HomeMy WebLinkAbout021621_ca10JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: David Fortino, Jail Superintendent
DATE: February 16, 2021
SUBJECT: SUBRECIPIENT AGREEMENT re: Residential Substance Abuse
Treatment; In the Amount
of $146,000; Jefferson County Sheriffs Office/Jail; Believe in Recovery
STATEMENT OF ISSUE:
AGREEMENT re: Residential Substance Abuse Treatment; In the Amount of $146,000; Jefferson County
Sheriff's Office/Jail; Believe in Recovery
ANALYSIS:
This subrecipient agreement in conjunction with the agreement WA State Health Care Authority establishes
a Residential Substance Abuse Treatment program at the Jefferson County Jail, providing an opportunity for
incarcerated individuals to engage in inpatient treatment services locally, and gain a head start on their road
to recovery. Additionally, this program would enhance existing Substance Use Disorder services, such as
our MAT program, and Relapse Prevention and Substance Use Disorder Assessments.
FISCAL IMPACT:
Reimbursement for programing is based on a deliverable table within the agreement include provision of
services and quarterly reporting. Maximum reimbursement allowed is $146,000.
RECOMMENDATION:
Approve AGREEMENT re: Residential Substance Abuse Treatment; In the Amount of $146,000; Jefferson
County Sheriff s Office/Jail; Believe in Recovery
Date
SUBCONTRACT FOR PROFESSIONAL SERVICES
BETWEEN
JEFFERSON COUNTY
AND
BELIEVE IN RECOVERY LLC
This Subcontract for Professional Services Between Jefferson County and Believe in Recovery LLC.
(this Agreement) is made and entered into between Jefferson County (COUNTY) and Believe in
Recovery LLC. (SUBCONTRACTOR) for provision of Residential Substance Abuse Treatment
(RSAT) for incarcerated individuals in the COUNTY's jail pursuant to by Contract # K4880 for
Residential Substance Abuse Treatment (HCA Contract), between the COUNTY and the
Washington Health Care Authority (HCA).
IT IS AGREED UPON BY THE PARTIES AS FOLLOWS:
A. TERM OF THIS AGREEMENT
The term of this Agreement is from September 30, 2020 through September 29, 2021.
B. TERMINATION
(1) Should a party default in providing services under this Agreement or materially breach
any of its provisions, the other party may terminate this Agreement upon ten (10) days
written notice. A party shall have the right and opportunity to cure any such material
breach within the ten (10) day period.
(2) The COUNTY may terminate this Agreement upon immediate notice to
SUBCONTRACTOR in the event that the funding for the project ceases or is reduced in
amount. SUBCONTRACTOR will be reimbursed for services expended up to the date
of termination.
(3) This Agreement may be terminated without cause at any time by either party subject to a
sixty (60) day advance written notice of such termination to the other party.
(4) Termination of this Agreement shall not constitute a breach of this Agreement.
C. PROFESSIONAL SERVICES BY SUBCONTRACTOR
Professional services to be provided by SUBCONTRACTOR shall include:
(1) All Work Required by the HCA Contracts. All work required by the HCA Contracts, a true
and correct copy of which is attached as APPENDIX B (HCA Contract).
(2) 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; maintain appropriate client service
records and progress reports; and track key program performance indicators.
(3) Perform All Subcontractor Obligations. In addition to the above, SUBCONTRACTOR shall
fulfill all of SUBCONTRACTOR Obligations listed below.
D. SUBCONTRACTOR'S OBLIGATIONS
SUBCONTRACTOR shall fulfill the following obligations:
(1) SUBCONTRACTOR shall fulfill all the requirements of the HCA Contract.
(2) SUBCONTRACTOR shall comply with all state and federal requirements regarding the
confidentiality of participant records.
(3) 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).
(4) SUBCONTRACTOR shall have a grievance policy that:
• Negotiates conflicts and advises participants of grievance procedures;
• Is explained to participants;
• Prohibits retaliation for using the grievance process;
• Includes a non -retaliation statement;
• Assures that advocates are available and encourages participants to bring advocates to
help negotiate;
• Includes a mediation process that promotes the use of someone who is unaffected by
the outcome if conflicts remain unresolved; and,
• Includes a process for tracking and reporting grievances.
(5) SUBCONTRACTOR shall comply with all applicable federal, state and local regulations.
(6) SUBCONTRACTOR shall comply with all applicable Jefferson County jail policies.
(7) SUBCONTRACTOR shall track and analyze incident reports for potential trends and
patterns.
(8) SUBCONTRACTOR shall maintain access to current emergency contact and medical
information (medications, diet, allergies, etc.) for each participant.
(9) SUBCONTRACTOR shall provide the following:
(a) Equal Access: SUBCONTRACTOR will assures 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.
(b) 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
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Work. SUBCONTRACTOR will assure that all direct service staff are trained, and
that training is documented. SUBCONTRACTOR will provide COUNTY with
information regarding staff qualifications upon request.
E. DEBARMENT
By signing this Agreement, 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).
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. SUBCONTRACTOR must
immediately notify the COUNTY if, during the term of this Agreement, SUBCONTRACTOR
becomes debarred. The COUNTY may immediately terminate this Agreement by providing
SUBCONTRACTOR written notice, if SUBCONTRACTOR becomes debarred during the term of
this Agreement.
F. FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA)
(1) This Agreement is supported by federal funds that require compliance with the Federal
Funding Accountability and Transparency Act (FFATA or the Transparency Act). The
purpose of the Transparency Act is to make information available online so the public can
see how federal funds are spent.
(2) To comply with the act and be eligible to enter into this Agreement, SUBCONTRACTOR
must have a Data Universal Numbering System (DUNS®) number. A DUNS® number
provides a method to verify data about your organization. If SUBCONTRACTOR does not
already have one, a DUNS® number is available free of charge by contacting Dun and
Bradstreet at www.dnb.com.
(3) Information about SUBCONTRACTOR and this Agreement will be made available on
www.uscontractorregistration.com by HCA as required by P.L. 109-282. HCA's
Attachment 3: Federal Funding Accountability and Transparency Act Data Collection
Form, is considered part of this Agreement and must be completed and returned along with
the Agreement.
G. FUNDING WITHDRAWN, REDUCED OR LIMITED
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 COUNTY, at its sole discretion, may: (1) Terminate this agreement; (2)
Renegotiate this Agreement under the revised funding conditions; or, (3) Suspend
SUBCONTRACTOR's performance under this Agreement upon five (5) business days' advance
notice to SUBCONTRACTOR, if the COUNTY determines that there is a reasonably likelihood that
the funding insufficiency may be resolved in time to allow SUBCONTRACT'S performance to
resume prior to the normal completion date of this Agreement.
H. REIMBURSEMENTS
(1) Total reimbursements for fiscal year 2020-2021 to SUBCONTRACTOR by COUNTY
under this Agreement shall not exceed $146,000.00, including any allowable expenses for
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the services provided under this Agreement without express written amendment signed by
both parties to this Agreement.
(2) For said services rendered under this Agreement, COUNTY shall reimburse
SUBCONTRACTOR pursuant to this Agreement and the HCA Agreement.
(2) Work performed between September 30, 2020 and the execution of this Agreement that is
consistent with the provisions of this Agreement is hereby ratified.
(3) SUBCONTRACTOR will bill COUNTY monthly in arrears and on a monthly basis, on or
before the 5th day of the month, for units of service provided under this Agreement.
SUBCONTRACTOR will submit a Monthly Services Report for its billings. 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.
(4) 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.
I. OVERPAYMENTS OR ERRONEOUS PAYMENTS TO SUBCONTRACTOR
If overpayments or erroneous payments have been made to SUBCONTRACTOR under this
Agreement, the COUTNY will provide notice to SUBCONTRACTOR and SUBCONTRACTOR
shall refund the full amount of the overpayment within thirty (30) calendar days of the notice. If
SUBCONTRACTOR fails to make timely refund, the COUNTY may charge SUBCONTRACTOR
one percent (1 %) per month on the amount due, until paid in full.
J. RECORDS AND DOCUMENTS REVIEW
(1) 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 HCA, the
Office of the State Auditor, and state and federal officials so authorized by- law, rule;
regulation, or agreement [See 42 USC 1396a(a)(27)(B); 42 USC 1396a(a)(37)(B); 42 USC
1396a(a)(42(A); 42 CFR 431, Subpart Q; and 42 CFR 447.202].
(2) 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.
K. RIGHTS OF STATE AND FEDERAL GOVERNMENTS
In accordance with 45 C.F.R. 95.617, all appropriate state and federal agencies, including but
not limited to the Centers for Medicare and Medicaid Services (CMS), will have a royalty -free,
nonexclusive, and irrevocable license to reproduce, publish, translate, or otherwise use, and to
authorize others to use for Federal Government purposes: (i) software, modifications, and
Believe in Recovery LLC. Contract 2020-2021 Page 4 of 13
documentation designed, developed or installed with Federal Financial Participation (FFP) under
45 CFR Part 95, subpart F; (ii) the Custom Software and modifications of the Custom Software,
and associated Documentation designed, developed, or installed with FFP under this Agreement;
(iii) the copyright in any work developed under this Agreement; and (iv) any rights of copyright
to which SUBCONTRACTOR purchases ownership under this Agreement.
L. COMPLIANCE WITH SUBRECIPIENT REQUIREMENTS FROM GRANT
(1) General. In accordance with 2 CFR 200.501 and 45 CFR 75.501, SUBCONTRACTOR
shall:
(a) Maintain records that identify, in its accounts, all federal awards received and expended
and the federal programs under which they were received, by Catalog of Federal
Domestic Assistance (CFDA) title and number, award number and year, name of the
federal agency, and name of the pass -through entity;
(b) Maintain internal controls that provide reasonable assurance that SUBCONTRACTOR is
managing federal awards in compliance with laws, regulations, and provisions of
contracts or grant agreements that could have a material effect on each of its federal
programs;
(c) Prepare appropriate financial statements, including a schedule of expenditures of federal
awards;
(d) Incorporate OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 audit requirements
into all agreements between SUBCONTRACTOR and its subcontractors who are
subrecipients;
(e) Comply with any future amendments to OMB Super Circular 2 CFR 200.501 and 45
CFR 75.501 and any successor or replacement Circular or regulation;
(f) Comply with the applicable requirements of OMB Super Circular 2 CFR 200.501 and 45
CFR 75.501and any future amendments to OMB Super Circular 2 CFR 200.501 and 45
CFR 75.501, and any successor or replacement Circular or regulation; and,
(g) Comply with the Omnibus Crime Control and Safe Streets Act of 1968, Title VI of the
Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the
Americans with Disabilities Act of 1990, Title IX of the Education Amendments of 1972,
The Age Discrimination Act of 1975, and The Department of Justice Non -Discrimination
Regulations, 28 C.F.R. Part 42, Subparts C.D.E. and G, and 28 C.F.R. Part 35 and 39.
(Go to http://ojp.gov/about/offices/ocr.htm for additional information and access to the
aforementioned Federal laws and regulations.)
(2) Single Audit Act Compliance. If SUBCONTRACTOR expends $750,000 or more in
federal awards from any and/or all sources in any fiscal year, SUBCONTRACTOR will
procure and pay for a single audit or a program -specific audit for that fiscal year. Upon
completion of each audit, SUBCONTRACTOR will:
(a) Submit to the Authority contact person the data collection form and reporting package
specified in OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, reports required by
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the program -specific audit guide (if applicable), and a copy of any management letters
issued by the auditor;
(b) Follow-up and develop corrective action for all audit findings; in accordance with OMB
Super Circular 2 CFR 200.501 and 45 CFR 75.501, prepare a "Summary Schedule of
Prior Audit Findings."
(3) Overpayments. If it is determined by HCA or the COUNTY, or during the course of a
required audit, that SUBCONTRACTO has been paid unallowable costs under this or any
Program Agreement, SUBCONTRACTOR will refund the full amount to HCA as
provided in Section I. OVERPAYMENTS OR ERRONEOUS PAYMENTS TO
SUBCONTRACTOR.
M. 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, SUBCONTRACTOR
shall submit a Monitoring Certification using the form attached as Appendix A for purposes
of the COUNTY performing the risk assessment of SUBCONTRACTOR and compliance
monitoring of this Agreement that is required of the County by HCA.
N. GENERAL TERMS AND CONDITIONS
(1) SUBCONTRACTOR'S relation to the COUNTY shall at all times be that of independent
SUBCONTRACTOR. Any and all employees of SUBCONTRACTOR, or other persons
engaged in the performance of any work or service required of SUBCONTRACTOR under
this Agreement, shall be considered employees of SUBCONTRACTOR only, and any
claims that may arise on behalf of or against said employees shall be the sole obligation
and responsibility of SUBCONTRACTOR.
(2) SUBCONTRACTOR shall not subcontract or assign any of the services covered by this
Agreement without the express written consent of the COUNTY. Subcontracting and
assignment does not include printing or other customary reimbursable expenses that may
be provided in an Agreement.
(3) SUBCONTRACTOR, by signature to this Agreement, certifies that 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. SUBCONTRACTOR also agrees to include the above
requirement to all subcontracts into which it enters.
(4) SUBCONTRACTOR shall obtain and keep in force during the terms of this Agreement,
or as otherwise required, the following insurance with companies or through sources
approved by the State Insurance Commissioner pursuant to Chapter 48:05 RCW:
(a) Worker's compensation and employer's liability insurance. SUBCONTRACTOR
will participate in the Worker's Compensation and Employer's Liability Insurance
Program as may be required by the State of Washington;
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(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 SUBCONTRACTOR'S performance of this
Agreement.
(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 HCA 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 completed
operations
(iv) Premises - Operations Liability (M&C)
(v) Independent Contractors and Subcontractors
(vi) Blanket Contractual Liability
(5) 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.
(6) It shall be the responsibility of SUBCONTRACTOR to insure that any and all persons
engaged in the performance_ of any work or service required_ of SUBCONTRACTOR under
this Agreement, shall comply with the same insurance requirements that
SUBCONTRACTOR is required to meet.
(7) Failure on the part of 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 SUBCONTRACTOR to correct the breach, immediately terminate
this Agreement 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
SUBCONTRACTOR from the COUNTY.
(8) All cost for insurance shall be considered incidental to and included in the unit contract
prices and no additional payment will be made.
(9) Excepting the Workers Compensation insurance and any professional liability insurance
secured by SUBCONTRACTOR, the COUNTY will be named on all certificates of
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insurance as an additional insured. 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.
(10) All insurance shall be obtained from an insurance company authorized to do business in
the State of Washington. 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 SUBCONTRACTOR shall be primary to any equivalent or
applicable policies held by the COUNTY. All insurance policies obtained by
SUBCONTRACTOR shall include a waiver of subrogation rights. Any self -insured
retention, deductible or risk retention maintained, or participated in, by the COUNTY
coverage for third -party liability claims provided to the county, shall be excess and shall
be non-contributory to the insurance policies provided by SUBCONTRACTOR in order to
comply with the insurance requirements of this Subcontract. All policies provided by
SUBCONTRACTOR in order to comply with the insurance requirements of this
Subcontract must be endorsed to show this primary coverage.
(11) The COUNTY will pay no progress payments under this Agreement until
SUBCONTRACTOR has fully complied with this section. This remedy is not exclusive;
and the COUNTY may take such other action as is available to them under other provisions
of this Agreement, or otherwise in law.
(12) Nothing in the foregoing insurance requirements shall prevent the COUNTY, at its option,
from additionally requesting that SUBCONTRACTOR deliver to the COUNTY an
executed bond as security for the faithful performance of this Agreement and for payment
of all obligations of SUBCONTRACTOR.
(13) It is understood and agreed that this Agreement is entered into in the State of Washington.
This Agreement shall be governed by and construed in accordance with the laws of the
United States, the State of Washington and the County of Jefferson, as if applied to
transactions entered into and to be performed wholly within Jefferson County, Washington
between Jefferson County residents. No party shall argue or assert that any state law other
than Washington law applies to the governance or construction of this Agreement.
(14) Should either_ party bring any legal action, each party in such action shall bear- the cost of
its own attorney's fees and court costs. The venue for any legal action shall be solely in the
appropriate state court in Jefferson County, Washington, subject to the venue provisions
for actions against counties in RCW 36.01.050.
(15) SUBCONTRACTOR shall comply with the WA State Department of Labor and Industries
Minimum Wage Act, Chapter 49.46 RCW, acknowledging persons with disabilities
participating in job assessments are not considered employees.
(16) SUBCONTRACTOR shall indemnify and hold the COUNTY, and its officers, officials,
employees, agents and volunteers (and their marital communities) harmless from and shall
process and defend at its own expense, including all costs, attorney fees and expenses relating
thereto, all claims, demands, or suits at law or equity arising in whole or in part, directly or
indirectly, from SUBCONTRACTOR'S negligence or breach of any of its obligations under
this Agreement; provided that nothing herein shall require a SUBCONTRACTOR to
indemnify the COUNTY and its officers, officials, employees, agents and volunteers (and
their marital communities) against and hold them harmless from claims, demands or suits
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based solely upon the conduct of the COUNTY, its officers, officials, employees, agents
and volunteers (and their marital communities), and provided further that if the claims or
suits are caused by or result from the concurrent negligence of:
(a) SUBCONTRACTOR'S agents or employees; and,
(b) The COUNTY, its officers, officials, employees, agents and volunteers (and their
marital communities), this indemnity provision with respect to: (i) claims or suits
based upon such negligence, or (ii) the costs to the COUNTY of defending such
claims and suits, etc., shall be valid and enforceable only to the extent of
SUBCONTRACTOR'S negligence or the negligence of SUBCONTRACTOR'S
agents or employees.
(c) 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
SUBCONTRACTOR under this Agreement and, solely for the purpose of this
indemnification and defense, SUBCONTRACTOR specifically waives any
immunity under the state industrial insurance law, Title 51 RCW.
SUBCONTRACTOR recognizes that this waiver was specifically entered into
pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation.
(d) The provisions of this section shall survive the expiration or termination of this
Agreement.
(17) SUBCONTRACTOR shall not discriminate against any person presenting themselves for
services based on race, religion, color, sex, age, or national origin.
(18) No portion of this Agreement 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 Agreement may be subcontracted to a third -party, then
any contract or agreement between 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.
(19) . This Agreement memorializes the entire agreement of the parties. No representation or .
promise not expressly contained in this Agreement has been made. The parties are not
entering into this Agreement based on any inducement, promise or representation,
expressed or implied, which is not expressly contained in this Agreement. This Agreement
supersedes all prior or simultaneous representations, discussions, negotiations, and
agreements, whether written or oral, within the scope of this Agreement.
(20) SUBCONTRACTOR 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.
SUBCONTRACTOR assumes responsibility for and all liability for the actions and quality
of services performed by any subcontractor. Every subcontractor must agree in writing to
follow every term of this Agreement. SUBCONTRACTOR 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 head of the County
department primarily responsible for overseeing SUBCONTRACTOR'S performance
under this Agreement or that department head's designee must approve any proposed
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subcontractors in writing. Any dispute arising between SUBCONTRACTOR and any
subcontractors or between any subcontractors must be resolved without involvement of
any kind on the part of the COUNTY and without detrimental impact on the delivery of
contracted goods or services.
(21) While performing services, the use of illegal drugs, alcohol, or controlled substances on
the COUNTY property or premises is strictly prohibited. SUBCONTRACTOR'S
employees shall not perform services while under the influence of drugs or alcohol, and if
discovered, may be reported to the appropriate law enforcement agency.
(22) The use of tobacco of any kind on property or premises of the COUNTY shall comply with
COUNTY policies.
(23) Any form of harassment, discrimination, or improper fraternization with any County
employee or a participant is strictly prohibited.
(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. 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) The terms of this Agreement are not severable. 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 enforceable.
(26) This Agreement shall be binding upon and inure to the benefit of the parties' successors in
interest, heirs and assigns.
(27) 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.
(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) The parties agree that this Agreement has been negotiated at arms -length, with the
assistance and advice of competent, independent legal counsel.
(31) 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), SUBCONTRACTOR agrees to maintain all records
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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. SUBCONTRACTOR
also agrees that upon receipt of any written public record request, SUBCONTRACTOR
shall, within two business days, notify the COUNTY by providing a copy of the request
per the notice provisions of this Agreement.
(32) 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 Jail
81 Elkins Rd,
Port Hadlock, WA 98339
Notices to SUBCONTRACTOR shall be sent to the following address:
Gabbie Caudill
Believe in Recovery LLC.
211 Taylor St Suite 20
Port Townsend, WA 98368
(SIGNATURES FOLLOW ON THE NEXT PAGE)
Believe in Recovery LLC. Contract 2020-2021 Page 11 of 13
ADOPTED THIS day of , 2021
BOARD OF COUNTY COMMISSIONERS Believe in Recovery LLC.
JEFFERSON COUNTY, WASHINGTON
By:
Kate Dean, Chair DATE
By:
Greg Brotherton, Commissioner DATE
By:
Heidi Eisenhour, Commissioner DATE
SEAL:
ATTEST:
Carolyn Galloway DATE
Clerk of the Board
Approved as to form only:
February 12, 2021
Philip C. Hunsucker DATE
Chief Civil Deputy Prosecuting Attorney
By:
Name:
Title:
DATE:
Believe in Recovery LLC. Contract 2020-2021 Page 12 of 13
.APPENDIX A - COMPLIANCE AND RISK MONITORING FORM
This Compliance and Risk Monitoring Form shall be submitted along with every request for
reimbursement.
HCA CONTRACT NO:
DATE:
NAME Or SUBCONTRACTOR:
By signing ,t lc' %v, I : eclare under penalty of perjury of the laws of the State of Washington and
the United S'at,s thLt d,,: forgoing is true and correct. (Check the applicable boxes.)
DATE
CERTII'ICATON ITEM
YES
NO
SUBCONTRACTOR has not been suspended, debarred or
,.e.,se excluded from any federal or state contract
B( I") .TR_ACTOR is providing all wri, ,n reports and
date r,�uired by the Agreement
l3t_, . NTRACTOR has provided any audit report
froni any government agency since the last
tit ;� i ACTOR certifies that all of the deliverables
u required since the last ceru'l-icatian have
i
__- on c."I
l �� r-- z, being billed for in the invoice, actually has
nicluding any timesheet or other backup
Jl?''-'(iACTOR agrees to submit to an audit within
ro nest from the COUNTY or HCA
,C- OR has corrected any Lckicieticics
the last certification
S(ACONT-RA��:r_ 'TXT FCE DATE
WRITTEN 'NIA ',`lS('N SIGNING CER.T ICA l ii)N
APPRO
COUNT` �,>�o� v$ x ` r,=TM, �_TL1tZE DATE
WRIT'nul , f: i I E � t ti' PPROVINCi CFR
Beiieve. in 1t c; { - Contract 2020-2021 Page 13 of 13
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APPENDIX B
HCA Contract Number K4880
RESIDENTIAL SUBSTANCE
Health Resulting from Solicitation Number (If
ABUSE Carr'�e"- A�uthority applicable: NA
CONTRACT
Contractor/Vendor Contract Number.
THIS CONTRACT is made by and between Washington State Health Care Authority, (FICA) and Jefferson
County Jail, (Contractor).
CONTRACTOR NAME
CONTRACTOR DOING BUSINESS AS (08A)
Jefferson County Jail
7
CONTRACTOR ADDRESS Street
City
State Zip Code
79 Elkins Road
Port Hadlock
WA 98339
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE
I CONTRACTOR E-MAIL ADDRESS
David Fortino
I (360) 385-3856
dfortino@co.jefferson.wa.us
Is Contractor a Subrecioient under this Contract)
7770—AMMSER(S)
I FFATA Form Reouired
GIYES CINO
1 16,593
1 [DYES [)NO
HCA PROGRAM
HCA DIVISION/SECTION
Department of Behavioral Health and Recoery
A CONTACT NAME AND TITLE
HCA CONTACT ADDRESS
Health Care Authority
Michele Gayle. Medical Program Specialist 3
626 8th Avenue SE
PO Box 42730
Olympia, WA 98504-2730
HCA CONTACT TELEPHONE
HCA CONTACT E-MAIL ADDRESS
(360) 725-5935
micneie gajIeALgA-_wa qov
CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT
Date of Execution September 30, 2021 $146:000,00
PURPOSE OF CONTRACT
Provide Residential Substance Abuse Treatment (RSAT) for incarcerated individuals,
I I
The parties signing below warrant that they have read and understand this Contract, and have authority to
execute this Contract. This Contract will be binding on HCA only upon signature by both parties
CONTRACTOR SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
I
HCA 9IGNATU4
PRINTED NAME AND TIT LE
DATE SIGNED
Docu%pwd W
Rachelle Amerine,Contracts Administrator
1/28/2021L
Division of Legal Services
I
rrt
Rev 5/6/2019
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4.30 REMEDIES NON-EXCLUSIVE ...............................
4.31 RIGHT OF INSPECTOIN.......................................
4.32 RIGHTS IN DATA/OWNERSHIP ............................
4.33 RIGHTS OF STATE AND FEDERAL GOVERNMENTS
4.34 SEVERABILITY...................................................
4.35 SITE SECURITY ..................................................
4.36 SUBCONTRACTING .............................................
4.37 SUBRECIPIENT..................................................
4.38 SURVIVAL..........................................................
4.39 TAXES...............................................................
4.40 TERMINATION.. . ...... ....... .................... .......
4.41 TERMINATION PROCEDURES ..............................
4.42 WAIVER............................................................
4.43 WARRANTIES... ................ ...................... I .... I
Attachments
.25
................................................... 25
............................................................ 25
.......................................................26
....................................................... 27
............................................................ 27
............................................................ 27
............................................................27
............................................................29
.........................................................29
....................................................... 29
................. I.......... 31
....................................... 32
......................................................32
Attachment 1: Federal Compliance, Certifications and Assurances
Attachment 2: Federal Funding Accountability and Transparency Act Data Collection
Form
Attachment 3: Federal Award Identification for Subrecipients (FATS)
Schedules
Schedule A: Statement of Work (SOW) RSAT Services
Washington State 3 RSAT
Health Care Authority HCA Contract # K4880
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"Confidential Information" means information that may be exempt from disclosure to the
public or other unauthorized persons under chapter 42.56 RCW or chapter 70.02 RCW or other
state or federal statutes or regulations. Confidential Information includes, but is not limited to,
any information identifiable to an individual that relates to a natural person's health, (see also
Protected Health information); finances, education, business, use or receipt of governmental
services, names, addresses, telephone numbers, social security numbers, driver license
numbers, financial profiles, credit card numbers, financial identfiers and any other identifying
numbers, law enforcement records, HCA source code or object code, or HCA or State security
information.
"Contract" means this Contract document and all schedules, exhibits, attachments,
incorporated documents and amendments.
"Contractor" means Jefferson County Jail, its employees and agents. Contractor includes any
firm, provider, organization, individual or other entity performing services under this Contract. It
also includes any Subcontractor retained by Contractor as permitted under the terms of this
Contract.
"Covered entity" means a health plan, a health care clearinghouse or a health care provider
who transmits any health information in electronic form to carry out financial or administrative
activities related to health care, as defined in 45 C.F.R. § 160.101
"Data" means information produced, furnished, acquired, or used by Contractor in meeting
requirements under this Contract.
"Effective Date" means the first date this Contract is in full force and effect. It may be a
specific date agreed to by the parties; or, if not so specified, the date of the last signature of a
party to this Contract.
"HCA Contract Manager" means the individual identified on the cover page of this Contract
who will provide oversight of the Contractor's activities conducted under this Contract.
"Health Care Authority" or "HCA" means the Washington State Health Care Authority, any
division, section, office, unit or other entity.of HCA, or any of the officers or other officials
lawfully representing HCA.
"Overpayment" means any payment or benefit to the Contractor in excess of that to which the
Contractor is entitled by law, rule, or this Contract, including amounts in dispute.
"Proprietary information" means information owned by Contractor to which Contractor claims
a protectable interest under law. Proprietary Information includes, but is not limited to,
information protected by copyright, patent, trademark, or trade secret laws.
Washington State 5 RSAT
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3. SPECIAL TERMS AND CONDITIONS
3.1 PERFORMANCE EXPECTATIONS
Expected performance under this Contract includes, but is not limited to, the following:
3.1.1 Knowledge of applicable state and federal laws and regulations pertaining to
subject of contract;
3.1.2 Use of professional judgment;
3.1.3 Collaboration with HCA staff in Contractor's conduct of the services;
3.1.4 Conformance with HCA directions regarding the delivery of the services;
3.1.5 Timely, accurate and informed communications;
3.1.6 Regular completion and updating of project plans, reports, documentation and
communications;
3.1.7 Regular, punctual attendance at all meetings; and
3.1.6 Provision of high quality services.
Prior to payment of invoices, HCA will review and evaluate the performance of Contractor
in accordance with Contract and these performance expectations and may withhold
payment if expectations are not met or Contractor's performance is unsatisfactory.
3.2 TERM
3.2.1 The initial term of the Contract will commence on the date of last signature,
whichever is later, and continue through September 30, 2021, unless terminated
sooner as provided herein.
3.2.2 This Contract may be extended by mutual agreement and amendment to this
Contract.
3.2.3 Work performed without a contract or amendment signed by the authorized
representatives of both parties will be at the sole risk of the Contractor. HCA will
not pay any costs incurred before a contract or any subsequent amendment(s) is
fully executed.
3.3 COMPENSATION
3.3.1 The Maximum Compensation payable to Contractor for the performance of all
things necessary for or incidental to the performance of work as set forth in
Schedule A: Statement of Work is $146,000.00, and includes any allowable
expenses.
Washington State 7 RSAT
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3.4.1.3 Uses that are unallowable under Section3.4.1.2 are allowable using state
funds in a commingled budget if only state funs are used to pay such
costs. To determine that only state funds are used, the following
conditions must be met:
a) The agreement includes state funds at least equal to the total amount
of all items under consideration; and
b) If the funds are used by a subcontractor, the subcontractor shall
document clearly that only state funds are included in the subcontract;
and
c) If the use is a direct use of the Contractor, the use, which is
unallowable, is clearly segregated from all other uses by accounting
for them in separate expenditure accounts.
3.4.1.4 The use of federal funds of influence or attempt to influence or attempt to
influence the award of, or amendment to, any federal contract, grant,
loan, or cooperative agreement is prohibited.
d) The use of funds other than feeral funds for such purposes requires
the Contractor to submit all required federal and state forms disclosing
such lobbying activity.
e) The Contractor must include this language in any contracts resulting
from this Contract and ensure that all subrecipients understand and
agree to these terms.
3.4.2 Charitable Choice. The Contractor will ensure that Charitable Choice
Requirements of 42 C.F.R. Part 54 are followed and that Faith -Based
Organizations (FBO) are provided opportunities to compete with traditional alcohol
and drug abuse prevention and treatment providers for funding.
3.4.2.1 If the Contractor contracts with FBOs. the Contractor shall require the
FBO to meet the requirements of 42 G.F.R. Part 54 as follows:
f) Applicants and recipients for or of services will be provided with a
choice of prevention and treatment providers;
g) The FBO must facilitate a referral to an alternative provider within a
reasonable time frame when requested by the recipient of services;
h) The FBO must report to the Contractor all referrals made to
alternative providers;
i) The FBO must provide recipients with a notice of their rights;
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3.4.4.5 Per 45 C.F.R. § 74.36 and 45 C.F.R. § 92.34 and the US Department of
Health and Human Services Grants Policy Statement, any copyrighted or
copyrightable works developed under this cooperative agreement/grant
shall be subject to royalty -free, nonexclusive and irrevocable license to
the government to reproduce, publish, or otherwise use them and to
authorize others to do so for General Government purposes. Income
earned from any copyrightable work developed under this grant must be
used as program income.
3.4.4.6 Program income accrued under this award must be used in accordance
with the additional costs alternative described in 45 C.F.R. § 74.24(b)(1)
or 45 C.F.R. § 92.25(g)(2) as applicable. Program income must be used
to further the grant objectives and shall only be used for allowable costs
as set forth in the applicable Office of Management and Budget circulars
A-102 and A-110.
3.4.4.7 No part of an appropriation contained in this Act shall be used, other than
for normal and recognized executive -legislative relationships, for publicity
or propaganda purposes, for the preparation, distribution, or use of any
kit, pamphlet, booklet, publication, radio, television, or video presentation
designed to support or defeat legislation pending before the Congress,
except in presentation to the Congress itself or any State legislature.
3.4.4.8 No part of any appropriation contained in this Act shall be used to pay the
salary or expenses of any grant or contract recipient, or agency acting for
such recipient, related to any activity designed to influence legislation or
appropriations pending before the Congress or any State legislature.
3.4.4.9 Where a conference is funded by a grant or cooperative agreement the
recipient must include the following statement on all conference materials
(including promotional materials, agenda, and internet sites): "Funding for
this conference was made possible (in part) by Grant H79TI081705 from
SAMHSA. The views expressed in written conference materials or
publications and by speakers and moderators do not necessarily reflect
the official policies of the Department of Health and Human Services, nor
does mention of trade names, commercial practices, or organizations
imply endorsement by the U.S. Government."
3.4.4.10 If federal funds are used by the Contractor to attend a meeting,
conference, etc. and meal(s) are provided as part of the program, then
the per diem applied to the Federal travel costs (Meal and Incidental
Expenses allowance) must be reduced by the allotted meal cost(s).
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3.5.4 HCA will return incorrect or incomplete invoices to the Contractor for correction and
reissue. The Contract Number must appear on all invoices, bills of lading,
packages, and correspondence relating to this Contract.
3.5.5 In order to receive payment for services or products provided to a state agency,
Contractor must register with the Statewide Payee Desk at https:i/ofm.wa.00v/it-
s�stems/statewide-vendorpayee-services/receiving; payment -state. Payment will
be considered timely if made by HCA within thirty (30) calendar days of receipt of
properly completed invoices. Payment will be directly deposited in the bank
account or sent to the address Contractor designated in its registration.
3.5.6 Upon expiration of the Contract, any claims for payment for costs due and payable
under this Contract that are incurred prior to the expiration date must be submitted
by the Contractor to HCA within sixty (60) calendar days after the Contract
expiration date. HCA is under no obligation to pay any claims that are submitted
sixty-one (61) or more calendar days after the Contract expiration date ("Belated
Claims"). HCA will pay Belated Claims at its sole discretion, and any such
potential payment is contingent upon the availability of funds.
3.6 CONTRACTOR AND HCA CONTRACT MANAGERS
3.6.1 Contractor's Contract Manager will have prime responsibility and final authority for
the services provided under this Contract and be the principal point of contact for
the HCA Contract Manager for all business matters, performance matters, and
administrative activities.
3.6.2 HCA`s Contract Manager is responsible for monitoring the Contractor's
performance and will be the contact person for all communications regarding
contract performance and deliverables. The HCA Contract Manager has the
authority to accept or reject the services provided and must approve Contractor's
invoices prior to payment.
3.6.3 The contact information provided below may be changed by written notice of the
change (email acceptable) to the other party.
Contractor
Contract Manager Information
Health Care Authority
Contract Manager Information
Name:
David Fortino
Name:
Michele Gayle
Title:
Title:
Medical Program Specialist 3
Address:
79 Elkins Road
Port Hadlock, WA 98339
Address:
_626 8th Avenue SE
PO Box 42730
Olympia, WA 98504
Phone:
(360) 385-3856
Phone:
(360) 725-5935
Email
dfortino@co.jefferson.wa.us
Email:
michele.gayle Dhca.wa.gav
Washington State 13 RSAT
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3.83 Attachment 3: Federal Award Identification for Subrecipients (FATS);
3.8.8 Schedule A(s): Statement(s) of Work;
3.8.9 Any other provision, term or material incorporated herein by reference or otherwise
incorporated.
3.9 INSURANCE
Contractor must provide insurance coverage as set out in this section. The intent of the
required insurance is to protect the State should there be any claims, suits, actions, costs,
damages or expenses arising from any negligent or intentional act or omission of
Contractor or Subcontractor, or agents of either, while performing under the terms of this
Contract. Contractor must provide insurance coverage that is maintained in full force and
effect during the term of this Contract, as follows:
3.9.1 Commercial General Liability Insurance Policy - Provide a Commercial General
Liability Insurance Policy, including contractual liability, in adequate quantity to
protect against legal liability arising out of contract activity but no less than
$1 million per occurrence/$2 million general aggregate. Additionally, Contractor is
responsible for ensuring that any Subcontractors provide adequate insurance
coverage for the activities arising out of subcontracts.
3.9.2 Business Automobile Liability. In the event that services delivered pursuant to this
Contract involve the use of vehicles, either owned, hired, or non -owned by the
Contractor, automobile liability insurance is required covering the risks of bodily
injury (including death) and property damage, including coverage for contractual
liability. The minimum limit for automobile liability is $1,000,000 per occurrence,
using a Combined Single Limit for bodily injury and property damage.
3.9.3 Professional Liability Errors and Omissions — Provide a policy with coverage of not
less than $1 million per claim/$2 million general aggregate.
3.9A The insurance required must be issued by an insurance companyhes authorized to
do business within the state of Washington, and must name HCA and the state of
Washington, its agents and employees as additional insured's under any
Commercial General and/or Business Automobile Liability policy/ies. All policies
must be primary to any other valid and collectable insurance. In the event of
cancellation, non -renewal, revocation or other termination of any insurance
coverage required by this Contract, Contractor must provide written notice of such
to HCA within one (1) Business Day of Contractor's receipt of such notice. Failure
to buy and maintain the required insurance may, at HCA's sole option, result in this
Contract's termination.
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4.6 ATTORNEYS' FEES
In the event of litigation or other action brought to enforce the terms of this Contract, each
party agrees to bear its own attorneys' fees and costs.
4.6 CHANGE IN STATUS
In the event of any substantive change in its legal status, organizational structure, or fiscal
reporting responsibility, Contractor will notify HCA of the change. Contractor must provide
notice as soon as practicable, but no later than thirty (30) calendar days after such a
change takes effect.
4.7 CONFIDENTIAL INFORATION PROTECTION
4.7.1 Contractor acknowledges that some of the material and information that may come
into its possession or knowledge in connection with this Contract or its
performance may consist of Confidential Information. Contractor agrees to hold
Confidential Information in strictest confidence and not to make use of Confidential
Information for any purpose other than the performance of this Contract, to release
it only to authorized employees or Subcontractors requiring such information for
the purposes of carrying out this Contract, and not to release, divulge, publish,
transfer, sell, disclose, or otherwise make the information known to any other party
without HCA's express written consent or as provided by law. Contractor agrees to
implement physical, electronic, and managerial safeguards to prevent unauthorized
access to Confidential Information.
4.7.2 Contractors that come into contact with Protected Health Information may be
required to enter into a Business Associate Agreement with HCA in compliance
with the requirements of the Health Insurance Portability and Accountability Act of
1996, Pub. L. 104-191, as modified by the American Recovery and Reinvestment
Act of 2009 ("ARRAM), Sec. 13400—13424, H.R. 1 (2009) (HITECH Act) (HIPAA).
4.7.3 HCA reserves the right to monitor, audit, or investigate the use of Confidential
Information collected, used, or acquired by Contractor through this Contract. -
Violation of this section by Contractor or its Subcontractors may result in
termination of this Contract and demand for return of all Confidential information,
monetary damages, or penalties.
4.7.4 The obligations set forth in this Section will survive completion, cancellation,
expiration, or termination of this Contract.
4.8 CONFIDENTIAL INFORMATION BREACH — REQUIRED NOTIFICATION
4.8.1 Contractor must notify the HCA Privacy Officer (Privacy0ffcer1,&-hca.wa.gov) within
five Business Days of discovery of any Breach or suspected Breach of Confidential
Information.
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4.10 COVENANT AGAINST CONTINGENT FEES
Contractor warrants that no person or selling agent has been employed or retained to
solicit or secure this Contract upon an agreement or understanding for a commission,
percentage, brokerage or contingent fee, excepting bona fide employees or bona fide
established agents maintained by the Contractor for the purpose of securing business.
HCA will have the right, in the event of breach of this clause by the Contractor, to annul
this Contract without liability or, in its discretion, to deduct from the contract price or
consideration or recover by other means the full amount of such commission, percentage,
brokerage or contingent fee.
4.11 DEBAREMENT
By signing this Contract, Contractor 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).
Contractor 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. Contractor must
immediately notify HCA if, during the term of this Contract, Contractor becomes debarred.
HCA may immediately terminate this Contract by providing Contractor written notice, if
Contractor becomes debarred during the term hereof.
4.12 DISPUTES
The parties will use their best, good faith efforts to cooperatively resolve disputes and
problems that arise in connection with this Contract. Both parties will continue without
delay to carry out their respective responsibilities under this Contract while attempting to
resolve any dispute. When a genuine dispute arises between HCA and the Contractor
regarding the terms of this Contract or the responsibilities imposed herein and it cannot be
resolved between the parties' Contract Managers, either party may initiate the following
dispute resolution process.
4.12.1 The initiating party will reduce its description of the dispute to writing and deliver it
to the responding party (email acceptable). The, responding_ party will respond in
writing within five (5) Business Days (email acceptable). If the initiating party is not
satisfied with the response of the responding party, then the initiating party may
request that the HCA Director review the dispute. Any such request from the
initiating party must be submitted in writing to the HCA Director within five (5)
Business Days after receiving the response of the responding party. The HCA
Director will have sole discretion in determining the procedural manner in which he
or she will review the dispute. The HCA Director will inform the parties in writing
within five (5) Business Days of the procedural manner in which he or she will
review the dispute, including a timeframe in which he or she will issue a written
decision.
4.12.2 A parry's request for a dispute resolution must:
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4.16 FUNDING WITHDRAWN, REDUCED, OR LIMITED
if HCA determines in its sole discretion that the funds it relied upon to establish this
Contract have been withdrawn, reduced or limited, or if additional or modified conditions
are placed on such funding after the effective date of this contract but prior to the normal
completion of this Contract, then HCA, at its sole discretion, may:
4.16.1 Terminate this Contract pursuant to Section 4.40.3, Termination forNon-Allocation
of Funds;
4.16.2 Renegotiate the Contract under the revised funding conditions; or
4.16.3 Suspend Contractor's performance under the Contract upon five (5) Business
Days' advance written notice to Contractor. HCA will use this option only when
HCA determines that there is reasonable likelihood that the funding insufficiency
may be resolved in a timeframe that would allow Contractor's performance to be
resumed prior to the normal completion date of this Contract.
4.16.3.1 During the period of suspension of performance, each party will inform
the other of any conditions that may reasonably affect the potential for
resumption of performance.
4.16.3.2 When HCA determines in its sole discretion that the funding insufficiency
is resolved, it will give Contractor written notice to resume performance.
Upon the receipt of this notice, Contractor will provide written notice to
HCA informing HCA whether it can resume performance and, if so, the
date of resumption. For purposes of this subsection, "written notice" may
include email.
4.16.3.3 If the Contractor's proposed resumption date is not acceptable to HCA
and an acceptable date cannot be negotiated, HCA may terminate the
contract by giving written notice to Contractor. The parties agree that the
Contract will be terminated retroactive to the date of the notice of
suspension. HCA will be liable only for payment in accordance with the
terms of this Contract_ for services rendered prior to the retroactive. date of
termination.
4.17 GOVERNING LAw
This Contract is governed in all respects by the laws of the state of Washington, without
reference to conflict of law principles. The jurisdiction for any action hereunder is
exclusively in the Superior Court for the state of Washington, and the venue of any action
hereunder is in the Superior Court for Thurston County, Washington. Nothing in this
Contract will be construed as a waiver by HCA of the State's immunity under the 11 tt,
Amendment to the United States Constitution.
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4.22.3 Failure to comply with any provisions of this section may result in Contract
termination.
4.23 LIMITATION OF AUHORITY
Only the HCA Authorized Representative has the express, implied, or apparent authority
to alter, amend, modify, or waive any clause or condition of this Contract. Furthermore,
any alteration, amendment, modification, or waiver or any clause or condition of this
Contract is not effective or binding unless made in writing and signed by the HCA
Authorized Representative.
4.24 NO THIRD -PARTY BENEFICIARIES
HCA and Contractor are the only parties to this contract. Nothing in this Contract gives or
is intended to give any benefit of this Contract to any third parties.
4.25 NONDISCRIMINATION
During the performance of this Contract, the Contractor must comply with all federal and
state nondiscrimination laws, regulations and policies, including but not limited to: Title VII
of the Civil Rights Act, 42 U.S.C. §12101 et seq.; the Americans with Disabilities Act of
1990 (ADA), 42 U.S.C. §12101 et seq., 28 C.F.R Part 35; and Title 49.60 RCW,
Washington Law Against Discrimination. In the event of Contractor's noncompliance or
refusal to comply with any nondiscrimination law, regulation or policy, this Contract may be
rescinded, canceled, or terminated in whole or in part under the Termination for Default
sections, and Contractor may be declared ineligible for further contracts with HCA.
4.26 OYERPAYMENETS TO CONTRACTOR
In the event that overpayments or erroneous payments have been made to the Contractor
under this Contract, HCA will provide written notice to Contractor and Contractor will
refund the full amount to HCA within thirty (30) calendar days of the notice. if Contractor
fails to make timely refund, HCA may charge Contractor one percent (1%) per month on
the amount due, until paid in full. If the Contractor disagrees with HCA's actions under this
section, then it may invoke the dispute resolution provisions of Section 4.12, Disputes.
4.27 PAY EQuiTY
4.27.1 Contractor represents and warrants that, as required by Washington state law
(Engrossed House Bill 1109, Sec. 211), during the term of this Contract, it agrees to
equality among its workers by ensuring similarly employed individuals are
compensated as equals. For purposes of this provision, employees are similarly
employed if (i) the individuals work for Contractor, (ii) the performance of the job
requires comparable skill, effort, and responsibility, and (iii) the jobs are performed
under similar working conditions. Job titles alone are not determinative of whether
employees are similarly employed.
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4.29 RECORDS AND DocUMENTs REVIEW
4.29A The Contractor must maintain books, records, documents, magnetic media,
receipts, invoices or other evidence relating to this Contract 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 Contract. At no additional cost, these records,
including materials generated under this Contract, are subject at all reasonable
times to inspection, review, or audit by HCA, the Office of the State Auditor, and
state and federal officials so authorized by law, rule, regulation, or agreement [See
42 USC 1396a(a)(27)(B); 42 USC 1396a(a)(37)(B); 42 USC 1396a(a)(42(A); 42
C.F.R § 431, Subpart Q; and 42 C.F.R. § 447.202].
4.29.2 The Contractor must retain such records for a period of six (6) years after the date
of final payment under this Contract.
4.29.3 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.
4.30 REMEDIES NON-EXCLUSIVE
The remedies provided in this Contract are not exclusive, but are in addition to all other
remedies available under law.
4.31 RIGHT of (NSPECTOIN
The Contractor must provide right of access to its facilities to HCA, or any of its officers, or
to any other authorized agent or official of the state of Washington or the federal
government, at all reasonable times, in order to monitor and evaluate performance,
compliance, and/or quality assurance under this Contract.
4.32 RIGHTS IN DATA/OWNERSHIP
4.32.1 HCA and Contractor agree that all data and work products (collectively "Work
Product") produced pursuant to this Contract will be considered a work for hire
under the U.S. Copyright Act, 17 U.S.C. §101 et seq, and will be owned by HCA.
Contractor is hereby commissioned to create the Work Product. Work Product
includes, but is not limited to, discoveries, formulae, ideas, improvements,
inventions, methods, models, processes, techniques, findings, conclusions,
recommendations, reports,- designs, plans, diagrams, drawings, Software,
databases, documents, pamphlets, advertisements, books, magazines, surreys,
studies, computer programs, films, tapes, and/or sound reproductions, to the extent
provided by law. Ownership includes the right to copyright, patent, register and the
ability to transfer these rights and all information used to formulate such Work
Product.
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4.34 SEVERABILITY
If any provision of this Contract or the application thereof to any person(s) or
circumstances is held invalid, such invalidity will not affect the other provisions or
applications of this Contract that can be given effect without the invalid provision, and to
this end the provisions or application of this Contract are declared severable.
4.35 SITE SECURITY
While on HCA premises, Contractor, its agents, employees, or Subcontractors must
conform in all respects with physical, fire or other security policies or regulations. Failure to
comply with these regulations may be grounds for revoking or suspending security access
to these facilities. HCA reserves the right and authority to immediately revoke security
access to Contractor staff for any real or threatened breach of this provision. Upon
reassignment or termination of any Contractor staff, Contractor agrees to promptly notify
HCA.
4.36 SUBCONTRACTING
4.36.1 Neither Contractor, nor any Subcontractors, may enter into subcontracts for any of
the work contemplated under this Contract without prior written approval of HCA.
HCA has sole discretion to determine whether or not to approve any such
subcontract. In no event will the existence of the subcontract operate to release or
reduce the liability of Contractor to HCA for any breach in the performance of
Contractor's duties.
4.36.2 Contractor is responsible for ensuring that all terms, conditions, assurances and
certifications set forth in this Contract are included in any subcontracts.
4.36.3 If at any time during the progress of the work HCA determines in its sole judgment
that any Subcontractor is incompetent or undesirable, HCA will notify Contractor,
and Contractor must take immediate steps to terminate the Subcontractor's
involvement in the work.
4.36.4 The rejection or approval by the HCA of any Subcontractor or the termination of a
Subcontractor will not relieve Contractor of any of its responsibilities under the
Contract, nor be the basis for additional charges to HCA.
4.36.5 HCA has no contractual obligations to any Subcontractor or vendor under contract
to the Contractor. Contractor is fully responsible for all contractual obligations,
financial or otherwise, to its Subcontractors.
4.37 SUBRECIRIENT
4.37.1 General
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4.37.2.1 Submit to the Authority contact person the data collection form and
reporting package specified in OMB Super Circular 2 C.F.R. § 200.501
and 45 C.F.R. § 75.501, reports required by the program -specific audit
guide (if applicable), and a copy of any management letters issued by the
auditor;
4.37.2.2 Follow-up and develop corrective action for all audit findings; in
accordance with OMB Super Circular 2 C.F.R. § 200.501 and 45 C.F.R. §
75.501, prepare a "Summary Schedule of Prior Audit Findings."
4.37.3 Overpayments
4.37.3.1 If it is determined by HGA, or during the course of a required audit, that
Contractor has been paid unallowable costs under this or any Program
Agreement, Contractor will refund the full amount to HCA as provided in
Section 4.26, Overpayments to Contractors.
4.38 SURVIVAL
The terms and conditions contained in this Contract that, by their sense and context, are
intended to survive the completion, cancellation, termination, or expiration of the Contract
will survive. In addition, the terms of the sections titled Confidential Information Protection,
Confidential Information Breach — Required Notification, Contractor's Proprietary
Information, Disputes, Overpayments to Contractor, Publicity, Records and Documents
Review, Rights in DatalOwnership, and Rights of State and Federal Governments will
survive the termination of this Contract. The right of HCA to recover any overpayments
will also survive the termination of this Contract.
4.39 TAXES
HCA will pay sales or use taxes, if any, imposed on the services acquired hereunder.
Contractor must pay all other taxes including, but not limited to, Washington Business and
Occupation Tax, other taxes based on Contractor's income or gross receipts, or personal
property taxes levied or assessed on Contractor's personal property. HCA, as an agency
of Washington State government, is exempt from property tax. -
Contractor must complete registration with the Washington State Department of Revenue
and be responsible for payment of all taxes due on payments made under this Contract.
4.40 TERMINATION
4.40.1 Termination for Default
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In the event that the authority of HCA to perform any of its duties is withdrawn,
reduced, or limited in any way after the commencement of this Contract and prior
to normal completion, HCA may immediately terminate this Contract by providing
written notice to the Contractor. The termination will be effective on the date
specified in the termination notice. HCA will be liable only for payment in
accordance with the terms of this Contract for services rendered prior to the
effective date of termination. HCA agrees to notify Contractor of such withdrawal of
authority at the earliest possible time. No penalty will accrue to HCA in the event
the termination option in this section is exercised.
4.40.5 Termination for Conflict of Interest
HCA may terminate this Contract by written notice to the Contractor if HCA
determines, after due notice and examination, that there is a violation of the Ethics
in Public Service Act, Chapter 42.52 RCW, or any other laws regarding ethics in
public acquisitions and procurement and performance of contracts. In the event
this Contract is so terminated, HCA will be entitled to pursue the same remedies
against the Contractor as it could pursue in the event Contractor breaches the
contract.
4.41 TERMINATION PROCEDURES
4.41.1 Upon termination of this Contract, HCA, in addition to any other rights provided in
this Contract, may require Contractor to deliver to HCA any property specifically
produced or acquired for the performance of such part of this Contract as has been
terminated.
4.41.2 HCA will pay Contractor the agreed -upon price, if separately stated, for completed
work and services accepted by HCA and the amount agreed upon by the
Contractor and HCA for (i) completed work and services for which no separate
price is stated; (ii) partially completed work and services; (iii) other property or
services that are accepted by HCA; and (iv) the protection and preservation of
property, unless the termination is for default, in which case HCA will determine the
extent of the liability. Failure to agree with such determination will be a dispute
within the meaning of Section 4.12, Disputes. HCA may withhold from any
amounts due the Contractor such sum as HCA determines to be necessary to
protect HCA against potential loss or liability.
4.41.3 After receipt of notice of termination, and except as otherwise directed by HCA,
Contractor must:
4.41.3.1 Stop work under the Contract on the date of, and to the extent specified
in, the notice;
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4.43.3 Any written commitment by Contractor within the scope of this Contract will be
binding upon Contractor. Failure of Contractor to fulfill such a commitment may
constitute breach and will render Contractor liable for damages under the terms of
this Contract. For purposes of this section, a commitment by Contractor includes:
(i) Prices, discounts, and options committed to remain in force over a specified
period of time; and (ii) any warranty or representation made by Contractor to HCA
or contained in any Contractor publications, or descriptions of services in written or
other communication medium, used to influence HCA to enter into this Contract.
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8. Provide Medications for treatment of Opioid Use Disorder (MOOD).
b) Provide a designated housing space, separate from the general population, for RSAT
participants.
c) Require random urinalysis and/or other proven reliable forms of drug and alcohol testing
for the RSAT participants throughout the duration RSAT program.
d) Assess for aftercare needs and schedule follow-up appointments with community agencies
prior to individual's departure.
e) Prepare inmates for successful community reintegration, including scheduled and
confirmed post -release appointments for after care treatment and services.
f) Ensure each RSAT offender is enrolled in aftercare services upon their release from }ail
with an outpatient community substance abuse treatment facility certified by the State of
Washington per Washington Administrative Code (WAC) 388-805.
g) Track the re -offense records of RSAT graduates for one (1) year.
3. REPORTING REQUIREMENTS
All contractors of the RSAT funding must comply with DOJ/BJA reporting requirements in
collaboration with the HCA DBHR. No personal identifiable information is collected by the HCA,
however, general demographics and numbers served/completing the program are required.
Further, HCA DBHR will request recidivism data, to include probation violation and new arrest
convictions, on the individuals served within the program.
HCA will report this information to the DOJ/BJA as part of the reporting requirements of the grant.
a) Reporting Requirements:
1. Average treatment cost per individual who receives program services.
2. Average length of stay in the program for incarcerated individuals completing the
program-
1 Number of participants carried over from the previous reporting period and number of
new participants.
4. The number of participants who successfully completed the program and number of
participants who were terminated or dropped out.
5. The number of new treatment beds and the percentage of them funded with DOJ grant.
6. The number of days of residential treatment provided.
7. The number of participants completing the program who passed drug -testing.
8. The number of participants who were screened or enrolled in Medicaid.
9. Criminal recidivism of participants who successfully completed the program.
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Attachment 1
Federal Compliance, Certifications, and Assurances
FEDERAL COMPLIANCE - The use of federal funds requires additional compliance and
control mechanisms to be in place. The following represents the majority of compliance
elements that may apply to any federal funds provided under this contract. For clarification
regarding any of these elements or details specific to the federal funds in this contract,
contact:Michele Gayle.
a. Source of Funds SAMHSA: This Contract is being funded partially or in full through Cooperative
Contract numbers 2017RTBX4027 and 2018J2BX4017, the full and complete terms and
provisions of which are hereby incorporated into this Contract. Federal funds to support this
Contract are identified by the Catalog of Federal Domestic Assistance (CFDA) number 16.593 in
the amount of $146,000.00The Contractor or Subrecipient is responsible for tracking and
reporting the cumulative amount expended under HCA Contract K4880.
b. Period of Availability of Funds through end of Contract term: Pursuant to 45 C.F.R. § 92.23,
Contractor or Subrecipient may charge to the award only costs resulting from obligations of the
funding period specified in 2017RTBX4027 and 2018J2BX4017 unless carryover of unobligated
balances is permitted, in which case the carryover balances may be charged for costs resulting
from obligations of the subsequent funding period. All obligations incurred under the award must
be liquidated no later than 90 days after the end of the funding period.
c. Single Audit Act. This section applies to subrecipients only. Subrecipient (including
private, for -profit hospitals and non-profit institutions) shall adhere to the federal Office of
Management and Budget (OMB) Super Circular 2 C.F.R. §200.501 and 45 C.F.R, §
75.501. A Subrecipient who expends $750,000 or more in federal awards during a given
fiscal year shall have a single or program -specific audit for that year in accordance with
the provisions of OMB Super Circular 2 C.F.R. § 200.501 and 45 C.F.R. § 75,501.
d. Modifications. This Contract may not be modified or amended, nor may any term or
provision be waived or discharged, including this particular Paragraph, except in writing,
signed upon by both parties.
1. Examples of items requiring Health Care Authority prior written approval
include, but are not limited to, the following:
i. Deviations from the budget and Project plan.
ii. Change in scope or objective of the Contract.
iii. Change in a key person specified in the Contract.
iv. The absence for more than one (1) months or a 25% reduction in time by
the Project Manager/Director.
v. Need for additional funding.
vi. Inclusion of costs that require prior approvals as outlined in the
appropriate cost principles.
vii. Any changes in budget line item(s) of greater than twenty percent (20%) of
the total budget in this Contract.
2. No changes are to be implemented by the Sub-awardee until a written notice of
approval is received from the Health Care Authority.
e. Sub -Contracting: The Contractor or Subrecipient shall not enter into a sub -contract for
any of the work performed under this Contract without obtaining the prior written
approval of the Health Care Authority. if sub -contractors are approved by the Health
Care Authority, the subcontract, shall contain, at a minimum, sections of the Contract
pertaining to Debarred and Suspended Vendors, Lobbying certification, Audit
requirements, and/or any other project Federal, state, and local requirements.
Washington State 37 RSAT
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State. Local and Indian OMB Super Circular 2 C.F.R. § 200.501 and 45 C.F.R. § 75.501
Tribal Governments and
Governmental Hospitals
Non -Profit
Organizations and Non -
Profit Hospitals
Colleges or Universities
and Affiliated Hospitals
For -Profit Organizations
III. STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES - Following are the
Assurances, Certifications, and Special Conditions that apply to all federally funded (in
whole or in part) Contracts administered by the Washington State Health Care Authority.
a. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION: The
undersigned (authorized official signing for the contracting organization) certifies to
the best of his or her knowledge and belief, that the contractor, defined as the
primary participant in accordance with 45 C.F.R. § Part 76, and its principals: are not
presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal Department or
agency have not within a 3-year period preceding this contract been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State, or local) transaction or contract under a public transaction; violation
of Federal or State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property; are not presently indicted or otherwise criminally or civilly charged
by a governmental entity (Federal, State, or local) with commission of any of the
offenses enumerated in Section 2 of this certification; and have not within a 3-year
period preceding this contract had one or more public transactions (Federal, State,
or local) terminated for cause or default.
Should the Contractor or Subrecipient not be able to provide this certification, an explanation
as to why should be placed after the assurances page in the contract.
The contractor agrees by signing this contract that it will include, without modification, the
clause above certification in all lower tier covered transactions (i.e., transactions with sub -
grantees and/or contractors) and in all solicitations for lower tier covered transactions in
accordance with 45 C.F.R. § Part 76.
b. CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS: The
undersigned (authorized official signing for the contracting organization) certifies that the
contractor will, or will continue to, provide a drug -free workplace in accordance with 45 C.F.R.
§ Part 76 by:
1. Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession or use of a controlled substance is prohibited in
the grantee's workplace and specifying the actions that will be taken against
employees for violation of such prohibition; Establishing an ongoing drug -free
awareness program to inform employees about
i. The dangers of drug abuse in the workplace;
Washington State 39 RSAT
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c. CERTIFICATION REGARDING LOBBYING: Title 31, United States Code, Section 1352,
entitled 'limitation on use of appropriated funds to influence certain Federal contracting and
financial transactions," generally prohibits recipients of Federal grants and cooperative
Contracts from using Federal (appropriated) funds for lobbying the Executive or Legislative
Branches of the Federal Government in connection with a SPECIFIC grant or cooperative
Contract. Section 1352 also requires that each person who requests or receives a Federal
grant or cooperative Contract must disclose lobbying undertaken with non -Federal
(nonappropriated) funds. These requirements apply to grants and cooperative Contracts
EXCEEDING $100,000 in total costs (45 C.F.R. § Part 93).
The undersigned (authorized official signing for the contracting organization) certifies, to the
best of his or her knowledge and belief, that. -
No Federal appropriated funds have been paid or will be paid„ by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan,
the entering into of any cooperative Contract, and the extension, continuation,
renewal, amendment, or modification of any Federal contract, grant, loan, or
cooperative Contract.
2. if any funds other than Federally appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee
of a Member of Congress in connection with this Federal contract, grant, loan, or
cooperative Contract, the undersigned shall complete and submit Standard Form-LLL,
"Disclosure of Lobbying Activities," in accordance with its instructions. (if needed,
Standard Form-LLL, "Disclosure of Lobbying Activities," its instructions, and
continuation sheet are included at the end of this application form.)
3. The undersigned shall require that the language of this certification be included in the
award documents for all subcontracts at all tiers (including subcontracts, subcontracts,
and contracts under grants, loans and cooperative Contracts) and that all sub -
recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by Section 1352, U.S. Code. Any person
who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
d. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT (PFCRA): The
undersigned (authorized official signing for the contracting organization) certifies that the
statements herein are true, complete, and accurate to the best of his or her knowledge, and
that he or she is aware that any false, fictitious, or fraudulent statements or claims may subject
him or her to criminal, civil, or administrative penalties. The undersigned agrees that the
contracting organization will comply with the Public Health Service terms and conditions of
award if a contract is awarded.
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5. The prospective contractor agrees by submitting this contract that, should the
proposed covered transaction be entered into, it shall not knowingly enter into any
lower tier covered transaction with a person who is debarred, suspended, declared
ineligible, or voluntarily excluded from participation in this covered transaction,
unless authorized by Authority.
6. Nothing contained in the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
7. Except for transactions authorized under paragraph 6 of these instructions, if a
participant in a covered transaction knowingly enters into a lower tier covered
transaction with a person who is suspended, debarred, ineligible, or voluntarily
excluded from participation in this transaction, in addition to other remedies available
to the Federal Government, HCA may terminate this transaction for cause or default.
CONTRACTOR SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
print or type name:
NAME: (if applicable)
Washington State 43 RSAT
Health Care Authority HCA Contract # K4880
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HCA will not endorse the Contractor's sub -award until this form is completed and returned.
HCA Contract Number: K4880
Sub -award Project Description (see instructions and examples below)
Residential Substance Abuse Treatment for State Prisoners
Contractor to provide chemical dependency treatment for incarcerated individuals in the Contractor's jail.
Instructions for Sub -award Project Description:
In the first line of the description provide a title for the sub -award that captures the main purpose of
the Subrecipients work. Then, indicate the name of the Subrecipient and provide a brief description
that captures the overall purpose of the sub -award, how the funds will be used, and what will be
accomplished.
Example of a Sub -award Project Description:
Increase Healthy Behaviors: Educational Services District XYZ will provide training and technical
assistance to chemical dependency centers to assist the centers to integrate tobacco use into their
existing addiction treatment programs. Funds will also be used to assist centers in creating tobacco
free treatment environments
Signature of Contractor Authorized Representative Date
Washington State 45 RSAT
Health Care Authority HCA Contract # K4880
APPENDIX B
Envelope Id: 81ABC23386C946C9B473AOD629C401FB
Subject: Please Partially Executed Signature required on Contract K4880 with Health Care Authority
Source Envelope:
Document Pages: 52 Signatures: 1
Certificate Pages: 5 Initials: 0
AutoNav: Enabled
Envetopetd Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
ROrrd TmckkV
Status: Original
1/22/2021 8:42:46 AM
Rachelle Amerine
rachelle.amerine@hca.wa.gov
Contracts Administrator
CloudPWR OBO Washington State Health Care
Authority -Sub Account
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
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Intermediary D*Rveq Evwft Status
CwM*d Dewwy Events Status
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Angela Hanson
angela.hanson@hca.wa.gov
Contract Specialist 3
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature disclosure:
Accepted 4127/2020 11:21:01 AM
I D: 6d738c84-55ca-48e5-813b-36dO98 tr40f80
David Fortino
dfortino@co.jefferson.wa.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Holder: Janet Stevens
janet.stevens@hca.wa.gov
Sit rWure
�---oxi,sipnee ur:
Signature Adoption: Pre -selected Style
Using tP Address. 198.239.13.15
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Status: Completed
Envelope Originator:
Janet Stevens
626 8th Ave SE
Olympia, WA 98501
janet.stevens@hca.wa.gov
IP Address: 198-239,14.189
Location: DocuSign
T
Sent: 1/22/2021 9:00:45 AM
Mewed: 1122/2021 8:01:40 PM
Signed: 1/28/2021 7:06:22 AM
Tkimoftmp
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Sent: 112212021 9:00:46 AM
Sent: 1/28/2021 7:06:26 AM
Mewed: 1/2812021 10:20:00 AM
Electronic "Xe Bsclosurecreated on. 5122=19 6:49:33 AM
Parties agreed to: Angela Hanson, Angela Hanson
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, CloudPWR OBO Washington State Health Care Authority -Sub Account (we,
us or Company) may be required by law to provide to you certain written notices or disclosures.
Described below are the terms and conditions for providing to you such notices and disclosures
electronically through the DocuSign system. Please read the information below carefully and
thoroughly, and if you can access this information electronically to your satisfaction and agree to
this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by
selecting the check -box next to `I agree to use electronic records and signatures' before clicking
'CONTINUE' within the DocuSign system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per -page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of -changing your mind -
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to
receive required notices and consents electronically from us or to sign electronically documents
from us.
All notices and disclosures will be sent to you electronically
APPENDIX B
To inform us that you no longer wish to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your signing session, and on the subsequent page,
select the check -box indicating you wish to withdraw your consent, or you may;
ii. send us an email to todd.stoneChca.wa.gov and in the body of such request you must state
your email, full name, mailing address; and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: fit
s:.`;`sport.docusin.eo%guidestsi ner-a��ide-
signin ;-system-requirements.
Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm that you have
read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further,
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check -box next to `I agree to use electronic records and signatures' before
clicking `CONTINUE' within the DocuSign system.
By selecting the check -box next to `I agree to use electronic records and signatures', you confirm
that:
• You can- access and read _this Electronic Record and Signature Disclosure; and _
• You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
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