Loading...
HomeMy WebLinkAboutAFS between Kittitas County and Ability STWKittitas County Public Health Contract/Agreement Review Form Today's Date: 07/02/26 Fund/Department: 116-Public Health Contract/Agreement Information Contract/Agreement Agency: Ability Legal Request #: 1 12583 Agenda Date: Kittitas County Public Health Department Contract/Agreement Title: AFS between Kittitas County and Ability Begin Date: 05/01/26 End Date: 09/30/27 Total $ Amount: $12,600.00 Contract/Agreement #: PHMH26-015 Contract/Agreement Summary: The purpose of the agreement is to provide school -to -work services, per the contractual requirements of the Washington State Department of Vocational Rehabilitation (DVR) including but not limited to intake, assessment, job placement along with required deliverables. Kittitas County Prosecutor and Auditor Review and Comment: APPROVED AS TO FORM: Signature of Prosecutor's Office Signature of Auditor's Office 4.4 fJ V 011- — — Z( , Budget Information Revenue Code(s): � 105-568.334.04.68 Expense Code(s): I HA1000-1101/4122 W Agency is not suspended/disbarred Pass Through Information Agency to Pass Through Amount to Pass Through Sub -Contract Approved Date: ❑ Not Checked (reason) Expense Code: Date IYVIaI67 Date -7(6 l 26 ADMIN Version: 0 Supersedes: 0 Date Adopted: 12/01/2024 1 Modified By: Katie Odiaga Approval By: Chelsey Loeffers 7/7/26, 9:30 AM An official website of the United States government Here's how you know Contract Data Availability Delay Show Details 1 1 Jul 7, 2026 • Scheduled SAM Maintenance Show Details Jul 7, 2026 JUISAM*Gov® Home Search Data Bank Data Services Help Search Filter By All Words e.g. 1606N020Q02 SAM.gov i Search N See All Alerts Search Results Saved Searches Keyword Search For more information on how to use our keyword search, visit our help guide Simple Search Search Editor 0 Any Words 0 All Words i OExact Phrase e.g. 123456789, Smith Corp ability x Spokane x Entity Location Status CC 1 Active Ej Inactive Reset 0 LEntity Information < All Entity Information Entities Disaster Response Registry Responsibility / Qt https://sam.gov/search/?page=1 &pageSize=25&sort=-relevance&index=ei&sfm%5BsimpleSearch%5D%5BkeywordTags%5D%5B0%5D%5Bkey%5D... 1 /2 7/7/26, 9:30AM SAM.gov I Search No matches found Your search did not return any results for active records. Would you like to include inactive records in your search results? Search Inactive Go Back Our Website Our Partners About This Site Acquisition.gov Our Community USASpending.gov Release Notes Grants.gov System Alerts More Partners Policies Customer Service Terms of Use Help Privacy Policy Check Entity Status Restricted Data Use Federal Service Desk Freedom of Information Act External Resources Accessibility Contact ® L WARNING This is a U.S. General Services Administration Federal Government computersystem that is "FOR OFFICIAL USE ONLY." This system is subject to monitoring. Individuals found performing unauthorized activities are subject to disciplinary action including criminal prosecution. This system contains Controlled Unclassified Information (CUI). All individuals viewing, reproducing ordisposing of this information are required to protect it in accordance with 32 CFR Part 2002 and GSA Order CIO 2103.2 CUI Policy. SAM. o'v An official websis:C 0f'i he U.S. Gznerai Services Adri- nistration https://sam.gov/search/?page=1 &pageSize=25&sort=-relevance&index=ei&sfm%5BsimpleSearch%5D%5BkeywordTags%5D%5B0%5D%5Bkey%5D... 2/2 KITTITAS COUNTY AGREEMENT FOR SERVICES PHMH26-015 This Agreement for Services (hereinafter "Agreement") is entered into by and between Kittitas County (hereinafter "County"), a political subdivision of the State of Washington, and Ability (hereinafter "Contractor"). The purpose of this Agreement is as follows: To provide school -to -work services, per the contractual requirements of the Washington State Department of Vocational Rehabilitation (DVR) including but not limited to intake, assessment, job placement along with required deliverables. The term of this Agreement shall be from May 1,2026 through September 30, 2027, unless the Agreement is terminated early or its term is extended as provided herein. The parties' addresses and points of contact for the administration of this Agreement are as follows: COUNTY 507 N Nanum St Ste 102 Ellensburg, WA 98926 Laurie Holt Developmental Disabilities Administrative Specialist Human Services Laurie. holt@co.kittitas.wa.us 509-962-7515 CONTRACTOR Ability 1212 N. Washington St. #124 Spokane, Washington 99201 Project Contact: Ty Lingo Director tlingo@abilityemployment.net 509-242-3758 This Agreement includes the following, which are attached hereto and hereby incorporated by this reference: Attachment "A": Scope of Work Attachment "B": Compensation Attachment "C": Insurance Requirements Attachment "D": General Terms and Conditions Attachment "E": W-9 (Contractor must complete and return to the County for payment) Attachment "F": DVR School to Work Contract with Kittitas County, including: Exhibit A Data Security Requirements Exhibit B School -to -Work Guide Instructions, including billing instructions Exhibit E School -to -Work Billing Checklist Attachment "G": Student Guide Attachment "H": School -to -Work Data Report Template Kittitas County Agreement for Services (rev. 5/14/25) Page 1 of 22 IN WITNESS WHEREOF, this Agreement has been executed by and on behalf of the parties through their authorized representatives, effective as of the latest date written below. KITTITAS COUNTY BOARD OF COUNTY COMM Chair Vice -Chair Commissioner Date: Attest: Clerk of the Board Kittitas County Agreement for Services (rev. 5/14/25) Page 2 of 22 ATTACHMENT "A" SCOPE OF WORK Provide School -to -Work services to eligible students in three phases including School -to -Work intake and assessment phase, job placement phase, and employment phase. • Ensure eligibility and complete a student intake process. o Work with students, student's legal guardian or representative, community rehabilitation program, and DVR to establish and document student employment goals and tools needed. • Complete assessment using Student Guide and/or Job Foundations report to complete the Student Guide to include DVR required information. • Work with the students to find and secure meaningful community employment based on goals. • Work with students to stabilize and maintain meaningful employment. ■ Submit required documentation including student guide and billing checklist. Kittitas County Agreement for Services (rev. 5/14/25) Page 3 of 22 ATTACHMENT "B" COMPENSATION THE COUNTY WILL NOT PROCESS PAYMENT FOR SERVICES RENDERED UNDER THIS AGREEMENT UNTIL CONTRACTOR SUBMITS A COMPLETED W-9 (SEE ATTACHMENT "E"). All funds must be spent by September 30, 2027. No extension of the funding period will be granted. Reimbursement Procedures A. The Contractor shall submit invoices to the county along with the DVR School -to -Work Billing Checklist. B. For DVR to release payment, contractors must submit the student guide monthly. C. The Contactor must provide adequate backup documentation to support costs in each invoice per the School -to -Work Guide Instruction, including billing instructions. For example, the contractor may bill $2,000 for the School -to -Work Intake Meeting and must complete team building and information along with team contacts, roles, and responsibilities to release payment. D. Failure to submit required documentation as outlined in School -to -Work Guide Instructions may result in delayed reimbursement payments or denial of invoices. E. Kittitas County will retain 10% administrative fees per School -to -Work Activity Billed. Administrative fees for Kittitas County will include the following for activities billed: a. Intake Meeting = $200 b. Assessment = $300 c. Job Seeker Tools = $100 d. Job Offer = $200 e. Employment Verification = $100 f. Stabilization = $500 g. Total administrative costs to Kittitas County per School -to -Work student will not exceed $1,400. In no event shall payments under this agreement total more than $12, 600 per School -to -Work student to the contractor. Kittitas County Agreement for Services (rev. 5/14/25) Page 4 of 22 ATTACHMENT "C" INSURANCE REQUIREMENTS Contractor shall secure and maintain in effect at all times during performance of work under this Agreement such insurance as will protect Contractor, its employees, and agents from all claims, losses, harm, costs, liabilities, damages and expenses arising out of Contractor's performance under this Agreement, including but not limited to personal injury (including death) or property damage. All insurance shall be issued by companies admitted to do business in the State of Washington and have a rating of A-, Class VII or better in the most recently published edition of Best's Reports unless otherwise approved by the County. If an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies must comply with Chapter 48.15 RCW and 284-15 WAC. At a minimum, Contractor shall maintain and provide proof of the following selected options: ® Commercial General Liability Insurance • Coverage limits not less than: • $1,000,000 per occurrence, for all covered losses • $2,000,000 general aggregate • $1,000,000 products & completed operations aggregate • $1,000,000 personal and advertising injury, each offense ■ The policy must be endorsed to include the County and its officials, employees and agents as additional insureds. © Commercial Automobile Liability Insurance • Automobile Liability for owned, non -owned, hired, and leased vehicles, with an MCS 90 endorsement and a CA 9948 endorsement attached if 'pollutants' are to be transported. • Coverage limits not less than: • $1,000,000 combined single limit ❑ Excess or Umbrella Liability • Contractor shall provide Excess or Umbrella Liability coverage of $5,000,000. This Excess or Umbrella Liability coverage shall apply, at a minimum, to both the Commercial General and Automobile Insurance policy coverages. If used to meet limit requirements, coverage must be at least as broad as specified for underlying coverages, and must cover those insured in the underlying policies. ■ This requirement may alternatively be satisfied through Contractor's primary Commercial General and Automobile Liability coverage, or any combination thereof. ■ The policy must be endorsed to include the County and its officials, employees and agents as additional insureds. ■ Coverage shall be "pay on behalf", with defense costs payable in addition to policy limits. ■ There shall be no cross liability exclusion precluding coverage for claims or suits by one insured against another. ® Workers' Compensation & Employer's Liabili is Contractor shall provide Workers Compensation and Employer's Liability insurance on a state -approved policy form providing benefits as required by law with employer's liability limits no less than $1,000,000 per accident or disease. Kittitas County Agreement for Services (rev. 5/14/25) Page 5 of 22 f Professional Liability / Errors and Omissions Liability ■ Coverage limits not less than: • $1,000,000 each claim • Contractor must provide evidence of this coverage on a policy form appropriate to Contractor's profession. Contractor shall furnish to the County a Certificate of Insurance, with endorsement where required above, as evidence that policies providing insurance required by this Agreement are in full force and effect. Contractor's insurance policies required above must apply on a primary non-contributing basis in relation to any other insurance or self-insurance available to the County. Contractor agrees to provide notice to the County at least thirty (30) days prior to cancellation, or any material alteration or non -renewal, of any of the above -required insurance coverages. Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools, machinery, equipment, or motor vehicles owned or utilized by Contractor, or Contractor's agents, employees, suppliers or contractors, as well as to any temporary structures, scaffolding and/or protective fences. Contractor shall have sole responsibility for ensuring the insurance coverage and limits required herein are also obtained by any subcontractors. NOTE: Notwithstanding any other provision(s) of this Agreement, no contract shall form under this Agreement until and unless the following are provided to the County: (1) a copy of the Certificate(s) of Insurance with all required endorsements, properly completed and in the amounts required, and (2) where requested by the County, a copy of the required insurance policies, including all required endorsements. Kittitas County Agreement for Services (rev. 5/14/25) Page 6 of 22 ATTACHMENT "D" GENERAL TERMS AND CONDITIONS 1. Scope of Contractor's Services: Contractor agrees to provide to the County services as set forth in Attachment "A". No materials, labor, or facilities will be furnished by the County, unless otherwise provided herein. All work performed under this Agreement shall comply with applicable laws and regulations. 2. Accounting and Payment: Compensation to Contractor for services rendered under this Agreement shall be as set forth in Attachment "B". Where Attachment "B" requires payment(s) by the County, payment shall be based upon billings, supported unless provided otherwise in Attachment "B", by documentation of units of work actually performed and amounts earned, including, where appropriate, the total number of hours for the month and the total dollar payment requested. Unless specifically stated in Attachment "B", the County will not reimburse Contractor for any costs or expenses incurred by Contractor in performance of this Agreement. Where required, the County shall, upon receipt of appropriate documentation, compensate Contractor, no more often than monthly, through the County voucher system, for Contractor's services pursuant to the fee schedule set forth in Attachment "B". In the event Contractor fails to perform any of its obligations under this Agreement within the time specified herein, then the County may withhold all monies due and payable to Contractor until such failure to perform is cured or otherwise adjudicated. The County will not process payment for services rendered under this Agreement until Contractor submits a completed W-9 (See Attachment "E"). 3. Taxes: Contractor understands and acknowledges that the County will not withhold Federal or State income taxes from payments made to Contractor. Where required by State or Federal law, Contractor authorizes the Countyto make withholdingfor anytaxes otherthan incometaxes (e.g., Medicare). All compensation received by Contractor will be reported to the Internal Revenue Service at the end of the calendar year in accordance with applicable IRS regulations. It is the responsibility of Contractor to make its necessary estimated tax payments throughout the year, if any, and Contractor is solely liable for any tax obligation arising from Contractor's performance of this Agreement. The County will pay sales and use taxes imposed on goods or services acquired hereunder as required by law. Contractor must pay all other taxes, including but not limited to: business and occupation tax; or taxes based on (1) Contractor's gross or net income, or (2) personal property to which the County does not hold title. The County is exempt from federal excise tax. 4. Independent Contractor: Contractor's services shall be furnished by Contractor as an independent contractor, and nothing stated herein shall be construed to create a relationship of employer -employee or a guarantee of future employment. Contractor acknowledges that its entire compensation under this Agreement is specified in Attachment "B", and that Contractor is not entitled to any County benefits, including but not limited to: vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance benefits, or any other rights or privileges afforded to Kittitas County employees. S. Assignment and Subcontracting: and Subcontracting: No portion of this Agreement may be assigned or subcontracted to any other individual, firm or entity without the express and prior written approval of the County. The Contractor may only subcontract work contemplated under this agreement if it obtains the prior written approval of the County. If the County approves subcontracting, the Contractor shall maintain written procedures related to subcontracting, as well as copies of all subcontracts and records related to subcontracts. For cause, the County in writing may require the Contractor to amend its subcontracting procedures as they relate to this agreement, prohibit the Contractor from subcontracting with a particular person or entity, or require the Contractor to rescind or amend a subcontract. Every subcontract shall bind the Subcontractor to follow all applicable terms of this agreement. The Contractor is responsible to the County if the Subcontractor fails to Kittitas County Agreement for Services (rev. 5/14/25) Page 7 of 22 comply with any applicable term or condition of this agreement. The Contractor shall appropriately monitor the activities of the Subcontractor to assure fiscal conditions of this agreement. In no event shall the existence of a subcontract operate to release or reduce the liability of the Contractor to the County for any breach in the performance of the Subcontractor's duties. Every subcontract shall include a term that County is not liable for claims or damages arising from a Subcontractor's performance of the subcontract. 6. Right to Review; Maintenance of Records: This Agreement is subject to review by any Federal or State auditor. The County or its designee shall have the right to review and monitor the financial and service components of the work performed under this Agreement by whatever means are deemed expedient by the County. Such review may occur with or without notice, and may include, without limitation, on -site inspection, inspection of all records or other materials which the County deems pertinent, and any and all communications with or evaluation by service recipients under this Agreement. Contractor shall preserve and maintain all records relating to this Agreement for six (6) years after termination or expiration of the Agreement, and upon request shall make them available for review by any Federal or State auditor, the County, and/or any persons authorized by the County. 7. Modification 7.1. This Agreement may be amended by mutual agreement of the parties. Any such amendment shall be in writing and signed by both parties. 7.2 The County may unilaterally amend this Agreement at any time by written notice ("Change Notice") to Contractor, to modify the work to be performed under this Agreement, within the general scope of the Agreement. Such changes may include, but are not limited to, changes in the exact scope of work to be performed (including modification, substitution, addition, or deletion of required tasks) and changes to the schedule of performance. If any such Change Notice causes an increase or decrease to Contractor's cost of, or the time required for, performance of the work, an equitable adjustment in the compensation to Contractor and/or in the schedule for the performance of the work shall be made by the County to reflect such an increase or decrease. Notwithstanding any dispute or delay in arriving at a mutually acceptable equitable adjustment, Contractor shall proceed in accordance with all Change Notices. Within thirty (30) days after receipt of any Change Notice which, in Contractor's opinion, lacks an adequate adjustment, Contractor must submit to the County a written statement requesting a modified adjustment; otherwise, Contractor will forfeit its right to any such modified adjustment. The County retains the final right to determine adjustments hereunder. 8. Termination 8.1 This Agreement may be terminated at any time by mutual written agreement of the parties. 8.2 The County, by giving written notice, may terminate this Agreement at any time without cause and without further obligation to Contractor except for payment due for deliverables provided and/or services performed prior to the effective date of termination. An equitable adjustment in the contracted price for partially completed tasks will be made by the County, but such adjustment shall not include compensation for loss of anticipated profit on uncompleted work. 8.3 If Contractor defaults by failing to perform any of its obligations under this Agreement, or becomes insolvent, is declared bankrupt or commits any act of bankruptcy or insolvency, or makes an assignment for the benefit of creditors, the County may, by written notice to Contractor, terminate the Agreement, and at the County's option, obtain performance of the work elsewhere. If the Agreement is terminated under this paragraph, Contractor shall not be entitled to receive any further payments under this Agreement until all of its obligations hereunder have been fully performed, and any extra cost or damage to the County shall be deducted Kittitas County Agreement for Services (rev. 5/14/25) Page 8 of 22 from any money due or coming due to Contractor. Furthermore, in the event of termination underthis paragraph, Contractor shall bear the costs of any extra expenses incurred by the County in completing the work, and all damages sustained, or which may be sustained, by the County. 8.4 Termination of this Agreement by any means provided herein shall not excuse any party's performance of its obligations hereunder through the effective date of termination, except that the County shall not be obligated to pay for services that have not been performed or deliverables that have not been provided. 9. Indemnification 9.1 To the fullest extent permitted by law, Contractor agrees to indemnify, defend and hold the County and its departments, elected and appointed officials, employees, agents and volunteers, harmless from and against any and all claims, damages, losses and expenses, including but not limited to court costs, attorney's fees and alternative dispute resolution costs, for any personal or bodily injury, sickness, disease or death, for any damage to or destruction of any property (including the loss of use resulting therefrom), and for any other claims, damages, losses, and expenses sustained by the County, which (1) are caused in whole or in part by any act or omission, negligent or otherwise, of Contractor, its employees, agents or volunteers, or Contractor's subcontractors, their employees, agents or volunteers; or (2) are directly or indirectly arising out of, resulting from, or otherwise connected with the performance of this Agreement; or (3) are based upon Contractor's or its subcontractors' use of, presence upon or proximity to the property of the County. This indemnification obligation of Contractor shall not apply in the limited circumstance where the claim, damage, loss or expense is caused by the sole negligence of the County. This indemnification obligation of Contractor shall not be limited in any way by the Washington State Industrial Insurance Act, RCW Title 51, or by application of any other workmen's compensation act, disability benefit act or other employee benefit act, and Contractor hereby expressly waives any immunity afforded by such acts. The foregoing indemnification obligations of Contractor are a material inducement to the County to enter into this Agreement, are reflected in Contractor's compensation, and have been mutually negotiated by the parties. 9.2 The County reserves the right, but not the obligation, to participate in the defense of any claim for damages, losses or expenses, and such participation shall not constitute a waiver of Contractor's indemnity obligations contained in any section of this Agreement. 9.3 In the event Contractor enters into subcontracts to the extent allowed under this Agreement, each such subcontractor shall indemnify the County on a basis equal to or exceeding Contractor's indemnity obligations to the County. 10. Venue and Choice of Law: In the event that any litigation should arise concerning this Agreement, the venue for such action shall be in the Superior Court of the State of Washington in and for the County of Kittitas. This Agreement shall be governed by the laws of the State of Washington. 11. Non-Appropriationof Funds: if the County does not appropriate sufficient funding for this Agreement for any future fiscal period, the County will not be obligated to make payments for services performed after the end of the last fiscal period for which sufficient funding was appropriated. No penalty or expense shall accrue to the County in the event this provision applies. 12. Contractor Commitments Warranties and Representations: Contractor represents and warrants as follows: Kittitas County Agreement for Services (rev. 5/14/25) Page 9 of 22 12.1 Contractor is duly incorporated, validly existing and in good standing under the laws of the State of Washington, and has all requisite corporate power and authority to enter into and to perform its obligations under this Agreement. 12.2 Contractor has the authority to execute this Agreement, to make the representations and warranties set forth herein, and to perform its obligations hereunder. 12.3 This Agreement has been validly executed by an authorized representative of Contractor and constitutes a valid and legally binding and enforceable obligation of Contractor. 12.4 Contractor holds, or will obtain prior to commencing work under this Agreement, such licenses, permits and other authorizations from federal, state and local governmental authorities, or from any applicable industrial or professional certification or licensing bodies, as are necessary for the lawful performance of its obligations under this Agreement, and will maintain such throughout the term of this Agreement. 12.5 Contractor is not in violation of any applicable law, ordinance or regulation the consequence of which will or may materially affect Contractor's ability to perform its obligations under this Agreement. Contractor is not subject to any order or judgment of any court, tribunal or governmental agency which materially and adversely affects its operations or assets in the State of Washington, or its ability to perform its obligations under this Agreement. 12.6 Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal or State department or agency. 12.7 None of the representations or warranties in this Agreement, and none of the documents, statements, certificates or schedules furnished by Contractor in connection with the performance of the obligations contemplated under this Agreement, contains or will contain any untrue statement of a material fact or omits or will omit a material fact necessary to make the statements of fact contained therein not misleading. 13. Ownership of Items Produced: All writings, programs, data, reports, films, recordings, or other materials prepared by Contractor and/or its consultants or subcontractors, in connection with the performance of this Agreement, shall be the sole and absolute property of the County. The County will have all rights of ownership therein, including but not limited to the right to use, copyright, trademark, and/or patent, and the ability to transfer any or all ownership rights. 14. Intellectual Property Infringement: Contractor will defend and indemnify the County from any claimed action, cause or demand brought against the County, to the extent such action is based on the claim that information and/or materials supplied by Contractor infringe any intellectual property rights of any third party(ies). Contractor will pay all costs and damages attributable to any such claims finally awarded against the County in any action. Such defense and payments are conditioned upon the following: (1) Contractor shall be notified promptly in writing by the County of any notice of such claim; and (2) Contractor shall have the right hereunder, at its option and expense, to obtain for the County the right to continue using the information and/or materials that are the subject of such claim, provided no reduction in performance or loss results to the County. 15. Use of County Name and Logo: Contractor may not use the County's name, logo(s), trademark(s), or other identifying information, or identify the County as a current or former client, on its website or in any marketing or promotional materials without the prior written consent of the County. 16. Disputes: Any dispute between the parties arising under or relating to this Agreement shall be resolved informally if possible. However, in the event such a dispute cannot be so resolved, it shall be adjudicated Kittitas County Agreement for Services (rev. 5/14/25) Page 10 of 22 by a dispute board ("Dispute Board") in the following manner: Each party shall appoint one member to the Dispute Board, the members so appointed shall jointly appoint an additional member to the Dispute Board, and the Dispute Board will evaluate the facts, Agreement terms, and all applicable statutes and rules, and make a determination as to the proper resolution of the dispute. Such determination shall be final and binding on both parties. The cost of resolution will be borne as allocated by the Dispute Board. Alternatively, if agreed to in writing by both parties, the parties may forego the option of establishing a Dispute Board to adjudicate the dispute, and instead pursue arbitration, jointly selecting an arbitrator acceptable to both parties. In the event the parties choose to pursue arbitration, the parties agree that: (1) the fees and expenses of the arbitrator shall be shared equally by both parties to this Agreement, (2) each party shall bear its own costs and attorney fees, (3) arbitration shall be conducted according to the commercial arbitration procedures of the American Arbitration Association, and (4) the arbitrator's decision or award shall be final and binding on both parties. 17. Confidentiality: Contractor, its employees, agents and volunteers, and any of Contractor's subcontractors and their employees, agents and volunteers, shall maintain the confidentiality of all information provided by the County or acquired by Contractor in performance of this Agreement, except upon the prior written consent of the Kittitas County Prosecuting Attorney or an order entered by a court after having acquired jurisdiction over the County. Contractor shall immediately provide the County notice of any judicial proceedings seeking disclosure of such information. Contractor agrees to indemnify, defend and hold harmless the County and its departments, elected and appointed officials, employees, agents and volunteers from all loss or expense, including but not limited to settlements, judgments, setoffs, attorneys' fees and costs resulting from Contractor's breach of this provision. Notwithstanding the foregoing, and to the extent that any information obtained by the Contractor hereunder is required to be shared with others by the explicit terms of the Scope of Work, this provision shall not be construed as prohibiting such sharing, provided there are no applicable laws or regulations prohibiting same. 18. Notices: Written notices required or permitted to be provided by one party to the other party under this Agreement may be provided by personal delivery, legal courier service, or certified mail, postage prepaid and return receipt requested. Notice may be provided by regular first-class mail if simultaneous notice is provided by email. Notices given by Contractor shall be provided to the County's point of contact listed on page 1 of this Agreement, at the address there listed, and to the department head of the county department for which services under this Agreement are rendered. Notices given by the County shall be provided to Contractor at Contractor's address listed on page 1 of this Agreement. 19. Prevailing Wage: Where labor to be performed under this Agreement is considered "public work" as defined in RCW 39.04.010, Contractor shall pay the prevailing rate of wages to all workers, laborers, or mechanics employed in the performance of work under this Agreement in accordance with RCW 39.12 and the rules and regulations of the Washington State Department of Labor and Industries. The schedule of prevailing wage rates for the applicable locality or localities is determined by the Industrial Statistician of the Department of Labor and Industries. It is Contractor's responsibility to verify the applicable prevailing wage rate. It is understood that Contractor is responsible for obtaining and completing all required government forms relating to prevailing wage and submitting same to the proper authorities. Disputes regarding prevailing wage rates shall be referred for arbitration to the Director of the Department of Labor and Industries. The arbitration decision shall be final and conclusive and binding on all parties involved in the dispute as provided for in RCW 39.12.060. 20. Standard of Care: Contractor shall perform its duties hereunder in a manner consistent with that degree of care and skill ordinarily exercised by members of the same profession or industry as Contractor currently practicing or working under similar circumstances. Contractor shall, without additional compensation, correct any of its services not meeting such a standard. 21. Nondiscrimination: Kittitas County Agreement for Services (rev. 5/14/25) Page 11 of 22 21.1 In the performance of this Agreement, Contractor will not discriminate against any employee or applicant for employment on the grounds of age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, honorably discharged veteran or military status, or the presence of any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a disability; provided that the prohibition against discrimination because of such disability shall not apply if the particular disability prevents the proper performance of the particular worker involved. Contractor shall ensure that applicants are employed, and that employees are treated during employment, without discrimination because of their age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, honorably discharged veteran or military status, orthe presence of any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a disability. Such requirements apply, without limitation, to the following: employment, promotion, demotion, transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and programs for training, including apprenticeships. Contractor shall take such action with respect to this Agreement as may be required to ensure full compliance with local, state and federal laws prohibiting discrimination in employment. 21.2 Contractor will not discriminate against any recipient of any services or benefits provided for under this Agreement on the grounds of age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, honorably discharged veteran or military status, or the presence of any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a disability. 21.3 If any assignment and/or subcontracting has been authorized by the County, said assignment or subcontract shall include appropriate safeguards against discrimination. 22. Waiver: The waiver of any default or breach of this Agreement, or the failure of a party to enforce any provision hereof or to exercise any right or privilege hereunder, shall not be deemed to waive any prior or subsequent default or breach, the enforcement of any provision hereof, or the exercise of any right or privilege hereunder, unless otherwise stated in a writing, signed by the parties hereto. 23. Headings: The headings of sections and paragraphs of this Agreement are for convenience of reference only and are not intended to restrict, affect, or be of any weight in the interpretation or construction of the provisions of such sections or paragraphs. 24. Survival: The provisions of paragraphs 2, 3, 4, 6, 8, 9, 10, 13, 14, 15, 16, 17, 19, 20, 22, 24, and 28 of these General Terms and Conditions shall survive the completion, expiration, termination or cancellation of this Agreement for any reason. 25. Complete Agreement: This Agreement constitutes the entire agreement between the parties and supersedes any and all other agreements, understandings, negotiations and discussions, oral or written, express or implied, regarding the work to be performed hereunder. The parties agree that no other representations, inducements, promises, agreements, or warranties relating to this Agreement, oral or otherwise, have been made between the parties. Except as provided elsewhere in this Agreement, no modification or waiver of this Agreement shall be valid or binding unless in writing and signed by the parties. 26. Severability: If any term or condition of this Agreement or the application thereof to any person(s) or circumstances is held invalid, such invalidity shall not affect other terms, conditions or applications which can be given effect without the invalid term, condition or application. To this end, the terms and conditions of this Agreement are declared to be severable. Kittitas County Agreement for Services (rev. 5/14/25) Page 12 of 22 27. Time: Time is of the essence in the performance of this Agreement unless otherwise agreed between the parties in a signed writing. 28. Construction: This Agreement has been mutually reviewed and negotiated by the parties and should not be construed against the drafter. 29. Agreement Not for Benefit of Third Parties: This Agreement is entered into solely for the benefit of the parties hereto and vests no rights in, nor is it enforceable by, any third parties. Kittitas County Agreement for Services (rev. 5/14/25) Page 13 of 22 ATTACHMENT "E" FormWill Request for Taxpayer Give form to the (Rev. March 2024) Identification Number and Certification requester. Do not Department of the Treasury Go to www.irs.gov1FormW9 for instructions and the latest information. Intinternallsend to the IRS. Revenue Service Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below. 1 Name o1 entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owners rame on line 1, and enter -.he business disregarded en•'ib/'s name online 2.) 2 Business name/cimrcgarood entity name, if different from above. 1. Check the appropriate oox ror federal lax classification of the entity/individual whose name is entered on line 1. Check 4 Exemptions (cedos apply only to only one of the following seven boxes. certain entities, not individuals: see instructions on page 3): ❑ Individuallsole propdetor ❑ C corporation ❑ S corporation ❑ Partnership ❑ Tnlst,'estato ❑ LLC, Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) . . . Exempt payee code (if any) Note: Check the "t1G" Dox above and, in theentry spw*. enler!I* AuMpriale code (C. &OF.P) for tl6e Wx classification of the LLa unless It is a disregarded entity. A disregorood entity should inslaW eheck the AWropriato Exemption from Foreign Account Tax box for the tax classification of its owner. Compliance Act (FATCA) reporting ❑ Other (see instructions) code (it any) 3b If on line 3a you checked "Partnership" or "TrusUestate." or checked "LLC" and entered "P" as its tax classification, (Applies to accounts maintained and you are pr4Wding this form to a oartnarrlhip, trust, or mibta in whim you have an ownersnip interest, check outside the United States.) this box if you have any forllgn partners, owhem, or benelicinnes. See instructions ❑ Address (number, street, and apt, or suite no ) See instructions. 6 City, state, and ZIP code 7 L at account numbeds) here (optional) ntification Number Requester's name and address (cptlonaQ Entet' your TIN in the aoproprlate box. The TIN provided mtfat match the nacre given on ling i to avoid I Social security number _J baefalp withholding. For ,ndivtduafs. ;his is gamemily your social unurity number (SSN). However, for a resident alien, sole proponlor, or disregarded entity, see ihw instructions for Pan I, later. For outer entities, A is your employer identification number (EIN). If you do not have a number, see How to get a or TIN, later. Employer Identification number Note: If the account is in more than one name, see the instructions for line 1, See also What Name and Number To Give the Requester for guidelines on whose number to enter. _ Under penalties of perjury, I certify that: 1, The number shown on this form is my correct taxpayer identdication number (or I am wafting for a number to be issued to me); and 2. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (f any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sigh the certification, but you must provida your correct TIN. See the instructions for Part 11. later. Sign Signature of Date Here U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9, What's New Line 3a has been modified to clarify hole a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax ciassifrcabon of its owner- Otherwise, it should check the "LLC" box and enter its appropriate lax classification. Cal No. 10231x Kittitas County Agreement for Services (rev. 5/14/25) Page 14 of 22 New line 3b has been added to this form. A flow -through entity is required to complete this line to Indicate that it has direct or indirect foreign partners. ot+ners, or berefiefaries vrher It provides the Form W-9 to anti erftow-through entity in which it has an ownership interest. This change is intended to provide a flow -through entity with information regarding the status of its indirect foreign partners, owners, or berericiaries, so that it can sa!isfy any applicahte reporting requiramants. For example. a partnership that has any indirect foreign Wriars may be required to complete Schedules K-2 and K 3. See the Prit-Ir l•ip Instn:ci=s for Schodulas K-2 and K-3 (Form IM). Purpose of Form An individual or entity (Form W-9 requester) who is required to rile an information return with the IRS is giving you this form because they Form w-9 (Rev- 3-2024) Form W-9 (Rev. 3-2024) must obtain your correct taxpayer identification number (TIN). which may be your social security number (SW. individual taxpayer identification number (ifl", adoption taxpayer identification number (ATtM. or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportabls on an information return. Examples of information returns imiluds, but are not limited to. the following. • Form 1 099-INT (interest earned or paid). • Form 1099•DIV (dividends, including those from stocks or mutual funds). • Form 1099-MISC (various types of income. prizm awards. or gross proceeds). • Form 1099-NEC (nonemployee compensation). • Form 1099-B [[stock or mutual fund sales and certain other transactions by hrokers). • Form 1099-S (proceeds from real estate transactions). • Form 1099-K (merchant card and third -party network hansactions). • Form 1098 (home mortgage interest). 1 D98-E (student loan interest), and 1 D96-T (tuition]. • Form 1099-0 (canceled debt). • Farm 1099-A (acquisi[ion or abandaament of secured property), Use Form W-9 only if you are a U.S. person (including a resident Wien). to provide your correct TIN. Caution: if you don't return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See Mat is backup withwE6ng, later. 13y signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting far a number to be issued); 2. Certify that you are not subject to backup withholding: or 3. Claim exemption from backup withholding if you are a U.S. exempt payee: and 4, Certify to your non -foreign status for purposes of withholding under chapter 3 or 4 of the Code {if applicable); and 5. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reportimg is correct. See What Is FATCA Reporting. later. for further inforrnatian. Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's farm it it is substandaliy similar to this Farm W-9- Defenition of a U.S. person. For federal tax purposes, you are considered a U,S. person if you are: • An individual who is a U.S. citizen or U.S, resident alien: • A partnership, corporation. company, or association created or organized in the United States or under the laws of the United States: • An estate (other than a foreign estate): or • A domestic trust (as defined in Regulations section 301.7701-4 Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding. Payments made to foreign persons, including certain distributions, allocations of income, or transfers of sales proceeds, may be subject to withholding under chapter 3 or chapter 4 of the Code (sections 14-41-1474). Under those rules, 9 a Form YV-9 or other certification of non -foreign status has not been received. a withholding agent, transferee. or partnership (payor) generally applies presumption rules that may require the payor to withhold applicable tax from the recipient. owner, transferor. or partner (payee). See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. The following persons must provide Form W-9 to the payor for purposes of establishing its ncn-foreign status. • in the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not tfw disregarded entity. • in the case of a grantor trust with a U.S. grantor or other U.S. owner. generally, the U.S. grantor a other U.S. owner of the grantor trust and not the grantor trust. • In the case of a U.S. trust (other than a grantor trust), the U.S. trust and not die beneficiaries of the trust. See pub. 515 for more information on providing a Ferm W-9 or a cer'tifwadon of non -foreign status to avoid withhoicfirmg Kittitas County Agreement for Services (rev. 5/14/25) Page 15 of 22 page 2 Foreign Person. If you are a Foreign person a the U.S. branch of a foreign bank that has elected to be treated as a U.S. person (under Regulations section 4.1441-1(15)(2}(iv) of other applicable section for chapter 3 or 4 purposes), do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a qualified foreign pension fund under Regulations section 1.897(I)-1(d), or a partnership that is wholly owned by qualified foreign pension funds. that is treated as a non -foreign person for purposes of section 1-US withholding. do not use Form W-9. Instead, use Form W-8EXP (or Other certification of non -foreign status). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a saving clause. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U-S. resident alien for tax purposes. If you are a U.S, resident alien who is relying on an exceptiarr contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items. 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Exampee. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States, Under U.S. law, this student will become a resident alien for tax purposes it their stay in the United States exceeds 5 calendar years. However. paragraph 2 of time first Protocol to the U.S.-China treaty (dated April 30. 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first Protocol) and is relying an this exception to claim an exemption from tax on their scholarship or fellowship income would attach to Forth W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity. give the requester the appropriate completed Form W-8 or Form 8233. Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withtwld and pay to the tRS 244b of such payments- This is called "backup withholding." Payments that may be subject to backup withholding include. but ate not limited to, interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonempayea pay. payments made in settlement of payment card and third -party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive it you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not fumish your -nN to the requester, 2. You do not certify your TIN when required (see the instructions for Part II for details); 3. The IRS tells the requester that you furnished an incorrect TiN; 4, The IRS tells you that you are subject to backup withholding because you did not refx;'n all your interest and dividends on your tax return (far reportable interest and dividends only); or 5. You do not certify to the requester that you are not subject to backup withholding, as described in item 4 under °2y signing are {rged- ouf form" above (for reportable interest and dividend accounts opened after 1983 only). Form W-9 (Rev. 3-2024) Certain payees and paymems are exempt from backup withholding. See Fxampt payee code, later. and the separate Instructions for the Requester of Form W-9 for more information. See also Estahlrshi T9 IJ.S. status farpurposes of chapter 3 and chapter 4 wifhholding, aadier. What Is FATCA Reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating Foreign financial institution to report all U.S. account holders that are specified U.S. persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you are no longer tax exempt In addition, you must furnish a ne v Fonn W-9 if the name or TIN changes for" account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of S50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a S500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment Misuse of T1Ns. If the requester discloses or uses TINS in violation of led" law, the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return. If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first. and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Farm W-9 to an FFI to document a joint account each holder of the account that is a U.S. person must provide a Form W-9. • Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change. enter your First name. the last name as shown on your social security card. and your new last name. Note for ITIN applicant Enter your individual name as it was entered on your Form W-7 application, line 1 a. This should also be the same as the name you entered on the Farm 1040 you filed with your application. • Sole proprietor. Enter your individual name as shown on your Form 1040 on line 1. Enter your business, trade, or "doing business ae (DBA) name on line 2. • Partnership. C corporation, S corporation, or LLC, other than a disregarded entity. Enter the entity's name as shown on the entity's tax return on line f and any busines-_ trade, or DBA name on line 2. • Other entities. Enter your name as shown on required U.S. federal tax documenls on line 1. This name should match the name shown on the charter or other legal document creating the entity. Enter any business, trade, or DBA name on line 2. • Disregarded entity. In general, a business entity that has a single owner. including an LLC, and is not a corporation, is disregarded as an entity separate from its owner (a disregarded entity) See Regulations section 301J701-2(e)(2). A disregarded entity should check the appropriate box for the tax classification of its owner. Enter the owner's name on line 1. The name of the owner entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For Kittitas County Agreement for Services (rev. 5/14/25) Page 16 of 22 example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, attar the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on fine 2. If the owner of the discarded entity is a foreign person• the owner must complete an appropriate Form Ye -8 is of a. Form W-9. This is the case even if the foreign person has a U.S_ TIN. Line 2 If you have a business name. trade name. DBA name. or disregarded entity name, enter it online 2. Line 3a Check the appropriate box an fine 3a for the U.S. federal tax classification of the person whose name is entered on line 1. Check only ona box on line 3a. IF the entitylindividual on line 1 THEN check the box for ... is a(n) ... • Corporation Corporation_ • Individual or Individual/sole proprietor. • Sole proprietorship • LLC classed as a partnership Limited liability company and for U.S. federal tax purposes or enter the appropriate tax • LLC that has filed Form 8832 or classification: 2553 electing to be taxed as a P = Partnership, corporation C = C corporation, or S = S corporation. • Partnership Pwrwsfup. • Trustlestate Tmstfestate. Line 3b Check this box if you are a partnership (ncluding an LLC classified as a partnership for U-S. federal tax purposes). trust or estate that has any foreign partners. owners. or beneficiaries. and you are providing this form to a partnership. trust. or estate. in which you have an ownership interest You must check the box on fine 3b if you receive a Form W-8 (or documentary evidence) from any partner, owner, or beneficiary establishing foreign status or if you receive a Form W-9 from any partner, owner. or beneficiary that has checked the box on line 3b. Note: A partnership that provides a Form W-9 and checks box 3b may be required to complete Schedules x-2 and K-3 iForm 1065'r• For more information, see the Partnership Instructions for Schedules K-2 and K-3 (Form 1065). If you are required to complete line 3b but foil to do so, you may not receive the information necessary to fife a correct information return with the IRS or furnish a correct payee statement to your partners or beneficiaries. See, for example, sections 6698, 6722. and 6724 for penalties that may apply. Line 4 Exemptions If you are exempt from backup wilhhokLN ancUbr FATCA reporting. trrler in lire Wprupriate spaix wi line 4 any c xSe(s) If rirt nmy apply to you. Exempt payee code. • Generally, individuals (including sole proprietors) are not exempt from backup withholding. • Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends_ ■ Corporations art not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. • Corporations are not exempt from backup witirhalding with respect to attomeys' fees or grass proceeds paid to attorne}-s and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form t 099-MISC, The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space on line 4. 1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(bX7) if the account satisfies the requirements of section 401(f)(2). Form W-9 (Rev. 3-2024) 2—The United $tales or any of its agencies or instrumentalities. 3—A state, the District of Columbia, a U.S. commonwealth or territory, or any of their political subdivisions or instrumentalities. 4—A foreign government or any of its political subdivisions, agencies, or instrumentalities. 5—A corporation. 6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or territory. 7—A futures commission merchant registered with the Commodity Futures Trading Commission. 8—A real estate investment trust 9--An entity registered at all times during the tax year under the Investment Company Act of 1940. 10—A common trust fund operated by a bank under section 584(a). 11 —A financial institution as defined under section 581. 12—A middleman known in the investment community as a nominee or custodian. 13—A trust exempt from tax under section 664 or described in section 4947. The following chart shows types of payments that may be exempt from backup withholding. The chart appfies to the exempt payees listed above, 1 through 13. IF the payment is for ... THEN the payment is exempt for... • Interest and dividend payments All exempt payees except for 7. • Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. • Barter exchange transactions Exempt payees 1 through 4. and patronage dividends • Payments over $600 required to Generally, exempt payees be reported and direct sales over 1 through 5.2 $5,000' • Payments made in settlement of Exempt payees 1 through 4. payment card or third -party network transactions See Form 1099-MISC, Miscellaneous Information, and its instructions. However, the following payments made to a corporation and repadable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, aftomeys' fees, gross proceeds paid to an attorney reportable under section 6045(0. and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATGk These codes apply to persons submitting this form for accounts maintained outside of the United States by ceriain foreign financial institutions. Therefore, it you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with "Not Applicable" (or any similar indicalion) entered on the line for a FATCA exemption code- A— An organization exempt from tax under section Sol (a) or any individual retirement plan as defined in section 7701(aX37). B—The United States or any of its agencies or instrumentalities. C—A state, the District of Columbia, a U.S. commonwealth or territory, or any of their political subdivisions or instrumentalities. ❑—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(r). E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(CHI)(i). Kittitas County Agreement for Services (rev. 5/14/25) Page 17 of 22 Page 4 F—A dealer in securities, commodities, or derivative financial instruments [nctuding notional principal contracts. futures, forwards, and options) that is registered as such under the laves of the United States or any state. G—A real estate investment trust H—A regulated investment company as defined in section a51 or an entity registered at all tirnes during the tax year under the Inves"art Company Act of 1940. 1—A common trust fund as defined in section 584(a). J—A bank as defined in section 581. K—A broker. L—A trust exempt from tax under section 664 or described in section 4947(a)(1). M—A tax-exempt trust under a section 403(b) plan or section 457(g) plan. Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code andiat, exempt payee code should be completed. Line 5 Enter your address (number. street. and apartment or suit- number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, enter "NEV'!" at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records. Line 6 Enter your city, state, and OF code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. II you are a resident alien and you do not have, and are not eligible to get. an SSN, your TIN is your iR5 ITIN. Enter it in the entry space for the Social security number. If you do not have an MN, see How to get a TIN below. If you are a sole proprietor and you have an FIN, you may enter either your SSN or FIN. If you are a single -member LLG that is disregarded as an entity separate from its owner, enter the owners SSN (or FIN, if the owner has one). If the LLG is classified as a corporation or partnership, enter the entity's FIN. Note: See What Name and Number To Give the Requester. Tatar, for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Fame SS-5, Application for a Social Security Card, from your local SSA office or get this farm online at www.SSAgnv. You may also get this form by calling 800-772-121S. Use Form W-7, Application for M individual Taxpayer Identification Number, to apply for an rriN, or Form SS-4. Application for Employer Identification Number. to apply for an FIN. You can apply for an FIN online by accessing the IRS website at www.iis.gov/E7N. Go to rwrw.irs garlFom�s to view, download. or print Form W-7 and/or Form s&_ Or. yuu can go to rvrvw.irs.guv1OrrdcvFwtrur to place an corder and have Form W-7 andlw Form SS-4 mailed to you within 15 business days. H you are asked to complete Form W-9 but do not have a TIN. apply for a TIN and enter "Applied For' in the apace for the TIN, sign and date the form. and give it to the requester. For interest and dividend payments, arsd certain payments made with respect to readily tradable instruments. you will generally have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholdatg on all such payments until you provide your TIN to the requester. Note: Entering "Applied Fob' means that you have already applied for a nN or that you intend to apply for one soon. See also Fstablishing U,S. stahrs for purposes of chapter wid chapter 4 wirYrhofding. earlier, for when you may instead be subject to withholding under chapter 3 or d of the Code. Caution: A disregard ed U.S. entity that has a foreign owner must use the appropriate Form W-8. Form W-9 (Rev. 3-2024) Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise. For a joint account, only the person whose TIN is shown in Pail I should signs (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts Opened after 119B3 and broker accounts considered inactive during 11=1. You must sign the cerlification or backup withholding will apply. If you are subject to backup v4thholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification_ You may cross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not hays to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties. goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third -party network transactions. payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments [under section 524), ABLE accounts (under section 529A). IRA, Coverdell ESA, Archer IVISA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do riot have to sign the certification. What Name and Number To Give the Requester For this type of account. I Give name and SSN of: 1. Individual The individual 2_ Two or more individuals 6oint account) The actual owner of the account or. other than an account maintained by if combined funds, the first individual an FR on the account' 3. Two or more U.S. persons Each holder of the account (joint account maintained by an FFI) 4. Custodial account of a minor The minor' (Uniform Gift to Minors Act) 5_ a. The usual revocable savings trust The grantor -trustee' (grantor is also trustee) b. So-called trust account that is not The actual owner' a legal or valid trust under state law 6. Sole proprietorship or disregarded The ovnera entity owned by an individual 7. Grantor trust filing under Optional The grantor' Filing Method 1 (see Regulations section 1.671-4(b)(2)f)(A)I" Kittitas County Agreement for Services (rev. 5/14/25) Page 18 of 22 Page 5 For this type of account: I Give name and EIN of: a. Disreg nded entity not; owned by an The owner ind ividunl 9. A valid trust. estate. or pension ULPA Legal entity-4 1o. Corparalkm or L LC deding caporals The corporation utn" on Form 8&32 or Form 2S53 11. Asscciation. dub. religious, charitable. The organization Vducational, or Wier taic�xeript organizzation 12. Ihutnership or mult-memberLLC The partnership ta. A broker or registered nominee The broker or nominee 14. Account with the Deportrcrent of The public entity Ag.iwlhre n the Wine of a public rntity (such as a state or local government school district. or prised that receivua agricultural progi om payments 15. Grantor trust fifrig Form 1041 or The trust under the Optional Filing Method 2, requiring Form 1099 tsee Regulations section 1.671-4tbX2xd(B)r* ' List first and circle the name of the person whose number you furnish. ff only one person on ajoint account has an SSN. that paison's number must be fumishad. 'Circle the minor's name and furnish the minor's SSN. 'You must show your individual name on line 1. and enter yyarn business or Ol3A name. if any, on fine 2. You may use "her your S alU or EIN Of you have ono), but the IRS encourages you to use your SSN. i List first and circte the name of the trust, estate. or pension trust. (Do not furnish the TIN of the personal representative or trusters runless the legal entity itself is not designated in the account title.) Note: The grantor must also provide a Farm W-9 to the trustee of the trust- .. For more infarmatkm on optional fling methods for grantor trUStS, see the Instructions for Form I D41. Note. If no name is circled when more than one name is fisted, the number will be considered to be that of the first name fisted. Secure Your Tax Records From Identity Theft Identity theft occurs when someone uses your personal Information, such as your name. SSN. or other identifying Information, without your permission to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Prweat your SSN. • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax return prepares. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed an the RS notice or letter. tf your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity, or a questionable credit report, contact the IRS Iderttity Theft Hotline at aW-908-44911 or submit Form I d173S_ For more information, see Pub. 5027. Identity Theft Information for Taxpayers. Form W-9 (Rev. 3-2024) victims of identity theft who are experiencing economic harm or a systemic probiam, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service ITAS) assistance. You can reach TAS by calling the TAS toll -free case intake line at 8T7-777-477a or TTY/TDD 800-829-4059. Protect yourself from suspicious amails or phi"9 schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emaiis and websites. The most common act is sending an emA[ to a user falsely claiming to be an established iagi6mate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank. or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phisfmirrjdirs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (nGTA) at 800-886- 3 im. You can forward suspicious emails to the Federal Trade Commission at sparnOuce.gov or report them at www. ftc.govlcompWnf. You can contact the FTC at www. Rc.govlidlheh or 877-IOT#- M {877-438-4338j. IF you have been the victim of identity theft, see www.IdeRStyTheftgov and Pub. 5027. Go to www.irs.gov/fdentilyThefi to team more about identity theft and how to reduce your risk. Kittitas County Agreement for Services (rev. 5/14/25) Page 19 of 22 Page 6 Privacy Act Notice Section 6109 of the Irnemai Revenue Code requires you to provide your correct TIN to persons f,rdudirig federal agencies] who are required to file information returns with the IRS to report interest, dividends, a certain other income paid to you: mortgage interest you paid: The acquisition or abandonment of secured propertT, the cancellation of debt; or contributions you made to an IRA. Archer 114SA, or HSA The person collecting this form uses the information on the form to file information returns with the IRS. reporting the above information. Routine uses of tlis information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commmnweatft and territories for use in administering their lairs. The information may also be disclosed to other countries under a treaty, to federal and state agencies to enioree civil and criminal laws, or to federal law erdorcemerr! and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3405, payors must generally withhold a percentage of taxable interest- dividends, and certain other payments to a payee who does not give a TIN to the payer. Certain penal ies may also apply for providing False or fraudulent information. Attachment "F" DSHS Agreement Number Washington State Department of Social M COUNTY PROGRAM AGREEMENT 2663-70974 & Health Services School -to -Work Direct Service Pilot Contract Transforming lives This Program Agreement is by and between the State of Washington Administration or Division Department of Social and Health Services (DSHS) and the County identified Agreement Number below, and is issued in conjunction with a County and DSHS Agreement On County Agreement Number General Terms and Conditions, which is incorporated by reference. DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE Division of Vocational Division of Vocational 1225 850OCC-63 Rehabilitation Rehabilitation DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Austin Diaz -Munoz 4565 7th Ave SE Contracts Specialist Lacey, WA 98503 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL 564) 200-2812 Click here to enter text. Austin. DiazMunoz dshs.wa. ov COUNTY NAME COUNTY ADDRESS Kittitas County Kittitas County Court House 205 W Fifth St Room 211 Ellensburg, WA 98926 COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Kasey Knutson COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL 509) 962-7090 509) 962-5883 kasey.knutson@co.kiftitas.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM ASSISTANCE LISTING NUMBERS AGREEMENT? No PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT 05/01 /2026 I 09/30/2027 Fee For Service EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this County Program Agreement by reference: ® Exhibits (specify): Exhibit A - Data Security Requirements Exhibit B - Student Guide Instructions, Exhibit C - Student Guide, Exhibit D - School -to -Work Student Data, Exhibit E - School -to -Work Billing Checklist No Exhibits. _-1 The terms and conditions of this Contract are an integration and representation of the final. entire and exclusive understanding between the parties superseding and merging all previous agreements, writings. and communications, oral or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only upon signature by DSHS. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 1 Special Terms and Conditions Definitions a. "Authorization for Purchase (AFP)" means the formal DVR fiscal document that officially identifies and authorizes a DVR Contractor to deliver a specific service. b. "CRP" or "Community Rehabilitation Program", means a provider which provides vocational rehabilitation service to individuals with disabilities to enable those individuals to maximize their opportunities for employment. c. "Contractor' means Kittitas County. d. "County" means the political subdivision of the State of Washington, named above, performing services pursuant to this Program Agreement and includes the County's officers, employees, and authorized agents. e. "County Coordinator" means the official developmental disabilities program coordinator or their designee. f. "DDCS" means the Developmental Disabilities Community Services, formerly known as the Developmental Disabilities Administration (DDA). g. "DVR" means Department of Social and Health Services, Division of Vocational Rehabilitation. h. "DVR Counselor(s)" means the Vocational Rehabilitation Counselor(s) assigned to the School -to - Work Student through the DVR eligibility process. i. "Individual Plan for Employment (IPE)" means a DVR form that documents important decisions about vocational rehabilitation services for a Student as defined in WAC 388-891-1115. The decisions documented on the IPE include, but are not limited to: (1) The employment outcome the Student plans to achieve; (2) Each major step needed to accomplish the employment outcome; (3) The Student's responsibilities in accomplishing each step of the plan; (4) DVR's responsibilities in assisting the Student to accomplish each step of the plan; (5) Vocational Rehabilitation (VR) services needed to complete each step; and (6) Terms and conditions the Student and the DVR Counselor agree are required for continued support from DVR. j. "Intensive Training Services" means individualized, one-on-one job skills training and support provided at the supported employment job site to enable a Student to: (1) Attain Job Stabilization in on-the-job performance, with job supports; (2) Meet the employer's expected level of work productivity; and (3) Transition to Long -Term Services when stabilization is achieved. k. "Job Foundation" — The Job Foundation process is intended to engage students earlier in targeted DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 2 Special Terms and Conditions employment planning and connection; increase partnerships with school staff to complete student's Job Foundation report with actionable next steps; and increase the number of students completing transition programs with a job or secondary education connection. (1) The Job Foundation report and process may be a source of information for the Assessment in determining an employment goal for the Student. I. "Job Placement" means locating, securing, and placing a Student into competitive integrated employment that is mutually agreed upon by the DVR Counselor, the Contractor, and the Student or the Student's Team. m. "Job Stabilization" means the Student, the employer, the DVR Counselor and the Contractor mutually agree that a Student placed in a Supported Employment position has demonstrated and maintained satisfactory on-the-job performance and has the quantity and type of long-term employment supports available to them that are needed to maintain satisfactory on-the-job performance. n. "Long Term Services" means ongoing support services provided by an entity other than DVR after the Student obtains employment and exits DVR School -to -Work services. o. "Monthly Progress Report" means progress reports that are to be filled out on a monthly basis and shared with the Student's Team to demonstrate progress towards employment and summarize monthly work being done with and on behalf of the Student. p. "Assessment" means (1) Identify a Student's unique work interests, abilities, and any competitive employment barriers related to communication, mobility, work skills, work tolerance, self -direction (cognition and learning), and interpersonal attitudes, skills, behavior, or self -care, etc.; and (2) Identify the nature and extent of support(s) and accommodations needed for the Student to obtain and maintain competitive integrated employment. q. "School -to -Work" means a program that supports a seamless transition for students with intellectual/developmental disabilities from school to adulthood through employment services and connecting students to the necessary resources for success. r. "Service Delivery Outcome Plan (SDOP)" is a written plan jointly developed by the Student, DVR, DVR Counselor, and CRP representative for obtaining School -to -Work services. The details of the agreement are tailored to the unique needs of the Student and documented. s. "Student" means an individual with an intellectual/developmental disability age 20 to 22 who is in their high school transition program. t. "Student Guide" means a guide designed for a Student and/or parent(s)/guardians to house School - to -Work related documentation, information, assessments, activity logs, and notes. This guide is a Student's 'roadmap' to ensure key activities and milestones are completed and organized. u. "Student's Team" means any combination of people, including, but not limited to; educators, CRPs, the Student's Legal Representative or Guardian, County Staff, DVR Counselor(s) who support a Student as they move towards Job Placement and Job Stabilization. DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 3 Special Terms and Conditions v. "Subcontractor" means a Community Rehabilitation Program that the Contractor has separately chosen to perform all or a portion of the duties and obligations that the Contractor is obligated to perform pursuant to this Contract. w. "Youth Extended Services" means ongoing support services and other appropriate services provided to support a Student with a most significant disability in employment as a means to bridge employment support between stabilization and long-term services. 2. Purpose. The purpose of this Contract is to represent a collaborative effort between community, educators, caregivers and providers to support Students with comprehensive training and experience that will lead to paid, integrated employment by graduation. 3. Period of Performance. The period of performance for this Contract shall begin May 1, 2026 and end September 30, 2027. Contractor will determine their specific program timeline within the period of performance. 4. General Requirements. The Contractor must perform the minimum expectations below in conducting the services of this Contract: a. Provide all services of this Contract in a manner and setting(s) that meet the requirements of Washington State DSHS Administrative Policy 7.02. b. Arrange and be responsible for all costs associated with communication interpreter services, as needed, to provide disability -related access per the Americans with Disabilities Act (ADA) unless the cost involved would cause an undue hardship (significant difficulty or expense) for the Contractor. Determination of what constitutes an undue hardship will be made on a case -by -case basis, relative to the Contractor's overall resources. (1) If an undue hardship does exist, the DVR School-to-Work/Transition Program Manager or their designated representative may authorize paying for interpreter services and/or translation services apart from the contracted fee for service. (2) Provide and be responsible for the cost of providing services through alternative formats, methods, and languages, as needed, for Students who have Limited English Proficiency (LEP) as per the Civil Rights Act of 1964. c. Contractor is responsible for addressing cultural, language, and technological accessibility for all Students to the best of their abilities when performing the services under this Contract. d. Eligibility: Students must meet the following criteria: (1) DDCS-eligible. (2) DVR-eligible. (3) Enrolled in a school district educational program that may include, but is not limited to: (a) High school; (b) Home school; (c) Technical college, by exception approved by the DVR Transition Program Manager or designated representative; DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 4 Special Terms and Conditions (4) Higher Education, by exception approved by the DVR Transition Program Manager or designated representative. Student starts School -to -Work services as of May 1, 2026 or later, as determined by the Student. (a) School -to -Work is a wrap -around service that's only available one (1) time per Student. i. Students who choose to participate in this cohort may not participate again under a different contract covering a different cohort. Should the Student change their mind on the cohort they choose to participate in, the Contractor is responsible for communicating with DVR to ensure there are no duplicate payments. ii. Should a Student move from one School -to -Work County to another, or pause services, due to individual circumstances, it is determined by the DVR Transition Program Manager or designated representative, whether School -to -Work services will continue, and if so, at one point in the process. (b) Students must apply for DVR to start School -to -Work services no later than January 31, 2027. Students who intend to start services after January 31 may only do so with prior written approval from the DVR School -to -Work Transition Program Manager or their designated representative. (5) Between ages 20-22. Students who have been identified to start services at age 19 may do so with prior written approval from the DVR School -to -Work Transition Program Manager or designated representative. (6) Have an Individualized Education Plan (IEP) (7) Establish a DVR Individual Plan for Employment (IPE) with an employment goal that requires Youth Extended Services as needed and Long -Term Services in order to be achieved. This requirement must be completed by the end of the School -to -Work Intake and Assessment Phase per section 5, Statement of Work. e. Meetings must be held in the format best suited for the Student. If all parties are not able to attend meetings in person, use of telephone or video conferences is encouraged to complete the process in a timely manner. f. Contractor must keep all Students enrolled in School -to -Work through the duration of this Contract, regardless of outcome and/or Stabilization, unless Student chooses to exit the program of their own volition or due to unforeseeable circumstances. (1) Should a Student exit early for any reason, Contractor must document the departure in Exhibit D — School -to -Work Student Data. See Section 6, Deliverables for further instruction. g. Service Delivery Agreement: The Contractor's delivery of VR services specified in this agreement will begin upon the completion and signing of the agreed upon SDOP. h. Service Delivery Payment: The Contractor will be paid upon completion and submission of the required documentation demonstrating completion of each of the three phases for each Student as outlined in Section 5, Statement of Work. i. Service Delivery Method: This Contract utilizes Exhibit C - Student Guide as a reporting tool and all associated activities outlined in Section 5, Statement of Work shall be carried out using the Student Guide. Exhibit B — Student Guide Instructions offers instruction on how the Contractor may use the DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 5 Special Terms and Conditions Student Guide. 5. Statement of Work. The Contractor shall provide a program to provide the services, staff, resources, and otherwise do all things necessary for, or incidental to the performance of work, as set forth below: Services shall be sorted into the following three phases: Intake and Assessment Phase. Job Placement Phase. Employment Phase. a. Intake and Assessment Phase. The intent of this phase is to ensure the Student and the Student's Team collaborate to determine if enough information is available to establish an employment goal, establish the employment goal, and build an individualized roadmap of the Student's transition from their education to meaningful community employment. This shall be accomplished through the following objectives: (1) Intake (a) At a minimum, the Contractor shall work with the Student, the Student's legal representative or guardian (unless they are their own), the CRP, and the DVR Counselor to: i. Complete intake forms as needed, including the SDOP. ii. Outline how assessment will occur, including additional meeting time. (b) The employment goal is established and documented. i. Determine what Job Seeker Tools are needed for the Student's employment goal. (2) Assessment (a) Through the assessment process, the Contractor will collect information about the Student's strengths, skills, and supports needed for success on the job. This information will be based on the Student's school, home, and community work -related activities, interviews with the Student, family, school personnel, and others who are familiar with the Student. This information may be obtained from Job Foundation report, work -based learning, school assessments, etc. (b) At a minimum, the following criteria must be addressed i. History of school attendance and reliability; ii. Behavior support or potential strategies; iii. Student Communication skills; iv. Student learning preferences; v. Student's personal hygiene; vi. Potential job safety concerns; DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 6 Special Terms and Conditions vii. Student stamina/endurance; viii. Student social skills; ix. Demonstrated skills and task performance; x. Transportation needs; and A. Work preferences and interests. (c) Based on the above criteria, the Contractor must determine recommendations regarding appropriate and attainable job goal(s) that align with the Student's: i. Skills and interests; ii. Desired work environment; iii. Desired schedule; iv. Ability to travel to/from work within a reasonable length of time; and v. Accommodations and supports necessary to achieve identified goals. b. Job Placement Phase. The intent of this phase is to provide the Student with the tools they will need to find and secure meaningful community employment based on their employment goal. The Contractor shall provide all services necessary to locate, secure, and place a Student into competitive integrated employment that is mutually agreed upon by the Student's Team. Specific placement expectations shall be outlined on the DVR SDOP for Job Placement and Intensive Training. Placements less than 10 hours: Job placement goals that are less than 10 hours per week shall be approved in advance by the appropriate DVR Vocational Rehabilitation Counselor in consultation with the Student's Team. (1) Job Seeker Tools (a) Contractor shall create tools based on individual need, such as a resume, cover letter, videos, PowerPoint (or comparable applications), and/or portfolios. (b) Contractor may also develop other materials as it pertains to the Student's individualized pathway to employment such as a letter of recommendation, create and/or update Linkedin page or other social media, etc. (2) Job Offer (a) If the Student received the job offer, Contractor must provide details of the job offer including the following: i. The Student's Employment Goal; ii. Job Title; iii. Start Date; DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 7 Special Terms and Conditions iv. Job Duties; v. Expected Weekly Hours; vi. Starting Wage; vii. Location; viii. Transportation Consideration; ix. Benefits Package; and x. Potential Training Services and Date/Additional Info. (b) If the Student rejected the job offer, Contractor must provide the reason(s) why the Student rejected the job offer. Details must include how the job did not meet their individualized employment goal, as well as the criteria in (2)(a). (c) If a Student has a job goal that is 10 hours or more per week, but receives a job offer fewer than 10 hours per week, the Contractor shall request approval from the DVR Counselor in consultation with the Student's Team should the Student want to accept the offer. c. Employment Phase. The intent of this phase is to verify, stabilize, and maintain meaningful community employment. (1) Employment Verification (a) Contractor shall submit the following method of verification of employment after Student's first day of employment: i. The Employment Verification page of the Student Guide. (2) Intensive Training Services (a) Intensive job training expectations shall be outlined by the Student's Team. The Contractor shall provide individualized, one-on-one job skills training and support at the supported employment job site that will enable a Student to: i. Achieve job stabilization in on-the-job performance, with job supports and services, and a fading plan; ii. Meet the employer's expected level of work productivity; and iii. Transition to Youth Extended Services as needed and Long -Term Services. (3) Stabilization (a) Stabilization is achieved when the Student's Team and their employer agree that the Student has demonstrated and maintained satisfactory on-the-job performance and has long-term supports in place. (b) Job stabilization is determined for each Student in supported employment based on their unique circumstances. The DVR Counselor determines that the Student's work performance is stabilized with input from the Student, employer and extended service provider when: DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 8 Special Terms and Conditions i. The Student has reached the agreed -upon goal for the number of weekly hours worked, unless the Student and the DVR Counselor agree that the job represents substantial and suitable employment. ii. The Student has reached a maximum level of on-the-job employment and meets employer expectations. iii. The supports available are adequate for the Student to maintain stable employment and meet the employer's expected level of work productivity. iv. The Student has long-term employment supports available or in process and is able to transition to these services to maintain job stability. (c) Once achieved, a Stabilization Report and supports on the job the Student may need, must be completed for the Student as outlined in the SDOP and must include: i. Detail and summary of how the placement hours were met (or if the job represents suitable employment); and ii. Detail, descriptions, and summary of how the DVR Counselor, CRP, and the employer agrees that the employer's expectation have been met; and iii. Detail and summary of how long-term supports have been set up and will occur; and iv. The strengths the Student brings to the job; and v. The Student's fading plan, including how they will remain stable on the job; and vi. Additional training, services, and supports the Student may need. (4) Stabilization needs to be achieved by September 30, 20Z7. However, exceptions may be made on a case -by -case basis through the end of the calendar year (December 31, 2027) with approval from the DVR Transition Program Manager or their designated representative. Youth Extended Services. (a) DVR shall provide Youth Extended Services needed by the Student until DDCS funds are available, in accordance with WAC 388-891 A-1 060. i. Should Youth Extended Services reach six (6) months, the Contractor and DVR shall collaborate to determine next steps which may include additional Youth Extended Services or other options as needed. (b) Youth Extended Services funded by DVR shall be outlined on the DVR Youth Extended Services SDOP. Maximum 26 hours per month at the hourly rate of $105.00 (A) If more than 26 hours per month are needed for a Student, the DVR Counselor must document the requirement for more service hours and staff the case with their supervisor to request an exception to this maximum. (B) Exceptions may be made on a case -by -case basis and must be reported to the DVR School -to -Work Transition Program Manager or designated representative. DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 9 Special Terms and Conditions 6. Deliverables. The Contractor shall demonstrate completion of activities for payment through the following reporting methods. Submissions should be written in language that directly addresses the Student and shall continue for 90 days beyond the Student's stabilization, or until DVR case closure. The Contractor shall submit the required Monthly Progress Report to the assigned DVR Vocational Rehabilitation Counselor for each Student who is served by this Contract. a. Student Guide (1) The Contractor shall submit a copy of the Student Guide to the Student's Team at the end of each month demonstrating the progress of the Student's transition year via completion of the Monthly Progress Reports section located on the front page and the back of the Student Guide. (2) The Contractor shall submit Exhibit E - School -to -Work Billing Checklist to the DVR Counselor upon completion of payment points for each Student as demonstrated in the Student Guide. (3) Contractor shall submit a minimum of three (3) School -to -Work Billing Checklists for all payment points for each Student. (4) The Student Guide is a living document that comprises the following activities: (a) Intake — Signed SDOP & Roles and Responsibilities of the Student's Team. i. Roles and Responsibilities of the Student's Team will include; (A) Team member's role. (B) Team member's contact information including name, email, and phone. (C) Team member's responsibility to the Student. (b) Assessment — Comprehensive assessment demonstrating how an Employment Goal is reached and established. (c) Job Seeker Tools — Such as Resume, Cover Letter, Video, PowerPoint, Portfolio, etc. (d) Job Offer — Documentation/Details of a Job Offer as stated in Section 5 — Statement of Work. (e) Employment Verification — Documentation/Details of a Job Start as stated in Section 5 — Statement of Work. (f) Stabilization — Stabilization Report.as stated in Section 5 - Statement of Work. b. Data Sharing and Reporting - DVR is tracking the progress and success of the School -to -Work program to ensure the program is available to all Students who meet eligibility requirements across the state. In order to accomplish this, the Contractor must submit Exhibit D — School -to -Work Student Data. (a) Exhibit D incorporates the following required data elements: i. Number of Students identified as eligible for School -to -Work in county or counties served. If the Contractor coordinates services for more than one county, the Contractor DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 10 Special Terms and Conditions shall submit data for each county. ii. Number of Students enrolled with DVR. iii. Number of Students employed. iv. Number of Students who exited School -to -Work early. v. Reason for Student exiting early. vi. Number of Students who exited School-to-Work/DVR employed and transferred into Long -Term Services with DDCS. vii. Number of Students transferred into Adult Services or Job Placement with DVR. (b) Exhibit D must be submitted a total of three (3) times to the DVR School -to -Work Transition Program Manager or their designated representative throughout the course of the 2027 transition cohort following the below schedule and with the appropriate tab completed: i. The "Aug 31, 2026" tab shall be submitted on August 31, 2026, or upon execution of the Contract, whichever is later. ii. The "March 31, 2027" tab shall be submitted on March 31, 2027. iii. The "Sept 30, 2027" tab shall be submitted on September 30, 2027, or at the conclusion of the Contractor's program, whichever is sooner. (c) If the above dates fall on a State -recognized holiday or weekend, Contractor may submit Exhibit D on the nearest workday prior to the due date. 7. Monitoring. The Department of Social and Health Services, Division of Vocational Rehabilitation is required to maintain a contract administration system which ensures that Contractors perform in accordance with the terms, conditions, and specifications of their Contracts. DVR manages and monitors its contracts through conducted risk assessments and monitoring plans. Authority to conduct such reviews is provided by Title 2 of the Code of Federal Regulations (CFR), 34 CFR 80.36, OFM SAAM Policy 16.20.55, DSHS Administrative Policies No. 13.11 and 19.50.30. b. Progress Meetings: DVR School -to -Work Transition Program Manager shall work with Contractors to plan meetings which allow discussion of program progress and support methods to ensure Students are receiving adequate services to obtain employment. In addition, Contractor may invite DVR partners to attend local County -initiated service provider meetings. DVR partners may include local DVR Counselors, supervisors, and School -to -Work staff. 8. Subcontractors. a. All Subcontractors utilized by the Contractor in delivery of direct services described in this Contract shall hold a current DVR Community Rehabilitation Program (CRP) contract in which they provide the following services: (1) Community -Based Assessments; and (2) CRP Job Placement; and DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 11 Special Terms and Conditions (3) CRP Intensive Training Services. b. Subcontracts (1) Copies of proposed subcontracts between the Contractor and subcontracted CRPs shall be provided to DVR School -to -Work Transition Program Manager prior to the start date of this agreement; OR (2) Within seven (7) calendar days of Contractor signature on this agreement. (3) All subcontracts must incorporate this Contract by reference and include all of this Contract's requirements. 9. Consideration. Total consideration payable to Contractor for satisfactory performance of the work under this Contract is up to a maximum of $14,000 per Student. This is a comprehensive rate for each service and takes into account the administrative costs associated with operating the program as well as the actual costs of each service, and shall be based on the following: a. Intake and Assessment Phase —A total payment of $5,000 per Student shall be paid to the Contractor when the individual Student has completed the following activities: (1) Intake Meeting: Paid upon receipt of a School -to -Work Billing Checklist and a written report in the Student Guide. The total billable amount for this activity is $2,000 per Student. (2) Assessment: Paid upon receipt of a School -to -Work Billing Checklist and a written report in the Student Guide. The total billable amount for this activity is $3,000 per Student. b. Job Placement Phase — A total payment of $3,000 per Student shall be paid to the Contractor when the individual Student has completed the following activities: (1) Job Seeker Tools: Paid upon receipt of a School -to -Work Billing Checklist and a written report in the Student Guide. The total billable amount for this activity is $1,000 per Student. (2) Job Offer: Paid upon receipt of a School -to -Work Billing Checklist and a written report in the Student Guide. The total billable amount for this activity is $2,000 per Student. A job offer is payable once upon receipt of the offer regardless of whether or not the Student accepts the job offer. (3) If a Student with a placement goal of 10 hours per week or more accepts a placement for less than 10 hours per week, an exception for payment may be granted with approval of the appropriate DVR Supervisor. This approval shall be in consultation with the team including the Student, Student's Family (as applicable), DVR Counselor, CRP, and County staff. c. Employment Phase — A total payment of $6,000 per Student shall be paid to the Contractor when the individual Student has completed the following activities: (1) Employment Verification: Paid upon receipt of a School -to -Work Billing Checklist and a written report in the Student Guide. The total billable amount for this activity is $1,000 per Student. DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 12 Special Terms and Conditions (2) Job Stabilization: Paid upon receipt of a School -to -Work Billing Checklist and a written report in the Student Guide. The total billable amount for this activity is $5,000 per Student. 10. Billing and Payment a. The Contractor shall submit no less than three (3) separate original School -to -Work Billing Checklists to the assigned DVR Vocational Rehabilitation Counselor for each Student who is successfully served by this Contract. (1) At a minimum, one School -to -Work Billing Checklist per phase as outlined in Section 5, Statement of Work. (2) School -to -Work Billing Checklists may only be submitted to DVR upon the successful completion of an activity outlined in the SDOP. (3) School -to -Work Billing Checklists must be submitted within sixty (60) days of service(s) having occurred or within sixty (60) days of the completion of each phase. b. Payment shall be considered timely if made by DSHS within thirty (30) days after receipt and acceptance by the designated DVR Counselor of the properly completed School -to -Work Billing Checklist. Payment shall be sent to the address designated by the Contractor on page one (1) of this Contract. c. DSHS may at its sole discretion, withhold payment claimed by the Contractor for services rendered if the Contractor fails to satisfactory comply with any term or condition of this Contract. 11. Insurance - Self -insured a. DSHS certifies that it is self -insured under the State's self-insurance liability program, as provided by RCW 4.92.130, and shall pay for losses for which it is found liable. b. The Contractor certifies, by checking the appropriate box below, initialing to the left of the box selected, and signing this Agreement, that: (1) ❑ The Contractor is self -insured or insured through a risk pool and shall pay for losses for which it is found liable; or (2) ❑ The Contractor maintains the types and amounts of insurance identified below and shall, prior to the execution of this Agreement by DSHS, provide certificates of insurance to that effect to the DSHS contact on page one of this Agreement. Commercial General Liability Insurance CGL — to include coverage for bodily injury, property damage, and contractual liability, with the following minimum limits: Each Occurrence - $1,000,000; General Aggregate - $2,000,000. The policy shall include liability arising out of premises, operations, independent contractors, products -completed operations, personal injury, advertising injury, and liability assumed under an insured contract. The State of Washington, DSHS, its elected and appointed officials, agents, and employees shall be named as additional insureds. 12. Investigations of Contractor or Related Personnel a. DSHS may, without prior notice, suspend the Contractor's performance of the Contract if the Contractor, or any partner, officer or director of the Contractor, or a subcontractor, or any employee DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 13 Special Terms and Conditions or volunteer of the Contractor or a subcontractor, is investigated by DSHS or a local, county, state or federal agency regarding any matter that, if ultimately established, could either: (1) Result in a conviction for violating a local, state or federal law. (2) In the sole judgment of DSHS, adversely affect the delivery of services under this Contract or the health, safety or welfare of DSHS Students. b. DSHS may also take other lesser action, including, but not limited to, disallowing a staff member, employee, or other individual associated with the Contractor or a subcontractor, from providing services, or from having contact with DSHS Students, until the investigation is concluded and a final determination made by the investigating agency if inconclusive or unsubstantiated. 13. Removal of Individuals from Performing Services a. In the event that any of the Contractor's employees, subcontractors, or volunteers who provide services under this Contract do not meet qualifications required by this Contract or do not perform the services as required in this Contract, DSHS may require that Contractor remove such individual from providing services to DSHS Students under this Contract. b. DSHS shall notify the Contractor of this decision verbally and in writing and the Contractor shall, within 24 hours, remove that individual from providing direct services to DSHS Students. Failure to do so may result in a Corrective Action Plan. 14. Compliance with Corrective Action Plan In the event that DSHS identifies deficiencies in Contractor's performance under this Contract, DSHS may establish a Corrective Action Plan When presented with a Corrective Action Plan, Contractor agrees to undertake the actions specified in the plan within the timeframes given to correct the deficiencies. Contractor's failure to do so shall be grounds for termination of this Contract. 15. Order of Precedence in DVR Process In the event of any inconsistency or conflict between the Terms and Conditions of this Contract and the DVR Service Delivery Outcome Plan (SDOP) and the Authorization for Purchase (AFP), the inconsistency or conflict shall be resolved by giving precedence this contract in its entirety. Terms or conditions that are more restrictive, specific, or particular than those contained in this contract shall not be construed as being inconsistent or in conflict. 16. Disputes When a dispute arises over an issue concerning the terms of this Contract, the following process is used to address the dispute: a. The Contractor and DVR shall attempt to resolve the dispute through informal means between the Contractor and the assigned DVR Counselor. For those contracts where a DVR Counselor is not assigned, the Contractor shall attempt to resolve the dispute with the contact person identified on the first page of the contract. b. If the Contractor is not satisfied with the outcome of the resolution with the DVR Counselor or DSHS contact person, the Contractor may submit a request for review of the disputed issue, in writing, for review within thirty (30) business days of the outcome to: DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 14 Special Terms and Conditions DVR Director DSHS/DVR PO Box 45340 Olympia WA 98504-5340 c. The Director may appoint a designee to review the disputed issue. d. A request for dispute resolution shall include: (1) Name of the requester. (2) Contractor's name, full address, phone number, and email. (3) Contract number. (4) Description of the issue in dispute. (5) A statement describing the requester's position on the issue in dispute, including any documentation that supports this position. (6) Steps already taken to resolve the dispute. e. The reviewer may request additional supporting documentation from either party to assist in reaching a fair resolution. f. The Director shall issue a written decision to the Contractor within thirty (30) business days of receipt of all information relevant to the issue. g. The dispute resolution process described above is the sole administrative remedy available under this Contract. DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 15 Special Terms and Conditions Exhibit A — Data Security Requirements Definitions. The words and phrases listed below, as used in this Exhibit, shall each have the following definitions: a. "AES" means the Advanced Encryption Standard, a specification of Federal Information Processing Standards Publications for the encryption of electronic data issued by the National Institute of Standards and Technology (https:Hnvipubs.nist.gov/nistpubs/FIPS/NIST.FIPS.197-upol.pdf). b. "Authorized Users(s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so. c. "Business Associate Agreement' means an agreement between DSHS and a contractor who is receiving Data covered under the Privacy and Security Rules of the Health Insurance Portability and Accountability Act of 1996. The agreement establishes permitted and required uses and disclosures of protected health information (PHI) in accordance with HIPAA requirements and provides obligations for business associates to safeguard the information. d. "Category 4 Data" is data that is confidential and requires special handling due to statutes or regulations that require especially strict protection of the data and from which especially serious consequences may arise in the event of any compromise of such data. Data classified as Category 4 includes but is not limited to data protected by: the Health Insurance Portability and Accountability Act (HIPAA), Pub. L. 104-191 as amended by the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH), 45 CFR Parts 160 and 164; the Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g; 34 CFR Part 99; Internal Revenue Service Publication 1075 (https://www.irs.gov/pub/irs-pdf/pl075.pdf); Substance Abuse and Mental Health Services Administration regulations on Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2; and/or Criminal Justice Information Services, 28 CFR Part 20. e. "Cloud" means data storage on servers hosted by an entity other than the Contractor and on a network outside the control of the Contractor. Physical storage of data in the cloud typically spans multiple servers and often multiple locations. Cloud storage can be divided between consumer grade storage for personal files and enterprise grade for companies and governmental entities. Examples of consumer grade storage would include iTunes, Dropbox, Box.com, and many other entities. Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, and Rackspace. f. "Encrypt' means to encode Confidential Information into a format that can only be read by those possessing a "key"; a password, digital certificate or other mechanism available only to authorized users. Encryption must use a key length of at least 256 bits for symmetric keys, or 2048 bits for asymmetric keys. When a symmetric key is used, the Advanced Encryption Standard (AES) must be used if available. g. "FedRAMP" means the Federal Risk and Authorization Management Program (see www.fedramp.gov), which is an assessment and authorization process that federal government agencies have been directed to use to ensure security is in place when accessing Cloud computing products and services. h. "Hardened Password" means a string of at least eight characters containing at least three of the following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 16 Special Terms and Conditions i. "Mobile Device" means a computing device, typically smaller than a notebook, which runs a mobile operating system, such as iOS, Android, or Windows Phone. Mobile Devices include smart phones, most tablets, and other form factors. "Multi -factor Authentication" means controlling access to computers and other IT resources by requiring two or more pieces of evidence that the user is who they claim to be. These pieces of evidence consist of something the user knows, such as a password or PIN; something the user has such as a key card, smart card, or physical token; and something the user is, a biometric identifier such as a fingerprint, facial scan, or retinal scan. "PIN" means a personal identification number, a series of numbers which act as a password for a device. Since PINS are typically only four to six characters, PINS are usually used in conjunction with another factor of authentication, such as a fingerprint. k. "Portable Device" means any computing device with a small form factor, designed to be transported from place to place. Portable devices are primarily battery powered devices with base computing resources in the form of a processor, memory, storage, and network access. Examples include, but are not limited to, mobile phones, tablets, and laptops. Mobile Device is a subset of Portable Device. I. "Portable Media" means any machine readable media that may routinely be stored or moved independently of computing devices. Examples include magnetic tapes, optical discs (CDs or DVDs), flash memory (thumb drive) devices, external hard drives, and internal hard drives that have been removed from a computing device. m. "Secure Area" means an area to which only authorized representatives of the entity possessing the Confidential Information have access, and access is controlled through use of a key, card key, combination lock, or comparable mechanism. Secure Areas may include buildings, rooms or locked storage containers (such as a filing cabinet or desk drawer) within a room, as long as access to the Confidential Information is not available to unauthorized personnel. In otherwise Secure Areas, such as an office with restricted access, the Data must be secured in such a way as to prevent access by non -authorized staff such as janitorial or facility security staff, when authorized Contractor staff are not present to ensure that non -authorized staff cannot access it. n. "Trusted Network" means a network operated and maintained by the Contractor, which includes security controls sufficient to protect DSHS Data on that network. Controls would include a firewall between any other networks, access control lists on networking devices such as routers and switches, and other such mechanisms which protect the confidentiality, integrity, and availability of the Data. o. "Unique User ID" 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. Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency (htts:t/watech.wa. ovl olicies?combine=&field categories target id=80&field type target id=All), and of the DSHS Information Security Policy and Standards Manual. Reference material related to these requirements can be found here: htt s://www.dshs.wa. ovlffa/kee in -dshs-client-information- private-and-secure, which is a site developed by the DSHS Information Security Office and hosted by DSHS Central Contracts and Legal Services. 3. Administrative Controls. The Contractor must have the following controls in place: DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 17 Special Terms and Conditions a. A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy. b. If the Data shared under this agreement is classified as Category 4, the Contractor must be aware of and compliant with the applicable legal or regulatory requirements for that Category 4 Data. c. If Confidential Information shared under this agreement is classified as Category 4, the Contractor must have a documented risk assessment for the system(s) housing the Category 4 Data. 4. Authorization, Authentication, and Access. In order to ensure that access to the Data is limited to authorized staff, the Contractor must: a. Have documented policies and procedures governing access to systems with the shared Data. b. Restrict access through administrative, physical, and technical controls to authorized staff. c. Ensure that user accounts are unique and that any given user account logon ID and password combination is known only to the one employee to whom that account is assigned. For purposes of non -repudiation, it must always be possible to determine which employee performed a given action on a system housing the Data based solely on the logon ID used to perform the action. d. Ensure that only authorized users are capable of accessing the Data. e. Ensure that an employee's access to the Data is removed immediately: (1) Upon suspected compromise of the user credentials. (2) When their employment, or the contract under which the Data is made available to them, is terminated. (3) When they no longer need access to the Data to fulfill the requirements of the contract. Have a process to periodically review and verify that only authorized users have access to systems containing DSHS Confidential Information. g. When accessing the Data from within the Contractor's network (the Data stays within the Contractor's network at all times), enforce password and logon requirements for users within the Contractor's network, including: (1) A minimum length of 8 characters, and containing at least three of the following character classes: uppercase letters, lowercase letters, numerals, and special characters such as an asterisk, ampersand, or exclamation point. (2) That a password does not contain a user's name, logon ID, or any form of their full name. (3) That a password does not consist of a single dictionary word. A password may be formed as a passphrase which consists of multiple dictionary words. (4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h. When accessing Confidential Information from an external location (the Data will traverse the Internet or otherwise travel outside the Contractor's network), mitigate risk and enforce password and logon requirements for users by employing measures including: DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 18 Special Terms and Conditions (1) Ensuring mitigations applied to the system don't allow end -user modification. (2) Not allowing the use of dial -up connections. (3) Using industry standard protocols and solutions for remote access. Examples would include RADIUS and Citrix. (4) Encrypting all remote access traffic from the external workstation to Trusted Network or to a component within the Trusted Network. The traffic must be encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network. (5) Ensuring that the remote access system prompts for re -authentication or performs automated session termination after no more than 30 minutes of inactivity. (6) Ensuring use of Multi -factor Authentication to connect from the external end point to the internal end point. Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication mechanism, such as a biometric (fingerprint, face recognition, iris scan) or token (software, hardware, smart card, etc.) in that case: (1) The PIN or password must be at least 5 letters or numbers when used in conjunction with at least one other authentication factor (2) Must not be comprised of all the same letter or number (11111, 22222, aaaaa, would not be acceptable) (3) Must not contain a "run" of three or more consecutive numbers (12398, 98743 would not be acceptable) If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes used on the device must: (1) Be a minimum of six alphanumeric characters. (2) Contain at least three unique character classes (upper case, lower case, letter, number). (3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable. k. Render the device unusable after a maximum of 10 failed logon attempts. 5. 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. For 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 provide equal or greater security, such as biometrics or smart cards. b. Network server disks. For 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 DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 19 Special Terms and Conditions authentication mechanisms which provide equal or greater security, such as biometrics or 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 DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as long as the disks remain in a Secure Area and otherwise meet the requirements listed in the above paragraph. Destruction of the Data, as outlined below in Section 8 Data Disposition, may be deferred until the disks are retired, replaced, or otherwise taken out of the Secure Area. c. Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS on optical discs which will be used in local workstation optical disc drives and which will not be transported out of a Secure Area. When not in use for the contracted purpose, such discs must be Stored in a Secure Area. Workstations which access DSHS 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. Data provided by DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. 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 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 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. Any 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 Secure Area. Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or Secure Access Washington (SAW) will be controlled by DSHS staff who will issue authentication credentials (e.g. a Unique User ID and Hardened Password) to Authorized Users on Contractor's staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an Authorized User's duties change such that the Authorized User no longer requires access to perform work for this Contract. g. Data storage on portable devices or media. (1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on portable devices or media unless specifically authorized within the terms and conditions of the Contract. If so authorized, the Data shall be given the following protections: (a) Encrypt the Data. (b) Control access to devices with a Unique User ID and Hardened 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. DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 20 Special Terms and Conditions (d) Apply administrative and physical security controls to Portable Devices and Portable Media by: i. Keeping them in a Secure Area when not in use, ii. Using check-in/check-out procedures when they are shared, and iii. Taking frequent inventories. (2) When being transported outside of a Secure Area, Portable Devices and Portable Media with DSHS Confidential Information must be under the physical control of Contractor staff with authorization to access the Data, even if the Data is encrypted. h. Data stored for backup purposes. (1) DSHS Confidential Information may be stored on Portable Media as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. Such storage is authorized until such time as that media would be reused during the course of normal backup operations. If backup media is retired while DSHS Confidential Information still exists upon it, such media will be destroyed at that time in accordance with the disposition requirements below in Section 8 Data Disposition. (2) Data may be stored on non -portable media (e.g. Storage Area Network drives, virtual media, etc.) as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. If so, such media will be protected as otherwise described in this exhibit. If this media is retired while DSHS Confidential Information still exists upon it, the data will be destroyed at that time in accordance with the disposition requirements below in Section 8 Data Disposition. i. Cloud storage. DSHS Confidential Information requires protections equal to or greater than those specified elsewhere within this exhibit. Cloud storage of Data is problematic as neither DSHS nor the Contractor has control of the environment in which the Data is stored. For this reason: (1) DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: (a) Contractor has written procedures in place governing use of the Cloud storage and Contractor attests in writing that all such procedures will be uniformly followed. (b) The Data will be Encrypted while within the Contractor network. (c) The Data will remain Encrypted during transmission to the Cloud. (d) The Data will remain Encrypted at all times while residing within the Cloud storage solution. (e) The Contractor will possess a decryption key for the Data, and the decryption key will be possessed only by the Contractor and/or DSHS. (f) The Data will not be downloaded to non -authorized systems, meaning systems that are not on either the DSHS or Contractor networks. (g) The Data will not be decrypted until downloaded onto a computer within the control of an Authorized User and within either the DSHS or Contractor's network. DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 21 Special Terms and Conditions (2) Data will not be stored on an Enterprise Cloud storage solution unless either: (a) The Cloud storage provider is treated as any other Sub -Contractor, and agrees in writing to all of the requirements within this exhibit; or, (b) The Cloud storage solution used is Fed RAMP certified. (3) If the Data includes protected health information covered by the Health Insurance Portability and Accountability Act (HIPAA), the Cloud provider must sign a Business Associate Agreement prior to Data being stored in their Cloud solution. 6. System Protection. To prevent compromise of systems which contain DSHS Data or through which that Data passes: a. Systems containing DSHS Data must have all security patches or hotfixes applied within 3 months of being made available. b. The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes. c. Systems containing DSHS Data shall have an Anti-Malware application, if available, installed. d. Anti-Malware software shall be kept up to date. The product, its anti -virus engine, and any malware database the system uses, will be no more than one update behind current. 7. Data Segregation. a. DSHS Data must be segregated or otherwise distinguishable from non-DSHS data. This is to ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or destruction. It also aids in determining whether DSHS Data has or may have been compromised in the event of a security breach. As such, one or more of the following methods will be used for data segregation. (1) DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will contain no non-DSHS Data. And/or, (2) DSHS Data will be stored in a logical container on electronic media, such as a partition or folder dedicated to DSHS Data. And/or, (3) DSHS Data will be stored in a database which will contain no non-DSHS data. And/or, (4) DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the value of a specific field or fields within database records. (5) When stored as physical paper documents, DSHS Data will be physically segregated from non- DSHS data in a drawer, folder, or other container. b. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the DSHS Data and the non-DSHS data with which it is commingled must be protected as described in this exhibit. 8. Data Disposition. When the contracted work has been completed or when the Data is no longer needed, except as noted above in Section 5.b, Data shall be returned to DSHS or destroyed. Media on which Data may be stored and associated acceptable methods of destruction are as follows: DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 22 Special Terms and Conditions F_ Data stored on: I Will be destroyed b Server or workstation hard disks, or Removable media (e.g. floppies, USB flash drives, portable hard disks) excluding optical discs Using a "wipe" utility which will overwrite the Data at least three (3) times using either random or single character data, or Degaussing sufficiently to ensure that the Data cannot be reconstructed, or no the disk Paper documents with sensitive or Confidential I Recycling through a contracted firm, provided the Information contract with the recycler assures that the confidentiality of Data will be protected. Paper documents containing Confidential Information On -site shredding, pulping, or incineration requiring special handling (e.g. protected health information) Optical discs (e.g. CDs or DVDs) Incineration, shredding, or completely defacing the i readable surface with a coarse abrasive Magnetic tape Degaussing, incinerating or crosscut shredding 9. Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1) business day of discovery. If no DSHS Contact is designated in the Contract, then the notification must be reported to the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS. 10. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If the Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub - Contractor must be submitted to the DSHS Contact specified for this contract for review and approval. DSHS Central Contract Services 6017CF County Program Agreement (10-31-2017) Page 23 Exhibit B: School -to Work Student Guide Instructions ThefoRowing is a billing guide for the Contractor as they work with students by following the pages of the Student Guide. As the following sections are completed, the Contractor will use Exhibit E: STW Billing Checklist for Student Guide, provided to the Contractor by DVR. These instructions will support guidance to School -to -Work (STW) contractors as theywork with students who are participating in STW. To begin the process of STW and to review the STW Student Guide, schedule a STW Intake and Assessment meeting with the Student and the Student's Team. During th is meeting, the STWStudent Guidewill be shared with the student, goingthrough the process of STW and whatthe student should expect in their final year of Transition. Billing Instructions: 1. Bill $2,000 for the STW Intake Meeting once the following pages are complete: • Team Building and Information • Team Contacts, Roles, and Responsibilities 2. Bill $3,000 for Assessment once the following pages are complete: Assessment pages may include the following pages being completed, as applicable for the student, as each student mayget to their employment goal in their own way. All sources of information may be used to determine the parts of the assessment. This may include job shadows, a Job Foundation Report through DDCS, Work Based Learning through Pre-ETS, or any source to determine the needed information to establish an employment goal. The student and the student's team will work together to determine this. The main goal for this section is to get to an employment goal and the next steps for the student. ■ STW Assessment • Job Goal • Next Steps and Team Actions 3. Bill $1,000 for the Job Seeker Tools once the following pages are complete: • Job Seeker Tools (determined bythe student's team and have been completed and shared with the student and DVR) 4. Bill $2,000 for the Job Offer once the following page is complete: • Job Offer Details on the page titled "You were offered the job! Way to go!" 5. Bill $1,000 for Employment Verification once the following page is complete: • Form is completed on the page titled "Congratulations, you are employed!" 6. Bill $5,000 for Stabilization once the following pages are complete: • Your Supports on the Job • Job Stabilization Report Please note there are additional pages in the Student Guide that do not affect the above payments and are intended to support the student. D5H5 Division of Vocational Rehabilitation (DVR) 00o Exhibit E: School -to -Work Billing Checklist Contractor Signature I AFP Number Student Initials Month and Year Date of Signature Activity Billed Amount Billed To be filled out by DVR Staff Only: DVR staff sign and date below to confirm items received and to authorize payment ❑ Intake Meeting ❑ Assessment ❑ Job Seeker Tools $ 2,000 $ 3,000 $ 1,000 ❑ Job Offer ❑ Employment Verification ❑ Stabilization $ 2,000 $ 1,000 $ 5,000 Total Billing: $ Instructions: 1. The Student Guide is sent monthly to the Student's Team, including the DVR Counselor. 2. The Contractor checks the appropriate box(es) as the corresponding activities are completed in the Student Guide (one form per student). 3. The Contractor submits this completed form to the assigned DVR Counselor. 4. The DVR Counselor confirms information from monthly submissions of the Student Guide, verifies activities were completed, then signs and dates the checklist. 5. The DVR Counselor submits for payment. Notables: • The Student Guide serves as documentation for proof of completion for the payment / activity point. • The Contractor submits no less than three (3) separate checklists to the assigned DVR Counselor for each student (submitting all payment points separately is also an option). Any questions, please contact the School -to -Work Team at DVRSchoolToWork dshs.wa, ov. Exhibit E: School -to -Work Billing Checklist DSHS 11-195A (04/2026) Attachment "G" SC..-hool-to-Work STUDENT GUIDE Job Seeker: Month/Year: w DSHS WASHINGTON STATE Department of Social and Health Services Please check out what is new in your Student Guide! Here is the monthly summary of progress made towards your job goal: No additional steps have been completed this month. Only the Monthly Summary above to share the progress being made towards supporting you in being employed! Phase One LJ Team Building and Information G Team Contacts, Roles, and Responsibilities Assessment Information II Job Goal Established ❑ Next Steps and Team Actions Phase Two FIJob Seeker Tools Phase Three Employment Verification C Job Offer Details F1 Supports on the Job Job Stabilization Report DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 2 Welcome,'. School -to -Work overview The School -to -Work program is designed to assist you in finding a job before you exit school in June. In this program, you will work directly with a job coach who will collaborate with you, your parent(s)/guardian(s), school district staff, County Developmental Disabilities programs, the Division of Vocational Rehabilitation, and Developmental Disabilities Administration. This School -to -Work Student Guide This guide will be updated regularly and is designed to house your School -to -Work related information, assessments, activity logs, notes, and much more. It will: • Ensure key activities and milestones are completed and organized effectively. • Support you in keeping important information in one place. • Bea great resource to bring to collaboration meetings with your team. This is a guide for students to ensure key activities and milestones have been completed and organized effectively. This tool will support students in keeping important information in one place, and it will also be a great resource to bring to collaboration meetings that occur with support partners and agencies. School -to -Work Phases You will be going through three phases for School -to -Work, all moving you toward your employment goal. The phases are described throughout this guide. Phase 1: Intake and Assessment This phase includes bringing your team together that will support and guide you through the program. Key intake and assessment activities will take place to ensure a positive experience for you. Phase 2: Job Placement This phase includes conducting and capturing importantjob placement activities like employment goals, site visits, job interviews, and more. Phase 3: Employment This phase serves as an exciting step to complete and capture all employment stabilization information like employment verification information, completion of the first day of work, and much more! DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 3 Next Steps and Team Actions You and your team will work together to decide what next steps are needed to support you. Everyone should agree on tasks and actions. Example: Example: Example: DVR Counselor will connect you Benefits Planner, Student, Family Before job start (and again, as with a Benefits Planner needed) Tip: Tasks may be added throughout your School -to -Work year, or removed if they are no longer something you want to explore. DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 4 Phase 1 Starts: Intake and Assessment This phase includes bringing your team together that will support and guide you through the program. Key intake and assessment activities will take place to ensure a positive experience for you. Team Building and Information Team Building Date To -Do -List 1. Introductions / Overview of Services / Strengths and Challenges 2. Assessment Needs 3. Job Goal is Established DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 5 Team Contacts, Roles, Responsibilities (This list is more than one page.) You, the Student (most important person on the team) Your Parent(s) or Guardian(s) Employment Provider: Your Job Coach Your County Program Name: Email: Phone: Name: Email: Phone: Name: Email: Phone: Name: Email: Phone: Show Up, Speak Up, and Share! You are the driver of your services and without your voice, the team is not able to support you with your goals. Work with your team to get a job. Services are person -centered and individualized. Supports you in partnership with school, county, and state departments to acquire employment. School -to -Work CRP/ Subcontractor who coordinates getting resources, training, and supports needed for you to get a job before you leave school in June. School -to -Work Contractor entity providing local support for you to find a job. DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 6 Team Contacts, Roles, Responsibilities (Continued) Your Vocational Rehabilitation Counselor Your School Teacher and/or School Staff Main Keeper of Your Student Guide Other Person on Your Team Name: Email: Phone: Name: Email: Phone: Name: Email: Phone: Name: Email: Phone: Coordinate with schools, counties, and other state departments to help you get a job. Provide job coach funding. This could be the Division of Vocational Rehabilitation, Department of Services for the Blind, or Tribal Vocational Rehabilitation. Connects you or your parent(s) or guardian(s) with community, county, and resources for School -to - Work. Lead role who edits this School -to -Work Student Guide monthly and shares the most current copy with each person listed above at the end of the month and gathers information from you and your team to share. DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 7 Assessment: Getting Ready for a Job! For your team to support you with your job goal, they need to learn more about you. This can happen in so many ways. Knowing more about you and who you are is key to success! Information will be gathered about you to get to a goal using multiple sources, such as a Job Foundation report, job shadowing, or knowing more about your learning style. Your job coach will collect information about your strengths, skills, and supports needed for success on the job. This information will be gathered through school, you, your family and friends, and community activities, as well as conversations and observations with those supporting you. History of school attendance and reliability: Behavior support or strategies likely to be needed: Communication skills: Learning preferences: Personal hygiene: Potential job safety issues: DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 8 Stamina/endurance: Social skills: Demonstrated skills and task performance: Transportation needs: Work preferences and interests, including: Skills and Interests, Desired Work Environment, Desired Schedule, and travel to and from work: Notable Accommodations and Necessary Supports: Your job goal: Congratulations! You are on your way to being employed! DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 9 Phase 2 Starts: Job Placement This phase includes conducting and capturing important job placement activities like employment goals, site visits, job interviews, and more. Job Seeker Tools Job seeker tools will be developed to support you as you look for a job. You will work with your team to figure out what you need, which may include the following: online portfolios, cover letters, video resumes, letters of recommendation, Linkedln pages, and more. Resume or Media Resume (Video, PowerPoint, Portfolio, etc.) Sent to Student: Yes No Date sent: Sent to DVR Counselor: Yes No Date sent: Cover Letter (as determined if needed by you and your team) Sent to Student: Yes u No U Date sent: Sent to DVR Counselor: Yes n No 17 Date sent: Employer Letter of Recommendation (optional) Sent to Student: Yes No U Date sent: Sent to DVR Counselor: Yes No ❑ Date sent: Linkedln Page (optional) Sent to Student: Yes No El Date sent: Sent to DVR Counselor: Yes No F—] Date sent: DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 10 You were Offered the Job! Way to Go! Did you accept this job offer? Yes No If yes, please complete the section below. If not, please complete the section below and explain why the job was not accepted: Does the job match your original goal on your DVR plan? Yes El No ❑ DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 11 Job Goal: Employer: Job Title: Start Date: Job Duties: Expected Weekly Hours: Starting Wage: Location: Transportation Considerations: Benefits Package: Potential Training Services and Date/Additional Information: DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 12 Phase 3 Starts: Employment This phase serves as an exciting step to complete and capture all employment stabilization information like employment verification information, completion of the first day of work, and much more! Congratulations! You are Employed! Now what? Please work with your job coach to complete the form below. Employee's Name: Employer's Name: Employee's Job Title: Employer's Address: Is this a new job? No Yes Date Employee Started Work: Average Number of Hours Worked Per Week: Rate of Pay or Salary: $ Hourly Monthly Annually Pay Frequency: Daily Weekly F- Every Two Weeks Two Times a Month Tips: No Yes; if yes, how often and how much? Commissions: No L Yes; if yes, how often and how much? Bonuses: No Yes; if yes, how often and how much? Overtime: No Yes; if yes, how often and how much? Work Schedule (include exact times when possible): Monday Tuesday Wednesday Thursday Friday Is health insurance available: No Yes 1. If yes, did the employee enroll in the health plan?: No Yes a. If yes, when does the coverage begin? b. If yes, what is the employee's portion of the premiums? $ Name and Title of Person Who Completed This Page: Date: Monthly ❑ Saturday Sunday DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 13 Your Supports on the Job! The strengths you bring to the job How you will become stable on the job (your fading plan) Additional training, services, and supports could include The support you receive on the job from the beginning will be shared with you and your team in the monthly notes at the end of this guide. DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 14 Job Stabilization Report You are considered stable on the job when the following things happen: 1. Your desired work hours are met (unless you and your team agree the job represents suitable employment). 2. Your DVR Counselor, your job coach, and your employer agree that you meet your employer's expectations (this is verified by your job coach). 3. You are ready for long-term support. But first... Did you meet your expected job goal? Yes ❑ No EI Was your starting wage what you wanted? Yes F No Does the job location meet your expected needs? Yes 7l No Anything else you want to add about your job? DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 15 Detail and summarize how the placement hours were met (or if the job represents suitable employment): Detail and summarize how it has been agreed that the employer's expectations have been met. Please provide descriptions and details as to how stabilization occurred for the employer's expectations to be met: Detail and summarize how long-term support is set up and will occur: DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 16 Helpful Resources Developmental Disabilities Administration • Website: www.dshs.wa.gov/dda • DDA Eligibility Information: www.dshs.wa.gov/dda/Consumer-s-and-families/eligibility Division of Vocational Rehabilitation, or DVR • Website: www.dshs.wa.gov/dvr • Phone:1-800-637-5627 Social Security Administration, or SSA • Website: www.ssa.gov • Phone:1-800-772-1213 Benefit U • Website: www.benefitu.org • Benefit U Information: support@benefitu.org ther Resources and/or Additional Contacts: Name: Phone: Email: Other: Name: Phone: Email: Other: DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 17 Optional Documents Copy of Food Worker Card Sent to Student: Yes ❑ No 1:1 Date sent: Sent to DVR Counselor: Yes ❑ No 7 Date sent: Copy of Current CPR and/or First Aid Certification Sent to Student: Yes U No Date sent: Sent to DVR Counselor: Yes ❑ No ] Date sent: Other* Sent to Student: Yes _1 No Date sent: Sent to DVR Counselor: Yes u No i] Date sent: Other* Sent to Student: Yes ❑ No Date sent: Sent to DVR Counselor: Yes No[ Date sent: * Ideas of other items to include could be a person -centered plan, other certifications, and other job -related documents. DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 18 Monthly Progress Reports Below is your story of finding a job! As your Job Coach works with you, they will be adding in their monthly reports that are on the first page of this Student Guide. You will be able to read the progress made for you ... the story of your journey to a job! DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 19 DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 20 DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 21 DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 22 DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 23 August Year September Year DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 24 Additional Comments DIVISION OF VOCATIONAL REHABILITATION I SCHOOL -TO -WORK I PAGE 25 Attachment "H" School to Work 2026/2027: Graduation Year 2027 or 2028 Legacy Pilot # of Students enrolled in School to Work # of Students in SDOP for Assessment # of Students in SDOP for Job Placement # of Students in SDOP # of Students Employed Asotin Benton Chelan Clark Columbia Cowlitz Douglas Ferry Franklin Island Jefferson King Kitsap Kittitas Lewis Lincoln Mason Okanogan Pend Orielle Pierce San Juan Skagit Snohomish Spokane Stevens Thurston Wahkiakum Walla Walla W hatcom Whitman Yakima Total 0 0 0 0 0 *Total enrolled includes students no longer in school, may have moved, not eligible yet, passed away, etc # of Students # of Students # of Students Comments # of Students in Transferred to Transferred to Exited STW Add'I Info to Share Y.E.S. DVR Only DDCS (on CSA) Early Reasons for STW Exit 0 0 0 0