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HomeMy WebLinkAboutAFS Between KC and ElmviewKITTITAS COUNTY AGREEMENT FOR SERVICES PHMH25-O22 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 Elmview (hereinafter "Contractor"). The purpose of this Agreement is as follows: To provide a coordinated and comprehensive state and local program of services for persons with developmental disabilities in accordance with Revised Code of Washington chapter 71,A.L4. The term of this Agreement shall be from July I't,2026, through June 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 CONTRACTOR This Agreement includes the following, which are attached hereto and hereby incorporated by this reference: Kittitas County Public Health 507 N. Nanum, Suite 102 Ellensburg, WA 98925 Project Contact: Laurie Holt Developmental Disabilities Administrative Specialist Human Services Lau rie. holt@co. kittitas.wa. us 509-962-7515 Attachment "A": Attachment "8": Attachment "C": Attachment "D": Attachment "E": Attachment "F": Attachment "G": Elmview PO Box 56 Ellensburg, WA 98926 Project Contact: Sherie Bury, Director sherieb@elmview.org Scope of Work Compensation lnsurance Requirements General Terms and Conditions Program agreement between DSHS and the county for DDCS services DSHS/DRW Agreement W-9 (Contractor must complete and return to the County for payment) Kittitas County Agreement for Services (rev.5/La/251 Page 1 of 21 lN WTTNESS 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. ',f Kittitas County Agreement for Services (rev.5/L4/25) Page2 of 2L KITTITAS COUNTY BOARD OF COUNTY COM Commissioner Date: Cha Vi ABSENT D Attest: rd CONTRACTOR Signature Printed Name Title Date ATTACHMENT "A,, SCOPE OF WORK o Provide community inclusion (Cl) Services in accordance with DDCS Policy 4.11 r Provide supported employment services through individual employment (lE) services or group supported services (GSE), if applicable, in accordance with DDCS Policy 4.11 o Provide any other direct services in compliance with attachment "E" and"F' o Ensure clients have a current lE, Cl, or GSE plan in place that includes the following: o Person Centered assessment o Clearly states the client's goal, who is responsible for what action steps. o Based on the client's strengths and builds on their skills. o The plan advances the client toward their goals and tracks their progress. o Measurable outcomes that can be identified. o Updated every 6 months to assess and revise as needed. o Contact clients according to their plan and provide case notes that center on the client's skills, gifts, interests, desires and preferences for activities or work. e Submit data and reports as requested by the county. o Follow billable requirements per DDCS. r Submit billing to county, monthly. . Participate in biennial county evaluation (monitoring) to meet the standards set forth on the DDCS County Best Practices site. . Comply with all applicable requirements in the contract between DDCS and Kittitas County (Attachment E). o Comply with referenced RCW, WAC, DDCS policies, confidential information, data security, and referenced materials. . Comply with referenced documents found at DDCS internet site Countv Best Practices I DSHS (wa.gov). . Any service provider offering transportation must ensure that drivers hold valid drive/s licenses and have a background screening completed to include a driving abstract in order to safely perform the services. Kittitas County Agreement for Services (rev.5hL/25]l Page 3 of 21 ATTACHMENT,,B,, COMPENSATION THE COUNTY WILL NOT PROCESS PAYMENT FOR SERVICES RENDERED UNDER THIS AGREEMENT UNTIL CoNTRACTOR SUBMITS A COMPLETED W-9 (SEE ATTACHMENT "G"). As full compensation for satisfactory performance of the work described in Attachment"A", and within thirty (30) days of receiving Contractor's itemized invoice, the County shall pay Contractorthe following amount(s) plus any applicable taxes as detailed in Contractor's invoice: Individual Employment (IE) $108.80 per servioe hour Group Supported Employment (GSE) $93.80 per service hour Community Inclusion (CD $66.08 per service hour Unless otherwise provided herein, the Contractor shall be solely responsible for Contractor's travel and related expenses. Any uses of these funds outside of the listed allowable uses must be approved by Kittitas County in advance of the expenditu re, in writing. All funds must be spent by June 30, 2027. No extension of the funding period will be granted. Reim bursement Procedures A. The Contractor will receive a billing template(s) each month from the Human Services Department of Kittitas County Public Health. B. The Contractor shall complete the billing templates each month and send to Laurie Holt laurie.holt@co.kittitas.wa.us by the 25th of the month following the calendar month in which services were delivered. C. The Contractor must provide an invoice for approval prior to the end of each month. lnvoices may not be processed for payment until after the end of the month D. All invoices must include an invoice date and an invoice number. E. Kittitas County Health Department will verify all invoices through AWA prior to processing payment. Kittitas County Agreement for Services (rev. 5/M/251 Page 4 of 2L ATTACHMENT'C" INSURANCE REQU IREMENTS 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 Vll or better in the most recently published edition of Best's Reports unless otherwise approved by the County. lf an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies must comply with Chapter 48.15 RCW and 284-L5 WAC. At a minimum, Contractor shall maintain and provide proof of the following selected options Commercial General Liabilitv lnsurance. Coverage limits are not less than: . 51",000,000 per occurrence, for all covered losses . 52,000,000 general aggregate . S1,000,000 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 Liabilitv lnsurance! 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. r Coverage limits are not less than: . S1,000,000 combined single limit Excess or Umbrella Liabilitv. The Contractor shall provide Excess or Umbrella Liability coverage of 55,000,000. This Excess or Umbrella Liability coverage shall apply, at a minimum, to both the Commercial General and Automobile lnsurance policy coverages. lf 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' Com pensation & Emplover/s Liabilitv. The 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 51,000,000 per accident or disease. Kittitas County Agreement for Services (rev.5/74/251 Page 5 of 21 Professional Liabilitv / Errors and Omissions Liabilitv . Coverage limits not less than: o $1,000,000 each claim . Contractor must provide evidence of this coverage on a policy form appropriate to Contractor's profession. Contractor shallfurnish to the County a Certificate of lnsurance, 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 Couttty. 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 lnsurance with all required endorsements, properly completed and in the amounts required, and (2)where requested bythe County, a copy of the required insurance policies, including all required endorsements. Kittitas County Agreement for Services (rev. 5/14/25) Page 6 of 21 ATTACHMENT'D" GENERAT TERMS AND CONDITIONS L. Scope of Contractorr'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 Pavment: Compensation to Contractor for services rendered under this Agreement shall be as set forth in Attachment "8". Where Attachment "B" requires payment(s) by the County, payment shall be based upon billings, supported unless provided otherwise in Attachment "8", by documentation of units of work actually perforrrred altd alrroulrts earned, includlng, where approprlate, 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". ln 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 "G"). 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 theCountytomakewithholdingforanytaxesotherthanincometaxes(e.g.,Medicare). Allcompensationreceived by Contractor will be reported to the lnternal Revenue Service at the end of the calendar year in accordance with applicable IRS regulations. lt 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 here under 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: Contracto/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 "8", 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. 5. Assignment 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. lf 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 particu lar 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 comply with any applicable Kittitas County Agreement for Services (rev.5/M/251 PageT of2L term or condition of this agreement. The Contractor shall appropriately monitor the activities of the Subcontractor to assure fiscal conditions of this agreement. ln 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 Su bcontractor's performa nce of the su bcontract. 5. 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 (5) 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.I. 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. lf any such Change Notice causes an increase or decrease to Contractol'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 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 an adjustment shall not include compensation for loss of anticipated profit on uncompleted work. 8.3 lf 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. lf the Agreement is terminated under this paragraph, Contractor shall not be entitled to receive any further payments under this Agreement until all 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.5/14/25l' Page 8 of 21 from any money due or coming due to Contractor. Furthermore, in the event of termination under this 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. lndemnification 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, lrarmless frotrt 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 (21 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 lndustrial lnsurance 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 ln 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: ln 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 forthe County of Kittitas. This Agreement shall be governed by the laws of the State of Washington. 11. Non-Appropriation of Funds: lf the Cou nty 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. Kittitas County Agreement for Services (rev.5/L4/25) Page 9 of 21 12. Contractor Commitments, Warranties, and Representations: Contractor represents and warrants as follows L2.! 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. I2.2 Contractor has the authority to execute this Agreement, to make the representations and warranties set forth herein, and to perform its obligations hereunder. 72.3 This Agreement has been validly executed by an authorized representative of Contractor and constitutes a valid and legally binding and enforceable obligation of Contractor. L2.4 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. I2.5 Contractor is not in violation of any applicable law, ordinance or regulation the consequence of which willor may materially affect Contractor's abilityto perform its obligations underthis 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. L2.6 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 ltems 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 ProperW lnfrineement: 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 Countv Name and Loeo: 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. Kittitas County Agreement for Services (rev.5/74/25) Page 10 of 21 15. 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 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 determinationastotheproperresolutionofthedispute. Suchdeterminationshallbefinalandbindingonboth 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. ln 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. !7. Confidentialitv: 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 lndustries. The schedule of prevailing wage rates for the applicable locality or localities is determined by the lndustrial Statistician of the Department of Labor and lndustries, lt is Contractor's responsibility to verify the applicable prevailing wage rate. lt 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 lndustries. The arbitration decision shall be finaland conclusive and binding on all parties involved in the dispute as provided for in RCW 39.1-2.050. 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 Kittitas County Agreement for Services (rev.5/14/25) Page 11 of 21 practicing or working under similar circumstances. Contractor shall, without additional compensation, correct any of its services not meeting such a standard. 2L. Nondiscrimination zL.L ln 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, 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; 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 employcd, 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, 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. 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. 2L.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. 2L.3 lf any assignment and/or subcontracting has been authorized by the County, said assignment or subcontract shall include appropriate safeguards against discrim ination. 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, orthe 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, L5,16, 17,19,20,22,24, and 28 ot 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 orwritten, 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' Kittitas County Agreement for Services (rev.5/t4/251 PageL2 of 2t 26. Severabilitv: lf 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. 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. Asreement Not for Benefit of Third Parties: This Agreement is entered into solcly for the benefit of the parties hereto and vests no rights in, nor is it enforceable by, anythird parties. Kittitas County Agreement for Services (rev. 5h4/25l' Page 13 of 21 Attachment E sHs WA5HIN6TON STATE Depanment of So.lal nnd Health Serylce! COUNTY PROGRAM AGREEMENT DDCS County Services DSHS Agreement Number 2663-71228 This Program Agreement is by and between the State of Washington Department of Social and Health Services (DSHS) and the County identified below, and is issued in conjunction with a County and DSHS Agreement On GeneralTerms and Conditions, which is incorporated by reference. Administration or Division Agreement Number County Agreement N umber DSHS ADMINISTRATION Developmental Disabilities Admin DSHS DIVISION Division of Developmental Disabilities DSHS INDEX NUMBER 1225 DSHS CONTMCT CODE 1769C5-63 DSHS CONTACT NAME AND TITLE Seanna Woodard Operations Manager DSHS CONTACTADDRESS 1611 W lndiana Ave Spokane, WA 99205 DSHS CONTACT TELEPHONE (509\329-2952 DSHS CONTACT FAX (509)568-3037 DSHS CONTACT E-MAIL woodas@dshs.wa.oov COUNry NAME Kittitas County Kittitas County DDA County Services COUNryADDRESS 507 North Nanum Street Suite 102 Ellensburo. WA 98926-2886 COUNry FEDEML EMPLOYER IDENTIFICATION NUMBER COUNTY CONTACT NAME Kasey Knutson COUNTY CONTACT TELEPHONE (509) 962-7090 COUNTY CONTACT FAX (509) 962-5883 COUNTY CONTACT E-MAIL kasev. knutson@co. kittitas.wa. us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGMM AGREEMENT? No ASSISTANCE LISTING NUMBERS PROGRAM AGREEMENT START DATE 07t01t2026 PROGMM AGREEMENT END DATE 06t30t2027 MAXIMUM PROGRAM AGREEMENT AMOUNT $1,021,440.00 EXHIBITS. The following Exhibits are attached: Exhibit A - Data Security Requirements;ExhibitB-Budgetand Spending Plan By their signatures below the pa rties agree to the terms and conditions of this County Program Agreem ent and all documents incorporated by reference.No other understa nd rngs or representation s,oral or otherwise,regard tng the subject matter of this Program Agreement sha be deemed to exist or bi nd the parties The parties srgnrng below certify that are authorized to this nt. COUNTY PRINTED AND TITLE(S) DSHS SIGNATURE PRINTED NAME AND TITLT DATE SIGNED DSHS Central Contract Services 1 769CS County Ag reement (1 2-26-2025) Page 1 1 Special Terms and Conditions Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "Acuity Level" means the level of a Client's abilities and needs as determined through the DDCS assessment. b. 'ALTSA Web Access (AWA)' means a web-based portalto the Developmental Disabilities Community Services CARE system designed to support county services for DDCS clients. c. "Additional Consumer Services" refers to indirect Client service types as follows: (1) "Community lnformation and Education": Activities to inform and/or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities. (2) "Training": To increase the job related skills and knowledge of staff, providers, volunteers, or interning students in the provision of services to people with developmental disabilities. Also to enhance program related skills of board or advisory board members. (3) "Other Activities" reserved for special projects and demonstrations categorized into the following types: (a) lnfrastructure projects: Projects in support of Clients (services not easily tracked back to a specific working age Client) or that directly benefit a Client(s) but the Client is not of working age. Examples include planning services like generic job development e.g. "Project Search". (b) Start-up projects: Projects that support an agency or directly benefit the agency. Examples include equipment purchases and agency administrative support. (c) Partnership Project: Collaborative partnerships with schooldistricts, employment providers, DVR, families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn twenty-one (21). d. "Budget and Accounting Reporting System (BARS)' means a master classification of balance sheet, revenue and expenditure/expense accounts. e. "Client" means a person with a developmental disability as defined in chapter 388-823 WAC who is currently eligible and active with the Developmental Disabilities Community Services or is an identified PASRR Client. f. "Competitive lntegrated Employment" means work performed by a Client on a part-time or full-time basis, within an integrated setting within the community that meets HCBS settings requirements. The Client must be compensated at minimum wage or higher, using the higher of the Federal, State, or local rate, and at a rate comparable to the wage paid to non-disabled workers performing the same tasks, including receiving the same benefits and opportunities for advancement. g. "Consumer Support" refers to direct Client service types as follows (1) "Community lnclusion" or "Cl": means individualized services provided in integrated community settings with other individuals without disabilities. The activities are based on Client interests Page 2 DSHS Central Gontract Services 1 769CS Gou nty Ag reement (12-26-2025) Special Terms and Conditions and provide opportunities typically experienced by the general public of similar age in their local community, accessible by public transit or a reasonable commute from their home. The goal of the service is to support clients to participate, contribute, and develop relationships with community members who are not paid staff. These services may be authorized for individuals age 62 and older. These services may be authorized in addition to or instead of employment support (lndividual Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. (2) 'Child Development Services" or "CDS": Birth to three services are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child's development. Service may include assistive technology, audiology, family training/home visits, health services, medical services, nursing services, nutrition services, occupational therapy, physicaltherapy, psychological services, sign language, socialwork, special instruction, speech-language pathology, vision, and transportation. Services are provided in natural environments to the maximum extent appropriate. (3) "lndividual Supported Employment" or "lE": services are a part of a Client's pathway to employment and are tailored to individual needs, interests, and abilities, and promote career development. These are individualized services necessary to help persons with developmental disabilities obtain and continue integrated employment at or above the state's minimum wage in the generalworkforce. These services may include intake, discovery, assessment, job preparation, job marketing, job supports, record keeping and support to maintain a job. (4) "lndividualized TechnicalAssistance" or "lTA": services are a part of a Client's pathway to individual employment or community inclusion. This service provides assessment and consultation to the provider to identify and address existing barriers to employment or community inclusion. This is in addition to supports received through supported employment or community inclusion services for Clients who have not yet achieved their goal. (5) "Group Supported Employment" or "GSE": services are a part of a Client's pathway to integrated jobs in typical community employment. These services are intended to be short term and offer ongoing supervised employment for groups of no more than eight (8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading to further career development in integrated employment at or above minimum wage. Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment in community settings. h. "County" is the political subdivision of the state of Washington and the county or counties entering into this Program Agreement. i. "DDCS Case Resource Manager (CRM)" means a case manager for DDCS Clients. j. "County Service Authorization (CSA)" means an authorization for county services k. "Developmentaldisabilities (DD)" means a disability attributable to intellectual disability, cerebral palsy, epilepsy, autism, or another neurological or other condition of an individual found by the secretary to be closely related to an intellectual disability or to require treatment similar to that required for individuals with intellectual disabilities, which disability originates before the individual attains age eighteen, which has continued or can be expected to continue indefinitely, and which constitutes a substantial limitation to the individual. l. "Developmental Disabilities Community Services "DDCS'means a division within the Department of Page 3 DSHS Central Contract Services 1 769CS Cou nty Ag reement ('12-26-2025) Special Terms and Conditions Social and Health Services. m. "DDCS Regional office (DDCS Region)" means the regional DDCS office that supports DDCS clients. n. "Division of Vocational Rehabilitation (DVR)" means a division within the Department of Social and Health Services o. "Employment Outcome Payment" means a payment to providers for transition students born between specific dates; have high acuity; are authorized for lndividual employment; and student obtains a competitive integrated job within a specific timeframes. lf the job is a minimum of ten hours of work per week an additional amount will be include in the payment. p. "General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. q. "High Acuity Client" means a DDCS Client who requires significant and intensive support in the community, often due to complex needs, as determined through the DDCS assessment. r. "Medicaid Home and Community Based Services (HCBS)' means services that occur in a Client's home or community rather than institutions or other isolated settings. These programs serve a variety of targeted populations groups, such as people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses s. "Job Foundation Report" is a document derived from emplovment readiness activities performed by students who are between ages 19 through 20 that identifies actionable next step for employment. The employment service providers developing the Job Foundation report will be supporting students with employment activities on average of 35 hours. t. "Preadmission Screening and Resident Review (PASRR)' means individuals with intellectual disabilities or related conditions (lD/RC) who have been referred for nursing facility (NF) care. u. "Person Centered Service Plan or PCSP' means a document that authorizes and identifies the DDCS paid services to meet a Client's assessed needs. Formerly referred to as the lndividual Support Plan. v. "Quality Assurance" means an adherence to all Program Agreement requirements, including DDCS Policy 6.13, Provider Qualifications for Employment and Day Program Services, County Guidelines and the Criteria for Evaluation, as well as a focus on reasonably expected levels of performance, quality, and practice. w. "Quality lmprovement" means a focus on activities to improve performance above minimum standards and reasonably expected levels of performance, quality and practice. x. "service Provider" is a qualified Client service vendor who is contracted to provide Employment and Day Program services. y. "subcontractor" is the service provider contracted by the County to provide services. 2. Purpose: This Program Agreement is entered into between the Developmental Disabilities Community Services and the County in accordance with chapter 71A.14 RCW. lts purpose is to advance the state legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental disabilities. DSHS central contract services Page 4 1 769CS Cou nty Ag reement (12-26-2025) 3. Special Terms and Conditions Client Eligibility: Client eligibility and service referral are the responsibility of DDCS under chapter 388-823 WAC (Eligibility) and chapter 388-825 WAC (Service Rules). Only persons referred by DDCS shall be eligible for direct Client services under this Program Agreement. lt is DDCS's responsibility to determine and authorize the appropriate direct service(s) type. Direct Client services provided without a current County Service Authorization are not reimbursable under this Program Agreement. 4.Gredentials and Minimum Requirements: a. Administration of the developmentaldisabilities County program cannot be subcontracted. b. Qualified DD Program Coordinator: A qualified DD program coordinator has a minimum of five years training and experience in the administration and/or the delivery of developmental disabilities services to a community. For a county where the coordinator administers more than one program area (e.9. Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/or a related Human or Social service may be considered. c. Administration Responsibility: The County must demonstrate the ability to administer the program agreement including contract oversight and monitoring, community outreach and education activities, and regular communication with the DDCS Regional Office (DDCS region) and contracted providers. d. Fiscal Responsibility: The County must demonstrate the ability to safeguard public funds including maintaining books, records, documents and other materials relevant to the provision of goods and services. e. Sufficient Policies and Procedures for establishment and maintenance of adequate internal control systems: The County will maintain written policy procedural manuals for information systems, personnel, and accounting/finance in sufficient detail such that operations can continue should staffing change or absences occur. Policies shall be dated and include dates when updated. f. Background/Criminal History Check: A background/criminal history clearance is required every three years for all employees (including DD program County staff), subcontractors, and/or volunteers who may have unsupervised access to vulnerable DSHS Clients, in accordance with RCW 43.43.830-845, RCW 74.15.030, and chapter 388 WAC. lf the entity reviewing the application elects to hire or retain an individual after receiving notice that the applicant has a conviction for an offense that would disqualify the applicant from having unsupervised access to vulnerable adults as defined in chapter 74.34 RCW, then DDCS shall deny payment for any subsequent services rendered by the disqualified individual provider. The DSHS Background Check Central Unit (BCCU) must be utilized to obtain background clearance. g. Qualified Advisory Board Members: A Developmental Disabilities advisory board shall include members knowledgeable about developmental disabilities. No board member shall have a contract with the County to provide Training, Community lnformation Activities, and Consumer Support as defined in this Program Agreement, and shall not be a board member, officer, or employee of an agency subcontracting with the County to provide such services. h. Qualified Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6.13, Program Qualifications for Employment and Day Program Providers. i. Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to assign to DDCS its Medicaid billing rights for DSHS central contract Services Page 5 1 769CS Cou nty Ag reement (1 2-26-2025) 5. Special Terms and Conditions services to DDCS Clients eligible under Title XIX programs in this Program Agreement. Written documentation shall be available to DSHS on request. j. Reporting Abuse and Neglect: The County staff and its subcontractors who are mandated reporters under RCW 74.34.020(13) must comply with reporting requirements described in RCW 74.34.035, .040 and chapter 26.44 RCW. lf the County is notified by DSHS that a subcontractor staff member is cited or on the registry for a substantiated finding, then that associated staff will be prohibited from providing services under this Program Agreement. k. Counties who provide Child Development Services (birth to three early intervention services), must provide those services under the regulations implementing the lndividuals with Disabilities Education Act (IDEA), Part C, and Washington State's Early Support for Infant and Toddler Federally Approved Plan. l. The County staff who perform evaluations of subcontractor work sites will promptly report to DSHS per DDCS Policy 6-08, lncident Management and Reporting Requirements for County and County- Contracted Providers, it: (1) They have reasonable cause to believe that abandonment, abuse, financial exploitation or neglect (as defined in RCW 74.34.020) of a person who has a developmental disability (as defined in RCW 71A.10.020) has occurred, and, (2) lf they have reason to suspect that sexual or physical assault of such a person has occurred, they shall also immediately report to the appropriate law enforcement agency. m. Counties are specifically authorized to have data storage on portable devices or media in accordance with the Data Security Requirements. n. Order of Precedence: ln the event of any inconsistency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency shall be resolved by giving precedence, in the following order, to: (1) County Program Agreement; and (2) Attached Exhibits. Duty to Disclose: Under 42 CFR 5455.104, the Administration must obtain certain disclosures and complete required screenings to ensure the State does not pay federal funds to excluded person or entities. The County is required to provide disclosures from managing employees, specifically the persons in the positions of Developmental Disabilities Director and Fiscal/Budget Director, i.e. the person who authorizes expenditures. A completed Medicaid Provider Disclosure Statement, DSHS Form 27-094, should be submitted to the Administration to complete the required screenings. Disclosures must be provided at contract renewal and within thirty-five (35) days whenever there is a change in the staff holding these management positions [42 CFR 455.104 (cXl)] Statement of Work: The County shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below. Working collaboratively and sharing information as needed for service coordination, the parties shall administer DD services within the county as set forth below: a. The DDCS region shall (1) Review subcontractors and shall immediately notify the County of any concerns with the 6 DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Page 6 Special Terms and Conditions subcontractors identified by the County; (2) lnform and include the County in the discharge planning of Client's leaving institutions and returning to the community who will need program funding; (3) lnform the County of Client's who have had their waiver status changed; (4) Work with the County when referring Client's for services and willwithdraw referrals when authorization is not issued; (5) Authorize new service within 5 working days and will extend existing service authorization before expiration date; (6) lnform Clients of service changes through Planned Action Notice(s); (7) Work with the County to document planned services in the Client's Person Centered Service Plan including notification of assessment dates; (8) Work with the County when terminating services; (9) Work with DDCS Head Quarters and the County on Spending Plan adjustments; and (10) Work with the County in participating in evaluation of direct service providers. b. The County shall: (1) Work with the DDCS Region when Clients are referred for services, authorized services, and/or for support modifications; (2) Work with the DDCS Region to document planned services in the Client's Person Centered Service Plan; (3) Assist with informing the DDCS Region of any potential service level changes not documented in the Client's DD Assessment prior to any changes; (4) Work with the DDCS Region regarding service termination; (5) Work with the DDCS Head Quarters on Spending Plan adjustments; (6) lnform the DDCS Region of new providers to be included on the ALTSA Web Access (AWA) system; (7) Notify the DDCS Region of any intent to terminate a subcontractor who is serving a DDCS referral; (8) Provide a copy of each subcontractor's contract upon written request from DDCS; and (9) Notify and work with the DDCS Regional Employment Specialist when performing evaluations of direct service providers. c. Compliance with Budget and Accounting Reporting System Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. DSHS Central Contract Services 1 769CS County Ag reement (1 2-26-2025) Page 7 Special Terms and Conditions d. The County shall comply with the following referenced documents (1) DDCS Policy 4.1 1, County Services for Working Age Adults; (2) Chapter WAC 388-850, chapter 388-828 WAC, WAC 388-845-0001, 0030, 0210, 0215, 0220, 0600-061 0, 1 030-1 040, 2100, 2110; (3) Criteria for Evaluation; (4) DDA Guidinq Values: (5) Countv Guide to Achieve DDA's Guidinq Values; (6) DDA Guidelines for Communitv Assessments within Emplovment and Vocational Proqrams; and (7) Disabilitv Riqhts Washinqton (formerlv Washinqton Protection and Advocacv Svstem) Access Aqreement. e. The County shall develop and submit a comprehensive plan for the County DD Services as required by WAC 388-850-020. f. Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The County shall submit the Service lnformation Forms (SlF's) (provided by DDCS at lnternet site https://www.dshs.wa.qov/dda/county-best-practices) to indicate the estimated number of people to be served, targeted outcomes, and identified goal(s) that focus on quality improvement within the categories of Training, Community lnformation, Direct Client Services, and Other Activities within 30 days of execution of the Program Agreement. Once approved, the SIF outcomes may be modified only by mutual agreement of the County and the DDCS Region. Solicitation for Qualified Employment and Day Program Service Providers: Requests for Applications (RFAs), Requests for lnformation (RFl's) and/or Requests for Proposals (RFPs), Requests for Qualifications (RFQ's) for direct services, excluding Child Development, will be open continuous enrollment. h. Qualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDCS. TechnicalAssistance: DDCS contracts with TechnicalAssistance providers that may be utilized by Counties with prior written approval. Subcontractors: The County will pass on all applicable contractual requirements that are between DDCS and the County to the subcontractor. The County shall immediately notify the DDCS Region of the County's intent to terminate a subcontractor who is serving a DDCS referral. lndividuals or agencies contracted with a county or DDCS may not subcontract for Employment or Community lnclusion services. k. The County shall provide or contract with qualified Employment and Day Program Service Providers for consumer support services that include the following program outcomes: (1) Monthly Community lnclusion (Cl) service support hours will be based on the Client's Cl service level per WAC 388-828-9310 for all Clients who began receiving Cl services July 1, 2011 and foruvard. g DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Page 8 Special Terms and Conditions (a) To ensure health and safety, promote positive image and relationships in the community, increase competence and individualized skill-building, and achieve other expected benefits of Cl, services will occur individually or in a group of no more than two (2) or three (3) Client's with similar interests and needs. (b) Cl services will focus on activities that are typically experienced by the general public Support to participate in segregated activities and/or specialized activities will not be reimbursed. (2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses. Clients should be supported to average twenty (20) hours of community work per week or eighty-six (86) hours per month; however, each person's preferred hours of employment should be taken into consideration. The amount of service a Client receives will be based on his/her demonstrated need, acuity level and work history per WAC 388-828. (3) The Client's DDCS PCSP is the driver for service. The AWA County Service Authorization (CSA) and updated Planned Rates information will not exceed the Client's DDCS PCSP. Service changes will not occur untilthe Client has received proper notification from DDCS. (4) All Clients will have an lndividualized Employment and/or Community lnclusion plan to identify Client's preferences. Minimum plan elements are outlined in the reference document "Criteria for an Evaluation." A copy of the Client's individualized plan will be provided to the Client, their DDCS Case Resource Manager (CRM), guardian and others as appropriate. (5) Six-month progress reports describing the progress made towards achieving Client's goalwill be provided by the service provider to the CRM, Client, and/or guardian, if any, within 30 days following the six-month period. The report will summarize activities and outcomes made towards the Client's individualized goal(s).All Clients will be contacted by their service provider according to Client need and at least once per month. (6) All Clients will be contacted by their service provider according to Client need and at least once per month. (7) lf Clients in lndividual Employment or Group Supported Employment, have not obtained paid employment at minimum wage or higher within six (6) months, the County will assure the following steps are taken: (a) Review the progress toward employment goals; (b) Provide evidence of consultation with the ClienVguardian; and (c) Develop additional strategies with the ClienUguardian, county staff, employment support staff, case manager, and others identified by the Client. Strategies may include providing technical assistance, changing to a new provider, and/or providing additional resources as needed to support the Client's pursuit of employment. The additional strategies will be documented for each Client and kept in the Client's file(s). (8) lf after twelve (12) months the Client remains unemployed, an additional review will be conducted. The provider will address steps outlined in the previous six month progress report in the next six month progress report. When requesting to participate in Cl, the Client shall communicate directly with his or her DDCS Case Manager. The DDCS Case Manager is responsible for authorizing Cl services. DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Page 9 Special Terms and Conditions (9) For lndividual Employment where the service provider is also the Client's employer, long term funding will remain available to the service provider employer for six months after the employee DDCS Client's date of hire. At the end of the six-month period, if the DDCS Client continues to need support on the job, another service provider who is not the employer of record must provide the support unless the County or DDCS issues prior written approvalfor the service provider to continue to provide longterm supports if needed. lf the County or DDCS approves the continuation of long-term supports where the service provider is also the Client's employer, the County or DDCS will regularly monitor these positions to assure fading efforts occur when appropriate and any potential conflict of interest is addressed. (10) lndividual Employment staff hours must be attributed to the "lndividual Emplovment and Billable Activitv Phase(s)". (11) For Group Supported Employment (GSE), Clients must have paid work. The total number of direct service staff hours provided to the group should be equal to or greater than the group's collective amount of individual support monthly base hours. lf the direct service staff hours are less than the collective amount, then the provider will be reimbursed only for the number of hours staff actually provided. (a) The collective group's individual hours should be the minimum staff hours delivered to support the group. (b) A GSE Client must be on-site/at work at least their base individual hours as a minimum pef month. lf a Client is not on-site/at work for all of their base hours, the county should verify that the provider delivered the collective group's individual hours to the group (what was the number of staff hours provided to the group duing the month? lf it was less than the collective group's total the provider can only bill for the staff hours that were provided). (c) A GSE agency may not bill for a GSE Client who does not receive services during an entire service month. (d) A GSE agency must have a record of which staff is supporting which Clients on any given day. (e) A GSE agency must have supportive documentation that provides clear evidence of support helping with specific activities as identified in the Client plan to move a Client on their pathway towards their employment goal(s). (f) Running a GSE service is a part of the business operation and not billable to Clients (contract procurement, contract maintenance, or administration functions associated with GSE). (g) lndividualtime in the community working towards the individual employment goal, separate from the group time, must include phase information (refer to Employment Phases and Billable Activities - see Phases 1 - 4 for element / activity description). (12) Employment and day services must adhere to the Home and Community Based settings (HCBS) requirements of 42 C.F.R. Section 441.301(cX4), including that: (a) The setting is integrated in the greater community and supports Client's to have full access to the greater community; (b) Ensures the Client receives services in the community to the same degree of access as Page 10 DSHS Central Contract Services 1 769CS Cou nty Agreement (1 2-26-2025) Special Terms and Conditions individuals not receiving Medicaid HCBS; (c) The setting provides opportunities to seek employment and work in competitive integrated settings; and (d) The setting facilitates individual choice regarding services and supports, and who provides them. Quality Assurance and Service Evaluation: The County shall develop and have available an evaluation system to review services. The evaluation system must have both a Quality Assurance and a Quality lmprovement component, and both must include objective measures. The objective measures at a minimum will include performance indicators, by acuity, that include the number of new jobs; job loss and reasons for job loss; the percentage employed earning minimum wage or better; and the average number of hours worked. The County's service evaluation system shall serve as the method by which current providers demonstrate that they continue to be qualified providers. A copy of description of such evaluation system shall be provided upon request to DDCS for review. m. Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one visit to each subcontractor every two (2) years excluding Child Development Services subcontractors. The County shall conduct at least one visit to Child Development Services providers every three (3) years. The County shall maintain written documentation of all evaluations, recommendations and corrective action plans for each subcontractor. Copies of such documentation will be provided to the DDCS upon request. n. The County shallwork with local developmental disability advisory groups to plan for and coordinate services. o. The County shall participate in regularly scheduled meetings between County DD staff and DDCS staff to remain updated and current including ACHS and Regional Meetings. p. AWA Data System: ln compliance with the AWA Traininq Manual, the County shall use the AWA data system for all: (1) Billing requests; (2) Service provider address and phone number maintenance; (3) Evaluation dates; (4) Employment outcome information; and (5) Monthly provide all data described in the Billing lnstructions and in the Employment Outcomes lnstructions, which is hereby incorporated by reference. q Assure the integrity of data submitted to the State. When data is submitted and rejected due to errors or an error is later identified, the County will correct and resubmit the data within thirty (30) days. Review and respond the AWA "Work List" items within 5 working days including Referrals and pending Authorization. s. Review the AWA "Ticklers" Planned Rate tab and update the planned rate within 5 working days Page 1 1 DSHS Central Contract Services 1 769CS County Ag reement (1 2-26-2025) r Special Terms and Conditions after the Planned Rate start date. t. PartnershipProject. (1) A Job Foundation document will be completed per guidelines for eligible students. Eligible students are DDCS clients who were born between: (a) For fiscal year 2026 911105 through 8/31/06 (b) For fiscal year 2027 911106 through 8131107 These students currently attending school and have completed an application to participate in this Value Based Payment (VPB) project. The VBP project application will include the following minimum criteria identified in the sample application found at: https://www.dshs.wa.oov/sites/defaulVfiles/DDA/dda/documents/Job%20Foundation%20Applica tion 29.docx (2) Qualified providers will collaborate with School District staff to complete the Job Foundation document and then provide a copy to the County. To be a qualified provider for the Partnership Project the Counties must require the provider to have a current contract with the Division of Vocational Rehabilitation; a contract in good standing with the County and cannot be in provisional status; a minimum of two years' experience providing lndividual Employment with demonstrated job placement skills. The Job Foundation recommendation will only have actionable next steps towards integrated competitive employment. (3) County participating in the Partnership Project must have the ability to work collaboratively with School Districts to identifiT DDCS students in high school, collect and track information, be proficient in electronic spreadsheets, and ability to evaluate if completed Job Foundation document(s) meet quality standards. u. Outcome Payment. Providers, with transition students born between (a) For fiscal year 2026 911103 through 8131104 (b) For fiscal year 2027 911104 through 8131105 (2) High acuity transition students who are authorized for lndividual employment, the provider may receive one outcome payment if transition student obtains a competitive integrated job approved by the County within timeframes described in the chart in the Billinq lnstructions. lf the County is also the service provider DDCS will provide the job approval. lf the job is at a minimum of ten hours of work per week an additional amount will be include in the payment. (3) High acuity Clients who are authorized for lndividual employment, provider may receive one outcome payment if client obtains a new competitive integrated job at a minimum of ten hours of work per week for a minimum of 4 out of each 6 months during the fiscal year. (4) Client who are authorized for Community lnclusion who have an acuity of F which equals 18 support hours per month or G which equals 20 support hours per month as based on the Support lntensity Scale (SlS), provider may receive on outcome payment per month if provider delivers a minimum of 80% of the authorized hours. DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Page 12 Special Terms and Conditions (5) A new Community lnclusion referral is defined as a Client who has a new County Service Authorization (CSA). lncentive/outcome payments to accept and support overall increased CSAs billed over the year may be requested from DDCS if funds are available. (6) Community lnclusion case notes and 6-month progress report summary review that scores 16 points or more with the "Community lnclusion Case Note Review Tool" when used in conjunction with a Community lnclusion plan that has scored 20+ points with the Community lnclusion plan Quality review tool, provider may receive an outcome payment. (7) All outcome payments are described in the chart in the Billinq lnstructions. 7. Consideration a. Fees (1) Approval of fees is the responsibility of the DDCS. The DDCS HQ Employment and Day Unit Manager reserves the right to approve fees/rates for the services being provided. The County will submit a fee/rate schedule with the initial Program Agreement. The County will submit updated fee/rate schedules to the HQ Employment and Day Unit Manager for approval as changes occur. The rate schedule will include the following information: (a) County(s) name; (b) Time period for which the schedule is applicable; and (c) Each contracted direct service (lE, GSE, Cl, lTA, CDS) and its associated rate (2) Fee Limitations: The Billinq lnstructions found on the County Best Practices site provides limitations on the Hourly Rate for each direct service. Hourly rates must be divisible by four b. Budget and Spending Plan, attached as Exhibit B: (1) Budget amount listed in Exhibit B: The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state-only employment and day services to waiver employment and day services. (2) Spending Plan: DDCS will provide the initial spending plan / Program Agreement Budget / Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The planned expenditures for Consumer Support are based on authorized Clients, their acuity level and work history for a given point in time. To determine the Additional Consumer Support amount, the Consumer Support amount is multiplied by a percentage. The spending plan may only be modified by mutual agreement of the parties in writing and shall not require a program agreement amendment. (a) Funds Designated for Additional Consumer Services: lf a County provides Community lnformation and Education services under additional consumer services, then activities must include outreach efforts to federally recognized local tribes. (b) Funds Designated for Adult Day Care Consumers: Funds designated for Adult Day Care Consumers are available to Clients who were served between December 1996 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible Page 13 DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) 8. DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Special Terms and Conditions for Level ll or lll services (Adult Day Health). Level ll and lll services are licensed rehabilitation and skilled nursing services along with socialization. Level I services (Adult Day Care) are supervised day programs where frail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing. These Clients may be referred to services defined in the statement of work, or to an Adult Day Care service other than Level ll or lll. lf a Client no longer needs and wants services, the funds are available for other Clients who are not part of the group of original Clients identified between December 1996 and 2003. An Adult Day Care service shall only be provided by Adult Day Care agencies certified by the localArea Agency on Aging. Adult Day Care service is not a waiver approved service. c. Program Agreement Amendments: A County can request an amendment at any time. An amendment for additional Client(s) may be supported when clients exceed the number used to develop the contract. An amendment for additional service hours authorized may be supported when county provides evidence. An amendment request for expenditures exceeding contract total due to hourly rates paid to service provider may not be supported as the county is responsible to manage contract and rates paid to their providers. d. Exemptions: The DDCS Assistant Secretary may approve in writing an exemption to a specific program agreement requirement. Billing and Payment: a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for: (1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration of the Developmental Disabilities Program. Allowable costs include personnel and overhead costs directly related to the administration and coordination of the program, including such activities as program planning, budgeting, contracting, monitoring, and evaluation. Also included are departmental and county indirect and/or direct administrative costs, to the extent that such costs are appropriately allocated to the program using an established methodology consistent with grants management guidelines. For a County whose designated coordinator manages multiple programs, the County must be able to provide evidence of the time the coordinator spent working on the Developmental Disabilities program. (2) Additional Consumer Services: (a) Training Staff Training: Costs incurred by the program for planned, structured activities for the purpose of providing, or improving, or enhancing job-related knowledge and skills of staff, providers, volunteers, or interning students in the provision of developmental disabilities services. ii. Board Training: Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program-related skills of board and advisory committee members. (b) Community lnformation and Education: to inform and/or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community Page 14 Special Terms and Conditions consultation, capacity building and organization activities. (c) Other Activities lnfrastructure projects: Projects in support of Clients (services not easily tracked back to a specific working age Client) or that directly benefit a Client(s) but the Client is not of working age. Examples include planning services like generic job development e.g. "Project Search." Start-up projects: Projects that support an agency or directly benefit the agency Examples include equipment purchases and agency administrative support. iii. Partnership project: Collaborative partnerships with school districts, employment providers, Division of Vocational Rehabilitation (DVR), families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn twenty-one (21). Supports provided should complement and not replace what the student(s) receive through the lndividualized Education Program (lEP). (3) Consumer Support. (a) Adult Day Care services are available to Clients who were served between December 1996 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible for Level ll or lll services (Adult Day Health). Level ll and lll services are licensed rehabilitation and skilled nursing services along with socialization. Level I services (Adult Day Care) are supervised day programs where frail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing. (b) Community lnclusion Services are individualized and provided in integrated community settings with other individuals without disabilities. The activities are based on Client interests and provide opportunities typically experienced by the general public of similar age in their local community, accessible by public transit or a reasonable commute from their home. The goal of the service is to support Clients to participate, contribute, and develop relationships with community members who are not paid staff. These services may be authorized for individuals age 62 and older. These services may be authorized in addition to or instead of employment support (lndividual Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. (c) Child Development Services are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the childls development. Service may include: assistive technology, audiology, family training/home visits, health services, medical services, nursing services, nutrition services, occupationaltherapy, physical therapy, psychological services, sign language, socialwork, special instruction, speech- language pathology, vision, and transportation. Services are provided in natural environments to the maximum extent appropriate. (d) lndividual Supported Employment services are a part of a Client's pathway to employment and are tailored to individual needs, interests, and abilities to promote career development. These are individualized services necessary to help persons with developmental disabilities obtain and continue integrated employment at or above the state's minimum wage in the generalworkforce. These services may include intake, discovery, assessment, job preparation, job marketing, job supports, record keeping and support to maintain a job (per Page 15 DSHS Central Contract Services 1 769CS County Agreement (12-26-2025) Special Terms and Conditions the lndividual Emplovment Phases & Billable Activities) (e) lndividualized Technical Assistance services are a part of a Client's pathway to employment or community inclusion. This service provides assessment and consultation to the provider to identify and address existing barriers to employment or community inclusion. This is in addition to supports received through supported employment or community inclusion services for individuals who have not yet achieved their goal. (0 Group Supported Employment services are a part of a Client's pathway to integrated jobs in typical community employment. These services are intended to be short term and offer ongoing supervised employment for groups of no more than eight (8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading to further career development in integrated employment at or above minimum wage. Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment community settings. b. Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this Program Agreement. However, with a Program Agreement amendment, the parties may increase or decrease the Program Agreement amount. Counties willwork with DDCS HQ on amendments to the Program Agreement. c. Monthly lnvoice with Signed Documentation: All requests for reimbursement amounts must be entered and posted into the AWA system. The County may post a combined claim of all programs/services covered by this Program Agreement. DSHS shall make all payments due to the Coung for all invoices submitted pursuant to this section within forty five (45) days following posting of required information. d. Clients will be assisted in accessing DVR services per the DDCS/DVR MOU. Client services shall not be reimbursed under this Program Agreement when the same services are paid for under the Rehabilitation Act of 1973 by DVR, Public Law 94-142 or any other source of public or private funding. e. Reimbursement of Client Services: A claim for each Client is made on the AWA system by indicating the number of service units delivered to each Client listed and the fee per unit. Units are defined as: (1) An "Hour'' is at least fifty (50) minutes of direct service. Partial hour to the quarter may be recorded. (2) A "Day" is at least four (4) hours of direct service and will only be used in connection with Adult Day Care reimbursement. (3) A "Month" represents a minimum of at least fifty (50) minutes of direct service for CDS reimbursement. f. Program Administration: The County will provide program administration and coordination including such activities as planning, budgeting, contracting, monitoring, and evaluation. Monthly claims for administration can be 1112 of the maximum amount identified in Exhibit B under Administration or for the actual costs incurred in the given month but the total Administration billed will be the lesser of the two. Administration cost reimbursement will not exceed 10% unless the Assistant Secretary of DDCS approves a request for an exception under chapter 388-850 WAC. g. The lndividual Employment Phases & Billable Activities document defines the individual Client Page 16 DSHS Central Contract Services 1 769CS County Agreement (12-26-2025) 9. 10. 11. Special Terms and Conditions services that DDCS reimburses. That document is located on the DSHS DDCS County Best Practices Web site at https://wvrry.dshs.wa.qov/dda/countv-best-practices. h. The Community lnclusion Billable Activities document defines the individual Client services DDCS reimburses. That document is located on the DSHS DDCS County Best Practices Web site at https://wrnftv. dshs.wa.qov/dda/countv-best-practices. i. Timeliness of and Modification to Billings: All initial invoices with signed documentation must be received by the DDCS Region within forty-five (45) calendar days following the last day of the month in which the service is provided. Corrected invoices and documentation including re-posted billing information will be accepted throughout the fiscal year as long as they are received within sixty (60) calendar days of the associated fiscal year unless an extension is approved by the DDCS Regional Administrator or designee. Payment will not be made on any invoice submitted past sixty (60) calendar days after the Program Agreement fiscal year. j. Recovery of Fees: lf the County bills and is paid fees for services that DSHS later finds were (a) not delivered or (b) not delivered in accordance with Program Agreement standards, DSHS shall recover the fees for those services and the County shall fully cooperate during the recovery. k. Preadmission Screening and Resident Review (PASRR) Administration: The County may billfor administration costs as identified in Exhibit B. Monthly claims for administration cost will be based on the actual PASRR expenditures multiplied by 1oo/o. l. Reimbursement for Partnership project: A claim of $3,000 per student for each completed Job Foundation document that is at a satisfactory or above rating will be requested through the AWA system as other monthly cost. m. Job Foundation report line item 95 as identified in the ADSA Web Access (AWA) billing system. A copy of the completed Job Foundation document will be sent electronically to the shared mailbox located at: DDAJobFoundationReports@dshs.wa.gov n. Job placement verification for transition students: The AWA Employment Output for lndividual Employment will be completed and submitted with payment request to verify employer, job start date, job type, etc. o. Job Foundation Administration: The County may billfor administration costs as identified in Exhibit B. Monthly claims for administration cost will be based on the actual expenditures multiplied by 10%. Participating counties will use line item 13. lntermediate Care Facilities for lntellectual Disabilities (lCF/lD) Agreement. lf applicable per 42 CFR 483.410, the County shall assure that all county-operated or subcontracted programs serving persons living in ICF/ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/lD resident. Single State Medicaid Agency-Health Care Authority (HCA): HCA, as the single state Medicaid Agency, has administrative authority for Title XIX coverage per 42 CFR 431.10. DSHS is the operating agency for the Home and Community Based Waivers for services for people with developmental disabilities. The County only has responsibility for services covered in this agreement. DSHS/DRW Access Agreement: The DRW February 27,2001 Access Agreement with DDCS is incorporated by reference. The County assures that it and its subcontractors have reviewed the Access Agreement. The agreement covers DRWs access to individuals with developmental DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Page 17 Special Terms and Conditions disabilities, Clients, programs and records, outreach activities, authority to investigate allegations of abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS contracted services. 12. Confidential lnformation. All Counties and their subcontractors must: a. Ensure the security of Confidential lnformation, and b. When transporting client records containing Confidential lnformation outside a Secure Area, one or more of the following as appropriate: (1) Using a Trusted Network; or (2) Encrypting the Confidential lnformation, including: (a) Email and/or email attachments (b) Confidential lnformation when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.Data Security Requirements. Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization, or transmits more than 5 records at one time. 14.Supersession of Prior Data Security Agreement. lf the Parties hereto have previously entered into a Standalone Data Security Requirements Agreement, both Parties hereby agree that upon mutual execution said Agreement shalltake precedence as the sole Data security Agreement between the Parties. DSHS Central Gontract Services 1 769CS Cou nty Ag reement (12-26-2025) Page 18 1 Special Terms and Gonditions 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 lnformation Processing Standards Publications for the encryption of electronic data issued by the National lnstitute of Standards and Technology (https://nvlpubs.nist.gov/nistpubs/FIPS/NlST.FlPS.197-upd1.pdf). b. "Authorized Users(s)" means an individual or individuals with a business need to access DSHS Confidential lnformation, and who has or have been authorized to do so. c. "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. For purposes of this contract, data classified as Category 4 refers to data protected by: the Health lnsurance Portability and Accountability Act (HIPAA). d. "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 iCloud, Dropbox, Box.com, and many other entities. Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and Rackspace. e. "Encrypt" means to encode Confidential lnformation 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 128 bits (256 preferred) 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. f. "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. g. "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. h. "Multi-factor Authentication" means controlling access to computers and other lT 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 physicaltoken; and something the user is, a biometric identifier such as a fingerprint, facial scan, or retinal scan. "PlN" means a personal identification number, a series of numbers which act as a password for a device. Since PlNs are typically only four to six characters, PlNs are usually used in conjunction with another factor of authentication, such as a fingerprint. i. "Portable Device" means any computing device with a small form factor, designed to be transported from place to place. Portable devices are primari[ battery powered devices with base computing resources in the form of a processor, memory, storage, and network access. Examples include, but Page 19 DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Special Terms and Conditions are not limited to, mobile phones, tablets, and laptops. Mobile Device is a subset of Portable Device. k. "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. "secure Area" means an area to which only authorized representatives of the entity possessing the Confidential lnformation 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 lnformation is not available to unauthorized personnel. ln 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. "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. m. "Unique User lD" 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. Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency (https://watech.wa.qov/policies?combine=&field cateqories tarqet id=8O&field tvpe tarqet id=All), and of the DSHS lnformation Security Policy and Standards Manual. Reference material related to these requirements can be found here: httos://www.dshs.wa.qov/ffalkeepinq-dshs-client-information- private-and-secure, which is a site developed by the DSHS lnformation Security Office and hosted by DSHS Central Contracts and Legal Services. 3. Administrative Controls. The Contractor must have the following controls in place 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. lf the Data shared under this agreement is classified as Category 4 data, the Contractor must be aware of and compliant with the applicable legal or regulatory requirements for that Category 4 Data. 2. 4. c. lf Confidential lnformation shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment for the system(s) housing the Category 4 Data. Authorization, Authentication, and Access. ln order to ensure that access to the Data is limited to authorized staff, the Contractor must: DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Page 20 f g. Special Terms and Conditions 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 lD 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 lD used to perform the action d. Ensure that only authorized users are capable of accesslng 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 lnformation 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 B 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 lD, or any form of theirfull 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. When accessing Confidential lnformation from an external location (the Data will traverse the lnternet or otherwise travel outside the Contractor's network), mitigate risk and enforce password and logon requirements for users by employing measures including: (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 lnternet, which is not a Trusted Network. h DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Page 21 5. DSHS Central Contract Services 1 769CS Cou nty Ag reement ('12-26-2025) Special Terms and Conditions (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) lf the contract specifically allows for the storage of Confidential lnformation 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 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 localworkstation hard disks, access to the Data will be restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User lD 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 lD and Hardened Password or other 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 lnformation 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. Page 22 Special Terms and Gonditions c. Optical discs (CDs or DVDs) in localworkstation optical disc drives. Data provided by DSHS on optical discs which will be used in localworkstation 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. Opticat 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 lD 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.. f. 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 lD 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. lf so authorized, the Data shall be given the following protections:: (a) Encrypt the Data. (b) Control access to devices with a Unique User lD and Hardened Password or stronger authentication method such as a physicaltoken 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. (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. DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Page23 Special Terms and Conditions (2) When being transported outside of a Secure Area, Portable Devices and Portable Media with DSHS Confidential lnformation 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 lnformation 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. lf backup media is retired while DSHS Confidential lnformation 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.9. Storage Area Network drives, virtual media, etc.) as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. lf so, such media will be protected as otherwise described in this exhibit. lf this media is retired while DSHS Confidential lnformation stillexists upon it, the data will be destroyed at that time in accordance with the disposition requirements below in Section 8 Data Disposition Cloud storage. DSHS Confidential lnformation 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 attest to the contact listed in the contract and keep a copy of that attestation for your records 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. (f) The Data will not be downloaded to non-authorized systems, meaning systems that are not on the contractor network (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. (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 HIPAA compliant. DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Page 24 6. Special Terms and Conditions (3) lf the Data includes protected health information covered by the Health lnsurance Portability and Accountability Act (HIPAA), the Cloud provider must sign a Business Associate Agreement prior to Data being stored in their Cloud solution. 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. Data Segregation. a. DSHS category 4 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. lt 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.9. hard disk, optical disc, tape, etc.) which will contain no non-DSHS Data. (2) DSHS Data will be stored in a logical container on electronic media, such as a partition or folder dedicated to DSHS Data. (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 practicalto 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. 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: 7 8. DSHS Central Contract Services 1 769CS County Ag reement (1 2-26-2025) Data stored on:Will be destroyed by: Server or workstation hard disks, or Using a "wipe" utility which will overwrite the Data at least three (3) times using either random or single character data, or Page 25 Removable media (e.9. floppies, USB flash drives, portable hard disks) excluding opticaldiscs Degaussing sufficiently to ensure that the Data cannot be reconstructed, or Phvsicallv destrovino the disk Paper documents with sensitive or Confidential lnformation Recycling through a contracted firm, provided the contract with the recycler assures that the confidentialitv of Data will be protected. Paper documents containing Confidential lnformation requiring special handling (e.9. protected health information) On-site shredding, pulping, or incineration Optical discs (e.9. CDs or DVDs)lncineration, shredding, or completely defacing the readable surface with a coarse abrasive Maqnetic tape Deqaussinq. incineratinq or crosscut shreddinq 9 Special Terms and Conditions Notification of Gompromise 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. lf 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. Data shared with Subcontractors. lf 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. lf 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. 10. DSHS Central Contract Services 1 769CS County Agreement (12-26-2025) Page 26 Exhibit B Program Agreement Budget X Original Budget Budget Revision REVENUES FiscalYear Fund Source Oriqinal 1"t Revision 2nd Revision 3'd Revision 2026 State onlv 567,912 576.712 Medicaid 555,171 562,371 TotalRev $1 ,1 23,083 s1 .139.083 $$ FiscalYear Fund Source Oriqinal 1st Revision 2nd Revision 3'd Revision 2027 State only Medicaid TotalRev $$$$ Job Foundation Funds PASRR Funds State Funds TOTAL ADM|NTSTRATION (11, 12.13. 14\51072 41786 92,858 OTHER CONSUMER SUPPORTS (31,32,41,92,93,94, 97)33411 60,748 CONSUMER SUPPORT STATE.ONLY G2.64,65,67,69) Child Development (61) MEDICAID CLIENTS rc2.64.67. 69. 95. 96)4339',17 439917 867.834 ROADS to COMMUNITY LIVING G2.64,65,67, 69) TOTAL 518.400 503,040 1,021,440 DSHS Central Contract Services 1 769CS County Ag reement (12-26-2025) Page 27 Attachment F ACCESS AGREEMENT BETWEEN \ilASHINGTON PROTECTION AI\[D AI}VOCACY SYSTEM, INC., AND THE DIYISION OF DEYELOPMENTAL DISABILITIES, DEPARTMENT OF SOCIAL AND IIEALTII SERWCDS. This agreement is entered into by the Washington Protection and Advocacy System, Ine. ftereinafter WPAS), the protection and advocacy system auttrorized purs!?nt to the Developmental Dsabilities Assistance and Bill of Rights Act of 1975, 42 U.S.C. sec. 6000, e!--Eq:, to investigate allesed incidents of abuse, neslect, and rishb violations of persons with developmental disabilities, and'ihe Division of Develbpmlntal Disabllities (hereinafter DDD) of the Departrnent of Social and Health Services, for the purpose of clarifying the rights and responsibilities of WPAS with respect to its access to individuals with developmental disabilities, clients, programs, and records. The Departrnent of Social and Health Services, specifically DDD, is responsible for providing serviCes to individuals with developmental disabilities, to the extent flrnding is available. in providing those services, DDD must protect the confidentiality of records and information regirding thbse individuals pursuant to the state and federal confidentiality laws. WPAS is charged by federal law to protect the legal and human rights of individuals with developmental disabilities. WPAS provides legal and rglated advocacy services to meet that obligation. WPAS is also required to maintain the conlidentiality of records and information regalding individuals with developmental disabilities consistent\4ltth 42 U.S.C. $ 6000, et seo. This agteement governs the access of Washington Protection and Advocacy System to DDD employees who do not work in Residential Habilitation Centers (RHCs) and records maintainedby ODp iarhictr are associated with individuals with developmental disabilities living outside of RHCs. Federal laws and regulations also provide WPAS with access to community programs and individuals with developmental disabilities served by DDD contracted providers. DDD will work with commr.urity providers and WPAS to arrive at an agreement governing access to DDD contracted prog&ms and the people served by them. General. A. That all tcrms uscd in this agrccmcnt which arc dcfincd in the Developmental Disabilities Assistance and Bill of Rights Act of 1975,42 U.S.C. $ 6000, et seq., will have the meaning given to them in the Act, unless otherwise stated in this agreement. B. This agreement is intended to carry out the provisions of the Developmental Disabilities Assistance and Bill of Rights Act of 1975, 42 U.S.C. $ 6000, et. seq., and therefore, if this agreement is or becomes inconsistent with the Act or the implementing regulations promulgated thereto, the terms of the Act and its implementing regulations will control. C. If any provision of the agreement is held invalid, the parties intend that the remainder of the agreement not be affected. I. COMMTINITY ACCESS AGREEMENT II. Definitions. A. Activelv Aggressive: means that the individual with developmental disabilities is assaulting others or is threatening to do so, or the individual with developmental disabilities is actively harming him or her self. B. Client Services: means legal representation. The term does not include monitoring and observation. C. Comnlaint: as defined in 45 CFR 1386, or hereinafter amended, includes, but is not limited to, any report or communication, whether formal or informal, written or oral, received by WPAS including media accounts, newspaper articles, telephone calls (tncluding anonymous calls), from any source alleging abuse or neglect of an individual with a developmental disability. D. DDD Consumer: means an individual with a developmental disability receiving support from a program firnded by DDD. The term includes DDD consumers who have died or whose whereabouts are unknown. See 45 CFR 1386.22(aX2). E. DDD Employees: includes those individuals who are employed by DDD or who volunteer for DDD to provide services to individuaJs with developmental disabilities. F. Emersencies: means actions, omissions, or conditions that immediately threaten an individual with a developmental disability's health, life or well being. G. Individual with a Develoomental Disability: means individuals with developmental disabiiities in the process of applying for or who have been found eligible for services from DDD. H. Monitoring: means unaccompanied access to all residents of a progtam at reasonable times, which at a minimum shall include normal working and visiting hours to ensure progam compliance with respect to the rights and safety of DDD consumers. See 45 C.F.R. $1386.22(e). I. Probable Cause: as defuned in 45 CFR 1386, or herernafter amended, means a reasonable gound for belief that an individual with developmental disabilities has been, or may be, subject to abuse or neglect. The individual making such determination may base tfue'decision on r-casonablc infsrenccs drawn fi-om his or hcr cxperielrco ol h-ainiug regalding similar incidents, conditions or problems that me usually associated with abuse and neglect. J. Program: consistent with the definition of "facility" in 45 CFR 1386.19 includes any setting that provides care, treatrnent services and habilitation, even if o"ly "as needed".or undei a conFactual arrangement. Programs include, but are not limited to, community living arrangemen8 (e.g., group homes, adult farnily homes, congregate care facilities, boarciing homes, individual residences and apartmenls), day programs, juvenile detention centers, nursing homes, homeless shelters, jails and prisons. K. Provider: means those individuals/corporations with whom DDD conrracts to provide services to DDD consumers, including but not limited to behavioral management services, family support services, vocational support services, sheltered employment, tenant support, inteniive tenant suppofi, altemative living, supported living, group home, adult fannity home, and congtegate care facilities, chore services, medicaid personal care and other personal assistance services. 2COMMTNITY ACCESS AGREEMENT uI. L. Provider Employee: includes those individuals who are employed by a provider or who volunieer for a provider to provide services to individuals with developmental disabilities. M. Recordg: as defined in 42 U.S.C. $ 5042 and 45 CFR 1386(22)(b), or hereinafter amended, reports prepared by any state staffor reports prepared lYan agenc.y charged with investigating reports of incidents of abuse, neglect, injqry, or death that describe incidents of abuse, ieglect, injury, or death occurring at a facility, investigative documerrts and discharge plannine iecords-. The term records also includes DDD consumer abuse and neglect 'c,ommiti'ee reports but does not include peer review death reports, attorney work produc! and records which are othenuise privileged under state or federal law. N. Regular Proeram Activitv: includes work assignments, education programs , therapy, health services, and daily living activities. O. SOLA: means the DDD consumer support prcgram, State Operated Living Altemative. P. WPAS Client(O: (l) Individuals with developmental disabilities who do not hqve a guar4_iqr or legal representative and who indicate either orally or in writing to a WPAS employee that they want WPAS to represent them' (2) Individuals with developmental disabilities without guardians who .are unable to communicate their rryishes regarding protection and advocacy services when WPAS has received a complaint of abuse and/or neglect about the individual with a disabilify, or WPAS dctermincs that there is probable cause to believe that the individual with a developmental disability has been abused or neglected. (3) individuals with developmental disabilities who have a guardian or legal ieirresentative where the guardian or legal representative has consented to the representation in writing. (4) Individuals with developmental disabilities whosg guardian _ or legal iepresentative fails or refuses to act on behalf of the individual with a developmental diSability, despite being contacted by WPAS, after a court has determined that the guardian has failed or refuses to act. (5) A WPAS client does not include those instances where WPAS represents the guardian. WPAS shall notify the DDD Regional Administrator or designee in writing that it represents the individual with developmental disabilities and forward a copy of that notice to either the guardian or the individual with developmental disabilities. a. WPAS Emplovees: includes paid employees and volunteer employees as identified by WPAS. Each employee shall carry WPAS identification. Access to Programs. A. DDD will not obstruct WPAS access to programs when consistent with the law and will ensure that SOLA and other programs staffed by DDD employees will comply with this agreement. For programs which contract with DDD to provide services, DDD will not 3COMMLINIry ACCESS AGREEMENT IV obstruct WPAS access to Fograms when consistent with the law, but WPAS will assume primary responsibility for enforcing its access rights. WPAS will attempt to resolve access issues at the lowest level possible. In cases where there is danger of imminent or continuing harm to an individual with developmental disabilities WPAS will report the occurrence to DDD, consistent with the Washington State Bar Association Rules of Professional Responsibility and other applicable state law. In those cases and wher-elhere is,a pattem of failure to provide access for WPAS to a Fogram or DDD consumers, WPAS will report this failure to DDD, and DDD will respond by investigating the allegation of failure to provide access and will take appropriate actions. ts. WPAS staff will identif themselves to any staff present when they arrive qt a program by showrng a WPAS photo identification badge. WPAS shall provide the DDD ilirector wi:th a list of employees and their pictures by July 1,1997, and WPAS shall update this list as necessary. C. WfAS shall have access to SOLAs and other proglams staffed by DDD employees as specified in this section. This agreement does not affect the right of an individual with a developmental disability served by such a program who owns or rents his or her own home to deny access to WPAS to his or her home. However, DDD ernployees do not have the right to deny WPAS access to programs or the residences of individuals who are served by proptrams. D. WPAS staff shall have access to all programs when WPAS has received a complaint or has probable cause to believe than an iniident ofabuse, neglect, or other rights violation has occurred; E. WPAS staff shall have access to all living areas of SOLAs and other programs staffed by DDD employees during regular business hows for the purpose of providing information on legal rights and self advocacy to the individuals with disabilities who participate in the program. During the course of such access, WPAS staff shall be allowed io engage in informal discussions with the individuals with disabilities, out of the presence of DDD employees or others, in an area that affords privacy. F. WPAS staff may visit any location where residents'are served by DDD employees, where the purpose is observation or monitoring compliance with respect to the rights and safety of service recipients (CFR 1386.22(g)QD. Such observ{ign and monitoring activities need not be limited to clients of WPAS, and WPAS staffshall not be required to ssfuedulc ur give priol notice of such visits tu DDD eruployees, prwided that WIAS lms ths permission of a DOp consumer. WPAS staff shall be pe-rmitted to monitor.the program without an accompanying DDD employee. WPAS staff shall conduct all monitgring activities in a manner which is respeCtful of the privacy of the individuals with disabilities who reside in the monitored program. Access to Individuals with Developmental Disabilities. A. WPAS staff will be provided access to their clients in the same manner as such access is provided to privately retained and/or court appointed attomeys. DDD shall assist and suppolt the profeisional relationship bemeen W?AS and its ciients. Written consent for such access is not required. B. WPAS recognizes that ail individuals with developmenlal disabilities have the right to refuse to talk with WPAS, to have a third party present during the interview, or to reschedule the appointment for a more convenient time. WPAS shall advise their clients and other indivicitials with developmental disabilities with whom they have contact of these 4COMMfLNITY ACCESS AGREEMENT rights before each meeting. A person who does not wish to talk with WPAS staffshall be all"owed to communicate fris diiectly and privately to WPAS staff unless he 91 sh9 overtly manifests fear of being alone with the WPAS staff. When the individual with a developmental disability overtly manifests such fear by words or behavior, WPAS shall respecf that person's desires and not meet alone with that person. C. WPAS will encourage its clients and other individuals with developmental disabilities to notifu DDD and/or providers of complaints regarding DDD services and to resolve those complaints through any existing dispute resolution process. D. WPAS staffshall comply with all safety and security requirements of DDD. DDD will communicate these requirements to WPAS staff. E. DDD employees shall not interfere with WPAS staff in obtaining. a p{y3te sp1c9 for meetings befween VfpaS staff and individuals with developmental disabilities. Private soace d--oes not mean a comer of a common area room or other location which would afford other residents and DDD employees open access to WPAS employees_ in living.areas or-on the grounds. I)DI) employees siallreipectthe confidentialityneeds_of the individual with a devElopmental disabiliiy ina WpaS. Where an individual with a dele]gnmegtal.disability indicatls that he or she does not want to meet in a private space, WPAS staff will respect this request. F. WPAS staffwill not be required to schedule visits with DDD employees in advance of their visits. However, WPAS siaff may contact DDD employees to do so if access to a WpAS client or other indMdual with a developmental disability will be facilitated due to the individual's daily activities. G. WPAS staff shall have the right to unaccompanied access to any SOLA or program staffed by DDD employees, and acceis to any indiviilual WPAS client or DD consumer they are authorized to serve, subject to the following limitations: (l) While WPAS need not notify the DDD employees.prior to meeting with its ilient or DDD consumer, WPAS agiees not to disturb a client or DDD consumer if the WPAS employee arrives at the iesidence or other building in which the client or DDD consum6r ii served and the client or DDD consumer is engaged in regularly scheduled program activity. In such case, WPAS staff will be permitted^to observe or otherwiie viritr' ttre programming without disaubing it. If WPAS staff presence disfurbs or is objecfed tb bt the WFaS client or any other DDD consumer who is present, WPAS"staff shall-make arrangements t9 meet with the WPAS client or bDD conr,1*er at a later time. Where- consulted prior to making an appointment DDD employees will cooperate with WPAS staff in making scheduling anangements. The WPAS erirployee shall not dishrb nor intemrpt the activity. If the ictivity is confidential, WPAS shall obtain the client or DDD consumer's permission to observe the activity or shall respect the client or f)DD consumer's iisht to privacy. WPAS statl'wil[ then either wart untrl the actrvtty ts completed or reichedrile the visit at a time that is mutually agreeable to WPAS staff and its individual client or DDD consumer, no later than 48 hours later. (Z) If the WPAS employee arrives for a meeting with a client or DDD consumer i"a mr individual is actively aggressive, in programming to address this behavior, or receiving "oneto-one" supervision, in such a situation, WPAS staff will be nermittel to observe the individual from a safe distance or otherwise veriff that the individual is actively aggressive. WPAS staffwill then either: )COMMLTNITY ACCESS AGREEMENT v. (a) wait until the individual's aggressive behavior..has_lqnped and be pemritted to meet with the individual .privately w$le-DDD employees remain in viewing distance; unless such distance woqq place the individual with developmental disabilities at serious risk of harm based on that individual's documented behavioral issues; if the individrnl would be at serious risk of harm, WPAS and DDD shall work cooperatively to address WPAS need for confidentiality with the individual's need for safety; provided that any such interview does not interfere with the individual's behavior Support Program, Individual Prograry Plan, Individual Service PIan, or oth6f program plan, nor interfere with staffing needs for other individuals withdevelopmental disabilities; or (b) reschedule the visit at a time mutually agreeable to WPAS and DDD employees, but no later than forty-eight (48) hours; (c) if the WPAS statr is notified that an individual is either actively aggressive or receiving one-to-one supervision and if knowing this the staff c[6oses to meet with t[e individual, WpeS agrees to release, indemniff, and hold DDD, DSHS, the State and its employees, agents, offtcers, and s-ervants harmless for any iqiuries that occur hom any claims or cause of action asserted by any WpaS employee or agent who is i4ry.e4 as a result of any act committe&by an individuil with d-evelopmenta.l^disabilities except that those circumstances where DDD employees' willful misconduct is the proximate cause of the injury to WPAS' employee.or agent. WPAS agrees ihat irs staff shall sign a itat-ement to this effect prior to reques.ting to meet with any such individual. If the WPAS staff refuses to sign such an agreemurt, DDD employees may deny the WPAS staff access to the inldividual.until such tim6 as DDD employees determine that safety to the WPAS staff is no longer an issue. When a WPAS staff member elects to meet with an individual who is actively aggressive, it is neither negligent nor willful misconduct for a state employee to allow the meeting to take place. H. All individuals with developmental disabilities who wish to contact WPAS staff shall be provided uncensored access to writing. materials, WPAS' address and toll-free ielephond number, a stamped envelope, an&or access to a telephone for private conversations without monitoring by or permission from DDD employees. L SOLAs zurd proglanr staffcd by DDD onrployecs shall pcrmit individuais with Jevelopmental disabilitiJs to set appointments with 'WPAS staff at tilnes agreeable to both the individual with a developmenlal disability and WPAS staff If the D_DD employees know that a meeting with i DDD conswnei witt be disruptive of the DDD consumer's rieular program acti-vity, WPAS staff shall be informed of this and allowed to reschedule ttrE appdintirent in orderto meet with the DDD consumer so that the appointment does not disrupt his or her regular activity' Access to Records of Individuals with Developmental Disabilities. A. W"AS has access to records as provided in 42 U.S.C: $ 6042, et. seq. WPAS tlas leeal authority to review an individual r,rrith developmental disabilities' records only whqn ifrEre is consent or, if a DDD consumer is unable to ionsent, there is a complaint or probable "ur6" to believe a pOD consumer has suffered abuse or neglect. WPAS has no general right to review records except in these circumstances. 6COMMLNITY ACCESS AGREEMENT B. Upon receiving a valid, written consent, DDD will have 48 hours in which to schedule an appointrnern with WPAS so that it may come to the record location to review specified recoids. DDD will verify that WPAS has received consent to view such records, or jf the DDD consumer is rurable fo consent and thers is no guardian to consent, that there is a complaint or proboble couse to bclieve the DDD oonsumer hos suffered obuse or neglect. bOO snAi make the requested records within its possession available within five working days from the date the request is made. C. WPAS may access records of: (l) any DDD consumer if he or she consents, or if he or she has a legal guardian with the power to consent for the DDD consumer and that guardian consents; a) the DDD consumer or guardian shall give written authorization for access on a form approved by WPAS and DDD jointly. (2) any DDD consumer: a) who by reason of his or her mental or physical condition is unable to authorize WPAS to have access to their records; b) who does not have a legal guardian, conservator, or other legal representative, or for whom the legal guardian is the state; and c) with rcspuot tu whonr a cotrplaint has been received by WPAS t-rr wiLh respect to whom, as a result of monitoring or other activities there is probable cause to believe that such individual has been subject to abuse or neglect. d) If records are requested pursuant to this section, the request shall be in writing and will staie that the resident, by reason of his or her mental or physical condition is unable to authorize WPAS to have access to his or her iecords, does not have a legal representative, and that a complaint has been received by WPAS with respect to the DDD consumer or that there is probable cause to believe the residem has been subjected to abuse or neglect. The DDD case manager will make a determination regarding whether a DDD consumer is able to consent to access within 3 working days, except in c.qse of an emergency, (3) in the case of a resident who has a legal guardian, and upon request by W?AS, DDD will provide WPAS with the name, address and telephone number of the legal guardian by 5 p.m. the next business day so that WPAS can contact such representative and offer its assistance. If the guardian !1s leen contacted by WP$S ana Aited or refused to act on behalf of the individual WPAS has received a complaint suffrciently that sufficiently identifies the individual or WPAS has probible cause to believe that the health or safety of the individual is in serious and immediate ieopardy, WPAS shall obtain court approval for such access. a) lf a guardian refuses to consent to allow WPAS access to records, and WPAS still wants access, WPAS will file a lawsuit to access the records and allow a lourt to determine whether the guardian has failed or refused to act on behalf of the DDD consumer. WPAS agrees to provide legal notice to DDD of any such proceeding. If the grrardian refuses to provide written 7COMML|NITY ACCESS AGREEMENT consent for WPAS to access the records, DDD shall not make the records available absent a court order. b) WPAS shall attempt to contact the guardian to obtain consent. Unless an emergency exists, theh WPAS shall contact the standby guardian if one has beentesignated. If no standby guardian is appointed and the guardian is unavailabl-e, and WPAS determines that the DDD consumer is at risk of serious injury or death, DDD shall make the records available to WPAS to review. D. WPAS staffmay review the requested records within normal business hows in the building or room in whi'ch such records are provided. A DDD emp!9ry9gay remain in the ioo* #trit" tl1e records are viewed. Under no circumstances may WPAS staff remove the original records, or any part thereof, from the room where they are viewed. E. WPAS agrees to reimburse DDD for the costs of copies.at the same rate-charged for ouUti" disclosurJrequests, currently $.15 per page. When feasible, copigg will be provided 'on the day the copies are requestid. If thaf iC not possihle, DIJD will make the copies available within l0 days of the requesl F. WPAS shall request.quardian information or access to DDD consumer records of the bOO Regional Administraltor of the region in which the DDD consumer resides. Thereafter] their contact regarding that DDD consumer shall be the regional administrator, or his or h"r designee. DOO stratt provide WPAS a list with contact information for purposes of access io records. DDD agiees to update that list at least annually. G. In order to access DDD records, WPAS will send a written request directly to the DDD Regional Administrator or designee in custody of the records. In the^request,-WPAS *in la"nfif,' the individual whose rec-ords it seeks. WPAS need not identify the.individual by name, 6ut must sufficiently identiff the individual so that the person reviewing -the iJrr,rest "rut drter*ine whose records ard being sought. WPAS will specifu which records it #;tr;Jfbi*triitr time periods. WPAS wil also indicate that it has received a complaint "oncerning the individual io that it has probable cause to believe the individual has suffered ubup o. #glect. WPAS need not flmGr speciff the nature of the complaint nor who made the complaint. H. In the event DDD denies access to records pusuant to a request, WPAS staff may requesf that the denai be n wnting and include the reason for the denjal. I. WPAS will limit its request to records it considers necessary investigation. DDD may request that wPAS specilically identiff the seeking if the request is too broad or voluminous' Outreach. A. All individuals with developmental disabilities shall have access to WPAS staff for ifr! pu.poi" of obtaining information about their legal {glrts3rnd self-advoclcy. WPAS staff ifr"fi Ui aitoweO to engige in infomral discussit-rns with DDD qorlstnners who wish to speak to them out of the presence of DDD employees in an area that affords privacy. B. WpAS may hdve regularly scheduled information/training sessions- Ft. ?Pn.onr**rr and parents/guardiins/family members regarding WPAS' services and individual iiettr. DDD employeeJ may attend ouheach and scheduled information sessions only with ad'vance written permission of WPAS staff. to accomplish its records that it is w. 8COMMLNITY ACCESS AGREEMENT C. DDD agrees to give WPAS a list of ail current DDD consumers and their addresses. DDD will provide WPAS an updated list annually. D. DDD agrees to provide DDD consumers with notice of WPAS services at the time of application for DDDservices. WPAS will provide DDD with copies of their brochure and/or any other information they want DDD to distribute at thattime. E. DDD agrees to require contractors to comply with 42 U.S.C. $6000 et. seq. and f5 C.F.R. Pads 1385-86 by including the requirement in contacts. Current contracts will be amended to include this requirement when they are renewed. VII. Authority to Investigate Allegations of Abuse and Neglect A. WPAS shall have unaccompanied reasonable access to DDD consumers and facilities when necessary to conduct a full investigation of an incident of abuse or neglect- This access shall includ-e the opportunity to interview any individual with a developmental disability, any DDD or providei employee, or any other persol who might be reasonably believeci Uy WnaS to have knowledge of the incident under inyestlgaliqq and to review what WPAS is entitled to review pursuant to this agreement. WPAS shall be permitted to do its own investigation ofallegations ofabuse or neglect regardless ofany pending action or investigation by the State or any other individual or enttty. B. WPAS' investigations shall not interfere with any other ongoing investigation. SryAS employees shall not visit meas at times that would violate any person's right to pnvacy. C. DDD shall allow and encowage all employees and providers to talk openly with WPAS employees. WPAS will not ask staff to disrupt their __1p1k^ schedules or responsibiliiies to talk with WPAS. Except in cases of emergency, W?AS will schedule appointrnents with staff in advance. D. While DDD and provider employees shall be encouraged to cooperyte with WPAS, employees have the righi to refuse to tatt< witfr WPAS. WPAS shall notifr employees of ttrai rigtrt prior to any attempt to interview them. E. Any complaint concerning WPAS staffshall be immediately brought to the attention of the WPAS Ex-ecutive Drector or his or her designee. Upon receipt of a complaint, the WPAS Executive Director or his or her designee shall conduct an investigation and submit a written response to the State within fourteen 1t+; days in an eflort to resolve any complaints as expediently as possible. DDD reserves the right to file formal charges if the behavior places a DDD consumer's health or safety at risk. F. WPAS shall inform DDD and providers, in writing, of its findings and concems upon completion of any investigatron qclivrty undertake,n pursuant to tts authonty under 4:2 U.S.C. $ 6000 et. seq., and ttre access rights granted to WPAS in this agreement, in an effort to resolie DDD consumer complaints or concems prior to commencing litigation, unless WPAS bclieve that such delay wbuld result in serious injury or harm to the DDD consumcr' \IIU, Implemenfafionofthe.Agreement. A. The DDD Director shall ensure that each supervisor will conduct an annual meeting with his or her staff to provide information regarding the parties' rights and rlsponsibilities under this agreement. ine Onp director shalf ensure that each employee of DDD has read 9COMMLNITY ACCESS AGREEMENT IX. and signed a copy of a form indicating that they have read this agreement at the time of hire and at*the time of his/her annual eviluation. 'DDD and WPAS shail develop a mutually agreed to summary of this agreement for use in informing DDD employees of the parties' ri-ghrs and responsibilities. When DDD and WPAS develop-and agree regarding the content oithir summarTr, DDD employees shall be required to read the srrmmary, rather than reading this agreemeni and acknbwledge that they read and understood the summary with a signature. B. The agreement is effective as of the date it is signed. C. DDD agrees that having an agreement in place that_would govem WPAS and DDI) provider relationships is appropriate. -This agreement will affect contractual relationships, so it will be negotiated with lioviders prior to implementatio:r. Thiq negotiation will take place during the f997-1998 prdvider contract negotiations. DDD_will rcquest WPAS review the prop&ed confact langi:age prior to confiact signing Fy ?Op. Th9 Sqal of this negotiation i,rof.r. will be to ailv6 at an agreement whicli implements the federal statutory and iegulatory requirements in a mannei consistent wi$ the_f..r.oyision of q'rqlity, individualized ""iri""* ind supports to people with developmental disabilities living in the commrurity. D. The DDD director will make changes as necessary to implement this_agreement by September l,1997,and prior to implementing changes will confer with WPAS. E. WPAS and DDD agree to work together to assist providers in becoming Qpiliar with WPAS access to programs. DDD agrees to host a forum in eachregion to familiarize providers with the access provisions. WPAS agrees to make staffavailalfe as.presenters at iegional forums, and otherwise as mutually agree! t9 with provide.rs. DDD will distribute to pr6viders a summary of the access provisions. 'Itu*s summary will be prepared by WPAS, ina *itt be subject to the review and approval of DDD prior to distribution. Miscellaneous. A. WPAS agrees that its staffshall not give medical advice and shall not engage in the oractice of mediline. It is WPAS' intent and purpose to give legal advice. For example, 'WPAS will not tell DDD consumers not to take medication or that medications are wrong for them, WPAS will not discourage individuals with developmental disabilities from participating in programs or activitiei. WPAS may explain DDD consumer legal rights includine ttr'e ridht Io informed consent, their right to be told of the risks and benefits of medicati"on or iredical procedures, their righi to refuse to take medications and the orocedure to follow if the-DDD consumer does not wish to take medications, and their right io refuse to participate in experimental programs or research, all as guaranteed under state and federal law. B. WPAS agrees that there are some DDD consumers who are identiled as medically fragile or to havJbehavioral concems that require constant monitoring. ,If WPAS requests a meEtins with such a DDD consumer and DDD determrnes that the llDD consumer cannot be leftinsupervised with a WPAS employee, a DDD or provider employee shall.be pfs:lt durins any meetings. If DDD consumers are hospitalized due to medical conditions, DDD gr privicltr enrplJyees rnay rcrnain within viewing distalce if necessary for the DD^D consumer's heafih dnd safety. The employees will not interfere with the meeting -e-1cep! for medical reasons and will respect the DDD consumer's privacy to the extent possible given his or her medical needs. COMMT'NITY ACCESS AGREEMENT l0 C. This agreement delineates the usual process by which WPAS and DDD will wo* together. In s6me situations, it may be necessary to amead these prccedures. WPAS and DDD may agtee to modiff these procedwes as necessary tbr any particular situation. x.Dispute Resolution. A. WPAS and DDD agree that informal resolution of disptrtes is preferred. If WPAS staff and the DDD Regional Administrator or designee are unable to agree about an, issue regarding interpretation or application of this agreement, .they will request the WPAS Eiecutiv? Direltor and the DDD Director review the situation and attempt to resolve the disagreement. B. The Directors Meeting and Mediation process are mandatory for both parties. The only exception to this term of the agreement is where WPAS, in good faith, has probabld cause to believe that there are -exigent circumstances wananting immediate iccess. Such circumstances are defined as "emergencies" as defined in the agcess agreements. In such cases, the WPAS Executive Director or his or- her designee shall c6ntact the Director of the Division of Developmentai Disabilities or his or her designee; and/or Office of the Attomey General to attempt to resolve the dispute. If the exigent access dispute is not resolved by the end of the following.business day, WPAS.may immediateiy take any necessary legal action, including seeking a temporary restraining order and preliminaiy injunction br an order to show cause in order to secure the necessary access without going through the ADR process discus,sed herein. When WPAS does tak6 such action, it sl'rall give the Office of the Attorney General advance notice of such action by telephone and facsimile. C. In thc cvcnt that thcrc is an accoss disputc rcgarding any aspcct of thc Acocss Agreements between WPAS and DDD (Community),_the aggrieveq parly shall send written no*tice to the director of the other party (e.g. WPAS Executive Director, the Director of DDD, or their designees) of the diipute and the desire to meet to attempt to resolve the dispuie. The DDD director (or his/trer designee) shall meet with the WPAS Executive Director (or hiVher designee) within ten days after receiving written notice form the aggrieved party. The date of receipt of notice shall be in accordance with Civil Rule 6 of the Wistrington Lburt Xules. 'lhe nieeting may take place rn person or telephonically. 'I'he parties have the right to bring their counsel to the directors meeting, howevm it is the ^preference of the parties not to have their counsel present. In the event a party intends to Lave his or hcr counsel preseirt, that party will advise the other parry of this intent iu advauce of the meeting. Howevbr, when either director (or his or her designee) is an attomey, it will be understood and expected that the other director may have his or her attorney present withor* prior notice. D. In the event. that the access issues are not resolved by a meeting between the Director/CEO and Executive Director of WPAS or their designees, the parties agree to attempt to resolve the dispute through mediation absent exigent circumstances as described in parlgraph l. An available mediator from the mutuaily agreed upon Mediator Panel list as described below will be used to conduct the mediation. Mediation will be scheduled to occur as soon as possible following the directors meeting, but will occur no later than 30 days fiom the time mediation is agreed upon by the parties, absent written agreement by both parties to extend this timeline. The mediation may iake place telephonically or in any manner the mediator believes will be effrcient and conducive to aproductive mediation. lf, at any time during the mediation, either party declares an impasse, the mediation will end. 'Ihe parties are then encouraged, but not llCOMMLINITY ACCESS AGREEMENT required, to arbitrate the dispute. The costs of mediation shall be bome equally by the purti"s. -If no litigation resulis within 90 days of the completion o_f mediation, WPAS shall wittrdraw its access request. Nothing, however, prevents WPAS from renewing its request in the future should that become necessary. In such event WPAS renews the request, and that request is denied by the State, the ADR process will begin again. E. Within 90 days of the execution of this agreement, the parties shall select a panel of at least 4 mrrfi.tally agreeable mediators. There will be twn separate lists: one for WPAS and DDD and one fof WPAS and the MHD. The parties agree that any one of the selected panel members will mediate all disputes related to the Access Agreemenl. However, the parties will rotate the order of contaCting the panel members for each mediation in a nonstategical manner. In order to select this panel, within 60 days of execution of this agreement, the parties will each propose at least 4 mediators. The parties will exchangg via fax, tleir list of broposed mediators and the mediators' curriculum vitae and any other necessary facts such as iost, mediation rules, etc. If the parties cannot agree upon at least 4 mediators from the first exchange of lists, the parties will exchange additional lists of mediators until an agreement can be reached. However, a final agreement must be reached no later than 90 d-ays from the date of the settlement agreement of this case absent written agreement for an extension ofa specific amount of time. Any party may strike a mediator from the list except that a party may not strike a mediator from the panel once the mediation process has been initiated to resolve a dispute. It a party strikes a medrator ftom the panel, that mediator will be replaced by another mediitorusing the same mediator selection process as described above. F. In the event that the access issues are not resolved through mediation, the parties may agree to attempt to resolve the dispute through arbitration. Written agreement fo pro.".I to arbitrati6n must be made rvithin five working days of the completion of mediation described in Section B. fur available arbitrafor from the mrrhtally agreed rrpon Arbitrator Panel list, as described below, will be used to conduct the arbitration of the dispute. Arbitration will be scheduled to occur as soon as possible, but will occur no later thail 45 davs from the time arbitration is agreed upon by the parties, absent written agreement by both parties to extend this timeline, Prior to the time of final agreement to albitrate the dispute, the parties shall agree in writing whether the arbitration decision will be binding or advisory, and if advisory, whether that opinion is.admissible in court. If no litigationiesults withih 90 days of fhe completion of this arbilration, WPAS shall withdraw its"access request. Nothing,-however, prevents WPAS from renewing its request in the future should that become n-ecessary. In-such event that WPAS renews its request, and that request is denied by the State, the ADR process will begin again. G. Within 120 days of the execution of this agreement, the parties shall select a.panel of at least 4 mtrtually agreeable arbitrators. The parties agree that any one of the selected panel members will arbitrate all disputes related to the Access Agreement. However, the barti"s will rotate the order of contacting the panel members for each arbitration in a nonstrategical manner. In order to select this panel, within 60 days of the execution of this agreemen! qe parties will each propose at least 4 arbitrators. The parties rvill exchange, via fbx, their Iist bfnroposed arbiaators'and the arbitrators' curriculum vitae and any other necessary facts ru"h dr cost, etc. If the parties cannot agree upon at least 4 arbitrators from the first exchange of lists, the parties will exchange additional lists of arbitrators.until iqt agreement can be ieached. Howbver, a final agreement must be reached no later thzur 120 days from COMMUNITY ACCESS AGREEMENT l2 the date of the settlement agrcement of this case absent written agreement for an extension of a specitic amount of time. Arty pafiy may strike an atbitrator from the list except that a party may not strike an arbitr.alur fi.our the pauvl ruuuv {rs tu.bitratiuu pluutrris has trscu iuitiatcd lu rvsulvc a dispute. If a party strikes an arbitator from the panel, that arbitrator will be replaced by another arbitrator using the same arbitrator selection process as described above. H. The timeframes for dispute resolution shall be as detailed above. Any timeframes not described in this proposal will be those set out in the cwrent relevant access agreements, Any timeframe may be extended by written agreement of the parties. L The parties agree they will abide by the timeframes contained in the Access Agreement and this settlement agreement. The parties may mutually agree 10 extend any timeframe. If a party fails to act or respond within the allotted time, the other party may request appropriale sdrnctions be imposed as provided by law or civil rule. 7 /ecu Date Director of Developmental Disabilities .) i \jif {)-U x {\\, MARK Date Executive f)irector Washington Protection & Advocacy System COMMLNITY ACCESS AGREEMENT t) o.,,,,llU'9 Attachment G Request for Taxpayer ldentification Number and Certification Go to www.ri6.govlFotmwg lor inatruction6 and ihe laiest intormation. Give lorm to the requester. Do not send to the lRS. {Hev, tularch 2024} Deparlmant of the Tieasury hltonal Rcvsnuc Soruicc 3a Chsk lhs appropriale Dox 'or lsd€rii lax c{aB$i(icalror of lhe c'rlilyrndrvidlJal i /hose nanle is ..leral gn hne 1 - Clw(;k only ono of tho fo'lolvng sovnn lroxo$, I lndivicluaysolopropriotor n ccorporation ! scorporatior I Parrncrslrip ! Trusvcsisio E Lt.C, [nlerlhol{xclas$ltlrfflion{C - Ccqrlsration, S = $trrporatio|, P = Padrrr$liip} Note: Chtrk lhe "l LC" bex above €ld, in the eolry space, ettter lhe appropriate code {C, S, o. P} lor lhe iu {:la6$jtloation ot lh€ LLC, urlo$s il iF a ilisregardmJ ontity, A disregard.)ri sntity stroold in$load chek lrle {ppropriafo box fortho td €la$itication ol rt3 orvner n Oth€r (soe hstruclions) 3b il on line 3a you .hecked "Parttrorsl'rip" or "frusv6late," o. clrecked "LLC" arld €.tered "fr" .3 lts iax ciassitication. and you are prolidin0 lhis to.,n to s psrtneBhrp, lruat, qr e$late n which you h.{vg itn oY/ners4ip tnleresl, chtrh lhjs bqx il ya{ havr any breig. partfleE, ovmers, or lxnefrciarre6. See inslnclbn$ 5 Ar{<iress{nunbe.. slrel, and epl, o,$rnl€noi. Seeirstnrclinns. 6 City, state, lnd ZIP code Part I q do co ORoo>tr OEz6 4o oo o.o ooa Belore you For relatod to th6 of Forrr] W-9, $ee af Form, balo\t t Nms gf entitylirdividucl. An entr is rcquired. iFo( a sole prop.ietor or di$reg$rdcd srliity. enter the osJner's name on lloE l, and enter ihe bisillcatdisregardcd enlly's nalri€ on I'ne ?.) 2 Susiross namo/disrcgardod o.ltily nalno, il ditfcrcnt t.om rbovo. 4 Exomptjors icodoe f,pply only to certain enlilies, not indilidualsi see iaslructa.s on pflge :l): axcapt pay* cod8 (il any) lxernptkrl frrxn For€igi\ Account Tax Complianco Act IFATCA) ropoding codo (it sy) {Applits to ,ccwtlts mainlained etside the united 9tata.) Requesler's tArne {rtd arJr:lresi {oplionAi) 7 : sl aqcdunl 4Lrnber{sl *ere {ol,tro')ai) Number Enter your TIN itl the appropriate box. Th6 TIN F.ovided rnust match the nalne qivsrl on line 1 to avoid backup rvithholding. For individuals, this is gonerally your social securily uumber {SSN}. llowovor, for a residsnt alion, col6 proprietor, or dis,egardcd qnlity, seo the in$lruction$ for Part l, ialer. Fo. other entlties, rt is your ernployer identiiication nunber (ElNl. lf you do not have g nurnber, see How to gel a flN, later. Nota: lf the accoQnt is i[ more than one name. see the x]stnrctions ttr line 1. See also tyhat Name an./ Numher To Qive lhe Requesler lor guidelinos on whos6 nunbet to cnler. Signsturu of U.3. porson D3to or Under penalties ol perjury, I cerliiy thal: 1 J he nilmber shown on thrs {orm ts lny correct taxpayer iclenlification Dumtrer {or I am waitinE for a number to ba issued lo me}; and 2. I am not subjecl to backup r,/ilhhol.Jing bocarisq (a) I afn exernpt [.om hackup !,/ithholding, or {b) I have nol ber:n noliflod by lho lqicrnal novont]e Service (lRS) that I atn suttiect to backup withholdiflg as a resillt of a failure lo report all intere$l or dividends, or (ci lhe IBS has noiilied rne that I aln no ionger sirbiect to backup r.rithholdingl and 3. I am a U.S. citizon or oiher U.S. oerson (defined boiowj; and 4. The FATCA code(s) entore(l or this form (if any) indlcaling lhnl I arn oxempl frorn F^TCA .eporling as cortect. Cortificalion inslruclions. You []ust cros orit item 2 above if you have been notified by the IBS ihat yotj are currently stbject to blckup withholding b€causg you havs iaiJed to report all intersst and divldends on your tax retuan. For real eslate transaciiols. itern 2 does not apply. For mortgage:nlerest paid, acquisition or abandonmeltt of strilred prop€rly, catrcallation ol debt, contributions to an individiral retirement anange{nent {lllA}, attd, generally, paymen{s othor than int0r€st and are not to lh6 cBrti{ication, but must corrsd TlN. Ss ths insiructions for Parl later Sign Here General lnstructions Section relerellces are to the lnlenral Revenue Code Llnless othenvise noted. Futulo dovelopmonls. For the laloe: infomation about devclopnents related lo Form W-9 ard its instructions. such as legislation en.rcled aJler they $ere pLiblished, go lo wrw.,rs.gov/{:otmwg, What's New Line 3a 5as be€n rnodilied to clar:iy ho\,r' a disreqarded entity cotnpletes lhrs line. AI LLC thai is a disregarded entity should check ths appropriate box for lhe tax cla$sification of;ts o\ryner. Olhe^(ise, it should check the "LLC" box and enter rts appropriste lax classificaiion. Novr lins 3b has boon addscl to this fonx, A tlow-lhrough enlity iii required to cornplete this line to andicale thal it has dirftt or indirect loreign partllers. o\,flreis, or beneticiaries wher: it provides the Fonn W-9 to another ilow-through entity in which rt has an ownsrship intatest- Ihis chanEle is irrtcndcd to provide a tlow-lhrough Bplity with jnformation regdrding tl'rd strtus of ;ls indircel loreign parln(rrs, owners, $r tleneficaaries, so that it carr salisfy any applicable reporting req!rirgrnents. For example, a parllrership that has any indirect toreiqn partners may be required io complote Schedules K-2 and K-3, Soe the Pflflnor$hip lnslruclions for Schodrrlog K-2;rnd K-3 iForm 1065). Purpose of Form An indlvidual or entity (Fofin w-9 roquesled \tho is required lo lll(] an nlorilation rsturn wilh the lfls is givinq yoL this form because tlley Employsr ldsrttmcfltlod numltet Part ll Oal. No. tli2illX Kittitas County Agreement for Services (rev. 5/M/251 Page L6 of 2L Fonn W-9 inev. l'!024) Form W-9 (Rev- 3-2024)Flge2 must obtain your correct tzu(payer identification number frlN], which may be your social security number {SSN}. individual taxpayer identificalion number (lTlN), adoption laxpaye. identification number (ATIN), or employer idenlilication number (ElN). lo report on an inforrnalion r6tum the amount paid tt you, or other amount repartable on an information retum. Examples of informaticn retums inciude, but are noi limited to, the following, r Form 1099-lNT (interest eamed or paid). ' Form 1099-DIV (dividends, including those from stocks or mutual funds). . Form 1099-MISC {various types of inc.ome, prizes, awards, or gross proceeds). o Fonn 1099-NEC (nonemployee compensation). o Form 1099-9 {stock or mutual fund sales and certain other transactions by brokersl. . Form 1099-5 {proceeds fiom real ostate transaclions). ' Form losg-K (merchanl card and third-party netviork transaclions). . Form 1098 (home mortgage interest), 1098-E {student loan interest), and 1 098-T (tuition). . Form 1099-C (canceled debt). . Form 10ss-A (acquisition or abandonment of secured property). Use Form W-9 only if you are a U.S. person i,including a resident alien), to provide your correct TlN. Caution: lf you don't retum Form W-9 to the tequeeter with a TlN, you might be subjmt to backup wiihholding- See What is backup withholding,lalar. By signing the {illed-out form. you: 1. Certify that the TIN you are giving ;s conect {or you are waiting for a number to lrc issued); 2. Certify thal you are not subiect to backup withhotding; or 3. Glaim exemption from backup withholding il you a:e a U.S. exempt payee; and 4. Certify to your non-loreign status for purpos€s of rvithholding under chapter 3 or 4 of the Code {if applicable)1 and 5. Certi! that FATCA code(s) entered on this form {if any} indicating that you are exempt from the FATCA reporting is corect. See What /s FATCA Fleporting, later, for further information. Note: lf you are a U.S. person and a reqilester gives you a form other than Form W-9 to requegt your TlN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal lax purposes, you are considered a U.S. person ifyou are: o 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 snder the laws of ihe United States; . An estate (other than a fo:eign estale); or o A domestic trust {as defined in Regulations seclion 3A1.7791-7],. Establishing U.S. status lor purposes of chapter 3 and chapter 4 withholding, Payments made lo foreign percons, including cerlain distributions, allocaiions of income, or transfers ol sales proceeds, may be subject to withholding under chapler 3 or chapler 4 of the Code (sections 1 441 -1 47 4). Under those rules, if a Form W-9 or other certificatirrn of non-foreign status has not been received, a withholding agent, transferee, or partnership {payorJ generally applies presumption rules that may require lhe payor to rvithhold applicable tax from the recipient, owner, traneferor, or parlner (payee). See Pub. 51 5, Withholding o{ Tax on Nonresident AJiens and Foreign Entities. The following persons must provide Form W-9 to lhe payor for purposes of establishing its non-foreign stalus. , ln the case of a disregarded entity with a U.S. owner, the U-S. owner of the disregarded entity and not the disregarded enlity, r ln the case of a granlor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the grantor trust. . ln the ca6e of a U.S. trusl and not the beneficiaries of (other than a granlor trusl), lhe U.S. trusl the trust. See Pub. 5 15 for rnore information on providing a Form W-9 or a certification of non-foreign status lo avoid withholding. Kittitas County Agreement for Services (rev.5/7a/251 Page L7 of 2! Foreign person, lf you are a foreign person or the U.S" branch ol a foreign bank that has elected to be treal€d as a U.S. person {under Regulations section 1.1a41 -1{b}{2}(iv) or olher applicable section lor chapter 3 or 4 purposes), do not use Form W-9- ln8tead, us€ the appropriate Form W-8 or Fonn 8233 (s€e Pub- 51 5i. ll you are a qualified foreign pension fund under Reguiations seclion l.897(li-t{d). or a patlnership that is rvholly owned by qualified foreign pension funds, that is trealed as a non-foreign person for purposes of section 1445 withholding, do nol use Form W-9. lnstead, use Form W-8EXP {or other certification of non-foreign statusl. Norrresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use tfie tenns of a tax treaty to reduce or eliminate U.S. tax on certain types of incame. l-loweuer, most tax treaties contain a provision known as a saving clause. Exceplions speci{ied in the saving clause may permi{ an exemption from lax to contlnue for certain types of income even after lhe payee has othervrise beconre a U.3" tesident alien for tax pur;:oses- lf you are a U,g, resideftt alien who is relying on an exception contained in lhe saving clause of a iax trsaty to claim an exemplion from U.S. lax on certain types of income, you must atlach a statement to Form W-9 that specifies the {ollowing fiva ilems. 1. The treaty counlry. Generally, this must be the same tie€ty ilnder which you claimed exemption fiom tax as a nonresident alien. 2. The treaty article addressing the income. 3. The ariicle number (or location) in lhe tax treaty that cantains the saving clause and its exceptions. 4. The type and amount of income thal qualilies for tfre exemption from tax. 5. Sulficient facts lo juslify the exemption trom tax under the lerms of the treaty article. Exanple. Article 20 of the U.S.-China incorfie tax treaty allows an exemption {rom iax lor scholarship income received by a Chinese student temporarily pres€nt in the United States- Under U,S. iaw, lhis student will become a residenl alien for tax pilrposes it lheir stay in the United States exceeds 5 calendar years. However, paragraph 2 of $e first Protocol to the U.S.-China lreaty (dated April 30, 1984) allDws the provisions ol lui.icle 20 to conlinue to app{y even after the Chinese etudent becomes a resident alien ol the United States- A Chineae student who qualifies for this exception {under paragraph 2 of the lirst Protocol) and is relying on this exception to clatm an exemption from lax on their scholarship oi fellowship income would attach to Form W-9 a statement that includes the information deseribed above lo support lhat exempiion. lf you are a nonresident alien or a foreign enliiy, give the requesier the appropriate complet€d Form W-8 or Form 8233. Backup Withholding What is backup withholding? Persons making cerlain paymente to yDu must under certain conditions withhold and pay to the IRS 24% of such payments. This is called "backup withholding." Payrnents thai may be subject to backup withholding include, but are not limiled to. interesl, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made tn sefllement of payment card and third-party netwq* transactisns, and certain payments {rom fishing boat op€rators. Real eslate transactions are nol subjecl to backup withholding. You will not be subject to backup withholding on payments you teceive il you give the requester your conett TlN, make the proper cedifications, and report all your taxable interest and dividends on your tax retum" Paynrenls you reeeive will be subject to l:ackup wilhholding il: '1. You do not ftrmish your TIN to the requesteq 2. You do not certify your TIN when required {see lhe inslruclions for Pad ll for details); 3. The IRS tells the requester that you fumished an jncorrect TIN; a. The IHS tells you that you are subject to batkup withholding because you did not report all your interest and dividends on yoilr lax retum (for reportable interest and dividends only); or 5. You do not cedify to the requester lhat you are not subieci to backup withholding, as described in item 4 under "By signing the filled- out form" above (for reportable interesl and dividend accounts opened after 1 983 only). Form W-9 [Bev.3-2024)Pase 3 Certain payees and payments are exempt Jrom backup withholding, See Exemfut-payee coile, lale(, and the separate lnstructions for the Requester of Form W-9 for more information. See also Estabfsfiing U"S. status for putpses of chapter 3 and chapter 4 withholding, eatlier. What ls FATCA Reporting? The Foreign Account Tax Compliance Act {FATCA} requires a parlicipating foreign financial instilulion to r€port all U,S. account holders lhat are specified U.9. persons. Certain payees are exempt frorl FATCA repnrting. See Exemption lrom FATCA repofting code, later, and the lnstiuctione for the Bequesler of Form W-9 for more information' Updating Your lnformation You must provide updated information to sny person to whom you claimod to bo an cxcmpt payoc if you are no longer an exetnpt payee and anticipate receiving reportable payments in the future fronr this person- Fir example, yiu may need td provide updated information if you are a C corporation that elects to be an S corporation, or:f you are no longer tax exempt. ln addition, you musl fumish a new Form W-9 if lhe name or TIN changes for the account, for example, if the grantor of a grantor lnrst dies. Penalties Failure to firrnish TlN, ll you fail to furnish your conect TIN to a requester, you are subjecl to a p€nalty of $50 for each such failure unless your failure is due lo reasonable cause and nol to willful neglect' Civil penalty {or false information wilh respect to withhokling. lf you make a falgi slatemeni with no reasonable basis that resuhs in no backup wilhholding, you are subject to a $500 penalty' Crinrinal penalty {or falsifying itrformalion' Willfully falsifying cerlifications or affirmations may subiect you to criminal penalties including fi nes and/or imprisonment. Misrrse of TlNs. lf the requester discloses or uses TlNs in violalion of lederal law, the requester may be subject to civil and crimrnal penalties. Specific lnstructions Line 1 You must enler one cf lhe following on this line; tlo not leave this line blank. The name should match the name on your tax retum. lf this Form W-9 is for a ioint account (other than an account maintained by a {oreign financial institution (FFID, list firsi, and then circle, the name of the person or entity whose number you entered in Parl I af Form W-9. lf you are prouiding Form W-9 to an FFI to document a ioint account, each holder of the account that is a U.S. person must provide a Form W-9. . lndividual. Generally, enter lhe name shown on your tax return. lf you have changed your last name witfiout informing the Social Security Adrninistration (SSA] of the aame change, enler your firsl name, the laal name ag shown on your social security card, and your new last name' Note for lTlN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the saDle as lhe name you entered on the Form 1040 you filed with your application. . Sole proprietor, Enter your individual name as shown on your Form 1 04O on line 1 , Enter your business, trade, or "doing business as" (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 retum on line 1 and any business, Itade, or DBA name on line 2. o Other entities. Enter your name as shown on required U,S. lederal tax documents on line 1. This name should match the name shown on the charter or olher legal documenl creating the entity. Enter any business, trade, or DBA name on line 2, . Disregarded entity. ln 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 feg.ulations section io1 .zzo1 -2{c){2). A disregarded entity should check the appropriate box {or the lax classification of ite owner. Enter the owner's name on line 1, The name of lhe owner entered on line 1 should never be a disreoarded entitv. The name on line 1 should be the name shown on the inc5me tax retJm on which the income shc'uld be reported. For example, if a foreign LLG that is lreaied as a divegarded entity for U.S. federil tax purposEs has a single owner that is a U.S. person, the U.S. olner's name is required 1o be provided on line 1' lf the direct owner oi lhe entily is also a disregarded enlity. enter lhe firEt owner that is nol disregarded ior lederal tax purpcses. Enter the disregarded entity's nafire on lina 2. lf the owner of the disregarded entity is a foreign person' lhe owller must complele an appropriate Form W-8 instead of a Form W-9. This is lhe case even if the foreign peman has a U.S. TlN. Line 2 lf you have a businese name, Itade name. DBA name, cr drsregrded entity name, enter it on line 2- Line 3a Check the appropriate box on line 3a for the U.S. Jederal tax classification of the prerEon whose fiame is entered on line 1. Check only one box on line 3a. Line 3b Check this box ll you are a partnership {including an LLC classified as a partnership for U.S. federal lax purposesl. lrust, ot estate that has any foreign partners, owners, or beneficiaries. and you are providing this formlo a partnership, trust, Dr eslale, in which you have an owner.ship interesl. You must iheck the box on line 3b il you receive a Form W-8 (or documentary evidence] from any partner, owner, or beneficiary eslablishing foreign stalus or;{ you receive a Form W-9 from any partner, owner, or beneficiary thal has che€ked lhe box on line 3b. Note: A partnership that provides a Flrm W-9 and checks box 9b may be required to complete Schedules K-2 and K-3 {Form 1065). For more information, see lhe Partner$hip lnstructicns for Schedules K-2 and K-3 {Form'1065). lf you are required to complete line 3b but fail to do so, you may not receive the information necessary 1o file a c.orrect information retum with the IRS or fumish a conecl payee statement to your partners or beneficiaries, See, for example, sections 6698, 6722, and 67?4 lor penalties thal may apply, Line 4 Exemptions lf you are exempt from backup wilhhclding andlor FATCA reporting, eriler irr the appiupriale spaue orl litts 4 any corJds) tllat. tllay alrply to you. Exempt payee code, . Generally, individuals {including sole proprietorsi are not exempt from backup withholding. . Except as provided belorE, corporaticns are exempt lrom backup wilhholding for certain payments, includirq interest and dividends. . Corporations are not exempt from backup withholding for paymentg made in settlement of payment card or third-party neiwork transactions' . Corporalions are not exempt {rom backlp withholding with respecl to attomeys'fees or gross proceeds paid to atlorneys, and corporations that provide medical or heallh care servic€s are not exempt with respsct to payments reportable on Form lS99-full$C. The tollowing codes idenlify payees that are exempl from backtrp wilhholding, Enter lhe appropriate code in tfie space on line 4' 1 -An organization exempt lrom tax under seciion 501(a), any lRA, or a custodial account undet section 403{b){/} if the accounl satisfies ihe requirements of seclion 4o1(lX2). Kittitas County Agreement for Services (rev.5/Ia/25) Page 18 of 21 lF the entity/individual on line I isa(n)... THEN check dre box fcr r Corporation Corporalion. r lndividual or . Sole proprietorship lndividual/sole proprietor r LLC classffied as a partnership for U.S. lederal tax purposes or . LLC that has Jiled Form 8932 or 2553 electing to be taxed as e corporation Limited liabilily company and enler the appropriate tax *lassification: P = Partrership, C=Ccorpcration,or S = S corporation. r Partnership Partnership, . TrusVestate Trust/estate. Form W-9 {Rev.3-2024)Page4 2-The United States or any of its agencies or instrumentalilies. 3-A state, the District of Columtria, a U.S. commonwealth or ternlory, or any of their political subdivisions or instrumentalitles. 4-A loreign govemment 6r any of its political subdivisions, agencies, or instrumentalities. 5-A corporation. 6-A dealer in seculities or commodities required to register in the United States, lhe District of Columbia, or a U.$. comnronwealth or tenitory. 7-A lutures commigsion merchant reoistered wilh the Cammodity Fulures Trading Commission. 8-A real estate investment trust. 9-An entity registered at all times during lhe tax year under lhe lnvestment Company Act ol 1940. l0-A cdmmon trust fund operated by a bank under section 584(a). 1 1 -A flnancial institution as defined under section 581. 12-A middleman known in lhe investment community as a nominee or cuslod;an. -13-A trust exempt from tax under section 664 or described in settion 4947. The following chart shows typ€s of payments that may be exempt lrom backup withholding. The chart applies to the exempt payees lisied above, 1 th 13. lF the payment is lor TIIEN the payment i$ exempt lor... ' lnterest and dividend payments All exempt payees except tor7. r Brokertransactions payees 1 through 4 and 6 through 1 1 and all C corpotations, S corporalions must nol enter atr exempt payee code because lhey are exempt only for sales oJ noncovered securities acquired Io 2012. . Barter transactions Exempt payees 1 through 4. and . Payments over $600 required to Generally, exempt payeeg be reported and direct sales over $5.ooo' 1 through 5.2 ' Payments made in settlement of Exempt payees 1 through 4. payment card or third-party network lransactions I See Form 1OS9-MlSC, Miscellaneous lnformation, and itg instructions. 2 However, the following payments trade to a corporation and reporlable on Form 1099-MISC are not exempl from backup wilhholding: medical and health care payments, atlomeys' fees, grosa proceeds paid to an attorney reportable under section 6045(0, and payments tor services paid by a federal executive agency. Exemption lrom FATCA reportirrg cocle. The following codes idenrify paye€s thal are exempt from reporting under FATCA. These codes apply io persons submitting this form for accounts maintained oulside of lhe United Siates by cerlain {oreign financial institutions. Therefore, if you are only submittin-g this form toian account you hold in the United State6, you may leave this {ield blank. Consult with the person requesting this iorm if you are uncertain if lhe financial institution is subiecl to these requirements. A reqttester may indicale that a code is not required by providing you whh a Fonn W-9 with "Not Applicable" (or any siriilar indication) enlered on the line for a FATCA exemption code. A-An organization exempl from tax under seclion 501{a) or any individual retitement plan as de{ined in section 7701(at@7). B-The United States or eny o{ its agencies or instrumentalities. C-A state, the District of Columbia, a U.S. cotnmonwealth or tenilory, or any of lheir political subdivisions or inslrumentalities. D-A corporation the stock of which is regularly traded on one or more established securities markels, as described in Regulations section 1,1 a72-1 (c)(.1 Xi). E-A corporation that is a member of the same expanded affiliated group ae a colporation described in Regulations secrion 1..1472-1(c}(1Xi). F-A dealer in securities, commodities, or derivalive financial inslruments (including notional principal conlracts, futures, forwards, and options) that is regisiered as such under lhe laws of lhe United Stales or any stale. G-A real estate investment trust. H-A regulated investrnent campany as defined in section 851 or an entity registered at all times during tfte tax year under tie lnvestment company Act 61 1940. l-A common trusl {und as defined in section 584(a}. J-A bank as dsiined in soction 581. K-A broker. L-A trust exempt from tax under section 664 or described in section aeaT{a}{1}. M-A lax-exempt trust under a seclion 403{b) plan or section 457(9) plEn. Note: You ilay wish to consult with the financial institution requesting lhis {orm to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your addr€ss (number, street, and apartment or suite number). This is where the requester o{ this Form W-9 will mail your infonnation retums. lf this address differs lrom the one the requester already has on fite, enter "NEW at the top. lf a new address is provided, there is still a chance lhe old address will be used until the payor changes your address in their records. Line 6 Enter your ci1y. state, and ZIP code. Part l. Taxpayer ldentification Number {TlN} Enter your TIN in the appropriate box, lf you are a resident alien and you do not have, and are not eligible to get, an SSN, your TIN is your iRS lTlN. Ent€r :t in the entry space for lhe Social security number. lf you do not have an lTlN, see How to get a lf\tbelow. ll you are a sole proprietor and you have an ElN, you may enter either your SSFI or ElN. ll you are a single-member LLC that is disregarded as an entity separale from its owner, enter the owner's SSN {or ElN, il the orvner has onil. lf th" LLC is classilied as a corporalion or partnership, enter the entity's ElN. Note: see What Name and Number To Give the Requester, later' for {urther ciarification of name and TIN combinations. How to get a TlN. lf you do not have a TlN, apply for one immediately- To apply for an SSN, get Form SS-5, Application for a Social Securiiy Card, from your local SSA office or get this form online at www,SSA-gov. You may also get this form by calling 8oD-772-1213' Us Form W-7, Application for lFlS lndividual Taxpayer ldentilication Number, to a'pply for an lTlN, or Form SS-4, Application for Employer ldentification Number, to apply for an ElN. You can apply for an EIN online by accessing the IRS websile alwww.irs.govlElN' Go to www.irs.govlFarms to view, download, or print Fom W-7 and/or Form SS-4. Or, you cittt ga lo urww.its.govlOnleFunns to place atl otder altd have Form W-7 and/or Form SS-4 mailed to you wilhin 15 business days, lf you are asked to complete Form W-9 bul do not have a TlN, apply for a TIN and enter "Applied Fo/' in the space lor tie TlN. sign and date lhe form, and give it to the requester. For interest and dividend paymenls, and certain payments made v,rith resp€ct 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 paymenls. The 60-day rule does not apply to other types of payments. You will be tubject to backup withholding on all such paymenls unlil you provide your TIN to the requesler. Note: Enlering "Applied Fo/' means that you have already applied lor a TIN or that you intend to apply for one soon. See also Eslab/tshing U.S status for pitposes of chapter 3 and chapter 4 withholding, earlier, for when you may instead be subject to withholding under chapier 3 or 4 of the Code. Caution: A disregarded U.S. entity thal hae a foreign owner must use the appropriate Form W-8. Kittitas County Agreement for Services (rev.5/t4/25) Page 19 of 21 Form W-9 {Rev.3-?024)Psqe 5 Part ll. Certification To establish to the withholding agent ihat you are a U.S' person, or resident alien, sign Form W-9, You rnay be requesled to sign by the withholding agent evan if item 1, 4, or 5 below indicates othentr'ise. For a joint account, only the person whose -IlN is shown in Part I should sign (when required). ln the case of a disregarded entily, the person identified on lirre 1 must sign. Exempt payees, see Exempt payee code, earlier. Signature requirements. ComPlete the certificalion as indicated in itemslthrough5below. l, lnteregt, dividencl, and barter exchange accounts opene<t before 1984 and broker aecounls considered aclive during l$tX|' You must give your correct TlN, but you do not have to sign the certification, 2. lnlere*i, divirJend, broker, and barter exchange accounls opened after -1983 and broker accounts considered inactive during l083. You must sign the certification or backup withholding will apply. if you are subiect to backup withholding and you are merely providing your conect TIN to the requester, you must cro3s out item 2 in *re certification before signing the lorm. 3. Real estate transactions. You must sign the c€rtification' You may cross out itern 2 of the certification. 4. Other payments. You must give your conect TlN, but you do nol have to sign the certification unless you have been nolified that you have previously given an inconect TlN, "Other payments" include paym-ents madein the course of the r€quester's trade or business for renls, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporalions), payments t6 a nonemployee for selices, payments made in settlement of payment card and thiid-party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attomeys (including paynents to corporations). 5. Mortgage interest paid by you, acquisilion or abandonmenl of secured propertv, cancellation of debt, qualified tuition Program paymentb (ui-rrlei section 529), ABLE accounts {under section 529Af, lRA, Coverdell ESA, Archer MSA or HSA cotrtribtdions or dislributions, atrd pension distributions. You mugt give your conecl TlN, but you do not have to sign lhe certification' What Name and Number To Give the Requester For lhis type of accounl:Give name and SSN ol: indivldud For this o{ account: 8- Disregarded eniity not ovrned by m individml 9. A valid trffit, trtate, or penEion trugt 10. Corpontion or LLC electing corpoate itatus on Fm 8&32 or Fsm 2553 11- Assrciatim, club, rel[iws, chaitable, educatioml, or qther td-exflpt orgeniation 12- Partrerchip or mufti-mmber LLC 13. A broker or registered nmine 1 4 . Ac@mt with the Departmmt ol Agriculture in the name of a public enlity (such * a state or l*al govemmst, cchool district, or pdmnl that recelveB nEdculturdl prdgrdm paymenls 15. Grtrtortrustfiling Fffi 1041 or under lhe Oplional Filing Method 2, requiring Fom 10Ag {se RegulatioG swtion 1.671 -4{bX2Xi){B))" Give name and EIN of: The oMer Legd entitya The crpcralion The wganiation The partnershi p Jhe broks or nominee The public mtiiy 1. Individual 2. Two or nrore indivkJuals foint account) other than an account maintained by an FFI 3. Two or more U-S. percons (oinl account maintained by an FFI) 4. Cuslodiai account of a mhq (Unitom Gift to MinaE Act) 5- a. The usual revocable savings lrust (grmtor is alrc trustee) b. So-called trust accsnt thal is rot a legal or valid trust under clale law 6. Sole proprietorship o disregaded mtity owned by an individual 7. Grantor trust filing under Optional Filinq Method 1 (see Regulations setion I .671 -abX?)(i)(A))" The actual owner of lhe mcount or, il mmbined firnds, the fimt individul on lhe acccunll Each holder oflhe rccounl The minof The grotorlrustel The aclual ownerr The ownero The grmtor' The trust 'List {irst and circle the name of the person whose number you fumish' lf only one percon on a ioint accounl has an SSN, lhat person's number must be fumished. ?Circle lhe minor'g nanre and fumish the mino/s SSN. 3You must show vour individual name on line 1, and enler your business or DBA name, il ahy, on line 2. You may use erther your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. I List {irst and circle the name of the trust, 6state. or pension trust. {Do nol fumish the TIN of the personal representalive or lruslee unlese the legal entity itself is not designated in the account tille,) ' Note: The grantor must also provade a Form W-9 ta tfie trustee of the trust. '. For more infonnation on optional filing melhods ior grantor trusls, see the lnstructiqns for Form 1041. Note: lf no name is circled when more than one name is lisled. the number witl be considered to be that of the rirst name listed. Secure Your Tax Records From ldentity Theft ldentiW theft occurs when someone uses your p€rsonal information, such a! your name, SSN, or other identi$ing information, withoul your permission to commit fraud or other crimes. An idenlity thief .may use your SSN to get a job or may file a tar retum using your SSN to receive a refund- To reduce your risk: . Protecl your SSN, . Ensure your employer is protecting your SSN, and . Be careful when choosing a tax telum preperer. lf your tax records are affected by identity theft and you receive a nolice from the lRS, respond right away to the name and phone number printed on the IRS notice or letter. lf your tax records are not cunenlly affected by rdentity theft but ygg thinli you are al dsk due to a lost or stolen purse or wailet, questionable credit card actavity, or a queetionable credit report, contacl the lFlS ldentityThefi Hotline at 800-908-44s0 or submll Form 14039. For more information, see Pub. 5027, ldentily Theft lnlormalion for Taxpayers. Kittitas County Agreement for Services (rev.5/14/251 Page2o of 2L Pasr 6 Form W-9 (Rev. 3-2024) Victims of identiw theft who are experiencing economic harm or a *uni.*i" oroUt"m.'or are seekinq heli in resolving tax problems that h'uu" not b""n resolved throughiormal channeb, may be eligible for Taxoaver Advocate Service (TAS) assistance. You can reach TAS by callingthe TAS toll-free case intake line a|877-777-477a orTfYnDD 800-829-4059. Protect yourself from suspicious emails or phishing schemes' Phishing-is the creation and use of email and websites designed to mimic lfuitimate business emails and webeites. The mosl common act is sendirig an email 1o a user falsely claiming- to be an established iegitimatienterprise in an atlemptio scam ihe user into surrenderirg private information that will be used for identity lheft. The IRS does not initiate ctntacls with taxpayers via emails' Also, the IBS does not request personal detailed informalion lhrough email or ask taxoavera for the PIN numbers, passwords, or similar secret access infrirniation for thpir credit card, bank, or other linancial acoounts' lf you receive an unsolicited email claiming to be from the lRS, forward this message to pirlishlngr@irs.gov. You may-also report misuse of the IRS name, loqo, or other IRS Property to the Treasury lnspector General for Tax Adfrinistration (IIGTA) at 8oo-360-4484' You can forward suspicious emails to the Federal Trade Commission at spam@uce,gav or report them at www.ftc.govlcomplainf. You can contact the"FTC al www'ftc.gov/idfheft or 877-IDTFIEFT (877-4i18--4338)' it you fruu* O""n the viclim # ident:ty theft, see www'ldentityTheftgov and Pub. 5027. Go to mvrv.irs.govlldentityTheftlo leam more about identity theft and how to reduce your risk' Privacy Act Notice Section 61 09 of the lnlerna| Flevenue Code requiree you lo provid€ your conect TIN lo persons {including federat agenciesJ who* are requhed to file information relurns with the IRS to report intetest' dividends, or certJin otner income paid to you; mortgige interesl you patd; lhe acouisition or abandonn}ent of aecured properiy; the cancellation of debt; or conlributions you made to an lRA, Archer MSA, or HSA" The mrson collectino this iorm uses the inlormation on lhe form to file ir*ormation retuirs with the lRS, reporting the above information' ioutin. ,"*u ol thie informalion inilude glving il to the Department ol JuJice for civil and criminal litigation and to cities. states, the Disttict ol Columbia, and U.S. commonwealths and tenitories {or use in administorino their laws. The informalion may also be disclosed to other "ountii"J un"U"t " treaty, to lederal and statsagencias to enforce civil and criminal laws, or to federal law erdorcemefit and intelligence agencies to uutttbst lerrcrisnt. Yau must provid€ your,TtN whether or not v6u are reouired to file a tax relum. Under sec{;on 34ffi, payon must 6.*tulfy *'mnold a percentag€ oltaxable interest, dividends, and Eertain 6ther payrnents to a payee who does not-give a TlN.to the payor' Certain penaliies may also apply for providing false or {raudulent information. Kittitas County Agreement for Services (rev-5/7a/251 Page 2L of 2L