Department of Commerce Local and Community Projects Program - Frances Anderson Center RoofZ I Originator:
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H Department/Division:
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Name of Consultant/Contractor:
05 CONTRACT TITLE:
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No.
CONTRACT ROUTING FORIII+I
(City Clerk Use Only)
Thom Sullivan Routed by: Thom Sullivan
Public Works/Facilities Date: 06/13/2018
Dept. of Commerce
Local and Community Projects Program -Frances Anderson Center Roof
Type of Contract: (GR) Grants (1) Intergovernmental Agreement
Z Z (S) Purchase of Services (W) Public Works
W
Z
Bid/RFP Number:
O
0 Effective Date:
L) Has the original City contract boilerplate language been modified?
I.- If yes, specify which sections have been modified:
pDescription
0 of Services:
Total Amount of Contract:
Budget #
J
Budget #
W
0
Q Budget #
a,
Z Are there sufficient funds in the current budget to cover this contract.
Q
Z Remarks:
Authorization Level: Mayor
W
1. Project Manager
Q2. Risk Management/Budget
Z 3. City Attorney
4. Consultant/Contractor
WEJ 5. Other
Completion Date:
®Yes ® No
Amount:
Amount:
Amount
Yes ® No
❑ 6. City Council Approval
Date (if applicable)
❑✓ 7. Mayor
❑ 8. City Clerk
(L) Lease Agreement
(0) Other
i
INTERLOCAL AGREEMENT
(((''�jj ��rr»Ry�o,� sorer `
❑�rnRT,VJEA rH Community Settings Respite Care
SC]C[SLkHALTi-!
1864DSHS 2333AgreementNumber:
1864-23337
ERV1
(excluding IFS Program Participants)
This Agreement is by and between the State of Washington Department
Program Contract Number:
of Social and Health Services (DSHS) and the Contractor identified
Contractor Contract Number:
below, and is issued pursuant to the Interlocal Cooperation Act, chapter
200128501
39.34 RCW. 11
CONTRACTOR NAME
CONTRACTOR doing business as (DBA)
Citv of Edmonds
Cit of Edmonds Parks And Recreation
CONTRACTOR ADDRESS
WASHINGTON UNIFORM DSHS INDEX NUMBER
BUSINESS IDENTIFIER (UBI)
700 Main St
Edmonds, WA 98020
312-000-093 22474
CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE
Todd Cort
425) 771-0229
1 (425) 771-0253 todd.cortedmondswa, ov
DSHS ADMINISTRATION DSHS DIVISION
DSHS CONTRACT CODE
Developmental Disabilities Division of Developmental Disabilities
1803LP-64
Admin
DSHS CONTACT NAME AND TITLE
_
DSHS CONTACT ADDRESS
Gina M. Thomas
840 N Broadway A100
Program Specialist II
Everett, WA 98201
DSHS CONTACT TELEPHONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL, ADDRESS
(425)339-4840
(425)339-4856
Thoma_ m dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? 1
CFDA NUMBER(S)
No
AGREEMENT START DATE
AGREEMENT END DATE
MAXIMUM AGREEMENT AMOUNT
03/01/2018
02/28/2021
Fee For Service
EXHIBITS. The following Exhibits are attached and are incorporated into this Agreement by reference:
® Exhibits (specify): Exhibit A - Rate Table
❑ No Exhibits.
The terms and conditions of this Agreement are an integration and representation of the final, entire and exclusive I
understanding between the parties superseding and merging all previous agreements, writings, and communications, oral
or otherwise regarding the subject matter of this Agreement, between the parties. The parties signing below represent
they have read and understand this Agreement, and have the authority to execute this Agreement. This Agreement shall
be bindinq on DSHS only upon signature by DSHS.
c
CONTRAC R SIG U
PRINTED NAME AND TITLE
DATE SIGNED
[
,,'-,
Todd Cort
SI
PRINTED NAME AND TITLE
DATE SIGNED
Joseph F. Carter, Operations Manager DDA R2
C'1A REGE1VED A✓-
CON_rRACrs 7-2/9
DSHS Central Contract Services JAN` u 2018
1803LP DDD Respite In Community Settings (5-6-11) Page 1
DDq REGION 2
EVERETT
DSHS General Terms and Conditions
1. Definitions. The words and phrases listed below, as used in this Contract, shall each have the
following definitions:
a. "Central Contracts and Legal Services" means the DSHS central headquarters contracting office, or
successor section or office.
b. "Confidential Information" or "Data" means information that is exempt from disclosure to the public
or other unauthorized persons under RCW 42.56 or other federal or state laws. Confidential
Information includes, but is not limited to, Personal Information.
c. "Contract" or "Agreement" means the entire written agreement between DSHS and the 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 or Facsimile transmission of a signed copy of this contract
shall be the same as delivery of an original.
d. "CCLS Chief' means the manager, or successor, of Central Contracts and Legal Services or
successor section or office.
e. "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.
f. "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.
g. "DSHS" or the "Department" means the state of Washington Department of Social and Health
Services and its employees and authorized agents.
h. "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,
i. "Personal Information" means information identifiable to any person, including, but not limited to,
information that relates to a person's name, health, finances, education, business, use or receipt of
governmental services or other activities, addresses, telephone numbers, Social Security Numbers,
driver license numbers, other identifying numbers, and any financial identifiers.
j. "Physically Secure" means that access is restricted through physical means to authorized
individuals only.
k. "Program Agreement" means an agreement between the Contractor and DSHS containing special
terms and conditions, including a statement of work to be performed by the Contractor and payment
to be made by DSHS.
I. "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.leg.wa.gov/rcw/.
m. "Regulation" means any federal, state, or local regulation, rule, or ordinance.
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DSHS General Terms and Conditions
n. "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.
o. "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.
p. "Tracking" means a record keeping system that identifies when the sender begins delivery of
Confidential Information to the authorized and intended recipient, and when the sender receives
confirmation of delivery from the authorized and intended recipient of Confidential Information.
q. "Trusted Systems" include only 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, DHQ 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.
r. "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.leg.wa.gov/wac/.
2. Amendment. This Contract may only be modified by a written amendment signed by both parties. Only
personnel authorized to bind each of the parties may sign an amendment.
3. Assignment. The Contractor shall not assign this Contract or any Program Agreement to a third party
without the prior written consent of DSHS.
4. Billing Limitations.
a. DSHS shall pay the Contractor only for authorized services provided in accordance with this
Contract.
b. DSHS 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.
c. The Contractor shall not bill and DSHS 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.
5. 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.
6. Confidentiality.
a. The Contractor shall 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
Contractor's performance of the services contemplated hereunder, except:
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DSHS General Terms and Conditions
(1) as provided by law; or,
(2) in the case of Personal Information, with the prior written consent of the person or personal
representative of the person who is the subject of the Personal Information.
b. The Contractor shall protect and maintain all Confidential Information gained by reason of this
Contract against unauthorized use, access, disclosure, modification or loss. This duty requires the
Contractor to employ reasonable security measures, which include restricting access to the
Confidential Information by:
(1) Allowing access only to staff that have an authorized business requirement to view the
Confidential Information.
(2) Physically_Securing any computers,_ documents, or other media containing the Confidential
Information.
(3) Ensure the security of Confidential Information transmitted via fax (facsimile) by:
(a) Verifying the recipient phone number to prevent accidental transmittal of Confidential
Information to unauthorized persons.
(b) Communicating with the intended recipient before transmission to ensure that the fax will be
received only by an authorized person.
(c) Verifying after transmittal that the fax was received by the intended recipient.
(4) When transporting six (6) or more records containing Confidential Information, outside a
Secured Area, do one or more of the following as appropriate:
(a) Use a Trusted System.
(b) Encrypt the Confidential Information, including:
i. Encrypting email and/or email attachments which contain the Confidential Information.
ii. Encrypting Confidential Information when it is stored on portable devices or media,
including but not limited to laptop computers and flash memory devices.
Note: If the DSHS Data Security Requirements Exhibit is attached to this contract, this
item, 6.b.(4), is superseded by the language contained in the Exhibit.
(5) Send paper documents containing Confidential Information via a Trusted System.
(6) Following the requirements of the DSHS Data Security Requirements Exhibit, if attached to this
contract.
c. Upon request by DSHS, at the end of the Contract term, or when no longer needed, Confidential
Information shall be returned to DSHS or Contractor shall certify in writing that they employed a
DSHS approved method to destroy the information. Contractor may obtain information regarding
approved destruction methods from the DSHS contact identified on the cover page of this Contract.
d. Paper documents with Confidential Information may be recycled through a contracted firm, provided
the contract with the recycler specifies that the confidentiality of information will be protected, and
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DSHS General Terms and Conditions
the information destroyed through the recycling process. Paper documents containing Confidential
Information requiring special handling (e.g. protected health information) must be destroyed on -site
through shredding, pulping, or incineration.
e. Notification of Compromise or Potential Compromise. The compromise or potential compromise of
Confidential Information must be reported to the DSHS Contact designated on the contract within
one (1) business day of discovery. Contractor must also take actions to mitigate the risk of loss and
comply with any notification or other requirements imposed by law or DSHS.
7. Debarment Certification. 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 DSHS if, during the term of this Contract, Contractor becomes
Debarred. DSHS may immediately terminate this Contract by providing Contractor written notice if
Contractor becomes Debarred during the term hereof.
8. 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.
9. 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 the Department. 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 the Department 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.
10. Inspection. The Contractor shall, at no cost, provide DSHS and the Office of the State Auditor with
reasonable access to Contractor's place of business, Contractor's records, and DSHS client records,
wherever located. These inspection rights are intended to allow DSHS 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.
11. 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.
12. Order of Precedence. In the event of any inconsistency or conflict between the General Terms and
Conditions and the Special Terms and Conditions of this Contract or any Program Agreement, the
inconsistency or conflict shall be resolved by giving precedence to these General Terms and
Conditions. Terms or conditions that are more restrictive, specific, or particular than those contained in
the General Terms and Conditions shall not be construed as being inconsistent or in conflict.
13. Severability. If any term or condition of this Contract is held invalid by any court, the remainder of the
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DSHS General Terms and Conditions
Contract remains valid and in full force and effect.
14. Survivability. The terms and conditions contained in this Contract or any Program Agreement which,
by their sense and context, are intended to survive the expiration or termination of the 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.
15. Contract Renegotiation, Suspension, or Termination Due to Change in Funding.
If the funds DSHS relied upon to establish this Contract or Program Agreement are withdrawn, reduced
or limited, or if additional or modified conditions are placed on such funding, after the effective date of
this_contract_but prior to the normal con pletion of this Contract or Program Agreement:
a. At DSHS's discretion, the Contract or Program Agreement may be renegotiated under the revised
funding conditions.
b. At DSHS's discretion, DSHS may give notice to Contractor to suspend performance when DSHS
determines that there is reasonable likelihood that the funding insufficiency may be resolved in a
timeframe that would allow Contractor's performance to be resumed prior to the normal completion
date of this contract.
(1) During the period of suspension of performance, each party will inform the other of any
conditions that may reasonably affect the potential for resumption of performance.
(2) When DSHS determines that the funding insufficiency is resolved, it will give Contractor written
notice to resume performance. Upon the receipt of this notice, Contractor will provide written
notice to DSHS informing DSHS whether it can resume performance and, if so, the date of
resumption. For purposes of this subsubsection, "written notice" may include email.
(3) If the Contractor's proposed resumption date is not acceptable to DSHS and an acceptable date
cannot be negotiated, DSHS may terminate the contract by giving written notice to Contractor.
The parties agree that the Contract will be terminated retroactive to the date of the notice of
suspension. DSHS shall be liable only for payment in accordance with the terms of this
Contract for services rendered prior to the retroactive date of termination.
c. DSHS may immediately terminate this Contract by providing written notice to the Contractor. The
termination shall be effective on the date specified in the termination notice. DSHS shall be liable
only for payment in accordance with the terms of this Contract for services rendered prior to the
effective date of termination. No penalty shall accrue to DSHS in the event the termination option in
this section is exercised.
16, 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 CCLS Chief or designee has the authority to waive any term or
condition of this Contract on behalf of DSHS.
Additional General Terms and Conditions — Interlocal Agreements:
17. Disputes. Both DSHS and the Contractor ("Parties") agree to work in good faith to resolve all conflicts
at the lowest level possible. However, if the Parties are not able to promptly and efficiently resolve,
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DSHS General Terms and Conditions
through direct informal contact, any dispute concerning the interpretation, application, or
implementation of any section of this Agreement, either Party may reduce its description of the dispute
in writing, and deliver it to the other Party for consideration. Once received, the assigned managers or
designees of each Party will work to informally and amicably resolve the issue within five (5) business
days. If managers or designees are unable to come to a mutually acceptable decision within five (5)
business days, they may agree to issue an extension to allow for more time.
If the dispute cannot be resolved by the managers or designees, the issue will be referred through each
Agency's respective operational protocols, to the Secretary of DSHS ("Secretary") and the Contractor's
Agency Head ("Agency Head") or their deputies or designated delegates. Both Parties will be
responsible for submitting all relevant documentation, along with a short statement as to how they
believe the dispute should be settled, to the Secretary and Agency Head.
Upon receipt of the referral and relevant documentation, the Secretary and Agency Head will confer to
consider the potential options of resolution, and to arrive at a decision within fifteen (15) business days.
The Secretary and Agency Head may appoint a review team, a facilitator, or both, to assist in the
resolution of the dispute. If the Secretary and Agency Head are unable to come to a mutually
acceptable decision within fifteen (15) business days, they may agree to issue an extension to allow for
more time.
The final decision will be put in writing, and will be signed by both the Secretary and Agency Head. If
the Agreement is active at the time of resolution, the Parties will execute an amendment or change
order to incorporate the final decision into the Agreement. The decision will be final and binding as to
the matter reviewed and the dispute shall be settled in accordance with the terms of the decision.
If the Secretary and Agency Head are unable to come to a mutually acceptable decision, the Parties
will request intervention by the Governor, per RCW 43.17.330, in which case the governor shall employ
whatever dispute resolution methods that the governor deems appropriate in resolving the dispute.
Both Parties agree that, the existence of a dispute notwithstanding, the Parties will continue without
delay to carry out all respective responsibilities under this Agreement that are not affected by the
dispute.
18. Hold Harmless.
a. The Contractor shall be responsible for and shall hold DSHS harmless from all claims, loss, liability,
damages, or fines arising out of or relating to the Contractor's, or any Subcontractor's, performance
or failure to perform this Agreement, or the acts or omissions of the Contractor or any
Subcontractor. DSHS shall be responsible for and shall hold the Contractor harmless from all
claims, loss, liability, damages, or fines arising out of or relating to DSHS' performance or failure to
perform this Agreement.
b. 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.
19. Ownership of Material. Material created by the Contractor and paid for by DSHS as a part of this
Contract shall be owned by DSHS and shall be "work made for hire" as defined by Title 17 USCA,
Section 101. This material includes, but is not limited to: books; computer programs; documents; films;
pamphlets; reports; sound reproductions; studies; surveys; tapes; and/or training materials. Material
which the Contractor uses to perform the Contract but is not created for or paid for by DSHS is owned
by the Contractor and is not "work made for hire"; however, DSHS shall have a perpetual license to use
this material for DSHS internal purposes at no charge to DSHS, provided that such license shall be
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DSHS General Terms and Conditions
limited to the extent which the Contractor has a right to grant such a license.
20. Subrecipients.
a. General. If the Contractor is a subrecipient of federal awards as defined by 2 CFR Part 200 and
this Agreement, the Contractor shall:
(1) 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;
(2) 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
agreements that could have a material effect on each of its federal programs;
(3) Prepare appropriate financial statements, including a schedule of expenditures of federal
awards;
(4) Incorporate 2 CFR Part 200, Subpart F audit requirements into all agreements between the
Contractor and its Subcontractors who are subrecipients;
(5) Comply with the applicable requirements of 2 CFR Part 200, including any future amendments to
2 CFR Part 200, and any successor or replacement Office of Management and Budget (OMB)
Circular or regulation; and
(6) 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.oip.usdoo.goy/ocrI for
additional information and access to the aforementioned Federal laws and regulations.)
b. Single Audit Act 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:
(1) Submit to the DSHS contact person the data collection form and reporting package specified in
2 CFR Part 200, Subpart F, reports required by the program -specific audit guide (if applicable),
and a copy of any management letters issued by the auditor;
(2) Follow-up and develop corrective action for all audit findings; in accordance with 2 CFR Part
200, Subpart F; prepare a "Summary Schedule of Prior Audit Findings" reporting the status of all
audit findings included in the prior audit's schedule of findings and questioned costs.
c. Overpayments. If it is determined by DSHS, or during the course of a required audit, that the
Contractor has been paid unallowable costs under this or any Program Agreement, DSHS may
require the Contractor to reimburse DSHS in accordance with 2 CFR Part 200.
21. Termination.
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a. Default. If for any cause, either party fails to fulfill its obligations under this Agreement in a timely
and proper manner, or if either party violates any of the terms and conditions contained in this
Agreement, then the aggrieved party will give the other party written notice of such failure or
violation. The responsible party will be given 15 working days to correct the violation or failure. If
the failure or violation is not corrected, this Agreement may be terminated immediately by written
notice from the aggrieved party to the other party.
b. Convenience. Either party may terminate this Interlocal Agreement for any other reason by
providing 30 calendar days' written notice to the other party.
c. Payment for Performance. If this Interlocal Agreement is terminated for any reason, DSHS shall
only pay for performance rendered or costs incurred in accordance with the terms of this Agreement
and prior to the effective date of termination.
22. Treatment of Client Property. Unless otherwise provided, the Contractor shall ensure that any adult
client receiving services from the Contractor has unrestricted access to the client's personal property.
The Contractor shall not interfere with any adult client's ownership, possession, or use of the client's
property. The Contractor shall provide clients under age eighteen (18) with reasonable access to their
personal property that is appropriate to the client's age, development, and needs. Upon termination of
the Contract, the Contractor shall immediately release to the client and/or the client's guardian or
custodian all of the client's personal property.
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Special Terms and Conditions
23. Definitions. The words and phrases listed below, as used in this Contract, shall each have the
following definitions:
a. "Assistance" means help provide to a client for the purpose of aiding him/her in the performance of
tasks.
b. "Authorized" means approved by a DDD case manager/social worker as evidenced by receipt of an
SSPS Social Services notice.
c. "Case Resource Manager" means the DSHS or DDD worker assigned to a client and who
authorized the services performed under this Contract.
d. "Client" means a person whom DSHS has determined financially and programmatically eligible to
receive services and for whom specific services have been authorized.
e. "Community Settings" means a public place such as community center, senior center, city or county
park and recreation, camps, or adult day care. Service cannot be provided in a private home.
f. "DDD" means the Division of Developmental Disabilities within the DSHS Aging and Disabilities
Service Administration.
g. "In -home respite" means respite provided by a home care agency in the client's home. Upon client
or primary caregiver request, home care agency provider may bring the client into their community.
h. "Individual Support Plan" or "ISP" means a written plan for long term care service delivery. The ISP
identifies ways to meet the Client's needs with the most appropriate services.
i. "Out -of -home respite" means respite provide out of the client's home by a licensed or certified
setting
j. "Personal care services" means those specific services defined in WAC 388-106 provided to DSHS
clients.
k. "Physical Assistance" means the provision of hands-on assistance on the performance of daily
tasks or activities.
I. "Primary Caregiver(s)" or "Caregiver" means the parents, legal guardians or other persons who
have or assume primary responsibility for the necessary care of the client.
m. "Protective Supervision" means supervision to ensure the safety and well being of a client,
exclusive of those responsibilities which should be assumed by a legal guardian.
n. "Provider One" means the DSHS payment system which is scheduled to replace the current SSPS
payment system about November 2012.
o. "Respite Care" means intermittent relief for persons providing care for developmentally disabled
individuals on either an emergency or planned basis.
p. "SSPS" means the Social Service Payment System, the service authorization and payment system
used by DSHS.
q. "Transportation Services" means the process of transporting a client from one location to another.
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Special Terms and Conditions
r. "Unusual Incidents" means a change in circumstances or events that concern a client's safety or
well being. These may include, but are not limited to the following examples: an increased
frequency, intensity, or duration of any medical conditions;, adverse reactions to medication, severe
behavioral incidents that are unlike the client's ordinary behavior, severe injury, running away,
physical or verbal abuse to themselves or others, etc.
24. Purpose.
The purpose of respite care is to provide intermittent relief for persons providing care for individuals
eligible for DDD services, on either an emergency or planned basis, to assist a client to remain in the
least restrictive environment.
25. Contractor Qualifications.
a. The Contractor shall be licensed, registered, and certified as is required by law.
b. Community settings providing respite care must meet the regulations governing their business or
activity.
c. Contractors offered services must be published on website and include;
(1) Identified number of service hours being provided in your program/class/event including
days/date and start and end time;
(2) Identify activities that will occur during program/class/event; and
(3) Published Fee schedule.
d. The Contractor agrees to undergo a criminal history background check conducted by DSHS, as
required by RCW 43.20A.710. If the Contractor has employees or volunteers who will have
unsupervised access to Clients in the course of performing the work under this Contract, the
Contractor will conduct criminal history background checks on those employees.
26. Statement of Work. The Contractor shall provide the services and staff, and otherwise do all things
necessary for or incidental to the performance of work, as set forth below:
a. Upon receipt of and in accordance with the provisions of a written service authorization form issued
by DSHS to the Contractor shall:
(1) Provide physical assistance, support and protective supervision to the client in daily routine
activities and to prevent injury to him or herself and to others;
(2) Obtain information about the client's identified needs and care requirements from the parent(s)
or primary caregiver(s) and ensure that the client's needs are met while providing services;
(3) Contact the client's parent or primary caregiver(s) if the Contractor has not heard from them
within seven (7) days of the Contractor's receipt of the service authorization to make
arrangements for specific dates and times of care;
(4) Make arrangement with the primary provider of assistance for emergency medical treatment
should this become a necessity;
(5) Ensure that the respite care is provided in the specific Community Setting and Respite services
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provided are as authorized and outlined in the ISP. If additional hours/services are provided
DSHS is not liable for payment;
(6) Maintain copies of all service authorizations to provide services; and
(7) Complete and maintain copies of the work verification records for all services provided. These
records shall be kept on file by the Contractor for the duration of this Contract and thereafter for
a period of 6 years and will be available to DSHS upon request for purposes of audit, monitoring
and/or service verification.
b. The Contractor may also provide transportation to and from the respite services community
resources and agencies as authorized and outlined in the ISP.
c. Maintain transportation records to document the dates, times, destinations, and distances of each
Client's Transportation Services. Upon request, the Contractor shall make the records available to
DSHS or DSHS/designee for review and audit.
d. Maintain sufficient vehicle and passenger insurance coverage in accordance with the requirements
in this Contract.
e. Operate and maintain the transportation vehicles in a manner consistent with protecting and
promoting the Client's health and welfare.
f. Community Settings shall provide all care that assists the client's participation in a safe manner.
g. Contractor shall provide written progress reports as requested by a DDD Case Resource Manager
or per other DDD written guidelines.
h. Contractor shall not require client, client's guardian and/or client's legal representative to enter into
any agreement releasing or limiting Contractor's legal liability for injuries arising out of premises
operation, acts of independent contractors, products completion, or personal injuries sustained due
to contractor's negligence in connection with providing services under this contract unless
contractor, at the same time, requires client, client's guardian and/or client's legal representative to
release the State of Washington and all of its agencies, agents, contractors, servants and
employees from liability for any acts of contractor causing injuries arising out of premises operation,
acts of independent contractors, products completion, or personal injuries sustained due to
contractor's negligence in connection with providing services under this Contract.
i. Contractor shall ensure that they or their care providers possess the following minimum
qualifications:
(1) Be eighteen (18) years of age or older;
(2) Possess the following minimum standards of knowledge and experience:
(a) General knowledge of acceptable standards of performance, including the necessity to
perform dependably, report punctually, maintain flexibility, and to demonstrate kindliness
and caring to the client; and
(b) Knowledge of when and how to contact the client's representative and the client's case
manager.
(3) Adequate skills to read, either directly or through an interpreter, understand, and implement the
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Special Terms and Conditions
services authorized in the plan;
(4) Adequate communication skills to convey and understand, either directly or through an
interpreter, information required to implement the client's written ISP(s) and verbal instructions;
and
(5) Adequate skills to maintain provider records of services performed and payments received.
j. Contractor shall ensure that the care providers are able to:
(1) Understand specific directions for providing the care that an individual client requires;
(2) Provide services within the scope of practice for their profession/skill level;
(3) Observe the client for change in health status, including weakness, confusion, and loss of
appetite;
(4) Identify problem situations and take appropriate action;
(5) Respond to emergencies without direct supervision; and
(6) Accept the client's individual differences and preferences when performing routine tasks.
k. The Contractor shall provide after -service duties, including but not limited to:
(1) Satisfaction Surveys and/or follow-up contact with clients, their families, guardians or primary
caregivers regarding their satisfaction with the services provided. Such surveys or follow up
contact will include a process to document and report responses;
(2) Investigation, documentation and resolution of all complaints or incidents regarding the service
provided; and
(3) Periodic monitoring of service documentation records, verification of provider qualifications, and
of billing and payment data in SSPS, functions and documentation need to be performed in a
manner that can be proven upon inspection.
The Contractor shall make available to DSHS any request for the inspection or verification of the
above mentioned duties for monitoring purposes.
27. Consideration. Total consideration payable to Contractor for satisfactory performance of the work
under this Contract shall be based on the following:
a. The fee for service shall not exceed the rate listed in Exhibit A — Rate Table.
b. DSHS will only reimburse the Contractor for the number of hours authorized and provided per
client.
c. In case of a legislatively mandated vendor rate changes, the rates will be adjusted accordingly and
will be incorporated into this Contract on the date the rate(s) become effective. DSHS will provide
written notification of rate changes to the Contractor.
d. The fee for transportation is an established rate of 0.51 per mile. The monthly payment for all
services provided to any Client will not exceed the amount authorized in the Client's ISP and in the
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Social Service Payment System (SSPS). The rate established in this Contract is subject to change
and does not require a contract amendment. Notification of rate changes will be made in a letter
from DSHS to the Contractor. Rates shall not exceed the DSHS Aging and Disability Services
Administration rates published for the Contractor's geographic area. Published rates are not
disputable.
e. DSHS shall reimburse the Contractor as preauthorized for fares and public transportation service at
the actual costs. Such costs must not exceed the preauthorized amount.
28. Billing and Payment.
a. DSHS shall issue invoices generated by SSPS to the Contractor.
b. The Contractor shall indicate on each invoice received from DSHS whether the services were
delivered.
c. The Contractor shall submit the invoices for payment as directed on the invoice or by using Invoice
Express.
d. The Contractor shall contact the DSHS staff who authorized the services if there is any problem
with the SSPS invoice.
e. DSHS shall use the completed SSPS invoice to generate payment to the Contractor.
f. DSHS shall not pay the Contractor for cancelled or missed appointments or for scheduled hours of
service when clients are not seen or served by the Contractor.
g. DSHS will not pay in advance of services being provided; all payments are contingent on
completion of planned activity.
h. In the event that the Client has fewer waiver resources available than the rate set in Exhibit A, the
client or their family may choose to pay for additional hours of service but may not supplement the
department's rate. The Contractor accepts the DSHS payment rate as sole and complete payment
for the services provided under this Contract.
i. If DSHS pays the Contractor for services authorized but not provided by the Contractor the amount
paid shall be considered to be an overpayment.
j. If this Contract is terminated for any reason, DSHS shall pay for only those services authorized and
provided through the date of termination.
k. DSHS Provider One payment system is scheduled to replace the current DSHS SSPS on or about
November of 2012. In the event this contract is in place at that time DSHS will notify you of new
billing instructions. Any new billing instructions will replace the SSPS billing instructions listed
above and will thereby be incorporated by reference into this contract.
29. Duty to Report Suspected Abuse. The Contractor shall report, in accordance with state law, all
instances of suspected Client abuse immediately to the Department at the current state abuse hotline
(1-800-562-6078).
30. Duty to Report Unusual Incidents. The Contractor shall submit written information of any unusual
incident to the DDD Resource Manager or the DSHS contact listed on page 1 of this Contract within
seventy-two (72) hours.
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31. Duty to Report Death of Clients. The Contractor shall report all deaths of DSHS clients receiving
services from the Contractor within twenty-four (24) hours to the DDD Resource Manager or the DSHS
contact listed on page 1 of this contract.
32. Drug Free Workplace. The Contractor, and the Contractor's employees and sub -contractors, shall
abstain from the use of alcohol and illegal drugs in the workplace and in the performance of their duties.
33. Insurance.
a. DSHS certifies that it is self -insured under the State's self-insurance liability program, as provided
by RCW 4.92.130, and shall pay for losses for which it is found liable.
b. The Contractor certifies, by checking the appropriate box below, initialing to the left of the box
selected, and signing this Agreement, that:
fl
® The Contractor is self -insured or insured through a risk pool and shall pay for losses
for which it is found liable; or
❑ The Contractor maintains the types and amounts of insurance identified below and
shall, prior to the execution of this Agreement by DSHS, provide certificates of insurance
to that effect to the DSHS contact on page one of this Agreement.
Commercial General Liability_ InSLlrance(CGQ — to include 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, DSHS, its elected
and appointed officials, agents, and employees shall be named as additional insureds.
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Provider
Out -of home in a
Adult day care center
(must be contracted
+ with the Area Agency
{ on Aging (AAA)
Camp and other
community settings
providing respite
Exhibit A Rate Table
Kate
$10.03 hr
Daily = $80.24
f8 hrs x $10.031
$17.46 hr
Y Payment Calculation Payment j
Codes
Not to exceed 8 hours in a 24
8177,
hour period.
8277,
8377,
Prior approval required to
8777
authorize more than 8 hours
Community Settings will be
reimbursed at the Contractor's
8177,
published fee for services
8277,
provided unless the number of
8377,
hours authorized exceeds the
8777
number of hours of respite
provided.
The maximum rate for one
hour of service $17.46.
Number of respite Hours =
Cost of service (published fee)
+ $17.46.
Notes,
• Respite and personal care cannot be paid at the same time for the same
service. Respite services include any personal care and supervision that is
needed.
• SSPS authorizations will be authorized at an hourly rate.
■ A copy of the Contractor's Published Service and Fee Schedule can be
located at the following web site City of Edmonds Parks and Recreation. A
printed copy of the Contractor's Published Service and Fee Schedule shall be
maintained in the Contractor's Contract file for each year services are
provided by this Contract.
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