HomeMy WebLinkAboutAgreements/Contracts - New Hope DV/SAGRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT:New Hope
REQUEST SUBMITTED BY: SuziFode
CONTACT PERSON ATTENDING ROUNDTABLE. SUZI FOCIe
I
CONFIDENTIAL INFORMATION: 11YES ANO
DATE: 12.5.2023
PHONE: 764.842
with Washington State Department of Commerce for Jan -Dec 2024 in the amount of $34,449
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Request to docusign Grant Number F23-31103-078 STOP Violence Against Women Formula Grant Program
with Washington State Department of Commerce for Jan -Dec 2024 in the amount of $34,449
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APPROVE: DENIED ABSTAIN
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December 5, 2023
Board of Grant County Commissioners
PO Box 37
Ephrata, WA 98823
RE: Signature for Contract #F23-31103-078
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: 1.1.2024 through 12.31.2024
Purpose: STOP Violence Against Women Formula Grant Program, grant pass through
allocation to improve the community response to violence against women.
Amount: $34,449
Suzi Fode is requesting permission to Docu-Sign electronically with the contractor.
Thank you for your consideration,
Suzi Fode, Director
Kids Hope and New Hope
DocuSign Envelope ID: 7B3BBCE6-CA97-4FC6-8C24-C3C3CDA08067
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Federal Interagency Grant Agreement with
New Hope
through
Office of Crime Victims Advocacy
Community Services Division
Grant Number:
F23-31103-078
For
K23-275
STOP Violence Against Women Formula Grant Program, grant pass
through allocation to improve the community response to violence against
women.
Dated: Monday, January 1, 2024
DocuSign Envelope ID: 7B3BBCE6-CA97-4FC6-8C24-C3C3CDA08067
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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.
APPLICABILITY OF PART 200 UNIFORM REQUIREMENTS AND DOJ GRANTS FINANCIAL GUIDE.........................5
5.
AUDIT.................................................................................................................................................................6
6.
BILLING PROCEDURES AND PAYMENT...............................................................................................................6
7.
COMPENSATION................................................................................................................................................7
8.
COMPLIANCE WITH 41 U.S.C. 4712 (INCLUDING PROHIBITIONS ON REPRISAL; NOTICE TO EMPLOYEES) .........7
9.
COMPLIANCE WITH DOJ REGULATIONS PERTAINING TO CIVIL RIGHTS AND NONDISCRIMINATION - 28 C.F.R.
PARTS38, 42, AND 54........................................................................................................................................7
10.
COMPLIANCE WITH GENERAL APPROPRIATIONS -LAW RESTRICTIONS ON THE USE OF FEDERAL FUNDS ..........
8
11.
COMPUTER NETWORK REQUIREMENT..............................................................................................................8
12.
CONFERENCES, MEETINGS, AND TRAININGS .....................................................................................................8
13.
CONFIDENTIALITY AND INFORMATION SHARING..............................................................................................8
14.
COPYRIGHTED WORKS.......................................................................................................................................9
15.
DEBARMENT......................................................................................................................................................9
16.
DETERMINATIONS OF SUITABILITY TO INTERACT WITH PARTICIPATING MINORS...........................................10
17.
FRAUD AND OTHER LOSS REPORTING..............................................................................................................10
18.
GRANT MANAGEMENT....................................................................................................................................10
19.
GRANT MODIFICATION....................................................................................................................................10
20.
INDIRECT COSTS.....................................................................................:.........................................................10
21.
INSURANCE......................................................................................................................................................11
22.
NON-COMPLIANCE WITH NON-DISCRIMINATION LAWS.................................................................................11
23.
NON-SUPPLANTING.........................................................................................................................................11
24.
NOTIFICATION OF FINDINGS OF DISCRIMINATION OR NONCOMPLIANCE......................................................11
25.
ONGOING COMPLIANCE WITH STATUTORY CERTIFICATIONS.........................................................................11
26.
POLICY FOR RESPONSE TO WORKPLACE -RELATED INCIDENTS OF SEXUAL MISCONDUCT, DOMESTIC
VIOLENCE, AND DATING VIOLENCE..................................................................................................................11
27.
POLITICAL ACTIVITIES.......................................................................................................................................12
28.
POTENTIAL FRAUD, WASTE, ABUSE, AND SIMILAR MISCONDUCT...................................................................12
29.
PROCUREMENT STANDARDS FOR FEDERALLY FUNDED PROGRAMS..............................................:................12
30.
REPORTING......................................................................................................................................................13
31.
REQUIREMENTTO REPORTACTUAL OR IMMINENT BREACH OF PERSONALLY IDENTIFIABLE INFORMATION
(PII)..................................................................................................................................................................13
32.
REQUIREMENTS PERTAINING TO PROHIBITED CONDUCT RELATED TO THE TRAFFICKING IN PERSONS
(INCLUDING REPORTING REQUIREMENTS AND OVW AUTHORITYTO TERMINATE AWARD) ..........................13
33.
REQUIREMENTS RELATED TO SYSTEM FOR AWARD MANAGEMENTAND UNIQUE ENTITY IDENTIFIERS ........13
34.
RESTRICTIONS ON "LOBBYING" AND POLICY DEVELOPMENT..........................................................................13
35.
SERVICES TO LIMITED -ENGLISH -PROFICIENT (LEP) PERSONS..........................................................................14
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DocuSign Envelope ID: 7B3BBC E6-CA97-4FC6-8C24-C3C3CDA08067
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36. STATUTORY AND REGULATORY REQUIREMENTS............................................................................................14
37. SUBGRANTEE/SUBCONTRACTOR DATA COLLECTION......................................................................................14
38. VAWA 2013 NON-DISCRIMINATION PROVISION.............................................................................................14
39. ORDER OF PRECEDENCE...................................................................................................................................15
GENERAL TERMS AND CONDITIONS.....................................................................................................................16
1.
DEFINITIONS....................................................................................................................................................16
2.
ALLWRITINGS CONTAINED HEREIN......................................................................................:..........................16
3.
AMENDMENTS.................................................................................................................................................16
4.
ASSIGNMENT...................................................................................................................................................17
5.
CONFIDENTIALITY AND SAFEGUARDING OF INFORMATION............................................................................17
6.
COPYRIGHT PROVISIONS..................................................................................................................................17
7.
DISPUTES.........................................................................................................................................................18
8.
GOVERNING LAW AND VENUE.........................................................................................................................18
9.
INDEMNIFICATION...........................................................................................................................................18
10.
LICENSING, ACCREDITATION AND REGISTRATION...........................................................................................18
11.
RECAPTURE......................................................................................................................................................18
12.
RECORDS MAINTENANCE................................................................................................................................18
13.
SAVINGS...........................................................................................................................................................19
14.
SEVERABILITY...................................................................................................................................................19
15.
SUBGRANTING.................................................................................................................................................19
16.
SURVIVAL.........................................................................................................................................................19
17.
TERMINATION FOR CAUSE...............................................................................................................................19
18.
TERMINATION FOR CONVENIENCE..................................................................................................................20
19.
TERMINATION PROCEDURES...........................................................................................................................20
20.
TREATMENT OF ASSETS...................................................................................................................................21
21.
WAIVER............................................................................................................................................................21
ATTACHMENT A: AWARD ACCEPTANCE............................................................................................................... 22
ATTACHMENT B: EEOP COMPLIANCE CERTIFICATION FORM...............................................................................23
ATTACHMENT C: RESTRICTIONS AND CERTIFICATIONS REGARDING NON -DISCLOSURE AGREEMENTS AND
RELATEDMATTERS.............................................................................................................................................. 24
ATTACHMENTD: SCOPE OF WORK...................................................................................................................... 25
ATTACHMENTE: BUDGET.................................................................................................................................... 27
Local Government Page 3 of 27
DocuSign Envelope ID: 7B3 BBC E6-CA97-4 FC6-8C24-C 3C 3C DA08067
64% Washing -n State
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Face Sheet
Grant Number: F23-31103-078
Community Services Division, Office of Crime Victims Advocacy ZSubrecipient
FFY 2023 Violence Against Women STOP Grant Program ElContractor
1. Grantee
2. Grantee Doing Business As (as applicable)
GRANT, COUNTY OF
New Hope
PO BOX 377
EPHRATA,WA 98823-0037
3. Grantee Representative
4. COMMERCE Representative
SuziFode
Mia Davidson PO Box 42525
Director
Program Coordinator 98504-2525
(509) 764-8402
(360) 725-2835
sfode@grantcountMa.gov
mia.davidson(c-Dcommerce.wa.gov 1011 Plum Street SE
Olympia, WA 98501
5. Grant Amount
6. Funding Source
7. Start Date
8. End Date
$341449.00
Federal: 0 State: 13 Other: 13 NIA: 13
01/01/2024
12/31/2024
9. Federal Funds (as applicable) Federal Agency: ALN Indirect Rate
$347449.00 Department of Justice, OVW 16.588 N/A
10. Tax ID #
11. SwV #
12. UBI #
13. UEl #
N/A
SWV0002426-17
132001884
ZL6WM26K8KR5
14. Grant Purpose
STOP Violence Against Women Formula Grant Program, grant pass through allocation to improve the community response
to violence against women.
COMMERCE, defined as the Department of Commerce, and the Grantee, as defined above, acknowledge and accept the
terms of this Grant and attachments and have executed this Grant on the date below and warrant they are authorized to
bind their respective agencies. The rights and obligations of both parties to this Grant are governed by this Grant and the
following other documents incorporated by reference: Grant Terms and Conditions including Attachment "A" — Award
Acceptance, Attachment "B" — EEOP Compliance Certification Form, Attachment "C" — Restrictions and Certifications
Regarding Non -Disclosure Agreements and Related Matters, Attachment "D" — Scope of Work, Attachment "E" — Budget,
and Grantee's Application for Funding as submitted and approved by COMMERCE.
FOR GRANTEE
FOR COMMERCE
SuziFode Director
Cindy Guertin -Anderson, Deputy Director
Date
Name, Title
Signature
APPROVED AS TO FORM ONLY
BY ASSISTANT ATTORNEY GENERAL
Date
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(Pri
(Signed)
Local Government Deputy Prosecuting Attorney Page 4 of 27
Date:,. 1112. 11�
DocuSign Envelope ID: 7B3BBC E6-CA97-4FC6-8C24-C3C3CDA08067
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Special Terms and Conditions
1. AUTHORITY
COMMERCE and Grantee enter into this Agreement pursuant to the authority granted by the
Interlocal Cooperation Act, Chapter 39.34 RCW.
2. ACKNOWLEDGEMENT OF FEDERAL FUNDING
Federal Award Date: 09/01/2021
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: $0.00
Awarding official: Rosemarie Hildago, 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: $3,060,021.0
Total amount of federal award 15JOVW-22-GG-00458-STOP funding in this grant: $0.00
Awarding official: Rosemarie Hildago, Director (202) 307-6026
Federal Award Date: 09/13/2023
Federal Award Identification Number (FAIN): 15JOVW-23-GG-00608-STOP
Total amount of the federal award: $3,784,202.00
Total amount of federal award 15JOVW-23-GG-00608-STOP funding in this grant: $34,449.00
Awarding official: Rosemarie Hildago, 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. F23-31103-078 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 36
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. APPLICABILITY OF PART 200 UNIFORM REQUIREMENTS AND DOJ GRANTS
FINANCIAL GUIDE
The Grantee 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 current edition of the DOJ Grants Financial
Guide can be found at: https://www.oLr).gov/doi-financial-guide-2022.
The Grantee also agrees that all financial records pertinent to this award, including the general
accounting ledger and all supporting documents, are subject to agency review throughout the life of
the award, during the close-out process, and for six (6) years after the Grant end date or as long as
the records are retained, whichever is longer, pursuant to 2 C.F.R. 200.334, 200.337.
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wa h rlv)n State
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Commerce
5. AUDIT
If the Grantee 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:
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.
Submit to COMMERCE follow-up and developed corrective action plans for all audit findings.
If the Grantee 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.
6. BILLING PROCEDURES AND PAYMENT
COMMERCE will pay Grantee upon acceptance of program activities provided and.receipt of properly
completed invoices which shall be submitted to the Representative for COMMERCE at least quarterly,
but not more than monthly.
Invoices shall be submitted to Mia Davidson, Program Coordinator, electronically by email to
mia.davidsonacommerce.wa.gov or via Secure Access Washington to the Commerce Contract
Management System (CMS).
If required, the attachments to the invoice request in the Commerce Contract Management System
shall describe and document, to COMMERCE's satisfaction, a description of the work performed, the
progress of the project, and fees.
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 Grant
shall be made by COMMERCE.
Invoices and End of Fiscal Year
Invoices are due on the 20th of the month following the provision of services.
Final invoices for a state fiscal year may be due sooner than the 20th and COMMERCE will provide
notification of the end of fiscal year due date.
The Grantee must invoice for all expenses from the beginning of the Grant through June 30, .
regardless of the Grant start and end date.
Duplication of Billed Costs
The Grantee shall not bill COMMERCE for services performed under this Grant, 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.
COMMERCE may, in its sole discretion, withhold ten percent (10%) from each payment until
acceptance by COMMERCE of the final report.
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DocuSign Envelope ID: 7B3BBCE6-CA97-4FC6-8C24-C3C3CDA08067
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Mishin .on State
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7. COMPENSATION
COMMERCE shall pay an amount not to exceed $34,449.00 for the performance of all things
necessary for or incidental to the performance of work as set forth in Attachment D — Scope of Work.
Grantee's compensation for services rendered shall be in accordance with Attachment E — Budget.
Victim services grantees cannot be required to provide match. Grantee can provide match voluntarily,
including "in kind" match. However, such provision of match must be truly voluntary. Grantee has
volunteered to provide a match of 0.00. 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.
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.gov/sites/default/files/public/resources/travel/colormap pdf.
8. COMPLIANCE WITH 41 U.S.C. 4712 (INCLUDING PROHIBITIONS ON REPRISAL;
NOTICE TO EMPLOYEES)
The Grantee, and any subgrantee 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 Grantee 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
Grantee is to contact COMMERCE for guidance.
9. COMPLIANCE WITH DOJ REGULATIONS PERTAINING TO CIVIL RIGHTS AND
NONDISCRIMINATION — 28 C.F.R. PARTS 38, 42, AND 54
The Grantee, and any 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 Grantee
and subgrantee organizations that engage in or conduct explicitly religious activities, as well as rules
and requirements that pertain to Grantees and subgrantees that are faith -based or religious
organizations.
The Grantee, and any 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.
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140 Commerce,
The Grantee, and any 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."
10. COMPLIANCE WITH GENERAL APPROPRIATIONS -LAW RESTRICTIONS ON THE
USE OF FEDERAL FUNDS
The Grantee, and any 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.justice.gov/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 the Grantee (or a
subgrantee) would or might fall within the scope of an appropriations -law restriction, the Grantee is to
contact COMMERCE for guidance, and may not proceed without the express prior written approval
of COMMERCE.
11. COMPUTER NETWORK REQUIREMENT
Grantees may not use any award funds to maintain or establish a computer network unless such
network blocks the viewing, downloading, and exchanging of pornography. Nothing in this
requirement limits the use of funds necessary for any local law enforcement agency or any other entity
carrying out criminal investigations, prosecution, or adjudication activities or victim assistance -related
activity.
12. 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 on Violence
Against Women (OVW) website at: https://www.justice.gov/ovw/conference-planning.
OVW Training 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:
htt s://www.justice, ov/sites/default/files/ovw/le ac /2012/06/28/ovw-trainin - uidin - rinci les -
a rantees-suba rantees. cdf.
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://www.'ustice. ov/ovw/ a e/file/1008816/download.
13. CONFIDENTIALITY AND INFORMATION SHARING
The Grantee 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.iustice.gov/ovw/resources-and-fags-grantees. The Grantee also
agrees to ensure that all subgrantees at any tier meet these requirements.
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Depwtmenf of
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14. COPYRIGHTED WORKS
Pursuant to 2 C.F.R. 200.315(b), the Grantee may copyright any work that is subject to copyright and
was developed, or for which ownership was acquired, under this Grant. The Office on Violence
Against Women (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 subgrantee of this Grant, for federal purposes, and to authorize others to do so.
In addition, the Grantee (or any subgrantee, contractor, or subcontractor of this Grant at any tier) must
obtain advance written approval from the COMMERCE representative assigned to this Grant, and
must comply with all conditions specified by the program manager in connection with that approval,
before: 1) using Grant 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 Grant.
It is the responsibility of the Grantee (and of each subgrantee, contractor, or subcontractor as
applicable) to ensure that this condition is included in any subgrant, contract, or subcontract under
this award.
15. 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:
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency.
2. 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;
3. 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
4. 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.
B. 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
1. 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.
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2. 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, lower 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.
16. DETERMINATIONS OF SUITABILITY TO INTERACT WITH PARTICIPATING MINORS
The Grantee, and any subgrantee 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.iustice.gov/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.
17. 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.
18. 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.
19. 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 -
obligated by COMMERCE as a result of a budget reduction may be made available to other Grantees
for the provision of eligible program activities.
20. 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 up to ten percent (10%)
of modified total direct costs (MTDC) may be used.
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21. 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.
22. 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.
23. 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.
24. NOTIFICATION OF FINDINGS OF DISCRIMINATION OR NONCOMPLIANCE
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 Grantee, any
subgrantee at any tier, or a program partner or participant receiving Grant funds, the Grantee will
forward a copy of the finding to the U.S. Department of Justice, Office of Justice Programs, Office of
Civil Rights (OCR), and COMMERCE.
The Grantee, and any subgrantee at any tier, shall include a statement clearly stating whether or not
the finding is related to any Grant activity supported with a Grant in which U.S. Department of Justice
funds are involved, and identify all open grants and contracts utilizing U.S. Department of Justice
funding by grant or contract number and program title.
25. ONGOING COMPLIANCE WITH STATUTORY CERTIFICATIONS
The Grantee agrees that compliance with the statutory certification requirements is an ongoing
responsibility during the Grant period and that, at a minimum, a hold may be placed on the Grantee's
funds for noncompliance with any of the requirements of 34 U.S.C. § 10449 (regarding rape exam
payments), 34 U.S.C. § 10449(e) (regarding judicial notification), 34 U.S.C. § 10450 (regarding certain
fees and costs), and 34 U.S.C. § 10451 (regarding polygraphing of sexual assault victims), and 34
U.S.C. 10454 (regarding victim -centered prosecution), and 34 U.S.C. 10446(d)(6) (regarding award
conditions). Non-compliance with any of the foregoing may also result in termination or suspension
of the Grant or other remedial measures, in accordance with applicable laws and regulations.
26. POLICY FOR RESPONSE TO WORKPLACE -RELATED INCIDENTS OF SEXUAL
MISCONDUCT, DOMESTIC VIOLENCE, AND DATING VIOLENCE
The Grantee, and any subgrantee at any tier, must have a policy, or issue a policy within 270 days of
the Grant start 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.iustice.gov/ovw/award-conditions
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V.Jashing.on State
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Commerce
(Award Condition: Policy for response to workplace -related sexual misconduct, domestic violence,
and dating violence), and are incorporated by reference here.
27. 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.
28. POTENTIAL FRAUD, WASTE, ABUSE, AND SIMILAR MISCONDUCT
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
https:Hoic justice.gov/hotline/contact-grants.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
is available from the DOJ OIG website at,https:Hoig.justice.gov/hotline.
29. 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:
1. Follow a procedure to assure the avoidance of purchasing unnecessary or duplicative
items.
2. Solicitations shall be based upon a clear and accurate description of the technical,
requirements of the procured items.
30 Positive efforts shall be made to use small and minority-owned businesses.
4. 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.
5. 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.
6. Some form of price or cost analysis should be performed in connection with every
procurement action.
7. Procurement records and files for purchases shall include all of the following:
a. Subcontractor selection or rejection.
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b. The basis for the cost or price.
c. Justification for lack of competitive bids if offers are not obtained.
8. 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 any subgrantees 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.
30. REPORTING
InfoNet Data: The Grantee shall submit data in the InfoNet data collection system, relative to the
provision of the STOP Formula Grant Program services. Report data will be due in InfoNet no later
than:
April 15, 2024; July 15, 2024; October 15, 2024; and January 15, 20el 25.
The Grantee shall submit non -personally identifying demographic, service and compliance data
required by state and federal funding sources in the InfoNet data collections system. The Grantee
shall maintain documentation and records that support the data reported in InfoNet. The Grantee shall
establish and maintain written procedures for the security pf InfoNet use at its site. Procedures shall
include:
• Only authorized staff are provided access to the InfoNet data and files;
• staff are informed of the need for security and confidentiality of data and files maintained in or
available through the InfoNet system; and
• that the Grantee shall notify the appropriate OCVA Program Coordinator for this Grant when
an employee is no longer authorized to access the InfoNet System.
31. REQUIREMENT TO REPORT ACTUAL OR IMMINENT BREACH OF PERSONALLY
IDENTIFIABLE INFORMATION (PII)
The Grantee, and any subgrantee 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 subgrantee) --1) creates,
collects, uses, processes, stores, maintains, disseminates, discloses, or disposes of personally
identifiable information (PII) (as defined in 2 C.F.R. 200.1) 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 Grantee's breach procedures, and the procedures of any subgrantee at any tier, must
include a requirement to report actual or imminent breach of PH to COMMERCE no later than 24
hours after an occurrence of an actual breach, or the detection of an imminent breach.
32. REQUIREMENTS PERTAINING TO PROHIBITED CONDUCT RELATED TO THE
TRAFFICKING IN PERSONS (INCLUDING REPORTING REQUIREMENTS AND OVW
AUTHORITY TO TERMINATE AWARD)
The Grantee, and any 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 the Grantee, subgrantees, or individuals defined (for purposes of this
condition) as "employees" of the Grantee or of any subgrantees. The details of the Grantee's
obligations related to prohibited conduct related to trafficking in persons are posted on the OVW
website at: https://www.justice.qov/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.
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33. REQUIREMENTS RELATED TO SYSTEM FOR AWARD MANAGEMENT AND UNIQUE
ENTITY IDENTIFIERS
Grantees must have obtained a Unique Entity Identifier from the System for Award Management
(SAM), currently at https://www.sam.gov, and provided their Unique Entity Identifier to OCVA.
Grantees are not required to maintain an active SAM registration, but must obtain a Unique Entity
Identifier.
34. RESTRICTIONS ON "LOBBYING" AND POLICY DEVELOPMENT
In general, as a matter of federal law, federal funds may not be used by the Grantee, or any
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 Grantee, or any 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 the Office on Violence Against
Women from being used by the Grantee, or any subgrantee 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.
Should any question arise as to whether a particular use of federal funds by the Grantee (or any
subgrantee) would or might fall within the scope of these prohibitions, the Grantee is to contact
COMMERCE for guidance, and may not proceed without the express prior written approval of
COMMERCE.
35. SERVICES TO LIMITED -ENGLISH -PROFICIENT (LEP) PERSONS
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.le„p.gov.
36. 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. 103-3221
Violence Against Women Act of 2000, P.L. 106-386, 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, the Violence Against Women Act Reauthorization Act of 2022, P.L. 117-1037
the Omnibus Crime Control and Safe Streets Act of 1968, 34 U.S.C. §§ 10101 et seq. and OVW's
implementing regulations at 28 C.F.R. Part 90.
37. 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
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not necessarily limited to minority-owned, woman -owned, and veteran -owned business
subgrantees/subcontractors. "Subgrantees/subcontractors" shall mean subgrantees of any tier.
38. 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.
The Grantee also agrees to ensure that any subrecipients (subgrantees) at any tier will comply with
this provision.
39. 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: Award Acceptance
• Attachment B: EEOP Compliance Certification Form
• Attachment C: Restrictions and Certifications Regarding Non -Disclosure Agreements and
Related Matters
• Attachment D: Scope of Work
• Attachment E: Budget
• General Terms and Conditions
• Application for Funding as submitted and approved by COMMERCE
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ashi g,.oi date
DeparlMorA of
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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.
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.
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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:
1. All material provided to the Grantee by COMMERCE that is designated as "confidential"
by COMMERCE;
2. All material produced by the Grantee that is designated as "confidential" by COMMERCE;
and
3. 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 24 hours 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 PROVISIONS
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
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
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Department of
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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
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.
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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 Grantee 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.
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.
Local Government Page 19 of 27
DocuSign Envelope ID: 7B3BBC E6-CA97-4FC6-8C24-C3C3CDA08067
Wa ling on Stale
Depamnerit of
1400, Comnilerele
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. As 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
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.
Local Government Page 20 of 27
DocuSign Envelope ID: 7B3BBCE6-CA97-4FC6-8C24-C3C3CDA08067
0 �'�{��`a hingwon State
3epa-,r ent of
*40 Commerce
20. TREATMENT OF ASSETS
I
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.
Local Government Page 21 of 27
DocuSign Envelope ID: 7B3BBCE6-CA97-4FC6-8C24-C3C3CDA08067
Wash ng:.on State
41*4
b, partment of
commerc�ek Attachment A
Attachment A: Award Acceptance
By signing the certification below, I --
A. Declare to the U.S. Department of Justice (DOJ), and COMMERCE under penalty of perjury, that
I have authority to make this declaration and certification on behalf of the applicant.
B. Certify to DOJ and COMMERCE, under penalty of perjury, on behalf of myself and the applicant,
to the best of my knowledge and belief, that the following are true as of the date of this award
acceptance:
1. 1 have conducted or there was conducted (including by applicant's legal counsel as appropriate
and made available to me) a diligent review of all terms and conditions of, and all supporting
materials submitted in connection with, this award, including any assurances and certifications
(including anything submitted in connection therewith by a person on behalf of the applicant
before, after, or at the time of the application submission and any materials that accompany
this acceptance and certification); and
2. 1 have the legal authority to accept this award on behalf of the applicant.
C. Accept this award on behalf of the applicant.
D. Declare the following to DOJ and COMMERCE, under penalty of perjury, on behalf of myself and
the applicant:
1. 1 understand that, in taking (or not taking) any action pursuant to this declaration and
certification, DOJ and COMMERCE will rely upon this declaration and certification as a material
representation; and
2. 1 understand that any materially false, fictitious, or fraudulent information or statement in this
declaration and certification (or concealment or omission of a material fact as to either) 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 under the federal False Claims Act (including under 31 U.S.C. §§
3729-3730 and/or §§ 3801-3812) or otherwise.
New Hope
Agency Name
Suzi Fode
Name of Authorized Official
Signature of Authorized Official
Director
Title of Authorized Official
Date
Local Government Page 22 of 27
DocuSign Envelope ID: 7B3BBCE6-CA97-4FC6-8C24-C3C3CDA08067
1Vi/8$hir1q*'on state.
enerit of
IF C Dpa, r
2
so 0MUN-111"Ce
Attachment B
Attachment B: EEOP Compliance Certification Form
Section B—Declaration Claiming Exemption from EEOP Submission Requirement and Certifying That an EEOP Is on
File for Review
If a recipient has fifty or more employees and is receiving a single award or, subaward of $25, 000 or more, but less than $500, 000, then the
recipient agency does not have to submit an EEOP to the OCR for review as long as it certifies the following (42 C.F.R. § 42.305):
17 [responsible official],
certify that [recipient]
Which has fifty or more employees and is receiving a single award for $25,000 or more, but less than $500,000, has formulated
an EEOP in accordance with 28 C.F.R. pt. 42, subpt E. I further certify that within the last twenty-four months, the proper authority
has formulated and signed into effect the EEOP and, as required by applicable federal law, it is available for review by the public,
employees, the appropriate state planning agency, and the Office for Civil Rights, Office of Justice Programs, U.S. Department
of Justice. The EEOP is on file at the following office:
[organization],
[address].
Local Government Page 23 of 27
DocuSign Envelope ID: 7B3BBC E6-CA97-4FC6-8C24-C3C3CDA08067
�laling,on Male
Depa--meet of
*4 1
COD] Melr
Attachment C
Attachment C: Restrictions and Certifications Reqarding 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.
A. In accepting this award, the recipient
1. 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
2. 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.
B. If the recipient does or is authorized under this award to make subawards ("subgrants"),
procurement contracts, or both
1. it represents that
a. 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
b. it has made appropriate inquiry, or otherwise has an adequate factual basis, to support this
representation; and
2. 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
Local Government Page 24 of 27
DocuSign Envelope ID: 7B3BBCE6-CA97-4FC6-8C24-C3C3CDA08067
AMA Wasohing.on State
Department of
CWaftheree,, Attachment D
Attachment D: Scope of Work
January 1, 2024 through December 31, 2024
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:
• active advocacy, medical advocacy and/or legal advocacy on behalf of the client;
• ensuring that crisis intervention and assistance in the development of individual safety plans are
available;
• assistance with obtaining protection orders or other court documents;
• ensuring outreach is provided to inform victims of existing services;
• assistance in accessing Crime Victims Compensation benefits;
• referrals to other agencies which can provide information for a client;
• active collaboration with law enforcement and prosecution to ensure a supportive and strong
coordinated response for victims of domestic violence; sexual assault, dating violence, and
stalking; and
• ensuring that goods and services, supplies or administrative costs supported by this grant
program are related to issues involving adult or youth victims (ages 11 and older) of domestic
violence, sexual assault, dating violence or stalking.
Services provided must be consistent with current state and federal laws and mandates.
Domestic Violence Advocacy
Provision of services to domestic violence clients must comply with the service model indicated in WAC-
61A- 1015.
Sexual Assault Advocacy
Sexual assault services provided shall meet the requirements set forth by Washington State RCW 70.125
and by the standards defined by the state of Washington Sexual Abuse/Assault Services Standards.
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 cannot be used to conduct public awareness or community education campaigns or
related activities to broadly address domestic violence, dating violence, sexual assault or stalking.
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.
Local Government Page 25 of 27
DocuSign Envelope ID: 7B3BBCE6-CA97-4FC6-8C24-C3C3CDA08067
0% � ashin0.on Slate
Bepartment of
SO Con-IM(-:'tI#CeX
%J4 'W
Attachment D
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:
A. 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, 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.
B. Procedures or policies that compromise the confidentiality of information and/or privacy of persons
receiving services.
C. Procedures or policies that require victims to take certain actions (e.g., seek an order of protection,
receive counseling, participate in couples counseling or mediation, report to law enforcement, seek
civil or criminal remedies) in order to receive services.
D. Procedures or policies that fail to include conducting safety planning with victims.
E. Project designs, products, services, and/or budgets that fail to account for the unique needs of
individuals with disabilities, with limited English proficiency, or who are Deaf or hard of hearing,
including accessibility for 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 victims, or allow offenders to escape responsibility for their
actions.
Deliverables
The Grantee shall be responsible for the following deliverables:
A. Participation in coordinated community response meetings at least quarterly — As detailed above
B. Reports —As described in Section 30 of the Special Terms and Conditions
C. Vouchers — Must be submitted at least quarterly
Performance Measures
Provision of the deliverables listed above will be measured using the following performance measures:
A. Participation in at least 75% of coordinated community response meetings
B. 100% of required reports will be submitted on time
C. 90% of vouchers will be completed on time
Local Government Page 26 of 27
DocuSign Envelope ID: 7B3BBC E6-CA97-4FC6-8C24-C3C3CDA08067
°0*14 Washing,on State
i epwiment of ,
C
1#4Ommelvee .
Attachment E
Attachment E: Budaet
January 1, 2024 through December 31, 2024
Budget Victim Services Victim Services
g Count(GrantTotal
(Adams y) County)
Salaries $9,654.00 $10,761.00 $20,415.00
Benefits $3,759.00 $4,136.00 $7,895.00
Goods and Services $2,159.00 $3,980.00 $6,139.00
Grant Total $157572.00 $187877.00 $34,449.00
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.
The cost of allowable equipment purchased with these funds must be prorated to Grant activity usage,
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 indicating, at a minimum, date of purchase, quantity,
and distribution. Equipment must also be purchased within the first quarter of the Grant.
Printing of Materials: OCVA must forward requests to print brochures, billboards, and other publications
developed with grant funds to the Office on Violence Against Women not less than twenty (20) days prior
to public release of the materials. If approved, 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 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: https://www.iustice.-qov/ovw/pa-qe/fiIe/1008816/download.
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.
Local Government Page 27 of 27
DocuSign Envelope ID: 763BBC E6-CA97-4FC6-8C24-C3C3CDA08067
�
AW, Wilingtor"k State
CDepartmentof
0nIMer(-,I,e
DocuSign Contract Review and Routing Form
Office of Crime Victims Advocacy
Mia Davidson Grant proofed documents 11/22/2023 19:11 AM PST
Manager
Matched approved Obligation Summary
Jodine Honeysett Section Memo and Allocation Spreadsheet 11/26/2023 16:14 PM PST
Manager Reviewed entry and coding in CMS
Assistant Correct template from IntraCOM has
been used
Trisha Smith or OR 11/27/20231:29 PM PST
Managing �
Director Documentation has been included with
reason for exception
.. � A ,
.
.71"!
Reviewed by: Title: I verify that I have: Date:
Grant I Checked that Grantee has completed all
Manager required certifications and/or forms
Updated 5/25/2022
DocuSigff
Certifca4e.Of Completion.. ...----------
Envelope Id: 7B3BBCE6CA974FC68C24C3C3CDA08067
Status: Sent
Subject: Complete with DocuSign: OCVA FFY 2023 VAWA STOP Grant - New Hope
11/22/2023 8:58:52 AM
Division:
Community Services and Housing
Pool: StateLocal
Program: OCVA
Storage Appliance Status: Connected
ContractNumber: F23-31103-078
Location: DocuSign
DocumentType: Contract
:...,.
Si natur e '
Source Envelope:
Mia Davidson
Document Pages: 28 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: 198.239.10.181
Recod-Te dkin"d
------------
Status: Original
Holder: Kelly Tracy
Location: DocuSign
11/22/2023 8:58:52 AM
kelly.tracy@commerce.wa.gov
Security Appliance Status: Connected
Pool: StateLocal
Storage Appliance Status: Connected
Pool: Washington State Department of Commerce
Location: DocuSign
_
id ner=Eve , '.
nts
:...,.
Si natur e '
Timestam
Mia Davidson
Completed
Sent: 11/22/2023 8:59:35 AM
mia.davidson@commerce.wa.gov
Viewed: 11/22/2023 9:10:54 AM
Commerce Specialist 1
Signed: 11/22/2023 9:11:26 AM
Washington State Department of Commerce
Using IP Address: 198.239.106.181
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jodine Honeysett
jodine.honeysett@commerce.wa.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Trisha Smith
trisha.smith@commerce.wa.gov
AMD
WA State Dept 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:
Completed
Using IP Address: 198.239.106.208
Completed
Using IP Address: 147.55.149.158
Sent: 11 /22/2023 9:11:28 AM
Viewed: 11/26/2023 6:12:50 PM
Signed: 11/26/2023 6:14:24 PM
Sent: 11/26/2023 6:14:26 PM
Viewed: 11/27/2023 1:29:43 PM
Signed: 11/27/2023 1:29:59 PM
Sent: 11/27/2023 1:30:01 PM
Viewed: 11 /28/2023 11:12:02 AM
'-
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Accepted: 7/22/2021 9:54:00 AM
ID: f9391c86-5931-4a2b-9328-a83d20f3b27c
Cindy Guertin -Anderson
cindy.guertin-anderson@commerce.wa.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
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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
DocuSign system. Please read the information below carefully and thoroughly, and if you can
access this information electronically to your satisfaction and agree to this Electronic Record and
Signature Disclosure (ERSD), please confirm your agreement by selecting the check -box next to
`I agree to use electronic records and signatures' before clicking `CONTINUE' within the
DocuSign system.
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
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.15 per -page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to
receive required notices and consents electronically from us or to sign electronically documents
from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or made
available to you during the course of our relationship with you. To reduce the chance of you
inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
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,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
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 through your
account preferences.
To request paper copies from Washington State Department of Commerce
To request delivery from us of paper copies of the notices and disclosures previously provided
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 subsequent page,
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 request you 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://s]ap-port.docusign.com/guides/signer-guide-
signing- system-recluirements.
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 that you 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', you 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.