HomeMy WebLinkAboutAgreements/Contracts - New Hope DV/SA (002)K21-100
DSHS Central Contract Services
3003XS WorkFirst Client Service Contract (02-22-2021)
DRE C
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DSHS Contract Number:
V-0 S , 01;OW State
f.
CLIENT SERVICE CONTRACT
2112-22136
Department of soc"I
Resulting From Solicitation Number:
7 $e.t,,4Ce$
WorkFirst
Transforming lives
Family Violence Services
This Contract is between the State of Washington Department of Social
Program Contract Number:
and Health Services (DSHS) and the Contractor identified below.
Contractor Contract Number:
CONTRACTOR NAME
CONTRACTOR doing business as (DBA)
Grant County
New Hope
CONTRACTOR ADDRESS
WASHINGTON UNIFORM
DSHS INDEX NUMBER
311 W. Third Ave.
BUSINESS IDENTIFIER (UBI)
Moses Lake, WA 98837
132-001-884
1221
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE
CONTRACTOR FAX
CONTRACTOR E-MAIL ADDRESS
SuziFode
(509) 764-8402
1
sfode@grantcount=a.2ov
DSHS ADMINISTRATION
DSHS DIVISION
1
DSHS CONTRACT CODE
Economic Services
Administration
Community Services Division
3003XS-1 2
DSHS CONTACT NAME AND TITLE
DSHS CONTACT ADDRESS
John Vasquez
8517 E Trent Ave
WorkFirst Coordinator
Ste 202
Spokane Valley, WA Click here to enter text.
DSHS CONTACT TELEPHONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL ADDRESS
.(509)961-1688
(509)227-2822
1 vasquja@dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?
CFDA.NUMBER(S)
No
CONTRACT START DATE
CONTRACT END DATE
CONTRACT MAXIMUM AMOUNT
07/01/2021
06/30/2023
$31,000.00
EXHIBITS. The following Exhibits are attached and are incorporated into this Contract by reference:
0 Data Security: Exhibit A — Data Security Requirements
® Other Exhibits (specify): Exhibit B - Statement of Work; Exhibit C - Monthly Report plus Attachment 1: TANF Family
Violence Service Plan (sample)
The terms and conditions of this Contract are,an integration and representation of the final, entire and exclusive
understanding between the parties superseding and merging all previous agreements, writings, gs, and communications, oral
or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they havie read and
understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only
u on. patu'rebyDSH
CON OR Sl TUR
PRINTED NAME AND TITLE
DATE SIGNED
Cindy Carter, BOCC Chair
DSHS SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Alice Hildebrant, Contracts Officer
DSHS/ESA/Com m unity Services Division
7/19/21
DSHS Central Contract Services
3003XS WorkFirst Client Service Contract (02-22-2021)
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DSHS General Terms and Conditions
1. Definitions. The words and phrases listed below, as used in this Contract, shall each have the
following definitions:
a. "Central Contracts and Legal Services" means the DSHS central headquarters contracting office, or
successor section or office.
b. "Confidential Information" or "Data" means information that is exempt from disclosure to the public
or other unauthorized persons under RCW 42.56 or other federal or state laws. Confidential
Information includes, but is not limited to, Personal Information.
c. "Contract" or "Agreement" means the entire written agreement between DSHS and the Contractor,
including any Exhibits, documents, or materials incorporated by reference. The parties may execute
this contract in multiple counterparts, each of which is deemed an original and all of which
constitute only one agreement. E-mail or Facsimile transmission of a signed copy of this contract
shall be the same as delivery of an original.
d. "CCLS Chief' means the manager, or successor, of Central Contracts and Legal Services or
successor section or office.
e. "Contractor" means the individual or entity performing services pursuant to this Contract and
includes the Contractor's owners, members, officers, directors, partners, employees, and/or agents,
unless otherwise stated in this Contract. For purposes of any permitted Subcontract, "Contractor"
includes any Subcontractor and its owners, members, officers, directors, partners, employees,
and/or agents.
f. "Debarment" means an action taken by a Federal agency or official to exclude a person or business
entity from participating in transactions involving certain federal funds.
g. "DSHS" or the "Department" means the state of Washington Department of Social and Health
Services and its employees and authorized agents.
h. "Encrypt" means to encode Confidential Information into a format that can only be read by those
possessing a "key;" a password, digital certificate or other mechanism available only to authorized
users. Encryption must use a key length of at least 256 bits for symmetric keys, or 2048 bits for
asymmetric keys. When a symmetric key is used, the Advanced Encryption Standard (AES) must
be used if available.
i. "Personal Information" means information identifiable to any person, including, but not limited to,
information that relates to a person's name, health, finances, education, business, use or receipt of
governmental services or other activities, addresses, telephone numbers, Social Security Numbers,
driver license numbers, other identifying numbers, and any financial identifiers.
j. "Physically Secure" means that access is restricted through physical means to authorized
individuals only.
k. "Program Agreement" means an agreement between the Contractor and DSHS containing special
terms and conditions, including a statement of work to be performed by the Contractor and payment
to be made by DSHS.
I. "RCW" means the Revised Code of Washington. All references in this Contract to RCW chapters or
sections shall include any successor, amended, or replacement statute. Pertinent RCW chapters
can be accessed at http://apps.leg.wa.gov/rcw/.
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DSHS General Terms and Conditions
m. "Regulation" means any federal, state, or local regulation, rule, or ordinance.
n. "Secured Area" means an area to which only authorized representatives of the entity possessing
the Confidential Information have access. Secured Areas may include buildings, rooms or locked
storage containers (such as a filing cabinet) within a room, as long as access to the Confidential
Information is not available to unauthorized personnel.
o. "Subcontract" means any separate agreement or contract between the Contractor and an individual
or entity ("Subcontractor") to perform all or a portion of the duties and obligations that the Contractor
is obligated to perform pursuant to this Contract.
p. "Tracking" means a record keeping system that identifies when the sender begins delivery of
Confidential Information to the authorized and intended recipient, and when the sender receives
confirmation of delivery from the authorized and intended recipient of Confidential Information.
q. "Trusted Systems" include only the following methods of physical delivery: (1) hand -delivery by a
person authorized to have access to the Confidential Information with written acknowledgement of
receipt; (2) United States Postal Service ("USPS") first class mail, or USPS delivery services that
include Tracking, such as Certified Mail, Express Mail or Registered Mail; (3) commercial delivery
services (e.g. FedEx, UPS, DHL) which offer tracking and receipt confirmation; and (4) the
Washington State Campus mail system. For electronic transmission, the Washington State
Governmental Network (SGN) is a Trusted System for communications within that Network.
r. "WAC" means the Washington Administrative Code. All references in this Contract to WAC
chapters or sections shall include any successor, amended, or replacement regulation. Pertinent
WAC chapters or sections can be accessed at http://apps.leg.wa.gov/wac/.
2. Amendment. This Contract may only be modified by a written amendment signed by both parties. only
personnel authorized to bind each of the parties may sign an amendment.
3. Assignment. The Contractor shall not assign this Contract or any Program Agreement to a third party
without the prior written consent of DSHS.
4. Billing Limitations.
a. DSHS shall pay the Contractor only for authorized services provided in accordance with this
Contract.
b. DSHS shall not pay any claims for payment for services submitted more than twelve (12) months
after the calendar month in which the services were performed.
c. The Contractor shall not bill and DSHS shall not pay for services performed under this Contract, if
the Contractor has charged or will charge another agency of the state of Washington or any other
party for the same services.
5. Compliance with Applicable Law. At all times during the term of this Contract, the Contractor shall
comply with all applicable federal, state, and local laws and regulations, including but not limited to,
nondiscrimination laws and regulations.
6. Confidentiality.
a. The Contractor shall not use, publish, transfer, sell or otherwise disclose any Confidential
Information gained by reason of this Contract for any purpose that is not directly connected with
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Contractor's performance of the services contemplated hereunder, except:
(1) as provided by law; or,
(2) in the case of Personal Information, with the prior written consent of the person or personal
representative of the person who is the subject of the Personal Information.
b. The Contractor shall protect and maintain all Confidential Information gained by reason of this
Contract against unauthorized use, access, disclosure, modification or loss. This duty requires the
Contractor to employ reasonable security measures, which include restricting access to the
Confidential Information by:
(1) Allowing access only to staff that have an authorized business requirement to view the
Confidential Information.
(2) Physically Securing any computers, documents, or other media containing the Confidential
Information.
(3) Ensure the security of Confidential Information transmitted via fax (facsimile) by:
(a) Verifying the recipient phone number to prevent accidental transmittal of Confidential
Information to unauthorized persons.
(b) Communicating with the intended recipient before transmission to ensure that the fax will be
received only by an authorized person.
(c) Verifying after transmittal that the fax was received by the intended recipient.
(4) When transporting six (6) or more records containing Confidential Information, outside a
Secured Area, do one or more of the following as appropriate:
(a) Use a Trusted System.
(b) Encrypt the Confidential Information, including:
i. Encrypting email and/or email attachments which contain the Confidential Information.
ii. Encrypting Confidential Information when it is stored on portable devices or media,
including but not limited to laptop computers and flash memory devices.
Note: If the DSHS Data Security Requirements Exhibit is attached to this contract, this
item, 6.b.(4), is superseded by the language contained in the Exhibit.
(5) Send paper documents containing Confidential Information via a Trusted System.
(6) Following the requirements of the DSHS Data Security Requirements Exhibit, if attached to this
contract.
c. Upon request by DSHS, at the end of the Contract term, or when no longer needed, Confidential
Information shall be returned to DSHS or Contractor shall certify in writing that they employed a
DSHS approved method to destroy the information. Contractor may obtain information regarding
approved destruction methods from the DSHS contact identified on the cover page of this Contract.
d. Paper documents with Confidential Information may be recycled through a contracted firm, provided
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DSHS General Terms and Conditions
the contract with the recycler specifies that the confidentiality of information will be protected, and
the information destroyed through the recycling process. Paper documents containing Confidential
Information requiring special handling (e.g. protected health information) must be destroyed on-site
through shredding, pulping, or incineration.
e. Notification of Compromise or Potential Compromise. The compromise or potential compromise of
Confidential Information must be reported to the DSHS Contact designated on the contract within
one (1) business day of discovery. Contractor must also take actions to mitigate the risk of loss and
comply with any notification or other requirements imposed by law or DSHS.
7. Debarment Certification. The Contractor, by signature to this Contract, certifies that the Contractor is
not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
by any Federal department or agency from participating in transactions (Debarred). The Contractor also
agrees to include the above requirement in any and all Subcontracts into which it enters. The
Contractor shall immediately notify DSHS if, during the term of this Contract, Contractor becomes
Debarred. DSHS may immediately terminate this Contract by providing Contractor written notice if
Contractor becomes Debarred during the term hereof.
8. Governing Law and Venue. This Contract shall be construed and interpreted in accordance with the
laws of the state of Washington and the venue of any action brought hereunder shall be in Superior
Court for Thurston County.
9. Independent Contractor. The parties intend that an independent contractor relationship will be created
by this Contract. The Contractor and his or her employees or agents performing under this Contract are
not employees or agents of the Department. The Contractor, his or her employees, or agents
performing under this Contract will not hold himself/herself out as, nor claim to be, an officer or
employee of the Department by reason hereof, nor will the Contractor, his or her employees, or agent
make any claim of right, privilege or benefit that would accrue to such officer or employee.
10. Inspection. The Contractor shall, at no cost, provide DSHS and the Office of the State Auditor with
reasonable access to Contractor's place of business, Contractor's records, and DSHS client records,
wherever located. These inspection rights are intended to allow DSHS and the Office of the State
Auditor to monitor, audit, and evaluate the Contractor's performance and compliance with applicable
laws, regulations, and these Contract terms. These inspection rights shall survive for six (6) years
following this Contract's termination or expiration.
11. Maintenance of Records. The Contractor shall maintain records relating to this Contract and the
performance of the services described herein. The records include, but are not limited to, accounting
procedures and practices, which sufficiently and properly reflect all direct and indirect costs of any
nature expended in the performance of this Contract. All records and other material relevant to this
Contract shall be retained for six (6) years after expiration or termination of this Contract.
Without agreeing that litigation or claims are legally authorized, if any litigation, claim, or audit is started
before the expiration of the six (6) year period, the records shall be retained until all litigation, claims, or
audit findings involving the records have been resolved.
12. Order of Precedence. In the event of any inconsistency or conflict between the General Terms and
Conditions and the Special Terms and Conditions of this Contract or any Program Agreement, the
inconsistency or conflict shall be resolved by giving precedence to these General Terms and
Conditions. Terms or conditions that are more restrictive, specific, or particular than those contained in
the General Terms and Conditions shall not be construed as being inconsistent or in conflict.
13. Severability. If any term or condition of this Contract is held invalid by any court, the remainder of the
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DSHS General Terms and Conditions
Contract remains valid and in full force and effect.
14. Survivability. The terms and conditions contained in this Contract or any Program Agreement which,
by their sense and context, are intended to survive the expiration or termination of the particular
agreement shall survive. Surviving terms include, but are not limited to: Billing Limitations;
Confidentiality, Disputes; Indemnification and Hold Harmless, Inspection, Maintenance of Records,
Notice of Overpayment, Ownership of Material, Termination for Default, Termination Procedure, and
Treatment of Property.
15. Contract Renegotiation, Suspension, or Termination Due to Change in Funding.
If the funds DSHS relied upon to establish this Contract or Program Agreement are withdrawn, reduced
or limited, or if additional or modified conditions are placed on such funding, after the effective date of
this contract but prior to the normal completion of this Contract or Program Agreement:
a. At DSHS's discretion, the Contract or Program Agreement may be renegotiated under the revised
funding conditions.
b. At DSHS's discretion, DSHS may give notice to Contractor to suspend performance when DSHS
determines that there is reasonable likelihood that the funding insufficiency may be resolved in a
timeframe that would allow Contractor's performance to be resumed prior to the normal completion
date of this contract.
(1) During the period of suspension of performance, each party will inform the other of any
conditions that may reasonably affect the potential for resumption of performance.
(2) When DSHS determines that the funding insufficiency is resolved, it will give Contractor written
notice to resume performance. Upon the receipt of this notice, Contractor will provide written
notice to DSHS informing DSHS whether it can resume performance and, if so, the date of
resumption. For purposes of this subsubsection, "written notice" may include email.
(3) If the Contractor's proposed resumption date is not acceptable to DSHS and an acceptable date
cannot be negotiated, DSHS may terminate the contract by giving written notice to Contractor.
The parties agree that the Contract will be terminated retroactive to the date of the notice of
suspension. DSHS shall be liable only for payment in accordance with the terms of this
Contract for services rendered prior to the retroactive date of termination.
c. DSHS may immediately terminate this Contract by providing written notice to the Contractor. The
termination shall be effective on the date specified in the termination notice. DSHS shall be liable
only for payment in accordance with the terms of this Contract for services rendered prior to the
effective date of termination. No penalty shall accrue to DSHS in the event the termination option in
this section is exercised.
16. Waiver. Waiver of any breach or default on any occasion shall not be deemed to be a waiver of any
subsequent breach or default. Any waiver shall not be construed to be a modification of the terms and
conditions of this Contract. Only the CCLS Chief or designee has the authority to waive any term or
condition of this Contract on behalf of DSHS.
Additional General Terms and Conditions — Client Service Contracts:
17. Advance Payment. DSHS shall not make any payments in advance or anticipation of the delivery of
services to be provided pursuant to this Contract.
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13. Construction. The language in this Contract shall be interpreted as to its fair meaning and not strictly
for or against any party. Any rule of construction to the effect that ambiguities are to be resolved
against the drafting party shall not apply in interpreting this Contract.
19. Contractor Certification Regarding Ethics. The Contractor certifies that the Contractor is now, and
shall remain, in compliance with Chapter 42.52 RCW, Ethics in Public Service, throughout the term of
this Contract.
20. Health and Safety. Contractor shall perform any and all of its obligations under this Contract in a
manner that does not compromise the health and safety of any DSHS client with whom the Contractor
has contact.
21. Indemnification and Hold Harmless.
a. The Contractor shall be responsible for and shall indemnify, defend, and hold DSHS harmless from
any and all claims, costs, charges, penalties, demands, losses, liabilities, damages, judgments, or
fines, of whatsoever kind of nature, arising out of or relating to a) the Contractor's or any
Subcontractor's performance or failure to perform this Contract, or b) the acts or omissions of the
Contractor or any Subcontractor.
b. The Contractor's duty to indemnify, defend, and hold DSHS harmless from any and all claims,
costs, charges, penalties, demands, losses, liabilities, damages, judgments, or fines shall include
DSHS' personnel -related costs, reasonable attorney's fees, court costs, and all related expenses.
c. The Contractor waives its immunity under Title 51 RCW to the extent it is required to indemnify,
defend, and hold harmless the State and its agencies, officials, agents, or employees.
d. Nothing in this term shall be construed as a modification or limitation on the Contractor's obligation
to procure insurance in accordance with this Contract or the scope of said insurance.
22. Industrial Insurance Coverage. The Contractor shall comply with the provisions of Title 51 RCW,
Industrial Insurance. If the Contractor fails to provide industrial insurance coverage or fails to pay
premiums or penalties on behalf of its employees, as may be required by law, DSHS may collect from
the Contractor the full amount payable to the Industrial Insurance accident fund. DSHS may deduct the
amount owed by the Contractor to the accident fund from the amount payable to the Contractor by
DSHS under this contract, and transmit the deducted amount to the Department of Labor and
Industries, (L&I) Division of Insurance Services. This provision does not waive any of L&I's rights to
collect from the Contractor.
23. Notice of Overpayment. If the Contractor receives a vendor overpayment notice or a letter
communicating the existence of an overpayment from DSHS, the Contractor may protest the
overpayment determination by requesting an adjudicative proceeding. The Contractor's request for an
adjudicative proceeding must:
a. Be received by the Office of Financial Recovery (OFR) at Post Office Box 9501, Olympia,
Washington 98507-9501, within twenty-eight (28).calendar days of service of the notice;
b. Be sent by certified mail (return receipt) or other manner that proves OFR received the request;
c. Include a statement as to why the Contractor thinks the notice is incorrect; and
d. Include a copy of the overpayment notice.
Timely and complete requests will be scheduled for a formal hearing by the Office of Administrative
Hearings. The Contractor may be offered a pre -hearing or alternative dispute resolution conference in
an attempt to resolve the overpayment dispute prior to the hearing.
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DSHS General Terms and Conditions
Failure to provide OFR with a written request for a hearing within twenty-eight (28) days of service of a
vendor overpayment notice or other overpayment letter will result in an overpayment debt against the
Contractor. DSHS may charge the Contractor interest and any costs associated with the collection of
this overpayment. DSHS may collect an overpayment debt through lien, foreclosure, seizure and sale
of the Contractor's real or personal property; order to withhold and deliver; or any other collection action
available to DSHS to satisfy the overpayment debt.
24. Subcontracting. Except as otherwise provided in this Contract, the Contractor shall not subcontract
any of the contracted services without the prior approval of DSHS. Contractor is responsible to ensure
that all terms, conditions, assurances and certifications set forth in this Contract are included in any and
all Subcontracts, unless an exception to including a particular term or terms has been approved in
advance by the CCLS Chief. Any failure of Contractor or its subcontractors to perform the obligations
of this Contract shall not discharge the Contractor from its obligations hereunder or diminish DSHS'
rights or remedies available under this Contract.
25. Subrecipients.
a. General. If the Contractor is a subrecipient of federal awards as defined by 2 CFR Part 200 and
this Agreement, the Contractor shall:
(1) Maintain records that identify, in its accounts, all federal awards received and expended and the
federal programs under which they were received, by Catalog of Federal Domestic Assistance
(CFDA) title and number, award number and year, name of the federal agency, and name of the
pass-through entity;
(2) Maintain internal controls that provide reasonable assurance that the Contractor is managing
federal awards in compliance with laws, regulations, and provisions of contracts or grant
agreements that could have a material effect on each of its federal programs;
(3) Prepare appropriate financial statements, including a schedule of expenditures of federal
awards;
(4) Incorporate 2 CFR Part 200, Subpart F audit requirements into all agreements between the
Contractor and its Subcontractors who are subrecipients;
(5) Comply with the applicable requirements of 2 CFR Part 200, including any future amendments to
2 CFR Part 200, and any successor or replacement Office of Management and Budget (OMB)
Circular or regulation; and
(6) Comply with the Omnibus Crime Control and Safe streets Act of 1968, Title VI of the Civil Rights
Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the Americans with
Disabilities Act of 1990, Title IX of the Education Amendments of 1972, The Age Discrimination
Act of 1975, and The Department of Justice Non -Discrimination Regulations, 28 C.F.R. Part 42,
Subparts C.D.E. and G, and 28 C.F.R. Part 35 and 39. (Go to
htt-ps://oip.gov/about/offices/ocr.htm for additional information and access to the aforementioned
Federal laws and regulations.)
b. Single Audit Act Compliance. If the Contractor is a subrecipient and expends $750,000 or more in
federal awards from any and/or all sources in any fiscal year, the Contractor shall procure and pay
for a single audit or a program -specific audit for that fiscal year. Upon completion of each audit, the
Contractor shall:
(1) Submit to the DSHS contact person the data collection form and reporting package specified in
2 CFR Part 200, Subpart F, reports required by the program -specific audit guide (if applicable),
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DSHS General Terms and Conditions
and a copy of any management letters issued by the auditor;
(2) Follow-up and develop corrective action for all audit findings; in accordance with 2 CFR Part
200, Subpart F; prepare a "Summary Schedule of Prior Audit Findings" reporting the status of all
audit findings included in the prior audit's schedule of findings and questioned costs.
c. Overpayments. If it is determined by DSHS, or during the course of a required audit, that the
Contractor has been paid unallowable costs under this or any Program Agreement, DSHS may
require the Contractor to reimburse DSHS in accordance with 2 CFR Part 200.
26. Termination for Convenience. DSHS may terminate this Contract in whole or in part when it is in the
best interest of DSHS by giving the Contractor at least thirty (30) calendar days' written notice. The
Contractor may terminate this Contract for convenience by giving DSHS at least thirty (30) calendar
days' written notice addressed to DSHS at the address listed on page 1 of this Contract.
27. Termination for Default. The CCLS Chief may immediately terminate this Contract for default, in
whole or in part, by written notice to the Contractor if DSHS has a reasonable basis to believe that the
Contractor has:
a. Failed to meet or maintain any requirement for contracting with DSHS;
b. Failed to protect the health or safety of any DSHS client pursuant to the section entitled Health and
Safety of this Contract;
c. Failed to perform under, or otherwise breached, any term or condition of this Contract; and/or
d. Violated any applicable law or regulation.
If it is later determined that the Contractor was not in default, the termination shall be considered a
termination for convenience.
28. Termination or Expiration Procedure. The following terms and conditions apply upon Contract
termination or expiration:
a. The Contractor shall cease to perform any services required by this Contract as of the effective date
of termination or expiration.
b. If the Contract is terminated, the Contractor shall comply with all instructions contained in the
termination notice.
c. The Contractor shall immediately deliver to the DSHS contact named on page one of this Contract,
or to his or her successor, all DSHS property in the Contractor's possession. The Contractor grants
DSHS the right to enter upon the Contractor's premises for the sole purpose of recovering any
DSHS property that the Contractor fails to return within ten (10) calendar days of the effective date
of termination or expiration of this Contract. Upon failure to return DSHS property within ten (10)
calendar days, the Contractor shall be charged with all reasonable costs of recovery, including
transportation.
d. DSHS shall be liable only for payment required under the terms of this Contract for service
rendered up to the effective date of termination or expiration.
e. DSHS may withhold a sum from the final payment to the Contractor that DSHS determines
necessary to protect DSHS against loss or additional liability.
f. The rights and remedies provided to DSHS in this Section are in addition to any other rights and
remedies provided at law, in equity, and/or under this Contract, including consequential and
incidental damages.
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DSHS General Terms and Conditions
29. Treatment of Client Property. Unless otherwise provided, the Contractor shall ensure that any adult
client receiving services from the Contractor has unrestricted access to the client's personal property.
The Contractor shall not interfere with any adult client's ownership, possession, or use of the client's
property. The Contractor shall provide clients under age eighteen (18) with reasonable access to their
personal property that is appropriate to the client's age, development, and needs. Upon termination of
services to a client, the Contractor shall immediately release to the client and/or the client's guardian or
custodian all of the client's personal property.
30. Treatment of Property. All property purchased or furnished by DSHS for use by the Contractor during
this Contract term shall remain with DSHS. Title to all property purchased or furnished by the
Contractor for which the Contractor is entitled to reimbursement by DSHS under this Contract shall
pass to and vest in DSHS. The Contractor shall protect, maintain, and insure all DSHS property in its
possession against loss or damage and shall return DSHS property to DSHS upon Contract termination
or expiration.
31. Taxes.
a. Where required by statute or regulation, Contractor shall pay for and maintain in current status all
taxes that are necessary for Contract performance. DSHS will pay sales or use taxes, if any,
imposed on the services and materials acquired hereunder. Contractor must pay all other taxes
including without limitation Washington Business and Occupation Tax, other taxes based on
Contractor's income or gross receipts, or personal property taxes levied or assessed on
Contractor's personal property. DSHS, as an agency of Washington State government, is exempt
from property tax.
b. Contractor shall complete registration with the Washington State Department of Revenue and be
responsible for payment of all taxes due on payments made under this Contract in accordance with
the requirements of Title 82 RCW and Title 458 WAC. Out-of-state Contractors must contact the
Department of Revenue to determine whether they meet criteria to register and establish an
account with the Department of Revenue. Refer to WAC 458-20-101 (Tax registration and tax
reporting) and call the Department of Revenue at 800-647-7706 for additional information. When
out-of-state Contractors are not required to collect and remit sales tax, DSHS shall be responsible
for paying use tax, if applicable, directly to the Department of Revenue.
c. All payments accrued on account of payroll taxes, unemployment contributions, any other taxes,
insurance, or other expenses for Contractor or Contractor's staff shall be Contractor's sole
responsibility.
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Special Terms and Conditions
1. Definitions.
The words and phrases listed below, as used in this Contract, shall each have the following definitions:
a. "CSD" .means the DSHS, Economic Services Administration (ESA,) Community Services Division
(CSD).
b. "Data" means any Personal Information, and/or other information accessed and gained while
providing services in association with this Contract.
c. "ESA" means the DSHS Economic Services Administration.
d. "TANF" means Temporary Assistance for Needy Families.
e. "WorkFirst Program" means Washington State's program to assist recipients of Temporary
Assistance for Needy Families (TANF) to meet their goals and provide well-being for their family.
f. "DSHS Contact" means the DSHS Contact listed on page one (1) of this Contract.
g. "Personnel" means the Contractor's employees, or subcontractors employees and or volunteers.
2. Purpose.
The purpose of this Contract is as set forth in attached Exhibit(s).
3. Statement of Work.
The Contractor shall provide the services and staff, and otherwise do all things necessary for or
incidental to the performance of work, as set forth in the attached Exhibit(s).
4. Consideration.
Total consideration payable to Contractor for satisfactory performance of the work under this Contract,
shall be paid in accordance with the fees set forth in the attached Exhibit(s).
Total consideration payable for the contract period to the Contractor for satisfactory work performance
including any and all expenses under this Contract is up to a maximum of $ 31,000.
Unspent funds designated for any State Fiscal Year shall remain unspent and may not be carried
forward into the following State Fiscal Year.
Consideration payable per State Fiscal Year:
State Fiscal Year 2022 (July 1, 2021 through June 30, 2022) _ $ 31,000
State Fiscal Year 2023 (July 1, 2022 through June 30, 2023) _ $ 0
5. Billing and Payment.
a. Invoice System. The Contractor shall submit invoices using State Form A-19 Invoice Voucher, or
such other form as designated by DSHS. Consideration for services rendered shall be payable
upon receipt of properly completed invoices, which shall be submitted to the DSHS Contact. The
Contractor shall submit one (1) invoice for each month. Invoices must be received by the DSHS
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Contact no later than thirty (30) calendar days after the last day of each month. The invoices shall
describe and document to DSHS' satisfaction a description of the work performed, activities
accomplished, and fees.
b. Payment. Payment shall be considered timely if made by DSHS within thirty (30) days after receipt
and acceptance by DSHS of the properly completed invoices. Payment shall be sent to the
address designated by the Contractor on page one (1) of this Contract. DSHS may, at its sole
discretion, withhold payment claimed by the Contractor for services rendered if Contractor fails to
satisfactorily comply with any term or condition of this Contract.
6. Child Abuse and Health and Safety Concerns.
In the delivery of services under this Contract, the health and safety of children and vulnerable adults
shall always be the first concern of the Contractor. The Contractor shall immediately report all
instances of suspected child or vulnerable adult abuse to Child Protective Services at 1 -866 -END
HARM.
7. Fraud Reporting.
The Contractor shall report any knowledge of welfare fraud by calling 1-800-562-6906 or online at
htfi s:Hwadshs.libera.com/S s7CMSPortaI-FCMS-WA/fraud/re ort.as x.
8. Contractor Information.
The Contractor shall forward to the DSHS Contact (or successor) within ten (10) working days, any
information concerning the Contractor's change of circumstances. Changes in the Contractor's
circumstances include change of business name, address, telephone number, fax number, e-mail
address, business status and names of staff who are current state employees.
9. Contract Suspension.
DSHS may take certain actions in the event the Contractor, or any of its partners, officers, directors, or
employees, is investigated by a local, county, state or federal agency, for a matter which DSHS
determines may adversely affect the delivery of services provided under this Contract. DSHS may,
without prior notice, either suspend the delivery of services or disallow the person(s) involved in the
allegation(s) from providing services or having contact with clients pending final resolution of the
investigation.
10. Criminal History Background Checks.
a. The Contractor Must:
(1) Have current Background checks on file for any employee, subcontractor and/or volunteer, who
will provide direct, one-on-one services to DSHS clients under this contract. Require a DSHS
executed criminal background check for each employee and volunteer who will provide direct,
one-on-one services to DSHS clients under this contract. The Contractor will obtain a DSHS
Background Check Authorization form 09-653 provided by the DSHS Contract Contact listed on
page one (1) of this contract, or their designee. Email or fax the Background Check
Authorization form to the DSHS Contact, or their designee.
(2) Require if the employee has lived outside of the State of Washington at any time during the past
three (3) years, an FBI background check to be completed which requires that the employee be
fingerprinted.
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(3) Verify that for personnel who have a criminal record that the crime is not "disqualifying" as
described on the DSHS Secretary's List of Crimes & Negative Actions. DSHS will provide the
Contractor with the DSHS Secretary's List of Crimes & Negative Actions. Personnel with a
disqualifying crime are prohibited from providing direct, one-on-one services to DSHS clients
under this contract. The Contractor can review what crimes are "disqualifying" as listed in the
following link to the DSHS Secreta 's List of Crimes & Negative Actions.
(4) Provide the DSHS contract contact listed on page one (1) of this contract, or their designee, with
a list of employees, subcontractors and/or volunteers who will be providing direct, one-on-one
services to DSHS clients and have successfully passed a Criminal Background check. Send
an updated list to the DSHS contract contact, or their designee, when there are changes in
personnel providing direct, one-on-one client services under this contract.
b. The DSHS Contract Contact, or their designee, will receive the background check results and will
determine if the applicant "passed" the background check. DSHS will notify the Contractor if
Contractor staff or volunteers:
(1) Have a record of disqualifying crime(s). The Contractor shall not hire or retain, directly or by
contract, any individual having direct contact with vulnerable adults to work under this contract if
the individual has a record of disqualifying crime(s).
(2) In the case of an employee or volunteer having a record of a past crime that is not a
disqualifying crime, the Contractor will need to consider character, competence, and suitability
of this individual. The Contractor would then weigh the risks before allowing them to have
unsupervised access to DSHS clients.
c. Copy of Criminal Background Check result is not provided to the Contractor. Criminal Background
Check results are kept confidential between DSHS and the Contractor's staff or volunteers.
d. Background check results will remain in effect for the period of performance of the contract.
e. The Contractor shall conditionally employ an individual without allowing said individual to have
direct one-on-one contact with vulnerable adults pending completion of a Criminal Background
Check.
f. Provide background check information to DSHS upon request and/or during contract monitoring
activities.
11. Notice of Nondisclosure.
The Contractor shall:
a. Ensure each employee, volunteer, etc. who will have access to client confidential information signs
an "ESA Nondisclosure of Confidential Information Agreement — Non -Employee" (hereafter,
referenced as "Nondisclosure form") provided by DSHS when a new contract is issued and signed
annually thereafter.
b. Remind employees, volunteers, etc. annually of DSHS nondisclosure requirements.
c. Retain copies of all signed nondisclosure forms on file for monitoring purposes and must be made
available for DSHS review upon request.
d. DSHS will only grant access to client confidential data as required to provide services under this
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contract.
e. Take precautions to secure against unauthorized physical and electronic access to client data in a
manner to prevent unauthorized access persons, including the public, from retrieving data by
means of computer, remote terminal, or other means.
f. Take note that violations of the nondisclosure provisions of this contract may result in criminal or
civil penalties. Violation is a gross misdemeanor under RCW 74.04.060, punishable by
imprisonment of not more than one year and/or a fine not to exceed five thousand dollars.
Sanctions also may apply under other state and federal law, including civil and criminal penalties for
violations of the H I PAA Privacy and Security rules.
12. Data Sharing - Access to eJAS.
a. Data Access.
The Contractor shall limit access to DSHS data to authorized personnel whose duties specifically
require access to such data in the performance of their assigned duties.
b. Description of Data.
(1) Data Elements.
Client's personal data including but not limited to:
(a) Name.
(b) Date of birth.
(c) Social security number.
(d) Address.
(e) Household composition.
(f) Employer and wage information.
(g) Component history, not including confidential components such as family violence, chemical
dependency, mental health, and HIV/AIDS.
(h) Individual Responsibility Plans (IRP's).
(i) eJAS notes, not including notes pertaining to confidential information pertaining to family
violence, chemical dependency, mental health, and HIV/AIDS.
c. Frequency and time frame(s) for data disclosure or exchange.
Contractor will have daily access to eJAS for the duration of the Contract.
d. Access to eJAS.
(1) The eJAS access level for the personnel will be as authorized by DSHS.
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(2) The Contractor shall access eJAS through on-line personal computers attached to a Local Area
Network (LAN) or dial-up connection on a secured Internet connection. All transactions shall be
secured through the Washington State Fortress server.
(3) The Contractor shall provide the DSHS Contact a list of personnel that will have access to
DSHS client data and or will have access to eJAS.
(a) The Contractor shall provide this information within one month after the Contract start date.
(b) If there are any changes to this list, within ten (10) business days, the Contractor shall
provide the DSHS Contact an updated list.
(c) The Contractor shall contact the DSHS Contact whenever they need to increase the number
of their staff that are granted access to eJAS.
e. The Contractor shall notify the DSHS Contact when any personnel with access to DSHS client data
is terminated from employment or when their duties no longer require access to DSHS client data.
f. The Contrator shall provide staff with appropriate privacy and confidentiality training and ensure
staff, contractors, and subcontractors read and sign ESA Nondisclosure of Confidential
Information Agreement — Non Employee form, prior to initial access and annually thereafter. The
DSHS Contact, or their designee, will provide the Contractor with the form.
(1) The Contractor shall retain the original signed copies of the forms for their records.
(2) Upon DSHS request, the Contractor shall provide DSHS with copies of the signed forms.
g. DSHS reserves the right to revoke, at any time, an individual's authorization to access information.
DSHS shall send a written Notice Termination of Access, effective no later than date of receipt, to
the effected individual. Such notice shall be made by certified mail.
h. The Contractor or their personnel may not release any DSHS data to any other agency or person
without the specific written consent of the client.
Unauthorized disclosure of data is a gross misdemeanor, punishable by law.
j. The Contractor is subject to the same standards and laws of confidentiality as is DSHS.
13. Data Confidentiality.
All data within eJAS belongs to DSHS. The contractor shall not use, publish, transfer, sell or otherwise
disclose any Confidential Information gained for any purpose that is not directly connected with the
purpose of this Contract set out in the Special Terms and Conditions except with the prior written
consent of DSHS.
14. Data Breach.
Specific to this Agreement if any employee becomes aware of compromise or potential compromise of
Confidential Information, the employee must immediately contact the ESA Privacy Officer and Security
Contact (DSHS: dshsprivacyofficer@dshs.wa.gov and ESA: esadsa@dshs.wa.gov) within one (1)
business day of discovery. The notifying party must also take actions to mitigate the risk of loss and
comply with any notification or other requirements imposed by law.
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15. Re -disclosure of Data.
The data to be shared under this Contract is confidential and is subject to state and federal
confidentiality requirements and all confidentiality and data use terms and conditions provided in the
Contract.
16. Consent.
a. The Contractor must obtain and retain a valid written consent form signed in advance by the
client that allows DSHS to share information with the Contractor. The form must meet the DSHS
authorization standards, or get DSHS approval on Contractors consent language. The contractor
can request the DSHS consent form 14-012(x) from the DSHS contact.
b. The Contractor must retain copies of the signed application and consent form(s) on file in either an
electronic format, hardcopy format, or both for monitoring purposes. Contractor must make these
forms available to DSHS Contact upon request.
c. The Contractor agrees not to access any other clients' data in eJAS who hasn't applied for
Contractor's services or who have not signed a consent.
17. Contract Monitoring.
The Contractor's records related to this Contract will be reviewed for compliance with terms and
conditions. DSHS reserves all other rights of inspection as provided in the General Terms and
Conditions of the Contract.
18. Subcontracting.
The Contractor is prohibited from subcontracting services under this contract.
19. Interpretation and Translation Services.
The Contractor shall provide interpreter and translation services as necessary to perform the
obligations of this Contract, and DSHS shall not reimburse the Contractor for the use of interpreter or
translation services, except if specifically stated in an Exhibit of this Contract.
20. Participant Referrals.
DSHS, at its sole discretion, shall refer participants to the Contractor on an as -needed basis, and does
not guarantee any participants shall be referred to the Contractor during the period of performance of
this Contract. DSHS reserves the right to withdraw any participant(s) referred to the Contractor.
21. Insurance
The Contractor shall obtain and maintain for the duration of the Contract, at Contractor's expense, the
following insurance coverages, and comply with the following insurance requirements.
a. General Liability Insurance
The Contractor shall maintain Commercial General Liability Insurance or Business Liability
Insurance, no less comprehensive than coverage under Insurance Service Offices, Inc. (ISO) form
CG 00-01, including coverage for bodily injury, property damage, and contractual liability. The
amount of coverage shall be no less than $1,000,000 per occurrence and $2,000,000 General
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Aggregate. The policy shall include liability arising out of the parties' performance under this
Contract, including but not limited to premises, operations, independent contractors, products -
completed operations, personal injury, advertising injury, and liability assumed under an insured
contract. The State of Washington, Department of Social & Health Services (DSHS), its elected
and appointed officials, agents, and employees of the state, shall be named as additional insureds.
b. In lieu of general liability insurance mentioned in Subsection a. above, if the Contractor is a sole
proprietor with less than three contracts, the contractor may choose one of the following three
general liability policies, but only if attached to a professional liability policy. If selected the policy
shall be maintained for the life of the contract:
Supplemental Liability Insurance, including coverage for bodily injury and property damage that will
cover the contractor wherever the service is performed with minimum limits of $1,000,000 per
occurrence; and $2,000,000 General Aggregate. The State of Washington, DSHS, its elected and
appointed officials, agents, and employees shall be named as additional insureds;
COTS
Workplace Liability Insurance, including coverage for bodily injury and property damage that
provides coverage wherever the service is performed with minimum limits of $1,000,000 per
occurrence; and $2,000,000 General Aggregate. The State of Washington, DSHS, its elected and
appointed officials, agents, and employees shall be named as additional insureds:
[oil
Premises Liability Insurance if services are provided only at their recognized place of business,
including coverage for bodily injury, property damage with minimum limits of $1,000,000 per
occurrence; and $2,000,000 General Aggregate. The State of Washington, DSHS, its elected and
appointed officials, agents, and employees shall be named as additional insureds.
c. Workers' Compensation
The Contractor shall comply with all applicable Workers' Compensation, occupational disease, and
occupational health and safety laws and regulations. The State of Washington and DSHS shall not
be held responsible for claims filed for Workers' Compensation under Title 51 RCW by the
Contractor or its employees under such laws and regulations.
d. Employees and Volunteers
Insurance required of the Contractor under the Contract shall include coverage for the acts and
omissions of the Contractor's employees and volunteers. In addition, the Contractor shall ensure
that all employees and volunteers who use vehicles to transport clients or deliver services have
personal automobile insurance and current driver's licenses.
e. Subcontractors
The Contractor shall ensure that all subcontractors have and maintain insurance with the same
types and limits of coverage as required of the Contractor under the Contract. Failure of
Subcontractors to comply with the insurance requirements in this Contract does not limit the
Contractor's liability or responsibility.
f. Separation of Insureds
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All insurance policies shall include coverage for cross liability and contain a "Separation of
Insureds" provision.
g. Insurers
The Contractor shall obtain insurance from insurance companies identified as an admitted
insurer/carrier in the State of Washington, with a current Best's Reports' rating of A-, Class VII, or
better.
h. Evidence of Coverage
The Contractor shall, upon request by DSHS, submit a copy of the Certificate of Insurance, policy,
and additional insured endorsement for each coverage required of the Contractor under this
Contract. The Certificate of Insurance shall identify the Washington State Department of Social and
Health Services as the Certificate Holder. A duly authorized representative of each insurer,
showing compliance with the insurance requirements specified in this Contract, shall execute each
Certificate of Insurance.
The Contractor shall maintain copies of Certificates of Insurance, policies, and additional insured
endorsements for each subcontractor as evidence that each subcontractor maintains insurance as
required by the Contract.
i. Material Changes
The insurer shall give the DSHS point of contact listed on page one of this Contract 45 days
advance written notice of cancellation or non -renewal of any insurance policy required under this
Contract. If cancellation is due to non-payment of premium, the insurer shall give DSHS 10 days
advance written notice of cancellation. Failure to provide notice as required may result in
termination of the Contract.
j. Waiver of Subrogation
Contractor waives all rights of subrogation against DSHS for the recovery of damages to the extent
such damages are or would be covered by insurance required under the Contract. Contractor
agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but
this provision applies whether or not DSHS receives the waiver of subrogation endorsement from
the insurer.
k. Coverage Limits
By requiring insurance, the State of Washington and DSHS do not represent that the coverage and
limits required in this Contract will be adequate to protect the Contractor. Such coverage and limits
shall not limit the Contractor's liability in excess of the required coverage and limits, and shall not
limit the Contractor's liability under the indemnities and reimbursements granted to the State and
DSHS in this Contract.
I. Primary Coverage
All Contractor's insurance provided in compliance with this Contract shall be primary and shall not
seek contribution from insurance or self-insurance programs afforded to or maintained by the State.
Insurance or self-insurance programs afforded to or maintained by the State shall be in excess of,
and shall not contribute with, insurance required of the Contractor and Subcontractors under this
Contract.
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m. Waiver
The Contractor waives all rights, claims and causes of action against the State of Washington and
DSHS for the recovery of damages to the extent said damages are covered by insurance
maintained by Contractor.
n. Liability Cap
Any limitation of liability or liability cap set forth in this Contract shall not preclude DSHS from
claiming under any insurance maintained by the Contractor pursuant to this Contract, up to the
policy limits.
o. Business Automobile Liability Insurance
The Contractor shall maintain a Business Automobile Policy on all vehicles used to transport
clients, including vehicles hired by the Contractor or owned by the Contractor's employees,
volunteers or others, with the following minimum limits: $1,000,000 per accident combined single
limit. The Contractor's carrier shall provide DSHS with a waiver of subrogation or name DSHS as
an additional insured.
p. Professional Liability (errors &omissions)
The Contractor shall maintain insurance of at least $1,000,000 per occurrence, $2,000,000 General
Aggregate for malpractice or errors and omissions coverage against liability for damages because
of personal injury, bodily injury, death, or damage to property, including loss of use, and damages
because of negligent acts, errors, and omissions in any way related to this contract.
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Exhibit A — Data Security Requirements
1. Definitions. The words and phrases listed below, as used in this Exhibit, shall each have the following
definitions:
a. "AES" means the Advanced Encryption Standard, a specification of Federal Information Processing
Standards Publications for the encryption of electronic data issued by the National Institute of
Standards and Technology (http://nvipubs.nist.gov/nistpubs/FIPS/NIST.FIPS.197.pdf).
b. "Authorized Users(s))I means an individual or individuals with a business need to access DSHS
Confidential Information, and who has or have been authorized to do so.
c. "Business Associate Agreement" means an agreement between DSHS and a contractor who is
receiving Data covered under the Privacy and Security Rules of the Health Insurance Portability
and Accountability Act of 1996. The agreement establishes permitted and required uses and
disclosures of protected health information (PHI) in accordance with HIPAA requirements and
provides obligations for business associates to safeguard the information.
d. "Category 4 Data" is data that is confidential and requires special handling due to statutes or
regulations that require especially strict protection of the data and from which especially serious
consequences may arise in the event of any compromise of such data. Data classified as Category
4 includes but is not limited to data protected by: the Health Insurance Portability and Accountability
Act (HIPAA), Pub. L. 104-191 as amended by the Health Information Technology for Economic and
Clinical Health Act of 2009 (HITECH), 45 CFR Parts 160 and 164; the Family Educational Rights
and Privacy Act (FERPA), 20 U.S.C. §1232g; 34 CFR Part 99; Internal Revenue Service
Publication 1075 (https://www.irs.gov/pub/irs-pdf/pl075.pdf); Substance Abuse and Mental Health
Services Administration regulations on Confidentiality of Alcohol and Drug Abuse Patient Records,
42 CFR Part 2; and/or Criminal Justice Information Services, 28 CFR Part 20.
e. "Cloud" means data storage on servers hosted by an entity other than the Contractor and on a
network outside the control of the Contractor. Physical storage of data in the cloud typically spans
multiple servers and often multiple locations. Cloud storage can be divided between consumer
grade storage for personal files and enterprise grade for companies and governmental entities.
Examples of consumer grade storage would include iTunes, Dropbox, Box.com, and many other
entities. Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, and Rackspace.
f. "Encrypt" means to encode Confidential Information into a format that can only be read by those
possessing a "key"; a password, digital certificate or other mechanism available only to authorized
users. Encryption must use a key length of at least 256 bits for symmetric keys, or 2048 bits for
asymmetric keys. When a symmetric key is used, the Advanced Encryption Standard (AES) must
be used if available.
g. "FedRAMP" means the Federal Risk and Authorization Management Program (see
www.fedramp.gov), which is an assessment and authorization process that federal government
agencies have been directed to use to ensure security is in place when accessing Cloud computing
products and services.
h. "Hardened Password" means a string of at least eight characters containing at least three of the
following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special
characters such as an asterisk, ampersand, or exclamation point.
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i. "Mobile Device" means a computing device, typically smaller than a notebook, which runs a mobile
operating system, such as iOS, Android, or Windows Phone. Mobile Devices include smart phones,
most tablets, and other form factors.
j. "Multi -factor Authentication" means controlling access to computers and other IT resources by
requiring two or more pieces of evidence that the user is who they claim to be. These pieces of
evidence consist of something the user knows, such as a password or PIN; something the user has
such as a key card, smart card, or physical token; and something the user is, a biometric identifier
such as a fingerprint, facial scan, or retinal scan. "PIN" means a personal identification number, a
series of numbers which act as a password for a device. Since PI Ns are typically only four to six
characters, PI Ns are usually used in conjunction with another factor of authentication, such as a
fingerprint.
k. "Portable Device" means any computing device with a small form factor, designed to be transported
from place to place. Portable devices are primarily battery powered devices with base computing
resources in the form of a processor, memory, storage, and network access. Examples include, but
are not limited to, mobile phones, tablets, and laptops. Mobile Device is a subset of Portable
Device.
I. "Portable Media" means any machine readable media that may routinely be stored or moved
independently of computing devices. Examples include magnetic tapes, optical discs (CDs or
DVDs), flash memory (thumb drive) devices, external hard drives, and internal hard drives that have
been removed from a computing device.
m. "Secure Area" means an area to which only authorized representatives of the entity possessing the
Confidential Information have access, and access is controlled through use of a key, card key,
combination lock, or comparable mechanism. Secure Areas may include buildings, rooms or
locked storage containers (such as a filing cabinet or desk drawer) within a room, as long as access
to the Confidential Information is not available to unauthorized personnel. In otherwise Secure
Areas, such as an office with restricted access, the Data must be secured in such a way as to
prevent access by non -authorized staff such as janitorial or facility security staff, when authorized
Contractor staff are not present to ensure that non -authorized staff cannot access it.
n. "Trusted Network" means a network operated and maintained by the Contractor, which includes
security controls sufficient to protect DSHS Data on that network. Controls would include a firewall
between any other networks, access control lists on networking devices such as routers and
switches, and other such mechanisms which protect the confidentiality, integrity, and availability of
the Data.
o. "Unique User ID" means a string of characters that identifies a specific user and which, in
conjunction with a password, passphrase or other mechanism, authenticates a user to an
information system.
2. Authority. The security requirements described in this document reflect the applicable requirements of
Standard 141.10 (https:Hocio.wa.gov/policies) of the Office of the Chief Information Officer for the state
of Washington, and of the DSHS Information Security Policy and Standards Manual. Reference
material related to these requirements can be found here: htt s://www.dshs.wa. ov/ffa/kee in -dshs-
client-information- rivate-and-secure, which is a site developed by the DSHS Information Security
Office and hosted by DSHS Central Contracts and Legal Services.
3. Administrative Controls. The Contractor must have the following controls in place:
a. A documented security policy governing the secure use of its computer network and systems, and
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which defines sanctions that may be applied to Contractor staff for violating that policy.
b. If the Data shared under this agreement is classified as Category 4, the Contractor must be aware
of and compliant with the applicable legal or regulatory requirements for that Category 4 Data.
c. If Confidential Information shared under this agreement is classified as Category 4, the Contractor
must have a documented risk assessment for the system(s) housing the Category 4 Data.
4. Authorization, Authentication, and Access. In order to ensure that access to the Data is limited to
authorized staff, the Contractor must:
a. Have documented policies and procedures governing access to systems with the shared Data.
b. Restrict access through administrative, physical, and technical controls to authorized staff.
c. Ensure that user accounts are unique and that any given user account logon ID and password
combination is known only to the one employee to whom that account is assigned. For purposes of
non -repudiation, it must always be possible to determine which employee performed a given action
on a system housing the Data based solely on the logon ID used to perform the action.
d. Ensure that only authorized users are capable of accessing the Data.
e. Ensure that an employee's access to the Data is removed immediately:
(1) Upon suspected compromise of the user credentials.
(2) When their employment, or the contract under which the Data is made available to them, is
terminated.
(3) When they no longer need access to the Data to fulfill the requirements of the contract.
f. Have a process to periodically review and verify that only authorized users have access to systems
containing DSHS Confidential Information.
g. When accessing the Data from within the Contractor's network (the Data stays within the
Contractor's network at all times), enforce password and logon requirements for users within the
Contractor's network, including:
(1) A minimum length of 8 characters, and containing at least three of the following character
classes: uppercase letters, lowercase letters, numerals, and special characters such as an
asterisk, ampersand, or exclamation point.
(2) That a password does not contain a user's name, logon I D, or any form of their full name.
(3) That a password does not consist of a single dictionary word. A password may be formed as a
passphrase which consists of multiple dictionary words.
(4) That passwords are significantly different from the previous four passwords. Passwords that
increment by simply adding a number are not considered significantly different.
h. When accessing Confidential Information from an external location (the Data will traverse the
Internet or otherwise travel outside the Contractor's network), mitigate risk and enforce password
and logon requirements for users by employing measures including:
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(1) Ensuring mitigations applied to the system don't allow end-user modification.
(2) Not allowing the use of dial-up connections.
(3) Using industry standard protocols and solutions for remote access. Examples would include
RADIUS and Citrix.
(4) Encrypting all remote access traffic from the external workstation to Trusted Network or to a
component within the Trusted Network. The traffic must be encrypted at all times while
traversing any network, including the Internet, which is not a Trusted Network.
(5) Ensuring that the remote access system prompts for re -authentication or performs automated
session termination after no more than 30 minutes of inactivity.
(6) Ensuring use of Multi -factor Authentication to connect from the external end point to the internal
end point.
Passwords or PIN codes may meet a lesser standard if used in conjunction with another
authentication mechanism, such as a biometric (fingerprint, face recognition, iris scan) or token
(software, hardware, smart card, etc.) in that case:
(1) The PIN or password must be at least 5 letters or numbers when used in conjunction with at
least one other authentication factor
(2) Must not be comprised of all the same letter or number (11111, 22222, aaaaa, would not be
acceptable)
(3) Must not contain a "run" of three or more consecutive numbers (12398, 98743 would not be
acceptable)
j. If the contract specifically allows for the storage of Confidential Information on a Mobile Device,
passcodes used on the device must:
(1) Be a minimum of six alphanumeric characters.
(2) Contain at least three unique character classes (upper case, lower case, letter, number).
(3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or
abcd12 would not be acceptable.
k. Render the device unusable after a maximum of 10 failed logon attempts.
5. Protection of Data. The Contractor agrees to store Data on one or more of the following media and
protect the Data as described:
a. Hard disk drives. For Data stored on local workstation hard disks, access to the Data will be
restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User ID
and Hardened Password or other authentication mechanisms which provide equal or greater
security, such as biometrics or smart cards.
b. Network server disks. For Data stored on hard disks mounted on network servers and made
available through shared folders, access to the Data will be restricted to Authorized Users through
the use of access control lists which will grant access only after the Authorized User has
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authenticated to the network using a Unique User ID and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or smart
cards. Data on disks mounted to such servers must be located in an area which is accessible only
to authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
For DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as
long as the disks remain in a Secure Area and otherwise meet the requirements listed in the above
paragraph. Destruction of the Data, as outlined below in Section 8 Data Disposition, may be
deferred until the disks are retired, replaced, or otherwise taken out of the Secure Area.
c. Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS
on optical discs which will be used in local workstation optical disc drives and which will not be
transported out of a Secure Area. When not in use for the contracted purpose, such discs must be
Stored in a Secure Area. Workstations which access DSHS Data on optical discs must be located
in an area which is accessible only to authorized personnel, with access controlled through use of a
key, card key, combination lock, or comparable mechanism.
d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by
DSHS on optical discs which will be attached to network servers and which will not be transported
out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through
the use of access control lists which will grant access only after the Authorized User has
authenticated to the network using a Unique User ID and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or smart
cards. Data on discs attached to such servers must be located in an area which is accessible only
to authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
e. Paper documents. Any paper records must be protected by storing the records in a Secure Area
which is only accessible to authorized personnel. When not in use, such records must be stored in
a Secure Area.
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 ID and Hardened Password) to Authorized Users on Contractor's
staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of
such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an
Authorized User's duties change such that the Authorized User no longer requires access to
perform work for this Contract.
g. Data storage on portable devices or media.
(1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on
portable devices or media unless specifically authorized within the terms and conditions of the
Contract. If so authorized, the Data shall be given the following protections:
(a) Encrypt the Data.
(b) Control access to devices with a Unique User ID and Hardened Password or stronger
authentication method such as a physical token or biometrics.
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(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.
(2) When being transported outside of a Secure Area, Portable Devices and Portable Media with
DSHS Confidential Information must be under the physical control of Contractor staff with
authorization to access the Data, even if the Data is encrypted.
h. Data stored for backup purposes.
(1) DSHS Confidential Information may be stored on Portable Media as part of a Contractor's
existing, documented backup process for business continuity or disaster recovery purposes.
Such storage is authorized until such time as that media would be reused during the course of
normal backup operations. If backup media is retired while DSHS Confidential Information still
exists upon it, such media will be destroyed at that time in accordance with the disposition
requirements below in Section 8 Data Disposition.
(2) Data may be stored on non-portable media (e.g. Storage Area Network drives, virtual media,
etc.) as part of a Contractor's existing, documented backup process for business continuity or
disaster recovery purposes. If so, such media will be protected as otherwise described in this
exhibit. If this media is retired while DSHS Confidential Information still exists upon it, the data
will be destroyed at that time in accordance with the disposition requirements below in Section 8
Data Disposition.
L Cloud storage. DSHS Confidential Information requires protections equal to or greater than those
specified elsewhere within this exhibit. Cloud storage of Data is problematic as neither DSHS nor
the Contractor has control of the environment in which the Data is stored. For this reason:
(1) DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following
conditions are met:
(a) Contractor has written procedures in place governing use of the Cloud storage and
Contractor attests in writing that all such procedures will be uniformly followed.
(b) The Data will be Encrypted while within the Contractor network.
(c) The Data will remain Encrypted during transmission to the Cloud.
(d) The Data will remain Encrypted at all times while residing within the Cloud storage solution.
(e) The Contractor will possess a decryption key for the Data, and the decryption key will be
possessed only by the Contractor and/or DSHS.
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(f) The Data will not be downloaded to non -authorized systems, meaning systems that are not
on either the DSHS or Contractor networks.
(g) The Data will not be decrypted until downloaded onto a computer within the control of an
Authorized User and within either the DSHS or Contractor's network.
(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 FedRAMP certified.
(3) If the Data includes protected health information covered by the Health Insurance Portability and
Accountability Act (HIPAA), the Cloud provider must sign a Business Associate Agreement prior
to Data being stored in their Cloud solution.
6. System Protection. To prevent compromise of systems which contain DSHS Data or through which
that Data passes:
a. Systems containing DSHS Data must have all security patches or hotfixes applied within 3 months
of being made available.
b. The Contractor will have a method of ensuring that the requisite patches and hotfixes have been
applied within the required timeframes.
c. Systems containing DSHS Data shall have an Anti-Malware application, if available, installed.
d. Anti-Malware software shall be kept up to date. The product, its anti-virus engine, and any malware
database the system uses, will be no more than one update behind current.
7. Data Segregation.
a. DSHS Data must be segregated or otherwise distinguishable from non-DSHS data. This is to
ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or
destruction. It also aids in determining whether DSHS Data has or may have been compromised in
the event of a security breach. As such, one or more of the following methods will be used for data
segregation.
(1) DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will contain no
non-DSHS Data. And/or,
(2) DSHS Data will be stored in a logical container on electronic media, such as a partition or folder
dedicated to DSHS Data. And/or,
(3) DSHS Data will be stored in a database which will contain no non-DSHS data. And/or,
(4) DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by
the value of a specific field or fields within database records.
(5) When stored as physical paper documents, DSHS Data will be physically segregated from non-
DSHS data in a drawer, folder, or other container.
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b. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the
DSHS Data and the non-DSHS data with which it is commingled must be protected as described in
this exhibit.
8. Data Disposition. When the contracted work has been completed or when the Data is no longer
needed, except as noted above in Section 5.b, Data shall be returned to DSHS or destroyed. Media on
which Data may be stored and associated acceptable methods of destruction are as follows:
Data stored on:
Will be destroyed by:
Server or workstation hard disks, or
Using a "wipe" utility which will overwrite the Data at
least three (3) times using either random or single
Removable media (e.g. floppies, USB flash drives,
character data, or
portable hard disks) excluding optical discs
Degaussing sufficiently to ensure that the Data
cannot be reconstructed, or
Physically destroying the disk
Paper documents with sensitive or Confidential
Recycling through a contracted firm, provided the
I nformation
contract with the recycler assures that the
confidentiality of Data will be protected.
Paper documents containing Confidential Information
On-site shredding, pulping, or incineration
requiring special handling (e.g. protected health
information
Optical discs (e.g. CDs or DVDs)
Incineration, shredding, or completely defacing the
readable surface with a coarse abrasive
Magnetic tape
Degaussing, incinerating or crosscut shredding
9. Notification of Compromise or Potential Compromise. The compromise or potential compromise of
DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1)
business day of discovery. If no DSHS Contact is designated in the Contract, then the notification must
be reported to the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also
take actions to mitigate the risk of loss and comply with any notification or other requirements imposed
by law or DSHS.
10. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a
subcontractor, the Contract with the subcontractor must include all of the data security provisions within
this Contract and within any amendments, attachments, or exhibits within this Contract. If the
Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub -
Contractor must be submitted to the DSHS Contact specified for this contract for review and approval.
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EXHIBIT B
Family Violence Services
Statement of Work
1. Purpose
Provide a qualified Domestic Violence Advocate to provide on-site or telephone Family
Violence Services for the DSHS Community Services Office (CSO) to:
a. Assist DSHS staff in determining appropriate WorkFirst activities for referred clients
who experience family violence
b. Provide referred clients community resource referrals and linkages appropriate to the
family's needs.
c. Provide empowerment -based advocacy to referred clients who experience family
violence.
2. Definitions
a. "Advocacy" means that the client is involved with an advocate in individual or group
sessions with a primary focus of safety planning, empowerment, and education of
through reinforcement of the client's autonomy and self-determination. Advocacy
also means speaking and acting for change or justice with, or on behalf of, another
person or cause. Advocacy is survivor centered and uses non -victim blaming
methods that include:
(1) Identifying barriers to, and strategies to enhance, safety, including safety
planning
(2) Clarifying and increasing awareness of the power and control associated with
domestic violence and the options one may have to obtain resources while
staying safe
(3) Supporting independent decision making based on the unique needs and
circumstances of each individual
b. "Advocate" means a trained staff person who works in a domestic violence agency
and provides advocacy to clients.
c. "CSO" means Community Service Office
d. "CSOK means a Community Service Office Administrator
e. "Domestic violence" or "family violence" is a pattern of assaultive and coercive
behaviors that an adult or adolescent uses to maintain power and control over one or
more, current, estranged or prior, intimate partner or other family member. The
abuser's use of physical force against persons or property or the use of conduct that
establishes a credible threat of physical harm (i.e. terrorizing tactics) combined with
other controlling tactics are key elements of domestic violence. The effect of the
overall pattern of assaultive and coercive behavior is to increase the abuser's power
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and control in the relationship. It includes, but is not limited to, the categorization of
offenses defined in RCW 10.99.020(3) when committed by one cohabitant against
another. Abusive tactics may include, but are not limited to the following:
(1) Physical abuse
(2) Sexual abuse
(3) Intimidating tactics
(4) Physical and/or psychological isolation of the victim
(5) Repeated attacks against the victim's competence
(6) Alternating use of indulgences
(7) Control of family funds and resources
(8) Stalking
(9) Use of children and systems to control the victim
f. "DSHS staff' means the CSO WorkFirst Social Worker, WorkFirst Case Manager,
WorkFirst Supervisor, or other Community Services Division staff acting on behalf of
the DSHS Contract Contact listed on page one of this contract.
g. "Excused Absence" means hours of non -participation from a scheduled session or
activity where the client reported to the Contractor that he/she is unable to attend
prior to the start of the scheduled session. Client absence also may be declared
excused by the Contractor in emergency circumstances where it is unreasonable to
expect the client to have notified the Contractor prior to the start of the scheduled
session.
h. "Made-up Absence" means comparable, supervised activities completed by a client
under the direction of the Contractor in lieu of attendance at a scheduled session or
activity.
"Marginalized populations" includes, but is not limited to, populations that have been
historically underserved and oppressed in society because of ethnicity, race, culture
or language diversity, age, sexual orientation, or disability.
j. "Participation" means attendance by the client at an activity supervised by the
Contractor. Participation does not include time spent by the client traveling to or from
sessions. Study, preparation or homework time is not counted as participation unless
the Contractor provides supervision of the client during study, preparation or
homework.
k. "Safety plan" is a process of thinking through with the victim how to increase safety
for both the victim of domestic violence and any dependent children of the victim.
Safety planning addresses both immediate and long term risks, barriers, or concerns
regarding the victim and any dependent children. It is based on knowledge about the
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specific pattern of the domestic violence perpetrator's tactics and the protective
factors of the victim and any dependent children. Safety planning can be done
formally, informally, in writing or orally, or in any other conversational process
between the victim and advocate.
I. "Unexcused Absence" means any hours of non -participation from a scheduled
session or activity by a client that does not meet the criteria established above for
"Excused Absence".
3. Qualifications for Domestic Violence Advocates and their Supervisors.
a. The Domestic Violence Advocates and their Supervisors must meet the training
requirements of WAC 388-61A-1080: What type of training is required for staff of the
domestic violence agency?
b. Initial training
(1) Staff providing supportive services and supervisors of staff shall obtain a
minimum of twenty (20) hours of initial basic training that covers the following
topics and skills:
(a) Theory and implementation of empowerment -based advocacy.
(b) The history of the domestic violence movement.
(c) Active listening skills.
(d) Legal, medical, social service and systems advocacy.
(e) Anti -oppression and cultural competency theory and practice.
(f) Confidentiality and ethics.
(g) Safety planning skills and barriers to safety.
(h) Planning, clarifying issues and options, and crisis intervention.
(i) Providing services and advocacy to individuals from marginalized
populations.
(j) Policies and procedures of the domestic violence agency.
(2) Initial training shall be completed prior to providing supportive services to clients
and/or their dependent children.
(3) The recommended format for initial trainings is live and in-person group
sessions. Structured job -shadowing and self -study may be included as part of the
overall initial training. All domestic violence agency in-house training must be
based on a training plan that covers one or more of the required initial training
topics.
c. Continuing education and supervisor training
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(1) Based on their date of hire with the domestic violence agency, staff providing
supportive services and staff supervisors must obtain an annual minimum of
twenty hours of continuing education training beginning in their second year with
the domestic violence agency, and in every year thereafter.
(2) A minimum of ten hours must be live training on topics specifically focused on
serving victims of domestic violence and their children.
(3) The remaining ten hours of training may be satisfied through self -study on topics
specifically focused on serving victims of domestic violence and their children.
(4) Within six months of being hired as an advocate supervisor and for each year
thereafter, the supervisor must obtain a minimum of five hours of training on
supervision. Supervision training can be counted toward the twenty hours of
annual continuing education training hours required by this chapter. Examples of
supervision training topics include leadership skills, job coaching and staff
evaluation, personnel management, effective communication and managing
conflict, multicultural supervision, and how to foster professional development of,
and self-care with, advocates. While live, in-person training is the preferred
method for supervision training, all methods of live and self -study training are
acceptable.
4. Staffing
a. The Contractor shall provide a qualified Domestic Violence Advocate to the Moses
Lake Community Services Office for up to 774 hours per state fiscal year.
b. The services may be provided in person at the CSO or by telephone.
c. If the Contractor cannot provide in person services they shall notify the CSO and
the DSHS Contact.
d. If the Contractor can provide the services by telephone they shall notify the CSO
and the DSHS Contact.
e. Actual scheduling and manner in which the services will be provided will be
negotiated between the Contractor and the CSO.
5. Contractor Obligations
The Contractor shall:
a. Conduct an initial client interview and develop a TANF Family Violence Service Plan
a Family Violence Service Plan format as provided by the DSHS, Contract Contact
listed on page one of this contract.
b. Participate in DSHS case staffing meetings as requested by DSHS staff.
Participation may be in person or by telephone.
c. Refer and link clients to family violence services and other appropriate resources
available in the community based on the client's needs.
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d. Provide empowerment -based advocacy to referred clients.
e. Contact DSHS for interpreter services as needed. If the Contractor chooses to
provide an interpreter, the Contractor shall pay for such services.
f. Supply the CSO with educational materials to promote public and professional
awareness of the problems regarding family violence and the availability of services
within the local community. These materials may be in the form of brochures, flyers,
posters, etc.
6. Reporting Requirements
The Contractor shall:
a. Submit a completed TANF Family Violence Service Plan within five (5) business
days of initial interview for each client referred and interviewed. This report will be
directed to the referring DSHS staff. A sample TANF Family Violence Service Plan
is attached as Exhibit C or an alternate format may be selected at the request of the
CSO Administrator. Any alternate formats must include the minimum sample
elements.
b. Submit a completed monthly report with each billing invoice (Exhibit C- Monthly
Report).
c. Have the choice whether or not to use the WAS system to report information
regarding each client.
If the Contractor uses the WAS system to report client information, the contractor shall:
d. Use the Contractor Caseload screen:
(1) Accept or reject each referral within three (3) business days of receipt.
(2) Enter the activity start and end dates on or within three (3) business days
following the client's start or end of the component(s).
(3) Provide notice of non -participation within one (1) business day when the client
has any unexcused absence.
e. Use the Client Notes screen to Notate:
(1) The results of the contractor's ongoing assessment or appraisal of each client's
strengths and barriers relatable to employability or family self-sufficiency within
three (3) business days of completing an assessment or appraisal.
(2) Additional, client -specific information or observations as required in the
Statement of Work.
(3) Contractor approval of all excused absences, including the date of the absence,
the date the Contractor approved the absence, and the reason given by the client
for the absence.
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f. Use the Multiple Client Participation Screen*, no later than the 10th calendar day of
the month following a month with reportable activity:
(1) Enter the total hours of client participation specific to the component(s) provided
under this Contract.
(2) Enter the total number of hours and the total number of instances for which the
client was excused from participation.
(3) Enter the total number of hours for which the client did not participate due to an
unexcused absence.
*Contractors may enter data at intervals of less than one calendar month. However,
each calendar month's data must be completely reported no later than the 10th calendar
day of the month following a month with reportable activity.
If the Contractor does not use the WAS system to report client information, the
contractor shall:
g. Accept or reject each referral within three (3) business days of receipt and notify
DSHS staff.
h. Provide DSHS staff with the activity start and end dates on or within three (3)
business days following the client's start or end of the component(s).
Provide DSHS staff with notice of non -participation within one (1) business day when
the client has any unexcused absence.
j. Provide DSHS staff of the results of the contractor's ongoing assessment appraisal
of each client's strengths and barriers relatable to employability or family self-
sufficiency within three (3) business days of completing an assessment or appraisal.
k. Provide DSHS staff with any additional client -specific information or observations as
required by the Statement of Work.
I. Provide DSHS staff with approval of all excused absences, including the date of the
absence, the date the Contractor approved the absence, and the reason given by
the client for the absence.
m. Return a completed WorkFirst Participation Verification Form* each month that a
participant received services from the Contractor to include the:
(1) Actual hours of countable family violence treatment participation as described in
the Washington State Work Verification Plan
(2) Total number of hours
(3) Total number of instances for which the client was excused from participation
(4) Total number of hours for which the client did not participate due to an
unexcused absence
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*DSHS staff will supply the Contractor with the necessary forms. This form must be
returned no later than the 5t" day of the month following the month in which a client
received family violence treatment services.
7. Documentation
The Contractor shall maintain written documentation of participation verification in a
format approved by the DSHS Contact person named on page 1 of this Contract (or
successor). Such documentation shall include, but not be limited to, client name (and/or
eJAS number), date, hours attended, hours of excused absence, hours of unexcused
absence and component code.
8. Compensation
DSHS shall pay $40 per hour for the Family Violence Advocate in the CSO. Payment
will be limited to actual hours worked by Advocates, prorated to 30 -minute intervals.
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Exhibit C
Monthly Report
Contractor ID:
Service Month:
eJAS or Client ID Comments
APPROVED:
DIRECTIONS: At minimum the eJAS or Client ID must be listed for each client who received
services in the service month. Comments such as a summary of services received may be
entered.
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Attachment 1
TANF Family Violence Service Plan
SAMPLE
eJAS # Date
1. Is the client's safety in jeopardy? (Are extra precautionary measures recommended?) Yes
No
Comments:
2. Does the client feel ready to participate in job search? Yes No
Comments:
3. If No, how long does the client need to be deferred? days
Comments:
4. Will the client be participating in Family Violence services? Yes No
Comments:
5. Was this client referred to any community resources? Yes No
Comments:
Additional information that will help coordinate services:
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