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Home My WebLink Aboutca6_051010 ~ JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of Commissioners FROM: Jefferson County Sheriff's Office DATE: ,('() t1...y_ ID 1--62C2/ 0 North Olympic Peninsula Child Passenger Safety RE: STATEMENT OF ISSUE: Contract between Washington State Department ofHea1th and Jefferson County Sheriff's Office Project Title: North Olympic Peninsula Child Passenger Safety ANALYSIS: Child Passenger Safety Technicians on the North Olympic Peninsula will partner with local libraries and child care centers to educate parents and children on the importance of using child booster seats while traveling in motor vehicles. A certification class will provide additional child passenger safety technicians in the region. Six child passenger safety clinics will be held at various locations. Most of the grant funds will be used to purchase combination seats with higher weight harnesses that can be provided to low income families. FISCAL IMPACT: The project is scheduled to begin on the day of contract execution and continue until September 30, 2010. The amount is $5,000. Matching funds are not required. Budget neutral.p RECOMMENDATION: Approval of contract. s-/*o Date Wasbmglnn State JJeparlmmt Ii Health CONTRACT NUMBER: SUB RECIPIENT · IZIYES DNO N18409 PERSONAL SERVICE DYES DNO . see Attachment 2 THIS AGREEMENT is made by and between the Washington State Department of Health, hereinafter referred to as DOH, and the party whose name appears below, hereinafter referred to as Contractor. CONTRACTOR NAME and ADDRESS: Jefferson County Sheriffs OffIce 79 Elkins Road Port Hadlock, WA 98339 UBI #: 602 616 806 IT IS MUTUALLY AGREED THAT: The purpose of this contract is to work with communities to educate children and families on child passenger safety STATEMENT OF WORK: The Contractor shall provide the all necessary personnel, equipment, materials, goods and services and otherwise do all things necessary for or incidental to the performance of the work as described in exhIbit A, attached hE!reto and incorporated herein. PERIOD OF PERFORMANCE: Subject to its other provisions, the period of performance under this contract shall be from Date of execution through September 30, 2010 unless sooner terminated as provided herein. No billable activity may take place until this contract has been signed by both parties. OFFICE OF FINANCIAL MANAGEMENT APPROVAL: In the event this agreement is designated above as a personal service: Under the provisions of Chapter 39.29 RCW, personal services contract(s) and amendments may be required to be filed with the Office of Financial Management (OFM) for approval. No contract or amendment required to be so filed is effective and no work thereunder shall be commenced nor payment made therefore until ten (10) working days following the date of filing, and, if required, until approved by OFM. In the event OFM fails to approve the contract or amendment, the contract shall be null and void. CONSIDERATION: The maximum consideration available under this contract shall not exceed $5,000 without a properly executed written amendment signed by representatives of both parties authorized to do so. Source of funds: Federal: $5,000 State: $ Other: $ Total: $5,000 Contract N18409 Page 1 of 29 Revised 0112010 Federal funds disbursed through this contract were received by DOH through OMS Catalogue of Federal Domestic AssIstance Number 20.613. Contractor agrees to comply with all applicable rules and regulations associated with these federal funds. In the event state funds are provided through this contract, unless otherwise indicated and executed with an amendment to this contract, any state fisCli\1 year (July - June) state funds which are unexpended as of June 30Ut, will not be available for carry over into the next state fiscal year. INVOICES AND PAYMENT: Contractor shall submit correct invoices to the DOH Project Manager for all amounts to be paid by DOH hereunder. All invoices submitted must meet with the approval of the Project Manager or hislher designee prior to payment, which approval shall not be unreasonably withheld. Contractor shall only submit invoices for services or dellverables as permitted by this section of the contract. The Contractor shall not bill DOH for services performed under this contract, and DOH shall not pay the Contractor, if the Contractor is entitled to payment or has been or will be paid by any other source, including grants, for that service. DOH will return incorrect or incomplete invoices to the Contractor for correction and reissue. The contract number and order number must appear on all invoices, bills of lading, packages, and correspondence relating to this contract. Invoices must reference this contract number and provide detailed information as requested by DOH. DOH will make payment to the Contractor within 30 days upon receipt of a properly executed invoice vouchers, and approval of the deliverable(s). (Nota: Failure to submit a properly completed IRS form W-9 may result In delayed payments.) 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 DOH within 60 days after the contract/agreement expiration date. Belated claims shall be paid at the discretion of DOH and are contingent upon the availability of funds. GOVERNANCE: In the event of an inconsistency in this contract, unless otherwise provided herein, the inconsistency shall be resolved by gMng precedence in the following order: . Applicable Federal and State statutes and regulations . Special Terms and Conditions . Attachment 1, General Terms and Conditions, . Attachment 2, Federal Compliance, and Standard Federal Certifications and Assurances . Exhibit A, Statement of Work . Any other provision of the contract whether incorporated by reference or otherwise. UNDERSTANDING: This contract, including referenced exhibits, attachments & documents Included herein by reference, contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this contract shall exist or bind anv of th.. n"rti.." n..""''' APPROVAL: This contract shall be subject to the written approval of DOH ~ontracti~g Officer and shall not be binding until so approved. Only the Contracting ~c:r or hlslher deSignee, ?y written delegation made prior to action, shall have the expressed, Implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this ~~tract. ~urthermore.' any alteration, amendment, modification, or waiver of any clause or cond.ition of thiS contract IS not effective or binding unless made in writing and signed by the Contracting Officer. IN WITNESS WHEREOF: DOH and the Contractor have signed this agreement. CONTRACTOR SIGNATURE DATE print or type name & title below: DOH CONTRACTING OFFICER SIGNATURE DATE This contract has been approved as to form by the attorney general. NOTE: THE CONTRACTOR'S SIGNATURE IS ALSO REQUIRED ON ATTACHMENT 2, FEDERAL CERTIFICATIONS AND ASSURANCE I,;: APPROVAL: This contract shall be subject to the written approval of DOH Contracting Officer and shall not be binding until so approved. Only the Contracting Officer or hislher designee, by written delegation made prior to action, shall have the expressed, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this contract Furthermore, any alteration, amendment, modification, or waiver of any clause or condition of this contract is not effective or binding unless made in writing and signed by the Contracting Officer. IN WITNESS WHEREOF: DOH and the Contractor have signed this agreement. CONTRACTOR SIGNATURE DATE print or type name & title below: DOH CONTRACTING OFFICER SIGNATURE DATE TIlls contract has been approved as to form by the attorney general. NOTE: THE CONTRACTOR'S SIGNATURE IS ALSO REQUIRED ON ATTACHMENT 2, FEDERAL CERTIFICATIONS AND ASSURANCE Contract N18409 Page 3 of 29 Revised 01/2010 EXHIBIT A STATEMENT OF WORK Jefferson County Child Passenger Safety DOE. September 30,2010 Objectives: Work with communities in the North Olympic Peninsula region of Jefferson and Clallam Counties to partner with community libraries and child care centers to educate about the importance of keeping children in booster seats to higher weight limits. Dellverables Education Proaram - Develop and present a 30-minute and 45-minute program for 3 to 6- year olds on the importance of child occupant protection (COP). Target audience: preschool - kindergarten age children and parents. Documentation: Written copy of presentation including handouts. Child Paesenaer Safety Course - Conduct a NHTSA child passenger safety technician course in Jefferson County offering reimbursement of course registration fee ($75) to new technicians in Jefferson and Clallam Counties upon successful completion of CPS technician course and 6 hours of work in child passenger safety. Documentation: Date and location of training, trainers, number of people who start training, number of people certified, and their locations. Support for New TechnIcians - Provide ongoing support and technical assistance to new technicians by providing a mentor for each new technician who resides in Jefferson and Clallam Counties. To receive reimbursement for the registration fee, new technicians must submit documentation of a minimum of 6 hours of work In child passenger safety that has been signed by the event coordinator(s). Documentation: Provide a written plan of how new technicians will receive mentoring from other technicians. Provide a list and signed documentation sheets from new technicians who received reimbursement of registration fees for CPS technician course. Community Outreach - Present 10 child occupant protection programs to children during library storytelling times (for children in preschool and kindergarten) and/or older child care storytelling times. Partner with Jefferson County bookmobile and present program to children in rural areas of Jefferson County. Documentation: Travel, food and lodging using the state per diem must be submitted. Listing of locations. Car Seat Check ups - Conduct six child passenger safety check ups on the North Olympic Peninsula. Documentation: Locations, of car seat check ups. Number of seats with potentially life-threatening misuse, with less serious misuse, and with no misuse. Purchase car seats. Contract N 18409 Page 4 of 29 Revised 01/2010 EXHIBIT A STATEMENT OF WORK Receipt for purchase of car seats. Amount received in donation for car seats. List of volunteers and their roles in each child passenger safety clinic. Time period Date of Contract Execution to September 30,2010. Reporting Reports shall be submitted on Report Fonn, (Attachment A) and will include documentation as described above. Report Fonn Report Fonn to A-19 In Amount of: and A-19 Due document activities from: June 15 DOE - May 30 $ 3,500 August 15 June 1 - July 31 $ 1,000 September 30 August 1 - Sept. 30 $ 500 Contract Amount $5,000.00 for Child Passenger Safety deliverables Funding Source Washington Traffic Safety Commission Grant Project K310-03 Billing Instructions: Reimbursement shall be contingent upon receipt of A-19 billing form and deliverables as described above. FINAL PAYMENT WILL BE MADE ONLY WHEN ALL DELlVERABLES HAVE BEEN RECEIVED BY DOH. Contract N 18409 Page 5 of 29 Revised 01/2010 EXHIBIT A STATEMENT OF WORK N 18409 Jefferson County Sheriff Department Attachment A A;~ ~>;i~~w.-4 fib Health '\'a8hing1ilrt Traffic Safety Project Report Applicant Agency: Jefferson County Sheriff Department Project Title: Child Passenger Safety Project Reporting Period: (Check appropriate time period) DOE - May 30 June 1 - July 21 August 1 - Sept. 30 (Due June 15) (Due August 15) (Due Sept. 30) Project Objectives achieved this reporting period (refer to objectives in approved contract and documentation requested) Objective 1 - Education Program Objective 2 - Child Passenger Safety Course Objective 3 - Support for New Technicians Contract N18409 Page 6 of 29 Revised 01/2010 EXHIBIT A STATEMENT OF WORK Objective 4 - Community Outreach Objective 5 - Car Seat Check-ups Evaluation: Problems Encountered/other Remarks: Prepared by: Date Submitted: E-Mail to: Mary Borges (Preferred method) marv.boraesIWdoh.wa.aov OR Mail to: Mary Borges Safe Kids Washington Department of Health, PO Box 47853 Olympia, WA 98504-7853 360-236-2861 Contract N 18409 Page 7 of 29 Revised 01/2010 ATTACHMENT 1 GENERAL TERMS AND CONDITIONS I. GENERAL TERMS (DEFINITIONS) As used throughout this contract, the following terms shall have the meanings set forth below: a) "Allowable Cost" shall mean an expenditure which meets the test of the appropriate OMS Circular (see "III. Federal Compliance"). The most significant factors affecting allowability of cost are; 1) they must be necessary and reasonable, 2) they must be allocable, 3) they must be authorized or not prohibited under state or local laws and regulations, and 4) they must be adequately documented. b) "Client" shall mean an agency, firm, organization, individual or other entity applying for or receiving services under this contract. c) "Cognizant State Agency" shall mean the state agency from whom the sub-recipient receives federal financial assistance. If funds are received from more than one state agency, the cognizant state agency shall be the agency who contributes the largest portion of federal financial assistance to the sub-recipient, unless a cognizant state agency has been designated by OFM. d) "Confidential Information " shall mean information that Is exempt from disclosure under chapter 42.56 RCW, and other state or federal statutes and regulations e) "Contractor" shall mean that agency, firm, provider, organization, individual or other entity performing services under this contract. It shall include any subcontractor retained by the prime contractor as permitted under the terms of this agreement. f) "Contracting Officer" shall mean that individual(s) of the Office of Contract Services of DOH and hislher delegates within that office authorized to execute this agreement on behalf of the Department. g) "Department" shall mean the Department of Health (DOH) of the State of Washington, any division, section, office, unit or other entity of the department, or any of the officers or other officials lawfully representing the department. h) "Equipment" shall mean an article of non-expendable, tangible property having a useful life of more than one year and an acquisition cost of $5,000 or more. i) "Personal Information" means information identifiable to any person, including, but not limited to, information that relates to a person's name, health, finances, education, business, use or receipt of governmental services or other activities, addresses, telephone numbers, social security numbers, driver license numbers, other identifying numbers, and any financial identifiers. Personal information includes "protected health information" as set forth in 45 CFR S 164.50 as currently drafted and subsequently amended or revised and any other Information that may be exempt from disclosure to the public or other unauthorized persons under either chapter 42.56 RCW or other state and federal statutes. Contract N18409 Page 8 of 29 Revised 0112010 j) "Reimbursement" shall mean that the Department of Health will repay the Contractor for allowable costs incurred under the terms of this contract. k) "Sensitive Data" means data that is held confidentially, and if compromised may cause harm to individual citizens or create a liability for the State I) "Subcontractor" shall mean a person, partnership, or company, not in the employ of or owned by the contractor, who is performing all or part of those services under a separate contract with or on behalf of the Contractor. The terms "subcontractor" and "subcontractors" mean subcontractor(s) in any tier. See OMS Circular A-133 for additional detail. m) A 'Subrecipienf is a contractor operating a federal or state assistance program receiving federal funds and having the authority to determine both the services rendered and disposition of program. See OMS Circular A-133 for additional detail. n) "Successor" is defined as any entity which, through amalgamation, consolidation, or other legal succession becomes invested with rights and assumes burdens of the first contractor! vendor. 0) A "Vendor" is an entity that agrees to provide the amount and kind of services requested by DOH; provides services under the contract only to those beneficiaries individually determined to be eligible by DOH; and, provides services on a fee-for- service or per-unit basis with contractual penalties if the entity fails to meet program performance standards. See OMS Circular A-133 for additional detail. II. GENERAL CONDmONS 1. ACCESS TO DATA - In compliance with chapter 39.29 RCW, the Contractor shall provide access to data generated under this contract to DOH, the Joint Legislative Audit and Review Committee, and the State Auditor at no additional cost. This includes access to all information that supports the findings, conclusions, and recommendations of the Contractor's reports, including computer models and methodology for those models. The Contractor agrees to make personal information covered under this agreement available to DOH for inspection or to amend the personal information, as directed by DOH. Contractor shall, as directed by DOH, incorporate any amendments to the personal information into all copies of such personal information maintained by the Contractor or its subcontractors. 2. ADVANCE PAYMENTS PROHIBITED - No payment in advance or in anticipation of services or supplies to be provided under this agreement shall be made by DOH. 3. AMENDMENTS - This contract may be amended by mutual written agreement of the parties. Such amendments shall not be binding unless they are in writing and signed by personnel authorized to bind each of the parties. 4. AMERICANS WITH DISABILmES ACT (ADA) OF 1990, PUBUc LAW 101-336, also referred to as the "ADA" 28 cFR Part 36 - The Contractor must comply with the ADA, which provides comprehensive civil rights protection to individuals with disabilities in the areas of employment, public accommodations, state and local government services, and telecommunications. Contract N 18409 Page 9 of 29 Revised 0112010 6. ASSIGNABilITY - Neither this contract nor any claim arising under this contract shall be transferred or assigned by the contractor without prior written consent of DOH. 6. ATTORNEYS' FEES -In the event of litigation or other action brought to enforce contract terms, each party agrees to bear its own attomey's fees and costs. 7. CHANGE IN STATUS -In the event of substantive change in the legal status, organizational structure, or fiscal reporting responsibility of the Contractor, Contractor agrees to notify DOH of the change. Contractor shall provide notice as soon as practicable, but at least thirty days prior to such a change taking effect. 8. CONFIDENTIALITY/SAFEGUARDING OF INFORMATION - The use or disclosure by any party, either verbally or in writing, of any Confidential Information shall be subject to Chapter 42.56 RCW and Chapter 70.02 RCW, as well as other applicable federal and state laws and administrative rules governing confidentiality. Specifically, the Contractor agrees to limit access to Confidential Information to the minimum amount of information necessary, to the fewest number of people, for the least amount of time required to do the work. The obligations set forth in this clause shall survive completion, cancellation, expiration, or termination of this Agreement. A. Notification of Confidentiality Breach Upon a breach or suspected breach of confidentiality, the Contractor shall immediately notify the DOH Privacy Officer. For the purposes of this Agreement, "immediately "shall mean within one calendar day. The contractor will take steps necessary to mitigate any known harmful effects of such unauthorized access including, but not limited to sanctioning employees, notifying subjects, and taking steps necessary to stop further unauthorized access. The Contractor agrees to indemnify and hold harmless Agency for any damages related to unauthorized use or disclosure by the Contractor, its officers, directors, employees, Subcontractors or agents. Any breach of this clause may result in termination of the contract and the demand for return of all Information. B. Subsequent Disclosure The Contractor will not release, divulge, publish, transfer, sell, disclose, or otherwise make the Confidential Information known to any other entity or person without the express prior written consent of the Secretary of Health, or as required by law. If responding to public record disclosure requests under RCW 42.56, the Contractor agrees to notify and discuss with the DOH Privacy Officer requests for all information that are part of this Agreement, prior to disclosing the information. DOH will provide to the Contractor the name and contact information for the DOH Privacy Officer. The Contrctor further agrees to provide DOH a minimum of two calendar weeks to initiate legal action to secure a protective order under RCW 42.56.540. 9. cONFUCT OF INTEREST - Notwithstanding any determination by the Executive Ethics Board or other tribunal, DOH may, in ifs sole discretion, by written notice to the Contractor, Contract N18409 Page 10 of 29 Revised 0112010 terminate this contract if it is found, after due notice and examination by DOH or it's agent that there is a violation of the ethics in public service act, chapter 42.52 RCW, or any similar statute involving the contractor in the procurement of, or performance of this contract. In the event this contract is terminated as provided above, DOH shall be entitled to pursue the same remedies against the Contractor as it could pursue in the event of a breach of the contract by the Contractor. The rights and remedies of DOH provided for in this section shall not be exclusive are in addition to any other rights and remedies provided by law. The existence of facts upon which DOH makes a determination under this section shall be an issue and may be reviewed as provided in the "disputes" section of this contract. 10. COVENANT AGAINST CONTINGENT FEES - The 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. DOH shall 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. 11. DEBARMENT - The Contractor, by signature to this contract, certifies that the Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded in any Federal department or agency from participating in transactions. The Contractor agrees to include the above requirement in all subcontracts into which it enters to complete this contract. 12. DISPUTES - The parties shall 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 the dispute under this section. When a genuine dispute arises between DOH and the Contractor regarding the terms of this agreement or the responSibilities imposed herein which caMot be resolved at the project management level, either party may submit a request for a dispute resolution to the DOH Contracts Unit which shall oversee the following dispute resolution process: DOH shall appoint a representative to a dispute panel; the Contractor shall appoint a representative to the diSpute panel; DOH's and Contractor's representatives shall mutually agree on a third person to chair the dispute panel. The dispute panel shall thereafter decide the dispute with the majority prevailing. A party's request for a dispute resolution must .be in writing, .state the disputed issues, . state the relative positions of the parties, .state the Contractor's name, address, and hislher department contract number, . be mailed to A TIN: Contracts and Procurement Manager, DOH Contracts Unit, PO Box 47905, Olympia, WA 98504-7905 within thirty (30) calendar days after the party could reasonably be expected to have knowledge of the issue which he/she now disputes. Contract N18409 Page 11 of 29 Revised 0112010 This dispute resolution process constitutes the sole administrative remedy available under this contract. The parties agree that this resolution process shall precede any action in a judicial and quasi-judicial tribunal. 13. EFFECTIVE DATE - Unless otherwise specified under period of performance, the effective date of this agreement and subsequent amendments, if any, is the date of execution. The date of execution is the last date of signature of the parties to the agreement. No billable activity may take place prior to the date of execution. Contractor assumes all liability for any expenses incurred prior to the date of execution or in the event the agreement/amendment is not executed. 14. GOVERNING LAW - This contract shall be governed by the laws of the state of Washington and applicable federal laws and regulations. The venue of any legal action or suit concerning this agreement shall be the Thurston County Superior Court and all actions or suits thereon shall be brought therein. 15. INDEMNIFICATION - To the fullest extent permitted by law, the Contractor shall indemnify, defend, and hold harmless the state of Washington, DOH, and all officials, agents and employees of the State, from and against all claims for injuries and death arising out of or resulting from the performance of the contract. Contractor's obligation to indemnify, defend and hold harmless includes any claim by Contractors agents, employees, representatives, or any subcontractor or its employees. Contractor expressly agrees to indemnify, defend, and hold harmless the State for any claim arising out of or incident to Contractor's or any subcontractor's performance or failure to perform the contract. Contractor's Obligation to indemnify, defend, and hold harmless the State shall not be eliminated or reduced by any actual or alleged concurrent negligence of State or its agents, agencies, employees and officials. Contractor waives its immunity under Title 51 RCW to the extent it is required to indemnify, defend and hold harmless State and its agencies, officials, agents or employees. 16.INDEPENDENT CAPACITY OF THE CONTRACTOR - The parties intend that an independent contractor relationship will be created BY this contract. The Contractor and his or her employees or agents performing under the contract are not employees or agents of DOH. The contractor shall not hold himself /herself out as nor claim to be an officer or employee of DOH or of the state of Washington by reason hereof, nor will the Contractor make any claim of right, privilege or benefit which would accrue to such employee under law. Conduct and control of the work will be solely with the Contractor. 17. INDUSTRIAL INSURANCE COVERAGE - The Contractor shall comply with the provisions of Title 51 RCW, Industrial Insurance. Prior to performing work under this contract, the Contractor shall provide or purchase industrial insurance coverage for the Contractor's employees, as may be required of an "employer" as defined in Title 51 RCW, and shall maintain full compliance with Title 51RCW during the course of this contract. If the Contractor fails to provide industrial insurance coverage or fails to pay premiums or penalties on behalf of its employees as may be required by law, DOH may collect from the Contractor the full amount payable to the Industrial Insurance accident fund. DOH may deduct the amount owed by the Contractor to the accident fund from the amount payable to the Contractor by DOH under this contract, and transmit the deducted amount to the Contract N 18409 Page 12 of 29 Revised 01/2010 Department of Labor and Industries, Division of Insurance Services. This provision does not waive any of the Department of Labor and Industries rights to collect from the Contractor. Industrial insurance coverage through the Department of Labor & Industries is optional for sole proprietors, partners, corporate officers and others, per RCW 51.12.020. 18. INSURANCE - The Contractor shall provide insurance coverage as set out in this section. The intent of the required insurance ;s 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 the Contractor or subcontractor, or agents of either, while performing under the terms of this contract. The Contractor shall provide insurance coverage which shall be maintained in full force and effect during the term of this Contract, as follows: A. Commercial General Liabilitv Insurance Policv - 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 $1,000,000 per occurrence. Additionally, the Contractor is responsible for ensuring that any subcontractors provide adequate insurance coverage for the activities arising out of subcontracts. B. Automobile Liabilitv. In the event that services delivered pursuant to this contract involve the use of vehicles, either owned or unowned by the Contractor, automobile liability insurance shall be required. The minimum limit for automobile liability is: 1. $1,000,000 per occurrence, using a combined single limit for bodily injury and property damage C. The insurance required shall be issued by an insurance companylies authorized to do business within the state of Washington, and shall name the state of Washington, its agents and employees as additional insureds under the insurance policylies. All policies shall be primary to any other valid and collectable insurance. Contractor shall instruct the insurers to give DOH 30 days advance notice of any insurance cancellation. Upon request, Contractor shall submit to DOH, a certificate of insurance which outlines the coverage and limits defined in the Insurance section. If a certificate of insurance ;s requested, Contractor shall submit renewal certificates as appropriate during the term of the contract. 19. UcENSING, ACCREDITATION AND REGISTRATION. The Contractor shall comply with all applicable local, state, and federal licensing, accreditation and registration requirements/standards, necessary for the performance of this contract. 20. UMITATlON OF AUTHORITY - Only the Contracting Officer or hislher delegate by writing (delegation to be made prior to action) shall have the express, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this contract on behalf of DOH. No alteration, modification, or waiver of any clause or condition of this contract is effective or binding unless made in writing and signed by the Contracting Officer. 21. NONDISCRIMINATION - During the performance of this contract, the Contractor shall comply with all federal and state nondiscrimination laws, regulations and policies. 22. NONDISCRIMINATION LAWS NONcOMPUANCE - In the event of the 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, and the Contractor may be declared ineligible for further contracts with DOH. The Contractor shall, however, be Contract N 18409 Page 13 of 29 Revised 0112010 given a reasonable time in which to cure this noncompliance. Any dispute may be resolved in accordance with the disputes procedure set forth herein. 23. OVERPAYMENTS AND ASSERTION OF LIEN - In the event that DOH establishes overpayments or erroneous payments made to the Contractor under this contract, DOH may secure repayment, plus interest, if any, through the filing of a lien against the Contractor's real property, or by requiring the posting of a bond, assignment or deposit, or some other form of security acceptable to DOH, or by dOing both. 24. PRIVACY - Personal information including, but not limited to "protected health information" collected, used or acquired in connection with this contract shall be used solely for the purposes of this contract. Contractor and its subcontractors agree not to release, divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal information without the express written consent of DOH or as provided by law. Contractor agrees to implement physical, electronic and managerial safeguards to prevent unauthorized access to personal information. The Department reserves the right to monitor, audit, or investigate the use of personal information collected, used or acquired by the contractor through this contract. The monitoring, auditing, or investigating may include but is not limited to "salting" by the department Contractor shall certify the return or destruction of all personal information upon expiration of this contract. Salting is the act of placing a record containing unique but false information in a database that can be used later to identify inappropriate disclosure of data contained in the database. Any breach of this provision may result in termination of the contract and the demand for return of all personal information. The contractor agrees to indemnify and hold harmless the department for any damages related to the contractor's unauthorized use of personal information. For the purposes of this provision, personal information includes but is not limited to information identifiable to an individual that relates to a natural person's health, finances, education, business, use or receipt of governmental services, or other activities, names, addresses, telephone numbers, social security numbers, driver license numbers, financial profiles, credit card numbers, financial identifiers and other identifying numbers. 25. PUBLICITY - The Contractor agrees to submit to DOH all advertising and publicity matters relating to this Contract wherein DOH's name is mentioned or language used from which the connection of DOH's name may, in DOH's judgment, be inferred or implied. The Contractor agrees not to publish or use such advertising and publicity matters without the prior written consent of DOH. 26. RECORDS, DOCUMENTS, AND REPORTS - The Contractor shall maintain books, records, documents, data and other evidence relating to this contract and performance of the services described herein, including but not limited to accounting procedures and practices which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this contract. Contractor shall retain such records for a period of six (6) years following the date of final payment At no additional cost, these records, including materials generated under the contract, shall be subject at all reasonable times to inspection, review or audit by DOH, personnel duly authorized by DOH, the office of the state auditor, and federal and state officials so authorized by law, regulation or agreement. Contract N18409 Page 14 of 29 Revised 01/2010 If the contract reimburses the Contractor for costs incurred in performance, the Contractor shall in addition maintain books, records, documents and other evidence of procedures and practices which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this agreement. If any litigation, claim or audit is started before the expiration of the six (6) year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved. 27. REGISTRATION WITH DEPARTMENT OF REVENUE - The Contractor shall complete registration with the Washington State Department of Revenue, if applicable, and be responsible for payment of all taxes due on payments made under this contract. 28. RIGHT OF INSPECTION - The Contractor shall provide right of access to its facilities to DOH, 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. The Contractor shall make available information necessary for DOH to comply with the client's right to access, amend, and receive an accounting of disclosures of their Personal Information according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or any regulations enacted or revised pursuant to the HIPAA provisions and applicable provisions of Washington State law. The Contractor's internal policies and procedures, books, and records relating to the Safeguarding, use, and disclosure of personal information obtained or used as a result of this contract shall be made available to DOH and the U.S. Secretary of the Department of Health & Human Services, upon request. 29. RIGHTS IN DATA/COPYRIGHT - Unless otherwise provided, all materials produced exclusively under this contract shall be considered ''works for hire" as defined by the U.S. Copyright Act and shall be owned by DOH. DOH shall be considered the author of such Materials. In the event the Materials are not considered "works for hire" under the U.S. Copyright laws, Contractor hereby irrevocably assigns all right, title, and interest in Materials, including all intellectual property rights, to DOH effective from the moment of creation of such materials. Materials means all items in any format and includes, but is not limited to, data, reports, documents, pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, and/or sound reproductions that derive exclusively from the Contractor's work under this contract. OWnership includes the right to copyright, patent, register and the ability to transfer these rights. For materials that are delivered under the contract, but that incorporate pre-existing materials not produced under the contract, Contractor hereby grants to DOH a nonexclusive, royalty-free, irrevocable license (with rights to sublicense others) in such materials to translate, reproduce, distribute, prepare derivative works, publicly perform, and publicly display. The Contractor warrants and represents that Contractor has all rights and permissions, including intellectual property rights, moral rights and rights of publicity, necessary to grant such a license to DOH. The Contractor shall exert all reasonable effort to advise DOH, at the time of delivery of materials furnished under this contract, of all known or potential invasions of privacy Contract N 18409 Page 15 of 29 Revised 0112010 contained therein and of any portion of such document which was not produced in the performance of this contract. DOH shall receive prompt written notice of each notice or claim of copyright infringement received by the Contractor with respect to any data delivered under this contract. DOH shall have the right to modify or remove any restrictive markings placed upon the data by the Contractor. 30. SECURITY OF INFORMATlON- Unless otherwise specifically authorized by the DOH IT Security Officer, Contractor receiving confidential information under this contract assures that: . It is compliant with the Washington State Information SelVices Board (lSB) information technology (IT) security policy and standards: htto:/Iisb. wa.aovlooliciesfsecuritv.asox . It will provide DOH copies of its IT security policies, practices and procedures upon the request of the DOH IT Security Officer. . DOH may at any time conduct an audit of the Contractor's security practices andlor infrastructure to assure compliance with the security requirements of this Agreement . It has implemented physical, electronic and administrative safeguards that are consistent with ISB IT security standards and guidelines to prevent unauthorized access, use, modification or disclosure of DOH Confidential Information in any form. This includes, but is not limited to, restricting access to specifically authorized individuals and services through the use of: . Documented access authorization and change control procedures; . Card key systems that restrict, monitor and log access; . Locked racks for the storage of selVers that contain Confidential Information or AES encryption (128bit or stronger) to protect confidential data at rest; . Documented patch management practices that assure all network systems are running critical security updates within 6 days of release when the exploit is in the wild, and within 30 days of release for all others; . Documented anti-virus strategies that assure all systems are running the most current anti-virus signatures within 1 day of release; . Complex passwords that are systematically enforced and expire at least every 180 days; . Strong (fwo Factor) authentication mechanisms that assure the identity of individuals who access Confidential Information; . Account lock-out after 5 failed authentication attempts for a minimum of 20 minutes, or for Confidential Information, until administrator reset; . AES encrypted (128bit or stronger) sessions for all data transmissions. . Firewall rules and network address translation that isolate database selVers from web selVers and public networks; . Regular review of firewall rules and configurations to assure compliance with authorization and change control procedures; . Log management and intrusion detection/prevention systems; . A documented and tested incident response plan Any breach of this clause may result in termination of the contract and the demand for return of all personal information. 31. SAVINGS - In the event funding from state, federal, Of other sources is withdrawn, reduced, or limited in any way after the effective date of this contract and prior to normal completion, DOH may terminate the contract under the Termination for Convenience clause, without the Contract N18409 Page 16 of 29 Revised 01/2010 ten (10) day notice requirement, subject to renegotiation at DOH's discretion under those new funding limitations and conditions. 32. SEVERABILITY - If any provision of this agreement or any provision of any document incorporated by reference shall be held invalid, such invalidity shall not affect the other provisions of this agreement which cen be given effect without the invalid provision, and to this end the prOVisions of this agreement are declared to be severable 33. SITE SECURITY - While on DOH premises, Contractor, its agents, employees, or subcontractors shall confonn 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. DOH 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 tennination of any Contractor staff, Contractor agrees to promptly notify DOH. 34. SUBCONTRACTING - Neither the Contractor, nor any subcontractors, shall enter into subcontracts for any of the work contemplated under this agreement without prior written approval of DOH. In no event shall the existence of the subcontract operate to release or reduce the liability of the contractor to the Department for any breach in the perfonnance of the contractor's duties. This clause does not apply to Hospitals and/or Medical Clinics that must contract with specialty physicians (e.g. anesthesiologists, radiologists, physicians groups, independent practitioners, etc) nor does it include contracts of employment between the contractor and personnel assigned to work under this contract. Additionally, the Contractor is responsible for ensuring that all tenns, conditions, assurances and certifications set forth in this agreement are carried forward to any subcontracts. Contractor and its subcontractors agree not to release, divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal infonnation without the express written consent of DOH or as provided by law. If, at any time during the progress of the work, DOH detennines in its sole judgment that any subcontractor is incompetent or undesirable, DOH shall notify the Contractor, and the Contractor shall take immediate steps to terminate the subcontractor's involvement in the work. The rejection or approval by DOH of any subcontractor or the termination of a subcontractor shall not relieve the Contractor of any of its responsibilities under the contract, nor be the basis for additional charges to DOH. DOH has no contractual obligations to any subcontractor or vendor under contract to the Contractor. The Contractor is fully responsible for all contractual obligations, financial or otherwise, to their subcontractors. 35. SURVIVABILITY-The tenns and cond'ltions contained in this contract which by their sense and context, are intended to survive the completion, cancellation, termination, or expiration of the contract shall survive, including but not limited to clauses 1,8,13, 14,23,24 and 29. 36. TAXES - All payments accrued on account of payroll taxes, unemployment contributions, any other taxes, insurance or other expenses for the Contractor or its staff shall be the sole responsibility of the Contractor. Contract N18409 Page 17 of 29 Revised 01/2010 37. TERMINATION FOR CONVENIENCE - Except as otherwise provided in this contract, the Contracting Officer may, by TEN (10) calendar days written notice, beginning on the second day after the mailing, terminate this contract in whole or in part when it is in the best interests of DOH. If this contract is so terminated, DOH shall be liable only for payment in accordance with the terms of this contract for services rendered prior to the effective date of termination. 38. TERMINATION FOR DEFAULT -In the event DOH determines the contractor has failed to comply with the conditions of this contract in a timely manner, DOH has the right to suspend or terminate this contract. Further, DOH may terminate this contract for default, in whole or in part, if DOH has a reasonable basis to believe that the contractor has: A. Failed to meet or maintain any requirement for contracting with DOH; B. Failed to ensure the health or safety of any client for whom services are being prOVided under this contract; C. Failed to perform under, or otherwise breached, any term or condition of this contract; and/or D. Violated any applicable law or regulation. Before suspending or terminating the contract, DOH shall notify the contractor in writing of the need to take corrective action. [f corrective action is not taken within fourteen (14) days, the contract may be terminated or suspended. In the event of termination or suspension, the contractor shall be liable for damages as authorized by law including, but not limited to, any cost difference between the original contract and the replacement or cover contract and all administrative costs directly related to the replacement contract, e.g., cost of the competitive bidding, mailing, advertising and staff time. DOH reserves the right to suspend all or part of the contract, withhold further payments, or prohibit the contractor from incurring additional obligations of funds during investigation of the alleged compliance breach and pending corrective action by the contractor or a decision by DOH to terminate the contract. A termination shall be deemed to be a "termination for convenience" if it is determined that the contractor. (1) was not in default; or (2) failure to perform was outside of his or her control, fault or negligence. The rights and remedies of DOH provided in this contract are not exclusive and are in addition to any other rights and remedies provided by law. 39. TERMINATION PROCEDURE - Upon termination of this agreement DOH may require the Contractor to deliver to DOH any property specifically produced or acquired for the performance of such part of this agreement as has been terminated. The provisions of the Treatment of Assets clause shall apply in such property transfer. DOH shall pay to the Contractor the agreed upon price, if separately stated, for completed work and services accepted by DOH. In addition DOH shall pay the amount agreed upon by the Contractor and the Contracting Officer for (a) completed work and services for which no separate price is stated, (b) partially completed work and services, (c) other property or services which are accepted by DOH, and (d) the protection and preservation of the property. If the termination is for default, the Contracting Officer shall determine the extent of the liability of DOH. Failure to agree with such determination shall be a dispute within the meaning of the Disputes clause of this contract. Contract N18409 Page 18 of 29 Revised 0112010 DOH may withhold from any amounts due the Contractor for such completed work or services such sum as the Contracting Officer determines to be necessary to protect DOH against potential loss or liability. The rights and remedies of DOH provided in this section shall not be exclusive and are in addition to any other rights and remedies provided by law or under this agreement. After receipt of a notice of termination, and except as otherwise directed by the Contracting Officer, the Contractor shall: . Stop work under the agreement on the date and to the extent specified in the notice; . Place no further orders or subcontracts for materials, services, facilities except as necessary to complete such portion of the work not terminated; . Assign to DOH, to the extent directed by the Contracting Officer, all of the rights, titles, and interest of the Contractor under the orders and subcontracts in which case DOH has the right, at its discretion, to settle or pay any or all claims arising out of the termination of such orders and subcontracts. . Settle all outstanding liabilities and all claims arising out of orders or subcontracts, with the approval or ratification of the Contracting Officer to the extent he/she may require, which approval or ratification shall be final for all the purposes of this clause; . Transfer title to DOH and deliver, as directed by the Contracting Officer, any property which, if the agreement had been completed, would have been required to be furnished to DOH; . Complete performance of such part of the work not terminated by the Contracting Officer; and, . Take such action as may be necessary, or as the Contracting Officer may direct, for the protection and preservation of the property related to this agreement which is in the possession of the Contractor and in which DOH has or may acquire an interest. 40. TREATMENT OF ASSETS - Equipment purchases, title, and treatment of assets are determined by fund source. OMS Circular A-102 and/or the Washington State Office of Financial Management's .OFM Directive A95-0S" (effective July 1, 1995) regulate treatment of assets. Equipment acqUisitions must be included in the official contract budget. 41. WAIVER OF DEFAULT - Waiver of any default or breach shall not be deemed to be a waiver of any subsequent default or breach. Any waiver shall not be construed to be a modification of the terms of this Contract unless stated to be such in writing and signed by authorized representative of DOH. 1/ Contract N18409 Page 19 of 29 Revised 0112010 ATTACHMENT 2 FEDERAL COMPLIANCE AND STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES In the event federal funds are Included In this agreement, added by future amendment(s), or redistributed between fund sources resulting In the provision of federal funds, the following sections apply: I. Federal Compliance and II. Standard Federal Assurances and Certifications. In the Instance of Inclusion of federal funds as a result of an amendment, the Contractor may be designated as a subreclplent and the effective date of the amendment shall also be thE! date at which these requirements go Into effect. I. 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. (Refer to Catalog of Domestic Assistance number(s) cited In the 'Payment" section of this contract for requirements specific to that fund source.) For clarification regarding any of these elements or details specific to the federal funds in this contract, contact: Compliance and Internal Control Officer Office of Financial Services Department of Health Post Office Box 47901 Olympia, Washington 98504-7901 1. CIRCULARS 'COMPLIANCE MATRIX' - The following compliance matrix identifies the OMB Circulars that contain the requirements which govern expenditure of federal funds. These requirements apply to the Department of Health, as the primary recipient of federal funds, and then follow the funds to the subreciplent. The federal Circulars which provide the applicable administrative requirements, cost principles and audit requirements are identified by subrecipient organization type. COMPUANCE MATRIX OMB CIRCULAR ENTITY TYPE ADMINISTRATIVE COST AUDIT REQUIREMENTS PRINCIPLES REQUIREMENTS State. Local and Indian Tribal A-102 & A-87 A-133 Governments & Governmental Common Rule Hospitals Non-Profit Organizations & A-110 A-122 A-133 Non-Profit Hospitals Colleges or Universities & A-110 A-21 A-133 Affiliated Hospitals 2. CITIZENSHIP/ALIEN VERIFICATIONIDETERMINATION. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 (PL 104-193) states that federal public benefits should be made available only to U.S. citizens and qualified aliens. Entities that offer a service defined as a "federal publiC benefit" must make a citizenship/qualified alien determination! verification of applicants at the time of application as part of the eligibility criteria. Non-US citizens Contract N 18409 Page 20 of 29 Revised 0112010 and unqualified aliens are not eligible to receive the services. PL 104-193 also includes specific reporting requirements. Exemptions from the determination/verification requirement is afforded the fOllowing programs offered by the Department of Health: Family Planning, Breast & Cervical Health Program (BCHP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), WlC Farmers Market Program, Immunization Programs, and Ryan White CARE Act programs and other communicable disease treatment and diagnostic programs. 3. CML RIGHTS AND NONDISCRIMINATION - During the performance of this agreement, the Contractor shall comply with all current and future federal statutes relating to nondiscrimination. These include but are not limited to: TItle VI of the Civil Rights Act of 1964 (PL 88-352), TItle IX of the Education Amendments of 1972 (20 U.S.C. !i!i1681-1683 and 1885-1686), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. !i 794), the Age Discrimination Act of 1975 {42 U.S.C. !i!i 6101-6107}, the Drug Abuse Office and Treatment Act of 1972 (PL 92-255), the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), !i!l523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. !l!i29Odd-3 and 290ee-3), Title VIII of the Civil Rights Act of 1968 {42 U.S.C. !l!i3601 et seq.}, and the Americans with Disability Act (42 U.S.C., Section 12101 et seq.). 4. SINGLE AUDIT ACT - A subrecipient (including private, for-profit hospitals and non-profit institutions) shall adhere to the federal Office of Management and Budget (OMB) Circular A-133, as well as all applicable federal and state statutes and regulations. A subrecipient who expends $500,000 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 Circular A.133. II. STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES - Following are the Assurances, Certifications, and Special Conditions that apply to all federally funded {in whole or in part} agreements administered by the Washington State Department of Health. CERTIFICATIONS 1. 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 CFR Part 76, and its principals: A. are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal Department or agency; B. 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; C. are not presently indicted or otherwise criminally or civilly charged by a govemmental entity {Federal, State, or local} with commission of any of the offenses enumerated in paragraph {b} of this certification; and Contract N 18409 Page 21 of 29 Revised 0112010 D. 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 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 titled Certification Regarding Debarment, Suspension, In eligibility, and Voluntaty Exclusion-Lower Tier Covered Transactions 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 CFR Part 76. 2. 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 CFR Part 76 by: A. 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; B. Establishing an ongoing drug-free awareness program to inform employees about I. The dangers of drug abuse in the workplace; il. The contractor's policy of maintaining a drug-free workplace; iil. Any available drug counseling, rehabilitation, and employee assistance programs; and iv. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C. Making it a requirement that each employee to be engaged in the performance of the contract be given a copy of the statement required by paragraph (a) above; D. Notifying the employee in the statement required by paragraph (a), above, that, as a condition of employment under the contract, the employee will- I. Abide by the terms of the statement; and ii. Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; E. Notifying the agency in writing within ten calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every contract officer or other designee on whose contract activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant; F. Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d) (Ii), with respect to any employee who is so convicted- I. Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or Contract N 18409 Page 22 of 29 Revised 01/2010 ii. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; G. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (A), (B), (C), (D), (E), and (F). For purposes of paragraph (e) regarding agency notification of criminal drug convictions, DOH has designated the following central point for receipt of such notices: Compliance and Internal Control Officer Office of Grants Management WA State Department of Health PO Box 47905 Olympia, WA 98504-7905 3. 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 agreements from using Federal (appropriated) funds for lobbying the Executive or legislative Branches of the Federal Government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also requires that each person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with non- Federal (nonappropriated) funds. These requirements apply to grants and cooperative agreements EXCEEDING $100,000 in total costs (45 CFR Part 93). The undersigned (authorized official signing for the contracting organization) certifies, to the best of his or her knowledge and belief, that: A. 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 agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant. loan, or cooperative agreement. B. 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 agreement, 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.) C. 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 agreements) and that all subrecipients shall certify and disclose accordingly. Contract N 18409 Page 23 of 29 Revised 0112010 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. 4. CERTIFICATION REGARDING PROGRAM FRAUD CML 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. 5. CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local govemments, by Federal grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed, operated, or maintained with such Federal funds. The law does not apply to children's services provided in private residence, portions of facilities used for inpatient drug or alcohol treatment, service providers whose sole source of applicable Federal funds is Medicare or Medicaid, or facilities where W1C coupons are redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. By signing the certification, the undersigned certifies that the contracting organization will comply with the requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act. The contracting organization agrees that it will require that the language of this certification be included in any subcontracts which contain provisions for children's services and that all subrecipients shall certify accordingly. The Public Health Services strongly encourages all recipients to provide a smoke-free workplace and promote the non-use of tobacco products. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. 6. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBIUTY MATTERS INSTRUCTIONS FOR CERTIFICATION By signing and submitting this proposal, the prospective contractor is providing the certification set out below. A. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective Contractor shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the Contract N18409 Page 24 of 29 Revised 01/2010 prospective contractor to furnish a certification or an explanation shall disqualify such person from participation in this transaction. B. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective contractor knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause of default. C. The prospective contractor shall provide immediate written notice to the department or agency to whom this contract is submitted if at any time the prospective contractor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. D. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the person to whom this contract is submitted for assistance in obtaining a copy of those regulations. E. 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 DOH. F. The prospective contractor further agrees by submitting this contract that it will include the clause titled Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction, provided by HHS, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. G. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List (of excluded parties). H. 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. I. 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, DOH may terminate this transaction for cause or default. 7. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS A. The prospective contractor certifies to the best of its knowledge and belief, that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; Contract N 18409 Page 25 of 29 Revised 01/2010 ii. Have not within a three-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; iii. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) ofthis certification; and iv. Have not within a three-year period preceding this contract had one or more public transactions (Federar, State or local) terminated for cause or default. B. Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective contractor shall attach an explanation to this contract. CONTRACTOR'S SIGNATURE IS REQUIRED SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TIne Please also print or type name: ORGANIZATION NAME: (If applicable) DATE / . .'Dro':~d as to fonn Cl_j: 0~ ;-/t.t)JO He..':; Contract N18409 Page 26 of 29 Revised 01/2010 FEDERAL ASSURANCES - NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the contractor, I certify that the contractor. 1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of Interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C..4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C..1681-1683, and 1685-1686), which prohibits discrimination on the Contract N 18409 Page 27 of 29 Revised 01/2010 basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C..794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C.. 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g). 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C.. 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VII/ of the Civil Rights Act of 1968 (42 U.S.C.. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and Q) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles 1/ and 1/1 of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C.. 1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C..276a to 276a-7), the Copeland Act (40 U.S.C..276c and 18 U.S.C..874) and the Contract Work Hours and Safety Standards Act (40 U.S.C.. 327-333), regarding labor standards for federally assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation offload hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Ad. of 1972 (16 U.S.C.. 1451 et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C.. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93- 523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). Contract N18409 Page 28 of 29 Revised 0112010 12Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C.. 1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C..470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C.. 469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C..2131 at seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C..4801 et seq.) which prohibits the use of lead- based paint in construction or rehabilitation of residence structures. 17. Wdl cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, Audits of States, Local Governments, and Non-Profit Organizations. 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and pOlicies governing this program. CONTRACTOR'S SIGNATURE IS REQUIRED SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TmE Please also print or typa nama: ORGANIZATION NAME: (If applicable) DATE l. ;':Jw.:",.:j as te ferm eo;,>: () . s/v"'}i) J. ,:,~,,":O!1 CO, Prosecu s Oli,cu Contract N 18409 Page 29 of 29 Revised 0112010