HomeMy WebLinkAbout052819_ca16" 615 Sheridan Street
„
Part Townsend, WA 9836
www.JeffersonCountyPublicHealth.org
1t' Consent Agenda
Public Health May 15, 2019
JEFFERSON'COUNTY
BOARD OF'COU'NTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Anna McEnery, Developmental Disabilities Coordinator
DATE: MN of % t ace
SUBJECT: Agenda Item — Professional Services Agreement between Kitsap Public
Health District and Jefferson County Public Health; January 1, 2019 —
December 31, 2020; $33,022
STATEMENT I S E:
Jefferson County Public Health is requesting Board approval of the Professional Services Agreement —
Kitsap Public Health District; January 1, 2019 — December 31, 2020; $33,022; ($16,511 each in Calendar
years 2019 and 2020).
ANALYST STRATE IC_ GOALS/PRO'S an CON'S:
This is an ongoing agreement with Kitsap Public Health District (KPHD) to monitor community health
needs, demographics, and risks. (Kitsap concurrently compiles data for three counties.) Additionally, KPHD,
while monitoring the community impact of mental health and chemical dependency, provides quarterly and
yearly service evaluations for all mental health and substance abuse subcontractors receiving funds
through the 1/10th of 1% Sales Tax Fund. JCPH subcontracts with KPHD to compile the data necessary for
policy decisions.
FISCAL IMPA.CT&QST BENEFIT ANALYSIS:
This is sales and use tax revenue raised by the County and deposited in the 1/10 of 1% Fund; is allocated
by the BOCC with advice from the Mental Health and Substance Abuse Advisory Committee, (now known as
the Behavioral Health Advisory Committee). The agreement states that funding is subject to availability and
if the sales tax revenue decreases, the vendor will be contacted and the contract may be renegotiated.
RECOMMENDATION:
JCPH management requests approval of the Professional Services Agreement with KPHD; January 1, 2019 —
December 31, 2020; $33,022.
znAdmi 'nim � r� Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always workingr a safer and healthier community
PROFESSIONAL SERVICES AGREEMENT FOR
Between
Jefferson County
And
Kitsap Public Health District
THIS PROFESIONAL SERVICES AGREEMENT ("this Agreement") is entered into between the
County of Jefferson, a municipal corporation ("the County"), and Kitsap Public Health District, (KPHD)
("the Contractor"), in consideration of the mutual benefits, terms, and conditions specified below.
1.n° j Dc igpat . The Contractor is retained by the County to perform the following Project:
to provide quarterly and yearly service evaluations for all Mental Health and Substance Use
Disorder Contractors receiving funds through the 1/10th of 1% Sales Tax Fund.
2. cop _of S rvrces. Contractor agrees to perform the services identified on Exhibit "A" attached
hereto including the provision of all labor.
3. 'rinse (`br Performance. This Agreement shall commence on January 1, 2019 and continue
through December 31, 2020. Work performed consistent with this Agreement during its term,
put prior to the adoption of this Agreement, is hereby ratified. The Contractor shall perform all
services pursuant to this Agreement as outlined on Exhibit "A". Time is of the essence in the
performance of this Agreement.
4. I 1� y!pent.. The Contractor shall be paid by the County for completed work and for services
rendered under this Agreement as follows:
a. Payment for the work provided by Contractor shall be made on an hourly basis at the rate
of $75.00 an hour. The total amount of payment to Contractor shall not exceed $33,022
($16,511 in 2019 and $16,511 in 2020) without express written modification of the
Agreement signed by the County.
b. Invoices must be submitted by the 15th of the month for the previous month's expenses.
Such invoices will be checked by the County, and upon approval thereof, payment will be
made to the Contractor in the amount approved. Failure to submit timely invoices and
reports may result in a denial of reimbursement. Invoices not submitted within 60 days
may be denied.
c. Final payment of any balance due the Contractor of the total contract price earned will be
made promptly upon its ascertainment and verification by the County after the
completion of the work and submittal of reports under this Agreement and its acceptance
by the County.
d. Contractor shall provide invoices and necessary backup documentation for all services
including timesheets and statements (specifying the services provided). Any indirect
charges require the submittal of an indirect cost methodology and rate using 2 C.F.R. Part
255 and 2 C.F.R. Part 230.
The Contractor's records and accounts pertaining to this Agreement are to be kept
available for inspection by representatives of the County and state for a period of six (6)
years after final payments. Copies shall be made available upon request.
f. County reserves first right to use as match the chemical dependency mental health tax
funds and the services funded by them for purposes of qualifying for additional funding
and grants. County may allow Contractor to use the chemical dependency mental health
tax funds as match, at the County's sole discretion. Should the County decline to use
chemical dependency mental health tax funds as match for additional funding and/or
grants, then the County may authorize the Contractor to use such funds for match (see
ATTACHMENT A).
g. Where Contractor proposes to use chemical dependency mental health County tax funds
for match, Contractor shall be solely responsible for compliance with all state and federal
laws and regulations, including, but not limited to DSHS, CMS and MCSR funding rules,
applicable to the use of MH/SA sales tax monies as match. Contractor shall document
they have met this responsibility by submitting to the County Administrator, in writing,
their match formula, allocation plan and any other documentation required of them
pursuant to ATTACHMENT A, attached hereto and incorporated in this Agreement.
h. The County may withhold authorization to utilize the MH/SA sales tax monies as match.
Contractor's failure to provide adequate documentation does not relieve the Contractor of
their responsibility to comply with all state and federal laws and regulations related to
match.
i. County reserves first right to use as match the chemical dependency mental health to the
County Administrator, in writing, their match formula, allocation plan and any other
documentation required of them pursuant to ATTACHMENT A, attached hereto and
incorporated in this Agreement.
5. Ownerslijp and Use of Documepts. All non -confidential or de -identified documents, drawings,
specifications, and other materials produced by the Contractor in connection with the services
rendered under this Agreement shall be the property of the County whether the project for which
they are made is executed or not. The Contractor shall be permitted to retain copies, including
reproducible copies, of drawings and specifications for information, reference and use in
connection with Contractor's endeavors. Contractor shall not be held liable for reuse of
documents or modifications thereof, including electronic data, by County or its representatives
for any purpose other than the intent of this Agreement.
Page 2 of 15
6. +:'crrl1ia11ce w1tli laws. Contractor shall, in performing the services contemplated by this
Agreement, faithfully observe and comply with all federal, state, and local laws, ordinances and
regulations, applicable to the services to be rendered under this Agreement.
7. Audit. An audit will be submitted to the County upon request. Upon request, Contractor will
submit the most recent financial audit within 30 days.
a. Upon request the County shall have the option of performing an onsite review of all
records, statements, and documentation.
b. If the County finds indications of potential non-compliance during the monitoring
process, the County shall notify Contractor within ten (10) days. County and Contractor
shall meet to discuss areas of contention in an attempt to resolve issues.
c. Audit will provide statements consistent with the guidelines of Reporting for Other Non -
Profit Organizations AICPA SOP 78-10, and is performed in accordance with generally
accepted auditing standards and with Federal Standards for Audit of Governmental
Organizations, Programs, Activities and Functions, and meeting all requirements of 2
C.F.R. Part 200, as applicable.
8. Inde11mil c t 0 ii. Contractor shall indemnify and hold harmless the County, its officers, and
employees, from and against all claims, losses or liability, or any portion thereof, including
reasonable attorney's fees and costs, arising from injury or death to persons, including injuries,
sickness, disease or death to Contractor's own employees, or damage to property occasioned by a
negligent act, omission or failure of the Contractor. Contractor shall be liable only to the extent
of Contractor's proportional negligence. The Contractor specifically assumes potential liability
for actions brought against the County by Contractor's employees, including all other persons
engaged in the performance of any work or service required of the Contractor under this
Agreement and, solely for the purpose of this indemnification and defense, the Contractor
specifically waives any immunity under the state industrial insurance law, Title 51 R.C.W. The
Contractor recognizes that this waiver was specifically entered into pursuant to provisions of
R.C.W. 4.24.115 and was subject of mutual negotiation.
9. 11 SM"WICC. Prior to commencing work, the Contractor shall obtain at its own cost and expense
the following insurance coverage specified below and shall keep such coverage in force during
the terms of the Agreement.
a. Commercial Automobile Liability 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 $500,000 each
occurrence with the County named as an additional insured in connection with the
Contractor's performance of this Agreement. This insurance shall indicate on the
certificate of insurance the following coverage: (a) Owned automobiles; (b) Hired
automobiles; and, (3) Non -owned automobiles.
Page 3 of 15
b. Commercial General Liability Insurance in an amount not less than a single limit of one
million dollars ($1,000,000) 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:
i. Broad Form Property Damage, with no employee exclusion;
ii. Personal Injury Liability, including extended bodily injury;
iii. Broad Form Contractual/Commercial Liability — including coverage for products
and completed operations;
iv. Premises — Operations Liability (M&C);
v. Independent Contractors and subcontractors;
vi. Blanket Contractual Liability.
c. Professional Liability Insurance. The Contractor shall maintain professional liability
insurance against legal liability arising out of activity related to the performance of this
Agreement, on a form acceptable to Jefferson County Risk Management in the amounts
of not less than $1,000,000 Each Claim and $2,000,000 Aggregate. The professional
liability insurance policy should be on an "occurrence" form. If the professional liability
policy is "claims made," then an extended reporting periods coverage (tail coverage)
shall be purchased for three (3) years after the end of this Agreement, at the Contractor's
sole expense. The Contractor agrees the Contractor's insurance obligation to provide
professional liability insurance shall survive the completion or termination of this
Agreement for a minimum period of three (3) years.
d. The County shall be named as an "additional named insured" under all insurance policies
required by this Agreement, except Professional Liability Insurance when not allowed by
the insurer.
e. Such insurance coverage shall be evidenced by one of the following methods: (a)
Certificate of Insurance; or, (b) Self-insurance through an irrevocable Letter of Credit
from a qualified financial institution.
f. The Contractor shall furnish the County with properly executed certificates of insurance
that, at a minimum, shall include: (a) The limits of overage; (b) The project name to
which it applies; (c) The certificate holder as Jefferson County, Washington and its
elected officials, officers, and employees with the address of Jefferson County Public
Health 615 Sheridan Street, Port Townsend, WA 98368, and, (d) A statement that the
insurance policy shall not be canceled or allowed to expire except on thirty (30) days
prior written notice to the County. If the proof of insurance or certificate indicating the
County is an "additional insured" to a policy obtained by the Contractor refers to an
endorsement (by number or name) but does not provide the full text of that endorsement,
then it shall be the obligation of the Contractor to obtain the full text of that endorsement
and forward that full text to the County. Certificates of coverage as required by this
Page 4 of 15
section shall be delivered to the County within fifteen (15) days of execution of this
Agreement.
g. Failure of the Contractor to take out or maintain any required insurance shall not relieve
the Contractor from any liability under the Agreement, nor shall the insurance
requirements be construed to conflict with or otherwise limit the obligations concerning
indemnification of the County.
h. The Contractor's insurers shall have no right of recovery or subrogation against the
County (including its employees and other agents and agencies), it being the intention of
the parties that the insurance policies, with the exception of Professional Liability
Insurance, so affected shall protect both parties and be primary coverage for all losses
covered by the above described insurance.
i. Insurance companies issuing the policy or policies shall have no recourse against the
County (including its employees and other agents and agencies) for payment of any
premiums or for assessments under any form of policy.
All deductibles in the above described insurance policies shall be assumed by and be at
the sole risk of the Contractor.
k. Any deductibles or self-insured retention shall be declared to and approved by the County
prior to the approval of this Agreement by the County. At the option of the County, the
insurer shall reduce or eliminate deductibles or self-insured retention, or the Contractor
shall procure a bond guaranteeing payment of losses and related investigations, claim
administration and defense expenses.
1. Insurance companies issuing the Contractor's insurance policy or policies shall have no
recourse against the County (including its employees and other agents and agencies) for
payment of any premiums or for assessments under any form of insurance policy.
m. Any judgments for which the County may be liable, in excess of insured amounts
required by this Agreement, or any portion thereof, may be withheld from payment due,
or to become due, to the Contractor until the Contractor shall furnish additional security
covering such judgment as may be determined by the County.
n. Any coverage for third party liability claims provided to the County by a "Risk Pool"
created pursuant to Ch. 48.62 RCW shall be non-contributory with respect to any policy
of insurance the Contractor must provide in order to comply with this Agreement.
o. The County may, upon the Contractor's failure to comply with all provisions of this
Agreement relating to insurance, withhold payment or compensation that would
otherwise be due to the Contractor.
p. The Contractor's liability insurance provisions shall be primary and noncontributory with
respect to any insurance or self-insurance programs covering the County, its elected and
appointed officers, officials, employees, and agents.
Page 5 of 15
q. Any failure to comply with reporting provisions of the insurance policies shall not affect
coverage provided to the County, its officers, officials, employees, or agents.
r. The Contractor's insurance shall apply separately to each insured against whom claim is
made or suit is brought, except with respect to the limits of the insurer's liability.
s. The Contractor shall include all subcontractors as insured under its insurance policies or
shall furnish separate certificates and endorsements for each subcontractor. All insurance
provisions for subcontractors shall be subject to all the requirements stated herein.
t. The insurance limits mandated for any insurance coverage required by this Agreement
are not intended to be an indication of exposure nor are they limitations on
indemnification.
u. The Contractor shall maintain all required insurance policies in force from the time
services commence until services are completed. Certificates, insurance policies, and
endorsements expiring before completion of services shall be promptly replaced. All the
insurance policies required by this Agreement shall provide that thirty (30) days prior to
cancellation, suspension, reduction or material change in the policy, notice of same shall
be given to the Jefferson County Public Health Contracts Manager by registered mail,
return receipt requested.
v. The Contractor shall place insurance with insurers licensed to do business in the State of
Washington and having A.M. Best Company ratings of no less than A-, with the
exception that excess and umbrella coverage used to meet the requirements for limits of
liability or gaps in coverage need not be placed with insurers or re -insurers licensed in the
State of Washington.
w. The County reserves the right to request additional insurance on an individual basis for
extra hazardous contracts and specific service agreements.
10 W'orker's Colrlptic11, 111111+tilw i1,�rallcc
a. If and only if the Contractor employs any person(s) in the status of employee or
employees separate from or in addition to any equity owners, sole proprietor, partners,
owners or shareholders of the Contractor, the Contractor shall maintain workers'
compensation insurance at its own expense, as required by Title 51 RCW, for the term of
this Agreement and shall provide evidence of coverage to Jefferson County Public
Health, upon request.
b. Worker's compensation insurance covering all employees with limits meeting all
applicable state and federal laws. This coverage shall include Employer's Liability with
limits meeting all applicable state and federal laws.
c. This coverage shall extend to any subcontractor that does not have their own worker's
compensation and employer's liability insurance.
Page 6 of 15
d. The Contractor expressly waives by mutual negotiation all immunity and limitations on
liability, with respect to the County, under any industrial insurance act, disability benefit
act, or other employee benefit act of any jurisdiction which would otherwise be
applicable in the case of such claim.
e. If the County incurs any costs to enforce the provisions of this subsection, all cost and
fees shall be recoverable from the Contractor.
11.411(l endepmI. Contractor, The Contractor and the County agree that the Contractor is an
independent contractor with respect to the services provided pursuant to this Agreement. The
Contractor specifically has the right to direct and control Contractor's own activities, and the
activities of its subcontractors, employees, agents, and representatives, in providing the agreed
services in accordance with the specifications set out in this Agreement. Nothing in this
Agreement shall be considered to create the relationship of employer and employee between the
parties. Neither Contractor nor any employee of Contractor shall be entitled to any benefits
accorded County employees by virtue of the services provided under this Agreement, including,
but not limited to: retirement, vacation pay; holiday pay; sick leave pay; medical, dental, or other
insurance benefits; fringe benefits; or any other rights or privileges afforded to Jefferson County
employees. The County shall not be responsible for withholding or otherwise deducting federal
income tax or social security or for contributing to the state industrial insurance program,
otherwise assuming the duties of an employer with respect to Contractor, or any employee of
Contractor.
12. 'ubcontractin & �I'�111e11ts.
a. The Contractor is responsible for meeting all terms and conditions of this Agreement
including standards of service, quality of materials and workmanship, costs, and
schedules. Failure of a subcontractor to perform is no defense to a breach of this
Agreement. The Contractor assumes responsibility for and all liability for the actions and
quality of services performed by any subcontractor.
b. Every subcontractor must agree in writing to follow every term of this Agreement. The
Contractor must provide every subcontractor's written agreement to follow every term of
this Agreement before the subcontractor can perform any services under this Agreement.
The Public Health Director or their designee must approve any proposed subcontractors
in writing.
Any dispute arising between the Contractor and any subcontractors or between
subcontractors must be resolved without involvement of any kind on the part of the
County and without detrimental impact on the Contractor's performance required by this
Agreement.
nt Ag Contin ent l"ces. The Contractor warrants that he has not employed or
13. te;�c�v�.l��l���t�rst .... a'
retained any company or person, other than a bona fide employee working solely for the
Contractor, to solicit or secure this Agreement, and that he has not paid or agreed to pay any
company or person, other than a bona fide employee working solely for the Contractor, any fee,
commission, percentage, brokerage fee, gifts, or any other consideration contingent upon or
Page 7 of 15
resulting from the award or making of this Agreement. For breach or violation of this warranty,
the County shall have the right to annul this Agreement without liability or, in its discretion to
deduct from the contract price or consideration, or otherwise recover, the full amount of such fee,
commission, percentage, brokerage fee, gift, or contingent fee.
14. Disci Jrnination Prolimib t d, The Contractor, with regard to the work performed by it under this
Agreement, will not discriminate on the grounds of race, color, national origin, religion, creed,
age, gender, sexual orientation, material status, sex, or the presence of any physical or sensory
handicap in the selection and retention of employees or procurement of materials or supplies.
15. No Ass' it. The Contractor 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.
16.:Non- Wain-er" Waiver by the County of any provision of this Agreement or any time limitation
provided for in this Agreement shall not constitute a waiver of any other provision.
17. Termination.
a. The County reserves the right to terminate this Agreement at anytime by giving ten (10)
days written notice to the Contractor.
b. In the event of the death of a member, partner, or officer of the Contractor, or any of its
supervisory personnel assigned to the project, the surviving members of the Contractor
hereby agree to complete the work under the terms of this Agreement, if requested to do
so by the County. This section shall not be a bar to renegotiations of this Agreement
between surviving members of the Contractor and the County, if the County so chooses.
c. The County reserves the right to terminate this contract in whole or in part, with 10 days'
notice, in the event that expected or actual funding from any funding source is
withdrawn, reduced, or limited in any way after the effective date of this agreement. In
the event of termination under this clause, the County shall be liable for only payment for
services rendered prior to the effective date of termination.
18. Notices. All notices or other communications which any party desires or is required to give
shall be given in writing and shall be deemed to have been given if hand -delivered, sent by
facsimile, email, or mailed by depositing in the United States mail, prepaid to the party at the
address listed below or such other address as a party may designate in writing from time to time.
Notices to the County shall be sent to the following address:
Jefferson County Public Health Department
615 Sheridan Street
Port Townsend, WA 98368
ATT: Anna McEnery-DD/10th County Coordinator
Page 8 of 15
Notices to Contractor shall be sent to the following address:
Kitsap Public Health District
345 6th Street, Suite 300
Bremerton, WA 98337-1866
ATT: Cris Craig, Manager HIR
19. IlAg i cscl A , 411" ent, This Agreement together with attachments or addenda represents the
entire and integrated Agreement between the County and the Contractor and supersedes all prior
negotiations, representations, or agreements written or oral. No representation or promise not
expressly contained in this Agreement has been made. This Agreement supersedes all prior or
simultaneous representations, discussions, negotiations, and agreements, whether written or oral,
by the County within the scope of this Agreement. The Contractor ratifies and adopts all
statements, representations, warranties, covenants, and agreements contained in its proposal, and
the supporting material submitted by the Contractor, accepts this Agreement and agrees to all of
the terms and conditions of this Agreement.
20. Modificatiollm o,f ffiis Aga ectnent. This Agreement may be amended only by written instrument
signed by both County and Contractor.
21. Di,5,p s. The Parties agree to use their best efforts to prevent and resolve disputes before they
escalate into claims or legal actions. Any disputed issue not resolved pursuant to the terms of
this Agreement shall be submitted in writing within 10 days to the County Risk Manager, whose
decision in the matter shall be final, but shall be subject to judicial review. If either party deem it
necessary to institute legal action or proceeding to enforce any right or obligation under this
Agreement, each party in such action shall bear the cost of its own attorney's fees and court
costs. Any legal action shall be initiated in the Superior Court of the State of Washington for
Jefferson County. The parties agree that all questions shall be resolved by application of
Washington law and that the parties have the right of appeal from such decisions of the Superior
Court in accordance with the laws of the State of Washington. The Contractor hereby consents to
the personal jurisdiction of the Superior Court of the State of Washington for Jefferson County.
22. Sectiop 11ead .l1_g . The headings of the sections of this Agreement are for convenience of
reference only and are not intended to restrict, affect, or be of any weight in the interpretation or
construction of the provisions of the sections or this Agreement.
23. Lirnits c�l�y Waiver of Default 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.
24. No Oral Waiver. No term or provision of this Agreement will be considered waived by either
party, and no breach excused by either party, unless such waiver or consent is in writing signed
on behalf of the party against whom the waiver is asserted. Failure of a party to declare any
breach or default immediately upon the occurrence thereof, or delay in taking any action in
connection with, shall not waive such breach or default.
25.fiver a2 l ty. 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
Page 9 of 15
Agreement and the application this Agreement shall not be affected and shall be enforceable to
the fullest extent permitted by law.
26. 1131nC1117. 11 S 1c eessol I eii s ,,t d Assig��ls. This Agreement shall be binding upon and inure to
the benefit of the parties' successors in interest, heirs, and assigns.
27. leo Asci inr�,.l en_t: The Contractor shall not sell, assign, or transfer any of rights obtained by this
Agreement without the express written consent of the County.
28. No l Iil-" 13111 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.
29 mnature 11Untt° amts, The parties agree that separate copies of this Agreement may be
signed by each of the parties and this Agreement shall have the same force and effect as if all the
parties had signed the original.
30 Facsimile and The parties agree that facsimile and electronic signatures
shall have the same force and effect as original signatures.
31. 1"tris-1,eiiglhmNe otiatiolas. The parties agree that this Agreement has been negotiated at arms-
length, with the assistance and advice of competent, independent legal counsel.
32. I'ulAic.-Records Act. „ Notwithstanding the 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 hereafter 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 further agrees that upon
receipt of any written public record request, Contractor shall, within two business days, notify
the County by providing a copy of the request per the notice provisions of this Agreement.
33. Confidentiality. With respect to all information relating to County that is confidential and
clearly so designated, as required by the Health Insurance Portability and Accountability Act
(HIPAA) and any other applicable privacy laws, the Contractor agrees to keep such information
confidential. The Contractor shall not disclose, transfer, or sell any such information to any
party, except as provided by law or, in the case of personal information, with the prior written
consent of the person to whom the personal information pertains. The Contractor shall maintain
the confidentiality of all personal information and other information gained by reason of this
Agreement, and shall return or certify the destruction of such information if requested in writing
by Jefferson County. This Agreement, once executed, will be a "public record" subject to
production to a third party if same is requested pursuant to • the Washington Public Records Act,
Chapter 42.56 RCW, as may hereafter be amended.
34. C iinNnal „l listot,-yr°Back Equin Check. Each of the Contractor's employees, the employees of any
of the Contractor's approved subcontractor, or volunteers used by the Contractor shall submit to
a Washington State Patrol fingerprint identity and criminal history check before they are
authorized to perform services for the Project. The County agrees to bear all reasonable costs
Page 10 of 15
incurred in the performance of this fingerprint identity and criminal history check. Contractors
who may or will have regular access or limited access to any juveniles shall also:
a. Require that each of the Contractor's employees, the employees of any of the Contractor's
approved subcontractor, or volunteers used by the Contractor undergo not less often than
once every three (3) years another Jefferson County approved criminal history and
background check;
b. Ensure all employees, subcontractors, or volunteers are knowledgeable about the
requirements of RCW 13.40.570 and of the new crimes included in RCW 9A.44, Sexual
Offense;
c. Sign the Contractor Requirements for Responding to Situation of Sexual Misconduct Form,
and shall submit to Jefferson County with signed Agreement.
DATED this .......... .1111.......-..._ day of .-. 20
(SIGNATURES FOLLOW ON THE NEXT PAGE)
Page 11 of 15
SIGNATURE PAGE
Name of Contractor
JEFFERSON COUNTY
BOARD OF COMMISSIONERS
Kate Dean, Chair
Contractor Representative (Please print) David Sullivan, Member
(Signature) Greg Brotherton, Member
Title
Date
APPROVED AS TO FORM ONLY:
a 7
Philip C. Hunsucker
Chief Civil Deputy Prosecuting Attorney
Page 12 of 15
EXHIBIT A
SCOPE OF WORK
Kitsap Public Health District
The County will prioritize the following work for the Contractor. The Contractor and County
will mutually agree upon the scope, data periods, number of meetings and format of deliverables
for each work item below.
Contractor will:
• Manage evaluation tracking data systems for Vendors who access 1/101h of 1% funding.
• Prepare and present data reports for the Behavioral Health Advisory Committee (use to be
called the Mental Health/Substance Abuse Advisory Committee)
• Process, analyze and update Jefferson County data from U.S. Census, BRFSS, Healthy
Youth Survey, communicable disease, mental health, substance abuse, births and deaths, and
other available demographic and public health data sources.
• Prepare data reports that compare Jefferson County over time to Washington State.
• Present data reports to Jefferson County Public Health staff and to Jefferson County
Behavioral Health Advisory Committee to identify if changes are needed in County policies
and priorities.
Page 13 of 15
ATTACHMENT A
JEFFERSON COUNTY MH/SA TREATMENT TAX FUNDING -
MATCH POLICY
Definitions:
Match: is a requirement for the grantee to provide contributions of a specified amount or
percentage to match funds provided by another grantor. Matching can be in the form of cash or
in-kind contributions.
Regulations: The specific requirements for matching funds are unique to each federal or state
program. The A-102 Common Rule provides criteria for acceptable costs and contributions in
regard to match.
Jefferson County Policy:
In 2005, the Washington State Legislature created an option for counties to raise the local sales tax by
0.1 percent, (the I/10th of I% sales tax initiative) to augment state funding for mental health and
chemical dependency treatment. Jefferson County collects and distributes the Mental Health/Chemical
Dependency (MH/SA) tax. Services purchased by the County are allocated through a formal Request
for Proposal (RFP) process, review and contracting; staffed by Jefferson County Public Health, overseen
by Jefferson County Mental Health Substance Abuse Fund Advisory Committee and adopted by the
Board of County Commissioners, (BOCC). BOCC does not assume any fiscal responsibility/liability for
any of the Contractors they contract for services with.
Jefferson County reserves the first right to use as match the chemical dependency mental health tax
funds and the services funded by them for purposes of qualifying for additional funding and grants.
County may make available to the Contractor the chemical dependency mental health tax funds for the
Contractor to propose as match to state, federal or other entities, at the County's sole discretion.
Contractor shall not use chemical dependency mental health County tax funds for match without prior
authorization by the Jefferson County Administrator and County fiscal team. To request authorization
of availability of the funds for match, Contractor must apply to the County Administrator in writing, and
include their match formula and allocation plan and may include other documentation to support their
request. The County Administrator will authorize or deny the availability of match funds in writing
within 30 days of the application.
If the County informs the Contractor of the availability of chemical dependency mental health County
tax funds for match, then the Contractor shall be solely responsible for compliance with all state and
federal laws and regulations, including, but not limited to DSHS, CMS and BIRR funding rules,
applicable to the use of MH/SA sales tax monies as match. Following state, federal and local guidelines
for match is the responsibility of the Contractor.
Page 14 of 15
For example, if a Contractor provides Title XIX Medicaid services (the Policy 19.50.02 or 42CFR
430.30) they are required by those rules to actually bill Medicaid for the services at the same time. If no
Medicaid billing exists, the match would not comply with state and federal guidelines for match.
Concurrent with its request for authorization of the availability of match, Contractor shall document it
has met its responsibility to follow state, federal and local guidelines for match by submitting in writing
to the County Administrator their match formula, allocation plan, and other documentation made
mandatory pursuant to this Agreement and this Attachment A. At a minimum, the Contractor shall also
provide the following to the County Administrator:
1. DSHS requires contractors to complete and submit a "Local Match Certification" form
(DSHS 06-155) or a form that has equivalent data elements prior to any agreement for
DSHS services. Submit a copy of this application and form when requesting match
availability from the County and at each monthly billing.
2. Submit the current administrative policy within WA State regulating your services and
the use of local match.
3. Submit to the County your last financial audit showing your use of match, County funds
and tracking systems.
4. Submit to the County the terms of the agreement showing the MH/SA allocation is an
allowable source of match.
5. Provide documentation that your financial reporting system tracks matching funds at a
level that meets the level of documentation required by federal or state statutes.
The County may reject permission for Contractor to utilize the MH/SA sales tax monies as match.
Page 15 of 15