HomeMy WebLinkAboutFully executed agreement (3)KITTITAS COUNTY
AGREEMENT FOR SERVICES
PHMH25-O23
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 Kittitas Valley Opportunities
( hereinaft er "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 7LA.t4.
The term of this Agreement shall be from July !'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
Project Contact:
Laurie Holt
Phone: 509-933-8310
Email: laurie.holt@co.kittitas.wa.us Project Contact:
Michelle Williams, Director
This Agreement includes the following, which are attached hereto and hereby incorporated by this
reference:
Kittitas County Public Health
507 N. Nanum, Suite 102
Ellensburg, WA 98926
Attachment "A"l
Attachment "B":
Attachment "C":
Attachment "D"
Attachment "E":
Attachment "F":
Attachment "G"
Kittitas Valley Opportu nities
DBA Parent to Parent
C/O Jerrol's
111 E. University Way
Ellensburg, Washington
98926
Scope of Work
Compensation
I nsurance Requirements
General Terms and Conditions
Program agreement between DSHS and the county for DDCS/DDA services
DSHS/DRW Agreement
W-9,(Contractor must complete and return to the County for payment)
Kittitas County Agreement for Services (rev. 5/La/251
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.
t1/ /c'tE LLF E' k)/L-L/ 4fl,t S
CONTRACTOR
Signature
Printed Name
Title
Date
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY
atrman
arrmanad
r
Attest
Date:g1lt5
of the
lie Kjorsvik
holz
Kittitas County Agreement for Services (rev. 5/7a/25],
2
ATTACHMENT.,A"
SCOPE OF WORK
Funding is provided for the following activities and deliverables related to the administration of the Parent to Parent
(p2P) and Parent Coalition programs whose goals are to provide emotional support and information and legislative
advocacy to families of children with developmental disabilities.
1. Organization and implementation of parent support meetings to provide information, education and referrals
to services and support to parents and families of children with developmental disabilities.
a. Deliverable: By June 30,2027, the contractor will facilitate at least forty (40) support meetings
annually. I
2. Weekly availability to families and other community contacts for information and referrals.
a. Deliverable: Through June 30, 2O27,lhe P2P coordinator will be available Monday-Friday from 9am -
5pm via phone, email, Facebook or in person.
3. Publish and distribute a quarterly newsletter to families and community partners.
a. Deliverable: Through June 30, 2027, quarterly newsletters will be published and distributed
b. Deliverable: By June 30,2027, the number of contacts on the database for the quarterly newsletter
will increase by 30.
4. Host a community outreach and education event'
a. Deliverable: By June 30,2027, the contractor will host or coordinate with the County Coordinator
and /or Transition Team, at least one outreach and education event.
5. Maintain a Parent Coalition program in Kittitas County
a. Deliverable: Through June 30, 2O27,the contractor will participate in all scheduled teleconferences
with the Statewide Parent Coalition and Community Advocacy Coalition.
b. Deliverable: Through June 30, 2027, the contractor will increase the number of contacts on the list by
15.
c. Deliverable: Through June 30, 2O27, lhe contractor will disseminate legislative and advocacy
information via the Facebook page and the email list at least quarterly.
6. Provide quarterly reports to the County.
a. Quarterly reports to the County shall be due by the following dates:
i. October 15,2026 (for July 1 - September 3O,2026)
ii. January 15,2027 (for October 1 - December 31,2O26)
iii. April 15, 2027 (for January 1 - March 3L,2027)
iv. July 15, 2027 (for April 1 - June 3O,20271
b. Quarterly reports shall include, at a minimum:
i. A narrative of the progress on the deliverables outlined above.
ii. Number of parent support meetings held and location
iii. Number of participants attending parent support meetings'
iv. Number of contacts made for information and referrals via phone, email, Facebook and in
person.
v. Copy of the quarterly newsletter published and/or emailed.
vi. List of community partners receiving quarterly newsletter'
vii, Number of outreach/community education events held.
viii. Number of participants at outreach events.
ix. Number of teleconferences attended.
x. The number of new emails added to Parent Coalition list serve.
xi. Number of emails sent out through list serve (include copies of emails
7. Any service provider offering transportation must ensure that drivers hold valid driver's licenses and have a
background screening completed to include a driving abstract in order to safely perform the services.
Kittitas County Agreement for Services (rev.5/14125l'
3
AfiACHMENT'8,,
COMPENSATION
THE COUNW WILL NOT PROCESS PAYMENT FOR SERVICES RENDERED UNDER THIS AGREEMENT UNTIL
CoNTRACTOR SUBMITS A COMPLETED W-9 (SEE ATTACHMENT "G"1.
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: 5 26,500.
Allowable direct expenses include, but are not limited to, salaries, wages, benefits, direct client services,
promotion, outreach activities, supplies, professional development and training, travel, equipment, and
subcontracts. All expenses must be necessary and directly related to the scope of work as outlined in Attachment
A. Contractor will refer to their approved budget document submitted through the funding request process for
line-item expenses. Any changes or updates to the budget must be approved by Kittitas County through the
appointed contract manager in advance of the expenditure, in writing.
Unless othenrvise provided herein, 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
expenditu re, in writing.
All funds must be spent by June 30, 2027. No extension of the funding period will be granted.
Reim bu rsement Procedures
A. The Contractor shall submit invoices for services due once a month, which shall be emailed to Katie
Odiaga, Kittitas County Public Health Department, at katie.odiaga@co.kittitas.wa.us.
B. Att invoices must be submitted by the 2Oth day of the month fottowing the catendar month in which
services were delivered.
C. The Contactor must provide adequate backup documentation to support costs in each invoice. This
includes a general ledger from the financial accounting system detailing transactions and expenditure
dates for allowable activities within the period of performance. Payroll expenses must show employee
names, hourly rate, number of hours, total pay, and project code. Benefits can be one line item but
should include project code. Non-payroll expenses must include a copy of the receipt or payment
invoice. Payments to subcontractors must be listed as a specific line item per subcontractor'
D. All invoices must include invoice date and an invoice number.
E. All invoices must also be accompanied by an updated Contractor Spending Form, as provided by Kittitas
County, to ensure that billing record keeping matches County records'
F. Failure to submit required monthly deliverable reports as outlined in Exhibit A: Scope of Work may
result in delayed reimbursement payments or denial of invoices.
G. Kittitas County is not liable for services provided unless the invoice is received on time or prior
arrangements are agreed to in writing signed by the County.
ln no event shall payments under this agreement total more than 525,500'
Kittitas County Agreement for Services (rev.5174/251
4
Amount Activiw
ss000 Salary and related expenses for the Parent Coalition program coordinator
S21,5oo Salary and related expenses for the Parent to Parent program coordinator
s26,500.q)TOTAL
Kittitas County Agreement for Services (rev. 5lL4/251
5
ATTACHMENT,,C"
INSURANCE REQUIREMENTS
Contractor shall secure and maintain in effect at all times during performance of work under this
Agreement such insurance as will protect Contractor, its employees, and agents from all claims, losses, harm,
costs, liabilities, damages and expenses arising out of Contractor's performance under this Agreement, including
but not limited to personal injury (including death) or property damage.
All insurance shall be issued by companies admitted to do business in the State of Washington and have
a rating of A-, Class Vll or better in the most recently published edition of Best's Reports unless otherwise approved
by the County. lf an insurer is not admitted, all insurance policies and procedures for issuing the insurance policies
must comply with Chapter 48.15 RCW and 284-15 WAC.
At a minimum, Contractor shall maintain and provide proof of the following selected options:
Commercial General Liabilitv lnsurance
. Coverage limits are not less than:
. SL,000,000 per occurrence, for all covered losses
r $2,000,000 general aggregate
r $1,000,000 products & completed operations aggregate
o $1,000,000 personaland advertising injury, each offense
r The policy must be endorsed to include the County and its officials, employees and agents
as additional insureds.
Commercial Automobile Liabilitv lnsurance
! Automobile Liability for owned, non-owned, hired, and leased vehicles, with an MCS 90
endorsement and a CA 9948 endorsement attached if 'pollutants' are to be transported.
. Coverage limits are not less than:
e $1,000,000 combined single limit
Excess or Umbrella Liabilitv
. The Contractor shall provide Excess or Umbrella Liability coverage of 55,000,000. This
Excess or Umbrella Liability coverage shall apply, at a minimum, to both the Commercial
General and Automobile lnsurance policy coverages. lf used to meet limit requirements,
coverage must be at least as broad as specified for undedying coverages and must cover
those insured in the underlying policies.
. This requirement may alternatively be satisfied through Contractor's primary Commercial
General and Automobile Liability coverage, or any combination thereof.
. The policy must be endorsed to include the County and its officials, employees and agents
as additional insureds.
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 & Emplover's Liabilitv
. The Contractor shall provide Workers Compensation and Employe/s Liability insurance
on a state-approved policy form providing benefits as required by law with employe/s
liability limits no less than S1,000,000 per accident or disease.
Kittitas County Agreement for Services (rev. 5/I l25l
t
Professional Liabilitv / Errors and Omissions Liabilitv
. Coverage limits not less than:
o $L,000,000 each claim
r Contractor must provide evidence of this coverage on a policy form appropriate to
Contractor's profession.
Contractor shallfurnish to the County a Certificate of lnsurance, with endorsement where required above,
as evidence that policies providing insurance required by this Agreement are in fullforce and effect. Contractor's
insurance policies required above must apply on a primary non-contributing basis in relation to any other
insurance or self-insurance available to the County.
Contractor agrees to provide notice to the County at least thirty (30) days prior to cancellation, or any
material alteration or non-renewal, of any of the above-required insurance coverages.
Contractor shall assume full responsibility for all loss or damage from any cause whatsoever to any tools,
machinery, equipment, or motor vehicles owned or utilized by Contractor, or Contractor's agents, employees,
suppliers or contractors, as well as to any temporary structures, scaffolding and/or protective fences.
Contractor shall have sole responsibility for ensuring the insurance coverage and limits required herein
are also obtained by any subcontractors.
NOTE: Notwithstanding any other provision(s) of this Agreement, no contract shall form under this Agreement
until and unless the following are provided to the County: (1) a copy of the Certificate(s) of 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'
7
Kittitas County Agreement for Services (rev.5174/251
ATTACHMENT,.D"
GENERAL TERMS AND CONDITIONS
t. Scope of Contracto/s Services: Contractor agrees to provide to the County services as set forth in
Attachment "A". No materials, labor, or facilities will be furnished by the County, unless otherwise provided
herein. All work performed under this Agreement shall comply with applicable laws and regulations
2. Accounting and Payment: Com pensation to Contractor for services rendered under this Agreement
shall be as set forth in Attachment "8". Where Attachment "8" requires payment(s) by the County, payment shall
be based upon billings, supported unless provided otherwise in Attachment "8", by documentation of units of
work actually performed and amounts earned, including, where appropriate, the total number of hours for the
month and the total dollar payment requested. Unless specifically stated in Attachment "8", the County will not
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
in Attachment "8". ln the event Contractor fails to perform any of its obligations under this Agreement within the
time specified herein, then the County may withhold all monies due and payable to Contractor until such failure
to perform is cured or otherwise adjudicated. The County will not process payment for services ren(ered under
this Agreement until Contractor submits a completed W-9 (See Attachment "G").
3. Taxes: Contractor understands and acknowledges that the County will not withhold Federal or State
income taxes from payments made to Contractor. Where required by State or Federal law, Contractor authorizes
the County to make withholding for any taxes other than income taxes (e.g., Medicare). All compensation received
by Contractor will be reported to the lnternal Revenue Service at the end of the calendar year in accordance with
applicable IRS regulations. lt is the responsibility of Contractor to make its necessary estimated tax payments
throughout the year, if any, and Contractor is solely liable for any tax obligation arising from Contractor's
performance of this Agreement.
The Cou'nty 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. lndependent Contractor: Contractor's services shall be furnished by Contractor as an independent
contractor, and nothing stated herein shall be construed to create a relationship of employer-employee or a
guarantee of future employment. Contractor acknowledges that its entire compensation under this Agreement
is specified in Attachment "8", and that Contractor is not entitled to any County benefits, including but not limited
to: vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance benefits, or any other rights or
privileges afforded to Kittitas County employees.
5. Assignment and Subcontracting: No portion of this Agreement may be assigned or subcontracted to
any other individual, firm or entity without the express and prior written approval of the County. The Contractor
may only subcontract work contemplated under this agreement if it obtains the prior written approval of the
County. lf the County approves subcontracting, the Contractor shall maintain written procedures related to
subcontracting, as well as copies of all subcontracts and records related to subcontracts. For cause, the County in
writing may require the Contractor to amend its subcontracting procedures as they relate to this agreement,
prohibit the Contractor from subcontracting with a 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 lrev.5/14/25)
I
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 bcontracto/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.
7.2 The County may unilaterally amend this Agreement at any time by written notice ("Change
Notice") to Contractor, to modify the work to be performed under this Agreement, within the general scope of
the Agreement. Such changes may include, but are not limited to, changes in the exact scope of work to be
performed (including modification, substitution, addition, or deletion of required tasks) and changes to the
schedule of performance. lf any such Change Notice causes an increase or decrease to Contractot's cost of, or the
time required for, performance of the work, an equitable adjustment in the compensation to Contractor and/or
in the schedule for the performance of the work shall be made by the County to reflect such an increase or
decrease. Notwithstanding any dispute or delay in arriving at a mutually acceptable equitable adjustment,
Contractor shall proceed in accordance with all Change Notices. Within thirty (30) days after receipt of any Change
Notice which, in Contractor's opinion, lacks adequate adjustment, Contractor must submit to the County a written
statement requesting a modified adjustment; otherwise, Contractor will forfeit its right to any such modified
adjustment. The County retains the final right to determine adjustments hereunder.
8. Termination
8.1 This Agreement may be terminated at any time by mutual written agreement of the parties.
8.2 The County, by giving written notice, may terminate this Agreement at any time without cause
and without further obligation to Contractor except for payment due for deliverables provided and/or services
performed prior to the effective date of termination. An equitable adjustment in the contracted price for partially
completed tasks will be made by the County, but such an adjustment shall not include compensation for loss of
anticipated profit on uncompleted work,
8.3 lf Contractor defaults by failing to perform any of its obligations under this Agreement, or
becomes insolvent, is declared bankrupt or commits any act of bankruptcy or insolvency, or makes an assignment
for the benefit of creditors, the County may, by written notice to Contractor, terminate the Agreement, and at
the County's option, obtain performance of the work elsewhere. lf the Agreement is terminated under this
paragraph, Contractor shall not be entitled to receive any further payments under this Agreement until all its
obligations hereunder have been fully performed, and any extra cost or damage to the County shall be deducted
Kittitas Cou nty Agreement for Services (rev . 5h4/25l'
9
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 (2) are directly or indirectly arising out of, resulting
from, or otherwise connected with the performance of this Agreement; or (3) are based upon Contractor's or its
subcontractors' use of, presence upon or proximity to the property of the County. This indemnification obligation
of Contractor shall not apply in the limited circumstance where the claim, damage, loss or expense is caused by
the sole negligence of the County. This indemnification obligation of Contractor shall not be limited in any way by
the Washington State 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 Contractot/s compensation, and have
been mutually negotiated by the parties.
9.2 The County reserves the right, but not the obligation, to participate in the defense of any claim
for damages, losses or expenses, and such participation shall not constitute a waiver of Contractor's indemnity
obligations contained in any section of this Agreement.
9.3 ln the event Contractor enters into subcontracts to the extent allowed under this Agreement,
each such subcontractor shall indemnify the County on a basis equal to or exceeding Contractor's indemnity
obligations to the County.
10. Venue a Choice of Law:ln the event that any litigation should arise concerning this Agreement,
the venue for such action shall be in the Superior Court of the State of Washington in and for the County of Kittitas.
This Agreement shall be governed by the laws of the State of Washington.
11. Non-Appropriationof Funds: lf theCountydoes notappropriatesufficientfundingforthisAgreement
for any future fiscal period, the County will not be obligated to make payments for services performed after the
end of the last fiscal period for which sufficient funding was appropriated. No penalty or expense shall accrue to
the County in the event this provision applies.
Kittitas County Agreement for Services (rev.5/74/25)
10
12. Contractor Commitments, Warranties, and Represehtations: Contractor represents and warrants as
follows:
tZ.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.
12.2 Contractor has the authority to execute this Agreement, to make the representations and
warranties set forth herein, and to perform its obligations hereunder.
I2.3 This Agreement has been validly executed by an authorized representative of Contractor and
constitutes a valid and legally binding and enforceable obligation of Contractor.
LZ.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.S Contractor is not in violation of any applicable law, ordinance or regulation the consequence of
which will or may materially affect Contractor's ability to perform its obligations under this Agreement. Contractor
is not subject to any order or judgment of any court, tribunal or governmental agency which materially and
adversely affects its operations or assets in the State of Washington, or its ability to perform its obligations under
this Agreement.
t2.6 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'
L27 None of the representations or warranties in this Agreement, and none of the documents,
statements, certificates or schedules furnished by Contractor in connection with the performance of the
obligations contemplated under this Agreement, contains or will contain any untrue statement of a material fact
or omits or will omit a material fact necessary to make the statements of fact contained therein not misleading.
13. Ownership ql llg!rylpCglgC: All writings, programs, data, reports, films, recordings, or other
materials prepared by Contractor and/or its consultants or subcontractors, in connection with the performance
of this Agreement, shall be the sole and absolute property of the County. The County will have all rights of
ownership therein, including but not limited to the right to use, copyright, trademark, and/or patent, and the
ability to transfer any or all ownership rights.
14. lntellectual Infrineement: 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: (L) Contractor shall be
notified promptly in writing by the County of any notice of such claim; and (2) Contractor shall have the right
hereunder, at its option and expense, to obtain for the County the right to continue using the information and/or
materials that are the subject of such claim, provided no reduction in performance or loss results to the County.
15. Use of County Name and Logo: Contractor may not use the County's name, logo(s), trademark(s), or
other identifying information, or identify the County as a current or former client, on its website or in any
marketing or promotional materials without the prior written consent of the County'
Kittitas County Agreement for Services (rev. 5/7a/251
11
1.6. 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 (a) the arbitrator's decision or award shall be final and binding on both parties.
L7. 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 Contractot/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 1of this Agreement.
19. Prevailins Wase: 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 cu
Kittitas County Agreement for Services (rev.5/14/25)
't2
rrently
practicingorworkingundersimilarcircumstances. Contractorshall,withoutadditionalcompensation,correctany
of its services not meeting such a standard.
21. Nondiscrimination
2L.t ln the performance of this Agreement, Contractor will not discriminate against any employee or
applicant for employment on the grounds of age, race, creed, color, national origin, citizenship or immigration
status, sex, sexual orientation, marital status, honorably discharged veteran or military status, orthe presence of
any sensory, mental or physical disability or the use of a trained dog guide or service animal by a person with a
disability; provided that the prohibition against discrimination because of such disability shall not apply if the
particular disability prevents the proper performance of the particular worker involved. Contractor shall ensure
that applicants are employed, and that employees are treated during employment, without discrimination
because of their age, race, creed, color, national origin, citizenship or immigration status, sex, sexual orientation,
marital status, honorably discharged veteran or military status, orthe presence of any sensory, mental or physical
disability or the use of a trained dog guide or service animal by a person with a disability. Such requirements
apply, without limitation, to the following: employment, promotion, demotion, transfer, recruitment or
recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and programs for
training, including apprenticeships. Contractor shall take such aition with respect to this Agreement as may be
required to ensure full compliance with local, state and federal laws prohibiting discrimination in employment'
ZI.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, orthe 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: Theprovisionsof paragraphs 2,3,4,6,8,9,LO, 13,t4,t5, 16,t7,L9,20,22,24,and28of
these General Terms and Conditions shall survive the completion, expiration, termination or cancellation of this
Agreement for any reason.
25. Comp lete Aereement: This Agreement constitutes the entire agreement between the parties and
supersedes any and all otheragreements, 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.5/14/25)
13
26. Severabiliw: lf any term or condition of this Agreement or the application thereof to any person(s)
or circumstances is held invalid, such invalidity shall not affect other terms, conditions or applications which can
be given effect without the invalid term, condition or application. To this end, the terms and conditions of this
Agreement are declared to be severable.
27. Time: Time is of the essence in the performance of this Agreement unless otherwise agreed between
the parties in a signed writing.
28. Construction: This Agreement has been mutually reviewed and negotiated by the parties and should
not be construed against the drafter.
29. Agreement Not for Benefit of Third Parties: This Agreement is entered into solely for the benefit of
the parties hereto and vests no rights in, nor is it enforceable by, any third parties.
Kittitas County Agreement for Services (rev. 5ha/25ll
14
Attachment E
sHs
WASHINGTON sTAIE
D€paftment ol So.ial
and Health Seryl.et
COUNTY
PROGRAM AGREEMENT
DDCS County Services
DSHS Agreement Number
2663-71228
This Program Agreement is by and between the State of Washington Department
Socialand Health Services (DSHS) and the County identified below, and is issued
of
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 CONTRACT CODE
1769CS-63
DSHS CONTACT NAME AND TITLE
Seanna Woodard
Operations Manager
DSHS CONTACT ADDRESS
1611 W lndiana Ave
Spokane, WA 99205
DSHS CONTACT TELEPHONE
(509)329-2952
DSHS CONTACT FAX
(509)568-3037
DSHS CONTACT E-MAIL
woodas@dshs.wa.qov
COUNry NAME
Kittitas County
Kittitas County DDA County Services
COUNTY ADDRESS
507 North Nanum Street Suite 102
Ellensburq. WA 98926-2886
COUNTY FEDERAL EMPLOYER IDENTIFICATION
NUMBER
COUNry CONTACT NAME
Kasey Knutson
COUNTY CONTACT COUNTY CONTACT FAX COUNTY
5 962 kittitas.wa.us
IS THE COUNTY A
AGREEMENT?
ENT PURPOSES OF THIS ASSISTANCE
No
PROGRAM AGREEMENT START DATE
07t01t2026
PROGRAM AGREEMENT END DATE
06t3012027
MAXIMUM PROGRAM AGREEMENT AMOUNT
$1.021.440.00
EXHIBITS. The following Exhibits are attached: Exhibit A - Data Security Requirements; Exhibit B - Budget and
s Plan
By their signatures below, the parties agree to the terms and conditions of this nty Program Agreement and all
documents incorporated by reference.No other understandings or representations,oral or otherwise,regard ing the
subject matter of this Program Agreement shall be deemed to exist or bind the parties The parties srgnrng below certify
that are to n this
SIGNATURE(S)PRINTED NAME(S) AND DATE(S)
DSHS SIGNATURE PRINTED NAME AND TITLE
DSHS Central Contract Services
't 769CS Cou nty Ag reement (1 2-26-2025)
15
1
Special Terms and Conditions
Definitions Specific to Program Agreement: The words and phrases listed below, as used in this
Program Agreement, shall each have the following definitions:
a. "Acuity Level" means the level of a Client's abilities and needs as determined through the DDCS
assessment.
b. "ALTSA Web Access (AWA)' means a web-based portalto the Developmental Disabilities
Community Services CARE system designed to support county services for DDCS clients.
c. "Additional Consumer Services" refers to indirect Client service types as follows:
(1) "Community lnformation and Education": Activities to inform and/or educate the general public
about developmental disabilities and related services. These may include information and
referral services; activities aimed at promoting public awareness and involvement; and
community consultation, capacity building and organization activities.
(2) "Training": To increase the job related skills and knowledge of staff, providers, volunteers, or
interning students in the provision of services to people with developmental disabilities. Also to
enhance program related skills of board or advisory board members.
(3) "Other Activities" reserved for special projects and demonstrations categorized into the following
types:
(a) lnfrastructure projects: Projects in support of Clients (services not easily tracked back to a
specific working age Client) or that directly benefit a Client(s) but the Client is not of working
age. Examples include planning services like generic job development e.g. "Project
Search".
(b) Start-up projects: Projects that support an agency or directly benefit the agency. Examples
include equipment purchases and agency administrative support'
(c) Partnership Project: Collaborative partnerships with schooldistricts, employment providers,
DVR, families, employers and other community collaborators needed to provide the
employment supports and services young adults with developmental disabilities require to
become employed during the school year they turn twenty-one (21)'
d. "Budget and Accounting Reporting System (BARS)' means a master classification of balance
sheet, reven ue and expend itu re/expense accou nts.
e. "Client" means a person with a developmentaldisability as defined in chapter 388-823 WAC who is
currently eligible and active with the Developmental Disabilities Community Services or is an
identified PASRR Client.
"Competitive Integrated 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.
"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
f
g.
DSHS Central Contract Services
1 769CS Cou nty Ag reement (12-26-2025)
'16
Special Terms and Conditions
and prbvide opportunities typically experienced by the general public of similar age in their local
community, accessible by public transit or a reasonable commute from their home. The goal of
the service is to support clients to participate, contribute, and develop relationships with
community members who are not paid staff. These services may be authorized for individuals
age 62 and older. These services may be authorized in addition to or instead of employment
support (lndividual Employment or Group Supported Employment) for working age individuals
who have received nine months of employment support.
(2) "Child Development Services" or "CDS": Birth to three services are designed to meet the
developmental needs of each eligible child and the needs of the family related to enhancing the
child's development. Service may include assistive technology, audiology, family training/home
visits, health services, medical services, nursing services, nutrition services, occupational
therapy, physicaltherapy, psychological services, sign language, social work, special
instruction, speech-language pathology, vision, and transportation. Services are provided in
natural environments to the maximum extent appropriate.
(3) "lndividual Supported Employment" or "lE": services are a part of a Client's pathway to
employment and are tailored to individual needs, interests, and abilities, and promote career
development. These are individualized services necessary to help persons with developmental
disabilities obtain and continue integrated employment at or above the state's minimum wage in
the generalworKorce. These services may include intake, discovery, assessment, job
preparation, job marketing, job supports, record keeping and support to maintain a job.
(4) "lndividualized Technical Assistance" or "lTA": services are a part of a Client's pathway to
individual employment or community inclusion. This service provides assessment and
consultation to the provider to identify and address existing barriers to employment or
community inclusion. This is in addition to supports received through supported employment or
community inclusion services for Clients who have not yet achieved their goal.
(5) "Group Supported Employment" or "GSE": services are a part of a Client's pathway to integrated
jobs in typical community employment. These services are intended to be short term and offer
ongoing supervised employment for groups of no more than eight (8) workers with disabilities in
the same setting. The service outcome is sustained paid employment leading to further career
development in integrated employment at or above minimum wage. Examples include
enclaves, mobile crews, and other business models employing small groups of workers with
disabilities in integrated employment in community settings.
h. "County" is the political subdivision of the state of Washington and the county or counties entering
into this Program Agreement.
i. "DDCS Case Resource Manager (CRM)" means a case manager for DDCS Clients.
j. "County Service Authorization (CSA)" means an authorization for county services.
k. "Developmentaldisabilities (DD)" means a disability attributable to intellectual disability, cerebral
palsy, epilepsy, autism, or another neurological or other condition of an individual found by the
secretary to be closely related to an intellectual disability or to require treatment similar to that
required for individuals with intellectual disabilities, which disability originates before the individual
attains age eighteen, which has continued or can be expected to continue indefinitely, and which
constitutes a substantial limitation to the individual.
l. "Developmental Disabilities Community Services "DDCS' means a division within the Department of
DSHS Central Contract Services
1 769CS Cou nty Ag reement (12-26-2025)
17
2.
Special Terms and Conditions
Social and Health Services
m. "DDCS Regional office (DDCS Region)" means the regional DDCS office that supports DDCS
clients.
n. "Division of Vocational Rehabilitation (DVR)" means a division within the Department of Social and
Health Services
o. "Employment Outcome Payment" means a payment to providers for transition students born
between specific dates; have high acuity; are authorized for lndividual employment; and student
obtains a competitive integrated job within a specific timeframes. lf the job is a minimum of ten
hours of work per week an additional amount will be include in the payment.
p. "General Terms and Conditions" means the contractual provisions contained within that agreement,
which govern the contractual relationship between DSHS and the county.
q. "High Acuity Client" means a DDCS Client who requires significant and intensive support in the
community, often due to complex needs, as determined through the DDCS assessment.
r. "Medicaid Home and Community Based Services (HCBS)' means services that occur in a Client's
home or community rather than institutions or other isolated settings. These programs serve a
variety of targeted populations groups, such as people with intellectual or developmental
disabilities, physical disabilities, and/or mental illnesses
s. "Job Foundation Report" is a document derived from emplovment readiness activities performed by
students who are between ages 19 through 20 that identifies actionable next step for employment.
The employment service providers developing the Job Foundation report will be supporting
students with employment activities on average of 35 hours.
t. "Preadmission Screening and Resident Review (PASRR)' means individuals with intellectual
disabilities or related conditions (lD/RC) who have been referred for nursing facility (NF) care.
u. "Person Centered Service Plan or PCSP" means a document that authorizes and identifies the
DDCS paid services to meet a Client's assessed needs. Formerly referred to as the lndividual
Support Plan.
v. "Quality Assurance" means an adherence to all Program Agreement requirements, including DDCS
Policy 6.13, Provider Quatifications for Employment and Day Program Seruices, 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.
Purpose: This Program Agreement is entered into between the Developmental Disabilities Community
Services and the County in accordance with chapter 71A.14 RCW. lts purpose is to advance the state
legislative policy to provide a coordinated and comprehensive state and local program of services for
persons with developmental disabilities.
DSHS Central Contract Services
1 769CS Cou nty Ag reement (1 2-26-2025)
18
3
4
Special Terms and Conditions
Client Eligibility: Client eligibility and service referral are the responsibility of DDCS under chapter
388-823 WnC letigiOility) 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.
Credentials and Minimum Requirements:
a. Administration of the developmentaldisabilities County program cannot be subcontracted.
b. Qualified DD Program Coordinator: A qualified DD program coordinator has a minimum of five
years training and experience in the administration and/or the delivery of developmental disabilities
services to a community. For a county where the coordinator administers more than one program
area (e.g. Chemical Dependency, Mental Health, Developmental Disabilities), training and
experience in administration and/or a related Human or Social service may be considered.
c.Administration Responsibility: The County must demonstrate the ability to administer the program
agreement including contract oversight and monitoring, community outreach and education
activities, and regular communication with the DDCS Regional Office (DDCS region) and contracted
providers.
Fiscal Responsibility: The County must demonstrate the ability to safeguard public funds including
maintaining books, records, documents and other materials relevant to the provision of goods and
services.
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.
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 OisquatineO individual provider. The DSHS Background Check Central Unit (BCCU)
must be utilized to obtain background clearance.
Qualified Advisory Board Members: A Developmental Disabilities advisory board shall include
members knowledgeable about developmental disabilities. No board member shall have a contract
with the County to provide Training, Community lnformation Activities, and Consumer Support as
defined in this Program Agreement, and shall not be a board member, officer, or employee of an
agency subcontracting with the County to provide such services.
Qualified Service Providers: The County assures that all service providers meet qualifications as
outlined in the DDCS Policy 6.13, Program Qualifications for Employment and Day Program
Providers.
Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County
assures that each subcontractor has agreed to assign to DDCS its Medicaid billing rights for
d
e.
'f
g.
h
DSHS Central Contract Services
1 769CS County Ag reement (12-26-2025)
19
5
Special Terms and Conditions
services to DDCS Clients eligible under Title XIX programs in this Program Agreement. Written
documentation shall be available to DSHS on request.
j. Reporting Abuse and Neglect: The County staff and its subcontractors who are mandated reporters
under RCW 74.34.020(13) must comply with reporting requirements described in RCW 74.34.035,
.040 and chapter 26.44 RCW. lf the County is notified by DSHS that a subcontractor staff member
is cited or on the registry for a substantiated finding, then that associated staff will be prohibited
from providing services under this Program Agreement.
k. Counties who provide Child Development Services (birth to three early intervention services), must
provide those services under the regulations implementing the lndividuals with Disabilities
Education Act (IDEA), Part C, and Washington State's Early Support for lnfant and Toddler
Federally Approved Plan.
l. The County staff who perform evaluations of subcontractor work sites will promptly report to DSHS
per DDCS Policy 6-08, tncident Management and Reporting Requirements for County and County-
Contracted P roviders, if:
(1) They have reasonable cause to believe that abandonment, abuse, financial exploitation or
neglect (as defined in RCW 74.34.020) of a person who has a developmental disability (as
defined in RCW 71A.10.020) has occurred, and,
(2) lf they have reason to suspect that sexual or physical assault of such a person has occurred,
they shall also immediately report to the appropriate law enforcement agency.
m. Counties are specifically authorized to have data storage on portable devices or media in
accordance with the Data Security Requirements.
n. Order of Precedence: ln the event of any inconsistency in this Program Agreement and any
attached exhibits, unless otherwise provided herein, the inconsistency shall be resolved by giving
precedence, in the following order, to:
(1) County Program Agreement; and
(2) Attached Exhibits.
Duty to Disclose: Under 42 CFR 5455.104, the Administration must obtain certain disclosures and
complete required screenings to ensure the State does not pay federalfunds to excluded person or
entities. The County is required to provide disclosures from managing employees, specifically the
persons in the positions of Developmental Disabilities Director and Fiscal/Budget Director, i.e. the
person who authorizes expenditures. A completed Medicaid Provider Disclosure Statement, DSHS
Form 27-094, should be submitted to the Administration to complete the required screenings.
Disclosures must be provided at contract renewal and within thifi-five (35) days whenever there is a
change in the staff holding these management positions [42 CFR 455.104 (cXl)1.
Statement of Work: The County shall provide the services and staff, and otherwise do all things
necessary for or incidental to the performance of work, as set forth below. Working collaboratively and
sharing information as needed for service coordination, the parties shall administer DD services within
the county as set forth below:
a. The DDCS region shall:
(1) Review subcontractors and shall immediately notify the County of any concerns with the
6
DSHS Central Contract Services
1 769CS Cou nty Ag reement (1 2-26-2025)
20
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;
(g) Work with DDCS Head Quarters and the County on Spending Plan adjustments; and
(10) Work with the County in participating in evaluation of direct service providers.
b. The County shall:
(1) Work with the DDCS Region when Clients are referred for services, authorized services, and/or
for support modifications;
(2) Work with the DDCS Region to document planned services in the Client's Person Centered
Service Plan;
(3) Assist with informing the DDCS Region of any potential service level changes not documented
in the Client's DD Assessment prior to any changes;
(4) Work with the DDCS Region regarding service termination;
(5) Work with the DDCS Head Quarters on Spending Plan adjustments;
(6) lnform the DDCS Region of new providers to be included on the ALTSA Web Access (AWA)
system;
(7) Notify the DDCS Region of any intent to terminate a subcontractor who is serving a DDCS
referral;
(8) Provide a copy of each subcontractor's contract upon written request from DDCS; and
(9) Notify and work with the DDCS Regional Employment Specialist when performing evaluations of
direct service providers.
c. Compliance with Budget and Accounting Reporting System Policies: The County shall take any
necessary and reasonable steps to comply with BARS Policies.
DSHS Central Contract Services
1 769CS Cou nty Ag reement (12-26-2025\
21
e
f
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, 21 10;
(3) Criteria for Evaluation;
(4) DDA Guidinq Values:
(5) Countv Guide to Achieve DDA's Guidinq Values;
16; DDA Guidelines for Communitv Assessments within Emplovment and Vocational Proqrams. and
(7) Disabilitv Riohts Washinoton (formerlv Washinqton Protection and Advocacv Svstem) Access
Agreement.
The County shall develop and submit a comprehensive plan for the County DD Services as
required by WAC 388-850-020.
Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The
County shall submit the Service lnformation Forms (SlF's) (provided by DDCS at lnternet site
https://www.dshs.wa.qov/dda/countv-best-practices) to indicate the estimated number of people to
be served, targeted outcomes, and identified goal(s) that focus on quality improvement within the
categories of Training, Community lnformation, Direct Client Services, and Other Activities within 30
daysof execution of the Program Agreement. Once approved, the SIF outcomes may be modified
only by mutual agreement of the County and the DDCS Region.
Solicitation for Qualified Employment and Day Program Service Providers: Requests for
Applications (RFAs), Requests for lnformation (RFl's) and/or Requests for Proposals (RFPs),
Requests for Qualifications (RFQ's) for direct services, excluding Child Development, will be open
continuous enrollment.
h. Qualified Providers: A qualified provider must be a county or an individual or agency contracted
with a county or DDCS.
i. TechnicalAssistance: DDCS contracts with TechnicalAssistance providers that may be utilized by
Counties with prior written approval.
j. Subcontractors: The County will pass on all applicable contractual requirements that are between
DDCS and the County to the subcontractor. The County shall immediately notify the DDCS Region
of the County's intent to terminate a subcontractor who is serving a DDCS referral. lndividuals or
agencies contracted with a county or DDCS may not subcontract for Employment or Community
lnclusion services.
k. The County shall provide or contract with qualified Employment and Day Program Service
Providers for consumer support services that include the following program outcomes:
(1) Monthly Community lnclusion (Cl) service support hours will be based on the Client's Cl service
level per WAC 388-828-9310 for all Clients who began receiving Cl services July 1 ,2011 and
forward.
g
DSHS Central Contract Services
1 769CS County Ag reement (1 2-26-2025)
22
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
snoutd be supported to average twenty (20) hours of community work per week or eighty-six
(86) hours per month; however, each person's preferred hours of employment should be taken
into consideration. The amount of service a Client receives will be based on his/her
demonstrated need, acuity level and work history per WAC 388-828.
(3) The Client's DDCS PCSP is the driver for service. The AWA County Service Authorization
(CSA) and updated Planned Rates information will not exceed the Client's DDCS PCSP.
Service changes will not occur untilthe Client has received proper notification from DDCS.
(4) All Clients will have an lndividualized Employment and/or Community lnclusion plan to identify
Client's preferences. Minimum plan elements are outlined in the reference document "Criteria
for an Evaluation." A copy of the Client's individualized plan will be provided to the Client, their
DDCS Case Resource Manager (CRM), guardian and others as appropriate.
(5) Six-month progress reports describing the progress made towards achieving Client's goalwill
be provided by the service provider to the CRM, Client, and/or guardian, if any, within 30 days
following the six-month period. The report will summarize activities and outcomes made towards
the Client's individualized goal(s).All Clients will be contacted by their service provider according
to Client need and at least once per month.
(6) All Clients will be contacted by their service provider according to Client need and at least once
per month.
(7) lf Clients in lndividual Employment or Group Supported Employment, have not obtained paid
employment at minimum wage or higher within six (6) months, the County will assure the
following steps are taken:
(a) Review the progress toward employment goals;
(b) Provide evidence of consultation with the ClienVguardian; and
(c) Develop additional strategies with the ClienUguardian, county staff, employment support
staff, case manager, and others identified by the Client. Strategies may include providing
technical assistance, changing to a new provider, and/or providing additional resources as
needed to support the Client's pursuit of employment. The additional strategies will be
documented for each Client and kept in the Client's file(s).
(8) lf after twelve (12) months the Client remains unemployed, an additional review will be
conducted. The provider will address steps outlined in the previous six month progress report in
the next six month progress report. When requesting to participate in Cl, the Client shall
communicate directly with his or her DDCS Case Manager. The DDCS Case Manager is
responsible for authorizing Cl services.
DSHS Central Contract Services
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Special Terms and Conditions
(9) For lndividual Employment where the service provider is also the Client's employer, long term
funding will remain available to the service provider employer for six months after the employee
DDCS Client's date of hire. At the end of the six-month period, if the DDCS Client continues to
need support on the job, another service provider who is not the employer of record must
provide the support unless the County or DDCS issues prior written approval for the service
provider to continue to provide long-term supports if needed. lf the County or DDCS approves
ihe continuation of long-term supports where the service provider is also the Client's employer,
the County or DDCS will regularly monitor these positions to assure fading efforts occur when
appropriate and any potential conflict of interest is addressed.
(10) lndividual Employment staff hours must be attributed to the "lndividual Emplovment and Billable
Activitv Phase(s)".
(11) For Group Supported Employment (GSE), Clients must have paid work. The total number of
direct service staff hours provided to the group should be equal to or greater than the group's
collective amount of individual support monthly base hours. lf the direct service staff hours are
less than the collective amount, then the provider will be reimbursed only for the number of hours
staff actually provided.
(a) The collective group's individual hours should be the minimum staff hours delivered to
support the grouP.
(b) A GSE Client must be on-site/at work at least their base individual hours as a minimum 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 duing 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) lndividualtime in the community working towards the individual employment goal, separate
from the group time, must include phase information (refer to Employment Phases and
Billable Activities - see Phases I - 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
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Special Terms and Conditions
individuals not receiving Medicaid HCBS;
(c) The setting provides opportunities to seek employment and work in competitive integrated
settings; and
(d) The setting facilitates individual choice regarding services and supports, and who provides
them.
Quality Assurance and Service Evaluation: The County shall develop and have available an
evaluation system to review services. The evaluation system must have both a Quality Assurance
and a Quality lmprovement component, and both must include objective measures. The objective
measures at a minimum will include performance indicators, by acuity, that include the number of
new jobs; job loss and reasons for job loss; the percentage employed earning minimum wage or
better; and the average number of hours worked. The County's service evaluation system shall
serve as the method by which current providers demonstrate that they continue to be qualified
providers. A copy of description of such evaluation system shall be provided upon request to DDCS
for review.
m. Evaluation: The County shall evaluate and review services delivered to reasonably assure
compliance and quality. The County shall conduct at least one visit to each subcontractor every two
(2) years excluding Child Development Services subcontractors. The County shall conduct at least
one visit to Child Development Services providers every three (3) years. The County shall maintain
written documentation of all evaluations, recommendations and corrective action plans for each
subcontractor. Copies of such documentation will be provided to the DDCS upon request.
n. The County shall work with local developmental disability advisory groups to plan for and coordinate
services.
o. The County shall participate in regularly scheduled meetings between County DD staff and DDCS
staff to remain updated and current including ACHS and Regional Meetings.
p. AWA Data System: ln compliance with the AWA Traininq Manual, the County shall use the AWA
data system for all:
(1) Billing requests;
(2) Service provider address and phone number maintenance;
(3) Evaluation dates;
(4) Employment outcome information; and
(5) Monthly provide all data described in the Billing lnstructions and in the Employment Outcomes
lnstructions, which is hereby incorporated by reference.
q. Assure the integrity of data submitted to the State. When data is submitted and rejected due to
errors or an error is later identified, the County will correct and resubmit the data within thirty (30)
days.
r. Review and respond the AWA "Work List" items within 5 working days including Referrals and
pending Authorization.
s. Review the AWA "Ticklers" Planned Rate tab and update the planned rate within 5 working days
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Special Terms and Conditions
after the Planned Rate start date.
t. PartnershipProject.
(1) A Job Foundation document will be completed per guidelines for eligible students. Eligible
students are DDCS clients who were born between:
(a) For fiscal year 2026 911105 through 8/31/06
(b) For fiscalyear 2027 911106 through 8131107
u
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://r,rnnrw.dshs.wa.qov/sites/defaulUfiles/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 Coun$ and cannot be in
provisional status; a minimum of two years' experience providing lndividual Employment with
demonstrated job placement skills. The Job Foundation recommendation will only have
actionable next steps towards integrated competitive employment.
(3) County participating in the Partnership Project must have the ability to work collaboratively with
School Districts to identifiT DDCS students in high school, collect and track information, be
proficient in electronic spreadsheets, and ability to evaluate if completed Job Foundation
document(s) meet quali$ standards.
Outcome Payment.
Providers, with transition students born between:
(a) For fiscal year 2026 911103 through 8131lO4
(b) For fiscal year 2027 911104 through 8131l9s
(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 Billino lnstructions. lf the County
is also the service provider DDCS will provide the job approval. lf the job is at a minimum of ten
hours of work per week an additional amount will be include in the payment.
(3) High acuity Clients who are authorized for lndividualemployment, provider may receive one
ouicome payment if client obtains a new competitive integrated job at a minimum of ten hours of
work per week for a minimum of 4 out of each 6 months during the fiscal year.
(4) Client who are authorized for Community lnclusion who have an acuity of F which equals 18
support hours per month or G which equals 20 support hours per month as based on the
Support lntensity Scale (SlS), provider may receive on outcome payment per month if provider
delivers a minimum of 80% of the authorized hours.
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Special Terms and Conditions
(5) A new Community lnclusion referral is defined as a Client who has a new County Service
Authorization (CSA). lncentive/outcome payments to accept and support overall increased
CSAs billed over the year may be requested from DDCS if funds are available.
(6) Community lnclusion case notes and 6-month progress report summary review that scores 16
points or more with the "Community lnclusion Case Note Review Tool" when used in
conjunction with a Community lnclusion plan that has scored 20+ points with the Community
lnclusion plan Quality review tool, provider may receive an outcome payment.
(7) All outcome payments are described in the chart in the Billinq lnstructions.
Consideration:
a. Fees:
(1) Approval of fees is the responsibility of the DDCS. The DDCS HQ Employment and Day Unit' .
tvlanager reserves the right to approve fees/rates for the services being provided. The County
will submit a fee/rate schedule with the initial Program Agreement. The County will submit
updated fee/rate schedules to the HQ Employment and Day Unit Manager for approval as
changes occur. The rate schedule will include the following information:
(a) County(s) name;
(b) Time period for which the schedule is applicable; and
(c) Each contracted direct service (lE, GSE, Cl, lTA, CDS) and its associated rate.
(2) Fee Limitations: The Billinq lnstructions found on the County Best Practices site provides
limitations on the Hourly Rate for each direct service. Hourly rates must be divisible by four.
b. Budget and Spending Plan, attached as Exhibit B:
(1) Budget amount listed in Exhibit B: The County may not exceed the state only revenue dollar
amount or the total revenue dollar amount indicated on the Program Budget Agreement
included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate
Clients moving from state-only employment and day services to waiver employment and day
services.
(2) Spending Plan: DDCS will provide the initial spending plan / Program Agreement Budget /'
Exhibit B-. Funding shall be distributed under State and Medicaid in the revenue section. The
planned expenditures for Consumer Support are based on authorized Clients, their acuity level
and work history for a given point in time. To determine the Additional Consumer Support
amount, the Consumer Support amount is multiplied by a percentage. The spending plan may
only be modified by mutual agreement of the parties in writing and shall not require a program
agreement amendment.
(a) Funds Designated for Additional Consumer Services: lf a County provides Community
lnformation and Education services under additional consumer services, then activities must
include outreach efforts to federally recognized local tribes.
(b) Funds Designated for Adult Day Care Consumers: Funds designated for Adult Day Care
Consumers are available to Clients who were served between December 1996 and
December 2003 in Adult Day Health agencies and were subsequently determined ineligible
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for Level ll or lll services (Adult Day Health). Level ll and lll services are licensed
rehabilitation and skilled nursing services along with socialization. Level I services (Adult
Day Care) are supervised day programs where frail and disabled adults can participate in
social, educational, and recreational programs without the need for skilled nursing. These
Clients may be referred to services defined in the statement of work, or to an Adult Day Care
service other than Level ll or lll. lf a Client no longer needs and wants services, the funds
are available for other Clients who are not part of the group of original Clients identified
between December 1996 and 2003. An Adult Day Care service shall only be provided by
Adult Day Care agencies certified by the localArea Agency on Aging. Adult Day Care
service is not a waiver approved service.
c. Program Agreement Amendments: A County can request an amendment at any time. An
amendment for additional Client(s) may be supported when clients exceed the number used to
develop the contract. An amendment for additional service hours authorized may be supported
when county provides evidence. An amendment request for expenditures exceeding contract total
due to hourly rates paid to service provider may not be supported as the county is responsible to
manage contract and rates paid to their providers.
d. Exemptions: The DDCS Assistant Secretary may approve in writing an exemption to a specific
program agreement requirement.
Billing and Payment:
a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by
DDCS as cost incurred by the program for:
(1) Administration: Costs of the County Human Services Department or similar county office,
responsible for administration of the Developmental Disabilities Program. Allowable costs
include personnel and overhead costs directly related to the administration and coordination of
the program, including such activities as program planning, budgeting, contracting, monitoring,
and evaluation. Also included are departmental and county indirect and/or direct administrative
costs, to the extent that such costs are appropriately allocated to the program using an
established methodology consistent with grants management guidelines. For a County whose
designated coordinator manages multiple programs, the County must be able to provide
evidence of the time the coordinator spent working on the Developmental Disabilities program.
(2) Additional Consumer Services:
(a) Training
Staff Training: Costs incurred by the program for planned, structured activities for the
purpose of providing, or improving, or enhancing job-related knowledge and skills of
staff, providers, volunteers, or interning students in the provision of developmental
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
28
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
replacewhatthe student(s) receive through the lndividualized Education Program (lEP).
(3) Consumer Support.
(a) Adult Day Care services are available to Clients who were served between December 1996
and December 2003 in Adult Day Health agencies and were subsequently determined
ineligible for Level ll or lll services (Adult Day Health). Level ll and lll services are licensed
rehabilitation and skilled nursing services along with socialization. Level I services (Adult
Day Care) are supervised day programs where frail and disabled adults can participate in
social, educational, and recreational programs without the need for skilled nursing.
(b) Community lnclusion Services are individualized and provided in integrated community
settings with other individuals without disabilities. The activities are based on Client
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 fami$ 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 individu alized services necessary to help persons with developmental disabilities
obtain and continue integrated employment at or above the state's minimum wage in the
generalworkforce. These services may include intake, discovery, assessment, job
preparation, job marketing, job supports, record keeping and support to maintain a job (per
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the lndividual Emplovment Phases & Billable Activities)
(e) lndividualized 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.
(D Group Supported Employment services are a part of a Client's pathway to integrated jobs in
typical community employment. These services are intended to be short term and offer
ongoing supervised employment for groups of no more than eight (8) workers with
disabilities in the same setting. The service outcome is sustained paid employment leading
to further career development in integrated employment at or above minimum wage.
Examples include enclaves, mobile crews, and other business models employing small
groups of workers with disabilities in integrated employment community settings.
b. Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this
Program Agreement. However, with a Program Agreement amendment, the parties may increase
or decrease the Program Agreement amount. Counties willwork with DDCS HQ on amendments to
the Program Agreement.
c. Monthly lnvoice with Signed Documentation: All requests for reimbursement amounts must be
entered and posted into the AWA system. The County may post a combined claim of all
programs/services covered by this Program Agreement. DSHS shall make all payments due to the
County for all invoices submitted pursuant to this section within forty five (45) days following posting
of required information.
d. Clients will be assisted in accessing DVR services per the DDCS/DVR MOU. Client services shall
not be reimbursed under this Program Agreement when the same services are paid for under the
Rehabil1ation Act of 1973 by DVR, Public Law 94-142 or any other source of public or private
funding.
e. Reimbursement of Client Services: A claim for each Client is made on the AWA system by
indicating the number of service units delivered to each Client listed and the fee per unit. Units are
defined as:
(1) An "Hour'' is at least fifty (50) minutes of direct service. Partial hour to the quarter may be
recorded.
(2) A "Day" is at least four (4) hours of direct service and will only be used in connection with Adult
Day Care reimbursement.
(3) A "Month" represents a minimum of at least fifty (50) minutes of direct service for CDS
reimbursement.
f. Program Administration: The County will provide program administration and coordination including
such activities as planning, budgeting, contracting, monitoring, and evaluation. Monthly claims for
administration can be 1112 of the maximum amount identified in Exhibit B under Administration or
for the actual costs incurred in the given month but the total Administration billed will be the lesser
of the two. Administration cost reimbursement will not exceed 10% unless the Assistant Secretary
of DDCS approves a request for an exception under chapter 388-850 WAC.
g. The lndividual Employment Phases & Billable Activities document defines the individual Client
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Special Terms and Conditions
services that DDCS reimburses. That document is located on the DSHS DDCS County Best
Practices Web site at https://www.dshs.wa.qov/dda/countv-best-oractices.
h. The Community lnclusion Billable Activities document defines the individual Client services
DDCS reimburies. That document is located on the DSHS DDCS County Best Practices Web site
at https://www.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
sixtylOO; calendar days of the associated fiscal year unless an extension is approved by the DDCS
Regionai Administrator or designee. Payment will not be made on any invoice submitted past sixty
(60) calendar days after the Program Agreement fiscal year.
j. Recovery of Fees: lf the County bills and is paid fees for services that DSHS later finds were (a) not
delivereri 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 10o/o-
l. Reimbursement for Partnership project: A claim of $3,000 per student for each completed Job
Foundation document that is at a satisfactory or above rating will be requested through the AWA
system as other monthlY cost.
m. Job Foundation report line item 95 as identified in the ADSA Web Access (AWA) billing system. A
copy of the completed Job Foundation document will be sent electronically to the shared mailbox
located at: DDAJobFoundationReports@dshs.wa.qov
n. Job placement verification for transition students: The AWA Employment Output for lndividual
Employment will be completed and submitted with payment request to verify employer, job start
date, job type, etc.
o. Job Foundation Administration: The County may bill for administration costs as identified in Exhibit
B. Monthly claims for administration cost will be based on the actual expenditures multiplied by
10%. Participating counties will use line item 13.
lntermediate Care Facilities for lntellectual Disabilities (lCF/lD) Agreement. lf applicable per 42
CFR 483.410, the County shall assure that all county-operated or subcontracted programs serving
persons living in ICF/ID facilities develop a plan and coordinate their services with the facility on behalf
of the ICF/lD resident.
Single State Medicaid Agency-Health Care Authority (HCA): HCA, as the single state Medicaid
Age-ncy, has administrative authority for Title XIX coverage per 42 CFR 431.1O. DSHS is the operating
agency for the Home and Community Based Waivers for services for people with developmental
disabilities. The County only has responsibility for services covered in this agreement.
DSHS/DRW Access Agreement: The DRW Febru ary 27,2001 Access Agreement with DDCS is
incorporated by reference. The County assures that it and its subcontractors have reviewed the
Access Agreement. The agreement covers DRWs access to individuals with developmental
10.
11
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Special Terms and Conditions
disabilities, Clients, programs and records, outreach activities, authority to investigate allegations of
abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS
contracted services.
12. Confidential lnformation. All Counties and their subcontractors must:
a. Ensure the security of Confidential lnformation, and
b. When transporting client records containing Confidential lnformation outside a Secure Area, one or
more of the following as appropriate:
(1) Using a Trusted Network; or
(2) Encrypting the Confidential lnformation, including:
(a) Email and/or email attachments
(b) Confidential lnformation when it is stored on portable devices or media including but not
limited to laptop computers and flash memory devices'
19. 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.
14.
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Special Terms and Conditions
Exhibit A - Data Security Requirements
Definitions. The words and phrases listed below, as used in this Exhibit, shall each have the following
definitions:
a. "AES' means the Advanced Encryption Standard, a specification of Federal 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.pdfl.
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 data that is confidential and requires special handling due to statutes or
regulations that require especially strict protection of the data and from which especially serious
consequences may arise in the event of any compromise of such data. For purposes of this
contract, data classified as Category 4 refers to data protected by: the Health lnsurance Portability
and Accountability Act (HIPAA).
d. "Cloud" means data storage on servers hosted by an entity other than the Contractor and on a
network outside the control of the Contractor. Physical storage of data in the cloud typically spans
multiple servers and often multiple locations. Cloud storage can be divided between consumer
grade storage for personalfiles and enterprise grade for companies and governmental entities.
Examples of consumer grade storage would include iCloud, Dropbox, Box.com, and many other
entities. Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and
Rackspace.
e. "Encrypt" means to encode Confidential lnformation into a format that can only be read by those
possessing a "key"; a password, digital certificate or other mechanism available only to authorized
users. Encryption must use a key length of at least 128 bits (256 preferred) for symmetric keys, or
2048 bits for asymmetric keys. When a symmetric key is used, the Advanced Encryption Standard
(AES) must be used if available.
f. "Hardened Password" means a string of at least eight characters containing at least three of the
following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special
characters such as an asterisk, ampersand, or exclamation point.
"Mobile Device" means a computing device, typically smaller than a notebook, which runs a mobile
operating system, such as iOS, Android, or Windows Phone. Mobile Devices include smart phones,
most tablets, and other form factors.
"Multi-factor Authentication" means controlling access to computers and other lT resources by
requiring two or more pieces of evidence that the user is who they claim to be. These pieces of
evidence consist of something the user knows, such as a password or PIN; something the user has
such as a key card, smart card, or physicaltoken; and something the user is, a biometric identifier
such as a fingerprint, facial scan, or retinal scan. "PlN" means a personal identiflcation number, a
series of numbers which act as a password for a device. Since PlNs are typically only four to six
characters, PlNs are usually used in conjunction with another factor of authentication, such as a
fingerprint.
"Portable Device" means any computing device with a small form factor, designed to be transported
from place to place. Portable devices are primarily battery powered devices with base computing
resources in the form of a processor, memory, storage, and network access. Examples include, but
g
h
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Special Terms and Conditions
are not limited to, mobile phones, tablets, and laptops. Mobile Device is a subset of Portable
Device.
"Portable Media" means any machine readable media that may routinely be stored or moved
independently of computing devices. Examples include magnetic tapes, optical discs (CDs or
DVDs), flash memory (thumb drive) devices, external hard drives, and internal hard drives that have
been removed from a computing device.
"secure Area" means an area to which only authorized representatives of the entity possessing the
Confidential lnformation have access, and access is controlled through use of a key, card key,
combination lock, or comparable mechanism. Secure Areas may include buildings, rooms or
locked storage containers (such as a filing cabinet or desk drawer) within a room, as long as access
to the Confidential lnformation is not available to unauthorized personnel. ln otherwise Secure
Areas, such as an office with restricted access, the Data must be secured in such a way as to
prevent access by non-authorized staff such as janitorial or facility security staff, when authorized
Contractor staff are not present to ensure that non-authorized staff cannot access it.
"Trusted Network" means a network operated and maintained by the Contractor, which includes
security controls sufficient to protect DSHS Data on that network. Controls would include a firewall
between any other networks, access control lists on networking devices such as routers and
switches, and other such mechanisms which protect the confidentiality, integrity, and availability of
the Data.
m. "Unique User lD" means a string of characters that identifies a specific user and which, in
conjunction with a password, passphrase or other mechanism, authenticates a user to an
information system.
Authority. The security requirements described in this document reflect the applicable requirements of
policies and standards of the Washington Technology Services Agency
(https://watech.wa.qov/policies?combine=&field cateqories tarqet id=80&field tvpe tarqet id=All),
and of the DSHS lnformation Security Policy and Standards Manual. Reference material related to
these requirements can be found here: https://www.dshs.wa.qov/ffalkeepinq-dshs-client-information-
private-and-secure, which is a site developed by the DSHS lnformation Security Office and hosted by
DSHS Central Contracts and Legal Services.
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:
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34
f
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Special Terms and Conditions
a. Have documented policies and procedures governing access to systems with the shared Data
b. Restrict access through administrative, physical, and technical controls to authorized staff.
c. Ensure that user accounts are unique and that any given user account logon lD and password
combination is known only to the one employee to whom that account is assigned. For purposes of
non-repudiation, it must always be possible to determine which employee performed a given action
on a system housing the Data based solely on the logon lD used to perform the action
d. Ensure that only authorized users are capable of accessing the Data.
e. Ensure that an employee's access to the Data is removed immediately:
(1) Upon suspected compromise of the user credentials.
(2) When their employment, or the contract under which the Data is made available to them, is
terminated.
(3) When they no longer need access to the Data to fulfill the requirements of the contract.
Have a process to periodically review and verify that only authorized users have access to systems
containing DSHS Confidential lnformation
When accessing the Data from within the Contractor's network (the Data stays within the
Contractor's network at all times), enforce password and logon requirements for users within the
Contractor's network, including :
('1) A minimum length of 8 characters, and containing at least three of the following character
classes: uppercase letters, lowercase letters, numerals, and special characters such as an
asterisk, ampersand, or exclamation point.
(2) That a password does not contain a user's name, logon lD, or any form of their full name.
(3) That a password does not consist of a single dictionary word. A password may be formed as a
passphrase which consists of multiple dictionary words.
(4) That passwords are significantly different from the previous four passwords. Passwords that
increment by simply adding a number are not considered significantly different.
When accessing Confidential lnformation from an external location (the Data willtraverse 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 externalworkstation to Trusted Network or to a
component within the Trusted Network. The traffic must be encrypted at all times while
traversing any network, including the lnternet, which is not a Trusted Network.
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Special Terms and Conditions
(5) Ensuring that the remote access system prompts for re-authentication or performs automated
session termination after no more than 30 minutes of inactivity.
(6) Ensuring use of Multi-factor Authentication to connect from the external end point to the internal
end point.
Passwords or PIN codes may meet a lesser standard if used in conjunction with another
authentication mechanism, such as a biometric (fingerprint, face recognition, iris scan) ortoken
(software, hardware, smart card, etc.) in that case:
(1) The PIN or password must be at least 5 letters or numbers when used in conjunction with at
least one other authentication factor
(2) Must not be comprised of all the same letter or number (11111,22222, aaaaa, would not be
acceptable)
(3) Must not contain a "run" of three or more consecutive numbers (12398, 98743 would not be
acceptable)
lf the contract specifically allows for the storage of Confidential lnformation on a Mobile Device,
passcodes used on the device must:
(1) Be a minimum of six alphanumeric characters.
(2) Contain at least three unique character classes (upper case, lower case, letter, number)
(3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or
abcd12 would not be acceptable.
k. Render the device unusable after a maximum of 10 failed logon attempts.
Protection of Data. The Contractor agrees to store Data on one or more of the following media and
protect the Data as described:
a. Hard disk drives. For Data stored on localworkstation hard disks, access to the Data will be
restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User lD
and Hardened Password or other authentication mechanisms, which provide equal or greater
security, such as biometrics or smart cards.
b. Network server disks. For Data stored on hard disks mounted on network servers and made
available through shared folders, access to the Data will be restricted to Authorized Users through
the use of access control lists which will grant access only after the Authorized User has
authenticated to the network using a Unique User lD and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or smart
cards. Data on disks mounted to such servers must be located in an area, which is accessible only
to authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
For DSHS Confidential lnformation stored on these disks, deleting unneeded Data is sufficient as
long as the disks remain in a Secure Area and otherwise meet the requirements listed in the above
parigraph. Destruction of the Data, as outlined below in Section 8 Data Disposition, may be
deferred until the disks are retired, replaced, or otherwise taken out of the Secure Area.
DSHS Central Contract Services
1 769CS Cou nty Agreement (12-26-2025)
36
Special Terms and Gonditions
c. Optical discs (CDs or DVDs) in localworkstation opticaldisc drives. Data provided by DSHS
on optical discs which will be used in localworkstation optical disc drives and which will not be
transported out of a Secure Area. When not in use for the contracted purpose, such discs must be
Stored in a Secure Area. Workstations which access DSHS Data on optical discs must be located
in an area which is accessible only to authorized personnel, with access controlled through use of a
key, card key, combination lock, or comparable mechanism
d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by
DSHS on optical discs which will be attached to network servers and which will not be transported
out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through
the use of access control lists which will grant access only after the Authorized User has
authenticated to the network using a Unique User lD and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or smart
cards. Data on discs attached to such servers must be located in an area, which is accessible only
to authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
e. Paper documents. Any paper records must be protected by storing the records in a Secure Area,
which is only accessible to authorized personnel. When not in use, such records must be stored in
a Secure Area..
f. Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or
Secure Access Washington (SAW will be controlled by DSHS staff who will issue authentication
credentials (e.g. a Unique User lD and Hardened Password) to Authorized Users on Contractor's
staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of
such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an
Authorized User's duties change such that the Authorized User no longer requires access to
perform work for this Contract.
g. Data storage on portable devices or media.
(1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on
portable devices or media unless specifically authorized within the terms and conditions of the
Contract. lf so authorized, the Data shall be given the following protections::
(a) Encrypt the Data.
(b) Control access to devices with a Unique User lD and Hardened Password or stronger
authentication method such as a physicaltoken or biometrics.
(c) Manually lock devices whenever they are left unattended and set devices to lock
automatically after a period of inactivity, if this feature is available. Maximum period of
inactivity is 20 minutes.
(d) Apply administrative and physical security controls to Portable Devices and Portable Media
by:
i. Keeping them in a Secure Area when not in use,
ii. Using check-in/check-out procedures when they are shared, and
iii. Taking frequent inventories.
DSHS Central Contract Services
1 769CS Cou nty Ag reement (1 2-26-2025)
37
Special Terms and Gonditions
(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 otheruvise 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. Gloud storage. DSHS Confidential lnformation requires protections equal to or greater than those
specified elsewhere within this exhibit. Cloud storage of Data is problematic as neither DSHS nor
the Contractor has control of the environment in which the Data is stored. For this reason:
(1) DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following
conditions are met:
(a) Contractor has written procedures in place governing use of the Cloud storage and
Contractor attest to the contact listed in the contract and keep a copy of that attestation for
your records in writing that all such procedures will be uniformly followed.
(b)The Data will be Encrypted while within the Contractor network'
(c) The Data will remain Encrypted during transmission to the Cloud'
(d) The Data will remain Encrypted at all times while residing within the Cloud storage solution.
(e) The Contractor will possess a decryption key for the Data, and the decryption key will be
possessed only by the Contractor.
(f) The Data will not be downloaded to non-authorized systems, meaning systems that are not
on the contractor network
(g) The Data will not be decrypted until downloaded onto a computer within the control of an
Authorized User and within either the DSHS or Contractor's network.
(2) Data will not be stored on an Enterprise Cloud storage solution unless either:
(a) The Cloud storage provider is treated as any other Sub-Contractor, and agrees in writing to
all of the requirements within this exhibit; or,
(b) The Cloud storage solution used is HIPAA compliant.
DSHS Central Contract Services
1 769CS Gou nty Ag reement (1 2-26-2025)
38
7
6.
8.
Special Terms and Conditions
(3) lf the Data includes protected health information covered by the Health lnsurance Portability and
Accountability Act (HIPAA), the Cloud provider must sign a Business Associate Agreement prior
to Data being stored in their Cloud solution.
System Protection. To prevent compromise of systems which contain DSHS Data or through which
that Data passes:
a. Systems containing DSHS Data must have all security patches or hotfixes applied within 3 months
of being made available.
b. The Contractor will have a method of ensuring that the requisite patches and hotfixes have been
applied within the required timeframes.
c. Systems containing DSHS Data shall have an Anti-Malware application, if available, installed.
d. Anti-Malware software shall be kept up to date. The product, its anti-virus engine, and any malware
database the system uses, will be no more than one update behind current.
Data Segregation.
a. DSHS category 4 data must be segregated or otherwise distinguishable from non-DSHS data. This
is to ensure that when no longer needed by the Contractor, all DSHS Data can be identified for
return or destruction. lt also aids in determining whether DSHS Data has or may have been
compromised in the event of a security breach. As such, one or more of the following methods will
be used for data segregation
(1) DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will contain no
non-DSHS Data.
(2) DSHS Data will be stored in a logical container on electronic media, such as a partition or folder
dedicated to DSHS Data.
(3) DSHS Data will be stored in a database which will contain no non-DSHS data. And/or,
(4) DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by
the value of a specific field or fields within database records.
(5) When stored as physical paper documents, DSHS Data will be physically segregated from non-
DSHS data in a drawer, folder, or other container.
b. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the
DSHS Data and the non-DSHS data with which it is commingled must be protected as described in
this exhibit.
Data Disposition. When the contracted work has been completed or when the Data is no longer
needed, except as noted above in Section 5.b, Data shall be returned to DSHS or destroyed. Media on
which Data may be stored and associated acceptable methods of destruction are as follows:
Data stored on:Will be destroyed by:
Server or workstation hard disks, or Using a "wipe" utility which will ovenarite the Data at
least three (3) times using either random or single
character data, or
DSHS Central Contract Services
1 769CS Cou nty Ag reement (1 2-26-2025)
39
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
Phvsically destroying the disk
Paper documents with sensitive or Confidential
lnformation
Recycling through a contracted firm, provided the
contract with the recycler assures that the
confidentiality of Data will be protected.
Paper documents containing Confidential lnformation
requiring special handling (e.9. protected health
information)
On-site shredding, pulping, or incineration
Optical discs (e.9. CDs or DVDs)lncineration, shredding, or completely defacing the
readable surface with a coarse abrasive
Maqnetic tape incinerati or crosscut shreddn
9.
10.
Special Terms and Conditions
Notification of Compromise or Potential Gompromise. The compromise or potential compromise of
DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1)
business day of discovery. lf no DSHS Contact is designated in the Contract, then the notification must
be reported to the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also
take actions to mitigate the risk of loss and comply with any notification or other requirements imposed
by law or DSHS.
Data shared with Subcontractors. lf DSHS Data provided under this Contract is to be shared with a
subcontractor, the Contract with the subcontractor must include all of the data security provisions within
this Contract and within any amendments, attachments, or exhibits within this Contract. lf the
Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub-
Contractor must be submitted to the DSHS Contact specified for this contract for review and approval.
DSHS Central Contract Services
1 769CS Cou nty Ag reement (1 2-26-2025)
40
Exhibit B
Program Agreement Budget
X Original Budget Budget Revision
REVENUES
FiscalYear Fund Source Oriqinal 1st Revision 2nd Revision 3'd Revision
2026 State onlv 567,912 576,712
Medicaid 555,171 562,371
TotalRev s1.123.083 $1 ,139,083 $$
Fiscal Year Fund Source Original 1"t Revision 2nd Revision 3rd Revision
2027 State onlv
Medicaid
TotalRev $$$$
Job
Foundation
Funds
PASRR Funds
State Funds
Medtcaid
Funds TOTAL
ADMTNTSTRATION (11,
12.13.14\51072 41786 92,858
OTHER CONSUMER
SUPPORTS
(31,32,41,92,93,94,
97)33411 27337 60,748
CONSUMER
SUPPORT
STATE.ONLY
rc2.64.65.67,69)
Child Development (61)
MEDICAID CLIENTS
rc2.64.67, 69, 95, 96)43391 7 433917 867,834
ROADS to
COMMUNITY LIVING
/62.64.65. 67. 69)
TOTAL
518,400 503,040 1.021.440
DSHS Central Contract Services
1 769CS County Ag reement (12-26-2025)
41
ACCESS AGREEMENT BETWEEN
wAsHr\GToN PROTECTTON AND ADVOCACY SYSTEM, rNC.'
ANI)
TrIE DTVISION OF DEVELOPMENTAL DISABTLITIE$,
DDpmTMDNT oF socrAl AND rrEALTn sERvrcns.
Attachment F
This agreement is entered into by the Washington Protection- and Advocacy_ System, Inc.
(hereinifter WPAS), the protection and advocacy system authorized purf!3!t to the Developmental
Disabilities Assistance ana gil of Rights Act of 1975, 42 U.S.C. sec. 6000, et seq.. t9 llvg{iqate
alleged incidents of abuse, neglec! anl rights violations of pelsqqs with developmental9lsabilities,
and"the Division of Devel-opriental Disabilities (hereinaftefDDD) of the Depq@enlof Social and
Health Services, for the purpose of clarifying the rights and responsibilities of WPAS with respect
to its access to individuafu with developm-ental disabilities, clients, programs, and records.
The Departnent of Social and Health Services, specifically DDD,_ is .responsible for
providing services to individuals with developmental disabiliiies, to the extent firnding is available.
in proviting those services, DDD must pr6tect the confideqtialiq/ of records and information
regirding those individuals pursuant to the state and federal confidentiality laws.
WPAS is charged by federal law to protect the legal and human rights of individuals with
developmental disabilities.
-
WPAS provides legal and rgl{ed. advocacy services 1o meet that
obligation. WPAS is also required
-to maintain the confidentiality of records and information
regaiding individuals with developmental disabilities consistent with 42 U.S.C. $ 6000, et seo.
This agreement governs the access of Washington Protection-and Advocacy.System to DDD
emoloyees wh-o do not iork in Residential Habilitation Centers (RHCs) and records maintained by
OdO *ttictt ore qssociated with individuals with developmentol disabilities living outsidc of RHCs.
Federal laws and regulations also provide WPAS with access to communiQl plograms and
individuals with developme;tal disabilities served by DDD contracted providers. DDD will work
with community provilers and WPAS to errive at an agreement goveming access to DDD
contracted prograrns and the people served by them.
GeneraL
A. That all tcrms uscd in this agrccmcnt which arc dcfincd in thc Dcvclopmcntal
Disabilities Assistance and Bill of Rights Act of 1975,42 U.S.C. $ 6000, et seq.. will have
the meaning given to them in the Ac! unless otherwise stated in this agleement.
B. This agreement is intended to carry out the provisions_of th_e_Developmental
Disabilities Aslistance and Bill of Rights Act of 1975, 42 U.S.C. $ 6000, et..seq.. and
therefore, if this agreement is or becomes inconsistent with the Act or the implementing
regulations promuftated thereto, the terms of the Act and its implementing regulations will
contol.
C. If any provision of the agreement is held invalid, the parties intend that the
remainder of the agreement not be affected.
I.
COMMUNITY ACCESS AGREEMENT
42
II. Definitions.
A. Activelv Aesressive: means that the individual with developmental disabilities. is
assaultinSEffittrreatening to do so, or the individual with developmental disabilities
is actively harrning him or her self.
B. Client Services: means legal representation. The term does not include monitoring
and observation.
C. Comnlaint: as defined in 45 CFR 1386, or hereinafter amended, includes, but is not
limited to, anfeport or communication, whether formal or informal, *ilt"g. or oral,
received by WirAS including media accounts, newspaper articles, telephone calls (including
anottymoui calls), from an-y source alleging abuie or neglect of an individual with a
developmental disability.
D. DDD Consumer: means an individual with a developmcntal disability receiving
support-fr6m a program funded by DDD. The term includes DDD consumers who have
di6ii or whose whereabouts are unknown. See 45 CFR 1386.22(aX2).
E. DDD Emplovees: includes those individuals who are employed Fy- ?PD or who
volunteefiDDD6provide services to individuals withdevelopmental disabilities.
F. Emersencies: means actions, omissions, or conditions that immediately threaten an
individuffia developmental disability's health, life or well being.
G. Individual with a Develonmental Disabilitv: m.eans individuals. with developmental
disabilit ve 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 ho-urs to
eniure program compliance with respectto the rights and safety of DDD consumers. S99 45
c.F.R. $1386.22(9).
I. Probable Cause: as delined in 45 C!'R 1386, or hereinafter amended, means a
reasonable ground for belief that an individual with developmental disabilities has been, or
may be, su6ject to abuse or neglect. The individu4 *$ng such determination may base
tfue dscisiou op rcasonablc infcrinccs drawn fi'otn his or hcr c4pcricncc or training rcgalding
similarincidents, conditions orproblems that are usually associated with abuse and neglect.
J. Prosram: consistent with the definition of "facility" in 45 CFR 1386.19 includes..any
setting @.oGaes care, teatnent services and habilitation, even.if gny "as needed".or
undeia contractual arrangement. Programs include, but are not limited to, community
living arrangements (e.g., group homes, adult family homes, congregate care facilities,
boarfring lio,ires, inaividuhl residences ahd apartnent-s), day progftrms, juvenile detention
centers, nursing homes, homeless shelters, jails and prisons.
K. provider: means those individuals/corporations with whom DDD contracts to
provide services to DDD consumers, includingbut not limited to behavioral management
iervices, family support services, vocational support services, sheltered employment, tenant
support, intensive ii'nant support, altemative ltying, supported living,. group home, adult
fairity fiome, and congrega,:tti caie facilities, chore services, medicaid personal care and
other personal assistance services.
COMMUNITY ACCESS AGREEMENT
43
m.
L. Provider Emolovee: includes those individuals who are employed by a provider or
who vo-lunteer-for a provider to provide services to individuals with developmental
disabilities.
M. Records: as defined in 42 U.S.C. $ 6042 and 45 CFR 1386(22)(b), or hereinafter
amended, reports prepared by any state staff or reports prepared byan agency charged with
investigatinf repoits of incidents of abuse, neglec! injqy, or death that describe incidents of
abuse, neglelt, injury, or death occuning at a facility, investigative documents and discharge
planning records-.
-The term records also includes DDD consumer abuse and neglect
iommittee reports but does not include peer review death repgrts, attomey work product,
and records which are otherwise privileged under state or federal law.
N. Reeular Proqrarn Activity: includes work assignments, education progranui, therapy,
health services, and daily living activities.
O. SOLA: means the DDD consumer support program, State Operated Living
Alternative.
P. WPAS Client(s):
(l) Individuals with developmental disabilities who do not lave a guar4ian or
legal representative and who indicate either orally or in uriting to a WPAS
employee that they want WPAS to represent them.
(2) Individuals with developmental disabilities without guardians who .are
inable to communicate their wishes regarding protection and advocacy services
when WPAS has received a complaint of abuse and/orneglect about the individual
with a disability, or WPAS dctcrmines that there is probable carxre to believe that the
individual with a developmental disability has been abused or neglected.
(3) Individuals with developmental disabilities who have a guardian or legal
iepresentative where the guardian or legal representative has consented to the
representation in writing.
(4) Individuals with developmental disabilities whosg guardian . or legal
iepresentative fails or refuses to act on behalfof the individual with a developmental
diiability, despite being contacted by WPAS, after a court has determined that the
guardian has failed or refrres to act.
(5) A WPAS client does not include those instances where WPAS represents the
lJardian. WPAS shall notifr the DDD Regional Administratol s1 .llsignee in
iriting that it represents the inAividual with developmental disabilities and forward a
copy of that notice to either the guardian or the individual with developmental
disahilities-
a. WPAS Emplovees: includes paid employees,and volunteer employees as identified
bt WPAS. Eachemployee shall carry WPAS identification.
Access to Programs.
A. DDD will not obstruct WPAS access to programs when consistent with the law and
will ensure that SOLA and otherprograms saffeil by DDD employees will comply with this
agreement. For programs which contract with DDD to provide services, DDD will not
COMMUNITY ACCESS AGREEMENT
44
IV.
obsfiuct WPAS access to programs when mnsistent with the law, but WPAS will assume
primary responsibility for 6nforcing its access rights. WPAS will attempt to resolve access
issues it the'lowest l6vel possible. -ln cases where there is danger of imminent or continuing
harm to an individual wiih deralopmental disabilities WPAS will report the occunence to
DDD, consistent with tre Washington State Bar Association Rules of Professional
Responsibility and other applicable state law. In those cases and wher-e ttrele il-l pattern- of
failire to proi,ide access tif WpeS to a program or DDD consumers, WP_A-S.rilill 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 staffpresent wh9'''''''''''''''',n they anive_at.a
progftrm by showing a wPAS photo identification ba9ge._ rylAS shgl_!ry9v^id9 the DDD
di.eltor wiih a list oTemployeei and their pictures by July 1,1997, and WPAS shall update
this list as necessary.
C. WPAS shall have access to SOLAs andother programs staffed by DDD employees
as specified in this section. This agreement does not trffect the right of an individual with a
dev6lopmental disability served by such a prcgmm who owns or rents his or her own home
to den! access to WPAS to his or her home. However, Dpp -g4ployees-do not have.the
right to deny WPAS access to programs or the residences of individuals who are served by
programs.
D. WPAS staffshall have access to all programswhen WPAS has received a complaint
or has probable cause to believe than an incident ofabuse, neglect, or other rights violation
has occurred;
E. WPAS staff shall have access to all living areas of SOLAs and other programs
staffed by DDD employees during regular business houn for the pg{pose of.providing
informatibn on legal rilhts and sElf advocacy to the individuals with disabilities who
participate in the piogram. During the course of such access, WPAS staff shall be allowed
i.t
"ngig"
in infonnaidiscussionslvith the individuals with disabilities, out of the presence
of DDDemployees or others, in an area that affords privacy.
F. WPAS staffmay visit any location where residents are served by DDD employees,
where the purpose is observatiori or monitoring compliance with respect to t!," nghts and
safety of iervice recipients (CFR 1386.22(9)@). Such_observation and monitoring
activities need not be limited to clients of WPAS, and WPAS staff shall not be required to
sslrsdulc or give prior notice of such visits tu DDD eurfloyees, pruvided lhat WPAS lns the
permission of a bOO consumer. WPAS saff sErll be pe-r_mittg{ to monitor-the program
without an accompanying DDD employee. WPAS staff shall conduct all monitoring
activities in a manner wnfun is respeCtful of the privacy of the individuals with disabilities
who reside in the monitoredprogram.
Access to Individuals with Developmental Disabilities.
A. WPAS staff will be provided access to their clients in the same manner as such
access is provided to privately retained and/or cou{ qppqinted attorneys. q_qP shall assist
and support the profeisional relationship between WFAS and irs clients. Written consent
for such access is not required.
B. WPAS recognizbs that all individuals with developmental disabilities have the right
to refuse to talk ui'ttr WpeS, to have a third party present during the interview, or to
reschedule the appointnent for a more convenient tifnb. WPAS shall advise their clients
and other individrials with developmental disabilities with whom they have contact of these
COMMUNITY ACCESS AGREEMENT
45
rights before each meeting. A person who does not wish to talk with WPAS staffshall be
aflowed to communicate ihis directly and privately to WPAS staff unless he or she overtly
manifests fear of being alone with the WPAS staff. When the individual with a
developmental disability overtly manifests such fear by words or behavior, WPAS shall
respecf that person's desires and not meet alone with that person-
C. WPAS will encourage its clients and other individuals ryttlt developmental
disabilities to notifu DDD and/or providers of complaints regarding DDD services and to
resolve those complaints through any exislng dispute resolution process.
D. WPAS staffshall comply with all safety and security requirements of DDD. DDD
will communicate theserequirements to WPAS staff.
E. DDD employees shall not interfere with WPAS staff in obtaining a g1y$e space for
meetings between lWaS staff and individuals with developlnental disabilities. Private
space d-oes not mean a comer of a common area room or othei location which would afford
oiher residents and DDD employees open access to WPAS employees in living.areas or.on
the grounds. I)DI) employees sfiallre.spectthe confi{entiality needs_of the individual with a
devElopmental disabiliiy ina WpaS. Where an individual with a developmental.disability
indicatbs that he or shedoes not want to meet in a private space, WPAS staff will respect
this request.
F. WPAS staffwill not be requiredto schedule visits with DDD employees in advance
of their visits. However, WPAS staffmay contact DDD employees to do so if access to a
WPAS client or other individual with a developmental disability will be facilitated due to
the individual's daily activities.
G. WPAS staffshall have the right to unaccompanied access to any SOLA or program
staffed by DDD employees, and access to any individual WPAS client or DD consumer they
are authorized to serve, subject to the following limitations:
(l) While WPAS need not notiff the DDD employees.prior to Tgeting with its
ilient 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 consumtir ii served and the client or DDD consumer is engaged in regularly
scheduled progrcm activity. ln such case, WPAS staffwill b-e permitted to observe
or otherwiie verifr the programming without disturbing it. If WPAS staffpresence
disturbs or is objected io by the WPAS client or any other DDD consumer who is
present, WPAS staffshaU-make arrangements to meet with the WPAS client or
bDD consumer at a later time. Where consulted prior to making an appointment,
DDD employees will cooperate with WPAS statr in makin-g scheduling
anangemeirts. The WPAS employee shall not disturb nor interrupt the activity. If
the aitivity 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
iight to privacy. WPAS staft'wilf then either wait untrl the actvity is completed or
re-schedule the visit at a time that is mutually agreeable to WPAS staff and its
individual client or DDD consumer, no laterthan 48 hours later.
@ If the WPAS employee arrivesfora meeting ryith a client or DDD consumer
an.-a tne individual is actively aggressive, in programming to address this behavior, or
receiving "onejto-one" superuisioq in such a situation" WPAS staff will be
permitte-d to observe the iniiividual from a safe distance or otherwise verifu that the
individual is actively aggressive. WPAS staffwill then either:
COMMUNITY ACCESS AGREEMENT
46
v.
(a) wait until the individual's. aggressive behavior.has_stopped and be
permitted to meet with the individual privately wfile. DDD emp.loyees
remain in viewing distance; unless such distance would place the individual
with developmental disabilities at serious risk of harm based on that
individual's documented behavioral issues; if the individual would be at
serious risk of harm, WPAS and DDD shall work cooperatively to address
WPAS need for confidentiality with the individual's need for safety;
provided that any such interview does not interfere with the individual's
ilehavior Support Program, Individual Program Pla4 Individlal- Service
Plan, or othei program 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-eight (4E) hours;
(c) if the WPAS staff is notified that an individual i9 ertfrgr actively
aggressive orreceiving one-to-one supervision and ifknowing lhis the staff
cf,ooses to meet with the individual, WPAS agrees to rclease, indemnifr, and
hold DDD, DSIIS, the State and its employees, agents, ofiEcers, and servants
harmless for any injuries that occur from any claims or cause of action
asserted by any WPAS employee or agent who is injured as a result of ryy
act committed by an individual with developmental disabilities except that
those circumstances where DDD employees' willful misconduct is the
proximate cause of the injury to WPAS' emp-loyee or agent. WPAS agrees
tnat its staff shall sign a statement to this effect prior to requesting to meet
with any such individual. If the WPAS staff refuses !9 sign such an
agreement, DDD employees may deny the WPAS staff access to the
intividual until such time as DDD employees determine that safety to the
WPAS staffis no longer an issue. When a WPAS staffmember elects to
meet with an individual who is actively aggressive, it is neither negligent nor
willfi,rl misconduct for a state employee to allow the meeting to take place.
H. All individuals with developmental disabilities who wish to contact WPAS staff
shall be provided uncensored access to witing materials, WPAS' address and toll-free
telephone number, a stamped envelope, anilor access to a telephone for private
conversations without monitoring by or permission from DDD employees.
L SOLAs and prograrns staffcd by DDD omployccs shall pcrmit inlividuals with
developmental disabiiitiJs to set appointnents with WpeS $aff at times agreeable to both
the individuat with a developmental disability and WPAS staff. If the DDD employees
know that ameeting with aDDD consumer will be disruptive of the DDD consumer's
regular program activity, WPAS staff shall be informed of this and allowed to reschedule
Ue appointnnent in order to meet with the DDD consumer so that the appointnent does not
disrupt his or her regularactivity.
Access to Records of IndMduals with Developmental Disabilities.
A. WPAS has access to records as provided in 42 U.S.C. $ 6042, eL seq. WPAS has
legal authority to review an individual with developmental disabilities' rec-o1ds only whe-n
thlre is consent or, if a DDD consumer is unable to cbnsent, there is a complaint or probable
cause to believe a pnD consumer has suffered abuse or neglect. WPAS has no general
right to review records except in these circumstances.
COMMUNITY ACCESS AGREEMENT
47
B. Upon receiving a valid, witten consent, DDD will have 48 hours in which to
schedule in appoinundnt wittr WPAS so that ir may come to the record location to review
specified records. DDD will veriff that WPAS hai received consent to view such records,
oi if tne DDD consumer is unableio consent and there is no guardian to consent that there
is a oompluint or probable oouse to believe the DDD consumer has suffered abuse or
neglect. bOO strati 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_h9 or she.has a legal guardian
wittr ttie power to consent forthe DDD consumer and tlnt guardian consents;
a) the DDD consumer or guardian strall give written authorization for access
on a form approved by WPAS andDDD jointly.
(2) any DDD consumer:
a) who by reason of his or her mental or physical condition is unable to
authorize WPAS to have access to their records;
b) who does not have a legal guardian' conservator, or other legal
representative, or for whom the legal guardian is the state; and
u) with rcspeut to whorn a uourplaiul hus l-rcctt recciietl by WPAS or with
respect to'whom, as a result bf 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
vniting and will state that the resident, by_reason-of his or her mental or
physicil condition is unable to authorize V[peS to have access to his or her
ieiords, does not have a legal representative, and that a complaint has been
received by WPAS with iespeCt to the DDD consumer or that there is
probable cduse to believe the rbsident 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
case of an emergency.
(3) In the case of a resident who has a legal guardian,.and upon request by
UDAS, DDD will provide WPAS with the name, address and telgphone number of
the legal guardian by 5 p.m. the next business day- so-that WPAS can contact such
represlntitive and offer its assistance. If the guardian has bee,n contacted by WP+S
und faited or refused to act on behalf of the individual WPAS has received a
complaint suffrciently that sufficiently identifies the individual or WPAS has
probible cause to believe that the health or safety ofthe individual is in serirus and
immediatejeopardy, WPAS shall obtain cout approval for such access.
a) If a guardian refuses to consent to allow WPAS access to records, and
WpeS itill wants access, WPAS will file a lawsuit to access the records and
allow a tourt to determine whether the guardian has failed or refused to act
on behalf of the DDD consumer. WPAS agrees to provide legal notice to
DDD of any such proceeding. If the guardian refuses to provide written
COMMUNITY ACCESS AGR"EEMENT
48
w.
consent for WPAS to access the records, DDD shall not make the records
available absent a court order.
b) WPAS shall attempt to contact the guardian to obtain consent. Unless an
emergency exists, theh WPAS shall contact the standby guardian if one has
beentesilnated. If no standby guardian is appointed and the guardian is
unavailable, 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 staff inay review the requested records within normal business hours in the
building or room in whith such records-are provided. A DDD emp!91e9gay ri:main in the
room rihile 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 agrees to reimburse DDD for the costs of copies at the same r{,e-charged for
public disclosurJrequests, cun€ntly $.15 per page. When fbasible, copies will be provided
bn the day the copils ate re.questid. lf thaf 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
DDD Regional Administrator of the region in which the DDD consumer resides.
Thereafter] their contact regarding that DDD consumer shall be the regional administrator,
or his or her designee. DnD slall provide WPAS.a list with contact information for
purposes of access to records. DDD agrees to update that list at least annually.
G. In order to access DDD records, WPAS will send a written request directly to the
DDD Regional Administator or designee in custody of the records. In the^request,-WPAS
will identlff the individual whose rec-ords it seeks. WPAS need not identifr the.individual
by name, but must sufficiently identifr the individual so that the person rwiewing.the
reouest can determine whose records are being sought. WPAS will speciff which records it
wahts and for whichtime periods. WPAS will also indicate that it has received a comp_laint
conceming the individual io that it has probable cause to believe the individual has suflered
abuse or nEglect. WPAS need not firth-erspecifl the nature of the complaint nor who made
the complaint.
H. In the event DDD denies access to records pursuant to a request, WPAS staff may
request that the denial be in writing and include the reason for the denial-
I. WPAS will limit its request to records it considers necessary to accomplish its
investigation. DDD may request that WPAS specifically identifr 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
the prpose of obtaining information about their legal rights and self-advocacy. WPAS staff
shafi G allowed to englge in informal tliscussiuns with-DOn cousuulets who wish to speak
to them out of the presence of DDD employees in an area that affords privacy.
B. WPAS may hdve regularly scheduled information/training sessions- for. DDD
consumers and parentVguaraianyfamily members regarding WPAS' services and individual
rights. DDD employeei may attend outeach and scheduled information sessions only with
advance written permission of WPAS staff.
COMMIINITY ACCESS AGREEMENT
49
C, DDD agrees to give WPAS a list of all current DDD consumers and their addresses.
DDD will provide WPAS an updated list annually.
D. DDD agrees to provide DDD consumers with notice of WPAS services at the time
of application for DDDservices. WPAS will provide DD! with copies of their brochure
and/bi any other information they want DDD to dishibute at that time.
E. DDD agrees to require conhactors to comply with4? U.S.q. $6000 et. seq. uqg 15
C.F.R. Parts 1t85-86 by iircluding the requirement in contacts. Cunent conftacts will be
amended to include this requirement when they are renewed.
VII. Authority to Investigate Allegations ofAbuse and Neglect
A. WPAS shall have unaccompanied reasonable access to DDD consumers and
facilities when necessary to conduct a full investigation of an incident of abuse or neglect.
This access shall include the opportunity to interview any individual with a developmental
disability, any DDD or providii employee, or any other person who might be -reasonably
believed by iVfeS to have lnowledgaof the incident under investisatigltt and to review
what WPAS is entitled to review pursuant to this agreement. WPAS shall be permitted to
do its orvn investigation ofallegations ofabuse or neglecl regardless ofany pending action
or investigation by the State or any other individual or entity.
B. WPAS' investigations shall not interfere with any other ongoing investigation.
qPAS employees shall not visit areas at times that would violate any person's right to
pnvacy.
C. DDD shall allow and encourage all employees and providers to talk openly with
WPAS employees. WPAS will not ask siaff to disrupt their work_ schedules or
responsibiliiieito talk with WPAS. Except in cases of emergency, WPAS will schedule
appointnents with staffin advance.
D. While DDD and provider employees shall be encouraged to coopeqte with WPAS,
employees have the righi to refuse t6 tatt wittr WPAS. WPAS shall notiff employees of
.
that right prior to any attempt to interview them.
E. Any complaint concerning WPAS saffshall be immediately brought to the attention
of the W?AS Ex-ecutive Director or his or her designee. Upon receipt of a complaint, the
WPAS Executive Director or his or her designee shall conduCt an investigation and submit a
written resporu;e to the State within fourteen (14) days in an e$ort t9 r-esolve any. complaints
as expedieirtly as possible. DDD reserves the right to file formal charges if the behavior
placei a DDD consumer's health or safety at risk.
F. WPAS shall infonn DDD and providers, in writing, of its findings and concems
upon completion of any investigation activrty undertaken pursuanl.to its authonty under 42
ti.S.C. $ 6b00 et. seo.. and ttre access rights granted to WPAS in this agreerJle.nt, in an effort
to resolie DDD consumer complaints br concems prior to commencing litigation, unless
WPAS bclicvu tlrat such delay wbuld result in serious injury or harm to the DDD consurncr.
V[I. Implementation oftheAgreement"
A. The DDD Director shall ensure that each supervisor will conduct an annual meeting
with his or her staffto provide information regarding the parties' rights and_responsibilities
under this afeement. ihe DDD director shallensure that each employee of DDD has read
COMMUNITY ACCESS AGREEMENT
50
and signed a copy of a form indicating that they have read this agreemen! at the time of hire
and afthe time- 6f his/her annual evaluation. DDD and WPAS shall develop a mutually
agreed to summary of this agreement for use in r$grm|ng DID employees. of the parties'
rilhts and responsibilities. When DDD and !V"Aq develop.and agreeregarding the content
oithis summiry, DDD employees shall be required to read the summary, ratherthan re1{ing
this agreemenq and acknowledge that they read and understood the summary with a
signature.
B. The agreement is effective as of the date it is signed.
C. DDD agrees that having an agreement in place that would govem WPAI and DDD
provider relationships is appropriate. -This agreement will affect contractual relationships, so
it will be negotiated with fioviders prior to implementalign This negotiation will take place
during the 1997-1998 provider conlact negotiations. DDD_will request WPAS review the
propoled contact language prior to contaCt signing !y POO. Th9 Sqal. of this negotiation
froiess will be to artve at an agreemgnt whiglr implements the federal statutory.and
iegulatory requirements in a mannei consistent with the,pryyision of quality, individualized
*"iui""s and supports topeople with developmental disabilities living inthe community.
D. The DDD director will make changes as necessary to implement this agreement by
September l,l997,andprior to implementing changes will conferwith WPAS.
E. WPAS and DDD agree to work together to assist providers in becomin-g familiar
with WPAS access to programs, DDD agrees to host a forum in- eachregion to familiarize
providers with the access provisions. WPAS agrees to make staffavailable a.s-presenters at
iegional forums, and othenvise as mutually agreed to with providers. DDD will distribute to
providers a summary of the access provisions. This summary -will-beprepared by WPAS,-ana wiU be subject to the review andapproval of DDD priorto distribution.
IX. Miscellaneous.
A. WPAS agrees that its saff shall not give medical advice and shalt not engage in the
practice of mediiine. It is WPAS' intent and purpogg tq give legal advice.. For example,
WPAS will not tell DDD coruiumers not to take medication or that medications are wrong
for them. WPAS will not discourage individuals with developmenkl disabilities from
participating in programs or activities. WPAS 4ay explain D?P consumer.l.egal lghts
including tE'e ;ght Io informed consent, their right to be told of the risks and benefits of
medicati-on or medical procedures, their right to refuse to take medications and the
procedure to follow if the DDD consumer does not wish to take medications, and their right
to refuse to participate in experimental programs or research, all as guaranteed under state
and federal law.
B. WPAS agrees that there are some DDD consumers who are identified as medically
fragile or to have behavioral concerns that require constant mgnitgring.- If WPAS requests a
meEting with such a DDD corxumer and DDD determtnes that the DDD consumer cannot
be left-unsupervised with a WPAS employee, a DlD or provider emp.loy-ee shall.be prysJ{
during any ineetings. If DDD consumers are hospitalized due to medical conditions, DDD
tur privitltr curpl,fces uray rcmain wjthiu vicwing disiancc if ucccssary for thc DDD
coniumet's healih dna safet!. The employees will not interfere with the meeting except for
medical reasons and will respect the DDD consumer's privacy to the extent possible given
his or hermedical needi.
COMMUNIry ACCESS AGREEMENT
51
x.
C. This agreement delineates the usual process by whp! WPAS and DDD will work
together. In s6me situations, it may be necessary to amend these procedures. WPAS and
DDD may agree to modiff ttrese pr6cedures as necessary for any particular situation.
Dispute Resolution.
A. WPAS and DDD agree that informal resolntion of disputes is preferred- If WPAS
staff and the DDD Regionil Administator or desigree are unable to agree about an- issue
regarding interpretation or application of this agreemenl -they will request the WPAS
Eiecutiv-e Direitor and the DbD Director review the situation and attempt to resolve the
disagreement
B. The Directors Meeting and Mediation process are mandatory for both parties.
The only exception to this term of the agreement is where WPAS, in good. faith,.tras
probabld caus6 to believe that there are exigent circumstances warranting immediate
iccess. Such circumstances are defined as 'oemergencies" as defined in the access
agreements. In such cases, the WP4S_ Executive Director or his or her designee shall
cSntact the Director of the Division of Developmental Disabilities or his or her designee;
and/or Office of the Attomey General to attehpt to resolve the dispute. If
-th_e
exigent
access dispute is not resolv6d by the end of the following business day, WPAS.may
immediateiy take any necessary iegal action, including seeking a temporary restraining
order and
-preliminaiy injunction or an order to show cause in order to secure the
necessary alcess with6ut {oing through the ADRprocess discussed herein. When WPAS
does tak6 such action, it ihall-give thl Oftrce of the Attorney General advance notice of
such action by telephone and facsimile.
C. In thc cvcnt that thcrc is an acccss disputc rcgarding any aspcct of thc Acccss
Agreements between WPAS and DDD (Commuiity), {e aggrievegpurty shall send written
no"tice to the director of the other parti (e.g. WPAS Executive Director, the Director of
Dl)D, or their designees) of the diiput-e and ttre desire to meet to alteql_pj_t9_rerolve the
dispuie. The DDd dire-ctor (or his&er designee) -shall meet with the WPAS Executive
Diiector (or hiVtrer designee) within ten days after receiving written notice form the
aggrieved party. The datJof receipt of notice shall be in accordance with Civil Rule 6 of the
Wistrington Cburt ttutes. 'lhe meeting may take place in percon or telephonically.. 'l'he
parties [ave the right to bring their counsel to the directors meeting, however. it is. the
preference of the pirties not to-have their counsel present.- In the ev^ent a. party.intends to
irave his or hcr counscl prcscnt, that party will alvisc thc othcr parfy of this intcnt in alvancc
of the meeting. Howev'er, when eith-er director (or his or her designee) is an attorney, it will
be wrderstood and expected that the other director may have his or her attorney present
withoutprior notice.
D. In the event. that the access issues are not resolved by a meeting between the
Director/CEO and Executive Director of WPAS or their designees, the parties agree to
attempt to resolve the dispute through mediation absent exigent circumstances as described
in par'agreph l. An available mediator from the mutually agreed upon Mediator Panel list as
described below will be used to conduct the mediation.
Mediation will be scheduled to occur as soon as possible following the directors
meeting, but will occurno later than 30 days fiom the time mediation is agreed upon by the
parties,-absent written alreement by both p-arties to extend this timeline. The mediation may
iuke piuc" telephonicafiy or in airy manner the mediator believes will be efficient and
condricive to a productive mediati6n. lf, at any time during the mediation, either party
declares an impasse, the mediation will end. The parties are then encouraged, but not
COMMUNITY ACCESS AGREEMENT
52
required, to arbitrate the dispute. The costs of mediation shall be b9I"9
"q1l4ly. !f .ttt9
parties. if no liigation results within 90 days of the complejlion of mediation, WPAS shall
withdraw its acceis request. Nothing, however, prevents WP4S from renewing its request
in the future should thit become necessary. In such event WPAS renews the request, and
that request is denied by the State, the ADR process will begin again.
E. Within !0 days of the execution of this agreement, the parties shall select-a panel of
at least 4 mrrhtally agreeahle mediators. There wil-l be two sepaiate lists: one firr WPAS and
DDD and one foi WFAS and the MIID. The parties agree that any one of the selected panel
members will mediate all disputes related to ihe Access Agreement. However, the parties
will rotate the order of contaciing 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, their list of
froposed mediat6rs
-and
the mediators' curriculum-vitae and any other necessary facts such
^as iost, mediation rules, etc. If the parties cannot aglee upon at least 4 mediators from the
first eichange of lists, the parles-will exchange-additional lists of mediators until an
agreement cin be reached. However, a final agreement must be reached no later than 90
d-ays from the date of the settlement agreement of tnis case absent written agreement for an
extension of a specific amount oftime.
Any party may strike a mediator from the list except that a party may not lFk". u
mediator from the panel once the mediation process has been initiated to resolve a dispute.
lf a party strikes i mediator from the panel, that mediator yt! be replaced by another
mediitoiusing the same mediator selection process as described above.
F. In the event that the access issues are not resolved through mediation, the parties
may agree to attempt to resolve the dispute through ar- bitration. Written agreement to
proceei to arbitrati6n must be made rdthin five working days of the completion of
inediation described in Section B. An available arbitrntor fmm the mrrtrtally agreed upon
Arbitrator Panel list, as described below, will be used to conduct the arbitration of the
dispute. Arbitration will be scheduled to occur as soon as possible, but will occur no later
thail 45 davs from the time arbitration is agreed upon by the parties, absent written
agreement by both parties to extend this timeline. Pribr to the time of final a-greement to
aibittat" the iispute, the parties shall agree in witing whether. the-arbitration decision will
be binding or aivisory, ana if advisory, whether thafopinion is.admissible in court. If no
lirigation iesults withiii 90 days of the complerion of this arbitration, WPAS shall withdraw
its -access request. Nothing,- however, prwents WPAS from renewing its request in the
future should'that become nCcessary. Irrsuch 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 selgct a-panel
of at least 4 mutually igreeable arbitrators. The parties agree that any one o-f_the selected
panel members will-arbltrate all disputes related io ttre Access Agreement. However, the
iarties 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.agpem-enJ, $e
parties will each propose at least 4 arbitrators. The parties will exchangg, via filx, their list
bfproposed arbitrators-and the arbitrators'curiculum vitae an{ any.other necessary facts
such a's cost, etc. If the parties cannot agree upon at least 4 arbitrators from the first
exchange of iists, the parties will exchange additiohal lists of arbitrators.until gl agreement
can be ieached. Howiver, a final agreement must be reached no later than 120 days from
COMMUNITY ACCESS AGREEMENT
53
the date of the settlement agreement of this case absent written agreement for an extension
of a specitic amount of time.
Any party may strike an arbitrator from the list except that.a party may. not stike an
ar.bitratur fi"riu th" panel uuce 1ltc rubitratiuu pruccss lms beeu iuitiatetl [u rcsulvc a tlisputc.
If a party strikes an arbitator fiom the. pan6l, that arbinator will 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 uritten agreement of the parties-
I. The parties agree they will abide by the timeframes contained in the Access
Agreement aira tnis sittlemeni agreement. lhe- partigs may mutually agree 1o extend any
tiileframe. If a party fails to act or respond within the allotted time,, the other party may
request appropriale sinctions be imposedas provided by law or civil rule.
7 /0(1
of Developmental Disabilities
.1 I p\t{
\"
,l\
fu,t \
{
MARK Date
Executive l)irector
Washington Protection & Advocacy System
C'MMUNIry ACCESS AGREEMENT
54
,.,,.11U'9
ATTACHMENT,.G"
Request lor TaxPaYer
ldentification Number and Certification
Ca lo www.irs.govlFomwglor inatructions and the lalesl infomation'
Give {orm to tho
requester. Do not
send to the lRS.{riry. March 2024)
Depadmont ol lh€ Tr€asury
lntomal Rovonuo Soryico
Befo16 b6gin. For ,elalsd to tho purposo oi Form W-9, soe of brilolv.
I Name of entity/indlvidual. An entry is required. {For a ele proprj€tor or di$regarded enlity, enicr the owne.'s temt on lhE l. and onter tho buEincss/dlsregarded
stity'9 nfl,ne gn iine 2.)
2 gusinosg nmo/disrcgardod ontity nam6, it difforont ftom
4 Exompiious {codos
cortain €ntitl€, not
apply orty io
individuals;
str lnslnictions on page 3):
€xsmpt payeo codo (il 6ny)
Exempllon from Foteigo AcwuntTax
Complianco Aet {FATCA} roporli,lg
code {if sy)
(Applios lo ,ccwnls maintainsd
utsid@ tte Unitod Statas )
Requester's name and addfe$s ioptionst
7 l.,sl acc@nl .urnber(s) here
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6
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OEqo\E
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4oIE
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do
Enter your TIN ilr th€ appropriaie box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individrals, thi$ is gon6rally your social socurity number {$sN}. Howev€r, for a
residonr allon, sotJproprielor, or dlsrsgardod ontity, sse the in$lructions for Pa.l l, later. For olher
entilies, it is your employer identitication nurnber (ElN). lf you do ilot have a number' see How lo get a
nN. later.
Not6: lf the account is in moro than one name. see th8 instruclions lor line 1. Ses also U?hal Nama and
NumberTa Aiva the Roquaslor lor guidslinos on whoso number to enler'
ot
Under penalties ol pe4ury, I certity that:
1 . The numbsr shown on this form ia my corect taxpayer rdentification number (or I am waiting for a nlmber lo bo issued lo mo): and
2. I i]m not sub.iect to backup lvathholding bocause {a) I am exempt from backup lvithholding, or (b} | have not bmn notifiad by the lntemal Revonue
seru,ce (lFls) that I am subiect to uact-up withhotoiirg as a result of a failure to.eport all interest or dividends, or (c) the lRs has noiilied me that I an
no ionger subiect to backuP rvilhholding; and
3. I am a U.S. ciiiz€n or other U S. person {defined belol'4; and
4. Th6 FATCA oods{s) enlo.ed on ihis form 0t any} indicaling thal I am oxempt from FATCA reporling is corr{rcl,
C€rtltlcallon lnstruclions. You lnust cfo33 out iten 2 atlove if you have been nollfied
btrause you have iailed to tsPori all irterest and divid€nds on your tax tetutn. For real
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Lin€ 3a has been tnoditied to clarity hovr a disregarded entity complstes
this line. An LLC that is a disreetarded entity should check the
appropriate box for tho tax classificatiott of rts owner. Othemiso, it
sirbukl check the "LLC" box and enter ils appropriate lax classification
96 Ch*k tt!6 appopriale box ior taderal iax clasgrficaliail of ihe slt'ly/indrvklual
only ono of lho lollorv.ilg sov€r boxes.
n lrldlvaduavscloproqdotor I Ccorporaion ! Scorporatlon I ParlneEbig n Trusvcstato
n LLC. Enter the lax cla$slficalion {C = C erporatlon, S = S.orporatlon, P = Parlnarship}
Note: Chsk the ,,Ltc" box airove and, ln the entry space, enter lhe approprlate cotje (C, S, or.P) farlhe {u
ctsc$iftoalion ot the LLc, unlo6s I i$ a disrs{ardodoDilty. A disrogarded entity sloukl h\staad chmk lho altproprlafo
4 othe {$o€ krstrucllotE)-)t0l c
whos€ nafie is srrteled otr lins l- Check
box lor ihe lry classificalion ol its ownor
3b It on lins 3a you chgcked 'portne6hip' or "T,!stloslal€." or cbscksd "LLC" and €nte.€d "P" as its tax cla$ilication.
and you are providing this fom to a parine,ghip, lruat, o' eslate in which you hflve an owngrship inleresl' ch&k
lhls box l{ you havQ any toreign pa.tn€6, osne6, ol benellciariG, See inslftrotlons ' n
Address (number, slrfft. snd spt. o. suile no,i,5 Ses lnslrucllons.
6 cry,codE
€
numberPart
7 4 IqOOb7
Part ll
Kittitas County Agreement for Services (rev.5/7a/251
55
Fonr W-9 incv. r-zoz+1Cat. No, 10231X
Pase2Fom W-9 {Rev.3-20241
musl obtain your correcl laxFayer identification number [IlN), which
may be your social seurity number {SSN}, individual taxpayer
ideitifcition number {lTlN}, adoption laxpayer identification number
(ATlNf , or ernployer identification number {ElN}, to report on an
inforn:ration relum the amount paid to you, or other amount reportable
on an infonnation retum. Examples of information ratums include, bul
are nol limited to. the following.
r Form 1099-lNT {interest eamed or Paid).
. Form 1099-DlV {dividends. including those from stocks ot mulual
fundsl.
. Form 1099-MISC (variaus lypes of income, prizes, awards, or gross
proceedsJ.
. Form 1099-NEC {nonemployee campensation).
o Form 1099-8 {stock or rnuiual fund sales and certain other
transactions by brokers).
. Form 1099-S {proceeds from real estate tnansaclions).
. Form 1099-K (merchanl card and third-party network transactione).
r Form .1098 {home mortgag€ interest}, 1098-E {student loan interest),
and I 098-T (tuhion).
. Form 1099-C {canceled debt}.
. Form 1099-4 (acquisition ar abandonment of secured property).
Use Form W-9 only if you are a U.S. person (ncluding a resident
alien), to provide your conect TlN.
Caution: lf you don't retum Form W-9 to the requester with a TIN' you
might be subj*t to backup withholding. See What is backup
withholding,laler.
By signing the lilled-out form, You:
1. Cediry that the TIN you are giving is conect (or you are waiting for a
number to be iss.ted);
2. Certify that you are not subi€ct to backup wilhholding; or
e. Claim exemption from backup withholdirlg if you are a U'S. exempt
payee; and
4. Certify to your non-Ioreign status for purposes of withholding under
chapter 3 or 4 of the Code {if applicable}; aM
5. Cediry thal FATCA code{s} entered on this form (f any) indicating
that you are exempt from the FATCA reporiing is conect. See What /s
FATCA Reporting, later, for further information.
Nole: lf you are a U.S. person and a requester gives you a form other
than Form W-9 10 request your TlN, you must use lhe requester's form if
it is substantially similar to lhis Form W-9.
Definition oi a U.S. person. For iederal tax purposes, you are
considered a U.S. person if you are:
' An individual who is a U.S. cilizen or U.S. resident alien;
. A partnership, corporation. company. or association created or
organized in the Uniled States or under the laws of the United States;
. An estate (other than a foreign estate); or
. A domestic trusl {as defined in Fegulations saction 301 .770 1 -7}.
Establislring U.S. status for purposes of chapter 3 and chaPt€r 4
withholding. Payments made to foreign persons, including certain
distributions, alldcatons ol income, or tlanslers of sales proceeds, may
be subject lo wilhholding under chapiet 3 or chapler 4 of the Code
(sections 1 441 -'l 47 4). Under those rules, if a Form W-g or other
certification of non-foreign slatus has not been received, a withholding
agent, transferee, or partrrership (payor) generally appliea presumption
ru1es that may require lhe payor to withhold aPplicable tax from the
recipient, owner, transleror, or Parlner {Payee). See Puh 515,
Wilhholding of Tax on Nonresident Aliens and Foreign Entities.
The following persons rnust provide Form W-9 to the psyor for
purposes ol establishing its non-ioreign stalus.
. ln the case of a disregarded entity with a U.S. orvner, the U.S- owner
of the disregarded entity and not fre disregarded entity.
. ln the case of a qrantor trust with a U.S. grantor or other U.S. owner,
generally, lhe U.Slgrantor or olher U.S. owner of the grantor trust and
not the grantor trust.
. ln the case of a U-S. trust {other than a granlor trusl}, the U.S- trust
and not the beneliciaties of the tusl.
See Pub. 515 lor more rntormation on providing a Form W-g or a
certification of non-foreign status 1o avoid withholding'
Foreign person, lf you are a froreign person or the U.S. branch o{ a
loreigi b'ank that his elected to b6 treated as a U.S. person (under
Regulalions section 1.14411tbi{2}{!v} or other applicable section for
chapter 3 or 4 purpoees), do nol use Form W-9. lnstead, use the
appropriate Form W-8 or Form 8233 {see Pub. 51 5}. lf you are a
oudifibd foreiqn pension fund under Requlations section 1.897(l)-1 (d)' or
i parrnership ihat is wholly owned by qualified foreign pension tunds.
that is treated as a non-foreign person for purposes of section 1445
wilhholding, do nol use Forrn W-9. lnslead, use Form W-8EXP (or other
certifi cation of non-foreign status)-
Nonresident alien who becomes a resident alien' Generally, only a
nonresident alien individual may use the terms of a tax trealy lo reduce
or eliminate U.S. lax on certain tyP€g of :ncome. However, mosl tax
treaties contain a provision knolvn as a aaving clause. Exceplions
srecified in the savino clause mav permit an exemption from tax to
cbntinue for certain ty;pes of incomb even after the payee has olherwise
become a U-S. resident alien for tax purposes.
lf you are a U.S. resident alien who is relying on an exception
cont-ained in the saving claus€ of a tax treaty to claim an exemplion
from U.S. lax on certai*n types of income, you must attach a stalement
to Form W-9 lhat specifies the following {ive items.
1 ^ The treaty counlry. Generally, this must be the same treaty under
which you claimed exemption lrom tax ae a nonresident al;en'
2. The treaty atlicle addreesing the income.
3. The article number (or location) in the tax trealy that contains the
saving clause and its excePtions.
4. The type and amcunt of incorne that qualities for the exemption
from tax.
5. Sufficient facts lo iuslify the exemption fmm tax under the terms of
the treaty article.
Exanwle, Article 20 of lhe U.S.-China income tax treaty allows an
exemptibn from tax lor schotarship income received by a Chinese
sludent temporarily present in the United States. Under U.S. law, this
student will become a residenl alien for tax purposes if their stay in the
Uniled Stales exceeds 5 calendar years. However, paragraph 2 of the
{irst Protocol 1o ths U"S.-China lreaty (dated Apnl 30, 1984} allows the
provisions of Aiicle 20 to conlinue to apply even after the_Chinese
Ltudent becomes a resident alien of the United Siates. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
Protocol) and is relvino on this exception to claim an exemplion lrom tax
on their icholarshii oifellowship iniome would attach to Form W-9 a
stalemenl that includes the inlormation described above to support that
exemption-
lf you are a nonresident alien or a foreign enlity, give the requester the
appropriate completed Form W-8 or Form 8233,
Backup Withholding
What is hackup wilhholding? Persons making certain payments to you
must under ceriain conditions lvithhold and pay to the IRS 24% of such
payments. This is called 'backup rvithholding." Paymenls that may be
3u61ect to backup withholding include, but ete not limited to, interest,
tax-exemDt interest, dividends, broker and barter exchange
transactions, rents, royalties. nonemPloyee pay' payments made in
setllement of paymeni card and third-party network tran*aclions, and
certain paymdnt! from fishing boat operalors. Real eslate lransactions
are not subjeci to backup wirhholding.
You will not be subject to backup wilhholding on payments you receive
if you give the requesier your conect TlN, make lhe proper certificalions,
and report all your taxable inlerest and div;dends on your tax return.
Paymenls you reeeive will be subjecl to backup withholding if:
1. You do not fumish your TIN to lhe requesler;
2. You do not certity your TIN when required {see the instruclion6 for
Parl ll for details);
3. The IRS tells the requester that you {umished an inconect TIN;
4. The IRS tells you that you are subiect to backup wiihholding
because you did not report all your inietesl and dividends on your tax
retum (for reportable interest and dividends only); or
5. You do not cerlify 1o the requesler that you ate-not subject to
backup withholding, ds described in item 4 under "8y signing the filled-
ouf foim" above {for rePorlable inleresl and dividend accounts opened
after I 983 only).
Kittitas County Agreement for Services (rev.5/M/251
56
Paqe 3Form W-9 tBev.3-2024)
Certain payees and payments are exempl from backup withholding.
See Exempt-pyee code,-later, and the separate lnstructions tor lh€
Requester of Form W-9 for more information.
See also Estab/ishrng U.S. status {or purposes of chapler 3 and
chapter 4 withholding, eailier.
What ls FATCA Reporting?
The Foreign Account Tax C,ompliance Acl {FATCA} requires a
parlicipaling foreign financial institution to report all U.S. account
holderb thaiare specified U.S- pemons. Certain payees ate exempt ftom
FATCA reporting.'See Exemption from FATCA reporting code,later, and
the lnstrualions for the Requeeter of Fom W-9 for more in{ormalion.
Updating Your lnformation
You must provide updated information to any person to whom you
claimed to be an exempt payee il you are no longer an exempl payee
and anticipate receivinq reportable paymenls in the future from this
person. F6r example, y-ou may need t6 provide updated information if
you are a C corporation that elects to be an S corporation,_or if you are
no longer tax eiempt. ln addition, you musl fumish a new Form W-9 if
the nafre or TIN chlnges for the account, for example, if the grantor of a
grantor trust dies.
Penalties
Failure to fumislt TlN. lf you fail to fumish your conect TIN to a
requesler, you are subiect to a penalty of $50 for each such.fuilure
unless youi failure is due to reasonable cause and not to will{ul neglect.
Civil oenaltv for false information with respect to wilhholding. If you
nraka a falsd slatemenl with no reasonable basis that resuhs in no
backup withholditrg, you are subject to a $500 penalty'
Criminal penafty {or falsi{ying 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 violalion of
lederal lalv, the requester may be subiect to civil and criminal penalties.
Specific lnstructions
Line 1
You must enler one of the following on this line; <lo rroi leave lhis line
blank. The name should match the name on your tar retum.
lf lhis Form W-9 is for a ioint account (olher than an account
maintained by a {oreign financial institution {FFl}' list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. lf you are providing Form W-9 to an FFI to document
a joint account, each holder of the accounl that is a U.S. person must
provide a Form W-9.
r lndividual. Generally, enter lhe name shown on your tax retum" lf you
have changed your last name without infonning the Social Security
Administration ISSA) of the name change, enter your first name' the last
name gs shown on your social security card, and your new last name"
Note for lTlN applicant Enter your individual name as it was entered
on your Form W-7 application, line 1a. This should also be the same as
lhe name you entered on the Form 1040 you filed wilh your applicatlon'
. Sole proprietor. Enter your individual name as shown on your Form
1040 on lan'e 1. Enter your business, trade, or "doing business as" (DBA)
name on line 2.
. Paflnershio. C corporation, S corporation, or LLC, othertlran a
disregar<.lecl'entity. Enter the entily's name as shown on the entily's ta;
retumon line 1 and any business, lrade, or DBA name on line 2.
' Other €ntilies. Enler your name as shown on required U.S. lederal tax
documenls on line 1, This name should match the name shown on the
charter or olher legal documenl creating lhe entity. Enter any business.
trade, or DBA name on line 2.
. Disregarded entity. ln general, a business entity lhat has a single
owner, including an LLC, and :e not a corporation, is disregarded as an
entity separate irom its owner (a disregarded entity). See Reg.ulations
section dot -zzo1 -2(cX2). A disregarded entity should check lhe
appropriate box for the tax classification of its owner. Enter the ownefs
name on ltne 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 inc6me tax rettim on which the income should be reported. For
examole. if a foreiqn LLC that is treated as a disregarded entity for U.S.
{ederjd tax purposls has a singie owner that is a U-S. person, the U.S.
orvnar's narneis required to be provided on line 1 ' lf the direct owner of
li€ ettity is also a disregarded entity, enterthe firsl owner thal is not
dis.€garAed {or tederal tax purposes. Enler th€ distegarded entity's
namJon ilne 2. lf tlte owner o{ the disregarded enlrty is a foreign person,
the o',ffner must complete an appropriate Form W-8 instead of a Form
W-s. T}ris is lhe case even rf ihe loreign person has a U.S. TlN.
Line 2
lf you have a business narn€, lrade name, DBA name, or disregarded
entitlr name. enter it on line 2.
Line 3a
Check the appropdate box on line 3a for the U,S' federal tax
classification of the perscn whose name is entered on line 1' Check only
one box on line 3a.
Line 3b
Check this box if you are a partnership {inctuding an LLC cla$ified as a
padnership for U-S. federal tax purposes), lrust, or estate that has any
ioreign partners, owners, or beneficiaries, and you are providing this
form-to a partnership, trust, or estate, in which you have an ownership
interest. You musl iheck the box on line 3b if you receive a Form W-8
(or documentary evidence) from any partner, owner, or beneficiary
establishing foreign slalus or i{ you receive a Form W-9 lrom any
partsrer, owner, or beneficiary that has checked the box on line 3b.
Note: A partnership that provides a Form W-9 and checks box 3b may
be requiied tc complele Schedules K-2 and K-3 {Form 1065). For more
infomation, see the Partnership lnstructions for S{hedules K-2 and K€
{Form 1065}.
lf vou are required to complete line 3b but failto do so, you may not
receive rhe information nece'ssary to file a conect information retum wilh
lhe IRS or fumish a conecl payee statement to your partners or
beneficiaries. See. for example, sections 6698, 6722, and 6724 lor
penalties that may apply.
Line 4 Exemptions
lf vou are exempt from backup withholding andlor FATCA reporting,
eriLer irr ilre appiopriate spaui orr lirre 4 illy code{s} tllat lllay alrply to
you-
Exenrpt payee code,
. Generalty, individuals {including sole proprietors) are not exempt from
backup vrithholding.
. Except as prpvided below, corporalions are exempt {rqq backup
wilhholbing fbr certain payments, including interesl and dividends-
r Corporations ffe not exempt from backup withholding for payments
made in settlement of paymeirl card or third-party network transactions-
. Corporalions ate not exempt from backup withholding wilh respecl to
attomiys'fees or gross proceeds paid to atlomeys, and corporations
that provide medicil or health care serviceG are not exempt with resPect
to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempl from backup
wilhholding. Enter the aPpropriate code in the space on line 4.
1 -An organization exempt from tax unde. seclion 501(al, any IRA' or
a cuslodiai account under seclion 403(bXZ) it the accounl satisfies the
requirements of section a01 (f)(2).
lF the entity/indiviclual on line I
isa(n)...
THEN check dre box for
r Corporation Corporation"
r lndivijuaj or
. Sole pmpaetorship
lndividual/sole ptoprielor
. LLC classified as a partnership
for U.S. federal lax purposss or
. LLC lhat has filed Folm 8832 or
2553 electing 10 be taxed as a
corporalion
Limited liability company and
enler the appropriate lax
classification:
P = Partnership,
C=Ccorporation,or
S = S corporation.
Parinership Partnership.
. Trust/estate Trusvestate^
Kittitas County Agreement for Services (rev' 5/74/25
57
Page 4Form W-9 (Hev.3-2024)
Z-The United States or any of its agencies or instrumentalilies.
3-A etate, the District of Columbia, a U.S. commonwealth or terrilory'
or any of lh€jr political subdivisions or:nstrumentalities.
4-A foreign govemment or any of its political subdivisions, agencies,
or instrumentalities.
5-A corporation.
6-4 dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S" commonwedth or
tenitory.
7-A futures commiesion merchant regislered wilh the Commodity
Futures Trading Commission.
8-A real estate investment trust.
9-An entity legistered at all times during the tax year under lhe
lnveslment CompanY Act ol 1 940.
10-A common trust fund operated by a bank under section 584(a)-
1 1 -A financial institution as delined under section 581.
12-A middleman known in lhe investment community as a nominee or
cuslodian.
13-A trust exempt from tax under section 664 or described in section
4947.
The following chart shows types of payments that may tre exempt
from backup w-ithholding. Thachan aPplies to the exemPt payees listed
above, l through 13.
lF the payment is for THEN the paym€nt:s exemPt
lor...
. lnterest and dividend payments All exempt payees except
lorT-
transactions payees 1 through 4 and 6
F-A dealer in securities, commodities, or derivative iinancial
inslrunrents (including notional principal conlracts' futures, fgnaards,
and opiions) that is registered as such under the laws of lhe Uniled
Slates or any stale.
G-A real estate inveslment taust.
H-A regulated investrnent comPany as defined in secticn 851 or an
entiiy registered at all times during the tax year under tfie lnveetrnent
Company Act ot 1940.
l-A common trust lund as defined in seclion 584{a}.
J-A bank as defined tn section 581.
K-A broker.
L-A trust exempt from tax under section 664 or described in section
aeaT(a){1}.
M-A tax-exempt trust und€r a section 403(b) plan or section 457{9)
plan.
Note: You may wish to consult wilh the financial institution requesting
lhis form to determine whether the FATCA code and/or exempl payee
code $rould be completed.
Line 5
Enter your address {number, street, and apartment or suite.n-umber}.
This ii where the requester of this Form W-9 will mail your information
retums. lf this address dilfers from lhe one the requesler already has on
Jite, enter "NEW" at the top. lf a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city. state, and ZIP code.
Part l. Taxpayer ldentification Number {TlN)
Enter your TIN in the appropriate box. lf you are a resident alien md
you do not have, and are not eligible to get, an.SSN, your TIN is your
iRS lTtru. Enter it in the entry spice for the Social security number. lf you
do nol have an lTlN, see How to get a IliV below.
lf you are a sole propdetor and you have an EIN' you may enter either
ycur SSN or ElN.
lf you are a single-member LLC that is disregarded ss.an entity
seoirate from itsbwner. enler the owner's SSN (or ElN, if the owner has
oni;. tt th" LLC is classified as a corporation or partnership. enter the
entity's ElN.
Note: See What Name and Number To Give the Fequester, later, for
further clarification of name and TIN combinalions.
How to get a TlN. lf you do nct have a TlN. apply for one immediately.
To applffor an SSN, get Form SS-5, Application for a Social Security
Carci, from your local SSA office or get this form online at
www,SSA.gov. You may also get thisform by calling S0o--772- 1213' Use
Form W-7, Application ior IRS lndividualTaxpayer ldentification
Number, to dpply for an lTlN, or Form SS-4, Application for Er.nployer
ldentification'lriumber, to apply for an ElN. You can apply for an EIN
online by accessing the IRS website at www.Jrs.govlE/N. Go to
www.irs-.govlFormJ to view, download, or print Form W-7 and/or Form
SS-4. O;yuu catt ge.r tu www.r'rs'gavlAdaFuuts lu place atl ulder alld
have Fomi W-7 and/or Fcrm S$4 mailed to you within 15 business
days.
lf you are asked to complete Form W-g but do not have a TlN, alply
{or ittN and enter "Applied For" in the space for theTlN, sign-and date
lhe form. and give it t6 the requester. For interest and dividend
payments, and certain payments made wittr respect to readily tradable
insiruments, you will generally have 60 days lo get a TIN and give it to
the reouestei b€fore vou are subiect to backup withholding on
pavmeirts. The 60-da'y rule does'not apply to other types of payments'
You will be subject tobackup withholding on all such payments untl
you provide your TIN to the requester.
Note: Entering "fuplied For'' means thal yau have already applied for a
TIN or that uo-u intehd to aoolv for one soon. See also Estabishing U.S.
status for plryoses of chaitiei s and chapter tl withholding, eatlier, for
when you'may instead be-subiect to withholding under chapter 3 or 4 of
the Code.
Caution: A disregarded U.S- enlity that has a loreign owner must use
the appropriale Form W-8.
through 1 l and all C corporations.
S corporations must not enter an
exempt payee code because theY
are exempt only for sales of
noncovered s€curities acquired
10 2012.
. Barter exchange transaclions Exempt payees 1 through 4.
and dividends
. Payments over required to
be reported and direct sales over
$5,ooot
r Payments made in settlement of
payment card or third-PartY
network ltEnsactions
I See Form 10s9-MlSC, Miscellaneous lnformation, and its instructions,
2 However, the following payments made to a corporation and
reportable on Form 1 o99-MISC are not exempt from backup
withholding: medical and heallh care paymenls, atlomeys' fees, grcss
proceeds faid to an attorney reportable under seclion S045(fl' and
payments tor services paid by a federal executiva agency.
Exemption lrom FATCA reporting code. The following codes identify
payee's that are exempt from reporling under FATCA. These codes
apply to ptr=on" submitting this form for accounts marntained outside
oi it'-* Uriit"O States by cenain {oreign financial institutions- Therefore, if
you are only submittin'g this form foian account you.hold in the United
States, you may leave this fleld blank. Consult with the person
requesdng this iorm i{ you are uncedain if the financial inslitution is
sublecl to these requirements. A requester may indicate that a code is
not reouired bv providinq vou wilh a Form W-9 wilh "Not Applicable" (or
any siriilar indic'ation) en-ttired on the line {or a FATCA exemption code.
A-An organization ex€mpt from lax under seclion 501 {a) or any
individual retirement plan as defined in section 7701 (aX37).
B-The United States or any of its agencies cr instrumentalities-
C-A state, the District ol Columbia, a U.S- commonwealth or
tenitory, or any of lheir political subdivisions or instrumentalities-
D-A corporation the stock of which is regularly lraded on one or
more established securities markets, as described in Begulations
section 1.1 472-1 (cX1Xi).
E-A corpcration that is a metnber of the same exPanded affiliated
group as a corporation described in Regulations section 1.1472-1{cX1}(i)-
Generally, exempt payees
1 through 5-2
Exempt payees 1 through 4.
Kittitas County Agreement for Services (rev.5/7a/25)
58
FqeSForm W-9 (Rev.3-2024)
Part ll. Certification
To establish to the withholding agent that you are a U.S. person' or
resident alien, sign Form W-9' You may be requesled to sign by the
withholding agerit even if item 1, 4, or 5 below indicates olherwise'
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). ln the case of a disregarded entity, the
person identified on line I musl sign. Exempt payees, see Exempt payee
code, earlier,
Signature requiremenls. Complete the certificalion as indicated in
itemslthrough5below'
1. lnterest, dividend, and barter exchange accounts opened
belore 1984 and broker accounts considered active during 1983'
iou must give your correct TlN, but you do not have lo sign the
certification.
2. hrterest, dividend, trroker, and barter exchange accounls
orened after 198i1 and broker accounts considered inactive during
iii$. V* must sign the cerlification or backup witrholding will aaply' If
you are subiect to backup withholding and you are merely providing
yorl' "on*i TIN to lhe requester, you must cross out item 2 in the
certificailon before signing the form.
3, Real estate transactions. You must sign the c€rtification' You may
crosa out item 2 of tfie cerlification.
4. Other paynrents' You must give your conect TlN, but you do nol
have to sign the certification unless yott have been notified that you
have prev-iouslv oiven an inconect TIN- 'Other payments" include
piym'ents mad'e"in the cours€ of the requester's trade or business {or
rents, royalties, goods (other than bills tor merchandise), medical and
heafth cire services (including payments 10 corporations), pa-ymenls to
a nonemolovee for services, pavments made in selflement of payment
Jard and'thiid-party netwo*'trjnsactions, paymenls to certain fishing
boat crew members and ishermen, and gross proceeds paid lo
attomeys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonmenl of
secured urooerw. cancellation of debt, quali{ied tuitiolr program
oavrnenti {uhde; section 529}, ABLE accounts (under section 529A}'
iRA. Coveraett ESA, Archer MSA or HSA contribtrtions or
rlistiibutions, and pension distributions. You must give your cofiect
TlN, but you do not have to sign the certification.
What Name and Number To Give the Requester
1 List {irst and circle the name of lhe person whose number you fumish'
lf only one p€rcon on a ioini accounl has an SSN, lhat Fetson's number
must be fumished.
zCircle the minor's name and fumish lhe minor's SSN.
sYou must show vour individual narne on line 1 ' and enter your business
oi -og'A na;r;-ii aitv. on line 2. Yor may use either your SN or EIN [f
you have one), but the IRS encourages you to use your SSN.
a List {irst and circle the name of lhe trust, estate. or pension trust' {Do
not fumish ihe TIN of the personal representative o; truslee unless the
legal entity itself is not designated in the account tille.i
'Note: The grantor must also provide a Form W-9 to tfie truste€ of the
tru9t.
.* For more information on optional filing methods lot gt:lnto. busts, see
the lnslructions for Form 1041,
Note: lf no name is circled when more lhan one name is lisled, the
number will be considered to be that of the first name listed.
Secure Your Tax Records From ldentity Theft
ldentitv theft occurs when someone uses your penional inlormation.
such ai your name, SSN. or other identifoing information, t'rithout your
permission to commit {raud or ather crirnes. An idenltly thie{.may use
your SSN to get a iob or may liie a tax rehjm using your SSN to receive
a refund.
To reduce your risk
. Protect your SSN,
. Ensure your employer is prolecting your SSN, and
. Be careful when choosing a tax letum Preparer.
lf vour tax records are aflected by identity lheft and you receive a
noliie from the lFlS, respond right away lo the name and phone number
printed on the lFlS nctice or letter.
lf vour tax records are not cunenllv affected by idenllty thefl bul you
thin( you are al risk due to a lost or itolen purce or wallet. quesiionable
credifcard activity, or a queslionable credit repot contact lhe IBS
ldentiry Theft Hotline at 800-908-4490 or submit Fonn 14t139'
For more information, see Pub. 5027, ldentity Theft lnformation for
Taxpayers.
For this of accounl:
8- Disregarded entity not ovined by o
individml
9- A valid lru$t, B$tate, or pensim lrust
10. Corporation or LLC electing corporate
status on Fm 8832 or Frym 2553
11. Ass@irtim, club, rcligios, chwikble,
educational, or other til-exflPt
organiation
12- Partnership or mufti-mmber LLC
13, A broker or regisieFd rominm
1 4 . Acmur{ with the Departmst of
Agricuhure in lhe name of a Public
entity (such c a state or lrcal
gDvemtrtrrt" schml dbtrict. or prisonl
that rtreives agdcultunl Program
payments
1 5. Granlor trust filing Fm 1041 or
under lhe Optional Frling Method 2.
requiring Fom 1G9 (se Regulatiom
swtion 1.67.1 -4(bX2XiXB))"
Give name and €lN of:
The ourer
Legnl enti8{
Th€ c{poralien
Ttre organinlim
The partrership
Tle bro*s or nominee
Th€ public stity
Th€ trust
For this of account:
1, lndividual
2, Two or more individuals {loint account)
other lhan an sccount maintained by
m FFI
3- Two or more U,S. penons
(joint account maintained by an FFI)
4. Cuslodial account oJ a mins
(Unifom Gift to Minots Act)
5- a. The usu3l revmble xvings tust
(grmlor is alw trustee)
b. So-called trust accrunt thal is not
a legal or valirJ trusl undtr stale law
6- Sole proprietorship u disreguded
mtity owned by an individual
7. Gmntor trust filing under Optirml
Filing Method 1 {see Flegulations
s*tion 1.671 -a{bX2XiXA)}"
Give name and SSN ol:
The
The rctual o$er of the accrunt or,
if mmbined tunds. the firet individual
on ihe accounll
Eadr holder of lhe account
The minorz
The gr$tor-lrust*l
The actual ownerl
The ownerg
The grmtor'
Kittitas Cou nty Agreement for Services (rev . 5h4/25)
59
Page 6Fom fv-g {Rsv. 3-2024)
Victims ol identity theft who are experiencing economic.harm or a
systernic problem, br are seeking heli in resolving tax problems that
hlve not been resolved through hormal channels, may be eligible for
Taxpayer Advocate Service ftAS) assistance. You can reach TAS by
cattiirg fre tAS toll-ftee case intake line at 877-777-4778 orTfYlTDD
800-829-4059.
Protecl yours€ll from suspicious emails or phishing schemes.
Phishing-b lhe creation and use of email and websites designed to
mimic legitimate business emails and webeites' The mosl common act
is sending an email to a user falsely claiming. to be an established
legitimatienterprise in an attemPt to scam the user into sunendering
private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does nol request personal detailed information lhrough email or ask
taxoaverc for the PIN numbers, passwords, or similar secret access
infdrniation for their credit card,-bank, or other linancial sccounts.
lf vou receive an unsolicited email claiming to be from the lRS,
forwird this message to phishing@irs.gov. You may also report misuse
of the IRS name, loqo, or other IRS property to the Treasury lnspector
General for Tax Adririnistration (IIGTA) at 800-366-4484. You can
lonrard suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them alwww'ftc'govlcomdaint- You can
contact the-FTC at www, ftc.govl idtheft or 877-IDTHEFT (817-4it8-433si'
* you have been the victim oJ identity theft, seewww.ldentityTheft.gov
and Pub. 5027.
Go to www.irs.govltdentitylheftlo leam more aboul identity theft and
how to rcduce your risk.
Privacy Act Notice
Section 8109 of the lritemal Revenue Code requires 1tou lo provide your
conect TIN to persons $ncluding federal agencies) who, are required lo
fife :n{ormafiort relurns with lhe IRS to report interest, dividends, or
certain other inaome paid to yo.l; mo/tgage inletest you paid; the
acquisition or abandonment if securedfroPerty; the-c-anc€llation of
debt; o{ conlributions you made to an !RA, Archer MSA, or HSA' The
oerson collectinc this form uses the inlormation on the form to file
information retuirs with the lRS, reportirg the above information.
Routine uses al thb infarmgtion include giving it to the Department of
Justice for civil and criminal lhigation and to chies, stales, the District of
Columbia, and U.E. commonwealths and tenitories for use in
administerina lheir laws. The information may also be disclosed to olher
countries unier a treaty, to federa! and statsagencies to enlorce civil
and criminal laurs, or to federal law enforcement and inielligence
agencies to combat terrorism. You m.ust provide your'l1N wftether or not
y6u are required to file a tax relurn. Under section 34o6,.payors must
lenerally *tnhold a percentage o{ taxable interest, dividends' and
iertain othet payments to a pa.yee who does not give a TIN-to lhe payor'
Certain penalhes may also apply for providing false or fraudulent
information.
Kittitas County Agreement for Services (rev.5/74/25)
60