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INTERLOCAL DATASHARE
AGREEMENT
Benefit Verification System (BVS)
Access
DSHS Agreement Number:
1791-17999
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
39.34 RCW.
CONTRACTOR NAME CONTRACTOR doing business as (DBA)
Ci of Edmonds Edmonds Municipal Court
CONTRACTOR ADDRESS WASHINGTON UNIFORM DSHS INDEX
250 5th Ave N BUSINESS IDENTIFIER (UBI)
Edmonds, WA 98020 312-000-093 22474
Sharon Whittaker
DSHS ADMINISTRATION
Economic Services
Administration
DSHS CONTACT NAME AND TITLE
Hope Schumacher
SHPM 2
DSHS CONTACT TELEPHONE
(360)688-8089
IS THE CONTRACTOR A SUBRECtl
No
AGREEMENT START HATE
(425) 771-0211
DSHS DIVISION
Community Services Division
DSHS CONTACT A
712 Pear St
FOR
(425) 771-0269I sharon.whittaker@edmonds
wa.gov
DSHS
3000 DC -91
- I Olympia, WA Click here to enter text.
DSHS CONTACT FAX DS`
Click here to enter text.
END DATE
MAXIMUM AGREEMENT AMOUNT
12/18/2017 1 12/31/2021 1 No Payment
EXHIBITS. The following Exhibits are attached and are incorporated into this Agreement by reference:
® Data Security: Exhibit A — Data Security
® Exhibits (specify): Exhibit.B - BVS Program User List - Format Requirement
The terms and conditions of this Agreement are an integration and representation of the final, entire and exclusive
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 binding on DSHS only tt on signature by-DSHS.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
DSHS SIGNATURE� n PRINTED NAME AND TITLE ✓ DATE SIGNED
elk" i .? fb/ %,F' og
DSHS Central Contract Services
6028LF Interlocal Datashare Agreement (11-14-2012)
Ramona Bushnell, Contracts Officer
DSHS/ESA-CommunityServices Division o
/2c/YL, '
- 7Z z 0
Page 1
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 parries 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.
"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 hftp://apps.leg.wa.gov/rcw/.
m. "Regulation" means any federal, state, or local regulation, rule, or ordinance.
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6028LF Interlocal Datashare Agreement (11-142012) Page 2
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, 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.
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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6028LF Interlocal Datashare Agreement (11-14-2012) Page 3
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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6028LF Interlocal Datashare Agreement (11=14-2012) Page 4
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'Contraactor, 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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6028LF Interlocal Datashare Agreement (11-14-2012) Page 5
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.
16. 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 priorto the normal completion 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.
Ths 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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6028LF Interlocal Datashare Agreement (11-14-2012) Page 6
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 tb 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 fnal;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 fihai' 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/brtraining 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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6028LF Interlocal Datashare Agreement (11-14-2012) Page 7
: 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 expanded and the
federal programs underwhich=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 Vl 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.oio.usdo'.gov/ocr/ 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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DSHS_.General.Terms and Conditions
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
1. Definitions Specific to Special Terms. The words and phrases listed below, as used in this
Agreement, shall each have the following definitions:
a. "Agreement" means this Datashare Agreement, including all Exhibits and other documents
attached or incorporated by reference.
b. "BVS", means Benefit Verification system containing client specific information about benefits
received through DSHS.
c. "Client" or "DSHS Client" or "participant" means any client of DSHS receiving benefits.
d. `.'Contractor" means the business listed under "Contractor Name" on page one of this Agreement.
The Contractor to determine if the applicant is eligible to receive services will provide services to
DSHS clients under federal and state rules and guidelines. The Contractor or its services are not in
any way associated with- DSHS, or DSHS provided public assistance programs.
e. "Data'`; means the information d'isclosed'or exchanged as described by this Agreement.
f. "Data Provider," as used in the Special Terms and Conditions of this Agreement, means the entity
that is disclosing their Data for use by the Data Recipient for completion of this Agreement.
g. "Data Recipient;" as used in the Special Terms and Conditions of this Agreement, means the entity
that is receiving the Data from.the Data Provider for purposes of completion of this Agreement.
h. "DSHS Contact" means the person whose name appears in the DSHS Contact box on page 1 of
this contract.
L "DSHS Client ID Number" or "Client ID #"is a number assigned to each client by DSHS. DSHS
Client ID Number is the primary means of identification of the client. This number is located in the
upper right corner of all DSHS correspondence to the client. On the DSHS letter it is called "Client
D #".
"ESA Nondisclosure of Confidential Information Agreement — Non -Employee DSHS # 3-3740"
(here after, referenced as "nondisclosure form") means the nondisclosure form that is must be
Signed by Contractor staff and returned to the DSHS Contact in order to receive BVS access. BVS
users must sign this form annually thereafter.
k. "Portable Device" includes but is not limited to smart phones, tablets, flash memory devices (e.g.
USB flash drives personal media players), portable hard disks, and laptoptnotebooklnetbook
computers if those�computers may be transported outside of a Secured Area.
I. "Portable Median includes, but is not limited to optical media (e.g. CDs, DVDs), magnetic media
(e.g. floppy disks, tape, removable or external hard disk drives), or flash media (e.g. Compact
Flash, SD, MMC).
2. Statement of Work
a. Programs Receiving and Providing Data
The Contractor listed on page one of this Data Share Agreement is the data recipient. DSHS is the
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6028LF Interlocal Datashare Agreement (11-14-2012)_ Page 10
data provider listed on page one of this agreement.
b. Purpose/Justification'
(1) Access to the DSHS Benefit Verification System (BVS) is for the Contractor to confirm if client
applicants are currently receiving DSHS services.
(2) The purpose of this data sharing agreement is to provide the Contractor specific public
assistance clieriffinancial data from the following program areas to verify client eligibility to pay
legal financial obligations imposed by the court and eligibility to be assigned a public defender.
(a) Clients'Name
(b) Address"
(c)' If person is or is not currently an active DSHS Client
(3) The Contractor shall use the information to administer eligibility for low income clients
c. Description of:Data
(1) All confidential client data needed by the Contractor to determine eligibility for Edmonds
Municipal Court will be obtained directly from the clients through their own application form for
the Contractor's services.
(2) Contractor receives a client's. written consent to view the client's confidential information through
the Contractor's application process to determine if client is eligible to receive Contractor's
services.
(3) The Contractor agrees to use the client's authorization for disclosure of client's confidential
information by DSHS to the Contractor within 95 days of the date of application for determining
client's eligibility for Contractor, program services only. The Contractor agrees not to access any
other clients' data in BVS who has not applied for Contractor's services.
(4) . The Contractor: shall provide DSHS BVS with the following information:
(a) DSHS Client ID number, or
(01 Client's first name,..Lasf Name; and Full Social Security Number
(c) Month/Year of information needed
(5) The results of the database search will display either a "yes" or a "no" to indicate if the client
received any means tested benefits in the inquiry month.
A "yes" answer means that during the inquired period of time the client received benefits from
one or several public assistance programs administered by DSHS. The DSHS means tested
public assistance programs are:
(a) Medicaid;
(b) Supplemental Nutrition Assistance Program (SNAP);
(c) Temporary Assistance for Needy Families (TANF);
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6028LF Interlocal Datashare Agreement.(11-142012) Page 11
(d) State Family -Assistance (SFA);
(e) Pregnant Women Assistance;
M Aged, Blind or Disabled (ABD) cash assistance;
(g) Housing and Essential Needs (HEN) referral;
(h) Refugee cash (RCA) and Refugee Medical Assistance (RMA);
.(i) Food -Assistance Program (FAP);
0) State Supplemental Payment (SSP) to eligible SSI recipients;
(6) A ".no answer means that during the inquired period of time the client did not receive any
benefits from public assistance programs administered by DSHS and listed above.
(7) The Contractor shall provide client data by entering inquiry information into a secure DSHS
Website (BVS) the URL will be supplied by DSHS to the contractor
(8) DSHS will return client data to the Contractor via the DSHS website
(9) Contractor shall not use programming scripts allowing Contractor to search on more than one
client at onetime.
d. Requiremeniffor Data Access
The Contractor Shall:
(1) Limit access to client information to staff whose duties specifically require access to such data in
the performance of their assigned duties.
(2).'When Agreement is fully; executed, the Contractor will notify the DSHS Contact listed on page
one of this Agreement to requesfBVS access for staff or when new staff are to be added.
(3) The DSHS Contact will send the Contractor the ESA Nondisclosure of Confidential Information
Agreement — Non Employee, DSHS #03-3740 nondisclosure form. Staff requiring BVS access
must read and sign this form.
(4) Provide information to staff who will have access to client information regarding client data use
and nondisclosure requirements as described in this Agreement and send PDF copies of.the
signed nondisclosure forms to the DSHS Contact prior to receiving BVS access. If there are
amendments during the, life of this Agreement that affect those with BVS access, the Contractor
agrees to share these type of changes with staff.
(5) Retain all Non -disclosure forms signed by staff on premises at all times, and send an email to
notify DSHS Contact on page one, The Contractor shall provide the DSHS Contact with signed
nondisclosure forms upon request.
(6) Create and maintain a current BVS users list throughout the period of performance of this
Agreement. Update this list as needed when adding staff or, when a current listed user no
longer has BVS access. Send this list to the DSHS Contact upon request.
(7) Request BVS access for new staff by notifying DSHS Contact via email with a PDF copy of
DSHS Central Contract Services
6028LF Interlocal DatashareAgreement (11-14-2012) Page 12
originally signed nondisclosure form by that new staff.
(8) Immediately notify the DSHS Contact if the contractor is no longer serving low-income clients
per services stated in this agreement.
(9) Immediately notify DSHS contact when staff with BVS access is terminated from employment
with the Contractor or no longer has a business need. If a user has not accessed the website
for ninety.consecutive days, on the ninety first (91) day the user's access will be revoked from
the system.
e. Annual Requirements
(a).A BVS user review of`client information use and nondisclosure requirements -as described in
this Agreement
(b) The ESA Nondisclosure of Confidential Information Agreement - Non -Employee, DSHS
#03-3740 nondisclosure form to BVS users for review and signature and keep signed forms
on file.
(c) Review. of Contractor maintained BVS Users List to make certain it contains all changes and
is current.
(d) Notify the DSHS Contact via email when these tasks are completed
3. Security of Data
a. Violations of the Nondisclosure provisions of this Agreement may result in criminal or civil penalties.
Violation is a gross misdemeanor under RCW 74.04.060 Records, confidential — Exceptions -
Penalty, punishable by imprisonment of not more than one year and/or a fine not to exceed five
thousand dollars.
b. The Contractor must obtain and retain a valid written consent form signed in advance by the
client that allows DSHS to -share information with the Contractor. The form must meet the DSHS
authorization standards. ,Client's signed consent can be a part of client's application for Contractor
services.- The Contractor will provide client, consent forms
c. The Contractor shall retain copies of the signed application for services forms on file in an electronic
or hard copy format for monitoring purposes. Contractor shall make these forms available to DSHS
upon request.
d. The Contractor shall take reasonable precautions to secure against unauthorized physical and
electronic access to data. Contractor shall protect data in a manner designed to prevent
unauthorized persons, including the public, from retrieving data by' means of computer, remote
terminal, or other means.
e. If the Contractor chooses to retain hard .copies of clients' information obtained under this
Agreement, the Contractor shall maintain all hard copies of information in a locked filing cabinet or
locked office when not in use and only authorized users shall have the key.
f. When the Contractor is required to retain any information, document, application or consent
identified in this Agreement, the Contractor may maintain such information, document, application
or consent in either electronic format, hardcopy format, or both. The storage of clients' personal
information on personal or company issued portable devices/media is not allowed under the
provision of services underthis Agreement.
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6028LF Interlocal Datashare Agreement (11-14-2012) Page 13
g. The information provided under this Agreement will remain the property of DSHS and will be
promptly destroyed by the Contractor, or returned to the DSHS, when the work for which the
information was required, as fully described herein, is completed.
h. The Contractor is responsible for the cost of mitigating any loss of DSHS data that results from a
corifidentiality breach.caused by the Contractor.
4. Confidentiality and. Nondisclosure
a. The data shared under this agreement is confidential in nature, and is subject to state and federal
confidentiality requirements that bind the Contractor its employees to protect the confidentiality of
the personal information contained in Economic Services Administration data. The Contractor may
use personal data and other data gained under this Agreement for the purpose of this Agreement
only.
b. The Contractor shall maintain the confidentiality of personal data in accordance with state and
federal laws, and shah have. adeq uate
policies and procedures in place to ensure compliance with
confidentiality requirements, including restrictions on re -disclosure.
c. The Contractor shall not disclose, transfer, or sell any data as described in this agreement to any
party in whole or in part, except as provided by law, or to any individual or agency not specifically
authorized by federal or state law, rule or regulation.
d. The Contractor staff shall not re -d
by prior written.corisent of DSHS. isclose the data unless specifically authorized in this agreement
5. Limitations:on Use of:Data
If the Data and -analyses generated by the Contractor contain personal information about DSHS clients,
there these Data -shall be subject -to -review and approval by DSHS, the Data Provider, prior to
publication in any medium or presentation in any forum.
6_ Payment
DSHS will provide the information under this Agreement at no charge to the Contractor. Each party
shall be responsible for any expenses incurred in providing or receiving Data. In exchange for the
receipt of data, the Contractor agrees to abide by the terms and conditions 'in this Agreement.
The Contractor will incur -the responsibility of any costs in order to access client data. This includes any
costs for hardware/software upgrades, and costs to improve any systems or processors that will enable
the Contractor to access the data.
7. Change of Contractor Information
DSHS shall consider the Contractor business name, address, telephone number, fax number, and e-
mail address as is shown on the first page of this Agreement. Changes in the Contractor's information
include change of business name, Contractor contact name, address, telephone number, fax number,
e-mail address, business status, and names of staff that are current employees.
If the Contractor's address; telephone number, fax number, or e-mail address change, the Contractor
shall provide written notice of. the change(s) to the DSHS Contact as shown on the first page of this
Agreement within (5) working days of the date of the change(s).
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6026LF Interlocal Datashare Agreement (11-14-2012) Page 14
8. Agreement Monitoring,
DSHS 'may conduct on-site visits'per. DSHS policies. The Contractor's records related to this
Agreement,will be reviewed for compliance.with the terms and conditions of this Agreement. DSHS
reserves, WI other rights. of inspection as provided in the General Terms and Conditions of this
Agreement.
9. Agreement Suspension,
DSHS may take certain actions in the event the Contractor, or any of its partners, officers, directors, or
employees, is under investigation by a. local, county, state or federal agency, for a matter, which DSHS
determines, may adversely affect the delivery of services provided under this Agreement. DSHS may,
without prior notice; either suspend the delivery of services or disallow the person(s) involved in the
allegation(s) from providing services or having contact with clients pending final resolution of the
investigation
10. Data Sharing
Data Provisions:
a. DSHS shall grant the Contractor limited access to the web -based Benefits Verification System
(herein called BVS) for client information specific only to the Contractor's caseload. CSD grants
BVS access based on the Contractor's "need to know". Authority for any system changes,
suspension, and removal of -access or data enhancements to BVS lies solely within CSD.
b. Federal and state - law's -bnd regulations protect the information disclosed. The Contractor and/or
Contractor's staff may not disclose, transfer, or sell any information to any other agency or person
without specific. written consent of DSHS. Unauthorized disclosure of information is a gross
misdemeanor, punishable by law. The Contractor is subject to the same standards and laws of
confidentiality as is DSHS.-
11-
SHS:
11- Contractor Information
The Contractor shall email to the DSHS Contract Contact, within 10 working days, any changes to the
Contractor Contact information. Changes include changes in business, name, Contractor, Contact
name, mailing address, email address, telephone number, fax number and business status and/or
names of staff who are current state employees.
12. Insurance
The Contractor shall comply at all times with the following insurance requirements.
a. Commercial General Liability Insurance (CGL)
The Contractor shall maintain Commercial General 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, including tort liability of
another assumed in a business contract. The State of Washington, DSHS, its elected and
appointed .ofl•Icials, ..agents; and'.employees shall be named as additional insureds.
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6028LF Interlocal Datashare Agreement (11-14-2012) Page 15
13. Subcontracting
The Contractor shall not subcontract services under this Agreement. If the Contractor has
subcontractors; who request to have BVS access the Contractor may refer them to the DSHS Contract
Contact for this Agreement for assistance.
14. Disputes
Either party may submit a request for resolution of an agreement dispute (rates set by law,
regulation, or DSHS policy are not disputable). The requesting party shall submit a written statement
identifying the issue(s) in dispute and the relative positions of the parties. A request for a dispute
resolution must include the Contractor's name, address, and Agreement number, and be mailed to the
CSD Contracts Unit at the address below and to the DSHS contact listed on page 1 of this Agreement
within thirty (30) calendar days after the party could reasonably be expected to have knowledge of the
issue in dispute.
DSHS/ESA-Community Services Division
P O Box 45470
Olympia, WA 98504
Attn: CSD Contracts Unit
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6028LF Interlocal Datashare Agreement (11-142012) Page 16
.Exhibit.A Data Security Requirements
1_ Definitions. The words and phrases:listed below, as used in this Exhibit, shall each have the following
definitions;
a. "Authorized User(s)" means an individual or individuals with an authorized business requirement to
access DSHS Confidential Information.
b. "Hardened .Password".means .a string of at least eight characters containing at least one alphabetic
character, at least one number and at least one special character such as an asterisk, ampersand
or exclamation point.
c. "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. Data Transport.. When transporting DSHS Confidential Information electronically, including via email,
the Data will be protected lay:
a. Transport!ng.the Data within. the (State Governmental Network) SGN or Contractor's internal
network, or; .
b. Encrypting any Data that will be; in transit outside the SGN or Contractor's internal network. This
includes transit over the public Internet.
3. Protection of Data. The Contractor agrees to store Data on one or more of the following media and
protect4he Data as described:
a. Hard disk drives. Data stored on' local Workstation hard disks. Access to the Data will be
restricted to Authorized Users) by requiring logon to the local workstation using a Unique User ID
and Hardened Password or other authentication mechanisms which provide equal or greater
security, such as biometrics or smart cards.
b. Network server disks. Data stored on hard disks mounted on network servers and made available
through shared folders. Access to the Data will be restricted to Authorized Users through the use of
access control lists which will grant access only after the Authorized User has authenticated to the
network using a Unique User ID and Hardened Password or other authentication mechanisms
which provide equal or greater security, such as biometrics or smart cards. Data on disks mounted
to such servers must be located in an area which is accessible only to authorized personnel, with
access controlled through use of a key, card key, combination lock, or comparable mechanism.
For DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as
long as the disks -remain ini a Secured Area and otherwise meet the requirements listed in the
above paragraph. Destruction of the Data as outlined in Section 5. Data Disposition may be
deferred until the disks are retired, replaced, or otherwise taken out of the Secured Area.
c. Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS
on optical discs which will be used in local workstation optical disc drives and which will not be
transported out of a Secured Area. When not in use for the contracted purpose, such discs must be
locked in a drawer, cabinet or other container to which only Authorized Users have the key,
combination or mechanism required to access the contents of the container. Workstations which
access DSHS Data on optical discs must be located in an area which is accessible only to
authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
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6028LF Interlocal Datashare Agreement (11-14-2012) Page 17
d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers, Data provided by
DSHS.on optical discs.which will be attached to network servers and which will not be transported
out of a Secured Area. Access to Data on these discs will be restricted to Authorized Users through
the use of access control lists which will grant access only after the Authorized User has
authenticated to the network using a Unique User ID and Hardened Password or other
authentication mechanisms which provide. equal or greater security, such as biometrics or smart
cards. Data on discs attalched to such servers must be located in an area which is accessible only
to authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
e. Paper documents. Any paper records must be protected by storing the records in a Secured Area
which is only accessible 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.
f. Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or
Secure Access Washington (SAW) will be controlled by DSHS staff who will issue authentication
credentials (e.g. a Unique User 1D and Hardened Password) to Authorized Users on Contractor
staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of
such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an
Authorized User's duties change such that the Authorized User no longer requires access to
perform work for this Contract.
g. Data storage on portable devices or media.
(1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on
portable devices or media unless specifically authorized within the terms and conditions of the
Contract. If so authorized, the Data shall be given the following protections,
(a) Encrypt the Data with a. key length of at least 128 bits
(b) Control access to devices with a Unique User ID and Hardened Password or stronger
authentication method such as a physical token or biometrics.
(c) Manually lock devices whenever they are left unattended and set devices to lock
automatically after a period of inactivity, if this feature is available. Maximum period of
inactivity is 20 minutes.
Physically secure the:portable devices) and/or media by
(d) Keeping them in locked;storage when not in use
(e) Using check-in/check-out procedures when they are shared, and
(f) Taking frequent inventories
(2) When being transported outside of a Secured Area, portable devices and media with DSHS
Confidential Information must be under the physical control of Contractor staff with authorization
to access the Data.
(3) Portable devices include, but are not limited to; smart phones, tablets, flash memory devices
(e.g. USB flash drives, personal media players), portable hard disks, and
laptop/notebook/netbook computers if those computers may be transported outside of a
Secured Area.
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6028LF Interlocal Datashare Agreement (11-14-2012) Page 18
(4) Portable media includes, but is not limited to; optical media (e.g. CDs, DVDs), magnetic media
(e.g. floppy disks; tape), or flash media (e.g. CompactFlash, SD, MMC).
Data -stored for backup p'u'rposes.
(1) DSHS data may be stored on portable media as part of a Contractor's existing, documented
backup process for business continuity or disaster recovery purposes. Such storage is
authorized until such time as that media would be reused during the course of normal backup
operations. If backup media is retired while DSHS Confidential Information still exists upon it,
such media will be destroyed at -that time in accordance with the disposition requirements in
Section 5. Data Disposition
(2) DSHS Data may be stored on non-portable media (e.g. Storage Area Network drives, virtual
media, etc.) as part of a Contractor's existing, documented backup process for business
continuity or disaster.recovery`purposes. If so, such media will be protected as otherwise
described in this exhibit.' If this media is retired while DSHS Confidential Information still exists
upon it, the data will be destroyed at that time in accordance with the disposition requirements in
Section 5. Data Disposition.
4. Data Segregation.
a. DSHS Data must be segregated or otherwise distinguishable from non-DSHS data. This is to
ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or
destruction.- It also.aids in determining whether DSHS Data has or may have been compromised in
the event of a security breach. As such; one or more of the following methods will be used for data
Segregation.
b. DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will contain no
non-DSHS data. And/or,
c. DSHS Data will be stored in a logical container on electronic media, such as a partition or folder
dedicated to DSHS Data. And/or,
d. DSHS Data will be stored in a database which will contain no non-DSHS data. And/or,
e. DSHS -Data. will be stored within a database and will be -distinguishable from non-DSHS data by the
value of a specific field or fields within database records.
f. When stored as physical paper documents, DSHS Data will be physically segregated from non-
DSHS data in a drawer, folder, or other container.
g. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the
DSHS Data and the non-DSHS data with which it is commingled must be protected as described in
this exhibit.
5. Data Disposition. When the contracted work has been completed or when no longer needed, except
as noted in Section 3. Protection of Data b. Network Server Disks above, Data shall be returned to
DSHS or destroyed. Media on which Data may be stored and associated acceptable methods of
destruction are as follows:
Data stored on:
Server or workstation hard disks, or
DSHS Central Contract Services
6028LF Interlocal Daiashare Agreement (11-1472012)
Will be destroyed by:
Using a "wipe" utility which will overwrite the Data at
least three (3) times using either random or single
Page 19
Removable media; (e.g floppies, USB flash drives,
portable hard :disks) excluding optical discs..
Paper documents with sensitive or Confidential
Information
character data, or
Degaussing sufficiently to ensure that the Data cannot
be reconstructed, or
the disk
Recycling through a contracted firm provided the
contract with the recycler assures that the
confidentiality of Data will be I)rotected.
Paper documents containing Confidential Information On-site shredding, pulping, or incineration
requiring special handling (e.g. protected health
information)
Optical discs (e.g. CDs or DVDs)
Incineration, shredding, or completely defacing the
readable surface with a coarse abrasive
Magnetic tae Degaussing, incinerating or crosscut shredding
6. Notification, of Compromise. or Potential Compromise. The compromise or potential compromise of
DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1)
business day of discovery. If no-DSHS Contact is designated in the Contract, then the notification must
be reported to the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also
take actions to mitigate the risk of loss and comply with any notification or other requirements imposed
by law or DSHS.
DSHS Central Contract Services
6028LF Intedocal. Datashare Agreement 01-142012)
Page 20
EXHIBIT B
BVS Program Users List - Format Requirement
Additions -deletions or other changes to.BVS users list'must lae'rnalntained b the format in
excel below:
Edmonds Municipal Court - BVS Users List
Completed by: Date:
Agency
Last Name First Name E -Mail Address Work Phone Name Add/Delete
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6028LF Interlocal Datashare Agreement (1.1-14-2012) Page 21