HomeMy WebLinkAboutSub-contract btwn Yakima Neighborhood Health & KCPH'i) .... ,., ....
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Yakima Neighborhood Health Services
t2 South SIb St, PO Box 2605
Yakima WA 98907-2605
Phone (509) 454-4143 Fax (509) 454-3651
www.ynhs.org
2017-2018
Navigator Program Services
SUB-CONTRACT BETWEEN
YAKIMA NEIGHBORHOOD HEALTH SERVICES
AND
Kittitas County Public Health Department
Contract Terms and Conditions
Based on
HBE -349 Navigator Program Services
Lead Organizations and Statewide Navigator Organizations
Navigator Program Services for the
Washington Health Benefit Exchange
August 2017 -June 2018
All terms and conditions of HBE 349 apply, along with the terms set
forth as follows by the Health Benefit Exchange:
The purpose of this sub-contract as follows:
A.Term:
This sub-contract extends the terms of the contract between YNHS and the Health
Benefit Exchange to the Sub-Contractor. The period of performance shall continue through
June 3D, 2018.
B. Contract Section 3 -Pricing:
The maximum not-to-exceed compensation, which includes any allowable expenses, payable to Sub-
Contractor for satisfactory performance of the work under this contract shall not exceed $27,834
inclusive of the 2017 base payment and potential outcome-based incentive. The payment schedule is set
forth as follows:
• $2150.81 monthly August -June 2018 to support Navigator activities for eleven months (base
payment).
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Accredited by the Joint Commission Patient Centered Medical Home Level 3
Yakima Neighborhood Health Services
12 South 8'h St, PO Box 2605
Yakima WA 98907·2605
Phone (509) 454-4143 Fax (509) 454·3651
www.ynhs.org
• $4,175 -one-time incentive payment for meeting QHP enrollment target of 369.. The incentive
will be paid by HBE to YNHS (and YNHS to the sub-contractor) for the proportion of the
amended enrollment target met for new and renewed plans selected through the end of the OE-5
Open Enrollment period as validated by the Washington Healthplanfmder system data.
Total Base Payment =
Total Potential Incentive Payment
Maximum Nine Month Contract Award
C. Contractor Payment:
$23,659
$ 4,175
$ 27,834
• Sub-Contractors will receive a one-time enrollment outcome payment after the 2018 open
enrollment period concludes. The payment will be generated upon validation through the
Washington Healthplanfmder system of the QHP new and QHP renewed plans selected by
service area navigators during the open enrollment period. The payment will be based on the
proportion, up to but not exceeding 100%, of the QHP plan selection contract goal met at the
conclusion of the open enrollment period.
• Should sub-contractor enroll or re-enroll fewer than 325 QHP members (as identified by the HBE
data system), sub-contractor's outcome-based enrollment payment will be pro-rated to that same
percentage of the one-time incentive payment.
D. Reporting:
Sub-contractor agrees to continue reporting monthly outreach activities to contractor, using the format
provided by HBE and/or contractor, to include: Highlights of community outreach events or key
activities during the previous month: Outreach events conducted in report month, city/county, target
population; Key accomplishments; BarrierslIssues experienced during outreach effort
Reports are due by the 5 th of the following month.
The parties hereto, having read this Sub-Contract Amendment in its entirety, do agree to the terms of the
amendment
Approved (Contractor)
Yakima Neighborhood Health Services
~~
Signature
Print name and title
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Accredited by the Joint Commission
R~rJn lt~Q) t AQ01 I~ 1 ~h121b)l
Print name and title
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Patient Centered Medical Home Level 3
DocuSign Envelope 10: 62955F10-7A37-4CBO-A808-2BA7AOB5515E
CONTRACT FOR NAVIGATOR SERVICES
BETWEEN
WASHINGTON HEALTH BENEFIT EXCHANGE
AND
YAKIMA NEIGHBORHOOD HEALTH SERVICES
This Contract is made and entered into by and between the Washington Health Benefit Exchange hereinafter
referred to as the "HBE" or "EXCHANGE", and the below named firm, hereinafter referred to as "Contractor,"
Contractor Name: Yakima Neighborhood Health Services
Business Address: 12 South 8th Street, PO Box 2605
City, State and Zip Code: Yakima, WA 98907-2605
Phone: (509)574-5550
Email: C1nfta :n10/l0Ian@ynhs.org
WA State UBI Number: 601139605
1. IT IS MUTUALLY AGREED THAT:
The purpose of this contract is to provide the Washington Health Benefit Exchange with a qualified
Navigator Lead Organization to conduct outreach and to build and oversee a network of organizations that
deliver Washington Healthplanfinder application and enrollment assistance throughout designated
services areas. The Contractor will perform the responsibilities and duties, as defined in Statements of
Work, throughout the term of the resulting Contract.
2. SPECIAL TERMS AND CONDITIONS
Under no circumstances will contractors perform any work until this Contract and any subsequent Statement
of Work (SOW) have been fully executed. Any work performed without a properly executed Contract,
Statement of Work, or amendment will be at the Contractor's risk. The EXCHANGE is under no obligation to
pay for work performed without properly executed authorization.
3. SCOPE OF WORK
3.1 Exhibit A, attached hereto and incorporated by reference, contains the General Terms and Conditions
governing work to be performed under this contract, the nature of the working relationship between
the EXCHANGE and the CONTRACTOR, and specific obligations of both parties.
3 .2 The CONTRACTOR will provide services and staff, and otherwise do all things necessary for or
incidental to the performance of work, as set forth in Exhibit C, Statement of Work, attached hereto
and incorporated by reference herein and any other Statement of Work entered into by the parties
under this Contract .
4. PERIOD OF PERFORMANCE
The initial period of performance for this Contract is August 1, 2017 or date of execution, whichever is
later, through June 30, 2018. The Exchange may extend this Contract in whatever timeframes the
EXCHANGE deems necessary, not to exceed June 30, 2022. No billable activity may take place until this
Contract has been signed by both parties.
HBE-349 YNHS Navigator Lead Organization Services Contract Page 1 of41
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5. COMPENSATION
5.1 The Maximum Not-To-Exceed Compensation, which includes any allowable expenses, payable to the
Contractor for satisfactory performance of the work under this Contract shall not exceed One Hundred
Fifty Nine Thousand Fifty Two Dollars ($159,052.00). In no event shall the cost or payment exceed the
Maximum Not-to-Exceed Compensation associated with this Contract.
Contractor's compensation for services rendered shall be based on the payment schedule provided in
Exhibit C, Statement of Work .
5.2 Expenses. Reimbursement for travel or per diem to or from the Olympia, Washington area will not be
authorized. Any travel associated with providing services under this contract is expected to be covered
within the maximum compensation provided .
6. INVOICES AND BILLING PROCEDURES
6.1 Payments to Contractors for Navigator Program Services are contingent on the Contractor submitting
properly completed, timely monthly progress reports to the HBE Navigator Program Manager.
Contractor will use a report format prescribed by HBE. Upon HBE's approval of the Contractor's
reports, HBE will prepare and submit a payment authorization to HBE Finance on behalf of the
Contractor to initiate payments authorized under this contract. HBE Finance will generate payment to
the Contractor. The Contractor will receive a copy of the payment authorization generated.
6.2 Invoices shall be submitted to WAHBE via email at flnan ce@ WAHBEx cllange.org . The first invoice
submitted for payment must be accompanied by the Contractor's IRS Form W·9 -Request for
Taxpayer Identification Number and Certification. Invoices must reference this contract number and
provide detailed information as requested by WAHBE.
6.3 Payment to the Contractor for meeting specific enrollment targets will be made at the conclusion of
the open enrollment period and will be generated upon validation of the HPF enrollments completed
by Contractor and the Contractor's subcontractors in the Contractor's service area network.
6.4 If HBE fails to make timely payment, Contractor may invoice HBE one percent (1%) per month of the
amount overdue or a minimum of one dollar ($1.00). HBE's payment will not be considered late if
payment is deposited electronically in Contractor's bank account or if a check or warrant is
postmarked within forty-five (45) calendar days of the date of the HBE payment authorization to HBE
Finance.
6.5 All deliverables must be submitted to the Project Manager, and must meet with the approval of the
Project Manager or his/her designee prior to payment . The Project Manager is responsible for review
of deliverables submitted and authorizing contractor payments, which such authorization shall not be
unreasonably withheld. The review shall ensure the authorized amount is not exceeded and reviewed
by the Finance Team to assure that the dollar limit established by this Contract will not be exceeded by
the sum of all Work Orders executed.
6.6 Payment shall be considered timely if made by the Exchange within thirty (30) calendar days after
receipt of properly completed invoices. Upon expiration of the Contract, any claims for payment for
costs due and payable under this Contract that are incurred prior to the expiration date must be
submitted by the Contractor to the EXCHANGE within 60 days after the Contract expiration date.
Belated claims shall be paid at the discretion of the Exchange and are contingent upon the availability
of funds.
HBE-349 YNHS Navigator Lead Organization Services Contract Page 2 of 41
Do c uSign Envelope ID : 62955F1D-7A37-4CBO-A8D8-28A7ADB5515E
6.7 Payment shall be sent to the address designated by the Contractor, unless the EXCHANGE has opted to
use electronic fund transfer.
6.8 The Exchange may, in its sole discretion, terminate this Contract or withhold payments claimed by the
Contractor for services rendered if the Contractor fails to satisfactorily comply with any term or
condition of this Contract .
6.9 No payments in advance or in anticipation of services or supplies to be provided under this Contract
shall be made by the EXCHANGE.
7. CONTRACT MANAGEMENT
7.1 The Contract Manager for each of the parties shall be the contact person for all communications and
billings regard ing the performance of this Contract.
Contract Manager For Contractor: For HBE:
Name and Title Anita Monoian Kelly Boston
President/Chief Executive Officer Associate Director of Outreach &
Communication
Address 12 South 8th Street 810 Jefferson Street
PO Box 2605 PO Box 657
City, State, Zip Yakima, WA 98907-2605 Olympia, WA 98507
Phone (509) 574-5550 (360) 688-7747
Email anita .monoian@~n ,hs.org kell~.boston@wahbexchange .org
7.2 Notices. Any notice or other communication required to be given under this Contract shall be effective If
it is in writing, properly addressed, and either delivered in person, or by a recognized courier service, or
deposited with the United States Postal Service as certified mail, postage prepaid, return receipt
requested, or by electronic mail (email), to the parties at the addresses and e-mail addresses provided in
this Section.
8. ASSURANCES
The EXCHANGE and the Contractor agree that all activity pursuant to this Contract will be in accordance
with all the applicable current federal, state and local laws, rules, and regulations.
9. ORDER OF PRECEDENCE
Each of the Exhibits listed below is by this reference hereby incorporated into this Contract. I n the event of
an inconsistency in this Contract, the inconsistency shall be resolved by giving precedence in the following
order:
• Applicable Federal and State of Washington statutes and regulations
• Special terms and conditions as contained in this basic Contract instrument
• Exhibit A -General Terms and Conditions
• Exhibit B -Federal Certifications and Assurances
• Exhibit C -Statement of Work
• Exhibit D -Data Security Requirements
• Exhibit E -Nondisclosure Agreement
• Exhibit F -Outreach Plan
• Exhibit G -Enrollment Sites
• Exhibit H -Lead Organization Budget and Fund Allocation
HBE -349 YNHS Navigator Lead Organization Services Contract Page 3 of 41
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• Exhibit 1-List of Disqualifying Crimes
• Contractor's Response to RFP 17-003 -dated May 7,2017
• RFP 17-003 -dated April 17, 2017
• Any other provision, term or material incorporated herein by reference or otherwise incorporated
10. ENTIRE AGREEMENT
This Contract including referenced exhibits represents all the terms and conditions agreed upon by the
parties. No other understandings or representations, oral or otherwise, regarding the subject matter of
this Contract shall be deemed to exist or to bind any of the parties hereto.
11. CONFORMANCE
If any provision of this Contract violates any statute or rule of law of the State of Washington, it is considered
modified to conform to that statute or rule of law.
12. APPROVAL
This Contract shall be subject to the written approval of the EXCHANGE's authorized representative and
shall not be binding until so approved. The Contract may be altered, amended, or waived only by a written
amendment executed by both parties.
THIS CONTRACT is executed by the persons signing below who warrant that they have the authority to
execute the Contract.
YAKIMA NEIGHBORHOOD HEALTH SERVICES WASHINGTON HEALTH BENEFIT EXCHANGE
Title
HBE-349 VNHS
7/27/2017
Date
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5 nJllOii3 111440.2 gnat:Ure
chief Marketing officer 7/27/2017
Title Date
Navigator Lead Organization Services Contract Page 4 of 41
DocuSign Envelope ID: 62955F1D-7A37-4CBO-A8D8-2BA7ADB5515E
EXHIBIT A -GENERAL TERMS AND CONDITIONS
1. DEFINITIONS
As used throughout this Contract, the following terms shall have the meaning set forth below:
A. "AGENT" shall mean the Chief Executive Officer (CEO) of the EXCHANGE, and/or the delegate
authorized in writing to act on the CEO's behalf.
B. "CONTRACTOR" shall mean that firm, provider, organization, individual or other entity performing
service(s) under this Contract, and shall include all employees of the CONTRACTOR.
C. "EXCHANGE" shall mean the Washington Health Benefit Exchange, any division, section, office,
unit or other entity of the EXCHANGE, or any of the officers or other officials lawfully representing
the EXCHANGE.
D. "SUBCONTRACTOR" shall mean one not in the employment of the CONTRACTOR, who is
performing all or part of those services under this Contract or under a separate contract with the
CONTRACTOR . The terms "SUBCONTRACTOR" and "SUBCONTRACTORS" means
SUBCONTRACTOR(s) in any tier.
2. ADVANCE PAYMENTS PROHIBITED
No payments in advance of or in anticipation of goods or services to be provided under this Contract
shall be made by the EXCHANGE.
3. AMENDMENTS
This Contract may be amended by mutual agreement of the parties. Such amendments shall not be
binding unless they are in writing and signed by personnel authorized to bind each of the parties.
4. AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, also referred to as the
"ADA" 28 CFR Part 35
The CONTRACTOR 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.
5. ASSIGNMENT
Neither this contract, nor any claim arising under this contract, shall be transferred or assigned by
the CONTRACTOR without prior written consent of the EXCHANGE. HBE may assign this Contract to
the Exchange Board established by chapter 43.71 RCW, or any public agency, commission, board, or
the like, within the political boundaries of the State of Washington.
6. ATTORNEYS' FEES
In the event of litigation or other action brought to enforce Contract terms, each party agrees to bear
its own attorney fees and costs.
7. BACKGROUND CHECKS
Due to the confidential nature ofthe information and materials which will be accessible to
Contractor, HBE will require the Contractor to conduct a state and/or federal criminal background
on Contractor Staff to be used to provide the Services. HBE reserves the right in its sole discretion to
reject any propose Contractor Staff as a result of information produced by background check.
HBE-349 YNHS Exhibit A -General Terms and Conditions Page 5 of41
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8. CONFIDENTIALITY/SAFEGUARDING OF INFORMATION
The CONTRACTOR shall not use or disclose any information concerning the EXCHANGE, or
information that is considered personally identifiable information (P.I.I.), for any purpose not
directly connected with its performance under or the administration of this contract, except with
prior written consent of the EXCHANG E, or as may be required by law. For the purposes of this
section, "Personally Identifiable Information" or "P.I.I." means information which can be used to
distinguish or trace an individual's identity, such as their name, social security number, biometric
records, etc., alone, or when combined with other personal or identifying information which is
linked or linkable to a specific individual, such as date and place of birth, or mother's maiden name,
etc.
9. CONFLICT OF INTEREST
Notwithstanding any determination by the Executive Ethics Board or other government tribunal, the
EXCHANGE may, in its sole discretion, by written notice to the CONTRACTOR terminate this Contract
if it is found after due notice and examination by the AGENT that there is a violation of the Ethics in
Public Service Act, Chapter 42.52 RCW; or any similar statute involving the CONTRACTOR in the
procurement of, or performance under this contract.
In the event this Contract is terminated as provided above, the EXCHANGE shall be entitled to pursue
the same remedies against the CONTRACTOR as it could pursue in the event of a breach of the
Contract by the CONTRACTOR. The rights and remedies of the EXCHANGE provided for in this clause
shall not be exclusive and are in addition to any other rights and remedies provided by law. The
existence of facts upon which the AGENT makes any determination under this clause shall be an issue
and may be reviewed as provided in the "Disputes" clause of this contract.
10. COPYRIGHT PROVISIONS
Unless otherwise provided, all materials produced under this Contract shall be considered "works for
hire" as defined by the U.S. Copyright Act and shall be owned by the EXCHANGE. The EXCHANGE shall
be considered the author of such materials. In the event the materials are not considered "works for
hire" under the U.S. Copyright laws, CONTRACTOR hereby irrevocably assigns all right, title, and
interest in materials, including all intellectual property rights, to the EXCHANGE effective from the
moment of creation of such materials.
Materials means all items in any format and includes, but is not limited to, data, reports, documents,
pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes,
and/or sound reproductions. Ownership includes the right to copyright, patent, register and the
ability to transfer these rights.
CONTRACTOR shall retain all patent, copyright and other intellectual property rights in the
methodologies, methods of analysis, ideas, concepts, know-how, models, tools, techniques, skills,
knowledge and experience (collectively, "Intellectual Property") owned or possessed by
CONTRACTOR before the commencement of, or acquired by CONTRACTOR during or after, the
performance of the services.
For materials that are delivered under the contract, but that incorporate pre-existing materials not
produced under the contract, CONTRACTOR hereby grants to the EXCHANGE a nonexclusive, royalty-
free, irrevocable license (with rights to sublicense others) in such materials to translate, reproduce,
distribute, prepare derivative works, publicly perform, and publicly display. The CONTRACTOR
warrants and represents that CONTRACTOR has all rights and permissions, including intellectual
property rights, moral rights and rights of publicity, necessary to grant such a license to the
EXCHANGE.
HBE-349 YNHS Exhibit A -General Terms and Conditions Page 6 of41
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The CONTRACTOR shall exert all reasonable effort to advise the EXCHANGE, at the time of delivery of
materials furnished under this contract, of all known or potential invasions of privacy contained
therein and of any portion of such document that was not produced in the performance of this
contract.
The EXCHANGE shall receive prompt written notice of each notice or claim of infringement received
by the CONTRACTOR with respect to any data delivered under this contract. The EXCHANGE shall
have the right to modify or remove any restrictive markings placed upon the data by the
CONTRACTOR.
11. COVENANT AGAINST CONTINGENT FEES
The CONTRACTOR warrants that no person or selling agent has been employed or retained to solicit
or secure this Contract upon an agreement or understanding for a commission, percentage, brokerage
or contingent fee, excepting bona fide employees or bona fide established agents maintained by the
CONTRACTOR for securing business.
The EXCHANGE shall have the right, in the event of breach of this clause by the CONTRACTOR, to annul
this Contract without liability or, in its discretion, to deduct from the Contract price or consideration
or recover by other means the full amount of such commission, percentage, brokerage or contingent
fee.
12. DISALLOWED COSTS
The Contractor is responsible for any audit exceptions or disallowed costs incurred by its own
organization or that of its Subcontractors.
13. DISPUTES
Except as otherwise provided in this contract, when a dispute arises between the parties and it cannot
be resolved by direct negotiation, either party may request a dispute hearing with AGENT.
1. The request for a dispute hearing must:
• Be in writing;
• State the disputed issue(s);
• State the relative positions of the parties;
• State the CONTRACTOR'S name, address, and Contract number; and
• Be mailed to the AGENT and the other party's (respondent's) Contract Manager within 3
working calendar days after the parties agree that they cannot resolve the dispute.
2. The respondent shall send a written answer to the requester's statement to both the agent and
the requester within 5 working calendar days.
3. The AGENT shall review the written statements and reply in writing to both parties within 10
working days. The AGENT may extend this period if necessary by notifying the parties.
4. The parties agree that this dispute process shall precede any action in a judicial or quasi-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.
HBE-349 YNHS Exhibit A -General Terms and Conditions Page 1 of41
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14. DUPLICATE PAYMENT
The EXCHANGE shall not pay the CONTRACTOR, if the CONTRACTOR has charged or will charge the
EXCHANCE or any other party under any other contract or agreement, for the same services or
expenses.
15. GOVERNING LAW
This Contract shall be construed and interpreted in accordance with the laws of the State of
Washington, and the venue of any action brought hereunder shall be in the Superior Court for
Thurston County.
16. INDEMNIFICATION
To the fullest extent permitted by law, CONTRACTOR shall indemnify, defend, and hold harmless the
EXCHANGE, the State, agencies of State and all officials, agents and employees of the EXCHANGE,
from and against all claims for injuries or death arising out of or resulting from the performance of
the contract. "Claim," as used in this contract, means any financial loss, claim, suit, action, damage,
or expense, including but not limited to attorney's fees, attributable for bodily injury, sickness,
disease, or death, or injury to or destruction of tangible property including loss of use resulting
therefrom.
CONTRACTOR'S obligations to indemnify, defend, and hold harmless includes any claim by
CONTRACTORS' agents, employees, representatives, or any subcontractor or its employees.
CONTRACTOR expressly agrees to indemnify, defend, and hold harmless the EXCHANGE for any claim
arising out of or incident to CONTRACTOR'S or any subcontractor's performance or failure to perform
the contract. CONTRACTOR'S obligation to indemnify, defend, and hold harmless the EXCHANGE shall
not be eliminated or reduced by any actual or alleged concurrent negligence of EXCHANGE or its
agents, agencies, employees and officials.
CONTRACTOR waives its immunity under Title S1 RCW to the extent it is required to indemnify, defend
and hold harmless the EXCHANGE and its officials, agents or employees.
17. INDEPENDENT CAPACITY OF THE CONTRACTOR
The parties intend that an independent contractor relationship will be created by this contract. The
CONTRACTOR and his or her employees or agents performing under this Contract are not employees
or agents of the EXCHANGE. The CONTRACTOR will not hold himself/herself out as or claim to be an
officer or employee of the EXCHANGE or of the State of Washington by reason hereof, nor will the
CONTRACTOR make any claim of right, privilege or benefit that would accrue to such employee under
law. Conduct and control of the work will be solely with the CONTRACTOR.
18. INDUSTRIAL INSURANCE COVERAGE
The CONTRACTOR shall comply with the provisions of Title 51 RCW, Industrial Insurance. If the
CONTRACTOR fails to provide industrial insurance coverage or fails to pay premiums or penalties on
behalf of its employees, as may be required by law, EXCHANGE may collect from the CONTRACTOR
the full amount payable to the Industrial Insurance accident fund. The EXCHANGE may deduct the
amount owed by the CONTRACTOR to the accident fund from the amount payable to the
CONTRACTOR by the EXCHANGE under this contract, and transmit the deducted amount to the
Department of Labor and Industries, (L&I) Division of Insurance Services. This provision does not
waive any of L&I's rights to collect from the CONTRACTOR.
HBE-349 YNHS Exhibit A -General Terms and Conditions Page 8 of41
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19. INSURANCE
19.1. Upon execution of the Contract, and during the remaining term of this Contract, Contractor
shall maintain in full force and effect, the insurance described in this section. Contractor shall
acquire such insurance from an insurance carrier or carriers licensed to conduct business in
the state of Washington and having a rating of A-, Class VII or better, in the most recently
published edition of Best's Reports. In the event of cancellation, non-renewal, revocation or
other termination of any insurance coverage required by this Contract, Contractor shall
provide written notice of such to HBE within one Business Day of Contractor's receipt of such
notice. Failure to buy and maintain the required insurance may result in this Contract's
termination.
19.2. The minimum acceptable limits shall be as indicated below for each of the following
categories:
a. Commercial General Liability covering the risks of bodily injury (including death),
property damage and personal injury, including coverage for contractual liability, with a
limit of not less than $1 million per occurrence/$2 million general aggregate;
b. Employers Liability insurance covering the risks of Contractor's employees' bodily injury
by accident or disease with limits of not less than $1 million per accident for bodily
injury by accident and $1 million per employee for bodily injury by disease;
c. Umbrella policy providing excess limits over the primary policies in' an amount not less
than $3 million;
d. Professional Liability Errors and Omissions, with a deductible not to exceed $25,000, and
coverage of not less than $2 million per occurrence/$4 million general aggregate; and
Crime Coverage with a deductible not to exceed $1 million, and coverage of not less
than $5 million single limit per occurrence and $10 million in the aggregate, which shall
at a minimum cover occurrences falling in the following categories: Computer Fraud;
Forgery; Money and Securities; and Employee Dishonesty.
19.3. Premiums on all insurance policies shall be paid by Contractor or its Subcontractors. Such
insurance policies shall name HBE as an additional insured on all general liability and umbrella
policies.
19.4. Contractor's insurance policies shall not be canceled or nonrenewed in scope of coverage
without provision for equivalent substitute insurance. Contractor's insurance policies shall
not be reduced in scope without HBE's prior written consent.
19.5. Contractor agrees to waive all rights of subrogation against HBE for losses arising from
services performed by Contractor under this Contract.
19.6. All insurance provided by Contractor shall be primary as to any other insurance or self-
insurance programs afforded to or maintained by the HBE and shall include a severability of
interests (cross-liability) provision.
19.7. Contractor shall include all Subcontractors as insured under all required insurance policies, or
shall furnish separate certificates of insurance and endorsements for each Subcontractor.
Subcontractor(s) shall comply fully with all insurance requirements stated herein. Failure of
Subcontractor(s) to comply with insurance requirements does not limit Contractor's liability
or responsibility.
19.8. Contractor shall furnish to HBE copies of certificates of all required insurance within 30
calendar days of this Contract's Effective Date, and copies of renewal certificates of all
HBE-349 YNHS Exhibit A -General Terms and Conditions Page 9 of41
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required insurance within 30 calendar days after the renewal date. These certificates of
insurance must expressly indicate compliance with each and every insurance requirement
specified in this section.
20. LICENSING, ACCREDITATION AND REGISTRATION
The CONTRACTOR shall comply with all applicable local, state, and federal licensing, accreditation and
registration requirements/standards, necessary for the performance of this contract.
21. LIMITATION OF AUTHORITY
Only the AGENT or AGENT'S delegate by writing (delegation to be made prior to action) shall have the
express, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of
this contract. Furthermore, any alteration, amendment, modification, or waiver or any clause or
condition of this Contract is not effective or binding unless made in writing and signed by the AGENT.
22. NONCOMPLIANCE WITH NONDISCRIMINATION LAWS
In the event of the CONTRACTOR'S non-compliance 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 CONTRACTOR may be declared ineligible for further contracts with the EXCHANGE. The
CONTRACTOR 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.
23. NONDISCRIMINATION
During the performance of this contract, the CONTRACTOR shall comply with all federal and state
nondiscrimination laws, regulations and policies .
24. Non-Solicitation.
During the term of this Contract and for 12 months after any termination of this Contract,
CONTRACTOR will not, without the prior written consent of the AGENT, either directly or indirectly,
on CONTRACTOR'S own behalf or in the service or on behalf of others], solicit or attempt to solicit,
divert or hire away any person employed by the EXCHANGE.
25. PRIVACY
Personal Identifiable Information including, but not limited to, "Protected Health Information,"
collected, used, or <;Icquired in connection with this Contract shall be protected against unauthorized
use, disclosure, modification or loss. CONTRACTOR shall ensure its directors, officers, employees,
subcontractors or agents use Personal Identifiable Information solely for the purposes of
accomplishing the services set forth herein. CONTRACTOR and its subcontractors agree not to release,
divulge, publish, transfer, sell or otherwise make known to unauthorized persons Personal Identifiable
Information without the express written consent of the Exchange or as otherwise required by law.
Any breach of this provision may result in termination of the Contract and the demand for return of
all personal information. The CONTRACTOR agrees to indemnify and hold harmless the EXCHANGE
for any damages related to the CONTRACTOR'S unauthorized use of personal information.
26. PUBLICITY
The CONTRACTOR agrees to submit to the EXCHANGE all advertising and publicity matters relating to
this Contract wherein the EXCHANGE'S name is mentioned or language used from which the
connection of the EXCHANGE'S name may, in the EXCHANGE'S judgment, be inferred or implied. The
CONTRACTOR agrees not to publish or use such advertising and pUblicity matters without the prior
written consent of the EXCHANGE.
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27. RECORDS MAINTENANCE
The CONTRACTOR shall maintain books, records, documents, data and other evidence relating to this
Contract and performance of the services described herein, including but not limited to accounting
procedures and practices that sufficiently and properly reflect all direct and indirect costs of any
nature expended in the performance of this contract.
CONTRACTOR shall retain such records for a period of six years following the date of final payment.
At no additional cost, these records, including materials generated under the contract, shall be subject
at all reasonable times to inspection, review or audit by the EXCHANGE, personnel duly authorized by
the EXCHANGE, the Office of the State Auditor, and federal and state officials so authorized by law,
regulation or agreement.
If any litigation, claim or audit is started before the expiration of the six (6) year period, the records
shall be retained until all litigation, claims, or audit findings involving the records have been resolved.
28. REGISTRATION WITH DEPARTMENT OF REVENUE
The CONTRACTOR shall complete registration with the Washington State Department of Revenue and
be responsible for payment of all taxes due on payments made under this contract.
29. RIGHT OF INSPECTION
The CONTRACTOR shall provide right of access to its facilities to the EXCHANGE, or any of its officers,
or to any other authorized agent or official of the state of Washington or the federal government, at
all reasonable times, in order to monitor and evaluate performance, compliance, and/or quality
assurance under this contract.
30. 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 Contract and prior to normal completion, the EXCHANGE may terminate
the Contract under the "Termination for Convenience" clause, without the ten-day notice
requirement, subject to renegotiation at the EXCHANGE'S discretion under those new funding
limitations and conditions.
31. SEVERABILITY
The provisions of this Contract are intended to be severable. If any term or provision is illegal or
invalid for any reason whatsoever, such illegality or invalidity shall not affect the validity of the
remainder of the contract.
32. SITE SECURITY
While on EXCHANGE premises, CONTRACTOR, its agents, employees, or subcontractors shall conform
in all respects with physical, fire or other security policies or regulations.
33. SUBCONTRACTING
Neither the CONTRACTOR nor any SUBCONTRACTOR shall enter into subcontracts for any of the work
contemplated under this Contract without obtaining prior written approval of the EXCHANGE. In no
event shall the existence of the subcontract operate to release or reduce the liability of the contractor
to the Washington Health Benefit Exchange for any breach in the performance of the contractor's
duties. This clause does not include contracts of employment between the contractor and personnel
aSSigned to work under this contract.
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Additionally, the CONTRACTOR is responsible for ensuring that all terms, conditions, assurances and
certifications set forth in this agreement are carried forward to any subcontracts. CONTRACTOR and
its subcontractors agree not to release, divulge, publish, transfer, sell or otherwise make known to
unauthorized persons Personally Identifiable Information without the express written consent of the
Exchange or as provided by law.
34. SURVIVORSHIP
All license and purchase transactions executed and services provided pursuant to the authority of
this Contract shall be bound by all of the terms, conditions, prices and price discounts set forth
herein, notwithstanding the expiration of the initial term of this Contract or any extension thereof.
Further, the terms, conditions and warranties contained in this Contract that by their sense and
context are intended to survive the completion of the performance, cancellation or termination of
this Contract shall so survive. In addition, the terms of the sections titled;
Confidentiality/Safeguarding of Information; Copyright Provisions; Incorporated Documents and
Order of Precedence; Limitation of Liability; Publicity; Disputes; Records Maintenance, Vendor's
Commitments; Vendor's Proprietary Information; and Warranties and Representations shall survive
the termination of this Contract.
35. TAXES
All payments accrued because of payroll taxes, unemployment contributions, any other taxes,
insurance or other expenses for the CONTRACTOR or its staff shall be the sole responsibility of the
CONTRACTOR.
36. TERMINATION FOR CAUSE
In the event the EXCHANGE determines the CONTRACTOR has failed to comply with the conditions of
this Contract in a timely manner, the EXCHANGE has the right to suspend or terminate this contract.
Before suspending or terminating the contract, the EXCHANGE shall notify the CONTRACTOR in
writing of the need to take corrective action. If corrective action is not taken within 30 calendar days,
the Contract may be terminated or suspended.
In the event of termination or suspension, the CONTRACTOR shall be liable for damages as authorized
by law including, but not limited to, any cost difference between the original Contract and the
replacement or cover contract and all administrative costs directly related to the replacement
contract, e.g., cost of the competitive bidding, mailing, advertising and staff time.
The EXCHANGE reserves the right to suspend all or part of the contract, withhold further payments,
or prohibit the CONTRACTOR from incurring additional obligations offunds during investigation of the
alleged compliance breach and pending corrective action by the CONTRACTOR or a decision by the
EXCHANGE to terminate the contract. A termination shall be deemed a "Termination for
Convenience" if it is determined that the CONTRACTOR: (1) was not in default; or (2) failure to perform
was outside of his or her control, fault or negligence.
The rights and remedies of the EXCHANGE provided in this Contract are not exclusive and are, in
addition to any other rights and remedies, provided by law.
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37. TERMINATION FOR CONVENIENCE
Except as otherwise provided in this contract, the EXCHANGE may, by 10 calendar days written notice,
beginning on the second day after the mailing, terminate this contract, in whole or in part. If this
Contract is so terminated, the EXCHANGE shall be liable only for payment required under the terms
of this Contract for services rendered or goods delivered prior to the effective date of termination.
38. TERMINATION FOR FUNDING CONTINGENCY
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, the EXCHANGE may terminate
this Contract without advance notice, subject to renegotiation under those new funding limitations
and conditions.
39. TERMINATION PROCEDURES
Upon termination of this contract, the EXCHANGE, in addition to any other rights provided in this
contract, may require the CONTRACTOR to deliver to the EXCHANGE any property specifically
produced or acquired for the performance of such part of this Contract as has been terminated. The
provisions of the "Treatment of Assets" clause shall apply in such property transfer.
The EXCHANGE shall pay to the CONTRACTOR the agreed upon price, if separately stated, for
completed work and services accepted by the EXCHANGE, and the amount agreed upon by the
CONTRACTOR and the EXCHANGE for (i) completed work and services for which no separate price is
stated, (ii) partially completed work and services, (iii) other property or services that are accepted by
the EXCHANGE, and (iv) the protection and preservation of property, unless the termination is for
default, in which case the AGENT shall determine the extent of the liability of the EXCHANGE. Failure
to agree with such determination shall be a dispute within the meaning of the "Disputes" clause of
this contract. The EXCHANGE may withhold from any amounts due the CONTRACTOR such sum as
the AGENT determines to be necessary to protect the EXCHANGE against potential loss or liability.
The rights and remedies of the EXCHANGE 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 notice of termination, and except as otherwise directed by the AGENT, the
CONTRACTOR shall:
A. Stop work under the Contract on the date, and to the extent specified, in the notice;
B. Place no further orders or subcontracts for materials, services, or facilities except as may be
necessary for completion of such portion of the work under the Contract that is not terminated;
C. Assign to the EXCHANGE, in the manner, at the times, and to the extent directed by the AGENT,
all of the rights, title, and interest of the CONTRACTOR under the orders and subcontracts so
terminated, in which case the EXCHANGE has the right, at its discretion, to settle or pay any or all
claims arising out of the termination of such orders and subcontracts;
D. Settle all outstanding liabilities and all claims arising out of such termination of orders and
subcontracts, with the approval or ratification of the AGENT to the extent AGENT may require,
which approval or ratification shall be final for all the purposes of this clause;
E. Transfer title to the EXCHANGE and deliver in the manner, at the times, and to the extent directed
by the AGENT any property which, if the Contract had been completed, would have been required
to be furnished to the EXCHANGE;
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F. Complete performance of such part of the work as shall not have been terminated by the AGENT;
and
G. Take such action as may be necessary, or as the AGENT may direct, for the protection and
preservation of the property related to this contract, which is in the possession of the
CONTRACTOR and in which the EXCHANGE has or may acquire an interest.
40. TREATMENT OF ASSETS
A. Title to all property furnished by the EXCHANGE shall remain in the EXCHANGE. Title to all
property furnished by the CONTRACTOR, for the cost of which the CONTRACTOR is entitled to be
reimbursed as a direct item of cost under this contract, shall pass to and vest in the EXCHANGE
upon delivery of such property by the CONTRACTOR. Title to other property, the cost of which is
reimbursable to the CONTRACTOR under this contract, shall pass to and vest in the EXCHANGE
upon (i) issuance for use of such property in the performance of this contract, or (ii)
commencement of use of such property in the performance of this contract, or (iii)
reimbursement of the cost thereof by the EXCHANGE in whole or in part, whichever first occurs.
B. Any property of the EXCHANGE furnished to the CONTRACTOR shall, unless otherwise provided
herein or approved by the EXCHANGE, be used only for the performance of this contract.
C. The CONTRACTOR shall be responsible for any loss or damage to property of the EXCHANGE that
results from the negligence of the CONTRACTOR or which results from the failure on the part of
the CONTRACTOR to maintain and administer that property in accordance with sound
management practices.
D. If any EXCHANGE property is lost, destroyed or damaged, the CONTRACTOR shall immediately
notify the EXCHANGE and shall take all reasonable steps to protect the property from further
damage.
E. The CONTRACTOR shall surrender to the EXCHANGE all property of the EXCHANGE prior to
settlement upon completion, termination or cancellation of this contract
F. All reference to the CONTRACTOR under this clause shall also include CONTRACTOR'S employees,
agents or SUBCONTRACTORS.
41. U.S. Department of Treasury, Office of Foreign Assets Control
The Exchange complies with U.S. Department of the Treasury, Office of Foreign Assets Control (OFAC)
payment rules. OFAC prohibits financial transactions with individuals or organizations, which have
been placed on the OFAC Specially Designated Nationals (SON) and Blocked Persons sanctions list
located at http://www.treas.go.v/offices/ei1forcement/ofac/index.htrnl. Compliance with OFAC
payment rules ensures that the Exchange does not conduct business with individuals or organizations
that have been determined to be supporters of terrorism and international drug dealing or that pose
other dangers to the United States.
Prior to making payment to individuals or organizations, the Exchange will download the current OFAC
SON file and compare it to Exchange and statewide vendor files. In the event of a positive match, the
Exchange reserves the right to: (1) make a determination of "reasonability" before taking the positive
match to a higher authority, (2) seek assistance from the Washington State Office of the State
Treasurer (OST) for advanced assistance in resolving the positive match, (3) comply with an OFAC
investigation, if required, and/or (4) if the positive match is substantiated, notify the contractor in
writing and terminate the Contract according to the Termination for Convenience provision without
making payment. The Exchange will not be liable for any late payment fees or missed discounts that
are the result of time required to address the issue of an OFAC match.
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42. CONTRACTOR'S PROPRIETARY INFORMATION
Contractor acknowledges that the Exchange is subject to chapter 42 .56 RCW and that this Contract
shall be a public record as defined in chapter 42.56 RCW. Any specific information that is claimed by
Contractor to be Proprietary Information must be clearly identified as such by Contractor. To the
extent consistent with chapter 42.56 RCW, the Exchange shall maintain the confidentiality of all such
information marked Proprietary Information . If a public disclosure request is made to view
Contractor's Proprietary Information, the Exchange will notify the Contractor of the request and of
the date that such records will be released to the requester unless the Contractor obtains a court
order from a court of competent jurisdiction enjoining that disclosure. If the Contractor fails to obtain
the court order enjoining disclosure, the Exchange will release the requested information on the date
specified.
43. WAIVER
Waiver of any default or breach shall not be deemed a waiver of any subsequent default or breach.
Any waiver shall not be construed to be a modification of the terms of this Contract unless stated to
be such in writing and signed by authorized representative of the EXCHANGE.
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EXHIBIT B -FEDERAL COMPLIANCE, CERTIFICATIONS, AND ASSURANCES
In the event federal funds are included in this agreement, the following sections apply: I. Federal
Compliance and II. Standard Federal Assurances and Certifications. In the instance of inclusion of
federal funds, the Contractor may be designated as a sub-recipient and the effective date of the
amendment shall also be the date at which these requirements go into effect.
I. The following represents the majority of compliance elements that may apply to any federal
funds provided under this contract. For clarification regarding any of these elements or details
specific to the federal funds in this contract, contact:
Carole Holland, CFO
WA Health Benefit Exchange
810 Jefferson Street (mailing address-PO Box 657, Olympia WA 98507)
Olympia, WA 98501
(360) 688-7720
Fax: (360) 688-7332
Email address: carole.ho ll and@wahbexchange :org
a. Source of Funds: Federal funds to support this agreement are identified by the Catalog of Federal
Domestic Assistance (CFDA) number 93.525, the full and complete terms and provisions of which are
hereby incorporated into this agreement.
b. Modifications: This agreement may not be modified or amended, nor may any term or provision be
waived or discharged, including this particular Paragraph, except in writing, signed upon by both
parties.
1. Examples of items requiring Washington Health Benefit Exchange prior written approval include,
but are not limited to, the following:
i. Deviations from the budget and Project plan.
ii. Change in scope or objective of the agreement.
iii. Change in a key person specified in the agreement.
iv. The absence for more than three months or a 25% reduction in time by the Project
Manager/Director.
v. Need for additional funding.
vi. Inclusion of costs that require prior approvals as outlined in the appropriate cost
principles.
vii. Any changes in budget line item(s) of greater than twenty percent (20%) of the total
budget in this agreement.
2. No changes are to be implemented by the Sub-recipient/vendor until a written notice of
approval is received from the Health Benefit Exchange.
c. Condition for Receipt of Health Benefit Exchange Funds: Funds provided by Washington Health
Benefit Exchange to the Sub-recipient/vendor under this agreement may not be used by the Sub-
recipient/vendor as a match or cost-sharing provision to secure other federal monies.
d. Citizenship/Alien Verification/Determination: The Personal Responsibility and Work Opportunity
Reconciliation Act (PRWORA) of 1996 (PL 104-193) states that federal public benefits should be
made available only to U.S. citizens and qualified aliens. Entities that offer a service defined as a
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"federal public benefit" must make a citizenship/qualified alien determination/ verification of
applicants at the time of application as part of the eligibility criteria. Non -US citizens and unqualified
aliens are not eligible to receive the services. PL 104-193 also includes specific reporting
requirements.
e. Federal Compliance : The Sub-recipient/vendor shall comply with all applicable State and Federal
statutes, laws, rules, and regulations in the performance of this agreement, whether included
specifically in this agreement or not.
f. Civil Rights and Non-Discrimination Obligatians During the performance of this agreement, the
Contractor shall comply with all current and future federal statutes relating to nondiscrimination .
These include but are not limited to: Title VI of the Civil Rights Act of 1964 (PL 88-352), Title IX of the
Education Amendments of 1972 (20 U.S.C. §§ 1681-1683 and 1685-1686), section 504 of the
Rehabilitation Act of 1973 (29 U.S.c. § 794), the Age Discrimination Act of 1975 (42 U.S.c. §§ 6101-
6107), the Drug Abuse Office and Treatment Act of 1972 (PL 92-255), the Comprehensive Alcohol
Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), §§523 and
527 of the Public Health Service Act of 1912 (42 U.s.c. §§290dd-3 and 290ee-3), Title VIII of the Civil
Rights Act of 1968 (42 U.S.c. §§3601 et seq.), and the Americans with Disability Act (42 U.S.c.,
Section 12101 et seq.) http:L!www.hhs.gov!ocr/civilrights
Exchange Federal Compliance Contact Information
Washington Health Benefit Exchange
810 Jefferson Street (mailing address-PO Box 657, Olympia WA 98507)
Olympia, Washington 98504
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 Health Benefit Exchange .
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 and the
principal(s), defined as an officer, director or owner
of the organization in accordance with 45 CFR Part
76, and its principles:
a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal
Department or agency;
b) 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;
c) 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
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d) 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 (a)
above;
d) Notifying the employee in the statement required by
paragraph (a), 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, HBE has
deSignated the following central point for receipt of
such notices :
Legal Services Director
WA Health Benefit Exchange
PO Box 657
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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:
(1) 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.
(2) 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
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.)
(3) 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 Sub-recipient/vendors 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.
S. 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 sale source of
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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 Sub-
recipient/vendors shall certify accordingly.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
I ~DocuSigned by:
aM~ IltblMitUA.
r-72F 'Pfflrs~21frs'O print or type name:
Anita Monoian
ORGANIZATION NAME: (if applicable)
Anita Monoian, CEO
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 CLEAN AIR ACT
CEO
By signing the certification, the undersigned certifies
that the contracting organization will comply with all
requirements, applicable standards, orders, and
regulations contained in the Clean Air Act (42 U.S.c.
7401-7671q.) and the Federal Water Pollution
Control Act (33 U.S.c. 1251-1387). The undersigned
also acknowledges and that any violations after
contract award must be reported to WAHBE and the
Regional Office of the Environmental Protection
Agency (EPA).
TITLE
DATE
1/27/2017
HBE-349 YNHS Exhibit B -Federal Compliance, Certifications, And Assurances Page 20 of41
DocuSign Envelope 10: 62955F1D-7A37-4CBO-A808-2BA7AOB5515E
EXHIBIT C -STATEMENT OF WORK
I. NAVIGATOR LEAD ORGANIZATION SERVICES
A. GENERAL RESPONSIBILITIES. Contractor Shall:
1. Serve as the designated Lead Organization, maintaining a physical business location and ongoing presence in
the service area in order to manage Navigator Program outreach and enrollment services and organize
partners for their designated service area.
2. Provide a single point of contact and responsibility between the service area Navigators and HBE. Act as the
liaison to HBE for all service area network partners and ensure network partners and Navigator staff receive
timely information about HBE initiatives and changes pertinent to providing Navigator services .
3. Complete activities reflected in the Outreach Plan (Exhibit F). Changes to Outreach Plan shall be submitted
in advance and subject to HBE approval.
4. Provide the Enhanced User support services to service area Navigators to troubleshoot, report
application/enrollment or system issues to HBE and follow up with Navigators in the service Plan and
coordinate service area-wide outreach to assure a coordinated and strategic approach and submit monthly
outreach reports to HBE using HBE's report format.
5. Participate in HBE Navigator Program regular or ad hoc reporting activities, including submission of the
monthly progress report in a format provided by HBE.
6. Develop a process for immediate notification to HBE regarding security, confidentiality and nondisclosure
breaches by Navigators.
7. Maintain accurate lists ofthe Navigators and ensure HBE is provided timely notification about new or
terminating Navigator staff.
8. Maintain accurate lists of network partners and provide HBE with timely notification about new or
terminated partners .
9. Respond quickly and report to HBE on complaints or issues reported to HBE or the Lead Organization
involving a Navigator or Navigator network partner.
B. NETWORK DEVELOPMENT AND SUPPORT. Contractor Shall:
1. Recruit, evaluate and select organizations in the service area that are best suited to accomplish this work
and preferably have existing relationships with consumers likely to need assistance obtaining health care
coverage or using the Washington Healthplanjinder system. Best suited to provide these essential services
are organizations that interact regularly with individuals and families, have experience serving vulnerable
and hard-to-reach populations, and have earned reputations for fairness and trustworthiness. The network
needs to reflect organizations with relationships to groups likely to be eligible for both QHPs and WAH .
2. Act as the funding agent for paid network partners, if compensated. Develop and administer a subcontract
compensating their paid, subcontracted network Navigator Organizations according to HBE guidelines .
Subcontracts will include the compensation approach for paid network partner organizations. Ensure
contracts with subcontractors contain the mandatory elements required by HBE.
3. If the Lead Organization includes unpaid partners in the network, the Lead Organization must maintain a
written agreement with these partners approved by the Exchange that includes pertinent Navigator service
expectations, especially pertaining to security, nondisclosure, and confidentiality.
4. The Lead Organization must provide the Navigator Program with a copy of all executed service area
Navigator partner subcontracts and unpaid partner agreements within 60 days of contract execution.
5. Maintain a list of active Brokers in the service area to be shared with network partner organizations and
Navigators. Ensure Navigator network organizations understand the HBE guidelines regarding referral to
Broker resources.
J:vhihit r _ C;:t::.t<>",<>nt nf \Alnrll 0""., .,1 ,..1' 41
DocuSign Envelope ID: 62955F1D-7A37-4CBO-A8D8-2BA7ADB5515E
6. Monitor network partner Navigator Program service delivery, enrollment volume, and integrity.
C. NAVIGATOR ADMINISTRATION. Contractor Shall:
1. Ensure Navigator staff of the Lead Organization and network partner organizations complete required
Navigator Program and HBE attestations, have a current background check with no disqualifying crimes, and
participate in HBE required Navigator training and certification processes.
2. Submit names of Navigator candidates qualified for certification following HBE procedures.
3. Ensure Navigator background checks are completed at least once every 24 months and no disqualifying
crimes are present. Contractor shall prohibit staff from providing services under his contract if a
disqualifying crime is present on their background check.
4 . Collect and retain signed attestation and non-disclosure forms for all navigators within 30 days of contract
execution.
5. Ensure Navigator services are available and accessible to service area residents by trained and certified
Navigators. Assure Navigators deliver the full range of application, consumer education, and enrollment
services in-person; at no cost to consumers; use the Washington Healthplan!inder to record consumer
applications; provide language support and disability access without cost to the consumer.
6. Provide periodiC forums for Navigators to network and receive updates.
7. Establish and maintain a consumer complaint resolution process and inform consumers about their
complaint resolution options beyond the consumer's Navigator.
D. NAVIGATOR LEAD ORGANIZATION SERVICES PAYMENT SCHEDULE. Contractor shall receive payment per the
following:
1. Contractor's overall award = $159,052.00
2. Contract navigator service delivery portion of overall award is $135,194.00; 11 equal monthly installments =
$12,290.36 per month. If, due to a delay in contract execution, the contract period is less than 11 months,
the monthly installment amount will be recalculated using the number of contract months remaining .
3. QHP enrollment maximum incentive is $23,858.00. The Contractor's target and corresponding maximum
incentive payment for each county is as follows:
County QHP Target Maximum Incentive Payment
Kittitas 369 $2,073
Yakima 1,672 $21,785
Total 2,041 $23,858
E. PAYMENT TERMS.
1. Monthly compensation: Contractor will be paid 85% of overall contract award in 11 equal monthly
installments upon receipt and acceptance ofthe Contractor's monthly progress reports. Upon acceptance,
the HBE Navigator Program will initiate a Contractor payment authorization for HBE Finance each month.
HBE Finance will use the payment authorization to release payment to the Contractor.
2. QHP Enrollment Incentive: Contractor will be paid 15% of overall contract award:
a. For performance against the QHP enrollment target for each county. Enrollments that are counted
towards the Contractor's enrollment target are: (1) new Qualified Health Plan enrollments (plan is
selected and confirmed) and (2) Qualified Health Plan renewals (plan selected and confirmed) that are
navigator-assisted.
b. The enrollment target incentive payment is paid once at the conclusion of open enrollment and when
enrollment data has been validated by HBE.
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DocuSign Envelope 10: 62955F1 D-7A37-4CBO-A8D8-2BA7ADB5515E
c. Enrollment target incentive payments are prorated based on the percentage of target met.
F. CONTRACTOR KEY STAFF.
The following are designated as Contractors' key staff for the delivery of services under this Contract. Any
substitution of key staff must be approved, in advance, by the EXCHANGE.
• Sandra Velasquez -Healthplanfinder Coordinator (50%)
• Alex Cordova -Enhanced User (50%)
• Cristella Martinez -Enhanced User (50%)
• Mary Diaz -Enhanced User (50%)
• Rhonda Hauff -Operating Officer/Deputy CEO (0% -administrative oversight provided in-kind)
HBE-349 YNHS Exhibit C -Statement Of Work PaE!'e 2l of41
DocuSign Envelope 10: 62955F1D-7A37-4CBO-A808-2BA7AOB5515E
EXHIBIT D -DATA SECURITY REQUIREMENTS
1. Definitions.
a. "Authorized User(s)" means an individual or individuals with an authorized business
requirement to access EXCHANGE Confidential Information.
b. "Hardened Password" means a string of at least eight characters including 1 upper case, 1
lower case, one number and 1 special character (i.e., nonalphanumeric characters). The
administrator and privileged user password must change every 60 days and other user
password once every 90 days. Previous 6 consecutive passwords cannot be reused. The
passwords must not allow User IDs, First Name or the last name of the user. "Transmitting"
means the transferring of data electronically, such as via email.
c. "Transmitting" means the transferring of data electronically, such as via email.
d. "Transporting" means the physical transferring of data that has been stored .
e. "Unique User 10" means a string of characters that identifies a specific user and which, in
conjunction with a password, passphrase, or other mechanism, authenticates a user to an
information system.
2. Data Transmitting. When transmitting EXCHANGE Confidential Information electronically,
including via email, the Data shall be protected by:
a. Transmitting the Data within the (State Governmental Network) SGN, Health Benefit
Exchange network or Contractor's internal network, or;
b. Encrypting any Data that will be transmitted outside the SGN or Contractor's internal
network with 128-bit Advanced Encryption Standard (AE5) encryption or better. This
includes transit over the public Internet.
3. Protection of Data. The Contractor agrees to store Data on one or more of the following media
and protect the Data as described:
a. Hard disk drives. Data stored on local workstation hard disks. Access to the Data will be
restricted to Authorized User(s) by requiring logon to the local workstation using a Unique
User ID and Hardened Password or other authentication mechanisms which provides equal
or greater security, such as biometrics or smart cards. The data on the drive will only be
accessible to authenticated individuals that need to access it. That is, the data will be
secured on the disk in such a way that other authenticated individuals that do not need
access to the data will not have the ability to access it. Workstations with sensitive data
stored on them will be tracked and their movements documented until the sensitive data is
removed from the workstation. When the data is removed the date of its removal and
method of its removal will be documented. Hard drives that have contained sensitive data
will be wiped with a method that will render the deleted information irretrievable.
b. Network server disks. Data stored on hard disks mounted on network servers and made
available through shared folders. Access to the Data will be restricted to Authorized Users
through the use of access control lists which will grant access only after the Authorized User
has authenticated to the network using a Unique User ID and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or
HBE-349 YNHS Exhibit D -Data Security Requirements Page 24 of41
DocuSign Envelope ID: 62955F1D-7A37-4CBO-A8D8-2BA7ADB5515E
smart cards . Data on disks mounted to such servers must be located in an area which is
accessible only to authorized personnel, with access controlled through use of a key, card
key, combination lock, or comparable mechanism.
For EXCHANGE Confidential Information stored on these disks, deleting unneeded Data is
sufficient as long as the disks remain in a Secured Area and otherwise meet the
requirements listed in the above paragraph. Destruction of the Data as outlined in Section
S. Data Disposition may be deferred until the disks are retired, replaced, or otherwise taken
out of the Secured Area ,
c. Removable Media, including Optical discs (CDs or DVDs) in local workstation optical disc
drives and which will not be transported out of a secure area. Sensitive or Confidential Data
provided by HBE on removable media, such as optical discs or USB drives, which will be used
in local workstation optical disc drives or USB connections shall be encrypted with 128-bit
AES encryption or better. When not in use for the contracted purpose, such discs must be
locked in a drawer, cabinet or other container to which only authorized users have the key,
combination or mechanism required to access the contents of the container. Workstations
which access EXCHANGE Data on optical discs must be located in an area which is accessible
only to authorized personnel, with access controlled through use of a key, card key,
combination lock, or comparable mechanism.
d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers and which will not be
transported out of a secure area. Data provided by HBE on optical discs which will be
attached to network servers shall be encrypted with 128-bit AES encryption or better.
Access to Data on these discs will be restricted to authorized users through the use of access
control lists which will grant access only after the authorized user has been authenticated to
the network using a unique user 10 and complex password or other authentication
mechanisms which provide equal or greater security, such as biometrics or smart cards.
Data on discs attached to such servers must be located in an area which is accessible only to
authorized personnel, with access controlled through use of a key, card key, combination
lock, or comparable mechanism.
e. Paper documents. All paper records must be protected by storing the records in a secure
area which is only accessible to authorized personnel. When not in use, such records must
be stored in a locked container, such as a file cabinet, locking drawer, or safe, to which only
authorized persons have access.
f. Access via remote terminal/workstation over the State Governmental Network (SGN) or WA
Health Benefit Exchange network (EXCHANGE Network). Data accessed and used interactively
over the SGN or EXCHANGE Network. Access to the Data will be controlled by EXCHANGE staff
who will issue authentication credentials (e.g. a unique user 10 and complex password) to
authorized contractor staff. Contractor shall have established and documented access
termination procedures for existing staff with access to EXCHANGE Data. These procedures
shall be provided to EXCHANGE staff upon request. The Contractor will notify EXCHANGE staff
immediately whenever an authorized person in possession of such credentials is terminated or
otherwise leaves the employment of the contractor, and whenever a user's duties change
such that the user no longer requires access to perform work for this Contract.
g. Access via remote terminal/workstation over the Internet through Secure Access
Washington. Data accessed and used interactively over the Internet. Access to the Data will
be controlled by EXCHANGE staff who will issue remote access authentication credentials
(e.g. a unique user 10 and complex password) to authorized contractor staff. Contractor will
HBE-349 VNHS Exhibit D -Data Security Requirements Page 25 of41
OocuSign Envelope 10: 62955F1D-7A37-4CBO-A808-2BA7ADB5515E
notify EXCHANGE staff immediately whenever an authorized person in possession of such
credentials is terminated or otherwise leaves the employ of the contractor and whenever a
user's duties change such that the user no longer requires access to perform work for this
Contract.
h. Data storage on portable devices or media .
(1) EXCHANGE Data shall not be stored by the Contractor on portable devices or media
unless specifically authorized within the Special Terms and Conditions of the contract. If
so authorized, the Data shall be given the following protections:
(a) Encrypt the Data with a key length of at least 128 bits using an industry standard
algorithm (e.g., AES, Two/ish, RC6, etc.)
(b) Control access to devices with a unique user 10 and password or stronger
authentication method such as a physical token or biometrics.
(c) Manually lock devices whenever they are left unattended and set devices to lock
automatically after a period of inactivity, if this feature is available. Maximum
period of inactivity is 20 minutes.
Physically protect the portable device(s) and/or media by
(d) Keeping them in locked storage when not in use
(e) Using check-in/check-out procedures when they are shared, and
(f) Taking frequent inventories
(2) When being transported outside of a secure area, portable devices and media with
confidential EXCHANGE Data must be under the physical control of contractor staff with
authorization to access the Data.
(3) Portable devices include any small computing device that can be transported. They
include, but are not limited to; handhelds/PDAs/phones, Ultramobile PCs, flash memory
devices (e.g. USB flash drives, personal media players), and laptop/notebook/tablet
computers.
(4) Portable media includes any Data storage that can be detached or removed from a
computer and transported. They include, but are not limited to; optical media (e.g. CDs,
DVDs), magnetic media (e.g. floppy disks, tape, Zip or Jaz disks), USB drives, or flash
media (e.g. CompactFlash, SO, MMC).
4. Data Segregation.
a. EXCHANGE Data must be segregated or otherwise distinguishable from non-EXCHANGE
Data. This is to ensure that when no longer needed by the contractor, all EXCHANGE Data
can be identified for return or destruction. It also aids in determining whether EXCHANGE
Data has or may have been compromised in the event of a security breach.
b. EXCHANGE Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will
contain no non-HBE Data. Or,
c. HBE Data will be stored in a logical container on electronic media, such as a partition or
folder dedicated to HBE Data. Or,
HBE-349 YNHS Exhibit D -Data Security Requirements Page 26 of41
DocuSign Envelope 10: 62955F1D-7A37-4CBO-A808-2BA7AOB5515E
d. HBE Data will be stored in a database which will contain no non-HBE Data. Or,
e. HBE Data will be stored within a database and will be distinguishable from non-HBE Data by
the value of a specific field or fields within database records. Or,
f. When stored as physical paper documents, HBE Data will be physically segregated from non-
HBE Data in a drawer, folder, or other container.
g. When it is not feasible or practical to segregate HBE Data from non-HBE Data, then both the
HBE Data and the non-HBE Data with which it is commingled must be protected as
described in this exhibit.
5. Data Disposition. When the contracted work has been completed or when no longer needed,
except as noted in 2.b above, Data shall be returned to the HBE or destroyed. Media on which
Data may be stored and associated acceptable methods of destruction are as follows:
Data stored on: Will be destroyed by:
Server or workstation hard disks, or Using a "wipe" utility which will overwrite
the Data at least three (3) times using either
Removable media (e.g. floppies, USB flash random or single character Data, or
drives, portable hard disks, Zip or similar
disks) Degaussing sufficiently to ensure that the
Data cannot be reconstructed, or
Physically destroyin~ the disk
Paper documents with sensitive or Recycling through a contracted firm provided
confidential Data the contract with the recycler assures that
the confidentiality of Data will be protected.
Paper documents containing confidential On-site shredding by a method that renders
information requiring special handling (e.g. the Data unreadable, pulping, or incineration
protected health information)
Optical discs (e.g. CDs or DVDs) Incineration, shredding, or cutting/breaking
into small pieces.
Magnetic tape Degaussing, incinerating or crosscut
shredding
6. Notification of Compromise or Potential Compromise. The Contractor shall have an established
and documented policy to deal with the compromise or potential compromise of Data that
complies with the HITECH Act of ARRA 209. The Contractor shall provide HBE staff of such policy
upon request. The compromise or potential compromise of HBE shared Data must be reported
to the HBE Contact designated on this Contract within one (1) business day of discovery.
7. Data shared with Sub-contractors. If HBE Data provided under this Contract is to be shared with
a sub-contractor, the contract with the sub-contractor must include all of the Data security
provisions within this Contract and within any amendments, attachments, or exhibits within this
Contract. If the subcontractor cannot protect the Data as stated within this Contract, then the
contract with the sub-contractor must be submitted to the HBE Contact Services for review and
approval.
HBE-349 YNHS Exhibit D -Data Security Requirements Page 27 of 41
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EXHIBIT E -CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT
For Navigator Organizations
This Confidentiality and Nondisclosure Agreement ("Agreement") is entered into by and between
the Washington Health Benefit Exchange, ("HBE"), and the Navigator Organization named in the
signature block ("Recipient").
This Navigator Organization is a subcontractor or agent of [Contractor Name] or the Health Benefit
Exchange and as such requires access to information or material related to the Washington Health
Benefit Exchange that is Confidential Information as defined herein. HBE agrees to release this
information to Recipient for those purposes pursuant to the terms and conditions contained in this
Agreement. Recipient agrees to the terms and conditions herein.
NOW THEREFORE, in consideration of the above premises and the promises contained herein, the
parties agree as follows:
Whenever used in this Agreement, the term "Confidential Information" will mean: individual's
names; ages; residential addresses; email addresses; telephone numbers; Driver's license number or
Washington identification card number; financial information (e.g., profiles, social security
numbers, income, credit card numbers, debit card numbers, electronic check numbers, card
expiration dates, or bank or other financial account numbers, security codes, access codes, or
passwords that would permit access to an individual's financial account); medical data/personal
health information; law enforcement records; or other records concerning the state's citizens and
businesses; information concerning recipients of services from public health agencies; state or
system software code, source code or object code and security data; system or network designs,
drawings, or specifications; computer programs; system and technical documentation; and trade
secrets or proprietary information of the HBE or the HBE's contractors.
Confidential Information may be in tangible or intangible form. HBE's failure to expressly identify
Confidential Information as such shall not in any way lessen or negate Recipient's obligation to keep
such information confidential in accordance with this Agreement.
The term "Confidential Information" shall not be construed to include information that (i) is or
becomes readily available in public records or documents, other than as a result of a disclosure by
Recipient or other entity acting on behalf of Recipient, or (ii) can be documented to have been
known by Recipient prior to its disclosure by HBE, or (iii) is disclosed pursuant to applicable law,
judicial action or government regulations, including without limitation the Washington State Public
Records Act, chapter 42.56 RCW.
Recipient agrees to hold such Confidential Information in confidence and except for disclosure
required by law; Recipient shall not disclose such Confidential Information.
Recipient understands that the breach of the terms of this Agreement would cause irreparable
damage to HBE and that Recipient could be subject to litigation and required to indemnify, and hold
HBE harmless from actual damages from losses that result from its breach.
This Agreement, its validity, construction and effect will be governed by the laws of the State of
Washington. Venue for any action between the parties shall be in Thurston County, State of
Washington.
HBE-349 YVHS Exhibit E -Non-Disclosure and Confidentiality Agreement Page 28 of41
DocuSign Envelope ID: 62955F1D-7A37-4CBO-A8D8-2BA7ADB5515E
This Agreement supersedes any and all prior understandings and agreements between the parties
with respect to the subject matter of this Agreement. This Agreement can be modified only by a
written amendment signed by authorized representatives of the parties.
Waiver of any breach of this Agreement shall not be a waiver of any subsequent breach nor shall it
be a waiver of the underlying obligation.
The requirement of confidentiality shall extend for three years beyond Recipient's association with
the Washington Health Benefit Exchange as a Contractor, subcontractor or agent of [Contractor's
Name] or Health Benefit Exchange.
WASHINGTON HEALTH BENEFIT EXCHANGE RECIPIENT
'-DocuSigned by:
flA.i~~~J 7/27/2017
-''Signaturi't -Date
(d:;:'~ioM. 7/27/2017
1-72S'ig'iYm1~F Date
~ichael Marchand chief Marketing affic r Anita Monoian CEO
Print or Type Name and Title Print or Type Name and Title
Anita Monoian, CEO
Organization/Firm/Vendor Name
Individual Navigators must complete HBE Attestations as a part of their Certification Process. These
attestations pertain to: Confidentiality and Non-Disclosure, Code of Ethics, Conflict of Interest
Standards and Conflict of Interest Disclosure.
HBE-349 VVHS Exhibit E -Non-Disclosure and Confidentiality Agreement Page 29 of41
DocuSign Envelope ID: 62955F1 D-7A37-4CBO-A8DB-2BA7ADB5515E
EXHIBIT F -OUTREACH PLAN
COUNTY: YAKIMA
A. TARGET GROUPS IN THIS COUNTY
Target group Est. size of Methods/information used to identify the target group
this group
H ispa nie/Latina 47.1% of population Census/American Fact Finder
Agricultural workers 27.7% of employed Employment Security
Self-employed 3.5% of employed Census/ Statistical Atlas
Homeless 2% of population Annual Point in Time Count
B. OUTREACH EVENTS OR ACTIVITIES PLANNED IN THIS COUNTY
MONTH Describe specific event/activity to be conducted City/ Community Site/Venue
OCTOBER Outreach and enrollment each Saturday in October Yakima Farmer's Market
Outreach and enrollment Granger Farmer's Market
Outreach & enrollment ever y Monday in October Yakima DSHS Office
Information dissemination via Spanish Language radio Granger Radio KDNA
NOVEMBER Information dissemination via Spanish Language radio Granger Radio KDNA
Outreach & enrollment every Monday in November Yakima DSHS Office
MLK Resource Fair Yakima Henry Beauchamp
Community Center
Coordinated Care Baby Shower -English Yakima Yakima Valley Memorial
Hospital
Coordinated Care Baby Shower-Spanish Yakima Yakima Valley Memorial
Hospital
Parent Night Yakima Harrah Elementary
School
Mobile Food Bank Yakima Food bank
DECEMBER Information dissemination via Spanish Language radio Granger Radio KDNA
Outreach & enrolment every Monday in December Yakima DSHS Office
JANUARY Information dissemination via Spanish Language radio Granger Radio KDNA
Outreach & enrollment ever y Monday in January Yakima DSHS Office
Wapato Middle School Health Fair Wapato Wapato Middle School
MLK Day Peace March Yakima Downtown Yakima
HBE-349 YNHS Exhibit F -Outreach Plan Page 30 of41
DocuSign Envelope ID: 62955F1D-7A37-4CBO-A8D8-2BA7ADB5515E
MONTH Describe specific event/activity to be conducted City/ Community Site/Venue
JANUARY Project Homeless Connect Toppenish Heritage University
Project Homeless Connect Sunnyside St. Joseph's Church
Project Homeless Connect Yakima Henry Beauchamp
Communitv Center
College student outreach & enrollment Toppenish Heritage University
Migrant Health trainng Yakima ESD 105
COUNTY: KITIITAS
A. TARGET GROUPS IN THIS COUNTY
Target group Est. size of Methods/information used to identify
this group the target group
Accommodation & Food Service 18.2% of employed Employment Security
Workers (low wage workers)
H ispa n ic/lati na 8.5% of population Census/American Fact Finder
B. OUTREACH EVENTS OR ACTIVITIES PLANNED IN THIS COUNTY
MONTH Describe specific event/activity to be conducted City/ Community Site/Venue
OCTOBER Enrollment Event Ellensburg Food Bank
NOVEMBER Enrollment Event Elensburg Food Bank
DECEMBER Enrollment Event Ellensburg Food Bank
Enrollment Event Ellensburg CHCW
Enronment Event Ellensburg Free Clinic
JANUARY Enrollment Event Ellensburg Senior Center
Enrollment Event Cle Elum Senior Center
Project Homeless Connect Cle Elum Putnam Centennial
Center
Project Homeless Connect Ellensburg CWU Student Medical &
Counseling Clinic
HBE-349 YNHS Exhibit F -Outreach Plan Page 31 of41
DocuSign Envelope 10: 62955F10·7A37·4CBO·A808·2BA7AOB5515E
EXHIBIT G -ENROLLMENT SITES
A. Enrollment sites in YAKIMA County:
Organization name Yakima Neighborhood Health Services
Address where navigator services are delivered 12 South 8tn St, Yakima WA 98902
Full service or limited availability (if limited, explain Full service
availability of navigator assistance]
Business days and hours M - F 7:45a m-6:30pm;Sat 8:30am-6:00pm
Public phone number 509 454-4143
Number of navigators 7
Languages spoken by navigators lother than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
Organization name Yakima Neighborhood Health Services-Hinman
Address where navigator services are delivered 610 Yakima Avenue, Yakima 98901
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 8:00 am-5:00pm
Public phone number 509 454-4143
Number of navigators 3
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
Organization name Yakima Neighborhood Health Services-Sunnyside
Address where naviKator services are delivered 617 Scoon Road, Sunnyside WA
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 8:00am-6:00pm; Sat 8:30am-6:00pm
Public phone number 509837-8200
Number of navigators 4
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
Organization name Yakima Neighborhood Health Services· Granger
Address where navigator services are delivered 111Main Street, GrangerWA
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 9:00am -6:00 pm
Public phone number 509317-2182
Number of navigators 2
Lal1guages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
Organization name Yakima Neighborhood Health Services -Sunnyside
Address where navigator services are delivered 2685 East Lincoln Ave., Suite E, Sunnyside WA
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 8:00 am -6:30pm
Public phone number 509 515-0580
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
HBE-349 YNHS Exhibit G -Enrollment Sites Page 32 of41
DocuSign Envelope ID: 62955F1D-7A37-4CBO-A8D8-2BA7ADB5515E
Organization name Yakima Neighborhood Health Services-
SE Yakima Community Center
Address where navigator services are delivered 1211 South 1 St., Yakima WA
Full service or limited availability (if limited, explain Full service
availability of navigator assistance)
Business days and hours M & F 8:00am -5:00pm; T & Th 8:00am-6:00pm
Public phone number 509 853-2372
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
Organization name Yakima Neighborhood Health Services @
Comprehensive Healthcare
Address where navigator services are delivered 402 S. 4th Street
Full service or limited availability (if limited, explain Full service
Business days and hours T & Th 8:00 am -6:00 pm W 8:00am -12:00 noon
Public phone number 509 575-5553
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
Organization name Yakima Neighborhood Health Services-
Neighborhood Connections
Address where navigator services are delivered 102 South Naches Ave., Yakima WA
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 7:30am-6:00pm
Public phone number 509 834-2098
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
Organization name Yakima Neighborhood Health Services-
Homeless Resource Center (The Depot)
Address where navigator services are delivered 602 East Yakima Ave .. Yakima WA
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 9:00am-5:00pm
Public phone number 509 249-6232
Number of navigators 2
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC & Lead Organization site
Organization name Yakima Neighborhood Health Services-Mobile Unit
Address where navigator services are delivered Varies
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 9:00am-5:00 pm
Public phone number 509515-0585
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selectinB this organization FQHC & Lead Organization Site
Orsanlzation name Community Health of Central Washington
Address where navigator services are delivered 1806 W. Lincoln Ave, Yakima 98902
Full service or limited availability (if limited, explain Full service
Business days and hours M-F 8 :00am-7 :30pm
Public phone number 509 452-4520
HBE-349 YNHS Exhibit G -Enrollment Sites Page 33 of41
DocuSign Envelope 10 : 62955F10-7A37-4CBO-A808-2BA7AOB5515E
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Community Health of Central Washington-
Pediatric Clinic
Address where navigator services are delivered 31411 Ave.; Yakima 98902
Full service or limited availability (if limited, explain Full Service
availability of navigator assistance)
Business days and hours M-F 8:00am -5:00pm
Public phone number 509575-0114
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Community Health of Central Washington-Naches
Address where navigator services are delivered 1 UL t:ast ~na Cll., I'lacnes l::IOl::l,j (
Full service or limited availability (If limited, explain Full Service
Business days and hours M-F 8:30am -5 :00pm
Public phone number 509 653-2235
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Community Health of Central Washington-Highland
Address where navigator services are delivered 915 Wisconsin Avenue, Tieton WA98947
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 8:00am-5:00pm
Public phone number 509 673-0044
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Farmworkers Clinic
Address where navigator services are delivered 602 East Nob HIIBlvd., Yakima 98901
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 7:30am -8:00pm; Sat 9:00am -4: OOpm
Public phone number 509 248-3334
Number of navigators 4
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Farmworkers Clinic-Lincoln Ave
Address where navigator services are delivered 2205 W. Lincoln Avenue, Yakima 98902
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 7:30am-7:00 pm
Public phone number 509575-1234
Number of navigators 2
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
HBE-349 YNHS Exhibit G -Enrollment Sites Page 34 of41
OocuSign Envelope 10 : 62955F1D-7A37-4CBO-A8D8-2BA7AOB5515E
Organization name Yakima Valley Farmworkers Clinic-Children's Village
Address where navigator services are delivered 3801 Kern Road, Yakima 98902
Full service or limited availability (if limited, explain Full service
Business days and hours M-F 8 :00am-5:00pm
Public phone number 509574-3200
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
I OrJlanization name Yakima Valley Farmworkers Clinic-Grandview
Address where navigator services are delivered 1000 Wallace Way~ Grandview 98930
Full service or limited availability (if limited, explain Limled to own patients
Business days and hours M-F 7 :30 am-8 :00pm
Public phone number 509882-3444
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Fannworkers Clinic-Mountainview
Address where navigator services are delivered 240 Oft/ision St .. Grandview 98930
Full service or limited availability (if limited, explain Limited to own patients
Business days and hours M-F 7:45am -5:00 pm
Public phone number 509882-4700
Number of navigators 3
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Farmworkers Clinic -Granger
Address where navigator services are delivered 115 Sunnyside Ave .• Suite A, Granger 98932
Full service or limited availability (if limited, explain Limited to own patients
Business days and hours M-8at 9:00am -7:00pm
Public phone number 509 865-6450
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Farmworkers Clinic-Sunnyside
Address where navigator services are delivered 2680 Yakima Valley Hwy, Suite S, Sunnyside 98944
Full service or limited availability (if limited, explain Limited to own ~atients
Business days and hours M-F 8:45 am -8:00 pm ; Sat 8:45 am-5 pm
Public phone number 509 839-3000
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Fannworkers Clinic-Toppenish
Address where navigator services are delivered 510 West 1 't, Toppenish 98948
Full service or limited availability (If limited, explain Limited to own patients
Business days and hours M-F 7:30am -8 :00pm;Sat 9:00am -4:00pm
Public phone number 509 865-5600
Number of navigators 8
languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
HBE-349 YNHS Exhibit G -Enrollment Sites Page 35 of41
DocuSign Envelope 10: 62955F1D-7A37-4CBO-A8D8-2BA7ADB5515E
Organization name Yakima Valley Farmworkers Clinic-
NW Community Action Center
Address where navigator services are delivered 706 Rentschler Lane , Toppenish 98948
Full service or limited availability (if limited, explain Limited to own patients
Business days and hours M-F 8:00am-5 :00pm
Public phone number 509 865-7630
Number of navigators 4
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Farmworkers Clinic-Behavioral Health
Address where navigator services are delivered 918 East Mead Ave., Yakima 98903
Full service or limited availability (if limited, explain Limited to own patients
Business days and hours M-Th 8:00am -6:00pm;F 8 :00am-5 :30pm
Public phone number 509 453-1344
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Farmworkers Clinic-Behavioral
Health
Address where navigator services are delivered 307 South 1 s t Avenue,Suite 4B, Yakima 98902
Full service or limited availability (if limited, explain Limled to own patients
Business days and hours M-F 8 :00am-5 :00pm
Public phone number 509 575-8457
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Farmworkers Clinic-YV Tech Dental
Address where navigator services are delivered 11208.18t Street , Yakima 98901
Full service or limited availability (If limited, explain Limited to own patients
Business days and hours M-F 8:30 am-5:30pm
Public phone number 509 573-5530
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Yakima Valley Farmworkers Clinic-Memorial WIC
Address where navigator services are delivered 218 S. 29th Avenue, Yakima 98902
Full service or limited availability (if limited, explain limited to own patients
Business days and hours M, Th, F 8:00-12 noon ,1 :00-5:00pm ; TW 8-12 :00 & 1-5
Public phone number 509576-0146
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization FQHC
Organization name Comprehensive Healthcare
Address where navigator services are delivered 4028. 4th Street, Yakima 98902
Full service or limited availability (if limited, explain limled service -focus on own new patients without
Business days and hours M -F 8 :00-5:00 pm
Public phone number 509 575-4084
Number of navigators 1
Languages spoken by navigators (other than English) none
Reason for selecting this organization Access to mental health clients that may lack insurance
HBE-349 YNHS Exhibit G -Enrollment Sites Page 36 of41
DocuSign Envelope 10: 62955F1D-7A37-4CBO-A8D8-2BA7ADB5515E
Organization name Comprehensive Healthcare
Address where navigator services are delivered 201 S. 2" Il Avenue, Yakima 98902
Full service or limited availability (If limited, explain Limited service· focus on own new patients without
Business days and hours M·F 8:00 am-5 pm
Public phone number 509 317·2839
Number of navigators 1
Languages spoken by navigators (other than English) none
Reason for selecting this organization Access to mental health clients that may lack insurance
Organization name MedData @Virginia Mason Memorial
Address where navigator services are delivered 2811 Teton Drive, Yakima 98902
Full service or limited availability (if limited, explain Limited to hospital patients only
Business days and hours M·F 8 :00am -9 :00 pm
Public phone number 509 575·8799
Number of navigators 3
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization Access to ER patients who lack heath insurance
Organization name Eligibility Screening Services @Toppenish
Community Hospital
Address where navigator services are delivered 502 W 4 ' Avenue, Toppenish 98948
Full service or limited availability (if limited, explain Full Service
Business days and hours M-Th 8:00 am-5 :30pm; Fri 8 :00am -12:00 pm
Public phone number 509 865-1690
Number of navigators 2
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization Access to ER patients who lack health insurance
Organization name Eligibl ity Screening Services @ Yakina Reg i onal
Medical Center
Address where navigator services are delivered 110 S. 9 ' Avenue , Yakima 98902
Full service or limited availability (if limited, explain Full Service
Business days and hours M-F 8:00am-4 :30pm
Public phone number 509454-6339
Number of navigators 2
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization Access to ER patients who lack health insurance
Organization name Sunnyside Community Hosptal
Address where navigator services are delivered 1016 Tacoma Avenue, Sunnyside 98944
Full service or limited availability (if limited, explain Full service
Business days and hours M-F 8:00am-4 :30pm
Public phone number 509 837-1500 Ext. 1591
Number of navigators 6
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization Access to ER clients that lack health insurance
HBE·349 YNHS Exhibit G -Enrollment Sites Page 37 of41
DocuSign Envelope 10: 62955F10-7A37-4CBO-A8D8-2BA7ADB5515E
B. Enrollment sites in KIITITAS County:
Organization name Kittitas County Health Department
Address where navigator services are delivered 507 N. Nanum St.. Suite 102, Ellensburg 98926
Full service or limited availability (if limited, explain Full Service
availability of navigator assistance)
Business days and hours M-F 9:00 am-5:00pm
Public phone number 509962-7515
Number of navigators 3
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization Strengthen coverage & outreach to remote areas of county
Organization name Community Health of Central Washington
Address where navigator services are delivered 521East Mountain View Ave. , Ellensburg 98926
Full service or limited availability (if limited, explain Full service
Business days and hours M-S 7:DOam-7:00 pm
Public phone number 509 962-1414
Number of navigators 1
Languages spoken by navigators (other than English) Spanish
Reason for selecting this organization Only FQHC in Kittitas County
HBE-349 YNHS Exhibit G -Enrollment Sites Page 38 of41
EXHIBIT H -LEAD ORGANIZATION BUDGET AND FUND ALLOCATION
I. Lead Organization
Budget Categories Cost In-Kind Comments
Administrative Fee 0 0
Project management/administration staff: 31,715 36,735 1 FTE, 54% HRSA
sal aries benefits and other employee costs
Enhanced User(sl : salaries, benefits, other 16,000 80,000 3 FTEs, 83% HRSA
Navigator staff: salaries, benefits, other 27,834 4,166 1 FTE, 13% HRSA
Supplies/equipment 2,000 Pri nt ing
Travel/transportation 600 Travel to various event venues
Outreach expenses 20,000 Media, Promotion & Registration Fees
Network partner organization allocation total 83,502 Each of the three network partners will receive $27,834 each, with 15%
of this amount subject to enrollment incentives ($4,175)
I
Total Contact Costs $159,051 $143,501 J ---
II. Navigator Partner Organization Allocations
Name of Navigator Partner Organizations Amount Allocated QHP Enrollment
Target
Yakima Neighborhood Health Services -lead Organization 75,549 511
Community Health of Central Washington 27,824 510
Yakima Valley Farmworkers Clinic 27,824 510
Kittitas County Public Health 27,824 510
Total Allocations $159,051 2,041
'-----
HBE-349 YNHS Exhibit H -lead Organization Budget and Fund Allocation Page 39 of41
DocuSign Envelope 10: 62955F10-7A37-4CBO-A8D8-2BA7AOB5515E
EXHIBIT I -LIST OF DISQUALIFYING CRIMES
RCW 9A.04.040 -Classes of Crimes
(1) An offense defined by this title or by any other statute of this state, for which a sentence of
imprisonment is authorized, constitutes a crime. Crimes are classified as felonies, gross
misdemeanors, or misdemeanors.
(2) A crime is a felony if it is so designated in this title or by any other statute ofthis state or if
persons convicted thereof may be sentenced to imprisonment for a term in excess of one year.
A crime is a misdemeanor if it is so designated in this title or by any other statute of this state or
if persons convicted thereof may be sentenced to imprisonment for no more than ninety days.
Every other crime is a gross misdemeanor.
RCW 9A.20.010 -Classification and Designation of Crimes
Classified Felonies:
(1) The particular classification of each felony defined in Title 9A RCW is expressly designated in
the section defining it.
(2) For purposes of sentencing, classified felonies are designated as one of three classes, as
follows: (i) Class A felony; or (ii) Class B felony; or (iii) Class C felony.
Crimes:
A person who has a felony crime listed below will be denied access to Healthplanfinder:
• Burglary
• Counterfeiting
• Extortionl
• Extortion 2
• Fraud and Swindles
• Forgery
• Identity Theft
• Money Laundering
A person who has a felony crime listed below will have an overall assessment of the person's
character, competence, and suitability to determine if they will have access to Healthplanfinder:
• Assault 1
• Assault 2
• Assault 3 Domestic Violence
• Assault 3 not Domestic Violence
• Assault of a child
• Coercion of Involuntary Servitude
• Custodial Assault
• Dealing in depictions or minor engaged in sexual explicit conduct
• Domestic Violence
• Drive by shooting
• . Homicide by abuse
• leading organized crime
HBE-349 YNHS Exhibit I -List of Disqualifying Crimes Page 40 of41
DocuSign Envelope 10: 62955F1D-7A37-4CBO-A808-2BA7AOB5515E
• Malicious mischief Domestic Violence
• Manslaughter
• Murder/Aggravated Murder
• Rape
• Rape of a child
• Residential burglary
• Robbery
• Sabotage
• Sexual exploitation of a minor
• Sexual misconduct of a minor
• Theft
• Use of a machine gun in a felony
• Vehicular homicide
• Violation of the Imitation Controlled Substance Act (manufacture/deliver/intent)
• Violation of the Uniform Controlled Substance Act (manufacture/deliver/intent)
• Violation of the Uniform Legend Drug Act (manufacture/deliver/intent)
• Violation of the Uniform Precursor Drug Act (manufacture/deliver/intent)
Pending Crime: A person who has a pending crime on list is denied access to Healthplanfinder
while awaiting a deCision by a court, administrative entity, or government entity. Upon
conviction or acquittal by the court, the list is applied.
Attempt: RCW 9A.28.020
Conspiracy RCW 9A.28.030i and Solicitation RCW 9A.28.040: These crimes appear with a listed
crim~, such as Burglary. When the crime of attempt, conspiracy, or solicitation appears in
conjunction with a crime on this list, is treated the same as the listed crime.
HBE-349 YNHS Exhibit I -List of Disqualifying Crimes Page 41 of41
loday's Date
09/20/2017
Fund/Department
116-Public Health
Kittitas County
Review Form
Grants & Contract Agreement
Agenda Date
Contract/Grant Information
o IIi-IT ,
Contract /Grant Agency: Sub-Contract between Yakima Neighborhood Health Services and Kittitas
County Public Health Department
Period Begin Date: August 1, 2017 I I Period End Date: June 30, 2018
Total Grant/Contract Amount: Not to exceed $27,834.00
Grant/Contract Number:
Contract/Grant Summary:
The sub-contract extends the terms ofthe contract between YNHS and the Health Benefit Exchange to
the Sub-Contractor. The period of performance shall continue through June 30, 2018. The sub-contract
allows the health department to continue to enroll Kittitas County residents in the Washington
Healthplanfinder and continue reporting monthly outreach activities to contractor.
Recommendation for Board of Health and Board of Health Review on
Department Head Signature :~ • Administrator Date: lOr 3{ 17
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
AP P AS TO FOR M :
Date
Date
Signature of Board of Health member Date
Financial Information
Total Amount $27,834 State Funds $ Federal Funds $27,834
Percentage County Funds Matching Funds $ CFDA# 93.525
Grant/Contract Review Page 1
In-Kind $
Explain
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring -reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes D attach budget form No []] Why not
New Division Created? Included in 2017 and 2018 budget
Revenue Code
116-612.30.333.93.525 -$27,834
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date :
Prosecutor Review
I Has the Prosecutor reviewed this agreement? I Yes 0 No 0
County Departments Impacted
Auditor Facilities Maintenance
Information Services Hu-man Resource
Prosecutor Treasurer
Submitted I Signature:
Department:
I Date :
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date
Grant/Contract Review Page 2