8.7, with the removal of item 8.5. Motion carried unanimously. N-aye; S-aye; D-aye. 8.5 Frank Pinter explained that there was a typographical error and the resolution originally read that the COLA increase read 1.02% when it should read 1.2%. Cmmr. Drexler/Shutty motioned to approve the resolution amending Resolution 60-17 correcting a clerical error in the Non-Representative Employee Salary Scale. Motion carried unanimously. N-aye; S-aye; D-aye. 9. Other Business (Department Heads and Elected Officials)- None. Break 9:24 a.m.- 9:31 a.m. 10. 9:30 a.m. Public Hearings and Items set for a certain time— 10.1 Public Hearing to receive public comment on the Private Line Occupancy Permit granting permission to run the water, septic transport lines, and power under the North Shore Road for parcel 22218-14-00050. Staff: Jerry Hauth/Loretta Swanson. Loretta Swanson explained that there is an existing cabin on the property being refurbished by the applicants. The cabin is on the water side of the road, and they would like to relocate the sewer and utility lines. Conely Watson asked what type of surface is on North Shore Road. Loretta said that it has a chip seal surface and will need to have boring done under the road for the lines. Cmmr. Drexler noted that because the cabin is on the water side, the utilities should be moved to the other side of the road and she is in favor. Cmmr. Shutty agreed. Cmmr. Shutty/Drexler moved to approve the Private Line Occupancy Permit granting permission to run the water, septic transport lines, and power under the North Shore Road for parcel 22218-14-00050. Motion carried unanimously. N-aye; S-aye; D-aye. 11. Board's Reports and Calendar -The Commissioners reported on meetings attended the past week and announced their upcoming weekly meetings. 12. Adjournment—The meeting adjourned at 9:36 a.m. BOARD OF MASON COUNTY COMMISSIONERS' PROCEEDINGS January 9, 2018 - PAGE 3 BOARD OF COUNTY COMMISSIONERS ATTEST: MASON COUNTY, WASHINGTON Melissa Drewry, Clerk of the Board Kevin Shutty, Chair Terri Drexler, Commissioner Randy Neatherlin, Commissioner MASON COUNTY AGENDA ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS From: Jennifer Giraldes Action Agenda x Public Hearing Other DEPARTMENT: Commissioners EXT: 380 COMMISSION MEETING DATE: January 16, 2018 Agenda Item # Commissioner staff to complete) BRIEFING DATE: January 16, 2018 BRIEFING PRESENTED BY: [ ] ITEM WAS NOT PREVIOUSLY BRIEFED WITH THE BOARD Please provide explanation of urgency ITEM: Approval to appoint Jamie Bariekman and Brian Smith to the Planning Advisory Commission for terms ending January 16, 2022. Background: The Mason County Planning Advisory Commission is a seven member citizen board appointed to advise the Board of Commissioners on policy related to the county comprehensive plan and on land use issues. The Planning Advisory Commission members help set the long-term direction or vision for the community's future. The Planning Advisory Commission considers and makes recommendations on many issues, including: • amendments to the Mason County Comprehensive Plan, Shoreline Master Program and land use regulations Recommended Action: Approval to appoint Jamie Bariekman and Brian Smith to the Planning Advisory Commission for a term ending January 16, 2022. 1/9/2018 MASON COUNTY AGENDA ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS From: Jennifer Giraldes Action Agenda _X_ Public Hearing Other DEPARTMENT: Support Services EXT: 380 DATE: January 16, 2018 Agenda Item # v (Commissioner staff to complete) BRIEFING DATE: BRIEFING PRESENTED BY: [X] ITEM WAS NOT PREVIOUSLY BRIEFED WITH THE BOARD Please provide explanation of urgency ITEM: Approval of Warrants &Treasure Electronic Remittances Claims Clearing Fund Warrant #s 8054044-8054141 $ 139,420.48 Direct Deposit Fund Warrant #s 46809-47175 $ 604,954.48 Salary Clearing Fund Warrant #s 7003329-7003369 $ 957,048.26 Total $ 1,701,423.22 Background: The Board approved Resolution No. 80-00 Payment of Claims Against County: Procedure Authorizing Warrant Issue and Release Prior to Board Claim Approval. Mason County Code 3.32.060(a) requires that the board enter into the minutes of the County Commissioners the approval of claims listing warrant numbers. Claims Clearing YTD Total $ 2,113,080.02 Direct Deposit YTD Total $ 1,254,090.92 Salary Clearing YTD Total $ 1,447,948.48 Approval of Treasure Electronic Remittances YTD Total $ .00 RECOMMENDED ACTION: Approval to: Move to approve the following warrants: Claims Clearing Fund Warrant #s 8054044-8054141 $ 139,420.48 Direct Deposit Fund Warrant #s 46809-47175 $ 604,954.48 Salary Clearing Fund Warrant #s 7003329-7003369 $ 957,048.26 Total $ 1,701,423.22 Attachment(s): Originals on file with Auditor/Financial Services (Copies on file with Clerk of the Board) MASON COUNTY AGENDA ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS From: Jennifer Giraldes Action Agenda _x_ Public Hearing Other DEPARTMENT: Support Services EXT: 380 DATE: January 16, 2018 Agenda Item # 9. 3 Commissioner staff to complete) BRIEFING DATE: January 16, 2018 BRIEFING PRESENTED BY: [ ] ITEM WAS NOT PREVIOUSLY BRIEFED WITH THE BOARD Please provide explanation of urgency ITEM: Approval to appoint Kathryn Haigh to the Mason County Housing Authority Board of Commissioners for a five year term that ends January 16, 2023. Back_roq und: The Housing Authority of Mason County, doing business as the Mason County Housing Authority, was organized in 1972 and serves citizens with low income in Mason County. It operates a Rural Development property, which includes the Goldsborough Cove and Fairmont Cove apartments, a Section 8 new construction property, which includes Pine Gardens, and the Kneeland Park Apartments. RECOMMENDED ACTION: Approval to appoint Kathryn Haigh to the Mason County Housing Authority Board of Commissioners for a five year term that ends January 16, 2023. 1/9/2018 MASON COUNTY AGENDA ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS From: Peter Jones Action Agenda X Public Hearing Other DEPARTMENT: Public Defense EXT: COMMISSION MEETING DATE: 1-16-18 Agenda Item # U, Commissioner staff to com tete BRIEFING DATE: 1-8-18 BRIEFING PRESENTED BY: Peter JOnes [] ITEM WAS NOT PREVIOUSLY BRIEFED WITH THE BOARD Please provide explanation of urgency: ITEM: Approval of 2018 contract renewals for public defense with the Law Offices of Sean Taschner. BACKGROUND: These contracts renew the Superior Court Contract and one of the two 2017 District Court Contracts for public defense. The second contract, with the Law Offices of Ari Goldstein, does not need renewal due to an anticipated change in caseload. BUDGET IMPACTS: As budgeted for in 2018 budget. Not renewing one of the two District Court contracts will lead to a $36,000 savings, mitigated somewhat by the conversion of current cases to hourly. RECOMMENDED ACTION: Approve the renewal contracts with the Law Offices of Sean Taschner. ATTACHMENT(S): See attachments to the 1-8-18 briefing JAPeter\Admin ReportsTriefing Reports\1-16-18 agenda cover.doc MASON COUNTY AGENDA ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS From: Dawn Twiddy Action Agenda x Public Hearing Other DEPARTMENT: Human Resources EXT: 422 COMMISSION MEETING DATE: 1/16/18 Agenda Item# 5 (Commissioner staff to complete) BRIEFING DATE: 1/8/18 BRIEFING PRESENTED BY: Dawn Twiddy [ ] ITEM WAS NOT PREVIOUSLY BRIEFED WITH THE BOARD Please provide explanation of urgency ITEM: Approval for the Chair to sign the AIG Storage Tank Third Party Liability Renewal Warranty Acknowledgement Form to bind coverage effective April 21,2018-April 21,2019. This policy provides coverage for the county's fuel storage tank systems. Background: The County's fuel storage tank insurance policy renews on April 21,2018. This policy provides coverage for the county's fuel storage tank systems. Arthur J. Gallagher Risk Management Services,Inc. is the County's assigned Broker through the Washington Counties Risk Pool RECOMMENDED ACTION: Approval to bind coverage for Mason County's third party liability TankGuard Renewal Policy with AIG effective April 21,2018—April 21,2019 and authorize the Chair to sign the Renewal Warranty Acknowledgement Form. There is no change in the policy as written for the prior year. Attachment: Storage Tank Third Party Liability TankGuard Renewal Warranty Acknowledgement Form on file with Clerk of the Board. IAIGI Storage Tank Third Party Liability TankGuard ® Renewal Warranty NAMED INSURED: Mason County INSURER: Commerce and Industry Insurance Company POLICY NUMBER: PLCO01926399 POLICY PERIOD: 4/21/18 - 04/21/19 The undersigned warrants and represents that there have been no changes to the schedule of covered tanks or locations: THIS RENEWAL WARRANTY DOES NOT BIND THE APPLICANT TO BUY, OR THE COMPANY TO ISSUE THE INSURANCE, BUT IT IS AGREED THAT THIS FORM SHALL BE THE BASIS OF THE CONTRACT SHOULD A POLICY BE ISSUED, AND IT WILL BE ATTACHED TO THE ORIGINAL APPLICATION AND MADE A PART OF THE POLICY. THE UNDERSIGNED APPLICANT DECLARES, WARRANTS AND REPRESENTS THAT THESTATEMENTSSET FORTH IN THIS WARRANTY ARE TRUE AND THAT NO MATERIAL FACTS HAVE BEEN SUPPRESSED OR MISSTATED. THE APPLICANT FURTHER DECLARES, WARRANTS AND REPRESENTS THAT IF THE INFORMATION SUPPLIED ON THIS WARRANTY CHANGES BETWEEN THE EXECUTION DATE OF THE WARRANTY AND THE RENEWAL POLICY EFFECTIVE DATE, THE APPLICANT WILL IMMEDIATELY NOTIFY THE COMPANY OF SUCH CHANGES, AND THE COMPANY MAY WITHDRAW OR MODIFY ANY OUTSTANDING QUOTATIONS AND/OR AUTHORIZATION TO BIND THE INSURANCE. ALL WRITTEN STATEMENTS AND MATERIALS FURNISHED TO THE COMPANY IN CONJUNCTION WITH THE MOST RECENT LONG FORM APPLICATION AS WELL AS THE RENEWAL WARRANTY SIGNED HEREUNDER ARE INCORPORATED BY REFERENCE INTO THIS APPLICATION AND MADE A PART THEREOF. In the event that the company issues a policy, the undersigned acting on behalf of the applicant and all proposed insureds, acknowledges that the company, in providing coverage, will have relied upon, as representations, the declarations and statements which are contained in or attached to or incorporated by reference into this warranty and which are incorporated into the policy. If the insured would like an indication for higher limits, please indicate. LIMITS DESIRED: (each incident/aggregate) ❑ $1 million/$1 million $1 million/$ 2 million ❑ $2 million/$2 million ❑ OTHER: DEDUCTIBLE DESIRED: (each incident) ❑ $5,000 ❑ $10,000 ❑ $25,000 01, $50,000 ❑ $100,000 For Deductibles above $50,000, please include your most current audited financial statement. 91177 (03/17) IAIGI Renewal Warranty Acknowledgement APPLICANT: BROKER: Arthur J. Gallagher Risk Managemen Mason CRIPWV 1501 MarKet Street, Suite 250 APPLICANT: Tacoma, WA 98402- (Print Name) (Street Mailing Address) DATE: Ms . Vicki Alridge (Contact person) (Phone#, Fax#, Email Address) (Signature of Broker or Agent) 247654 (License Number and State) 36-2102482 (Tax I.D.#) Please note that if you are planning on adding either additional tanks or locations to this policy, the Company requires that we first receive a fully completed renewal application within thirty(30) days of the policy expirations expiration date. Please visit our website www.chambera.gent.com to download to application. NOTICE TO APPLICANTS: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION OR, CONCEALS, FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT ACT, WHICH IS A CRIME AND SUBJECTS SUCH PERSON TO CRIMINAL AND CIVIL PENALTIES. 91177 (03/17) MASON COUNTY BIfitG ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS FROM: Frank Pinter DEPARTMENT: Support Services EXT: 530 BRIEFING DATE: 1/16/18 ITEM: Sub-recipient agreement with Community Action Council of Lewis, Mason and Thurston Counties for service provision under a Public Services Washington State Community Development Block Grant (CDBG). EXECUTIVE SUMMARY: The County applied for and was awarded a Public Services CDBG grant through the Washington Department of Commerce. The County has partnered with the Community Action Council who will provide referrals and/or direct client services for eligible participants who are residents of Lewis or Mason County. This effort is funded under CDBG contract #17-62210-010. The contract total is a $102,789 with a performance period of 7/1/17 through 6/30/18. This is formula grant that can be applied for annually. The County has agreed to serve as the applicant and grantee for this program. $3,500 in grant funds will be used to off-set administrative costs. The sub-recipient agreement with the Community Action Council is for $99,003. The primary responsibilities include providing referrals for a minimum of 6,000 individuals in Mason and Lewis counties of which a minimum of 3,060 must meet HUD's 51% income qualification and providing direct services and referrals for a minimum of 300 child victims. Cost Impact to the County This project is full-funded by the CDBG grant. RECOMMENDED OR REQUESTED ACTION: Request approval for the Chair to sign the sub-recipient agreement. Attachments: Sub-recipient agreement with the Community Action Council of Lewis, Mason and Thurston Counties Briefmg Summary 2017 PUBLIC SERVICES COMMUNITY DEVELOPMENT BLOCK GRANT SUB-RECIPIENT AGREEMENT BETWEEN MASON COUNTY AND COMMUNITY ACTION COUNCIL OF LEWIS, MASON AND THURSTON COUNTIES This AGREEMENT is made between Mason County,Washington (herein called the COUNTY) and Community Action Council of Lewis, Mason and Thurston Counties (herein called SUB-RECIPIENT) for the 2017 Public Services Community Development Block Grant (herein called PROJECT). COUNTY and SUB-RECIPIENT are collectively referred to as "PARTIES"to the AGREEMENT. As the Washington State Department of COMMERCE (COMMERCE) is authorized by the federal Department of Housing and Urban Development(HUD)to provide funds to units of the COUNTY selected to undertake and carry out PROJECTs under the Washington State Community Development Block Grant (CDBG) Program in compliance with all applicable local,state, and federal laws, regulations and policies; and As the COUNTY has applied for and received a CDBG award, contract number 17-62210-010(CFDA 14.228),to fund the PROJECT with Federal Award Identification Number B-17-DC-53-0001;and As it benefits the COUNTY to engage the SUB-RECIPIENT to accomplish the Scope of Work and the objectives of the local CDBG PROJECT; The PARTIES agree that: 1. SCOPE OF SERVICES A. COUNTY Responsibilities The COUNTY is responsible for administration of the CDBG contract, and ensuring CDBG funds are used in accordance with all program requirements [(24 CFR 570.501(b)] and its CDBG contract with COMMERCE referenced above.The COUNTY will provide such assistance and guidance to the SUB-RECIPIENT as may be required to accomplish the objectives and conditions set forth in this AGREEMENT. The COUNTY is responsible for completing the following tasks to accomplish the objectives of the PROJECT: Principal Tasks • Execute contract with COMMERCE • Execute sub-recipient AGREEMENT • Establish administrative and other record keeping systems • Process and submit payment requests and CDBG Beneficiary Reports • Formulate and implement a sub-recipient monitoring plan and conduct on-site review • Ensure grant activities are completed • Conduct a final public hearing • Complete the grant close-out process with COMMERCE B. SUB-RECIPIENT Responsibilities The SUB-RECIPIENT will complete in a satisfactory and proper manner as determined by the COUNTY the tasks and activities as detailed in "Exhibit A Scope-of-Work"to accomplish the objectives of the PROJECT.The SUB- RECIPIENT will periodically meet with the COUNTY to review the status of these tasks. Principal Tasks • Provide referrals for a minimum of 6,000 individuals in Mason and Lewis counties of which a minimum of 3,060 must meet HUD's 51%income qualification. • Provide direct services and referrals for a minimum of 300 child victims. • Formulate and submit required reports and payment requests to COUNTY in an accurate and timely manner. 2. TIME OF PERFORMANCE The effective date of this AGREEMENT will be the date the PARTIES sign and complete execution of this AGREEMENT through 6/30/2018 and will be in effect for the time period during which the SUB-RECIPIENT remains in control of CDBG funds or other CDBG assets as defined and required by COMMERCE and/or HUD. 3. AGREEMENT REPRESENTATIVES Each party to this AGREEMENT shall have a representative. Each party may change its representative upon providing written notice to the other party.The PARTIES' representatives are as follows: A. SUB-RECIPIENT: John Walsh, CEO Community Action Council of Lewis, Mason and Thurston Counties 420 Golf Road Lacey, WA 98503 360-438-1100 johnw@caclmt.org DUNS#096245428 B. COUNTY: Jessica Sweet, Financial Analyst Mason County 411 N. 5th Street Shelton,WA 98584 360-427-9670 Ext. 644 jsweet@co.mason.wa.us 4. BUDGET The COUNTY will pass through to the SUB-RECIPIENT no more than$99,289 in CDBG funds for eligible incurred costs and expenses for the PROJECT according to the following budget. PROJECT Budget Element Budgeted Amount 05 Public Services $99,289 Indirect Cost Rate: _% Federally Approved Indirect Rate, or 10%de minimis rate, or fill out"N/A" declining to charge indirect The COUNTY may require a more detailed budget breakdown, and the SUB-RECIPIENT will provide such supplementary budget information in a timely fashion in the form and content prescribed by the COUNTY. Indirect Cost Rate if the SUB-RECIPIENT chooses to charge Indirect under this grant, the SUB-RECIPIENT shall provide their indirect cost rate that has been negotiated between their entity and the Federal Government. If no such rate exists, a de minimis indirect cost rate of 10%of modified total direct costs(MTDC)will be used. "Modified Total Direct Costs (MTDC)" shall mean all direct salaries and wages,applicable fringe benefits, materials and supplies, services,travel, and up to the first$25,000 of each subaward (regardless of the period of performance of the subawards under the award). MTDC excludes equipment, capital expenditures, and rental costs. Any amendments to this AGREEMENT's Budget must first be determined by the COUNTY as consistent with its CDBG contract with COMMERCE and then approved in writing by the COUNTY and the SUB-RECIPIENT. 5. PAYMENT The COUNTY shall reimburse the SUB-RECIPIENT in accordance with the payment procedures outlined in the CDBG Management Handbook, Financial Management Section for all allowable expenses agreed upon by the PARTIES to complete the Scope of Service. Reimbursement under this AGREEMENT will be based on billings, supported by appropriate documentation of costs actually incurred. It is expressly understood that claims for reimbursement will not be submitted in excess of actual, immediate cash requirements necessary to carry out the purposes of the AGREEMENT. Funds available under this AGREEMENT will be utilized to supplement rather than supplant funds otherwise available. It is understood that this AGREEMENT is funded in whole or in part with CDBG funds through the Washington State CDBG Program as administered by COMMERCE and is subject to those regulations and restrictions normally associated with federally-funded programs and any other requirements that the State may prescribe. 6. PERFORMANCE MONITORING The COUNTY will monitor the performance of the SUB-RECIPIENT by tracking PROJECT progress, reviewing payment requests for applicable costs, managing the timely pass-through of CDBG funds, overseeing compliance with CDBG requirements, and ensuring recordkeeping and audit requirements are met. Substandard performance as determined by the COUNTY will constitute noncompliance with this AGREEMENT. If action to correct such substandard performance is not taken by the SUB-RECIPIENT within a reasonable period of time after being notified by the COUNTY, contract suspension or termination procedures will be initiated. 7. SPECIAL CONDITIONS A. Withholding Payment: In the event the SUB-RECIPIENT has failed to perform any obligation under this AGREEMENT within the times set forth in the AGREEMENT,the COUNTY may, upon written notice, withhold from amounts otherwise due and payable to SUB-RECIPIENT,without penalty, until such failure to perform is cured or otherwise adjudicated. Withholding under this clause shall not be deemed a breach entitling SUB- RECIPIENT to termination or damages, provided that the COUNTY promptly gives notice in writing to the SUB-RECIPIENT of the nature of the default or failure to perform, and in no case more than 10 days after it determines to withhold amounts otherwise due.A determination of the Administrative Office set forth in a notice to the SUB-RECIPIENT of the action required and/or the amount required to cure any alleged failure to perform shall be deemed conclusive under this clause, without prejudice to any other remedy under the AGREEMENT,to take all or any of the following actions: (1) cure any failure or default, (2)to pay any amount so required to be paid and to charge the same to the account of the SUB-RECIPIENT, (3)to set off any amount so paid or incurred from amounts due or to become due the SUB-RECIPIENT. In the event the SUB-RECIPIENT obtains relief upon a claim under the Disputes clause, no penalty or damages shall accrue to SUB-RECIPIENT by reason of good faith withholding by the COUNTY under this clause. B. Labor Standards: SUB-RECIPIENT agrees to comply with all applicable state and federal requirements, including but not limited to those pertaining to payment of wages and working conditions, in accordance with RCW 39.12.040,the Prevailing Wage Act;the Americans with Disabilities Act of 1990;the Davis-Bacon Act; and the Contract Work Hours and Safety Standards Act providing for weekly payment of prevailing wages, minimum overtime pay, and providing that no laborer or mechanic shall be required to work in surroundings or under conditions which are unsanitary, hazardous, or dangerous to health and safety as determined by regulations promulgated by the Federal Secretary of Labor and/or the State of Washington. C. Waiver of Noncompetition: SUB-RECIPIENT irrevocably waives any existing rights which it may have, by contract or otherwise,to require another person or corporation to refrain from submitting a proposal to or performing work or providing supplies to the COUNTY, and SUB-RECIPIENT further promises that it will not in the future, directly or indirectly, induce or solicit any person or corporation to refrain from submitting a bid or proposal to or from performing work or providing supplies to the COUNTY. D. Ownership of Items Produced: All writings, programs, data, public records or other materials prepared by SUB-RECIPIENT and/or its consultants or sub-contractors, in connection with performance of this AGREEMENT, shall be the sole and absolute property of COUNTY. E. E-verify: The E-Verify contractor program for Mason County applies to contracts of$100,000 or more and subcontracts for$25,000 or more if the primary contract is for$100,000 or more.SUB-RECIPIENT represents and warrants that it will,for at least the duration of the AGREEMENT, register and participate in the status verification system for all newly hired employees.The term "employee" as used herein means any person that is hired to perform work for Mason County. As used herein, "status verification system: means the Illegal Immigration Reform and Immigration Responsibility Act of 1996 that is operated by the United States Department of Homeland Security, also known as the E-Verify Program, or any other successor electronic verification system replacing the E-Verify Program.SUB-RECIPIENT agrees to maintain records of such compliance and, upon request of the COUNTY,to provide a copy of each such verification to the COUNTY.SUB-RECIPIENT further represents and warrants that any person assigned to perform services hereunder meets the employment eligibility requirements of all immigration laws of the State of Washington. SUB-RECIPIENT understands and agrees that any breach of these warranties may subject SUB- RECIPIENT to the following: (a) termination of the AGREEMENT and ineligibility for any Mason County contract for up to three (3)years,with notice of such cancellation/termination being made public. In the event of such termination/cancellation,SUB-RECIPIENT would also be liable for any additional costs incurred by the COUNTY due to contract cancellation or loss of license or permit. SUB-RECIPIENT will review and enroll in the E-Verify program through this website:www.uscis.gov F. Disputes: Differences between SUB-RECIPIENT and COUNTY, arising under and by virtue of the AGREEMENT Documents, shall be brought to the attention of COUNTY at the earliest possible time in order that such matters may be settled or other appropriate action promptly taken. Except for such objections as are made of record in the manner hereinafter specified and within the time limits stated,the records, orders, rulings, instructions, and decisions of the Administrative Officer shall be final and conclusive. G. Notice of Potential Claims: Subrecipient shall not be entitled to additional compensation which otherwise may be payable, or to extension of time for(1) any act or failure to act by the Administrative Officer or COUNTY, or(2)the happening of any event or occurrence, unless Subrecipient has given COUNTY a written Notice of Potential Claim within ten (10) days of the commencement of the act,failure,or event giving rise to the claim, and before final payment by COUNTY.The written Notice of Potential Claim shall set forth the reasons for which Subrecipient believes additional compensation or extension of time is due,the nature of the cost involved, and insofar as possible, the amount of the potential claim.Subrecipient shall keep full and complete daily records of the work performed, labor and material used, and all costs and additional time claimed to be additional. H. Detailed Claim: Subrecipient shall not be entitled to claim any such additional compensation,or extension of time, unless within thirty (30) days of the accomplishment of the portion of the work from which the claim arose, and before final payment by COUNTY, Subrecipient has given COUNTY a detailed written statement of each element of cost or other compensation requested and of all elements of additional time required, and copies of any supporting documents evidencing the amount or the extension of time claimed to be due. I. Arbitration: Other than claims for injunctive relief brought by a party hereto (which may be brought either in court or pursuant to the arbitration provision), and consistent with the provisions hereinabove, any claim, dispute or controversy between the PARTIES under, arising out of, or related to the AGREEMENT or otherwise, including issues of specific performance,shall be determined by arbitration in Shelton, Washington, under the applicable American Arbitration Association (AAA) rules in effect on the date hereof, as modified by the AGREEMENT.There shall be one arbitrator selected by the PARTIES within ten (10) days of the arbitration demand,or if not, by the AAA or any other group having similar credentials.Any issue about whether a claim is covered by this AGREEMENT shall be determined by the arbitrator.The arbitrator shall apply substantive law and may award injunctive relief, equitable relief(including specific performance), or any other remedy available from a judge, including expenses, costs and attorney fees to the prevailing party and pre-award interest, but shall not have the power to award punitive damages.The decision of the arbitrator shall be the sole and exclusive remedy between them regarding any dispute presented or pled before the arbitrator.At the request of either party made no later than forty-five (45) days after the arbitration demand,the PARTIES agree to submit the dispute to nonbinding mediation, which shall not delay the arbitration hearing date; provided,that either party may decline to mediate and process with arbitration. J. Venue and Choice of Law: In the event that any litigation should arise concerning the construction or interpretation of any of the terms of the AGREEMENT,the venue of such action of litigation shall be in the courts of the State of Washington in and for the County of Mason. Unless otherwise specified herein,this AGREEMENT shall be governed by the laws of Mason County and the State of Washington. K. Communication: Subrecipient will not communicate directly with COMMERCE concerning this PROJECT without COUNTY's prior approval. 8. GENERAL CONDITIONS A. General Compliance The SUB-RECIPIENT agrees to comply with: • The requirements of Title 24 of the Code of Federal regulations, 570 (HUD regulations concerning CDBG); and • All other applicable Federal, State and Local laws, regulations, and policies, governing the funds provided under this AGREEMENT. B. CDBG National Obiective The SUB-RECIPIENT certifies the activities carried out under this AGREEMENT meet a CDBG Program National Objective defined in 24 CFR 570.208. C. Independent Contractor Nothing contained in this AGREEMENT is intended to, or will be construed in any manner, as creating or establishing the relationship of employer/employee between the PARTIES. The SUB-RECIPIENT will at all times remain an "independent contractor" with respect to the services to be performed under this AGREEMENT. The COUNTY will be exempt from payment of all Unemployment Compensation, FICA, retirement, life and/or medical insurance and Workers' Compensation Insurance, as the SUB-RECIPIENT is an independent contractor. D. Indemnification To the fullest extent permitted by law, SUB-RECIPIENT will hold harmless, defend and indemnify the COUNTY and its departments, elected and appointed officials, employees, agents and volunteers,from any and all claims,actions, suits, charges and judgments whatsoever that arise out of the SUB- RECIPIENT's performance or nonperformance of the services or subject matter called for in this AGREEMENT.This indemnification obligation of the SUB-RECIPIENT shall not apply in the limited circumstance where the claim, damage, loss, or expense is caused by the sole negligence of COUNTY. This indemnification obligation of the SUB-RECIPIENT shall not be limited in any way by the Washington State Industrial Insurance Act, RCW Title 51, or by application of any other workmen's compensation act, disability benefit act or other employee benefit act, and the SUB-RECIPIENT hereby expressly waives any immunity afforded by such acts.The foregoing indemnification obligations of the SUB-RECIPIENT are a material inducement to COUNTY to enter into the AGREEMENT, are reflected in SUB-RECIPIENT'S compensation, and have been mutually negotiated by the PARTIES. SUB-RECIPIENT's initials acknowledging indemnity terms: E. Workers'Compensation The SUB-RECIPIENT will provide Workers' Compensation Insurance Coverage for all of its employees involved in the performance of this AGREEMENT. F. Insurance and Bonding The SUB-RECIPIENT will carry sufficient insurance coverage to protect contract assets from loss due to theft, fraud and/or undue physical damage, and as a minimum will purchase a blanket fidelity bond covering all employees in an amount equal to cash advances from the COUNTY as detailed in "Exhibit B Insurance Requirements." The SUB-RECIPIENT shall furnish the COUNTY with properly executed certificate of insurance or a signed policy endorsement as"Exhibit C Certificate of Insurance" which shall clearly evidence all insurance required in this section prior to commencement of services.The certificates will, at a minimum, list limits of liability and coverage.The certificate will provide that the underlying insurance contract will not be cancelled or allowed to expire except on thirty (30) days prior written notice to the COUNTY. G. Funding Source Recognition The SUB-RECIPIENT will insure recognition of the roles of COMMERCE, the WA State CDBG program, and the COUNTY in providing services through this AGREEMENT.All activities,facilities and items utilized pursuant to this AGREEMENT will be prominently labeled as to funding source. In addition, the SUB- RECIPIENT will include a reference to the support provided herein in all publications made possible with funds made available under this AGREEMENT. H. Amendments The COUNTY or SUB-RECIPIENT may amend this AGREEMENT at any time provided that such amendments make specific reference to this AGREEMENT, and are executed in writing,signed by a duly authorized representative of each organization, and approved by the COUNTY's governing body.Such amendments will not invalidate this AGREEMENT, nor relieve or release the COUNTY or SUB-RECIPIENT from its obligations under this AGREEMENT. I. Suspension or Termination In accordance with 2 CFR 200.338-9, the COUNTY may suspend or terminate this AGREEMENT if the SUB- RECIPIENT materially fails to comply with any terms of this AGREEMENT, which include (but are not limited to)the following: 1. Failure to comply with any of the rules, regulations or provisions referred to herein, or such statues, regulations,executive orders, and HUD guidelines, policies or directives as may become applicable at any time; 2. Failure,for any reason, of the SUB-RECIPIENT to fulfill in a timely and proper manner its obligations under this AGREEMENT. 3. Ineffective of improper use of funds provided under this AGREEMENT; or 4. Submission by the SUB-RECIPIENT to the COUNTY of reports that are incorrect or incomplete in any material respect. In accordance with 2 CFR 200.339,this AGREEMENT may also be terminated by either the COUNTY or the SUB-RECIPIENT, in whole or in part, by setting forth the reasons for such termination, the effective date, and, in the case of partial termination,the portion to be terminated. However, if in the case of a partial termination,the COUNTY determines that the remaining portion of the award will not accomplish the purpose for which the award was made,the COUNTY may terminate the award in its entirety. 9. ADMINISTRATIVE REQUIREMENTS A. Financial Management 1. Accounting Standards The SUB-RECIPIENT agrees to comply with 2 CFR 200 and agrees to adhere to the accounting principles and procedures required therein, utilize adequate internal controls, and maintain necessary source documentation for all costs incurred. 2. Cost Principles The SUB-RECIPIENT will administer its program in conformance with 2 CFR 200.These principles will be applied for all costs incurred whether charged on a direct or indirect basis. 3. Duplication of Costs The SUB-RECIPIENT certifies that work to be performed under this AGREEMENT does not duplicate any work to be charged against any other contract, subcontract or other source. B. Documentation and Record Keeping 1. Records to Be Maintained The SUB-RECIPIENT will maintain all records required by the Federal regulations specified in 24 CFR 570.506 that are pertinent to the activities to be funded under this AGREEMENT and those records described in the CDBG Management Handbook. Such records will include but not be limited to: a. Records providing a full description of each activity undertaken; b. Records demonstrating that each activity undertaken meets one of the National Objectives of the CDBG program; c. Records required to determine the eligibility of activities; d. Records required to document the acquisition, improvement, use or disposition of real property acquired or improved with CDBG assistance; e. Records documenting compliance with the civil rights components of the CDBG program; f. Financial records as required by 24 CFR 570.502, and 2 CFR 200.333; g. Labor standards records required to document compliance with the Davis Bacon Act,the provisions of the Contract Work Hours and Safety Standards Act, and all other applicable Federal, State and Local laws and regulations applicable to CDBG-funded construction PROJECTs; and h. Other records necessary to document compliance with Subpart K of 24 CFR 570. 2. Access to Records and Retention The grantee,the Washington State Department of COMMERCE, and other authorized representatives of the state and federal governments shall have access to any books, documents, papers and records of the SUB-RECIPIENT that are directly pertinent to this AGREEMENT for the purposes of making audit,examination, excerpts and transcriptions. All such records and all other records pertinent to this AGREEMENT and work undertaken under this AGREEMENT will be retained by the SUB-RECIPIENT for a period of six years after final audit of the COUNTY's CDBG PROJECT, unless a longer period is required to resolve audit findings or litigation. In such cases,the COUNTY will request a longer period of record retention. 3. Audits and Inspections All SUB-RECIPIENT records with respect to any matters covered by this AGREEMENT will be made available to the COUNTY, COMMERCE, and duly authorized officials of the state and federal government, at any time during normal business hours, as often as deemed necessary,to audit, examine, and make excerpts or transcripts of all relevant data. Any deficiencies noted in audit reports must be fully cleared by the SUB-RECIPIENT within 30 days after receipt by the SUB-RECIPIENT. Failure of the SUB-RECIPIENT to comply with the above audit requirements will constitute a violation of this AGREEMENT and may result in the withholding of future payments. The SUB-RECIPIENT that expends$750,000 or more in a fiscal year in federal funds from all sources hereby agrees to have an annual agency audit conducted in accordance with current COUNTY policy concerning SUB-RECIPIENT audits and 2 CRF 200.501.The Catalog of Federal Domestic Assistance (CFDA) number is 14.228. C. Reporting 1. Program Income The SUB-RECIPIENT will report annually all program income (as defined at 24 CFR 570.500(a)) generated by activities carried out with CDBG funds made available under this AGREEMENT.The use of program income by the SUB-RECIPIENT will comply with the requirements set forth at 24 CFR 570.504. 2. Periodic Reports The SUB-RECIPIENT, at such times and in such forms as the COUNTY may require, will furnish the COUNTY such periodic reports as it may request pertaining to the work or services undertaken pursuant to this AGREEMENT,the costs and obligations incurred or to be incurred in connection therewith, and any other matters covered by this AGREEMENT. D. Use and Reversion of Assets The use and disposition of real property and equipment under this AGREEMENT will be in compliance with the requirements of 2 CFR 200.311 and 313, 24 CFR 570.502, 570.503, 570.504, as applicable,which include but are not limited to the following: 1. The SUB-RECIPIENT will transfer to the COUNTY any CDBG funds on hand and any accounts receivable attributable to the use of funds under this AGREEMENT at the time of expiration, cancellation, or termination. 2. Real property under the SUB-RECIPIENT's control that was acquired or improved, in whole or in part, with funds under this AGREEMENT in excess of$25,000 will be used to meet one of the CDBG National Objectives pursuant to 24 CFR 570.208 until ten (10)years after the contract between COMMERCE and the COUNTY is closed. If the SUB-RECIPIENT fails to use CDBG-assisted real property in a manner that meets a CDBG National Objective for this 10-year period of time,the SUB-RECIPIENT will pay the COUNTY an amount equal to the current fair market value of the property less any portion of the value attributable to expenditures of non-CDBG funds for acquisition of, or improvement to,the property after the CDBG program's approval. Such payment will constitute program income to the COUNTY.The SUB-RECIPIENT may retain real property acquired or improved under this AGREEMENT after the expiration of the ten-year period. 3. In cases in which equipment acquired, in whole or in part, with funds under this AGREEMENT is sold, the proceeds will be program income. Equipment not needed by the SUB-RECIPIENT for activities under this AGREEMENT will be (a)transferred to the COUNTY for CDBG-eligible activities as approved by the CDBG program or(b) retained after compensating the COUNTY. 10. PERSONNEL AND PARTICIPANT CONDITIONS A. Civil Rights Title VI of the Civil Rights Act of 1964: Under Title VI of the Civil Rights Act of 1964, no person will, on the grounds of race, color, creed, religion, sex or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. Section 109 of the Housing and Community Development Act of 1974: No person in the United States will on the grounds of race, color, creed, religion, sex or national origin be excluded from participation in, be denied benefits of,or be subjected to discrimination under any program or activity funded in whole or in part with funds made available under this title. Age Discrimination Act of 1975, as Amended No person will be excluded from participation, denied program benefits, or subjected to discrimination on the basis of age under any program or activity receiving federal funding assistance. (42 U.S.C. 610 et. seq.) Section 504 of the Rehabilitation Act of 1973,as Amended No otherwise qualified individual will, solely by reason or his or her disability, be excluded from participation (including employment), denied program benefits, or subjected to discrimination under any program or activity receiving Federal funds. (29 U.S.C. 794) Public Law 101-336.Americans with Disabilities Act of 1990 Subject to the provisions of this title, no qualified individual with a disability will, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity. B. Section 3 of the Housing and Community Development Act of 1968 Compliance in the Provision of Training, Employment,and Business Opportunities: 1. The work to be performed under this AGREEMENT is on a PROJECT assisted under a program providing direct federal financial assistance from HUD and is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u.Section 3 requires that to the greatest extent feasible opportunities for training and employment be given lower- income residents of the PROJECT area; and contracts for work in connection with the PROJECT be awarded to business concerns which are located in,or owned in substantial part, by persons residing in the area of the PROJECT. 2. The PARTIES to this contract will comply with the provisions of said Section 3 and the regulations set forth in 24 CFR 135, and all applicable rules and orders of HUD and COMMERCE issued thereunder prior to the execution of this contract.The PARTIES to this contract certify and agree that they are under no contractual or other disability that would prevent them from complying with these provisions. 3. The SUB-RECIPIENT will send to each labor organization or representative of workers with which he has a collective bargaining AGREEMENT or other contract or understanding, if any, a notice advising the said labor organization or workers' representative of his commitments under this Section 3 clause and will post copies of the notice in conspicuous places available to employees and applicants for employment or training. 4. The SUB-RECIPIENT will include this Section 3 clause in every subcontract for work in connection with the PROJECT and will, at the direction of the applicant, or recipient of federal financial assistance, take appropriate action pursuant to the subcontract upon a finding that the subcontractor is in violation of regulations issued by the Secretary of HUD, 24 CFR 135.The SUB-RECIPIENT will not subcontract with any subcontractor where it has notice or knowledge that the latter has been found in violation of regulations under 24 CFR 135 and will not let any subcontract, unless the subcontractor has first provided it with a preliminary statement of ability to comply with the requirements of these regulations. 5. Compliance with the provisions of Section 3,the regulations set forth in 24 CFR 135,and all applicable rules and orders of HUD and COMMERCE issued hereunder prior to the execution of the contract,will be a condition of the federal financial assistance provided to the PROJECT, binding upon the applicant or recipient for such assistance, its successors, and assigns. Failure to fulfill these requirements will subject the applicant, or recipient, its consultants and subcontractors, its successors and assigned to those sanctions specified by the grant or loan AGREEMENT or contract through which federal assistance is provided, and to such sanctions as are specified by 24 CFR 135. C. Conduct 1. Assignability The SUB-RECIPIENT will not assign or transfer any interest in this AGREEMENT without the prior written consent of the COUNTY thereto; provided, however,that claims for money due or to become due to the SUB-RECIPIENT from the COUNTY under this contract may be assigned to a bank,trust company, or other financial institution without such approval. Notice of any such assignment or transfer will be furnished promptly to the COUNTY and COMMERCE. 2. Conflict of Interest No member of the COUNTY's governing body and no other public official of such locality,who exercises any functions or responsibilities in connection with the planning or carrying out of the PROJECT, will have any personal financial interest, direct or indirect, in this AGREEMENT; and the SUB-RECIPIENT will take appropriate steps to assure compliance. The SUB-RECIPIENT agrees to abide by the provisions of 2 CFR 200.318 and 24 CFR 570.611,which includes maintaining a written code or standards of conduct that will govern the performance of its officers, employees or agents engaged in the award and administration of contracts supported by Federal funds. The SUB-RECIPIENT covenants that its employees have no interest and will not acquire interest, direct or indirect, in the study area or any parcels therein or any other interest which would conflict in any manner or degree with the performance of services hereunder.The SUB-RECIPIENT further covenants that in the performance of this AGREEMENT, no person having such interest will be employed. 3. Certification Regarding Debarment Suspension, Ineligibility and Voluntary Exclusion- Lower Tier Covered Transactions a. The lower tier contractor certifies, by signing this contract that neither it nor its principals is presently debarred,suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. b. Where the lower tier contractor is unable to certify to any of the statements in this contract, such contractor will attach an explanation to this contract. D. Copyright If this AGREEMENT results in any copyrightable material or inventions, the COUNTY and/or COMMERCE reserves the right to royalty-free, non-exclusive and irrevocable license to reproduce, publish or otherwise use and to authorize others to use,the work or materials for governmental purposes. E. Religious Activities The SUB-RECIPIENT agrees that funds provided under this AGREEMENT will not be utilized for inherently religious activities prohibited by 24 CFR 570.200(j), such as worship, religious instruction, or prose lytization. 11. SEVERABILITY If any provision of this AGREEMENT is held invalid,the remainder of this AGREEMENT will not be affected thereby and all other parts of this AGREEMENT will nevertheless be in full force and effect. 12. PERFORMANCE WAIVER The COUNTY's failure to act with respect to a breach by the SUB-RECIPIENT does not waive its right to act with respect to subsequent or similar breaches. The failure of the COUNTY to exercise or enforce any right or provision will not constitute a waiver of such right or provision. 13. ENTIRE AGREEMENT This AGREEMENT constitutes the entire AGREEMENT between the COUNTY and the SUB-RECIPIENT for the use of funds received under this AGREEMENT and it supersedes all prior communications and proposals,whether electronic,oral, or written between the COUNTY and the SUB-RECIPIENT with respect to this AGREEMENT. The attachments to this AGREEMENT are identified as follows: Exhibit A Scope-of-Work and Budget Exhibit B Insurance Requirements Exhibit C Certificate of Insurance Exhibit D Sample Forms and Instructions IN WITNESS WHEREOF,the COUNTY and the SUB-RECIPIENT have executed this AGREEMENT as of the date and year last written below. BOARD OF COUNTY COMMISSIONERS COMMUNITY ACTION COUNCIL OF LEWIS, MASON COUNTY, WASHINGTON MASON and THURSTON COUNTIES Randy Neatherlin, Chair John Walsh, CEO Date: Date: Approved As To Form: Tim Whitehead, Chief DPA EXHIBIT A SCOPE-OF -WORK The Community Action Council of Lewis, Mason and Thurston Counties (CAC) will be responsible for completing the tasks and activities below as well as others as detailed throughout this AGREEMENT, Washington Department of Commerce's (Commerce) Community Development Block Grant (CDBG) Management Handbook and other guides as required to provide referral and direct services in compliance with the CDBG program and Mason County's (COUNTY) policies and procedures. It is the CAC's responsibility to review, understand, implement and adhere to all requirements as this Scope-of-Work is a summary, not an exhaustive list. SUB-RECIPIENT will: 1. Conduct participant eligibility screening for Lewis and Mason county residents to determine program eligibility in compliance with CDBG requirements. 2. Provide referrals for a minimum of 6,000 individuals in Mason and Lewis counties of which a minimum of 3,060 must meet current HUD's low-middle income qualifications. 3. Provide Children's Justice and Advocacy Center direct services and referrals for a minimum of 300 eligible residents of Mason and Lewis counties. Services include; resource referrals, advocacy, support case coordination, child forensic interviews, technical assistance for victims of child abuse, and consultation and case support for victims of other crimes. 4. Collect, track and report PROJECT data in a manner consistent with the requirements detailed in this AGREEMENT, COMMERCE's CDBG Management Handbook and other guides as applicable. SUB- RECIPIENT must ensure that the services provided to eligible individuals under this PROJECT are not reported to any other funding entities for the purpose of meeting contractual obligations. 3. Voucher Requests and Reports: A. Formulate and submit a Washington State Voucher Distribution request (form A19) to COUNTY on a quarterly basis due September 15, January 15, April 15th and July 15. Submission to include one digital copy in WORD e-mailed to Jessica Sweet and one copy that has been printed, signed and either scanned and e-mailed or sent by U. S. mail or hand delivery. Signed and certified timesheets must be maintained by the SUB-RECIPIENT. County will be responsible for submitting completed requests to COMMERCE. See "Exhibit E Sample Forms and Instructions." B. Formulate and submit a CDBG Quarterly Beneficiary Reporting Form and a CDBG Project Status Report to COUNTY on a quarterly basis due September 15, January 15, April 15th and July 15. A digital or hard copy is acceptable e-mailed or delivered to Jessica Sweet. County will be responsible for submitting completed forms and reports to COMMERCE. See Exhibit E Sample Forms and Instructions Jessica Sweet Mason County 411 N. 5th Street Shelton, WA 98584 isweet(a)-co.mason.wa.us 4. Participate in PROJECT meetings, including a grant start-up meeting, as scheduled by COUNTY. 5. Participate and support on-site compliance reviews conducted by COUNTY per CDBG requirements. 6. Assist COUNTY with all aspects of program administration and requirements including grant close-out process as requested. 7. Assist with preparation of 2018 Public Services Grant application as requested by COUNTY. EXHIBIT B Budget 1. The approved project budget for the SUB-RECIPIENT of$99,289 allows for reimbursement requests for staff salaries and benefits. The SUB-RECIPIENT cannot use Community Development Block Grant (CDBG) funds from this AGREEMENT for travel, equipment, contracted services, materials/supplies, other and/or indirect expenses. 2. Staff charging time to the CDBG grant must record actual hours worked on a timesheet. Timesheets are to be signed, certifying that the hours charged are for time spent providing CDBG grant-related services. 3. Signed and certified timesheets must be maintained by the SUB-RECIPIENT. 4. Financial policies, practices and processes must adhere to the requirements detailed in this AGREEMENT, COMMERCE's CDBG Management Handbook and other guides as well as applicable Mason County's (COUNTY) policies and procedures. 5. SUB-RECIPIENT will provide COUNTY with a copy of the annual A-133 compliant audit within nine months of the end of CAC's fiscal year. EXHIBIT C INSURANCE REQUIREMENTS 1. MINIMUM Insurance Requirements: A. Commercial General Liability Insurance using Insurance Services Office "Commercial General Liability" policy form CG 00 01, with an edition date prior to 2004, or the exact equivalent. Coverage for an additional insured shall not be limited to its vicarious liability. Defense costs must be paid in addition to limits. Limits shall be no less than $1,000,000 per occurrence for all covered losses and no less than $2,000,000 general aggregate. B. Workers' Compensation on a state-approved policy form providing statutory benefits as required by law with employer's liability limits no less than $1,000,000 per accident for all covered losses. C. Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including owned, non-owned and hired autos, or the exact equivalent. Limits shall be no less than $1,000,000 per accident, combined single limit. If SUB-RECIPIENT owns no vehicles, this requirement may be satisfied by a non-owned auto endorsement to the general liability policy described above. If SUB-RECIPIENT or SUB-RECIPIENT 's employees will use personal autos in any way on this project, SUB-RECIPIENT shall obtain evidence of personal auto liability coverage for each such person. D. Excess or Umbrella Liability Insurance (Over Primary) if used to meet limit requirements, shall provide coverage at least as broad as specified for the underlying coverages. Such policy or policies shall include as insureds those covered by the underlying policies, including additional insureds. Coverage shall be "pay on behalf', with defense costs payable in addition to policy limits. There shall be no cross liability exclusion precluding coverage for claims or suits by one insured against another. Coverage shall be applicable to COUNTY for injury to employees of SUB-RECIPIENT, subcontractors or others involved in the Work. The scope of coverage provided is subject to approval of COUNTY following receipt of proof of insurance as required herein. 2. Certificate of Insurance: A certificate of insurance is attached hereto as "Exhibit D Certificate of Insurance." 3. Basic Stipulations: A. SUB-RECIPIENT agrees to endorse third party liability coverage required herein to include as additional insureds COUNTY, its officials, employees and agents, using ISO endorsement CG 20 10 with an edition date prior to 2004. [If this is a construction contract, ISO endorsement 20 37 also is required.] SUB- RECIPIENT also agrees to require all SUB-RECIPIENT s, subcontractors, and anyone else involved in this Contract on behalf of the SUB-RECIPIENT (hereinafter"indemnifying PARTIES") to comply with these provisions. B. SUB-RECIPIENT agrees to waive rights of recovery against COUNTY regardless of the applicability of any insurance proceeds, and to require all indemnifying PARTIES to do likewise. C. All insurance coverage maintained or procured by SUB-RECIPIENT or required of others by SUB- RECIPIENT pursuant to this Contract shall be endorsed to delete the subrogation condition as to COUNTY, or must specifically allow the named insured to waive subrogation prior to a loss. D. All coverage types and limits required are subject to approval, modification and additional requirements by COUNTY. SUB-RECIPIENT shall not make any reductions in scope or limits of coverage that may affect COUNTY's protection without COUNTY's prior written consent. E. Proof of compliance with these insurance requirements, consisting of endorsements and certificates of insurance shall be delivered to COUNTY prior to the execution of this Contract. If such proof of insurance is not delivered as required, or if such insurance is canceled at any time and no replacement coverage is provided, COUNTY has the right, but not the duty, to obtain any insurance it deems necessary to protect its interests. Any premium so paid by COUNTY shall be charged to and promptly paid by SUB-RECIPIENT or deducted from sums due SUB-RECIPIENT. F. It is acknowledged by the PARTIES of this Contract that all insurance coverage required to be provided by SUB-RECIPIENT or indemnifying party, is intended to apply first and on a primary non-contributing basis in relation to any other insurance or self-insurance available to COUNTY. G. SUB-RECIPIENT agrees not to self-insure or to use any self-insured retentions on any portion of the insurance required herein and further agrees that it will not allow any indemnifying party to self- insure its obligations to COUNTY. If SUB-RECIPIENT 's existing coverage includes a self-insured retention, the self- insured retention must be declared to the COUNTY. The COUNTY may review options with SUB- RECIPIENT, which may include reduction or elimination of the self-insured retention, substitution of other coverage, or other solutions. H. SUB-RECIPIENT will renew the required coverage annually as long as COUNTY, or its employees or agents face an exposure from operations of any type pursuant to this Contract. This obligation applies whether or not the Contract is canceled or terminated for any reason. Termination of this obligation is not effective until COUNTY executes a written statement to that effect. EXHIBIT D CERTIFICATE OF INSURANCE ® DATE(MM/DD/YYYY) ACoR" CERTIFICATE OF LIABILITY INSURANCE 1/8/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: (OR)Heffernan Insurance Brokers PHONE FAX 5100 SW Macadam, Suite 440 A/c No Ext•503-226-1320 A/c No):503-226-1478 E-MAIL Portland OR 97239 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED COMMACT-08 INSURER B: Community Action Council of Lewis, Mason &Thurston Counties INSURERC: 3020 Willamette Dr. NE INSURERD: Lacey WA 98516 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1662793430 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR IN POLICYNUMBER MM/DD/YYYY MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y PHPK1720952 10/1/2017 10/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PREM SES Ea occurrence $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑PRO ❑LOC PRODUCTS-COMP/OPAGG $2,000,000 X JECT OTHER: $ A AUTOMOBILE LIABILITY PHPK1720952 10/12017 10/12018 COMBINED SINGLE LIMIT $ Ea accident 1 000 000 IX ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLA LIAB X OCCUR PHUB602795 10/12017 10/12018 EACH OCCURRENCE $1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED I X RETENTION$to 000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/M EMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability PHPK1720952 10/12017 10/12018 Aggregate $2,000,000 Ea.Professional incl $1,000,000 Crime - Limit$250,000 Ded.$5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:As per contract or agreement on file with insured.Mason County,its officials,employees and agents are included as an additional insured on General Liability policy per the attached endorsement,if required.Waiver of Subrogation is included on General Liability policy per the attached endorsement,if required. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mason County ACCORDANCE WITH THE POLICY PROVISIONS. attn:Todd Parker 411 N. 5th Street AUTHORIZED REPRESENTATIVE Shelton,WA 98584 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PI-GLD-HS(10/11) K. Key and Lock Replacement—Janitorial Services Client Coverage SECTION I—COVERAGES, SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the"clients"premises due to theft or other loss to keys entrusted to you by your"client," up to a$10,000 limit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members,officers, "employees", "managers", directors,trustees, authorized representatives or any one to whom you entrust the keys of a"client"for any purpose commit,whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: a. "Client"means an individual,company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent"employee" as defined in Paragraph (1)above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee"does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm,factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any"manager,"director or trustee except while performing acts coming within the scope of the usual duties of an "employee." c. "Manager"means a person serving in a directorial capacity for a limited liability company. L. Additional Insureds SECTION II-WHO IS AN INSURED is amended as follows: 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators—Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors—Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your"employees"are also insureds for"bodily injury"to a co- "employee"while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a)as it applies to managers of a limited liability company. c. Broadened Named Insured—Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part. However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source—Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers—At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises—Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment—Automatic Status When Required in Lease Agreement With You—Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such person or organization is to be added as an additional insured on your policy. Such person or Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) organization is an insured only with respect to liability for"bodily injury,""property damage"or "personal and advertising injury'caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds,this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. h. Grantors of Permits—Any state or political subdivision granting you a permit in connection with your premises subject to the following additional provision: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with the premises you own, rent or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. L Vendors—Only with respect to"bodily injury" or"property damage"arising out of"your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: (1) The insurance afforded the vendor does not apply to: (a) "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; Page 8 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Sub-paragraphs (d) or(fl; or (ii) Such inspections, adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization,from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. j. Franchisor—Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by Contract—Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily injury," "property damage"or"personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations I. Owners, Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage"or"personal and advertising injury"caused, in whole or in part, by: (1) Your acts or omissions;or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 9 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) m. State or Political Subdivisions—Any state or political subdivision as required, subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) 'Bodily injury,""property damage"or"personal and advertising injury"arising out of operations performed for the state or municipality; or (b) "Bodily injury"or"property damage"included within the"products-completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition applies only when the'occurrence"or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit' is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) m. State or Political Subdivisions—Any state or political subdivision as required,subject to the following provisions: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, and is required by contract. (2) This insurance does not apply to: (a) 'Bodily injury,""property damage"or"personal and advertising injury"arising out of operations performed for the state or municipality; or (b) 'Bodily injury"or"property damage"included within the"products-completed operations hazard." M. Duties in the Event of Occurrence, Claim or Suit SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 2. is amended as follows: a. is amended to include: This condition applies only when the`occurrence"or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. b. is amended to include: This condition will not be considered breached unless the breach occurs after such claim or"suit' is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. N. Unintentional Failure To Disclose Hazards SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 6. Representations is amended to include the following: It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. O. Transfer of Rights of Recovery Against Others To Us SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, 8.Transfer of Rights of Page 10 of 12 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. ©2011 Philadelphia Indemnity Insurance Company PI-GLD-HS(10/11) Recovery Against Others To Us is deleted in its entirety and replaced by the following: If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,the insured will bring "suit"or transfer those rights to us and help us enforce them. Therefore,the insured can waive the insurer's rights of recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. P. Liberalization SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, is amended to include the following: If we revise this endorsement to provide more coverage without additional premium charge, we will automatically provide the additional coverage to all endorsement holders as of the day the revision is effective in your state. Q. Bodily Injury—Mental Anguish SECTION V—DEFINITIONS, Paragraph 3. Is deleted in its entirety and replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above)at any time. R. Personal and Advertising Injury—Abuse of Process, Discrimination If COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE is not otherwise excluded from this Coverage Part, the definition of"personal and advertising injury' is amended as follows: 1. SECTION V—DEFINITIONS, Paragraph 14.b. is deleted in its entirety and replaced by the following: b. Malicious prosecution or abuse of process; 2. SECTION V—DEFINITIONS, Paragraph 14. is amended by adding the following: Discrimination based on race, color, religion, sex, age or national origin, except when: a. Done intentionally by or at the direction of, or with the knowledge or consent of: (1) Any insured; or (2) Any executive officer, director, stockholder, partner or member of the insured; b. Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; Page 11 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ©2011 Philadelphia Indemnity Insurance Company EXHIBIT E SAMPLE FORMS AND INSTRUCTIONS CDBG PUBLIC SERVICES GRANT QUARTERLY BENEFICIARY REPORT This report is due Oct.31 (for 1St Qtr.),Jan 31 (for 2nd Qtr.),Apr.30(for 3rd Qtr.),July 15 (for 4'Qtr.) Instructions follow. Grantee Name: Submission Date: Subrecipient CDBG Contract Number: Name: Reporting ❑ 11t Quarter(July-Sept) ❑2nd Quarter(Oct-Dec) ❑3rd Quarter(Jan-March) ❑41h Quarter(Apr-June) Period 2017-2018 —_ THE TOTAL NUMBER OF: VT Quarter 2nd Quarter 3"'Quarter 41''Quarter Cumulative PERSONS ASSISTED IN 2017-2018 OF THE TOTAL NUMBER OF PERSONS ASSISTED,THE NUMBER OF PERSONS WITH: NEW OR CONTINUING ACCESS TO SERVICE/BENEFIT IMPROVED ACCESS TO SERVICE/ BENEFIT RECEIVING A SERVICE/BENEFIT THAT IS NO LONGER SUBSTANDARD 15TQuarter 2"d Quarter 3"Quarter 41h Quarter Cumulative RACE/ETHNICITY OF BENEFICIARIES # #of # #of # #of # #of # #of Hispanic Hispanic Hispanic Hispanic Hispanic WHITE 0 0 B LA CK/A FRICA N A MERICA N 0 0 ASIAN 0 0 AMERICAN INDIAN/ALASKAN NATIVE 0 0 NATVE HAWAIIAN/OTHER PACIFIC 0 0 ISLANDER AMERICAN INDIAN/ALASKAN NATIVE 0 0 AND WHITE ASIAN AND WHITE 0 0 BLACK/AFRICANAMERICAN AND WHITE 0 0 AMERICAN INDIAN/ALASKAN NATIVE 0 0 AND BLACK/AFRICAN AMERICAN OTHER MULTI-RACIAL 0 0 TOTALS 0 0 0 0 0 0 0 0 0 0 HISPANIC*=Hispanic is an ethnic group and not a racial group. For example: a person can be both Hispanic and White,or Hispanic and Black/African American,but cannot be designated only as Hispanic. BENEFICIARY INCOME DATA %OFHUD ADJUSTED MEDIAN 1STQuarter 211 Quarter 3rd Quarter 4111 Quarter Cumulative FAMILY INCOME 0-30%(VERY LOW-INCOME) 0 31-50% (LOW-INCOME) 0 51-80% (MODERATE INCOME) 1 0 81%AND ABOVE 1 0 TOTALS 0 0 0 0 0 Briefly describe the quarter's public services accomplishments: (i.e., 150 meals provided to senior citizens, drug counseling provided to 25 people,etc.) Signature Date of Signature I certify that all CDBG funds expended for personnel costs are directly attributed to CDBG eligible activities. Printed name,title and phone number of person completing or signing this form: INSTRUCTIONS This report is due on Oct.31 (for 11t Qtr.),Jan 31 (for 2'Qtr.),Apr.30(for 3rd Qtr.),and July 15(for 41 Qtr.)No voucher will be paid unless your quarterly reports are up to date. This form should be completed and signed by the contract subrecipient and sent to the CDBG grantee(county). Then the CDBG grantee(county)is to review the form and send it to the CDBG project manager.Retain a copy for your records. This form has been updated to calculate totals in each column. To activate the imbedded Excel table in the worksheet,double click on the table area;to close the worksheet,click outside the table area.All section totals must match. Total Number of Persons Assisted: The unduplicated beneficiary count is a count of individuals and not a count of the services received.Unduplicated means each person is counted only once during the calendar year.Only report individuals you maintain written records on.These records must be established at the time the person first receives services from the agency. Since in one quarter an individual may receive any or all of the services listed on your CDBG application's Project Description and Low-and Moderate Income Benefit table,you must establish the most appropriate one service(I,N or S)to count the beneficiary under. EXAMPLE 1: Bob visits the food bank in first quarter,and needs rental assistance in the 2nd quarter.While he was served 2 times,from 2 different services over 2 quarters,he is only one individual. His unduplicated cumulative count for the quarterly beneficiary report is one(1)in the first quarter. Bob is counted only once for the year,the first service he received that year. EXAMPLE 2: Bob,Bill and Jane visit the food bank during the 2'and 4'quarters. Bill also gets rental assistance in the 2nd quarter. Jane receives job training in the 4'quarter.The unduplicated count of persons receiving benefit is three(3).Even though multiple services were provided only 3 persons were actually assisted during the year.Each person would be recorded once,on the first month of recorded assistance. EXAMPLE 3:In the third quarter,Jeff visits the food bank and also meets monthly with a case manager. Jeff would be counted once in the third quarter and year. On the CDBG application's Project Description and LMHBenefit Table,the food bank is designated as an Improved(I)service and case management services are designated as a New/Continuing(1)service for the agency. So even though Jeff received food bank assistance first,the agency determined his one count is best reported as an(1)service count since that was the most significant service Jeff received that quarter. Race/Ethnicity: Insert the racial group and ethnicity for the unduplicated clients served during this reporting period.When completing this section, if the individual is not Hispanic or Latino,use the first column labeled#Total.If the individual is Hispanic,use the first column to identify race(which gives us a total),then count the individual in the second column,which is a subset of the first column. Income: Insert the unduplicated clients(not households)served whose household income is Very Low-Income(0-30%),Low Income(31- 50%)and Moderate Income(51-80%)based on family size,the relevant area median income,and CDBG income limits. The current CDBG income limits for each county are available on the CDBG website at www.commerce.wa.goykft under Guidance Materials. For LMI Limited Clientele activities such as a public services targeting one of the"presumed benefit"groups below,HUD allows us to use and report the following income levels instead of collecting specific household income. Abused Children Very Low Income Illiterate Adults Low Income Battered Spouses Low Income Persons with AIDS Low Income Severely Disabled Adults Low Income Migrant Farm Workers Low Income Elderly Low Income >ro� WASHINGTON STATE DEPARTMENT OF COMMERCE X114, 5 AGENCY NUMBER IDIS PROJECT NUMBER Commerce Contract Number A19 VOUCHER DISTRIBUTION 1030 17-62210-010 AGENCY NAME INSTRUCTION TO VENDOR OR CLAIMANT: DEPARTMENT OF COMMERCE Submit this form to claim payment for materials,merchandise or services. ATTN: CDBG Show complete detail for each item. PO BOX 42525 OLYMPIA,WA 98504-2525 Vendor's Certificate: I hereby certify under perjury that the items and totals listed herein are proper charges for materials,merchandise or services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without VENDOR OR CLAIMANT(Warrant is to be payable to:) discrimination because of age,sex,marital status,race,creed,color,national origin,handicap, religion or Vietnam era or disabled veterans status. MASON COUNTY By: PO BOX 429 (SIGN IN BLUE INK) SHELTON,WA 98580-4292 REPORTING PERIOD: (TITLE) (DATE) Description QUANTITY AMOUNT PREVIOUSLY AMOUNT REMAINING BUDGET REQUESTED THIS INVOICE BALANCE 7578 05 Public Services 99,289.00 $99,289.00 $0.00 $0.00 7579 21A General Admin 3,500.00 $3,500.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL PAYMENT REQUEST $102,789.00 $0.001 0.00 $102,789.00 Everything below this line is for Dept of Commerce FED TAX ID A PROGRAM APPROVAL DATE DOC DATE CURRENT DOC.NO. REFERENCE DOC NO. VENDOR NUMBER SWV0001893-11 ACCOUNT NO. ASD NUMBER VENDOR MESSAGE 33275 CDBG P mt# M SUB TRANS 0 MASTER SUB SUB GL ACCT SUBSID INVOICE CODE D INDEX OBJ OBJ AMOUNT NUMBER 62270320 NZ 15152 17-62210-010 SIGNATURE OF ACCOUNTING PREPARER FOR PAYMENT DATE WARRANTTOTAL ACCOUNTING APPROVAL FOR PAYMENT DATE MASON COUNTY AGENDA ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS From: Frank Pinter Action Agenda _x_ Public Hearing Other DEPARTMENT: Support Services EXT: 530 DATE: January 16, 2018 Agenda Item # g �� Commissioner staff to complete) BRIEFING DATE: January 8, 2018 BRIEFING PRESENTED BY: Frank Pinter [ ] ITEM WAS NOT PREVIOUSLY BRIEFED WITH THE BOARD Please provide explanation of urgency ITEM: Rate Increase for Mason County Baseball Field Use Background: Mason County Parks has not increased the field use fees since 2009 and is bringing forward to the BOCC a rate increase consistent with Resolution 10-09 and Fees and Charges Policy for Parks. We would like to add supplemental fees to increase the field revenue and hopefully be able to rehire the layed-off staff employees and maintain a basic level of field maintenance. Organized Youth $16/2hr Practice, $28/Game Organized Adult $23/2hr Practice, $34/Game Tournaments $140/Field, $$978/Full Complex, $34/Game Evening Only Misc. Charge $16/hr. 50% deposits required at time of booking Deposit refund if booking cancelled within 3 months of play 1000/0 If cancelled within 1 to 3 months of play 50% If cancelled within 1 to 15 days of play 100/0 If cancelled within 15 to 2 days of play 50/0 If cancelled within 24 hours of play 00/0 If cancelled by Parks Department for reason of weather 1000/0 Cleanup Fee if field is not returned in condition it was received or cigarette butts or garbage are left on the Synthetic Turf fields $250/occurrence Biohazard Cleanup Fee to remove body fluids $400/occurrence Supplemental Fees Per. Field 3.5'X 8' sign on outfield fence $200/yr. $350/2 yrs. 3.5'X 8' sign in preferred location $375/yr. $675/2 yrs. Sponsor is responsible for purchasing sponsor banner County Staff will erect banner and remove at end of season RECOMMENDED ACTION: Approve the above reference fee schedule C Ie-FK MASON COUNTY AGENDA ITEM SUMMARY FORM TO: BOARD OF MASON COUNTY COMMISSIONERS From: Casey Bingham Action Agenda _X_ Public Hearing Other DEPARTMENT: Community Services (Public Health) EXT: _562 COMMISSION MEETING DATE: 1/16/18 Agenda Item # Commissioner staff to complete) BRIEFING DATE: 1/8/18 BRIEFING PRESENTED BY: Dave Windom [] ITEM WAS NOT PREVIOUSLY BRIEFED WITH THE BOARD Please provide explanation of urgency: ITEM: Consolidated Contract #CLH18253 Background: This Consolidated Contract CLH18253 will provide funding in years 2018-2020. This contract supersedes Contract C17118 which covered years 2015-2017. This initial contract is a boiler plate for amendments that will come from DOH. Programs Included: 1. Maternal & Child Health Block Grant 50,771.00 2. Onsite Sewage Management 174,304.00 3. Drinking Water Group A Program 26,000.00 4. Drinking Water Group B Program 2,500.00 5. Emergency Preparedness 191917.00 6. Immunizations 7,944.00 7. Prescription drug Overdose Prevention 33,400.00 8. Recreational Shellfish 7,500.00 9. Onsite Septic Implementation 60,000.00 These are all Current and budgeted Programs in the 2018 budget. RECOMMENDED ACTION: Move to approve Contract CLH18253 between State of Washington Department of Health and Mason County. Attachment(s): Consolidated Contract CLH18253 IWarissa WHO Consent Con Con C17118.doc i DOH CONTRACT#: CLH18253 2018 -2020 WASHINGTON STATE DEPARTMENT OF HEALTH CONSOLIDATED CONTRACT Page 1 of 17 i DOH CONTRACT#: CLH18253 Table of Contents 1. Purpose ....................................................................................................................................3 2. Statements of Work.................................................................................................................3 3. Exhibits....................................................................................................................................3 4. Definitions ...............................................................................................................................3 5. Funding and Billing.................................................................................................................4 6. Contract Management..............................................................................................................5 7. Access to Records....................................................................................................................5 8. All Writings Contained Herein................................................................................................5 9. Assignment..............................................................................................................................5 10. Assurances...............................................................................................................................5 11. Confidential Information.........................................................................................................6 12. Ethics.......................................................................................................................................6 13. Debarment Certification..........................................................................................................6 14. Disputes...................................................................................................................................6 15. Equipment Purchases...............................................................................................................6 16. Governing Law and Venue......................................... ...................................7 17. Independent Capacity i 18. Insurance..................................................................................................................................7 19. Licensing,Accreditation and Registration ... 7 20. Maintenance of Records..........................................................................................................7 21. Modifications and Waivers......................................................................................................7 22. No Third-Party Rights Created................................................................................................7 23. Nondiscrimination...................................................................................................................7 24. Order of Precedence ................................................................................................................8 25. Ownership of Material/Rights in Data.....................................................................................8 26. Publications..............................................................................................................................8 I27. Responsibility for Actions.......................................................................................................8 28. Loss or Reduction of Funding ...................................................8 29. Severability..............................................................................................................................8 30. Subcontracts.............................................................................................................................8 31. Subrecipient.............................................................................................................................9 32. Survivability ............................................................................................................................9 33. Term.........................................................................................................................................9 34. Termination for Convenience..................................................................................................9 35. Termination for Default...........................................................................................................9 36. Termination Procedure............................................................................................................9 Standard Federal Certifications and Assurances........................................................................11 Federal Assurances-Non-Construction Programs....................................................................16 i 2018-2020 Consolidated Contract Page 2 of 17 I I i DOH CONTRACT#: CLH18253 CONSOLIDATED CONTRACT between STATE OF WASHINGTON DEPARTMENT OF HEALTH (Referred to as"DOH") and MASON COUNTY PUBLIC HEALTH (Referred to as"LHJ") for THE DELIVERY OF PUBLIC HEALTH SERVICES FOR THE PERIOD OF January 1,2018 through December 31,2020 1. Purpose This Contract is entered into in accordance with RCW 43.70.520,RCW 43.70.580,the general statutory powers of the Secretary of the Department of Health(DOH),including at RCW 43.70.040,the general statutory powers of local health jurisdictions(LHJs), including at RCW 70.05.060,RCW 70.08.020,and RCW 70.46.060,and the authority for joint or cooperative action provided for under chapter 39.34 RCW. The purpose of this Contract is to define the parties'joint and cooperative relationship. The contract and all statements of work adopted under its provisions are intended to implement applicable objectives under the Public Health Improvement Plan and to facilitate the delivery of public health services to the people in Washington State. This Contract is the result of cooperative planning efforts between the LHJ and DOH. 2. Statements of Work The individual program activities, requirements, and outcomes/deliverables to be achieved by the parties under this Contract are described in Exhibit A, Statements of Work. Each statement of work shall comply with the performance- based criteria under RCW 43.70.580(2)(b). The LHJ shall furnish the necessary personnel,equipment,material and/or services and otherwise do all things necessary for or incidental to the performance of the work as set forth in Exhibit A, Statements of Work. 3. Exhibits This Contract incorporates by reference the following Exhibits: • Exhibit A-Statements of Work • Exhibit B-Allocations • Exhibit C-Schedule of Federal Awards 4. Definitions As used throughout this Contract and unless amended for a particular Statement of Work,the following terms shall have the meanings set forth below: "Budget, Accounting, and Reporting System (BARS)": The system designed by the State Auditor's office for collecting,consolidating,and reporting financial budgeting and accounting information from all local governmental units. "Client": An agency,firm, organization, individual or other entity applying for or receiving services provided by the LHJ under this Contract. "Catalog of Federal Domestic Assistance(CFDA)": The unique identifying code assigned to a federal assistance program which identifies the awarding agency. "Confidential Information": Information protected from disclosure under federal or state law. 2018-2020 Consolidated Contract Page 3 of 17 DOH CONTRACT#: CLH18253 "Contract Coordinator": Each party's designated contact for all notices required or permitted under this Contract. "Contracting Officer": The DOH Contracts and Procurement Office Director and his/her delegates within that office authorized to execute this agreement on behalf of DOH. "Contractor": An entity that provides goods or services to DOH and others. A contractor normally operates its business in a competitive environment, provides its goods and/or services to many different purchasers during normal business hours,and is not subject to the compliance requirements of the federal program. "Equipment": When used in this Contract is defined as an article of non-expendable,tangible property other than land, buildings, or fixtures which is used in operations and having a useful life of more than one year and an acquisition cost of$5,000 or more or as otherwise provided in the Exhibit A, Statements of Work. "Federal Assistance": Assistance provided by a federal agency in the form of grants, contracts, loans, loan guarantees, property, cooperative agreements, interest subsidies, insurance, or direct appropriations, but does not include direct federal cash assistance to individuals. "Federal Funding Accountability and Transparency Act(FFATA or the Transparency Act)": A federal act to make information available online so the public can see how federal funds are spent. "Fixed Assets": Fixed assets are property and/or equipment obtained through donation,gift,purchase,capital lease, or construction with a service life of more than one year. "Program Contact": Each party's designated contact for those purposes identified in the Exhibit A, Statements of Work. "Subcontractor": Any individual or group contracted with the LHJ to perform all or part of the services included in this Contract. This term will also apply to situations where an LHJ's subcontractor contracts with another individual or group to perform all or part of the services included in its agreement with the LHJ. I "Subrecipient" or "Subgrantee": A non-federal entity that receives a subaward of federal grant money or goods directly or indirectly from DOH and makes decisions regarding who can receive what federal assistance; has its performance measured against the objectives contained in the DOH agreement with the federal government;makes decisions on how to operate the program to accomplish the program goals;has the obligation to comply with federal Subrecipient requirements; and/or use federal funds to carry out a program for the public purpose specified in the authorizing statute. 5. Funding and Billing A. DOH shall pay the LHJ for services asset forth in the Exhibit A,Statements of Work,not to exceed funding amounts as detailed in the Contract Allocations,Exhibit B,for those services provided herein. The LHJ will advise the Program Contact identified in the applicable Statement of Work in writing 90 calendar days prior to the end of the funded period,or as soon as practicable thereafter, if the LHJ anticipates not using all Contract funding. B. If the Exhibit A, Statement of Work, is supported by federal funds that require compliance with FFATA (the Transparency Act),the corresponding checkbox on the statement of work will be checked. C. Total consideration for this Contract is$382,336,or as amended. The LHJ will submit accurate and timely billings which,for clarity and consistency,will be prepared using the form provided and following the instructions located on the DOH website,www.doh.wa.gov. DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable costs as outlined in the statement of work and/or budget. 2018-2020 Consolidated Contract Page 4 of 17 i DOH CONTRACT#: CLH18253 D. The LHJ will submit a BARS A financial report by April 15 for the prior calendar year. 6. Contract Management Unless otherwise specified in the Contract,the following individuals are the contacts("Contract Coordinators")for all notices required or permitted under this Contract: LHJ Contract Coordinator: DOH Contract Coordinator: Name: Lydia Buchheit Name: Brenda Henrikson Title: Contracts Specialist Mailing Address: Mailing Address: 415 N.6'h Street Bldg 81 Shelton WA 98584 PO Box 47905,Olympia WA 98504-7905 Physical Address: Ph sical Address: Same as above 101 Israel Rd. SE,Tumwater WA 98501-5570 i Phone: 360-427-9670 Fax: 360-427-7787 Phone: 360-236-3933 Fax: 360-236-2401 Email Address: Email Address: lydiab@co.mason.wa.us brenda.henrikson@doh.wa.gov A party may change its Contract Coordinator or its Program Contact by providing written notice to the other party. DOH Program Contacts can be found in the Exhibit A, Statements of Work, and on the DOH website at www.doh.wa.gov. 7. Access to Records To the extent authorized by applicable federal and state law, the parties shall provide access to records relevant to this Contract to each other, the Joint Legislative Audit and Review Committee, the State Auditor, and authorized federal officials,at no additional cost. Inspections shall occur at reasonable times and upon reasonable notice. 8. All Writings Contained Herein This Contract contains all the terms and conditions agreed upon by the parties. No other understandings,oral or otherwise, regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. The individuals signing this Contract certify by their signatures that they are authorized to sign this Contract on behalf of their respective entity. 9. Assignment Except for subcontracting as authorized in this Contract,the LHJ shall not assign or delegate, in whole or in part,this Contract or any of its rights, duties, obligations, or responsibilities, without the prior written consent of DOH's Contracting Officer,which consent shall not be unreasonably withheld. 10. Assurances The parties agree that all activity pursuant to this Contract shall be in accordance with all applicable current federal, state and local laws,rules,and regulations. The LHJ acknowledges its agreement to comply with federal certifications and assurances by signing and returning the following: 1. Standard Federal Certifications and Assurances 2. Federal Assurances for Non-Construction Programs 2018-2020 Consolidated Contract Page 5 of 17 DOH CONTRACT#: CLH18253 11. Confidential Information The parties agree to comply with all state and federal statutes and regulations relating to Confidential Information. DOH and LHJ will limit access to the Confidential Information to the fewest number of people necessary to complete the work. Everyone having access to Confidential Information covered by this Contract must agree to protect the confidentiality of the information. Either party to this Contract may designate certain Confidential Information as "Confidential Information/Notice Requested."The designation shall be made by clearly stamping,watermarking, or otherwise marking each page of the Confidential Information. If a third party requestor seeks information that has been marked "Confidential Information/Notice Requested," notice shall be given to the marking party prior to release of the information. Such notice shall be provided to the program contact no less than five (5) business days prior to the date of disclosure, to allow the party objecting to disclosure to seek a protective order from the proper tribunal. DOH and LHJ agree to establish, document and maintain security practices and safeguards consistent with state and federal laws, regulations, standards, and guidelines to prevent unauthorized access, use, or disclosure of Confidential Information in any form. In accordance with federal and state contracting requirements, DOH may monitor, audit, or investigate LHJ management of Confidential Information relating to this Contract. Working together, the LHJ and DOH may use any and all tools available to track Contract related Confidential Information. If one of the parties becomes aware of an actual or suspected breach of confidentiality,that party will promptly notify the Contract Coordinator for the other party of the facts. The parties will work within their respective organizations to take any steps necessary to determine the scope of the breach and to restore reasonable security to the Confidential Information. Both parties agree to mitigate any known harmful effects of a breach in confidentiality,including notifying affected individuals to the extent required by law. The parties will also reasonably cooperate with law enforcement as appropriate. 12. Ethics Both parties and their officers shall comply with all ethics laws applicable to their- activities under this Contract, ! including Chapters 42.23 and 42.52 RCW. If a violation occurs and is not cured within a reasonable time after notice, the other party shall have the right to terminate this Contract. This section is expressly subject to the Disputes section of this Contract. i 13. Debarment Certification The LHJ,by signing this Contract,certifies that the LHJ is not presently debarred,suspended,proposed for debarment, declared ineligible, or voluntarily excluded from participating in this Contract by any federal department or agency. The LHJ also agrees to include the above requirement in all subcontracts into which it enters. The LHJ will notify DOH of any such events that may occur during the term of the Contract. 14. Disputes Except as otherwise provided in this contract, when a dispute arises between the parties and it cannot be resolved by direct negotiation,the parties agree to participate in good faith in non-binding mediation. The mediator shall be chosen by agreement of the parties. If the parties cannot agree on a mediator,the parties shall use a mediation service located in Washington State that selects a qualified mediator for the parties. Each party shall bear its own costs for mediation and each party shall contribute equally to the mediator's fee,if any. The parties agree that mediation shall precede any action in a judicial tribunal. Nothing in this contract shall be construed to limit the parties' choice of a mutually acceptable alternate dispute resolution method in addition to the dispute resolution procedure outlined above. 15. Equipment Purchases Equipment purchased by the LHJ for use by the LHJ or its subcontractors during the term of this Contract using federal funds, in whole or in part,shall be the property of the LHJ. The use, management and disposal of the equipment must comply with federal requirements. These requirements are found in the Office of Management and Budget's(OMB's) 2018-2020 Consolidated Contract Page 6 of 17 DOH CONTRACT#: CLH18253 Uniform Guidance,Title 2 Code of Federal Regulations Part 200(2 CFR 200)-Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, or are included in the federal funding agency's regulations. i 16. Governing Law and Venue The laws of the state of Washington govern this Contract. In the event of a lawsuit by the LHJ against DOH arising under this Contract, venue shall be proper only in Thurston County, Washington. In the event of a lawsuit by DOH j against the LHJ arising under this Contract,venue shall be proper only in the county in which the LHJ is located or in either of the two nearest judicial districts within the meaning of RCW 36.01.050. 17. Independent Capacity The employees or agents of each party who are engaged in the performance of this Contract shall continue to be employees or agents of that party and shall not be considered for any purpose to be employees or agents of the other party. 18. Insurance The LHJ certifies that it is self-insured, is a member of a risk pool, or maintains insurance coverage as required by this Contract. Each party shall pay for losses for which it is found liable. The LHJ agrees to require all subcontractors to maintain insurance in types and with limits as may be determined by the LHJ and/or its risk manager,unless the LHJ and DOH agree otherwise. i i 19. Licensing,Accreditation and Registration The LHJ shall comply with all applicable local,state,and federal licensing,accreditation and registration requirements and standards,necessary for the performance of this Contract. 20. Maintenance of Records Each party to this Contract shall maintain books, records,documents and other evidence that sufficiently and properly reflect all direct and indirect costs expended by it. All books,records, documents, and other material relevant to this Contract will be retained for six(6)years after expiration.If any litigation,claim or audit is started before the expiration of the six-year period,the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved. Each party will use reasonable security procedures and protections to assure that records and documents provided by the other party are not erroneously disclosed to third parties. Both parties agree to continue protecting records until such time as the information is destroyed in accordance with applicable state and federal records retention laws. 21. Modifications and Waivers This Contract,or any term or condition,may be modified only by a written amendment signed by the DOH Contracting Officer and the authorized representative for the LHJ. Either party may propose an amendment. Failure or delay on the part of either party to exercise any right,power,privilege or remedy provided under this Contract shall not constitute a waiver.No provision of this Contract may be waived by either party except in a writing signed by the DOH Contracting Officer or the authorized representative of the LHJ. 22. No Third-Party Rights Created This Contract, or any program hereunder, is entered into solely for the benefit of the two parties thereto and shall not be construed as giving rise to any right,remedy or expectancy of any kind or nature on the part of any third party. 23. Nondiscrimination During the performance of this Contract,the LHJ and DOH shall comply with all federal and state nondiscrimination laws, regulations and policies. In the event of the LHJ'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,and the LHJ may be declared 2018-2020 Consolidated Contract Page 7 of 17 DOH CONTRACT#: CLH18253 ineligible for further contracts with DOH. The LHJ shall, however, be given a reasonable time in which to cure this noncompliance. Any dispute may be resolved in accordance with the"Disputes"procedure set forth herein. 24. Order of Precedence In the event of an inconsistency in the terms of this Contract,or between its terms and any applicable statute or rule,the inconsistency shall be resolved by giving precedence in the following order: • Applicable state and federal statutes,and local laws,rules and regulations. • Terms and conditions of this Contract. • Statements of Work. • Any other provisions of this Contract, including other materials incorporated by reference. 25. Ownership of Material/Rights in Data Records and other documents relevant to this Contract, in any medium, furnished by one party to this Contract to the other party, will remain the property of the furnishing party, unless otherwise agreed. Data which is delivered under the Contract shall be transferred to DOH with a nonexclusive, royalty-free, perpetual, irrevocable license to publish, translate,reproduce, modify,deliver, perform,dispose of,and to authorize others to do so; provided that such license shall be limited to the extent which the LHJ has a right to grant such a license. The LHJ shall exert all reasonable effort to advise DOH, at the time of delivery of data furnished under this Contract, of all known or potential invasions of privacy contained therein and of any portion of such document which was not produced in the performance of this Contract. DOH shall receive prompt written notice of each notice or claim or copyright infringement received by the LHJ with respect to any data delivered under this Contract. DOH shall have the right to modify or remove any restrictive markings placed upon the data by the LHJ,provided that if DOH modifies or removes such markings without the LHFs approval,it assumes all liability for doing so. 26. Publications Any program reports, articles, and publications that result from information gathered through use of state and federal funds must acknowledge receiving support from DOH and/or the appropriate federal agencies. Correspondingly, such documents resulting from information gathered through use of local funds must acknowledge receipt of such local support. 27. Responsibility for Actions Each party to this Contract shall be solely responsible for the acts and omissions of its own officers, employees, and agents in the performance of this Contract. Neither party to this Contract will be responsible for the acts and omissions of entities or individuals not party to this Contract. DOH and the LHJ shall cooperate in the defense of tort lawsuits, when possible. 28. Loss or Reduction of Funding In the event funding from state,federal,or other sources is withdrawn,reduced,or limited in any way after the effective date of this contract and prior to normal completion,DOH may elect to suspend or terminate the contract, in whole or in part, under the "Termination for Convenience" clause with a ten (10) business day notice to LHJ, to the extent possible, subject to renegotiation at DOH's discretion under those new funding limitations and conditions. 29. Severability If any term or condition of this Contract is held invalid,such invalidity shall not affect the validity of the other terms or conditions of this Contract,provided,however,that the remaining terms and conditions can still fairly be given effect. 30. Subcontracts The LHJ may subcontract any or all of the services or other obligations specified in this Contract. The LHJ will require the subcontractor to comply with all the applicable terms and conditions of this Contract,including all terms,conditions, certifications and assurances. The LHJ agrees it is responsible for assuring adequate performance on the part of the subcontractor. 2018-2020 Consolidated Contract Page 8 of 17 DOH CONTRACT#: CLH18253 The parties agree that all subcontractors must be responsible for any liabilities created by their actions or omissions. In the event DOH,LHJ,and subcontractor are found by a jury or trier of fact to be jointly and severally liable for personal injury damages arising from any act or omission,then each entity shall be responsible for its proportionate share. 31. Subrecipient For those activities designated as "subrecipient" on Exhibit A, Statements of Work, the LHJ must comply with applicable federal requirements, including but not limited to OMB's Uniform Guidance at 2 CFR 200, Subparts D (Administrative Requirements), E (Cost Principles) and F (Audit Requirements), and program specific federal regulations. If the LHJ expends $500,000 or more in federal awards from all sources, it is responsible for obtaining appropriate audits. If the LHJ expends$750,000 or more in federal grants or awards from all sources,it is responsible for obtaining the required single audit. 32. Survivability The terms and conditions contained in this Contract, which by their sense and context are intended to survive the expiration of the Contract,shall survive. Surviving terms include,but are not limited to:Access to Records,Confidential Information, Disputes, Responsibility for Actions, Maintenance of Records, Ownership of Material/Rights in Data, Subcontracts,Termination for Convenience,Termination for Default, and Termination Procedure. 33. Term This Contract will be in effect following execution by the parties from January 1, 2018 through December 31, 2020, unless terminated earlier as provided herein. 34. Termination for Convenience Except as otherwise provided in this Contract, either party may terminate or suspend this Contract, or any program hereunder,for convenience by providing at least thirty(30)days' advance written notice to the other party. If DOH elects to suspend the Contract,in whole or in part,LHJ shall stop work as of the effective date of DOH's written notice of suspension. During suspension,each Party will reasonably notify the other of any conditions that may affect resumption of performance. Upon DOH's written notice to resume performance, LHJ shall resume work unless the LHJ provides notice to DOH that services cannot be resumed. If LHJ cannot resume performance, the Contract or affected Exhibit A, Statement of Work, will be deemed terminated upon the date the LHJ received notice to suspend performance. 35. Termination for Default (a) In the event of a default by either party under this Contract,the nondefaulting party may give written notice to the defaulting party that it intends to terminate this Contract,or any program hereunder,if the default is not cured within thirty(30)days of the date of the notice,or such longer period of time as may be reasonable under the circumstances. If the default is not cured within that time,the nondefaulting party may then notify the defaulting party in writing that this Contract is terminated. In the event of such termination,the nondefaulting party shall have all rights and remedies available to it under general law. j (b) A disputed termination for default is expressly subject to the Disputes section of this Contract. 36. Termination Procedure Upon termination DOH may require the LHJ to deliver to DOH any non-LHJ-owned equipment,data,or other property specifically produced or acquired for the performance of such part of this Contract as has been terminated. DOH shall pay to the LHJ the agreed upon price, if separately stated, for completed work and services accepted by DOH. In addition DOH shall pay the amount determined by DOH's Contracting Officer for(a)completed work and services for which no separate price is stated,(b)partially completed work and services,(c)other property or services which are accepted by DOH, and(d)the protection and preservation of the property. Disagreement by the LHJ with the determination of DOH's Contracting Officer that relates to the obligations or amounts due to the LHJ shall be considered a dispute within the meaning of the"Disputes"clause of this Contract. 2018-2020 Consolidated Contract Page 9 of 17 DOH CONTRACT#: CLH18253 DOH may withhold from any amounts due the LHJ for such completed work or services such sum as DOH's Contracting Officer reasonably determines to be necessary to protect DOH against potential loss or liability. The rights and remedies of DOH provided in this section shall not be exclusive and are in addition to any other rights and remedies provided by law or under this Contract. After receipt of a written notice of termination,the LHJ shall: • Stop work under the Contract on the date and to the extent specified in the notice; • Place no further orders or subcontracts for materials,services,or facilities,except as necessary to complete such portion of the work not terminated; • Assign to DOH,to the extent reasonably directed by DOH's Contracting Officer and to the extent that the LHJ has the legal right to do so, all of the right, title, and interest of the LHJ under the orders and subcontracts in which case DOH has the right, at its reasonable discretion,to settle or pay any or all claims arising out of the termination of such orders and subcontracts. • Settle all outstanding liabilities and all claims arising out of orders or subcontracts, with the approval or ratification of DOH's Contracting Officer to the extent he/she may reasonably require, which approval or ratification shall be final for all the purposes of this clause; • Transfer title to DOH and deliver,as reasonably directed by DOH's Contracting Officer,any property which, if the Contract had been completed,would have been required to be furnished to DOH; • Complete performance of such part of the work not terminated by DOH's Contracting Officer;and, j • Take such action as may be necessary,or as DOH's Contracting Officer may reasonably direct,for the protection and preservation of the property related to this Contract which is in the possession of the LHJ, or its subcontractors,and in which DOH has or may acquire an interest. I IN WITNESS WHEREOF,the parties have executed this Contract. i MASON COUNTY PUBLIC HEALTH STATE OF WASHINGTON i DEPARTMENT OF HEALTH I I I Signature Signature I Title: Title: I Print Name: Print Name: Date: Date: 2018-2020 Consolidated Contract Page 10 of 17 DOH CONTRACT#: CLH18253 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 Department of Health. CERTIFICATIONS 1. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION The undersigned (authorized official signing for the contracting organization) certifies to the best of his or her knowledge and belief,that the contractor, defined as the primary participant in accordance with 45 CFR Part 76,and its principals: A. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transactions by any Federal Department or agency; Have not within a 3-year period preceding this contract been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,making false statements,or receiving stolen property; B. Are not presently indicted or otherwise criminally or civilly charged by a governmental entity(Federal,State,or local)with commission of any of the offenses enumerated in paragraph(b)of this certification;and C. Have not within a 3-year period preceding this contract had one or more public transactions (Federal, State, or local)terminated for cause or default. Should the contractor not be able to provide this certification, an explanation as to why should be placed after the assurances page in the contract. The contractor agrees by signing this contract that it will include,without modification,the clause titled Certification Regarding Debarment, Suspension, In eligibility, and Voluntary Exclusion--Lower Tier Covered Transactions in all lower tier covered transactions(i.e.,transactions with sub-grantees and/or contractors)and in all solicitations for lower tier covered transactions in accordance with 45 CFR Part 76. 2. CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS The undersigned(authorized official signing for the contracting organization)certifies that the contractor will,or will continue to,provide a drug-free workplace in accordance with 45 CFR Part 76 by: A. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition; B. Establishing an ongoing drug-free awareness program to inform employees about: 1) The Dangers of drug abuse in the workplace; 2) The contractor's policy of maintaining a drug-free workplace; 3) Any available drug counseling,rehabilitation,and employee assistance programs;and 4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C. Making it a requirement that each employee to be engaged in the performance of the contract be given a copy of the statement required by paragraph 1)above; 2018-2020 Consolidated Contract Page 11 of 17 DOH CONTRACT#: CLH18253 D. Notifying the employee in the statement required by paragraph 1), above, that, as a condition of employment under the contract,the employee will: 1) Abide by the terms of the statement;and 2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; E. Notifying the agency in writing within ten calendar days after receiving notice under paragraph D. 2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice,including position title,to every contract officer or other designee on whose contract activity the convicted employee was working,unless the Federal agency has designated a central point for the receipt of such notices.Notice shall include the identification number(s)of each affected grant; F. Taking one of the following actions, within 30 calendar days of receiving notice under paragraph D. 2) with respect to any employee who is so convicted: 1) Taking appropriate personnel action against such an employee,up to and including termination,consistent with the requirements of the Rehabilitation Act of 1973,as amended;or 2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; G. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (A),(B),(C),(D),(E),and(F). For purposes of paragraph (E)regarding agency notification of criminal drug convictions, DOH has designated the following central point for receipt of such notices: Compliance and Internal Control Officer Office of Grants Management WA State Department of Health PO Box 47905 Olympia,WA 98504-7905 3. CERTIFICATION REGARDING LOBBYING Title 31, United States Code, Section 1352, entitled "Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions," generally prohibits recipients of Federal grants and cooperative agreements from using Federal(appropriated)funds for lobbying the Executive or Legislative Branches of the Federal Government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also requires that each person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with non-Federal(nonappropriated)funds.These requirements apply to grants and cooperative agreements EXCEEDING $100,000 in total costs(45 CFR Part 93). The undersigned (authorized official signing for the contracting organization) certifies, to the best of his or her knowledge and belief,that: A. No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any person for influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract,grant,loan,or cooperative agreement. B. If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,the undersigned shall complete and submit Standard Form-LLL,"Disclosure of Lobbying 2018-2020 Consolidated Contract Page 12 of 17 DOH CONTRACT#: CLH18253 Activities," in accordance with its instructions. (If needed, Standard Form-LLL, "Disclosure of Lobbying Activities,"its instructions,and continuation sheet are included at the end of this application form.) C. The undersigned shall require that the language of this certification be included in the award documents for all subcontracts at all tiers(including subcontracts, subcontracts,and contracts under grants, loans and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352,U.S.Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. 4. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT(PFCRA) The undersigned(authorized official signing for the contracting organization)certifies that the statements herein are true,complete,and accurate to the best of his or her knowledge,and that he or she is aware that any false,fictitious, or fraudulent statements or claims may subject him or her to criminal, civil, or administrative penalties. The undersigned agrees that the contracting organization will comply with the Public Health Service terms and conditions of award if a contract is awarded. 5. CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE Public Law 103-227, also known as the Pro-Children Act of 1994 (Act),requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health,day care,early childhood development services,education or library services to children under the age of 18,if the services are funded by Federal programs either directly or through State or local governments,by Federal grant,contract,loan,or loan guarantee.The law also applies to children's services that are provided in indoor facilities that are constructed,operated,or maintained with such Federal funds.The law does not apply to children's services provided in private residence, portions of facilities used for inpatient drug or alcohol treatment, service providers whose sole source of applicable Federal funds is Medicare or Medicaid, or facilities where WIC coupons are redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. By signing the certification, the undersigned certifies that the contracting organization will comply with the requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act. The contracting organization agrees that it will require that the language of this certification be included in any subcontracts which contain provisions for children's services and that all subrecipients shall certify accordingly. The Public Health Services strongly encourages all recipients to provide a smoke-free workplace and promote the non-use of tobacco products.This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. 6. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS-INSTRUCTIONS FOR CERTIFICATION By signing and submitting this proposal,the prospective contractor is providing the certification set out below. A. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction.The prospective contractor shall submit an explanation of why it cannot provide the certification set out below.The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction.However,failure of the prospective contractor to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 2018-2020 Consolidated Contract Page 13 of 17 i DOH CONTRACT#: CLH18253 B. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective contractor knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government,the department or agency may terminate this transaction for cause of default. C. The prospective contractor shall provide immediate written notice to the department or agency to whom this contract is submitted if at any time the prospective contractor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. D. The terms covered transaction,debarred,suspended,ineligible,lower tier covered transaction,participant,person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549.You may contact the person to whom this contract is submitted for assistance in obtaining a copy of those regulations. E. The prospective contractor agrees by submitting this contract that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by DOH. F. The prospective contractor further agrees by submitting this contract that it will include the clause titled Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered Transaction,provided by HHS,without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. G. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction,unless it knows that the certification is erroneous.A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List(of excluded parties). H. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. I. Except for transactions authorized under paragraph 6.of these instructions,if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government,DOH may terminate this transaction for cause or default. 7. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS-PRIMARY COVERED TRANSACTIONS A. The prospective contractor certifies to the best of its knowledge and belief,that it and its principals: 1) Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transactions by any Federal department or agency; 2) Have not within a three-year period preceding this contract been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain, or performing a public(Federal,State or local)transaction or contract under a public transaction;violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,making false statements,or receiving stolen property; 3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity(Federal, State or local)with commission of any of the offenses enumerated in paragraph 1.B.of this certification;and 4) Have not within a three-year period preceding this contract had one or more public transactions (Federal, State or local)terminated for cause or default. 2018-2020 Consolidated Contract Page 14 of 17 i DOH CONTRACT#: CLH By signing the certification, the undersigned certifies that the contracting organization will comply with the requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act. The contracting organization agrees that it will require that the language of this certification be included in any subcontracts which contain provisions for children's services and that all subrecipients shall certify accordingly. The Public Health Services strongly encourages all recipients to provide a smoke-free workplace and promote the non-use of tobacco products.This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. 6. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS INSTRUCTIONS FOR CERTIFICATION By signing and submitting this proposal,the prospective contractor is providing the certification set out below. A. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction.The prospective contractor shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective contractor to furnish a certification or an explanation shall disqualify such person from participation in this transaction. B. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective contractor knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government,the department or agency may terminate this transaction for cause of default. C. The prospective contractor shall provide immediate written notice to the department or agency to whom this i contract is submitted if at any time the prospective contractor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. D. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,primary covered transaction,principal,proposal,and voluntarily excluded,as used in this clause,have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the person to whom this contract is submitted for assistance in obtaining a copy of those regulations. E. The prospective contractor agrees by submitting this contract that,should the proposed covered transaction be entered into,it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by DOH. F. The prospective contractor further agrees by submitting this contract that it will include the clause titled Certification Regarding Debarment, Suspension,Ineligibility and Voluntary Exclusion--Lower Tier Covered Transaction, provided by HHS, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. G. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List(of excluded parties). H. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause.The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 2018-2020 Consolidated Contract Page 15 of 18 i DOH CONTRACT#: CLH I. Except for transactions authorized under paragraph 6. of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible,or voluntarily excluded from participation in this transaction,in addition to other remedies available to the Federal Government,DOH may terminate this transaction for cause or default. 7. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS-PRIMARY COVERED TRANSACTIONS A. The prospective contractor certifies to the best of its knowledge and belief,that it and its principals: 1) Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transactions by any Federal department or agency; 2) Have not within a three-year period preceding this contract been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,or performing a public(Federal, State or local)transaction or contract under a public transaction;violation of Federal or State antitrust statutes or commission of embezzlement,theft, forgery, bribery, falsification or destruction of records,making false statements,or receiving stolen property; 3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity(Federal, State or local)with commission of any of the offenses enumerated in paragraph 1.B. of this certification; and 4) Have not within a three-year period preceding this contract had one or more public transactions(Federal, State or local)terminated for cause or default. B. Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective contractor shall attach an explanation to this contract. AUTHORIZED SIGNATURE REQUIRED SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE PLEASE PRINT OR TYPE NAME: ORGANIZATION NAME:(if applicable) DATE 2018-2020 Consolidated Contract Page 16 of 18 i i i i DOH CONTRACT#: CLH Federal Assurances—Non-Construction Programs Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project(0348-0040), Washington,DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED,FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your projector program. If you have questions,please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.If such is the case,you will be notified. As the duly authorized representative of the contractor,I certify that the contractor: 1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost)to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency,the Comptroller General of the United States,and if appropriate,the State,through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest,or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. ❑❑4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration(5 C.F.R.900,Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination.These include but are not limited to:(a)Title VI of the Civil Rights Act of 1964(P.L.88-352)which prohibits discrimination on the basis of race,color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. ❑❑1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex;(c)Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C. ❑794),which prohibits discrimination on the basis of handicaps; (d)the Age Discrimination Act of 1975,as amended (42 U.S.C. ❑❑6101-6107),which prohibits discrimination on the basis of age;(e)the Drug Abuse Office and Treatment Act of 1972(P.L.92-255),as amended,relating to nondiscrimination on the basis of drug abuse;(f)the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) =l 523 and 527 of the Public Health Service Act of 1912(42 U.S.C. ❑C 290 dd-3 and 290 ee 3),as amended,relating to confidentiality of alcohol and drug abuse patient records;(h)Title VIII of the Civil Rights Act of 1968(42 U.S.C. E 3601 et seq.),as amended,relating to nondiscrimination in the sale,rental or financing of housing;(i)any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s)which may apply to the application. 7. Will comply,or has already complied,with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646)which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs.These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 2018-2020 Consolidated Contract Page 17 of 18 i DOH CONTRACT#: CLH 8. Will comply,as applicable,with the provisions of the Hatch Act(5 U.S.C. 1501-1508 and 7324-7328)which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 9. Will comply,as applicable,with the provisions of the Davis-Bacon Act(40 U.S.C. `17276a to 276a-7),the Copeland Act(40 U.S.C. 'L-276c and 18 U.S.C. F 874)and the Contract Work Hours and Safety Standards Act(40 U.S.C. ❑❑ 327-333),regarding labor standards for federally assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is$10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order(EO) 11514; (b)notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d)evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972(16 U.S.C. -i 1451 et seq.);(f)conformity of Federal actions to State(Clear Air)Implementation Plans under Section 176(c)of the Clear Air Act of 1955,as amended(42 U.S.C. -17401 et seq.);(g)protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h)protection of endangered species under the Endangered Species Act of 1973,as amended,(P.L.93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968(16 U.S.C. -❑1721 et seq.)related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974(16 U.S.C. -469a-1 et seq.). 14. Will comply with P.L.93-348 regarding the protection of human subjects involved in research,development,and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. ❑-'2131 et seq.) pertaining to the care,handling,and treatment of warm blooded animals held for research,teaching,or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act(42 U.S.C. '_E4801 et seq.)which prohibits the use of lead-based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1'996 and OMB Supercircular 2 CFR 200, Subpart F. 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program. AUTHORIZED SIGNATURE REQUIRED SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE PLEASE PRINT OR TYPE NAME ORGANIZATION NAME(if applicable) DATE 2018-2020 Consolidated Contract Page 18 of 18 I MASON COUNT'PUBLIC HEALTH 2018-2020 CONSOLIDATED CONTRACT#CLH18253 EXHIBIT A-STATEMENTS OF WORD TABLE OF CONTENTS DOH Program Name or Title: Maternal & Child Health Block Grant- Effective January 1,2018.....................................................................................................2 DOH Program Name or Title: NEP SSI Onsite Sewage Management- Effective January 1,2018 ...................................................................................................6 DOH Program Name or Title: Office of Drinking Water Group A Program-Effective January 1,2018........................................................................................25 DOH Program Name or Title: Office of Drinking Water Group B Program -Effective January 1,2018........................................................................................29 DOH Program Name or Title: Office of Emergency Preparedness&Response- Effective January 1,2018..................................................................................31 DOH Program Name or Title: Office of Immunization &Child Profile-Effective January 1, 2018...............................................................................................36 DOH Program Name or Title: OSS LMP Implementation -Effective January 1,2018 ...................................................................................................................42 DOH Program Name or Title: Prescription Drug Overdose Prevention for States Supplement- Effective January 1,2018...........................................................45 DOH Program Name or Title: Recreational Shellfish Activities-Effective January 1,2018 ..........................................................................................................47 Exhibit A, Statements of Work Page i of 48 Contract Number CLH 18253 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Maternal&Child Health Block Grant- Local Health Jurisdiction Name: Mason County Public Health Effective January 1,2018 Contract Number: CLH18253 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment ® Federal Subrecipient (check if applicable) ® Reimbursement Period of Performance: January 1,2018 through September 30,2018 ❑ State ® FFATA(Transparency Act) ❑ Fixed Price ❑Other Ej Research&Development Statement of Work Purpose: The purpose of this statement of work is to support local interventions that impact the target population of the Maternal and Child Health Block Grant. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date FFY18 MCHBG LHJ CONTRACTS 93.994 333.93.99 78120281 01/01/18 09/30/18 0 50,771 50,771 TOTALS 1 0 50,771 50,771 Task Task/Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information Number Standards/Measures and/or Amount Maternal and Child Health Block Grant(MCHBG)Administration la Participate in calls,at a minimum of every Designated LHJ staff will participate September 30,2018 Reimbursement for quarter,with DOH contract manager.Dates in contract management calls. actual costs,not to and time for calls are mutually agreed upon exceed total funding between DOH and I.HJ consideration. Action Ib Report actual expenditures for October 1, Submit actual expenditures using the May 26,2018 Plan and Progress 2017 through March 31,2018 MCHBG Budget Workbook to DOH Reports must only contract manager reflect activities paid 1 c Develop 2018-2019 MCHBG Budget Submit MCHBG Budget Workbook September 5,2018 for with funds provided Workbook for October 1,2018 through to DOH contract manager in this statement of September 30,2019 using DOH provided work for the specified template. funding period. See Program Specific Re uirements and Exhibit A,Statements of Work Page 2 of 48 Contract Number CLH 18253 Task Task/Activity/Description 'Mav Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information Number Standards/Measures and/or Amount Special Billing Requirements. MCHBG Assessment and Evaluation 2a Participate in project evaluation activities Documentation using report template September 30,2018 Reimbursement for developed and coordinated by DOH, as provided by DOH actual costs,not to requested. exceed total funding 2b Report program level strategy measure data Documentation using report template January 15,2018 consideration. (CSHCN,UDS,ACEs). provided by DOH April 15,2018 July 15,2018 See Program Specific Requirements and Special Billing Re uirements. MCHBG Implementation 3a Develop 2018-2019 MCHBG Action Plan Submit MCHBG Action Plan to Draft August 17,2018 Reimbursement for for October 1,2018 through September 30, DOH contract manager Final September 5,2018 actual costs,not to 2019 using DOH-provided template. exceed total funding 3b Report activities and outcomes of 2017-2018 Submit Action Plan monthly reports Monthly,on or before consideration.Action MCHBG Action Plan using DOH-provided to DOH contract manager the 1511'of the following Plan and Progress template. month Reports must only reflect activities paid for with funds provided in this statement of work for the specified funding period. See Program Specific Requirements and Special Billing Requirements. Children with Special Health Care Needs(CSHCN) 4a Complete Child Health Intake Form(CHIF) Submit CHIF data into Secure File January 15,2018 Reimbursement for using the CHIF Automated System on all Transport(SFT)website: April 15,2018 actual costs,not to infants and children served by the CSHCN hqps://sft.wa.gov July 15,2018 exceed total funding Program as referenced in CSHCN Program consideration.Action Manual. Plan and Progress Exhibit A,Statements of Work Page 3 of 48 Contract Number CLI-I18253 Task Task/Activity/Description "May Support PHAB Deliverables/Outcomes Due Date/Time Frame Payment Information Number Standards/Measures and/or Amount Reports must only Ensure client data is collected on all children reflect activities paid served by CSHCN contractors,including for with funds provided neurodevelopmental centers,regional in this statement of maxillofacial coordinators,and the DOH work for the specified Newborn Screening Program. funding period. 4b Administer requested DOH Diagnostic and Submit completed Health Services 30 days after forms are Treatment funds for infants and children per Authorization forms and Central completed. See Program Specific CSHCN Program Manual when funds are Treatment Fund requests directly to Requirements and used. the CSHCN Program as needed. Special Billing 4c Participate in the CSHCN Regional System Submit Action Plan monthly reports Monthly,on or before Requirements. and quarterly meetings as described in the including number of regional the 15"'of the following CSHCN Program Manual. meetings attended to the DOH month contract manager. *For information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: li!tp://www.pliaboard.org/wp-content/uploads/P HA B-Standards-and-Measures-Vers ion-L 0 pdf Program Specific Requirements/Narrative Special Requirements Federal Funding Accountabilitv and Transparenev Act(FFATA) This statement of work 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 the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Data Universal Numbering System(DUNS©)number. Information about the LHJ and this statement of work will be made available on USASpending.�ov by DOH as required by P.L. 109-282. Program Manual,Handbook,Policy References Children with Special Health Care Needs Manual-htt: /�v\Nw.doh.wa.gov/Portals/l/Documents/Pubs/970-209-CSHCN-Manual pdf Health Services Authorization(HSA)Form http://www.doh.wa.gov/Portals/l/Documents/Pubs/910-002-ApprovedHSA docx Restrictions on Funds(what funds can be used for which activities,not direct payments,etc) 1. At least 30%of federal Title V funds must be used for preventive and primary care services for children and at least 30%must be used services for children with special health care needs. [Social Security Law, Sec. 505(a)(3)]. Exhibit A,Statements of Work Page 4 of 48 Contract Number CLH 18253 2. Funds may not be used for: a. Inpatient services,other than inpatient services for children with special health care needs or high risk pregnant women and infants,and other patient services approved by Health Resources and Services Administration(HRSA). b. Cash payments to intended recipients of health services. c. The purchase or improvement of]and,the purchase,construction,or permanent improvement of any building or other facility,or the purchase of major medical equipment. d. Meeting other federal matching funds requirements. e. Providing funds for research or training to any entity other than a public or nonprofit private entity. f. payment for any services furnished by a provider or entity who has been excluded under Title XVIII(Medicare),Title XIX(Medicaid),or Title XX(social services block grant).[Social Security Law,Sec 504(b)]. 3. If any charges are imposed for the provision of health services using Title V(MCH Block Grant)funds,such charges will be pursuant to a public schedule of charges;will not be imposed with respect to services provided to low income mothers or children;and will be adjusted to reflect the income,resources,and family size of the individual provided the services. [Social Security Law,Sec. 505 (1)(D)]. Monitoring Visits(frequency,type) Telephone calls with contract manager at least one every quarter,and annual site visit. Special Billing Requirements Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable A]9-1 A invoice voucher. Payment to completely expend the"Total Consideration" for a specific funding period will not be processed until all deliverables are accepted and approved by DOl-1. Invoices must be submitted monthly by the 30th of each month following the month in which the expenditures were incurred and must be based on actual allowable program costs. Billing for services on a monthly fraction of the"Total Consideration"will not be accepted or approved. DOH Program Contact Mary Dussol Community Consultant Office of Family and Community Health hmprovement Washington State Department of Health Street Address: 310 Israel Rd SE,Tumwater,WA 98501 Mailing Address:PO Box 47848,Olympia,WA 98504 Telephone: 360-236-3781 /Fax:360-236-3646 Email: ma .dussol doh.wa.gov Exhibit A,Statements of Work Page 5 of 48 Contract Number CLH 18253 Exhibit A Statement of Work Contract Term: 2018-20207 DOH Program Name or Title: NEP SSI Onsite Sewage Management- Local Health Jurisdiction Name: Mason County Public Health Effective January 1,2018 Contract Number: CLH18253 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment ® Federal Subrecipient (check if applicable) ® Reimbursement Period of Performance: January 1,2018 through March 31,2019 ❑ State ® FFATA(Transparency Act) ❑ Fixed Price ❑ Other ❑ Research&Development Statement of Work Purpose: The purpose of this statement of work is for Mason County Public Health(MCPH)to protect public health by minimizing the public's effects of onsite septic systems(OSS)on surface water,assure effective treatment and disposal of sewage on a long-term basis,minimize potential for public exposure to sewage,uphold and comply with design,installation,and management requirements for OSS to accommodate effective treatment and disposal of sewage on a longterm basis,and enhance protection of environmentally sensitive areas within the Oakland Bay and Hammersley Inlet shellfish growing areas. Mason County Public Health(MCPH)will employ previously successful tools used by the health department such as following up on unsatisfactory service events and complaints,creating as-builts to complete records,completing parcel surveys,offering monitary operation and maintenance(O&M)incentives,notifying OSS owners of an overdue O&M status and educating the public about O&M and water quality. MCPH will identify and correct non-point source pollution sources by conducting a monitoring program for optical brighteners. MCPH will also prioritize for the emergency closure growing area of Hammersley Inlet to implement OSS regulation and increase O&M compliance. MCPH will develop,enhance,and review risk-based protocols to support the work. Mason County Public Health(MCPH)will work with the Washington Department of Health(DOH)to develop and implement a risk based on-site sewage system evaluation program within the Hammersley inlet area. The program will employ previously successful tools used by the health department such as file review,parcel evaluations,sampling(fecal coliform and optical brightener),dye studies,notifying homeowners of overdue O&M evaluations,offering O&M incentives,and educating the public about O&M and water quality. Mason County Public Health will focus primarily on the Hammersley Inlet shoreline and upland area.Outreach and education activities will also occur in the Oakland Bay watershed including Uncle John's Creek which feeds Oakland Bay's Chapman Cove. NOTE:This statement of wort:(SOW)carries forward incomplete tasks and unspent funds from the 2015-2017 consolidated contract SOW.Total spending between the two SOWS may not exceed the total award amount of$202,407.There are multiple funding sources for this award.See Special Instructions for spending requirements from each funding source. NOTE 2: Dates that precede January 1,2018 are for reference only. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date NEP 5-6 ONSITE SEWAGE MANAGEMENT 66.123 333.66.12 261Al2A5 01/01/18 03/31/19 0 74,426 74,426 PS SSI 1-5 OSS TASK 4 66.123 333.66.12 261KI209 01/01/18 03/31/19 0 99,878 99,878 TOTALS 0 174,304 174,304 Exhibit A,Statements of Work Page 6 of 48 Contract Number CLI 118253 GOALS& MEASURABLE OBJECTIVES This simply summarizes key deliverables and measures called out in the tasks below. This table is a component of the FEATS report. Description (e.g.,"shellfish beds reopened") Units Targets (e.g."acres") (°number") Complete Task 0.3 Evaluation Plan Evaluation Plan 1 Complete Task 1.1 Project Factsheet Project Factsheet 1 Change the status of 19 parcel closures from Closed to Open in the growing area of Hammersley Inlet Parcel Open 19 Growing Area QAPP QAPP 1 Optical Brightener Policy&Procedure Plan I Risk Based On-Site Sewage System Evaluation Policy&Procedure Plan I Updated OSS Dye Testing Policy&Procedure Plan 1 Fecal coliform monitoring plan Plan 1 Number of Hammersley Inlet fecal coliform samples collected Samples 600 Number of Hammersley Inlet Optical Brighteners(OB)pads analyzed by Mason County Public Health OB pads analyzed(MCPH) 600 MCPH Number of Hammersley Inlet Optical Brighteners(OB)pads analyzed by Ozark Underground Laboratory OB pads analyzed(OUL) 60 OUL Number of sanitary surveys conducted in Hammersley Inlet Sanitary Surveys Up to 10 200 Investigative fecal coliform monitoring Samples Up to 30 Risk based list of parcels for field evaluation in Hammersley Inlet List 1 Risk based list of parcels requiring OSS dye studies. List 1 Number of dye tests conducted in Hammersley Inlet Dye Tests 100%of parcels identified to bed e tested Number or percentage of OSS failures found that have been fixed OSS Failures repaired or in repair 100% process Number of OSS Rebates distributed Rebates 100 Oakland Bay Day EDDM for DOH approval Mailer 1 Number of Oakland Bay Day Mailers went in 2018 EDDMs sent Up to 12,000 Number of Oakland Bay Day Mailers went in 2019 EDDMs sent Up to 12,000 Oakland Bay overdue O&M educational mailings Mailings Up to 80 Mailer for community meeting for DO]i approval Mailer I Final Project Report Report 1 Exhibit A, Statements of Work Page 7 of 48 Contract Number CLH 18253 Task *May Support PHAB Payment Task/Activity/Description Standards/Measures Deliverables/Outcomes Due Date/Time Frame Information Number and/or Amount NEP ONSITE SEWAGE MANAGEMENT ROUNDS 5-6—CFDA 66.123 THESE FUNDS MUST BE SPENT FIRST. Costs for activities charged to this grant will not exceed$74,426. All A19-lA invoice vouchers for these expenditures will be billed to NEP 5-6 ONSITE SEWAGE MANAGEMENT(Master Index Code 261Al2A5). FEATS,MBE/WBE,and any other reporting for activities conducted under Cooperative Agreement#OOJ88801 and will reference this agreement number. See Special Instructions for applicable federal Terms and Conditions for this agreement. NEP SHELLFISH STRATEGIC INITIATIVE ONSITE SEWAGE MANAGEMENT—CFDA 66.123 THESE FUNDS CAN ONLY BE SPENT AFTER ALL NEP OSS ROUNDS 5-6 FUNDS ARE SPENT. Costs for activities charged to this grant will not exceed$99,878. All A]9-1 A invoice vouchers for these expenditures will be billed to PS SSI 1-5 TASK 4(Master Index Code 261 K1204).FEATS,MBE/WBE,and any other reporting for activities conducted under Cooperative Agreement#OOJ 18001 and will reference this agreement number. See Special Instructions for applicable federal Terms and Conditions for this agreement. TASK 0. PROJECT DEVELOPMENT This task must be completed before initiating any other work under this subaward.Work completed prior to the completion of Task 0 will be ineligible for reimbursement under this subaward. 0.1 Project Spatial Data and Climate Change Project Spatial Data and September 15,2017 Reimbursement Assessment Climate Assessment up to$0 based In the tasks below subrecipients will create a on actual costs. detailed project outline and timeline to describe This was included as project expectations and outcomes.The detailed informational only for contract project plan will also identify how the negotiations,not intended to objectives of the project will be evaluated, stay in contract. including quantifiable performance measures and targets.DOH will review project to see if actions may have climate change intersections. If there is a strong climate change interconnections,DOH will work with the subrecipient on how the project may be developed to be climate resilient. DOH will work with the subrecipient on the plan and establish mutual expectations. Subrecipients should provide relevant spatial data for their project,and this should be identified in the detailed project plan. Subrecipients should consult with technical staff and spatial analysts where appropriate to determine the spatial data,associated metadata, and data storage location that are relevant for Exhibit A,Statements of Work Page 8 of 48 Contract Number CLH18253 the project.All subrecipients should submit project coordinates(latitude, longitude)in decimal degrees. 0.2 Quality Assurance Project Plan (QAPP) QAPP Within 60 days of award Development Subrecipient will submit a Quality Assurance MCPH will work with Kitsap Project Plan(QAPP)or QAPP waiver using Public Health District,Hood Environmental Protection Agency's(EPA's) Canal Coordinating Council, National Estuary Program(NEP)guidance for Island County Public Health, QAPPs. If a QAPP is required,subrecipients and Department of Ecology will work with the Washington State (ECY)to develop an approved Department of Ecology's QA Officer to develop QAPP. and approve the QAPP. Work related to collecting environmental data may not begin until the QAPP or waivers are completed and approved. See EPA Programmatic Condition#5 in this agreement for more information. 0.3 Evaluation Plan Complete a short one-page Within 30 days of award document. Use it to plan the process your program will use to gather information or collect data. Following the project,it will be used to assist in describing what the outcome results tell you about the impact and success of your program activities. TASK I.PROJECT MANAGEMENT AND REPORTING This task describes the data collection and reporting requirements associated with this subaward.Maintenance of project records,submittal of payment vouchers,fiscal forms, and progress reports;compliance with applicable procurement,contracting and interlocal agreement requirements;application for,receipt of,and compliance with all required permits,licenses,easements,or property rights necessary for the project and submittal of required performance items. Carry out project in accordance with any completion dates outlined in the agreement. Refer to and comply with all underlying federal terms and conditions. 1.1 Project Factsheet Project Fact Sheet August 30,2017 Reimbursement Create a project factsheet(using included up to$4,603 template)and submit it in MS Word with the based on actual first quarterly progress report. costs. 1.2 Bi-monthly(ConCon invoices are due every 60 Bi-monthly invoice and project Due annually: days)Invoicing and Progress Summary summaries. The Subrecipient will email bi-monthly progress June 15 summary and invoicing related to project tasks FEATS will serve as project August 15 and deliverables to the contract manager.The summary for performance October 1 (FEATS) summary period is synced to inform the Grant periods that fall on or near December 15 Program's EPA reporting schedule;therefore it FEATS due dates.See FEATS March 15(FEATS) is critical that the Project Sponsor submit these schedule in Task 1.2.1. summaries to the Grant Program according to Exhibit A,Statements of Work Page 9 of 48 Contract Number CLH 18253 the following schedule. Progress Summaries Annual Performance Periods shall include,at a minimum: • A description of the work completed in the First Period: last performance period, including total January 1 —February spending by the project sponsor and any partners and any completed deliverables. Second Period: • The status and completion date for the March—April(FEATS) project activities and near-term deliverables. Third Period: • Description of any problem or May—June 30 circumstances affecting the completion date,scope of work,or costs. Fourth Period: • Evidence that all the reporting requirements July 1 —August have been satisfactorily completed(see below). Fifth Period: September—October(FEATS) Sixth Period: November—December 1.2.1 Financial and Ecosystem Accounting Tracking Semi-annual FEATS reports April I System(FEATS) October 1 Complete semi-annual FEATS progress reports, FEATS will serve as project as well as a final FEATS report.The final summary for performance And upon contract completion FEATS report,reflecting the final project periods that fall on or near billing,will be provided during project closeout, FEATS due dates. See FEATS after the end of the grant,and will describe the schedule in Task 1.2.1. entire project,highlighting project outcomes and discussing lessons learned.See EPA Programmatic Condition 91. 1.2.2 Puget Sound Partnership Required Near-Term 1. Implementation Status l: March 31-April 28,2017 Actions(NTA)Reporting November 1-30,2017 NTA owners are required to report on the May 1-31,2018 following: Upon prcject/NTA • Implementation status of their actions on a completion or semiannual basis November 2018 • Financial status of their actions on an annual basis 2. Financial Status 2.:June 30-August 15,2017 June 29-August 13,2018 Upon project/NTA completion or August 2019 1.2.3 Women/Minority-Owned Business MBE/WBE Reporting October 15 annually (MBE/WBE)Reports MBE/WBE reporting is required annually.This And upon project completion federal reporting is required for assistance agreements where there are funds budgeted for procuring construction,equipment,services and Exhibit A,Statements of Work Page 10 of 48 Contract Number CLH 18253 supplies,including funds budgeted for direct procurement by the recipient or procurement under subawards or loans in the"Other" category that exceed the threshold amount of $150,000,including amendments and/or modifications. 1.3 Final Project Report Final Report and updated Fact Upon project completion A final report will be written by the project Sheet owners that describes the methods,results, lessons learned and recommendations for future work. The final report will evaluate the success of achieving the performance measures identified in the detailed project plan. Included with the final project report will be an updated Project Fact Sheet see 1.1 . TASK 2. POLICY DEVELOPMENT AND REVIEW MCPH will develop a policy and procedure that will be used in the implementation of a sampling plan to include the analysis of optical brighteners. in addition,MCPH will develops and implements a risi<based analysis of all OSS along the shoreline of Hammersley Inlet to assure the systems are functioning properly and not impacting surface water. Policies and procedures,using existing practices in Mason and other counties,will be developed. 2.1 OB Policy&Procedure a)QAPP or QAPP addendum a-b)Within 60 days of award Reimbursement MCPH will evaluate,develop,and complete a up to$0 based policy and procedure for OB sampling,analysis, b)Policy and procedure for OB on actual costs. and regulatory implication. MCPH will provide sampling reviewed by DOH a copy to DOH for review and approval. 2.2 Risk Based OSS Evaluation Procedure Development of a risk based Final procedure to DOH by MCPH,in cooperation with DOH,will develop OSS evaluation procedure September 30,2017 a risk based OSS evaluation procedure.The reviewed by DOH. procedure will assess the risk of individual OSS and the potential for impact to surface water. The procedure will assign high,medium,and low tiers with the intent of implementing field- based OSS evaluations and dye studies based on the assigned tier. 2.3 OSS Dye Study Protocol&Procedure a)Evaluation of the current a-b)Final procedure to DOH by Reevaluation OSS dye study protocols and October 31,2017 MCPH, in cooperation with DOH,will evaluate procedures, in cooperation with the county's current OSS dye study protocols DOH and procedures.Protocols will be updated,as necessary,based on current conditions and b)Update current OSS dye evaluation techniques. study protocols and procedures Exhibit A,Statements of Work Page 11 of 48 Contract Number CLH 18253 TASK 3. SHORELINE MONITORING AND"HOT SPOT" IDENTIFICATION Hammersley inlet is a shallow,narrow tidal channel connecting Oakland Bav with the main body of southern Puget Sound.The inlet is approximately 6.5 miles in length and 0.13 mile wide.The entire watershed is approximately 36.5 square miles,most of which is along the southern shoreline. There are approximately 175 small creeks,drainages, culverts,and seeps exist along the shorelines of the inlet. This study will target a minimum of 50 drainages with historically elevated bacteria levels or located near significant upland development. MCPH will use the policies and procedures developed in Task 2 to conduct a pilot project to monitor for optical brighteners(OB)and fecal coliform(FC). Optical brighteners are fluorescent dyes found in most laundry detergents. Since adsorption is critical in the performance of on-site sewage systems(OSS),the presence of OB in surface water may indicate ineffective OSS treatment. Monitoring for OB will help differentiate the source of elevated fecal coliform bacteria levels currently and previously identified in upland drainages. MCPH will work with DOH to develop the sampling plan. General direction of the sampling will include drainage and discharge analysis during both the"wet"and"dry" seasons of the study period. The period of October through April will be considered the"wet"season while May through September will be considered the"dry"season. OB cotton pads will be installed at each site during portions of the evaluation period. Sites will be evaluated for a four week period during both"wet"and"dry"seasons. During these evaluation periods,cotton pads will be replaced each week. Flow measurements and FC samples will be collected when the cotton pads are replaced. Additional FC and OB sampling may be used to investigate and segment drainages with positive OB detections or elevated FC concentrations. Sampling and analysis activities will be performed according the plans and policies developed for the study. MCPH will analyze OB pads under a long wavelength ultraviolet(365 nm) light in-house and verify the results of approximately 10%of the samples at Ozark Underground Laboratory. Fecal coliform samples will be analyzed at a certified laboratory outside Mason County. All results will be provided to DOH. 3.1 OB&Fecal Coliform Sampling a)OB and FC monitoring plan May 31,2019 Reimbursement MCPH will conduct fresh water monitoring at a approved by DOH up to 541,806 minimum of 50 drainages to Hammersley Inlet based on actual to identify the presence of optical brighteners b)Number and results of OB costs. (OB). Sampling at each drainage will occur one cotton sample pads(up to 600) time during the predefined"wet"and"dry" analyzed by MCPH seasons.All OB pads will be analyzed in-house according to developed and approved c) Number and results of OB procedures.Ten percent of the pads will be cotton sample pads analyzed by analyzed by Ozark Underground Laboratory for Ozark Underground Laboratory QA/QC.Simultaneously,the selected drainages (up to 60 for QA/QC) will be monitored for fecal coliform bacteria. Fecal coliform samples will be analyzed by a d)Number and results of fecal certified laboratory. MCPH will develop a coliform monitoring samples. sampling plan in cooperation with DOH. (Up to 600 samples collected by MCPH) e)Number of drainages evaluated along the shorelines of Hammersley Inlet. (A minimum of 50 drainages evaluated. Exhibit A,Statements of Work Page 12 of 48 Contract Number CLH 18253 TASK 4: RISK BASED EVALUATION OF ON-SITE SEWAGE SYSTEMS(OSS) According to a 2016 shoreline survey completed by DOH,there are approximately 350 developed parcels along the Hammersley inlet shorelines using OSS for wastewater treatment and dispersal. Land use is a mix of residential,timber,and agricultural lands with residential development along the fresh and marine water shorelines.Ninety-eight percent of these sites were single family use sites with 60%considered to be full time residential sites. Fifty-eight percent of tyle OSS used gravity distribution for dispersal of effluent and 43%of the systems were greater than 30 years old.To identify impacts fi•om OSS inte shellfish growing areas MCPH will complete an OSS risk based evaluation along Hammersley Inlet. 4.1 OSS Record Search a) In-house record search a) Ongoing. Reimbursement MCPH will complete an OSS record search for and data evaluation for a up to$90,000 all systems along the Hammersley Inlet minimum of 350 First record search due based on actual shoreline. A risk based analysis will be shoreline parcels October 31,2017. costs. completed using the data collected and summarized to prioritize field based analysis. b) Development of a risk b) September 30,2018 This will be a working document that will be based list of parcels for continually revised and updated. field evaluation 4.2 OSS Field Evaluations a)Number of field parcel a) Field evaluation of 100 MCPH will complete"wet"season field surveys.Conduct a minimum of parcels by April 2018 evaluations using the procedures identified in the 200 field parcel surveys in the OSS field evaluation portion of the performance work area. plan outline in Task 2. b)Development of a risk based b) Field evaluation of 100 list of parcels requiring OSS parcels by April 2019 dye studies. c) Summarize number and c) See Task 1. results Deliverables/Outcomes and other progress indicators utilizing DOH Pollution Identification and Correction Implementation Reporting form quarterly. Attach reports to each FEATS report. The final quarterly report will have the cumulative total for the entire project period. 4.3 OSS Dye Testing a) Number of OSS dye tests a) OSS dye test of 30-50% MCPH will complete dye tests of the OSS of completed. A target of parcels by April 2018 concern identified in Task 4.2 using approved 100%of OSS identified dye testing methodologies. in the risk analysis will be OSS dye test of 100%of dye tested. parcels April 2019 b) Number of OSS b) April 2019 deficiencies/failures identified Exhibit A,Statements of Work Page 13 of 48 Contract Number CLH 18253 c) Summarize number and c) See Task 1. results Deliverables/Outcomes and other progress indicators utilizing DOH Pollution Identification and Correction implementation Reporting form quarterly. Attach reports to each FEATS report. The final quarterly report will have the cumulative total for the entire project period. 4.4 OB Positive"Hot Spot"OSS Follow up a) Completed record a) Record search and field MCPH will follow up on positive OB and fecal searches for developed evaluations completed for coliform results identified in Task 3 by parcels near OB postive first"wet"season by.lune completing OSS record searches for those parcels drainages within 30 days 2018 in the vicinity of the implicated drainages. Risk of positive sampling based field evaluation and dye tests shall be results. completed according to the pet-fee plan b) Completed risk based b) Record search and field risk-based OSS evluation procedure outlined in field evaluations of evaluations completed for Task 2. developed parcels near second"wet"season by OB positive drainages May 2019 within 15 days of record search c) Completed risk based c) OSS dye studies completd OSS dye studies of by May 2019 developed parcels near OB positive drainages. d) Up to 30 investigative FC d) May 2019 samples and results. TASK 5. STUDY EDUCATION AND OUTREACH As a member of Mason ECO Net,MCPH will help plan and participate in Oakland Bay Day.Oakland Bay Day is hosted by Mason ECO Net to educate the community about water quality.Mason County will have an educational booth educating attendees about OSS maintenance and regulation and water quality.MCPH will provide twelve thousand (12,000)every door direct mailings(EDDM)to the residents and landowners in the Oakland Bay MRA to encourage attendance. MCPH will educate the shoreline OSS owners within the Hammersley Inlet emergency closure area with an out of date O&M status about their maintenance status and ways to move into compliance.These informational mailings will occur four(4)times throughout the project.The number of mailings will depend on the number of shoreline OSS out of compliance at the time of the mailing. One hundred(100)rebates will be offered first come,first served to incentivize OSS maintenance.A$200 rebate will be offered for O&M or pumping.A second$200 rebate will be offered for the installation of risers or an effluent filter.MCPH will prioritize the rebates first to the OSS owners in the I-lammersley Inlet and then to the general MRA where appropriate.Within each priority area MCPH will offer rebates to OSS with no O&M or out-of-date O&M. MCPH will inform all residents and landowners in the Hammersley Inlet study area,via direct mailing,of the project described in Tasks 2-3 before work starts. The mailing will inform owners of the pending project,the importance of OSS operation and maintenance,and the time,date,and location of the scheduled community-based meeting.At L-project completion, findings will be available for landowner review. Exhibit A,Statements of Work Page 14 of 48 Contract Number CLH 18253 5.1 Oakland Bay Days a) Copy of the direct mailing. a) May 30,2018 Reimbursement MCPH will coordinate and participate in Draft mailer materials May 30,2019 up to$37,895 Oakland Bay Day 2018 and 2019 by providing will be sent to DOH staff based on actual water quality and onsite infonnation at an for review costs. educational booth. b) Number of mailings. b) June 30,2018 MCPI I will send 12,000 EDDM mailings to 12,000 mailings for 2018 inform and invite residents and landowners of the Oakland Bay MRA to Oakland Bay Day to c) Number of mailings. c) June 30.2019 help increase attendance and to track the 12,000 mailings for 2019 effectiveness of EDDM for educational events. d) Coordinate and participate d) July 2018 in Oakland Bay Day July 2019 e) Number of Oakland Bay e) Upon project completion Day 2018 and 2019 attendees who heard about the event through the mailings. MCPH will report outcomes in FEATS. 52 Oakland Bay OSS O&M Educational Mailings up to eighty(80) a)October 2017 Mailings shoreline and upland OSS MCPH will inform all shorelines OSS owners owners within Oakland Bay b)April 2018 within the Oakland Bay Shellfish Growing Area with out of date operation and with out of date OSS of O&M status and next maintenance compliance. c)October 2018 steps for O&M compliance and rebate d)April 2019 information.There will be four 4 mailings. 5.3 OSS Rebates a)Provide up to one hundred a)April 30,2019 Incentives will be offered to OSS owners within (100)rebates the Oakland Bay and Hammersley shellfish growing areas in the form of rebates.Applicants will be required to submit their paid invoices with the proper paperwork to receive the rebate. A$200 rebate will be offered for either maintenance or pumping.A second$200 rebate will be offered to install risers and or effluent filter. If a homeowner self-installs risers or an effluent filter,MCPH will conduct a site visit to inspect the construction. Each interested household will be eligible for both rebates with the maximum amount of$400 per household. MCPH will-offer rebates exclusively to Hammersley Inlet OSS owners until April 201 S. Exhibit A,Statements of Work Page 15 of 48 Contract Number CLH 18253 After April 2018,the rebates offered are first come,first served. Within each priority area MCPH will offer rebates to OSS with no O&M and out of date O&M.MCPH will offer incentives to individuals as well as targeted areas. 5.4 Hammersley Inlet Study Education& Outreach 5.4.1 MCPH will inform all Hammersley Inlet a)Copy of the mailing. Draft a-b)September 2017 shoreline residents and landowners in the study mailer materials will be sent to area,via direct mailing,of the project before DOH staff for review. work starts. The mailing will inform owners of the pending project,the importance of OSS b)Date and number of mailings operation and maintenance,and the time,date, sent(up to 400). and location of the scheduled community-based meeting.At project completion,findings will be available for landowner review. 5.4.2 MCPH will hold one community-based meeting a)Report showing agenda, a) November 2017 to inform the shoreline OSS owners,and other time,date, location and interested parties,of the upcoming project. estimated number of attendees. TASK 6. BROADER IMPACTS AND COMMUNICATION MCPH will participate in and present project outcomes at a knowledge exchange event relevant to the project topic(conference,forum,stakeholder workshop).The subrecipient will submit high-quality project photos or video clips of the project(process,progress,etc.). MCPH will ensure anyone in the photo or video has signed a release in case photos or videos are used for future publications. 6.1 Submit high-quality project photos or videos. a) Photos a) Upon completion of project Reimbursement up to$0 based Participate in and present project outcomes at a b) MCPH will create a poster b) November 2018 or on actual costs. knowledge exchange event relevant to the displaying their results June 2019 depending on project topic. and discussion. workshop schedule c) Draft materials will be c) Upon completion of project sent to DOH staff for review. MCPH will present and display their poster at the South Sound Science Symposium in September 2019 after the close of the grant. Exhibit A,Statements of Work Page 16 of 48 Contract Number CLH 18253 "For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http•//www pliaboard org/wp-contentluplloads/PHAB-Standards-and-Measures-Version-I.O.pol' BUDGET Category Amount Personnel/Salaries $72,734 Fringe Benefits $41,633 Travel $0 Equipment (federal definition) $0 Supplies $750 Contracts $20,500 Lab Services Subawards $0 Name and amount ea. Other $24,630 • Rebates • Postage • EDDM Mailings Total Direct Charges $160,247 Indirect Charges $14,057 (federally approved rate TOTAL $174,304 Program Specific Requirements/Narrative Special Requirements Federal Funding Accountability and Transparency Act(FFATA) This statement of work 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 the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Data Universal Numbering System(DUNS®)number. Information about the LHJ and this statement of work will be made available on USASpendin!% ov by DOH as required by P.L. 109-282. Program Manual,I;andbook,Policy References Mason County's On-site Sewage System Management Plan,December 5,2007 Exhibit A,Statements of Work Page 17 of 48 Contract Number CLH 18253 Special References(RCWs,WACs,etc.) WAC 246-272A,RCW 70.118A,Puget Sound Action Agenda, Interim PIC Program Protocols Federal funds from the Environmental Protection Agency(EPA)National Estuary Program(NEP)Account must be used to implement elements and activities of the local on-site sewage management plans that do not conflict with and are consistent with the goals,strategies,objectives,and actions of the Puget Sound Action Agenda. Monitoring Visits(frequency,type) The DOH program contact may conduct at least one(1)monitoring visit during the life of this project.The type,duration,and timing of visit will be determined and scheduled in cooperation with the subawardee.The DOH Fiscal Monitoring Unit may conduct at least one(1)fiscal monitoring visit during the life of this project. Special Instructions "Unexpended funds,tasks, and deliverables in this statement of work that are not completed by December 31,2017 will be reauthorized for work in 2018 in a new statement of work under the new consolidated contract term beginning January 1,2018.Total spending between the 2015-2017 and 2018-2020 SOWs may not exceed$202,427(award total)." Progress reports are due to DOH via email to tracy.farrell,,@doh.wa.gov and meean.schell�a doh.wa. on the following dates: March 1,2018,September 1 2018,and upon contract completion.Minority and Women-Owned business Reporting is due to kristy.warner(@doh.wa.iZov and cc: tracy.farrellAdoh.wa.gov and me�zan.schell a,doh.wa._-ov on the following dates:October 15 annually, and upon contract completion. All environmental data must be entered by the LHJ into EPA's Storage and Retrieval data system (STORET)at http://www.epa.�ov/STORET.The semi-annual report format and data reporting requirements will be provided by DOH and may be modified throughout the contract period via email announcement. **Note: Deliverables and due dates after December 31,2017 are included in this statement of work for informational purposes only and will be included in a new statement of work under the new consolidated contract term beginning January 1,2018. Program Specific Requirements/Narrative The following provisions are the pass-thru requirements of all U.S. EPA-DOH subawards funded under cooperative agreement PCOI J 18001-0. Administrative Conditions 1. General Terms and Conditions-Effective March 29,2016 The subrecipient agrees to comply with the current EPA general terms and conditions available at: https://www.epa.gov/ rag nts/epa-general-terms-and-conditions-effective- march-29-2016-or-later.These teens and conditions are in addition to the assurances and certifications made as part of the award and terms,conditions or restrictions cited below. The EPA repository for the general terms and conditions by year can be found at: https://www.epa.gov/ rg ants/!rant-terms-and-conditionsggeneral 2. General Terms and Conditions-Consultant Cap-Additional Information In addition to the General Terms and Conditions 46 "Consultant Cap",as of January 1,2016,the limit is$614.48 per day$76.81 per hour. NOTE:For future years'limits,the subrecipient may find the annual salary for Level IV of the Executive Schedule on the following Internet site: http://www.opm. og v/oca. Select"Salary and Wages",and select"Rates of Pay for the Executive Schedule".The annual salary is divided by 2087 hours to determine the maximum hourly rate,which is then multiplied by 8 to determine the maximum daily rate. 3. General Terms and Conditions—Cybersecurity The subrecipient agrees to comply with the current EPA general terms and conditions"Cybersecurity'. The terms and conditions can be found on the EPA Grants Terms and Conditions Website. For STATE:https•//www epa gov/grants/state-C rant-cybersectirity-condition For TRIBE:https://www.epa.gov/ rg ants/tribal-,grant-cybersecurity-condition For Other Recipients: http//www2 epa,,ov/sites/production/files/2015-07/documents/cybersecurityQrantconditionforotherr ecipients.pdf. Exhibit A,Statements of Work Page 18 of 48 Contract Number CLH 18253 4. General Terms and Conditions-indirect Costs for States and Tribal The cost principles of 2 CFR 200 Subpart E are applicable,as appropriate,to this subaward. in addition to the General Terms and Conditions"indirect Cost Rate Agreements", if the subrecipient does not have a previously established indirect cost rate, it agrees to prepare and submit its indirect cost rate proposal in accordance with 2 CFR 200 Appendix VII. For State Agencies The subrecipient must send its proposal to its cognizant federal agency within six(6)months after the close of the governmental unit's fiscal year. if EPA is the cognizant federal agency,the state subrecipient must send its indirect cost rate proposal within six(6)months after the close of the governmental unit's fiscal year to: Regular Mail Financial Analysis and Rate Negotiation Service Center Office of Acquisition Management U.S. Environmental Protection Agency 1200 Pennsylvania Avenue,NW,MC 3802R Washington,DC 20460 Mail Courier(e.g.FedEx, UPS,etc.) Financial Analysis and Rate Negotiation Service Center Office of Acquisition Management US Environmental Protection Agency 1300 Pennsylvania Avenue,NW,6th floor Bid and Proposal Room Number 61 107 Washington,DC 20004 For Indian Tribe If the subrecipient does not have a previously established indirect cost rate,the subrecipient must submit their indirect cost rate proposals to: National Business Center Indirect Cost Services U.S. Department of the Interior 2180 Harvard Street,Suite 430 Sacramento,CA 95815-3317 The subrecipient agrees to comply with the audit requirements in accordance with 2 CFR 200 Subpart F. 5. Utilization of Small,Minority and Women's Business Enterprises(MBE/WBE) General Compliance,40 CFR,Part 33 The subrecipient agrees to comply with the requirements of EPA's Disadvantaged Business Enterprise(DBE)Program for procurement activities under assistance agreements, contained in 40 CFR,Part 33. MBE/WBE Reporting,40 CFR,Part 33,Subpart E MBE/WBE reporting is required in annual reports. Reporting is required for assistance agreements where there are funds budgeted for procuring construction,equipment, services and supplies, including funds budgeted for direct procurement by the subrecipient or procurement under subawards or loans in the"Other"category that exceed the threshold amount of$150,000.,including amendments and/or modifications. Based on EPA's review of the planned budget,this award meets the conditions above and is subject to the Disadvantaged Business Enterprise(DBE)Program reporting requirements.However,if subrecipient believes this award does not meet these conditions,the subrecipient must provide a justification and budget detail within 21 days of the award date clearly demonstrating that,based on the planned budget,this award is not subject to the DBE reporting requirements to the Region 10 DBE Coordinator. The subrecipient agrees to complete and submit a"MBE/WBE Utilization Under Federal Grants,Cooperative Agreements and Interagency Agreements"report(EPA Form 5700-52A)on an annual basis. All procurement actions are reportable,not just that portion which exceeds$150,000. Exhibit A, Statements of Work Page 19 of 48 Contract Number CLH 18253 When completing the annual report,subrecipients are instructed to check the box titled"annual"in section 1 B of the form. For the final report,subrecipients are instructed to check the box indicated for the"last report"of the project in section 1 B of the form.Annual reports are due by October 30"'of each year.Final reports are due by October 30"' or 90 days after the end of the project period,whichever comes first. The reporting requirement is based on total procurements. Subrecipients with expended and/or budgeted funds for procurement are required to report annually whether the planned procurements take place during the reporting period or not. If no budgeted procurements take place during the reporting period,the subrecipient should check the box in section 5B when completing the form. The current EPA Form 5700-52A can be found at the EPA Office of Small Business Program's Home Page at littp://www.epa.szov/osbp/dbereporting.htm. This provision represents an approved deviation fi-om the MBE/WBE reporting requirements as described in 40 CFR,Part 33,Section 33.502;however,the other requirements outlined in 40 CPR Part 33 remain in effect, including the Good Faith Effort requirements as described in 40 CFR Part 33 Subpart C,and Fair Share Objectives negotiation as described in 40 CFR Part 33 Subpart D and explained below. Six Good Faith Efforts,40 CFR,Part 33,Subpart C Pursuant to 40 CPR,Section 33.301,the subrecipient agrees to make the following good faith efforts whenever procuring construction,equipment,services and supplies under an EPA financial assistance agreement,and to require that sub-subrecipients, loan subrecipients,and prime contractors also comply. Records documenting compliance with the six good faith efforts shall be retained: (a) Ensure DBEs are made aware of contracting opportunities to the fullest extent practicable through outreach and recruitment activities. For Indian Tribal, State and Local and Government subrecipients,this will include placing DBEs on solicitation lists and soliciting them whenever they are potential sources. (b) Make information on forthcoming opportunities available to DBEs and arrange time frames for contracts and establish delivery schedules,where the requirements permit, in a way that encourages and facilitates participation by DBEs in the competitive process.This includes,whenever possible,posting solicitations forbids or proposals for a minimum of 30 calendar days before the bid or proposal closing date. (c) Consider in the contracting process whether firms competing for large contracts could subcontract with DBEs. For Indian Tribal,State and local Government subrecipients,this will include dividing total requirements when economically feasible into smaller tasks or quantities to permit maximum participation by DBEs in the competitive process. (d) Encourage contracting with a consortium of DBEs when a contract is too large for one of these firms to handle individually. (e) Use the services and assistance of the SBA and the Minority Business Development Agency of the Department of Commerce. (f) If the prime contractor awards subcontracts,require the prime contractor to take the steps in paragraphs(a)through(e)of this section. Contract Administration Provisions,40 CFR,Section 33.302 The subrecipient agrees to comply with the contract administration provisions of 40 CFR, Section 33.302. Bidders List,40 CFR,Section 33.501(b)and(c) Subrecipients of a Continuing Environmental Program Grant or other annual reporting grant,agree to create and maintain a bidders list. Subrecipients of an EPA financial assistance agreement to capitalize a revolving loan fund also agree to require entities receiving identified loans to create and maintain a bidders list if the subrecipient of the loan is subject to,or chooses to follow,competitive bidding requirements. Please see 40 CFR, Section 33.501 (b)and(c)for specific requirements and exemptions. Fair Share Objectives,40 CFR,Part 33,Subpart D (1) For Grant Awards$250,000 or Less This assistance agreement is a Technical Assistance Grant(TAG);or the award amount is$250,000 or less;or the total dollar amount of all of the subrecipient's financial assistance agreements from EPA in the current Federal fiscal year is$250,000 or less.Therefore,the subrecipient of this assistance agreement is exempt from the fair share objective requirements of 40 CPR,Part 33,Subpart D,and is not required to negotiate fair share objectives/goals for the utilization of MBE/WBEs in its procurements. Exhibit A,Statements of Work Page 20 of 48 Contract Number CLH 18253 (2) For Subrecipients Accepting Goals A subrecipient must negotiate with the appropriate EPA award official,or his/her designee, fair share objectives for MBE and WBE participation in procurement under the financial assistance agreements. In accordance with 40 CFR,Section 33.411 some Subrecipients may be exempt from the fair share objectives requirements as described in 40 CFR,Part 33,Subpart D.Subrecipients should work with their DBE coordinator,if they think their organization may qualify for an exemption. Accepting the Fair Share Objectives/Goals of Another Subrecipient The dollar amount of this assistance agreement,or the total dollar amount of all of the subrecipient's financial assistance agreements in the current federal fiscal year from EPA is$250,000,or more.The subrecipient accepts the applicable MBE/WBE fair share objectives/goals negotiated with EPA.The Region 10 fair share objectives/goals can be found:http://www.epa.gov/osbp//pdfs/rl0fairsharegoals.pdf. By signing this financial assistance agreement,the subrecipient is accepting the fair share objectives/goals and attests to the fact that it is purchasing the same or similar construction,supplies,services and equipment,in the same or similar relevant geographic buying market. Negotiating Fair Share Objectives/Goals,40 CFR,Section 33.404 The subrecipient has the option to negotiate its own MBE/WBE fair share objectives/goals. If the subrecipient wishes to negotiate its own MBE/WBE fair share objectives/goals,the subrecipient agrees to submit proposed MBE/WBE objectives/goals based on an availability analysis,or disparity study,of qualified MBEs and WBEs in their relevant geographic buying market for construction,services,supplies and equipment. The submission of proposed fair share goals with the supporting analysis or disparity study means that the subrecipient is not accepting the fair share objectives/goals of another subrecipient.The subrecipient agrees to submit proposed fair share objectives/goals,together with the supporting availability analysis or disparity study,to the Regional MBE/WBE Coordinator within 120 days of its acceptance of the financial assistance award. EPA will respond to the proposed fair share objective/goals within 30 days of receiving the submission. If proposed fair share objective/goals are not received within the 120 day time frame,the subrecipient may not expend its EPA funds for procurements until the proposed fair share objective/goals are submitted. (3) For Subrecipients with Established Goals The subrecipient must negotiate with the appropriate EPA award official,or his/her designee,fair share objectives for MBE and WBE participation in procurement under the financial assistance agreements. In accordance with 40 CFR,Section 33.411 some Subrecipients may be exempt from the fair share objectives requirements described in 40 CPR,Part 33, Subpart D. Subrecipients should work with their DBE coordinator, if they think their organization may qualify for an exemption. Current Fair Share Objective/Goal The dollar amount of this assistance agreement or the total dollar amount of all of the subrecipient's financial assistance agreements in the current federal fiscal year from EPA is$250,000,or more.The Region 10 fair share objectives/goals can be found: http://www.epa.gov/osbp/pdfs/rl Ofairsharegoals.pdf. Negotiating Fair Share Objectives/Goals in accordance with 40 CPR,Part 33, Subpart D,established goals/objectives remain in effect for three fiscal years unless there are significant changes to the data supporting the fair share objectives.The subrecipient is required to follow requirements as outlined in 40 CFR Part 33,Subpart D when renegotiating the fair share objectives/goals. (4) For DWSRF CWSRF and BROWNFTELDS RLF Subrecipients ONLY Objective/Goals of Loan Subrecipients As a subrecipient of an EPA financial assistance agreement to capitalize revolving loan funds,the subrecipient agrees to either apply its own fair share objectives negotiated with EPA to identified loans using a substantially similar relevant geographic market,or negotiate separate fair share objectives with its identified loan subrecipients.These separate objectives/goals must be based on demonstrable evidence of the availability of MBEs and WBEs in accordance with 40 CFR,Part 33, Subpart D. The subrecipient agrees that if procurements will occur over more than one year,the subrecipient may choose to apply the fair share objective in place either for the year in which the identified loan is awarded or for the year in which the procurement action occurs.The subrecipient must specify this choice in the financial assistance agreement,or incorporate it by reference therein. Exhibit A, Statements of Work Page 21 of 48 Contract Number CLH 18253 (5) RSO DBE Coordinator and Where to Send Report Andrea Bennett at(206)553-1789 or email: Bennett.Andrea^epa.€ov. The coordinator can answer any MBE/WBE reporting questions you may have. MBE/WBE reports should be sent to the EPA Region 10,Grants and Interagency Agreements Unit, 1200 Sixth Avenue, Suite 900,OMP-173,Seattle,WA 98101 or FAX to (206)553-4957. Pro6rammatic Conditions 1. Semi-Annual Performance Reports The subrecipient shall submit performance reports every six(6)months during the life of the project.Reports are due 30 calendar days after the end of each reporting period. Reports shall be submitted to the DOH Contract Manager and may be provided electronically. In accordance with 2 CFR 200.328,as appropriate,the subrecipient agrees to submit performance reports that include brief information on each of the following areas: (a) A comparison of actual accomplishments to the outputs/outcomes established in the assistance agreement work plan for the period; (b) The reasons why established goals were not met, if appropriate; (c) Additional pertinent information including,when appropriate,analysis and explanation of cost overruns or high unit costs. In addition to the semi-annual performance reports,the subrecipient shall immediately notify the DOH Contract Manager of developments that have a significant impact on the award-supported activities. As appropriate, the subrecipient agrees to inform the DOH Contract Manager as soon as problems, delays or adverse conditions become known which will materially impair the ability to meet the outputs/outcomes specified in the assistance agreement work plan. This notification shall include a statement of the action taken or contemplated,and any assistance needed to resolve the situation. The subrecipient will submit performance reports through EPA's Puget Sound Financial and Ecosystem Accounting Tracking System(FEATS). Reports are due at least 30 calendar days after the end of each reporting period. Earlier,but not later due dates may be mutually agreed upon by the Contract Manager and subrecipient in the award document.The reporting periods shall end March 31 st and September 30th of each calendar year. Reports shall be submitted to the DOH Contract Manager on the FEATS form provided by the Contract Manager and shall be submitted by electronic mail.The subrecipient agrees to submit performance reports that include brief information on each of the following areas: (a) A comparison of actual accomplishments to the outputs/outcomes established in the assistance agreement work plan for the period; (b) The reasons for slippages if established outputs/outcomes were not met; (c) Additional pertinent information, including when appropriate,analysis and information of cost overruns or high unit costs. 2. Final Performance Report The subrecipient shall submit a final performance report through FEATS,which is due 90 calendar days after the expiration or termination of the award.The report shall be submitted to the DOH Contract Manager and must be provided electronically.The report shall generally contain the same information as in the periodic reports,but should cover the entire project period.After completion of the project,the DOH Contract Manager may waive the requirement for a final performance report if the DOH Contract Manager deems such a report is inappropriate or unnecessary. 3. Program income-Addition If program income is generated,the subrecipient is required to account for program income related to this project. Program income earned during the project period shall be retained by the subrecipient and shall be added to funds committed to the project by EPA and the subrecipient,and shall be used to further eligible project objectives. 4. Recognition of EPA Funding Reports,documents,signage,videos,or other media,developed as part of projects funded by this assistance agreement shall contain the following statement: "This project has been funded wholly or in part by the United States Environmental Protection Agency under assistance agreement(number)to(subrecipient).'The contents of this document do not necessarily reflect the views and policies of the Environmental Protection Agency,nor does mention of trade names or commercial products constitute endorsement or recommendation for use." Exhibit A,Statements of Work Page 22 of 48 Contract Number CLH 18253 5. Quality Assurance Requirements(2 GFR 1500.11)(if applicable) Acceptable Quality Assurance documentation must be submitted within 30 days of the acceptance of this agreement or another date as negotiated with the DOH Contract Manager and NEP Quality Assurance Coordinator.No work involving direct measurements or data generation,environmental modeling,compilation of data from literature or electronic media,and data supporting the design,construction,and operation of environmental technology shall be initiated under this project until the EPA Project Officer,in concert with the EPA Quality Assurance Manager,has approved the quality assurance document. Instructions to Submit Quality Assurance Documents for Review Please refer to The Department of Ecology's website at: http://www ecy wa gov/programs/eap//ga/docs/NEPOAPP/index.himI for guidance and templates. Submit the Acceptable Quality Assurance documentation to Tom Cries at terl461 @ecy wa eov(NEP Quality Assurance Coordinator)for review with a ce:to me�an.schell(c�doh.wa.gov and trace farrell a doh wa-_ov(DOH NEP Contract Managers). Additional information on these requirements can be found at the EPA Office of Grants and Debarment website: http://www.epa.gov/ogd/grants/assurance.htm. 6. Peer Review The results of this project may affect management decisions relating to Puget Sound.Prior to finalizing any significant technical products the Principal Investigator(PI)of this project must solicit advice,review and feedback from a technical review or advisory group consisting of relevant subject matter specialists.A record of comments and a brief description of how respective comments are addressed by the PI will be provided to the Project Monitor prior to releasing any final reports or products resulting from the funded study. 7. Competency of Organizations Generating and/or Using Environmental Measurement Data In accordance with Agency Policy Directive Number FEM-2012-02, Policy to Assure the Competencyof f Organizations Generating Environmental Measurement Data under Agency-Funded Assistance Agreements,Subrecipient shall maintain competency for the duration of the project period of this agreement and this will be documented during the annual reporting process.A copy of the Policy is available online at liUp://www.epa.gov/fem/lab comp.htm or a copy may also be requested by contacting the DOH Contract Manager for this award. Federal Assistance Agreement Funds Up To$200,000 Subrecipient agrees that if the total federal funding obligated on this award exceeds$200,000(resulting from subsequent amendments to this agreement)and will involve the use or generation of environmental data it will (unless it has otherwise done so)demonstrate competency prior to carrying out any activities involving the generation or use of environmental data under this agreement. Federal Assistance Agreement Funds Exceed or Expect to Exceed$200,000 Subrecipient agrees,by entering into this agreement,that it has demonstrated competency prior to award,or alternatively,where a pre-award demonstration of competency is not practicable. Subrecipient agrees to submit documentation and demonstrate competency prior to carrying out any activities under the award involving the generation or use of environmental data. Shellfish Strategic Initiative Quality Assurance Coordinator Contact:Tom Gries at tgr1461 n,ecy.wa.gov 8. STORET Requirement Subrecipients are required to institute standardized reporting requirements into their work plans and include such costs in their budgets.All water quality data generated in accordance with an EPA approved Quality Assurance Project Plan as a result of this assistance agreement,either directly or by subaward,will be required to be transmitted into the Agency's Storage and Retrieval(STORET)data warehouse using either WQX or WQX web. Water quality data appropriate for STORET include physical,chemical, and biological sample results for water,sediment and fish tissue.The data include toxicity data,microbiological data,and the metrics and indices generated from biological and habitat data.The Water Quality Exchange(WQX)is the water data schema associated with the EPA,State and Tribal Exchange Network. Using the WQX schema partners map their database structure to the WQX/STORET structure. WQX web is a web based tool to convert data into the STORET format for smaller data generators that are not direct partners on the Exchange Network.More information about WQX, WQX web,and the STORET warehouse,including tutorials,can be found at littp://www.epa.gov/storet/wq If activities submitted as match for this federal assistance agreement involve the generation of water quality data,the resulting information must be publicly accessible(in STORET or some other database). Subrecipients are encouraged to develop a cross walk between any non-STORET database utilized for the storage of water quality data associated with match activities and EPA's Water Quality Exchange(WQX). Exhibit A,Statements of Work Page 23 of 48 Contract Number CLH 18253 9. Riparian Buffers Riparian buffer restoration projects in agricultural areas shall be consistent with the interim riparian buffer recommendations provided to EPA and the Natural Resource Conservation Service by National Marine Fisheries Service letters of January 30,2013 (stamp received date-February 4,2013)and April 9,2013 (stamp received date— April 16,2013),or the October 28,2013 guidance.Grantees shall confirm in writing projects'consistency with the recommendations referenced above.When developing project proposals,grantees also should consider the extent to which proposals include appropriate riparian buffers or otherwise address pollution sources on other water courses on the properties in the project area to support water quality and salmon recovery. Deviations can only be obtained through an exception approved by EPA.In order for EPA to evaluate a request for an exception,the grantee must submit the scientific rationale demonstrating adequacy of buffers for supporting water quality and salmon recovery.The request must summarize tribal input on the scientific rationale or other relevant issues.The scientific rationale could be developed from sources such as site- specific assessment data,salmon recovery plans,Total Maximum Daily Loads(TMDLs)and the state nonpoint plan. EPA will confer with the National Oceanic and Atmospheric Administration (NOAA)and the Washington Department of Ecology and provide the opportunity for affected tribes to consult with EPA before making a final decision on a deviation request. 10. International Travel(Including Canada) All International Travel must be approved by the Office of International and Tribal Affairs(OITA)BEFORE travel occurs.Even a brief trip to a foreign country,for example to attend a conference,requires OITA approval.Please contact your DOH Contract Manager as soon as possible if travel is planned out of the country, including Canada and/or Mexico,so that they can obtain appropriate approvals fi•om EPA Headquarters. If you have questions,please contact your DOH Contract Manager listed in this award document. 11. Geospatial Data Standards All gcospatial data created must be consistent with Federal Geographic Data Committee(FGDC)endorsed standards. Information on these standards may be found at www.fade.gov 12. ULO Stretch Goal Subrecipients should manage their programs and subaward funding in ways that reduce the length of time that federal funds obligated and committed to subaward projects are "unspent"federal funds,not yet drawn down through disbursements. EPA encourages the reduction of these unliquidated obligations(ULOs)by applying the following programmatic term and condition to these assistance agreements Assistance agreement Subrecipients are to apply these"stretch"goals throughout the life of the assistance agreement and to confer with your DOH Contract Manager whenever instances arise that make attainment of these stretch goals unlikely. A stretch goal for utilization of funds is established.All funds should be spent by 2 years. Stretch Goal Funds Awarded in FY 2016 (October, 1,2016-September 30,2017) Should all Be Drawn Down by March 2019 DOH Program Contact Tracy Farrell,Office of Environmental Health,PO Box 47824,Olympia WA 98504-7824;360.236.3337;tracy.farrelltdoh.wa.gov Exhibit A,Statements of Work Page 24 of 48 Contract Number CLH 18253 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Office of Drinking Water Group A Program- Local Health Jurisdiction Name: Mason County Public Health Effective January 1,2018 Contract Number: CLH18253 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment ® Federal Contractor (check if applicable) ❑ Reimbursement Period of Performance: January 1,2018 through December 31,2020 ® State ❑ FFATA(Transparency Act) ® Fixed Price ❑ Other ❑ Research&Development Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small community and non-community Group A water systems. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date Yr 20 SRF-Local Asst 15% (FS) SS N/A 346.26.64 24139220 01/01/18 12/31/20 0 12,000 12,000 Sanitary Survey Fees FO-SW SS-State N/A 346.26.65 24232522 01/01/18 12/31/20 0 12,000 12,000 Yr 20 SRF- Local Asst 15% (FS) TA N/A 346.26.66 1 24139220 1 01/01/18 12/31/20 0 2,000 2,000 TOTALS 0 26,000 26,000 Task Task/Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information and/or Amount Number Standards/Measures Frame 1 Trained LHJ staff will conduct Provide Final* Sanitary Final Sanitary Upon ODW acceptance of the Final sanitary surveys of small community Survey Reports to ODW Survey Reports Sanitary Survey Report,the LHJ shall be and non-community Group A water Regional Office.Complete must be received by paid$400 for each sanitary survey of a non- systems identified by the DOH Office Sanitary Survey Reports the ODW Regional community system with three or fewer of Drinking Water(ODW)Regional shall include: Office within 30 connections. Office. I. Cover letter identifying calendar days of significant deficiencies, conducting the Upon ODW acceptance of the Final See Special Instructions for task significant findings; sanitary survey. Sanitary Survey Report,the LHJ shall be activity. observations, paid$800 for each sanitary survey of a non- recommendations,and community system with four or more referrals for further connections and each community system. ODW follow-up. 2. Completed Small Water Payment is inclusive of all associated costs System checklist. such as travel,lodging,per diem. Exhibit A,Statements of Work Page 25 of 48 Contract Number CLH 18253 Task Task/Activity/Description *May Support fHAB Deliverables/Outcomes Due Date/Time Payment Information and/or Amount Number Standards/Aleasures Frame 3. Updated Water Payment is authorized upon receipt and Facilities Inventory acceptance of the Final Sanitary Survey (WFI). Report within the 30-day deadline. 4. Photos of water system with text identifying Late or incomplete reports may not be features accepted for payment. 5. Any other supporting documents. *Final Reports reviewed and accepted by the ODW Regional Office. DOH will provide a tablet and GPS The LHJ surveyor will unit for the LHJ to gather source data record at least two(2)GPS during a routine sanitary survey. DOH data points,for each source, expects the LHJ to commit to using into the preloaded Excel the tablet and GPS for a five-year template on the tablet and period. submit that data file with the associated sanitary survey. 2 Trained LI IJ staff will conduct Provide completed SPI Completed SPI Upon acceptance of the completed SPI Special Purpose Investigations(SP1) Report and any supporting Reports must be Report,the LHJ shall be paid$800 for each of small community and non- documents and photos to received by the SP1. community Group A water systems ODW Regional Office. ODW Regional identified by the ODW Regional Office within 2 Payment is inclusive of all associated costs Office. working days of the such as travel,lodging,per diem. service request. See Special Instructions for task Payment is authorized upon receipt and activity. acceptance of completed SPI Report within the 2 working day deadline. Late or incomplete reports may not be accepted for payment. 3 Trained LHJ staff will provide direct Provide completed TA Completed TA Upon acceptance of the completed TA technical assistance(TA)to small Report and any supporting Report must be Report,the LHJ shall be paid for each community and non-community documents and photos to received by the technical assistance activity as follows: Group A water systems identified by ODW Regional Office. ODW Regional • Up to 3 hours of work: $250 the ODW Regional Office. Office within 30 . 3-6 hours of work:$500 calendar days of o More than 6 hours of work:$750 See Special Instructions for task providing technical activity. assistance. Exhibit A, Statements of Work Page 26 of 48 Contract Number CLH 18253 Task Task/Activity/Description *May Support PHAB Deliverables/Outcomes Due Date/Time Payment Information and/or Amount Number Standards/Measures Frame Payment is inclusive of all associated costs such as consulting fee,travel, lodging,per diem. Payment is authorized upon receipt and acceptance of completed TA Report within the 30-day deadline. Late or incomplete reports may not be accepted for payment. 4 LHJ staff performing the activities Prior to attending the Annually LHJ shall be paid mileage,per diem, under tasks 1,2 and 3 must have training,submit an lodging,and registration costs as approved completed the mandatory Sanitary "Authorization for Travel on the pre-authorization form in accordance Survey Training. (Non-Employee)"DOH with the current rates listed on the OFM Form 710-013 to the ODW Website See Special Instructions for task Program Contact below for littp://www.ofiii.wa.gov/resources/travel.asp activity. approval(to ensure that enough funds are available). *For information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http•//www pliaboard org/wp-content/uploads/PI-IAB-Standards-and-Measures-Version_1.0.ndf Program Specific Req uirements/Narrative Special References(RCWs,WACs,etc) Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work,ODW contracts with the LHJ to conduct sanitary surveys(and SPIs,and provide technical assistance)for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys(and SPLs,and provide technical assistance)for small community and non-community water systems with surface water sources, large water systems,and systems with complex treatment. LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4,below. Special Billing Requirements The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed,noting on the invoice the quarter and year being billed for. Payment cannot exceed a maximum accumulative fee of$24,000 for Task 1,and$2,000 for Task 2,Task 3 and Task 4 combined during the contracting period,to be paid at the rates specified in the Payment Method/Amount section above. When invoicing for sanitary surveys,bill half to BARS Revenue Code 346.26.64 and half to BARS Revenue Code 346.26.65. When invoicing for Task 1,submit the list of WS Name,ID#,Amount Billed,Survey Date and Letter Date that you are requesting payment. When invoicing for Task 2-3,submit the list of WS Name,ID#,TA Date and description of TA work performed,and Amount Billed. When invoicing for Task 4,submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-1A Invoice Exhibit A,Statements of Work Page 27 of 48 Contract Number CLH 18253 Voucher to the DOH Grants Management,billing to BARS Revenue Code 346.26.66 under Technical Assistance(TA). Special Instructions Task 1 Trained LHJ staff Nvill evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW. Detailed guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistm7ce(Field Guide).The sanitary survey will include an evaluation of the following eight elements: source;treatment;distribution system; finished water storage;pumps,pump facilities and controls;monitoring,reporting and data verification;system management and operation;and certified operator compliance. If a system is more complex than anticipated or other significant issues arise,the LHJ may request ODW assistance. • No more than 0 surveys of non-community systems with three or fewer connections to be completed between January 1,2018 and December 31,2018. o No more than 30 surveys of non-community systems with four or more connections and all community systems to be completed between January 1,2018 and December 31,2018. The process for assignment of surveys to the LHJ,notification of the water system,and ODW follow-up with unresponsive water systems;and other roles and responsibilities of the LHJ are described in the Field Guide. Task 2 Trained LHJ staff will perform Special Purpose Investigations(SPIs)as assigned by ODW. SPis are inspections to determine the cause of positive coliform samples or the cause of other emergency conditions. SPIs may also include sanitary surveys of newly discovered Group A water systems.Additional detail about conducting SPis is described in the Field Guide.The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff. Task 3 Trained LHJ staff will conduct Technical assistance as assigned by ODW.Technical Assistance includes assisting water system personnel in completing work or verifying work has been addressed as required,requested,or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the Field Guide.The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system. Task 4 LHJ staff assigned to perform activities under tasks 1,2,and 3 must be trained and approved by ODW prior to performing work. LHJ staff performing the activities under tasks 1, 2 and 3 must have completed,with a passing score,the ODW Online Sanitary Survey Training and the ODW Sanitary Survey f=ield Training.LHJ staff performing activities under tasks 1,2,and 3 must attend the Annual ODW Sanitary Survey Workshop,and are expected to attend the Regional ODW LHJ Drinking Water Meetings. If required trainings,workshops or meetings are not available,not scheduled,or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks,the LHJ staffperson may,with ODW approval,substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW staff,co-surveys with ODW staff,or other activities as arranged and pre-approved by ODW. LHJ staff may not perform the activities under tasks 1,2,and 3 without completing the training that has been arranged and approved by ODW. Program Manual,Handbook,Policy References http://www.doh.wa.aov/Portals/1/Documents/Pubs/331-486.pdf DOH Program Contact DOH Fiscal Contact Denise Miles Karena McGovern DOH Office of Drinking Water DOH Office of Drinking Water 243 Israel Rd SE 243 Israel Rd SE Tumwater,WA 98501 Tumwater,WA 98501 Denise.Miles@doh.wa.gov Karena.McGovern[wdoh.wa.7ov (360)236-3028 (360)236-3094 Exhibit A,Statements of Work Page 28 of 48 Contract Number CLH 18253 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Office of Drinking Water Group B Program- Local Health Jurisdiction Name: Mason County Public Health Effective January_1,2018 Contract Number: CLH18253 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment ❑ Federal <Select One> (check if applicable) ❑ Reimbursement Period of Performance: January 1,2018 through June 30,2018 ® State ❑ FFATA(Transparency Act) ®Fixed Price ❑ Other ❑ Research&Development Statement of Work Purpose: The purpose of this statement of work is to provide financial support to LHJs implementing local Group B water system programs. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date GFS-Group B FO-SW N/A 334.04.90 24230103 01/01/18 06/30/]8 0 2,500 2,500 TOTALS 0 2,500 2,500 Task "May Support PHAB Memorandum of Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Agreement Number Information and/or Amount I Implement a partial Group B water system An executed joint plan of Reference DOH JPR Lump sum payment program. responsibility(JPR)with DOH #N20495 (See Special Billing identifying responsibilities of a Requirements) partial Group B program. *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: littp_//www phaboard or,(r/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.O.pdf Program Specific Requirements/Narrative Special Billing Requirements The LHJ shall submit a$2,500 invoice before May 15,2018. Exhibit A,Statements of Work Page 29 of 48 Contract Number CLH 18253 DOH Program Contact DOH Fiscal Contact Bonnie Waybright, P.E. Karena McGovern Southwest Regional Manager DOH Office of Drinking Water DOH Office of Drinking Water 243 Israel Rd SE 243 Israel Rd SE Tumwater,WA 98501 Tumwater,WA 98501 Karena.Mc overs a doh.wa.gov Bonn ie.Waybri,,ht(@doh.wa.eov (360)236-3094 (360)236-3025 Exhibit A,Statements of Work Page 30 of 48 Contract Number CLH 18253 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Office of Emergency Preparedness&Response- Local Health Jurisdiction Name: Mason Countv Public Health Effective January 1,2018 Contract Number: CLH18253 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment ® Federal Subrecipient (check if applicable) ® Reimbursement Period of Performance: January ❑ State ® FFATA(Transparency Act) E] Fixed Price 1,2018 through June 30,2018 Other:1 ❑ Research&Development Statement of Work Purpose: The purpose of this statement of work is to establish the funding and tasks for the Public Health Emergency Preparedness and Response program for the 2017 grant period. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date FFY17 EPR PHEP BPI LHJ FUNDING 93.069 333.93.06 18101380 01/01/18 06/30/18 0 19,917 19,917 TOTALS 0 19,917 19,917 Task *May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount I Attend emergency preparedness events,(e.g. Submit end of year progress report. June 30,2018 Reimbursement for trainings,meetings,conference calls,and actual costs not to conferences)as necessary to advance LHJ exceed total funding preparedness or complete the deliverables in this consideration amount. statement of work. 2 Complete reporting templates as requested by Submit completed templates to June 30,2018 DOH to comply with program and federal grant DOH requirements(e.g.performance measures,gap analysis,mid-year and end-of-year reporting templates,etc. 3 Use established procedures to activate a public Submit end of year progress report. June 30,2018 health emergency response plan within the jurisdiction. Test the following: Submit the most recent Public • How the command structure is utilized to Health Emergency Response Plan. manage emergency response Exhibit A,Statements of Work Page 31 of 48 Contract Number CLH 18253 Task *May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount o The relationship between the LHJ and the Submit documentation of the use county Emergency Operations Center of the Public Health Emergency (EOC)during a response. Response Plan during an incident An EOC location from which public and/or exercise. Documents health will coordinate the Public Health should include an Incident Action Emergency Response Plan Plan(IAP),After Action Report • The process for notifying and mobilizing (AAR),Situation Reports(SitRcp), staff during an incident. Corrective Action Plans(CAP). 3.1)Provide training for appropriate staff who Submit agenda and sign in sheets serve in the EOC and the Emergency Support of trainings, including attendee Function#8(ESF#8)role on the Incident signatures and contact information, Command System(ICS),recent Public Health conducted on Public Health Emergency Response plans and policies Emergency Response Plan 3.2)Train appropriate public health emergency Agenda and sign in sheets of response staff on Web EOC or applicable trainings conducted,with attendee information management system utilized by local signatures and contact information, emergency management in the county. or registrations if training is not conducted by the LHJ 4 Use established decision making protocol to Submit end of year progress report. June 30,2018 support the Local Health Officer and the Public Health Administrator in making policy level Submit documented use of the decisions during an emergency. decision making protocol used during an emergency to DOH 4.1 Document that Public Health,Medical and Mortuary Response is identified in the Public Public Health,Medical and Health Emergency Plan and is integrated with the Mortuary Response documentation City and County Emergency Plans. showing inclusion in city and county plans. 5 Maintain Washington Secure Electronic Submit end of year progress report. June 30,2018 Communication,Urgent Response and Exchange System(WASECURES)program as the primary A list of registered users to include emergency notification system within the LHJ and their title and role in the include all critical LHJ positions as registered emergency response plan. users. Results of notification drill. 5.1) Conduct a notification drill using WASECURES. Notes: Registered users must log in quarterly at a minimum. DOH will provide on-site technical assistance to LI-IJs,as needed,on utilizing Exhibit A,Statements of Work Page 32 of 48 Contract Number CLH 18253 Task "May Support PHAB Due Date/Time payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount WASECURES. LHJs may choose to utilize other notification systems in addition to WASECURES to alert staff during incidents. 6 Use established procedures for your LHJ to request Submit end of year progress report. June 30,2018 assistance from the local EOC,neighboring LI-IJs, and DOH during disasters. Submit AARs and IAPB that • Identify how resources are coordinated with includes documentation of the the local EOC. elements listed. • Identify how to coordinate the logistical issues to receive resources from DOH and other partners. (If LHJs rely on local Emergency Management(EM)or other partners to coordinate logistical issues for receiving resources,and the local EM plan documents this fact,that documentation will suffice. 7 Use established procedures and plans to inform the Submit end of year progress report. June 30,2018 public of threats to health and safety by various means. Include a list of the various mechanisms Submit AARs and messaging used used by your LHJ for releasing information to the to inform the public during drills, public during drills,exercises or incident response. exercise or incident response. Include a summary of how 7.1)Create and maintain templates for news communication tools were used. releases for categories of public health hazards. Submit sample templates. 8 Participate in evaluation of response capabilities Submit end of year progress report. June 30,2018 based on a standard evaluation tool created by DOH. 9 Use established procedures to gain and maintain Submit end of year progress report. June 30,2018 situational awareness during an incident. Use forms and processes for collecting key data Submit an AAR which includes elements during disasters including: how these plans and forms were e The functionality of critical public health used to maintain situational operations awareness during all drills, • The functionality of critical healthcare exercises and real world incidents facilities and the services they provide s The functionality of critical infrastructure Submit SitReps that include the serving public health and healthcare facilities data elements listed and a (roads,water,sewer,power,communications) summary of how it was • Number of disease cases disseminated. • Number of fatalities attributed to an incident • If key elements are collected by others,such Data collection form templates. as local EM or Health Care Coalition(HCC), Exhibit A, Statements of Work Page 33 of 48 Contract Number CLH 18253 Task "May Support PHAB Due Date/Time Payment Number ETask/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount describe how the LHJ gains access to that information. 9.1)Create an ESF#8 situation report form based Submit ESF#8 SitReps used on an established planning cycle to include,at a during drills,exercises or real minimum,the data elements listed above. world incidents. 9.2)Demonstrate disseminating situation reports to Submit agenda and sign in sheets, ESF#8 response partners including attendee signatures and contact information,for trainings 9.3)Train staff on all procedures established to conducted on situational maintain situational awareness during an incident. awareness. 10 Participate in one or more exercises or real world Submit end of year progress report. June 30,2018 incidents testing each of the following: • The process for requesting and receiving Submit AAR and Improvement mutual aid resources Plan for each • The process for gaining and maintaining drill/exercise/incident. situational awareness • Development of an ESF#8 situation report,or compilation of situational awareness information to be included in a County situation report • EOC or ICS activation • The COOP plan for the LHJ 11 Update or develop procedures to request,receive Submit end of year progress report. June 30,2018 and dispense medical countermeasures. Submit up to date procedure to request,receive and dispense medical countermeasures. 12 Use established procedures and plans to manage Submit end of year progress report. June 30,2018 spontaneous health and medical volunteers during disaster response,including roles non-vetted Submit documentation of volunteers can perform. management of medical volunteers during a response. 13 Implement the Continuity of Operations Plan Submit end of year progress report. June 30,2018 (COOP)plan for the local health jurisdiction. Demonstrate the following: Submit the most current COOP • Identification of essential services to sustain and AAR documenting COOP LHJ mission and operations implementation demonstrating the • Implementation of the Line of succession and elements listed. written delegation of authority for select critical positions in the LHJ,including LHO Exhibit A,Statements of Work Page 34 of 48 Contract Number CLH 18253 Task "May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount • Reassigning staff(scalable workforce reduction)and temporarily discontinuing select LHJ functions to sustain critical services 14 Provide notification to DOH for all instances Submit end of year progress report. June 30,2018 involving a public health response by the LHJ to an emergency utilizing emergency response plans and Submit Incident Action Plans, structures. Situation Reports and After Action Reports. 15 Provide LHJ situation reports to DOH during all Submit end of year progress report. June 30,2018 incidents involving an emergency response by the LHJ. Provide Situation Reports. 16 Submit essential elements of information(EEls) Submit end of year progress report. June 30,2018 during incident response upon request by DOH. Provide information upon request. 17 Participate in the regional healthcare coalition and Submit end of year progress report. June 30,2018 attend coalition meetings as necessary Provide a summary of participation in coalition activities. 18 Provide notification to the DOH Duty Officer at Submit end of year progress report. June 30,2018 360-888-0838 or hanalert,r doh.wa.gov for all response. Documentation that notification to DOH was provided;or statement that no incident response occurred. *For Information Only: Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board(PHAB)Standards/Measures that may apply can be found at: http://www.phaboard.or(.!Lvo-content/uploads/PHAB-Standards-and-Measures-Version-I.O.pdf Special Requirements Federal Fundina Accountabilitv and Transparency Act(FFATA) This statement of work 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 the federal funds are spent. To comply with this act and be eligible to perform the activities in this statement of work,the LHJ must have a Data Universal Numbering System(DUNS(12)number. Information about the LHJ and this statement of work will be made available on USASpendinggov by DOH as required by P.L. 109-282. DOH Program Contact: Jennifer Albertson,Contract and Finance Specialist Department of Health P O Box 47960,Olympia,WA 98504-7960 iennifer.albertson(i2�.doh.wa.aov/PHEP/HPP Deliverable Submission email address: concondeliverables n.doh.wa.gov Exhibit A, Statements of Work Page 35 of 48 Contract Number CLH 18253 Exhibit A Statement of Work Contract Term: 2018-2020 DOH Program Name or Title: Office of Immunization&Child Profile- Local Health Jurisdiction Name: Mason County Public Health Effective January 1,2018 Contract Number: CLI-118253 SOW Type: Original Revision#(for this SOW) Funding Source Federal Compliance Type of Payment ® Federal Subrecipient (check if applicable) ® Reimbursement Period of Performance: January 1,2018 through June 30,2018 ❑ State ® FFATA(Transparency Act) ❑ Fixed Price ❑ Other ❑ Research&Development Statement of Work Purpose: The purpose of this statement of work is to define required immunization tasks,deliverables,and funding for the period January 1,2018 through June 30,2018. Revision Purpose: N/A Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change Total Revenue Index (LHJ Use Only) Consideration Increase(+) Consideration Code Code Start Date End Date FFY 17 VFC Ops 93.268 333.93.26 74310271 01/01/18 06/30/18 0 2,228 2,228 FFY 17 317 Ops 93.268 33 33.93.26 74310270 01/01/18 06/30/18 0 1,423 1,423 FFY 17 AFIX 93.268 333.93.26 743]0272 Ol/01.l 8 06/30/18 0 4,293 4,293 TOTALS 0 7,944 7,944 Task *May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount Perform accountability activities in accordance with state and federal requirements for the Vaccines for Children(VPC)Program as outlined in the Centers for Disease Control and Prevention(CDC)VPC Operations Guide and as directed by the state administrators of the VPC program. Accountability requirements include,but are not limited to: provider education,provider site visits and required corrective action,quality assurance activities,VPC screening,satisfaction survey,outside provider agreements,new provider enrollment visits,fraud and abuse reporting,monthly accountability reports,and private provider report of vaccine usage. 1 Facilitate annual renewal of the provider agreement Provider Agreements for Receipt Annually,per Annual Reimbursement for for receipt of state supplied vaccine for all of State Supplied Vaccine received VFC Provider actual costs incurred, healthcare providers receiving state-supplied online via the Washington Agreement Update not to exceed total childhood vaccines Immunization Information System. Schedule funding consideration amount. Funds available for this task*: FFY17 AFIX 74310272 Exhibit A,Statements of Work Page 36 of 48 Contract Number CLH 18253 Task 4 May Support PHAR Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount *See Restrictions on Funds below 2 Enroll new providers. Conduct an enrollment site Provider Agreement for Receipt of Within ten(10)days Reimbursement for visit to all new providers,and gather information State Supplied Vaccine with after the date of the actual costs incurred, needed to complete Program enrollment original signature—DOH 348-002 provider enrollment not to exceed total (NOTE: a photocopy will not be visit funding consideration accepted) amount. Funds available for this task*: FFY17 AFIX 74310272 *See Restrictions on Funds below 3 Use and facilitate provider use of the Washington Electronic submission of provider Based on provider Reimbursement for Immunization Information System to place and vaccine orders via the Washington order schedules actual costs incurred, approve provider vaccine orders. Monitor provider Immunization Information System not to exceed total orders for appropriateness(including:accuracy of funding consideration shipping information,order frequency,timing, amount. quantity and type)and approve vaccine order online after assuring the appropriateness of the Funds available for order. this task*: FFY17 VFC Ops 74310271 FFY 17 317 Ops 74310270 *See RestTictions on Funds below 4 Monitor and assure electronic or paper submission a) Monthly Vaccine a) By the 25th of Reimbursement for of vaccine accountability reports for compliance Accountability Report(DOH each month actual costs incurred, with Provider Agreement related to vaccine 348-006 not to exceed total management(ordering, inventory management, funding consideration reconciliation,compliance with storage and b) Report of Vaccine Storage b) Within seven (7) amount, handling,and reporting of all vaccine incidents and Incidents(DOH 348-154) days of the returns). complete with reason and incident Funds available for corrective action as needed. this task*: Exhibit A,Statements of Work Page 37 of 48 Contract Number CLH 18253 Task "May Support PHAB Due Date/Time Payment Number Task/Activity/Description Standards/Measures Deliverables/Outcomes Frame Information and/or Amount c) Report all cases(or suspected c) Within seven(7) FFY17 AFIX cases)of vaccine fraud or days of the 74310272 abuse. incident *See Restrictions on Funds below 5 Provide communication,technical assistance, Summary of LHJ Technical June 30,2018 Reimbursement for consultation,and education to providers about Assistance Form(DOH 348-257) actual costs incurred, vaccine quality assurance,accountability,program not to exceed total participation and vaccine management. funding consideration amount. Funds available for this task*: FFY17 VFC Ops 74310271 FFY17 317 Ops 74310270 *See Restrictions on Funds below 6 Conduct a total of two(2)VFC Compliance Site a) Enter responses from the VFC a) At the time of the Reimbursement for Visits at the assigned provider site(s)within your Compliance Site Visit VPC Compliance actual costs incurred, jurisdiction.DOH will assign provider site(s)via Reviewer Guide into the VFC Site Visit or not to exceed total the VFC Site Visit Selection Tool. Provider Education, within five(5) funding consideration Assessment,and Reporting business days of amount. Site visits should address all requirements outlined (PEAR)online system for the site visit. in the Provider Agreement,the CDC Vaccines for each Compliance Site Visit. Funds available for Children Operations Guide,and messages from the Follow all corrective action this task*: Childhood Vaccine Program. and follow-up guidance provided by PEAR and the Conduct VFC Compliance Site Visit Follow-Up to Childhood Vaccine Program FFY 17 AFIX assure providers resolve all follow-up actions for each incorrect response. 74310272 identified during the initial visit. Follow-up actions may include another physical site visit or b) Attach copy of signed b) Within five(5) *See Restrictions on verification by email,fax,or mail that follow-up Acknowledgement of Receipt days of the site Funds below actions were completed. Documentation for each form to the Site Visit in visit VFC Site Visit follow-up action must be uploaded PEAR. into PEAR and/or properly notated in the Reviewer Notes section of PEAR. Exhibit A,Statements of Work Page 38 of 48 Contract Number CLH 18253