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HomeMy WebLinkAboutCONSENT School to work program 615 Sheridan Street Port Townsend, WA 98368 c9efrefison www.JeffersonCountyPublicHealth.org Consent Agenda Public Heat JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Josh Peters, County Administrator FROM: Apple Martine, Jefferson County Public Health Director Bonnie Obremski, Intellectual and Developmental Disabilities Coordinator DATE: c-610+e`n ,— � ZCaS SUBJECT: Agenda item — Division of Vocational Rehabilitation's "School-to-Work" Program Direct Services Agreement between Jefferson County Public Health and Cascade Community Connections October 1, 2025 - September 30, 2026, Fee for Service: $10,088.40 per student served. STATEMENT OF ISSUE: Jefferson County Public Health, the Intellectual and Developmental Disabilities division (JCPH), requests Board approval of Cascade Community Connections (Cascade) providing direct services dictated by Division of Vocational Rehabilitation's (DVR) "School-to-Work" program; October 1, 2025 - September 30, 2026. ANALYSIS/STRATEGIC GOALS/PROS and CONS: "School-to-Work" is a step-by-step guide to employment for students with intellectual and/or developmental disabilities who desire to have a job by the time they graduate high school. Steps include but are not limited to goal setting, resume drafting, job searching, and support to stabilize a client at their place of work. FISCAL IMPACT/COST BENEFIT ANALYSIS: Funding will be fee for service ($10,088.40 per student served, no limit to number of students served); funding provided by an existing contract between the Jefferson County and DVR. RECOMMENDATION: JCPH management recommends approval for JCPH to subcontract Cascade to provide DVR School-to-Work direct services in Jefferson County. REVIEWED BY: rd 7 IgC Josh Peters, County Administrator Date Community Health Environmental Public Health Developmental Disabilities 360-385-9444 360-385-9400 (f) 360-379-4487 360-385-9401 (f) Always working for a safer and healthier community DD-25-061 CONTRACT REVIEW FORM Clear Form (INSTRUCTIONS ARE ON THE NEXT PAGE) CONTRACT WITH: Cascade Community Connections Contract No: DD-25-061 Contract For: School-to-Work Program Svcs Term: July 1, 2025 to June 30, 2026 COUNTY DEPARTMENT: Public Health Contact Person: Bonnie Obremski Contact Phone: 360-385-7301 Contact email: bonnieo@co.jefferson.wa.us AMOUNT: $10,088.40 per student PROCESS: Exempt from Bid Process Revenue: Cooperative Purchase Expenditure: Competitive Sealed Bid Matching Funds Required: Small Works Roster Sources(s) of Matching Funds Vendor List Bid Fund# 127 RFP or RFQ Munis Org/Obj 12756800 Other: APPROVAL STEPS: STEP 1: DEPARTMENT CERTIFIES COMP E W '' • . .080 AND CHAPTER 42.23 RCW. CERTIFIED: E N/A: /// / August 19, 2025 Signature Date STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE COUNTY (CONTRACTOR) HAS NOT BE DEBA 4 D BY ANY FEDERAL, STATE, OR LOCAL AGENCY. CERTIFIED: N/A: E 0/kir August 19,2025 Signature Date STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche): Electronically approved by Risk Management on 8/20/2025. STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche): Electronically approved as to form by PAO on 8/20/2025. Subcontract paid at a per student rate through reimbursement from the Washington State Division of Rehabilitation. Standard terms included. STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY(IF REQUIRED). STEP 6: CONTRACTOR SIGNS STEP 7: SUBMIT TO BOCC FOR APPROVAL 1 SUBCONTRACT FOR PROFESSIONAL SERVICES Division of Vocational Rehabilitation's "School to Work" Program Direct Services AGREEMENT BETWEEN JEFFERSON COUNTY PUBLIC HEALTH AND CASCADE COMMUNITY CONNECTIONS This agreement is made and entered into between Jefferson County Public Health(COUNTY) and Cascade Community Connections (SUBCONTRACTOR) for provision of the Department of Vocational Rehabilitation's "School-to-Work"Program direct services to students with intellectual and/or developmental disabilities in Jefferson County. The term of this agreement is October 1, 2025 through September 30, 2026. Payments for direct services under this contract may not exceed $10,088.40 per student and payments are dependent on submission of deliverables listed in Exhibit A. There is no limit to the number of students who may be served in the term of this Contract. The Washington State Division of Rehabilitation (DVR) is reimbursing the COUNTY for each student served, per contract DD-25-029. This Contract may be terminated by either party upon 60 days written notice. Termination of this contract shall not constitute a breach. It is agreed Upon by Both Parties as Named Herein as Follows: A. PROFESSIONAL SERVICES Professional services to be provided by SUBCONTRACTOR shall include: (1) "School-to-Work"provides individualized, direct services necessary to help eligible students with intellectual and developmental disabilities obtain and continue integrated employment in the general workforce at or above the state's minimum wage. Deliverables are listed in Exhibit A. B. OBLIGATIONS SUBCONTRACTOR shall fulfill the following obligations: (1) SUBCONTRACTOR shall comply with all state and federal requirements regarding the confidentiality of Client records. Client information is not disclosable to the public. Information acquired pursuant to RCW 71A.14.070 requires a signed Release of Information or a signed Oath of Confidentiality Form. (2) SUBCONTRACTOR is required to assure that each employee has a current(within three years) DSHS background check in accordance with RCW 43.43.830-845, RCW 74.15.030 and WAC 388-825. Any prospective employee or volunteer who will or may have unsupervised access to a vulnerable person with a developmental disability in the course of his or her employment,or involvement with the business or organization,must have a background/criminal history clearance before they have unsupervised access. The DSHS Background Check Central Unit(BCCU)must be utilized to obtain background clearance. (3) "Intellectual and developmental disabilities(IDD)" means a disability attributable to intellectual disability, cerebral palsy, epilepsy, autism, or another neurological or other condition of an individual found by the secretary to be closely related to an intellectual disability or to require treatment similar to that required for individuals with intellectual disabilities, which disability DD-25-061 originates before the individual attains age 18, which has continued or can be expected to continue indefinitely, and which constitutes a substantial limitation to the individual. (4) If SUBCONTRACTOR reviews the application and elects to hire or retain an individual after receiving notice that the applicant has a conviction for an offense that would disqualify the applicant from having unsupervised access to vulnerable adults as defined in Chapter 74.34 RCW, then the COUNTY shall deny payment for any subsequent services rendered by the disqualified individual Provider. (5) COUNTY and its SUBCONTRACTOR are mandated reporters under RCW 74.34.020(13)and must comply with reporting requirements described in RCW 74.34.035, .040 and Chapter 26.44 RCW. If the County is notified by DSHS that a subcontractor staff member is cited or on the registry for a substantiated finding, then that associated staff will be prohibited from providing services under this Program Agreement. (6) SUBCONTRACTOR is required pursuant to RCW 74.15.030; that if any prospective employee who has not resided in Washington State during the last three years, and who will or may have unsupervised access to a vulnerable person with an intellectual or developmental disability in the course of their employment, or involvement with the business or organization,must have an F.B.I. Fingerprint Check before they have unsupervised access and before prospective employer begins working. The DSHS Background Check Central Unit(BCCU)must be utilized to obtain background clearance. (7) SUBCONTRACTOR is required to repeat the background/criminal history clearance for all employees or volunteers who will or may have unsupervised access to a vulnerable person with a developmental disability in the course of his or her employment, or involvement with the business or organization, every three years. The DSHS Background Check Central Unit(BCCU)must be utilized to obtain background clearance in accordance with RCW 43.43.8 30-845, RCW 74.15.030 and WAC 388-825. (8) SUBCONTRACTOR shall comply, as mandated reporters under RCW 74.34.020 (11), with all state and federal requirements under RCW 74.34.035, .040 Abuse and neglect of Vulnerable Adults; RCW 26.44,Abuse of Children;the WACs: 275-26 Division of Developmental Disabilities Services Rules; 296-24 General Safety & Health; 296-62 General Occupational Health Standards; WACs: 388-828 Developmental Disabilities Administration, (DDA)Assessment; 388- 845 Home and Community Based Waivers; Definitions 0001; Criteria for HCBS Services 0030; Basic Waiver Services 0200; Basic Plus Waiver Services 0210; Core Waiver Services 0215; Community Protection Waiver Services 0220; 0600-0610 Community Access Service; Supported Employment Service 2100. (9) SUBCONTRACTOR shall comply with the following Developmental Disabilities Administration, (DDA)Policies: 3.01 Client Service Plans; 5.01 Criminal History Background Checks and Safeguarding Personal Information; 5.02 Necessary Supplemental Accommodation(NSA); 5.03 Client Complaints; 5.05 Limited English Proficiency(LEP) Clients; 5.06 Client Rights; 5.13 Protections From Abuse; 5.14 Positive Behavior Support; 5.15 Use of Restrictive Procedures; 6.08 Mandatory Reporting Requirements for Employment and Day Program Services Providers; 6.13 Employment/Day Program Provider Qualifications; 9.07 Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome(AIDS); 12.01 Incident Management; 13.04 DRW Access Agreement, and County Guide to Achieve DDA's Guiding Values. 2 (10) The COUNTY staff who performs on-site evaluations of SUBCONTRACTOR work sites, will promptly report to DSHS per DDA Policy 5.13,Protection from Abuse: Mandatory Reporting, if: (a) They have reasonable cause to believe that abandonment, abuse, financial exploitation or neglect (as defined in RCW 74.34.020) of a person who has a developmental disability (as defined in RCW 71A.10.020) has occurred, and, (b) If they have reason to suspect that sexual or physical assault of such a person has occurred, they shall also immediately report to the appropriate law enforcement agency. (11) SUBCONTRACTOR shall comply with the following referenced documents found at DDA Internet site https://www.dshs.wa.gov/dda/county-best-practices under"Counties:" (a) DDA Policy 4.11, County Services for Working Age Adults; (b) WAC 388-850, WAC 388-828, WAC 388-845-0001, 0030, 0205,0210, 0215, 0220, 0600- 0610, 1200-1210, 1400-1410, 2100, 2110; (c) Criteria for Evaluation; https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/Criteria o30for%20Evaluat ion%202021-2023.docx (12) Onsite Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct several, scheduled, onsite visits to SUBCONTRACTOR during the term of the contract to observe program successes and challenges. The County shall maintain written documentation of visits. Copies of such documentation will be provided to the DDA or DVR upon request. (13) SUBCONTRACTOR shall meet the definition of Quality Assurance, by adherence to all Program Agreement requirements and reasonably expected levels of performance, quality, and practice by adherence to: (a) DDA Policy 6.13, Employment/Day Program Provider Qualifications, https://www.dshs.‘ka.goviddepolicies-and-ru l es/polio,-manual; (b) County Guide to Achieve DDA's Guiding Values; (c) DDA Guidelines for Community Assessments within Employment and Vocational Programs (14) The DRW Access Agreement with DDA; assures that the COUNTY and SUBCONTRACTORS have reviewed the Access Agreement; Disability Rights Washington(formerly Washington Protection and Advocacy System) Access Agreement. The Access Agreement covers DRW's access to individuals with developmental disabilities,to Clients, to programs and records,to outreach activities,to authority to investigate allegations of abuse,neglect, and other miscellaneous matters,and it is binding for all Providers of DDA contracted services. (15) SUBCONTRACTOR shall have written policies regarding sexual harassment and non- discrimination(said policies must guarantee human/civil rights); regarding a person's right to privacy,regarding safeguarding personal information and abuse of participants; regarding agency medication procedure; regarding respectful staff-to-participant interactions (i.e.: including a person's right to be treated with dignity and respect free of abuse). 3 (16) SUBCONTRACTOR shall have a County-approved grievance policy for clients that: (a) Is explained to clients and others in accordance with DDA Policy 5.02,Necessary Supplemental Accommodation; https:// www.dshs.wa.gov/sites/default/files/DDA/dda/documents/policy/policv5.02.pdf (b) Negotiates conflicts; (c) States advocates are available and clients are encouraged to bring advocates to help negotiate; (d) Provides a mediation process using someone who is unaffected by the outcome if conflicts remain unresolved a DDA Case Resource Manager may be included as an alternative option; (A DDA Case Resource Manager (CRM)"means a case manager for DDA Clients) (e) Prohibits retaliation for using the grievance process; and (f) Includes a process for tracking and reporting grievance (17) SUBCONTRACTOR shall assure that clients and others, in accordance with DDA Policy 5.06, Client Rights,have been informed of their rights, what services and benefits may be expected from the program,the program's expectations of them, and if necessary,the client's family, guardian or advocate is also informed.https://www.dshs.wa.gov/sites/defaultifi les/DI)A/dda/documents/policy/policy5.06.pdf (18) SUBCONTRACTOR shall assure that they have policies that protect individual rights; include but are not limited: (a) SUBCONTRACTOR shall assure that they have policies that protect individual rights; include but are not limited: (b) Respectful staff-to-client interactions (c) A person's right to be treated with dignity, respect and free of abuse; (d) A person's right to privacy; and (e) Safeguarding personal information. (19) SUBCONTRACTOR shall obtain and retain in the clients' files signed proof of client's and/or family's review of all policies, provider expectation, and receipt of information about services and benefits to be provided by the program. The signed proof required by this section shall be reviewed and renewed, with new documentation, annually. (20) SUBCONTRACTOR will encourage participant involvement in policy development. (21) SUBCONTRACTOR shall update Client Intake Forms once at the beginning of service provision. (22) SUBCONTRACTOR shall assure potential conflict of interest, real or apparent,will not arise. Such a conflict will arise when: The employee, officer or agent, any member of immediate family, Guardian/decision maker,or an organization that employs or is about to employ any of the above has financial or other interest in the client(s). (23) SUBCONTRACTOR shall have adequate staffing ratios and patterns to maintain quality and safety. 4 (24) All services for persons with developmental disabilities must be provided with attention to their health and safety. SUBCONTRACTOR shall comply with all applicable federal, state and local fire,health, and safety regulations. (25) SUBCONTRACTOR shall make sure that all incidents involving injury,health or safety issues are reported to DDA and the County; reference DDA Policy 6.08, Mandatory Reporting Requirements for Employment Providers. https://www.dshs.wa.jov/sitesldefault/fi les/DDAldda/documents/policv/policy6.08.pdf (26) SUBCONTRACTOR shall track and analyze incident reports for potential trends and patterns. (27) Current emergency contact and medical information(medications, diet, allergies, etc.) needed during the hours of service is readily available for each participant. (28) SUBCONTRACTOR shall provide evidence that it employs typical safety protection based upon the environment the client is working or receiving services in. (29) The COUNTY and all SUBCONTRACTORS are mandated reporters under RCW 74.34.020(11); Abuse of Vulnerable Adults https://apps.le2.wa.eov/RCW/default.aspx:'cite=74.34 and Chapter 26.44 RCW; Abuse of Children. All parties must comply with reporting requirements described in RCW 74.34.035, 040 and Chapter 26.44 and must adhere to DDA Policy, 6.08 Mandatory Reporting Requirements for Employment and Day Program Service Providers. All service provider employees, contractors, and volunteers are mandatory reporters and must report every incident of observed, reported, or suspected abuse, improper use of restraint, neglect, self-neglect, personal or financial exploitation, abandonment and/or mistreatment of clients. (30) School to Work Program Phases and payment structure is documented in Exhibit B. (31) SUBCONTRACTOR is required to maintain the following minimum organizational capacity in order to meet the performance standards set forth in this agreement. Failure or inability of SUBCONTRACTOR to meet any or all of these minimum capacity requirements, as determined solely by COUNTY, may be cause for termination of this agreement as provided herein. (a) Accreditation: SUBCONTRACTOR must be able to demonstrate conformance to Commission on Accreditation of Rehabilitation Facilities (CARF) standards for quality assurance and CARF accreditation. (b) Confidentiality: SUBCONTRACTOR shall protect and maintain all Confidential Information gained by reason of the Program Agreement against unauthorized use, access, disclosure, modification or loss. This duty requires the COUNTY to employ reasonable security measures, which includes restricting access to Confidential Information through: (32) Authority: The security requirements described in this document reflect the applicable requirements of Standard 141.10 (https://ocio.wa.gov/policies)of the Office of the Chief Information Officer for the state of Washington, and of the DSHS Information Security Policy and Standards Manual. Reference material related to these requirements can be found here: https://www.dshs.wa.gov/fsa/cent ral-contract-services/keeping-dshs-Client-information-private- and-secure,which is a site developed by the DSHS Information Security Office and hosted by DSHS Central Contracts and Legal Services. 5 (33) Administrative Controls: The Contractor must have the following controls in place: (a) A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy. (b) If the Data shared under this agreement is classified as Category 4 data, the Contractor must be aware of and compliant with the applicable legal or regulatory requirements for that Category 4 Data. (c) If Confidential Information shared under this agreement is classified as Category 4 data,the Contractor must have a documented risk assessment for the system(s) housing the Category 4 Data. (34) Authorization, Authentication,and Access: In order to ensure that access to the Data is limited to authorized staff,the Contractor must: (a) Have documented policies and procedures governing access to systems with the shared Data. (b) Restrict access through administrative, physical, and technical controls to authorized staff. (c) Ensure that user accounts are unique and that any given user account logon ID and password combination is known only to the one employee to whom that account is assigned. For purposes of non-repudiation, it must always be possible to determine which employee performed a given action on a system housing the Data based solely on the logon ID used to perform the action. (d) Ensure that only authorized users are capable of accessing the Data. (e) Ensure that an employee's access to the Data is removed immediately: 1. Upon suspected compromise of the user credentials. 2. When their employment, or the contract under which the Data is made available to them, is terminated. 3. When they no longer need access to the Data to fulfill the requirements of the contract. (f) Have a process to periodically review and verify that only authorized users have access to systems containing DSHS Confidential Information. (g) When accessing the Data from within the Contractor's network (the Data stays within the Contractor's network at all times), enforce password and logon requirements for users within the Contractor's network, including: 1. A minimum length of 8 characters, and containing at least three of the following character classes: uppercase letters, lowercase letters, numerals, and special characters such as an asterisk, ampersand, or exclamation point. 2. That a password does not contain a user's name, logon 1D, or any form of their full name. 3. That a password does not consist of a single dictionary word. A password may be formed as a passphrase, which consists of multiple dictionary words. 4. That passwords are significantly different from the previous four passwords. (h) When accessing Confidential Information from an external location (the Data will traverse the Internet or otherwise travel outside the Contractor's network), mitigate risk and enforce password and logon requirements for users by employing measures including: 1. Ensuring mitigations applied to the system do not allow end-user modification. Examples would include but not he limited to installing key loggers. malicious software, or any software that will compromise DSHS data. 2. Not allowing the use of dial-up connections. 6 3. Using industry standard protocols and solutions for remote access. Examples include, but are not limited to RADIUS Microsoft Remote Desktop (RDP) and Citrix. 4. Encrypting all remote access traffic from the external workstation to Trusted Network or to a component within the Trusted Network. The traffic must be encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network. 5. Ensuring that the remote access system prompts for re-authentication or performs automated session termination after no more than 30 minutes of inactivity. 6. Ensuring use of Multi-factor Authentication to connect from the external end point to the internal end point. All Contractors must be in compliance by 6/30/2020. (i) Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication mechanism, such as a biometric (fingerprint, face recognition, iris scan) or token (software, hardware, smart card, etc.) in that case: 1. The PIN or password must be at least 5 letters or numbers when used in conjunction with at least one other authentication factor 2. Must not be comprised of all the same letter or number(11111, 22222, aaaaa, would not be acceptable) 3. Must not contain a"run" of three or more consecutive numbers (12398, 98743 would not be acceptable) (j) If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes used on the device must: 1. Be a minimum of six alphanumeric characters. 2. Contain at least three unique character classes (upper case, lower case, letter, number). 3. Not contain more than a three consecutive character run. Passwodes consisting of 12345, or abcd12 would not be acceptable. (k) Render the device unusable after a maximum of 10 failed logon attempts. (35) Protection of Data. The Contractor agrees to store Data on one or more of the following media and protect the Data as described: (a) Hard disk drives. For Data stored on local workstation hard disks, access to the Data will be restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. (b) Network server disks. For Data stored on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized Users through the use of access control lists which will grant access only after the Authorized User has authenticated to the network using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on disks mounted to such servers must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism. For DSIIS Confidential Information stored on these disks. deleting unneeded Data is sufficient as long as the disks remain in a Secure Area and otherwise meet the requirements listed in the above paragraph. Destruction of the Data, as outlined below in Section (31) Data Disposition, may be deferred until the disks are retired, replaced, or otherwise taken out of the Secure Area. 7 (c) Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS on optical discs which will be used in local workstation optical disc drives and which will not be transported out of a Secure Area. When not in use for the contracted purpose, such discs must be Stored in a Secure Area. Workstations which access DSHS Data on optical discs must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism. (d) Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by DSI-IS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through the use of access control lists which will grant access only after the Authorized User has authenticated to the network using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on discs attached to such servers must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism. (e) Paper documents. Any paper records must be protected by storing the records in a Secure Area which is only accessible to authorized personnel. When not in use, such records must be stored in a Secure Area. (f) Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or Secure Access Washington(SAW) will be controlled by DSHS staff who will issue authentication credentials (e.g. a Unique User ID and Hardened Password) to Authorized Users on Contractor's staff Contractor will notify DSHS staff immediately whenever an Authorized User in possession of such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an Authorized User's duties change such that the Authorized User no longer requires access to perform work for this Contract. (g) Data storage on portable devices or media. 1. Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on portable devices or media unless specifically authorized within the terms and conditions of the Contract. If so authorized, the Data shall be given the following protections: a. Encrypt the Data. b. Control access to devices with a Unique User ID and Hardened Password or stronger authentication method such as a physical token or biometrics. c. Manually lock devices whenever they arc left unattended and set devices to lock automatically after a period of inactivity, if this feature is available. Maximum period of inactivity is 20 minutes. d. Apply administrative and physical security controls to Portable Devices and Portable Media by: i. Keeping them in a Secure Area when not in use, ii. Using check-in/check-out procedures when they are shared, and iii. Taking frequent inventories. 2. When being transported outside of a Secure Area, Portable Devices and Portable Media with DSI IS Confidential Information must be under the physical control of Contractor staff with authorization to access the Data, even if the Data is encrypted. 8 (h) Data stored for backup purposes. 1. DSHS Confidential Information may be stored on Portable Media as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. Such storage is authorized until such time as that media would be reused during the course of normal backup operations. If backup media is retired while DSHS Confidential Information still exists upon it, such media will be destroyed at that time in accordance with the disposition requirements below in Section (31) Data Disposition. 2. Data may be stored on non-portable media(e.g. Storage Area Network drives, virtual media, etc.) as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. If so, such media will be protected as otherwise described in this exhibit. If this media is retired while DSHS Confidential Information still exists upon it,the data will be destroyed at that time in accordance with the disposition requirements below in Section (31) Data Disposition. (i) Cloud storage. DSHS Confidential Information requires protections equal to or greater than those specified elsewhere within this exhibit. Cloud storage of Data is problematic as neither DSHS nor the Contractor has control of the environment in which the Data is stored. For this reason: 1. DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: a. Contractor has written procedures in place governing use of the Cloud storage and Contractor attest to the contact listed in the contract and keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. b. The Data will be Encrypted while within the Contractor network. c. I'he Data will remain Encrypted during transmission to the Cloud. d. The Data will remain Encrypted at all times while residing within the Cloud storage solution. e. The Contractor will possess a decryption key for the Data, and the decryption key will be possessed only by the Contractor. f. The Data will not be downloaded to non-authorized systems, meaning systems that are not on the contractor network. g. The Data will not be decrypted until downloaded onto a computer within the control of an Authorized User and within the contractor's network. 2. Data will not be stored on an Enterprise Cloud storage solution unless either: a. The Cloud storage Provider is treated as any other Sub-Contractor, and agrees in writing to all of the requirements within this exhibit; or, b. The Cloud storage solution used is HIPAA compliant. 3. If the Data includes protected health information covered by the Health Insurance Portability and Accountability Act (HIPAA), the Cloud Provider must sign a Business Associate Agreement prior to Data being stored in their Cloud solution. (36) System Protection. To prevent compromise of systems which contain DSHS Data or through which that Data passes: (a) Systems containing DSHS Data must have all security patches or hotfixes applied within 3 months of being made available. 9 (b) The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes. (c) Systems containing DSHS Data shall have an Anti-Malware application, if available, installed. (d) Anti-Malware software shall be kept up to date. The product, its anti-virus engine, and any malware database the system uses, will be no more than one update behind current. (37) Data Segregation. (a) DSHS category 4 data must be segregated or otherwise distinguishable from non-DSHS data. This is to ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or destruction. It also aids in determining whether DSIIS Data has or may have been compromised in the event of a security breach. As such, one or more of the following methods will he used for data segregation. 1. DSHS Data will be kept on media(e.g. hard disk, optical disc,tape, etc.) which will contain no non-DSHS Data. 2. DSIIS Data will be stored in a logical container on electronic media, such as a partition or folder dedicated to DSHS Data. 3. DSHS Data will be stored in a database which will contain no non-DSHS data. And/or, 4. DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the value of a specific field or fields within database records. 5. When stored as physical paper documents, DSHS Data will be physically segregated from non-DSHS data in a drawer, folder, or other container. (b) When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the DSHS Data and the non-DSHS data with which it is commingled must be protected as described in this exhibit. (38) Data Disposition. When the contracted work has been completed or when the DSHS Data is no longer needed, except as noted above in Section(30. b.)DSHS Data shall be returned to DSHS or destroyed. Media on which Data may be stored and associated acceptable methods of destruction are as follows: Data stored on: Will be destroyed by: Server or workstation hard disks, or Using a"wipe"utility which will Removable media(e.g. floppies, USB overwrite the Data at least three (3)times flash drives, portable hard disks) using either random or single character excluding optical discs data, or Degaussing sufficiently to ensure that the Data cannot be reconstructed, or Physically destroying the disk Paper documents with sensitive or Recycling through a contracted firm, Confidential Information provided the contract with the recycler assures that the confidentiality of Data will be protected. Paper documents containing Confidential On-site shredding, pulping, incineration, Information requiring special handling or contractor (e.g. protected health information) 10 Data stored on: Will be destroyed by: Optical discs (e.g. CDs or DVDs) Incineration, shredding, or completely defacing the readable surface with a coarse abrasive Magnetic tape Degaussing, incinerating or crosscut shredding (39) Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1)business day of discovery. If no DSHS Contact is designated in the Contract, then the notification must be reported to the DSHS Privacy Officer at dshsprivacyofcer@dshs.wa.gov. Contractor must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS. (40) Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a subcontractor,the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If the Contractor cannot protect the Data as articulated within this Contract,then the contract with the sub-Contractor must be submitted to the DSHS Contact specified for this contract for review and approval. (41) Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1)business day of discovery If no DSHS Contact is designated in the Contract,then the notification must be reported to the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law. (42) SUBCONTRACTOR shall provide the following: (a) Equal Access: SUBCONTRACTOR will assure equal access to persons who do not speak or have a limited ability to speak, read, or write English well enough to understand and communicate effectively (reference DDA Policy 5.05. Limited English Profrient (LEE) (iients). (b) The date policies are implemented or the date, they are revised. (c) Financial and Program Management: SUBCONTRACTOR will maintain an administrative/organizational structure that clearly defines responsibilities; systems and personnel to maintain accounting records that accurately reflect all program revenues and expenditures; prepare monthly statements of activity (ADSA Reports); maintain appropriate client service records and progress reports; and track key program performance indicators. (d) Participants: SUBCONTRACTOR has a commitment to support integration of individuals with developmental disabilities with people who arc not disabled and has involved participants with developmental disabilities in policy development. (e) Partnerships: SUBCONTRACTOR has a history of working cooperatively with community- based organizations including Employers, other Agencies, the COUNTY IDD Program, the Division of Vocational Rehabilitation (DVR), and the Schools. 11 (f) Student Guide: SUBCONTRACTOR will adhere to the plan published in the Division of Vocational Rehabilitation's School to Work Student Guide. (g) Internal Control Systems: SUBCONTRACTOR will have an administrative/organizational structure that clearly defines responsibilities. 1. SUBCONTRACTOR has sufficient policies and procedures for establishment and maintenance of adequate internal control systems. 2. SUBCONTRACTOR will maintain written policy procedural manuals for information systems, personnel, and accounting/finance in sufficient detail such that operations can continue should staffing change or prolonged absences occur. 3. SUBCONTRACTOR will date all policies when they are implemented or date when they are revised. (h) Qualified Staff: SUBCONTRACTOR will provide adequate, qualified staff with skills and experience in evaluation,training, supervision, counseling and support of adults with developmental disabilities who are earning wages, per the attached Statement of Work. 1. SUBCONTRACTOR will assure that all direct service staff are trained and has experience in accordance with DDA Policy 6.13 and that training is documented. 2. SUBCONTRACTOR will assure that each employee has a current (within three years) DSHS background check in accordance with RCW 43.43.830-845, RCW 74.15.030 and WAC 388-825. 3. SUBCONTRACTOR will provide COUNTY with information regarding staff qualifications upon request. (i) Safety: SUBCONTRACTOR will provide evidence that it employs safety protection based on the environment in which the participant is working or receiving services. (j) Integration: Employment and day services must adhere to the Home and Community Based settings (HCBS)requirements of 42CFR 441 530(a)(1), including that: 1. The setting is integrated in the greater community and supports individuals to have full access to the greater community; 2. Ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid IICBS; 3. The setting provides opportunities to seek employment and work in competitive integrated settings; and 4. The setting facilitates individual choice regarding services and supports, and who provides them. (43) SUBCONTRACTOR shall identify settings that isolate people from the broader community or that have the effect of isolating individuals from the broader community of individuals who do not receive Medicaid HCB services. These settings are presumed not to be home and community- based. (44) SUBCONTRACTOR shall adhere to the Department of Vocational Rehabilitation's Student Guide and submit copies of completed forms contained therein. (45) The SUBCONTRACTOR shall report any injury or accident that requires more than simple first aid, and any extraordinary incident that requires intervention by the SUBCONTRACTOR to the DSIIS/DDA Case Manager for the individual involved, and then report the injury, accident, or extraordinary incident to the COUNTY Coordinator. This includes serious physical or emotional harm or potential harm. 12 (a) Incidents involving injury, health or safety issues are reported to DDA and the County reference DDA Policy 6.08. Mandatory Reporting Requirements for Employment and Day Program Services Providers. (b) The initial report to the COUNTY may be done via documented telephone calls to the COUNTY Coordinator. (c) The SUBCONTRACTOR shall submit a written follow-up report within 10 days to the COUNTY Coordinator. The report to the COUNTY Coordinator may be submitted by email, facsimile (FAX) to 360-385-9401, or by mail to Jefferson COUNTY Public Health 615 Sheridan Port Townsend, WA 98368. (d) Serious and emergent incidents shall be handled in accordance with DSHS/DDA Policy 12.01, Incident Management. (e) Incident reports are tracked and analyzed for potential trends and patterns. (f) Mandatory reporting is done in accordance with Chapter 74.34 RCW,Abuse of 1 irinerahle Adults and Chapter 26.44 RCW,Abuse of Children. (46) For six years following the end date of this agreement, SUBCONTRACTOR will maintain client records and books,records, documents, reports and other evidence of accounting procedures and practices, which sufficiently and properly reflect all direct and indirect expenditures of funds provided under this agreement. (47) Client records shall minimally include copies of filled-out forms contained in the DVR School to Work Student Guide. (48) SUBCON TRACTOR will provide COUNTY with Individual Employment/Vocational Plans (or Person-Centered Plan/Profile),client goals, and a summary of progress towards meeting those goals on a bi-annual basis. (49) COUNTY shall review services to ensure SUBCONTRACTOR is following the DVR School to Work Student Guide and meeting milestones on deadline. (50) SUBCONTRACTOR agrees to assign to COUNTY its Medicaid Billing Rights for services to clients eligible under Title XIX programs. Written documentation shall be available to COUNTY on request. If SUBCONTRACTOR contracts directly with DSHS to provide covered services under Title XIX,COUNTY agrees that funding intended for those clients shall be excluded from this agreement. If SUBCONTRACTOR contracts directly with Social Security to provide covered services under a PASS/IRWE,COUNTY agrees that funding intended for those clients shall be excluded from this agreement. C. REIMBURSEMENTS For said services rendered under this agreement, COUNTY shall reimburse SUBCONTRACTOR up to $10,088.40 per student and payments are dependent on submission of deliverables listed in Exhibit B. There is no limit to the number of students who may be served in the term of this Contract. (1) SUBCONTRACTOR will bill COUNTY on or before the 5th day of the month. At no time shall the invoices for reimbursement be submitted more than 60 calendar days following the last day of the month for which the services were provided without COUNTY approval. 13 (2) COUNTY may, at its option,withhold reimbursement for any month for which required reports and/or invoices have not been received, or are not accurate and/or complete, or for contractual non- compliance issues. (3) Total reimbursements for fiscal year 2023-2024 to SUBCONTRACTOR by COUNTY under this contract shall not exceed $10,088.40 per student without express written amendment signed by both parties to this Agreement. This Agreement shall commence on August 1, 2024 and continue through September 30, 2025 unless terminated as provided herein. Work performed between August 1, 2024 and the execution of this Agreement that is consistent with the provisions of this Agreement is hereby ratified. This total reimbursement includes any amendment within the fiscal year of 2024-2025. (4) SUBONTRACTOR will access Division of Vocational Rehabilitation (DVR) funding as a resource. Client services shall not be reimbursed under this agreement when the same services are paid for under the Rehabilitation.Act of 1973,DVR, P.L. 94-142 (Public Education), or are being funded under PASS/IRWE. (5) If SUBCONTRACTOR contracts directly with DSHS to provide covered services under Title XIX, COUNTY agrees that funding intended for those Clients shall be excluded from this agreement. If SUBCONTRACTOR contracts directly with Social Security to provide covered services under a PASS/IRWE, COUNTY agrees that funding intended for those Clients shall be excluded from this agreement. D. DEBARMENT By signing this Agreement, the SUBCONTRACTOR certifies that it is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded in any Washington State or Federal department or agency from participating in transactions (debarred). The SUBCONTRACTOR agrees to include the above requirement in any and all subcontracts into which it enters, and also agrees that it will not employ debarred individuals. The SUBCONTRACTOR must immediately notify the County if, during the term of this Agreement, the SUBCONTRACTOR becomes debarred. The County may immediately terminate this Agreement by providing the SUBCONTRACTOR written notice, if the SUBCONTRACTOR becomes debarred during the term of this Agreement. E. FUNDING WITHDRAWN,REDUCED OR LINIITED If the COUNTY determines in its sole discretion that the funds it relied upon to establish this Agreement have been withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding after the effective date of this Agreement but prior to the normal completion of this Agreement, then the COUNT, at its sole discretion, may: (1) Terminate this agreement; (2) Renegotiate this Agreement under the revised funding conditions; or, (3) Suspend the SUBCONTRACTOR's performance under this Agreement upon five (5) business days' advance notice to the SUBCONTRACTOR, if the COUNTY determines that there is a reasonably likelihood that the funding insufficiency may be resolved in time to allow the SUBCONTRACTOR's performance to resume prior to the normal completion date of this Agreement. 14 F. OVERPAYMENTS OR ERRONEOUS PAYMENTS TO SUBCONTRACTOR If overpayments or erroneous payments have been made to the SUBCONTRACTOR under this Agreement,the COUNTY will provide notice to the SUBCONTRACTOR and the SUBCONTRACTOR shall refund the full amount of the overpayment within thirty (30) calendar days of the notice. If the SUBCONTRACTOR fails to make timely refund, the COUNTY may charge the SUBCONTRACTOR one percent(1%)per month on the amount due, until paid in full. G. RECORDS AND DOCUMENTS REVIEW (1) The SUBCONTRACTOR must maintain books,records, documents, magnetic media, receipts, invoices or other evidence relating to this Agreement and the performance of the services rendered, along with accounting procedures and practices, all of which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Agreement. At no additional cost,these records, including materials generated under this Agreement, are subject at all reasonable times to inspection,review, or audit by the Agency,the Office of the State Auditor, and state and federal officials so authorized by law,rule, regulation, or agreement. (2) The SUBCONTRACTOR must retain such records for a period of six(6)years after the date of final payment under this Agreement. (3) If any litigation, claim or audit is started before the expiration of the six (6) year period, the records must be retained until all litigation, claims, or audit findings involving the records have been resolved. H. RISK ASSESSMENT AND MONITORING FOR COMPLIANCE BY THE COUNTY. (1) SUBCONTRACTOR shall immediately report to the COUNTY any failure to perform under this Agreement. (2) Along with every request for reimbursement under this Agreement,the SUBCONTRACTOR may submit a Monitoring Certification for purposes of the County performing the risk assessment of the SUBCONTRACTOR and compliance monitoring of this Agreement that is required under the Program Agreement. I. MISCELLANEOUS (1) DSHS Developmental Disabilities Administration(DDA) shall determine client eligibility and service referral are the responsibility of the DDA pursuant to Chapter 388-823 WAC (Eligibility) and Chapter 388-825 WAC (Service Rules). Only persons referred by DDA shall be eligible for direct Client services under this Program Agreement. It is DDA's responsibility to determine and authorize the appropriate direct service(s)type. Direct Client services provided without authorization are not reimbursable under this Program Agreement. (2) DSHS Developmental Disabilities Administration(DDA) shall notify COUNTY of persons authorized for services reimbursed under this agreement. Only persons referred to COUNTY by DDA through a County Service Authorization, (CSA) shall be eligible for services reimbursed under this agreement. 15 (3) The SUBCONTRACTOR'S relation to the COUNTY shall at all times be that of independent SUBCONTRACTOR. Any and all employees of the SUBCONTRACTOR, or other persons engaged in the performance of any work or service required of the SUBCONTRACTOR under this Agreement, shall be considered employees of the SUBCONTRACTOR only, and any claims that may arise on behalf of or against said employees shall be the sole obligation and responsibility of the SUBCONTRACTOR. (4) The SUBCON TRACTOR shall not sublet or assign any of the services covered by this Agreement without the express written consent of the COUNTY. Assignment does not include printing or other customary reimbursable expenses that may be provided in an Agreement. (5) The SUBCONTRACTOR, by signature to this Agreement, certifies that the SUBCONTRACTOR is not presently debarred, suspended,proposed for debarment, declared ineligible, or voluntarily excluded from participating in this Agreement, or any Agreement by any Federal department or agency. The SUBCONTRACTOR also agrees to include the above requirement to all subcontracts into which it enters. (6) The SUBCONTRACTOR shall obtain and keep in force during the terms of the Agreement, or as otherwise required,the following insurance with companies or through sources approved by the State Insurance Commissioner pursuant to RCW 48:05: (a) Worker's compensation and employer's liability insurance. The Contractor will participate in the Worker's Compensation and Employer's Liability Insurance Program as may be required by the State of Washington; (b) Commercial Automobile Liability or Business Use Insurance providing bodily injury and property damage liability coverage for all owned and non-owned vehicles assigned to or used in the performance of the work for a combined single limit of not less than $1,000,000 each occurrence with the COUNTY named as an additional insured in connection with the SUBCONTRACTOR'S performance of the contract. (c) General Commercial Liability Insurance in an amount not less than a single limit of two million dollars($2,000,000.00)per occurrence and an aggregate of not less than two (2) times the occurrence amount ($2,000,000.00 minimum) for bodily injury, including death and property damage, unless a greater amount is specified in the contract specifications. The insurance coverage shall contain no limitations on the scope of the protection provided and include the following minimum coverage: 1. Broad Form Property Damage, with no employee exclusion 2. Personal Injury Liability, including extended bodily injury 3. Broad Form Contractual/Commercial Liability - including completed operations 4. Premises - Operations Liability (M&C) 5. Independent Contractors and Subcontractors 6. Blanket Contractual Liability (7) All employees or subcontractors of SUBCONTRACTOR who are required to be professionally certified by the State in the performance of services under this agreement shall maintain professional liability insurance/error and omissions liability insurance in the amount of not less than one million dollars($1,000,000). In no case shall such professional liability to third parties be limited in any way. 16 (8) It shall be the responsibility of the SUBCONTRACTOR to ensure that any and all persons engaged in the performance of any work or service required of the SUBCONTRACTOR under this Agreement, shall comply with the same insurance requirements that SUBCONTRACTOR is required to meet. (9) Failure on the part of the SUBCONTRACTOR to maintain the insurance as required shall constitute a material breach of contract upon which the COUNTY may, after giving five working days' notice to the SUBCONTRACTOR to correct the breach, immediately terminate the contract or, at its discretion, procure or renew such insurance and pay any and all premiums in connection therewith, with any sums so expended to be repaid to the COUNTY on demand, or at the sole discretion of the COUNTY,offset against funds due the SUBCONTRACTOR from the COUNTY. (10) All cost for insurance shall be considered incidental to and included in the unit contract prices and no additional payment will be made. (11) Excepting the Workers Compensation insurance and any professional liability insurance secured by the SUBCONTRACTOR,the COUNTY will be named on all certificates of insurance as an additional insured. The SUBCONTRACTOR shall furnish the COUNTY with verification of insurance and endorsements required by this Agreement. The COUNTY reserves the right to require complete, certified copies of all required insurance policies at any time. (12) All insurance shall be obtained from an insurance company authorized to do business in the State of Washington. The SUBCONTRACTOR shall submit a verification of insurance as outlined herein within 14 days of the execution of this Agreement to the COUNTY. All insurance policies obtained by the SUBCONTRACTOR shall be primary to any equivalent or applicable policies held by the COUNTY. All insurance policies obtained by the SUBCONTRACTOR shall include a waiver of subrogation rights. Any insurance self-insured retention, deductible or risk retention maintained, or participated in,by the COUNTY shall be excess and shall be non-contributory to the insurance policies provided by the SUBCONTRACTOR in order to comply with the insurance requirements of this Subcontract. All policies provided by the SUBCONTRACTOR in order to comply with the insurance requirements of this Subcontract must be endorsed to show this primary coverage. (13) Nothing in the foregoing insurance requirements shall prevent the COUNTY, at its option, from additionally requesting that the SUBCONTRACTOR deliver to the COUNTY an executed bond as security for the faithful performance of this contract and for payment of all obligations of the SUBCONTRACTOR. (14) The SUBCONTRACTOR shall comply with all Federal, State, and local laws and ordinances applicable to the work to be done under this Agreement. This Agreement shall be interpreted and construed in accord with the laws of the State of Washington and venue shall be in Jefferson COUNTY, WA. (15) The SUBCONTRACTOR shall comply with the WA State Department of Labor and Industries Minimum Wage Act, RCW 49.46, acknowledging persons with disabilities participating in job assessments are not considered employees. 17 (16) The SUBCONTRACTOR shall defend, indemnify and hold the COUNTY, its officers, officials, employees, agents and volunteers (and their marital communities)harmless from any claims, injuries, damages, losses or suits, including attorney's fees, arising out of or resulting from the acts, errors or omissions of the SUBCONTRACTOR in performance of this Agreement, except for injuries and damages caused by the sole negligence of the COUNTY. Should a court of competent jurisdiction determine this Agreement is subject to RCW 4.24.115 if liability for damages occurs arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the SUBCONTRACTOR and the COUNTY, its officers, officials, employees, agents and volunteers (and their marital communities)the SUBCONTRACTOR's liability, including the duty and cost to defend, shall be only for the SUBCONTRACTOR's negligence. It is further specifically understood that the indemnification provided constitutes the SUBCONTRACTOR's waiver of immunity under Industrial Insurance, Title 51 RCW, solely for the purposes of this indemnification. This waiver has been mutually negotiated by the parties. This section shall survive the expiration or termination of this Agreement. (17) Claims against the COUNTY shall include, but not be limited to assertions that the use and transfer of any software, hook, document,report, film,tape, or sound reproduction of material of any kind, delivered there under, constitutes an infringement of any copyright,patent, trademark, trade name, or otherwise results in an unfair trade practice or an unlawful restraint of competition. (18) The SUBCONTRACTOR specifically assumes potential liability for actions brought against the COUNTY by SUBCONTRACTOR'S employees, including all other persons engaged in the performance of any work or service required of the SUBCONTRACTOR under this Agreement and, solely for the purpose of this indemnification and defense,the SUBCONTRACTOR specifically waives any immunity under the state industrial insurance law, Title 51 RCW. The SUBCON TRACTOR recognizes that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation. (19) SUBCONTRACTOR shall not discriminate against any person presenting themselves for services based on race,religion, color, sex, age, or national origin. (20) COUNTY reserves the right to terminate this contract in whole or in part, without prior written notice,in the event that contractual terms are not fulfilled, or if expected or actual funding from the Department of Social and Health Services Division of Developmental Disabilities is withdrawn, reduced,or limited in any way after the effective date of this agreement. In the event of termination under this clause, COUNTY shall be liable only for payment for services rendered prior to the effective date of termination. (21) No portion of this contract may be assigned or subcontracted to any other individual, firm, or entity without the express and prior written approval of COUNTY. If the COUNTY agrees in writing that all or a portion of this Contract may be subcontracted to a third-party, then any contract or agreement between the SUBCONTRACTOR and a third-party subcontractor must contain all provisions of this Agreement and the third-party subcontractor must agree to be bound by all terms and obligations found in this agreement. (22) The parties agree that: (a) No representation or promise not expressly contained in this Agreement has been made. 18 (b) They are not entering into this Agreement based on any inducement, promise or representation, expressed or implied, which is not expressly contained in this Agreement. (c) This Agreement supersedes all prior or simultaneous representations, discussions, negotiations, and agreements, whether written or oral, within the scope of this Agreement. (23) Provided it does not result in a material change in the terms of this Agreement, if any provision of this Agreement or the application of this Agreement to any person or circumstance shall be invalid, illegal, or unenforceable to any extent,the remainder of this Agreement and the application this Agreement shall not be affected and shall be enforceable to the fullest extent permitted by law. (24) No consent by either party to, or waiver of, a breach by either party, whether express or implied, shall constitute a consent to, waiver of, or excuse of any other, different, or subsequent breach by either party. (25) The Contractor shall not sell, assign, or transfer any of rights obtained by this Agreement without the express written consent of the County. (26) The parties do not intend, and nothing in this Agreement shall be construed to mean, that any provision in this Agreement is for the benefit of any person or entity who is not a party. (27) This Agreement may be amended or supplemented only by a writing that is signed by duly authorized representatives of all the parties. (28) This Agreement may be executed in one or more counterparts, each of which shall be deemed an original, and all of which counterparts together shall constitute the same instrument which may be sufficiently evidenced by one counterpart. Execution of this Agreement at different times and places by the parties shall not affect the validity of this Agreement, so long as all the parties execute a counterpart of this Agreement. (29) The parties agree that facsimile and electronic signatures shall have the same force and effect as original signatures. (30) Notwithstanding any provisions of this Agreement to the contrary,to the extent any record, including any electronic, audio, paper or other media, is required to be kept or indexed as a public record in accordance with the Washington Public Records Act, Chapter 42.56 RCW(as may be amended),the Contractor agrees to maintain all records constituting public records and to produce or assist the County in producing such records, within the time frames and parameters set forth in state law. The Contractor also agrees that upon receipt of any written public record request, the Contractor shall, within two business days, notify the County by providing a copy of the request per the notice provisions of this Agreement. APPROVED AND ADOPTED this day of , 2025. (SIGNATURES FOLLOW ON NEXT PAGE) 19 SIGNATURE PAGE JEFFERSON COUNTY WASHINGTON CASCADE COMMUNITY CONNECTIONS Board of County Commissioners Jefferson County, Washington By: By: tt Heidi Eisenhour, Chair Taylor We Y bster, Executive Director By: Date: O /2 9/2—D25 Greg Brotherton, Commissioner By: Heather Dudley-Nollette, Commissioner SEAL: ATTEST: Carolyn Gallaway. Clerk of the Board Approved as to form only: i? Z for 08/20/2025 P ' ip C. Hunsucker, Date Chief Civil Deputy Prosecuting Attorney 20 EXHIBIT A STATEMENT OF WORK SCHOOL TO WORK PROGRAM I. WORK STATEMENT SUBCONTRACTOR shall provide School-to-Work Program direct services for clients as described hereinafter. SUBCONTRACTOR shall be reimbursed for direct services pursuant to Student Guide Deliverable table below. The Student Guide itself is attached below as Exhibit C. The purpose of School-to-Work efforts are to provide employment-related services to individuals with developmental disabilities who will be exiting school with outcome of paid employment. This is a collaborative effort with school districts, Department of Vocational Rehabilitation(DVR), Developmental Disabilities Community Services (DDCS), provider, and the COUNTY. IL ELIGIBILITY School-to-Work direct services may be authorized for individuals with birthdates between 9-1-2004 and 8-31-2005. These services may be authorized in addition to or instead of Individual Employment or Group Supported Employment services. III. DELIVERABLES a. At a minimum,the SUBCONTRACTOR shall submit the following deliverables to demonstrate completion of the required services. Deliverables should be submitted in the formats provided in the School-to-Work Program's Student Guide (Exhibit C) and the tillable forms in Exhibits D and E. (1) Intake and Assessment Phase (a) Intake deliverable is a signed Service Delivery Outcome Plan (SDOP) issued by the Washington State Division of Vocational Rehabilitation (DVR) and the completed form titled Team Contacts, Roles, and Responsibilities, which is in the Student Guide. i. Team Contacts, Roles, and Responsibilities will include; (A) Team member contact information including name, email, and phone. (B) Team member roles. (C) Each team member's responsibility to the student. (b) Assessment deliverable includes completion of the Job Goal form and an explanation on how it was reached. (2) Job Placement Phase (a) Job Seeker Tools: Resume and cover letter (video, PowerPoint, portfolio, etc.). (b) Job Offer: Documentation/details of a job offer. (3) Stabilization Phase (a) Employment Verification: Documentation/details of a job start. (b) Stabilization: Stabilization Report. 21 EXHIBIT B PAYMENT Deliverables are completed forms that are in the Student Guide attached as Exhibit C. SUBCONTRACTOR must submit deliverables at time of invoicing in order to receive payment. Student Guide Deliverable Payment The following completed forms: • Signed Service Delivery Outcome Plan (SDOP) $2,163 per student • Team Building Meeting and Information; Team Contacts, Roles, and Responsibilities • First and second School-to-Work student data forms in Exhibit D The following completed forms, as applicable for the student*: $1,441.20 per student • Job Foundation Report; Job Foundation Executive Summary and Job Recommendation; School-to Work Assessment; Job Goal; Next Steps and Team Actions The following completed form: $720 per student • Job Seeker Tools (both required tools are complete and shared with the student and DVR) The following completed forms: $1,441.20 per student • Job Offer Details on the page titled "You were offered the job! Way to go!" • The third School-to-Work student data form The following completed form: $720 per student • Page titled "Congratulations, you are employed!" The following completed forms: $3,603 per student • Your Supports on the job • Job Stabilization Report • Fourth and final student data form • Student Success Story form(Exhibit E) along with associated release form Maximum total payment per student under this agreement. There is $10,088.40 per student no limit on number of students served during the term of this contract. *The main goal of Assessment is to set an employment goal and next steps. If a Job Foundation Report achieves that goal, no additional assessment is required. If that report was not enough, then further assessment is required. The student and their team will decide what is needed. 22 . DSHS WDepartmentASHING1ON of STSo cATE ial i I and Health Services School -to-Work Student Guide DSHS' Division of Vocational Rehabilitation Job Seeker: Month/Year: Check out what's new this month in your Student Guide! Monthly Summary: Washington State Department of Social and Health Services Table of Contents Contents Table of Contents 2 Welcome 4 School-to-Work Overview 4 School-to-Work Phases 5 Phase 1: Intake and Assessment 5 Phase 2: Job Placement 5 Phase 3: Employment 5 Phase 1: Intake and Assessment 6 Team Building and Information 7 Team Building Date 7 To-Do-List 7 Team Contacts, Roles, Responsibilities 8 Assessment(s) 10 Job Foundation Report and/or School-to-Work Assessment 10 Job Foundation Report 11 What is the purpose of Job Foundation? 11 Job Foundation Executive Summary and Job Recommendation 12 School-to-Work Assessment 13 Job Goal 16 Next Steps and Team Actions 17 Phase 2: Job Placement 18 Job Seeker Tools 19 Resume or Media Resume 19 Cover Letter 19 You Were Offered the Job! Way to Go! 20 Job Offer Details 20 Phase 3: Employment 21 DVRSchoolToWork@dshs.wa.gov Page 2 Congratulations! You are Employed! 22 Your Supports on the Job! 23 Job Stabilization Report 24 Helpful Resources 26 Other Helpful Contacts 27 Optional Documents 28 Monthly Progress Reports 29 Notes 33 DVRSchoolToWork@dshs.wa.gov Page 3 Welcome School-to-Work Overview The School-to-Work program is designed to assist students in finding a job before they exit school in June. Students enrolled in the program will work directly with a supported employment agency that will collaborate with them, their parent(s)/guardian(s), school district staff, County Developmental Disabilities programs, the Division of Vocational Rehabilitation, and the Developmental Disabilities Administration. This School-to-Work Student Guide is a document that is updated regularly and is designed for students and/or parent(s)/guardian(s) to house program related documentation, assessments, activity logs, notes and so much more! This is a guide for students to ensure key activities and milestones have been completed and organized effectively. This tool will support students in keeping important information in one place, and it will also be a great resource to bring to collaboration meetings that occur with support partners and agencies. DVRSchoolToWork@dshs.wa.gov Page 4 School-to-Work Phases Phase 1: Intake and Assessment This phase includes bringing a team together that will ' support and guide you through the School-to-Work 4 program. Key intake and assessment activities will w take place to ensure a positive experience for you. Phase 2: Job Placement This phase includes conducting and capturing :;• , important job placement activities like employment r. goals, site visits, job interviews, and more. —�,' • e Phase 3 : Employment . rw---- mij ir . This phase serves as an exciting step to complete and t' capture all employment stabilization information like - Ilkjoi employment verification information, completion of PIPLIUMminj the first day of work, and much more! DVRSchoolToWork@dshs.wa.gov Page 5 Phase 1 : Intake and Assessment li 1 i ' r v . 1 W . if "--, • j _ r ,, $f. ip, . lititNilifth. ,. -- .! lit' , , Phase 1 includes: • Team Building and Information • Team Contacts, Roles, and Responsibilities • Job Foundation Report and/or School-to-Work Assessment • Job Goal • Next Steps and Team Actions DVRSchoolToWork@dshs.wa.gov Page 6 Team Building and Information Team Building Date To-Do-List 1. Introductions / Overview of Services / Strengths and Challenges 2. Job Foundation Review / Assessment Needs 3. Job Goal is Established Name Role/Agency DVRSchoolToWork@dshs.wa.gov Page 7 Team Contacts, Roles, Responsibilities (This list is more than one page.) Team Member Team Member Contact Team Member Role Information Responsibility to You Name: Show Up, Speak Up, and Share! You are the driver of your services and without You, the Student Email: your voice, the team is not (most important able to support you with your person on the team) Phone: goals. Work with your team to get a job. Services are person-centered and individualized. Name: I i Supports you in partnership Your Parent(s) or Email: with school, county, and state Guardian(s) departments to acquire employment. Phone: Name: School-to-Work CRP/Subcontractor who Employment coordinates getting Provider: Email: resources, training, and Your Job Coach supports needed for you to Phone: get a job before you leave school in June. Name: Your County School-to-Work Contractor Email: entity providing local support Program for you to find a job. Phone: DVRSchoolToWork@dshs.wa.gov Page 8 Name: Coordinate with schools, counties, and other state departments to help you get Your Vocational Email: a job. Provide job coach Rehabilitation funding. This could be the Phone: Division of Vocational Counselor Rehabilitation, Department of Services for the Blind, or Tribal Vocational Rehabilitation. Name: Connects you or your Your School Teacher parent(s) or guardian(s) with Email: community, county, and and/or School Staff resources for School-to- Phone: Work. Name: Lead role who edits this School-to-Work Student Guide monthly and shares Main Keeper of Your Email: the most current copy with Student Guide each person listed above at Phone: the end of the month and gathers information from you and your team to share. Name: Other Person on Email: Your Team Phone: DVRSchoolToWork@dshs.wa.gov Page 9 Assessment(s) Job Foundation Report and/or School-to-Work Assessment Your job coach will collect information about your strengths, skills, and support needed for success on the job. This information will be gathered through school, home, and community work-related activities, as well as conversations and observations with those supporting your School-to-Work journey. Assessment includes the areas listed below: • History of school attendance and reliability • Behavior support or strategies likely to be needed • Student's communication skills • Student's learning preferences • Student's personal hygiene • • Potential job safety issues • Student's stamina/endurance r • Student's social skills • Demonstrated skills and task performance • Transportation needs • Work preferences and interests Go to the next page to determine the next step! DVRSchoolToWork@dshs.wa.gov Page 10 Job Foundation Report What is the purpose of Job Foundation? The purpose of Job Foundation is to engage, connect, and plan with you in your second to last year of school.Through discovery and the completion of the Job Foundation Report, your next steps toward employment will be explored and determined. Answer the following questions: Is the Job Foundation Report complete? Yes No Final Report sent to the Student and the DVR Counselor? Yes No Date sent: If no, complete a School--to-Work Assessment. At this point, do you feel you have a job goal in mind? Yes j No If yes, have your job coach complete the next page, the Job Foundation Executive Summary and Job Recommendation. If no, complete a School-to-Work Assessment and come back together with your team to establish a job goal. Set your next meeting to talk about the assessment... *Team meeting date to discuss the results of assessment: DVRSchoolToWork@dshs.wa.gov Page 11 Job Foundation Executive Summary and Job Recommendation Check if not applicable 7 Add Job Foundation Executive Summary below: Add Job Recommendation based on what was learned through the Job Foundation Process below: DVRSchoolToWork@dshs.wa.gov Page 12 School-to-Work Assessment Check if not applicable ri It has been determined that a School-to-Work Assessment is needed to learn more about what you would like to do for a job; this will help you figure out your job goal! Your job coach will collect information about your strengths, skills, and support needed for success on the job. The following information will be based on your school, home, and community work-related activities, interviews with you, your family, school staff, others who are familiar with you, and your job coach observations. The School-to-Work Assessment may take two or more pages to complete. Summary of Assessment Areas History of school attendance and reliability: Behavior support or strategies likely to be needed: Communication skills: L DVRSchoolToWork a@dshs.wa.gov Page 13 Learning preferences: Personal hygiene: Potential job safety issues: Stamina/endurance: Social skills: Demonstrated skills and task performance: Transportation needs: DVRSchoolToWork@dshs.wa.gov Page 14 Work preferences and interests: Recommendations Skills and interests: Desired work environment: Desired schedule: Ability to travel to and from work within a reasonable length of time: Accommodations and Necessary Supports DVRSchoolToWork@dshs.wa.gov Page 15 Job Goal Your Job Goal Is: 0, ` 'Congratulations! You are on your way to being employed! DVRSchoolToWork(Edshs.wa.gov Page 16 Next Steps and Team Actions Task Who When Example: Example: Example: DVR Counselor will connect Benefits Planner, Student, Before job start (and again, as you with a Benefits Planner Family needed) lel Tip: Tasks may be added throughout your School-to-Work year, or removed if they are no longer something you want to explore. DVRSchoolToWork@dshs.wa.gov Page 17 Phase 2 : Job Placement !)1 J 1 `' • C I i 1 1111 i, . ki Aft I Mir fir- Tail a r Hil.,, ,yr .44 ilif" 1 t l ., 4 ; Phase 2 includes: • Job Seeker Tools • Job Offer Details DVRSchoolToWork@dshs.wa.gov Page 18 Job Seeker Tools Job seeker tools will be developed to support you as you look for a job. You will work with your team to figure out what you need, which may include the following: online portfolios, cover letters, video resumes, letters of recommendation, Linkedln pages, and more. Resume or Media Resume (Video, PowerPoint, Portfolio, etc.) Sent to Student: Yes I I No 7 Date sent: Sent to DVR Counselor: Yes No Date sent: Cover Letter Sent to Student: Yes [ I No n Date sent: Sent to DVR Counselor: Yes [ I No Ii Date sent: Employer Letter of Recommendation (optional) Sent to Student: Yes [ I No Date sent: Sent to DVR Counselor: Yes n No Date sent: Linkedln Page (optional) Sent to Student: Yes No I I Date sent: Sent to DVR Counselor: Yes No n Date sent: DVRSchoolToWork@dshs.wa.gov Page 19 You Were Offered the Job ! Way to Go ! Did you accept this job offer? Yes I No L I If yes, please complete the section below. If not, please complete the section below and explain why the job was not accepted: Job Offer Details Job Goal: Employer: Job Title: Start Date: Job Duties: Expected Weekly Hours: Starting Wage: Location: Transportation Considerations: Benefits Package: Potential Training Services and Date/Additional Information: DVRSchoolToWork@dshs.wa.gov Page 20 Phase 3 : Employment Congratulations! You have a job! r e r_ r ,, . ,,.... .... a ,. . .:, : . ,.. i \ ,- . tew. ,ftir.0- . . ‘.47 , i • I • ♦4' / ' fit. a�2 .. «� �' - -,#.... or t 1 Allir Phase 3 includes: • Job Verification • Your Supports on the Job • Job Stabilization Report DVRSchoolToWork@dshs.wa.gov Page 21 Congratulations ! You are Employed ! Now what? Please work with your job coach to complete the form below. Employee's Name: Employer's Name: Employee's Job Title: Employer's Address: Is this a new job? r f No 1 Yes Date Employee Started Work: Average Number of Hours Worked Per Week: Rate of Pay or Salary: $ Hourly Monthly Annually Pay Frequency: Daily Weekly Every Two Weeks I I Two Times a Month Monthly n Tips: No 7 Yes; if yes, how often and how much? Commissions: I I No L J Yes; if yes, how often and how much? Bonuses: No Li Yes; if yes, how often and how much? Overtime: n No Yes; if yes, how often and how much? Work Schedule (include exact times when possible): Monday Tuesday Wednesday Thursday Friday Saturday Sunday Is health insurance available: 1 No [ _I Yes 1. If yes, did the employee enroll in the health plan? I I No _ Yes a. If yes, when does the coverage begin? b. If yes, what is the employee's portion of the premiums? $ Name and Title of Person Who Completed This Page: Date: DVRSchoolToWork@dshs.wa.gov Page 22 Your Supports on the Job ! The strengths you bring to the job How you will become stable on the job (your fading plan) Additional training, services, and supports could include 4,The support receive on thejob from the beginning will be shared with you and your PP you g g team in the monthly notes at the end of this guide. DVRschoolToWorkPdshs.wa.gov Page 23 Job Stabilization Report You are considered stable on the job when the following things happen: 1. Your desired work hours are met (unless you and your team agree the job represents suitable employment). 2. Your DVR Counselor, your job coach, and your employer agree that you meet your employer's expectations (this is verified by your job coach). 3. You are ready for long-term support. But first... Did you meet your expected job goal? Yes No Was your starting wage what you wanted? Yes I I No Does the job location meet your expected needs? Yes I ] No Anything else you want to add about your job? Job Stabilization Summary Detail and summarize how the placement hours were met (or if the job represents suitable employment): DVRSchoolToWork@dshs.wa.gov Page 24 Detail and summarize how it has been agreed that the employer's expectations have been met. Please provide descriptions and details as to how stabilization occurred for the employer's expectations to be met: Detail and summarize how long-term support is set up and will occur: DVRSchoolToWork@dshs.wa.gov Page 25 Helpful Resources Developmental Disabilities Administration, or DDA 411,• • Website: www.dshs.wa.gov/dda Ail ilk • DDA Eligibility Information: www.dshs.wa.gov/dda/consumers- '7�• and-families/eligibility Division of Vocational Rehabilitation, or DVR Mina • Website: www.dshs.wa.gov/dvr • • • • • " • Phone: 1-800-637-5627 ro Social Security Administration, or SSA • Website: www.ssa.gov • Phone: 1-800-772-1213 Benefit U • Website: www.benefitu.org • Benefit U Information: support@benefitu.org Other Resources: Name: Phone: Email: Other: Name: Phone: Email: Other: DVRSchoolToWork@dshs.wa.gov Page 26 Other Helpful Contacts Name: Phone: Email: Other: Name: Phone: Email: Other: Name: Phone: Email: Other: DVRSchoolToWork@dshs.wa.gov Page 27 Optional Documents Copy of Food Worker Card Sent to Student: Yes No Date sent: Sent to DVR Counselor: Yes Li No Date sent: Copy of Current CPR and/or First Aid Certification Sent to Student: Yes No ❑ Date sent: Sent to DVR Counselor: Yes No Date sent: *Other Sent to Student: Yes I I No Date sent: Sent to DVR Counselor: Yes ri No { Date sent: *Other Sent to Student: Yes I I No Date sent: Sent to DVR Counselor: Yes Li No I Date sent: *Ideas of other items to include could be a person-centered plan, other certifications, and other job-related documents. DVR5choolToWork@dshs.wa.gov Page 28 Monthly Progress Reports May June July August September DVRSchoolToWork@dshs.wa.gov Page 29 October November December January DVRSchoolToWork@dshs.wa.gov Page 30 February March April------ -- - May DVRSchoolToWork@dshs.wa.gov Page 31 June July _-- August September DVRSchoolloWork@dshs.wa.gov Page 32 Notes DVRSchooIToWork@dshs.wa.gov Page 33 Exhibit D-School-to-Work Student Data June 30th,2025 Instructions:Put the total number of Students Into each apol:cable column o^row S.Use t'e'Other Race'colcmr for students with*race not listed or are two cr more races,and state each race+n the'Other Race(please specify)"column.Fat all students in the*Exited STW"column,list out each reason far the colt In the`Ferry Exit Reasons"colt.mn. Eligible OVR•Enraltesl Employed Exited STW Transferred to Extended Services Transferred to Adult Services/lab Placement American Indian/Alaska Native Astan/swan/American Nlack/Afrlcan Amerr:an Hispanic/Latino Native HavnRanlPaclftc Wander White Other Race Other Race(please spedlyj Early Exit Reasons: Exhibit D-School-to-Work Student Data September 3001,2025 Instructions:Put the total number of Students into each applicable column on row 5.Use the'Other Race'column for students with a race not listed or are two or more races,and state each race in the"Other Race(please specify)"column.For all students in the"Exited STW":ofumn,list out each reason br the exit I.the"Ear;Exit Reasons' o'urrrr. Elfeihle NB-Enrolled Employed Exited STW Transferred to Extended Services Tramferrrd to Aduft Services/Job Placement American Indian,/0.aske Native ftsien/PsianjAmer!can 'Mack/African American Ilispanic/tatine Native Hawaiian/Pacific islander White Other Race Other Race{pie-ase speckE Ea sly Exit Reasons._ _ J Exhibit D-School-to-Work Student Data December 31st,W25 Instructions:Put the total number of Students into each applicable column on row 5.Use the"other Race'column,for students with a race not listed or are two or mom races,and state each race in the'Other Race(please specify)'column.Fur all students in the'ExKed sTW"column,Hot out each reason for the exit I'the'Tarty ExA Reasons'column. Eligible OVR-Enrolled Employed Etched STW Transferred to Extended Services Transferred to Aduh Services/lob Placement American lndlan/Alaska Native Asian/Asian/American Ellaclt/Alrican American Mlspantc/Lstlnn Native Mawalian/Padfc Islander White Other Rau Other Race(please spell ) ;Early Exit Reasons; Esdriblt D-School-to-Work Student Data March 30th,2026 Instructions:Put the total number of Students fnto each applicable column an row S.Use the'Other Race'column for students with a ran not listed or are two or more races,and state each race in the"Other Race(please specify)'column.For all students in the"Exited STW'column,list out each reason for the malt h the"v rty tot Reasons"column. Disable DV -Enrolled Employed Exited STW Transferred to Extended Services Transferred to Adult Services/Job Placement American Indian/Alaska Native Aslan/Asian/Amer!can 181ack/African American Iflspanic/Latino Hamm Hawalian/Paclficislandec White Other Race Other Race(please specify? I Early Exit Reasons: _ Exhibit 0-School-to-Worw Student Data June 30th,2026 nstructrons:Put the total number of Students Into each applicable column on row S.Use the"Other Race'column for students with a race not listed or are two or mom races,and state each race in the"Other Race(please specify)"column.For all students In the'Exited S?VW"column,list out each reason fu•the exit in the"Early Exit Reasons"column, Eligible DVR•Enrolled Employed Exited STW Transferred to Extended Sankey Transferred to Adult SeMres/lob Placement American IndlanJAledra Native Asia n(Astan/Amerlan Blacit/Afncen American Mltpsr.lgtattnn N.Kxe HawaiianfP-4,k Islander White Other Race Other Race(please speci)} Early bit Romans: Exhibit D-School-to-Work Student Data September 30th,2026 Instructions:Put the total number of Students into each applicable column on row S.Use the'Other Race"colu.nn for students wtth a race not listed or are two or more races,and state each race in the"Other Race(please specify)"column.For all students In the'Exited STW"column,list out each reason for the matt in the'Ear:y Exit Reason?column. MOW DVR-Enrolled Emptoyed felted STW Transferred tc Extended Services 'Transferred to Adult Services/lob Pkxrsaent American Indian/Alaska Native Asien/Asian/American Btack/Afrfran American H ispanlcjLattno Native Hawaiian/Padite Intender 1 Whtte Other Race Other Race(please specify) Early EaltReasons _ Exhibit D-School-to-Work Student Data 2025-2026 Successful Job Outcome Report Instructions:Submit information for each Student in the 2026 cohort who obtained employment between June 30th,2025 and September 30th,2026. First Name Job Placement Allanment w/Employment Goal cmpioyer Name Start Date Ilndust,y lob Tide Hours(weekly) Wage(hourly) Be neflt Package Of applicable) End Date(If applicable) Reason for lerwdnatIon Of applicable) fircg:;,;x,;,;,'a ;; Division of Vocational Rehabilitation iedm kakis T,.,,,1Diminp„res Exhibit E: School-to-Work Success Story Name of Student (optional) I Month and Year Reporting County Describe the student's journey and success* in school to work: * Success may be, for example: Job Placements, movement towards community employment, personal challenges the student was able to overcome, or getting connected to valuable community resources. 250 words minimum or summary with a link to a video. Exhibit E must be submitted one (1) time per county served to the DVR School-to-Work Transition Program Manager by June 30th This form is not valid without the following signed documents: • DVR's Personal Information Release form: DSHS 16-178, Personal Information Release (wa.00v); and • DSHS's Photo Release form: DSHS 16-235, Photo Release (wa.gov). Exhibit E: School-to-Work Success Story Page 1 of 1 DSHS 16-278 (05/2024)