HomeMy WebLinkAboutAgreements/Contracts - New Hope DV/SAikV*
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new beginnings. better tomorrows,
December 20, 2022
Board of Grant County Commissioners
PO Box 37
Ephrata, WA 98823
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RE: Signature for Contract #F22-31103-040 (New Hope's STOP Grant)
Dear Board of County Commissioners:
Please see attached contract for review and approval.
Contractor: Department of Commerce, Office of Crime Victims Advocacy
Term of Contract: 1.1.2023 to 12.31.2023
Purim: To renew annual STOP Grant for Violence Against Women
Amount: $33,178
There is no change in the amount of funding this year, this is just a renewal to continue on with
the same services and funding as previous year.
Thank you for your consideration,
�'�. Few°
Suzi Fode, Director
Kids Hope and New Hope
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GRANT COUNTY COMMISSIONERS,
DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
.�.' Washington State
Vi►V Commerce
Federal Interagency Agreement with
New Hope
through
Office of Crime Victims Advocacy
Community Services Division
Grant Number:
F22-31103-040
For
K22-255
STOP Violence Against Women Formula Grant Program, grant pass
through allocation to improve the community response to violence against
women.
Dated: Sunday, January 1, 2023
DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
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Table of Contents
TABLEOF CONTENTS .............................................................................................................................................. 2
FACESHEET............................................................................................................................■............................... 4
SPECIAL TERMS AND CONDITIONS........................................................................................................................■ 5
1.
AUTHORITY......................................................................................................................................................5
2.
ACKNOWLEDGEMENT OF FEDERAL FUNDING.................................................................................................5
3.
AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, ALSO REFERRED TO AS THE "ADA" 28
C. F. R. PART 35............................................................................................................................................................5
4.
AUDIT..............................................................................................................................................................5
5.
BILLING PROCEDURES AND PAYMENT.............................................................................................................6
6.
COMPENSATION..............................................................................................................................................6
7.
CONFERENCES, MEETINGS, AND TRAININGS...................................................................................................7
8.
DEBARMENT....................................................................................................................................................7
9.
FRAUD AND OTHER LOSS REPORTING.............................................................................................................8
10.
GRANT MANAGEMENT....................................................................................................................................8
11.
GRANT MODIFICATION....................................................................................................................................8
12.
INDIRECT COSTS..............................................................................................................................................9
3.
13.
INSURANCE ......................................................................................................................................................9
ASSIGNMENT.................................................................................................................................................14
14.
NON-COMPLIANCE WITH NON-DISCRIMINATION LAWS.............................................................................:...9
6.
15.
NON-SUPPLANTING.........................................................................................................................................9
DISPUTES.......................................................................................................................................................15
16.
POLITICAL ACTIVITIES......................................................................................................................................9
9.
17.
POTENTIAL FRAUD, WASTE, ABUSE, AND SIMILAR MISCONDUCT...................................................................9
LICENSING, ACCREDITATION AND REGISTRATION.........................................................................................15
18.
PROCUREMENT STANDARDS FOR FEDERALLY FUNDED PROGRAMS.............................................................10
12.
19.
REPORTING....................................................................................................................................................10
SAVINGS ........................................................................................................................................................16
20.
SERVICES TO LIMITED -ENGLISH -PROFICIENT (LEP) PERSONS........................................................................11
21.
STATUTORY AND REGULATORY REQUIREMENTS..........................................................................................11
22.
SUBGRANTEE/SUBCONTRACTOR DATA COLLECTION....................................................................................11
23.
VAWA 2013 NON-DISCRIMINATION PROVISION..................'.........................................................................11
24.
ORDER OF PRECEDENCE................................................................................................................................11
GENERAL TERMS AND CONDITIONS.....................................................................................................................13
1.
DEFINITIONS..................................................................................................................................................13
2.
ALLWRITINGS CONTAINED HEREIN...............................................................................................................13
3.
AMENDMENTS..............................................................................................................................................14
4.
ASSIGNMENT.................................................................................................................................................14
5.
CONFIDENTIALITY AND SAFEGUARDING OF INFORMATION.........................................................................14
6.
COPYRIGHT....................................................................................................................................................14
7.
DISPUTES.......................................................................................................................................................15
8.
GOVERNING LAW AND VENUE......................................................................................................................15
9.
INDEMNIFICATION........................................................................................................................................15
10.
LICENSING, ACCREDITATION AND REGISTRATION.........................................................................................15
11.
RECAPTURE....................................................................................................................................................15
12.
RECORDS MAINTENANCE..............................................................................................................................15
13.
SAVINGS ........................................................................................................................................................16
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14. SEVERABILITY.................................................................................................................................................16
15. SUBGRANTING...............................................................................................................................................16
16. SURVIVAL.......................................................................................................................................................16
17. TERMINATION FOR CAUSE.............................................................................................................................16
18. TERMINATION FOR CONVENIENCE................................................................................................................17
19. TERMINATION PROCEDURES.........................................................................................................................17
20. TREATMENT OF ASSETS.................................................................................................................................18
21. WAIVER.........................................................................................................................................................18
ATTACHMENT A: CERTIFICATION OF COMPLIANCE WITH FEDERAL REGULATIONS..............................................19
ATTACHMENT B: U.S. DEPARTMENT OF JUSTICE CERTIFIED STANDARD ASSURANCES .........................................
23
ATTACHMENT C: ESOP COMPLIANCE CERTIFICATION FORM................................................................................
25
ATTACHMENT D: RESTRICTIONS AND CERTIFICATIONS REGARDING NON -DISCLOSURE AGREEMENTS AND
RELATEDMATTERS..............................................................................................................................................
26
ATTACHMENT E: REQUIREMENT TO REPORT ACTUAL OR IMMINENT BREACH OF PERSONALLY IDENTIFIABLE
INFORMATION.....................................................................................................................................................
27
ATTACHMENTF: SCOPE OF WORK■......................................................................................................................
28
ATTACHMENTG: BUDGET...................................................................................................................................■
30
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DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
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Special Terms and Conditions
1. AUTHORITY
COMMERCE and Grantee enter into this Grant pursuant to the authority granted by the Interlocal
Cooperation Act, Chapter 39.34 RCW.
2. ACKNOWLEDGEMENT OF FEDERAL FUNDING
Federal Award Date: 09/17/2020
Federal Award Identification Number (FAIN): 2020 -WF -AX -0054
Total amount of the federal award: $3,415,734.00
Total amount of federal award 2020 -WF -AX -0054 funding in this grant: $0.00
Awarding official: Allison Randall, Acting Director (202) 307-6026
Federal Award Date: 09/1/2021
Federal Award Identification Number (FAIN): 15JOVW-21-GG-00548-MUMU
Total amount of the federal award: $3,449,421.00
Total amount of federal award 15JOVW-21-GG-00548-MUMU funding in this grant: $17,500.00
Awarding official: Allison Randall, Acting Director (202) 307-6026
Federal Award Date: 09/13/2022
Federal Award Identification Number (FAIN): 15JOVW-22-GG-00458-STOP
Total amount of the federal award: $3,060,210.00
Total amount of federal award 15JOVW-22-GG-00458-STOP funding in this grant: $15,768.00
Awarding official: Allison Randall, Acting Director (202) 307-6026
The Grantee agrees that all materials and publications (written, web -based, visual, or any other
format) resulting from grant activities shall contain the following statements:
"This project was supported by Subgrant No. F22-31103-040 awarded by the state administering
office for the Office on Violence Against Women, U.S. Department of Justice's STOP Formula Grant
Program. The opinions, findings, conclusions, and recommendations expressed in this
publication/program/exhibition are those of the author(s) and do not necessarily reflect the views
of the state or the U.S. Department of Justice."
Grant funds are administered by the Office of Crime Victims Advocacy, Community Services Division,
Washington State Department of Commerce.
3. AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, also
referred to as the "ADA" 28 C.F.R. Part 35
The Grantee must comply with the ADA, which provides comprehensive civil rights protection to
individuals with disabilities in the areas of employment, public accommodations, state and local
government services, and telecommunications.
4. AUDIT
If the Grantee is a subrecipient and expends $750,000 or more in federal awards from any and/or all
sources in any fiscal year, the Grantee shall procure and pay for a single audit or a program -specific
audit for that fiscal year. Upon completion of each audit, the Grantee shall:
A. Submit to COMMERCE the reporting package specified in Uniform Guidance 2 C.F.R. 200,
reports required by the program -specific audit guide (if applicable), and a copy of any
management letters issued by the auditor.
B. Submit to COMMERCE follow-up and developed corrective action plans for all audit findings.
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If the Grantee is a subrecipient and expends less than $750,000 in federal awards from any and/or
all sources in any fiscal year, the Grantee shall notify COMMERCE they did not meet the single audit
requirement.
The Grantee shall send all single audit documentation to the Federal Audit Clearinghouse.
5. BILLING PROCEDURES AND PAYMENT
The Grantee shall submit all requests for reimbursement on the Invoice Voucher (A-19) form provided
by OCVA program staff.
Invoices shall be submitted at least quarterly, but not more often than monthly, on the Invoice Voucher
(A-19) Forms. The Invoice Voucher shall be submitted to Mia Davidson, Program Coordinator, Office
of Crime Victims Advocacy, Post Office Box 42525, Olympia, Washington 98504-2525. Invoices can
also be submitted electronically by email to mia.davidsongcommerce.wa.gov or via Secure Access
Washington to the Commerce Contract Management System (CMS).
COMMERCE will pay Grantee upon acceptance of program activities provided and receipt of properly
completed invoices.
Payment shall be considered timely if made by COMMERCE within thirty (30) calendar days after
receipt of properly completed invoices. Payment shall be sent to the address designated by the
Grantee.
COMMERCE may, in its sole discretion, terminate the Grant or withhold payments claimed by the
Grantee for services rendered if the Grantee fails to satisfactorily comply with any term or condition
of this Grant.
No payments in advance or in anticipation of services or supplies to be provided under this Agreement
shall be made by COMMERCE.
The Grantee agrees to comply with the financial and administrative requirements set forth in the
current edition of the U.S. Department of Justice, Financial Grants Management Guide, which can be
found at: https://www.oip.gov/do,i-financial-quide-2022.
Duplication of Billed Costs
The Grantee shall not bill COMMERCE for services performed under this Agreement, and
COMMERCE shall not pay the Grantee, if the Grantee is entitled to payment or has been or will be
paid by any other source, including grants, for that service.
Disallowed Costs
The Grantee is responsible for any audit exceptions or disallowed costs incurred by its own
organization or that of its subgrantees/subcontractors.
6. COMPENSATION
COMMERCE shall pay an amount not to exceed X33,178.00 for the performance of all things
necessary for or incidental to the performance of work as set forth in Attachment F — Scope of Work.
Grantee's compensation for services rendered shall be in accordance with Attachment G — Budget.
Grantee shall provide a non-federal match. The total match to be provided shall be at least 0.00
unless otherwise agreed upon and fulfilled by STOP Grant county partners. Match funds may be
expended in a greater proportion to grant funds, however, all match funds must be expended prior to
the close of this Grant. An expended amount of match funds must be identified on the invoice voucher
form provided by COMMERCE.
Transfer of funds between line item budget categories must be approved by the Office of Crime
Victims Advocacy (OCVA) program staff. A cumulative amount of these transfers exceeding ten (10)
percent of the total program budget shall be subject to justification and negotiation between the
Grantee and OCVA, including approval from the Grantee's signature authority and the relevant OCVA
Section Manager.
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DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
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Payment will be on a reimbursement basis only.
Consultant/contractor fees may not exceed $650 per day (excluding travel and subsistence costs) for
an eight-hour day or may not exceed $81.25 per hour for less than an eight-hour day. Grantees are
required to maintain documentation to support all daily or hourly rates.
Travel expenses incurred or paid by the Grantee shall be reimbursed at a rate not to exceed the
current state rate and in accordance with the state of Washington Office of Financial Management
Travel Regulations. Travel expenses are included in the maximum grant amount for this Grant.
Current rates for travel may be accessed using the following link:
https://www.ofm.wa.govlsites/default/files/public/resources/travel/colormap pdf.
7. CONFERENCES, MEETINGS,.AND TRAININGS
The Grantee, and any Subgrantee, must comply with all applicable laws, regulations, policies, and
official Department of Justice (DOJ) guidance (including specific cost limits, prior approval and
reporting requirements, where applicable) governing the use of federal funds for expenses related to
conferences (as that term is defined by DOJ, including the provision of food and/or beverages at such
conferences, and costs of attendance at such conferences. Information on the pertinent DOJ
definition of conferences and the rules applicable to this award appears on the Office of Violence
Against Women (OVW) website at https://www.iustice.qov/ovw/conference-planning.
OVW Traininq Guiding Principles
The Grantee understands and agrees that any training or training materials developed or delivered
with funding provided under this award must adhere to the OVW Training Guiding Principles for
Grantees and Subgrantees, available at htfi s://www.justice. ov/ovw/ rantees#Resources.
Food and Beverage Costs
The Grantee agrees STOP Formula Grant Program funds will not be used to purchase food and/or
beverages for any meeting, conference, training, or other event, with the exception of support groups
or otherwise within the context of victim services where it is necessary and integral to providing
services to enhance victim safety. Additional information may be found in the Frequently Asked
Questions (FAQs) About STOP Formula Grants available at:
htt s:Hwww.'ustice. ov/ovw/ a e/file/1008816/download.
8. DEBARMENT
A. Grantee, defined as the primary participant and its principals, certifies by signing these Special
Terms and Conditions that to the best of its knowledge and belief that they:
L Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from covered transactions by any Federal department or
agency.
iii. Have not within a three-year period preceding this Grant, been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense
in connection with obtaining, attempting to obtain, or performing a public or private
agreement or transaction, violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, tax evasion, receiving stolen property, making
false claims, or obstruction of justice;
iii. Are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of the offenses
enumerated in paragraph (1)(b) of federal Executive Order 12549; and
iv. Have not within a three-year period preceding the signing of this Grant had one or
more public transactions (Federal, State, or local) terminated for cause of default.
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D. Where the Grantee is unable to certify to any of the statements in this Grant, the Grantee shall
attach an explanation to this Grant.
C. The Grantee agrees by signing this Grant that it shall not knowingly enter into any lower tier
covered transaction with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized by
COMMERCE.
D. The Grantee further agrees by signing this Grant that it will include the clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower
Tier Covered Transaction," as follows, without modification, in all lower tier covered
transactions and in all solicitations for lower tier covered transactions:
LOWER TIER COVERED TRANSACTIONS
The lower tier Grantee certifies, by signing this Grant that neither it nor its principals
is presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal department
or agency.
ii. Where the lower tier Grantee is unable to certify to any of the statements in this
Grant, such Grantee shall attach an explanation to this Grant.
E. The terms covered transaction, debarred, suspended, ineligible, lover tier covered
transaction, person, primary covered transaction, principal, and voluntarily excluded,
as used in this section, have the meanings set out in the Definitions and Coverage sections
of the rules implementing Executive Order 12549. Grantee may contact COMMERCE for
assistance in obtaining a copy of these regulations.
9. FRAUD AND OTHER LOSS REPORTING
Grantee shall report in writing all known or suspected fraud or other loss of any funds or other property
furnished under this Grant immediately or as soon as practicable to the Commerce Representative
identified on the Face Sheet.
10. GRANT MANAGEMENT
The Representative for each of the parties shall be responsible for and shall be the contact person
for all communications and billings regarding the performance of this Grant.
The Representative for COMMERCE and their contact information are identified on the Face Sheet
of this Grant.
The Representative for the Grantee and their contact information are identified on the Face Sheet
of this Grant.
11. GRANT MODIFICATION
Notwithstanding any provision of this Grant to the contrary, at any time during the Grant period,
COMMERCE may, by written notification to the Grantee and without notice to any known guarantor
or surety, make changes within the general scope of the program activities to be performed under this
Grant. All other modifications shall not be valid unless made in writing and signed by the parties. Any
oral understandings and agreements not incorporated herein, unless made in writing and signed by
the parties hereto, shall not be binding.
Notwithstanding any provision of this Grant to the contrary, at any time during the Grant period,
COMMERCE may analyze Grant expenditures as a proportion of the Grant budget. If COMMERCE
determines, in its sole discretion, that the Grant funding is underutilized, COMMERCE, in its sole
discretion, may unilaterally modify the Grant to reduce the balance of the Grant budget. Funds de -
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DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
VOM Washfirxg-.un State
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obligated by COMMERCE as a result of a budget reduction may be made available to other Grantees
for the provision of eligible program activities.
12. INDIRECT COSTS
Grantee shall provide their indirect cost rate that has been negotiated between their entity and the
federal government. If no such rate exists a de minimis indirect cost rate of 10% of modified total
direct costs (MTDC) may be used.
13. INSURANCE
Each party certifies that it is self-insured under the State's or local government self-insurance liability
program, and shall be responsible for losses for which it is found liable.
14. NON-COMPLIANCE WITH NON-DISCRIMINATION LAWS
During the performance of this Grant, the Grantee shall comply with all federal, state, and local
nondiscrimination laws, regulations and policies. In the event of the Grantee's non-compliance or
refusal to comply with any nondiscrimination law, regulation or policy, this Grant may be rescinded,
canceled or terminated in whole or in part, and the Grantee may be declared ineligible for further
Grants with COMMERCE. The Grantee shall, however, be given a reasonable time in which to cure
this noncompliance. Any dispute may be resolved in accordance with the "Disputes" procedure set
forth herein.
The funds provided under this Grant may not be used to fund religious worship, exercise, or
instruction. No person shall be required to participate in any religious worship, exercise, or instruction
in order to have access to the facilities funded by this Grant.
15. NON -SUPPLANTING
The Grantee agrees that grant funds will be used to supplement, not supplant, non-federal funds that
would otherwise be available for the activities under this Grant. Violation of the non -supplanting
requirement can result in a range of penalties, including suspension of future funds under this Grant,
recoupment of monies provided under this Grant, and civil and/or criminal penalties.
16. POLITICAL ACTIVITIES
Political activity of Grantee's employees and officers are limited by the State Campaign Finances and
Lobbying provisions of Chapter 42.17A RCW and the Federal Hatch Act, 5 U.S.C. 1501 - 1508.
No funds may be used for working for or against ballot measures or for or against the candidacy of
any person for public office.
17. POTENTIAL FRAUD, WASTE, ABUSE, AND SIMILAR MISCONDUCT
.Mm
The Grantee agrees to promptly refer to the Department of Justice Office of the Inspector General
(OIG) any credible evidence that a principal, employee, agent, subgrantee, contractor, subcontractor,
or other person has, in connection with funds under this award — (1) submitted a claim that violates
the False Claims Act; or (2) committed a criminal or civil violation of laws pertaining to fraud, conflict
of interest, bribery, gratuity, or similar misconduct.
Potential fraud, waste, abuse, or misconduct involving or relating to funds under this award should be
reported to the OIG by — (1) online submission accessible via the OIG webpage at
htfips://oig.iustice.gov/hotline/contact- rants htm (select "Submit Report Online"); (2) mail directed to:
U.S. Department of Justice, Office of the Inspector General, Investigations Division, ATTN: Grantee
Reporting, 950 Pennsylvania Ave., NW, Washington, DC 20530; (3) by facsimile directed to the DOJ
OIG Fraud Detection Office (Attn: Grantee Reporting) at (202) 616-9881 (fax). Additional information
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DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
0ep{.i~'ririerit obi
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is available from the DOJ OIG website at https:Hoig.iustice.gov/hotline.
18. PROCUREMENT STANDARDS FOR FEDERALLY FUNDED PROGRAMS
All Grantees must establish procurement policies and procedures in accordance with 2 C.F.R. Part
200, for all purchases funded by this Grant.
The Grantee's procurement system should include at least the following:
A. A code or standard of conduct that shall govern the performance of its officers, employees, or
agents engaged in the awarding of contracts using federal funds.
B. Procedures that ensure all procurement transactions shall be conducted in a manner to
provide, to the maximum extent practical, open and free competition.
C. Minimum procedural requirements, as follows:
Ii. Follow a procedure to assure the avoidance of purchasing unnecessary or
duplicative items.
H. Solicitations shall be based upon a clear and accurate description of the technical
requirements of the procured items.
iii. Positive efforts shall be made to use small and minority-owned businesses.
iv. The type of procuring instrument (fixed price, cost reimbursement) shall be
determined by the Grantee, but must be appropriate for the particular procurement
and for promoting the best interest of the program involved.
v. Contracts shall be made only with reasonable subcontractors who possess the
potential ability to perform successfully under the terms and conditions of the
proposed procurement.
vi. Some form of price or cost analysis should be performed in connection with every
procurement action.
vii. Procurement records and files for purchases shall include all of the following:
1) Subcontractor selection or rejection.
2) The basis for the cost or price.
3) Justification for lack of competitive bids if offers are not obtained.
viii. A system for contract administration to ensure subcontractor conformance with
terms, conditions and specifications of this Grant, and to ensure adequate and
timely follow-up of all purchases.
D. Grantee and Subgrantee must receive prior approval from COMMERCE for using funds from
this Grant to enter into a sole source contract or a contract where only one bid or proposal is
received when value of this Grant is expected to exceed $5,000.
Prior approval requests shall include a copy of proposed contracts and any related procurement
documents and justification for non-competitive procurement, if applicable.
19. REPORTING
The Grantee shall submit an annual progress report electronically on a form provided by COMMERCE
for the work performed. The electronic report is due to COMMERCE January 15, 2024 (for the
performance period January 1, 2023 through December 31, 2023). The Grantee shall maintain
documentation and records that support the progress report.
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20. SERVICES TO LIMITED -ENGLISH -PROFICIENT (LEP) PERSONS
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To ensure compliance with Title VI and the Safe Streets Act, Grantees are required to make
reasonable steps to ensure that LEP persons have meaningful access to their programs. Meaningful
access may entail providing language assistance services, including interpretation and translation
services, where necessary. Recipients are encouraged to consider the need for language services
for LEP persons served or encountered both in developing their programs and budgets and in
conducting their programs and activities. Reasonable costs associated with providing meaningful
access for LEP individuals are considered allowable program costs. Additional assistance regarding
LEP obligations and information may be found at www.lep.gov.
21. STATUTORY AND REGULATORY REQUIREMENTS
The Grantee agrees to comply with all relevant statutory and regulatory requirements which may
include, among other relevant authorities, the Violence Against Women Act of 1994, P.L. 103-3227
Violence Against Women Act of 2000, P.L. 106-386, Omnibus Crime Control and Safe Streets Act of
19687 42 U.S.C. 3711 et seq., the Violence Against Women and Department of Justice
Reauthorization Act of 2005, P.L. 109-162, the Violence Against Women Reauthorization Act of 2013,
P.L. 113-4, and OVW's implementing regulations at 28 C.F.R. Part 90.
22. SUBGRANTEE/SUBCONTRACTOR DATA COLLECTION
Grantee will submit reports, in a form and format to be provided by Commerce and at intervals as
agreed by the parties, regarding work under this Grant performed by subgrantees/subcontractors and
the portion of Grant funds expended for work performed by subgrantees/subcontractors, including but
not necessarily limited to minority-owned, woman -owned, and veteran -owned business
subgrantees/subcontractors. "Subgrantees/subcontractors" shall mean subgrantees of any tier. -
23. VAWA 2013 NON-DISCRIMINATION PROVISION
The Grantee acknowledges that 34 U.S.C. § 12291(b)(13) prohibits recipients of OVW awards from
excluding, denying benefits to, or discriminating against any person on the basis of actual or perceived
race, color, religion, national origin, sex, gender identity, sexual orientation, or disability in any
program or activity funded in whole or in part by this Grant. Grantees may provide sex -segregated or
sex-specific programming if doing so is necessary to the essential operations of the programs, so
long as the Grantee provides comparable services to those who cannot be provided with sex -
segregated or sex-specific programming. The Grantee agrees that it will comply with this provision.
24. ORDER OF PRECEDENCE
In the event of an inconsistency in this Grant, the inconsistency shall be resolved by giving
precedence in the following order:
• Applicable federal and state of Washington statutes and regulations
• Special Terms and Conditions
• Attachment A: Certification of Compliance with Federal Regulations
• Attachment B: U.S. Department of Justice Certified Standard Assurances
• Attachment C: EEOP Compliance Certification Form
• Attachment D: Restrictions and Certifications Regarding Non -Disclosure Agreements and
Related Matters
• Attachment E: Requirement to Report Actual or Imminent Breach of Personally Identifiable
Information
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Am Commerce
• Attachment F: Scope of Work
• Attachment G: Budget
• General Terms and Conditions
• Application for Funding as submitted and approved by COMMERCE
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General Terms and Conditions
1. DEFINITIONS
As used throughout this Grant, the following terms shall have the meaning set forth below:
A. "Authorized Representative" shall mean the Director and/or the designee authorized in writing
to act on the Director's behalf.
B. "COMMERCE" shall mean the Washington Department of Commerce.
C. "Grant" or "Agreement" or "Contract" means the entire written agreement between
COMMERCE and the Grantee, including any Exhibits, documents, or materials incorporated
by reference. E-mail or Facsimile transmission of a signed copy of this Grant shall be the same
as delivery of an original.
D. "Grantee" shall mean the entity identified on the face sheet performing service(s) under this
Grant, and shall include all employees and agents of the Grantee.
E. "Modified Total Direct Costs" (MTDC) shall mean all direct salaries and wages, applicable fringe
benefits, materials and supplies, services, travel, and up to the first $25,000 of each subaward
(regardless of the period of performance of the subawards under the award). MTDC excludes
equipment, capital expenditures, charges for patient care, rental costs, tuition remission,
scholarships and fellowships, participant support costs and the portion of each subaward in
excess of $25,000.
F. "Personal Information" shall mean 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, and "Protected Health Information" under the federal Health Insurance Portability
and Accountability Act of 1996 (HIPAA).
G. "State" shall mean the state of Washington.
H. "subaward" shall mean an award provided by a pass-through entity to a subrecipient for the
subrecipient to carry out part of a Federal award received by the pass-through entity. It does
not include payments to a contractor or payments to an individual that is a beneficiary of a
Federal program. A subaward may be provided through any form of legal agreement, including
an agreement that the pass-through entity considers a contract.
I. "Subgrantee/subcontractor" shall mean one not in the employment of the Grantee, who is
performing all or part of those services under this Grant under a separate Grant or contract
with the Grantee. The terms "subcontractor" and "subcontractors" mean subcontractor(s) in
any tier.
J. "subrecipient" shall mean a non -Federal entity that receives a subaward from a pass-through
entity to carry out part of a Federal program; but does not include an individual that is a
beneficiary of such program. A subrecipient may also be a recipient of other Federal
awards directly from a Federal awarding agency.
2. ALL WRITINGS CONTAINED HEREIN
This Grant contains all the terms and conditions agreed upon by the parties. No other understandings,
oral or otherwise, regarding the subject matter of this Grant shall be deemed to exist or to bind any of
the parties hereto.
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3. AMENDMENTS
This Grant may be amended by mutual agreement of the parties. Such amendments shall not be
binding unless they are in writing and signed by personnel authorized to bind each of the parties.
4. ASSIGNMENT
Neither this Grant, work thereunder, nor any claim arising under this Grant, shall be transferred or
assigned by the Grant without prior written consent of COMMERCE.
5. CONFIDENTIALITY AND SAFEGUARDING OF INFORMATION
A. "Confidential Information" as used in this section includes:
L All material provided to the Grantee by COMMERCE that is designated as
"confidential" by COMMERCE;
H. All material produced by the Grantee that is designated as "confidential" by
COMMERCE; and
iii. All Personal Information in the possession of the Grantee that may not be disclosed
under state or federal law.
B. The Grantee shall comply with all state and federal laws related to the use, sharing, transfer,
sale, or disclosure of Confidential Information. The Grantee shall use Confidential Information
solely for the purposes of this Grant and shall not use, share, transfer, sell or disclose any
Confidential Information to any third party except with the prior written consent of COMMERCE
or as may be required by law. The Grantee shall take all necessary steps to assure that
Confidential Information is safeguarded to prevent unauthorized use, sharing, transfer, sale or
disclosure of Confidential Information or violation of any state or federal laws related thereto.
Upon request, the Grantee shall provide COMMERCE with its policies and procedures on
confidentiality. COMMERCE may require changes to such policies and procedures as they
apply to this Grant whenever COMMERCE reasonably determines that changes are necessary
to prevent unauthorized disclosures. The Grantee shall make the changes within the time
period specified by COMMERCE. Upon request, the Grantee shall immediately return to
COMMERCE any Confidential Information that COMMERCE reasonably determines has not
been adequately protected by the Grantee against unauthorized disclosure.
C. Unauthorized Use or Disclosure. The Grantee shall notify COMMERCE within five (5) working
days of any unauthorized use or disclosure of any confidential information, and shall take
necessary steps to mitigate the harmful effects of such use or disclosure.
6. COPYRIGHT
Unless otherwise provided, all Materials produced under this Grant shall be considered "works for
hire" as defined by the U.S. Copyright Act and shall be owned by COMMERCE. COMMERCE shall
be considered the author of such Materials. In the event the Materials are not considered "works for
hire" under the U.S. Copyright laws, the Grantee hereby irrevocably assigns all right, title, and interest
in all Materials, including all intellectual property rights, moral rights, and rights of publicity to
COMMERCE effective from the moment of creation of such Materials.
"Materials" means all items in any format and includes, but is not limited to, data, reports, documents,
pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes,
and/or sound reproductions. "Ownership" includes the right to copyright, patent, register and the ability
to transfer these rights.
For Materials that are delivered under the Grant, but that incorporate pre-existing materials not
produced under the Grant, the Grantee hereby grants to COMMERCE a nonexclusive, royalty -free,
irrevocable license (with rights to sublicense to others) in such Materials to translate, reproduce,
distribute, prepare derivative works, publicly perform, and publicly display. The Grantee warrants and
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DocuSign Envelope ]D: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
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represents that the Grantee has all rights and permissions, including intellectual property rights, moral
rights and rights of publicity, necessary to grant such a license to COMMERCE.
The Grantee shall exert all reasonable effort to advise COMMERCE, at the time of delivery of
Materials furnished under this Grant, of all known or potential invasions of privacy contained therein
and of any portion of such document which was not produced in the performance of this Grant. The
Grantee shall provide COMMERCE with prompt written notice of each notice or claim of infringement
received by the Grantee with respect to any Materials delivered under this Grant. COMMERCE shall
have the right to modify or remove any restrictive markings placed upon the Materials by the Grantee.
7. DISPUTES
In the event that a dispute arises under this Agreement, it shall be determined by a Dispute Board in
the following manner: Each party to this Agreement shall appoint one member to the Dispute Board.
The members so appointed shall jointly appoint an additional member to the Dispute Board. The
Dispute Board shall review the facts, Agreement terms and applicable statutes and rules and make a
determination of the dispute. The Dispute Board shall thereafter decide the dispute with the majority
prevailing. The determination of the Dispute Board shall be final and binding on the parties hereto. As
an alternative to this process, either of the parties may request intervention by the Governor, as
provided by RCW 43.17.330, in which event the Governor's process will control.
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 the Superior Court for
Thurston County.
9. INDEMNIFICATION
Each party shall be solely responsible for the acts of its employees, officers, and agents.
10. LICENSING, ACCREDITATION AND REGISTRATION
The Grantee shall comply with all applicable local, state, and federal licensing, accreditation and
registration requirements or standards necessary for the performance of this Grant.
11. RECAPTURE
In the event that the Grantee fails to perform this Grant in accordance with state laws, federal laws,
and/or the provisions of this Grant, COMMERCE reserves the right to recapture funds in an amount
to compensate COMMERCE for the noncompliance in addition to any other remedies available at law
or in equity.
Repayment by the Grantee of funds under this recapture provision shall occur within the time period
specified by COMMERCE. In the alternative, COMMERCE may recapture such funds from payments
due under this Grant.
12. RECORDS MAINTENANCE
The Grantee shall maintain books, records, documents, data and other evidence relating to this Grant
and performance of the services described herein, including but not limited to accounting procedures
and practices that sufficiently and properly reflect all direct and indirect costs of any nature expended
in the performance of this Grant.
The Grantee shall retain such records for a period of six (6) years following the date of final payment.
At no additional cost, these records, including materials generated under the Grant, shall be subject
at all reasonable times to inspection, review or audit by COMMERCE, personnel duly authorized by
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COMMERCE, the Office of the State Auditor, and federal and state officials so authorized by law,
regulation or agreement.
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.
13. SAVINGS
In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way
after the effective date of this Grant and prior to normal completion, COMMERCE may suspend or
terminate the Grant under the "Termination for Convenience" clause, without the ten (10) calendar
day notice requirement. In lieu of termination, the Grant may be amended to reflect the new funding
limitations and conditions.
14. SEVERABILITY
The provisions of this Grant are intended to be severable. If any term or provision is illegal or invalid
for any reason whatsoever, such illegality or invalidity shall not affect the validity of the remainder of
the Grant.
15. SUBGRANTING
The Grantee may only subgrant work contemplated under this Grant if it obtains the prior written
approval of COMMERCE.
If COMMERCE approves subgranting, the Grantee shall maintain written procedures related to
subgranting, as well as copies of all subgrants and records related to subgrants. For cause,
COMMERCE in writing may: (a) require the Grantee to amend its subgranting procedures as they
relate to this Grant; (b) prohibit the Grantee from subgranting with a particular person or entity; or (c)
require the Grantee to rescind or amend a subgrant.
Every subgrant shall bind the Subgrantee to follow all applicable terms of this Grant. The Grantee is
responsible to COMMERCE if the Subgrantee fails to comply with any applicable term or condition of
this Grant. The Grantee shall appropriately monitor the activities of the Subgrantee to assure fiscal
conditions of this Grant. In no event shall the existence of a subgrant operate to release or reduce
the liability of the Grantee to COMMERCE for any breach in the performance of the Grantee's duties.
Every subgrant shall include a term that COMMERCE and the State of Washington are not liable for
claims or damages arising from a Subgrantee's performance of the subgrant.
16. SURVIVAL
The terms, conditions, and warranties contained in this Grant that by their sense and context are
intended to survive the completion of the performance, cancellation or termination of this Grant shall
so survive.
17. TERMINATION FOR CAUSE
In the event COMMERCE determines the Grantee has failed to comply with the conditions of this
Grant in a timely manner, COMMERCE has the right to suspend or terminate this Grant. Before
suspending or terminating the Grant, COMMERCE shall notify the Grantee in writing of the need to
take corrective action. If corrective action is not taken within 30 calendar days, the Grant may be
terminated or suspended.
In the event of termination or suspension, the Subgrantee shall be liable for damages as authorized
by law including, but not limited to, any cost difference between the original Grant and the replacement
or cover Grant and all administrative costs directly related to the replacement Grant, e.g., cost of the
competitive bidding, mailing, advertising and staff time.
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COMMERCE reserves the right to suspend all or part of the Grant, withhold further payments, or
prohibit the Grantee from incurring additional obligations of funds during investigation of the alleged
compliance breach and pending corrective action by the Grantee or a decision by COMMERCE to
terminate the Grant. A termination shall be deemed a "Termination for Convenience" if it is determined
that the Grantee: (1) was not in default; or (2) failure to perform was outside of his or her control, fault
or negligence.
The rights and remedies of COMMERCE provided in this Grant are not exclusive and are, in addition
to any other rights and remedies, provided by law.
18. TERMINATION FOR CONVENIENCE
Except as otherwise provided in this Grant, COMMERCE may, by ten (10) business days written
notice, beginning on the second day after the mailing, terminate this Grant, in whole or in part. If this
Grant is so terminated, COMMERCE shall be liable only for payment required under the terms of this
Grant for services rendered or goods delivered prior to the effective date of termination.
19. TERMINATION PROCEDURES
Upon termination of this Grant, COMMERCE, in addition to any other rights provided in this Grant,
may require the Grantee to deliver to COMMERCE any property specifically produced or acquired for
the performance of such part of this Grant as has been terminated. The provisions of the "Treatment
of Assets" clause shall apply in such property transfer.
COMMERCE shall pay to the Grantee the agreed upon price, if separately stated, for completed work
and services accepted by COMMERCE, and the amount agreed upon by the Grantee and
COMMERCE for (i) completed work and services for which no separate price is stated, (ii) partially
completed work and services, (iii) other property or services that are accepted by COMMERCE, and
(iv) the protection and preservation of property, unless the termination is for default, in which case the
Authorized Representative shall determine the extent of the liability of COMMERCE. Failure to agree
with such determination shall be a dispute within the meaning of the "Disputes" clause of this Grant.
COMMERCE may withhold from any amounts due the Grantee such sum as the Authorized
Representative determines to be necessary to protect COMMERCE against potential loss or liability.
The rights and remedies of COMMERCE provided in this section shall not be exclusive and are in
addition to any other rights and remedies provided by law or under this Grant.
After receipt of a notice of termination, and except as otherwise directed by the Authorized
Representative, the Grantee shall:
A. Stop work under the Grant on the date, and to the extent specified, in the notice;
B. Place no further orders or subgrants for materials, services, or facilities except as may be
necessary for completion of such portion of the work under the Grant that is not terminated;
C. Assign to COMMERCE, in the manner, at the times, and to the extent directed by the
Authorized Representative, all of the rights, title, and interest of the Grantee under the orders
and subgrants so terminated, in which case COMMERCE has the right, at its discretion, to
settle or pay any or all claims arising out of the termination of such orders and subgrants;
D. Settle all outstanding liabilities and all claims arising out of such termination of orders and
subgrants, with the approval or ratification of the Authorized Representative to the extent the
Authorized Representative may require, which approval or ratification shall be final for all the
purposes of this clause;
E. Transfer title to COMMERCE and deliver in the manner, at the times, and to the extent directed
by the Authorized Representative any property which, if the Grant had been completed, would
have been required to be furnished to COMMERCE;
F. Complete performance of such part of the work as shall not have been terminated by the
Authorized Representative; and
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DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
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G. Take such action as may be necessary, or as the Authorized Representative may direct, for
the protection and preservation of the property related to this Grant, which is in the possession
of the Grantee and in which COMMERCE has or may acquire an interest.
20. TREATMENT OF ASSETS
Title to all property furnished by COMMERCE shall remain in COMMERCE. Title to all property
furnished by the Grantee, for the cost of which the Grantee is entitled to be reimbursed as a direct
item of cost under this Grant, shall pass to and vest in COMMERCE upon delivery of such property
by the Grantee. Title to other property, the cost of which is reimbursable to the Grantee under this
Grant, shall pass to and vest in COMMERCE upon (i) issuance for use of such property in the
performance of this Grant, or (ii) commencement of use of such property in the performance of this
Grant, or (iii) reimbursement of the cost thereof by COMMERCE in whole or in part, whichever first
occurs.
A. Any property of COMMERCE furnished to the Grantee shall, unless otherwise provided herein
or approved by COMMERCE, be used only for the performance of this Grant.
B. The Grantee shall be responsible for any loss or damage to property of COMMERCE that
results from the negligence of the Grantee or which results from the failure on the part of the
Grantee to maintain and administer that property in accordance with sound management
practices.
C. If any COMMERCE property is lost, destroyed or damaged, the Grantee shall immediately
notify COMMERCE and shall take all reasonable steps to protect the property from further
damage.
D. The Grantee shall surrender to COMMERCE all property of COMMERCE prior to settlement
upon completion, termination or cancellation of this Grant.
E. All reference to the Grantee under this clause shall also include Grantee's employees, agents
or subgrantees/subcontractors.
21. WAIVER
Waiver of any default or breach shall not be deemed to be a waiver of any subsequent default or
breach. Any waiver shall not be construed to be a modification of the terms of this Grantee unless
stated to be such in writing and signed by Authorized Representative of COMMERCE.
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DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
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Attachment A
Attachment A: Certification of Compliance with Federal Regulations
All OVW award recipients, and any subrecipient ("subgrantee") at any tier, must comply with the
requirements below. In addition, the general terms and conditions applicable to all OVW grants and
cooperative agreements are available at bttps://www.iustice.ciov/ovw/award-conditions. These do not
supersede any specific conditions in this award document.
1. Part 200 Uniform Requirements and Compliance with DOJ Grants Financial Guide
The recipient agrees to comply with the Uniform Administrative Requirements, Cost Principles, and
Audit Requirements in 2 C.F.R. Part 200, as adopted and supplemented by the Department of Justice
(DOJ) in 2 C.F.R. Part 2800 (together, the "Part 200 Uniform Requirements"), and the current edition
of the DOJ Grants Financial Guide as posted on the OVW website, including any updated version that
may be posted during the period of performance. The details of this requirement are posted on the
OVW website at https://www.,austice.qov/ovw/award-conditions (Award condition: Applicability of Part
200 Uniform Requirements and Compliance with DOJ Grants Financial Guide), and are incorporated
by reference here.
2. Requirements related to System for Award Management and unique entity identifiers
Grantees may not receive a grant unless they have obtained a Unique Entity Identifier from the System
for Award Management (SAM), currently at https://www.Sam--qov. Recipients are not required to
maintain an active SAM registration, but must obtain a Unique Entity Identifier. Recipients must provide
their Unique Entity Identifier when requested.
3. Requirement to report actual or imminent breach of personally identifiable information (E UI
The recipient (and any subrecipient at any tier) must have written procedures in place to respond in the
event of an actual or imminent breach (as defined in OMB M-17-12) if it (or a subrecipient)-- 1) creates,
collects, uses, processes, stores, maintains, disseminates, discloses, or disposes of personally
identifiable information (P11) (as defined in 2 C.F.R. 200.1) within the scope of an OVW grant -funded
program or activity, or 2) uses or operates a Federal information system (as defined in OMB Circular
A-130). The recipient's breach procedures must include a requirement to report actual or imminent
breach of PH to an OVW Program Manager no later than 24 hours after an occurrence of an actual
breach, or the detection of an imminent breach.
4. Requirements- pertaining to prohibited conduct related to trafficking_ in persons (including
reporting requirements and OVW authority to terminate award)
The recipient, and any subrecipient (subgrantee) at any tier, must comply with all applicable
requirements (including requirements to report allegations) pertaining to prohibited conduct related to
the trafficking of persons, whether on the part of recipients, subrecipients (subgrantees), or individuals
defined (for purposes of this condition) as "employees" of the recipient or of any subrecipient. The
details of the recipient's obligations related to prohibited conduct related to trafficking in persons are
posted on the OVW website at bttps://www.justice.gov/ovw/award-conditions (Award Condition:
Prohibited conduct by recipients and subrecipients related to trafficking in persons (including reporting
requirements and OVW authority to terminate award)), and are incorporated by reference here.
5. Determinations of suitability to interact with participating minors
The recipient, and any subrecipient at any tier, must make determinations of suitability before certain
individuals may interact with participating minors. This requirement applies regardless of an
individual's employment status. The details of this requirement are posted on the OVW website at
https://www.justice.ciov/ovw/award-conditions (Award condition: Determination of suitability required,
in advance, for certain individuals who may interact with participating minors), and are incorporated
by reference here.
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Attachment A
6. Compliance with DOJ regulations pertaining to civil rights and nondiscrimination - 28 C.F.R.
Parts 42, 38, and 54
The recipient, and any subrecipient (subgrantee) at any tier, must comply with all applicable
requirements of 28 C.F.R. Part 42, specifically including any applicable requirements in Subpart E of
28 C.F.R. Part 42 that relate to an equal employment opportunity program.
The recipient, and any subrecipient (subgrantee) at any tier, must comply with all applicable
requirements of 28 C.F.R. Part 38.
Among other things, 28 C.F.R. Part 38 includes rules that prohibit specific forms of discrimination on
the basis of religion, a religious belief, a refusal to hold a religious belief, or refusal to attend or
participate in a religious practice. Part 38 also sets out rules and requirements that pertain to recipient
and subrecipient (subgrantee) organizations that engage in or conduct explicitly religious activities, as
well as rules and requirements that pertain to recipients and subrecipients that are faith -based or
religious organizations.
The recipient, and any subrecipient (subgrantee) at any tier, must comply with all applicable
requirements of 28 C.F.R. Part 54, which relates to nondiscrimination on the basis of sex in certain
"education programs."
7. -Compliance with general appropriations -law restrictions on the use of federal funds for this
fiscal
The recipient, and any subrecipient (subgrantee) at any tier, must comply with all applicable restrictions
on the use of federal funds set out in federal appropriations statutes. Pertinent restrictions, for each
fiscal year, are set out at https://www..i,ustice.qov/ovw/award-conditions (Award Condition: General
appropriations -law restrictions on use of federal award funds), and are incorporated by reference here.
Should a question arise as to whether a particular use of federal funds by a recipient (or a subrecipient)
would or might fall within the scope of an appropriations -law restriction, the recipient is to contact OVW
for guidance, and may not proceed without the express prior written approval of OVW.
8. Compliance with 41 U.S.C. 4712 (includingProhibitions on reprisal; notice to employees)
The recipient (and any subrecipient at any tier) must comply with, and is subject to, all applicable
provisions of 41 U.S.C. 4712, including all applicable provisions that prohibit, under specified
circumstances, discrimination against an employee as reprisal for the employee's disclosure of
information related to gross mismanagement of a federal grant, a gross waste of federal funds, an
abuse of authority relating to a federal grant, a substantial and specific danger to public health or safety,
or a violation of law, rule, or regulation related to a federal grant.
The recipient also must inform its employees, in writing (and in the predominant native language of the
workforce), of employee rights and remedies under 41 U.S.C. 4712.
Should a question arise as to the applicability of the provisions of 41 U.S.C. 4712 to this award, the
recipient is to contact OVW for guidance.
9. Employment eligibility verification for hiring under the award
The recipient must ensure that, as part of the hiring process for any position within the United States
that is or will be funded (in whole or in part) with award funds, the recipient (or any subrecipient) properly
verifies the employment eligibility of the individual who is being hired, consistent with the provisions of
8 U.S.C. § 1324a(a)(1) and (2). The details of the recipients obligations under this condition are posted
on the OVW website at -https://www.justice.gov/ovw/award-conditions (Award Condition: Employment
eligibility verification for hiring under award), and are incorporated by reference here.
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10. Restrictions on "lobbying" and policy development
In general, as a matter of federal law, federal funds may not be used by the recipient, or any subrecipient
(subgrantee) at any tier, either directly or indirectly, in support of the enactment, repeal, modification or
adoption of any law, regulation or policy, at any level of government, in order to avoid violation of 18
U.S.C. 1913. The recipient, or any subrecipient (subgrantee) may, however, use federal funds to
collaborate with and provide information to federal, state, local, tribal and territorial public officials and
agencies to develop and implement policies and develop and promote state, local, or tribal legislation
or model codes designed to reduce or eliminate domestic violence, dating violence, sexual assault, and
stalking (as those terms are defined in 34 U.S.C. 12291(a)) when such collaboration and provision of
information is consistent with the activities otherwise authorized under this grant program.
Another federal law generally prohibits federal funds awarded by OVW from being used by the recipient,
or any subrecipient at any tier, to pay any person to influence (or attempt to influence) a federal agency,
a Member of Congress, or Congress (or an official or employee of any of them) with respect to the
awarding of a federal grant or cooperative agreement, subgrant, grant, subcontract, or loan, or with
respect to actions such as renewing, extending, or modifying any such award. See 31 U.S.C. 1352.
Certain exceptions to this law apply, including an exception that applies to Indian tribes and tribal
organizations.
11. Confidentiality and information sharing
The recipient agrees to comply with the provisions of 34 U.S.C. 12291(b)(2), nondisclosure of
confidential or private information, which includes creating and maintaining documentation of
compliance, such as policies and procedures for release of victim information. The recipient also agrees
to comply with the regulations implementing this provision at 28 C.F.R. 90.4(b) and "Frequently Asked
Questions (FAQs) on the VAWA Confidentiality Provision (34 U.S.C. 12291(b)(2))" on the OVW website
at https://www.justice.qov/ovw/resources-and-fags-g.rantees. The recipient also agrees to ensure that
all subrecipients (subgrantees) at any tier meet these requirements.
12. Policy for response to workplace -related incidents of sexual misconduct, domestic violence,
and dating violence
The recipient, and any subrecipient at any tier, must have a policy, or issue a policy within 270 days of
the award date, to address workplace -related incidents of sexual misconduct, domestic violence, and
dating violence involving an employee, volunteer, consultant, or contractor. The details of this
requirement are posted on the OVW website at https://www.justice.qov/ovw/award-conditions (Award
Condition: Policy for response to workplace -related sexual misconduct, domestic violence, and dating
violence), and are incorporated by reference here.
13. Unreasonable restrictions on competition under the award; association with the federal
government
No recipient (or subrecipient, at any tier) may (in any procurement transaction) discriminate against any
person or entity on the basis of such person or entity's status as an "associate of the federal
government" (or on the basis of such person or entity's status as a parent, affiliate, or subsidiary of
such an associate), except as expressly set out in 2 C.F.R. 200.319(a) or as specifically authorized by
DOJ. The details of the recipient's obligations under this condition are_ posted on the OVW website at
https://www.iustice.gov/ovw/award-conditions (Award Condition; Unreasonable restrictions on
competition under the award; association with federal government), and are incorporated by reference
here.
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Attachment A
14. Notification of Findings of Discrimination or Non -Compliance
In the event a state or federal court or a state or federal administrative agency makes a finding of
discrimination after a due process hearing on the basis of actual or perceived race, color, religion,
national origin, sex, gender identity, sexual orientation, age, or disability against the recipient, or a
program partner or participant receiving contract funds, the recipient will forward a copy of the finding
to the U.S. Department of Justice, Office of Justice Programs, Office of Civil Rights (OCR), and the
Department of Commerce (COMMERCE).
The recipient, and any subrecipient ("subgrantee") at any tier, shall include a statement clearly stating
whether or not the finding is related to any contract activity supported with a contract in which U.S.
Department of Justice funds are involved, and identify all open contracts utilizing U.S. Department of
Justice funding by contract number and program title.
15. Copyrighted works
Pursuant to 2 C.F.R. 200.315(b), the recipient may copyright any work that is subject to copyright and
was developed, or for which ownership was acquired, under this award. OVW reserves a royalty -free,
nonexclusive, and irrevocable right to reproduce, publish, or otherwise use the work, in whole or in
part (including in the creation of derivative works), for federal purposes, and to authorize others to do
so.
OVW also reserves a royalty -free, nonexclusive, and irrevocable right to reproduce, publish, or
otherwise use, in whole or in part (including in the creation of derivative works), any work developed
by a subrecipient (subgrantee) of this award, for federal purposes, and to authorize others to do so.
In addition, the recipient (or subrecipient, contractor, or subcontractor of this award at any tier) must
obtain advance written approval from the OVW program manager assigned to this award, and must
comply with all conditions specified by the program manager in connection with that approval, before:
1) using award funds to purchase ownership of, or a license to use, a copyrighted work; or 2)
incorporating any copyrighted work, or portion thereof, into a new work developed under this award.
It is the responsibility of the recipient (and of each subrecipient, contractor, or subcontractor as
applicable) to ensure that this condition is included in any subaward, contract, or subcontract under
this award.
As the duly Authorized Representative of the Grantee, I hereby certify that the Grantee (and any
subgrantees) will comply with the above regulations, as applicable
New Hope
Agency Name
Suzi Fode Director
Name of Authorized Official Title of Authorized Official
Signature of Authorized Official Date
Page 22 of 30
DocuSig n Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
W�-Shdng'on State
V
Depvc—Mientof IP 2F
Mg COMMeIrCe Attachment B
Attachment B: U.S. De artment of Justice Certified Standard
Assurances
On behalf of the Applicant, and in support of this application for a grant or cooperative agreement, I certify
under penalty of perjury to the U.S. Department of Justice ("Department"), that all of the following are true
and correct:
I have the authority to make the following representations on behalf of myself and the Applicant. I
understand that these representations will be relied upon as material in any Department decision to
make an award to the Applicant based on its application.
2. 1 certify that the Applicant has the legal authority to apply for the federal assistance sought by the
application, and that it has the institutional, managerial, and financial capability (including funds
sufficient to pay any required non-federal share of project costs) to plan, manage, and complete the
project described in the application properly.
3. 1 assure that, throughout the period of performance for the award (if any) made by the Department
based on the application—
A. the Applicant will comply with all award requirements and all federal statutes and regulations
applicable to the award;
B. the Applicant will require all subrecipients to comply with all applicable award requirements and all
applicable federal statutes and regulations; and
C. the Applicant will maintain safeguards to address and prevent any organizational conflict of interest
and also to prohibit employees from using their positions in any manner that poses, or appears to
pose, a personal or financial conflict of interest.
4. The Applicant understands that the federal statutes and regulations applicable to the award(if an
made by the Department based on the application specifically include statutes and regulations
pertaining to civil rights and nondiscrimination, and, in addition—
A. the Applicant understands that the applicable statutes pertaining to civil rights will include section
601 of the Civil Rights Act of 1964 (42 U.S.C. § 2000d); section 504 of the Rehabilitation Act of
1973 (29 U.S.C. § 794); section 901 of the Education Amendments of 1972 (20 U.S.C. § 1681);
and section 303 of the Age Discrimination Act of 1975 (42 U.S.C. § 6102);
B. the Applicant understands that the applicable statutes pertaining to nondiscrimination may include
section 809(c) of Title I of the Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. §
10228(c)); section 1407(e) of the Victims of Crime Act of 1984 (34 U.S.C. § 20110(e)); section
299A(b) of the Juvenile Justice and Delinquency Prevention Act of 2002 (34 U.S.C. § 11182(b));
and that the grant condition set out at section 40002(b)(13) of the Violence Against Women Act (34
U.S.C. § 12291(b)(13)),which will apply to all awards made by the Office on Violence Against
Women, also may apply to an award made otherwise;
C. the Applicant understands that it must require any subrecipient to comply with all such applicable
statutes (and associated regulations); and
D. on behalf of the Applicant, I make the specific assurances set out in 28 C.F.R. §§ 42.105 and
42.204.
Page 23 of 30
DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
A'a's-hing,':on Stade
DepLvtmerit of
94111kar'" C 0 MD - I e, 1r, c, e
Attachment B
5.t The Applicant also understands that (in addition to any applicable program -specific regulations and to
applicable federal regulations that pertain to civil rights and nondiscrimination) the federal regulations
applicable to the award (if any) made by the Department based on the application may include, but are
not limited to, 2 C.F.R. Part 2800 (the DOJ "Part 200 Uniform Requirements") and 28 C.F.R. Parts 22
(confidentiality - research and statistical information), 23 (criminal intelligence systems), 38 (regarding
faith -based or religious organizations participating in federal financial assistance programs), and 46
(human subjects protection).
6. 1 assure that the Applicant will assist the Department as necessary (and will require subrecipients and
contractors to assist as necessary) with the Department's compliance with section 106 of the National
Historic Preservation Act of 1966 (54 U.S.C. § 306108), the Archeological and Historical Preservation
Act of 1974 (54 U.S.C. §§ 312501-312508), and the National Environmental Policy Act of 1969 (42
U.S.C. §§ 4321-4335), and 28 C.F.R. Parts 61 (NEPA) and 63 (floodplains and wetlands).
7. 1 assure that the Applicant will give the Department and the Government Accountability Office, through
any Authorized Representative, access to, and opportunity to examine, all paper or electronic records
related to the award (if any) made by the Department based on the application.
8. 1 assure that, if the Applicant is a governmental entity, with respect to the award (if any) made by the
Department based on the application—
A. it will comply with the requirements of the Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (42 U.S.C. §§ 4601-4655), which govern the treatment of persons
displaced as a result of federal and federally -assisted programs; and
B. it will comply with requirements of 5 U.S.C. §§ 1501-1508 and 7324-7328, which limit certain
political activities of State or local government employees whose principal employment is in
connection with an activity financed in whole or in part by federal assistance.
9. If the Applicant applies for and receives an award from the Office of Community Oriented Policing
Services (COPS Office), I assure that as required by 34 U.S.C. § 10382(c)(11), it will, to the extent
practicable and consistent with applicable law --including, but not limited to, the Indian Self -
Determination and Education Assistance Act --seek, recruit, and hire qualified members of racial and
ethnic minority groups and qualified women in order to further effective law enforcement by increasing
their ranks within the sworn positions, as provided under 34 U.S.C. § 10382(c)(11).
10. If the Applicant applies for and receives a DOJ award under the STOP School Violence Actprogram , I
assure as required by 34 U.S.C.10552(a)(3), that it will maintain and report such data, records, and
information (programmatic and financial) as DOJ may reasonably require.
I acknowledge that a materially false, fictitious, or fraudulent statement (or concealment or omission of a
material fact) in this certification, or in the application that it supports, may be the subject of criminal
prosecution (including under 18 U.S.C. §§ 1001 and/or 1621, and/or 34 U.S.C. §§ 10271-10273), and also
may subject me and the Applicant to civil penalties and administrative remedies for false claims or otherwise
(including under 31 U.S.C. §§ 3729-3730 and 3801-3812). 1 also acknowledge that the Department's
awards, including certifications provided in connection with such awards, are subject to review by the
Department, including by its Office of the Inspector General.
New Hope
Agency Name
SuziFode
Name of Authorized Official
Director
Title of Authorized Official
Signature of Authorized Official Date
Page 24 of 30
DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
Depa�-.ment of
ff
ar e
" 4 Con, -im 1
r(T
Attachment C
Attachment C: EEOP Compliance Certification Form
Recipient's Name: New Hope
Address: PO BOX 37 , EPHRATA, WA 98823-0037
Is agency a 0 Direct or Z Sub recipient of OJP, OVW or COPS funding? —Law Enforcement &genc y?[]Yes- 0 No
UEl Number: ZL6WM26K8KR5 I Vendor Number (only if direct recipient): N/A
Name and Title of Contact Person: Suzi Fode, Director
Telephone Number: (509) 764-8402 1 E -Mail Address: sfo.d.ea.qrantcountvwa.aov
Urant Uounty, dba New Hope [organization],
Page 25 of 30
DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
Aft Wa-hing-on State
44►C onimerev,
Attachment D
Attachment D: Restrictions and Certifications Regarding Non -
Disclosure Agreements and Related -Matters
No recipient or subrecipient ("subgrantee") under this award, or entity that receives a procurement contract
or subcontract with any funds under this award, may require any employee or contractor to sign an internal
confidentiality agreement or statement that prohibits or otherwise restricts, or purports to prohibit or restrict,
the reporting (in accordance with law) of waste, fraud, or abuse to an investigative or law enforcement
representative of a federal department or agency authorized to receive such information.
The foregoing is not intended, and shall not be understood by the agency making this award, to contravene
requirements applicable to Standard Form 312 (which relates to classified information), Form 4414 (which
relates to sensitive compartmented information), or any other form issued by a federal department or
agency governing the non -disclosure of classified information.
1. In accepting this award, the recipient
A. represents that it neither requires nor has required internal confidentiality agreements or statements
from employees or contractors that currently prohibit or otherwise currently restrict (or purport to
prohibit or restrict) employees or contractors from reporting waste, fraud, or abuse as described
above; and
B. certifies that, if it learns or is notified that it is or has been requiring its employees or contractors to
execute agreements or statements that prohibit or otherwise restrict (or purport to prohibit or
restrict), reporting of waste, fraud, or abuse as described above, it will immediately stop any further
obligations of award funds, will provide prompt written notification to the federal agency making this
award, and will resume (or permit resumption of) such obligations only if expressly authorized to
do so by that agency.
2. If the recipient does or is authorized under this award to make subawards ("subgrants"), procurement
contracts, or both
A. it represents that -
1) it has determined that no other entity that the recipient's application proposes may or will
receive award funds (whether through a subaward ("subgrant"), procurement contract, or
subcontract under a procurement contract) either requires or has required internal
confidentiality agreements or statements from employees or contractors that currently prohibit
or otherwise currently restrict (or purport to prohibit or restrict) employees or contractors from
reporting waste, fraud, or abuse as described above; and
2) it has made appropriate inquiry, or otherwise has an adequate factual basis, to support this
representation; and
B. it certifies that, if it learns or is notified that any subrecipient, contractor, or subcontractor entity that
receives funds under this award is or has been requiring its employees or contractors to execute
agreements or statements that prohibit or otherwise restrict (or purport to prohibit or restrict),
reporting of waste, fraud, or abuse as described above, it will immediately stop any further
obligations of award funds to or by that entity, will provide prompt written notification to the federal
agency making this award, and will resume (or permit resumption of) such obligations only if
expressly authorized to do so by that agency.
New Hope
Agency Name
Suzi Fode Director
Name of Authorized Official Title of Authorized Official
Signature of Authorized Official Date
Page 26 of 30
DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
Depa zMent of
Commerce
mere
Attachment E
Attachment E: Requirement to Report Actual or Imminent Breach of
Personally Identifiable Information
The Grantee (and any Subgrantee) must have written procedures in place to respond in the event of an
actual or imminent breach (as defined in OMB M-17-12) if it (or a subgrantee)-- 1) creates, collects, uses,
processes, stores, maintains, disseminates, discloses, or disposes of personally identifiable information
(PII) (as defined in 2 C.F.R. 200.79) within the scope of an OVW grant -funded program or activity, or 2)
uses or operates a Federal information system (as defined in OMB Circular A-130).
The Grantee's breach procedures must include a requirement to report actual or imminent breach of
personally identifiable information to the Authorized Representative identified on the Face Sheet of this
Grant no later than 24 hours after an occurrence of an actual breach, or the detection of an imminent
breach.
Subgrantee's breach procedures must include a requirement to report actual or imminent breach of
personally identifiable information to the Grantee no later than 24 hours after an occurrence of an actual
breach, or the detection of an imminent breach.
Grantees (and any Subgrantee) are prohibited from disclosing, revealing, or releasing personally identifying
information or individual information collected in connection with services requested, utilized, or denied
through the Grantee's (and any Subgrantee's) programs, regardless of whether the information has been
encoded, encrypted, hashed, or otherwise protected (34 U.S.C. § 12291(b)(2)).
As the duly Authorized Representative of the Grantee, I hereby certify that the Grantee (and any
Subgrantee) will comply with the above requirements. I also understand, as part of grant monitoring, OCVA
staff may request a copy of Grantee's breach procedures.
New Hope
Agency Name
Suzi Fode Director
Name of Authorized Official Title of Authorized Official
Signature of Authorized Official Date
Page 27 of 30
DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
oaMer)4 of
10 A Commerce
Attachment F
Attachment F: Scope of Work
January 1, 2023 through December 31, 2023
New Hope shall provide staff and furnish goods and services necessary to accomplish the activities under
the STOP Violence Against Women Formula Grant Program during the Grant period.
This Grant is not a Benefit or Entitlement to the Grantee. It is not to be used to acquire property or services
for the state government's direct benefit. The principle purpose of this Grant is to provide funding for New
Hope to accomplish a public purpose.
Funding from this Grant must be used to support the Grantee's STOP Violence Against Women Formula
Grant Program. Grantee must ensure that activities funded under this Grant program are available to adult
or youth victims (ages 11 or older) of domestic violence, sexual assault, stalking or dating violence during
Grantee's regular business hours and shall include, but not be limited to:
• system -based advocacy on behalf of the victim;
• information and support for victims;
• assistance with obtaining protection orders or other court documents;
m assistance with restitution;
• assistance in accessing Crime Victims Compensation benefits;
• notification of hearings and other relevant events;
• referrals to other agencies which can provide information for a victim;
• active collaboration with victim services and law enforcement to ensure a supportive and strong
coordinated response for victims of domestic violence, sexual assault, dating violence, and/or
stalking; and
• ensuring that goods and services, s.upplies or direct costs supported by this grant program are related
to issues involving adult or youth victims (ages 11 or older) of domestic violence, sexual assault,
dating violence and/or stalking.
Services provided must be consistent with current state and federal laws and mandates.
Outreach, Public Awareness and Education Activities
Grant funds may only be used to support, inform, and outreach to victims about available services. Grantee
agrees Grant funds will not be used to conduct public awareness or community education campaigns or
related activities.
Coordinated Community Response Team
The Grantee and Subgrantees, if applicable, shall participate at least quarterly, in the county's Coordinated
Community Response Team to increase the safety of victims of domestic violence, sexual assault, dating
violence and/or stalking and hold offenders accountable. OCVA Program Staff may conduct periodic checks
for compliance with participation in the CCR Team. Noncompliance may result in suspension of payments
to Grantee under this Grant.
Victim Safetv and Recovery
The Grantee and Subgrantees, if applicable, agree that these funds will not support activities that
compromise victim safety and recovery and undermine offender accountability, such as:
1. Procedures or policies that exclude victims from receiving safe shelter, advocacy services, counseling,
and other assistance based on their actual or perceived sex, age, immigration status, race, religion,
Page 28 of 30
oonuoignEnvelope ID:
"ashing-on State
-
er)a,-rnent of
Attachment F
sexual orientation, gender identity, mental health condition, physical health condition, criminal record,
work in the sex industry, income or lack of income, or the age and/or sex of their children.
2. Procedures or policies that compromise the confidentiality ofinformation and/or privacy of persona
receiving services.
3. Procedures or policies that require victims totake certain actions (e.g., seek an order of protection,
receive counseling, participate in couples counseling ormediation, report to law enforcement, seek civil
orcriminal remedies) inorder toraoeivaeen/icea.
4. Procedures or policies that fail to include conducting safety planning with victims.
5. Project daeigne, producto, aemioao, end/or budgets that fail to account for the unique needs of
individuals with disabilities, with limited English profoienoy, or who one Deaf or hand of hearing,
including eomaoeibi|�yfor such individuals.
The Office on Violence Against Women (OVW) does not fund activities that jeopardize victim safety, deter
or prevent physical or emotional healing for viotima, or allow offenders to escape responsibility fortheir
actions.
Deliverables
The Grantee shall baresponsible for the following deliverables:
1. Participationincoordinated community responsemeetingoatbastquartedy—Asdetai|edebove
2. Reports —As described inSection 19ofthe Special Terms and Conditions
3. Vounhara—N?uetbeaubmittedat|eea quarterly
Performance Measures
Provision of the deliverables listed above will be measured using the following performance measures:
1. Participation in at least 7596 of coordinated community -
response meetings
2. 100% of required reports will be submitted on time
3 8O%ofvouchers will bocompleted ontime
Page 29 of 30
000uoignEnvelope ID: 2roEoese-2
'it Washirig-on State
DAPpa.-tinent of
1W OmMerce,
Attachment G: Budget
January 1, 2023 through December 31v 2023
Attachment G
Budget
STOP - Victim
Services (Adams
County)
STOP - Victim
Services (Grant
County)
Total
Salaries
$97443.00
$101480.00
$195923.00
Benefits
$31362.00
$37859.00
$752,21.00
$65034.00
Goods and Services
$27611.00
$37423.00
Total
$155416.00
$175762.00
$335178.00
Transfer of funds between line item budget categories must be approved by the Office of Crime Victims
Advocacy (OCVA)program staff. Acumulative amount of these transfers exceeding ten (10percent of the
total program budget shall be subject to justification and negotiation between the Grantee and C>C\AA'
including approval from the Grantee's signature authority and the relevant OCVA Section Manager.
The cost of allowable equipment purchased with these funds must be prorated to Grant activity uaoge,
unless items are used 90% or more on Grant activities. Equipment authorized to be purchased with Grant
funds must be documented in an inventory system indioating, at e minimum, date of purchase, quantity,
and distribution. Equipment must also be purchased within the first quarter of the Grant.
Printing of Materials: DC\AA must forward requests to print brochures, biUboarda, and other publications to
the Office on Violence Against Women not less than twenty (20) days prior to public release of the mobaha|e
If approvad, the printing must be completed within the first three (3) months of the Grant.
Food and Beverage Costs: The Grantee agrees Grant funds will not be used to purchase food end/or
beverages for any meetinQ, confarenoe, tnaining, orother event, with the exception of support groups or
otherwise within the context of victim services where it is necessary and integral to providing services to
enhance victim safety. Additional information may be found in the Frequently Asked Questions (FAQs)
About STOP Formula Grants available at:ag e/fi le/1 00881 6/d own load.
Consultant/contractor fees may not exceed $650 per day (excluding travel and subsistence costs) for an
eight-hour day or may not exceed $81.25 per hour for less than an eight-hour day. Grantees are required
to maintain documentation to support all daily orhourly rates.
No Grant funds may be used to maintain or establish a computer network unless such network blocks the
viewing' downloading, and exchanging of pornography. However' this does not apply to law enforcement
agencies or any other entity carrying out criminal invaatigotiona, proaeoution, or adjudication activities.
Page 30 of 30
DocuSign Envelope ID: 272EBE59-2DC2-4AC2-A9A0-F02999C5FA90
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Section
Jodine Honeysett
Memo and Allocation Spreadsht
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12/12/2022 15:56 AM PST
Manager
Reviewed entry and coding in CMS
Correct template from IntraCOM has
Assistant
been used
or
Richard Torrance
OR
Managing
12/12/202211:01 PM PST
Documentation has been included with
Director
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......... .........
Reviewed by: Title: I verify that I have: Date:
Grant Checked that Grantee has completed all
Manager required certifications and/or forms
Updated 5/25/2022
Certificate Of Completion
Envelope Id: 272EBE592DC24AC2A9AOF02999C5FA90 Status: Sent
Subject: Complete with DocuSign: OCVA - STOP FY22 Local Government Grant # F22-31103-040
Division:
Community Services and Housing
Program: OCVA
ContractNumber: F22-31103-040
DocumentType: Contract
Source Envelope:
Document Pages: 31 Signatures: 0
Envelope Originator:
Certificate Pages: 5 Initials: 0
Kelly Tracy
AutoNav: Enabled
1011 Plum Street SE
Envelopeld Stamping: Enabled
MS 42525
Time Zone: (UTC -08:00) Pacific Time (US & Canada)
Olympia, WA 98504-2525
kelly.tracy@commerce.wa.gov
IP Address: 198.239.10.209
Record Tracking;-
--Status: Original Holder: Kelly Tracy Location: DocuSign
12/9/2022 9:50:16 AM kelly.tracy@commerce.wa.gov
Security Appliance Status: Connected Pool: StateLocal
Storage Appliance Status: Connected Pool: Washington State Department of Commerce Location: DocuSign
Si ner Events
9 Signature:Timestamp
Richard Torrance
richard.torrance@commerce.wa.gov
Washington State Department of Commerce
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Suzi Fode
sfode@grantcountywa.gov
Director
Grant County
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 7/22/2021 9:54:00 AM
ID: f9391 c86-5931-4a2b-9328-a83d20f3b27c
Diane Klontz
diane.klontz@commerce.wa.gov
Security Level: Email, Account Authentication
(None) "
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Using IP Address: 147.55.134.84
Sent: 12/12/2022 5:56:18 AM
Viewed: 12/12/2022 1:01:04 PM
Signed: 12/12/2022 1:01:12 PM
Sent: 12/12/2022 1:01:15 PM
Viewed: 12/14/2022 12:05:35 PM
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Payment Events
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Eleetronic. Record and Ssgnature Disclosure
Electronic Record and Signature Disclosure created on: 8/11/2020 4:44:12 PM
Parties agreed to: Suzi Fode
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, Washington State Department of Commerce (we, us or Company) may be
required by law to provide to you certain written notices or disclosures. Described below are the
terms and conditions for providing to you such notices and disclosures electronically through the
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I agree to use electronic records and signatures' before clicking `CONTINUE' within the
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Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
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elect to create a DocuSign account, you may access the documents for a limited period of time
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If you decide to receive notices and disclosures from us electronically, you may at any time
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Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
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All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we willp rovide
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inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
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How to contact Washington State Department of Commerce:
You may contact us to let us know of your changes as to how we may contact you electronically,
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To contact us by email send messages to: docusign@commerce.wa.gov
To advise Washington State Department of Commerce of your new email address
To let us know of a change in your email address where we should send notices and disclosures
electronically to you, you must send an email message to us at docusign@commerce.wa.gov and
in the body of such request you must state: your previous email address, your new email
address. We do not require any other information from you to change your email address.
If you created a DocuSign account, you may update it with your new email address y
through our
account preferences.
g
To request paper copies from Washington State Department of Commerce
To request delivery from us of paper copies of the notices and disclosures previouslyp rovided
by us to you electronically, you must send us an email to docusign@commerce-wa.gov and in
the body of such request you must state your email address, full name, mailing address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Washington State Department of Commerce
To inform us that you no longer wish to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your signing session, and on the subsequentpage
,
select the check -box indicating you wish to withdraw your consent, or you may;
ii. send us an email to docusign@commerce.wa.gov and in the body of such requesty ou must
state your email, full name, mailing address, and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: https://sUi)ort.docusi .. n.com/guides/si ,.neL ide-
si gning-ssystem-requirements.
Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm thaty ou have
read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check -box next to `I agree to use electronic records and signatures' before
clicking `CONTINUE' within the DocuSign system.
By selecting the check -box next to `I agree to use electronic records and signatures',y ou confirm
that:
You can access and read this Electronic Record and Signature Disclosure; and
You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
Until or unless you notify Washington State Department of Commerce as described
above, you consent to receive exclusively through electronic means all notices,
disclosures, authorizations, acknowledgements, and other documents that are required to
be provided or made available to you by Washington State Department of Commerce
during the course of your relationship with Washington State Department of Commerce.