Approve agreement with Washington Health Care Authority for CBO Prevention Services. BEFORE THE BOARD OF COUNTY COMMISSIONERS
LEWIS COUNTY, WASHINGTON
IN THE MATTER OF: RESOLUTION NO. 21-299
APPROVE AGREEMENT BETWEEN WASHINGTON
HEALTH CARE AUTHORITY AND LEWIS COUNTY
FOR CBO PREVENTION SERVICES
WHEREAS, the Lewis County Board of County Commissioners (BOCC) has
reviewed Contract Number K5263, between Lewis County and Washington Health
Care Authority (HCA) for the period of July 1, 2021, through June 30, 2023; and
WHEREAS, this agreement provides funding for the after-school programs in
Morton and White Pass; and
WHEREAS, funding is available through HCA for $40,000 in year one
(7/1/21-6/30/22) and $40,000 in year two (7/1/22 - 6/30/23) for a total of $80,000
and has no required county match; and
WHEREAS, it appears to be in the best public interest to authorize the execution
of said contract for Lewis County.
NOW THEREFORE BE IT RESOLVED that Contract #K5263 between HCA and
Lewis County in the amount of $80,000 effective July 1, 2021, through June 30,
2023, is hereby approved, and the Director of Public Health & Social Services is
authorized to sign the same.
DONE IN OPEN SESSION this 10th day of August, 2021.
Page 1 of 2 Res. 21-299
APPROVED AS TO FORM: BOARD OF COUNTY COMMISSIONERS
Jonathan Meyer, Prosecuting Attorney LEWIS COUNTY, WASHINGTON
Andrew Loge rwell Gary Stampe r
By: Andrew Logerwell, Gary Stamper, Chair
Senior Deputy Prosecuting Attorney
ATTEST: OF9sy• Lindsey R. Pollock, DVM
CE Ltiddsey R. Pollock, DVM, Vice Chair
: :
8
Rieva Lester "'-* CO`=" :•* Sean D. Swope
Rieva Lester, Sean D. Swope, Commissioner
Clerk of the Lewis County Board of
County Commissioners
Page 2 of 2 Res. 21-299
Executive Summary — K5263
CBO Prevention Services
between
Washington Healthcare Authority (HCA)
and Lewis County
Description
This is the primary source of substance use disorder prevention funding from the
Washington Healthcare Authority (HCA/DBHR), used to fund our after school
program in Morton and White Pass. Typical programs funded by this contract are
positive action education, community awareness campaigns, and Youth Mental
Health First Aid training. This is the second contract that LCPHSS has held for CBO
prevention service for this purpose. The contract period is from 7/1/2021 to
6/30/2023.
Recommendation
Approve resolution
Budget Impact
Year 1 (7/1/2021- Year 2 (7/1/2022-
Fund 6/30/2022) 6/30/2023) Total
MHPP 1040SREV 334046 $20,000 $20,000 $40,000
DMA 1040SREV 334046 $20,000 $20,000 $40,000
Total amount $80,000
Total amount: $80,000.00
This amount was anticipated and there is no county match required.
Cover Letter
Washington Healthcare Authority, CIO Brittany Smith
626 8th Ave SE, P.O. Box 42730, Olympia WA 98504
Other
Please email signed copies to the following HCA/DBHR employees:
Brittany Smith: Brittany.Smith c(�hca.wa.gov
Heidi Jones: Hiedi.Jones(c�hca.wa.gov
Rachelle Amerine: Rachelle.Amerine(a�hca.wa.gov
Lisa Nelson: Lisa.Nelson(a�hca.wa.gov
Submitted by
Darci Southgate
DocuSign Envelope ID:CFE8684B-3162-447B-9C08-6FB664EBF8F7
Washington State CLIENT SERVICES HCA Contract Number: K5263
Health Care Authority CONTRACT
For CBO Prevention Services
This Contract is by and between the State of Washington Health Care Authority (HCA) and the Contractor identified below.
CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA)
Lewis County Lewis County Public Health and Social Services
CONTRACTOR I Street City State Zip Code
360 NW NORTH STREET CHEHALIS WA 98532-1925
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS
Darci Southgage 360-520-0820 darci.southgateglewiscountywa.gov
Is Contractor a Subrecipient under this Contract? CFDA NUMBER(S): FFATA Form Required
OYES NO OYES ®NO
HCA PROGRAM HCA DIVISION/SECTION
CBO Prevention Services Division of Behavioral Health and Recovery/SUD
Prevention and MH Promotion Section
HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS
Health Care Authority
Brittany Smith, Contract Manager 626 8th Avenue SE, PO Box 42730
Olympia, WA 98504-2730
HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS
360-819-3570 brittanv.smith(a�hca.wa.gov
CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT
July 1, 2021 June 30, 2023 $80,000
The following Attachments and Exhibits are attached and are incorporated into this Contract by reference:
Attachment 1: Statement of Work
Attachment 2: Confidential Information Security Requirements
Attachment 3: Business Associate Agreement
Attachment 4: Data Use, Security and Confidentiality
Exhibit A: HCA RFA 2021HCA2(reference only, available upon request)
Exhibit B: Application (reference only, available upon request)
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
ARA,- CT.?, kitikfv50-\• \O'
wet, 0- bt(Je
HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
,—DocuSigned by Rachelle Amerine
Contracts Administrator 7/21/2021
0 71E471-0000771E7...
Page 1 of 58
Washington State CBO Prevention Services
Health Care Authority HCA Contract K5263
DocuSign Envelope ID:CFE8684B-3162-447B-9C08-6FB664EBF8F7
RECITALS 5
1. DEFINITIONS 5
2. PURPOSE 10
3. TERM 10
4. APPLICABLE LAW 11
5. PERFORMANCE STANDARDS 11
6. CONTRACTOR AND HCA CONTRACT MANAGERS 12
7. CONTRACTOR MONITORING 12
7.1. SUBRECIPIENT COMPLIANCE 12
7.1.1. SINGLE AUDIT COMPLIANCE 13
7.2. MONITORING ACTIVITIES 13
7.2.1. CORRECTIVE ACTION PLANS 14
7.2.2. EXTENSION TO DELIVERABLES 14
8. COMPENSATION AND BILLING 14
8.1. CONSIDERATION AND SOURCE OF FUNDS 14
8.2. REIMBURSEMENTS 15
8.3. INVOICE SYSTEM 16
8.4. PAYMENTS FOR UNALLOWABLE COSTS AND/OR OVERPAYMENTS 17
8.5. STATE AND FEDERAL FUNDING REQUIREMENTS 17
9. SUBCONTRACTING 17
9.1. SUBCONTRACT LANGUAGE 18
9.2. SUBCONTRACT MONITORING 19
9.2.1. CONTRACTS 19
9.2.2. ON-SITE MONITORING 19
9.2.3. MINERVA MONITORING 19
9.2.4. ADDITIONAL MONITORING ACTIVITIES 20
9.2.5. SUBCONTRACTOR TERMINATION REQUIREMENTS 20
10. REMEDIAL ACTION 20
10.1. CAUSES 20
11. THIRD-PARTY BENEFICIARIES 20
12. DISPUTES 20
12.1. REQUESTING A DISPUTE 20
12.2. CONTENT OF THE DISPUTE REQUEST: 21
12.3. ACTION ON THE REQUEST: 21
13. INSURANCE 21
13.1. GENERAL LIABILITY INSURANCE 21
13.2. WORKER'S COMPENSATION 21
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Health Care Authority HCA Contract K5263
DocuSign Envelope ID:CFE8684B-3162-447B-9C08-6FB664EBF8F7
13.3. EMPLOYEES AND VOLUNTEERS 22
13.4. SUBCONTRACTORS 22
13.5. SEPARATION OF INSUREDS 22
13.6. INSURERS 22
13.7. EVIDENCE OF COVERAGE 22
13.8. MATERIAL CHANGES 22
13.9. GENERAL 22
14. NOTICES 23
15. TAXES,FEES AND LICENSES 23
15.1. TAXES 23
15.2. FEES/LICENSES 23
16. ACCESS TO DATA 24
17. AMENDMENT 24
18. ANTITRUST ASSIGNMENT 24
19. ASSIGNMENT 24
20. ASSURANCES 24
21. ATTORNEY'S FEES 24
22. BILLING LIMITATIONS 24
23. CHANGE IN STATUS 25
24. COMPLIANCE WITH APPLICABLE LAW 25
25. CONFLICT OF INTEREST 25
26. CONFORMANCE 25
27. CONTRACTOR CERTIFICATION REGARDING ETHICS 25
28. COVENANT AGAINST CONTINGENT FEES 25
29. DEBARMENT CERTIFICATIONS 25
30. FORCE MAJEURE 26
31. FRAUD AND ABUSE REQUIREMENTS 26
32. GOVERNING LAW AND VENUE 26
33. HEALTH AND SAFETY 26
34. HOLD HARMLESS AND INDEMNIFICATION 26
35. INDEPENDENT CONTRACTOR 26
36. INDUSTRIAL INSURANCE COVERAGE 27
37. INSPECTION 27
38. LIMITATION OF AUTHORITY 27
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Washington State CBO Prevention Services
Health Care Authority HCA Contract K5263
DocuSign Envelope ID:CFE8684B-3162-447B-9C08-6FB664EBF8F7
39. MAINTENANCE OF RECORDS 27
40. PAY EQUITY 27
41. PUBLICITY 28
42. RECORDS AND DOCUMENTS REVIEW 28
43. REGISTRATION WITH THE STATE OF WASHINGTON 28
44. REMEDIES NON-EXCLUSIVE 29
45. RIGHTS IN DATA/OWNERSHIP 29
46. SEVERABILITY 29
47. SITE SECURITY 30
48. SURVIVABILITY 30
49. SYSTEM SECURITY 30
50. TERMINATION FOR CONVENIENCE 30
51. TERMINATION FOR DEFAULT 30
52. TERMINATION DUE TO CHANGE IN FUNDING 31
53. TERMINATION OR EXPIRATION PROCEDURES 31
53.1. CONTRACT CLOSEOUT 32
54. TREATMENT OF PROPERTY 32
55. WAIVER 32
56. ORDER OF PRECEDENCE 32
ATTACHMENT 1-STATEMENT OF WORK:COMMUNITY-BASED ORGANIZATION(CBO)PREVENTION SERVICES 34
ATTACHMENT 2-CONFIDENTIAL INFORMATION SECURITY REQUIREMENTS 44
ATTACHMENT 3—BUSINESS ASSOCIATE AGREEMENT 47
ATTACHMENT 4-DATA USE,SECURITY AND CONFIDENTIALITY 55
EXHIBIT A-HCA RFA 2021HCA2(REFERENCE ONLY,AVAILABLE UPON REQUEST)
EXHIBIT B-APPLICATION(REFERENCE ONLY,AVAILABLE UPON REQUEST)
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RECITALS
The state of Washington, acting by and through the Health Care Authority (HCA), issued a Request for
Applications (RFA) dated February 22, 2021, for the purpose of purchasing CBO Prevention Services in
accordance with its authority under chapters 39.26 and 41.05 RCW.
Lewis County, DBA Lewis County Public Health and Social Services, submitted a timely Response to HCA's RFA
#2021 HCA2.
HCA evaluated all properly submitted Responses to the above-referenced RFA and has identified Lewis County,
DBA Lewis County Public Health and Social Services, as one of the Apparent Successful Applicants.
HCA has determined that entering into a Contract with Lewis County, DBA Lewis County Public Health and Social
Services, will meet HCA's needs and will be in the State's best interest.
NOW THEREFORE, HCA awards to Lewis County, DBA Lewis County Public Health and Social Services, this
Contract, the terms and conditions of which will govern Contractor's providing to HCA the CBO Prevention
Services.
Both parties agree to the following terms and conditions:
1. Definitions.
"Administrative Costs" or"Indirect Costs" are elements of costs incurred by the Contractor as costs that
are necessary to administrate or operate a program that are not considered direct program costs.
Admin/indirect costs are those elements of cost incurred by the entity or organization as a whole and are not
generally subject to the direct control of the individual department managers. Criteria for
Administrative/Indirect Costs, Contract-Specific Direct Costs, and Shared Direct Costs are outlined in the
Substance Use Disorder Prevention and Mental Health Promotion Services Billing Guide. Further, all
references to the term"Admin" or"Indirect" are hereby replaced by"Admin/Indirect."
"Agent"shall mean the Washington State Health Care Authority Director and/or the Director's delegate
authorized in writing to act on behalf of the Director.
"Allowable cost" means an expenditure which meets the test of the appropriate executive office of the
president of the United States' Office of Management and Budget(OMB)circular. The most significant factors
which determine whether a cost is allowable are the extent to which the cost is:
• Necessary and reasonable;
• Allocable;
• Authorized or not prohibited under Washington state or local laws and regulations;
• Adequately documented.
"Authorized Representative" means a person to whom signature authority has been delegated in writing
acting within the limits of his/her authority.
"Awards and Revenues" or"A&R"details the Contractor's Awards and Revenues. For new funding starting
7/1/2021, the Awards and Revenue will be sent separately from the Contract and is incorporated within the
Contract by reference to the Award and Revenues. The Contractor must budget and bill according to each
Award and Revenues.
"Breach" means the unauthorized acquisition, access, use, or disclosure of confidential information that
compromises the security, confidentiality, or integrity of the confidential information.
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Health Care Authority HCA Contract K5263
DocuSign Envelope ID:CFE8684B-3162-447B-9C08-6FB664EBF8F7
"Business Associate" means a Business Associate as defined in 45 CFR 160.103, who performs or assists
in the performance of an activity for or on behalf of HCA, a Covered Entity,which involves the use or
disclosure of protected health information (PHI).Any reference to Business Associate in this Contract
includes Business Associate's employees, agents, officers, Subcontractors, third party contractors,
volunteers, or directors.
"Business Days and Hours" means Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific Time, except for
holidays observed by the state of Washington.
"Certified Prevention Professional" or"CPP" means the Prevention Specialist certification recognized by
the International Credentialing and Reciprocity Consortium (IC&RC) and supported by the Prevention
Specialist Certification Board of Washington, www.pscbw.com.
"CFR" means the Code of Federal Regulations. All references in this Contract to CFR chapters or sections
include any successor, amended, or replacement regulation. The CFR may be accessed at
http://www.ecfr.gov/cqi-bin/ECFR?Pape=browse.
"Coalition" means a formal arrangement for cooperation and collaboration between groups or sectors of a
community. Each participant in the Coalition retains their identity, but all agree to work together toward a
common goal of building a safe, healthy, and drug-free community.
"Community" means an approved geographic area within school district boundaries, or within High School
Attendance Areas (HSAA) and their feeder schools.
"Community-based Organization" or"CBO" means a public or private nonprofit organization of
demonstrated effectiveness that is representative of a Community, or of significant segments of a Community,
and that provides educational or related services to individuals in the Community. This includes faith-based
and religious organizations.
"Community Prevention and Wellness Initiative" or"CPWI" means the HCA substance use disorder
prevention delivery system that focuses prevention services in high-need communities in Washington State
as approved by HCA.
"Confidential Information" means information that is protected from disclosure to the public or other
unauthorized persons under chapter 42.56 RCW or other federal or state laws. Confidential information
includes, but is not limited to, personal information.
"Contract" or"Agreement" means the entire written agreement between HCA and Contractor, including any
exhibits, documents, or materials incorporated by reference. The parties may execute this contract in multiple
counterparts, each of which is deemed an original and all of which constitute only one agreement. E-mail
(electronic mail) or fax(facsimile)transmission of a signed copy of this contract shall be the same as delivery
of an original.
"Contractor" means the individual or entity performing services pursuant to this contract and includes the
Contractor's owners, members, officers, directors, partners, employees, and/or agents, unless otherwise
stated in this Contract. For purposes of any permitted subcontract, "Contractor" includes any subcontractor
and its owners, members, officers, directors, partners, employees, and/or agents.
"CSAP" means SAMHSA's Center for Substance Abuse Prevention. CSAP works with federal, state, public,
and private organizations to develop a comprehensive prevention system.
"Cultural Competency" means a set of congruent behaviors, attitudes and policies that come together in a
system, or agency, and enables that system or agency to work effectively in cross-cultural situations.A
culturally competent system of care acknowledges and incorporates at all levels the importance of language
and culture, assessment of cross-cultural relations, knowledge and acceptance of dynamics of cultural
differences, and expansion of cultural knowledge and adaptation of services, to meet culturally unique needs.
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DocuSign Envelope ID:CFE8684B-3162-447B-9C08-6FB664EBF8F7
"Data" means information produced, furnished, acquired, or used by Contractor in meeting requirements
under this contract. This includes Personal Information and Protected Health Information.
"DBHR" means the"Division of Behavioral Health and Recovery," a division of HCA, or its successors.
"DEA" means the United States federal"Drug Enforcement Agency".
"Debarment" means an action taken by a federal agency or official to exclude a person or business entity
from participating in transactions involving certain federal funds.
"Dedicated Marijuana Account" or"DMA" means revenue generated by taxation of retail marijuana as a
result of the implementation of Initiative 502 (1-502) as authorized by the Washington State Legislature in
2E2SHB 2136.
"DUNS" or"Data Universal Numbering System" means a unique identifier for businesses. DUNS numbers
are assigned and maintained by Dun and Bradstreet(D&B) and are used for a variety of purposes, including
applying for government contracting opportunities.
"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.
"Encrypt" means to encode confidential information into a format that can only be read by those possessing a
"key"; a password, digital certificate or other mechanism available only to authorized users. Encryption must
use a key length of at least 128 bits.
"Ensure" means to make sure that something will happen or will be available within the resources identified
in the Consideration.
"EPA" means the Environmental Protection Agency.
"Evidence-Based Program" or"EBP" means a program that has been tested in heterogeneous or intended
populations that can be implemented with a set of procedures to all successful replication in Washington.An
EBP has had multiple randomized and/or statistically-controlled evaluations, or one large multiple-site
randomized and/or statistically-controlled evaluations, and the weight of the evidence from a systematic
review demonstrates sustained improvements in at least one of the desired outcomes.
"For Profit" means a business or institution initiated or operated for the purpose of making a profit.
"General Fund State" or"GFS" or"SFG" means the administrative/indirect allocation awarded for
Substance Abuse Block Grant.
"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.
"Health disparities" means a particular type of health difference that is closely linked with social, economic,
and/or environmental disadvantage. Health disparities adversely affect groups of people who have
systematically experienced greater obstacles to health based on their racial or ethnic group; religion;
socioeconomic status; gender; age; mental health; cognitive sensory, or physical disability; sexual orientation
or gender identity; geographic location; or other characteristics historically linked to discrimination or
exclusion." (Healthy People 2020).
"Health equity" means the attainment of the highest level of health for all people. Achieving health equity
requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities,
historical and contemporary injustices, and the elimination of health and health care disparities." (Healthy
People 2020)
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"Innovative program" means a program that does not fall into the other categories of Evidence-based,
Research-based, or Promising.
"Media Materials and Publications" means:
• News Release: A brief written announcement the agency provides to reporters highlighting key
events, research, results, new funding and programs, and other news;
• Paid Media: Any advertising space/time that is purchased for prevention/coalition messages (printed
publications/newspapers, online, outdoor, on-screen, TV and radio);
• Earned Media: Published news stories (print, broadcast or online) resulting from the Contractor's
Agreements with reporters;
• Donated Media, including public service announcements. Any free advertising space or time from
broadcast, print, outdoor, online, and other advertising vendors;
• Social Media:Also referred to as new media: messaged posted online of Facebook, Twitter,
YouTube, Instagram, Snapchat and similar sites.
• Other Media Material and Publications: Other print and video materials that are created under this
Contract.
"Office of Contracts and Procurement" or"OCP" means the Washington State Health Care Authority
central headquarters contracting office, or successor section or office.
"OMB" means the Office of Management and Budget of the executive office of the president of the United
States.
"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.
"Partnerships for Success" means the Federal Substance Abuse and Mental Health Services Administration
(SMHSAA) Grant 2013 and 2018, CFDA number 93.243.
"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.
"Physically Secure" means that access is restricted through physical means to authorized individuals only.
"Prevention Activity Data" means information input to the"Substance Abuse Disorder Prevention Mental
Health Promotion Online Reporting System"or"Minerva"or its successor to record all active prevention
services including outcome measures. This information will be used to verify services identified in A-19
invoices prior to payment and must be entered into Minerva by the close of business of the fifteenth (15th)of
each month for prevention activities provided during the previous month.
"Prevention System Manager" or"PSM" means the designee assigned to manage day to day
responsibilities associated with this Contract.
"Program Income" means gross income earned by the non-Federal entity that is directly generated by a
supported activity or earned as a result of the Federal award during the period of performance.
"Promising Program" means a program that is based on statistical analyses or a well-established theory of
change, shows potential for meeting the"evidence-based" or"research-based" criteria, and could include the
use of a program that is evidence-based for outcomes other than the alternative use.
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"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.
"Protected Health Information" or"PHI" means individually identifiable information that relates to the
provision of health care to an individual; the past, present, or future physical or mental health or condition of
an individual; or past, present, or future payment for provision of health care to an individual, as defined in 45
CFR 160.103. Individually identifiable information is information that identifies the individual or about which
there is a reasonable basis to believe it can be used to identify the individual, and includes demographic
information. PHI is information transmitted, maintained, or stored in any form or medium. 45 CFR 164.501.
PHI does not include education records covered by the Family Educational Rights and Privacy Act, as
amended, 20 USC 1232g(a)(4)(b)(iv).
"Public information" means information that can be released to the public. It does not need protection from
unauthorized disclosure, but does need protection from unauthorized change that may mislead the public or
embarrass HCA.
"RCW" means the revised code of Washington. All references in this contract to RCW chapters or sections
shall include any successor, amended, or replacement statute. Pertinent RCW chapters can be accessed at:
http://apps.leq.wa.qov/rcw/.
"Regular Annual Schedule" means consistent, reliable services with a pattern of implementation intervals
throughout the year.
"Regulation" means any federal, state, or local regulation, rule, or ordinance.
"Research-Based Program" means a program that has been tested with a single randomized and/or
statistically controlled evaluation, demonstrates sustained desirable outcomes; or where the weight of the
evidence from a systematic review supports sustained outcomes as identified in the term"evidence-based,"
but does not meet the full criteria for"evidence-based."
"RFA" means the Request for Application used as the solicitation document to establish this Contract,
including all its amendments and modifications and is Exhibit A hereto.
"SAMHSA" means the Substance Abuse and Mental Health Services Administration.
"Secured Area" means an area to which only authorized representatives of the entity possessing the
confidential information have access. Secured areas may include buildings, rooms or locked storage
containers (such as a filing cabinet)within a room, as long as access to the confidential information is not
available to unauthorized personnel.
"Sensitive information" means information that is not specifically protected by law, but should be limited to
official use only, and protected against unauthorized access.
"State Opioid Response" or"SOR" or SOR II means the Federal Substance Abuse and Mental Health
Services Administration (SAMHSA) Grant, CFDA number 93.788.
"Statement of Work" or"SOW" means a detailed description of the work activities the Contractor is required
to perform under the terms and conditions of this Contract, including the deliverables and timelines identified
in Attachment 1.
"Subcontract" means any separate agreement or contract between the Contractor and an individual or entity
("Subcontractor")to perform all or a portion of the duties and obligations that the contractor is obligated to
perform pursuant to this contract.
"Substance Abuse Block Grant"or"SABG" means Federal Substance Abuse Block Grant funded by the
Substance Abuse and Mental Health Services Administration (SAMHSA), CFDA number 93.959.
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"Substance Use Disorder" or"SUD" means a cluster of cognitive, behavioral, and physiological symptoms
indicating that an individual continues using the substance despite significant substance-related problems.
The diagnosis of a Substance Use Disorder is based on a pathological pattern of behaviors related to the use
of the substances.
"Substance Use Disorder Prevention and Mental Health Promotion Services Billing Guide" means the
Supplementary Instructions and Fiscal Policy Standards for Reimbursable Costs as used by HCA, located at
https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-
guides-and-fee-schedules#t.
"Substance Use Disorder Prevention and Mental Health Promotion Online Reporting System" or
"Minerva" or its successor means the management information system maintained by HCA that collects
planning, demographic, and prevention service data.
"Successor" means any entity which, through amalgamation, consolidation, or other legal succession
becomes invested with rights and assumes burdens of the original contractor.
"Subaward" means an award provided by a pass-through entity to a subrecipient for the subrecipient to carry
out part of a Federal award received by the pass-through entity. It does not include payments to a contractor
or payments to an individual that is a beneficiary of a Federal program. A subaward may be provided through
any form of legal agreement, including an agreements that the pass-through entity considers a contract.
"Sub-Recipient" means a non-federal entity that receives a subaward from a pass-through entity to carry out
part a federal program, but does not include an individual that is a beneficiary of such a program. A sub-
recipient may also be a recipient of other federal awards directly from a federal awarding agency.
"USC" means the United States Code. All references in this Contract to USC chapters or sections will include
any successor, amended, or replacement statute. The USC may be accessed at http://uscode.house.gov/.
"Vendor" means a dealer, distributor, merchant, or other seller providing goods or services that are required
for the conduct of a federal program. These goods or services may be for an organization's own use or for the
use of beneficiaries of the federal program.
"WAC" means the Washington administrative code.All references in this contract to WAC chapters or
sections shall include any successor, amended, or replacement regulation. Pertinent WAC chapters or
sections can be accessed at: http://apps.leq.wa.gov/wac/.
2. Purpose
The purpose of this contract is to obtain Community-Based Organization (CBO) contracts to provide quality
and culturally competent Evidence-Based Programs, Research-Based Programs, and Promising Programs to
address Substance Use Disorder Prevention and Mental Health Promotion Programs and/or Suicide
Prevention. Contractors will implement direct primary prevention programs, environmental and public
education strategies to prevent and reduce marijuana use among youth and/or promote mental wellness and
prevent suicide in high need communities.
3. Term
The initial term of this Contract will commence on July 1, 2021, and continue through June 30, 2023, unless
terminated sooner as provided herein.
This Contract may be extended in whatever time increments HCA deems appropriate.
Work performed prior to full contract execution, 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 subsequent
amendment is fully executed.
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4. Applicable Law
These legal resources identified below are incorporated by reference and include but are not limited to the
following:
i. 21 CFR Food and Drugs Chapter I, Subchapter C, Drugs: General;
ii. 42 CFR Subchapter A-General Provisions, Part 2 Confidentiality of Alcohol and Drug Abuse Patient
Records;
iii. Omnibus Crime Control and Safe Streets Act of 1968;
iv. 45 CFR Public Welfare, Part 96 Block Grants, Subpart L Substance Abuse Block Grant;
v. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Award, 45
CFR Part 75, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
HHS Awards;
vi. Substance Use Disorder Prevention and Mental Health Promotion Services Billing Guide
https://www.hca.wa gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-
billing-guides-and-fee-schedules#t;
vii. Title VI of the Civil Rights Act of 1964;
viii. Section 504 of the Rehabilitation Act of 1973;
ix. Title II of the Americans with Disabilities Act of 1990;
x. Title IX of the Education Amendments of 1972;
xi. The Age Discrimination Act of 1975; and
xii. The Department of Justice Non-Discrimination Regulations at 28 CFR Part 42, Subparts C, D, E and
G, and 28 CFR Parts 35 and 39.
If this Contract is not supported by Federal funds,then all references to Federal laws and regulations do not
apply.
5. Performance Standards
Contractor is expected to adhere to the following performance standards throughout the duration of this
Contract:
i. Adherence to all applicable state and federal laws, including but limited to all legal resources
identified in Section 4 of this Contract;
ii. Use of professional judgment;
iii. Collaboration with HCA staff in Contractor's conduct of services;
iv. Conformance with HCA directions regarding the delivery of services;
v. Timely, accurate and informed communications;
vi. Regular completion and updating of project plans, reports, documentation and communications;
vii. Ensure all services and activities provided by the Contractor or subcontractors are designed and
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delivered in such a manner sensitive to the needs of all diverse populations;
viii. Regular, punctual attendance at all meetings; and
ix. Provision of high quality services.
6. Contractor and HCA Contract Managers
Contractor's Contract Manager or designee 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.
HCA's Contract Manager or designee 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 or designee has the authority to accept or reject the services provided and must approve
Contractor's invoices prior to payment.
The contact information provided below may be changed by written notice of the change(email acceptable)to
the other party.
CONTRACTOR Health Care Authority
Contract Manager Information Contract Manager Information
Name: Darci Southgage Name: Brittany Smith
360 NW North Street
Address: Address: 621 8th Avenue SE
Chehalis, WA 98532- Olympia, WA 98504
1925
Phone: 360-520-0820 Phone: 360-819-3570
Email: darci.southgate(a�lewisco Email: brittany.smithhca.wa.qov
untywa.gov
7. Contractor Monitoring
HCA will monitor the performance of the Contractor against goals and performance standards as stated in
Attachment 1: Statement of Work. Substandard performance as determined by HCA will constitute non-
compliance with this Contract. If action to correct such substandard performance is not taken by the
Contractor within a reasonable period of time after being notified by HCA, suspension or termination
procedures will be initiated.
7.1. Subrecipient Compliance
If the Contractor is a subrecipient(as defined in 45 CFR 75.351) of federal awards, then the
Contractor shall:
i. 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;
ii. Maintain internal controls that provide reasonable assurance that the Contractor is managing
federal awards in compliance with laws, regulations, and provisions of contracts or grant
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agreements that could have a material effect on each of its federal programs;
iii. Prepare appropriate financial statements, including a schedule of expenditures of federal
awards;
iv. Incorporate 45 CFR Part 75, Subpart F, Audit Requirements, into all agreements between the
Contractor and its Subcontractors who are sub-recipients;
v. Comply with any future amendments to 45 CFR Part 75, Subpart F, Audit Requirements, and
any successor or replacement Circular or regulation;
vi. Comply with the applicable requirements of 45 CFR Part 75, Subpart E, Cost Principles, and
any future amendments to 45 CFR Part 75, Subpart E, Cost Principles, and any successor or
replacement; and
vii. 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
www.ojp.usdoi.gov/ocr/statutes.htm for additional information and access to the
aforementioned Federal laws and regulations.)
7.1.1. Single Audit Compliance
If the Contractor is a subrecipient and expends$750,000 or more in federal awards from any
and/or all sources in any fiscal year, the Contractor shall procure and pay for a single audit or a
program-specific audit for that fiscal year. Upon completion of each audit, the Contractor shall:
i. Submit to the HCA contact person the data collection form and reporting package
specified in-45 CFR Part 75, Subpart F, Audit Requirements reports required by the
program-specific audit guide(if applicable), and a copy of any management letters
issued by the auditor.
ii. Follow-up and develop corrective action for all audit findings; in accordance with 45 CFR
Part 75, Subpart F, Audit Requirements, including preparing a"Summary Schedule of
Prior Audit Findings."
7.2. Monitoring Activities
The Contractor is required to meet or exceed the monitoring activities, as outlined below. Compliance
will be monitored throughout the performance period to assess risk. Concern will be addressed
through a Corrective Action Plan. Monitoring activities may include, but are not limited to:
i. Review of financial and performance reports;
ii. Monitoring and documenting the completion of Contract deliverables;
iii. Documentation of phone calls, meetings (e.g. agendas, sign-in sheets, meeting minutes), e-
mails and correspondence;
iv. Review of reimbursement requests and supporting documentation to ensure allowability and
consistency with Contract work plan, budget and Federal requirements;
v. Observation and documentation of Contract-related activities, such as trainings and events;
vi. On-site visits or desk audits to review records and inventories, to verify source documentation
for reimbursement requests and performance reports, and to verify completion of deliverables.
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7.2.1. Corrective Action Plans
HCA may require the Contractor to develop a Corrective Action Plan (CAP), which must be
submitted for approval to HCA within fifteen(15) calendar days of notification unless otherwise
specified. CAPs may require modification to any policies or procedures by the Contractor relating
to fulfillment of its obligations pursuant to this Contract. HCA, at its sole discretion, may extend or
reduce the time allowed for corrective action depending upon the nature of the situation.
i. CAPs must at a minimum include:
a. A brief description of the finding(s), including all relevant information specific to
the issue(s);
b. Specific actions taken and to be taken by the Contractor, including a timetable
and a description of the monitoring to be performed.
ii. CAPs are subject to approval by HCA. HCA may:
a. Accept the plan as submitted;
b. Accept the plan with specified modifications;
c. Request a modified plan;
d. Reject the plan.
7.2.2. Extension to Deliverables
The Contractor must request prior written approval from the HCA Contract Manager to waive or
extend a due date identified in Attachment 1: Statement of Work and, once approved, submit
those deliverables and the associated costs on the next scheduled reimbursement due date.
Waiving or missing deadlines serves as an indicator for assessing an agency's level of risk of
noncompliance with the regulations, requirements, and the terms and conditions of the Contract
and may increase required monitoring activities.
Any request for a waiver or extension of a due date identified in Attachment 1: Statement of Work
will be treated as a request for an Amendment of the Contract. This request must be submitted to
the HCA Contract Manager sufficiently in advance of the due date to provide adequate time for
HCA to review and consideration and may be granted or denied within HCA's sole discretion.
8. Compensation and Billing
8.1. Consideration and Source of Funds
Total consideration payable to the Contractor for satisfactory performance of the work under this
Contract is up to a maximum of$80,000, including any and all expenses, in accordance with the
Award and Revenues.
Funding for any additional periods past the initial term are contingent on satisfactory completion of all
contract requirements and continued state and/or federal funding. Contractors may be required to
submit an updated Action Plan and Budget to HCA in order to receive funding for additional terms.
Funding that supports this Contract comes from state and/or federal grant funds, HCA, and the
Catalog of Federal Domestic Assistance(CFDA)as listed within the Awards and Revenue.Any state
or federal funds obligated under this Contract which are not expended according to the timeline on
the Awards and Revenues, may not be used or carried forward to any other Contract or time period.
Subrecipients shall only use federal award funds under this Contract to supplement existing funds
and will not use them to replace(supplant) non-federal funds that have been budgeted for the same
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purpose. The Subrecipient may be required to demonstrate and document that a reduction in non-
federal resources occurred for reasons other than the receipt or expected receipt of federal funds.
8.2. Reimbursements
HCA shall reimburse the Contractor only for actual incurred and allowable costs for the services
identified in this Contract and in accordance with the Substance Use Disorder Prevention and Mental
Health Promotion Services Billing Guide.
The Contractor shall not bill and HCA shall not pay for services performed under this contract, if the
contractor has charged or will charge another agency of the state of Washington or any other party
for the same services.
Reimbursement requests will not be approved for payment until the Contractor is current with all
reporting requirements contained in this Contract.
HCA shall not make any payments in advance or anticipation of the delivery of services to be
provided pursuant to this Contract.
All work under this Contract must end on or before the funding source end date and the final
reimbursement request must be submitted to HCA within forty-five(45) calendar days after the
funding source end date, except as otherwise authorized by either(1)written amendment of this
Contract or(2)written notification from the HCA to the Contractor.
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 or within forty-five(45) calendar days
after the funding source end date, whichever comes first, except as otherwise authorized by either(1)
written amendment of this Contract or(2)written notification from the HCA to the Contractor.
The Contractor must submit invoices for costs due and payable under this contract within ninety(90)
days of the date services were provided or within sixty (60) calendar days after the Contract
expiration date or within forty-five(45)calendar days after the funding source end date, whichever
comes first, except as otherwise authorized by either(1)written amendment of this Contract or(2)
written notification from HCA to the Contractor.
HCA is under no obligation to pay any claims that are submitted forty-six(46) or more days after the
funding source end date, sixty-one (61) or more calendar days after the Contract expiration date, or
ninety-one(91) or more calendar days after the date of services were provided ("Belated Claims").
HCA will pay Belated Claims at its sole discretion, and any such potential payment is contingent upon
the availability of funds.
Payment shall be considered timely if made by HCA within thirty(30) business days after receipt and
acceptance by HCA of the properly completed invoices. Payments shall be sent to the address
designated by the Contractor on page one (1)of this Contract. HCA may, at its sole discretion,
withhold payment claimed by the Contractor for services rendered if Contractor fails to satisfactorily
comply with any term or condition of this Contract.
8.3. Invoice System
The Contractor shall submit invoices using State Form A-19 Invoice Voucher, or such other form as
designated by HCA. Consideration for services rendered shall be payable upon receipt of properly
completed invoices which shall be submitted via email to:A-19DBHR at7,hca.wa.gov by the Contractor
not more often than monthly unless otherwise specified. Please include the contract number in the
subject line of the email, followed by the Prevention System Naming Convention and cc the Contract
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Manager or designee when submitting the invoice. Contractor may bill for cost reimbursement for
month of service if appropriate service data is provided in Minerva.
Invoices must describe and document to HCA's satisfaction a description of the work performed, the
progress of the project, and fees. If expenses are invoiced, invoices must provide a detailed
breakdown of each type. All fund sources are to be billed for separately as outlined on the A-19
Invoice Voucher. All invoices will be reviewed and must be approved by the Contract Manager or
his/her designee prior to payment. HCA shall not be obligated to reimburse the Contractor for any
services or activities performed prior to having a fully executed copy of this Contract. The Contractor
shall ensure all expenditures for services and activities under the Contract are submitted on the A-19
invoice and have the associated appropriate Minerva data entry.
HCA will deny 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.
In order to receive payment for services or products provided to a state agency, Contractor must
register with the Statewide Payee Desk at https://ofm.wa.gov/it-systems/statewide-vendorpayee-
services/receiving-payment-state. Payment will be directly deposited in the bank account or sent to
the address Contractor designated in its registration.
Administrative/indirect costs shall be billed separately from direct prevention services as indicated on
the A-19 invoice.
i. Administrative/indirect costs are defined in Section 1. Definitions.
ii. The Contractor shall use no more than eight percent 8%of each fund source allocation for
administrative/indirect costs.
i. Contractor may bill up to 8% of total costs to admin/indirect by fund source as specified
on the A&R however the following also applies:
1. Admin/indirect costs must be billed in proportion to direct expenses.
Admin/indirect should be charged using the following formula: Direct costs/(1 -
allowed admin/indirect rate)=Total costs; Total costs-Direct costs=
Admin/indirect costs.
2. Administrative/indirect costs are to be reconciled at the end of each fund source
time period to ensure adherence.
iii. No SABG funds allocated in this contract shall be used for administrative/indirect costs unless
otherwise specified on the A&R.Admin/indirect for SABG is allocated as GFS unless otherwise
specified.
HCA reserves the right to reduce the Prevention funds awarded in the Contract if the Contractor
expenditures are below 60% of expected levels during each fiscal quarter. Expenditures will be
reviewed quarterly.
If the fund source is a discretionary grant or state funds, funds may not be carried forward from year
to year, based upon their respective fiscal year noted on the Awards and Revenues.
8.4. Payments for Unallowable Costs and/or Overpayments
If it is determined by the HCA, or during the course of a required audit, that the Contractor has been
paid unallowable costs under this Contract, HCA may require the Contractor to reimburse HCA in
accordance with 45 CFR Part 75, Subpart E, Cost Principles.
In the event that overpayments or erroneous payments have been made to the Contractor under this
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Contract, HCA will provide written notice to Contractor and Contractor shall refund the full amount to
HCA within thirty (30) calendar days of the notice.
8.5. State and Federal Funding Requirements
The Contractor shall comply with the following:
i. Comply with all applicable provisions of the Notice of Awards for the any federal grants as listed
on the Awards and Revenues;
ii. Comply with RCW 69.50.540 Dedicated Marijuana Account Appropriations;
iii. Maintain records that identify, in its accounts, all federal awards received and expended and
the federal programs under which they were received, by CFDA title and number, award
number and year, name of the federal agency, and name of the pass-through entity;
iv. Maintain internal controls that provide reasonable assurance that the Subrecipient 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;
v. The Contractor shall ensure that Charitable Choice Requirements of 42 CFR Part 54 are
followed and that Faith-Based Organizations (FBO) are provided opportunities to compete with
traditional alcohol/drug substance use disorder prevention providers for funding;
vi. If the Contractor subcontracts with FBOs, the Contractor shall require the FBO to meet the
requirements of 42 CFR Part 54 as follows:
a. Applicants/recipients for/of services shall be provided with a choice of prevention
providers.
b. The FBO shall facilitate a referral to an alternative provider within a reasonable time
frame when requested by the recipient of services.
c. The FBO shall report to the Contractor all referrals made to alternative providers.
d. The FBO shall provide recipients with a notice of their rights.
e. The FBO provides recipients with a summary of services that includes any inherently
religious activities. Prepare appropriate financial statements, including a schedule of
expenditures of federal awards.
f. Funds received from the federal block grant must be segregated in a manner
consistent with Federal regulations.
vii. No funds may be expended for religious activities.
9. Subcontracting
Neither the Contractor nor any Subcontractor shall enter into subcontracts for any of the work contemplated
under this Contract without obtaining prior written approval of the HCA. In no event shall the existence of the
subcontract operate to release or reduce the liability of the contractor to the HCA for any breach in the
performance of the Contractor's duties. This clause does not include contracts of employment between the
Contractor and personnel assigned to work under this Contract.
Additionally, the Contractor is responsible for ensuring that all terms, conditions, assurances and certifications
set forth in this Contract 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 Confidential
Information without the express written consent of HCA or as provided by law.
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The rejection or approval by HCA of any subcontractor or the termination of a subcontractor shall not relieve
the Contractor of any of its responsibilities under this Contract, nor be the basis for additional charges to HCA.
HCA 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.
9.1. Subcontract Language
It is the Contractor's sole responsibility to ensure that its subcontractors performing services under
this Contract are meeting the requirements below and as otherwise outlined in this Contract when
providing services to patients, clients, or persons seeking assistance, which include but are not
limited to:
i. Subcontractor's identifying information including DUNS number and Zip code+4 of
subcontractor
ii. Applicable definitions
iii. Identification of purpose and term of subcontract
iv. Federal and state laws as applicable
a. This includes, but not limited to 45 CFR Part 75, Uniform Administrative Requirements,
Cost Principles, and Audit Requirements, if applicable to the subcontractor
v. Subrecipient requirements as applicable
vi. Identification of funding sources and associated funding requirements
vii. Determination of eligible clients
viii. Compensation and billing arrangement in compliance with the terms of this contract and the
Substance Use Disorder Prevention and Mental Health Promotion Services Billing Guide(see
definitions for more information).
ix. Termination and contract closeout language as applicable to include:
a. That termination of a subcontract shall not be grounds for a fair hearing for the service
applicant or a grievance for the recipient if similar services are immediately available in
the county
b. What actions the Subrecipient will take in the event of a termination of a subcontractor to
ensure all prevention data on services provided have been entered into Minerva
x. How service recipients will be informed of their right to a grievance in the case of:
a. Denial or termination of service
b. Failure to act upon a request for services with reasonable promptness
xi. Statement of work and/or identification of deliverables and plan for monitoring
xii. Identification of data entry into Minerva, as applicable
xiii. Authorization for Contractor to conduct an inspection of any and all subcontractor facilities
where services are performed including for contract monitoring activities
a. Requirement that subcontractors will perform background checks on its employees and
independent contractors used to perform the services
xiv. FBO requirements if applicable
xv. Insurance requirements
xvi. Debarment and suspension certification
xvii. Protection of confidential Information and restrictions on the providing and sharing of data
xviii. Business Associate Agreement in compliance with the requirements of HIPAA
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xix. Federal compliance, certifications, and assurances as applicable
xx. SAMHSA award terms as applicable, and
xxi. Identifying unallowable uses of federal funds if applicable
9.2. Subcontract Monitoring
9.2.1. Contracts
The Contractor shall obtain prior approval before entering into any subcontracting arrangement.
In addition, the Contractor shall submit to the DBHR Contract Manager identified on page one(1)
of this Contract at least one of the following for review within 30 business days of the intended
start date of the subcontract:
i. Copy of the proposed subcontract; or
ii. Copy of the Contractor's standard contract template; or
iii. Certify in writing that the subcontractor meets all requirements under the Contract and
that the subcontract contains all required language under the Contract, including any
data security, confidentiality and/or Business Associate language, as appropriate.
9.2.2. On-Site Monitoring
The Contractor shall:
i. Conduct a subcontractor review which shall include at least one(1) on-site visit,
annually, to each subcontractor site providing services to monitor fiscal and
programmatic compliance with subcontract performance criteria for the purpose of
documenting that the subcontractors are fulfilling the requirements of the subcontract
unless otherwise specified.
ii. Submit written documentation of each on-site visit upon completion to Contract Manager
or designee. A copy of the full report shall be kept on file by the Contractor.
9.2.3. Minerva Monitoring
The Contractor shall ensure that subcontractors have entered services funded under this
Contract in Minerva.
i. Ensure accurate and unduplicated reporting. Contractor may not require subcontractor
to enter duplicate prevention service data that is entered into Minerva into an additional
system.
ii. Ensure proper training of staff and designated back-up staff for Minerva data entry to
meet report due dates.
9.2.4. Additional Monitoring Activities
The Contractor shall maintain records of additional monitoring activities in the Contractor's
subcontractor file and make them available to HCA upon request including any audit and any
independent documentation.
9.2.5. Subcontractor Termination Requirements
When terminating a subcontract, the Contractor shall withhold the final payment of any
subcontract until all required Minerva reporting is complete. This also applies to all subcontractor
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closures.
10. Remedial Action
10.1. Causes
HCA may initiate remedial action if HCA determines any of the following situations exists:
i. A problem exists that negatively impacts individuals receiving services under this Contract;
ii. The Contractor has failed to perform any of the requirements or services required under this
Contract;
iii. The Contractor has failed to develop, produce, and/or deliver to HCA any of the statements,
reports, data, data corrections, accountings, claims, and/or documentation required under this
Contracts;
iv. The Contractor has failed to perform any administrative functions required under this Contract,
where administrative function is defined as any obligation other than the actual provision of
mental health services;
v. The Contractor has failed to implement corrective action required by the state and within HCA
prescribed timeframes.
11. Third-Party Beneficiaries
Although HCA and Contractor mutually recognize that services under this Contract may be provided by the
Contractor to individuals receiving services under the Medicaid program, and chapters 71.05, 71.24, and
71.34 RCW, it is not the intention of either HCA or the Contractor that such individuals, or any other persons,
occupy the position of intended third-party beneficiaries of the obligations assumed by either party to this
Contract.
12. Disputes
12.1. Requesting a Dispute
Requests must be sent by certified mail or other method providing a signed receipt to the following
address:
Office of Contracts and Procurements
Health Care Authority
PO Box 42702
Olympia, Washington 98504-2702
Requests must be received by Contract Services no later than twenty-eight(28) calendar days after
this Contract expiration or termination.
Requests must identify in writing the spokesperson for the Contractor, if other than the Contractor's
signatory.
12.2. Content of the dispute request:
The party requesting a dispute resolution shall submit a statement that:
i. Identifies the issue(s) in dispute;
ii. Identifies the relative positions of the parties; and
iii. Requests resolution through the current HCA process
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12.3. Action on the request:
HCA shall notify the non-requesting party that the request has been made, notify both parties of the
dispute resolution process to be followed, and manage the process to its conclusion.
The Contractor shall provide pertinent information as requested by the person assigned to resolve the
dispute.
Contractor and HCA agree that, the existence of a dispute notwithstanding, they will continue without
delay to carry out all their respective responsibilities under this Contract that are not affected by the
dispute Insurance.
13. Insurance
The Contractor shall at all times comply with the following insurance requirements.
13.1. General Liability Insurance
The Contractor certifies by signing this Contract that either:
i. The Contractor is self-insured or insured through a risk pool and shall pay for losses for which
it is found liable; or
ii. The Contractor maintains the types and amounts of insurance identified below and shall, if
requested by HCA, provide certificates of insurance to that effect to the HCA Contract
Manager:
a. The Contractor shall maintain Commercial General Liability Insurance, or Business
Liability Insurance, including coverage for bodily injury, property damage, and
contractual liability, with the following minimum limits: Each Occurrence-$1,000,000;
General Aggregate-$2,000,000. The policy shall include liability arising out of
premises, operations, independent contractors, products-completed operations,
personal injury, advertising injury, and liability assumed under an insured contract.
The State of Washington, Health Care Authority (HCA), and elected and appointed
officials, and employees of the state, shall be named as additional insureds.
b. Professional Liability(PL) Insurance. The Contractor shall maintain PL Insurance or
Errors& Omissions, with the following minimum limits: Each Occurrence-
$1,000,000; Aggregate-$2,000,000.
13.2. Worker's Compensation
The Contractor shall comply with all applicable Worker's Compensation, occupational disease, and
occupational health and safety laws and regulations. The State of Washington and HCA shall not be
held responsible for claims filed for Worker's Compensation under Title 51 RCW by the Contractor or
its employees under such laws and regulations.
13.3. Employees and Volunteers
Insurance required of the Contractor under the Contract shall include coverage for the acts and
omissions of the Contractor's employees and volunteers. In addition, the Contractor shall ensure that
all employees and volunteers who use vehicles to transport clients or deliver services have personal
automobile insurance and current driver's licenses.
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13.4. Subcontractors
The Contractor shall ensure that all subcontractors have and maintain insurance with the same types
and limits of coverage as required of the Contractor under this Contract.
13.5. Separation of Insureds
All insurance policies shall include coverage for cross liability and contain a"Separation of Insureds"
provision.
13.6. Insurers
Unless Contractor is self-insured or insured through a risk pool and shall pay for losses for which it is
found liable, the Contractor shall obtain insurance from insurance companies identified as an
admitted insurer/carrier in the State of Washington, with a Best's Reports' rating of B++, Class VII, or
better. Surplus Lines insurance companies will have a rating of A-, Class VII, or better.
13.7. Evidence of Coverage
The Contractor, upon request by HCA staff, submits a copy of the Certificate of Insurance or other
evidence of self-insurance or insurance through a risk pool, policy, and additional insured
endorsement for each coverage required of the Contractor under this Contract. The Certificate of
Insurance shall identify the Washington State Health Care Authority(HCA) as the Certificate Holder.
A duly authorized representative of each insurer, showing compliance with the insurance
requirements specified in this Contract, shall execute each Certificate of Insurance. The Contractor is
not required to submit to the HCA copies of Certificates of Insurance for personal automobile
insurance required of the Contractor's employees and volunteers under the Contract.
The Contractor shall maintain copies of Certificates of Insurance for each subcontractor as evidence
that each subcontractor maintains insurance as required by the Contract.
13.8. Material Changes
The insurer shall give HCA forty-five (45) business days advance written notice of cancellation or
non-renewal. If cancellation is due to non-payment of premium, the insurer shall give HCA ten (10)
business days advance written notice of cancellation.
13.9. General
By requiring insurance, the State of Washington and HCA do not represent that the coverage and
limits specified will be adequate to protect the Contractor. Such coverage and limits shall not be
construed to relieve the Contractor from liability in excess of the required coverage and limits and
shall not limit the Contractor's liability under the indemnities and reimbursements granted to the State
and HCA in this Contract. All insurance provided in compliance with this Contract shall be primary as
to any other insurance or self-insurance programs afforded to or maintained by the State.
14. Notices
Whenever one party is required to give notice to the other party under this Contract, it shall be deemed given
if mailed by United States Postal Service, registered or certified mail, return receipt requested, postage
prepaid and addressed as follows:
i. In the case of notice to the Contractor, notice shall be sent to the point of contact identified on page one
(1) of this Contract;
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ii. In the case of notice to HCA, notice shall be sent to:
Office of Contracts and Procurements
Washington State Health Care Authority
P. O. Box 42702
Olympia, Washington 98504-2702
Taxes, Fees and Licenses. Contracts(a7hca.wa.gov
Said notice shall become effective on the date delivered as evidenced by the return receipt or the date
returned to sender for non-delivery other than for insufficient postage. Either party may at any time change its
address for notification purposes by mailing a notice in accordance with this Section, stating the change and
setting forth the new address,which shall be effective on the tenth (10th) day following the effective date of
such notice unless a later day is specified in the notice.
15. Taxes, Fees and Licenses
15.1. Taxes
Where required by state statute or regulation, the Contractor shall pay for and maintain in current
status and all taxes that are necessary for performance under this Contract. Unless otherwise
indicated, HCA agrees to pay State of Washington sales or use taxes on all applicable consumer
services and materials purchased. The Contractor shall not charge federal excise taxes and the
HCA agrees to furnish the Contractor with an exemption certificate where appropriate.
In general, Contractors engaged in retail sales activities within the State of Washington are required
to collect and remit sales tax to the Department of Revenue (DOR). In general, out-of-state
Contractors must collect and remit"use tax"to DOR if the activity carried on by the seller in the State
of Washington is significantly associated with the Contractor's ability to establish or maintain a
market for its products in Washington State. Examples of such activity include where the Contractor
either directly or by an agent or representative:
i. Maintains an in-state office, distribution house, sales house, warehouse, service enterprise, or
any other in-state place of business;
ii. Maintains an in-state inventory or stock of goods for sale;
iii. Regularly solicits orders from purchasers located within the State of Washington via sales
representatives entering the State of Washington;
iv. Sends other staff into the State of Washington (e.g. product safety engineers, etc.)to interact
with purchasers in an attempt to establish or maintain market(s); or
v. Other factors identified in Chapter 458-20 WAC.
15.2. Fees/Licenses
Contractor shall pay for and maintain in a current status, any license fees, assessments, permit
changes, etc., which are necessary for contract performance. It is the Contractor's sole responsibility
to monitor and determine any changes of the enactment of any subsequent regulations for said fees,
assessments or charges and to immediately comply with said changes or regulations during the
entire term of this Contract.
16. Access to Data
In compliance with RCW 39.26.180 (2) and federal rules, the Contractor must provide access to any data
generated under this Contract to HCA, the Joint Legislative Audit and Review Committee, the State Auditor,
and any other state or federal officials so authorized by law, rule, regulation, or agreement at no additional
cost. This includes access to all information that supports the findings, conclusions, and recommendations of
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the Contractor's reports, including computer models and methodology for those models.
17. Amendment
This Contract may be amended by mutual agreement of the parties. Such amendments will not be binding
unless they are in writing and signed by personnel authorized to bind each of the parties.
18. Antitrust Assignment
The Contractor hereby assigns to the State of Washington any and all of its claims for price fixing or
overcharges which arise under the antitrust laws of the United States, or the antitrust laws of the State of
Washington, relating to the goods, products or services obtained under this Contract.
19. Assignment
Contractor may not assign or transfer all or any portion of this Contract or any of its rights hereunder, or
delegate any of its duties hereunder, except delegations as set forth in Section 9: Subcontracting, without the
prior written consent of HCA.Any permitted assignment will not operate to relieve Contractor of any of its
duties and obligations hereunder, nor will such assignment affect any remedies available to HCA that may
arise from any breach of the provisions of this Contract or warranties made herein, including but not limited to,
rights of setoff. Any attempted assignment, transfer or delegation in contravention of this Subsection of the
Contract will be null and void. HCA may assign this Contract to any public agency, commission, board, or the
like, within the political boundaries of the State of Washington, with written notice of thirty(30)calendar days
to Contractor.
This Contract will inure to the benefit of and be binding on the parties hereto and their permitted successors
and assigns.
20. Assurances
HCA and the Contractor agree that all activity pursuant to this Contract will be in accordance with all
applicable federal, state and local laws, rules, and regulations.
21. Attorney's Fees
In the event of litigation or other action brought to enforce contract terms, each party agrees to bear its own
attorneys'fees and costs.
22. Billing Limitations
The HCA shall pay the Contractor only for authorized services provided in accordance with this Contract.
The HCA shall not pay any claims for payment for services submitted more than twelve(12) months after the
calendar month in which the services were performed. HCA within the special terms and conditions of this
contract may reduce length of time following the provision of services in which the contractor may submit
claims for payment.
23. Change in Status
In the event of substantive change in the legal status, organization structure, or fiscal reporting responsibility
of the Contractor, the Contractor agrees to notify the Office of Contracts and Procurement(OCP) of the
change. The Contractor shall provide notice as soon as practicable, but no later than thirty(30) calendar days
after such a change takes effect.
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24. Compliance with Applicable Law
At all times during the term of this Contract, the Contractor shall comply with all applicable federal, state, and
local laws and regulations, including but not limited to, nondiscrimination laws and regulations.
25. Conflict of Interest
Notwithstanding any determination by the Executive Ethics Board or other tribunal, the HCA may, in its sole
discretion, by written notice to the Contractor terminate this Contract if it is found after due notice and
examination by the 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 services under this Contract.
In the event this Contract is terminated as provided above, the HCA shall be entitled to pursue the same
remedies against the Contractor as it could pursue in the event of a breach of this Contract by the Contractor.
The rights and remedies of the HCA provided for in this Section shall not be exclusive and are in addition to
any other rights and remedies provided by the law. The existence of facts upon which the Agent makes any
determination under this Section shall be an issue and may be reviewed as provided in the"Disputes" Section
of this Contract.
26. Conformance
If any provision of this Contract violates any statute or rule of law of the State of Washington, it is considered
modified to conform to that statute or rule of law.
27. Contractor Certification Regarding Ethics
The Contractor certifies that the Contractor is now, and shall remain, in compliance under Chapter 42.52
RCW, Ethics in Public Service, throughout the term of this Contract.
28. 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. The HCA 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.
29. Debarment Certifications
The Contractor, by signature to this Contract, certifies that the Contractor is not presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or
agency from participating in transactions(Debarred). The Contractor also agrees to include the above
requirement in any and all Subcontracts into which it enters. The Contractor shall immediately notify the HCA
Contact designated on the cover page of this Contract if, during the term of this Contract, the Contractor
becomes debarred. HCA may immediately terminate this Contract by providing Contractor written notice if
Contractor becomes Debarred during the term of this Contract.
30. Force Majeure
If the Contractor is prevented from performing any of its obligations hereunder in whole or in part as a result of
a major epidemic, act of God, war, terrorist acts, civil disturbance, court order, or any other cause beyond its
control, such nonperformance shall not be grounds for termination for default. Immediately upon the
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occurrence of any such event, the Contractor shall commence to use its best efforts to provide, directly or
indirectly, alternate and, to the extent practicable, comparable performance. Nothing in this Section shall be
construed to prevent HCA from terminating this Contract for reasons other than for default during the period of
event set forth above, or for default, if such default occurred prior to such event.
31. Fraud and Abuse Requirements
The Contractor shall report in writing all verified cases of fraud and abuse, including fraud and abuse by the
Contractor's employees and/or subcontractors, within five(5) business days, to the HCA Contact designated
on page one (1)of this Contract. The report shall include the following information:
i. Subject(s) of complaint by name and either provider/subcontractor type or employee position;
ii. Source of complaint by name and provider/subcontractor type or employee position;
iii. Nature of compliant;
iv. Estimate of the amount of funds involved; and
v. Legal and administrative disposition of case.
32. Governing Law and Venue
This Contract shall be construed and interpreted in accordance with the laws of the state of Washington and
the venue of any action brought hereunder shall be in Superior Court for Thurston County.
33. Health and Safety
Contractor shall perform any and all of its obligations under this Contract in a manner that does not
compromise the health and safety of any HCA client with whom the Contractor has contact.
34. Hold Harmless and Indemnification
i. The Contractor shall be responsible for and shall indemnify, defend, and hold HCA harmless from all
claims, loss, liability, damages, or fines arising out of or relating to:
a. The Contractor's or any Subcontractor's performance or failure to perform this Contract, or
b. The acts or omissions of the Contractor or any Subcontractor;
ii. The Contractor waives its immunity under Title 51 RCW to the extent it is required to indemnify, defend,
and hold harmless the State and its agencies, officials, agents, or employees.
iii. Nothing in this Section shall be construed as a modification or limitation on the Contractor's obligation
to procure insurance in accordance with this Contract or the scope of said insurance.
35. Independent 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 this Contract are not employees or agents of HCA. The
Contractor, his or her employees, or agents performing under this Contract will not hold himself/herself out as,
nor claim to be, an officer or employee of HCA by reason hereof, nor will the Contractor, his or her
employees, or agent make any claim of right, privilege or benefit that would accrue to such officer or
employee.
All payments accrued on account of payroll taxes, unemployment contributions, and other taxes, insurance or
other expenses for the Contractor or its staff shall be the sole responsibility of the Contractor.
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36. Industrial Insurance Coverage
The Contractor shall comply with the provisions of Title 51 RCW, Industrial Insurance. 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, HCA may collect from the Contractor the full amount payable to the Industrial Insurance
accident fund. HCA may deduct the amount owed by the Contractor to the accident fund from the amount
payable to the Contractor by HCA under this Contract, and transmit the deducted amount to the Department
of Labor and Industries, (L&I) Division of Insurance Services. This provision does not waive any of L&I's rights
to collect from the Contractor.
37. Inspection
The Contractor shall, at no cost, provide HCA, or any of its officers, or to any other authorized agent or officer
of the state of Washington or the federal government, and the Office of the State Auditor with reasonable
access to Contractor's place of business, Contractor's records, and HCA client records, wherever located.
These inspection rights are intended to allow HCA and the Office of the State Auditor to monitor, audit, and
evaluate the Contractor's performance and compliance with applicable laws, regulations, and these Contract
terms. These inspection rights shall survive for six(6)years following this Contract's termination or expiration.
38. Limitation of Authority
Only the Agent or Agent's 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.
Furthermore, any alteration, amendment, modification, or waiver of any Section or condition of this Contract is
not effective or binding unless made in writing and signed by the Agent or Agent's delegate.
39. Maintenance of Records
The Contractor shall maintain records relating to this Contract and the performance of the services described
herein. The records include, but are 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.
All records and other material relevant to this Contract shall be retained for six(6) years after expiration or
termination of this Contract.
Without agreeing that litigation or claims are legally authorized, 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.
40. Pay Equity
i. 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.
ii. Contractor may allow differentials in compensation for its workers based in good faith on any of the
following: (i) a seniority system; (ii) a merit system; (iii) a system that measures earnings by quantity or
quality of production; (iv) bona fide job-related factor(s); or(v) a bona fide regional difference in
compensation levels.
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iii. Bona fide job-related factor(s)" may include, but not be limited to, education, training, or experience,
that is: (i)consistent with business necessity; (ii) not based on or derived from a gender-based
differential; and (iii) accounts for the entire differential.
iv. A"bona fide regional difference in compensation level" must be: (i) consistent with business necessity;
(ii) not based on or derived from a gender-based differential; and (iii)account for the entire differential.
v. Notwithstanding any provision to the contrary, upon breach of warranty and Contractor's failure to
provide satisfactory evidence of compliance within thirty(30)calendar days of HCA's request for such
evidence, HCA may suspend or terminate this Contract.
41. Publicity
The award of this Contract to Contractor is not in any way an endorsement of Contractor or Contractor's
Services by HCA and must not be so construed by Contractor in any advertising or other publicity materials.
Contractor agrees to submit to HCA, all advertising, sales promotion, and other publicity materials relating to
this Contract or any Service furnished by Contractor in which HCA's name is mentioned, language is used, or
internet links are provided from which the connection of HCA's name with Contractor's Services may, in
HCA's judgment, be inferred or implied. Contractor further agrees not to publish or use such advertising,
marketing, sales promotion materials, publicity or the like through print, voice, the Web, and other
communication media in existence or hereinafter developed without the express written consent of HCA prior
to such use.
42. Records and Documents Review
i. 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 CFR 431, Subpart Q; and 42 CFR 447.202].
ii. The Contractor must retain such records for a period of six(6)years after the date of final payment
under this Contract.
iii. 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.
43. Registration with the State of Washington
The Contractor shall be responsible for registering with Washington State agencies, including but not limited
to, the Washington State Department of Revenue, the Washington Secretary of State's Corporations Division,
and the Washington State Office of Financial Management, Division of Information Services' Statewide
Vendors program.
44. Remedies Non-Exclusive
The remedies provided in this Contract are not exclusive, but are in addition to all other remedies available
under law.
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45. Rights in Data/Ownership
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, surveys, 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.
If for any reason the Work Product would not be considered a work for hire under applicable law, but was
otherwise produced pursuant to this Contract, Contractor assigns and transfers to HCA, the entire right, title
and interest in and to all rights in the Work Product and any registrations and copyright applications relating
thereto and any renewals and extensions thereof.
Contractor will execute all documents and perform such other proper acts as HCA may deem necessary to
secure for HCA the rights pursuant to this section.
Contractor will not use or in any manner disseminate any Work Product to any third party, or represent in any
way Contractor ownership of any Work Product, without the prior written permission of HCA. Contractor will
take all reasonable steps necessary to ensure that its agents, employees, or Subcontractors will not copy or
disclose, transmit or perform any Work Product or any portion thereof, in any form, to any third party.
Material that is delivered under this Contract, but that does not originate therefrom ("Preexisting Material"),
must be transferred to HCA with a nonexclusive, royalty-free, irrevocable license to publish, translate,
reproduce, deliver, perform, display, and dispose of such Preexisting Material, and to authorize others to do
so. Contractor agrees to obtain, at its own expense, express written consent of the copyright holder for the
inclusion of Preexisting Material. HCA will have the right to modify or remove any restrictive markings placed
upon the Preexisting Material by Contractor.
Contractor must identify all Preexisting Material when it is delivered under this Contract and must advise HCA
of any and all known or potential infringements of publicity, privacy or of intellectual property affecting any
Preexisting Material at the time of delivery of such Preexisting Material. Contractor must provide HCA with
prompt written notice of each notice or claim of copyright infringement or infringement of other intellectual
property right worldwide received by Contractor with respect to any Preexisting Material delivered under this
Contract.
46. Severability
If any term or condition of this Contract is held invalid by any court, the remainder of this Contract remains
valid and in full force and effect.
47. 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.
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48. Survivability
The terms and conditions contained in this Contract which, by their sense and context, are intended to survive
the expiration or termination of this particular agreement shall survive. Surviving terms include, but are not
limited to: Billing Limitations; Confidentiality, Disputes; Indemnification and Hold Harmless, Inspection,
Maintenance of Records, Notice of Overpayment, Ownership of Material, Termination for Default, Termination
Procedure, and Treatment of Property.
49. System Security
Unless otherwise provided, the Contractor agrees not to attach any Contractor-supplied computers,
peripherals or software to HCA Network without prior written authorization. HCA's Security Administrator.
Contractor-supplied computer equipment, including both hardware and software, must be reviewed by HCA's
Security Administrator prior to being connected to any HCA network connection and that it must have up-to-
date anti-virus software and personal firewall software installed and activated on it.
Unauthorized access to HCA networks and systems is a violation of HCA Policy 06-03 and constitutes
computer trespass in the first degree pursuant to RCW 9A.52.110. Violation of any of these laws or policies
could result in termination of this Contract and other penalties.
50. Termination for Convenience
Except as otherwise provided in this Contract, the Agent, or designee, may, by giving thirty (30)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 interest of HCA. If this Contract is so terminated, HCA shall be liable only for payment in
accordance with the terms of this Contract for services rendered prior to the effective date of termination.
51. Termination for Default
In the event HCA determines the Contractor has failed to comply with the terms and conditions of this
Contract, HCA has the right to suspend or terminate this Contract. HCA shall notify the Contractor in writing of
the need to take corrective action. If corrective action is not taken within ten (10) business days, this Contract
may be terminated. HCA reserves the right to suspend all or part of this 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 Contractor or a decision by HCA to terminate this
Contract.
In the event of termination, 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/indirect costs directly related to the replacement contract, e.g., cost of the competitive bidding,
mailing, advertising, and staff time. The termination shall be deemed a"Termination for Convenience" if it is
determined that:
i. Contractor was not in default, or
ii. Failure to perform was outside of Contractor's control, fault or negligence.
52. Termination Due to Change in Funding
HCA's ability to make payments is contingent on funding availability. In the event funding from state, federal,
or other sources is withdrawn, reduced, or limited in any way after the effective date and prior to completion or
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expiration date of this Contract, HCA, at its sole discretion, and with fifteen (15) Calendar Days' notice, may
elect to terminate the Contract, in whole or part, or to renegotiate the Contract subject to new funding
limitations and conditions. HCA may also elect to suspend performance of the Agreement until HCA
determines the funding insufficiency is resolved. HCA may exercise any of these options.
53. Termination or Expiration Procedures
The following terms and conditions apply upon Contract termination or expiration:
i. 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.
ii. HCA shall pay to Contractor the agreed upon price, if separately stated, for completed work and service
accepted by HCHA's program staff and the amount agreed upon by Contractor and HCA 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 HCA's program staff; and
d. The protection and preservation of property unless the termination is for default, in which case the
Agent or designee shall determine the extent of the liability. Failure to agree with such
determination shall be a dispute within the meaning of the"Disputes" Section of the Contract.
HCA may withhold from any amounts due Contractor such sum as the Agent or designee
determines to be necessary to protect HCA against potential loss or liability.
iii. The rights and remedies of HCA provided in this Section shall not be exclusive and are in addition to
any other rights and remedies provided by law or under this Contract.
iv. After receipt of notice of termination, and except as otherwise directed by the Agent or designee,
Contractor shall:
a. Stop work under this Contract on the date, and to the extent specified in the notice;
b. Place no further orders or subcontracts for materials, services, or facilities except as may be
necessary for completion of such portion of the work under this Contract that is not terminated;
c. Assign to HCA, in the manner, at the times, and to the extent directed by the Agent or designee,
all the rights, title, and interest of Contractor under the orders and subcontracts so terminated; in
which case HCA has the right, at its discretion, to settle or pay any or all claims arising out of the
termination of such orders and subcontracts;
d. Settle all outstanding liabilities and all claims arising out of such termination of orders and
subcontracts, with the approval or ratification of the Agent or designee to the extent the Agent or
designee may require, which approval or ratification shall be final for all the purposes of this
Section;
e. Transfer title to HCA and deliver in the manner, at the times, and to the extent directed by the
Agent or designee any property which, if this Contract has been completed, would have been
required to be furnished to HCA;
f. Complete performance of such part of the work as shall not have been terminated by the Agent or
designee; and
g. Take such action as may be necessary, or as the Agent or designee may direct, for the protection
and preservation of the property related to this Contract which is in the possession of Contractor
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and in which HCA has or may acquire an interest.
53.1. Contract Closeout
Upon termination or lapse of this Contract in whole or in part for any reason including completion of
the project, the following provisions may apply:
i. Upon written request by Contractor, HCA may make or arrange for payments to Contractor of
allowable reimbursable costs not covered by previous payments.
ii. Disposition of program assets (including the return and/or transfer of all unused materials,
equipment, unspent cash advances, and program income balances)to include creating an
inventory list of all property purchased or furnished by HCA for use by Contractor during
performance of this Contract.
iii. Contractor shall submit within thirty (30)calendar days after the date of expiration of this
Contract, all financial, performance and other reports required by this Contract, and in addition,
will cooperate in a program audit by HCA or its designee as requested; and
iv. Closeout of funds will not occur unless all requirements of the Contract's associated state and
federal funds are met and all outstanding issues with Contractor have been resolved to the
satisfaction of HCA.
Contractor's obligation to HCA shall not end until all closeout requirements are completed.
Notwithstanding the foregoing, the terms of this Contract shall remain in effect during any period that
Contractor has control of the Contract's associated state and federal funds, including program
income.
54. Treatment of Property
All property purchased or furnished by HCA for use by Contractor during this Contract term shall remain with
HCA or transferred by request of HCA. Title to all property purchased or furnished by Contractor for which
Contractor is entitled to reimbursement by HCA under this Contract shall pass to and vest in HCA upon
termination or lapse or this Contract unless otherwise specified by HCA. Contractor shall protect, maintain,
and insure all HCA property in its possession against loss or damage and shall return HCA property to HCA
upon Contract termination or expiration unless otherwise specified by HCA.
55. Waiver
Waiver of any breach or default on any occasion shall not be deemed to be a waiver of any subsequent
breach or default. Any waiver shall not be construed to be a modification of the terms and conditions of this
Contract. Only the HCA Contracts Administrator or designee has the authority to waive any term or condition
of this Contract on behalf of HCA.
56. Order of Precedence
i. The federal statute authorizing the grant program and any other federal statutes directly affecting
performance of the award including the Federal Funding Accountability and Transparency Act(FFATA),
as applicable)
ii. Program regulations
iii. National policy requirements
iv. Administrative regulations, cost principles and audit requirements
v. Applicable state laws not in conflict with any applicable federal laws
vi. This Contract
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ATTACHMENT 1 -Statement of Work: Community-based Organization (CBO) Prevention Services
Contractor shall ensure services, and staff, and otherwise do all things necessary for or incidental to the
performance of work, as set forth below. Prevention programs and services include, but are not limited to:
1. Consideration.
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 this Schedule A: Statement of Work is $80,000, and
includes any allowable expenses.
i. Schedule for DMA Allocations is as follows:
a. $20,000-Contract start date to June 30, 2022; and
b. $20,000-July 1, 2022 to June 30, 2023.
c. Funding for the second year, July 1, 2022 to June 30, 2023, is contingent on satisfactory
completion of all contract requirements and continued state funding.
d. In order to receive funding for the second year, grantees are required to submit an updated
Action Plan and Budget to DBHR by June 15, 2022, for approval by Contract Manager.
ii. Schedule for MHPP Allocations is as follows:
a. $20,000-Contract start date to June 30, 2022; and
b. $20,000-July 1, 2022, to June 30, 2023.
c. Funding for the second year, July 1, 2022 to June 30, 2023, is contingent on satisfactory
completion of all contract requirements and continued state funding.
d. In order to receive funding for the second year, grantees are required to submit an updated
Action Plan and Budget to DBHR by June 15, 2022, for approval by Contract Manager.
iii. Contractor must manage the Contract to ensure that services are provided in a manner that allocates
the available resources over the life of the Contract, utilizing only the funding assigned within each
respective fiscal year.
iv. HCA reserves the right to reduce the funds awarded in the Contract if the Contractor does not
implement services within 30 days of the services start date in the approved Action Plan.
v. HCA reserves the right to reduce the funds awarded in the Contract if the Contractor expenditures are
below sixty percent(60%) of expected levels during the fiscal quarter. Expenditures will be reviewed
quarterly.
2. Implementation of Prevention Services.
Contractor must implement the approved programs and strategies from HCA RFA#2021HCA2 and
approved by HCA as outlined below:
i. Program implementation must be in alignment with the approved Action Plan and Budget submitted
by the Contractor in response to HCA RFA#2021HCA2. This includes the approved program(s),
dates and timelines, scope, dosage, target audience(s), leadership, and responsible parties.
ii. If requested by HCA, submit revised Action Plan and/or Budget to accommodate federal or state
funding requirements within 15 days of executed contact or as needed. Contractor must receive
approval of Action Plan prior to implementation and spending.
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iii. Funds must only be used to support program costs included in the approved Action Plan. This
includes staff for program planning, training, implementation, service data entry, and evaluation.
iv. Programs must be implemented for the target audience for which they were designed, in an ongoing
cycle, and within the communities designated in the HCA approved Action Plan.
v. Ensure only program facilitators which are formally trained or certified as trainers are used for the
program(s) selected, if indicated as necessary by the program.
vi. Ensure program is implemented with full fidelity. Specified adaptations must be submitted in writing,
via email, to the HCA Contract Manager for approval no less than twenty (20) days in advance of
program implementation. Specified adaptations may not affect the core components of the program.
vii. All mentoring programs must be implementing the 4th edition of the Elements of Effective Practice for
Mentoring, https://www.mentorinq.orq/resource/elements-of-effective-practice-for-mentoring/ . Any
COVID-19 adaptions, shall include adherence to E-Mentoring Supplements to the Elements of
Effective practices for Mentoring and MENTOR National's Resources and Recommendations for the
COVID-19 Pandemic.
viii. Participate in monthly check-in phone calls with HCA Contract Manager or designee. Frequency of
check-in calls may change if deemed appropriate by HCA and will be based on technical assistance
needs and contract compliance.
ix. Contractor shall ensure that a regular annual schedule of direct prevention services for public
dissemination is established.
a. Regular annual schedule shall take into account items including, but not limited to:
implementation times that maximize participation and service outcomes; local needs and gaps;
leveraged resources; and, other locally identified factors that influence service delivery throughout
the year.
b. Regular annual schedule and community dissemination plan shall be identified as part of the
CBO Action Plan and Budget Update and submitted to Contract Manager or designee for HCA
review annually.
I. Submit an annual Action Plan and Budget with projected expenditures, including salary
and benefits for HCA funded prevention staff, program costs, training and travel to the
Contract Manager or designee, according to the RFA#2021 HCA2 or within thirty (30)
business days upon request.A template will be provided at least thirty (30) business days
prior to due date, unless otherwise specified. For DMA and MHPP CBOs, an updated
Action Plan and Budget is due by June 15 of each year that this Contract is active. For
any CBOs receiving SOR funding, an updated Action Plan and Budget are due August 15
of each year that this Contract is active, unless otherwise specified.
II. Budget adjustments that are ten percent(10%) or more of the total of the approved
Contractor budget shall submit a budget revision for approval to Contract Manager or
designee at least fifteen (15) business days prior to expending adjusted budget items.
Approval must be granted prior to expending funds.
III. Enter approved programs, based on the priorities, goals and objectives described in the
approved Action Plan, into Minerva within thirty (30) business days of Action Plan
approval or as directed by PSM.
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3. DMA Program Requirements:
i. Dedicated Marijuana Account Funds (DMA) shall be used for program and strategy training and
implementation.
a. All programs planned and implemented with DMA shall be programs selected from the current
DBHR provided youth marijuana use prevention and reduction program list as outlined by DBHR
in the RFA#2021 HCA2 and found at https://www.theathenaforum.org/EBP.
I. No less than eighty-five percent(85%)of DMA funds shall be expended on evidence-
based or research-based programs on the identified program list.
1. At the end of each SFY, Contractor must ensure this requirement is met.
II. Up to fifteen percent(15%) of DMA funds may expended on Promising Programs on the
identified program list.
2. At the end of each SFY, Contractor must ensure this requirement is met.
b. Any and all DBHR approved changes to the original application or Action Plan must adhere with
RCW 69.50.540, to ensure at least eighty-five percent (85%) of the funds are directed to
evidence-based (EBP) or research-based programs (RBP), and up to fifteen percent(15%) of the
funds may be directed to promising practices (PP)as outlined by DBHR in the RFA#2021 HCA2.
4. MHPP Program Requirements:
i. A minimum of two(2) Youth Mental Health First Aid (YMHFA)trainings will be provided and must
include the following;
a. Must be delivered by certified YMHFA instructors;
b. Must take place in the community identified in the application;
c. Must utilize the training curriculum and instructional materials associated with Youth Mental
Health First Aid, a trademarked program marketed by the National Council for Behavioral Health,
http://www.thenationalcou ncil.org/about/mental-health-first-aid.
d. Up to$5,000 from this award can be used to support implementation of each required YMHFA
training in Year 1 and Year 2, not to exceed $5,000 per state fiscal year and for a total of$10,000
over the grant period. Eligible expenses include trainer fees, materials, facility rental and all other
expenses associated with the training.
These funds can be used to train individuals to participate in YMHFA Training of Trainers.
e. Must be delivered in one of the following formats:
I. One(1) session with eight (8) hours of instruction: or,
II. Two(2) sessions with a total of eight(8) hours of instruction;
f. Contractor must implement, with fidelity, the required YMHFA Trainings one(1)to be completed
in Year 1 by June 30, 2022 and the second (2) completed in Year 2 no later than June 30, 2023.
g. If Contractor has previously held a contract with HCA for MHPP/Suicide Prevention CBO services
and has fully saturated their Community with this training they may submit a request for an
exception to this requirement. This must be approved by the HCA Contract Manager.
ii. Contractor will conduct at least two(2)Community Awareness raising activities focusing on mental
health promotion or suicide prevention, or both, during the period of the contract. The contractor shall
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implement one(1) Community Awareness activity per state fiscal year, with the first one completed by
June 30, 2022 and second completed no later than June 30, 2023.
5. Prevention Training
i. Contractor shall participate in all required training events identified by HCA.
ii. Contractor contact on page one(1) of this Contract and primary fiscal staff or their designee(s) shall
attend an annual contractor training or meeting that will be scheduled for four(4) hours in duration.
Date and location will be announced by DBHR at least thirty (30) business days prior to the training.
iii. Non-Required Training in CBO contracts
a. In the absence of trainings identified in the approved Action Plan, all additional (non-required)
training paid for by HCA shall be approved by Contract Manager or designee prior to training
and meet the approved goals and objectives in approved Action Plan.
b. Contractor shall ensure any requests for training in addition to the approved training in the
Action Plan are requested in writing and sent directly to the Contract Manager or designee, a
minimum of ten (10) business days before the date of the proposed training. Trainings shall
relate to one(1) of the following four(4)categories:
I. Coalition building and/or community organization.
II. Capacity building regarding prevention theory and practice.
III. Capacity building for Evidence-based Practice and environmental strategy
implementation, related to the goals and objectives of the approved Action Plan.
IV. Capacity building in non-CPWI communities to expand CBO efforts and meets overall
goals and objectives of CBO grants may be approved by Contract Manager or
designee upon request.
c. Contractor shall ensure training paid for by HCA that requires travel follows state travel
reimbursement guidelines and rates accessible at www.ofm.wa.gov/policy/10.90.htm.
d. Contractor shall bill for training events on an A-19 per billing code according to the Substance
Use Disorder and Mental Health Promotion Services Billing Guide and record training events
in the HCA Substance Use Disorder Prevention and Mental Health Promotion Online
Reporting Systems or Minerva in accordance with the monthly reporting requirements
described in Section 3 c., Prevention Report Schedule/Due Dates.
6. Media Materials
HCA must be cited as the funding source in news releases, publications, and advertising messages
created with or about HCA funding. The funding source shall be cited as: Washington State Health
Care Authority. The HCA logo may also be used in place of the above citation.
ii. Media materials and publications developed with HCA funds, including messaging specifically
directed to youth, shall be submitted to the Contract Manager or designee for approval prior to
publication (HCA will respond within five (5) business days).
a. Exceptions: Contractor does not need to submit the following items to Contract Manager or
designee:
I. Newsletters and fact sheets.
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II. News coverage resulting from interviews with reporters. This includes online news
coverage.
III. Newspaper editorials or letters to the editor.
IV. Posts on Facebook, YouTube, Tumblr, Twitter, Instagram, Snapchat and other social
media sites.
V. When a statewide media message is developed by HCA, is localized, and if the only
change is the local CBO information and funding source acknowledgment from CBO,
coalition or public health entities.
VI. When a national prevention media campaign is developed by SAMHSA, is localized,
and if the only change is the local CBO information and funding source
acknowledgement from CBO, coalition or public health entities.
7. Secure Prescription Take-Back and Lock Box project.
Contractors who implement a Secure Prescription Take-Back and/or Lock Box project must ensure the
following additional requirements:
i. The Secure Prescription Take-Back and/or Lock Box project must align with the community needs
assessment and will increase local capacity to address prescription drug misuse and abuse by
reducing social availability of prescriptions in the community.
ii. Contractor shall provide the services and staff, and otherwise do all things necessary for or incidental
to the Secure Prescription Take-Back and/or Lock Box project as set forth below:
a. Enhance community capacity to practice safe disposal of medications by promoting
permanent secure drop box in the location where community readiness has been
established. (Installation and disposal must follow all DEA rules and all federal and state laws
and regulations).
b. Collaborate with community partners to maintain and/or enhance policies and procedures
necessary to maintain a permanent secure medicine take-back drop box.
c. Overtime wages for law enforcement officers and staff as outlined in strategic plan and
outside of normal duties and other real costs (including mileage reimbursement)associated
with transporting and properly disposing of collected medicines at EPA approved locations
may be permitted depending upon source of funds and must be approved by the Contract
Manager in advance.
d. Create, utilize and disseminate public education information materials to increase awareness
of the secure medicine take-back project, local treatment resources, naloxone information
and medical response(Good Samaritan law)cards.
e. Disseminate public information including information on local treatment resources, naloxone
information and medical response cards and posters. (Print ready materials are available
online at www.stopoverdose.org).
f. Utilize publications already available through HCA/DBHR and other websites. (i.e., SAMHSA
Opioid Overdose Toolkit, and downloadable/printable materials on www.stopoverdose.orq
and www.takebackyourmeds.orq.
g. Submit locally-developed educational and informational materials to HCA/DBHR for approval
at least ten (10) business days prior to publication.
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h. Prior to purchasing home medication lock boxes or bags Contractor will submit to HCA/DBHR
in writing a plan for the purchase and distribution of home medication storage device
including the cost and source of the home storage devices, the number of devices to be
purchased, a clear plan for distribution, and method for tracking the use of the devices.
Contractor must also demonstrate how the distributed home medication devices will be
altered (by engraving, indelible ink, or other means)to have no cash value.
i. Contractor is required to maintain records of pre and post surveys for lock box distribution
and record in Minerva upon request from HCA/DBHR.
8. Food Costs.
Food costs are generally unallowable during program implementation except within the following parameters:
i. Light refreshment costs for training events and meetings lasting longer than two (2) hours in duration
are allowable.
ii. Ensure that light refreshment costs do not exceed $3.00 per person.
iii. Meals may be provided for participants using MHPP or DMA funds only if:
a. The training is four(4) hours or more in duration; or
b. The program is a recurring, direct service in the family domain, lasting two (2) hours or more
in duration and must be approved in the action plan and budget.
iv. Meals are not allowable costs with SOR or SOR II funds.
v. Contractor shall adhere to current state per-diem rates for meals accessible at
www.ofm.wa.gov/policv/1 0.90.htm.
vi. No more than a total of$1,000 may be spent on food or light refreshments per CBO contract per
year.
9. Reporting Requirements.
Contractor shall report on all requirements as identified in the HCA Substance Use Disorder Prevention and
Mental Health Promotion Online Reporting System or Minerva. HCA reserves the right to add reporting
requirements based on requirements of funding sources.
i. Prevention Activity Data Reports
Contractor shall:
a. Ensure that monthly prevention activities are reported in Minerva in accordance with the
requirements and timelines set forth.
b. Ensure accurate and unduplicated reporting.
c. Ensure proper training of staff and designated staff for back-up Minerva data entry to meet
report due dates.
d. If special circumstances arise and Contractor is unable to enter the data by the reporting
deadline(s), Contractor shall ensure any requests for extensions to reporting deadlines are
requested in writing and sent directly to the PSM via email five(5) business days before the
report due date.
e. The maximum extension request permitted is ten (10) business days.
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f. Monthly invoices submitted with active data entry extensions will be denied and may be re-
submitted by Contractor once data for the month(s) in question is complete.
g. Contractors with three(3) or more consecutive months of data entry extensions or late
reporting or four(4) or more program data entry extensions or late reporting within a six(6)
month period shall be required to submit a Corrective Action Plan to HCA.
I. Extensions granted due to Minerva technical issues will be excluded from this count.
h. Ensure all required demographic information is provided for individual participant; population
reach; aggregate; environmental and mentoring or 1-to-1 services in Minerva.
i. Report Community Coalition Coordination Staff Hours in Minerva for each month of the
calendar year.
j. Complete prevention reporting, according to the Schedule/Due Dates below:
Reporting Period Report(s) Report Due Dates Reporting
System
Annually and as Enter programs listed on Within 30 business
Action Plan
approved Action Plan by days of Action Plan Minerva
revisions are
approved HCA into Minerva. approval
As requested GPRA Measures. As requested Minerva
Prevention activity data
input for all active
services including 15�h of each month for
Monthly coordination staff hours
and efforts, services, activities from the Minerva
participant information, previous month
training, evaluation tools
and assessments.
As required by SAMHSA Minerva or as
As requested or HCA/DBHR. As requested required
ii. Outcome Measures
a. Contractor shall report on all required evaluation tools identified in Minerva that measure
primary program objective.
I. Pre/Post test are required for all recurring direct service programs.
II. Specific surveys for Information Dissemination or Environmental strategies/programs
based on specific program to be determined and approved in Action Plan.
b. Special situations and exceptions regarding evaluation tools identified in Minerva include, but
are not limited to, the following:
I. Contractor may negotiate with the Contract Manager or designee to reduce multiple
administrations of surveys to individual participants.
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II. Participants in recurring program groups in which the majority of participants are
younger than ten (10)years old on the date of that group's first service.
iii. Performance Work Statement/Evaluation.
a. Contractor shall ensure program results show positive outcomes for at least half of the
participants in each program group as determined by Activity Log with individual participant
sessions.
I. "Positive outcomes" means that at least half of the participants in a group report
positive improvement or maintenance as determined by the program measurable
objective between pre and post-tests.
II. Positive outcomes will be determined using the pre-test and post-test data reported in
Minerva.
III. Evaluation of Minerva data will occur on the 15th of the month following the final date
of service for each group.
b. HCA shall use the following protocol for evaluation:
I. Matched pre-test and post-test pairs will be used in the analysis.
II. To allow for normal attendance drop-off, a 20% leeway will be given for missing post-
tests.
III. If there are missing post-tests for entered pre-tests in excess of 20% of pre-tests,
missing post-test will be counted as a negative outcome.
Example: there are ten (10) pre-tests and seven (7) post-tests. The denominator
would be eight(8) and the maximum numerator would be seven (7).
c. Different groups, as determined by Activity Logs, receiving the same program will be
clustered by school district.
I. In cases where multiple providers are serving the same school district, groups will be
clustered by school district and provider.
II. The results of one(1) provider in a given school district will not impact another
provider in the same district.
1. In cases where the survey instrument selected for a given program includes
more than one scale, the scale that is most closely aligned with the
measurable objective linked to the program in Minerva will be used.
2. Results for groups, as determined by Activity Logs, with services that span
two (2) contracting periods will be analyzed in the contracting period that the
post-test was administered.
III. If fewer than half of the participants in a group, as determined by Activity Log, within
a given school district, report positive change in the intended outcome:
1. Contractor shall submit a Performance Improvement Plan (PIP)for the non-
compliant program to the Contract Manager or designee or designee within
forty-five(45) calendar days of notice by HCA.
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2. Reimbursement for the CSAP Category row on the A-19 for that program will
be held until the PIP is approved by Contractor Manager or designee or their
designee.
3. If a second group, as determined by Activity Log, within that same school
district has fewer than half of the participants report positive change in the
intended outcome, then the following steps will be taken:
a. In cases where there is no active non-compliant program, Contractor
shall discontinue implementation of that program within the specified
geography.
b. In cases where the same programs as the non-compliant program
are active and continuing in the same school district, those groups,
as determined by Activity Logs, will be allowed to complete the
expected number of sessions. No new groups, as determined by
Activity Logs, will be started.
c. Following the conclusion of all groups, as determined by Activity
Logs, completing the program, results will be reviewed for those
groups.
d. If the results do not show positive change for each group, as
determined by Activity Logs, Contractor shall take the following
action:
i. In cases where the program is being delivered by a single
provider in the specified geography, Contractor shall
discontinue implementation of that program in the specified
geography.
ii. In cases where the program is being delivered by multiple
providers in the specified geography, Contractor shall
discontinue implementation of that program by the
underperforming provider in the specified geography.
IV. A program that resulted in the need for a Performance Improvement Plan and Plan
during the former Contract period will not carry that record forward into the new
Contract period. Implement and monitor prevention programs and reporting to assure
compliance with these guidelines.
10. Requirements
i. Background Checks.
a. The Contactor shall ensure a criminal background check is conducted for all staff members,
case managers, outreach staff members, etc. or volunteers who have unsupervised access
to children, adolescents, vulnerable adults, and persons who have developmental disabilities.
b. When providing services to youth, Contractor shall ensure that requirements of WAC 388-06-
0170 are met.
ii. Services and Activities to Racial/Ethnic Minorities and Diverse Populations.
Contractor shall:
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a. Ensure all services and activities provided by Contractor or subcontractor under this Contract
shall be designed and delivered in a manner sensitive to the needs of all diverse populations.
b. Initiate actions to ensure or improve access, retention, and cultural relevance of prevention or
other appropriate services, for racial/ethnic minorities and other diverse populations in need
of prevention services as identified in their needs assessment.
c. Take the initiative to strengthen working relationships with other agencies serving these
populations. Contractor shall require its subcontractors to adhere to these requirements.
iii. Continuing Education.
Ensure that continuing education is provided for employees of any entity providing prevention
activities in accordance with42 USC 300x-28(b)and 45 CFR 96.132(b).
iv. Single Source Funding.
a. Contractor shall ensure all subcontractors that Single Source Funding means that a
subcontractor can use only one(1) source of funds at any given time.
b. Each cost reimbursement Prevention service provided must be billed only one(1)time
through the source selected for funding this expense. At no time may the same expense be
billed through more than one (1)funding source.
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ATTACHMENT 2-Confidential Information Security Requirements
1. Definitions
In addition to the definitions set out in Section 2: Definitions of this Contract K5263 for CBO Prevention
Services, the definitions below apply to this Attachment.
i. "Hardened Password" means a string of characters containing at least three of the following character
classes: upper case letters; lower case letters; numerals; and special characters, such as an asterisk,
ampersand or exclamation point.
a. Passwords for external authentication must be a minimum of 10 characters long.
b. Passwords for internal authentication must be a minimum of 8 characters long.
c. Passwords used for system service or service accounts must be a minimum of 20 characters
long.
ii. "Portable/Removable Media" means any Data storage device that can be detached or removed from
a computer and transported, including but not limited to: optical media (e.g. CDs, DVDs); USB drives;
or flash media (e.g. CompactFlash, SD, MMC).
iii. "Portable/Removable Devices" means any small computing device that can be transported, including
but not limited to: handhelds/PDAs/Smartphones; Ultramobile PC's, flash memory devices (e.g. USB
flash drives, personal media players); and laptops/notebook/tablet computers. If used to store
Confidential Information, devices should be Federal Information Processing Standards (FIPS) Level 2
compliant.
iv. "Secured Area" means an area to which only Authorized Users have access. Secured Areas may
include buildings, rooms, or locked storage containers (such as a filing cabinet)within a room, as long
as access to the Confidential Information is not available to unauthorized personnel.
v. "Transmitting" means the transferring of data electronically, such as via email, SFTP, web services,
AWS Snowball, etc.
vi. "Trusted System(s)" means the following methods of physical delivery: (1) hand-delivery by a person
authorized to have access to the Confidential Information with written acknowledgement of receipt;
(2) United States Postal Service ("USPS")first class mail, or USPS delivery services that include
Tracking, such as Certified Mail, Express Mail or Registered Mail; (3)commercial delivery services
(e.g. FedEx, UPS, DHL)which offer tracking and receipt confirmation; and (4)the Washington State
Campus mail system. For electronic transmission, the Washington State Governmental Network
(SGN) is a Trusted System for communications within that Network.
vii. "Unique User ID" means a string of characters that identifies a specific user and which, in conjunction
with a password, passphrase, or other mechanism, authenticates a user to an information system.
2. Confidential Information Transmitting
i. When transmitting HCA's Confidential Information electronically, including via email, the Data must be
encrypted using NIST 800-series approved algorithms
(http://csrc.nist.gov/publications/PubsSPs.html). This includes transmission over the public internet.
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ii. When transmitting HCA's Confidential Information via paper documents, the Receiving Party must
use a Trusted System.
3. Protection of Confidential Information
Contractor agrees to store Confidential Information as described:
i. Data at Rest:
a. Data will be encrypted with NIST 800-series approved algorithms. Encryption keys will be
stored and protected independently of the data. Access to the Data will be restricted to
Authorized Users through the use of access control lists, a Unique User ID, and a
Hardened Password, or other authentication mechanisms which provide equal or greater
security, such as biometrics or smart cards. Systems which contain or provide access to
Confidential Information must be located in an area that is accessible only to authorized
personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
b. Data stored on Portable/Removable Media or Devices:
1. Confidential Information provided by HCA on Removable Media will be encrypted with
NIST 800-series approved algorithms. Encryption keys will be stored and protected
independently of the Data.
2. HCA's data must not be stored by the Receiving Party on Portable Devices or Media
unless specifically authorized within the Data Share Agreement. If so authorized, the
Receiving Party must protect the Data by:
i. Encrypting with NIST 800-series approved algorithms. Encryption keys will be
stored and protected independently of the data;
ii. Control access to the devices with a Unique User ID and Hardened Password or
stronger authentication method such as a physical token or biometrics;
iii. Keeping devices in locked storage when not in use;
iv. Using check-in/check-out procedures when devices are shared;
v. Maintain an inventory of devices; and
vi. Ensure that when being transported outside of a Secured Area, all devices with
Data are under the physical control of an Authorized User.
ii. Paper documents.Any paper records containing Confidential Information must be protected by
storing the records in a Secured Area that is accessible only to authorized personnel. When not in
use, such records must be stored in a locked container, such as a file cabinet, locking drawer, or
safe, to which only authorized persons have access.
4. Confidential Information Segregation
HCA Confidential Information received under this Contract must be segregated or otherwise
distinguishable from non-HCA data. This is to ensure that when no longer needed by Contractor, all HCA
Confidential Information can be identified for return or destruction. It also aids in determining whether
HCA Confidential Information has or may have been compromised in the event of a security Breach.
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The HCA Confidential Information must be kept in one of the following ways:
a. on media (e.g. hard disk, optical disc, tape, etc.)which will contain only HCA Data; or
b. in a logical container on electronic media, such as a partition or folder dedicated to HCA's
Data; or
c. in a database that will contain only HCA Data; or
d. within a database and will be distinguishable from non-HCA Data by the value of a
specific field or fields within database records; or
e. when stored as physical paper documents, physically segregated from non-HCA Data in
a drawer, folder, or other container.
ii. When it is not feasible or practical to segregate HCA Confidential Information from non-HCA data,
then both the HCA Confidential Information and the non-HCA data with which it is commingled
must be protected as described in this Attachment.
5. Confidential Information Shared with Subcontractors
If HCA Confidential Information provided under this Contract is to be shared with a Subcontractor, the
contract with the Subcontractor must include all of the Confidential Information Security Requirements.
6. Confidential Information Disposition
When the Confidential Information is no longer needed, except as noted below, the Confidential
Information must be returned to HCA or destroyed. Media are to be destroyed using a method
documented within NIST 800-88 (http://csrc.nist.gov/publications/PubsSPs.html).
i. For HCA's Confidential Information stored on network disks, deleting unneeded Confidential
Information is sufficient as long as the disks remain in a Secured Area and otherwise meet the
requirements listed in Section 4: Confidential Information Segregation, above. Destruction of the
Confidential Information as outlined in this section of this Attachment may be deferred until the
disks are retired, replaced, or otherwise taken out of the Secured Area.
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ATTACHMENT 3—Business Associate Agreement
This BUSINESS ASSOCIATE AGREEMENT is made between Lewis County (Business Associate) and the
Washington State Health Care Authority (HCA). This agreement does not expire or automatically terminate except
as stated in Section 5.
This Agreement relates to K5263 between the Business Associate and HCA unless otherwise agreed. Business
Associate is or may be a"Business Associate" of HCA as defined in the HIPAA Rules. If there is a conflict
between the provisions of this Agreement and provisions of other contracts, this Agreement controls; otherwise,
the provisions in this Agreement do not replace any provisions of any other contracts. If the other Contract is
terminated, this Agreement nonetheless continues in effect.
This Business Associate Agreement supersedes any existing Business Associate Agreement the Business
Associate may have with HCA. It also supersedes any"business associate" section in an underlying Contract.
1. DEFINITIONS
Access attempts - Information systems are the frequent target of probes, scans, "pings,"and other activities
that may or may not indicate threats, whose sources may be difficult or impossible to identify, and whose
motives are unknown, and which do not result in access or risk to any information system or PHI. Those
activities are"access attempts."
Day -means business days observed by Washington State government unless otherwise specified.
Catch-all definitions -The following terms used in this Agreement have the same meaning as those terms in
the HIPAA Rules: Breach, Business Associate, Data Aggregation, Designated Record Set, Disclosure, Health
Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Secretary, Security Incident,
Unsecured Protected Health Information (PHI), and Use.
Clients or Individuals -"Clients" or"individuals" are people who have health or other coverage or benefits
from or through HCA. They include Medicaid clients, Public Employees Benefits Board subscribers and
enrollees, and others.
Contract or Underlying Contract-"Contract"or"underlying contract" means all agreements between
Business Associate and HCA under which Business Associate is a"business associate" as defined in the
Security or Privacy Rules. The terms apply whether there is one such agreement or more than one, and if
there is more than one the terms include them all even though a singular form is used except as otherwise
specified. The terms include agreements now in effect and agreements that become effective after the
effective date of this Agreement.
Effective Date-"Effective Date" means the date of the signature with the latest date affixed to the
Agreement.
HIPAA Rules; Security, Breach Notification, and Privacy Rules -"HIPAA Rules" means the Privacy,
Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164, as now in effect and
as modified from time to time. In part 164 of title 45 CFR, the"Security Rule" is subpart C (beginning with
§164.302), the"Breach Notification Rule" is subpart D (beginning with§ 164.400), and the"Privacy Rule" is
subpart E (beginning with § 164.500).
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Protected Health Information or PHI -"Protected Health Information" has the same meaning as in the
HIPAA Rules except that in this Agreement the term includes only information created by Business Associate
or any of its contractors, or received from or on behalf of HCA, and relating to Clients. "PHI" means Protected
Health Information.
2. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE
i. Limits
Business Associate will not use or disclose PHI other than as permitted or required by the Contract or this
Agreement or as required by law. Except as otherwise limited in this Agreement, Business Associate may
use or disclose PHI on behalf of, or as necessary for purposes of the underlying contract, if such use or
disclosure of PHI would not violate the Privacy Rule if done by a Covered Entity and is the minimum
necessary.
ii. Safeguards
Business Associate will use appropriate safeguards and will comply with the Security Rule with respect to
electronic PHI, to prevent use or disclosure of PHI other than as provided for by the Contract or this
Agreement. Business Associate will store and transfer PHI in encrypted form.
iii. Reporting Security Incidents
Business Associate will report security incidents that materially interfere with an information system used
in connection with PHI. Business Associate will report those security incidents to HCA within five(5) days
of their discovery by Business Associate. If such an incident is also a Breach or may be a Breach,
subsection 3 applies instead of this provision.
Access Attempts shall be recorded in Business Associate's system logs. Access Attempts are not
categorically considered unauthorized Use or Disclosure, but Access Attempts do fall under the definition
of Security Incident and Business Associate is required to report them to HCA.
Since Business Associate's reporting and HCA's review of all records of Access Attempts would be
materially burdensome to both parties without necessarily reducing risks to information systems or PHI,
the parties agree that Business Associate will review logs and other records of Access Attempts, will
investigate events where it is not clear whether or not an apparent Access Attempt was successful, and
determine whether an Access Attempt:
a. Was in fact a"successful" unauthorized Access to, or unauthorized Use, Disclosure,
modification, or destruction of PHI subject to this Agreement, or
b. Resulted in material interference with Business Associate's information system used with
respect to PHI subject to this Agreement, or
c. Caused an unauthorized Use or Disclosure.
Subject to Business Associate's performance as described herein. This provision shall serve as Business
Associate's notice to HCA that Access Attempts will occur and are anticipated to continue occurring with
respect to Business Associate's information systems. HCA acknowledges this notification, and Business
Associate is not required to provide further notification of Access Attempts unless they are successful as
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described in this Section 2 in which case Business Associate will report them in accordance with this
Section 2.
3. BREACH NOTIFICATION
"Breach" is defined in the Breach Notification Rule. The time when a Breach is considered to have been
discovered is explained in that Rule. HCA, or its designee, is responsible for determining whether an
unauthorized Use or Disclosure constitutes a Breach under the Breach Notification Rule, RCW 42.56.590
or RCW 19.255.010, or other law or rule, and for any notification under the Breach Notification Rule,
RCW 42.56.590 or RCW 19.255.010, or other law or rule.
Business Associate will notify HCA of any unauthorized use or disclosure and any other possible Breach
within five(5) business days of discovery. If Business Associate does not have full details at that time, it
will report what information it has, and provide full details within fifteen business (15)days after discovery.
The initial report may be oral. Business Associate will give a written report to HCA, however, as soon as
possible. To the extent possible, these reports must include the following:
i. The identification of each individual whose PHI has been or may have been accessed,
acquired, or disclosed;
ii. The nature of the unauthorized Use or Disclosure, including a brief description of what
happened, the date of the event(s), and the date of discovery;
iii. A description of the types of PHI involved;
iv. The investigative and remedial actions the Business Associate or its subcontractor took or
will take to prevent and mitigate harmful effects, and protect against recurrence;
v. Any details necessary for a determination of the potential harm to Individuals whose PHI is
believed to have been Used or Disclosed and the steps such Individuals should take to
protect themselves; and
vi. Such other information as HCA may reasonably request.
If Business Associate determines that it has or may have an independent notification obligation under any
state breach notification laws, Business Associate will promptly notify HCA. In any event, Business
Associate will notify HCA of its intent to give any notification under a state breach notification law no fewer
than ten (10) business days before giving such notification.
If Business Associate or any subcontractor or agent of Business Associate actually makes or causes, or
fails to prevent, a use or disclosure constituting a Breach within the meaning of the Breach Notification
Rule, and if notification of that use or disclosure must(in the judgment of HCA) be made under the
Breach Notification Rule, or RCW 42.56.590 or RCW 19.255.010, or other law or rule, then:
i. HCA may choose to make any notifications to the individuals, to the Secretary, and to the
media, or direct Business Associate to make them or any of them.
ii. In any case, Business Associate will pay the reasonable costs of notification to individuals,
media, and governmental agencies and of other actions HCA reasonably considers
appropriate to protect clients (such as paying for regular credit watches in some cases), and
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iii. Business Associate will compensate HCA clients for harms caused to them by the Breach or
possible Breach described above.
Business Associate's obligations regarding breach notification survive the termination of this Agreement
and continue for as long as Business Associate maintains the PHI and for any breach or possible breach at
any time.
4. Subcontractors
Business Associate will ensure that any subcontractors or agents that create, receive, maintain, or transmit
PHI on behalf of the Business Associate agree to protective restrictions, conditions, and requirements at
least as strict as those that apply to the Business Associate with respect to that information. Upon request
by HCA, Business Associate will identify to HCA all its subcontractors and provide copies of its agreements
(including business associate agreements or contracts)with them. The fact that Business Associate
subcontracted or otherwise delegated any responsibility to a subcontractor or anyone else does not relieve
Business Associate of its responsibilities.
5. Access
Business Associate will make available PHI in a designated record set to the HCA as necessary to satisfy
HCA's obligations under 45 CFR§ 164.524. Business Associate will give the information to HCA within five
(5) business days of the request from the individual or HCA, whichever is earlier. If HCA requests,
Business Associate will make that information available directly to the individual. If Business Associate
receives a request for access directly from the individual, Business Associate will inform HCA of the
request within three(3) business days, and if requested by HCA it will provide the access in accordance
with the HIPAA Rules.
6. Amending PHI
Business Associate will make any amendments to PHI in a designated record set as directed or agreed to
by the HCA pursuant to 45 CFR§ 164.526, or take other measures requested by HCA to satisfy HCA's
obligations under that provision. If Business Associate receives a request for amendment directly from an
individual, Business Associate will both acknowledge it and inform HCA within three (3) business days, and
if HCA so requests act on it within ten (10) business days and inform HCA of its actions.
7. Accounting
Business Associate will maintain and make available to HCA the information required to provide an
accounting of disclosures as necessary to satisfy HCA's obligations under 45 CFR§ 164.528. If Business
Associate receives an individual's request for an accounting, it will either provide the accounting as
required by the Privacy Rule or, at its option, pass the request on to HCA within ten (10) business days
after receiving it.
8. Obligations
To the extent the Business Associate is to carry out one or more of HCA's obligations under the Privacy
Rule, it will comply with the requirements of that rule that apply to HCA in the performance of such
obligations.
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9. Books, etc.
Business Associate will make its internal practices, books, and records available to the Secretary for
purposes of determining compliance with the HIPAA Rules.
10. Mitigation
Business Associate will mitigate, to the extent practicable, any harmful effect of a use or disclosure of PHI
by Business Associate or any of its agents or subcontractors in violation of the requirements of any of the
HIPAA Rules, this Agreement, or the Contract.
11. Indemnification
To the fullest extent permitted by law, Business Associate will indemnify, defend, and hold harmless the
State of Washington, HCA, and all officials, agents and employees of the State from and against all claims
of any kind arising out of or resulting from the performance of this Agreement, including Breach or violation
of HIPAA Rules.
12. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE
i. Limited use and disclosure
Except as provided in this Section 3, Business Associate may use or disclose PHI only as necessary
to perform the services set forth in the Contract.
ii. General limitation
Business Associate will not use or disclose PHI in a manner that would violate the Privacy Rule if
done by HCA.
iii. Required by law
Business Associate may use or disclose PHI as required by law.
iv. De-identifying
Business Associate may de-identified PHI in accordance with 45 CFR§ 164.514(a)-(c).
v. Minimum necessary
Business Associate will make uses and disclosures of only the minimum necessary PHI, and will
request only the minimum necessary PHI.
13. DISCLOSURE FOR MANAGEMENT AND ADMINISTRATION OF BUSINESS ASSOCIATE
Subject to subsection 3.6.2, Business Associate may disclose PHI for the proper management and
administration of Business Associate or to carry out the legal responsibilities of the Business Associate.
The disclosures mentioned in subsection 3.6.1 above are permitted only if either:
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a. The disclosures are required by law, or
b. Business Associate obtains reasonable assurances from the person to whom the information
is disclosed that the information will remain confidential and used or further disclosed only as
required by law or for the purposes for which it was disclosed to the person, and that the
person will notify Business Associate of any instances of which it is aware in which the
confidentiality of the information has been breached.
i. Aggregation
Business Associate may use PHI to provide data aggregation services relating to the health care
operations of the HCA, if those services are part of the Contract.
14. ACTIVITIES OF HCA
i. Notice of privacy practices
HCA will provide a copy of its current notice of privacy practices under the Privacy Rule to Business
Associate on request. HCA will also provide any revised versions of that notice by posting on its
website, and will send it on request.
ii. Changes in permissions
HCA will notify Business Associate of any changes in, or revocation of, the permission by an
individual to use or disclose his or her PHI, to the extent that such changes may affect Business
Associate's use or disclosure of PHI.
iii. Restrictions
HCA will notify Business Associate of any restriction on the use or disclosure of PHI that HCA has
agreed to or is required to abide by under 45 CFR§ 164.522, to the extent that such restriction may
affect Business Associate's use or disclosure of PHI. Business Associate will comply with any such
restriction.
15. TERM AND TERMINATION
i. Term
This Agreement is effective as of the earliest of:
a. The first date on which Business Associate receives or creates PHI subject to this
Agreement, or
b. The effective date of the Contract, or if there is more than one Contract then the effective
date of the first one to be signed by both parties.
This Agreement continues in effect until the earlier of:
a. Termination of the provision of Services under the Contract or, if there is more than one
Contract, under the last of the Contracts under which services are terminated,
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b. The termination of this Agreement as provided below, or
c. The written agreement of the parties.
ii. Termination for Cause
HCA may terminate this Agreement and the Contract(or either of them), if HCA determines Business
Associate has violated a material term of the Agreement. The termination will be effective as of the
date stated in the notice of termination.
iii. Obligations of Business Associate upon termination
The obligations of the Business Associate under this subsection 5.3 survive the termination of the
Agreement. Upon termination of this Agreement for any reason, Business Associate will:
a. Retain only that PHI that is necessary for Business Associate to continue its proper management
and administration or to carry out its legal responsibilities;
b. Return to HCA or, if agreed to by HCA, destroy the PHI that the Business Associate and any
subcontractor of Business Associate still has in any form (for purposes of this subsection 5.3, to
destroy PHI is to render it unusable, unreadable, or indecipherable to the extent necessary to
establish it is not Unsecured PHI, and Business Associate will provide HCA with appropriate
evidence of destruction within ten (10) business days of the destruction);
c. Continue to use appropriate safeguards and comply with the Security Rule with respect to
electronic PHI to prevent use or disclosure of the PHI, other than as provided for in this Agreement,
for as long as Business Associate retains any of the PHI (for purposes of this subsection 5.3, If the
PHI is destroyed it shall be rendered unusable, unreadable or indecipherable to the extent
necessary to establish it is not Unsecured PHI. Business Associate will provide HCA with
appropriate evidence of destruction);
d. Not use or disclose any PHI retained by Business Associate other than for the purposes for which
the PHI was retained and subject to the same conditions that applied before termination;
e. Return to HCA, or, if agreed to by HCA, destroy, the PHI retained by Business Associate when it is
no longer needed by Business Associate for its proper management and administration or to carry
out its legal responsibilities; and
f. Business Associate's obligations relating to providing information to the Secretary and other
government survive the termination of this Agreement for any reason.
iv. Successor
Nothing in this Agreement limits the obligations of Business Associate under the Contract regarding
giving data to HCA or to a successor Business Associate after termination of the Contract.
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16. MISCELLANEOUS
i. Amendment
The Parties agree to take such action as is necessary to amend this Agreement from time to time as
is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law.
ii. Interpretation
Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules.
iii. HCA Contact for Reporting and Notification Requirements
Business Associate will address all reporting and notification communications required in this
Agreement to:
HCA Privacy Officer
Washington State Health Care Authority
626 8th Avenue SE
PO Box 42704
Olympia, WA 98504-2700
Telephone: 360-725-2108
E-mail: PrivacyOfficer@hca.wa.gov
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ATTACHMENT 4-Data Use, Security and Confidentiality
1. Definitions
In addition to the definitions set out in Section 2: Definitions, of the Contract, the definitions below apply to
this Attachment:
"Authorized User" means an individual or individuals with an authorized business need to access HCA's
Confidential Information under this Contract.
"Client" means an individual who is eligible for or receiving services.
"Data" means the information that is disclosed or exchanged as described by this Contract. For purposes
of this Contract, Data means the same as"Confidential Information."
"Disclosure" means the release, transfer, provision of, access to, or divulging in any other manner of
information outside the entity holding the information.
"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, address, telephone numbers, social security numbers, driver's
license numbers, credit card numbers, any other identifying numbers, and any financial identifiers.
"Regulation" means any federal, state, or local regulation, rule, or ordinance.
"Use" includes the sharing, employment, application, utilization, examination, or analysis of Data.
2. Description of Data
i. Contractors collect various data elements associated with prevention programming and
service delivery. The Data will be provided by contractors on a monthly and a quarterly basis
and entered into Minerva.
ii. Data Use Purpose. (if more detail from purpose of overarching agreement is needed(i.e.,
more restrictions, etc.)The data is used by state and local providers for contract
management, program monitoring and to evaluate outcomes.
iii. Data elements associated with prevention programming including but not limited to:
a. Program and service details such as:
i. Name of program
ii. Program length in time and date
iii. Target service populations
iv. Target age groups
v. Location of activity in city, county, and zip code
vi. Number of participants
vii. Survey instruments used as well as fidelity plan
viii. Indirect and direct hours contributed by program staff and community
coalition coordinators
ix. EBP status
x. CSAP strategy and service code
xi. IOM category
xii. Target substance and behavioral health problem
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iv. The Data may be linked with the following: contract management and cost analysis via
PowerBI.
3. Data Classification
The State classifies data into categories based on the sensitivity of the data pursuant to the Security
policy and standards promulgated by the Office of the state of Washington Chief Information Officer. (See
Section 4, Data Security, of Securing IT Assets Standards No. 141.10 in the State Technology Manual at
https://ocio.wa.gov/policy/securing-information-technology-assets. Section 4 is hereby incorporated by
reference.)
The Data that is the subject of this Contract may be in any of the Categories indicated below:
❑ Category 1 —Public Information
Public information is information that can be or currently is released to the public. It does not need
protection from unauthorized disclosure, but does need integrity and availability protection controls.
❑ Category 2—Sensitive Information
Sensitive information may not be specifically protected from disclosure by law and is for official use only.
Sensitive information is generally not released to the public unless specifically requested.
❑x Category 3—Confidential Information
Confidential information is information that is specifically protected from disclosure by law. It may include
but is not limited to:
• Personal Information about individuals, regardless of how that information is obtained;
• Information concerning employee personnel records;
• Information regarding IT infrastructure and security of computer and telecommunications
systems;
❑ Category 4—Confidential Information Requiring Special Handling.
Category 4 Data is information that is specifically protected from disclosure and for which:
• Especially strict handling requirements are dictated, such as by statutes, regulations, or
agreements;
• Serious consequences could arise from unauthorized disclosure, such as threats to health and
safety, or legal sanctions.
4. Constraints on Use of Data
i. The Data being shared/accessed is owned and belongs to HCA.
ii. This Contract does not constitute a release of the Data for Contractor's discretionary use.
Contractor must use the Data received or accessed under this Contract only to carry out the
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purpose of this Contract. Any analyses, use, or reporting that is not within the Purpose of this
Contract is not permitted without HCA's prior written consent.
iii. Any disclosure of Data contrary to this Contract is unauthorized and is subject to penalties
identified in law.
5. Security of Data
i. Data Protection
a. Contractor must protect and maintain all Confidential Information gained by reason of
this Contract, information that is defined as confidential under state or federal law or
regulation, or Data that HCA has identified as confidential, against unauthorized use,
access, disclosure, modification or loss. This duty requires Contractor to employ
reasonable security measures, which include restricting access to the Confidential
Information by:
b. Allowing access only to staff that have an authorized business requirement to view the
Confidential Information; and
c. Physically securing any computer, documents, or other media containing the
Confidential Information.
ii. Data Security Standards
Contractor must comply with the Data Security Requirements set out in Attachment 4,
Confidential Information Security Requirements, and the Washington OCIO Security Standard,
141.10, which will include any successor, amended, or replacement regulation
(https://ocio.wa.gov/policy/securing-information-technology-assets.)The Security Standard
141.10 is hereby incorporated by reference into this Contract.
iii. Data Disposition
For the purposes of this section"fiscal year" is from July 1 to June 30.
Upon request by HCA, at the end of the Contract term, when no longer needed, or 6 years after
the end of the fiscal year in which the Data is received, Confidential Information/Data must be
returned to HCA or disposed of as set out in Attachment 4, Confidential Information Security
Requirements, except as required to be maintained for compliance or accounting purposes.
6. Data Confidentiality and Non-Disclosure
i. Data Confidentiality and Non-Disclosure
a. Data Confidentiality
Contractor will not use, publish, transfer, sell or otherwise disclose any Confidential
Information gained by reason of this Contract for any purpose that is not directly
connected with the purpose of this Contract, except:
• as provided by law; or
• with the prior written consent of the person or personal representative of the
person who is the subject of the Confidential Information.
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b. Penalties for Unauthorized Disclosure of Data
Contractor must ensure that all employees or Subcontractors who will have access to
the Data described in this Contract(including both employees who will use the Data
and IT support staff) are instructed and made aware of the use restrictions and
protection requirements of this Contract before gaining access to the Data identified
herein. Contractor will also instruct and make any new employee aware of the use
restrictions and protection requirements of this Contract before they gain access to the
Data.
State laws (including RCW 74.04.060 and RCW 70.02.020)and federal regulations
(including HIPAA Privacy and Security Rules, 45 CFR Part 160 and Part 164;
Confidentiality of Alcohol and Drug Abuse Patient Records, 42 CFR, Part 2; and
Safeguarding Information on Applicants and Beneficiaries, 42 CFR Part 431, Subpart
F) prohibit unauthorized access, use, or disclosure of Confidential Information.
Contractor must comply with all applicable federal laws and regulations concerning
collection, use, and disclosure of Personal Information and PHI. Violation of these laws
may result in criminal or civil penalties or fines.
Contractor accepts full responsibility and liability for any noncompliance by itself, its
employees, and its Subcontractors with these laws and any violations of the Contract.
c. Data Shared with Subcontractors
If Data access is to be provided to a Subcontractor under this Contract, Contractor
must include all of the Data security terms, conditions and requirements set forth in this
Contract in any such Subcontract. However, no subcontract will terminate Contractor's
legal responsibility to HCA for any work performed under this Contract nor for oversight
of any functions and/or responsibilities it delegates to any subcontractor
ii. Data Breach Notification
The Breach or potential compromise of Data must be reported to the HCA Privacy Officer at
PrivacyOfficer ..hca.wa.gov within two (2) business days of discovery. If Contractor does not
have full details, it will report what information it has, and provide full details within fifteen (15)
business days of discovery. To the extent possible, these reports must include the following:
a. The identification of each individual whose PHI has been or may have been improperly
accessed, acquired, used, or disclosed;
b. The nature of the unauthorized use or disclosure, including a brief description of what
happened, the date of the event(s), and the date of discovery;
c. A description of the types of Data involved;
d. The investigative and remedial actions Contractor or its Subcontractor took or will take to
prevent and mitigate harmful effects, and protect against recurrence;
e. Any details necessary for a determination of the potential harm to individuals whose Data
is believed to have been used or disclosed and the steps those individuals should take to
protect themselves; and
f. Any other information HCA reasonably requests.
Page 57 of 58
Washington State CBO Prevention Services
Health Care Authority HCA Contract K5263
Attachment 4—Data Use,Security and Confidentiality
DocuSign Envelope ID:CFE8684B-3162-447B-9C08-6FB664EBF8F7
iii. Contractor must take actions to mitigate the risk of loss and comply with any notification or other
requirements imposed by law or HCA including but not limited to 45 C.F.R. Part 164, Subpart D;
RCW 42.56.590; RCW 19.255.010; or WAC 284-04-625.
iv. If notification of the Breach or possible Breach must, in the judgement of HCA, be made under
the HIPAA Breach Notification Rule, or RCW 42.56.590 or RCW 19.255.010, or other law or rule,
then:
a. HCA may choose to make any required notifications to the individuals, to the U.S.
Department of Health and Human Services(DHHS) Secretary, and to the media, or
direct Contractor to make them or any of them.
b. In any case, Contractor will pay the reasonable costs of notification to individuals,
media, and governmental agencies and of other actions HCA reasonably considers
appropriate to protect HCA clients, such as paying for regular credit watches in some
cases.
c. Contractor will compensate HCA clients for harms caused to them by any Breach or
possible Breach.
v. Any breach of this clause may result in termination of the Contractor and the demand for return or
disposition, as described in Section 5.iii, of all Confidential Information.
vi. Contractor's obligations regarding Breach notification survive the termination of this Contract and
continue for as long as Contractor maintains the Confidential Information and for any Breach or
possible Breach at any time.
7. Inspection
HCA reserves the right to monitor, audit, or investigate compliance with this Contract in regards to the
Personal Information and PHI of Enrollees collected, used, or acquired by Contractor during the term of
this Contract and for six(6)years following termination or expiration of this Contract. HCA will have
access to Contractor's records and place of business for this purpose. All HCA representatives
conducting onsite audits of Contractor agree to keep confidential any patient-identifiable information
which may be reviewed during the course of any site visit or audit.
8. Indemnification for Unauthorized Use or Release
The Contractor must indemnify and hold HCA and its employees harmless from any damages related to
the Contractor's or Subcontractor's unauthorized use or release of Personal Information or PHI of
Enrollees.
Page 58 of 58
Washington State CBO Prevention Services
Health Care Authority HCA Contract K5263
Attachment 4—Data Use,Security and Confidentiality
DocuSign
Certificate Of Completion
Envelope Id:CFE8684B3162447B9C086FB664EBF8F7 Status:Delivered
Subject:DocuSign Notice:K5263-GSR-Lewis County Public Health&Social Svcs.pdf,K5263-LewisCounty.pdf
Source Envelope:
Document Pages:67 Signatures: 1 Envelope Originator:
Certificate Pages:5 Initials:0 Lisa Nelson
AutoNav:Enabled 626 8th Ave SE
Envelopeld Stamping:Enabled Olympia,WA 98501
Time Zone:(UTC-08:00)Pacific Time(US&Canada) Lisa.Nelson@HCA.WA.GOV
IP Address: 198.239.14.178
Record Tracking
Status:Original Holder:Lisa Nelson Location:DocuSign
7/20/2021 8:50:17 PM Lisa.Nelson@HCA.WA.GOV
Signer Events Signature Timestamp
Rachelle Amerine DoeuSipne°by:
Sent:7/21/2021 7:27:06 AM
rachelle.amerine@hca.wa.gov ' ""`"' Viewed:7/21/2021 8:15:30 PM
`71E17FEBBC774E7...
Contracts Administrator Signed:7/21/2021 8:16:47 PM
CloudPWR OBO Washington State Health Care
Authority-Sub Account Signature Adoption:Pre-selected Style
Security Level:Email,Account Authentication Using IP Address: 147.55.199.235
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Electronic Record and Signature Disclosure:
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JP Anderson Sent:7/21/2021 8:16:50 PM
jp.anderson@lewiscountywa.gov Viewed:7/22/2021 8:04:59 AM
Director
Lewis County Public Health&Social Services
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
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ID:b297e448-0b54-41d1-a611-c5e77fb70035
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Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Brittany Smith COPIED Sent:7/21/2021 7:27:07 AM
brittany.smith@hca.wa.gov
Security Level:Email,Account Authentication
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Electronic Record and Signature Disclosure:
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Carbon Copy Events Status Timestamp
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held i.jones@hca.wa.gov
Security Level:Email,Account Authentication
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Electronic Record and Signature Disclosure:
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Envelope Sent Hashed/Encrypted 7/21/2021 7:27:07 AM
Certified Delivered Security Checked 7/22/2021 8:04:59 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on:5/22/2019 6.49:33 AM
Parties agreed to:JP Anderson,Brittany Smith
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HOUSING
OPPORTUNITIES
— of SW Washington
Connecting people to homes,hope and opportunity. Jennifer Westerman,CEO
July 26, 2021
Marcus Valderrama
237 Logan Hill Rd
Chehalis WA 98532
RE: Final Contract Paperwork
Dear Marcus Valderrama:
The housing assistance for your new unit will start on 08-01-2021. Rent payment will be as
follows:
Beginning August 2021 forward rent will be:
$ 492.00 from HOSWWA and
$ 358.00 from you Marcus Valderrama for a total of
$ 850.00 Contract rent.
The Housing Authority will not pay rental assistance for days prior to 08-01-2021.
Please be aware that your portion of the rent does not include fees for parking, additional storage units or
any other optional cost charged by the landlord/owner. Those fees must be added onto your portion of
$358.00.
Your paperwork is ready and in need of signatures. I have enclosed it with this letter. Please sign and date
at the yellow highlighted marks. Please know this is time sensitive. Rental Assistance will not be released
to your landlord until all paperwork is signed, dated and received by our agency.
If you have any question, please feel free to call me.
Sincerely, Office Hours:
Monday- Thursday
10:00am—4:30pm
Cecilia Larson
Housing Specialist
(360)423-0140 ext. 24
cecilia.larsonhoswwa.org
820 11t Avenue •Longview, WA 98632 •(360)423-0140 •Toll Free(866) 570-8840
�"` FAX(360) 425-9930 •Toll Free Fax(888)424-7145 •TDD(800)833-6388 www.hoswwa.org
HOUSING OPPORTUNITIES OF SW WASHINGTON
*Certification of Rent: This information is presented to you in accordance with the
terms and conditions of 24 CFR 983, the PHA Administrative Policy, the HAP Contract
and your Lease Agreement. Please keep this information for your records. Copies of
signed HAP Contracts will no longer be mailed. If you wish copies of signed
certification documents, please contact an HOSWWA representative.
a Tenant's Copy to keep 0 Landlord's Copy to keep 0 HOSWWA Copy
*To the best of our knowledge Marcus Valderrama is responsible for paying the following utilities and providing the following
appliances:
Electricity 0Heat OWaterHeating water sewer Intrash ❑Range ❑Refrigerator
Tenant: Marcus Valderrama
Address: 237 Logan Hill Rd Chehalis
Landlord: Mary Ann Norris Date Leased: 08-01-2021
1. Contract Rent: 850
2. Tenant Rent to Owner: 358
3. HOSWWA Payment: 492
If rent begins on any day of the month after the 1",the rent will be prorated:
❑ HOSWWA will send Q each month to this tenant's utility provider
0 PUD
❑ City WGS
1 certify this info on is true a complete to the best of my knowledge. * PLEASE REMEMBER TO NOTIFY
FAMILY AND HOSWWA OF NEW
clarson RATE IN WRITING NO LESS THAN 60
DAYS BEFORE COMMENCEMENT
Date: July 26.2021 DATE (After first term is completed, or at
least 60 days before completion date)
HQS COMPLIANCE CERTIFICATION
SMOKE DETECTOR: Washington State law and 24 CFR 207 requires my landlord to install a
smoke detection device. I have been shown the location(s) and understand how it works. I agree to
the following statements:
• The smoke detection device (s) are functional.
• The smoke detection device (s)are located, to the extent practicable, adjacent to a bedroom.
• There is an operable smoke detection device on each level of my rented dwelling unit.
• I will not tamper or remove the smoke detection device.
• It is my responsibility to ensure that working batteries are kept in place.
REQUEST FOR REPAIRS: It is my responsibility...
• to keep my home in decent and safe condition. This includes removing garbage,
animal waste and other debris to garbage containers to help keep my home free from rodents and
insects;
• to keep my range top, oven or stove clean and free from grease and debris to prevent
grease fires;
• to notify my landlord IN WRITING (with a copy to HOSWWA) if owner provided appliances are
not working properly;
• to notify my landlord IN WRITING (with a copy to HOSWWA) if I need any repairs including
electrical,plumbing, windows, doors and locks, etc;
• to pay for any damages caused by my family or guests to my home;
• to keep all debris and furniture at least 12 inches from wall heaters.
I understand my responsibilities to notify the Owner and HOSWWA of any problems with
my rental unit.
Tenant-'Marcus Valderrama Date
Rev 10/10
Vouchers
V I VO-1243 Lewis
Valderrama Marcus
clarson
GUEST POLICY
Tenants participating in the Section 8 Rental Assistance Programs must adhere to the following rules when
allowing guests to stay in their assisted housing units:
1. All guests must have an alternate place of residence. (Exceptions to this rule may be granted
by the Housing Opportunities of SW Washington.)
2. Guests may stay in your dwelling unit for up to 14 days without notifying the Housing
Opportunities of SW Washington. You MUST notify your housing specialist in writing if
guests will be staying for more than 30 days.
3. Guests may stay in an assisted unit for up to 30 days with written approval from the
Housing Opportunities of SW Washington and the landlord, without adding them to the
Lease.
4. After 30 days, guests determined eligible(by the Housing Authority and the Landlord), will be
added to the lease.
5. After 30 days, guests determined ineligible by either the Housing Authority or your Landlord
must leave the dwelling. Their failure to leave may jeopardize your continued assistance.
6. You may have guests for no more than sixty (60) cumulative(TOTAL) days in a twelve (12)
month period.
I, Marcus Valderrama, understand that the purpose of this policy is to insure that my assistance is
accurately based on the total income of my household. If I add an additional person to my household
during the term of the Lease, I agree to provide written notice to my housing specialist within ten(10) days
of the change.
Head of Household,Marcus Valderrama Date
Spouse/Co-head or Other Adult Date
Other Adult Date
Vouchers
VIO VO-1243 Lewis
Valderrama Marcus
clarson
Reasons You Could Lose your Assistance!
Families who participate in the Housing Choice Voucher program are required to comply with all
rules of participation.
Please sign or initial each section:
All program participants and all members of the assisted family are required to comply with
all 21 rules of program participation listed on the back of the Housing Voucher.
All program participants are required to provide written notice of their intention to vacate, to
their landlord and HOSWWA. You must also sign a new Housing Voucher before
moving. If you move without a signed Voucher, your assistance will be terminated.
Any money owed to HOSWWA whether pending, in collections or with a signed repayment
agreement, will prevent you from being admitted to the program, being able to move and/or
remain on the assistance program until the debt is paid in full. All debts to all Housing
Authorities as a result of any participation on a rent assistance program must be paid
in full.
Failure to abide by the terms of a signed Repayment Agreement will always result in
termination of program participation.
The program participant including all members of that assisted family must not engage in
any abusive behavior toward Housing Authority personnel (staff). This includes
threatening Housing Authority personnel. Use of expletives (foul language) that are
generally considered insulting, racial epithets, or other language, written or oral,that is
customarily used to insult or intimidate, may be cause for termination or denial of
assistance.
You must always report all change in household income and family composition, in
writing within ten (10)days of the change.
If you are adding someone new, you must have your landlord's and the Housing Authority's
approval first! Failure to get approval before someone moves in could jeopardize your
assistance.
You must never pay additional or extra rent to your landlord that has not been approved
by the Housing Authority.
I, Marcus Valderrama certify by my signature that I have read and understand my responsibilities to
the Housing Authority.
Marcus Valderrama Date
Spouse or other adult Date
Other adult Date
Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards
Lead Warning Statement
Housing built before 1978 may contain lead-based paint. Lead from paint,paint chips,and dust can
pose health hazards if not managed properly. Lead exposure is especially harmful to young children
and pregnant women. Before renting pre-1978 housing,lessors must disclose the presence of known
lead-based paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a
federally approved pamphlet on lead poisoning prevention.
Lessor's Disclosure
(a) Presence of lead-based paint and/or lead-based paint hazards(check(i)or(ii)below):
(i) Known lead-based paint and/or lead-based paint hazards are present in the housing(explain.
(ii) Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
(b) Records and reports available to the lessor(check(i)or(ii)below):
(i) Lessor has provided the lessee with all available records and reports pertaining to lead-based
paint and/or lead-based paint hazards in the housing(list documents below).
(ii) 1- Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards
in the housing.
Lessee's Acknowledgme u t(initial)
(c) Lessee/Ten- ewed copies of all information listed above.
; (d) Lessee/Tenant has received the pamphlet Protect Your Family from Lead in Your Home. 'J
Agent's Acknowledgment(if applicable)(initial)
(e) Agent has informed the lessor of the lessor's obligations under 42 U.S.C.4852(d)and is aware of
his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify,to the best of their knowledge,that
the information they have provided is true and accurate.
PI a r J r1!�t Af 1r r K Y L 1/4/..7/
LessorfPrint Name) / Signature Date
Lessee/Tenant(Print Name) Signature a'.to
Agent(Print Name) Signature Date
8
Voucher U.S.Department of Housing OMB No.2577-0169
and Urban Development (exp.',,4130/2018)
Housing Choice Voucher Program Office of Public and Indian Housing
Public reporting Burden for this collection of information is estimated to average 0.05 hours per response,including the time for reviewing instructions,searching
existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. This agency may not conduct or
sponsor,and a person is not required to respond to,a collection of information unless that collection displays a valid OMB control number. Assurances of
confidentiality are not provided under this collection. This collection of information is authorized under Section 8 of the U.S.Housing Act of 1937(42 U.S.C.
1437f). The information is used to authorize a family to look for an eligible unit and specifies the size of the unit. The information also sets forth the family's
obligations under the Housing Choice Voucher Program.
Privacy Act Statement. The Department of Housing and Urban Development(MUD)is authorized to collect the information required on this.fonn by Section 8 of
the U.S.,Housing Act of 1937(42 U.S.C.1437f). Collection of family members'names is,mandatory.':The information is used to.authorize,a family to look for an
eligible unit and specifies the size of the unit. The information also sets forth the family's obligations under the Housing Choice Voucher Program. HUD may
disclose this information to Federal,State and local agencies when relevant to civil,criminal,or regulatory investigations and prosecutions. It will not be otherwise
disclosed or released outside of HUD,except as permitted or required by law. Failure to provide any of the information may result In delay or rejection of family
voucher Issuance.
Please read entire document before completing form Voucher Number
Fill in all blanks below. Type or print clearly. VASH
1. tnsert unit size in number of bedrooms. (This is the number of bedrooms for which the Family qualifies and is 1. Unit Size
used in determining the amount of assistance to be paid on behalf of the Family to the owner.) 2
2. Date Voucher Issued(mmlddlyyyy) 2. Issue Date(mm/dd/yyyy)
Insert actual date the Voucher is issued to the Family 06/10/2021
3. Date Voucher Expires(mmldd/yyyy) Insert date sixty days after date 3. Expiration Date(mm/dd/yyyy)
Voucher is issued. (See Section 6 of this form.) 10/08/2021
4. Date Extension Expires(if applicable)(mm/dd/yyyy) Date Extension Expires(mm/dd/yyyy)
(See Section 6.of this form) N/A
5. Name of Family Representative 6. Signature of Family Representative Date Signed(mm/dd/yyyy)
Marcus Valderrama {J
7. Name of Public Housing Agency(PHA)
Housing Opportunities of SW Washington
8. Name and Title of PHA Official 9. Signature o HA Official Date Signed(mm/dd/yyyy)
' 6/10/2021
Cecilia Larson, Housing Specialist
1. Housing Choice Voucher Program
A. The public housing agency PHA)has determined that the above-named family(item 5)is eligible to participate in the
housing choice voucher program. Under this program,the family chooses a decent,safe and sanitary unit to live in. If the
owner agrees to lease the unit to the family under the housing choice voucher program,and if the PHA approves the unit,
the PHA will enter into a housing assistance payments(HAP)contract with the owner to make monthly payments to the
owner to help the family pay the rent.
B. The PHA determines the amount of the monthly housing assistance payment to be paid to the owner. Generally,the
monthly housing assistance payment by the PHA is the difference between the applicable payment standard and 30 percent
of the monthly adjusted family income. In determining the maximum initial housing assistance payment for the family,the
PHA will use the payment standard in effect on the date the tenancy is approved by the PHA. The family may choose to
rent a unit for more than the payment standard,but this choice does not change the amount of the PHA's assistance
payment. The actual amount of the PHA's assistance payment will be determined using the gross rent for the unit selected
by the family.
2. Voucher
A. When issuing this voucher the PHA expects that if the family finds an approvable unit,the PHA will have the money
available to enter into a HAP contract with the owner. However,the PHA is under no obligation to the family,to any owner,
or to any other person,to approve a tenancy. The PHA does not have any liability to any party by the issuance of this
voucher.
B. The voucher does not give the family any right to participate in the PHA's housing choice voucher program. The family
becomes a participant in the PHA's housing choice voucher program when the HAP contract between the PHA and the
owner takes effect.
C. During the initial or any extended term of this voucher,the PHA may require the family to report progress in leasing a unit at
such intervals and times as determined by the PHA
3. PHA Approval or Disapproval of Unit or Lease
A. When the family finds a suitable unit where the owner is willing to participate in the program,the family must give the PHA the request for
tenancy approval(on the form supplied by the PHA),signed by the owner and the family,and a copy of the lease including the HUD-
prescribed tenancy addendum. Note: Both documents must be given to the PHA'no later than the expiration date stated in item 3 or 4
on top of page one of this voucher.
B. The family must submit these documents in the manner that is required by the PHA. PHA policy may prohibit the family from submitting
more than one request for tenancy approval at a time.
C. The lease must include,word-for-word,all provisions of the tenancy addendum required by HUD and supplied by the PHA. This is done by
adding the HUD tenancy addendum to the lease used by the owner. If there is a difference between any provisions of the HUD tenancy
addendum and any provisions of the owner's lease,the provisions of the HUD tenancy addendum shall control.
D. After receiving the request for tenancy approval and a copy of the lease,the PHA will inspect the unit. The PHA may not give approval for
the family to lease the unit or execute the HAP contract until the PHA has determined that all the following program requirements are met:
the unit is eligible;the unit has been inspected by the PHA and passes the housing quality standards(HQS);the rent is reasonable;and the
landlord and the tenant have executed the lease including the HUD-prescribed tenancy addendum.
E. If the PHA approves the unit,the PHA will notify the family and the owner,and will furnish two copies of the HAP contract to the owner.
1. The owner and the family must execute the lease.
2. The owner must sign both copies of the HAP contract and must furnish to the PHA a copy of the executed lease and both copies of the
executed HAP contract.
3. The PHA will execute the HAP contract and return an executed copy to the owner.
F. If the PHA determines that the unit or lease cannot be approved for any reason,the PHA will notify the owner and the family that:
1. The proposed unit or lease is disapproved for specified reasons,and
2. If the conditions requiring disapproval are remedied to the satisfaction of the PHA on or before the date specified by the PHA,the unit
or lease will he approved.
4. Obligations of the Family
A. When the family's unit is approved and the HAP contract is executed,the family must follow the rules listed below in order to continue
participating in the housing choice voucher program.
B. The family must:
I. supply any information that the PHA or HUD determines to be necessary including evidence of citizenship or eligible immigration
status,and information for use in a regularly scheduled reexamination or interim reexamination of family income and composition.
2. disclose and verify social security numbers and sign and submit consent forms for obtaining information.
3. supply any information requested by the PHA to verify that the family is living in the unit or information related to family absence from
the unit.
4. promptly notify the PHA in writing when the family will be away from the unit for an extended period of time in accordance with PHA
policies.
5. allow the PIIA to inspect the unit at reasonable times and after reasonable notice.
6. notify the PHA and the owner in writing before moving out of the unit or terminating the lease.
7. Use the assisted unit for residence by the family. The unit must be the family's only residence.
8. Promptly notify the PHA in writing of the birth,adoption,or court-awarded custody of a child.
9. Request PHA written approval to add any other family member as an occupant of the unit.
10. Promptly notify the PHA in writing if any member no longer lives in the unit. Give the PHA a copy of any other eviction notice.
11. Pay utility bills and provide and maintain any appliances that the owner is not required to provide under the lease.
C. Any information the family supplies must be true and complete.
D. The family(including each family member)must not:
I. Own or have any interest in the unit(other than in a cooperative,or the owner of a manufactured home leasing a manufactured home
space).
2. Commit any serious or repeated violation of the lease.
3. Commit fraud,bribery or any other corrupt or criminal act in connection with the program.
4. Engage in drug-related criminal activity or violent criminal activity or other criminal activity that threatens the health,safety or right to
peaceful enjoyment of other residents residing in the immediate vicinity of the premises.
5. Sublease or let the unit or assign the lease or transfer the unit.
6. Receive housing choice voucher program housing assistance while receiving another housing subsidy,for the same unit or a different
unit under any other Federal,state or local housing assistance program.
7. Damage the unit or premises(other than damage from ordinary wear and tear)or permit any guest to damage the unit or premises.
8. Receive housing choice voucher program housing assistance while residing in a unit owned by a parent,child,grandparent,grandchild,
sister or brother of any member of the family,unless the PHA has determined(and has notified the owner and the family of such
determination)that approving rental of the unit,notwithstanding such relationship,would provide reasonable accommodation for a
family member who is a person with disabilities.
9. Engage in abuse of alcohol in a way that threatens the health,safety or right to peaceful enjoyment of the other residents and persons
residing in the immediate vicinity of the premises.
5. Illegal Discrimination
If the family has a reason to believe that,in its search for suitable housing,it has been discriminated against on the basis of age,race,color,religion,
sex,disability,national origin,or familial status,the family may file a housing discrimination complaint with any HUD Field Office in person,by
mail,or by telephone. The PHA will give the family information on how to fill out and file a complaint.
6. Expiration and Extension of Voucher
The voucher will expire on the date stated in item 3 on the top of page one of this voucher unless the family requests an extension in writing and the
PHA grants a written extension of the voucher in which case the voucher will expire on the date stated in item 4. At its discretion,the PHA may
grant a family's request for one or more extensions of the initial term.
HOUSING
� :. OPPORTUNITIES
of SW Washington
Connecting people to homes,hope and opportunity. Jennifer Westerman,CEO
July 26, 2021
Office Hours
Monday-Thursday
Mary Ann Norris 1 0:00am—4:30pm
246 Lucas Creek Rd.
Centralia WA 98531
RE: Marcus Valderrama - 237 Logan Hill Rd , Chehalis WA 98532
Final Contract Paperwork
Dear Mary Ann Norris:
The housing assistance for Marcus's new unit will start on 08-01-2021. Payment will be as follows:
Beginning August 1, 2021 forward rent will be:
$ 492.00 from HOSWWA and
$ 358.00 from Marcus Valderrama for a total of
$ 850.00 Contract Rent
The Housing Authority will not pay rental assistance for days prior to 08-01-2021.
Please be aware that the tenant's portion of the rent does not include fees for parking, additional storage units
or any other optional cost charged by the landlord/owner. Those fees must be added onto their portion of
$358.00.
The paperwork is ready and in need of signatures. I have enclosed it with this letter. Please sign and date at the
blue highlighted marks. Return the enclosed signature pages.
OUR AGENCY IS REQUIRED TO HAVE ALL PAPERWORK SIGNED BEFORE RELEASING THE RENTAL
ASSISTANCE.
If you have any questions, please feel free to contact me.
Sincerely
Cecilia Larson
Housing Specialist
cecilia.Iarson(a hoswwa.orq
820 1l"Avenue •Longview, WA 98632 •(360)423-0140 •Toll Free(866) 570-8840
FAX(360)425-9930 •Toll Free Fax(888) 424-7145 •TDD(800)833-6388 www.hoswwa.org
HOUSING OPPORTUNITIES OF SW WASHINGTON
*Certification of Rent: This information is presented to you in accordance with the
terms and conditions of 24 CFR 983, the PHA Administrative Policy, the HAP Contract
and your Lease Agreement. Please keep this information for your records. Copies of
signed HAP Contracts will no longer be mailed. If you wish copies of signed
certification documents, please contact an HOSWWA representative.
❑ Tenant's Copy to keep Landlord's,Copy to keel) 0 HOSWWA Copy
*To the best of our knowledge Marcus Valderrama is responsible for paying the following utilities and providing the following
appliances:
EElectricity OHeat OWater Heating water sewer trash ❑Range ❑Refrigerator
Tenant: Marcus Valderrama
Address: 237 Logan Hill Rd Chehalis
Landlord: Mary Ann Norris Date Leased: 08-01-2021
I 4. Contract Rent: 850
5. Tenant Rent to Owner: 358
6. HOSWWA Payment: 492
If rent begins on any day of the month after the 1",the rent will be prorated:
❑ HOSWWA will send each month to this tenant's utility provider
❑ PUD
❑ City WGS
I certifythis i at s true and c * PLEASE REMEMBER TO NOTIFY
plete to the best of my knowledge. FAMILY AND LHA OF NEW RATE IN
clarson WRITING NO LESS THAN 60 DAYS
BEFORE COMMENCEMENT DATE
Date: July 26,2021 (After first term is completed, or at least 60
days before completion date)
Attachment to: Tenancy Addendum
Section 8 Tenant-Based Assistance
Housing Choice Voucher Program
(to be attached to Tenant Lease)
X The Lease document attached to this Tenancy Addendum will have an initial term of 1
year(s), 0 month(s), commencing on and terminating on
All other provisions of the lease remain the same.
OR
The Lease document attached to this Tenancy Addendum has been amended to have a new initial
term of 1 year(s), 0 month(s), commencing on 08-01-2021 and terminating on 07-31-2022
All other provisions of the lease remain the same.
✓ This lease document complies with State and Local Law.
This lease document contains all the required information (please indicate):
✓ the unit address
✓ the amount of monthly rent to owner
✓ the name of the owner and the tenant
✓ which utilities and appliances are the tenant's responsibility, and which are the owner's
responsibility.
By signing below, I understand and agree to all the terms of the attached Lease document.
Marcus Valderrama Date
Spouse or other adult signature Date
mar,An.Moms Date
24 CFR 982.308
VouchersVlOVO-1243 Lewis
Marcus Valderrama
clarson
Rev LFIA 4/05
cl U.S.Department of Housing
Housing Assistance Payments Contract and Urban Development
(HAP Contract) Office of Public and Indian
Section 8 Tenant-Based Assistance Housing
Housing Choice Voucher Program
Part A of the HAP Contract: Contract Information
(To prepare the contract,fill out all contract information in Part A.
1. Contents of Contract
This HAP contract has three parts:
Part A: Contract Information
Part B: Body of Contract
Part C: Tenancy Addendum
2. Tenant
Marcus Valderrama
3. Contract Unit
237 Logan Hill Rd
Chehalis WA 98532
4. Household
The following persons may reside in the unit. Other persons may not be added to the household without prior written
approval of the owner and the PHA.
Marcus Valderrama
Veronica Valderrama
Jayson Valderrama
5. Initiat Lease Term
The initial lease term begins on(mm/dd/yy): *PLEASE REMEMBER TO NOTIFY
08-01-2021 FAMILY AND HOSWWA OF NEW RATE IN
WRITING NO LESS THAN 60 DAYS
07-31^2022 BEFORE COMMENCEMENT DATE (After
first tertn is completed,or at least 60 days
The initial lease term ends on(mm/dd/yyyy):
before completion date)
6. Initial Rent to Owner
The initial rent to owner is: 850.00
During the initial lease term, the owner may not raise the rent to owner.
7. Initial Housing Assistance Payment
The HAP contract term commences on the first day of the initial lease term. At the beginning of the HAP contract term,the
amount of the housing assistance payment by the PHA to the owner $492.00 per month. The amount of the monthly
housing assistance payment by the PHA to the owner is subject to change during the HAP contract term in accordance with
HUD requirement.
Previous editions are obsolete Page 2 of 12 Form HUD-52641
(3/2000)
ref Handbook 7420.8
8. Utilities and Appliances
The owner shall provide or pay for the utilities and appliances indicated below by an"0". The tenant shall provide or pay for the utilities and appliances
indicated below by a"T". Unless otherwise specified below,the owner shall pay for all utilities and appliances provided by the owner.
Item Special fuel type Provided by Paid by
Heating o Natural Gas o Bottle Gas ID Oil or electric o Coal/Other O Tenant
Owner
Cooking o Natural Gas o Bottle Gas ❑x Oil or electric o Coal/Other Owner Tenant
Water heating o Natural Gas o Bottle Gas Oil or electric o Coal/Other Owner Tenant
Other electric Owner Tenant
Water Owner Owner
* PLEASE REMEMBER TO NOTIFY FAMILY AND
Sewer HOSWWA OF NEW RATE IN WRITING NO LESS Owner Owner
Trash Collection THAN 60 DAYS BEFORE COMMENCEMENT DATE Owner Tenant
(After first term is completed, or at least 60 days before
Air conditioning completion date)
Refrigerator
Owner
Range/Microwave Owner
Other(specify)
Signatures:
Public Housing Agency Owner
HOUSING OPPORTUNITIES OF SW Mary Ann Norris
WASHINGTON
Print or Type Name of PHA Print or Type name of Owner
Signature Signature
Vickie Rhodes, HAP Manager Mary Ann Norris
Print or Type name and Title of Signatory Pr' t or Type Name and Title of Signatory
Date(mm/dd/yyyy) Date(min/dd/my)
Mail Payments to:
246 Lucas Creek Rd.
Centralia, WA 98531
Previous editions are obsolete Page 3 of 12 Form HUD-52641
(3/2000)
Rev Handbook 7420.8
VouchersV I OVO-I243 Lewis
Val derramaMarcus/clarson
Housing Assistance Payments Contract U.S.Department of Housing
(HAP Contract) and Urban Development
Section 8 Tenant-Based Assistance Office of Public and Indian Housing
Housing Choice Voucher Program
Part B of HAP Contract: Body of Contract HAP contract. The PHA may not exercise such
remedies against the owner because of an HQS breach
1. Purpose for which the family is responsible, and that is not
a. This is a HAP contract between the PHA and the owner. caused by the owner.
The HAP contract is entered to provide assistance for d. The PHA shall not make any housing assistance pay-
the family under the Section 8 voucher program (see ments if the contract unit does not meet the HQS,unless
HUD program regulations at 24 Code of Federal the owner corrects the defect within the period specified
Regulations Part 982). by the PHA and the PHA verifies the correction. If a
b. The HAP contract only applies to the household and defect is life threatening, the owner must correct the
contract unit specified in Part A of the HAP contract. defect within no more than 24 hours. For other defects,
the owner must correct the defect within the period
c. During the HAP contract term, the PHA will pay specified by the PHA.
housing assistance payments to the owner in accordance
with the HAP contract. e. The PHA may inspect the contract unit and premises at
d. The family will reside in the contract unit with such times as the PHA determines necessary, to ensure
assistance under the Section 8 voucher program. The
that the unit is in accordance with the HQS.
housing assistance payments by the PHA assist the f. The PHA must notify the owner of any HQS defects
tenant to lease the contract unit from the owner for shown by the inspection.
occupancy by the family. g. The owner must provide all housing services as agreed
to in the lease.
2. Lease of Contract Unit
a. The owner has leased the contract unit to the tenant for 4. Term of HAP Contract
occupancy by the family with assistance under the Sec- a. Relation to lease term. The term of the HAP contract
tion 8 voucher program. begins on the first day of the initial term of the lease,
b. The PHA has approved leasing of the unit in accordance and terminates on the last day of the term of the lease
with requirements of the Section 8 voucher program. (including the initial lease term and any extensions).
c. The lease for the contract unit must include word-for- b. When HAP contract terminates.
word all provisions of the tenancy addendum required (1) The HAP contract terminates automatically if
by HUI)(Part C of the HAP contract). the lease is terminated by the owner or the
d. The owner certifies that: tenant.
(1) The owner and the tenant have entered into a (2) The PHA may terminate program assistance for
lease of the contract unit that includes all the family for any grounds authorized in
provisions of the tenancy addendum. accordance with HUD requirements. If the PHA
terminates program assistance for the family,the
(2) The lease is in a standard form that is used in HAP contract terminates automatically.
the locality by the owner and that is generally
used for other unassisted tenants in the (3) If the family moves from the contract unit, the
premises. HAP contract terminates automatically.
(3) The lease is consistent with State and local law. (4) The HAP contract terminates automatically 180
calendar days after the last housing assistance
e. The owner is responsible for screening the family's payment to the owner.
behavior or suitability for tenancy. The PHA is not
responsible for such screening.The PHA has no liability (5) The PHA may terminate the HAP contract if the
or responsibility to the owner or other persons for the PHA determines, in accordance with HUD
family's behavior or the family's conduct in tenancy. requirements, that available program funding is
not sufficient to support continued assistance for
3. Maintenance,Utilities,and Other Services families in the program.
a. The owner must maintain the contract unit and premises (6) The 1-1AP contract terminates automatically upon
in accordance with the housing quality standards(HQS). the death of a single member household,
b. The owner must provide all utilities needed to comply including single member households with a live-
with the HQS. in aide.
(7) The PHA may terminate the HAP contract if the
c. If the owner does not maintain the contract unit in PHA determines that the contract unit does not
accordance with the HQS,or fails to provide all utilities provide adequate space in accordance with the
needed to comply with the HQS,the PHA may exercise HQS because of an increase in family size or a
any available remedies. PHA remedies for such breach change in family composition.
include recovery of overpayments, suspension of
housing assistance payments, abatement or other (8) If the family breaks up,the PHA may terminate
reduction of housing assistance payments, termination the HAP contract, or may continue housing
of housing assistance payments, and termination of the
Previous editions are obsolete Page 4 of 13 form HUD-52641 (7/2019)
t0010293
assistance payments on behalf of family PHA is due to factors beyond the PHA's
members who remain in the contract unit. control. Moreover, the PHA shall not be
(9) The PHA may terminate the HAP contract if the obligated to pay any late payment penalty if
PHA determines that the unit does not meet all housing assistance payments by the PHA are
requirements of the HQS,or determines that the delayed or denied as a remedy for owner breach
owner has otherwise breached the HAP contract. of the 1-IAP contract (including any of the
following PHA remedies: recovery of
5. Provision and Payment for Utilities and Appliances overpayments, suspension of housing assistance
a. The lease must specify what utilities are to be provided payments, abatement or reduction of housing
assistance payments, termination of housing
or paid by the owner or the tenant, assistance payments and termination of the
h. The lease must specify what appliances are to be pro- contract).
vided or paid by the owner or the tenant. (4) Housing assistance payments shall only be paid
c. Part A of the HAP contract specifies what utilities and to the owner while the family is residing in the
appliances are to be provided or paid by the owner or contract unit during the term of the HAP
the tenant. The lease shall be consistent with the HAP contract. The PHA shall not pay a housing
contract. assistance payment to the owner for any month
after the month when the family moves out.
6. Rent to Owner: Reasonable Rent b. Owner compliance with HAP contract Unless the
a. During the HAP contract term,the rent to owner may at owner has complied with all provisions of the HAP
no time exceed the reasonable rent for the contract unit contract, the owner does not have a right to receive
as most recently determined or redetermined by the housing assistance payments under the HAP contract.
PHA in accordance with HUD requirements. c. Amount of PHA payment to owner
b The PHA must determine whether the rent to owner is {t} The amount of the monthly PHA housing
reasonable in comparison to rent for other comparable assistance payment to the owner shall be
unassisted units. To make this determination, the PHA determined by the PHA in accordance with
must consider: HUD requirements for a tenancy under the
(1) The location, quality, size, unit type, and age of voucher program.
the contract unit;and
(2) The amount of the PHA housing assistance
(2) Any amenities, housing services, maintenance payment is subject to change during the HAP
and utilities provided and paid by the owner. contract term in accordance with HUD
c. The PHA must redetermine the reasonable rent when requirements. The PHA must notify the family
required in accordance with HUD requirements. The and the owner of any changes in the amount of
PHA may redetermine the reasonable rent at any time. the housing assistance payment.
d. During the HAP contract term, the rent to owner may (3) The housing assistance payment for the first
not exceed rent charged by the owner for comparable month of the HAP contract term shall be pro-
unassisted units in the premises. The owner must give rated for a partial month.
the PHA any information requested by the PHA on rents d. Application of payment The monthly housing
charged by the owner for other units in the premises or assistance payment shall be credited against the monthly
elsewhere. rent to owner for the contract unit.
7. PHA Payment to Owner e. Limit of PHA responsibility
a. When paid (I) The PHA is only responsible for making
housing assistance payments to the owner in
(1) During the term of the HAP contract, the PHA accordance with the HAP contract and HUD
must make monthly housing assistance requirements for a tenancy under the voucher
payments to the owner on behalf of the family program.
at the beginning of each month. (2) The PHA shall not pay any portion of the rent to
(2) The PHA must pay housing assistance payments owner in excess of the housing assistance
promptly when due to the owner. payment. The PIIA shall not pay any other
(3) If housing assistance payments are not paid claim by the owner against the family.
promptly when due after the first two calendar f. Overpayment to owner If the PHA determines that the
months of the HAP contract term,the PHA shall owner is not entitled to the housing assistance payment
pay the owner penalties if all of the following or any part of it,the PHA,in addition to other remedies,
circumstances apply: (i) Such penalties are in may deduct the amount of the overpayment from any
accordance with generally accepted practices amounts due the owner (including amounts due under
and law, as applicable in the local housing any other Section 8 assistance contract).
market,governing penalties for late payment of
rent by a tenant;(ii)It is the owner's practice to 8. Owner Certification
charge such penalties for assisted and unassisted During the term of this contract,the owner certifies that:
tenants; and (iii) The owner also charges such a. The owner is maintaining the contract unit and premises
penalties against the tenant for late payment of in accordance with the HQS.
family rent to owner. However, the PHA shall b. The contract unit is leased to the tenant. The lease
not be obligated to pay any late payment penalty includes the tenancy addendum (Part C of the HAP
if HUD determines that late payment by the
Previous editions are obsolete Page 5 of 13 form HUD•52641 (7/2019)
t0010293
contract), and is in accordance with the HAP contract criminal act in connection with the mortgage or
and program requirements. The owner has provided the loan.
lease to the PHA,including any revisions of the lease. (5) If the owner has engaged in any drug-related
•
c. The rent to owner does not exceed rents charged by the criminal activity or any violent criminal activity.
owner for rental of comparable unassisted units in the b. If the PHA determines that a breach has occurred, the
premises. PHA may exercise any of its rights and remedies under
d. Except for the rent to owner,the owner has not received the HAP contract, or any other available rights and
and will not receive any payments or other remedies for such breach. The PHA shall notify the
consideration(from the family,the PHA,HUD, or any owner of such determination,including a brief statement
other public or private source)for rental of the contract of the reasons for the determination. The notice by the
unit during the HAP contract term. PHA to the owner may require the owner to take
e. The family does not own or have any interest in the corrective action,as verified or determined by the PHA,
contract unit. by a deadline prescribed in the notice.
f. To the best of the owner's knowledge,the members of c. The PHA's rights and remedies for owner breach of the
the family reside in the contract unit,and the unit is the HAP contract include recovery of overpayments,
family's only residence. suspension of housing assistance payments, abatement
g. The owner (including a principal or other interested or other reduction of housing assistance payments,
party) is not the parent,child, grandparent, grandchild, termination of housing assistance payments, and
sister, or brother of any member of the family, unless termination of the HAP contract.
the PHA has determined(and has notified the owner and d. The PHA may seek and obtain additional relief by
the family of such determination)that approving rental judicial order or action,including specific performance,
of the unit, notwithstanding such relationship, would other injunctive relief or order for damages.
provide reasonable accommodation for a family e. Even if the family continues to live in the contract unit,
member who is a person with disabilities. the PHA may exercise any rights and remedies for
owner breach of the HAP contract.
9. Prohibition of Discrimination.In accordance with applicable f. The PHA's exercise or non-exercise of any right or
equal opportunity statutes,Executive Orders,and regulations: remedy for owner breach of the HAP contract is not a
a. The owner must not discriminate against any person waiver of the right to exercise that or any other right or
because of race,color,religion,sex,national origin,age, remedy at any time.
familial status,or disability in connection with the HAP
contract. Eligibility for HUD's programs must be made 11. PHA and HUD Access to Premises and Owner's Records
without regard to actual or perceived sexual orientation, a. The owner must provide any information pertinent to
gender identity,or marital status. the HAP contract that the PHA or HUD may reasonably
b. The owner must cooperate with the PHA and HUD in require.
conducting equal opportunity compliance reviews and b. The PHA, HUD and the Comptroller General of the
complaint investigations in connection with the HAP United States shall have full and free access to the
contract. contract unit and the premises, and to all accounts and
c. Violence Against Women Act. The owner must comply other records of the owner that are relevant to the HAP
contract, including the right to examine or audit the
with the Violence Against Women Act, as amended, records and to make copies.
and HUD's implementing regulation at 24 CFR part 5,
Subpart L,and program regulations. c. The owner must grant such access to computerized or
other electronic records, and to any computers, equip-
10. Owner's Breach of HAP Contract ment or facilities containing such records, and must
a. Any of the following actions by the owner(including a provide any information or assistance needed to access
principal or other interested party) is a breach of the the records.
HAP contract by the owner: 12. Exclusion of Third Party Rights
(1) If the owner has violated any obligation under a. The family is not a party to or third party beneficiary of
the HAP contract, including the owner's Part B of the HAP contract.The family may not enforce
obligation to maintain the unit in accordance any provision of Part B,and may not exercise any right
with the HQS. or remedy against the owner or PHA under Part B.
(2) If the owner has violated any obligation under b. The tenant or the PHA may enforce the tenancy
any other housing assistance payments contract addendum (Part C of the HAP contract) against the
under Section 8. owner,and may exercise any right or remedy against the
owner under the tenancy addendum.
(3) If the owner has committed fraud, bribery or c. The PHA does not assume any responsibility for injury
any other corrupt or criminal act in connection to, or any liability to, any person injured as a result of
with any Federal housing assistance program.
the owner's action or failure to act in connection with
(4) For projects with mortgages insured by HUD or management of the contract unit or the premises or with
loans made by HUD, if the owner has failed to implementation of the HAP contract, or as a result of
comply with the regulations for the applicable any other action or failure to act by the owner.
mortgage insurance or loan program, with the d. The owner is not the agent of the PHA,and the HAP
mortgage or mortgage note, or with the contract does not create or affect any relationship
regulatory agreement; or if the owner has between the PHA and any lender to the owner or any
committed fraud,bribery or any other corrupt or suppliers,employees,contractors or subcontractors used
Previous editions are obsolete Page 6 of 13 form HUD-52641 (7/2019)
10010293
by the owner in connection with management of the (2) A court or administrative agency has determined
contract unit or the premises or with implementation of that the owner or proposed new owner violated
the HAP contract. the Fair Housing Act or other Federal equal
opportunity requirements.
13. Conflict of Interest e. The HAP contract may not be assigned to a new owner
a. "Covered individual"means a person or entity who is a if the new owner (including a principal or other
member of any of the following classes: interested party) is the parent, child, grandparent,
(1) Any present or former member or officer of the grandchild, sister or brother of any member of the
PHA (except a PHA commissioner who is a family,unless the PHA has determined(and has notified
participant in the program); the family of such determination) that approving the
(2) Any employee of the PHA, or any contractor, assignment, notwithstanding such relationship, would
sub-contractor or agent of the PHA, who provide reasonable accommodation for a family
formulates policy or who influences decisions member who is a person with disabilities.
with respect to the program; f. The PHA may deny approval to assign the HAP contract
(3) Any public official, member of a governing if the owner or proposed new owner (including a
body,or State or local legislator,who exercises principal or other interested party):
functions or responsibilities with respect to the (1) Has violated obligations under a housing
program;or assistance payments contract under Section 8;
(4) Any member of the Congress of the United (2) Has committed fraud, bribery or any other
States. corrupt or criminal act in connection with any
b. A covered individual may not have any direct or indirect Federal housing program;
interest in the HAP contract or in any benefits or (3) Has engaged in any drug-related criminal
payments under the contract(including the interest of an activity or any violent criminal activity;
immediate family member of such covered individual) (4) Has a history or practice of non-compliance
while such person is a covered individual or during one with the HQS for units leased under the Section
year thereafter. 8 tenant-based programs, or non-compliance
c. "Immediate family member" means the spouse, parent with applicable housing standards for units
(including a stepparent), child (including a stepchild), leased with project-based Section 8 assistance or
grandparent, grandchild, sister or brother (including a for units leased under any other Federal housing
stepsister or stepbrother)of any covered individual. program;
d. The owner certifies and is responsible for assuring that (5) Has a history or practice of failing to terminate
no person or entity has or will have a prohibited interest, tenancy of tenants assisted under any Federally
at execution of the HAP contract, or at any time during assisted housing program for activity engaged in
the HAP contract term. by the tenant, any member of the household, a
e. If a prohibited interest occurs, the owner shall guest or another person under the control of any
promptly and fully disclose such interest to the PHA member of the household that:
and HUD.
(a)Threatens the right to peaceful enjoyment
f. The conflict of interest prohibition under this section of the premises by other residents;
may be waived by the HUD field office for good cause. (b)Threatens the health or safety of other
g. No member of or delegate to the Congress of the residents,of employees of the PHA,or of
United States or resident commissioner shall be owner employees or other persons engaged
admitted to any share or part of the HAP contract or to in management of the housing;
any benefits which may arise from it. (c)Threatens the health or safety of,or the
right to peaceful enjoyment of their
14. Assignment of the HAP Contract residents by,persons residing in the
a. The owner may not assign the HAP contract to a new immediate vicinity of the premises;or
owner without the prior written consent of the PHA. (d) Is drug-related criminal activity or violent
b. If the owner requests PHA consent to assign the HAP criminal activity;
contract to a new owner, the owner shall supply any (6) Has a history or practice of renting units that fail
information as required by the PHA pertinent to the to meet State or local housing codes;or
proposed assignment. (7) Has not paid State or local real estate taxes,
c. The HAP contract may not be assigned to a new owner fines or assessments.
that is debarred,suspended or subject to a limited denial g. The new owner must agree to be bound by and comply
of participation under HUD regulations(see 24 Code of with the HAP contract. The agreement must be in
Federal Regulations Part 24). writing, and in a form acceptable to the PHA. The new
d. The FIAP contract may not be assigned to a new owner owner trust give the PHA a copy of the executed
if HUD has prohibited such assignment because: agreement.
(I) The Federal government has instituted an
administrative or judicial action against the 15. Reserved
owner or proposed new owner for violation of
the Fair Housing Act or other Federal equal 16.Written Notices Any notice by the PHA or the owner in
opportunity requirements, and such action is connection with this contract must be in writing.
pending;or
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17. Entire Agreement:Interpretation
a. The HAP contract contains the entire agreement
between the owner and the PHA.
h The HAP contract shall be interpreted and implemented
in accordance with all statutory requirements, and with
all HUD requirements, including the HUD program
regulations at 24 Code of Federal Regulations Part 982.
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Housing Assistance Payments Contract U.S.Department of Housing
(HAP Contract) and Urban Development
Office of Public and Indian Housing
Section 8 Tenant-Based Assistance
Housing Choice Voucher Program
Part C of HAP Contract: Tenancy Addendum (2) Rent charged by the owner for comparable
unassisted units in the premises.
1. Section 8 Voucher Program
5. Family Payment to Owner
a. The owner is leasing the contract unit to the tenant for
occupancy by the tenant's family with assistance for a a. The family is responsible for paying the owner any
tenancy under the Section 8 housing choice voucher portion of the rent to owner that is not covered by the
program (voucher program) of the United States PHA housing assistance payment.
Department of Housing and Urban Development(HUD). b. Each month, the PHA will make a housing assistance
payment to the owner on behalf of the family in
b. The owner has entered into a Housing Assistance Payments accordance with the HAP contract. The amount of the
Contract (HAP contract) with the PHA under the voucher monthly housing assistance payment will be determined
program. Under the HAP contract, the PHA will make by the PHA in accordance with HUD requirements for a
housing assistance payments to the owner to assist the tenancy under the Section 8 voucher program.
tenant in leasing the unit from the owner.
c. The monthly housing assistance payment shall be credited
2. Lease against the monthly rent to owner for the contract unit.
a. The owner has given the PHA a copy of the lease,including d. The tenant is not responsible for paying the portion of rent
any revisions agreed by the owner and the tenant. The to owner covered by the PHA housing assistance payment
owner certifies that the terms of the lease are in accordance under the HAP contract between the owner and the PHA.
with all provisions of the HAP contract and that the lease A PHA failure to pay the housing assistance payment to
includes the tenancy addendum, the owner is not a violation of the lease. The owner may
b. The tenant shall have the right to enforce the tenancy not terminate the tenancy for nonpayment of the PHA
addendum against the owner. If there is any conflict housing assistance payment.
between the tenancy addendum and any other provisions of e. The owner may not charge or accept,from the family or
the lease, the language of the tenancy addendum shall from any other source,any payment for rent of the unit in
control. addition to the rent to owner. Rent to owner includes all
3. Use of Contract Unit housing services, maintenance, utilities and appliances to
be provided and paid by the owner in accordance with the
a. During the lease term, the family will reside in the lease.
contract unit with assistance under the voucher program. f. The owner must immediately return any excess rent
h. The composition of the household must be approved by payment to the tenant.
the PHA. The family must promptly infonn the PHA of 6. Other Fees and Charges
the birth, adoption or court-awarded custody of a child.
Other persons may not be added to the household without a. Rent to owner does not include cost of any meals or
prior written approval of the owner and the PHA. supportive services or furniture which may be provided
c. The contract unit may only be used for residence by the by the owner.
PHA-approved household members.The unit must be the b. The owner may not require the tenant or family members
fan-lily's only residence. Members of the household may to pay charges for any meals or supportive services or
engage in legal profit making activities incidental to furniture which may be provided by the owner.
primary use of the unit for residence by members of the Nonpayment of any such charges is not grounds for
family. termination of tenancy.
d. The tenant may not sublease or let the unit. c. The owner may not charge the tenant extra amounts for
e. The tenant may not assign the lease or transfer the unit. items customarily included in rent to owner in the
locality,or provided at no additional cost to unsubsidized
4. Rent to Owner tenants in the premises.
a. The initial rent to owner may not exceed the amount 7. Maintenance,Utilities,and Other Services
approved by the PHA in accordance with HUD a. Maintenance
requirements.
(1) The owner must maintain the unit and premises in
b. Changes in the rent to owner shalt be determined by the accordance with the HQS.
provisions of the lease.However,the owner may not raise (2) Maintenance and replacement (including
the rent during the initial term of the lease. redecoration) must be in accordance with the
c. During the term of the lease(including the initial term of standard practice for the building concerned as
the lease and any extension term),the rent to owner may established by the owner.
at no time exceed:
(1) The reasonable rent for the unit as most recently b Utilities and appliances
(1) The owner must provide all utilities needed to
determined or redetermined by the PHA in comply with the HQS.
accordance with HUD requirements,or
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(2) The owner is not responsible for a breach of the (3) The owner may terminate the tenancy for criminal
HQS caused by the tenant's failure to: activity by a household member in accordance with
(a) Pay for any utilities that are to be paid by the this section if the owner determines that the
tenant. household member has committed the criminal
activity,regardless of whether the household
(b) Provide and maintain any appliances that arc member has been arrested or convicted for such
to be provided by the tenant. activity.
c. Family damage.The owner is not responsible for a (4) The owner may terminate the tenancy during the
breach of the HQS because of damages beyond normal term of the lease if any member of the household
wear and tear caused by any member of the household or has engaged in abuse of alcohol that threatens the
by a guest. health,safety or right to peaceful enjoyment of the
d. Housing services. The owner must provide all premises by other residents.
housing services as agreed to in the lease. d. Other good cause for termination of tenancy\
8. Termination of Tenancy by Owner (I) During the initial lease term,other good cause for
a. Requirements.The owner may only terminate the tennination of tenancy must be something the
tenancy in accordance with the lease and HUD family did or failed to do.
requirements. (2) During the initial lease term or during any
b. Grounds. During the term of the lease (the initial extension term,other good cause may include:
term of the lease or any extension term),the owner (a) Disturbance of neighbors,
may only terminate the tenancy because of: (b) Destruction of property,or
(1) Serious or repeated violation of the lease; c
( ) Living or housekeeping habits that cause
(2) Violation of Federal, State, or local law that damage to the unit or premises.
imposes obligations on the tenant in connection (3) After the initial lease term,such good cause may
with the occupancy or use of the unit and the include:
premises;
(a) The tenant's failure to accept the owner's
(3) Criminal activity or alcohol abuse (as provided in offer of a new lease or revision;
paragraph c);or (b) The owner's desire to use the unit for personal
(4) Other good cause(as provided in paragraph or family use or for a purpose other than use
d)• as a residential rental unit;or
c. Criminal activity or alcohol abuse. (c) A business or economic reason for termination
(1) The owner may terminate the tenancy during of the tenancy (such as sale of the property,
the term of the lease if any member of the renovation of the unit, the owner's desire to
household, a guest or another person under a rent the unit for a higher rent).
resident's control commits any of the following (d) The examples of other good cause in this
types of criminal activity: paragraph do not preempt any State or local
(a) Any criminal activity that threatens the
laws to the contrary.
health or safety of,or the right to peaceful 9. Protections for Victims of Domestic Violence, Dating
enjoyment of the premises by,other Violence,Sexual Assault,or Stalking.
residents(including property management
staff residing on the premises); a. Purpose: This section incorporates the protections for
(b) Any criminal activity that threatens the victims of domestic violence, dating violence, sexual
health or safety of,or the right to peaceful assault, or stalking in accordance with subtitle N of the
enjoyment it residences by,persons Violence Against Women Act of 1994, as amended
residing in the immediate vicinity of the (codified as amended at 42 U.S.C. 14043e et seq.)(VAWA)
premises;
and implementing regulations at 24 CFR part 5,subpart L.
(c) Any violent criminal activity on or near the b. Conflict with other Provisions:In the event of any conflict
premises;or between this provision and any other provisions included in
Part C of the HAP contract,this provision shall prevail.
(d) Any drug-related criminal activity on or
near the premises.
(2) The owner may terminate the tenancy during the
term of the lease if any member of the household is:
(a) Fleeing to avoid prosecution,or custody or
confinement after conviction, for a crime,
or attempt to commit a crime, that is a
felony under the laws of the place from
which the individual flees, or that, in the
case of the State of New Jersey, is a high
misdemeanor;or
(b) Violating a condition of probation or parole
under Federal or State law.
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c. Effect on Other Protections: Nothing in this section shall be However, the Landlord or the PHA will not subject the
construed to supersede any provision of any Federal,State,or tenant, who is or has been a victim of domestic violence,
local law that provides greater protection than this section for dating violence, sexual assault, or stalking, to a more
victims of domestic violence,dating violence,sexual assault, demanding standard than other tenants in determining
or stalking. whether to evict or terminate assistance. 24 CFR
d. Definition: As used in this Section, the terms "actual and 5.2005(d)(2).
imminent threat,""affiliated individual","bifurcate","dating i. Actual and imminent Threats:
violence," "domestic violence," "sexual assault," and (1) Nothing in this section will be construed to limit the
"stalking"are defined in HUD's regulations at 24 CFR part 5, authority of the Landlord to evict the Tenant if the
subpart L. The terms"Household"and"Other Person Under Landlord can demonstrate that an "actual and imminent
the Tenant's Control"are defined at 24 CFR part 5,subpart A. threat"to other tenants or those employed at or providing
e. VAWA Notice and Certification Form: The PHA shall service to the property would be present if the Tenant or
provide the tenant with the "Notice of Occupancy Rights lawful occupant is not evicted. In this context, words,
under VAWA and the certification form described under 24 gestures, actions, or other indicators will be construed as
CFR 5.2005(a)(1)and(2). an actual and imminent threat if they meet the following
f. Protection for victims of Domestic Violence,Dating standards for an actual and imminent threat: "Actual and
imminent threat" refers to a physical danger that is real,
Violence,Sexual Assault,or Stalking:
would occur within an immediate time frame, and could
(1) The landlord or the PHA will not deny admission to, result in death or serious bodily harm. In determining
deny assistance under,terminate from participation in, whether an individual would pose an actual and imminent
or evict the Tenant on the basis of or as a direct result threat,the factors to be considered include:the duration of
of the fact that the Tenant is or has been a victim of the risk,the nature and severity of the potential harm,the
domestic violence, dating violence, sexual assault,or likelihood that the potential harm will occur,and the length
stalking, if the Tenant otherwise qualifies for of time before the potential harm would occur. 24 CFR
admission, assistance,participation,or occupancy. 24 5.2005(d)(3).
CFR 5.2005(b}(1). (2) If an actual and imminent threat is demonstrated,eviction
(2) The tenant shall not be denied tenancy or occupancy should be used only when there are no other actions that
rights solely on the basis of criminal activity engaged could be taken to reduce or eliminate the threat,including,
in by a member of the Tenant's Household or any but not limited to, transferring the victim to a different
guest or Other Person Under the Tenant's Control,if unit, barring the perpetrator from the property, contacting
the criminal activity is directly related to domestic law enforcement to increase police presence, developing
violence, dating violence, sexual assault, or stalking, other plans to keep the property safe,or seeking other legal
and the Tenant or an Affiliated Individual of the remedies to prevent the perpetrator from acting on a threat.
Tenant is the victim or the threatened victim of Restrictions predicated on public safety cannot be based on
domestic violence, dating violence, sexual assault, or stereotypes,but must be tailored to particularized concerns
stalking.24 CFR 5.2005(b)(2). about individual residents.24 CFR 5.2005(d)(4).
(3) An incident or incidents of actual or threatened j. Emergency Transfer: A tenant who is a victim of domestic
domestic violence, dating violence, sexual assault or violence,dating violence, sexual assault,or stalking may request
stalking will not be construed as serious or repeated an emergency transfer in accordance with the PHA's emergency
violations of the lease by the victim or threatened transfer plan. 24 CFR 5.2005(e). The PHA's emergency transfer
victim of the incident.Nor shall it not be construed as plan must be made available upon request, and incorporate strict
other "good cause" for termination of the lease, confidentiality measures to ensure that the PHA does not disclose
tenancy, or occupancy rights of such a victim or a tenant's dwelling unit location to a person who committed or
threatened victim.24 CFR 5.2005(c)(l)and(c)(2). threatened to commit an act of domestic violence,dating violence,
g. Compliance with Court Orders: Nothing in this sexual assault,or stalking against the tenant;
Addendum will limit the authority of the landlord, when For transfers in which the tenant would not be considered a new
notified by a court order,to comply with the court order with applicant, the PHA must ensure that a request for an emergency
respect to the rights of access or control of property transfer receives,at a minimum,any applicable additional priority
(including civil protection orders issued to protect a victim of that is already provided to other types of emergency transfer
domestic violence, dating violence, sexual assault, or requests. For transfers in which the tenant would be considered a
stalking) or with respect to the distribution or possession of new applicant,the plan must include policies for assisting a tenant
property among members of the Tenant's Household. 24 with this transfer.
CFR5.2005{d)(l), k. Bifurcation: Subject to any lease termination requirements or
h. Violations Not Premised on Domestic Violence, Dating procedures prescribed by Federal, State, or local law, if any
Violence, Sexual Assault, or Stalking: Nothing in this member of the Tenant's Household engages in criminal activity
section shall be construed to limit any otherwise available directly relating to domestic violence, dating violence, sexual
authority of the Landlord to evict or the public housing assault, or stalking, the Landlord may "bifurcate"the Lease, or
authority to terminate the assistance of a Tenant for any remove that Household member from the Lease,without regard to
violation not premised on an act of domestic violence,dating whether that Household member is a signatory to the Lease, in
violence,sexual assault,or stalking that is in question against order to evict, remove, or terminate the occupancy rights of that
the Tenant or an Affiliated Individual of the Tenant. Household member without evicting, removing, or otherwise
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penalizing the victim of the criminal activity who is also a tenant time-limited release; required for use in an eviction
or lawful occupant. Such eviction, removal, termination of proceeding;or is required by applicable law.
occupancy rights,or termination of assistance shall be effected in 10. Eviction bycourt action
accordance with the procedures prescribed by Federal, State, and
local law for the termination of leases or assistance under the The owner may only evict the tenant by a court action.
housing choice voucher program.24 CFR 5.2009(a). 11. Owner notice of grounds
lithe Landlord bifurcates the Lease to evict,remove,or terminate (I) At or before the beginning of a court action to evict the
assistance to a household member,and that household member is tenant,the owner must give the tenant a notice that specifies
the sole tenant eligible to receive assistance, the landlord shall the grounds for termination of tenancy. The notice may be
provide any remaining tenants or residents a period of 30 calendar included in or combined with any owner eviction notice.
days from the date of bifurcation of the lease to:
(1) Establish eligibility for the same covered housing program (2) The owner must give the PHA a copy of any owner eviction
under which the evicted or terminated tenant was the notice at the same time the owner notifies the tenant.
recipient of assistance at the time of bifurcation of the lease; (3) Eviction notice means a notice to vacate,or a complaint or
(2) Establish eligibility under another covered housing other initial pleading used to begin an eviction action under
program;or State or local law.
(3) Find alternative housing. 12. Lease: Relation to HAP Contract
1. Family Break-up: If the family break-up results from an If the HAP contract terminates for any reason, the lease terminates
occurrence of domestic violence,dating violence,sexual assault,or automatically.
stalking,the PHA must ensure that the victim retains assistance.24 13. PHA Termination of Assistance
CFR 982315. The PHA may terminate program assistance for the family for any
m. Move with Continued Assistance: The public housing agency grounds authorized in accordance with HUD requirements.If the PHA
may not terminate assistance to a family or member of the family terminates program assistance for the family, the lease terminates
that moves out of a unit in violation of the lease, with or without automatically.
prior notification to the public housing agency if such a move 14. FamilyMove Out
occurred to protect the health or safety of a family member who is
or has been a victim of domestic violence,dating violence,sexual The tenant must notify the PHA and the owner before the family moves
assault, or stalking; and who reasonably believed they were out of the unit.
imminently threatened by harm from further violence if they 15. Security Deposit
remained in the dwelling unit,or if any family member has been
the victim of sexual assault that occurred on the premises during a. The owner may collect a security deposit from the
the 90-calendar-day period preceding the family's request to tenant. (However, the PHA may prohibit the owner
move. from collecting a security deposit in excess of private
(1) The move is needed to protect the health or safety of the market practice, or in excess of amounts charged by
family or family member who is or has been a victim of the owner to unassisted tenants. Any such PHA-
domestic violence dating violence, sexual assault or required restriction must be specified in the HAP
stalking;and contract.)
(2) The family or member of the family reasonably believes that b When the family moves out of the contract unit, the
he or she was threatened with imminent harm from further owner, subject to State and local law, may use the
security deposit,including any interest on the deposit,
violence if he or she remained in the dwelling unit. as reimbursement for any unpaid rent payable by the
However,any family member that has been the victim of a tenant,any damages to the unit or any other amounts
sexual assault that occurred on the premises during the 90- that the tenant owes under the lease.
calendar day period preceding the family's move or request
to move is not required to believe that he or she was c. The owner must give the tenant a list of all items
threatened with imminent harm from further violence if the charged against the security deposit, and the amount
or she remained in the dwelling unit.24 CFR 982.354, of each item.After deducting the amount,if any,used
to reimburse the owner, the owner must promptly
n. Confidentiality. refund the full amount of the unused balance to the
(I) The Landlord shall maintain in strict confidence any tenant.
information the Tenant(or someone acting on behalf of the d.If the security deposit is not sufficient to cover
Tenant) submits to the Landlord concerning incidents of amounts the tenant owes under the lease, the owner
domestic violence,dating violence,sexual assault or stalking, may collect the balance from the tenant.
including the fact that the tenant is a victim of domestic
violence,dating violence,sexual assault,or stalking. 16. Prohibition of Discrimination
(2) The Landlord shall not allow any individual administering In accordance with applicable equal opportunity statutes, Executive
assistance on its behalf, or any persons within its employ,to Orders, and regulations, the owner must not discriminate against any
have access to confidential information unless explicitly person because of race, color, religion, sex, national origin, age,
authorized by the Landlord for reasons that specifically call for familial status or disability in connection with the lease. Eligibility for
these individuals to have access to the information pursuant to HUD's programs must be made without regard to actual or perceived
applicable Federal,State,or local law, sexual orientation,gender identity,or marital status.
(3) The Landlord shall not enter confidential information into
any shared database or disclose such information to any other 17. Conflict with Other Provisions of Lease
entity or individual,except to the extent that the disclosure is a. The terms of the tenancy addendum are prescribed
requested or consented to in writing by the individual in a by HUD in accordance with Federal law and
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regulation, as a condition for Federal assistance to Housing quality standards(HQS).The HUD minimum quality
the tenant and tenant's family under the Section 8 standards for housing assisted under the Section 8 tenant-based
voucher program. programs.
b. In case of any conflict between the provisions of the HUD.The U.S.Department of Housing and Urban Development.
tenancy addendum as required by HUD, and any
other provisions of the lease or any other agreement HUD requirements.HUD requirements for the Section 8 program.
HUD requirements are issued by HUD headquarters,as regulations,
between the owner and the tenant,the requirements
Federal Register notices or other binding program directives.
of the HUD-required tenancy addendum shall
control. Lease.The written agreement between the owner and the tenant for
the lease of the contract unit to the tenant.The lease includes the
IS. Changes in Lease or Rent tenancy addendum prescribed by HUD.
a. The tenant and the owner may not make any change PHA.Public Housing Agency.
in the tenancy addendum.However,if the tenant and Premises.The building or complex in which the contract unit
the owner agree to any other changes in the lease, is located,including common areas and grounds.
such changes must be in writing, and the owner
Program.The Section 8 housing choice voucher program.must immediately give the PHA a copy of such
changes.The lease, including any changes, must be Rent to owner.The total monthly rent payable to the owner for the
in accordance with the requirements of the tenancy contract unit.The rent to owner is the sum of the portion of rent
addendum. payable by the tenant plus the PHA housing assistance payment to the
b. In the following cases, tenant-based assistance shall owner.
not be continued unless the PHA has approved a Section 8.Section 8 of the United States Housing Act of 1937(42
new tenancy in accordance with program United States Code 1437f).
requirements and has executed a new HAP contract Tenant. The family member(or members)who leases the unit from
with the owner: the owner.
(I) If there are any changes in lease Voucher program.The Section 8 housing choice voucher program.
requirements governing tenant or owner Under this program,HUD provides funds to a PHA for rent subsidy
responsibilities for utilities or appliances; on behalf of eligible families.The tenancy under the lease will be
(2) If there are any changes in lease provisions assisted with rent subsidy for a tenancy under the voucher program.
governing the term of the lease;
(3) If the family moves to a new unit, even if
the unit is in the same building or complex.
c. PHA approval of the tenancy, and execution of a
new HAP contract, are not required for agreed
changes in the lease other than as specified in
paragraph b.
d. The owner must notify the PHA of any changes in
the amount of the rent to owner at least sixty days
before any such changes go into effect, and the
amount of the rent to owner following any such
agreed change may not exceed the reasonable rent
for the unit as most recently determined or
redetermined by the PHA in accordance with HUD
requirements.
19. Notices
Any notice under the lease by the tenant to the owner or by the owner
to the tenant must be in writing.
20. Definitions
Contract unit.The housing unit rented by the tenant with assistance
under the program.
Family.The persons who may reside in the unit with assistance under
the program.
HAP contract.The housing assistance payments contract between the
PHA and the owner. The PHA pays housing assistance payments to
the owner in accordance with the HAP contract.
Household. The persons who may reside in the contract unit. The
household consists of the family and any PHA-approved live-in aide.
(A live-in aide is a person who resides in the unit to provide necessary
supportive services for a member of the family who is a person with
disabilities.)
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BOCC AGENDA ITEM SUMMARY
Resolution: 21-299 BOCC Meeting Date: Aug. 10, 2021
Suggested Wording for Agenda Item: Agenda Type: Deliberation
Approve Agreement between Washington Health Care Authority and Lewis County for CBO
Prevention Services
Contact: Sandi Andrus Phone: 360-740-1148
Department: PHSS - Public Health & Social Services
Description:
This is the primary source of substance use disorder prevention funding used to fund our after-
school programs in Morton and White Pass. Typical programs funded by this contract are positive
action education, community awareness campaigns, and Youth Mental Health First Aid training.
Effective 7/1/2021 to 6/30/2023.
Approvals: Publication Requirements:
Publications:
User Status
Erik Martin Pending
J.P. Anderson Pending
PA's Office Approved
Tammy Martin Pending
Additional Copies: Cover Letter To:
Sandi Andrus, Darci Southgate, Sara Email: Brittany Smith:
Bumgardner, Grace Jimenez, Michelle Sauter, Brittany.Smith@hca.wa.gov
Jill Nielson, Sherri Dokken, Bryan Hall Heidi Jones: Hiedi.Jones@hca.wa.gov
Rachelle Amerine:
Rachelle.Amerine@hca.wa.gov
Lisa Nelson: Lisa.Nelson@hca.wa.gov