HomeMy WebLinkAboutAFS between KC and AbilityKITTITAS COUNTY
AGREEMENT FOR SERVICE
PHMH25.O2O
This Agreement for Services (hereinafter "Agreement") is entered into by and between Kittitas County
(hereinafter "County"), a political subdivision of the State of Washington, and Ability (hereinafter "Contractor").
The purpose of this Agreement is as follows: To provide 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.I4.
The term of this Agreement shall be from July L'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
COUNW CONTRACTOR
Kittitas County Public Health
507 N. Nanum, Suite 102
Ellensburg, WA 98926
Project Contact:
Laurie Holt
Developmental Disabilities Administrative
Specialist
Human Services
La u rie. holt@co. kittitas.wa. us
509-952-7515
Ability
1212 N. Washington St, Suite 124
Spokane, WA 99201
Project Contact:
Ty Lingo, Director
This Agreement includes the following, which are attached hereto and hereby incorporated by this
reference:
Attachment "A":
Attachment "B":
Attachment "C":
Attachment "D":
Attachment "E":
Attachment "F":
Attachment "G":
Kittitas County Agreement for Services (rev.5/14/25l.
Page 1 of 21
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)
lN WITNESS WHEREOF, this Agreement has been executed by and on behalf of the parties through their
authorized representatives, effective as of the latest date written below.
Kittitas County Agreement for Services (rev.5/La/25)
Page2 of 2L
)u Lrilqo
CONTRACTOR
Signatu re
Print"a ftf 'rt6
Date
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Title
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BOARD OT COUNTY COMMISSION
KITTITAS COUNTY
/iBSEIVT
Commissioner
Date:
Attest
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ATTACHMENT'A,,
SCOPE OF WORK
o Provide community inclusion (Cl) Services in accordance with DDCS Policy 4'11
. Provide supported employment services through individual employment (lE) services or group supported
services (GSE), if applicable, in accordance with DDCS Policy 4.11
. 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
9 Clearly sl.ates Llre client's goal, who is responslble for what actlon 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 5 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.
r Submit data and reports as requested by the county.
o Follow billable requirements per DDCS,
r Submit billing to county, monthly.
r 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 driver'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.5/Ia/251
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 Contractor the following amount(s)
plus any applicable taxes as detailed in Contractor's invoice:
Individual Employment (IE) $108.80 per service hour
Group Supported Employment (GSE) $93.80 per service hour
Community Inclusion (CI) $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/t4/251
Page 4 of 21
ATTACHMENT "C"
I NSU RANCE 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 itrsuraltce pulicies
must comply with Chapter 48.15 RCW and 284-15 WAC.
At a minimum, Contractor shall maintain and provide proof of the following selected options:
Commercial General Liabilitv lnsurance
r Coverage limits are not less than:
o $1,000,000 per occurrence, for all covered losses
. $2,000,000 general aggregate
r $1,000,000 products & completed operations aggregate
. S1,OOO,O00 personal and advertising injury, each offense
. The policy must be endorsed to include the County and its officials, employees and agents
as additional insureds,
Com mercial Automobile Liabilitv lnsurance
r Automobile Liability for owned, non-owned, hired, and leased vehicles, with an MCS 90
endorsement and a CA 9948 endorsement attached if 'pollutants' are to be transported.
. Coverage limits are not less than:
o $1,000,000 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 employe/s
liability limits no less than S1,000,000 per accident or disease.
Kittitas County Agreement for Services (rev.5/M/251
Page 5 of 21
Professional Liabilitv / Errors and Omissions Liabilitv
r Coverage limits not less than:
. S1,000,000 each claim
r Contractor must provide evidence of this coverage on a policy form appropriate to
Contractor's profession.
Contractorshallfurnish 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
ilrsurarrce or self-insurance available to the County'
Contractor agrees to provide notice to the County at least thirty (30) days prior to cancellation, or any
material alteration or non-renewal, of any of the above-required insurance coverages.
Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools,
machinery, equipment, or motor vehicles owned or utilized by Contractor, or Contractor's agents, employees,
suppliers or contractors, as well as to any temporary structures, scaffolding and/or protective fences.
Contractor shall have sole responsibility for ensuring the insurance coverage and limits required herein
are also obtained by any subcontractors.
NOTE: Notwithstanding any other provision(s) of this Agreement, no contract shall form under this Agreement
until and unless the following are provided to the County: (1) a copy of the Certificate(s) of 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 Cou nty Agreement for Services (rev . 5/14/25l'
Page 6 of 21
ATTACHMENT'D"
GENERAL TERMS AND CONDITIONS
1. Scope of Contractor's Services: Contractor agrees to provide to the County services as set forth in
Attachment "A". No materials, labor, or facilities will be furnished by the County, unless otherwise provided
herein. All work performed under this Agreement shall comply with applicable laws and regulations.
2. Accounting and Pavment: Compensation to Contractor for services rendered under this Agreement
shall be as set forth in Attachment "8". Where Attachment "8" 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 performed and amounts earned, including, where appropriate, the total number of hours for the
month and the total dollar payment requested. Unless specifically stated in Attachment "8", 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
the County to make withholding for any taxes other than income taxes (e.g., Medicare). All compensation received
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 (L) 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. lndependent Contractor: Contractor's services shall be furnished by Contractor as an independent
contractor, and nothing stated herein shall be construed to create a relationship of employer-employee or a
guarantee of future employment. Contractor acknowledges that its entire compensation under this Agreement
is specified in Attachment "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. Assisnment 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/Ia/251
PageT of 2l
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.
6. Right to Review; Maintenance of Records: This Agreement is subject to review by any Federal or State
auditor. The County or its designee shall have the right to review and monitor the financial and service
components of the work performed under this Agreement by whatever means are deemed expedient by the
County. Such review may occur with or without notice, and may include, without limitation, on-site inspection,
inspection of all records or other materials which the County deems pertinent, and any and all communications
with or evaluatiolr by service recipieltl,s unrler Lltis Agreenrelrt. Cultl.lacLur shall preselve artd lltairt[airt all recurds
relating to this Agreement for six (6) years after termination or expiration of the Agreement, and upon request
shall make them available for review by any Federal or State auditor, the County, and/or any persons authorized
by the County.
7. Modification
7.L. 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
scheduleofperformance. lfanysuchChangeNoticecausesanincreaseordecreasetoContracto/scostof,orthe
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 priorto 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.5/74/251
Page 8 of 21
fromanymoneydueorcomingduetoContractor. Furthermore,intheeventofterminationunderthisparagraph,
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 dcpartments, elected and appointed officials, employees, agents and volunteers, hartttless frorlt
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 for the County of Kittitas.
This Agreement shall be governed by the laws of the State of Washington.
11. Non-Appropriationof Funds: lf theCountydoes notappropriatesufficientfundingforthisAgreement
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. 5/74/251
Page 9 of 21
12. Contractor Commitments, Warranties, and Representations: Contractor represents and warrants as
follows:
t2.I 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.
L2.3 This Agreement has been validly executed by an authorized representative of Contractor and
constitutes a valid and lcgally binding and cnforceable 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 will or may materially affect Contractor's ability to 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.
12.6 Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible or
voluntarily excluded from covered transactions by any Federal or State department or agency.
12; 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 orsubcontractors, 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 Propertv lnfrinsement: 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.
L5. Use of Countv Name and Logo: Contractor may not use the County's name, logo(s), trademark(s), or
other identifying information, or identify the County as a current or former client, on its website or in any
marketing or promotional materials without the prior written consent of the County.
Kittitas County Agreement for Services (rev. 5/14/25)
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
determination as to the proper resolution of the dispute. Such determination shall be final and binding on both
parties. The cost of resolution will be borne as allocated by the Dispute Board. Alternatively, if agreed to in writing
by both parties, the parties may forego the option of establishing a Dispute Board to adjudicate the dispute, and
instead pursue arbitration, jointly selecting an arbitrator acceptable to both parties. 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) cach 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.
t7. Confidentialitv: Contractor, its employees, agents and volunteers, and any of Contracto/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
returnreceiptrequested. Noticemaybeprovidedbyregularfirstclassmailifsimultaneousnoticeisprovidedby
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 Waee: 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 final and
conclusive and binding on all parties involved in the dispute as provided for in RCW 39.12.050.
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/M/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.
21. Nondiscrimination
2L.1, 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 employed, and that employees are treated during employment, without discrimination
because of their age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation,
marital status, honorably discharged veteran or military status, 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.
2\.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 discrimination.
22. Waiver: The waiver of any default or breach of this Agreement, or the failure of a party to enforce
any provision hereof or to exercise any right or privilege hereunder, shall not be deemed to waive any prior or
subsequent default or breach, the enforcement of any provision hereof, or the exercise of any right or privilege
hereunder, unless otherwise stated in a writing, signed by the parties hereto'
23. Headings: The headings of sections and paragraphs of this Agreement are for convenience of
reference only and are not intended to restrict, affect, or be of any weight in the interpretation or construction of
the provisions of such sections or paragraphs.
24. Survival: Theprovisionsof paragraphs 2,3,4,6,8,9,!0,!3,L4,L5,16,17,19,20,22,24, and28of
these General Terms and Conditions shall survive the completion, expiration, termination or cancellation of this
Agreement for any reason.
25. Complete Aereement: This Agreement constitutes the entire agreement between the parties and
supersedes any and all other agreements, understandings, negotiations and discussions, oral or written, express
or implied, regarding the work to be performed hereunder. The parties agree that no other representations,
inducements, promises, agreements, or warranties relating to this Agreement, oral or otherwise, have been made
between the parties, Except as provided elsewhere in this Agreement, no modification or waiver of this
Agreement shall be valid or binding unless in writing and signed by the parties.
Kittitas County Agreement for Services (rev.5/7a/251
Page L2 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. Agreement Not for Benefit of Third Parties: This Agreement is entered into solely for the benefit ot
the parties hereto and vests no rights in, nor is it enforceable by, anythird parties.
Kittitas County Agreement for Services (rev.5/M/251
Page 13 of 21
Attachment E
sHs
WASH'NGION STATE
Depanment ol So<lal
and Health serulces
COUNTY
PROGRAM AGREEMENT
DDCS County Services
DSHS Agreement Number
2663-71228
This Program Agreement is by and between the
Socialand Health Services (DSHS) and the Cou
State of Washington Department of
nty identified below, and is issued in
conjunction with a County and DSHS Agreement On General Terms and Conditions,
which is incorporated by reference.
Administration or Division
Agreement Number
County Agreement Number
DSHS ADMINISTRATION
Developmental Disabilities
Admin
DSHS DIVISION
Division of Developmental
Disabilities
DSHS INDEX NUMBER
1225
DSHS CONTRACT CODE
1769C5-63
DSHS CONTACT NAME AND TITLE
Seanna Woodard
Operations Manager
DSHS CONTACT ADDRESS
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.qov
COUNry NAME
Kittitas County
Kittitas County DDA County Services
COUNryADDRESS
507 North Nanum Street Suite 102
Ellensburo, WA 98926-2886
COUNTY FEDERAL EMPLOYER IDENTIFICATION
NUMBER
COUNry CONTACT NAME
Kasey Knutson
TELEPHONE FAX CONTACT E-MAIL
962-7090 962-5883 kn WA.US
COUNTY A SUBRECIPIENT P OF THIS PROGRAM STANCE LISTING NUMBERS
AGREEMENT?
No
PROGRAM AGREEMENT START DATE
07t01t2026
PROGRAM AGREEMENT END DATE
06t30t2027
MAXIMUM PROGRAM AGREEMENT AMOUNT
$1,021 ,440.00
EXHIBITS. The following Exhibits are attached: Exhibit A - Data Security Req uirements; Exhibit B - Budget and
Spending Plan
By their stg natures below,the parties agree to the terms and conditions of this Cou nty Program Agreement and all
documents incorporated by reference No other understandi ngs or representati ons,ora or otherwise,regard tng the
SU bject matter of this Prog ram Ag reement shall be deemed to
reement.
exist or bind the pa rties.The parti es signi ng below certify
that are authorized to this
COUNry PRINTED AND TITLE(S)TE(S) SIGNED
DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
DSHS Central Contract Services
1 769CS County Agreement (12-26-2025)
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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 developmentaldisabilities and related services. These may include information and
referral services; activities aimed at promoting public awareness and involvement; and
community consultation, capacity build ing and organ ization 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 developmentaldisability 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
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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 partiiipate, 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 Technical Assistance" 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 (B) 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
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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 iob 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 Servrbes, 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 71AJ4 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.
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3
Special Terms and Conditions
Ctient 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.
Credentials 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.g. 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
RCW43.43.830-845, 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.
4.
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.
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.
Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The Coun$
assures that each subcontractor has agreed to assign to DDCS its Medicaid billing rights for
h
DSHS Central Contract Services
1 769CS Cou nty Ag reement (12-26-2025)
Page 5
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 lnfant 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 P roviders, if:
(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 federalfunds 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 (cX1)].
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 (1 2-26-2025)
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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 will withdraw 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;
(B) 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
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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;
16; DDA Guidelines for Communitv Assessments within Emplovment and Vocational Proqrams: and
17; Disabilitv Riqhts Washinqton (formerlv Washinqton Protection and Advocacv Svstem) Access
Agreement.
The County shall develop and submit a comprehensive plan for the County DD Services as
required by WAC 388-850-020.
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://vvww.dshs.wa.qov/dda/countv-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.
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
forward.
e
f
g
h
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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 until the Client has received proper notification from DDCS.
(4) All Clients will have an lndividualized Employment and/or Community lnclusion plan to identiff
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 ClienVguardian, 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 providerwill 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.
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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 long-term supports if needed. lf the County or DDCS approves
the continuation of longterm 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 per
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 during the month? lf it was less than the
collective group's totat 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) lndividual time 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
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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 aia 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.
r. Review and respond the AWA "Work List" items within 5 working days including Referrals and
pend ing Authorization.
s. Review the AWA "Ticklers" Planned Rate tab and update the planned rate within 5 working days
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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 8l31l07
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:/iwww.dshs.wa.qov/sites/defaulUfiles/DDA/ddaidocuments/Job%20Foundation%20Ap0lica
tion 0407 20o/o20o/o28002o/o29.do cx
(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 identify 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 8131lO4
(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
ouicome 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.
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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.
Consideration:
a. Fees:
(1) Approval of fees is the responsibility of the DDCS. The DDCS HQ Employment and Day Unit'
tr/lanager 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 localtribes.
(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
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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.
8.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 Coun$ 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.
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
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consultation, capacity building and organization activities.
(c) Other Activities.
i. 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."
ii. 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 child's 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
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the lndividual Emplovment Phases & Billable Activities)
(e) lndividualized TechnicalAssistance 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.
(f) 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 will work 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
County 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 "Hout'' 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
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10.
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Special Terms and Conditions
services that DDCS reimburses. That document is located on the DSHS DDCS County Best
Practices Web site at https:i/www.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://wvrnry.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
RegionalAdministrator or designee. Payment will not be made on any invoice submitted past six$
(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 10%.
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.qov
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 Intellectual 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/lD 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
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12.
13.
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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.
Confidential Information. 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.
Data Security Requirements. Exhibit A shall only apply to the County if the Coun$ possesses 150 or
more DSHS records across all programs or services throughout their organization, or transmits more
than 5 records at one time.
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 shall take precedence as the sole Data security Agreement between the
Parties.
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1 Definitions
definitions:
Special Terms and Conditions
Exhibit A - Data Security Requirements
The words and phrases listed below, as used in this Exhibit, shall each have the following
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.
"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).
"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.
"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.
"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.
"Mobile Device" means a computing device, typically smaller than a notebook, which runs a mobile
operating system, such as iOS, Android, or Windows Phone. Mobile Devices include smart phones,
most tablets, and other form factors.
"Multi-factor Authentication" means controlling access to computers and other 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 physical token; 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.
"Portable Device" means any computing device with a small form factor, designed to be transported
from place to place. Portable devices are primarily battery powered devices with base computing
resources in the form of a processor, memory, storage, and network access. Examples include, but
Page 19
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2.
3.
Special Terms and Gonditions
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
thttps://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: https://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.
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.
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:
4.
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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 accessing the Data.
e. Ensure that an employee's access to the Data is removed immediately:
(1) Upon suspected compromise of the user credentials.
(2) When their employment, or the contract under which the Data is made available to them, is
terminated.
(3) When they no longer need access to the Data to fulfill the requirements of the contract.
Have a process to periodically review and verify that only authorized users have access to systems
containing DSHS Confidential lnformation
When accessing the Data from within the Contractor's network (the Data stays within the
Contractor's network at alltimes), enforce password and logon requirements for users within the
Contractor's network, including:
(1) A minimum length of 8 characters, and containing at least three of the following character
classes: uppercase letters, lowercase letters, numerals, and special characters such as an
asterisk, ampersand, or exclamation point.
(2) That a password does not contain a user's name, logon lD, or any form of their full name.
(3) That a password does not consist of a single dictionary word. A password may be formed as a
passphrase which consists of multiple dictionary words.
(4) That passwords are significantly different from the previous four passwords. Passwords that
increment by simply adding a number are not considered significantly different.
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.
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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) Mustnotbecomprisedof allthesameletterornumber(11111,22222,aaaaa,wouldnotbe
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 Use(s) by requiring logon to the localworkstation 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 I Data Disposition, may be
deferred until the disks are retired, replaced, or otherwise taken out of the Secure Area.
Page 22
Special Terms and Conditions
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. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by
DSHS on optical discs which will be attached to network servers and which will not be transported
out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through
the use of access control lists which will grant access only after the Authorized User has
authenticated to the network using a Unique User 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 physicalsecurity 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)
Page 23
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 still exists upon it, the data
will be destroyed at that time in accordance with the disposition requirements below in Section 8
Data Disposition
i. Cloud storage. DSHS Confidential 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 County Agreement (12-26-2025)
Page 24
7
6.
DSHS Central Contract Services
1 769CS Cou nty Ag reement (12-26-2025)
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.g. 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 practical to segregate DSHS Data from non-DSHS data, then both the
DSHS Data and the non-DSHS data with which it is commingled must be protected as described in
this exhibit.
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:
8
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 or
Page 25
Removable media (e.9. floppies, USB flash drives,
portable hard disks) excluding optical discs Degaussing sufficiently to ensure that the Data
cannot be reconstructed, or
Physically destroying the disk
Paper documents with sensitive or Confidential
lnformation
Recycling through a contracted firm, provided the
contract with the recycler assures that the
confidentia of Data will be
Paper documents oontaining 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 shredding
9.
10.
Special Terms and Gonditions
Notification of Compromise or Potential Compromise. The compromise or potential compromise of
DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1)
business day of discovery. 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.
DSHS Central Contract Services
1 769CS County Agreement (1 2-26-2025)
Page 26
Exhibit B
Program Agreement Budget
X Original Budget Budget Revision
REVENUES
FiscalYear Fund Source Orioinal 1"t Revision 2nd Revision 3rd Revision
2026 State onlv 567,912 576,712
Medicaid 555,171 562.371
Total Rev $1,123,083 $1.139,083 $$
FiscalYear Fund Source Oriqinal 1st Revision 2nd Revision 3d Revision
2027 State onlv
Medicaid
Total Rev $$$$
Job
Foundation
Funds
PASRR Funds
State Funds
Meelleaid
Funda TOTAL
ADMTNISTRATTON (11,
12. 13.14\51072 41786 92.858
OTHER CONSUMER
SUPPORTS
(31, 32, 41,92,93,94,
97)334',11 ,27337'60,748
CONSUMER
SUPPORT
STATE.ONLY
rc2.64.65,67,69)
Child Development (61)
MEDICAID CLIENTS
t62.64.67.69. 95.96)433917 4389t17 867,834
ROADS to
COMMUNITY LIVING
rc2.64.65,67,69)
TOTAL
518,400 503,040 1.021.440
DSHS Central Contract Services
1 769CS Cou nty Ag reement (1 2-26-2025)
Page 27
This agreement is entered into by the Washington Prolection and Advocacy_ System, Inc-
(hereinifter WPAS), the protection and advocacy syqtgm. qtlrgryed pursuant to the Developmental
bisabilities Assistance ana gil of Rights Act of 1975, 42 U.S.C. sec. 6000, qt-geq,, to investigate
allesed incidents of abuse, neglect, and riehs violations of persons with developmental disabilities.
and'ihe Division of Deve[opmental Disabilities ftrereinafter DDD) of the Departnent 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 Deparhnent of Social and Health Services, specifically DDD,- is responsible for
providing services to individuals with developmental disabilities, to the extent {*ding is available.
in providing those services, DDD must protect the confidentiality of records and information
regirding those individuals pursuant to the state and federal confidentiality 1aws.
WPAS is charged by federal law to protect the legal ard human rights of individuals with
developmental disabilities. WPAS provides legal and re-l{ed advoeacy services.to meet that
obligafion. WPAS is also required to maintain the confidentiality of rycords and information
regarding individuals with developmental disabilities consistent'Nlth 42 U.S.C. $ 6000, et leq
This agteement govems the access of Washington Protection and Advocacy Systgm to DDD
employees whb do not work in Residential Habilitation Centerp tr491i and records maintaine4_by
nnO wnicir are associated with individuals with developmental disabilities living outsidc of RHCs.
Federal laws and regulations also provide WPAS with access to commurufy programs and
individuals with developmeirtal disabilities served by DDD contracted providers. DDD will work
with community proviclers and WPAS to arrive at an agreement governing access to DDD
contracted programs and the people served by them.
Attachment F
ACCESS AGREEMENT BETWEEN
WASHINGTON PROTECTION Ai\iD ADVOCACY SYSTEM' INC.'
AND
TIIE DIWSION OF DEVELOPMENTAL DISABILITfES,
DEPARTMENT OF SOCIAL AND IIEALTII SERYICDS.
General.
A. That all tcrms uscd in this agrccmcnt which arc defincd 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 fughts Act of 1975, 47 U.S.C. $ 6000, 91--ge,!L, and
therefore, if this agreement is or becomes inconsistent with the Act or the irnplementing
regulations promul-gated 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.
T.
COMMLNITY ACCESS AGREEMENT
U. Definitions.
A. Actively Aggressive: means that the individual with developmental disabilities is
assaulting otheis oris threatening to do so, or the individual with developmental disabilities
is actively harming him or her self.
B. Client Services: rneans legal representation. The term does not include monitoring
and observation.
C. Complaint: as defined in 45 CFR 1386, or hereinafter amended, includes, but is not
limited to, *y report or communication, whether formal or informal, ranitten o{ q{al,
received by WPAS includrrg media aceounts, newspaper articles, telephone calls (includtng
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 progftlm firnded by DDD. The term includes DDD consumers who have
died or whose whereabouts are unknown. See 45 CFR 1386'22(a)(2)'
E. DDD Employees: includes those individuals who are employed by DDD or who
volunteer for DpD to provide seryices to individuals with developmental disabilities.
F. Emerqencies: means actions, omissions, or conditions that immediately threaten an
individual with a developmental disability's health, life or well being.
G. Individual with a DevelopmBntal Disability: means individuals with developmental
disabilities in the process of appllng for or who have been found eligible for services from
DDD.
H. Monitoring: means unaccompanied access to all residents of a program 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. $1386.22(e).
I. Probable Cause: as detrned in 45 CFR 13E6, or hereinafter amelded, means a
reasonable ground foi belief that an individual with developmental disabilities has been, or
may be, suSject to abuse or neglect. The individual *4.ing such determination may base
t1e'decision on reasorrablc infcroncss drawn fi'om his or hcr cxpericllcc 01'training rcgarding
similar incidents, conditions or problems that are usually associated with abuse and neglect.
J. Prosram: consistent with the definition of "facility" in 45 CFR 1386.19 includes any
setting tirat proviaes care, treatnent services and habilitation, even.if gUy "as needed" .or
undeia con-hacfual arrangement. Programs include, but are not limited to, community
living arrangemenb (e.g., group homes, adult fanfily homes, congregate care facilities,
boarding ho*mes, individual-residences and apartmen*1, day programs, juvenile detention
centers,-nursing homes, homeless shelters, jails and prisons.
K. Provider: means rhose individuals/corporarions with whom DDD contrac$ to
provide servicbs to DDD consumers, including but not limited to behavioral management
iervices, family support services, vocational support services, sheltered employnent, tenant
support, inteniiveli:nant suppotl, altemative living, supported living,.group home, adult
A-ity home, and congregal6 care facilities, chore services, medicaid personal care and
other personal assistance services.
2COMMTINITY ACCESS AGREEMENT
L. Provider Employee: includes those individuals who are employed by a provider or
who volunteer for a provider to provide services to individuals with developmental
disabilities.
M. Recordg: as defined in 42 u.S.C. $ 6042 and 45 CFR 1386(22)(b), or, hereinafter
amended, repo*s prepared by any state staffor reports prepared f _an agency charged with
investigatinf repoits 6f incidbnts of abuse, neglect, injgry,or death that describe incidents of
abuse, ieglect, injury, or death occurring at a facility, investigative documents and discharge
planning -records-. -The term records
-also includes DDD consumer abuse and neglect
iommitiee reports but does not include peer review death reports, attomey work product,
and records which are otherwise privileged utder state or federal law.
N. Rezular Progam Activitv: includes work assignments, education progrcms,therapyo
health services, and daily living activities.
O. SOLA: means the DDD consumer support program, State Operated Living
Altemative,
P WPAS Client(s):
(l) Individuals with developmental disabilities who do not have a guard_ian.or
iegal 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 wilhout guardians who are
unable to communicate their wishes regarding protection and advocacy services
when WPAS has received a complaint of abuse and/or neglect about the individual
with a disability, or WPAS dctcrmincs that there is probable oause 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
iepresentative where the guaniian or legal representative has consented to the
representation in writing.
(4) Individuals with developmental disabilities whose guardian or lega4
iepresentative fails or refuses to act on behalf of the individual with a developmental
diiability, 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 rep-resents the
guordian. WPAS shall notify the DDD Regional A$ryt9+19r or designee in
ivriting that it represents the indiviaual with developmental disabilities and forward a
copy 6f that n6tice to either the guardian or the individual with developmental
disahilities.
includes paid employees atrd volunteer employees as identified
shall carry WPAS identification.
a. WPAS Employees:
by WPAS. Each employee
III Access to Programs.
A. DDD will not obsfruct WPAS access to programs when consistent with the law and
will ensure that SOLA and otherprograms staffed by DDD employees will comply will this
agreement. For programs which contract with DDD to provide services, DDD will not
3COMMLTNITY ACCESS AGREEMENT
IV.
obstruct WPAS access to programs when consistent with the law, but WPAS will assume
primary responsibility for enforcing its access rights. WPAS will attempt to resolve access
issues at the lowest level possible. In cases where there is danger of imminent or continuing
harm to an individual with developmental disabilities WPAS will report t}re occurrence to
DDD, consistent with the Washington State Bar Association Rules of Professional
Responsibility and other applicable state law. ln those cases and where-there is-a pattem of
faihire to proiide access for WPAS to a pro$am 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 identity themselves to any staft'present when they aryve-q!-a
progam by showing a WPAS photo identification badge. WPAS shall provide the DDD
iirector wittr a list of employees and their pictures by July 1,1997, and WPAS shall update
this list as necessary.
C. WPAS shall have access to SOLAs and other programs staffed by DDD employees
as specified in this section. This agreement does not affect the right of an individual with a
developmental disability served bysuch a program who owns_or rents his or her own home
to deny access to WPAS to his or her home. However, DDD -e-mployees-do not have_the
right t6 deny WPAS access to programs or the residences of individuals who are served by
proEtrams.
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 hours for the purpose of providing
informatibn on legal rights and self advocacy to the individuals with disabilities who
participate in the piogram. During the course of such access, WPAS staff shall be allowed
io engage in informai discussions with the individuals with disabilities, out of the presence
of DDDemployees 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 observatiori or monitoring compliancg wlth resp-ect to the rights and
safety of 3ervice recipients (CFR 13S6.22(9)(Z)). ,!qch_obs9!v?ti9n and monitoring
activities need not be limited to clients of WPAS, and WPAS staff shall not be required to
suhsdule ur give prior notice of such visits tu DDD enrployees,. provided that WPAS Irru thv
permission of a DOO consumer. WPAS staff shall _be pe^rmitted to monitor.the prggrlm
*ithout an accompanying DDD employee. WPAS staff shall conduct all monitoring
activities in a manner wtrictr is respeclful of the privacy of the individuals with disabilities
who reside in the monitored program.
Access fo Individuals with Developmental Disabilifies.
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. qPP shall assist
and support rhe profeislonal'relationship berween WPAS and its clients. Wrinen consent
for such access is not required.
B. W?AS recognizes that all individuals with developmental disabilities have the right
to refuse to talk $,ith 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 indiviriuals with developmental disabilities with whom they have contact of these
4COMMUNITY ACCESS AGR-EEMENT
rights before each meeting. A person who does not wish to talk with WPAS staff shall be
atloweO to communicate *ris directly and privately to WPAS staff ',rless }1q g{ th" oYqrtly
**if"itr fear of being alone with thd W?AS staff. When the individual with a
divelopmental disability*overtly manifesfs such fear by words or behavrot, WPAS shall
."rpecf that person's desires and not meet alone with that person'
C. WpAS will encourage its clients and o*ler individuals wi4l developmental
Jisabilities to notifu DDD andior providers of complaints regarding DDD services and to
ieioi"e those complaints through any existing dispute resolution process.
D. WPAS stall'shall comply with all safety and secwity requirements of DDD. DDD
will communicate these requirements to WPAS staff.
E. DDD employees shall not interfere with WPAS staff in obtaining. a PltySte space fbr
rneetings benveen WpeS staff and individuals with developmental disabilities. Private
snace dloes not mean a comer of a common area room or other location which would afford
o'ther residents and DDD employees open accoss to WPAS employees_ in living.areas or-on
the srorrnds. DDD employee.s siall respect the confidentialifneeds_of the individual with a
J.uEfop-.ntut disabiliiy dnO WpaS. iWhere an individual with a de-velopmental.disability
i"A"utbr that he or she does not want to meet in a private space, WPAS staff will respect
this request.
F. WPAS staffwiil not be required to schedule visits with DDD employees in advance
of tfr"it visits. However, WPAS siaff may contact DDD employees to do so if access to a
WpaS client or other individual 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 IOLA or progrcm
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 emplgyees.prior to meeting with its
ilient or DDD consumer, WPAS agrees not to dishub a client or DDD consumer if
the WPAS employee arrives at the iesidence or other building in which the client or
DDD consumer ii served and the client or DDD consumer is engaged in regularly
scheduled program activity. In such case, WPAS staff will
,b_e
permitted 1o observe
or otherwiie virify *re programming without disturbingit. {IPAS staffpresence
disturbs or is objected fo by ttre WfaS client or any other. DDD consumer who is
present, WPAS staff shall-make arrangem"nt. tg meet.with the WPAS client or
bDD "onru-er
at a later time. Where consulted prior to making an appointment
DDb employees will cooperate with WPAS staff in making scheduling
arrangements. The WPAS erirployee shall not disturb 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 DDD consumer's
iintrt to orivacy. WPAS statf wili then erther wzut untll the actruty ts completed or
i"i.n"AUr 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.
(Zl If the WPAS employee arrives for a meeting with a client or DDD consumer
i"a m" individual is actively aggressive, in programming to address this behavior, or
riceiving "onejto-one" superilsion, in such- a situation, WPAS staff will be
p"..itt "a to observe the individual from a safe distance or otherwise veriff that the
individuat is actively aggressive. WPAS staffwill then either:
JCOMMIINITY ACCESS AGREEMENT
v
(a) wait until the individual's aggressive behavior.-has_lqnned ryd be
pdmritted to meet with the individual .privately wlrile-DDD employees
remain in viewing distance; unless such distance wogl{ place the individual
with developmeital disabilities at serious risk of harm based on frtat
individual's ^documented behavioral issues; if the individual 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 lrogrqrl Plan, Individlal Servjce
PIan, or oth6r progfafi plan, nor interfere with staffing needs for other
individuals wittr developmental disabilities; or
(b) reschedule the visit at a time mutually agreeable to WPAS and DDD
employees, but no later than forry-eight (48) hours;
(c) if the WPAS statr is notified that an individual is either actively
aggressive or receiving one-to-one sup_ervision and if knowing this the staff
c[6oses to meet with t[e individual, WpaS agrees to release, indemniff, and
hold DDD, DSIIS, the State and its employees, agents, offtcers, and ryrvqnts
harmless for any injwies that occur hom any.claims or cause of action
asserted by arry WpaS employee or agent.who is injured as a result of 1nl
act committeilby an individual with developmental disabilities except that
those circumstances where DDD employees' willful misconduct is the
proximate cause of the injury to \VPAq:em^p^loyee.or agent. WPAS agrees
itrat its staff shall sign a itar-ement to this effect-prior to reques.ting to mee[
with any such indi-vidual. If the wPAS staff refuses 19 sign such an
agreem*,lnt, DDD employees may deny the WPAS staff access to the
in?ividual-until such timi 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 allowthe meeting to take place.
H. All individuals with developmental disabilities who wish to contact WPAS staff
ihall be provided uncensored acceis to writing. materials, }IPAS' address and toll-free
ieliphone' number, a stamped envelope, an&or access to a telephone tbr private
conversations without monitoring by orpermission from DDD employees.
I. SOLAs and programs staffcd by DDD cmployecs shall pcmrit individuais with
developmental disabijitiJs to set appointnents with WPAS staff at times agreeable to both
the individual with a developmen:tll disability and WPAS staff, I_f the _D_D_D employees
know that a meeting with i DDD consumei witt be disruplive of the DDD consumer's
r"grt* program acti'vity, WPAS statf sha! be informed of this and allowed to reschedule
tl! appdintiient in orderto meet with the DDD consumer so that the appointment does not
disrupt his or her regular activity.
Aecess to Records of Individuals with Developmental Disabilities.
A. WPAS has access to records as provided in 42 U.S.C: $ 6q42, et. seq. WPAS has
leeal authorify to review an individual with developmental disabilities' records only when
iftE i ir .onrent or, if a DDD consumer is unable to consent, there is a complaint or probable
.u"." to believe i OpD consumer has suflered abuse or neglect. WPAS has no general
right to review records except in these circumstances.
6COMMLNIITY ACCESS AGREEMENT
B. Upon receiving a valid, written consent, DDD will have 48 hours in which to
schedule bn appointment with WPAS so that it may come to the record location to review
specified recorils. DDD will verify that WPAS has received consent to view such records,
or if the DDD consumer is unable to consent and there is no guardian to consent that there
is a comolaint or probable couse to bclieve the DDD consurner hos suffered obuse or
neglect. bOO si,ati make the requested records within its possession available within five
wo'rking days from the date the request is made.
C. WPAS may access records of:
(1) any DDD consumer if he or she consents, or if-he or she-has a legal guardian
ivith 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 andDDD jointly'
Q) arry 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, conseryator, or other legal
representative, or for whom the legal guardian is the state; and
c) with rcspcut tu whunr a t;urnplailt has been reueivcd by WPAS ur wi*r
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) Ifrecords 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
physiial condition is unable to authorize WPAS to have access to his or her
ieiords, 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 beiieve rhe residenr 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
csse of iitr emergency.
(3) In the case of a resident who has a legal guardian,-and qpon request by^
'vVPAS, 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
represintalive and oifer its assistance. If &e guardian t-tp !.,"1 conlacted by WPf'S
ana AnteA or refused to act on behalf of the individual WPAS has received a
complaint suffrciently that sufficiently identifies the individual or WPAS has
probubl" cause to believe that the health or safef of the- individual is in serious and
immediate jeopardy, WPAS shall obtain court approval for such access'
a) If a guardian refuses to sonsent to allow WPAS access to records, and
WpaS still wants access, WPAS will file a lawsuit to access the records and
allow a tourt 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 guardian refuses to provide written
7COMMLINITY ACCESS AGREEMENT
consent for WPAS to access tJle records, DDD shall not make the records
available absent a court order.
b) WPAS shall attempt to confact the guardian to obtain consent. Unless an
emergency exists, then WPAS shall contact the standby guardian if one has
been-desiiprated. If no standby guardian is appointed and the guardian is
unavailabl-e, and WPAS determines that the DDD consumer is at risk of
serious iqiury or death, DDD shall make the records available to WPAS to
review.
D. WPAS statt'inay review the requested records within normal business hours in the
U"ifang or room in which such records are provided. A DDD emplglTpayremain in the
room wltile the records are viewed. Under no circumstances may WPAS statf remove the
original records, or any part thereo{ from the room where they are viewed.
E. WPAS agrees to reimburse DDD for the costs of copies..al the same rate.charged for
nublic disclosurirequests, cunently $.15 per page. When fbasible, copig,s will be- provided
;; th" day the copils are requestid. If thaf is not pnssihle, DDD will make the copies
available within l0 days of the request.
F. WPAS shall request guardian information or access to DDD consumer records of the
bbO n gi*al Administritor of the region in which the DDD consumer resides.
ftr"reafterl their contact regarding that DDD consumer shall be the regional administrator,
;; hir ; her designee. 5OO Jtratt provide WPAS a list with contact information fbr
furporer of access Io records. DDD agi'ees to update that list at least annually.
G. In order to access DDD records, WPAS will send a written request directly_-to the
nOO n"sio"al Administrator or designee in custody of the records. In the^request,.WPAS
*ff la."fify the individual whose rec-ords it seeks.
-WPAS
need not identiff the.individual
by name, 6ut must sufficiently identify the individual so that the person _reviewing.the;J";;;* determine whose records are being sought, WPAS will specifr which records it
wants and for which time periods. WPAS will also indicate that it has received-a comp_la:nt
g;;;-i;e the individual io that it has probable cause to believe the individual has suffered
ffi;; ;;"glect. WPAS need not fluth-er specify the nature of the complaint nor who made
the complaint.
H. In the event DDD denies access to records pursuant to a request,
iequest that the derual be in wntng and include the reason for the derttal.
I. WPAS will limit its request to records it considers necessary
investigation. DDD may reque.st that WPAS specifically identify the
seekinf if the request is too broad or voluminous'
Outreach.
A. All individuals with developmental disabilities shail have access to WPAS staff for
ih" prrpor" of obtaining information about their legal 1g!r53nd self-advocacy. WPAS staff
il;li #;il"*"d tu
"ngEg"
in infomral discussions-with DOD consuurers who wish to speak
to them out of the preGice of DDD employees in an area that affords privacy'
B. WpAS may hdve regularly scheduled informatior/training sessions. Ft. PPD
*nto*"rr and parJntVguardiilslfariily members regar-dpg. WPAS'services and individual
iiehG. Dnt employeei may attend outreach and scfieduled information sessions only with
ad'vance written permission of WPAS staff.
WPAS staff may
to accomplish its
records that it is
VI
8COMMLINITY ACCESS AGREEMENT
VII.
VIII.
C. DDD agrees to give WPAS a list of all 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 ior DDD services. WPAS will provide DDq wiqr copies of their brochure
and/or any other information they want DDD to dishibute at that time'
E. DDD agrees to require contractors to comply with 42 u.s.q. $6000 et. seq. *]g 15
C.F.R. Parts 13-85-86 by iircluding the requirement in conhacts. Currenl contracts will be
amended to include this requirement when they are renewed.
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 fuU investigation of an incident of abuse or neglect.
hir u"i"rr shall includl the opportunity to interview any individual with,a developmental
Jiutitity, any DDD or providbi employee, or any othei person who might be reasonablv
Gliev;d'UV iVpeS to h'ave knowledge-of the incident under investigajiqrl, and to review
*ftut WpaS is entitled to review purJuant to this agreement. W_,PAS 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 entity.
B. WPAS' investigations shall not interfere with any other ongoing investigation'
*ryOt employees shail not visit areas at times that would violate any person's right to
pnvacy.
C. DDD shall allow and encourage all employees and providers to talk openly with
WpaS employees. WPAS will n5t ask sfaff-to disrupt their work schedules or
responsititiiles'to ralk with WPAS. Except in cases of emelgency, WPAS will schedule
appointrnents with staff in advance.
D. While DDD and provider employees shall be enco!rygeg to cooperate with WPAS,
"*ptoy"er
hive the right to refuse to.talk"with WPAS. WPAS shall notify employees of
that right prior to any anempt to interview them.
E. Any complaint concerning WPAS staffshall be immediately brought to the attention
oi tfr" WpnS Eiecutive Directoior his or her designee. Upon receipt of a complailt, the
WpAS Executive Director or his or her designee shall conduct an investigation and submrt a
""ltt"" ."rponr" to the State within fourteeri(t4; days in an
"Fott
tg resolve any complaints
* "rp"Oi"-rtiy
as possible. DDD reserves tlq rigti't to file formal charges if the behavior
placei a DDD consumels health or safety at risk.
F. WpAS shall inform DDD and providers, in writing, of its findingl and concems
upon completion of any investigation ?clivity undertaken pursyaqt.to its authortty under 42
tii.b. $?'0-_00 et. seq.,'and the iccess rights granted to WpAs in this aqreerye.nt, in an effort
to ,"rolu" DDD coniumer complaints -or
"6ncems
prior to commencing ltigation, unless
WpeS belie ve that such delay wbuld result in serious injury or harm to the DDD consumcr'
Implemenfafion of the.Agreement.
A. The DDD Director shall ensure that each supervisor will conduct an annual megling
with his oiher staff to provide information regarding the parties' rights and.rgsponsibilities
under this agreement. ift" OpO director shalfensurE that each employee of DDD has read
9COMMINITY ACCESS AGREEMEN'|
and signed a copy of a form indicating that they have rea{ 1$ agreement at the time of hire
*O ut"A" time of his/her annual evlluation. DDD and WPAS shall develop_ a mutually
&r"a io r*ury of this agreement for use in informing DDD employees. of the parties'
ri"gtts *a r"sponsibilities. ffiien DDD and WPAS develop and agree regarding the content
;fthir ;itnt*^.y, DDD employees shall be required to read the srrmmary, rather than rel{ing
tftir ugrc"rneni'and acknowledge that they read and understood the summary with a
signafure.
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 DDD
provider relatio"nships is approfriate. -This agreement will affect contractual relationships, so
ir*iit U" n"gotiated with iioviders prior to implementaliqn. This negotiatiglyilt take place
during the fggT-1998 prdvider coniract negotiations. DDD_will request UP}S review the
propdsed contract langi:age prior to confiact signing Fy POn. Th.e eqal.of this negotiation
ild;* will be to aiiul at un agr"ement vihicli implements the federal.statutory-.anq
i"g"tuto.y ,iquirements in a mannei consistent wi!r.$re. nr.olision. of quality, individualized
""iri"". ind supports to people with developmental disabilities living inthe community.
D. The DDD director will make changes as necessary to implemel,tlhis-agreement by
september l,lggT,and prior to implementing changes will confer with WPAS'
E. WpAS and DDD agree to work together to asslst providers in becoming !|.ni|*
with WpAS access to progrf,ms. DDD agrels to host a forum in each.region to familiarize
Droviders with the access frovisions. WpaS agrees to make q$ avg!!!e as.presenters at
i"gi"*if"-"rs, and othenvise as mutually agree{tg with providers. DDD will distribute to
oroviders a summary of the access provisionl. This summary will be prepared by WPAS'
Ltta *iU be subject to the review and approval of DDD prior to distribution.
IX. Miscellaneous.
A. WpAS agrees that its staffshall not give medical advice and sh{l not engage in the
nractice oi mediiine. It is WPAS' intent aid purpose to give legal advice. For example,
'WpaS will not tell DDD consumers not to take medication or that medications are wrong
fd rhil. WPAS will not discourage individuals with developmental disabilities from
oarticinatine in Drosrams or activitiei. WPAS may explain DDD consumer legal rights
i;il4ffi t,fi" risht io informed consent, their right io Ue tota of the risks and benefits of
;;;;?; or hedical procedures, ttr6lr rlehito refuse to take medications and the
".""La*" io follow if thiDDD corlriumer doei not wish to take medications, and their right
[o r"n ." 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 identified as medically
frasile or to havibehavioral concems that require constant monitoring. If WPAS requests a
meEting wrttr such a DDD consumer and UDD determrnes that the Dlll) consumer cannot
6" i.iii.."pervised with a WPAS employee, a DDD.or provider employee shall.be pts:1t
;;;g */it"etings. If DDD consumeri are hospitalized due to medical conditions, DDD
u. priui,llr .ruplo"yees rnay rcrnain within viewing distance if. necessary for the DDD
r*i"r"it 6"uftn dna safety. The employees will not interfere with the meeting 9.x9ept for
*.Oi"ut t"*ons and will reipect the OOb consumer's privacy to the extent possible given
his or her medical needs'
COMMUNITY ACCESS AGREEMENT l0
C. This agreement delineates the usual process by whr.cf WPAS and DDD will woft
t-og"tfrer. ln i"ome situations, it may be necessary to dmend these procedures. WPAS and
ObO may agree to modiff these procedures as necessary tbr any particular situation.
X.Dispute Resolution.
A. WPAS and DDD agree that informal resolution of disputes is preferred- if WPAS
itaf und the DDD Regionil Administrator or designee are unable to-agree abotlt a1$y9
iig*A"g interpretatioi or apalication of this agieernenq .they will request the WPAS
iiil;iiG Director and the DDD Director review the situation and attempt to resolve the
disagreement.
B. The Directors Meeting and Mediation process are m_andatory for both parties.
fir" ontv exception to this te-rm of the agreement is where WPAS, in good.faith,-has
;;;UbE "ur5,i
to believe that there arelxigent circumstances warranting immediate
;;;;. Such circumstances are defined as-"emergencies" as defined in the access
ugi""*"ntr. In such cases, the.WPAS Executive Dilector or his or_ her designee shall
.8oiu.t ttt* Director of the Division of Developmental Disabilities.or his or_her designee;
*Ol"i Om"e of the Attomey General to attempt to resolve the dispute. If_-the exigent
*"".r dispute is not resolv6d Uy the end of the &llowing.business day, WPAS.may
t-*"ai"iiiy take any necessary iegal action, inciuding seeking a temporary reshaining
order and prelimina,ry injunction br an order to show cause in order to secure the
"..""rury u"""rt with6ut going through th-e ADR process discussed herein. When WPAS
,iggst.k; such action, it Jtratt glve the Office of ihe Attorney General advance notice of
such action by telephone and facsimile.
C. In thc cvcnt that thcrc is an accoss disputc rcgarding any aspcct 9f th" Acccss
Asreements between WPAS and DDD (Commuriity), the aggrieved parfy shall send written
no?"" l" the director of the other party (e.g. WPAS Executive Director, the Director of
if-nn, .r their designees) of the diipute ind the desire to meet to attem_pt to_resolve the
dispuie. The DDd director (or his/her designee) shall meet with the WPAS Executive
Oir'."tor (or his4rer designee) within ten days after receiving written notice form the
agerievedpafty. The datelf r6ceipt of notice shall be in accordance with Civil Rule 6 of the
Wiiitinmoh Lburt Rules. 'lhe nieeting may take place in person or telephonically.. lhe
p"rti"i fiave the right to bring their c6uns6t to the directors meeting, however it is- the
ireference ofthe pirties not to have their counsel present. In the event a party intends to
Lavelrisorhcrcounselpreserrt, thatputywilladvise the otherpartyofthisintentinadvance
oittr" me"tlng. HoweGr, when eith'er director (or his or her designee) is an attomey, it wili
be understood and expected that the other director may have his or her attorney present
rvithout prior notice.
D. In the event. that the access issues are not resolved by a meeting between the
birector/CEO and Executive Director of WPAS or their designees, the parties .agree to.
attempt to resolve the dispute through mediation absenl exigent circumstances as described
in narisraph 1. An available mediator from the mutually agreed upon Mediator Panel list as
aeicribEd below wili be used to conduct the mediation.
Mediation will be scheduled to occur as soon as possible following the directors
meefing, but will occur no later than 30 days from the time mediation is agreed upon by the
parties."ahsent written afireement by both parties to extend this timeline. Th9 mei]lalion may
iut r piu"" telephonicafly or in any manner the mediator believes will be efficient and
conducive to a-productive mediation. If, at any time during the mediation, either party
declares an imp-asse, lhe mediation will end. The parties are then encouraged, but not
llCOMML'NI'IY ACCESS AGREEMENT
required, to arbitrate the dispute. The costs of mediation shall be bo.me equalll !V.th:p*rti"s. If no litigation resulfs within 90 days of the completion of mediation, WPAS shall
withdruw its access request. Nothing, however, prevenls WPAS from renewing its request
in the futgre should that become neclssary. In such event WPAS renews the request, and
that request is denied by the State, the ADRprocess will begin again.
E. Within 90 days of the execution of this agreement, the parties shall select a panel of
at least 4 mrrhtally agreeahle mediators. There will be two separate lists: one for WPAS and
DDD and one foi WP,{S and the MHD. The parties agree that any one of the selected panel
members will mediate all disputes related to the Access Agreement. However, the parties
will rotate the order of contaciing the panel members for each mediation in a nonstategical
manner.
In order to select this panel, within 60 days of execution of this qgreemen! the
parties will each propose at leasi 4 mediators. The piuties will exchange, via fax, their list of
nrooosed mediators and the mediators' curriculum-vitae and any other necessary facts such
io 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
asreement cin be reached. However, a final agriement must be reached no later than 90
diys 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 parly may not strike a
mediator from ttie panel once the mediation process has been initiated to resolve a dispute.
lf a parly strikes i mediator trom the pan€I, that medtator will be replaced by another
mediitoiusing 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 tkough arbitration. Written agreement to
oio'rr.[ to arbihation must be made rvithin five working days of the completion of
mediation described in SecJion B. Ax available arbitrator from the mrrhrally agreed upon
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
tha; 45 days from the time arbitration is agreed upon by tlp parlte_s, absent written
asreement bv both parties to extend this timeline. Prior to the time of final agreement to
#bitrut* the dispute, the parties shall agree in writing whether the arbitration decision will
be binding or advisory, anA if advisory, whether that cpinion is.admissible in court. If no
lifigation iesulrs withih 90 days of the'completion of this arbilration, WPAS shall wilhdraw
its "access request. Nothing,- however, prevents WPAS from renewing its request in the
future should'that become necessary. 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 s-elgct a.panel
of at least 4 mufi:rllly agreeable arbitrators. The pa*ies agree that any one olthe selected
p*et mirnUers will arb-itrate all disputes related io the Access Agreement. However, the
iu.ti". 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_agleem_enl, Se
narties will each propose at least 4 arbitrators. The parties will exchange, via f-ax, their list
Lf oronosed arbitrators'and the arbitrators' curriculum vitae and any other necessary facts
rudtt d" cost, etc. If the parties cannot agree upon at least 4 arbitrators from the hrst
exchange of iists, the parties will exchange additional lists of arbitrators until an agreement
can be ieached. How^ever, a final agreement must be reached no later than 120 days from
COMMUNITY ACCESS AGREEMENT t2
the date of the settlement agreement of this case absent written agreement for an extension
of a specific amount of time.
Any party may strike an arbitrator from the list except that aparty ntay not strike an
arbilralur frulu the p;urvl ouuc tlrs ubitraliurr lrruucris has bscn furiliatsd tu lesulvs a ilis;;u[c'
If a party strikes an arbitator from the panel, that arbitator yr! be replaced by another
arbitratoi 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 current relevant access agleements.
Any timeframe may be extended by
"witten
agreement of the parties.
I. The parties agree they will abide by the timeframes contained in the Access
Agreement and ttris settlement agreement. The parties may mutually agreelo extend any
tirieframe. If a party fails to act or respond within the allotted time, the other pafiy may
request appropriate sanctions be imposed as provided by law or civil rule'
I I v
Date
Director
of Developmental Disabilities
.) | \i',! ,*,
ot
I
MARK Date
Execrrtive Director
Washinglon Protection & Advocacy System
COIV{MI'NITY A CCESS AGREEMENT l3
,'",,,' lllf'9
{llev. Itarch 20241
Dopannlonl ot lhd Treisury
lntotnat Rcvcnuc Soryico
Attachment G
Request for Taxpayer
ldentification Number and Certification
Go to ww.irs.govlFormwg lor i^sttuctions and the latest information'
Give form to lhe
requester. Do not
send to the lRS.
Before begin, For relaiod to tho of Form !V-9, $oo Pi [pose of bal6!v
I Nane of entity/individual. /\n entry is rcquired. lFo. a sole proprleior ot disregardcd enlity. cnter the o\,/ner'g limc on lioe 1, and cntcr :he b(slness/disreq{rded
enlity's name 0n l,ne 2l
2 BusiDo$s narncld;srcearded outily namo.
'l
dfierclrt f/om abovc.
aoNo
o
OEao;E
oc
q.u
ooath
ooo
4 Excrnptior)s icodos appiv oniyto
certain entities, not rrdividuals;
sae iflslruct4ns on pi0e 3):
Excmct payee codo (il flnyi
Exefilption korn Forei{r Acco[lrl T[x
ConrpliaDco Act IaATCA) roporlirlg
codo {if eyi
dtrptos to ,ccdJnfs triaintainod
outside the Uoitad Staies.)
Flerluesler's nHrne ard dddress iopliona )
7 i .sl $'{xrnl rurrt}er{!i) r,ere f)pliotal}
T Number
Enter your 1lN in the appropriato box, Ilre flN provided
'nrrst
natch the name given on lilte 1 to avoid
backup rvilhhol.iing. For individua|:, ihis is gonerally yorr social sccurity number (SSN)' I'lowover, for a
rosidOnt alien. lrole propriotor, or disrcgarded entily, Seo the in3!ftlolions for Part l, 18ter. Fof olncI
entities, it is yoil. ernployer identilication surnber (ElN). lf you do not have a runber. see How to get a
f/N. later.
Note: lf the accoultt ls in more than onc rame, see ths instructiorrs for line 1. See also What Name and
Numbcr To Cive lhc Requester for grtidolnes on whoso number lo enier.
or
n
Under penalties of perjilry, I certify that:
1 , fhe uilmber shown on this lotm is lny correcl tilpayer i.lcntificalion trumber (or I am lvaiting for a rlumber to be is$ued to lno]; and
A. I am nol sbtljeql to backLp yilhhold;ng beoau3a {a} I am excrflpt from b,tckup uilhholdkrg, or {b) I havo ro! bge! nolified by !hr.' inlerrral Re'/onre
Seruice (lRSj ihB! I arn subject !o bsckup withholding as a re$ult of a tsilLre to report all interest or dividends. or (c) the IBS has uotiiied tne thal I arr)
no :onger silbiect to backup lrilbholding: alld
3. I am a U.S. citizen or other U.S. persotr {defined 'beiow): and
4. The FAICA codeis) enio.ed on this forrn (if anyl indicaling lhai I artt exornpl lrotn FATCA reportiflg ilt corr{}cl-
b€cause you have ia,ied to report all interest and dividends ol1 your tax /eturn. For real estate transacliols. ilem ? does nol apply. For nlortgage;nteresl oaid,
acquisitior) or abandotrment ol secilred prooerty. carrcellation ol debt,contrjbritions to an individual ratiremBni arangernent {lRA), and, generally' paymenis
ta Chek the {ppropriald Dox ty iqJerit lax (:lagi{(alron ef th€ snt;ly/:nril1(lual \,/host narie i3 e.ler*i dn lirle l - Cl€ck
oniy ono of lho follolv;.{ sove. box€s-
n hldivldunl/Erloproorictor I Ccorpo,a:ion ! Scorporatioo ! Padno*hio n Trusvestatc
f] LLC. =nt,v
tne trt clas$ifkjrliori (C." C rn.lFtatiui, S.' S iorForaliorr, P = Pn.1rc.$llip]
Note: Chflk t:re "LLC" btx noove i1.1, itl lhe erlry sJta(ie, enler llle afpropriale (odc {0, S, or P} tor llre lax
ctas$ification it tlrG l"LC, url6s$ it is a disrevardqt 0iltity. A.li$r60x(lod fnlily shoujd lnsload (tx{k !ho atproprialo
oor ior:re !u alassilicalron ot ,ts orvnc.
n othe. {$oe instruclionsl
3b ii on Fne 3a you cbeckei "ParineBhip" or ''Iruguoslate,' or cl.eckod "LLC" and erter€d "f]- as :ts ifx ciassilication.
iud you .ire providiog l|.ig {or{ lo a parlnershrp, trrsl, or eslalle h whmh you hiive an ovJnersnlp rnler€sl, check
lhis box il yoir have ilrly l.'rei$il Parlrle6, ovrilers, or iEr!elrciar.es. See:nslr,lclk)ng
5 Addrexs {rxilrtbei, strel, and ppl, o. silile no i. See instrlclions,
6 Cjiy, state, trid ZlP code
Social numbgr
Part I
Part
other rftorost and dividends, you aro rot
Sign
Here
General lnstructions
Sectiorr refereDces are to the lnlemal Reverlue Code unless otheruise
noted.
Futurs dev€lopm€nis. For lh6 lale$t intoftrlaliolr abotjl devcloplnenl$
relaled io Fo.r[ W-9 3nd its ir]structions, such as legislation enacted
afler they nere published, go 10 www.irs.gov/FoffiWg,
What's New
Ljne 3a ras been rnoditied to clarily ho\T a disregarded entity completes
thrs lino. An l-LC that is a crsrogarded eniily should check lhe
appropriate box lor ih€ tax classificatian of ils owrrer. Olharsiso, it
::houltl check the "LLC" box and enier its apprt)priate lax clalisiticiltiorr.
lho cerli{icalion,but you must providg correfi TlN. See tho lnstructions for Part ll iatsr
Drto
Nov{ iine :lb haai been addod to this fonil. A llouFlhrough €rlity ial
reqilired to conplete tiris line to ind,cale that it has di/eet or indireet
foreign padllers, ovJners, or seueliciaries {shen it provides the lronn W-g
to another llow-throuqh entity tn which it has an owrrorship itrtcrost. l-his
chanqe is intcnded to provide a ilow-through enlily Yith informalion
rogarding lhe stiius of ils indircet {orcign partrrors, drvrlers, .)r
bBneliciar;es, so ihat it can satrsly any applicablo reporting
reqilirements. For example. a padtlership that has any indirect loreign
,rartners may bs required to conplete Schedrles K-2 ar:d K-3. 6ee thc
Par':ncrslrip lnstruclions for $chetlules K 2 artd K-3 (Fortn lC6li).
Purpose of Form
io
Siqnaturc of
U.3. potaon
n n individual or a.tily (Forr$ W-9
,nformation retuil wilh the lFlS is
reqile.-sb4 \,rl1o is required to llle eo
givir)g you ttris lofi* because they
Cal.
^kr.
l02lt1X
Kittitas County Agreement for Services (rev.5/7a/25)
Page 16 of 21
Fonr W-g {Arv. 3-2024)
Fom W-5 {Rev.3-2024)Page 2
must obiain your correct laxpayer identification number fIlN), which
may be your saciat security number {SSN), individual taxpayer
ideiti{ication number (lTlN}. adoption taxpayer identification nunrber
(ATIN), or employer:dentitieation number {ElN}, to tepcrt on an
information relum the amount paid to you, Dr other amouni repartable
rn an information relum. Examples of information retums include, but
are not limited to, the following,
. Form 1ogglNT (interest eamed or paid).
r Form 1099-DlV (dividends, including those ftcm stocks or mulual
funds).
r Form 1099-MISC (vaious types o{ inmrne, prizes, awards, or gross
proceeds).
. Form 1099-NEC (nonemployee comp€nsation).
o Form 1099-8 (stock or mutual fund sales and certain other
transactions by brckers).
o Form 1099-5 (proceeds fiom real estate l€nsaclions).
e Form 1099-K {merchant card and th;rd-party nelwork transactions).
. Form 1098 (home mortgage inter€si), 1098-E {student loan interesl)'
and 1098-T (tuition).
. Form .l099-C (canceled debt).
o Form 1099-A {acquigition or abandonment of secured properly}.
Use Form W-9 only if you are a U.S. person fincluding a resident
alien), to provide your conect TlN.
Caution: lf you don't relum Form W-9 to the lsquester 'flith a TlN, you
might be subject to backup withholding. See What is backup
withholding,later.
By signing the lilled-out form. you:
't. Certifo that lhe TIN you are giving is conect {ot you are waiting for a
number to be issued);
2. Certity that you are not subiect to backup wilhholding; or
3, Claim exemption from backup withholding il you are a U-S' exempt
payee; and
4. Certify to your non-foreign status for purposes ol lvithholding under
chapier 3 or 4 bf the Code (if applicable); and
5. Certifi that FATCA codeis) entered on this fonn df any) indicating
that you aie exempt from the FATCA reporting is conect. See What /s
FATCA Reporting, later, for further information.
Note: lf you are a U.S. person and a requester gives you a form other
than Forh W-s to request your TlN, you must use lhe requester's fcrm if
it is substantially similar to this Form W-9.
Definition of a U.S. 1>erson, For federal lax purposes, you are
considered a U.S. person il you are:
. An individual who is a U.S. cilizen or U.S" resident alien;
. A partnership, corporation, company, cr association created or
organized in the United States or under the laws of &e United Stales;
. An estate (other than a foreign eslale); or
o A domestic trust (as defined in Fegulations eection 301 -7701-7).
Establishing U.S. status for purposes of chapler 3 and chapter 4
withholcling. Payments made to foreign P€rsons, including certain
distributioni, allocations of income, or translers o{ sal€s Proceeds, may
be subject to wilhholding under chapler 3 or chapter 4 o{ the Code
(sections 1 441 -1 47 4\. Under those rules, if a Form W-9 or oiher
certification of non-foreign status has not been received, a withholding
agent, transferee, or partnership {payorl generally applies presumption
rules lhat may require the payor to lqithhold applicable lax lrom the
recipient, owner, transfercr, or parlner (payee). 9ee Pu!. 515,
Whhholding of Tax on Nonresident Aliens and Foreign Enbties.
The following persons must Pttvide Form W-9 to lhe payor for
purposes of establishing its non-fcreign status'
r ln the c.ase of a disregarded entity lvith a U.S. olmer, lhe U.S. owner
of lhe disregarded entity and not the disregarded entily,
r ln the case of a grantor trust wiih a U.S- granlor or other U.S. owner,
generally, the U.sigrantor or other U.S. owner of the grantor lnrst and
not th6 grantor trust.
e ln the case of a U.S. trusl {olher than a grantor trusl), lhe U.S' irust
and not the beneficiaries of the trust-
See Pub. 515 for more in{ormation on providing a Form W-9 or a
certification of non-foreign slatus to avoid withholding.
Foreign person, It you are a foreign petson or the U.S. branch ol a
foreigi b'ank that hds elecled lo G t#ated as a U.S. person {under
Regulations seciicn 1 .1441-1p)(2|(iv) or other applicable section for
chJpter a or 4 purposes), do not use Form W-9. lnstead. use the
appropriate Form W-8 or Form 82gg {see Pub. 51 5}' lf 1ou ar+ a
qualified foreiqn pension fund under Regulations seclion 1'897{l}-1{d), orj partnership ihrit is wholly owned by qrialified foreign peosion funds,
thit is treated as a non-{oreign person for purposes of seclion 1445
wilhholding, do nol use Form W-9. lnstead, use Fcrm W-8tr(P {orother
c€difi cation of non-foreign statue).
Nonresi<lent alien who becomes a resideni alien. Generally. oniy a
nonresident alien individual may us+ the terms of a tax treaty to feduc€
or eliminale U.S. lax on certain lyPes of incsme. However' most tax
lrealies conlain a provision known as a saving clause. Exceplions
specified in the saving clause may permit an exemption {lom tax i4
cbntinue for certain types of income even after the payee has otfierwise
bacoma a U.S" resident alien for tax purpos€c.
ll you are a U.S. resident alien who is relying on an excepticn
contained in the saving clause of a lax treaty to claim anexemption
lrom U.S. tax on certain types ol income, you must atliach a stalement
lo Form W-9 that speci{ies the following five items.
1, The treaty country. Generally. this must be the same beaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressirrg the income.
3. The article number {or location) in the tax trealy that contains the
saving clause and its exceptions.
4. The type and amount of income that qualilies for tfte exemption
from tax.
5. Sulficienl facts lo iusli{y the exernption lrom tax under lhe lerms of
the treaty article.
Example, Article 20 of the U.S.-China income tax treaty allo',gs an
exemptibn from iax for scholarship income received by a Ghinese
student temporarily present in the United Slates. Under U.$. law. this
sludent will become a resident alien for tax purposes if lheir 6tay in lhe
United Slales exceeds 5 calendar years. However, paragraph 2 ol the
firgt Prolocol to the U.S.-China treaiy (dated April 30, 1s84) allows the
provisions of Article 20 to continue to apply even after the_Chinese
student becornes a resident alien of tha United States. A Chinese
student who qualifies lor lhis exception {under paragraph 2 of the first
Protocol) arrd is relvino on this excepiion to clatm an exemplion from tax
on therr icholarshif oifellowship iniome would attach to Form l /-9 a
statement that includes the inlormation described above lo support that
exemption.
lf you are a nonresident alien or a foreign entity, give the requ€sler tfie
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain paymenbto you
must under ceriain conditions withhold and pay to ths IRS 24Y' ol strch
payments, This is called "backup withholding." Payments that may be
subject to backup withholding include, but are not limited to, inter€st,
tax-exempt interest, dividends, broker and barter exchange
transactians, rents, royalties, nonemployee pay, payrnents made in
settlement of payment card and third-party netrork t.ansactitns. and
certain payments from fishing boat opetalots. Real eslate transaf,tions
are not subject to backup wilhholding.
You will not be sub.iect to backup wiihholding on payrnents you receive
il you give the requester your conect TlN, make the proper cedificalions,
and report all your taxable interest and divrdends on your tax rellrn-
Paymenls you receive will be subject to backup wilhholding if:
1. You do not fumish your TIN to the requester;
2. You do not certify your TIN rvhen required {see the inslnrclions for
Part ll for details);
3" The IRS tells the requester lhat yau ium;shed an inconect TIN;
4. The IRS tells you that you are subiect to backup withholding
because you did not report all your interest and dividends on your lax
retum (for reportable inierest and dividends only); or
5. You do not cedify to the requester that you are not subiect !o
backup withholding, is described in itern 4 under "8y agning the filled'
out foim" above (for reportable inleresl and dividend accounts opened
after 1983 only)-
Kittitas County Agreement for Services (rev.5/M/25l.
Page L7 of 2t
Form W-9 (Rev. 3-2024)Page 3
C,ertain payees and payments are exempt from backup wilhholding.
See Exemi:t-payee code, later, and the separate lnstructions for the
Requester of Form W-9 for more in{ormation.
S€e also Estab/ish,ng U,S. slalus Ior purposes of ch€pfer 3 and
chapter 4 withholding, eadier.
What ls FATCA Reporting?
The Foreign Account Tax Compliance Acr {FATCA} requires a
parlicipating foreign financial instilulion lo report all U.S. account
holder3 thai are specified U.S" persons. Certain payees are exempt from
FATCA reporting.'See Exernptron from FATCA reporting code,later' and
the lnstruclions for lhe Requester of Fotm W-9 for more information.
Updating Your lnformalion
You must provide updated information to any pecion lo whom you
olqimod to bc on cxcmpt poyea if you oro no longor on oxcmpl psyee
and anticipale receiving reportable paymenls in the future from this
person. F6r example, y-ou may need lo provide updated information if
you are a C corporation that elects to be an S corporation,_or if you are
no longer tax exempt. ln addition, you musl fumish a new Form W-9 if
the name or TIN changes for the account. for example, if :he g€ntor oI a
grantor lrust dies.
Penalties
Failure to furnish TlN. ll you fail to fumish your conect TIN to a
r€quesler, you are subiect to a penalty o{ $50 {or each such {ailure
unless youi failure is due to reasonable caus€ and nol to willful neqlect.
Civil penalty lor false information with respect to withholtlittg. lf you
make a falsri slatemenl with no reasonable basis that results in no
backup withholding, you are subject 10 a $500 penalty'
Crinrinal penafty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fi nes and/or imprisonmant.
Misuse of TlNs. ll the requeeler discloses or uses TlNs in violation of
federal larv, ihe requester may be sublecl to civil and criminal penalties.
Specific lnstructions
Line 1
You must enler one of the following on this line; clo not leave this line
blank. The name should match the name on your tax relum.
lf this Form W-9 is for a joint account (other than an account
maintained by a {oreign financial institution {FFl)}, lisf irsl, and then
circle, the name of the person or entity whose number you enlered in
Part I of Form W-9. lf you are providing Form W-9 to an FFI to doctiment
a joint account, each holder of the account that is a U'S. person must
provide a Form W-9.
. lndividual, Generally, enter the name shown on your tax retum' lf you
have changed your last name wiErout informing the Social Security
AdministrJtion (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note for lTlN applicant: €nter your individual name as it was enlered
on your Form W-7 apPlication, line 1a. Thrs should also be the same as
the name you entered on the Form 104o you filed with your application.
. Sole proprietor. Enter your individual name as shown on ycur Form
1 040 on lin; 1 . Enter your business, lrade, or "doing business as" (DBA)
name on line 2.
e Partnership, C corporation, S corPoration, or LLC, other thall a
disregarded'entity. Enter the enlily's name as shown on the enlity's tax
retum on line I and any business, lrade, or DBA name on line 2'
. Other enlities. Enter your name as shown on requirecl U,S' federal tax
documenls on line 1. This name should match the name shawn on the
charter or olher legal documenl creating the entity' Enter any business,
trade, or DBA nam6 on line 2.
, Disregarded entity. In general, a business entity that has a single
owner, including an LLC, and :s not a corporation, is disregarded as an
entitv separate hom its owner (a disregarded entity). See Regulations
section i01 -72o1 -2(cX2). A disregarded entity should check the
appropriate box for the lax clasaification of its owner. Enter the owner's
nbine on lhre 1. The name of the owner entered on line 1 should never
be a disregarded entity. The nalre on line 1 should be the name shown
on the inc6me tax retrim on which lhe income should be reported. For
lF the entiVindividual on line {
isa(n)...
THEN check lhe box tor
. Corporation Corporation-
. lndividual or
. Sole proprietorsftip
lndirridual/sole propnetor.
. LLC classified as a partnership
for U.S. federal lax purposes or
. LLC that has filed Form 8832 or
2553 etecting to be taxed as a
corporalion
Umlled liability company and
enter the appropriate lax
classification:
P = Partnership,
C=Gcorparation,or
S = S corporation.
. Parhership Parinership.
' Trusl/estate Trust]estale.
examDle, if a foreiqn LLG that is lr€atad as a dlsregarded entity {or U.S.
teaeral tix purposls has a stngle owner that is a U.S. person, the U.S'
owner's narne is required tc be provided on line 1 . lf the direct owner of
the entity is also a disregarded enlitg. enter the first ownsr dtat is nol
disregarded for lederal tax purp*ses. Enter th€ disregarded entity's
name on line 2. ll the owner ol the disneEanded enlily is a foreign person,
lhe owner muet complete an appropriate F'rrn W-9 irstead of a Form
W-9, This is the case even if the foreign pers,on has a U.S. TIN-
Line 2
lf you have a business name. lrade narne, DBA narne, or disregarded
entity name, enter it 0n line 2,
Line 3a
Check the appropriate box on line 3a for the U,S" fed€ral tax
classification bf the person whose rame is enlered on line 1. Check only
nne hox on line 3a.
Line 3b
Check this box if you ate a partnership lincluding an LLC classified as a
parkrership for U.S. federal tax purposes|. lrust, or estate thal has any
ioreign partners, owners, or beneficiaries. and yau ate providing this.
form to a partnership. trust, Dr eslale, in which you have an ownership
interesl. You must iheck the box on line 3b i{ you receive a Form W-8
{or documentary evidence) from any partneq owner, or benaficiary
establishing loreign slalus or i{ you receive a Form W-g trcm any
partner, owner, or beneliciary tfrat has chacked the box on line 3b.
Note: A partnership that provides a Form UJ-g and checks box 3b may
be required to complete Schedules K-z and K-s {Form 1 065}. For more
information, see the PartnerEfiip lnstructions for Schedules K-2 and K-3
{Form 1065}.
ll you are required to complete line 3b but fail to dl so, you may not._.
receive lhe information necessaty lo file a conect information retum with
the IRS or fumish a conect payee staiernent to your parElers or
beneficiaries. See, for examplq 3&lioils 6698, 6722, and 67?4fo(
penalties thal may apply.
Line 4 Exemptions
lf vou are exempt from backup withholding andlor FATCA reporting'
eriter irr the uppiupriale spate on lirre,l arly cr-xie{s} lllat lllay apply to
you.
gxenpt payee code,
. Generally, individuals {including so{e proprietors} are not exempt from
backup withholding.
. Except as provided belolv, corporatio{ls are exempl ftom. backup
wilhholiling for certain payments, includin'g ifiterest and dividends-
. Corporalions are not eKempt trqm backup withholding for payments
made ln settlement of paymeirt card or third-party neiwork traneaclions.
. C,orporalions are not exempt frorn backup wilhholding with respect to
attomeys' fees or gross proceeds paid to atlcrneys, and corporations
that prdvide medicalor heallh care services are not exempt with respect
to payments reportable on Form !099-hllSC-
The follorving ccdes idenldy payees tlnat are exempt {rom backup
withholding. Enter lhe appropriate code in tfre space on line 4
1 -An organization exempt from tai und€( seclion 501(af, any lBA, or
a custodial account under seclion 403lbJ{/l !I the account satisfies the
requirements of section a01f)(?).
Kittitas County Agreement for Services (rev' 5/M/251
Page 18 of 21
Fom W-9 {Rev.3-2024)Page 4
2-The United $lat6s or any of its agencies or instrumentalities.
3-A state, the Dislrict of Cclumbia, a U.S' commonwealth or lerritory
or any ot lheir political subdivisions or instrumentalities.
4-A foreign govemmenl or any of its political subdivisions, agencies,
or :nsbume8lalities.
5-A corporation.
6-A dealer in securilies or commodities required to register in the
Uniled States, the District of Columbia, or a U.S. commonwealth or
tenitory.
7-A lutures comnrission merchant i'egistered with the Gommodity
Futures Trading Commission.
8-A real estate anvastment trust.
9-An entig registered at all times during the tax year under the
lnvestment Company Act of 1 940.
l0-A common Sust fund operated by a bank under section 5t 4(a).
1 | -A financial institulion as defined under section 581,
13-A middleman known in lhe investment community as a nominee or
custodian.
I 3-A trust exempt from tax under section 9S4 or describ€d in secticn
4947.
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exemPt payees listed
above, 1 13.
lF the payment is for THEN the paymenl is exempt
for. . .
' lnterest and dividend payments All exempt payees except
lor L
r Brcker transactiong Exempt payees through 4 and 6
through 11 and all C corporalions.
S corpontions must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
ta 2012.
. Barter exchange transactions Exempt payees 1 through 4.
and dividends
r Paymenls over $600 required to Generally, exempt payees
be reported and direct sales over
$s,ooo'
1 through 5.2
r Payments made in settlement of Exempt payees I through 4.
payment card or third-party
n€twork transaclions
F-A dealer in securilies, commodities, or deriualive finarrcial
inslruments {including notional ptincipal conlracts, futures, fonrrards,
and options! that is registered as such under the laws of the United
Stales or any slale.
G-A real Bstate:n'iestrnent hust,
H-A regulated invesbnent company as defined in section 851 or an
entity registered at all tirnes during the tax year under the lnvestment
Company Act at 1940,
l-A comrnon trust fund as defined in section 584(a),
J-A bank as dsflned in section 581.
K-A broker.
L-A trust exempt lrom tax under section 664 or described in section
4s47{a}(1}.
M-A tax-exempt trust under a section 403{b) plan or section 457(9)
plan.
I'lote: You may wish to consult wilh the financial inslilution requesting
this torm to determine whether the FATCA code andlor exempt payee
code should be compleied.
Line 5
Enter your address {number, street. and apartment or suite number).
This is where the requesler of this Form W-9 will nrail your information
retums. lf this address dilfers from the one the requester already has on
file, 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 iheir records.
Line 6
Enter ycur city, slate, and ZIP code.
Part l. Taxpayer ldentification Number {TlN}
Enter your TIN in lhe appropriate box. lf you are a residant alien and
you do not have, and are not eligible to get, an SSN, your TIN is your
IRS fIlN. Erter it in the entry space for the Social security number. lf you
do not have an fIlN, see F/ow lo gel a IJ / below.
lf you are a sole proprielor and you have an ElN, you may enter either
your SSlrl or ElN.
lf yoil are a single-rnember LLG lhal is disregarded as an entity
sepirate from its owner, enter the ownar's SSN (or ElN, if the owner has
one1. lf the LLC is classified as a corporation or partnership, enter the
entity's ElN.
Note: See What Ararna and Nuntber To Give the Reguester, later, for
further clarification of name and TIN ccmbinalions'
llow to get a TlN. lf you do not have a TlN, apply lor one immediately.
To apply for an S.SN, get Form SS-5. Application for a Social Securily
Card, from your local SSA office or get this form online at
rvww.S&{gou. You may also get this form by calling 800-772-1213. Use
Form W-7, Application for IRS lndividual Taxpayer ldenliticalion
Number, to apply for an lTlN, or Form 9S-4, Application for Employer
ldentificalicn Number, to apply f€r an ElN. You can apply for an EIN
online by accessing lhe lRS website at rvwwlrs.govlEfN. Go to
www.lrs.gov/Forrns to view, download, or print Fom W-7 and/cr Form
SS-4. Orlyuu sart gr-r !u www,rrs.gr..rvlOuleFuns ltr place att r:rdet altd
have Form W-7 andlor Form SS-4 mailed to you wilhin 15 business
days.
lf you are asked to complete Form W-9 but do not have a TlN, apply
for a TIN and enter'"Applied Fo/' in the space for the TlN, sign.and date
the form, and give it to the requester. For interest and dividend
paymenls. and certain payments made with resp€ct to readily tmdatrle
inslruments, you wil! generally have 60 days to get a TIN and give it to
the requester b€fore you are sublect lo backup withholding on
payrneirts. The 60-day rule does not apply lo olher types of paymenls'
Vou will be *ubject to backup withholding on all such payments until
you provide your TIN to lhe requester,
Note: Enlering "fuplied For'' means tfiat you have already applied for a
TIN or that you intend to apply for one soon. See also Eslab/isnyS t1'S
slatus forpirposes af chapter 3 and chapter 4 withholding, earlier, lor
wher you may instead be subiect io wilhholding under chapter 3 or 4 of
the Code.
Carrtion: A disregnrded U.S. entity thal has a loreign owner rnust use
the appropriate Form W-4.
1 See Form 1099-MlSC. Miscellaneous Infomration, and its instructions.
2 However, the lollowing payments made lo a corporation and
reportable on Form 1 099-MISC are not exempt from backup
withholding: medical and heallh care paymenls, attomeys' fees, gross
proceeds pdd to an attorney reportable under seclion 6045(f), and
paymenls for services paid by a federal sxecutive agency.
Exemption frotn FATCA reporting code' The following codes identify
payees thal are exempl frorn reporting under FATCA. These codes
appiy to persons submitting this form for accounts maintained oulside
of the United Stales by cedain ioreign financial institutions. Therefore, if
you are only submittin'g rhis form foian account you hold in the United
States, you may leave this field blank. Consult with the person
r€qu€sling lhis form if you are uncertain if the financial inslitution is
subject to these requirements. A requester may indicate lhat a code is
nol required by providing you with a Form W-9 with "Not Applicable".(or
any siririlar indic'ation) ent6red on the line for a FATCA exemption code.
A-An organization exempt from tax under seclion 501(a) or any
individual retirement plan as defined in section 7701{a)(37).
B-The United States or any of its agencies or instrumentalities.
C-A state, the District of Columbia, a U.S. commonwealth or
teriiory, or any of their political subdivisions or instrumentalities.
D-A corporation the stock of which is regulady lraded on one or
more established securit,es markels, as described in Flegulations
section 1.1 472-1 (cX1 Xi).
E-A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1 a72-1 (c)(1 )(i)-
Kittitas County Agreement for Services (rev. 5/M/25)
Page 19 of 21
Pa,se 5Form W-9 (Rev.3-2024)
Part ll. Certification
To establish to the wilhholding sgent that you are a U.S. person' or
resident alien, sign Form W-9. You may be requested to sign by lhe
withholding agent even if item 1, 4, or 5 belaw indicales othenvise'
For a joint account, only the person whoee TIN is shown in Part I
should riign (when reguired)- In the case of a disregarded enlity, the
person identified on line 1 must sign. Exempt payees, see Fxernpfpayee
code, earlier.
Signature requirenrents. Complete the certi{icalion as lndicaied in
items l through5below.
l. lnterest, eliviclencl, and barter exchanga aceounts opened
before {984 ancl broker accounts considered active during 1983'
You must give your correct TlN, but you do not have to sign the
certification,
2. lnt6r€Bt, dividend, broker, and barter orchango accounl6
onened after 1983 and broker accounts considered inaclive during
lb83. You must sign the certificalion or backup witfiholding will apply. lf
you are subject to backup withholding and you are merely providing
your coneci TIN to tho requester, you must oross out item 2 in the
certification before signing lhe form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the cerlification'
4. Other paynrettls, You must give your correct TlN, but yru do not
have to sign the certification unless you have been notified lhat you
have previously given an incorrect TlN. "Otherpayments" include
paym'ents mad-ein the course of the requester's trade or business for
iene, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporalions), payments to
a nonemolovee for services, pavments made in seldement of paym€nt
card and'thiid-party network-trdnsactions, paymenls to certarn fishing
boat crew members and fislrermen, and gross proceeds paid to
attomeys (irrcluding payments to corpotations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured Drooertv, cancellation of debt, qualified tuition program
paymenti (uhde; section 5291, ABLE accounts (under section 529A!,
iRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions' You must give yoLir con€ct
TlN, but you do not hqve to sign the certilication.
What Name and Number To Give the Requester
For this of sccount:
8. Disregarded entity not ovrned by m
individual
9. A valid trust, qtate, or Pension trust
:o- Corpamtion or LLC elrcting corpoale
status on Fm 8832 or Form 25S
1 1- A$triatim, club. religiws, chritable,
aducational. or other tu-exemPl
orqanimiion
12. Prrtrership or multi-mmber LLC
'13. A broker or registeBd nominw
14. lamunt with the Deparlmmt of
Agriculture in the name of a Public
entity (such re a etate or lmnl
gDvernment, school dbarict, or prisonl
that r*€lvea igdcultr,lral progrnm
pnyments
15. Grsntor trust filing Fm 1041 or
under the Opilonal Filing Method 2,
equiriq Fom lCm {ee Flegulatioru
smtion 1.671 -a{bX2XiXB))"
Give name and €lN of,
Theormr
Legal entity{
The ctrporatian
The organiatim
The parhership
Tle broks or nominee
The public mtity
ThB trust
For this type of account:
1. lndividual
?. Two or more individuals (joini acrcunt)
other thm an acrcunl maintained bY
an FFI
3. Two or more U-S. percons
(oini arcount maintained bY an FFI)
4- Custodial account ol a minq
{Unifm Gift to Minors Act)
5- a. Jhe usual revrcable savings trust
(grmlor is drc trustee)
b. So-€lled trusl sccwnt thal is not
a legal or valid trust under state law
6. Sole proprietorehip u disregarded
entity owned by an individual
7. Grantor trust iling under Optional
Filing Method 1 (see Flegulations
sff tbn 1.671 -4{bX2XiXA)}.'
rList first and circle the name of the peftion whose number you fumish.
lf only one p€Gon on a joint account has an SSN, lhat person's number
musi be fumished.
2Circle the minor's name and fumish the minor's SSN'
rYorr must show vour individual name on line 1, and enter your business
oi OgA nare, if a'ny, on line 2. You may use eilher your SSN o. EIN (if
you have one), but the IRS sncounrg€s you lo use your SSN.
llist first and circle the name of lhe 1ru3t, estate, or pension lrust- {Do
nol fumish lhe TIN of the personal representative or truslee unless the
legal entity ilself is not designat€d in the account tille.)
'Nole: The grantor must also provide a Form W-g to the trustee of the
trust.
* For more information on optional filing methods for grantor ttusts, see
the lnstructions lor Form 1 04 1 .
Note: lf no name is circled when more then one name is listed, the
number will be considered to be that of the lirst name listed.
Secure Your Tax Records From ldentity Theft
ldentitv theft occurs when someone uses your p€rsonal lnformatiotr.
such a! your name, SSN, or other identifying information, luithoLrt your
permission to commit {raud or other crimes. An idenlity thief may use
your SSN to get a job or may lile a tax retum using your SSN to receive
a refund.
To reduce your risk:
. Protect your SSN,
. Ensure your employer is prolecting your SSN, and
. Be careful when choosing a lax retum preparer'
lf your tax records are affected by identity theft and you receive a
notice from the lRS, respond righl away to the name and phone nurnber
printed on the IRS notice or letter.
lf vour tax records are not cufienllv affected by rdentity theft bul you
thin( you are at risk due to a lost or itolen purse or wallet. questionable
credifcard activity, or a questionable credit report, conlacl lhe IRS
ldentity Theft Hotlins at 900-908-449{) or submil Form 14039'
for more information, see Pub. 5027, ldentiiy Theft lnlormalion for
Taxpayers.
Give name and SSN ol:
The individml
The actual owner ofthe ecount or.
if combined tunds. the finl irdividwl
on the accountl
Each holder olihe accaunl
The minorl
The grstor-trusler
The qctual ownell
The qwneF
The grstor'
Kittitas County Agreement for Services (rev.5/M/25)
Page 20 of 2L
Page 6
Form W-9 {Rsv.3-20?4)
Viclims of identitv theft who are experiencing economic harm or a
svstemic problem, br are seeking hel! in resolving tax problems that
have not 6een resolved through normal channels, may be eligible for
TaxpayerAdvocate Service [tAS] assislance. You can reach TASty-
callinE tre TAS toll-free case intake line at 877-777-4778 or TTY/TDD
800-829-4059.
Protect vourselt from suspicious emails or phishing schemes.
Phishing'is the crealion and use of email and websites designed to
mimrc ldoitimate business smails and websites. Th€ most common act
is sendiiq an email to a user falsely claiming to be an astablished
ie,gitimadenterprise in an attemptio scam the user into surrenderirq
priuate information that will be used for identity theft.
The lFlS does not initiate oontacts wilh taxpayers via emails. Also, lhe
IRS does nol request personal detailed information lhrough email or aek
taxoavers for the PIN trumbers, passwords, or similar secret access
infdrnietion tor their crsdit card,-bank, or othor linancial accounts.
lf vou receive an unsolicited email claiming to be from the IBS'
forwird thb message to phrbhing@irs-gov. You may also €Port misus€
of the IHS name, logo, or other IRS property to the Treasury lnspector
General forTax Adriinislration (TIGTA) at 800-366-4484. You can
fonvard suspicious emails lo the Federal Trade Commission at
soam@uce.cov or report them alwww.ftc'govlcomplaint- You can
iontaa the'FTC at www.ftc'govlidffreft or 877-IDTHEFT (877-438-4338)'
ff you have been the viclim oJ identity theft, seewww.ldentilyTheftgov
and Pub. 5027.
Go to wwrv.ris.govlldentityTheftla leam more about identity ihaft and
horv to reduce Your risk.
Privacy Act Notice
S€ctlon 5109 ol the lntemal Revenue Code requires you to provide your
correct TIN lo pereons {including federal agencies) who are required to
file inlormalion relurns wilh lhe IRS to report interest, dividends, or
certain other incorne paid to you; mortgage interesl you patd; the
acquisition or abandonrnent of secured property; the csncellation ol
detit; or conlributions yol made to an lHA, Archer MSA, or HSA. The
mrson collectino thie iorm mes the information on the form to f le
information retuirs with the lRS, reporting the above information.
Foutine uses ol thb irdormation include giving it to lhe Department ot
Juetice fcr civil and cdminal liligation and to cities, states, the District of
Columbia, and U.S, commcnweafths and tenitories lor use in
administenno their taws. The information may also be disclosed to other
countries unier a treaty. to federal and statsagencies to enlorce civil
and criminal lalqs, or to federal law enforcement and intelligence
agenctes to combat terrqrism. You mwt provlde your I lN whether or not
you are required to file a tax retum. Under section 3406'. payors must
fienerally wnnhold a percentage ol taxable interest, dividends, and
dertain othet payrnents to a payee who does not give a TlN.to the payor.
Certain penafties may also apply for providing false or fraudulent
infomation.
Kittitas County Agreement for Services (rev.5l14/25].
Page2l of 2L