HomeMy WebLinkAboutCHOICE Regional Health Network - Contract DocuSign En Pi ID:01DDOD83-5023-4636-B74C-953B4EC578B7
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CHOICE Regional Health Network Contract No: CB027574-
CHOICE REGIONAL Cascade Pacific Action Alliance MCPHHS2023
HEALTH NETWORK 1217 41h Ave E., Suite 200
Olympia, WA 98506 ❑New Contract
.ascade Pacific Action Alliance
(360) 539-7576 ❑Amendment No:
CHOICE Regional Health Network, Regional Lead Organization (RLO) coordinator of Youth Cannabis and
Commercial Tobacco Prevention Program
Subcontractor Information
Name Address Phone Number(s)
Mason County Public Health and Street: 415 N 6th St 360-490-5698
Human Services City: Shelton State: WA Zip: 98584
Social Security or Federal ID# Contract Signatory Project Contact
91-6001354; DUNS 232-002-01 Sharon Trask, County Commissioner Emily Layman
Contact Phone Number Contract Signatory E-Mail Address Project Contact E-Mail Address
360-427-9670x400 strask@masoncountywa.gov elayman(a�masoncountywa.gov
RLO Subcontractor
CHOICE Regional Health Network
Project/Contract
Youth Cannabis and Commercial Tobacco Prevention Program-CB027574
CHOICE Subcontract# Contact Person Contact Title
CB027574-MCPHHS2023 Rob Molina Program Manager
Contact Phone Number Contact Fax Number Contact E-Mail Address
786.663.3585 360.943.1164 molinar@crhn.org
Funding Source Contract Amount Amendment Amount (if
Washington State Department of $ 52,676.01 applicable)
Health Grant#CB027574 $
Reason for Amendment
Effective Date:
Upon Execution July 1, 2022 to June 30, 2023
The terms and conditions of this Agreement, including all attachments and subsequent amendments
constitute the entire and exclusive understanding between the parties. No other understandings, writings, and
communications, oral or otherwise regarding the subject matter of this Agreement will exist to bind the Parties.
The Parties signing below represent they have read and understand this Agreement, and have the authority to
execute this Agreement. This Agreement will be binding on CHOICE only upon signature by CHOICE.
S 6pQ T ACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
54. T-.k Sharon Trask, County Commissioner 4/14/2023
C TURE PRINTED NAME AND TITLE DATE SIGNED
�p alJt,VSbh, JP Anderson, CEO 4/17/2023
eeeAFIB€li�reaas e
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PURPOSE
The Washington State Department of Health (DOH) will provide state funding to plan, implement, and evaluate
cannabis and commercial tobacco (including vaping products) prevention and control activities focused in the
Cascade Pacific Action Alliance (CPAA) Region, and to participate in the Coverage Study in partnership with the
Washington State Healthcare Authority (HCA).
State funding is further defined on Exhibit B, Funding, incorporated herein.
GRANT REQUIREMENTS &STATEMENT OF WORK: The Subcontractor will furnish the necessary personnel,
equipment, material and/or services and otherwise do all things necessary for or incidental to the performance
of the work detailed in Exhibit A, Statement of Work (SOW), incorporated herein.
LoS PAYMENT PROVISIONS: Compensation for the work provided in accordance with this agreement has been
5 established under the terms of RCW 39.34.130. The Parties have estimated that the cost of accomplishing the
work described will not exceed $52,676.01 in accordance with Exhibit B, Funding. Payment will not exceed this
amount without a prior written amendment. CHOICE will authorize payment only upon satisfactory completion
and acceptance of deliverables and for allowable costs as outlined in the SOW and/or budget.
BILLING PROCEDURE: Payment to the Subcontractor for approved and completed work will be made by
CHOICE within 30 days of receipt of the Subcontractor's invoice (Exhibit C Subcontract Invoice Template) and
approved deliverables. Upon expiration of the agreement, any claim for payment not already made will be
submitted within 60 days after the expiration date or the end of the fiscal year, whichever is earlier.
SUBCONTRACTOR RESPONSIBILITIES:
A. The Subcontractor has full responsibility for the conduct and activity supported under this contract and
for adherence to the contract conditions. Although the Subcontractor is encouraged to seek the advice
and opinion of CHOICE and DOH on special problems that may arise, such advice does not diminish the
Subcontractor's responsibility for making sound scientific and administrative judgments and should not
imply that the responsibility for operating decisions has shifted to CHOICE or DOH. The Subcontractor
is responsible for notifying CHOICE about any significant problems relating to the administrative or
financial aspects of the contract.
B. The requirements of this contract are contained in the General Terms and Conditions and SOW unless
otherwise specified in this contract. Certain applicable Federal standards are incorporated by reference.
C. By acceptance of this contract, the Subcontractor agrees to comply with the applicable Federal
requirements and management of all expenditures and actions affecting the contract. Documentation for
each expenditure or action affecting this contract must reflect appropriate organizational reviews or
approvals which should be made in advance of the action. Organizational reviews are intended to help
assure that expenditures are allowable, necessary and reasonable for the conduct of the project, and
that the proposed action:
1. Is consistent with the contract terms and conditions;
2. Represents effective utilization of resources; and
3. Does not constitute a significant project change.
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GENERAL TERMS & CONDITIONS
AGREEMENT ALTERATIONS AND AMENDMENTS: This agreement may be amended by mutual agreement of
the Parties. Such amendments will not be binding unless they are in writing and signed by those authorized to bind
each of the parties. Only the Contracting Officer or his/her delegate will have the express, implied, or apparent
authority to alter, amend, modify, or waive any clause or condition of this agreement on behalf of DOH. No
alteration, modification, or waiver of any clause or condition of this agreement is effective or binding unless made
in writing and signed by authorized parties.
AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, also referred to as the
"ADA" 28 CFR Part 35: The Subcontractor must comply with the ADA, which provides comprehensive civil
rights protection to individuals with disabilities in the areas of employment, public accommodations, state and
local government services, and telecommunications.
ASSIGNMENT: The work to be provided under this Contract, and any possible claim, cannot be assigned or
delegated by either party in whole or in part, without the express prior written consent of the other party.
CHANGE IN STATUS: In the event of substantive change in the legal status, organizational structure, or fiscal
reporting responsibility of the Subcontractor, Subcontractor agrees to notify CHOICE of the change. Subcontractor
will provide notice as soon as practicable, but no later than thirty(30) days after such a change takes effect.
CONFIDENTIALITY/SAFEGUARDING OF INFORMATION: The use or disclosure by any party, either verbally
or in writing, of any Confidential Information will be subject to Chapter 42.56 RCW and Chapter 70.02 RCW, as
well as other applicable federal and state laws and administrative rules governing confidentiality. Specifically, the
Subcontractor agrees to limit access to Confidential Information to the minimum amount of information necessary,
to the fewest number of people, for the least amount of time required to do the work. The obligations set forth in
this clause will survive completion, cancellation, expiration, or termination of this Contract.
A. Notification of Confidentiality Breach
Upon a breach or suspected breach of confidentiality, the Subcontractor will immediately notify
CHOICE. CHOICE will subsequently notify the DOH Privacy Officer of the suspected breach. For the
purposes of this Agreement, "immediately "will mean within one calendar day.
The Subcontractor will take steps necessary to mitigate any known harmful effects of such unauthorized
access including, but not limited to sanctioning employees, notifying subjects, and taking steps
necessary to stop further unauthorized access. The Subcontractor agrees to indemnify and hold
harmless CHOICE and DOH for any damages related to unauthorized use or disclosure by the
Subcontractor, its officers, directors, employees, contractors or agents.
Any breach of this clause may result in termination of the agreement and the demand for return of all
confidential information.
B. Subsequent Disclosure
The Subcontractor will not release, divulge, publish, transfer, sell, disclose, or otherwise make the
Confidential Information known to any other entity or person without the express prior written consent
of the Secretary of Health, or as required by law.
If responding to public record disclosure requests under RCW 42.56, the Subcontractor agrees to notify
and discuss with CHOICE requests for all information that are part of this Contract, prior to disclosing
the information. The Subcontractor further agrees to provide DOH and CHOICE a minimum of two
calendar weeks to initiate legal action to secure a protective order under RCW 42.56.540.
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DEBARMENT: The Subcontractor, by signature to this Contract, certifies that the Subcontractor is not presently
debarred,suspended, proposed for debarment,declared ineligible,or voluntarily excluded in any Federal department
or agency from participating in transactions. The Subcontractor agrees to include the above requirement in all
subcontracts into which it enters to complete this Contract.
DISPUTES: The Subcontractor and CHOICE agree that any disputes that arise relating to the terms under this
Contract will be submitted to mediation before either party starts litigation in any form. An impartial third party
acceptable to both the Subcontractor and CHOICE will be appointed to mediate. The Subcontractor and CHOICE
will pay an equal percentage of the mediator's fees and expenses. The mediation will be confidential in all
respects, as allowed or required by law.
GOVERNANCE: This agreement is entered into pursuant to and under the authority granted by the laws of the
state of Washington and any applicable federal laws. The provisions of this agreement will be construed to
conform to those laws.
In the event of an inconsistency in the terms of this Contract, or between its terms and any applicable statute or
rule, the inconsistency will be resolved by giving precedence in the following order:
A. Federal statutes and regulations
B. State statutes and regulations
C. Agreement amendments
D. The Contract (in this order)
1. Primary document (document that includes the signature page)
2. Statement of Work (Exhibit A)
3. Funding (Exhibit B)
4. Subcontractor Invoice Template (Exhibit C)
HOLD HARMLESS: The Subcontractor will defend, protect, and hold harmless the State of Washington, DOH,
CHOICE or any employees thereof, from and against all claims, suits or action arising from any intentional or
negligent act or omission of the Subcontractor, or agents of either, while performing under the terms of this
agreement. Claims will include, but not be limited to, assertions that the use or transfer of any software, book,
document, report, film, tape or sound reproduction or material of any kind, delivered hereunder, constitutes an
infringement of any copyright, patent, trademark, trade name, or otherwise results in an unfair trade practice.
INDEPENDENT CAPACITY: The employees or agents of each party who are engaged in the performance of this
Contract will continue to be employees or agents of that party and will not be considered for any purpose to be
employees or agents of the other party.
INDUSTRIAL INSURANCE COVERAGE: The Subcontractor will comply with the provisions of Title 51 RCW,
Industrial Insurance. Prior to performing work under this agreement, the Subcontractor will provide or purchase
industrial insurance coverage for the Subcontractor's employees, as may be required of an "employer"as defined
in Title 51 RCW, and will maintain full compliance with Title 51 RCW during the course of this agreement. If the
Subcontractor fails to provide industrial insurance coverage or fails to pay premiums or penalties on behalf of its
employees as may be required by law, CHOICE may collect from the Subcontractor the full amount payable to
the Industrial Insurance accident fund. CHOICE may deduct the amount owed by the Subcontractor to the
accident fund from the amount payable to the Subcontractor by CHOICE under this agreement, and transmit the
deducted amount to the Department of Labor and Industries, Division of Insurance Services. This provision does
not waive any of L&I's rights to collect from the Subcontractor.
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Industrial insurance coverage through the Department of Labor & Industries is optional for sole proprietors,
partners, corporate officers and others, per RCW 51.12.020.
NONDISCRIMINATION: During the performance of this agreement, the Subcontractor will comply with all federal
and state nondiscrimination laws, regulations, and policies.
NONDISCRIMINATION LAWS NONCOMPLIANCE: In the event of the Subcontractor's noncompliance or
refusal to comply with any nondiscrimination law, regulation, or policy, this agreement may be rescinded,
canceled or terminated in whole or in part, and the Subcontractor may be declared ineligible for further contracts
with CHOICE. The Subcontractor will, however, be given a reasonable time in which to correct this
noncompliance. Any dispute may be resolved in accordance with the "Disputes" procedure set forth herein.
RECORDS MAINTENANCE: The Parties to this agreement will each maintain books, records, documents, and
other evidence which sufficiently and properly reflect all direct and indirect costs expended by either party in the
performance of the services described herein. These records will be subject to inspection, review, or audit by
personnel of both parties other personnel duly authorized by either party, the Office of the State Auditor, and federal
officials so authorized by law. All books, records, documents, and other material relevant to this Agreement will be
retained for six years after expiration and the Office of the State Auditor, federal auditors, and any persons duly
authorized by the parties will have full access and the right to examine any of these materials during this period.
Records and other documents, in any medium,furnished by one party in this Contract to the other party,will remain
the property of the furnishing party, unless otherwise agreed. The receiving party will not disclose or make available
this material to any third parties without first giving notice to the furnishing party and giving it a reasonable opportunity
to respond. Each party will utilize reasonable security procedures and protections to assure that records and
documents provided by the other party are not erroneously disclosed to third parties.
RIGHT OF INSPECTION: The Subcontractor will provide right of access to its facilities to DOH and CHOICE,
or any of its officers, or to any other authorized agent or official of the state of Washington or the federal
government, at all reasonable times, in order to monitor and evaluate performance, compliance, and/or quality
assurance under this agreement. The Subcontractor will make available information necessary for DOH and
CHOICE to comply with the client's right to access, amend, and receive an accounting of disclosures of their
confidential information according state and federal law. The Subcontractor's internal policies and procedures,
books, and records relating to the safeguarding, use, and disclosure of confidential information obtained or
used as a result of this agreement will be made available to DOH, CHOICE, and the U.S. Secretary of the
Department of Health & Human Services, upon request.
SAVINGS: In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any
way after the effective date of this agreement and prior to normal completion, DOH may terminate the Grant
under the "Termination" clause, subject to renegotiation under those new funding limitations and conditions.
SEVERABILITY: If any provision of this Contract or any provision of any document incorporated by reference is
deemed invalid, such invalidity will not affect the other provisions of this Contract which can be given effect
without the invalid provision, and to this end the provisions of this Contract are declared to be severable.
SUBGRANTING: The Subcontractor will not enter into subcontracts for any of the work contemplated under this
agreement without prior written approval of DOH and CHOICE. In no event will the existence of the subcontract
operate to release or reduce the liability of the Subcontractor to DOH or CHOICE for any breach in the performance
of the Subcontractor's duties. This clause does not include contracts of employment between the Subcontractor and
personnel assigned to work under this agreement, nor does it prevent vendor agreements from being issued y the
Subcontractor. Please refer to the Statement of Work for final details on vendor agreements and contracts.
Additionally, the Subcontractor is responsible for ensuring that all terms, conditions, assurances, and certifications
set forth in this Contract are carried forward to any approved subcontracts.
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If, at any time during the progress of the work, DOH determines in it sole judgment that the Subcontractor is
incompetent or undesirable, DOH will notify CHOICE and CHOICE will take immediate steps to terminate the
Subcontractor's involvement in the work. This clause also includes any further approved subcontracts the
Subcontractor may have entered into.
SURVIVABILITY: The terms and conditions contained in this agreement, will survive the completion,
cancellation, termination, or expiration of the agreement.
SUSPENSION OF PERFORMANCE AND RESUMPTION OF PERFORMANCE: In the event of government
closure, suspension or limitation of funding in anyway after the effective date of this agreement and prior to normal
completion, CHOICE may give notice to Subcontractor to suspend performance as an alternative to termination.
CHOICE may elect to give written notice to the Subcontractor to suspend performance when CHOICE determines
that there is a reasonable likelihood that the funding insufficiency may be resolved in a timeframe that would allow
performance to be resumed prior to the end date of this agreement. Notice may include notice by facsimile or
email to the Subcontractor's representative. The Subcontractor will suspend performance on the date stated in
the written notice to suspend. During the period of suspension of performance, each party may inform the other
of any conditions that may reasonably affect the potential for resumption of performance.
When CHOICE determines that the funding insufficiency is resolved, CHOICE may give the Subcontractor
written notice to resume performance and a proposed date to resume performance. Upon receipt of written notice
to resume performance, Subcontractor will give written notice to CHOICE as to whether it can resume
performance, and, if so, the date upon which it agrees to resume performance. If Subcontractor gives notice to
CHOICE that it cannot resume performance, the Parties agree that the agreement will be terminated retroactive
to the original date of termination. If the date the Subcontractor gives notice it can resume performance is not
acceptable to CHOICE, the Parties agree to discuss an alternative acceptable date. If an alternative date is not
acceptable to CHOICE, the Parties agree that the agreement will be terminated retroactive to the original date
of termination.
TAXES: All payments accrued on account of payroll taxes, unemployment contributions, any other taxes,
insurance or other expenses for the Subcontractor or its staff will be the sole responsibility of the
Subcontractor.
TERMINATION: Either party may terminate this agreement upon thirty (30) days prior written notification to the
other party. If this agreement is so terminated, the Parties will be liable only for performance rendered or costs
incurred in accordance with the terms of this agreement prior to the effective date of termination.
TERMINATION FOR CAUSE: If for any cause, either party does not fulfill in a timely and proper manner its
obligations under this agreement, or if either party violates any of these terms and conditions, the aggrieved party
will give the other party written notice of such failure or violation. The responsible party will be given the opportunity
to correct the violation or failure within 15 working days. If the failure or violation is not corrected, this agreement
may be terminated immediately by written notice of the aggrieved party to the other.
WAIVER: A failure by either party to exercise its rights under this agreement will not preclude that party from
subsequent exercise of such rights and will not constitute a waiver of any other rights under this agreement unless
stated to be such in a writing signed by an authorized representative of the party and attached to the original
agreement.
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DS
EXHIBIT A
STATEMENT OF WORK
The Mason County Public Health and Human Services (MCPHHS) and CHOICE will work together on a series of events that
will be focused on cannabis and commercial tobacco prevention efforts towards youth, school districts, and community
members.With this relationship, we are hoping to strengthen the work being done around smoking and vaping, leverage
the expertise of ESD 113 professionals in the region, and increase cessation by youth in the region.
Responsibilities of Mason County Public Health and Human Services (MCPHHS):
Responsibilities of Mason County Public Health Department:
1. Deliverable: Support schools in implementing effective and equitable Substance Use Discipline Policies, Practices,
and Procedures, and in providing prevention resources on cannabis and tobacco prevention.
Activities:
a. Support at least 3 additional schools/Youth coalitions on school discipline topics through technical
assistance on specific areas of need. Propose
b. Compile, and disseminate prevention and cessation resources to school and coalition partners.
c. Assess training needs of school partners in relation to School Substance Use
d. Hold at least 1 training with school professionals on School Substance Use/ Fentanyl, Fetal Alcohol or vape.
e. Promote Prevention Voices Tools and Resources to Mason County Substance Abuse Prevention Coalition
Partners
2. Deliverable: Create a community engagement campaign around prioritized populations/communities on youth
cannabis and tobacco prevention.
Activities•
a. Complete assessment of Mason County capacity needs related to inequities in youth cannabis and tobacco
prevention in our region. Prioritized youth populations of focus may include: LGBTQ+, Rural, Low Hope,
Native American, and/or Hispanic.
b. Support regional equity training&TA opportunities to regional network partners via email, local coalition
meetings, regional coalition coordinators meetings, and ESD promotion to school admin &SAPs.
i. At least 1 regional equity training in the region
3. Deliverable: City and County tobacco and vape policies review
Activities•
a. Conduct Shelton City Tobacco and Marijuana Vape Policy assessment
b. Share results of policy assessment and determined priorities to City Council and Mason County Board of
Health partners via regional network meeting/email updates.
c. Meet with City and County leadership. Council, County Commission meetings providing technical
assistance as requested.
d. YCCTPP coordinator to attend at least 1 capacity building/training event on prevention or related subject
4. Deliverable: Community education
Activities•
a. Host at least 1Region Wide Prevention Summit
b. Create a regional positive community norms campaign addressing youth cannabis and tobacco prevention
c. Create media plan for 22-23 to promote You Can, Under the Influence of You,WA Quitline and any
additional Youth Cannabis and Tobacco Prevention campaigns and resources provided by WA DOH:
i. Social media campaign
ii. Traditional brick and mortar campaign
d. Hold at least 2 focus groups/listening sessions on how to best support and assist Mason County Substance
Abuse Prevention Coalition. Include CHOICE High, Cedar High and North Mason High schools
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5. Deliverable: Collaborate with regional partners to explore addressing safe storage of cannabis &tobacco products
Activities:
a. Plan and implement safe storage project or RX take back Day promotion Project in Spanish and English
b. Promote safe storage project opportunities &safe storage messaging via email and social media and North
Mason Safety Days project
c. Implement "National Drug Take-back" day"Month" Partner with CHOICE High, Cedar High and North
Mason High school Youth Coalitions and Prevention Groups
d. Work with at least 2 private businesses to distribute safe storage materials in Mason Co.
Responsibilities of CHOICE to Mason County Public Health Dept.
1. CHOICE will disburse funds to Mason County
2. CHOICE will provide technical assistance if needed
CHOICE will report to DOH on implementation progress.
Other Activities
To ensure compliance and consistency with program requirements, CHOICE will conduct a series of monitoring activities
throughout the life of this contract and any subsequent amendments and/or extensions made by either CHOICE or DOH.
Those activities include, but are not limited to,the following:
• Reporting on any other activities outlined in MCPH;s Work Plan as listed below:
• Timely reporting by Subrecipient/Subcontractor
• Audit of Subrecipient/Subcontractor invoices (if applicable)
• Site visits
• Regular attendance to network monthly meetings and activities
Mason County
Work Plan- 2022- 2023 Fiscal Year
Coordination Plan
Required Activities By DOH
ctivity
Hire or assign project staff FTE-TBA
Assure all staff working with youth have an acceptable criminal background Complete and required in subcontracts
check on file. that work directly with youth
Participate in performance measure data collection activities in collaboration Yes
with DOH.
Participate in project evaluation activities developed and coordinated by DOH. Yes
Participate in meetings with State YCCTPP contractors hosted by the DOH. Yes
Participate in Monthly YCCTPP Practice collaborative meeting
Attend a one-day workshop with other Department of Health YCCTPP Yes
contractors to receive orientation and foster collaboration(Year 1 only. Travel
paid by DOH).
Provide workforce development training, technical assistance and support to Yes, see workplan
project partners as needed.
Participate in the recruitment of Healthy Youth Survey participation with school Yes, at county level
districts in your community.
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Create data management plan to protect participant confidentiality
Additional Coordination Efforts
Network PSE Goal 1: Support schools in implementing effective and equitable Substance Use Discipline Policies,
Practices, and Procedures,and in providing prevention resources on cannabis and tobacco prevention.
Objective 1:
Support at least 2 schools in the Conducting Social Norms Messaging
Objective 2:
Support at least 3 additional schools/coalitions on school discipline topics through technical assistance on specific areas of
need.
Which State goal(s) does this contribute to? 1,2,3,4
Network Activities
Strategy 1: Network Management & Sustainability
ActivitySubstance(s) Funding Who is responsible? By when? Or
Addressed Source(s) How often?
Participate in TA opportunities with regional Cannabis& Regional partners 2 twice a year,
network partners Tobacco Fall 22&
Spring 23
Strategy 2: Collaboration & Engagement
ActivitySubstance(s) Funding Who is responsible? By when? Or
Addressed ource(s) How often?
Cannabis&
Tobacco
Strategy 3: Media & Communication
Activity ubstance(s) Funding Who is responsible? By when? Or
Addressed ource(s) How often?
Partner with Mason County Coalition and County YCCTPP staff Updates
Media team and CHOICE and Cedar high youth Partner w/mason throughout the
groups to develop social norms messages County Sub Abuse year
Coalition Coordinator.
Compile, and disseminate prevention and cessation Cannabis& CCTPP staff Annually
resources to school and coalition partners/ Tobacco artner w/mason
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County Sub Abuse
Coalition Coordinator
Strategy 4: Education & Technical Assistance
Activity ubstance(s) Funding Who is responsible? By when? Or
Addressed ource(s) How often?
Sept 22—June
23
Assess training needs of school partners in relation Cannabis& YCCTPP staff Winter/Spring
to School Substance Use DATA HYS, then Tobacco Partner w/mason 23
Coordinate related training opportunities and County Sub Abuse
resources. Coalition Coordinator
Strategy 5: Workforce Development
Activity ubstance(s) Funding Who is responsible? By when? Or
Addressed ource(s) How often?
Network PSE Goal 2: Explore and address inequities in relation to youth cannabis and tobacco prevention.
Objective 1: Complete assessment and develop plan to address LGBTQ+youth and additional prioritized populations.
Which State goal(s) does this contribute to? 1,2,3
Network Activities
Strategy 1: Network Management & Sustainability
Activity ubstance(s) Funding Who is By when? Or
Addressed ource(s) responsible? How often?
Assist region with planning, reviewing and Cannabis& Mason YCCTPPAug-Oct 22
feedback with YCCTPP Regional Network Tobacco staff/
Health Equity Planning Tool with regional
network partners
Assist with Assessment of Mason Cannabis& Mason YCCTPPAug-Oct 22
County capacity/needs related to inequities in Tobacco staff/
relation to youth cannabis and tobacco
prevention in our region. Prioritized youth
populations of focus may include: LGBTQ+,
Rural, Low Hope,Native American, and/or
Hispanic.
Strategy 2: Collaboration & Engagement
Activity ubstance(s) Funding Who is By when? Or
Addressed Source(s) responsible? How often?
Support Engagement with school and Cannabis& YCCTPP staff Fall 22- Spring
community partners to provide TA and support Tobacco Partner with 23
around LGBTQ+ youth Coalition
Coordinator Maso
County
Strategy 3: Media & Communication
Activity ubstance(s) Funding Who is By when? Or
Addressed ource(s) _responsible? How often?
Support regional equity training& TA Cannabis& YCCTPP staff July 22-June 23
opportunities to regional network partners via: Tobacco Partner with
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email, local coalition meetings, regional Coalition
coalition coordinators meetings, and ESD Coordinator Mason
promotion to school admin& SAPs. County
Strategy 4: Education & Technical Assistance
ActivitySubstance(s) Funding Who is By when? Or
AddressedSource(s) responsi ble? How often?
Continue building Mason County TA and Cannabis& YCCTPP staff Summer/Fall—
training provided in Spring 22 to support Tobacco Partner with Assess needs and
building spaces of safety and belonging with Coalition plan. Fall—
LGBTQ+Youth. Assess needs and next steps Coordinator Mason Spring,provide
for TA and support for a Mason County school County training and TA
and coalition partners.
Support additional priority population TA and Cannabis& Mason YCCTPP Fall-Assessment,
training provided based on Regional and Tobacco staff Winter—Summer
network assessment -additional TA&
raining
Strategy 5: Workforce Development
ActivitySubstance(s) Funding Who is By when? Or
Addressed ounces responsible? How often?
Promote training and TA opportunities Cannabis& Mason YCCTPP Sept 22—June
provided by YCCTPP Priority Population Tobacco staff/ 23
Contractors, as well as other local/state/and
national training addressing equity in cannabis
and tobacco prevention to regional
subcontractors and regional network partners.
Network PSE Goal 4: Increase engagement of YCCTPP Staff prevention partners in involvement with LCB rulemaking,
outreach to decision makers on cannabis and tobacco prevention topics,and in addressing local cannabis and tobacco
policies&advertising and promotion practices.
Objective 1:
Objective 2: Increase confidence, skills, and engagement among regional prevention partners on outreach with decision
makers and with LCB (Liquor and Cannabis Board)rulemaking process(as measured through network survey).
Objective 3: Complete a regional scan of community tobacco and vape policies within the 5 counties in our region and
identify at least one priority of focus per county. (Will also include cannabis,but focus will be on tobacco&vaping).
Which State goal(s) does this contribute to? 1,2,3,4
Network Activities
Strategy 1: Network Management & Sustainability
ActivitySubstance(s) Funding Source(s) Who is By when? Or How
Addressedresponsible? often?
Engage network partners in reviewing Cannabis& YCCTPP staff Winter/Spring
assessment results and determining Tobacco Partner with 2023
priorities Coalition
Coordinator Mason
County
Strategy 2: Collaboration & Engagement
ActivitySubstance(s) Funding Source(s) Who is By when? Or How
Addressedresponsible? often?
Participation in Prevention Voices. Cannabis& Mason YCCTPP July 22-June 23
YCCTPP Staff will participate in monthly Tobacco staff
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information meetings as appropriate for
Mason Count
Engage local coalition and youth groups Cannabis& Mason YCCTPP July 22-June 23
with advertising/promotion assessment Tobacco staff
project opportunities
Utilize Prevention Voices partnerships, Cannabis& Mason YCCTPP July 22-June 23
tools, and resources to engage in Tobacco staff
education and advocacy re: youth
marijuana and tobacco prevention
regarding key topics in legislation and
rulemaking as appropriate for Mason
County
Participate in Statewide Tobacco Tobacco Mason YCCTPP July 22-June 23
Prevention Coalition and Tobacco Policy staff
Learning Circles. Promote opportunities
to participate to subcontractors and
regional network partners as appropriate
for Mason County
Participate in Retailer Workgroup of WA Cannabis Mason YCCTPP July 22 -June 23,
Practice Collaborative as appropriate for staff monthly meetings
Mason County or as scheduled
Strategy 3: Media and Communication
ActivitySubstance(s) Funding Source(s) Who is By when? Or How
Addressedresponsible? often?
Conduct Shelton City Tobacco and Cannabis& Mason YCCTPP July 22-June 23
Marijuana Vape Policy assessment Tobacco staff/Mason County
Prevention
Coalition
Coordinator
Share results of policy assessment and Cannabis& Mason YCCTPP inter/Spring
determined priorities to City Council and Tobacco staff and Mason 2023
Mason County Board of Health partners county Coalition
via regional network meeting/email coordinator
updates
Strategy 4: Education & Technical Assistance
Activity Substance(s) Funding Source(s) Who is By when? Or How
Addressedresponsible? often?
Prevention Voices Tools and Resources Cannabis& Mason YCCTPP July 22-June 23
will be promoted to Mason County Tobacco staff
Substance Abuse Prevention Coalition
Partners
Conduct 1 County Wide Prevention Cannabis& Mason YCCTPP inter/Spring
Summit Tobacco staff/Mason County 2023
substance Abuse
Coalition
coordinator/FESS
Family Support
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Strategy 5: Workforce Development
ActivitySubstance(s) Funding Source(s) Who is By when? Or How
Addressedresponsible? often?
Promote related training and TA Cannabis& Mason YCCTPP July 22-June 23
opportunities throughout Mason County Tobacco staff/Mason
Web sites, and other social media sources
other local/state/and national
opportunities.
Network PSE Goal 5: Increase Positive Community Norms around youth cannabis and tobacco prevention. Promote
positive messaging and resources to youth and families through use of local,regional, and state
messaging/campaigns.
Objective 1: You Can and Under the Influence of You Campaign will be promoted through local channels in all 5 counties
in the North Sound Region.
Objective 2: Create regional positive community norms messages addressing youth cannabis and tobacco prevention.
Which Stategoal(s) does this contribute to? 1,2,3
Network Activities
Strategy 1: Network Management & Sustainability
ActivitySubstance(s) Funding Who is By when? Or
Addressed ounces responsible? How often?
Strategy 2: Collaboration & Engagement
ActivitySubstance(s) Funding Who is By when? Or
Addressed ounces responsible? How often?
Utilizing Regional HYS data and/or Cannabis& Mason YCCTPP Sept 22—June 23
community surveys, create shared Mason Tobacco staff/Mason
County positive community norms messaging County Substance
around youth cannabis and tobacco prevention Abuse Prevention
Coalition/Shelton
CHOICE Schools
Strategy 3: Media and Communication
ActivitySubstance(s) Funding Who is By when? Or
AddressedSource(s) responsible? ow often?
Create media plan for 22-23 to promote You Cannabis& Mason YCCTPP Updated Media
Can, Under the Influence of You, WA Quitline Tobacco staff/ Plan—Fall,Media
and any additional Youth Cannabis and promotion July-
Tobacco Prevention campaigns and resources June
provided by WA DOH.
Create promotion plan for regional positive Cannabis& Mason YCCTPP inter/Spring 23
community norms messages Tobacco staff//Mason
Coalition
Coordinator,
Shelton CHOICE
Sshool
Strategy 4: Education & Technical Assistance
ActivitySubstance(s) Funding Who is By when? Or
AddressedSource(s) responsible? How often?
Support and assist with development of Mason Cannabis& Mason YCCTPP all/Winter—
County Substance Abuse Prevention Coalition Tobacco staff/Mason Planning
with School Based positive community inter/Spring-
norms/science of the positive messaging and I I I ITraining
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promotion. 2 focus groups or listening
sessions
Strategy 5: Workforce Development
Activity ubstance(s) unding 01 s y when? Or
ddressed ource(s) W w often?
Network PSE Goal 6: Collaborate with regional partners to explore 1) addressing safe storage of cannabis & tobacco
products, and 2)increase focus on youth mental health as a protective factor to decrease youth cannabis and tobacco
use.
Objective 1:
Complete at Safe Storage project within Mason County"Safety Days and Rx Drug Take back promotion
Objective 2: Based on data review&information gathering with local and statewide partners,determine&implement at
least one mental health connection strategy.
Which Stategoal(s) does this contribute to? 1,2,4
Network Activities
Strategy 1: Network Management & Sustainability
Activity Substance(s) Funding Who is By when? Or How
Addressed ource s res onsible? often?
Utilize network partner input in planning for Cannabis& Mason YCCTPP Spring 2023
safe storage project Tobacco staff/
Strategy 2: Collaboration & Engagement
Activity Substance(s) Funding Who is By when? Or How
AddressedSource(s) responsible? often?
Mason County Rx Take safe storage Cannabis& Mason YCCTPP Spring 2023
project(s) Safety Days Project Promotion Tobacco staff/
Plan and implement safe storage project(s) Cannabis& Mason YCCTPP inter/Spring 2023
To include Spanish language translation and Tobacco staff/North Mason
promotion School Dist.
Public Health
Hispanic
translator
Strategy 3: Media and Communication
ActivitySubstance(s) Funding Who is By when? Or How
AddressedSource(s) responsible? often?
Gather input and share updates through Cannabis& Mason YCCTPP all/Winter/Spring
regional network meetings and emails Tobacco staff/
Promote safe storage project opportunities & Cannabis& Mason YCCTPP inter/Spring 23
safe storage messaging via email and social Tobacco staff/
media
Strategy 4: Education & Technical Assistance
ActivitySubstance(s) Funding Who is By when? Or How
AddressedSource(s) responsible? often?
Assess and coordinate related training needs Cannabis& Mason YCCTPP Assess Fall,training
For Mason County YCCTPP Staff(such as Tobacco staff inter/Spring
WA Poison Control or other), or support
local partners in attending statewide training
Strategy 5: Workforce Development
Activity Substance(s) Funding Who is Oy when? Or How
ddressedSource(s) responsible? loften?
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Attend and promote related state/national Cannabis & Mason YCCTPP July-June
training opportunities Such as (WA Tobacco staff
Prevention Summit, Social Norms Training,
SAPTS or related Substance Use Prevention
Training, yearly ESD 112 rural prevention
conference or other related tabaco and
marijuana trainings
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EXHIBIT B
Funding
The Youth and Cannabis and Commercial Tobacco Prevention Program's(YCCTPP)mission is to prevent initiation and
reduce cannabis and commercial tobacco use by youth, ages 12-20, support adults who influence these youth,leverage
resources for promoting and supporting commercial tobacco dependence treatment and reduce cannabis and commercial
tobacco-related inequities within Washington State.
The program itself is made up of four(4)different funding sources for cannabis and commercial tobacco:
• The National and State Tobacco Control Program(NTCP)from the Centers for Disease Control and Prevention
(CDC) and Office of Smoking and Health(OSH);
• The Youth Tobacco and Vapor Product Prevention Account(YTVP);
• The Dedicated Cannabis Account(DCA); and
• The Tobacco Prevention Provision(TPP).
Total consideration by DOH: $571,636 and is further divided as follows:
Chart of Accounts,Program Funding Period Start Date Funding Period End Date Funding Amount
Name or Title
SFY23 Youth Tobacco Vapor July 1,2022 June 30,2023 $48,756.00
Products
SFY23 Marijuana Education July 1,2022 June 30,2023 $312,880.00
SFY23 Tobacco Prevention July 1,2022 June 30,2023 $210,000.00
Provision
1. For the services performed hereunder, the Contractor shall be paid no more than $52,676.01
2. No payment shall be made for any work performed by the Contractor, except for work identified and set
forth in this Contract or supporting exhibits or attachments incorporated by reference into this Contract.
3. The Monthly Activity Reports are to be submitted to CHOICE by the 5th day of each month for the
previous month's activity, and the Expenditure Report and Invoice Request for Reimbursement must
be provided to CHOICE by the 15th day of the month for the previous month's activity in order to receive
reimbursement for the previous month. If CHOICE does not receive the Monthly Expenditure Report and
Request for Reimbursement form by the end of the month, CHOICE may withhold approval and payment,
at its discretion, until the 30th of the month following submittal.
4. Contractor will submit all reimbursement forms to financegglin.org and to the CHOICE/CPAA
YCCTPP Program Manager.
5. Reimbursement requests must include supporting documentation such as approved timesheets,payroll
records, and receipts for equipment, goods, services, related travel, and payments to vendors contracted by
MCPHHS.
6. Expectations related to monthly billing will remain consistent. Late invoices will be processed in the
subsequent month. CHOICE will no longer accept end of year invoices with less than ten days before final
deadline submission to DOH to allow CHOICE finance appropriate time to process all documents.
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Exhibit C
Subcontract Invoice Template
CHOICE REGIONAL CONTRACT NO.
HEALTH NETWORK FUNDING SOURCE:
Cascade Pacific ActionAllianceTOTAL CONTRACT BUDGET:
INVOICE NO.
SUBCONTRACTOR NAME AND ADDRESS TAX ID:
'Reporting
Month and
Year:
Date Description Amount
TOTAL 0
CONTRACT EXPENDITURE AND REVENUE RECONCILIATION
(a)Total Subcontract Amount:
(b)Reimbursements Received to Date:
Total Reimbursement Requested This Month: 0
(c)Balance of Total Contract Amount:
For internal use only:
Approved by:
(Signature and date required to process payment to partner) Date
1217 4th Avenue,Suite 200,Olympia,WA 98506
(360)539-7576
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Exhibit D
Subcontractor/Vendor
Proclamation 21-14—COVID-19 Vaccination Certification
To reduce the spread of CO VID-19, Washington state Governor Jay Inslee,pursuant to emergency powers authorized in RC W
43.06.220, issued Proclamation 21-14—COVIDI9 Vaccination Requirement(dated August 9, 2021), as amended by Proclamation 21-
14.2—COVID-19 Vaccination Requirement(dated September 27, 2021)and as may be amended thereafter. The Proclamation requires
contractors/vendors who have goods, services, or public works contracts with a Washington state agency to ensure that their personnel
(including subcontractors)who perform contract activities on-site comply with the COVID-19 vaccination requirements, unless
exempted as prescribed by the Proclamation.
I hereby certify, on behalf of Mason County Public Health and Human Services has or does not have a
COVID-19 Contractor Vaccination Verification Plan that complies with the state's Vaccination Proclamation as defined
below:
1. I have reviewed and understand the Subcontractor/Vendor obligations as set forth in Proclamation 21-14—COVID-
19 Vaccination Requirement(dated August 9,2021),as amended by Proclamation 21-14.2—COVID-19
Vaccination Requirement(dated September 27, 2021);
2. 1 have developed a COVID-19 Vaccination Verification Plan for personnel that complies with the above-referenced
Proclamation;
3. 1 have obtained a copay or visually observed proof of full vaccination against COVID-19 for my personnel who are
subject to the vaccination requirement in the above-referenced Proclamation;
4. 1 am complying with the requirements for granting disability and religious accommodations for my personnel who
are subject to the vaccination requirement in the above-referenced Proclamation;
5. I have operational procedures in place to ensure that any contract activities that occur in person and on-site at DOH
premises performed by our organization will be performed by personnel who are fully vaccinated or properly
exempted;
6. 1 have operational procedures in place to enable my personnel who perform contract activities on-site at DOH
premises to provide compliance documentation that such personnel are in compliance with the above-referenced
Proclamation;
7. 1 will provide to DOH and/or CHOICE,upon request,my COVD-19 Vaccination Verification Plan,and related
records, except as prohibited by law,and will cooperate with any investigation or inquiry pertaining to the same.
OR
Mason County Public Health and Human Services does not have a current COVID-19 Vaccination Verification Plan
and, is not able to develop and provide a COVID-19 Vaccination Verification Plan to ensure that personnel meet the
COVID-19 vaccination requirements as set forth in the above-referenced Proclamation, and provide the same to DOH
within twenty-four(24)hours of such request. (NOTE: Compliance with the Proclamation is mandatory and failure to
comply could result in termination of Contract/purchase order.)
I hereby certify,under penalty of perjury under the laws of the State of Washington,that the certifications herein are
true and correct and that I am authorized to make these certifications on behalf of the organization listed above.
SIG "Edd ®FyAUTHORIZED CERTIFYING OFFICIAL NAME AND TITLE
Sharon Trask, Commissioner
SUBCONTRACTOR ORGANIZATION DATE SUBMITTED
Mason County Public Health and Human Services 4/14/2023
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Exhibit E
Subcontractor/Vendor
Background Check Verification Certification
In accordance with Washington State Legislature RCW 43.150.080(At risk children—Collaborative program)and RCW
43.43.830 through 43.43.834(Background checks—Access to children or vulnerable persons), all Subcontractors and Vendors
who work directly with youth (ages 0-17)are required to disclose that their background check policies include language that
covers both volunteers and staff who may work with or have unsupervised access to youth and at-risk youth ages 0 to 17, ,
developmentally disabled persons or vulnerable adults.
I hereby certify, on behalf of Mason County Public Health and Human Services has or does not
have a Background Checks Policy that complies with RCW 43.150.080 and 43.43.830 through 43.43.834. 1 further
understand that if I do not currently have a compliant Background Checks Policy,that I have 30 days from the date of
this fully executed contract to amend any existing policy with relevant language based on the following RCW
43.43.830 language:
1. An"Applicant"or"Volunteer"means:
a. Any prospective employee who will or may have unsupervised access to children,youth, and at-risk
youth seventeen years or younger, or developmentally disabled persons or vulnerable adults during
the course of their employment or involvement with the business or organization;
b. Any prospective volunteer who will have regularly scheduled unsupervised access to children
seventeen years or younger,developmentally disabled persons, or vulnerable adults during the course
of their employment or involvement with the business or organization under circumstance where such
access will or may involve groups of(i) five or fewer children under twelve years of age, (ii)three or
fewer children and/or at-risk youth between twelve and sixteen years of age, (iii)developmentally
disabled persons, or(iv)vulnerable adults
2. "Peer counselor"means a nonprofessional person who has equal standing with another person,providing
advice on a topic about which the nonprofessional person is more experienced or knowledgeable, and who is
a counselor for a peer counseling program that contracts with or is otherwise approved by the department,
another state or local agency, or the court.
a. With regard to peer counselors, "unsupervised"does not include incidental contact with children or at-
risk youth under age seventeen at the location at which the peer counseling is taking place.
b. "Incidental contact"means minor or casual contact with a child or at-risk youth in an area accessible
to and within visual or auditory range of others. It could include passing a child or at-risk youth while
walking down a hallway but would not include being alone with a child or at-risk youth for any
period of time in a closed room or office.
SI &Tjri ,fa QF AUTHORIZED CERTIFYING OFFICIAL NAME AND TITLE
�—", T" Sharon Trask, Commissioner
SUBCONTRACTOR ORGANIZATION DATE SUBMITTED
Mason County Public Health and Human Services 4/14/2023
END OF CONTRACT
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