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HomeMy WebLinkAboutAFS between KC and CompassKITTITAS COUNTY AGREEMENT FOR SERVICES PHMH26.019 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 Compass (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.1,4. The term of this Agreement shall be from July 7't,2026, through June 30, 2027, unless the Agreement is terminated early or its term is extended as provided herein. The parties' addresses and points of contact for the administration of this Agreement are as follows: COUNTY CONTRACTOR Kittitas County Public Health 507 N. Nanum, Suite 102 Ellensburg, WA 98926 Project Contact: Laurie Holt Developmental Disabilities Administrative Specialist Human Services Lau rie. holt@co. kittitas.wa.us s09-962-7515 Compass 1440 N. 15th Ave Suite 3 Yakima, WA 98902 Project Contact: Brandy Gerdes-Schutz, Director bgerdesschutz@du nga rvin.com This Agreement includes the following, which are attached hereto and hereby incorporated by this reference: Attachment "A": Attachment "8": Attachment "C": Attachment "D"t Attachment "E": Attachment "F": Attachment "G" Kittitas County Agreement for Services (rev.5/7a/251 Page L of 2L 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) CONTRACTOR Printed Name ',ft.Q1& Date: re ^1, v Title U1? Sttntw- KITTITAS COUNTY ERSBOARD OF COUNTY COMM Chair Commissioner ol ofthe Board s Attest la (- tr Date: 94 I ABSENT tN 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.5/74/251 Page2 of 2t a ATTACHMENT'A" SCOPE OF WORK 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" Ensure clients have a current lE, Cl, or GSE plan in place that includes the following: o Person Centered assessment o Clearly states the client's goal, who is responsible for what action steps. o Based on the client's strengths and builds on their skills' o The plan advances the client toward their goals and tracks their progress. o Measurable outcomes that can be identified. o Updated every 6 months to assess and revise as needed. 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. Submit data and reports as requested by the county. Follow billable requirements per DDCS. Submit billing to county, monthlY. Participate in biennial county evaluation (monitoring) to meet the standards set forth on the DDCS County Best Practices site. Comply with all applicable requirements in the contract between DDCS and Kittitas County (Attachment E)' o Comply with referenced RCW, WAC, DDCS policies, confidential information, data security, and referenced materials. Comply with referenced documents found at DDCS internet site Countv Best Practices I DSHS (wa.gov). Any service provider offering transportation must ensure that drivers hold valid driver's licenses and have a background screening completed to include a driving abstract in order to safely perform the services. a a a o a o a o a Kittitas County Agreement for Services (rev.5/Ia/25) Page 3 of 21 ATTACHMENT,'8,, 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 Attachmenl "N' , 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 (CD $66.08 per service hour Unless otherwise provided herein, the Contractor shall be solely responsible for Contracto/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 expenditure, in writing. All funds must be spent by June 30, 2027. No extension of the funding period will be granted. Reimbursement 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.5/74/251 Page 4 of 2l ATTACHMENT,,C" I NSURANCE REQUIREMENTS Contractor shall secure and maintain in effect at all times during performance of work under this Agreement such insurance as will protect Contractor, its employees, and agents from all claims, losses, harm, costs, liabilities, damages and expenses arising out of Contractor's performance under this Agreement, including but not limited to personal injury (including death) or property damage. All insurance shall be issued by companies admitted to do business in the State of Washington and have a rating of A-, Class Vll or better in the most recently published edition of Best's Reports unless otherwise approved by the County. lf an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies must comply with Chapter 48.1.5 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: r $L,000,000 per occurrence, for all covered losses o $2,000,000 general aggregate r $1,000,000 products & completed operations aggregate o $1,000,000 personaland advertising injury, each offense . The policy must be endorsed to include the County and its officials, employees and agents as additional insureds. Commercial Automobile Liabilitv lnsurance 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. r Coverage limits are not less than: . S1,000,000 combined single limit Excess or Umbrella Liabilitv . The Contractor shall provide Excess or Umbrella Liability coverage of 55,000,000. This Excess or Umbrella Liability coverage shall apply, at a minimum, to both the Commercial General and Automobile lnsurance policy coverages. lf used to meet limit requirements, coverage must be at least as broad as specified for underlying coverages and must cover those insured in the underlying policies. r This requirement may alternatively be satisfied through Contractor's primary Commercial General and Automobile Liability covera8e, or any combination thereof. . The policy must be endorsed to include the County and its officials, employees and agents as additional insureds. r Coverage shall be "pay on behalf", with defense costs payable in addition to policy limits. r There shall be no cross-liability exclusion precluding coverage for claims or suits by one insured against another. Workers' Compensation & Emplove/s Liabilitv . The Contractor shall provide Workers Compensation and Employer's Liability insurance on a state-approved policy form providing benefits as required by law with employer/s liability limits no less than S1,000,000 per accident or disease. Kittitas County Agreement for Services (rev.5/14/251 Page 5 of 21 Professional Liabilitv / Errors and Omissions Liabilitv . Coverage limits not less than: r $1,000,000 each claim . Contractor must provide evidence of this coverage on a policy form appropriate to Contractor's Profession. Contractor shall furnish to the County a Certificate of lnsurance, with endorsement where required above, as evidence that policies providing insurance required by this Agreement are in fullforce and effect. Contracto/s insurance policies required above must apply on a primary non-contributing basis in relation to any other insurance or self-insurance available to the County. Contractor agrees to provide notice to the County at least thirty (30) days prior to cancellation, or any material alteration or non-renewal, of any of the above-required insurance coverages. Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools, machinery, equipment, or motor vehicles owned or utilized by Contractor, or Contractor's agents, employees, suppliers or contractors, as well as to any temporary structures, scaffolding and/or protective fences. Contractor shall have sole responsibility for ensuring the insurance coverage and limits required herein are also obtained by any subcontractors' NOTE: Notwithstanding any other provision(s) of this Agreement, no contract shall form under this Agreement until and unless the following are provided to the County: (1) a copy of the Certificate(s) of lnsurance with all required endorsements, properly completed and in the amounts required, and (2) where requested by the County, a copy of the required insurance policies, including all required endorsements. Kittitas County Agreement for Services (rev. 5/14/25l, Page 5 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 "B". Where Attachment "B" requires payment(s) by the County, payment shall be based upon billings, supported unless provided otherwise in Attachment "8", by documentation of units of work actually 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 reimburseContractorforanycostsorexpensesincurredbyContractorinperformanceofthisAgreement. 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 inAttachment"B". lntheeventContractorfailstoperformanyofitsobligationsunderthisAgreementwithinthe time specified herein, then the County may withhold all monies due and payable to Contractor until such failure to perform is cured or otherwise adjudicated. The County will not process payment for services rendered under this Agreement until Contractor submits a completed W-9 (See Attachment "G"). 3. Taxes: Contractor understands and acknowledges that the County will not withhold Federal or State income taxes from payments made to Contractor. Where required by State or Federal law, Contractor authorizes theCountytomakewithholdingforanytaxesotherthanincometaxes(e.g.,Medicare). Allcompensationreceived by Contractor will be reported to the lnternal Revenue Service at the end of the calendar year in accordance with applicable IRS regulations. lt is the responsibility of Contractor to make its necessary estimated tax payments throughout the year, if any, and Contractor is solely liable for any tax obligation arising from Contractor's performance of this Agreement. The County will pay sales and use taxes imposed on goods or services acquired here under as required by law. Contractor must pay all other taxes, including but not limited to: business and occupation tax; or taxes based on (1) Contractor's gross or net income, or (2) personal property to which the County does not hold title. The County is exempt from federal excise tax. 4. Independent Contractor: Contractol's services shall be furnished by Contractor as an independent contractor, and nothing stated herein shall be construed to create a relationship of employer-employee or a guarantee of future employment. Contractor acknowledges that its entire compensation under this Agreement is specified in Attachment "B", and that Contractor is not entitled to any County benefits, including but not limited to: vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance benefits, or any other rights or privileges afforded to Kittitas County employees. 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 particular person or entity, or require the Contractor to rescind or amend a subcontract. Every subcontract shall bind the Subcontractor to follow all applicable terms of this agreement. The Contractor is responsible to the County if the Subcontractor fails to comply with any applicable Kittitas County Agreement for Services (rev.5/7a/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 evaluation by service recipients under this Agreement. Contractor shall preserve and maintain all records relating to this Agreement for six (6) years after termination or expiration of the Agreement, and upon request shall make them available for review by any Federal or State auditor, the County, and/or any persons authorized by the County. 7. Modification 7 .1,. This Agreement may be amended by mutual agreement of the parties. Any such amendment shall be in writing and signed by both parties. 1.2 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. lfanysuchChangeNoticecausesanincreaseordecreasetoContractol'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 prior to the effective date of termination. An equitable adjustment in the contracted price for partially completed tasks will be made by the County, but such an adjustment shall not include compensation for loss of anticipated profit on uncompleted work. 8.3 lf Contractor defaults by failing to perform any of its obligations under this Agreement, or becomes insolvent, is declared bankrupt or commits any act of bankruptcy or insolvency, or makes an assignment for the benefit of creditors, the County may, by written notice to Contractor, terminate the Agreement, and at the County's option, obtain performance of the work elsewhere. lf the Agreement is terminated under this paragraph, Contractor shall not be entitled to receive any further payments under this Agreement until all its obligations hereunder have been fully performed, and any extra cost or damage to the County shall be deducted Kittitas County Agreement for Services (rev.5/Ia/251 Page 8 of 21 from any money due or coming due to Contractor. Furthermore, in the event of termination under this paragraph, Contractor shall bear the costs of any extra expenses incurred by the County in completing the work, and all damages sustained, or which may be sustained, by the County. 8.4 Termination of this Agreement by any means provided herein shall not excuse any party's performance of its obligations hereunder through the effective date of termination, except that the County shall not be obligated to pay for services that have not been performed or deliverables that have not been provided. 9. lndemnification 9.1 To the fullest extent permitted by law, Contractor agrees to indemnify, defend and hold the County and its departments, elected and appointed officials, employees, agents and volunteers, harmless from and against any and all claims, damages, losses and expenses, including but not limited to court costs, attorney's fees and alternative dispute resolution costs, for any personal or bodily injury, sickness, disease or death, for any damage to or destruction of any property (including the loss of use resulting therefrom), and for any other claims, damages, losses, and expenses sustained by the County, which (1) are caused in whole or in part by any act or omission, negligent or otherwise, of Contractor, its employees, agents or volunteers, or Contractor's subcontractors, their employees, agents or volunteers; or (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. g.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 Contracto/s indemnity obligations contained in any section of this Agreement' g.3 ln the event Contractor enters into subcontracts to the extent allowed under this Agreement, each such subcontractor shall indemnify the County on a basis equal to or exceeding Contractor's indemnity obligations to the County. 10. Venue and Choice of Law: ln the event that any litigation should arise concerning this Agreement, the venue for such action shall be in the Superior Court of the State of Washington in and forthe County of Kittitas. This Agreement shall be governed by the laws of the State of Washington' 11. Non-Appropriation of Funds: lf the County does not appropriate sufficient funding for this Agreement for any future fiscal period, the County will not be obligated to make payments for services performed after the end of the last fiscal period for which sufficient funding was appropriated. No penalty or expense shall accrue to the County in the event this provision applies. Kittitas County Agreement for Services lrev.5/A/25) Page9 of 2L 12. Contractor Commitments, Warranties, and Representations: Contractor represents and warrants as follows: IZ.L 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. L2.2 Contractor has the authority to execute this Agreement, to make the representations and warranties set forth herein, and to perform its obligations hereunder. LZ.3 This Agreement has been validly executed by an authorized representative of Contractor and constitutes a valid and legally binding and enforceable obligation of Contractor. L2.4 Contractor holds, or will obtain prior to commencing work under this Agreement, such licenses, permits and other authorizations from federal, state and local governmental authorities, or from any applicable industrial or professional certification or licensing bodies, as are necessary for the lawful performance of its obligations under this Agreement, and will maintain such throughout the term of this Agreement. L2.5 Contractor is not in violation of any applicable law, ordinance or regulation the consequence ot which will or may materially affect Contractor's ability to perform its obligations under this Agreement' Contractor is not subject to any order or judgment of any court, tribunal or governmental agency which materially and adversely affects its operations or assets in the State of Washington, or its ability to perform its obligations under this Agreement. LZ.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' L2.7 None of the representations or warranties in this Agreement, and none of the documents, statements, certificates or schedules furnished by Contractor in connection with the performance of the obligations contemplated under this Agreement, contains or will contain any untrue statement of a material fact or omits or will omit a material fact necessary to make the statements of fact contained therein not misleading' l-3. Ownership of Produced: All writ ings, programs, data, reports, films, recordings, or other materials prepared by Contractor and/or its consultants or subcontractors, in connection with the performance of this Agreement, shall be the sole and absolute property of the County. The County will have all rights of ownership therein, including but not limited to the right to use, copyright, trademark, and/or patent, and the ability to transfer any or all ownership rights. 14. lntellectual Properw Infringement: Contractor will defend and indemnify the County from any claimed action, cause or demand brought against the County, to the extent such action is based on the claim that information and/or materials supplied by Contractor infringe any intellectual property rights of any third party(ies). Contractor will pay all costs and damages attributable to any such claims finally awarded against the County in any action. Such defense and payments are conditioned upon the following: (1) Contractor shall be notified promptly in writing by the County of any notice of such claim; and (2) Contractor shall have the right hereunder, at its option and expense, to obtain for the County the right to continue using the information and/or materials that are the subject of such claim, provided no reduction in performance or loss results to the County. 15. Use of Countv Name and Loeo: Contractor may not use the County's name, logo(s), trademark(s), or other identifying information, or identify the County as a current or former client, on its website or in any marketing or promotional materials without the prior written consent of the County. Kittitas County Agreement for Services (rev.5/L4/251 Page 10 of 21 L6. 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) each party shall bear its own costs and attorney fees, (3) arbitration shall be conducted according to the commercial arbitration procedures of the American Arbitration Association, and (4) the arbitrator's decision or award shall be final and binding on both parties' 17. Confidentiality: Contractor, its employees, agents and volunteers, and any of Contractor's subcontractors and their employees, agents and volunteers, shall maintain the confidentiality of all information provided by the County or acquired by Contractor in performance of this Agreement, except upon the prior written consent of the Kittitas County Prosecuting Attorney or an order entered by a court after having acquired jurisdiction over the County. Contractor shall immediately provide the County notice of any judicial proceedings seeking disclosure of such information. Contractor agrees to indemnify, defend and hold harmless the County and its departments, elected and appointed officials, employees, agents and volunteers from all loss or expense, including but not limited to settlements, judgments, setoffs, attorneys'fees and costs resulting from Contractor's breach of this provision. Notwithstanding the foregoing, and to the extent that any information obtained by the Contractor hereunder is required to be shared with others by the explicit terms of the Scope of Work, this provision shall not be construed as prohibiting such sharing, provided there are no applicable laws or regulations prohibiting same. 18. Notices: Written notices required or permitted to be provided by one party to the other party under this Agreement may be provided by personal delivery, legal courier service, or certified mail, postage prepaid and return receipt requested. Notice may be provided by regular first class mail if simultaneous notice is provided by email. Notices given by Contractor shall be provided to the County's point of contact listed on page 1 of this Agreement, at the address there listed, and to the department head of the county department for which services under this Agreement are rendered. Notices given by the County shall be provided to Contractor at Contractor's address listed on page 1 of this Agreement. L9. Prevailins Wage: Where labor to be performed under this Agreement is considered "public work" as defined in RCW 39.04.010, Contractor shall pay the prevailing rate of wages to all workers, laborers, or mechanics employed in the performance of work under this Agreement in accordance with RCW 39.12 and the rules and regulations of the Washington State Department of Labor and lndustries. The schedule of prevailing wage rates for the applicable locality or localities is determined by the lndustrial Statistician of the Department of Labor and lndustries. lt is Contractor's responsibility to verify the applicable prevailing wage rate. lt is understood that Contractor is responsible for obtaining and completing all required government forms relating to prevailing wage and submitting same to the proper authorities. Disputes regarding prevailing wage rates shall be referred for arbitration to the Director of the Department of Labor and lndustries. The arbitration decision shall be final and conclusive and binding on all parties involved in the dispute as provided for in RCW 39.12.060' 20. Standard of Care: Contractor shall perform its duties hereunder in a manner consistent with that degree of care and skill ordinarily exercised by members of the same profession or industry as Contractor currently Kittitas County Agreement for Services (rev.5/14/251 PagetLof 2t practicing or working under similar circumstances. Contractor shall, without additional compensation, correct any of its services not meeting such a standard. 2L. Nondiscrimination zL.I 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 hecause of their ager 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. 21,.2 Contractor will not discriminate against any recipient of any services or benefits provided for under this Agreement on the grounds of age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation, marital status, honorably discharged veteran or military status, or the presence of any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a disability. 2t.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 bythe parties hereto. 23. Headings: The headings of sections and paragraphs of this Agreement are for convenience of reference only and are not intended to restrict, affect, or be of any weight in the interpretation or construction of the provisions of such sections or paragraphs. 24. Survival: The provisions of paragraphs 2,3, 4, 6,8, g, 10, 73, L4, 15, t6, L7 , 19,20,22,24, and 28 of these General Terms and Conditions shall survive the completion, expiration, termination or cancellation of this Agreement for any reason. 25. Complete Agreement: This Agreement constitutes the entire agreement between the parties and supersedes any and all other agreements, understandings, negotiations and discussions, oral orwritten, express or implied, regarding the work to be performed hereunder. The parties agree that no other representations, inducements, promises, agreements, or warranties relating to this Agreement, oral or otherwise, have been made between the parties. Except as provided elsewhere in this Agreement, no modification or waiver of this Agreement shall be valid or binding unless in writing and signed by the parties. Kittitas County Agreement for Services (rev.5/7a/25) Page L2 of 2L 26. Severabilitv: lf any term or condition of this Agreement or the application thereof to any person(s) or circumstances is held invalid, such invalidity shall not affect other terms, conditions or applications which can be given effect without the invalid term, condition or application. To this end, the terms and conditions of this Agreement are declared to be severable. 27 . Time: Time is of the essence in the performance of this Agreement unless otherwise agreed between the parties in a signed writing. 28. Construction: This Agreement has been mutually reviewed and negotiated by the parties and should not be construed against the drafter. 29. Asreement Not for Benefit of Third Parties: This Agreement is entered into solely for the benefit of the parties hereto and vests no rightS in, nor is it enforceable by, anythird parties' Kittitas County Agreement for Services (rev.5h4/25l, Page 13 of 21 Attachment E sHs WASHINGTON STAII Depa*m€nt of So<lal end Health Serulces COUNTY PROGRAM AGREEMENT DDCS Gounty Services DSHS Agreement Number 2663-71228 This Program Agreement is by and between the State of Washington Departm ent of Social and Health Services (DSHS) and the County identified below, and is issued in conjunction with a County and DSHS Agreement On GeneralTerms and Conditions, which is incorporated by reference. Administration or Division Agreement Number County Agreement Number DSHS ADMINISTRATION Developmental Disabilities Admin DSHS DIVISION Division of Developmental Disabilities DSHS INDEX NUMBER 1225 DSHS CONTMCT CODE 1769C5-63 DSHS CONTACT NAME AND TITLE Seanna Woodard Operations Manager DSHS CONTACTADDRESS 1611 W lndiana Ave Sookane. WA 99205 DSHS CONTACT TELEPHONE (509\329-2952 DSHS CONTACT FAX (509)568-3037 DSHS CONTACT E-MAIL woodas@dshs.wa.gov COUNry NAME Kittitas County Kittitas County DDA County Services COUNry ADDRESS 507 North Nanum Street Suite 102 Ellensburq, WA 98926-2886 COUNTY FEDEML EMPLOYER IDENTIFICATION NUMBER COUNry CONTACT NAME Kasey Knutson COUNTY CONTACT TELEPHONE (509) 962-7090 COUNry CONTACT FAX (509) 962-5883 COUNTY CONTACT E-MAIL kasev. kn utson@co. kittitas.wa. us IS THE COUNry A SUBRECIPIENT FOR PURPOSES OF THIS PROGMM AGREEMENT? No ASSISTANCE LISTING NUMBERS PROGRAM AGREEMENT START DATE 07t0112026 PROGRAM AGREEMENT END DATE 06t3012027 MAXIMUM PROGMM AGREEMENT AMOUNT s1.021.440.00 EXHIBITS. The following Exhibits are attached: Exhibit A - Data Security Requirements; Exhibit B - Budget and ndi Plan By their signatures below, the parties agree to the terms and conditions of this County Program Agreement and all documents incorporated by reference. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify that they are authorized to siqn this Program Agreement. COUNry SIGNATURE(S)PRINTED NAME(S) AND TITLE(S)DATE(S) SIGNED DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED DSHS Central Contract Services 1 769CS County Agreement (12-26-2025) Page 1 1 Special Terms and Conditions Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "Acuity Level" means the level of a Client's abilities and needs as determined through the DDCS assessment. b. "ALTSA Web Access (AWA)" means a web-based portalto the Developmental Disabilities Community Services CARE system designed to support county services for DDCS clients. c. "Additional Consumer Services" refers to indirect Client service types as follows: (1) "Community lnformation and Education": Activities to inform and/or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities. (2) "Training": To increase the job related skills and knowledge of staff, providers, volunteers, or interning students in the provision of services to people with developmental disabilities. Also to enhance program related skills of board or advisory board members. (3) "Other Activities" reserved for special projects and demonstrations categorized into the following types: (a) lnfrastructure projects: Projects in support of Clients (services not easily tracked back to a specific working age Client) or that directly benefit a Client(s) but the Client is not of working age. Examples include planning services like generic job development e.g. "Project Search". (b) Start-up projects: Projects that support an agency or directly benefit the agency. Examples include equipment purchases and agency administrative support. (c) Partnership Project: Collaborative partnerships with school districts, employment providers, DVR, families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn twenty-one (21). d. "Budget and Accounting Reporting System (BARS)' means a master classification of balance sheet, revenue and expenditure/expense accounts. e. "Client" means a person with a developmental disability as defined in chapter 388-823 WAC who is currently eligible and active with the Developmental Disabilities Community Services or is an identified PASRR Client. f. "Competitive lntegrated Employment" means work performed by a Client on a part-time or full-time basis, within an integrated setting within the community that meets HCBS settings requirements. The Client must be compensated at minimum wage or higher, using the higher of the Federal, State, or local rate, and at a rate comparable to the wage paid to non-disabled workers performing the same tasks, including receiving the same benefits and opportunities for advancement. g. "Consumer Support" refers to direct Client service types as follows: (1) "Community lnclusion" or "Cl": means individualized services provided in integrated community settings with other individuals without disabilities. The activities are based on Client interests Page 2 DSHS Central Contract Services 1 769CS County Ag reement (12-26-2025) h Special Terms and Conditions and provide opportunities typically experienced by the general public of similar age in their local community, accessible by public transit or a reasonable commute from their home. The goal of the service is to support clients to participate, contribute, and develop relationships with community members who are not paid staff. These services may be authorized for individuals age 62 and older. These services may be authorized in addition to or instead of employment support (lndividual Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. (2) 'Child Development Services" or "CDS": Birth to three services are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child's development. Service may include assistive technology, audiology, family training/home visits, health services, medicalservices, nursing services, nutrition services, occupational therapy, physrcaltherapy, psychological services, sign language, Soclalwork, speclal 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 generalworKorce. These services may include intake, discovery, assessment, job preplration, job marketing, job supports, record keeping and support to maintain a job. (4) "lndividu alized 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 ongoingsupervised employment for groups of no more than eight (8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading to further career development in integrated employment at or above minimum wage. Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment in community settings. "County" is the political subdivision of the state of Washington and the county or counties entering into this Program Agreement. "DDCS Case Resource Manager (CRM)" means a case manager for DDCS Clients. "County Service Authorization (CSA)" means an authorization for county services. "Developmental disabilities (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. "Developmental Disabilities Community Services "DDCS" means a division within the Department of Page 3 k. t. DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Special Terms and Conditions Social and Health Services m. "DDCS Regional office (DDCS Region)" means the regional DDCS office that supports DDCS clients. n. "Division of Vocational Rehabilitation (DVR)" means a division within the Department of Social and Health Services o. "Employment Outcome Payment" means a payment to providers for transition students born between specific dates; have high acuity; are authorized for lndividual employment; and student obtains a competitive integrated job within a specific timeframes. lf the job is a minimum of ten hours of work per week an additional amount will be include in the payment. p. "General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. q. "High Acuity Client" means a DDCS Client who requires signiflcant 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 Quatifications 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 71A.14 RCW. lts purpose is to advance the state legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental disabilities. Page 4 DSHS Central Contract Services 1 769CS County Agreement (12-26-2025) 3. Special Terms and Conditions Glient Eligibility: Client eligibility and service referral are the responsibility of DDCS under chapter 3BB-823 WnC (etigiOility) 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 ind authorize the appropriate direct service(s) type. Direct Client services provided without a current County Service Authorization are not reimbursable under this Program Agreement. 4.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 servlces to a community. For a county where the coordinator adtttittisters nrore 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 Coun$ must demonstrate the ability to safeguard public funds including maintaining books, rgcords, documents and other materials relevant to the provision of goods and services. e. Sufficient Policies and Procedures for establishment and maintenance of adequate internal control systems: The County will maintain written policy procedural manuals for information systems, personnel, and accounting/finance in sufficient detail such that operations can continue should staffing change or absences occur. Policies shall be dated and include dates when updated. f. Background/Criminal History Check: A background/criminal history clearance is required every three years for all employees (including DD program County staff), subcontractors, and/or volunteers who may have unsupervised access to vulnerable DSHS Clients, in accordance with RCW 43.43.830-845, RCW 74.15.030, and chapter 388 WAC. lf the entity reviewing the application elects to hire or retain an individual after receiving notice that the applicant has a conviction for an offense that would disqualify the applicant from having unsupervised access to vulnerable adults as defined in chapter 74.34 RCW, then DDCS shall deny payment for any subsequent services rendered by the disqualified individual provider. The DSHS Background Check Central Unit (BCCU) must be utilized to obtain background clearance. g. Qualified Advisory Board Members: A Developmental Disabilities advisory board shall include members knowledgeable about developmental disabilities. No board member shall have a contract with the County to provide Training, Community lnformation Activities, and Consumer Support as defined in this Program Agreement, and shall not be a board member, officer, or employee of an agency subcontracting with the County to provide such services. h. Qualified Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6.13, Program Qualifications for Employment and Day Program Providers. i. Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to assign to DDCS its Medicaid billing rights for Page 5 DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) 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 Repofting Requirements for County and County- Contracted Provide rs, 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. O. Duty to Disclose: Under 42 CFR 5455.104, the Administration must obtain certain disclosures and complete required screenings to ensure the State does not pay federal funds to excluded person or entities. The County is required to provide disclosures from managing employees, specifically the persons in the positions of Developmental Disabilities Director and Fiscal/Budget Director, i.e. lhe 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 455j04 (cX1)] 6. 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 Page 6 DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) 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; (8) Work with the County when terminating services; (9) Work with DDCS Head Quarters and the County on Spending Plan adjustments; and (10) Work with the County in participating in evaluation of direct service providers. b. The County shall: (1) Work with the DDCS Region when Clients are referred for services, authorized services, and/or for support modifi cations; (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 (g) 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 shalltake any necessary and reasonable steps to comply with BARS Policies. DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Page 7 Special Terms and Conditions d. The County shall comply with the following referenced documents: (1) DDCS Policy 4.11, 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 Proorams;and 6 f g h 17; Disabilitv Riohts WashinOton (formerlv WashinOton Protection and Advocacv Svstem) Access Aqreement. 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:rvwvw.dshs.wa.qov/dda/countv-best-practices) to indicate the estimated number of people to Oe se.rveO, taigeted outcomes, and identified goal(s) that focus on quality improvement within the categories of iraining, Community lnformation, Direct Client Services, and Other Activities within 30 dayJof execution of ihe 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. 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. k. DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Page 8 Special Terms and Conditions (a) To ensure health and safety, promote positive image and relationships in the community, increase competence and individualized skill-building, and achieve other expected benefits of Cl, services will occur individually or in a group of no more than two (2) or three (3) Client's with similar interests and needs. (b) Cl services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/or specialized activities will not be reimbursed. (2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses. Clients should be supported to average twenty (20) hours of community work per week or eighty-six (86) hours per month; however, each person's preferred hours of employment should be taken into consideration. The amount of service a Client receives will be based on his/her demonstrated need, acuity level and work history per WAC 388-828. (3) The Client's DDCS PCSP is the driver for service. The AWA County Service Authorization (CSA) and updated Planned Rates information will not exceed the Client's DDCS PCSP. Service changes will not occur 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 goal will 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 ClienUguardian; and (c) Develop additional strategies with the ClienUguardian, county staff, employment support staff, case manager, and others identified by the Client. Strategies may include providing technical assistance, changing to a new provider, and/or providing additional resources as needed to support the Client's pursuit of employment. The additional strategies will be documented for each Client and kept in the Client's file(s). (8) lf after twelve (12) months the Client remains unemployed, an additional review will be conducted. The provider will address steps outlined in the previous six month progress report in the next six month progress report. When requesting to participate in Cl, the Client shall communicate directly with his or her DDCS Case Manager. The DDCS Case Manager is responsible for authorizing Cl services. DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Page 9 Special Terms and Conditions (g) 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 approval for the service provider to continue to provide long-term supports if needed. lf the County or DDCS approves the continuation of long-term supports where the service provider is also the Client's employer, the County or DDCS will regularly monitor these positions to assure fading efforts occur when appropriate and any potential conflict of interest is addressed. (10) lndividual Employment staff hours must be attributed to the "lndividual Emolovment 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 DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Special Terms and Conditions individuals not receiving Medicaid HCBS; (c) The setting provides opportunities to seek employment and work in competitive integrated settings; and (d) The setting facilitates individual choice regarding services and supports, and who provides them. Quality Assurance and Service Evaluation: The County shall develop and have available an evaluation system to review services. The evaluation system must have both a Quality Assurance and a Quality lmprovement component, and both must include objective measures. The objective measures at a minimum will include performance indicators, by acuity, that include the number of new jobs; job loss arrd reasons for job loss; the percentage employed carning 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 statf 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. Assure the integrity of data submitted to the State. When data is submitted and rejected due to errors or an error is later identified, the County will correct and resubmit the data within thirty (30) days. Review and respond the AWA "Work List" items within 5 working days including Referrals and pending Authorization. s. Review the AWA "Ticklers" Planned Rate tab and update the planned rate within 5 working days Page 1 1 DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025\ q r Special Terms and Conditions after the Planned Rate start date. t. PartnershipProject. (1) A Job Foundation document will be completed per guidelines for eligible students. Eligible students are DDCS clients who were born between: (a) For fiscal year 2026 911105 through 8131106 (b) Forfiscalyear 2027 9l1lOG through 8131107 These students currently attending school and have completed an application to participate in this Value Based Payment (VPB) project. The VBP project application will include the following minimum criteria identified in the sample application found at: https://ranffw.dshs.wa.qov/sites/defaulVfiles/DDA/dda/documents/Job%20Foundation%20Aoplica 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 identifo 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 Bl31lO5 (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 Coun$ 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. DSHS Central Contract Services 'l 769CS Cou nty Ag reement (1 2-26-2025) Page 12 7 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' - ttlanager 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 Page 13 DSHS Central Contract Services 1 769CS County Agreement (12-26-2025) I Special Terms and Conditions for Level ll or lll services (Adult Day Health). Level ll and lll services are licensed rehabilitation and skilled nursing services along with socialization. Level I services (Adult Day Care) are supervised day programs where frail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing. These Clients may be referred to services defined in the statement of work, or to an Adult Day Care service other than Level ll or lll. lf a Client no longer needs and wants services, the funds are available for other Clients who are not part of the group of original Clients identified between December 1996 and 2003. An Adult Day Care service shall only be provided by Adult Day Care agencies certified by the local Area Agency on Aging. Adult Day Care service is not a waiver approved service. c. Program Agreement Amendments: A County can request an amendment at any time. An amendment for additional Client(s) may be supported when clients exceed the number used to develop the contract. An amendment for additional service hours authorized may be supported when county provides evidence. An amendment request for expenditures exceeding contract total due to hourly rates paid to service provider may not be supported as the county is responsible to manage contract and rates paid to their providers. d. Exemptions: The DDCS Assistant Secretary may approve in writing an exemption to a specific program agreement requirement. Billing and Payment: a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for: (1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration of the Developmental Disabilities Program. Allowable costs include personnel and overhead costs directly related to the administration and coordination of the program, including such activities as program planning, budgeting, contracting, monitoring, and evaluation. Also included are departmental and county indirect and/or direct administrative costs, to the extent that such costs are appropriately allocated to the program using an established methodology consistent with grants management guidelines. For a County whose designated coordinator manages multiple programs, the County must be able to provide evidence of the time the coordinator spent working on the Developmental Disabilities program. (2) Additional Consumer Services: (a) Training: i. 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 d isabilities services. ii. Board Training: Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program-related skills of board and advisory committee members. (b) Community lnformation and Education: to inform and/or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community Page 14 DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Special Terms and Conditions 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 replacewhat the student(s) receive through the lndividu alized 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 intereits 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 Page 15 DSHS Central Contract Services 1 769CS County Ag reement (1 2-26-2025) Special Terms and Conditions the lndividual Emolovment Phases & Billable Activities) (e) lndividualized Technical Assistance services are a part of a Client's pathway to employment or community inclusion. This service provides assessment and consultation to the provider to identify and address existing barriers to employment or community inclusion. This is in addition to supports received through supported employment or community inclusion services for individuals who have not yet achieved their goal. (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 irrtegrated ernployment at or above minimum wage. Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment community settings. b. Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this Program Agreement. However, with a Program Agreement amendment, the parties may increase or decrease the Program Agreement amount. Counties willwork with DDCS HQ on amendments to the Program Agreement. c. Monthly lnvoice with Signed Documentation: All requests for reimbursement amounts must be entered and posted into the AWA system. The County may post a combined claim of all programs/services covered by this Program Agreement. DSHS shall make all payments due to the Coung for all invoices submitted pursuant to this section within forty five (45) days following posting of required information. d. Clients will be assisted in accessing DVR services per the DDCS/DVR MOU. Client services shall not be reimbursed under this Program Agreement when the same services are paid for under the Rehabilitation Act of 1973 by DVR, Public Law 94-142 or any other source of public or private funding. e. Reimbursement of Client Services: A claim for each Client is made on the AWA system by indicating the number of service units delivered to each Client listed and the fee per unit. Units are defined as: (1) An "Hou/' 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 1t12 of the maximum amount identified in Exhibit B under Administration or for the actual costs incurred in the given month but the totalAdministration 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 The lndividual Employment Phases & Billable Activities document defines the individual Client Page 16 g DSHS Central Contract Services 1 769CS County Agreement (12-26-2025) Special Terms and Conditions services that DDCS reimburses. That document is located on the DSHS DDCS County Best Practices Web site at https://www.dshs.wa.qov/ddaicountv-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://vrnryw. 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 (OO) calendar days of the associated fiscal year unless an extension is approved by the DDCS Regional Administrator or designee. Payment will not be made on any invoice subntitted past sixty (60) calendar days after the Program Agreement fiscal year. j. Recovery of Fees: lf the County bills and is paid fees for services that DSHS later finds were (a) not delivered or (b) not delivered in accordance with Program Agreement standards, DSHS shall recover the fees for those services and the County shall fully cooperate during the recovery. k. Preadmission Screening and Resident Review (PASRR) Administration: The County may billfor administration costs as identified in Exhibit B. Monthly claims for administration cost will be based on the actual PASRR expenditures multiplied by 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.gov n. Job placement verification for transition students: The AWA Employment Output for lndividual Employment will be completed and submitted with payment request to verify employer, job start date, job type, etc. o. Job Foundation Administration: The County may billfor administration costs as identified in Exhibit B. Monthly claims for administration cost will be based on the actual expenditures multiplied by 10%. Participating counties will use line item 13. 9. 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. 10. 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. 11. DSHS/DRW Access Agreement: The DRW February 27,2001Access 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 Page 17 DSHS Centrat Contract Services 'l 769CS County Ag reement (1 2-26-2025\ 12 13 14. 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 County 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 shalltake precedence as the sole Data security Agreement between the Parties. DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) Page 18 Special Terms and Conditions Exhibit A - Data Security Requirements 1. Definitions. The words and phrases listed below, as used in this Exhibit, shall each have the following definitions: a. 'AES' means the Advanced Encryption Standard, a specification of Federal lnformation Processing Standards Publications for the encryption of electronic data issued by the National lnstitute of Standards and Technology (https://nvlpubs.nist.gov/nistpubs/FIPS/NlST.FlPS.197-upd1.pdf). b. "Authorized Users(s)" means an individual or individuals with a business need to access DSHS Confidential lnformation, and who has or have been authorized to do so. c. "Category 4 Dala" is daLa that is confidential and requires special handling due to statutes or regulations that require especially strict protection of the data and from which especially serious consequences may arise in the event of any compromise of such data. For purposes of this contract, data classified as Category 4 refers to data protected by: the Health lnsurance Portability and Accountability Act (HIPAA). d. "Cloud" means data storage on servers hosted by an entity other than the Contractor and on a network outside the control of the Contractor. Physical storage of data in the cloud typically spans multiple servers and often multiple locations. Cloud storage can be divided between consumer grade storage for personal files and enterprise grade for companies and governmental entities. Examples oi consumer grade storage would include iCloud, Dropbox, Box.com, and many other entities. Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and Rackspace. e. "Encrypt" means to encode Confidential lnformation into a format that can only be read by those possessing a "key"; a password, digital certificate or other mechanism available only to authorized users. Encryption must use a key length of at least 128 bits (256 preferred) for symmetric keys, or 2048 bits for asymmetric.keys. When a symmetric key is used, the Advanced Encryption Standard (AES) must be used if available. f. "Hardened Password" means a string of at least eight characters containing at least three of the following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point' g. "Mobile Device" means a computing device, typically smaller than a notebook, which runs a mobile operating system, such as iOS, Android, or Windows Phone. Mobile Devices include smart phones, most tablets, and other form factors. h. "Multi-factor Authentication" means controlling access to computers and other lT resources by requiring two or more pieces of evidence that the user is who they claim to be. These pieces of evidence consist of something the user knows, such as a password or PIN; something the user has such as a key card, smart card, or physicaltoken; and something the user is, a biometric identifier such as a fingerprint, facial scan, or retinal scan. "PlN" means a personal identification number, a series of numbers which act as a password for a device. Since PlNs are typically only four to six characters, PlNs are usually used in conjunction with another factor of authentication, such as a fingerprint. i. "Portable Device" means any computing device with a smallform 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't9 DSHS Gentral Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Special Terms and Conditions are not limited to, mobile phones, tablets, and laptops. Mobile Device is a subset of Portable Device. k. "Portable Media" means any machine readable media that may routinely be stored or moved independently of computing devices. Examples include magnetic tapes, optical discs (CDs or DVDs), flash memory (thumb drive) devices, external hard drives, and internal hard drives that have been removed from a computing device. "secure Area" means an area to which only authorized representatives of the entity possessing the Confidential lnformation have access, and access is controlled through use of a key, card key, combination lock, or comparable mechanism. Secure Areas may include buildings, rooms or locked storage containers (such as a filing cabinet or desk drawer) within a room, as long as access to the Confidential lnforrnatiorr is not available to unauthorized personnel. ln otherwise Securc 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 cateoories tarqet id=80&field tvpe tarqet id=All), anO of tne OSHS tntormation 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. 3. Administrative Controls. The Contractor must have the following controls in place: a. A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy. b. lf the Data shared under this agreement is classified as Category 4 data, the Contractor must be aware of and compliant with the applicable legal or regulatory requirements for that Category 4 Data. 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. 4.Authorization, Authentication, and Access. ln order to ensure that access to the Data is limited to authorized staff, the Contractor must: DSHS Central Contract Services 1 769CS Cou nty Ag reement (12-26-2025) 2. Page 20 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. f. Have a process to periodically review and verify that only authorized users have access to systems containing DSHS Confidential lnformation g. 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. h. 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. DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Page 21 t. Special Terms and Conditions (5) Ensuring that the remote access system prompts for re-authentication or performs automated session termination after no more than 30 minutes of inactivity. (6) Ensuring use of Multi-factor Authentication to connect from.the external end point to the internal end point. Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication mechanism, such as a biometric (fingerprint, face recognition, iris scan) or token (software, hardware, smart card, etc.) in that case: (1) The PIN or password must be at least 5 letters or numbers when used in conjunction with at least one other authentication factor (2) Must not be comprised of all the same letter or number (11111,22222, aaaaa, would not be acceptable) (3) Must not contain a "run" of three or more consecutive numbers (12398, 98743 would not be acceptable) lf the contract specifically allows for the storage of Confidential lnformation on a Mobile Device, passcodes used on the device must: (1) Be a minimum of six alphanumeric characters. (2) Contain at least three unique character classes (upper case, lower case, letter, number). (3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be accePtable. k. Render the device unusable after a maximum of 10 failed logon attempts. Protection of Data. The Contractor agrees to store Data on one or more of the following media and protect the Data as described: a. Hard disk drives. For Data stored on localworkstation hard disks, access to the Data will be restricted to Authorized User(s) by requiring logon to the 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 parigraph. Destruction of the Data, as outlined below in Section 8 Data Disposition, may be deferred until the disks are retired, replaced, or othenruise taken out of the Secure Area. j. 5. DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Page 22 c d Special Terms and Conditions 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 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 mechanisrns 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. 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.. e 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 Uniqle 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 othenrvise leaves the employ of the Contractor, and whenever an Authorized User's duties change such that the Authorized User no longer requires access to perform work for this Contract. g. Data storage on portable devices or media. (1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on' portable devices or media unless specifically authorized within the terms and conditions of the Contract. lf so authorized, the Data shall be given the following protections:: (a) Encrypt the Data. (b) Control access to devices with a Unique User lD and Hardened Password or stronger authentication method such as a physicaltoken or biometrics. (c) Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available. Maximum period of inactivity is 20 minutes. (d) Apply administrative and physical security controls to Portable Devices and Portable Media by: i. Keeping them in a Secure Area when not in use, ii. Using check-in/check-out procedures when they are shared, and iii. Taking frequent inventories. DSHS Central Contract Services 1 769CS County Agreement (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 otherurrise described in this exhibit. lf this media is retired while DSHS Confidential lnformation stillexists upon it, the data will be destroyed at that time in accordance with the disposition requirements below in Section 8 Data Disposition 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. Forthis reason: (1) DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: (a) Contractor has written procedures in place governing use of the Cloud storage and Contractor attest to the contact listed in the contract and keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. (b)The Data will be Encrypted while within the Contractor network. (c) The Data will remain Encrypted during transmission to the Cloud. (d) The Data will remain Encrypted at all times while residing within the Cloud storage solution. (e) The Contractor will possess a decryption key for the Data, and the decryption key will be possessed only by the Contractor. (f) The Data will not be downloaded to non-authorized systems, meaning systems that are not on the contractor network (g) The Data will not be decrypted until downloaded onto a computer within the control of an Authorized User and within either the DSHS or Contractor's network' (2) Data will not be stored on an Enterprise Cloud storage solution unless either: (a) The Cloud storage provider is treated as any other Sub-Contractor, and agrees in writing to all of the requirements within this exhibit; or, (b) The Cloud storage solution used is HIPAA compliant. DSHS Central Contract Services 1 769CS Cou nty Agreement (1 2-26-2025) 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.9. hard disk, optical disc, tape, etc.) which will contain no non-DSHS Data. (2) DSHS Data will be stored in a logical container on electronic media, such as a partition or folder dedicated to DSHS Data. (3) DSHS Data will be stored in a database which will contain no non-DSHS data. And/or, (4) DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the value of a specific field or fields within database records. (5) When stored as physical paper documents, DSHS Data will be physically segregated from non- DSHS data in a drawer, folder, or other container. b. When it is not feasible or 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 ovenivrite the Data at least three (3) times using either random or single character data, or Page 25 Removable media (e.9. floppies, USB flash drives, portable hard disks) excluding 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 confidenti of Data will be Paper documents containing Confidential lnformation requiring special handling (e.9. protected health informati 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 incinerati or crosscut shredd 9. Special Terms and Conditions Notification of Gompromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1) business day of discovery. lf no DSHS Contact is designated in the Contract, then the notification must be reported io the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS. Data shared with Subcontractors. lf DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. lf the Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub- Contractor must be submitted to the DSHS Contact specified for this contract for review and approval. 10. DSHS Central Contract Services 1 769CS Cou nty Ag reement (1 2-26-2025) Page 26 Exhibit B Program Agreement Budget X Original Budget Budget Revision REVENUES FiscalYear Fund Source Oriqinal 1st Revision 2nd Revision 3rd Revision 2026 State onlv 567,912 576.712 Medicaid 555.171 562,371 TotalRev $1,123,083 $1 .1 39,083 $$ FiscalYear Fund Source Oriqinal 1st Revision 2nd Revision 3rd Revision 2027 State onlv Medicaid TotalRev $$$$ Job Foundation Funds PASRR Funds State Funds Medleaid Funds TOTAL ADMTNTSTRATION (11, 12.13.'14\51072 41786 92,858 OTHER CONSUMER SUPPORTS (31,32,41,92,93, 94, e7)33411 60,748 CONSUMER SUPPORT STATE.ONLY (6,2.64.65.67, 69) Child Development (61) MEDICAID CLIENTS 162.64,67, 69, 95, 96)433917 867.834 ROADS to COMMUNITY LIVING G2.64.65,67.69) TOTAL 518,400 503,040 1,021,440 DSHS Central Contract Services 1 769CS Cou nty Agreement (12-26-2025) Page 27 This agreement is entered into by the Washington Pmtec.tion and Advocacy_ System, Ine. (hereinifter WPAS), the protection and advocacy system lqtlrqri_zed pwgygt to the Developmgntal bisabilities Assistance ana gil of Rights Act of 1975, 42 U.S.C. sec. 6000, et seq., to investigate alleeed incidents of abuse, neglect, anA rigirs violations of persons with developmental disabilities, ana-ttri Division of Devefopnientai Disabilities (hereinafter DDD) of the Departrnent of Social and Health Services, for the purpose of clarifying the rights and responsibilities of WPAS with respect to its access to individuals wlth developmental disabilities, clients, programs, and records. The Deparrnent of Social and Health Services, specifically DDD, is -responsible for providing serviies to individuals with developmental disabilities, to the extent fiurding is available. in providing those services, DDD must protect the confidentiality.of records and information regirding those individuals pursuantto the state and federal confidentiality laws. WPAS is charged by federal law to protect the legal and human rights of individuals with developmental disabilities.- WPAS provides legal and related advocacy services to meet that obligation. WPAS is also required to maintain the confidentiality of 1eg9r!s q$ information regaiding individuals with developmental disabilities consistentrutth42 U.S.C. $ 6000, et seq. This agreement governs the access of Washington Protection-and Advocacy-systqm to DDD employees wlio do not *ork in Residential Habilitation Centers (RHCs) and records maintatnedby Odn i"iricir are associated with individuals with developmental disabilities living outside of RHCs. Federal laws and regulations also provide WPAS with access to communify programs and individuals with developmental disabilitiei served by DDD contracted providers. DDD will work with commrurity providers and WPAS to arrive at an agreement governing aceess to DDD contracted programs and the people served by them. General. A. That all tcrms uscd in this agrccmcnt which arc dcfincd in thc Developmental Disabilities Assistance and Bill of Rights Act of 1975, 42 U.S.C. $ 6000, 9!-!9S., will have the meaning given to them in the Act, unless otherwise stated in this agreement. Attachment F ACCESS AGREEMENT BETWEEN WASHTNGTON PROTECTTON AF{D Ar}VOCACY SYSTEM, rNC', AND TIIE DIWSION OF DEVELOPMENTAL DISABILITIES, DEPARTMENT OF SOCIAL AND IIEALTII SER\TCDS. B. This agreement is intended to carry out the provisions of the Developmental Disabilities Assistance and Bill of Rights Act of 1975, 42 U.S.C. $ 6000, et. seg., and therefore, if this agreement is or becomes inconsistent witli the Acf or the implementing 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. I. COMMIJNITY ACCESS AGREEMENT II. Definitions, A. Actively Aggressive: means that the individual with developmental disabilities is assaulting otheis or ii threatening to do so, or the individual with developmental disabilities is actively harming him or her self. B. Clienl$ervices: means 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 t", *y report or communication, whether formal or informal, *ilt.l o1 o-r_al, received by WPAS including media accounts, newspaper articles, telephone -calls (tncluding anonymous calls), from any source alleging abuse or neglect of an individual with a developmental disability. D. DDD Consu8er: means an individual with a developmental disability receiving suppoft from a program funded by DDD. The term includes DDD consumers who have di6d or whose u,hereabouts are unknown, See 45 CFR 1386'22(a)(2). E. DDD Employees: includes those individuals who are employed by_QDD or who volnnteer foiDpD to provide services to individuals with developmental disabilities. F. Emergencies: means actions, omissions, or conditions_that immediately threaten an individuat wi-h a developmental disability's health, life or well being. G. Individual with a Developmental Disability: means individuals.witlr developmental disabilities in the process of applying for or who have been found eligible for services from DDD. H. Monitorins: means unaccompanied access to all residents of .a- .program at reasonable times,-which at a minimum shall include normal working and visiting hows to ensure progam compliance with respect to the rights and safety of DDD consumers. See 45 c.F.R. $t386.22(9. I. Probabb Cause: as detrned in 45 CF'R 13U6, or hereinafter amended, means a reasonable ground foi belief that an individual with developmental disabilities has been, or may be, su6ject to abuse or neglect. The individual .4.ing such determination may base tle"clecisiolbrr rcasonablc infcre.uccs drawrr fi'our his or hcr cxpcricucc or training rcgarding similar incidents, conditions orproblems that me usually associated with abuse and neglect. J. Program: consistent with the definition of "facility" in 45 CFR 1 3 86. 19 includes any setting that provides care, treahnent services and habilitation, even.if gnly "as needed" .or under-a conractual arrangement. Programs include, but are not limited to, community Iiving arrangements (e.g., group homes, adult family. homes, congregate care facilities, boarding ho"mes, individ-ual rcsidences and apartments), day programs, juvenile detention centers,-nursing homes, homeless shelters, jails and prisons' K. provider: means those individuals/corporadons with whom DDD contracts to provide services to DDD consumers, including but not limited to behavioral management iervices, family support services, vocational support services, sheltered employment, tenant support, intensive-tenant suppoft, altemative living, supported living,.group home, adult Airity itome, and congregal6 care facilities, chore services, medicaid personal care and other personal assistance services. 2COMMLNITY ACCESS AGREEMENT III. L. Provider Employee: includes those individuals who are employed by a provider or who volunGef for a provider to provide services to individuals with developmental disabilities. M. Recordq: as defined in 42 U.S.C. $ 6042 and 45 CFR 1386(22)ft), or- hereinafter amended reports prepared by any state staffor reports prepared by-an agency charged with investigating- reports of incidents of abuse, neglect, injgrl, or death that describe incidents of abuse, ieglJct, injury, or death occurring at a Facility, invesfigative documents and discharge olannine records-. -The term records also includes DDD consumer abuse and neglect iommitTee reports but does not include peer review death reports, attomey work product, and records wtrictr are otherwise privileged under state or federal law. N. Regular Proeram Activitv: includes work assignments, education programs,therapy, health services, and daily living activities. O. SOLA: means the DDD consumer support program, State Operated Living Altemative. P. WPAS Client(.s): (l) Individuals with developmental disabilifies who do not harre a guardian.or legal representative and who indicate either orally or in writing to a WPAS employee that they want WPAS to represent them. (2) Individuals with developmental disabilities without guardians who .are unable to communicate their wishes regarding protection and advocacy services when WPAS has received a complaint of abuse and.ior neglect about the individual with a disability, or WPAS dctermincs 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 havg a guardian or legal iepresentative where the guardian or legal representative has consented to the representation in writing. (4) Individuals with developmental disabilities whosg Blardian . or legal 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 represents the guardion. WPAS shall notiS the DDD Regional A4ry=949r or delignee in i'rititg that it represents the individuat with developme{af disabilities and forward a copy of that notice to either the guardian or the individual with developmental disabilities. a. WPAS Emplovees: includes paid employegs-an{ volunteer employees as identified UV WpAS. Each employee shall carry WPAS identification. Access to Programs. A. DDD will not obstruct WPAS access to prognms when consistent with the law and will ensure that SOLA and otherprograms staffed by DDD employees will comply wil! this agreement. For programs which cdntract with DDD to provide services, DDD will not 3COMMLNIry ACCESS AGREEMENT IV. obstruct WPAS access to programs when consistent with *re law, but WPAS will assume primary responsibility for enforcing its access rights. WPAS will attempt to resolve access i5u"r it the lowest level possible. ln cases where there is danger of imminent or continuing harm to an individual wiih developmental disabilities WPAS will report the occurrence to DDD, consistent with the Washington State Bar Association Rules of Professional Responsibility and other applicable state law. In those cases and wherelhere is.a pattem.of failire to provide access f<if WpaS to a program 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. B. WPAS staff will identiff themselves to any staff present whgn they aryve_4]!.a program by showrng a WPAS photo identitication badge. WPAS shal-l provide the DDD dire-ctor witn a list oT employeed and their pictures by July l, 1997, and WPAS shall update this list as necessary. C. WPAS shall have access to SOLAs and other prograrns staffed by DDD employees as specified in this section. This agreement does not affect the right of an individual with a devilopmental disability served bysuch a progr{rm who owns_or rents his or her olvn home to denj' access to WPAS to his oi her home. However, DDD-employees-do not have.the right to deny WPAS access to programs or the residences of individuals who are served by proptrams. D. WPAS staff shall have access to all programs when WPAS has received a complaint or has probable cause to believe than an iniident ofabuse, neglecl or other rights violation has occurred; E. WPAS staff shall have access to atl living areas of SOLAs and other progr:Ims staffed by DDD employees during regular business hours for the pYrpose of.providing informati-on on legal ri!$rts and s-elf advocacy to the individuals with disabilities who participate in the piogram. During the course of such access, WPAS staff shall be allowed in .ngig" in informal discussions-with the individuals with disabilities, out of the presence of DDD employees ot others, in an area that affords privacy. F. WPAS staff may visit any location where residents are served by DDD employees, where the purpose rs observatiori or monitoring compliancg utth respect to the rights and safety of iervice recipients (CFR 1386:2(g){2)) _Stch^observation and monitoring activities need not be limited to clients of WPAS, and WPAS staff shall not be required to sul.rsduls ur give prior notice of such visits tu DDD eruployees,_provided that WPAS has thc permission of a bOO consumer. WPAS staff shall be permitted to monitor.the prggrgm without an accompanying DDD employee. WPAS staff shall conduct all monitgnng activities in a manner wtri-ctr is respeitfui of the privacy of the individuals with disabilities who reside in the monitored program. Access fo IndMduals with Developmental Disahilifies. 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 appo^inted attomeys. D-DD shall assist and support the professlonal'relationship between WPAS and its clients. Written consent for such access is not required. B. WPAS recogniz-es that all individuals with developmental disabilities have the right to refuse to talk with WpAS, to have a third party present during the interview, or to reschedule the appointment for a more convenietrt time. WPAS shall advise their clients and other indiviridals with developmental disabilities with whom they have contact of these qCOMMUNITY ACCESS AGREEMENT riehts before each meeting. A person who does not wish to talk with WPAS staff shall be ufTo*.4 to communicate [ris directly and privately to WPAS staff unless h9 91 shp oYgrtly -*if"itr fear of being alone with the W?AS staff. When the individual with a J"u.top-"ntal disability overtly manifests such fear by words or behavio4 WPAS shall respecf that person's desires and not meet alone with that person' C. WPAS will encourage its clients and other individuals _ry{ devglopmental disabilities to notifu DDD anl/or providers of complaints regarding DDD services and to riiolve those complaints tkough any existing dispute resolution process. D. WPAS staffshall comply with all safety and security requirements of DDD. DDD will cnmmunicate these reqtrirementsto WPAS staff. E, DDD employees shall not interfere with WPAS staff in obtaining.a PltySte spPg fbr meetings between VfpaS staff and individuals with developmental disabilities. Private soace d"oes not mean a comer of a common atea room or other location which would aftord o'ther residents and DDD employees open access to WPAS employees- in living.qea:s o.l.on the srolnds. l)DD employee.s shall reipect the confidentialityneeds of the individual with a J""Etop-enta disabiliiy ina WpeS. iWhere an individual with a deleJqpme$al.disability inai"itir that he or she does not want to meet in a private space, WPAS staff will respect this request. F. WPAS staffwill not be required to schedule visits with DDD employees in advance of tfr"ir visits. However, WPAS staff may contact DDD employees to do so if access to a WpAS cfient or other individual with a developmental disability will be facilitated due to the individual's daily activities' G. WPAS staffshall have the right to unaccompanied access to any SOLA or program siaffed by DDD employees, and acceis !9 any indiviitual WPAS client or DD consumer they are authorized to serve, subject to the following limitations: (l) While WPAS need not notify the DDD _employees.prior to meeting with its client or DDD consumer, WPAS agrees not to disturb a client or DDD consumer if the WPAS employee arrives at the iesidence or other building in which the client or DDD consum6r ii served and the client or DDD consumer is engaged in regularly scheduled program activity. In such case, WPAS staff will b^e permitted 1o observe or otherwiielrEritr, ttre programming wi&out disturbingit. qyPAS staffpresence dishybs or is objected tb bt tUe WFaS client or any other. DDD conswrler who is present, WPAS stuff sh*ll-make arrangements to meet.w'ith the WPAS client or bDD conr,r*er at a later time. Where- consulted prior to making an appointment, bno employees will cooperate with WPAS staff in making scheduling anangements. 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 iinht to privacy. WPAS staif wili then either wart urtrl the actrnly ts completed or i.iin.AU. the visit at a time that is mutually agreeable to WPAS staff and its individual client or DDD consumer, no later than 48 hours later' (Z) If the WPAS employee arrives for a meeting wifi a client or DDD consumer i"a tft" individual is actively aggressive, in programming to address this behavior, or receiving "one-io-one" suferilsion, in such- a situation, WPAS staff will be nermittei to observe the individual from a safe distance or otherwise verify that the individual is actively aggressive. WPAS staffwill then either: fCOMMUNITY ACCESS AGREEMENT v (a) wait until the individual's aggressive behavior-has_{Erped qnd be p6rmi6ed to meet with the individual .privately while-DDD employees remain in viewing distance; unless such distance wogl{ place the individital with developmental disabilities at serious risk of harm based on that individual's -documented behavioral issues; if the individu,al would be at serious risk of harm, WPAS and DDD shall work cooperatively to address WPAS need for confidentialitv with the individual's need for safety; provided that any such interview does not interfere with the individual's behavior Support Program, Individual -Progralg Plan, Individual^ Service PIan, or oth6f prograrn plan, nor interfere with staffing needs for other individuals with developmental disabilities; or (b) reschedule the visit at a time mutually agreeable to WPAS and DDD employees, but no later than forty-eigltt (48) hours; (c) if the WPAS staff is notified that an individual is either actively aggressive or receiving one-to-one, zupervision and if knowine lhis $3 staff c[6oses to meet with 6e individual, WpaS agrees to release, indemniff, and hold DDD, DSIIS, the State and its employees, agents, officers, and s^ervgts harmless tbr any-injwies that occur hom any.claims or cause of action asserted by any WpaS employee or agent who is injured as a result of 4nY act committedby an individual with developmental disabilities -except that those circumstances where DDD employets' willful misconduct is the proximate cause of the injury to WPAS'emp^loyee.or agent. WPAS agrees itrat irs sraff shall sign a itat-ement to this effect-prior to requesting to meet with any such indiiidual. If the WPAS staff refuses to sign such an agree*"lttt, DDD employees may deny the 1VPAS staff access to the in?ividual'until such tim6 as DDD empioyees determine that safety to the WPAS staff is no longer an issue. When a WPAS staff member elects to meet with an individud 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 W?AS staff ihall be provided uncensored acceis to writing. materials, WPAS' address and toll-free iit"ptond number, a stamped envelope, andlor access to a telephone tbr private conversations without monitoring by or permission from DDD employees. I. SOLAs and programs staffcd by DDD cmplo.yegs shall pcrmit individuals with developrnental disabilitiJs to set appoinhnents with WPAS staff at times agreeable to both itre indiviaual with a developmentil disability and W?AS staff. If the _D_DD employees know that a meeting with i DDD consurnei witt be disruptive of the DDD consumer's i"sul* p.ogram acti"vity, WPAS staff shall be informed of this and allowed to reschedule tltE uoo.ilntiitent in orderto meet with the DDD consumer so that the appointment does not Aisrubi his or her regular activity. Access to Records of Individuals with Developmental Disabilities. A. WPAS has access to records as provided in 42 U.S.C: $ 6042, et. seq. WPAS ttas lesal authorify to review an individual with developmental disabilities' records only when iftEi" ir ionr"nt or. if a DDD consumer is unable to ionsent, there is a complaint or probable ;;; t" titi"u* i nnD consumer has suffered abuse or neglect. WPAS has no general right to review records except in these circumstances. 6COMMU{ITY ACCESS AGREEMENT B. Upon receiving a valid, written consent, DDD will have 48 hours in which to schedule -an appointment with WPAS so t}lat it may come t9 the record location to review specified recorcls. DDD will verif, that WPAS has received consent to view such records, or if the DDD consumer is unable fo consent and there is no guardian to consent, that there is a complaint or probable couse to bclieve the DDD conoumer hos sufflered obuse or neglect. bOn snal make the requested records within its possession available within five working days from the date the request is made. C. WPAS may access records of: (1) any DDD consumer if he or she consents, or if-he or she.tras a legal guardian giith the power to consent for the DDD consumer and that guardian consents; a) the DDD consumer or guardian shall give written authorization for access on a form approved by WPAS and DDD jointly. Q) wry DDD consumer: a) who by reason of his or her mental or physical condition is unable to authorize WPAS to have access to their records; b) who does not have a legal guardian, conservator, or other legal representative, or for whom the legal guardianis the state; and c) with respcct tu whunr a cr-rurplairrt han beerr teueived by WPAS ur with respect to -whom, as a result of monitoring or other activities there is probable cause to believe that such individual has been subject to abuse or neglect. d) If records are requested pursuant to this section, the request shall be in writing and will staie that the resident, by reason of his or her mental or 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 believe the resident 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 cslse of an emergency, (3) In the case of a resident who has a legal ggardian,_and upon request by^ VPAS, 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 represintaAve and offer its assistance. If the guardian has been contacted by WPAS ana AileO or refused to act on behalf of the individual WPAS has received a complaint sufficiently that sufficiently identifies the individual or WPAS has probable cause to believe thatthe health or safbfy of the_individual is in serious and immediate jeopardy, WPAS shall obtain court approval for such access' a) If a guardian refuses to consent to allow WPAS access to records, and WpaS still wanm access, WPAS will file a lawsuit to access the records and allow a tourt to determine whether the guardian has failed or refised 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 7COMML|NITY ACCESS AGREEMENT u. consent for WPAS to access the records, DDD shall not make the records available absent a court order. b) WPAS shall attempt to contact the guardian to obtain consent. Unless an emergency exists, then WPAS shall contact the standby guardian if one has been?esilnated. If no standby guardian is appointed and the guardian is unavailabie, and WPAS determines that the DDD consumer is at risk of serious injury or death, DDD shall make the records available to WPAS to review D. WPAS staffmay review the requested records witltin normal business hours in the ir,iitaing nr room in which such recnrds are provided. A DDD e.mplglegpayremain in the roo* *itit" the records are viewed. Under no circumstances may WPAS staff remove the original records, or any part thereof, from the room where they are viewed. E. WPAS aglees to reimburse DDD for the costlof copies.at the same rate.charged for public disclosurirequests, cunently $.15 per page. When feasible, copig,t *ill be- provided tn th. day the copies are reqrrested IFJhat is not possihle, 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 ijOO n gionA Administritor of the region in which the DDD consumer resides' ffr"*uto] their contact regarding that DDD consumer shall be the regional administrator, ;;-hi;;ait;r designee. fnO Jttatt provide WPAS a list with contact information fbr fu.por"r of accessio records. DDD agrees to update that list at least arurually. G. [n order to access DDD records, WPAS will send a written request directly,_to the nnn n"gional Administator or designee in custody oJth-e reco.rds. In the request,.WPAS ffi rd"ifitttr" indil iaual whose recirds it seeks. -WPAS need not identiff the.individual by name, but must sufficiently identiff the individual so that the person reviewing.the ;J";i;* determine whose records are being sought. WPAS will speci& which records it ;il;*d itawtrich time periods. WPAS wilt atso inOicate that it has received a comPJaint .*r**6g ttt" individuat io that it has probable cause to believe the individual has suffered ffi;; ffiglect. WPAS need not flrther speciff the nature of the complaint nor who made the complaint. H. In the event DDD denies access to records pwsuant to a request, WPAS staff may iequest thatthe dentalbe in writing and include the reason for the denial. L WpAS will limit its request to records it considers necessary to accomplish its investigation. DDD may t"q,reit that WPAS specifically identiff the records that it is seeking if the request is too broad or voluminous. Outreach. A. All individuals with developmental disabilities shall have access to WPAS staff for iftl p".por" "fobtaining information about their t"gullqltF:"d self-advocacy. WPAS staff sftufi Uj uifo*ed to engige in infomral discussiorrs with pnD cgrrsurllers wiro wish to speak io tfi"- out of the preGnie of DDD employees in an area that affords privacy' B. yPAS may hdve regularly scheduled information/training sessions. Ft. ?PD Jonru-*.r and pardntVguardifrs/faririly members regqdgrq ylAS' services and individual ;;ht" Dbb employeelmay attend outreach and sc[eduled information sessions only with ud'vance written permission of WPAS staff' 8COMMLTNITY ACCESS AGREEMENT C. DDD agrees to give WPAS a list of all cunent 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 6r DDD services. WPAS will provide DDD with copies of their brochure and/br any other information they want DDD to distibute at that time. E. DDD agrees to require contractors to comply with 42 U.S.p. $6000 et. seq. and 45 C.f.n. Parts 13-85-86 by iircluding the requirementln confiacts. Current contracts will be amended to include this-requirement when they are renewed. VII. Authorify to Investigate Allegations of Abuse and Neglect. A. W?AS shall have unaccompanied reasonable access to DDD consumers and facilities when necessary to conduct i fuU investigation of-an incident of abuse or neglect- tiii. u*""5 shall inchdb the opportunity to interview any individual with a developmental Ji*Uf;ty, any DDD or proviGi employee, .or gny _othei persol whg mleht be reasonablv b;ii;";diriiwAS to have knowledge-of the iniident under glegtigalio.T; and to review what WPAS is entitled to review purluant to this agreement. WPAS shall be permitted to do its own investigation bfallegations ofabuse or neglect regardless ofany pending action or investigation by the State or any other individual or enttty' B. WPAS' investigations shall not interfere with any- other ongoing investigation. WpnS employees shaii not visit areas at times that would violate any person's right to privacy. C. DDD shall allow and encourage all employees and providers to talk openly with WpaS employees. WPAS will n5t ask siaff to disrupt their -work schedules or t.rp"*lUitifies'to talk with WPAS. Except in cases of emelgency, WPAS will schedule appointrnents with staff in advance. D. While DDD and provider employees shall be encour3gejltg igope11te with WPAS, J*ptoy""r ttu* G tigtti to refuse t6 tutt< *itft WPAS. WPAS shall notify employees of tnai riltrt prior to any afiempl to interview them. E. Any complaint concerning WPAS staffshall be immediately brought to the attention oi tt " WpAS Eiecutive Drectoior his or her designee. Upon receip of a complaint, the WpAS Executive Director or his or her designee shall conduct -an investigation and submit a *ritt"n response to the State within fouteeri(l4) days in an effort to resolve any- complaints ;;6;;tiAdy as possible. DDD reserves the right to file formal charges if the behavior placei a DDD coniumels health or safety at risk. F. WPAS shall inform DDD and providers, in writing, of its findingl and concems .rpon co*pt"tion of any investigation qclivrty undertake-n pursuant to tts authortty under 42 U:i.-C. $ 6T0O "i. r"q., "*a tn" icc"ss rights granted to WpAS in this aq'reeTe.nt, in an effort to resolve DDilcoisgmer complaints -or cdncettts prior to commencing !{gation, unless WpAS bclieve that sush delay wi,uld result in serious injury or harm to the DDD consurnct. VIII. fmplementation ofthe.Agreement. A. The DDD Director shall ensure that each supervisor will conduct an annual rye-g}Tg with his or her staff to provide information regarding the parties' rights and_responsibilities under this agreernent. tir" OnO director shafensurE that each employee of DDD has read 9COMMLNITY ACCESS AGREEMEN'T rx. and signed a copy of a form indicating that they have read this agreement at the time of hire *j uftn" time of hislher annual eviluation. - DDD and WPAS shall develop a mutually asre"a to summary of this agreement for use in informing DD-D employees. of the parties' ri?irts and r"soonsibilities. !ftren DDD and WPAS develop and agree regarding the content oithi* summaqy, DDD employees shall be required to read the srtmmary, rather than reading this agreemeni and acknowledge that they read and understood the summary wth a signature. B. The agreement is effective as of the date it is signed. C. DDD agrees that having an agrcement in place that^would govem WPAS and DDD provider relatio"nships is appropliate. This agreernent will affect contrac.tual relationships, so It;iib;;"totiut"a *ith pioviaers prior to ilirplementatig": T4il negotiatioLwill take place during me iggl,tggS pr&ider contract negotiations. DDD_will request WPAS review the ilffie?;; "ruri1ie,;s" ptiot to "onruit signing Fv Pon. rh9 egal, of |hf rygotiatioliroi.r" will be to diin5 ut * ugr""-ent ','ihicli implements the- federal statutory-.and i.g"tuto.y riquirements in a mannei consistent *iF.F -p.lgision of quality, individualized *"iri"". ind suppons to people with developmental disabilities living in the community. D. The DDD director will make changes as necessary to implementfhis-agteement by September l,lggT,and prior to implemendng changes will confer with WPAS. E. WpAS and DDD agree to work together to asslst providers in becoming f$.ntliar with WpAS access to progrims. DDD agrJes to host a forum in each.region to familiarize providers with the access frovisions. WPAS agrees to make staff available as_presenters at i"gi"r.if"*-s, and othenrise as mutually ageegtg with providers.. DDD will distribute to providers a sunmary of the access provisioni. This summary will be prepared by WPAS' lna *iU be subject to the review and approval of DDD prior to distribution. llliscellaneous. A. WPAS agrees that its staffshall not give medical advice and shall not engage in the oiactice oi mediiine. It is WPAS' intent aid pu{pose to give legal advice. For example, 'WpaS witl not tell DDD consumers not to take medication or that medications are vwong foi tfti;11. W?AS will not discourage individuals with develgpmental disabilities from oarticioatine in programs or activitieJ. WPAS may explain DDD consumer legal rights ilffiffi tfi" rieht io informed consent, their right io b6 totd of the risks and benefits of ;;i;;llil or iredical procedutes, ttr6tu riebi to refuse to take medications and the "ro""a*l to follow if the DDD consuner doei not wish to take medications, and their right i" rrn." t" participate in experimental progams or research, all as guaranteed under state and federal law. B. WpAS agrces that there are some DDD consumen who are identified as medically fraeile or to have"behavioral concerns that require constant monitoring. If WPAS requests a miEiing *itit such a DDD consumer and DDD determrnes that the LlLllJ consumer cannot ilGftfuJpervised with a WPAS employee, a DDD.or provider employee shall.be pr:s:lt a*inn anv meetines. If DDD consuniers are hospitalized due to medical conditions, DDD ;;;;;i"r eruplJyees rnay rcmain within vie#ng distance if. necessary for the DD^D "".,!r*"it tt""titt ira safety. The employees will not interfere with the meeting except for ;;ai..i ;#";; and will respect the OOO consumer's privacy to the extent possible given his or her medical needs' COMMUNITY ACCESS AGREEMENT l0 C. This agrcement delineates the usual process by whicli WPAS and DDD will work iogether. in s6me situations, it may be necessary to dme.-nd these procedwes. WPAS ard DbD may agree to modiS, these procedures as necessary lbr any particular situation. x.Dispute Resolution. A. WPAS and DDD agree that informal resolution of dispr{es is preferred- If WPAS itan and the DDD Regionil Administator or designee are unable to agree about an_ issue i.g*Airg interpreatioi or application of this agreemenq .they will request tne pf{S pie""tlvi Direitor and the DDD Director review the situation and attempt to resolve the disagree.ment. B. The Directors Meeting and Mediation process are qlqdatgry for both parties. iir" onty exception to this tJrm of the agreernent is where W?AS, in good.faith,.has ri"U"UiE cuusd to believe that there aretxigent circumstances warranting immediate i"a"ar. Such circumstances are defined as- "emergencies" as defined in the access agreements. In such casss, the IVP4S Executive Director or his or. her designee shall cSntact the Director of the Division of Developmental Disabilities or his or her designee; *alor Office of the Attomey General to attempt to resolve the dispute. If _the e}igent u.r"rt dispute is not resolv6a Uy the end of the following.business day, WPAS.may immediateiy take any necessary iegal action, including seeking a temporary restraining oid"r and "preliminaiy injunction or an order to show cause in order to secure the necessary aicess with6ut going through th-e_ADR process discussed herein. When WPAS ao*r tut " such action, it Jhall-give tlie 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 aspoct of thc Acocss Agreements between WPAS and DDD (Community), the aggrieved party shall s91d written no"tice to the director of the other party (e.g. WPAS Executive Director, the Director of ilnn, "t their designees) of the diiput-e ind the desire to meet to attempt to re-solve the dispuie. The DDd dire'ctor (or hisftrer designee) shall meet with the WPAS Executive Dir'ector (or hisArer designee) within ten days after receiving written notice form the aeerieved'party. The date-of receipt of notice shall be in accordance with Civil Rule 6 of the U7istringtdtr Lburt Xutes. 'lhe nieeting may take place in person or telephonically.. 'lhe parties fiave the right to bring their couns6t to the directors meeting, however it is the ireference ofthe pirties not to have their counsel present. ln the event a parly intends to iravc ftis or hcr counsel preseirt, thatparty will advisc the otherparly of this intent in advance oithe meeting. HoweGr, when eitlier director (or his or her designee) is an attomey, it will be understood and expected that the other director may have his or her attomey present without prior notice. D. In the event that the access issues are not resolved by a meeting between the Director/CEO and Executive Director of WPAS or their designees, the parties agree to utti1;1pfto iesolve the dispute through mediation absent exigent circumstances as described in parisraph 1. An available mediatbr from the mutually agreed upon Mediator Panel list as aeicrib"ed below will be used to conduct the mediation. Mediation will be scheduled to occur as soon as possible following the directors meetins. but will occur no later than 30 days iiom the time mediation is agreed upon by the parties,-absent written a!,reement by both parties to extend this timeline. The medlation may iak" piar" telephonicaily 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, the mediation will end. 'fhe parties are then encouraged, but not llCOMMLINITY ACCESS AGREEMENT required, to arbitate the dispute. The costs of mediation shall be borne equally by th9 paities. "If no litigation resulfs within 90 days of the completion of mediation, WPAS shall *ithdraw its acceis request. Nothing, however, prevents WPAS from renewing its request in the fi.rture should that become necessary. 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 mrrtutally agreeable mediators. There will be two separate lists: one for WPAS and DDD and one foi WPAS 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 contaCting the panel members for each mediation in a nonstrategical manner, In order to select this panel, within 60 days of execution of this agreement, the parties will each propose at least 4 mediators. The parties will exchange, via fax, t4eir list of orooosed mediators and the mediators' cu:riculum vitae and any other necessary facts such is iost, mediation rules, etc. If the parties cannot agree upon at least 4 mediators from the first exchange of lists, the parties-will exchange additional lists of mediators until an agreement can Ue reached. However, a final agteement must be reached no later than 90 d-ays from the date of the settlement agreement of this case absent written agreement for an exfension of a specific amount of time. Any party may strike a mediator from the list except that a party may not strike a mediator from ttie panel once the mediation process has been initiated to resolve a dispute. lf a party strikes a mediator trom the panel, that mediator will be replaced by another mediltorusing the same mediator selection process as described above. F. In the event that the access issues are not resolved tluough mediation, the parties may agree to attempt to resolve the dispute tkough arbitration. Written agreement to prot"el to arbitrati6n must be made wifiin five working days of the completion of mediation described in Section B An available arbitrator from the mrrhtally agteed trpon 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 thah 45 davs from the time arbitration is agreed upon by the parties, absent written agreement by both parties to extend this timeline. Prior to the time_of final agreement to uibittut* the dispute, the parties shall agree in writing whether the arbitration decision will be binding or advisory, and if advisory, whether that opinion is admissible in court. If no lidgarion iesults wiftih 90 days of the completion of this arbilration, WPAS shall withdraw its "access request. Nothing,- howeverr prevents WPAS from renewing its request in the fuhge should that become necessary. Irsuch event that WPAS renews its request, and that request is denied by the State, the ADR process will begin again' G. Within 120 days of the execution of this agreement, the parties shall select a_panel of at least 4 mutually agreeable arbitrators. The parties agree that any on€ olthe selected panel members will arb-itrate all disputes related to the Access Agreement. However, the bu*i"r 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 agreem_enl, Fe parties will each propose at least 4 arbitrators. The parties will exchange, via fax, their list bfnroposed arbitrators'and the arbitrators' curriculum vitae and any other necessary facts ru"h as cost, etc. If the parties cannot agree upon at least 4 arbitrators from the hrst exchange of iisg, the parties will exchange additional lists of arbitrators-until an agreement can be ieached. Howbver, 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 uritten agreement for an extension of a specitic amount of time. Any party may strike an arbitrator from the list except that apqrty may not stike an albitratur fruiu tlrr palvl r.lruc ths arbi{.ratiuu pruuEris has besl iuitiatcd tu rssulvs a disputc. If a party strikes an arbitator from the panel, that arbitatgr yrl-l be replaced by another arbitiatoi 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 agreements. Any timeframe may be extended by r,vritten agreement of the parties' I. The parties agree they will abide by the timeframes contained in the Access Agreement and this settlement agrcement. The parties may mutually agree -to extend any tirieframe. If a pafiy fails to act or respond within the allotted time, the other party may request appropriale sanctions be imposed as provided by law or civil rule. il Date Director of Developmental Disabiiities .) I \j\{l ,l\ \\, t { STROH Date Executive f)irector Washington Protection & Advocacy System COMMTINITY ACCESS AGREEMENT l3 o.,,,,llUt9 Attachment G Request for Taxpayer ldentification Number and Certification Go to ffi.t'rs.govlFormwg lor insttuctions and the latest information. Give form to the requester, Do not send to the lRS. (Hev, March 2024, DDpartilont of lhs lroasu/y h*onrdt Rovonuo Soruico Beforo 7 I st arcounl nurnb4r(sl here {opto)al} Entor your ?lN in ihe appropriate box. Tha -flN provided rnust lnatch the nams qivell on line 1 to avoid backup withholding. For individuals, this is genarally your social security number (ssN). ljowever, for a r{rsident ali6n, sole proprietor, or disrsgatded entily, $eB the insl.uclions for Part l, ,aler. Fo. oihot entities, it is your elnployer idenlificatiou nurilber (ElN). lf you do not have a nunrber, see How to gel a fN. later. Note: lf the account is in more than one namc, see the instftrciions for line 1. See slso What Narne and NumharTo Qiva the Requestor for guidelinos on whose numbBr to enler. For relaled to the pu.po$€ ot Foiln W-9, $ee o/Form, bglolY. enxty's nnm€ on lrne 2.) 2 gusinoss rEmo/disreqnrdod orlily !ato. il dificfont ,tom sbove. 4 Exomplions (codo8 apply wfy to certf,in entiti€. not individuals: see lnrlnlclinn9 nn pato 3); €xempt payre code {l{ ftny) oof,o ao OEao 'Eoc 4o f oI da €xempllon lrfln complianco Act cods (if sy) For.ign Accorni Trx lfATCA, roporlirg (Applies to accounls tnaintairod au$ids the Unitad Stat*.) Reqresler's n6.re ar{l Eddress {optlons'} or Cartification Under penalties ot periury, I certift thai: 1 , 'fhe numb€r shown on this form is my corroct tupayer identification trumber (or I am waiting for a number to be issued lo me); and 2. I am not subject to backup lvithholding bccatr$e (a) I arn exempt f,om backup !,/ithholdkrg, or {b} I have aol be*n notifiecj by lhe lnlernal Rgvsntra Servtce {lRS) that I am subject to backup withholding as a result ot a lailure to report 3ll interest or dividetrds, ot (c} the IRS has rolilied rne that I am no long€r slrDiect to backup withholding; and 3. I am a U.S. citizen or other U.S. person {defined belour); arrd 4, The FATC^ code(s) entor8d on this form (if any) indicating thal I am oxernpt from F^TCA.eporting i3 correcl. Certificstion inslruclions. You rnust cross out ltern 2 above lf you have been roiified by the IBS ihat you 6re cilrrently subjml to backuP wllhholding because you nave iajlod to t€port all interest and divid€nds ot1 your tax relurn. For real estale transaclions, itetn 2 does not apply. For modgage ir)terest paid, acquisiiion or abandonment of secured property. cancellation of debt, conlribt{ions to an individual 3a Chtrklh6apprrpriatcooxtorfederalldrclassificatioilollhs4tll'lylndredual!'/hosenamei6 only ono of Il€ lollolving sevor box€*. E htdividuavsotoprooriotor I Ccorpomri^n ! $corporation ! Partnushir E Trust/catato n LLC. €ntc, the tai tlassificeliar {C = C corpo.alior!, S - S.:orfsrAiioh, P = Pa.hsrshipi Nate: Chfrik lh€ 'LLC" box dtrove ald, in tile trlry space, enter lhe ngprotriate code iC, S. or P) lor the lax classificatjotr of th6 LLC, urrlos6 ll is a (JaBregar.rorl mrtlty, A diBrdgardtrl sntity $ho!'d instqad ehek lho apProDriato box iorthe tax elassificatiof oi ats orvnoa. erlered on l,ne L Clreck f] other (so€ i.r&truclions) 3b if on line 3a you chockGd "Partnorghrp" or'"T,usvestate," o. checkBd "LLC" and ontc.€d "P- as ,ts tax classificati06 nnd you a.e providing ll'ts fo,f, lo & psrtne.ghlp, lrusi, or dElale in which yo! have il ownersaip rnleaesl, chtrk tirls 5or if yo! have any toreigu lE.lnsE, ovr'ners, or beoellciarie$. See inslr,;cliong 5 A(ldresc (nrFrber, slte€!, and apt. o. surte no.). Se€ ixstrncllons. 6 Ciry, stale, and ZiP code ldentificationPart I Emplqyer ld€ndfi cotlon numbet Part ll other thtr intsrost and dividends,ara not reqriired fo Sign Here lh6 csditication, but mu€l Signaturo of U.S- porson General lnstructions Section reierences are to the htlenlal Hevenlle Code uilless otheroise notod. Flturs dovalopmonis. For the lntost informalion about developments related to Fo.rn !V-9 and its insliuctions, such as legislation enacted afler ihey were published, go lo www.its.govlFomwg, What's New Line 3a has been rnodified to clanfy hovr a disregarded entity completes lhrs lino. An LLC that is a disregarded enlily should check lhe appropriate irox for iho lax classificittion of its owner- OlheruJise, it should check lh6 "LLC" box and ertler its appropriate tax classificatiorr' Dato Nev., line 3b has been addod to lhis fonn. A tlow-through enlity i5 required to cornplete this line to indicate that it has direct or indirect foreign partners, ovJrlers, or belleliciaries when il provides the Fonn W-9 to another flow-throtqit entity rn which jt has an ownership interest l his chanqo is intonded to provide a llow-through snlity wlth ;nformation regarding lh6 slatu$ of its indlr6ot for6ign partrl€rs, owlrsrs, or berlaliciaries, so that it can salis{y any applicable reporting requirernents. For example, a padnership that has atry indirect ioreigtl partner$ may be required lo complele Sch€dules K-2 and K-3, See the Par:n6r3hjp lnstruclions for Schedules K-2 and K'3 {Form 1065). Purpose of Form An lndlvidual or enti!y (Fotrn W-9 'nforrnatior'r r€iurt with the IRS is rsqilsle4 wlro is rcqulrc.j to lile an giving you this lorm because they Cal. No. 1oir,i:X Kittitas County Agreement for Services (rev.5/!4/251 Page 16 of 21 Form \rV'9 tncv 3 20241 Form W-9 {Hec- 3-20241 Pase 2 musl oblain your corect t:xpay€r identification number [[lN), which rnay be yout social security number (SSN). individual taxpayer idehlificilion number {lllN}, adoption taxpaye. iden*fication numb€r {ATIN}. or employer idenlifleation number {ElN}, to rePort on an informalion relum lhs amount paid to you, or olher amount reporlable on an intonnation retum. ExamPles ol information retums include, bul are not limited to. the following. . Form 1O99JNT {interesl eamed or paid}. r Form 1O99-D|V {diuidends, including those from stocks or mutual tunds). r Form 1099-MISC {various types of income, prizes, awards, or gross proceeds). . Form lo99-NEC {nonernployee comp€nsation). r Form 1099-9 {stock or muiual fund sales and certain other lransactions by brokers!. . Form 1099-5 {proceeds from real eslate traneaclions). r Farm 1099-K (nrerchanl card and third-party network transerJinn-e). r Form 1098 (home mortgag€ interest), t098-E (sludent loan interesl), and 1098-T {tuiiion}. r FsFn 1o99-C {canceled debt). o Forn 1o99-A (acquisilion or abandonment of secured propedy). Use Form W-9 only if you are a U.S. person fncluding a resident alien), to provide your conect TlN. Caution: lf you don't relum Form W-9 to the r€quester $/ith a TlN, you m;ght be subisct to backup withholding. See What is backup withholding, laier. By signing lhe filled-out form. you: 1. Certity that the TIN you are giving is conect (or you are waiting for a number to hte issjed); 2. Certity that you ara not subiect to backup withholding; or 3. Claim exemption from backup withholding if you are a U.S. exempt payee; and 4. Certi{y to your aan-foreign status for purposes o{ withholding under chapter 3 or 4 bf the Code [f applicable]; and 5. CertiS that FATCA code(e) enlered on this form ff any) indicaling that you are exempt from the FATCA reporting is conect. See What ls FATCA Eeporting, latsr, for further information. Note: lf you are a U.S. person and a requesler gives you a form other than Fsrm !1y'-9 llr request yourTlN, you muet us€ the requester's fi:tm if it is sub€tantially similar to lhis Form W-9. Definition of a U.S, person. For federal tax putposes, you are considered a U.S. person if you are: . An individual *rho is a U.S, cilizen or U.S, resident alieni . A partnership, ccrpcralion, company, or association created or organized in the Uniled States or under the laws of Ure United Siales; . An eslate {other lhan a foreign estatei; or . A dornestic lrusl {as def ned in Regulations sectian 3a1 .7701-71. Eslablishing U,S" status tor purposes of clrapter 3 and chapter 4 withholding, Paymenls mad6lo foreign persons, including certain dislributioni, alldcalions ot income, or transfere ol sales proceeds, may be sublecl lo wilhholding under chaplet 3 or chapler 4 o{ the Code (sections 1441-1474J. Under those rules, if a Form W-9 or cther certifrcation of non-forelgn status has not been received, a withholding agenl, transferee. or partsrership {payor) generally applies presumption rules that may require the payor to withhold applicable lax trom the recipient, owner. tans'eror, or parlner {payee}, See Pub. 51 5, 1i/ilhholding of Tax on Nonreeident Aliens and Foreign Entities' The foltowing persons must provide Form W-9 to the payor for purposes cf establishing its non-foreign slalus. r ln the case of a disregarded entity with a U.S, owner, lhe U-S. owner of the disregarded enlity and not tfre disregardod entity. . ln the 6ase of a grantor trusl with aU.S. granlar or other U'S. owner, generally, the U.Slgrantor or olher U.S. owner D{ the granlor trust and nal the grantor tn-,sl. . ln the c.ase of a U.9. trust (other than a grantor trusl), the U.S. trust and not the beneficia.ies of the trust. See Pub" 515 tor more information on providing a Form W-9 or a certification of non-foreign status 1o avoid rvithholding. Kittitas Cou nty Agreement for Services (rev . 5/14/251 Page L7 of 2L Foreign person, ll you are a foreign person or the U.S. branch of a foreigi bbnk:hat h# elecled lo be tieated as a U.S. person (under Bsgulatione secrion 1.1441-1(bl(2){iv) cr other applicable seclion for chapter 3 or 4 purpmes], do not use Form W-9. lnstead, use lhe appropdate Form W-8 or Form 8233 {see Pub. 51 5). lf you are a qualified foreiqn pension fund under Regulations section 1.897(l)-l(d), or a'partnership ihat is rvholly owned by qualilied forelgn pension funds, that is treated as a non-foreign person for purposeg of section 1445 withholding, do nol uBe Form W-9. lnstead, use Form W-8EXP (or oth€r certitication of non-foreign status!. Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may uee tfie terms ot a tat( lreaty to teduce or eliminate U.S- tax on certain typ€s ol income- However, most tax treaties contain a provision known ae a saving clause. Exceptions sp€cified in the saving claus€ may pe{mit an exemption from tax to cbntinue for certain tfoes of income even after the payee has otherwise become a U.S. rgsident al;en for tax purpos€s. ll you are a U.S. resident albn who is relying on an exception cont'alned in the saving clause ol a lax trsaty to claim an €xelnplion Jrom U.S. tax on certain typea of income, you musl attach a stat€ment to Form W-9 that specifies the {ollor.ring {ive items' .l. The trealy country. Generally, this must be the same trea:y under which you claimed axemplion fom tax as a nonresident alien. 2, The treaty article addressing *te income. 3, The artlcle number {or location) in thB tax trealy that contains the saving clause and ils excePtions. ,1. The typ6 and amount of :ncome that qualifies for the exemption from tax. 5. Sulficient facts to iustifil the exemption from tax under the lerms of the treaty article- Exanwle, Article 20 of the U.S.-China income tax treaty allows an exemptibn from tax for scholarship income received by a Chinese studant temporarily presenl in the United States. Under U-S. law, this student will become a residenl aliea for tax purposee if their stay in the United Stales exceeds 5 calendar years. However, paragraph 2 of the iirst Prolocol to tfie U.S.-China lreaty (dated April 30, 1984) allor,vs the provisions of Article 20 to conlinue to apply even after the,Chinese student becomes a resident alien of the United Slatee. A Chinese student who qualifies lor this exception (under paragraph 2 of lhe first Protocoll and is relvino on this axception to claim an exemption from tax on their 6cholarshifi or-fellowship iniome would att'ach to Form W-9 a stalement that includes the in{ormation described above to support that exemption. lf you are a nonresident alien or a foreign entity, giva the requester the appropriate completed Form W-8 or Form 8233. Backup Withholding What is backup wilhholding? Persons making certain paymentsto you must under ceriain eonditions rvithhold and pay to the IRS 24% of such paymenls. This is called 'backup vrithholding." Payments that may be irublect to backup withholding include, but are not limited to. interest, lax-exempl inlerest, dividends, broker and barter exchange transactions, rents. royalties, nonemployee pay, payments made in settlemenl of paymeni catd and third-party network lransactions, and certain payments from {ishing boai op€rators. Real eslate traDsactions are nol subject to backup withholding. You will not be sub.iect to backup withholding on payments you receive if you give lhe requester your corect TlN, make lhe proper certi{ications, and report all yout taj,(able inlerest and dividends on your tax relum" Paynrents yau receive will be subject to backup withholding if: 1. You do not fumish your TIN to the r€quesie[ 2.You do not cerlily yourTlltl rvhen required {see the instruciions for Part ll for details); 3. The IRS tells the requeslerlhat you {umished an incorrect 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 interest and dividends only); or 5. You do not certify lo the requ€star that you ate not subject to backup rvithholding, ds describeb in item 4 inder "By signing the filled- out form" above (for reportable inlersst and dividend accounts opened atter 1 983 only). Form W-9 (Rev.3-2024)Pase 3 Certain payees and payments are exempl from backup wilhholding, See Exempt payee code, lale\ and the separate lnstructions for the Flequester of Form W-9 for more information. See also Estab/ishing U,S. status {ot putposes of ehapter 3 and chapter 4 withholding, e*lier. What ls FATCA Reporting? Tie Foreign Account Tax Compliance Act (FATCA| requires a participating foreign financial institution to repoft all U.S. account holdars that are specified U.S. persons. Certain payees are exempt from FATCA reporting. Sea Exemption from FATCA repofting code, laler, and the Instructions for the Bequester of Form W-9 for more informalion. Updating Your lnformation You mus: provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt paye€ and anlicipate receiving reportabl€ paymenls in the future from lhis person. Fir example, ybu may need lo provide rrfdated 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 must fumish a n€w Form W-9 if the name or TIN changes for lhe account, for example, if the grantcr of a grantor trust dies. Penalties Failure to fumish TlN. lf you fail to furnish your correct TIN to a requester, you are subiect to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false slatement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subiect you to criminal penalties including fi nes and/or imprisonment. Misuse of TlNs. lf the requester discloses or uses TlNs in violation of lederal law, the requester may be subjecl 1o civil and criminal penalties. Specific lnstructions Line 1 you must enler one of the Jollowing on this line; do not leave this line blank. The name should match the name on your tax refum. lf this Form W-9 is for a joint account (olher than an account maintained by a foreign financial institution {FFl}), list firsl, and then circle, the name of lhe person or entity whose number you entered in Part I of Form W-9. lf you are providing Form W-9 1o an FFI to document a joint accouni, each holder of the accounl that is a U.S. person must provide a Form W-9- . lndividual. Generally, enter the name shown on your tax return. lf you have changed your last name wilhout informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note for ITIN applicant: Enter your individual name as it was entered cn your Form W-7 application, line 1a. This should also be lhe sanle as lhe name you entered on lhe Form 1040 you filed with your application. ' Sole proprietor, Enter your individual name as shown on your Form 1040 on tine 1. Enter your business, trade, or "doing business as" (DBA) name on line 2. . Partnership, C corporation, S corporation, or LLC, other than a disregardeel entity. Enier the etttity's name as shown on the entity's tax rstum on line 1 and any business, trade, or DBA name on line 2' . Other enlities, Enter your name as ghown on required U'S. federal tax documents on line 1. Thig name should match the name shown on the charler or olher legal document creating the entity. Enler any business. trade, or DBA name on line 2. . Disregarded entity. ln general, a business entity that has a single owner, including an LLC, and is not a corporation, is disregarded as an entity separate from its owner (a disregarded entity). See Regulations section 301.7701 -2{c)(2). A disregarded entity should check the apprapriate box for the tax classification of its owner. Enter the owneds name on line 1- The name of lhe owner entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax retrim on which the income should be reported, For Kittitas County Agreement for Services (rev.5/7a/251 Page 18 of 21 example, if a foreign LLC that is lreatad as a discegarded entrty for U.S. federel tax purpos-es has a srngle owner thal is a U.S. p€rson, the U.S. owner's narne is required 1o be provided on line 1' lf the direct owner of the entity is also a disregarded enlity, enter the first owner that is nol dbregarded lor lederal tax purposes. Enter the disregarded entity's name on {ine 2. ll the owner oJ the disregarded enlity is a foreign person, the o$ner must complete an appropriate Form W-8 iretead of a Form W-9. This is lhe case even i{ the foreign person has a U.S. TlN. Line 2 lf you have a business narne. lrade name, DBA narne, or disregarded entity name, enter:t on line 2. Line 3a Check the appropriate box on line 3a for lhe U.S. federal tax classification of the pereon whose name is entered on line 1. Check only one box on line 3a. Line 3b Check this box il ycu are a partnerchiP (inchrding an LLC classified as a partrrership for U.S" federal tax purposes), trust, or €state that has any foreign partners, owners, or treneficiaries, and you are providing this iormlo a parlnership, trust, or eslate, in which you have an ownership interest- You rnust iheck the box on line 3b il you receive a Form W-8 {or documentary evidence) lrom any partner, owner, or beneliciary establishing foreign slalus or if you receive a Form W-g lrom any partner, gwn€r, or beneficiary that has checked the box on line 3b. Note: A parlnership that provides a Form W-g and checks box gb may be required to complete Schedules K-2 and K-3 {Form 1 065), For more infonnation, see the Partnersiip lnstructions for Schedules K-2 and K-3 {Form 1065}. lf you are equired to complete lire 3b but fail to do so, you may not . rece]rie lhe info'rmation necessary to file a correcl informatjon retum whh the lFlS or fumish a coffecl payee statement to your parhers or beneficiaries. See, for example, sections 6698, 6722. and ts724 tor penalties that may apply. Line 4 Exemptions lf you are €xempt {rom backup wilhholding and/or FATCA reporting, eriler ilr llte a;:pnrpriate spaue ott lirte 4 atty er.rdds) lltat tltay apply io yo1J. Exempt payee code, . Generally, individuals {including soie proprietors} ara not exempt {rotn backup vrithholding. ' Except as provided below, corPoralions are exempt from backup wilhholding for certain payments, including interest and dlvidends. . Corporalions are not exempt from backup withholding for payments made in seftlement of payment card or third-party network transactions. . Corpomlions are not exempt from backup withholding wllh respecl 10 attomeys'fees or gross proceeds paid to atlomeys, and corporations that Frovide medical or health care services are not exempt with respect lo payments reportable on Form 1999-M|SC. The follon'ing codes idenlify payees that are exempi from backup wilhholding. Enter the appropriate code in the space on line 4. 1-An organization exempt from tax under seclion 50lial, any lRA, or a custodial account under seclion 403(b)(71 il the acccunl satisfies the requiremerts of section 401 (f)(2). lF the entity/individrral on line I isa(n!.., THEN check tho bcx for 0orporation Cotporation. , lndividuai or . Sole proprielorship lndiuiduallsole proprietor, ' LLC classified as a partnership for U.S. federal tax purposes ot r LLC that has filed Form 8832 or 2553 electing to be taxed as a corporation Limiled liability company and enler the apptopriate tax classification: P = Parhership, C=Gcorporalion,or S = S corporation. Parhershlp Partnership. . Trust/estate Trustlestate. Form W-9 (Rev. 3-2024)Fose4 2-The United States or any of its agencies or instrumentalilies" 3-A state, the District of Columbia a U.S. commonwealth or lertilory, or any of thdr political subdivisions or instrumentalities. 4-A foreign govemmenl or any of ;ts political subdivisions, agencies, or ingtrumentalities. 5-A corporation. 6-A dealer in securilies or commodities r*quired lo reg;ster in the United States, the Dislrict of Columbia, or a U.S. commonweallh or t6nitory. 7-A futures commission merchanl registeied w;th the Comrftadi.ty Futures Trading Commission. 8-A real estate investment trust. 9-An entity registered at all times during the tax year under the lnvestment Company Act of 1 940. 1o-A common trust fund op€rated by a bank under section 584ia). 1 1 -A financial institntion as defined under section 581. 12-A middleman known in ihe investment community as a nominee or custod:an. 13-A trust exempt from tax under section 664 or described in s€€tion 4947. The following chart shows types of payments that may be exempt from backup withholding. The chart applies to tfte exempt payees listed above, l through 13. lF the payment is for THEN the payment is exempt lor... . lnterest and dividend payments All exempt payees excepi far 7 . Broker transactions Exempt payees 1 F-A dealer in securities, commodities, or derivalive linancial inslniments (including notional principaj contracts, future€, fonvards, and options) that is registered as such undet the laltrs oflhe United States or any slate. G-A real estate in'/estm6nt trust. H-A regulated investment company as defined in secticn 85-l or an entity registered at all tinres during the tax year under tie lnuest'nmt Company Act ol 1940. l-A common trust fund as defined in s€ctaon 584r{a}. J-A bank as defined in section 581. K-A broker. L-A trugt exempt from tax under section 664 or described in secdon 4e47(a){1). M-A lax-exempt trust undet a seetion 403{b) plan or s.ectiott 457{9} plan. Note: You may wish to consult wilh the Fnancial inditution requBsting this lorm to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your address (number, street, and aFartm€nt or suite number). This is where the requesler of this Form W-9 will mail your information retums. lf this address differs from the one the requester already has on file, enter "NEW'at the top. lf a new address is provided.lhere is still a charre the old address will be used until lhe payor changes your address in their records. Line 6 Enter your cily, state, and ZIP code. Part l. Taxpayer ldentification Number (TlN) Enter your TIN hr the aPpropriate box, lf you are a residenl alien and you do nol have, and are nol eligible to get, an SSN, your TIN is your IRS fTlN. Erter it in the entry space for lhe Social secur;ty number. lf you do nol have an lTlN, see How to get a ntV below. lf you are a sole proplietor and you have an ElN, you may enter eitlrer your SSN or ElN. lf you are a single-member LLC thal is disregarded as an entity separate from its owner, enter the owner's SSN {or ElN, il lhe owrner has onel. if the LLC is classified as a corporation or partrrership. enter the entity's ElN. Note: See What Name and NumberTo Give tl:e Requester,laler, for further clarification of name and TIN combinalions" How to get a TlN. If you do not have a TlN, apply fcr one irnmediately. To apply for an SSN, get Form SS-5, Application for a Social Secudty Card. from your local SSA oflice or get lh;s fonn Dnline at www.SSA.gov. You may also get this form by calling$O9-772-1213. Use Form W-7, Application for IRS lndividual Taxpayer ldenlilicalion Number, to apply for an lTlN. or Form SS-4, ,Application for Ernployer ldentification Number, to apply {or an ElN, You can apply for an EIN onlfne by accessing the IRS w€bsite at rvlvwirs.grovlFilV. Go te www.irs.govlForms to view, download. or print Form W-7 and/or Form SS-4. Oriyuu can gu l.o Lvww.ris.gqvlOrderFuruts lu plal'e an order attd have Form W-7 and/or Form SS-4 mailed to you wilhin 15 business dalrs. lf you are asked to ccmplete Form W-9 but do not have a TlN, apply for a TIN and enler "Applied For" in the space lor tfie TlN. sign and date the form, and give it to the requester. Fo. inlerest and dividend payments, and certain payments made 'r.'ith respect to readily lradable instrumenis, you will generally have ffi days ta get a TIN and give it lo the requeEter b€fore you are subiect ta backuP B'ithholding on paymenls. The 60-day rule does not apply to olher rypes st payments. You will be subject to backup withholding on all such paymeflts unfil you provide your TIN to the requester. Note: Entering "fuplied For'' means thal ycu have already applied lor a TIN or that you intend to apply for one soon. See also Estab/ishing t!-5. status for pirposes ol chapter 3 and chapter 4 withlnlding, earlier. for when you may inslead be subject to withholding under chapter 3 or 4 of the Code. Caution: A disregarded U.S. entity that has a foreign olcner milst use 'lhe appropriale Form W-8. 4 through 11 and all C corpcrations. S corporations must rol enier an exempt payee code because they are exempt only for sales of noncovered securitiee acquired prior to 2012. . Barter exchange transactions Exempt payees 1 through 4. and dividends r Payments over$600 required to be reported and direct sales over $s,ooo' . Payments made in settlement of payment card or third-party network lransactions Exempt payees I through 4. 1 See Form 1OS9-MISC, Miscellaneous lnformation. and its inatructions. 2 However, the following paymenls made la a cotporation and repodable on Form 1 099-MISC are not exempi fmm backup withholding: medical and health care payments, attomeys'fees, gros* proceeds paid to an attorney reportable under section 6045{q, and payments for services paid by a federal executive agency. Exemption trom FATCA reporting code. The following cod* idenri{y payees that are exempt from reporting under FATCA These codes apply to persons submitting this form for accounts maintained outside of the United States by cedain foreign financial inshtulions. Therefore, i{ you are only submitting this form foian account you hold in the United State6, you may leave this field blank. Consult witi the person requesting this form if you are uncertain it the financial inslitution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 rvith "Not Applicable".{or any siririlar indication) enlered on the line for a FATCA exemption ccde. A-An organization exempl from tax under seclion 501{aJ or any individual retirement plan as de{ined in section 7701{4X37}. B-The United States or any of its agencies or insttumefltalilies, C-A state, the Disirict of Columbia, a U.S- commonwealth or tenitory, or any of their political subdivisions or inslrumentalities. D-A corporation the stock of which is regulady traded on one or more established securities markets, as described in Regulations section 1.1a72-1(cX.lXi). E-A corporation lhat is a member of the same expanded aJfiliated group as a corporation described in Regulations section 1.1472-1(c}(1l(i)- Kittitas County Agreement for Services (rev.5/14/25) Page 19 of 21 Generally, exempl payees 1 through 5.? Fom W-9 (Rev. 3-2024)Paqe 5 Part ll. Gertification To establish to the withholding agent that you are a U.S. person, or resident alien. sign Form W-9. You may be reguested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise. For a joint account, only the person whose TIN is shown in Parl I should sign (when required). ln the case of a disregarded enlity, lhe person identified on line 1 must sign. Exempt payees , see Exempt payee code, earlier. Signalure requirements, Complete the certificalion as indicated in items I through5below. l. lnterest, dividend, and barter exohange accounts opened trefore 1984 and broker accounls considered active during 1993. You must give your correct TlN, but you do not have to sign the certilication, 2. lnlerest, dividend, broker, and bader exchange accounts olrerred after 1983 and broker accounts considered inactive during 1093. You must siqn the cerlification nr hankup withholding will opply. lf you are subiect to backup withholding and you are merely providing your conect TIN to the requeste{, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the cerlifieation. 4. Other payments. You must give your conect TlN, but you do not have to sign the certifioation unless you have been notified that you have previously given an inconect TlN. "Otherpayments" include paym'ents mad:eln the course af the requester's trade or business for ients, royalties, goods (other lhan bills for merchandise), medical and heafth care services (including payments to corporalions), paymenls to a nonemployee for services, payments made in setdement of_payment card and'thiid-party nelwork'lninsactions, payments to certain fishing boat crew memberg and fishermen, and gross proceeds paid to attomeys (including paym€nts to corporations). 5. Mortgage interest paid by you, acquisilion or abandonment of secured property, cancellation oi debt, qualified tuition prograrn, _. payrnenti; (uhde; section 529f, ABLE accounts (under seclion 529A), lRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TlN, but you do not have to sign the certi{ication. What Name and Number To Give the Requester For this ol account: L Disregarded entity not own€d by m individml 9. A valid trsst, estate, or peffiim kust 'lo. Corporation or LLC electing corpoate status on Fom 8832 or Fsm 2553 1 1. Asgmialim, club, rclbiws, cfisitable, edumtioml, or other td-exmPt organiation 12- Partrership or muhi-mmber LLC '!3. A b.oker or registercd nminre t4- Ac6unt with lhe Deparantrt !f Agriculture in lhe name cf a public entity {such m a state or lml govemmmt, sch@l dbtrict, or pri*cn] that rtreives egricultuEl proEram paymenls 15- Gmntorlrustfiling Fm lo41 or under the Oplional Filing Meihod 2, Give name and EIN o{: Jhe ourer LeEsl €nlilja Tlte cwparalion Tlhe ugania$m The parfilssfiip T[p brcks s nomiree The public qrtity For this type of account: 1. Individual ?. Two or more individuals {oint account) other than an accoxnt maintained by an FFI 3. Two or rcre U,S. pereons (oint account maintained by an FFI) 4. Custodial account ol a mins flJnifom Gift to Minors Act) 5. a. The wud revrcable svings lrust (grmtor is dm trustee) b. So-called tret accwni thal is not a legal or valid trcl unds state lav/ 6- Sole proprieloBhip w disreguded trtity owned by an individual 7. Grantor trust filing under Optional Filing Method 1 (see Begulatiore strtbn 1.671 -4{bX?XiXAD" Give narne and SSN of: individual Jhe aclual omer of lhe lccount or. il mmbined funds, the fimt individual on the accounll Each holder oflhe accounl The mins? The grstor-trueteel The aclual ownerl The ovrned The grmtor' Tlh€ trust requiring Fom 1otx) {s* Fegulatb$ smtion 1.671-a(b){2XiXB}" ' List {irst and circle the name of lhe person livhoee number }lou fumieh. lf only one p€nion on a ioinl account has sn SSN. that person's number musl be fumished. ?Circle the minor's name and fumish lhe minor's SSN. rYou must show vour indrvidual name on line 1. and enter your business or DBA name, if ahy. on line 2. You may use erther your SSN or EIN (if you have one), but the IRS encourages yGu to use your SSN. llist first and circle the name of lhe lrust, estate. or peneion 1ru3t. (Do not fumish the TIN of the personal repr€s€ntalive or truslee unless the legal entity itself is not designated in the account tille.) 'Nole: The grantor must also provide a Forrn W-9 lo the trustee gf the trust" t* For more information on oplional filing methods for grantor truets, 3€€ the lnstructions for Form 1041" Note: lf no name is circled when more thsn sne flame is lisled, the number will be considered tc be that of lhe lirsl name listed. Secure Your Tax Records From ldentity Theft ldentitv theft occurs when someone uses ]iour personal information, such ai your name, SSN, or olher identifying infonnation, lvithout your permission to commit fraud or otfier crirnes. An identity thief may use your SSN to get a job or may lile a tax return using your SSN to receive a refund. To reduce your risk . Prolect your SSN, . Ensure your employer is proiecting yout SSN, and . Be careful when chaosing a lax {elurn p(eparer" lf your tax records are affecled by identity lheft and you receive a notice trom the lRS. respond righl away to the narne and phone number printed on the IRS notice or letter. lf vour tax records are not cunenlly affucted by idenlity theft but you thin( you are al risk due to a lost or sto{en purse or wallet, questionable credit card activity, or a gueslionable credit report, conlact the lFlS ldentily Thefi Hotline at 800-90&4499 or subnnil Fonn 14039' For more infomation, see Pub- 5027, ldenti$ Theft lnformalion for Taxpayers. Kittitas County Agreement for Services (rev.5/7a/251 Page 20 of 21 Paur G Form W-9 (Rev. 3-2024) Victims of identitv lheft who are experiencing economic harm or a "uit"*i" problem, -or are seeking heli in resolving tax problems that hlve not been resolved through normal channels, may be eligible for Taxoaver Advocat€ Service FAS) assistance. You can reach TAS by callinothe TAS toll-free case intake line at 877 -777-4778 or TTY/TDD 800-829-4059. Protect yourselt lrom suspicious emails or phishing schemes' Phishing is the creation and use of email and websites designed to mimic ldgitimate business emails and websites. The most common act is sendini an email to a user falsely claiming to be an established iegiti;atdenterprise in an attemptio scam the user into sunendering private information tfiat will be used lor identity theft. The IHS does not inhiate contacG with taxpayers via emails' Also, the IRS does not tequeet personal detailed information through email or ask taxoave$ for thC PIN numbers, passwords, or similar secret access infdrniation tor their credit card, bank, or other financial accounts' lf you receive an unsolicited email claiming to be from ihe lR$' tonri,ard this message topl,,slitrg@irs-gov. You may also report misuse oflhe IRS name, logo, oi other lRSproperty to the Treasury lnspector General for Tax Adririnistration (IIGTA) at 800-360-4484 You can forward suspicious emails to the Federal Trade Commission at soam@uce.oov or report them alwww.ftc'govlcomdaint. You can dontact the"FTC at iww. ftc.govt idffiefl or 877-IDTHEFT (877-4i18--i1338)' it y"u tr"u. U".n the viclim o;f identity theft, see www'ldentilyTheftgov and Pub. 5027. Go to www.irs.govlldentityTheftlo leam more aboul identity theft and how to reduce Your risk' Privacy Act Notice Secfion 81 0q ol the lnlernal Flevenue Code requires 1tou lo provide your correct TIN 1o persons $r:cluding federal agenciesJ who- are required io file informalion relums rvittr ltre IRS to teport intere+t, dividends, or iertain other income paid tE yqu: mortgrage inleresl you pald; lhe acouisdion or ahandonnefil of secured property; the csncellation ol dedt; or contribdions you made to an lFA. Archer MSA' or HSA' The emn ccllectinq thls iorm uses the inlormation on the form to f le informalion retuirs with the lHS, reportirg lhe above information' Foutine uses sf thb information inilude giving il to the Department of Juetiee fsr civn! end criminal litigation and to cilies, states, the District of Columbia, and t-!.S. cornnnonwealths and temtories lor use in administerinq their laws. The information may also be disclosed to olher "ountii"" unier a treaty, to {ederal and statsagencies to enlorce civil and criminal lavrs. o'r to federal law erdorcement and intelligence agerrbs lo combat tetrorism' You mtst provide your TIN whether or not viu aro reouired to file a tax telurl Unrier secrlion 3il0ti, payort mu$t i;"r*t"lfy *irt't'"td a percentage ol taxable interest, dividends, and iertain other payrnents to a payee '.{ho does nol give a- TlN.to the payor' Certain penaftiei rnay also epply for providing false or fraudulent information. Kittitas County Agreement for Services (rev.5/tL/25l' Page2Lof 2L