Issuu

Board of Cowlitz County Commissioners

Steve Rader, Commissioner District 1 Steven L. Ferrell, Commissioner District 2 Richard R. Dahl, Commissioner District 3 Kelly Grayson, Clerk of the Board

Regular Public Meeting September 15, 2026, 9:00 a.m. Board Meeting Convenes at 9:00 a.m. • • • •

•

Invocation by Invitation Live KLTV Pledge of Allegiance ZOOM Stream Link Link Minutes of August 31-September 1, 2026 Consent Agenda of September 15, 2026 Phone Option: (253) 215-8782 Webinar ID: 820 1961 3917 o Call for Bids o Contracts/Agreements/Bid Awards o Correspondence o Motion Items o Public Hearings – 9:30 a.m. Print Agenda o Work Session – 10:00 a.m. Public Comments o Citizen Participation may be anonymous. See RCW 42.30.040

Consent Agenda Contracts/Agreements/Bid Awards Public Works 1. Custom Project Energy Efficiency Agreement with Public Utility District No. 1 to provide an incentive award for Energy Efficiency Improvements completed at the Hall of Justice. The total incentive award is $385,330.55. (233540) 2. Bid Award to TITAN Earthwork, Inc. for the one-time purchase of high-density polyethylene pipe. The total cost is $44,770.78. (234024) 3. Bid Award to ACF West Inc. for the purchase of 28 – 100 ft x 200 ft Scrim Reinforced Polyethylene Geomembranes. The total cost is $120,578.77. (234019) 4. Bid Award to Western United Civil Group, LLC for the Shadow Mountain Packaged Pump Station Project. The total cost is $242, 855.53.(233993) Resolutions Public Works 5. Federal Debarment, Suspension, Ineligibility, and Voluntary Exclusion Document, the Designation of Applicant's Agent Resolution and the Signature Authorization Form (SAF) for the December 2025 Flood Event. (233823)

Page 1 of 4

Regular Public Meeting September 15, 2026, 9:00 a.m. Correspondence 6. Letters/Notices/Executed Contract a. Federal Energy Regulatory Commission (FERC) letter dated 09/01/2026 regarding the Authorization for Construction, Spillway Stoplog/Gate Retrofit Project Design Changes, Swift No. 1 Project. (233577) b. Federal Energy Regulatory Commission (FERC) letter dated 09/01/2026 regarding the License Article 302: 2025/2026 Lewis River Vacant Storage Report, Merwin, Yale and Swift No. 1 Projects. (233576) c. Signed Request for Obligation of Funds and a Letter of Intent to meet Conditions for the Ryderwood Reservoir Project for Grant Funding for $1,000,000. (233828) d. Signed and Recorded Permanent Road and Utility Easement from Carol A. Ross for the Toutle Water System. (233813) e. Signed and Recorded Temporary Construction Easement from David and TerraSue Brittell for Project 1524 E. Canyonview Dr slide repair. (233811) Vouchers The following vouchers/warrants are approved for payment. Funds Claims Claims Claims Claims Claims Claims Special Purpose District No. 1 Special Purpose District No. 1 Special Purpose District No. 1 Special Purpose District No. 1 Special Purpose District No. 2 Special Purpose District No. 2 Payroll Payroll Total

Voucher Numbers 1000028443-1000028523 1000074343-1000074411 1000028524-1000028587 1000028588-1000028601 10000074412-1000074634 1000074635-1000074643 5000004271-5000004279 5000021508-5000021523 5000004280-5000004293 5000021524-5000021527 7000000668-7000000672 7000004668-7000004675 164723-164749 303798-304342

Amount 1,080,321.30 1,903,453.14 737,285.58 1,679,161.21 121,195.82 58,797.79 91,611.90 68,255.65 23,117.93 15,203.08 27,587.71 42,032.70 25,557.80 1,387,399.57 7,260,981,017

Motion Items Health & Human Services 7. Amendment #7 to the Consolidated Contract with Washington State Department of Health for the PHEPR and Perinatal Hepatitis B programs. (233360) 8. Contract with Wise to provide Developmental Disability Employment Services until 6/30/2027. The funding is passed through Washington State Department of Social Health Development Disabilities Administration and will not exceed $30,000. (233345) 9. Contract with Progress Center to provide Developmental Disability Child Development Services until 6/30/2027. The funding is passed through Washington State Department of Social Health Development Disabilities Administration and will not exceed $126,940. (233342) Page 2 of 4

Regular Public Meeting September 15, 2026, 9:00 a.m. 10. Contract with Lifeworks to provide Developmental Disability Employment Services until 6/30/2027. The funding is passed through Washington State Department of Social Health Development Disabilities Administration and will not exceed $1,427,000. (233340) 11. Contract with iEmbrace to provide Developmental Disability Employment Services until 6/30/2027. The funding is passed through Washington State Department of Social Health Development Disabilities Administration and will not exceed $77,000. (233337) 12. Contract with Goodwill to provide Developmental Disability Employment Services until 6/30/2027. The funding is passed through Washington State Department of Social Health Development Disabilities Administration and will not exceed $72,000. (233336) 13. Contract with Employers Overload to provide Developmental Disability Employment Services until 6/30/2027. The funding is passed through Washington State Department of Social Health Development Disabilities Administration and will not exceed $92,000. (233326) 14. Contract with Compass Career Solutions to provide Developmental Disability Employment Services until 6/30/2027. The funding is passed through Washington State Department of Social Health Development Disabilities Administration and will not exceed $402,000. (233318) Public Works 15. Authorize negotiations with Wolf Water Resources for Geomorphic Assessment of the Lower Toutle and Cowlitz River and authorize the Director of Public Works to execute the agreement not to exceed in the amount of $200,000. (234053) 16. Award an agreement with Lakeside Industries Inc. for W Canyonview Drive roadway repairs in the amount of $70, 221.80 and authorize the Director of Public Works to execute the agreement. (234052)

Continuation Public Hearing – 10:00 a.m. (from 9/1/26) Public Works 17. Resolution to establish a “No Parking” Zone on a Portion of Kalama River Road. (233965)

Work Session – 10:15 a.m. •

Cowlitz County Behavioral Health Center

Updates Chairman Updates Upcoming Meetings/Important Dates: • Tuesday, September 22nd @ 10:00 a.m. – Department of Ecology • Tuesday, September 29th @ 10:00 a.m. – Board of Health Interviews • Monday, October 12th @ 9:30 a.m. – Board of Health Interview • Tuesday, October 20th @ 9:30 a.m. – Board of Health Appointments Page 3 of 4

Regular Public Meeting September 15, 2026, 9:00 a.m. RCW 42.30.040 – Conditions to attendance not to be required. A member of the public shall not be required, as a condition, to attend a meeting of a governing body, to register his or her name and other information, to complete a questionnaire, or otherwise to fulfill any condition precedent to his or her attendance. People may remain anonymous when logging on to Zoom by creating any name and email of their choosing. In a meeting, public comments will be received, either or both, orally (raise hand in Zoom or use *9 on phone) and by writing. Note: Written comments may be sent to the Board at any time. For oral presentations, the Board may set a time for comments and speakers. All matters listed with the Consent Agenda were previously distributed to each Board Member for reading and study, were available for public viewing, are considered items of regular County business, and will be approved, without separate discussion, by one motion of the Board of County Commissioners. An item may be removed from the Consent Agenda and placed on the Regular Agenda for separate discussion and voting at the request of any Board Member. The Board of Commissioners may add and take action on other items not listed on this Agenda. • • •

Agenda Online Address: https://www.co.cowlitz.wa.us/535/Agendas---Regular-Public-Meetings ZOOM Invitation Address (for all meeting days): o https://us06web.zoom.us/j/82019613917 KLTV Live Feed Address: http://www.kltv.org

Page 4 of 4

233540

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 Agreement—

Project

Custom

Energy Efficiency

Agreement—

Public Utility District No. 1

Submitted By: Christine Miller, Accounting Specialist II Submitted For: Savannah Clement, Public Services DeputyDirector Department:

Roads

Administration

Information

Subject and Summary Statement

The Custom Project Energy Efficiency Agreement between Cowlitz County and Public Utility District No. 1 of

Cowlitz County, Washington, provides an incentive award for energy efficiency improvements completed at the Hall of Justice in 2026. The improvements include HVAC mechanical system and lighting upgrades designed to improve the facility' s overall energy efficiency. The agreement establishes the applicable industrial standard offer, incentive amount, payment structure, project report, and associated

The total incentive

terms and conditions.

award is $ 385, 330. 55.

Staff Attendance Savannah Clement Department

Recommendation

It is the recommendation of the Department of Facilities Maintenance that the Board move to approve

this agreement between Public Utility District No. 1 and Cowlitz County to receive the energy efficiency incentive. Attachments

PUD- Custom Project Energy Efficiency Agreement

08202026

Form

Task

User Anonymous Mejia,

User

Agenda

Averie

Review

Action

Timestamp

Item Submission

Submit

8/ 31/ 2026

2: 17: 00 PM

Review-

Submit

8/ 31/ 2026

2: 37: 00 PM

Approver

Revisions

8/ 31/ 2026

3: 03: 00 PM

Submit

8/ 31/ 2026

3: 24: 00 PM

Approve

8/ 31/ 2026

3: 45: 00 PM

Preliminary PW1

Clement,

Savannah

Department

Needed

Review Miller, Christine

Revise-

Request

by Dept

Approvers Clement,

Savannah B.

Department

Approver

233540

Consent

Agenda

Review Grayson,

Clerk of the Board

Kelly

Approve

9/ 3/ 2026

11: 47: 00 AM

Approve

9/ 3/ 2026

11: 47: 00 AM

Review Grayson,

Legal Review

Kelly

Approved: BOARD

OF COUNTY

OF COWLITZ

COMMISSIONERS

COUNTY,

WASHINGTON

Richard R. Dahl, Chairman

Steve

Steven

Rader,

Commissioner

L. Ferrell, Commissioner

Attest:

Clerk of the Board

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

CUSTOM

PROJECT

ENERGY EFFICIENCY

AGREEMENT

Public Utility District No. 1 of Cowlitz County, Washington and

Cowlitz County Public Works District Agreement

No. ECA- 26- 012

This Agreement, executed by Public Utility District No. 1 of Cowlitz County, Washington District) and Cowlitz County Public Works ( Customer) for its facility at 312 SW lst Ave Service Address) establishes the terms and conditions of participation in the District' s Project

Custom

Energy

This

Program.

Efficiency

Agreement

sets

forth

the

entire

agreement of the parties as of the effective date of this Agreement. The rights and obligations of the parties hereunder shall be subject to and governed by this Agreement. The terms of this Agreement shall begin on the date the Customer and the District have both signed the Agreement, and it shall continue until 9/ 30/ 2028. The Customer will forfeit

the right to receive any incentive payment provided for in this Agreement in the event the work designated to be done is not completed, verified, and the required Project Completion

Report ( see Exhibit C) submitted to the District prior to 9/ 30/ 2028. Either party

may terminate this Agreement upon 30 calendar days' written notice to the other party. All obligations incurred prior to such notice shall be satisfied. 1.

BASIS OF AGREEMENT:

On 7/ 13/ 2026, a completed Energy Conservation Agreement ( ECA) Project Proposal was

submitted to the District. Existing electric resistance/ chilled water hydronic system will be improved with installation of VRF system, new ERV to serve ventilation needs, a packaged

heat pump RTU, new thermostats, and a new building wide HVAC automation system. This

project

submitted

was

under

the

Bonneville

Power

Administration ( BPA) "

Energy

Efficiency Implementation Manual" dated April 1, 2026. Customer agrees to install measures and meet requirements as described in Exhibit A Custom

The

Project

District' s

executed and

Proposal).

Energy

Agreement,

Conservation

September 14, 2017 ( Agreement),

Contract

Number

17- ES- 11467,

fully

with BPA is the basis for this Agreement

by reference. The Customer, as the District' s subcontractor, in the District' s Agreement with BPA, agrees to comply with BPA' s terms,

incorporated

contemplated

conditions, requirements, and provisions as set out in the BPA' s " Implementation Manual" and " Industrial

PROJECT

Customer

Offer" delineated

COMPLETION agrees

Determination verification

Standard

attached hereto.

REPORT: submit

of Incentive

of the

in " Exhibit B"

project'

Project

Payment" (

energy

Completion

Report"

and

completed

Exhibits C and D) within 30 days following

savings.

the

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

Agreement No. ECA- 26- 012 ( page 2)

After the Completion Report has been reviewed and approved by the District, the Customer

shall submit

invoice for

payment

to the District utilizing "

Exhibit E."

requested, Customer will provide the District with copies of all invoices pertaining to the energy portion of the project cost. Customer agrees to retain back-up invoices and work orders for at least six years beyond the completion date of the project to substantiate

program project costs and to provide not less than ten ( 10) days written notice prior to their destruction.

INSTALLMENT PAYMENTS FOR LARGE PROJECTS: with

For projects

total

incentive

2 million, instead of a single lump sum

exceeding $

payment, the District will make quarterly installment payments to the Customer over the course of 30 months upon District approval of the project Completion quarterly 4.

installment

payment

will be equal to 10%

Report. Each

of the total project incentive.

COMMUNICATIONS:

Written communication between the parties shall be delivered in person or mailed to the address and to the attention of the person specified below: If to the Customer:

If to the District: Cowlitz

County

12t" Avenue-

961

Longview, Attn:

Cowlitz County Public Works

PUD P. O. Box 3007

1600 S 13th Ave

Kelso, WA 98632

98632

Attn: Mike Moss,

Jennifer Langdon,

Energy Efficiency Manager

Public

360) 501- 9392

360- 577- 3030

Services

Director

jlangdon@cowlitzpud. org

MossM@cowlitzwa. gov

The District shall not disclose proprietary information except as required by laws and regulations.

If Customer

does not want certain

information

disclosed

to the public,

at the top of each applicable page. Exclusive of proprietary information, the District shall have the right to publicly disseminate information provided by the Customer pursuant to this Agreement. Customer acknowledges the right

Customer

shall

of the District

mark " confidential"

to contact

appropriate

federal,

state, or local jurisdictions

regarding

environmental, health, and safety matters related to each Project; make site visits; and conduct an evaluation of each Project, which may include discussion between and

among staff members, Directors, and District' s consultants as necessary. Customer shall arrange to make available to the District, subject to confidentiality requirements, such information or records as the District may request in conducting such inspection, evaluation or review.

TAX IMPLICATIONS:

Payments made under this Agreement may have tax implications and the Customer may wish to contact a tax advisor. The District makes no representations with respect to the fax implications

of this Agreement

and its implementation.

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

Agreement No. ECA- 26- 012 ( page 3) 6.

REPAYMENT OF INCENTIVE PAYMENTS:

If the Customer receives payment under the terms of this Agreement and ( a) discontinues operation of the upgraded process or equipment, or ( b) stops purchasing its electricity from the District, including energy the Customer produces from its own generation resources, the Customer shall be responsible for repayment to the District and agrees to

return payments received from the District for all energy according to the following terms:

conservation

measures

The District will render a bill to the Customer who shall be responsible to pay within 60

sixty) business days and where said repayment will be based on the calculation of the formula

below.

The

reimbursement

calculation

will

applied

each

measure

individually and determined by when the process/ equipment upgraded under the measure( s) cease( s) to place firm load on the District. The District'

payment to the Customer)

x ( Lm- Y) _

Lin

where:

Reimbursement to the District

Lm =

Assumed

Life

reported

to BPA.

energy

measure

conservation

Useful life ( years) of energy conservation measure while it was in operation using energy supplied by the District. Useful life will be calculated beginning with the month the Completion Report was approved by the District.

If Customer was paid in installments as described in Section 3 ( Installment Payments for the total amount of installments paid will be used as the first factor to calculate the District' s payment to the Customer in the repayment formula. Large

Projects),

AMENDMENTS:

The provisions of this Agreement may be amended only by written agreement of both parties.

If any provision of this Agreement is determined to be invalid or unenforceable, both parties agree that the remainder of this Agreement will continue in full force and effect. 8.

CUSTOMER CERTIFICATION:

Customer certifies that projects implemented and incented under this Agreement would not otherwise have been installed. They further certify that all measures for this project meet or exceed all applicable local, state, and federal codes and requirements in the

design and installation of all energy efficient measures. Customer agrees to comply with all state and federal environmental disposal

of abandoned

including

the

proper

disposal

PCB- contaminated

lighting

materials

ballasts,

and

etc.).

equipment (

requirements, i. e. -

noncompliance

proper occurs,

payments may be withheld until project is brought into substantial compliance and all terms of this Agreement

have been

met.

Docusign Envelope ID: ECD10E7F-22C9- 8660- 82EB- C2CF60815BBF

Agreement No. ECA- 26- 012 ( page 4)

To the fullest extent allowed by law, the Customer agrees to indemnify, defend, and hold harmless the District and BPA, its officers, agents, and employees, from all claims, loss,

damages, or litigation including personal injury, death or property damage arising from or in connection with the performance of the Agreements herein unless said liability is occasioned

by the sole or partial negligence

of the District and BPA. The Customer

expressly acknowledges that this Agreement has been mutually negotiated. DISPUTE

RESOLUTION:

The Parties hereto agree in the event of a dispute they will meet and confer in good faith within

ten (

10) days of the date of the dispute to reach a reasonable resolution. If a not reached, the Parties agree to refer their dispute to non- binding

resolution

arbitration, the terms and conditions of such to be agreed on in writing or, in the absence of agreement Association

on terms and conditions,

office in Seattle

to refer the matter to the American

under the rules for commercial

arbitration.

Arbitration

The Parties may

agree in writing to make any arbitration binding.

Each party hereto represents that it has the authority to execute this Agreement and that it has been duly authorized to enter into this Agreement. This Agreement is binding on any successors and assigns of the parties. Signature Warranty. The undersigned personally warrants their respective authority as Agents to bind their principals under this Agreement.

Cowlitz

County

Public Works

Public Utility District No. 1 of Cowlitz County, Washington nd b,.

Signature:

Signature: Mike Pu

Title: Date:

Attachments:

Exhibit B Exhibit

Exhibit

4Aoss

lic S

rvices

F z 7'

Gary Huhta Director

Title:

General

Date:

8/ 1 0/ 2026 1 1: 50 PM PDT

Manager

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT B ( page 1 of 2)

INDUSTRIAL

PROJECT

STANDARD

OFFER

DESCRIPTION

The Industrial Standard Offer ( ISO) provides reimbursements for Custom Projects and specific Deemed Measures installed in Commercial and Industrial facilities. Customer shall implement this Project in accordance with the terms of this ISO to receive reimbursements PROJECT

from the District.

REQUIREMENTS

Only Measures installed in Industrial and Commercial facilities served by the District are eligible for reimbursements

under this Project.

Only purchases and installation of new equipment is eligible for incentives.

All Measures shall be completed prior to requesting reimbursement

from

BPA.

Customer should note that the District will retain supporting documents of the Deemed and Custom Project Measures installed under this Agreement.

PROJECT COMPLETION

REPORTS FOR CUSTOM PROJECTS:

Customer shall submit a written Project Completion Report for the Custom Project. 1)

Elements of Completion Report

The

required

elements

the

Project

Completion

Report

are

identified in subsequent Exhibit " C". 2)

Additional

Information

After initial review of the Completion

Report, and after consultation

with the District, BPA may ask for additional information pertaining to If BPA determines

Project.

the Custom

that the Completion

Report

is still incomplete, BPA will request the District and Customer to revise and resubmit the Completion Report. Customer shall then assist

District in supplying the requested information. The District customer

devices, databases. available

may request site energy data from any available contractor-

building

owned

assets

equipment

The

Customer

energy

data

the

including

control

project District

meters,

logging

systems,

energy

contractor( s)

will

provide

request,

and project

contractor(s) will provide data to the Customer by request in cases where data is held by project contractor( s). 3)

Notification by BPA Upon

completing

its

review

the

Completion

Report,

BPA will

provide written notice to the District either accepting or rejecting the Project Completion

Report.

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT B ( page 2 of 2) 4.

ENERGY SAVINGS The District

REQUIREMENTS

FOR CUSTOM MEASURES

and its Customer

shall use the measurement

and verification

plan approved by BPA to determine the actual Energy Savings for each Custom

Project.

BPA may request, and the District and Customer shall subsequently make

for

arrangements

site

visits

BPA

representatives,

for

review

of the

measurement and verification methodology proposed in a Custom Project

proposal, or as part of BPA' s review of a Completion Report. 5.

PAYMENT FOR CUSTOM PROJECTS

Total incentive payments for Custom Projects will be capped at the lesser of the following three values: a)

Multiplier

annual

energy ( kWh)

of verified

incremental

verified

b) Fixed percentage

savings ...

see table below

Project Cost ...

see table below.

c) The estimated incentive amount in the original Project Proposal. Reimbursement/ kWh

End- Use Sector

Project

Cost Ca

0. 30 x Busbar savings up to annual 1, 000, 000 kWh + $ 0. 20 x Industrial

70%

Busbar savings greater than 1, 000, 000 kWh

Commercial-

0. 33/ kWh

70%

Retrofit New

Commercial-

0. 33/ kWh

Construction

MEASURE

2. 86% Building not land

LIFE

The Measure Life for all Measures under this Project is 10 years unless otherwise stated by notice to the District. 7.

IMPLEMENTATION

PERIOD

This is a limited- term Agreement. The Customer will forfeit the right to receive any

incentive payment in the event the designated work is not completed, verified, and the required Project Completion Report submitted by the Customer to the District

by the date stated

in the original

Project

Proposal.

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF608158BF

EXHIBIT C ( page 1 of 1)

COMPLETION

REPORT REQUIREMENTS

FOR CUSTOM

PROJECTS

After completion of the project, Customer shall submit a Project Completion Report to the District. The report shall be written in the following format: 1.

Name and Full Address of Customer.

Date of Submittal.

Title of Proiect.

Description of the Completed

Project.

Include a description of each measure, a list of the equipment, which was installed, the date on which each measure was installed, and the electrical energy efficiency

improvement accomplished. Describe any changes made to the Project Proposal and their impact, if any, on energy savings and project cost. S.

Energy Savings Verification. The Customer

shall complete

and document

the results

of the energy

savings

verification as determined from the results of the metering and verification plan agreed upon in the Project Proposal. 6.

Documentation of Commissionin .

The Customer shall submit a report documenting

commissioning services performed

for all applicable energy efficiency measures installed in the scope of the Project Proposal.

Actual Incremental_ Project Cost.

The Customer shall state and provide supporting documentation and itemization of the verified ( incremental)

Project Cost. Eligible Project Costs may also include costs

for initial project scoping, for development of the Project Proposal, for execution of the M& V Plan, for analysis and determination of verified energy savings, and for development of the Project Completion Report document. 8.

Comments

and Recommendations.

Provide a critique of the project to identify possible improvements in equipment or procedures

for similar projects.

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT E

INVOICE FOR CUSTOM PROJECT PROGRAM Incentive

Payment

Form -

Projects

Directions: Review payee and mailing address for accuracy, sign, return to ilanadonLcowlitzpud. ora, and retain a copy for your records.

CUSTOMER NAME AND MAILING ADDRESS

Cowlitz County Public Works 1600 S 13th Ave Kelso, WA 98632

PROJECT

NAME

Existing

electric

COWLITZ PUD PROJECT NUMBER resistance/

chilled

water

hydronic

system

will be

ECA- 26- 012

improved with installation of VRF system, new ERV to serve

ventilation needs, a packaged heat pump RTU, new thermostats, and a new building wide HVAC automation system.

PAYMENT TOTAL PAYMENT

REQUESTED (

CERTIFICATION

BY CUSTOMER

See Exhibit D - " Actual"

Column)

I hereby certify that the information contained in the attached documents and the amount requested on this invoice is true, correct, and complete.

SkbDture

Vy, Title

7-I t Date

APPROVAL

BY COWLITZ

PUD

COWLITZ

PUD BUDGET INFORMATION

GL Code: Department Purpose

Code:

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT A

Commercial- Sector ' Retrofit'

Custom Project Proposal Submitted by Cowlitz County Hall of Justice 312 SW 1st Ave Kelso,

WA 98632

For

Cowlitz Hall of Justice HVAC Upgrades

Cowlitz PUD Project No. ECA- 26- 012)

Prepared By Daniel

Meyers

Senior Energy Efficiency Specialist 360- 501- 9561

For

Jen Langdon, Energy Efficiency Manager Cowlitz County PUD 961 12th Avenue. Box 3007 Longview, WA 98632 360) 501- 9392

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF EXHIBIT A

Input Form ( Cover Sheet)

REQUESTED PUD

DATA:

CUSTOMER INPUT:

Name):

Cowlitz County Hall of Justice

Customer( Company

1600 S 13th Ave

Company Mailing Address:

Kelso

City:

State:

98632

ZIP:

312 SW

Facility Street Address: Facility City: Facility State:

98632

Facility ZIP: Contact

Project

Mike Moss

Employee at facility):

Name(

Director of Public Works

Project Contact Job Title: Project Contact Phone

360- 557- 3030

Number:

Project Contact Email: Project Title:

mossmecowlitzwa, eoV

Cowlitz Hall of Justice HVAC Upgrades

Installing a new VRF system utilizeing some of the existing building ductwork, a new ERV to serve ventilation needs, a packaged heat pump RTY, new thermostats, and a new building wide building automation system to

1- 3 sentences):

Brief Project Summary(

control

Select TYPE of Project:

Today' s Date( MM/ DD/ YYYY): Estimated Date to Start Detailed Ordering Estimated

Date

of Equipment

1st Ave

Kelso

Design

and/ or

all the enw HVAC equipment. COMMERCIAL''

Retrofit"

6/ 5/ 2026 511112026

YYYY :

that Project will be fully commissioned

and

613012026

delivering expected savings( MM/ DD/ YYYY): Estimated Requested

Agree ment'

verity the

savings

M& V

Completion Date( MM/ DD/ YY):

Expiration

and submit

Date'(

Customer

commits

9/ 30/ 2027

required ' Project Completion

913012028

Report' prior to this date or potentially forfeit PUD incentives) MM/ DD/ YYYY): Estimated Project( Incremental) Estimated

annual

site

savings(

kWh) from Project:

Measure

0. 0565 per kWh

Life of the project(

years)

payback:

28. 2 years

Current Incentive Rate ($/ kWh):

0. 33/ kWh

Current Incentive'

Resulting Estimated

1, 050, 222 kWh

kWh)

Resulting estimated before- Incentive

Resulting

1, 671, 299. 00

Approx($/

Customer Cost of PowerEstimated

Cost$:

CAP'( 7o of Project Cost): Incentive:

385, 330. 55 1, 285, 968

Simple Payback:

21. 7 years

Incentive

incentive

70%

Project Cost:

maximum

after-

simple

PUD

filename ECA- 26- 012_ Cowl itzCo Hal lOfJustice_ HVAC_ Proposa1_ 2026. 07. 14 worksheet

1. Input_ Form

Exhibit A, Page 2

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF EXHIBIT

2. Eligibility Criteria Checklist Please select YES or NO for the following questions. Once the Proposal is accepted, a copy

of this page will be included in a project Formal Agreement to be generated by the District and sent to the Customer. The Customer will then be asked to certify these answers by

signing this page in the Formal Agreement.

YES =

proposed new equipment has not been purchased: Key equipment not yet purchased).

2. This

project

The

does

3. The measures

not result

are

designed

YES

Yes= True).

in fuel switching (

YES

in improvements

to result

in the

is at least

YES

efficiency of electricity generation, distribution or use. 4. The expected

life of energy

savings

for each

measure

four years: 5. The

proposed

baseline

for each

measure

is documented

and

provides a basis for establishing energy savings. 6. The

proposal

showing

how

includes

energy

7. The expected

measurement

and

verification

plan

6. YES

savings will be verified.

project

benefit/

cost

ratio meets

the current

BPA

7. YES

minimum requirement.

If over 1, 000, 000 kWh/ yr, is BPA CPP approved?

8. YES

CERTIFICATION ( to be signed by Customer in Formal Agreement) I certify that the answers provided above are true, correct, and complete. Signed:

Title:

Date:

filename ECA- 26- 012_ Cow IitzCoHaIIOfJustice_ HVAC_ Proposal_ 2026. 07. 14 worksheet

Eligibility_ Criteria

Exhibit

A, Page

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT A

3. Project Description Describe in detail the existing equipment, system, or process, and the product or service of your facility and how the proposed Project( s) will modify them. Include estimates of changes in system output ( use the space below or, if necessary, provide a separate' Appendix' to this Proposal).

Existing System:

The original Hall of Justice constructed in 1973 was 122, 237 square feet and included four stories, one

below grade and three above ground. In 1984, an extension of the third- floor jail added 9, 900 more square feet. The building is generally occupied from 7: 30 AM to 5: 00 PM, Monday through Friday. The Sheriff' s office, Records, and 911/ EOC operate 24/ 7. Cowlitz Hail of Justice has been heated with what was, in those respective eras, some of the most advanced, efficient systems and architecture including water- to- water

heat pumps for simultaneous heating and cooling, an open- loop connection to the nearby river for heat transfer, a roof mounted water tank for system apacitance, and numerous heat exchangers to promote

redundancy for space heating and domestic water heating systems to support one another during regular maintenance or equipment failure. The open- loop connection was replaced with a closed- loop well field located below the field Southwest of the HOJ, which has long since been out of operation due to suspected leaks and associated poor heat transfer performance. Over time, the system became progressively more complex, and historical institutional

knowledge

of the original design intent and control strategies was lost.

The primary heating source for nearly all HVAC systems in the HOJ is a 900 kW electric resistance hot water boiler, original to the 1973 construction. Cooling for the chilled water loop is generated by a single Multistack heat recovery chiller, recently installed in 2023. In alignment with the hydronic design from the 1980' s, this heat recovery chiller was intended to reject heat from the

chilled water loop into the hot water loop, reducing the burden on the electric resistance boiler and improving system efficiency. Additional heat not needed by the hot water loop was supposed to be rejected to a roof mounted Evapco induced draft cooling tower, installed in 2017. Chilled water is delivered

solely to two chilled water coils, one in each of the main multizone air handling units. Chilled water was routed to smaller 4- pipe air handling units serving the Jail addition, but those units have now been decommissioned

and disconnected for more than a decade. The complicated existing

conditions are outlined in detail in the attached " Cowlitz HOJ Energy Audit. pdf'.

filename worksheet

ECA- 26- 012_ CowlitzCoHallOfJustice_ HVAC_ Proposal_ 2026. 07. 14 3. Project— Description

Exhibit

A, Page

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT A

3. Project Description Describe in detail the existing equipment, system, or process, and the product or service of your facility and how the proposed Project( s) will modify them. Include estimates of changes in system output( use the space below or, if necessary, provide a separate ' Appendix' to this Proposal).

Proposed

System:

The proposed work is to install a new Air- Source VRF system to serve occupied portions of the basement, 1st, and perimeter offices on the second floor. The system will utilize much of the existing supply ductwork, some of which will continue to serve as supply air duty and some of which will be converted to serve

ventilation air duty. New outdoor units for the VRF system will be located on the roof. Refrigerant piping, branch selector boxes, and new indoor VRF units will generally be installed above the existing lay- in

acoustical ceiling. A new ERV will be installed in the West basement mechanical room to provide tempered ventilation air to all areas listed above. A new packaged heat pump will be mounted on the roof and ducted to connect to 2nd floor courtroom ductwork via the vertical duct shaft on the West side of the building to

provide heating, cooling, and ventilation. It also includes installing a separate, smaller VRF system to serve the old 911/ EOC area of the basement to replace the existing hot water/ DX air handling units, installing

mini- split heat pumps to serve spaces with cooling demands inconsistent with the rest of the HOJ, and electric unit heaters in perimeter spaces not covered by the radiant heating system. New thermostats and a new building-wide building automation system will be installed to control all new HVAC equipment, allowing for scheduling, monitoring, troubleshooting, and data trending. Additional information may be found in the attached " Cowlitz HOJ Energy Audit. pdf" and " 2025- 02- 21 Cowlitz HOJ_ Mech Bid Set. pdf'

filename ECA- 26- 012_ Cowl itzCoHaIIOfJustice_ HVAC_ Proposal_ 2026. 07. 14 worksheet

3. Project— Description

Exhibit

A, Page

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT A

4. Energy Savings Estimate/ Calculations Dscrive the Energy Savings Estimate/ Calculations ( including non- energy benefits and O& M changes if applicable). If attaching file, please include full file name and a brief summary,

Millig utilized the facility energy modeling program eQUEST to create a three- dimensional, 8, 760 hourly computer simulation of the buildings' hourly energy use. These models incorporate the buildings' actual construction, equipment, system types, and operational characteristics. They were closely calibrated to the

site' s actual utility data to validate their accuracy. These baseline models were used to understand each major energy end- use in the buildings and provided the basis for detailed simulations of upgrade opportunities. The weather normalized electricity consumption baseline reflects the target output for the

baseline energy model, with a total of 2, 637, 978 kWh per year, and is represented by the dark blue line on the following chart. Stacked colored bars for each month reflect the modeled electricity usage by end use such as space heating or lighting. The sum of the annual kWh from the weather normalized baseline data is 2, 637, 978 kWh, while the sum of the annual kWh from the eQuest model is 2, 704, 418 kWh, reflecting an

Additional information including monthly outputs broken up by end use and comparison between baseline and proposed install results from the model may be found in the attached " Cowlitz HCJ- Summary of eQUEST Calculated Savings. pdf". overall

difference of less than 2. 5%.

ANNUAL

Energy 5avinc

1, 050, 222. 00 kWh

filename ECA- 26- 012_ CowlitzCo Hal lOfJustice_ HVAC_ Proposal_ 2026. 07. 14 worksheet

Energy_ Savings_ Calcs

Exhibit

A, Page

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT A

5. Measurement and Verification ( M& V) Plan Describe the Measurement and Verification Plan. In the description, please include the following information:

Baseline conditions:

current practice or pre condition

Pre metering: whole building, affected end use, or none Post metering: whole building, affected end use, or none

Model type: engineering, regression, or indexing summary:

In accordance with State DES performance contracting requirements, the installer( ESCO) will perform ongoing

M& V to monitor the progress of contractually guaranteed energy savings. The ESCO will retain and utilize all available sources of data including Building Automation System trends for the purposes of monitoring and verifying energy savings throughout the energy savings guarantee period. The ESCO will provide a

Commissioning Report to the end user upon completion of initial commissioning and perform ongoing commissioning throughout the guarantee period, reporting energy savings to the end user on a monthly basis and addressing any deviations from expected energy savings achievement as required. Final M& V for verification of guaranteed energy savings and for fulfillment of the performance contract will be performed by the ESCO using IPMVP Option C methodology.

M& V for determination of rebate- eligible energy savings and final approval of the BPA custom project

completion report will be performed separately by a BPA Customer Service Engineer at the end of the 12month BPA performance period. In accordance with the BPA M& V Protocol Selection Guide, the M& V protocol that will be utilized will be Verification by Energy Modeling. A statistical energy model will use actual building utility data ( provided by the utility revenue meter) and be analyzed using the modeling program SCAM. The various proposed measures overlap and have interactive effects so utility billing data is the best way to capture all the pieces of the project. 12 months of pre- project baseline data and 12 months of post- project performance period data will be compared to determine the energy savings.

filename ECA- 26- 012_ Cowl itzCoHaIIOfJustice_ HVAC_ Proposal_ 2026. 07. 14 worksheet

S. MV

Plan

Exhibit

A, Page

Docusign

Envelope

ID: ECD10E7F-

22C9- 8660- 82EB- C2CF60815BBF

EXHIBIT A

6. Estimated Project Costs Describe the Estimated Project Costs. If attaching file, please include full file name and a brief summary. Eligible Pro' ect Costs:

1. Solely allocated administrative cost.

2. Energy review cost including in- house engineering design ( staff or contract) and proposal preparation costs. 3. Equipment costs.

4. Equipment installation costs ( including labor and overhead for facilities doing their own installation). 5. Equipment removal or abandonment- in- place costs. 6. Instrumentation and data collection to verify energy savings. 7. Permit or inspection 8. Sales

fees.

tax.

Operation and maintenance costs, depreciation, or any incurred project expenses that are not listed

above may not be reimbursable. For example, customer profit is not an eligible project cost. If you have any project cost question please contact Cowlitz PUD at 360-501- 9392.

The project costs associated with the energy savings measures are highlighted and summed within the attached " Harris Invoice- Cowlitz HOJ_ RMedit. pdf" to result in the total of$ 1, 671, 299. An additional attachment describes the non- energy operations and maintenance savings that will also result from this

project. That total of$ 20, 800 may be found in the attached " Cowlitz Co HOJ Maintenance Savings. pdf'. Total estimated

project

costs:$

1, 671, 299. 00

filename ECA- 26- 012_ Cowl itzCo Hal I0fJustice_ HVAC_ Proposal_ 2026. 07. 14 worksheet

6. Cost

Details

Exhibit

A, Page

Docusign Envelope ID: ECD10E7F- 22C9- 8660- 82EB- C2CF60815BBF EXHIBIT

7/ 14/ 2026

Commercial- Sector ' Retrofit' DETERMINATION

OF INCENTIVE

PAYMENT

The incentive payment in the Custom Project Program is based on actual project costs and annual verified energy savings resulting from the project. Verification is secured through a mutually agreed upon verification scheme to be submitted as part of the Project Proposal. The amount of the incentive payment shall be taken as the lesser of the two quantities given by the calculation methods below. Additionally, the two- tiered incentive is contingent upon meeting the project completion date identified on the Input- Form of the Project Proposal. a) Final verified annual Busbar kWh savings multiplied by the payment rate of: 0. 33/ kWh b)

70%

of the final verified ( incremental) project costs.

Original estimated

incentive

amount.

The ESTIMATED column below is populated with data entered on the ' lnput_ Form' tab of the Project Proposal. The ACTUAL column is to be completed after energy savings have been verified. The incentive payment figure at the bottom of the ACTUAL column shall be the actual incentive payment paid to the customer. 1.

Project Title:

Cowlitz County Hall of Justice Cowlitz Hall of Justice HVAC Upgrades

Cowlitz PUD Project No. ECA- 26- 012) ESTIMATED

1, 671, 299

Project Cost:

Annual Site kWh Energy Savings:

Annual Busbar

kWh Energy Savings:

1, 050, 222

kWh

0 kWh

1, 767, 668. 33 kWh

1. 1 11830*)

Line 3 x NOTE:

ACTUAL

Actual '

Busbar

Factor'

multiplier

can vary( by less than 0. 57.)depending on BPA- defined project category 5.

Incentive

5a.

Cap # 1 ($

5b.

Cap# 2

5c.

Cap# 3 ( Original ' Estimated'

Payment

Caps:

0. 33 x Busbar Savings)

(

70%

Incentive

Amount)

Resulting

Incentive

Project Cost)

Payment

lesser of lines 5a, 5b, and 5c above)

385, 330. 55

1, 169, 909. 30

NIA

385, 330. 55

Docusign Envelope ID: ECD10E7F- 22C9- 8660-82EB- C2CF60815BBF

7. 0 Appendix A Please use the space below to include additional information from the Project-Description,

Energy_Savings_Calcs, or MV_Plan tabs where necessary. Please see the following supporting

documentation:

Cowlitz HOJ Energy Audit. pdf 2025- 02- 21 Cowlitz HOJ_ Mech Bid Set. pdf

Cowlitz HOJ- Summary of eQUEST Calculated Savings. pdf Cowlitz Co HOJ Maintenance

Savings. pdf

filename ECA- 26- 012_ Cowl itzCoHaIlOfJustice_ HVAC_ Proposal_ 2026. 07. 14 worksheet

Appendix A

Appendix A, Page 10

233823

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 RESOLUTION - Washington EMD-

Designation of Agent Resolution and SAD-

December 2025 Flood Event

Submitted By: Averie Mejia, Administrative Assistant III Submitted For: Susan Eugenis, County Engineer Department:

Roads

Administration

Information

Subject and Summary Statement

Attached is the Federal Debarment, Suspension, Ineligibility, and Voluntary Exclusion ( Exclusion) Document, the Designation of Applicant' s Agent Resolution and the Signature Authorization Form SAF) for the December

2025 flood event.

The Exclusion Document is to be signed by the Board

Chairman. The SAF form is to be signed by the Commissioners. The Designation of Applicant's Agent Resolution allows Susan Eugenis, County Engineer, or her alternate, Christopher Andrews, to sign for

the Board for the execution of contracts, certify completion of projects, request payments and prepare required documentation for funding requirements from the Washington Military Department, Emergency Management Division. The expenditures include debris removal from county roads, emergency leachate pumping, maintaining detours, reconstruction of Barnes Drive and other emergency work. Staff Attendance Susan Eugenis Department

Recommendation

It is the recommendation of the Department of Public Works that the Board move to sign the Exclusion and SAF documents and adopt the Resolution. Attachments

Signature Authorization

Form signed,

Designation

of Applicant

Form

Task

User Mejia,

Averie

Andrews,

Chris

resolution,

Exclusion

Certification

form

Review

Action

Timestamp

Item Submission

Submit

9/ 3/ 2026

Review-

Submit

9/ 3/ 2026 9: 56: 00 AM

Review-

Submit

9/ 3/ 2026

1: 24: 00 PM

Approver

Approve

9/ 3/ 2026

2: 00: 00 PM

Legal Review

Approve

9/ 4/ 2026 2: 09: 00 PM

Clerk of the Board

Approve

9/ 8/ 2026 7: 52: 00 AM

Agenda

Preliminary

9: 39: 00 AM

PW1 Eugenis,

Susan

Preliminary PW2

Eugenis,

Susan

Department Review

Jensen, Grayson,

Doug Kelly

Review

233823

Consent

Agenda

D26- 147 Designation

of Applicant' s Agent Resolution

Be it resolved

of Cowlitz County

Board of Commissioners

Public Agency)

Governing Body) County

Susan Eugenis

Engineer

and

representative

is hereby designated the authorized

Title)

Name of New Agent)

Senior Engineer

Chris Andrews Name of Alternate)

the alternate

for and in behalf of

Cowlitz

is designated

Title)

County

a public

Public Agency Name)

agency established under the laws of the state of Washington.

The purpose of this designation as the authorized representative is to obtain federal and/ or state emergency Cowlitz

disaster

assistance

County

funds.

These representatives

are authorized on behalf of the

to execute all contracts, certify completion of projects, request

payments, and prepare all required documentation for funding requirements. Passed

day of

and approved this

Signature)

Title)

Signature)

Title)

Signature)

Title)

Signature)

Title)

Signature)

Title)

Signature)

Title)

Certification

of Cowlitz County

duly appointed and

Public Agency)

Title)

Name)

do hereby certify that the above is a true and correct copy of a resolution passed and approved by the

Board of Commissioners

Governing Body)

of Cowlitz

County

the

day of

Public Agency)

Date:

Official Position)

Signature) 12/ 10/ 09

INSTRUCTIONS FOR COMPLETING DESIGNATION OF APPLICANT' S AGENT

Governing Body = council, commissioners, board of directors, etc. Public

Agency = name of the applicant

entity, i. e.,

county, city, fire district, etc.

General Notes:

Must have signatures of voting members of the governing body; titles may be typed. A majority of the governing body must sign the resolution. The certification must be signed by the clerk of the governing body.

The signed resolution itself may be photocopied, but the certification needs to have the original signature of the signer. The A letter may be substituted for the Designation of Applicant' s Agent Resolution. letter should be from the chief executive officer for the public agency, i. e., Mayor, City Manager.

One may not appoint oneself as the applicant agent.

12/ 10/ 09

Washington Military Department Contract Number:

Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form Doing business as( DBA)

NAME

Cowlitz County ADDRESS

Applicable

207 N 4th Avenue

Identifier(

if any:

Federal Employer Tax

Business

Identification#:

UBI)

91- 6001310

083- 003- 788

98626

Kelso

WA Uniform

Procurement

Solicitation#,

This certification

is submitted

as part of a request to contract.

Instructions For Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-- Lower Tier Covered Transactions

READ CAREFULLY BEFORE SIGNING THE CERTIFICATION.

Federal regulations require contractors and bidders to sign and

abide by the terms of this certification, without modification, in order to participate in certain transactions directly or indirectly involving federal funds. 1.

By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out

The certification

below.

in this clause is a material representation

of fact upon which reliance was placed when this

transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government the department or agency

with which this transaction originated may pursue available remedies, including suspension and/ or debarment. 3.

The prospective lower tier participant shall provide immediate written notice to the department, institution or office to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or had become erroneous by reason of changed circumstances. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,

primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning

set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the

person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5.

The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered

transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is

proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily excluded

from participation in this covered transaction, unless authorized by the department or agency with which this transaction 6.

originated.

The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled Debarment,

Regarding

Certification Transaction,"

Suspension,

Ineligibility and Voluntary Exclusion- Lower Tier Covered

without modification, in all lower tier covered transactions and in all solicitations for lower tier covered

transactions. 7.

A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the

method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the List of Parties Excluded from Federal Procurement and Non- procurement Programs. 8.

Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business activity. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction

knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable

CFR, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may

pursue available remedies, including suspension and/or debarment. Suspension, Ineligibility and Voluntary Exclusion-- Lower Tier Certification Regarding Debarment, Covered Transactions

The prospective lower tier participant certifies, by submission of this proposal or contract, that neither it nor its

principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded

from

participation

this

transaction

by any Federal

department

agency.

Where the prospective

lower tier

participant is unable to certify to any of the statements in this certification, such prospective participant shall attach

an explanation

Bidder

or Contractor

Name

and Title:

to this form.

Signature:

Date:

Washington

Contract

Military Department

Number: --'-' '

FEDERAL DEBARMENT, SUSPENSION

INELIGIBILITY and VOLUNTARY EXCLUSION FREQUENTLY ASKED QUESTIONS) What is " Debarment Suspension, Ineligibility, and Voluntary Exclusion"?

These terms refer to the status of a person or company that cannot contract with or receive grants from a federal agency. In order to be debarred, suspended, ineligible, or voluntarily excluded, you must have: had a contract or grant with a federal agency, and

gone through some process where the federal agency notified or attempted to notify you that you could not contract with the federal agency.

Generally, this process occurs where you, the contractor, are not qualified or are not adequately performing under a contract, or have violated a regulation or law pertaining to the contract. Why am I required to sign this certification? You

are

requesting

contract

grant with the Washington Military Department.

Federal law ( Executive Order 12549)

requires Washington Military Department ensure that persons or companies that contract with Washington Military Department are not prohibited from having federal contracts. What is Executive Order 12549? Order

Executive

12549

refers

Executive

Federal

Order

The executive order was signed by the

12549.

Number

President and directed federal agencies to ensure that federal agencies, and any state or other agency receiving federal

funds were not contracting or awarding grants to persons, organizations, or companies who have been excluded from in

participating

federal

contracts

Federal agencies have codified this requirement in their individual agency

grants.

Code of Federal Regulations ( CFRs). What is the purpose of this certification?

The purpose of the certification is for you to tell Washington Military Department in writing that you have not been prohibited by federal agencies from entering into a federal contract. What does the word " proposal" mean when referred to in this certification?

Proposal means a solicited or unsolicited bid, application, request, invitation to consider or similar communication from you to Washington Military Department. What or who is a " lower tier participant"

Lower tier participants means a person or organization that submits a proposal, enters into contracts with,Department. or receives aIf

grant

from

Washington Military Department,

any subcontractor

of a contract

with Washington

Military

you hire subcontractors, you should require them to sign a certification and keep it with your subcontract. What is a covered transaction

when referred to in this certification?

Covered Transaction means a contract, oral or written agreement, grant, or any other arrangement where you contract with

receive

money

from

Washington

Military

Department.

Covered

Transaction

does

not

include

mandatory

entitlements and individual benefits.

Sample Debarment, Suspension, Ineligibility, Voluntary Exclusion Contract Provision Certification.

Debarment

The Contractor certifies that the Contractor is not presently debarred, suspended,

proposed for debarment, declared ineligible, or voluntarily excluded from participating in this Contract by any Federal department or agency. If requested by Washington Military Department, the Contractor shall complete a

Certification

completed

Regarding Debarment,

by the Contractor

Suspension,

for this Contract

shall

Ineligibility,

and

be incorporated

Voluntary Exclusion form. Any such form by reference.

into this Contract

SIGNATURE AUTHORIZATION WASHINGTON

MILITARY

FORM ( SAF)

DEPARTMENT

Camp Murray, Washington 98430- 5122 Please read instructions on page 2 before completing this form. NAME

DATE SUBMITTED

OF ORGANIZATION

Cowlitz County CONTRACT /

PROJECT

CONTRACT NUMBER

DESCRIPTION

D26- 147

4906- DR- WA

AUTHORIZING AUTHORITY

PHYSICAL SIGNATURE

E- SIGNATURE

Richard R. Dahl

AUTHORIZED

TO SIGN CONTRACTS /

E- SIGNATURE

Chairman

AMENDMENTS PRINT

PHYSICAL SIGNATURE

TITLE

TYPE NAME

TITLE

TYPE NAME

Susan Eugenis

County Engineer

Chris Andrews'

Senior Engineer

Mike Moss

Public Works Director

AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT PRINT OR PHYSICAL SIGNATURE

E- SIGNATURE

TITLE

TYPE NAME

Susan Eugenis

County Engineer

Chris Andrews

Senior Engineer

Tiffany Nelson

Accounting Specialist

SAF Revised 5/ 8/ 2024

Pagel

INSTRUCTIONS

FOR THE SIGNATURE AUTHORIZATION

FORM ( SAF)

This form identifies the authorizing authority( ies) and person( s) who have the authority to sign contracts, amendments, and requests for reimbursement. It is required for the management of your contracts with the Washington

Military

Department (

WMD).

Please complete all sections.

The signature and/ or e- signatures included on this SAF must match what is on the contracts, amendment, debarment form, and A- 19 invoice voucher submitted.

It is required that the

signatures in WMD' s files are current. Changes in staffing or responsibilities will require a new SAF.

At least one person must be assigned to each of the three roles and the same person can be assigned to multiple roles. If more than one individual will be signing a contract,

amendment, or reimbursement request please make sure everyone signs this form. If

additional lines are needed, please fill out two forms and title them 1 of 2 and 2 of 2. 1.

Authorizing Authority. Generally, the person( s) signing in this section heads the organization such as the chief executive office. In some cases, other employees within

the organization may have been delegated this authority. 2.

Authorized to Sign Contracts / Amendments. The person( s) given the authority to bind the organization to the terms and conditions of the contract.

Authorized to Sign Requests for Reimbursement. Often the chief financial officer or members of the accounts receivable team. When a request for reimbursement is received, the signature on the A- 19 invoice voucher is verified that it matches the signature on this form.

It is advisable to have more than one person authorized to

sign reimbursement requests. This will help prevent delays in processing a request if

one person is temporarily unavailable. The payment can be delayed if the request is presented without the proper signature. Once filled out, send the original to WMD with the signed contract. It is recommended you keep

a copy with the executed contract in your files.

If you have any questions regarding this form or to request new forms, please email the contracts office

at contracts. office@mil. wa. gov.

233828

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 US Department of Agriculture-

Request for Obligation of Funds and Letter of Intent-

Ryderwood

Reservoir

Project

Submitted By: Averie Mejia, Administrative Assistant III Submitted For: Susan Eugenis, County Engineer Department:

Roads

Administration

Information

Subject and Summary Statement Attached are a Request for Obligation

of Funds and a Letter of Intent to meet Conditions

for the

Ryderwood Reservoir Project. These documents are required by the US Department of Agriculture for grant funding in the amount of$ 1, 000, 000 and were signed by the Chairman of the Board on August 25th, 2026. Also attached is the Letter of Conditions for the grant. Staff Attendance Susan

Eugenis

Department

Recommendation

It is the recommendation

of the Department

of Public Works that the Request for Obligation of Funds

and the Letter of Intent be acknowledged by the Board and received for the Commissioners official record. Attachments

RD1942- 6 signed

Letter of Intent, RD1940- 1 signed

Request for Obligation

of Funds,

LOC USDA

8- 25- 2026

Ryderwood

Form

Task

User Mejia,

Averie

Andrews,

Chris

Eugenis,

Susan

Eugenis,

Susan

Review

Action

Timestamp

Submit

9/ 3/ 2026

10: 08: 00 AM

Review-

Submit

9/ 3/ 2026

10: 29: 00 AM

Preliminary Review-

Submit

9/ 3/ 2026

1: 22: 00 PM

Approve

9/ 3/ 2026

2: 01: 00 PM

Legal Review

Approve

9/ 4/ 2026

2: 08: 00 PM

Clerk of the Board

Approve

9/ 8/ 2026

7: 52: 00 AM

Agenda

Item

Preliminary

Submission

PW1

PW2 Department

Approver

Review Jensen, Grayson,

Doug Kelly

Review

USDA

Rural 1835 United

States Department

Black

Development•

Lake

Blvd

Voice(

of Agriculture

Olympia

SW, Ste B, Olympia,

360)

704- 7705•

Area

Office

WA 98512

Fax 855- 847- 5488

August 25, 2026

Cowlitz County Department of Public Works 1600 13th Avenue South Kelso, WA 98626

SUBJECT:

Letter of Conditions Project Name FY 24 CDS Ryderwood DR Project Water and Waste Disposal Systems for Rural Communities Assistance Listings Number-

10. 760

Agency Grant: $ 1, 000, 000 Cowlitz County: $ 1, 140, 250 Dear Chairman Dahl:

This letter establishes conditions which must be understood and agreed to by you before further consideration may be given to your application, including US Department of Agriculture General Terms and Conditions for Federal Awards

effective

December

31, 2025 ( USDA GT& C). The

grant will be administered on behalf of the Rural Utilities Service (RUS) by the State and Area staff of USDA Rural Development(

RD), both of which are referred to throughout

this letter as

the Agency. Any changes in project cost, source of funds, scope of project, or any other significant changes in the project or applicant must be reported to and concurred with by the Agency by written amendment to this letter. This includes any significant changes in the Applicant' s financial condition, operation, organizational structure or executive leadership. Any changes made without Agency concurrence may be cause for discontinuing processing of the application.

This letter does not constitute grant approval, nor does it ensure that funds are or will be available for the project. The funding is being processed on the basis of a grant not to exceed 1, 000, 000. The grant will be considered

approved

the date Form RD 1940- 1, "

Request for

Obligation of Funds" is signed by the Agency approval official. The applicant will ensure projects are completed in a timely, efficient, and economical manner. meet all conditions set forth under Section III— Requirements Prior to Advertising for Bids within 1 year of this letter. You must

If you do not meet the conditions of this letter, the Agency reserves the right to withdraw Agency funding. If you agree to meet the conditions set forth in this letter and desire further consideration, be

given to your application, please execute and return the following forms within 30 days: Form RD 1942- 46, " Letter of Intent to Meet Conditions" Form RD 1940- 1, "

Request

for Obligation of Funds"

Cowlitz County Ryderwood Letter of Conditions

All parties may access information and regulations referenced in this letter at our website located

at: https://www.rd.usda.gov/programs-services/waterWater and Environmental Programs I Rural Development ( usda. gov) and the USDA GT& C environmental-programs https://www.usda.gov/sites/default/files/documents/usda-general-terms-conditionshttps:// www. usda. gov/ sites/ default/ files/ documents/ usda-,general- terms- conditions- 2025. pdf 2025.pdf The conditions are as follows: SECTION I- PROJECT SCOPE 1. Project Description—

Funds of$ 2, 140, 250 will be used for initial capital improvements,

including construction of a 500, 000- gallon raw water reservoir, site preparation, and associated infrastructure. This alternative represents a more permanent, long- term solution for improving system storage capacity.

Facilities will be designed and constructed in accordance with sound engineering practices and must meet the requirements of Federal, State, and local agencies. The proposed facility design

must be based on the Preliminary Engineering Report( PER), prepared by RH2 Engineering dated April 2026/ amended 5/ 21/ 2026, as concurred with by the Agency. 2. Project Funding—

The Agency is offering the following funding for your project:

Agency Grant-

1, 000, 000

This offer is based upon the following additional funding being obtained. Cowlitz CountyTOTAL

PROJECT

1, 140, 250

COST -

$ 2, 140, 250

Any changes in funding sources following obligation of Agency funds must be reported to the processing official. Prior to grant closing, any increase in non- Agency funding will be applied

first as a reduction to Agency funds. The applicant must certify that they have exhausted all other funding avenues and have no pending funding considerations from any other sources. Further, the applicant must certify that

they do not intend to apply anywhere else to fund this project. If, after obligation of Agency funds, other funding becomes available, the Agency reserves the right to deobligate any, and all

funding for this project and to re- underwrite. This may result in the offering of a different funding package for this project. Prior to advertisement for construction bids, you must provide evidence of applicant

contributions and other funding sources. This evidence should include a copy of the commitment letter. Agency funds will not be used to pre- finance funds committed to the project from other sources.

Cowlitz County Ryderwood Letter of Conditions

3. Proiect Budget—

Funding from all sources has been budgeted for the estimated expenditures

as follows: Costs:

Total Budgeted:

Development

1, 960, 950

Contingency

179, 300

Proiect

Sales tax

168, 450

TOTAL

2, 140, 250

Project feasibility and funding will be reassessed if there is a significant change in project costs after bids are received. Obligated grant funds not needed to complete the proposed project defined in the Project Scope will be deobligated. Any reduction will be applied to Agency grant funds first. Proiect Costs also include Contingency funds, which are to only be used to cover unexpected

costs within the scope of the approved

scope of the project if funds remain at completion.

project and not expand the

If actual project costs exceed the project

cost estimates, an additional contribution by the Owner may be necessary. An" Amended Letter of Conditions" will be issued for any significant changes to the total project budget. 4. Proiect

Timeline—

To ensure that the project proceeds in a timely manner, key processing

milestones have been established in accordance with the PER or other Agency approved documentation. Project should be completed and all Agency funds fully disbursed within two years of obligation.

By accepting the terms outlined herein, you agree to adhere to the milestones specified below. If one or more of the milestones cannot be met, you must submit a written extension request to the

Agency 30 days in advance, or no less than 10 calendar days before the referenced date. Should your final payment date extend beyond two years from the obligation date, a written request must be submitted following the procedures outlined in Section VI of this letter, with a

minimum of 90 days' notice before the benchmark date. The request must provide valid justification for the delay and include a revised project completion schedule. If the Agency

concurs with the modification, written confirmation will be provided. The Agency reserves the right to deobligate grant funds, or take other appropriate action, if the established or amended deadlines are not met.

Milestone Final Drawings, Specifications

Date

and other

7/ 1/ 26

Bidding Documents submitted for Agency Review Acquisition Complete

7/ 13/ 26

Initial Advertisement for Bids

10/ 13/ 26

Award Contract( s)

11/ 24/ 26

Permits

Commencement of Construction Substantial Completion

Contract( s)

01/ 04/ 27 06/ 30/ 27

Cowlitz County Ryderwood Letter of Conditions

Final Payment

8/ 1/ 27

SECTION II—GRANT AGREEMENT 5. Grant Agreement-

The RUS Bulletin

1780- 12, "

Grant Agreement" will be executed prior to

the first disbursement of grant funds. The grantee understands that any property acquired or improved with Federal grant funds may

have use and disposition conditions which apply to the property as provided by 2 CFR part 200 in effect at this time and as may be subsequently modified. The grantee understands that any

sale or transfer of property is subject to the interest of the United States Government in the market value in proportion to its participation the project. SECTION III— REQUIREMENTS

PRIOR TO ADVERTISING FOR BIDS

6. Or2anization— The Bond Counsel transcripts

of proceedings must show that your

organization is a duly incorporated public body and has continued legal existence. Your organization must have the authority to own, construct, operate, and maintain the proposed

facility, as well as for borrowing money, pledging security and raising revenues. 7.

Suspension and Debarment

SUSPENSION) -

Screening—(

See also USDA GT& C, 12. 2 Civil Rights

As a recipient of Federal funding, you are required to comply

with U. S. statutory and public policy requirements, including but not limited to: a.

Section 504 of the Rehabilitation Act of 1973,

Act of 1973 — Under Section 504 of the Rehabilitation

amended( 29 U. S. C. 794), no handicapped individual in the United States

shall, solely by reason of their handicap, be excluded from participation in, be denied the

benefits of, or be subjected to discrimination under any program or activity receiving Agency financial assistance. b.

Civil Rights Act of 1964— All borrowers are subject to, and facilities must be operated

in accordance with, Title VI of the Civil Rights Act of 1964 ( 42 U.S. C. 2000d et seQ•). c.

The Americans with Disabilities Act( ADA) of 1990— This Act( 42 U. S. C. 12101 et sec..)

prohibits discrimination on the basis of disability in employment, State and local

government services, public transportation, public accommodations, facilities, and telecommunications.

Age Discrimination

Act of 1975— This Act( 42 U. S. C. 6101 et seq.)

provides that no

person in the United States shall on the basis of age, be excluded from participation in, be

denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. e.

Controlled Substances Act-

Even though state law may allow some activities, as a

recipient of Federal funding, you are subject to the Controlled Substances Act. Specific

questions about the Controlled Substances Act should be directed to the Servicing Official who will contact the Office of General Counsel, as appropriate.

Cowlitz County Ryderwood Letter of Conditions

39. Compliance Reviews and Data Collection—

Agency financial programs must be extended

without regard to race, color, religion, sex, national origin, marital status, age, or physical or

mental handicap. You must display posters (provided by the Agency) informing users of these requirements, and the Agency will monitor your compliance with these requirements during regular

compliance

reviews.

As a recipient of Rural Development funding, you are required to post and use the NonDiscrimination Statement as directed by the Agency in your office and on all materials produced

for public information, public education, and public distribution both print and non-print. Currently at a minimum use the following Non-Discrimination Statement: This institution is an equal opportunity provider and employer." The Agency will conduct regular compliance reviews of the borrower and its operation in accordance with the Age Discrimination Act of 1975, as amended; the Americans with Disabilities Act of 1990, as amended; the Americans with Disabilities Amendments Act of 2008, as amended; Section 504 of the Rehabilitation Act of 1973, as amended; Title VI of the Civil Rights Act of 1964, 42 U. S. C. 2000d, as amended; Title VIII of the Civil Rights Act of 1968, as

amended.

Compliance reviews will typically be conducted in conjunction with the security

inspections described in this letter.

If beneficiaries ( users) are required to complete an application or screening for the use of the facility or service that you provide, you must request and collect data by race ( American Indian or Alaska Native, Asian, Black or African American, White); ethnicity( Hispanic or Latino, Not Hispanic or Latino); and by sex. The Agency will utilize this data as part of the required compliance

review.

Cowlitz County Ryderwood Letter of Conditions

SECTION VIII—REMEDIES FOR NON- COMPLIANCE

Non-compliance with the conditions in this letter or requirements of your security documents will be addressed under the provisions of Agency regulations, statutes, and other applicable policies.

We look forward to working with you to complete this project. If you have any questions, please contact Cathleen Walker at 360- 704- 7727 or by e- mail at Cathleen. walker@usda. gov Sincerely,

Cathleen Walker

Community Program Specialist Attachments

cc: Koni Reynolds, Community Programs Director Appendix A- Build America, Buy America Evidence Standards

Cowlitz County Ryderwood Letter of Conditions

FORMS, BULLETINS and LINKS:

Internal Revenue

Service Form 1023, Appendix A, " Sample Conflict of Interest

Policy" - Item

15 Form RD 442- 20, " Right- of-Way Easement"—

Item 14

Form RD 442- 21, " Right- of-Way Certificate"—

Item 14

Form RD 442- 22, " Opinion of Counsel Relative

to Rights- of-Way"— Item 14

Form RD 1927- 9, " Preliminary

Title Opinion"— Item 14

Form RD 1927- 10, " Final Title Opinion"— Item 27 Form RD 1940- 1, "

Request

for Obligation of Funds"— Page I

Form RD 1942- 46, " Letter of Intent to Meet Conditions"— Page I

SF 3 88 1, "

ACH Vendor/ Miscellaneous Payment

RUS Bulletin

Enrollment

Form"—

Item 23

1780- 7, " Legal Services Agreement"— Item 13

RUS Bulletin

1780- 9, " Water Users Agreement" -

RUS Bulletin

1780- 12 " Grant Agreement"— Item 5

RUS Bulletin

1780- 26, " Guidance for the Use of EJCDC Documents on Water and Waste

Projects

Items 15 and 17

with RUS Financial Assistance"— Items 10 and I I

USDA GT& C https:// www. usda. gov/ sites/ default/ files/ documents/ usda- general- termsconditions- 2025. pdf https://www.usda.gov/sites/default/files/documents/usda-general-termsconditions-2025.pdf

USDA

Rural 1835 United

States Department

of Agriculture

Black

Development•

Lake Voice(

Blvd

Olympia

Area

SW, Ste B, Olympia,

360)

704- 7705•

Office

WA 98512

Fax 855- 847- 5488

Appendix A

Build America, Buy America Evidence Standards

Manufacturers

For each item to which BABA applies ( every item permanently installed on the project, except for aggregate and aggregate binding materials), a manufacturer' s certification letter or other document demonstrating compliance is required. It must, at a minimum, identify the item being certified( short written description as well as part number, if applicable) and affirm that the item complies with BABA. This document must be signed by an authorized company representative. Architects and Engineers Compliance with BABA will be spelled out in agreements for services, construction contracts,

and procurement contracts. Generally, the A/E contract should include, as a basic service, obtaining and maintaining all BABA documentation( particularly manufacturers' certifications) during construction, which shall be transferred to the Owner upon completion of the project. The architect or engineer will need to certify to this action at the project' s end. Resident Project Representative I Resident Inspector

As part of their duties, Resident Project Representative/ Resident Inspector should be instructed to verify items delivered to the site and installed are accompanied by documentation of compliance with BABA. They should photograph items as appropriate. RPR/RI daily logs and photographs will become part of the construction record and can be used as supporting information during audits, providing evidence for items that are buried or otherwise inaccessible. Contractors

Construction contract( s) must include a requirement to procure and install only items that comply with BABA or are subject to an approved waiver. Contractors must provide

manufacturers' certifications for all BABA compliant items to the responsible party before a request for reimbursement to the Agency is made. At completion, the contractor will be required to certify that all items used on the contract complied with BABA and that all manufacturers' certifications were provided.

FORM APPROVED USDA

OMB No. 0570- 0062

Form

RD 1940- 1

Rev

02- 26)

View Burden Statement

Exp. Date: 9/ 30/ 2028 OMB No. 0570- 0067

Exp. Date: 9/ 30/ 2028

Request for Obligation of Funds

7 1.

Borrower

Borrower Address

MEOW

Cowlitz

Name

City, State,

County

Amount

Zip Code

Name

11.

Type

12.

Fiscal Year

of Assistance Code

Case/ Borrower

6. Type

South

Number

of Applicant

Cowlitz

S. community

Size/ Service Are.

13. Interest Rate

1, 000, 000. 00

14- Repayment Terms( years) 15.

Type

817380325

Public Body

0. 00

935

BORROWER

008

Blank

Collateral Code

of Grant

Amount

Kelso, WA 98626- 2851

of Loan

10.

of Public Works

Department

13th Avenue

1600

County

Blank

of Payment

16. Kept Blank for lature

use

17. COMMENTS AND REQUIREMENTS OF CERTIFYING OFFICIAL:

18, 1 HEREBY CERTIFY that I am unable to obtain sufficient credit elsewhere to finance my actual needs at reasonable rates and terms, taking into consideration prevailing private and cooperative

rates and terms in or near my communityfor loans for similar purposes and periods of time( as applicable in accordance with program regulations)_I agree to use the sum specified herein, subject to and in accordance with regulations and applicable to the type of assistance indicated above, and request payment of such sum. I agree to report to USDA any material adverse changes, financial

or otherwise, that occur prior to loan/ grant closing. I certify that no part of the sum specified herein has been received. I have reviewed the loan/ grant approval requirements and comments associated with this loan/ grant request and agree to comply with these provisions.

Whoever, in any matter with In the jurisdiction of any department or agency of the United States, knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material fact, or makes any false, Rctltious or fraudulent statements or representations, or makes use of any false writing or document know the same to contain any false fictitious or fraudulent statement or entry, shall be fined under this title or imprisoned not more than five years, or both.

16VARNING:

For loans at eligible terms only) If this loan is approved, I elect the interest rate to be charged on my loan to be the laver of the interest rate In effect at the time of loan approval or loan closing. If I e-

check" NO" the interest

rate

charged on

loan will

the rate

specified

this

form.

YES

N/ A- Grant Only

fV0

01 faJ

001ron

eten

arure

Richard Dahl, Chairman of the Board

Cowlitz County Dept. of Public Works 9=

rgrrawre

or Pthitme

Namen

OFAUPIOD110

RVIef"

Ararmt)

For Internal Use Only

19. 1 HEREBY CERTIFY that all of the committee and administrative determinations and certifications required by regulations prerequisite to providing assistance ofthe type indicated above have been made and that evidence thereof is in the docket, and that all requirements of pertinent regulations have been complied with. I hereby approve the above- described assistance in the amount set forth

above, and by this document, subject to the availability of funds, the Government agrees to advance such amount to the applicant for the purpose of and subject to the availability prescribed by regulations

applicable

to this type of assistance,

YN—)Pdruie be Approving

Typed or Printed Name

ofApproving

rcia

fete)

Official)

Obligation Date for Obligation ID

this is notice that your application for financial assistance from the USDA has been approved, as indicated

20. TO THE APPLICANT: As of this date above, subject

to the

availability of funds and

other

conditions

required

by the USDA. If you have any questions, contact

the appropriate

USDA

Servicing

Office.

Position 3

UNITED

Form RD 1942- 46

STATES

DEPARTMENT

FORM

OF AGRICULTURE

RURAL DEVELOPMENT

APPROVED

OMB NO. 0575- 0015

Rev. 6- 10)

OMB

NO. 0570- 0062

LETTER OF INTENT TO MEET CONDITIONS

Date 08/ 25/ 2026

TO: United States Department of Agriculture Rural

Development

Name of USDA Agency) 1835

Black

Olympia,

Lake

Blvd.

Suite

98512

USDA Agency Office Address)

We have reviewed

and understand

the conditions set

forth in your letter dated

0 8/

2 5/

2 026 .

It is our intent to meet all of

them not later than 0 8/ 2 5/ 2 0 2 7

Cowlitz

County

Dept .

Public

Works

e qfArialir

B Richard

Dahl,

Chairman

the

Board Title)

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a persons is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0575=0015 and 0570- 0062. The time required to complete this information collection is estimated to average I hour per response, including the lime for reviewing instructions, searching existing data sources, gathering and maintaining the data. needed, and completing and reviewing the collection of information.

Form RD 1942- 46( Rev. 6- 10)

233993

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 BID AWARD- Shadow Mountain Packaged Pump Station - Wester United Civil Group Submitted By: Averie Mejia, Administrative Assistant III Submitted For: Susan Eugenis, County Engineer Department:

Roads

Administration

Information

Subject and Summary Statement

The Shadow Mountain Packaged Pump Station Project Bids were received and opened on September 8th, 2026. There was one bid submitted. Western United Civil Group, LLC is the lowest responsive bidder. A copy of the bid tabulation is attached. Staff Attendance Susan

Eugenis

Department

Recommendation

It is the recommendation of the Department of Public Works that the Board move to award the Shadow

Mountain Packaged Pump Station Project to the lowest responsible bidder, Western United Civil Group, LLC at a cost of$ 242, 855. 53 including sales tax. Attachments

BID TAB- Toutle Shadow Mtn Packaged Pump Station

Form

Task

User Mejia,

Averie

Andrews,

Chris

Eugenis,

Susan

Eugenis,

Susan

Jensen,

Doug

Review

Action

Timestamp

Submit

9/ 8/ 2026

12: 13: 00 PM

Review-

Submit

9/ 8/ 2026

12: 51: 00 PM

Review-

Submit

9/ 8/ 2026

3: 05: 00 PM

Approver

Approve

9/ 8/ 2026

5: 23: 00 PM

Legal Review

Approve

9/ 9/ 2026

8: 39: 00 AM

Clerk of the Board

Approve

9/ 9/ 2026

8: 40: 00 AM

Agenda

Item

Preliminary

Submission

PW1

Preliminary PW2 Department Review

Reed, Pervie

Review

Approved: BOARD

OF COUNTY

OF COWLITZ

COMMISSIONERS

COUNTY,

WASHINGTON

233993

Consent

Richard R. Dahl, Chairman

Steve

Rader,

Commissioner

Steven L. Ferrell, Commissioner

Attest:

Clerk of the Board

Agenda

BID TABULATION

Project

Name

Toutle

Shadow

Mt Packaged

Pump

Station

Bid Opening Date September 8, 2026 Project No.

9505

Western

United Civil Group LLC PO Box 236

Engineer'

Yacolt, WA98675

Estimate

360) 309- 7114

Bid Item

Item

Unit

Quantity

No. 1

Packaged Pump

Station

Lump

Sum

Subtotal Washington

Unit

Total

Unit

Total

Price

Amount

Price

Amount

200, 000. 00

200, 000. 00 200, 000. 00

State

Sales

Tax

7. 7%

Grand Total

Page

1 of 1

225, 492. 60

225, 492. 60 225, 492. 60

15, 400. 00

17, 362. 93

215, 400. 00

242, 855. 53

234019

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 Bid Award— 2026- 0036- 01— Scrim

Reinforced Polyethylene

Geomembranes—

ACF West

Inc.

Submitted By: Ashley Claussen, Purchasing Supervisor Submitted For: Mike Moss, Director of Public Services Department:

Roads

Administration

Information

Subject and Summary Statement

Bids

received and opened on August

were

Reinforced Polyethylene

Geomembranes.

17, 2026, for the purchase

of 28 - 100 ft x 200 ft Scrim

Six companies submitted bids as indicated on the attached bid

tabulation. Two bids were found to be non- responsive. ACF West Inc. submitted the lowest, responsive bid in the amount of$ 120, 578. 77 Staff Attendance Mike

Moss

Department

Recommendation

It is the recommendation of the Department of Public Works that the Board move to award the bid for the purchase

of 28 - 100 ft x 200 ft Scrim Reinforced Polyethylene

Geomembranes,

to the lowest

responsive bidder, ACF West Inc., for the total cost of$ 120, 578. 77, which includes Washington State

sales tax. The bid proposal shall serve as the binding contract for the purchase of materials. Attachments

Bid Tab- Scrim Reinforced Polyethylene Geomembranes

Form

User

Task

Claussen,

Ashley

Agenda

Claussen,

Ashley

Preliminary

Item

Review

Action

Timestamp

Submit

9/ 8/ 2026

2: 12: 00 PM

Review-

Submit

9/ 8/ 2026

4: 54: 00 PM

Approver

Approve

9/ 9/ 2026

4: 00: 00 PM

Approve

9/ 9/ 2026

4: 01: 00 PM

Submission

PW1 Clement,

Savannah B.

Department Review

Reed, Pervie

Clerk of the Board Review

Approved: BOARD

OF COUNTY

OF COWLITZ

COMMISSIONERS

COUNTY,

WASHINGTON

234019

Richard

Steve

Consent

R. Dahl, Chairman

Rader,

Commissioner

Steven L. Ferrell, Commissioner

Attest:

Clerk of the Board

Agenda

BID TABULATION

Cowlitz County Department Scrim Reinforced Bids Due:

of Public Works

Polyethylene August

Geomembranes

17, 2026 at 4: 00 PM NW Linings&

Products Inc

Geotextile

20824 77th Avenue South Kent, WA 98032 Item

Bid Item

Unit

Quantity

Roll

No. 1

Geomembranes

Houston, Unit

Total

Price

Amount

Price

Amount

4, 528. 80

126, 806. 40

5, 516. 54

154, 463. 12

7. 7%

SALES TAX

Unit

Quantity

Roll

No. Geomembranes SUB- TOTAL WASHINGTON SALES TAX

Total

Price

Amount

4, 445. 00

124, 460. 00

154, 463. 12

124, 460. 00

11, 893. 66

9, 583. 42

166, 356. 78

134, 043. 42

Technology

Bldg 2, Ste 111

International,

1331 S Intl

Inc.

American Geo Products 2205 Leslie Locke Rd

Pkwy, Ste 2251

Lake Mary, FL 32746

Unit

Total

Unit

Total

Price

Amount

Price

Amount

3, 998. 50

Unit

9, 764. 09

Fife, WA 98424 Bid Item

Ave

WA 98662

136, 570. 49

ACF West Inc 2505 Frank Albert Rd,

Main

NE 1177th

Vancouver,

Total

BID TOTAL

TX 77049

126, 806. 40

WASHINGTON

Core& 9115

Unit

SUB- TOTAL

Item

WPL Fab LLC* 15847 Kimberlee St

111, 958. 00

3, 145. 00

88, 060. 00

Unit

Total

Price

Amount

3, 399. 00

95, 172. 00

111, 958. 00

88, 060. 00

95, 172. 00

8, 620. 77

6, 780. 62

7, 328. 24

7. 7%

120, 578. 77

94, 840. 62 NOT RESPONSIVE

Page 1 of 1

102, 500. 24 NOT RESPONSIVE

234024

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 Bid Award— 2026- 0035- 01— High- Density Polyethylene

Pipe— Titan Earthwork

Submitted By: Ashley Claussen, Purchasing Supervisor Submitted For: Mike Moss, Director of Public Services Department:

Roads

Administration

Information

Subject and Summary Statement

Bids were received and opened on August 17, 2026, for the one- time purchase of high- density polyethylene pipe. Three companies submitted bid proposals as indicated on the attached bid tabulation. TITAN Earthwork submitted the lowest responsive bid. Staff Attendance Mike

Moss

Department

Recommendation

It is the recommendation

of the Department

of Public Works that the Board move to award the bid for

the one- time purchase of high- density polyethylene pipe to the lowest responsible bidder, TITAN Earthwork, Inc., for the total cost of$ 44, 770. 89, which includes Washington

State sales tax. The bid

proposal shall serve as the binding contract for the purchase of materials. Attachments

2026- 0035- 01 Bid Tab

Form

User

Task

Claussen,

Agenda

Ashley

Claussen,

Ashley

Clement,

Savannah

Review

Action

Timestamp

Item Submission

Submit

9/ 8/ 2026

2: 18: 00 PM

Review-

Submit

9/ 8/ 2026

4: 55: 00 PM

Approver

Approve

9/ 9/ 2026

3: 59: 00 PM

Approve

9/ 9/ 2026

4: 01: 00 PM

Preliminary PW1 B.

Department Review

Reed, Pervie

Clerk of the Board Review

Approved: BOARD

OF COUNTY

OF COWLITZ

COMMISSIONERS

COUNTY,

WASHINGTON

234024

Consent

Richard R. Dahl, Chairman

Steve

Rader,

Commissioner

Steven L. Ferrell, Commissioner

Attest:

Clerk of the Board

Agenda

BID TABULATION

Cowlitz County Department

of Public Works

High- Density

Pipe

Bids Due:

Polyethylene

August 17, 2026 at 4: 00 PM Ferguson Waterworks*

Ferguson Plastics Division**

TITAN Earthwork

14103 NW 3rd Ct

740 S 28th St

1585 Valentine Ave SE

Vancouver, Item

Bid Item

Quantity

HDPE, SDR 17, PE4710

4, 000

2. 36

9, 440. 00

HDPE, SDR 17, PE4710

1, 000

6. 42

6, 420. 00

No. 1

4- inch

diameter

4- inch diameter

Washougal,

WA 98685

Unit

Total

Price

Amount

6- inch diameter

HDPE, SDR 17, PE4710

3, 000

5. 11

15, 330. 00

6- inch diameter

HDPE, SDR 17, PE4710

2, 000

9. 79

19, 580. 00

SUB- TOTAL WASHINGTON SALES TAX

7. 7%

BID TOTAL

tax

was

calculated

bid form as 8. 1%,

Pacific, WA 98047

Total

Unit

Total

Price

Amount

Price

Amount

2. 4239

9, 695. 60

2. 59

10, 360. 00

5. 09

5, 090. 00

3. 43

3, 430. 00

5. 2608

15, 782. 40

5. 16

15, 480. 00

8. 06

16, 120. 00

6. 15

12, 300. 00

50, 770. 00

46, 688. 00

3, 909. 29

7, 189. 95

3, 200. 89

54, 679. 29

53, 877. 95

44, 770. 89

shown above using correct rate

amount on bid form for line item no. 3 was calculated

WA 98671

Unit

using qty 5, 000, shown above using correct

qty

Page 1 of 1

41, 570. 00

233811

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 EASEMENT- Temporary Construction Easement- E Canyonview Dr Slide Repair- Project No. 1524- Brittell Submitted By: Averie Mejia, Administrative Assistant III Submitted For: Susan Eugenis, County Engineer Department:

Roads

Administration

Information

Subject and Summary Statement

Attached is the Temporary Construction Easement from David and TerraSue Brittell for Project 1524 E. Canyonview Dr slide repair. The temporary construction easement impacts subject parcel 606706000,

was signed on 8/ 31/ 2026 by the landowner, accepted by the Chairman of the Board of County Commissioners on 9/ l/ 2026, and recorded at the Cowlitz County Auditor' s Office on 9/ 1/ 2026 under Auditor' s File Number 3796144. Staff Attendance Susan

Eugenis

Department

Recommendation

It is the recommendation of the Department of Public Works that Temporary Construction Easement from David and TerraSue Brittell be acknowledged by the Board and received for the Commissioners official record. Attachments

AFN 3796144 Brittell Temp Constr Easement

Form

Task

User Mejia,

Averie

Lunday, Anna

Review

Action

Timestamp

Submit

9/ 3/ 2026

8: 47: 00 AM

Review-

Submit

9/ 3/ 2026

9: 27: 00 AM

Approver

Approve

9/ 3/ 2026

1: 59: 00 PM

Legal Review

Approve

9/ 4/ 2026

2: 07: 00 PM

Clerk of the Board

Approve

9/ 8/ 2026

7: 53: 00 AM

Agenda

Item

Preliminary

Submission

PW1 Eugenis,

Susan

Department Review

Jensen, Grayson,

Doug Kelly

Review

After Recording Return Document to:

Cowlitz County Dept of Public Works 1600— 13"

Avenue South

Kelso, WA 98626- 2851

3796144 01/ 2026 Easement 09/

Cowlitz

03:

19:

Pages:

COWLITZ COUNTY PUBLIC WORKS

County

306. 50

Washington

111111111 IN MPTex

Document Title: Temporary Construction

Easement

Grantor( s): David E. Brittell and TerraSue

D. Brittell

Grantee( s):

AFFIDAVrrN

tax&

Dale

Cowlitz County

Abbr. Description: 21- 8N- 2W T- 6A- 1 Legal Description: Page 3 Additional Depiction: Page 4 Assessor' s Tax Parcel Number: 606706000

TEMPORARY

CONSTRUCTION

EASEMENT Project

1524

E. Canyon View Dr Slide Repair

The Grantors, consideration

David E. Brittell and TerraSue

of TEN

AND

NO/ 100 ($

10. 00)

D. Brittell, husband

and wife, for and in

DOLLARS, and other valuable consideration,

conveys and grants unto the COWLITZ COUNTY, a political subdivision of the State of Washington, and its assigns, Grantee, a nonexclusive easement in, upon, over, under, and across

the

property

described

the

attached

Exhibit "

A",

and being more particularly

delineated on the attached Exhibit " B" for the purpose of access and maintenance associated to the slide repair on E. Canyon

View Dr.

Said lands being situated in Cowlitz County, State of Washington, and described in Exhibit A, attached hereto and made a part hereof. The term of this Temporary Easement shall commence

on September

1, 2026 and shall

terminate on August 31, 2028, hereinafter the " Term".

It is further agreed that this Temporary Easement may be extended by up to one year at the Grantee' s option. The rate associated with this extension shall be at the same rate as the

original Temporary Easement, or at the newly established rate determined by an updated appraisal; whichever is higher. Grantee shall notify Grantor in writing, and render payment, prior to exercising this option.

It is understood and agreed that delivery of this temporary easement is hereby tendered and that the terms and obligations hereof shall not become binding upon the COWLITZ COUNTY unless and until accepted and approved hereon in writing for the COWLITZ COUNTY, by its authorized agent.

Page

1 of 4

Parcel Number: 606706000

Dated:

4_ w(, 201.E ,

2026

J GRANTOR(

By:

S):

Elk

Name:

By(:,

7,Z

44,-

Name: TerraSue D. Brittell

David E. Brittell

1 STATE OF WASHINGTON

County of

y§ y

J-L,

day of

this

Brittell and TerraSue

jq IASt2026, before me personally appeared David E.

D. Brittell,

me known to be the individuals

described

in and who

executed the foregoing instrument and acknowledged that they signed and sealed as their

free and voluntary act and deed, for the uses and purposes therein mentioned.

ry Public

i for the

My commission

21016124

ate of Washington A

Residing at:

Washington

on#

ACCEPTED

Notary Public

LUNDAY

expires

Lf• V- L9

pires Apr 21, 2029

vVZbeV

DAY OF

THIS

BOARD

2026

OF COUNTY

COMMISSIONERS

OF COWLITZ COUNTY, WASHINGTON

GUNr Attest?

Attested by Kel

Richard R.

Clerk of the Board Dated:

ahl, Chairman

Grays co

Authorized to sign by Board per RCW

COWLITZ COUNTY

6. 32. 100)

WASIIINGTON b clb"

Zx cn,lvt`1

Page 2 of 4

Exhibit " A" ROAD NAME ( 1524- 01)

BRITTELL RIGHT OF WAY DESCRIPTION September 1, 2026 Page 1 OF 1

A tract of land lying in the southeast one- quarter of Section 21, Township 8 North, Range 2 West, Willamette Meridian, Cowlitz County, Washington and being a portion of that property described in that Boundary Line Adjustment Deed to David E. & and

TerraSue D. Brittell, recorded July 1st, 2025 in Auditor's File Number 3772343 of Cowlitz County Auditor' s Records; the said tract being that portion of said property described as follows:

Bearings and linework are per survey by Chad W. Bobbitt, PLS 56650, titled " E. Canyon 0. 31", dated 7/ 23/ 2025, a copy of which is available in the Cowlitz County Road Engineer' s Office.

View Dr Slide Milepost

BEGINNING at the southwest corner of Lot 14 of the plat of" Canyon View Addition No. per Volume 9 of Plats at Page 90, Cowlitz County Auditor' s Records; Thence, along the southerly line of said Lot 14, South 810 42' 05" East, 50. 00 feet; Thence, leaving 2",

said line, South 080 17' 55" West, 26. 00 feet; Thence South 400 50' 28" West, 23. 00 feet; Thence South 690 24' 37" West, 30. 00 feet; Thence North 490 13' 01" West, 4. 00

feet to a point of 45. 00 foot radius curve to the left on the easterly right of way of E Canyon View Dr ( County Road # 12480); Thence along said right of way line, along said curve to the left, through a central angle of 800 43' 16" an arc distance of 63. 40 feet ( the chord of which bears North 000 25' 21" East, 58. 28 feet) to said POINT OF BEGINNING.

Contains 1, 826 square feet, more or less. See the attached

Exhibit " B", labeled " BRITTELL"

RIGHT OF WAY DESCRIPTION",

and " SKETCH TO ACCOMPANY

which is made a part hereof.

20 2-

r4l

r, 07s

AI, i 40

F:\ Design\

Civil 3D\ Projects\ 1524 E Canyon

View

Dr Slide\ SURVEY\ DOCS\ LEGALS\

1524- 01- Brittell- ROW Ease. doc

EXHIBIT

"B "

i CODY O GALLAGHER AND CASSANDRA

KOBAYASHI-

GALLAGHER

6067031

Q' c

AFN

3710284

LOT CANYON

W --.

VIEW ADDITION PLATS/

NO. 2"

zN z

30'

S 81° 42' 05" E 50.00• M

Q W

0 o

O co

80* 43' 16"

45. 00'

AREA=

1, 826 SF±

L= 63. 40' LC=

N0'

25' 21"

58 28'

45'

N 49° 13' 01" W 4. 00' 00,

DAVID

E BRITTELL

TERRASUE

6060301

AG`

PARCEL f

AFN

20 I

jAL LAI`

SCALE

ID:

3772343

PROJECT

AND

D BRITTELL

PARCEL

1524- 01

NAME OF OWNER:

BRITTELL

OWNER ADDRESS:

3660

DAVID/

NUMBER:

STR:

606706000

TERRASUE

CEDARBROOK

S 21

ALEXANDER

PARCEL

ADDRESS:

T 8 N

VACANT

SKETCH TO ACCOMPANY RIGHT OF WAY DESCRIPTION

DWG:

1524 ROW

FEET

R 2 W

CRAWFORD

LONGVIEW, WA 98632

Brittell.

dwg

40 I

LOT

DLC#

233576

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 Federal Energy Regulatory Commission ( FERC) letter dated 09/ 01/ 2026 regarding the License Article 302: 2025/

2026

Lewis

River Vacant

Storage

Report,

Submitted By: Pervie Nancy Reed, Administrative Assistant III Submitted For: Pervie Nancy Reed, Administrative Assistant III Department:

Commissioners

Information

Subject and Summary Statement

Federal Energy Regulatory Commission (FERC) letter dated 09/ 01/ 2026 regarding the License Article 302: 2025/ 2026 Lewis River Vacant Storage Report, Merwin, Yale and Swift No. 1 Projects. Staff Attendance

Department

Recommendation

Attachments

Untitled Extract Pages

Form

User

Task

Reed, Pervie

Agenda

Grayson,

Clerk of the Board

Kelly

Item Submission

Review

Action

Timestamp

Submit

9/ 1/ 2026

9: 03: 00 AM

Approve

9/ 2/ 2026

8: 54: 00 AM

Approve

9/ 2/ 2026

8: 54: 00 AM

Review Grayson,

Kelly

Department Review

Approver

FEDERAL ENERGY REGULATORY COMMISSION Division of Dam

Office of Energy Projects Safety and Inspections — Portland Regional Office 8/ 13/ 2026

In reply refer to: P- 935, P- 2071, P- 2111

VIA Electronic Mail RECENE. fl Mr. William Shallenberger

SEP 01 2026

Vice President, Renewable Resources

COMMISSIO fERS OFF1CI

PacifiCorp will. shallenberger@pacificorp. Subject:

com

License Article 302: 2025/ 2026 Lewis River Vacant Storage Report, Merwin, Yale and Swift No. 1 Projects

Dear Mr. Shallenberger:

This letter is to acknowledge your June 26, 2026 letter transmitting the 2025/ 2026 Lewis River Vacant Storage Report required by Article 302 of the licenses for the Merwin, Yale and Swift No. 1 Projects, FERC Nos. 935, 2071 and 2111 respectively. We have reviewed the information provided and have no comments.

Thank you for your continued cooperation and interest in dam safety. If you have

any questions, please contact Justin Nettle of this office at ( 503) 552-2714. Sincerely,

E R! C

Digitally signed by ERIC KENNEDY

KENNEDy° 321a-0*00' Eric Kennedy, P. E. Regional Engineer

233577

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 Federal Energy Regulatory Commission ( FERC) letter dated 09/ 01/ 2026 regarding the Authorization for Construction,

Spillway Stoplog/ Gate Retrofit Proje

Submitted By: Pervie Nancy Reed, Administrative Assistant III Submitted For: Pervie Nancy Reed, Administrative Assistant III Department:

Commissioners

Information

Subject and Summary Statement

Federal Energy Regulatory Commission (FERC) letter dated 09/ 01/ 2026 regarding the Authorization for Construction, Spillway Stoplog/ Gate Retrofit Project Design Changes, Swift No. 1 Project Staff Attendance

Department

Recommendation

Attachments

Untitled Extract Pages

Form

User

Task

Reed, Pervie

Agenda

Grayson,

Department

Kelly

Item Submission Approver

Review

Action

Timestamp

Submit

9/ 1/ 2026

9: 05: 00 AM

Approve

9/ 2/ 2026

8: 53: 00 AM

Approve

9/ 2/ 2026

8: 54: 00 AM

Review Grayson,

Kelly

Clerk of the Board Review

FEDERAL ENERGY REGULATORY COMMISSION Office of Energy Projects Division of Dam

Safety and Inspections — Portland Regional Office 8/ 20/ 2026

In reply refer to: P- 2111

VIA Electronic Mail

RECENT Mr. William Shallenberger

SEP 41 202

Vice President, Renewable Resources

OOM WSSIONERS

PacifiCorp will. shallenberger@pacificorp. Subject:

com

Authorization for Construction, Spillway Stoplog/Gate Retrofit Project Design Changes, Swift No. 1 Project

Dear Mr. Shallenberger:

This letter is to acknowledge your August 6, 2026 letter transmitting information related to the previously authorized Spillway Stoplog/ Gate Retrofit Project at the Swift No. 1 Project, FERC No. 2111. Your submittal included the following documents for our review:

Plate Steel Trunnion Revised Plans and Specifications Plate Steel Trunnion Design Documentation

Report

The spillway stoplog/ gate retrofit work was initially authorized by our August 24, 2023 letter. The current submittal requests authorization for deviations from the

originally authorized design of the trunnion yokes due to deficiencies identified during pre- installation testing of the original design. Our review did not find any significant

deficiencies or errors with the modified design that would affect the safety of the project works or the adequacy of the project works to perform their intended functions. You are

authorized to install the new trunnion yokes per the documents provided and continue the construction work previously authorized. All conditions and requirements outlined in our August 24, 2023 construction

authorization

letter continue

apply.

Thank you for your continued cooperation and interest in dam safety. If you have any questions, please contact Mr. Justin Nettle of this office at ( 503) 552- 2714. Sincerely,

ERIC

Digitally signed by ERIC KENNEDY Date: 2026. 08. 20

K E N N E DY 10: 26: 22 - 07' 00' Eric Kennedy, P. E. Regional Engineer

233813

BOCC

Consent

Agenda

Meeting Date: 9/ 15/ 2026 Perpetual Road and Utility Easement-

EASEMENT-

Toutle

Water

System -

Ross

Submitted By: Averie Mejia, Administrative Assistant III Submitted For: Susan Eugenis, County Engineer Department:

Roads

Administration

Information

Subject and Summary Statement

Attached is the Permanent Road and Utility Easement from Carol A. Ross for the Toutle Water System. The permanent easement impacts subject parcel WG2520034, was signed on August 26, 2026, accepted by the Chairman of the Board of County Commissioners on Septmber 1, 2026, and recorded at the Cowlitz County Auditor' s Office on September 1, 2026 under Auditor' s File Number 3796145. Staff Attendance Susan

Eugenis

Department

Recommendation

It is the recommendation of the Department of Public Works the Permanent Easement from Carol A.

Ross for the Toutle Water System be acknowledged by the Board and received for the Commissioners official record. Attachments AFN

3796145

Ross

Permanent

Easement

Form

Task

User Mejia,

Averie

Lunday, Anna

Review

Action

Timestamp

Submit

9/ 3/ 2026

Review-

Submit

9/ 3/ 2026 9: 26: 00 AM

Approver

Approve

9/ 3/ 2026

2: 04: 00 PM

Legal Review

Approve

9/ 4/ 2026

2: 09: 00 PM

Clerk of the Board

Approve

9/ 8/ 2026

7: 52: 00 AM

Agenda

Item

Preliminary

Submission

8: 52: 00 AM

PW1 Eugenis,

Susan

Department Review

Jensen, Grayson,

Doug Kelly

Review

After Recording Return Document to:

Cowlitz County Dept of Public Works 1600— 13' h Avenue South

Kelso, WA 98626- 2851

3796145 09/ 01/ 2026 03: 26: 25 PM COWLITZ COUNTY Easement Cowlitz County Washington

PUBLIC

Pages: 6 WORKS 308

1111111111111 IN 1111111111111111111111111111111111111111111111

Document

Title: Easement

Grantor(

s):

Carol Ross

Grantee(

s):

Cowlitz County

Abbr. Description:

556 ( TOUTLE LAKE TRS) - 2A, 3A 25 - 10N - 1W EXC TR 2A- 1, 3A- 1 FEE

Legal

Page 3

3391253 Description:

EXC TR 2A- 2 FEE 3391254

EXC CC16093

LOT 1 FEE 3431670.

Additional Depiction: Page 4- 6 Assessor' s Tax Parcel Number: WG2520034

PERPETUAL ROAD AND UTILITY

EASEMENT Project: Toutle Water System

Toutle Highschool Water Tower)

The Grantor, Carol A. Ross, an individual, and as surviving spouse of Daniel K. Ross, as her separate

estate,

for and in consideration

of TEN AND NO/ 100($ 10. 00) DOLLARS, and other

valuable consideration, conveys and grants unto the COWLITZ COUNTY, a political subdivision of the State of Washington, and its assigns, a nonexclusive road and utility easement in, upon, and across the property described on the attached Exhibit " A", and being over, under, depicted on the attached Exhibit " B" for the purpose of ingress/ egress, construction, use, and maintenance

of an access road, construction,

use, and maintenance

of utilities, and other

related functions necessary to the operation and maintenance of a water reservoir and/ or other County facilities as may be necessary.

It is understood and agreed that delivery of this easement is hereby tendered and that the terms and obligations hereof shall not become binding upon the COWLITZ COUNTY unless and until accepted and approved hereon in writing for the COWLITZ COUNTY, by its authorized agent.

Dated:

LLQ.'

o (

SEP 0 1 2026 J/BXEMPT

2026

Page

1 of 6

Parcel

Number:

WG2520034

GRANTOR(

S):

By: "-

. "

tfl-

Name: Carol A. Ross

7 STATE OF WASHINGTON

LJ h-+2

County of

On this

00411) day of

2026, before me personally appeared Carol A. Ross,

L,5

to me known to be the individ16als described in and who executed the foregoing instrument

and acknowledged that they signed and sealed as their free and voluntary act and deed, for the uses and purposes therein mentioned.

AM LUNDAY

Notary Public in and fdr1he State of Washington

Notary Public

Residing at:

State of Washington Commission# 21016124

My commission

MY Comm. Expires Apr 21, 2029

ACCEPTED

THIS

OF COWLITZ COUNTY, WASHINGTON

Richard R. Dahl, Chairman

Authorized to sign by Board per RCW 36. 32. 100)

UL ' I

Attested

by Kelly Grayson,

Cler

COWLITZ

f the 99ATY 0

WASHINGTON L

Dated:

expires

2026

DAY OF

BOARD OF COUNTY COMMISSIONERS

Attest:

Lgta':mA .

z cla Wli" Colo

Page 2 of 6

Uljq

f • T I • 29

EXHIBIT " A"

EASEMENT AREA 1:

Commencing at the Northeast corner of Tract 2 of the Plat of Toutle Lake Tracts recorded in volume 7 at page 99, situate in the Northeast Quarter of Section 25, Township 10 North, Range 1 West of the Willamette Meridian, Cowlitz County, Washington;

Thence South 00` 55' 14" West along the East boundary of said Tract 2 a distance of 897. 05 feet to the TRUE POIINT of BEGINNING

of this easement

description;

Thence continuing along said East boundary South 00' 55' 14" West a distance of 134. 37 feet; Thence leaving said East boundary North 57' 14' 00" West a distance of 76. 49 feet; Thence North 00' 56' 00" East a distance of 67. 52 feet;

Thence North 68` 44' 00" East a distance of 70. 15 feet to the point of beginning.

EASEMENT

AREA 2:

Thence South 00' 55' 14" West along the East boundary of said Tract 2 a distance of 1327.33 feet to the Southeast corner of the North 1327. 32 feet of Tract 2 of said Toutle Lake tracts and the TRUE POIINT of BEGINNING of this easement description;

Thence along said East boundary of said Tract 2 North 00' 55' 14" East a distance of 22. 00 feet; Thence leaving said East boundary South 13' 42' 45" West a distance of 22. 58 feet to the South boundary of the North 1327. 32 feet of said Tract 2; Thence along the South boundary of the North 1327. 32 feet of said Tract 2 South 89' 19' 36" East a distance of 5. 00 feet to the point of beginning.

Prepared

GER

by:

K. Germunson

tea$

Surveying Inc.

` 4-

PO Box 1336 Castle Rock, WA. 98611

3a ,

CAI. t.

Page 3 of 6

yCt o

m Ln

w Oi

tsrI,' Lo

202E

5i8"

rebar

TRACT

C rn

GP4P,HRI- SCALE -

FEET

Scoie

J" =

1VE Cor.

tract

Tourle

Lake

12O

89° 19' 36 ' w)

240

120

360

reel

TOUTLE LAKE TPA C TS

AM 89G403005

', `

r '

328. 4624

Tousle Loke School Oislrlct

TOUTLE LAKE

N89° 19' 364

T'racrs

cap

Rcss

i 70. OG )

120

11i30i2025

rebar

Fnd. Ben'

5.,18"

Fnd.

I LS 10997

SCHOOL

r5 J ,>+

C t—

30 0. 18'

from

Sec.

line.

Meld for polnl on Eov boundary

Tract

Troct

Tout! e

Lake

Tracts

Peroored by: K. Germunsen

Plot

o O

Oerarl " No

PO Box

Casr! e , Rock,

Scale

LOT V: 28 PG.

360)

AV-

Surveying

Inc.

1336

751 -

VIA.

9861

8633

kvgermunson@comcosr.

net

Sq.

Ft. Area

3 Fnd. 2"'

Fnd.

S89° 19' 36" E

0 bens, r, ed

2J` 518 '

rebcr',

+- 130i2. spin

hole.

, 1

1"!

Brass

cap.

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Sec. 1i4 Beormg5

d ast' g Jo 9

NE of

per

46491

Boundary 60515

POS

15i i 60 ( 328. 07') Plat ( 334. 72)

N 890l9' 36" W

328. 46'

Fnd. 1"

7ill,

1P,

Plat

Toutle

Lake

Fnd.

5i8"

rebar &

Section

Held

for

LOT

Short

L; ne.

point Ear boundary

Short

Plat V., 6

Pg.

T 10 N, R

lIV. 1Vr.

COWL/ TZ COUNTY,

5. 18"

rebcr 8 cap

389a8

Q4 Q4

Toutle Lake Dist.

P055

09- 007

A,FN

Pg.

890403006

North

Fnd. LS

SriI

665 Toutle Lake

Tracts

-~^! .

O , ioi-

t R=

feet Lot !

000

vim g7. 9Q}'

'{ R-= 520• 00

3c' G

LOT

J: 28 PG.

CLO

28 PG. 39

Cfl

Fnd.

Fnd. fi8" rebar 8 cap 90. 74')

239. 08') Ls

w v o0

WA.

405

Pipe

School

g / / 4, SEC.

Iron

P TN: NE

Plat CC 09- 007

V: 16

Tract 2 of Plat. LOT

cap

7ii1i2026

lli2"

LS 38958

Tracts

500055' 14" W 0. l8' from

T 14 N

261, 32,

2026

10997

199. 84'

Reservoir

Motion

233318

BOCC

Item

Agenda

Meeting Date: 9/ 15/ 2026 Contract with Compass Career Solutions

Submitted By: Amanda Foshaug, Accounting Specialist II Submitted For: Gena James, HHS Deputy Director Department:

Human

Services

Dept

Information

Subject and Summary Statement

The purpose of this County Contract# 26- 015 with Compass Career Solutions is to provide

developmental disability employment and day services. This contract is paid on a cost reimbursement basis, not to exceed $ 402, 000. 00 during the period July 1,

2026, through June 30, 2027. Funding for this contract is passed through from the County' s contract with State Department

Washington

of Social & Health Services, Developmental Disabilities Administration.

Contract/ SOW Name

Current

Original

Change

Total

402, 000. 00

ITime Period 7/ 01/ 26- 6/ 30/ 27

Staff Attendance Gena James

Department

It is the

Recommendation

recommendation

of the Cowlitz County Health&

Human Services that the Cowlitz County

Board of Commissioners move to approve this Contract 26- 015 with Compass Career Solutions. Attachments 26- 015

DD-

Compass

Career

Solutions

Form

Task

User

Foshaug,

Amanda

Agenda

Item

Submission

Drake,

Jamie

Preliminary

Review-

James,

Gena

Department

Approver

HHS

Review

Action

Timestamp

Submit

8/ 27/ 2026

Approve

8/ 31/ 2026

Approve

9/ 1/ 2026

11: 08: 00 AM

10: 02: 00 AM 11: 07: 00 AM

Review Berger, David

Legal Review

Approve

9/ 4/ 2026

3: 21: 00 PM

Grayson,

Clerk of the Board

Approve

9/ 8/ 2026

7: 52: 00 AM

Kelly

Review

233318

Motion

Item

rz co&

SUBRECIPIENT

GRANT

AGREEMENT

Number:

gSM1NG G

26- 015

Purpose of Subrecipient

Grant Agreement. This Subrecipient

Grant Agreement (" Agreement")

is made by and between COWLITZ COUNTY, a political subdivision of the State of Washington, hereinafter called " County" or" Cowlitz County") and Compass Career Solutions ( hereinafter called " Subrecipient") to set forth the terms and conditions by which the County will provide the Subrecipient with a grant award to be used to pay or reimburse necessary expenditures incurred for services for persons with developmental disabilities. 2.

Term.

Scope of Eligible Expenditures. Grant funds may only be used to pay or reimburse eligible

This Agreement

shall take effect on July 1, 2026, and terminate on June 30, 2027.

expenditures consistent and as detailed in Attachment A- Scope of Work for Project ( the Project").

Grant Award.

The Subrecipient is awarded a total of$ 402, 000.

Budget. The Grant Award shall be expended by the Subrecipient as set forth in Attachment B Budget.

Subrecipient

Responsibilities.

Subrecipient

agrees to administer the Grant Award proceeds

consistent with this Agreement. Subrecipient shall provide the County with certification using the form of Attachment C that Grant Award funds will be used for eligible expenditures. Subrecipient

shall request payment from the County as outlined in Attachment B. 7.

In addition to the responsibilities outlined herein and in Attachment A Reporting Requirements. Scope of Work for Project, at least once a quarter, and at the conclusion of either the grant expenditure or the grant contract period, the Subrecipient shall provide a report on the progress made to date on the Project, using such forms and meeting such requirements as determined by the County. Such reports shall be provided by the Subrecipient to the County electronically to the County' s Project Manager identified herein.

Access to and Maintenance of Records. Subrecipient shall maintain internal controls, accounts

and records, including personnel, property, financial, and programmatic records and other such records as may be deemed necessary by the County, for a period of six ( 6) years to ensure proper accounting for all Grant Award funds and compliance with this Agreement. Subrecipient acknowledges that records may be subject to disclosure under the Public Records Act, Chapter 42. 56 RCW.

Subrecipient agrees that the County or any duly authorized representatives shall have at any time and from time to time during normal business hours, access to any work product, books, documents, papers, and records of Subrecipient which are related to this Agreement, for the purpose of inspection, audits, examinations, and making excerpts, copies and transcriptions. 9.

Termination. The following provisions apply regarding termination of this Agreement: a. Termination for Loss of Funding. The County shall have the right to terminate this Agreement upon advance written notice if the funds relied upon for the Grant Award are

terminated, b.

suspended,

or otherwise

Termination for Convenience. convenience

lost or impaired

in whole or in part.

Either party may terminate this Agreement for

upon giving the other party at least 30 days' advance written notice.

In that

event, the Subrecipient will be entitled to payment only for those expenses and costs reasonably and actually incurred prior to the effective date of the termination. 1 of 52

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Termination for Default. If either party defaults in its performance under this Agreement, the nondefaulting party may give the defaulting party written notice that it has 30 days in which to cure the default.

If the default is not cured within 30 days of notice, the

nondefaulting party may terminate this Agreement. In the event of such a termination, the nondefaulting party shall have all rights and remedies available to it under the law. However, if a notice of termination for default has been issued and it is later determined for

any reason that the Subrecipient was not in default, the rights and obligations of the parties shall be the same as if the notice of termination had been issued pursuant to the Termination for Public Convenience paragraph hereof. 10. Termination Procedure.

The following provisions apply in the event that this Agreement is

terminated: a.

The Subrecipient shall cease to perform hereunder as of the effective date of termination and shall comply with all reasonable instructions contained in the notice of termination, if

The Subrecipient shall provide the County with an accounting of authorized services provided through the effective date of termination.

any.

11.

Conflict of Interest. Subrecipient designees, agents, members, officers, employees, consultants,

and any other public official who exercise or who has exercised any functions or responsibilities with respect to the Project during his or her tenure, or who is in a position to participate in a decision- making process or gain inside information with regard to the Project, are barred from any interest, direct or indirect, in any grant or proceeds of the Project, or benefit therefrom, which is part of this Agreement at any time during or after such person' s tenure. 12. Governing Laws. This Agreement shall be governed by and construed in accordance with the laws of the State of Washington. The venue for any dispute regarding or arising out of this Agreement shall be Cowlitz County Superior Court. 13. Personnel.

The Subrecipient will secure at its own expense all labor and materials required to

perform any work in connection with the Project. The Subrecipient shall be responsible for all applicable payroll, labor and industries premiums, and taxes. All employees and subcontractors of the Subrecipient shall be covered by Industrial Insurance in full compliance with Title 51 RCW. The Subrecipient shall defend and indemnify the County, and their officials, officers, employees, and agents from and against all claims arising from any actual or alleged violation of the Subrecipient' s duties under this section or applicable law. Solely for the purposes of this indemnification provision, the Subrecipient expressly waives its immunity under Title 51 RCW and acknowledges that this waiver was mutually negotiated by the parties. The Subrecipient' s duty to defend and indemnify shall survive the termination of this Agreement. 14. Contract Representatives. The parties' designated representatives shall be responsible for the administration of this Agreement and for receiving notices given in connection with this Agreement. The following are designated as the representatives of the parties: For the

Gena James

Brandy Gerdes- Schutz

Title:

Deputy Director

Senior Director

Department:

Health &

Address:

1952

Telephone:

(

Compass Career Solutions

5709 W. Sunset Hwy, Suite 100

WA 98632

414- 5599

HHSContracts(

Fax:

Spokane, WA 99224 360)

cowlitzwa. gov

577- 5717

bgerdesschutz@dungarvin. com

UEI:

TZ8RNRDSRNN1

DAEKB3UYE6P1

UBI:

08- 300- 3788

604- 099- 950 2 of 52

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mailto:HHSContracts 360) 425- 7531 @cowlitzwa.

E- mail:

Date

360)

Human

9th Ave

Longview,

Last

For the Subrecipient:

County:

Name:

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

15.

GRANT

AGREEMENT

Notices. Any notice required or permitted to be made under this Agreement may be given personally, by facsimile, or by first- class, registered or certified mail. A notice personally delivered to the other party is deemed given upon proper delivery. A notice sent by first- class, registered or certified mail is deemed given three days after mailing, if properly addressed and having proper postage. Notices delivered by facsimile shall be deemed to have been given on the date of transmission if received during the subrecipient' s business day or, if not, on the subrecipient' s next business day.

16. Insurance Requirements. The Subrecipient shall maintain in full force and effect during the term of this Agreement, and until final acceptance of the work, public liability and property damage insurance with companies or through sources approved by the state insurance commissioner pursuant to RCW Title 48, as now or hereafter amended. The County, its appointed and elected officials, agents and employees, shall be specifically named as additional insureds in a policy with the same company which insures the Subrecipient or by endorsement to an existing policy or with a separate carrier approved pursuant to RCW Title 48, as now or hereafter amended, and the following coverages shall be provided: COMPREHENSIVE GENERAL LIABILITY:

Bodily injury, including death. Property damage

Per occurrence

1, 000, 000 1, 000, 000

Per occurrence

2, 000, 000

Aggregate

1, 000, 000

Per occurrence

2, 000, 000

Aggregate

ERRORS AND OMISSIONS or PROFESSIONAL

LIABILITY with an Extended Reporting Period

Endorsement(

two year tail).

WORKERS COMPENSATION:

Statutory amount Waiver of Title 51 Rights

EMPLOYER' S LIABILITY/ Stop Gap: Per occurrence

1, 000, 000

AUTOMOBILE:

coverage on owned, non- owned, rented and hired vehicles

Bodily injury, liability, including death and property damage liability 1, 000, 000

Combined Single Limit

All Subrecipient' s and Subrecipient' s subcontractors' insurance policies and additional named insured endorsements

shall provide primary insurance coverage and be non- contributory.

Any

insurance, self- insured retention, deductible, risk retention or insurance pooling maintained or participated in by the County shall be excess and not contributory to such insurance policies. All Subrecipient' s and Subrecipient' s subcontractors' liability insurance policies must be endorsed to show this primary coverage. Upon request, the Subrecipient shall provide a full and complete and certified copy of all requested insurance policies to the County. The County reserves the right, but not the obligation, to revise any insurance requirement, not limited to limits, coverages and endorsements, or to reject any insurance policies which fail to meet the requirements of this Agreement. Additionally, the County reserves the right, but not the obligation, to review and reject any proposed insurer providing coverage based upon the insurer' s financial condition or licensing status in Washington. Any deductibles

and/ or self- insured

retentions

exceeding $

10, 000 or any stop- loss provisions,

the

County shall have the right to request and review the Subrecipient' s most recent annual financial reports and audited financial statements as a condition of approval.

Subrecipient hereby agrees to waive subrogation with respect to each insurance policy maintained under this Agreement. When required by an insurer, or if a policy condition does not 3 of 52

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permit Subrecipient to enter into a pre- loss agreement to waive subrogation without an endorsement, then Subrecipient agrees to notify the insurer and obtain such endorsement. This requirement shall not apply to any policy which includes a condition expressly prohibiting waiver of subrogation by the insured or which voids coverage should the Subrecipient enter into such a waiver of subrogation on a pre- loss basis. The County, its departments, elected and appointed officials, employees, agents and volunteers shall be named as additional insureds on Subrecipient' s and Subrecipient' s subcontractors'

insurance policies by way of endorsement for the full available limits of insurance maintained by the Subrecipient

and subcontractor,

and all coverage shall be primary and non- contributory.

state or notion of additional insured status on a Certificate of Insurance shall not satisfy these requirements. [ This endorsement shall not be required if the Subrecipient is a governmental entity and is insured through a governmental entity risk pool authorized by the State of Washington.] The Subrecipient shall, for each required insurance policy, provide a Certificate of Insurance, with endorsements attached, evidencing all required coverages, limits, deductibles, self- insured retentions and endorsements and which is conditioned upon the County receiving thirty ( 30) days prior written notice of reduction in coverages, cancellation or non- renewal. Each Certificate of Insurance and all insurance notices shall be provided to: ATTN: County Project Manager, Cowlitz County Health & Human Services, 1952 91h Avenue, Longview, WA 98632. This Agreement shall be void ab initio if the proof of coverage is not timely supplied. The insurance maintained under this Agreement shall not in any manner limit or qualify the liabilities or obligations of the Subrecipient under this Agreement. All insurance policy deductibles and self- insured retentions for policies maintained

under this Agreement shall be paid by the

Subrecipient.

Compensation and/ or payments due to the Subrecipient under this Agreement are expressly conditioned

upon the Subrecipient' s strict compliance with all insurance requirements.

to the Subrecipient shall be suspended

in the event of noncompliance.

Payment

Upon receipt of evidence

of Subrecipient' s compliance, payments not otherwise subject to withholding or set- off will be released to the Subrecipient.

This Agreement

shall be void ab initio if the proof of coverage

is not

timely supplied. If the Errors and Omissions or Professional Liability insurance obtained is an occurrence policy as opposed to a claims- made policy, the Extended Reporting Period Endorsement is not required. 17. Indemnification. To the fullest extent permitted by the law, the Subrecipient shall indemnify, defend, and hold harmless Cowlitz County and the officials, officers, employees, and agents of each of them, from and against all claims in any way resulting from or arising out of the performance of this Agreement, whether such claims arise from the acts, errors or omissions of the Subrecipient, its subcontractors, third parties, Cowlitz County, or anyone directly or indirectly employed by any of them or anyone for whose acts, errors or omissions any of them may be liable. " Claim" means any loss, claim, suit, action, liability, damage or expense of any kind or nature whatsoever, including but not limited to attorneys' fees and costs, attributable to personal or bodily injury, sickness, disease, or death, or to injury to or destruction of property, including the loss of use resulting therefrom. The Subrecipient' s duty to indemnify, defend, and home harmless includes not is not limited to claims by the Subrecipient' s or any subcontractor' s officers, employees, or agents. The Subrecipient' s duty, however, does not extend to claims arising from the sole negligence or willful misconduct of Cowlitz County, or tis officials, officers, employees, and agents. Solely for the purposes of this indemnification provision, the Subrecipient expressly waives its immunity under Title 51 RCW and acknowledges that this waiver was mutually negotiated by the parties. This section shall survive the expiration or termination of this Agreement.

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GRANT

18. Debarment

AGREEMENT

Certification.

The Subrecipient,

by signature to this Agreement,

certifies that the

Subrecipient is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded in this Agreement by any federal department or agency from participating in transactions ( Debarred). The Subrecipient also agrees to include the above requirement

in all

subcontracts into which it enters. The Subrecipient shall immediately notify the County if, during the term of this Contract, the Subrecipient becomes debarred. The County may immediately terminate this Contract by providing Subrecipient written notice if Subrecipient becomes debarred during the term hereof. 19. Compliance with Laws.

The Subrecipient and its officials, officers, employees, agents, and

subcontractors shall comply with all applicable federal, state, and local laws, regulations, rules, and policies. The County shall have no obligation to ensure such compliance. 20. Religious Activities.

If the Subrecipient is a faith- based or religious organization, it retains its

independence and may continue to carry out its mission, including the definition, development, practice, and expression of its religious beliefs. Such a subrecipient, however, may not use any funding provided under this Agreement to support or engage in any explicitly religious activities, including activities that involve overt religious content such as worship, religious instruction, or proselytization, nor may such a subrecipient condition the provision of services provided pursuant to this Agreement upon a participant' s engaging in any such explicitly religious activities. 21.

Permissible

Use Warranty.

The Subrecipient

recognizes

and agrees that the Grant Award

consists of both developmental disability assistance funds as established by RCW 71. 20. 110 and pass- through' funds coming from Washington State Department of Social and Health Services Developmental

Disabilities

Administration.

The Subrecipient

warrants that its planned and actual

uses of the Grant Award herein constitute permissible uses consistent with RCW 71. 20. 110, services for persons with developmental disabilities. The Subrecipient also agrees to use the Grant Award funds awarded to it in accordance with Attachment A and in accordance with

Chapter 71A. 14 RCW. The Subrecipient recognizes and agrees that the purpose of the Grant Award is to advance the state legislature policy to provide a coordinated and comprehensive state and local program of services for persons with developmental disabilities. The Subrecipient warrants that its planned and actual uses of the Grant Award herein constitute

permissible

uses

consistent with Attachment A and the pass- through funding requirements discussed immediately above.

This section shall survive termination of this Agreement.

22. Organizational Status Warranty. The Subrecipient warrants that it is duly organized, existing and in good standing under the laws of the State of Washington. 23. Relationship of the Parties. This Agreement, and the parties' and the County' s activities under it, shall not be construed as creating any kind of partnership or joint venture, nor shall it be construed as creating any kind of independent contractor, agency or employment relationship between the parties or the County. 24. No Third- Party Rights. This Agreement is entered into by the parties solely for their own benefit and it creates or grants no rights of any kind to any other party. 25. Assignment. The Subrecipient shall not assign any of its rights or delegate any of its duties under this Agreement without the prior express written consent of the County, which may be granted or refused at the County' s sole discretion. 26. Waiver.

No term or condition of this Agreement shall be deemed waived unless such waiver is

expressly agreed to in writing by the party granting the waiver. In addition, waiver of any breach of this Agreement shall not be deemed a waiver of any prior or subsequent breach. 27. Amendment. This Agreement can only be amended in writing, and only upon execution by both parties.

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28. Entire Agreement. The parties acknowledge that this Agreement is the complete expression of their agreement regarding the subject matter of this Agreement. Any oral or written representations or understandings not incorporated into this Agreement are specifically excluded. 29. Headings. The headings in this Agreement are for convenience only and shall not be deemed to affect the meaning of its provisions. 30. Severability. If any provision of this Agreement is held by a court of competent jurisdiction to be invalid, such invalidity shall not affect the validity of the remaining provisions that can be given effect without the invalid provision, provided that the underlying intent of the parties can still be given effect. 31. Signature Authority. Each person signing this Agreement on behalf of a party warrants that he or she has full authority to sign this Agreement on that party' s behalf. 32. Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall be deemed one agreement.

Each counterpart

may be executed and delivered by facsimile to the other party. 33. Attachments. The following attachments are incorporated into this Agreement by reference. a. Attachment

A— Scope

b. Attachment

B—

c. Attachment

C— Certification

d. Attachment

D—

Retirement

e. Attachment

E—

f. Attachment

F—

Data Security Requirements DSHS County Program Agreement DDCS County Services

IN WITNESS

WHEREOF,

of Work

for Project

Budget Form Certification

the parties have executed this Agreement

day of

this

2026.

BOARD OF COUNTY COMMISSIONERS

SUBRECIPIENT:

OF COWLITZ

Signature

COUNTY,

WASHINGTON

Richard

R. Dahl,

Chairman

Steven

L. Ferrell,

Commissioner

Print name:

Steve

Title:

FORM

HAS BEEN APPROVED AS TO

BY COWLITZ

COUNTY

PROSECUTING ATTORNEY

Date

Clerk of the Board Date

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Last

Rader,

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

SCOPE

OF WORK

FOR

PROJECT

The Subrecipient shall ensure services, and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: 1.

Definitions. The words and phrases listed below, as used in this Grant Agreement, shall each have the following definitions: a. " Acuity Level" means the level of a Client' s abilities and needs as determined through the DDCS assessment. b. "

Additional Consumer Services" refers to indirect Client service types as follows: 1) " Community Information and Education": Activities to inform and/ or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities. 2) " Training": To increase the job related skills and knowledge of staff, providers, volunteers, or interning students in the provision of services to people with developmental disabilities. Also to enhance program related skills of board or advisory board members. 3) " Other Activities" reserved for special projects and demonstrations categorized into the following types:

a) Infrastructure

projects: Projects in support of Clients ( services not easily

tracked back to a specific working age Client) or that directly benefit a Client( s) but the Client is not of working age. Examples include planning services like generic job development e. g. " Project Search". b) Start- up projects: Projects that support an agency or directly benefit the agency. Examples include equipment purchases and agency administrative support.

c) Partnership Project: Collaborative partnerships with school districts, employment providers, DVR, families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn twenty- one ( 21). " CFR" means the Code of Federal Regulations. All references in this Agreement and any Program Agreement to CFR chapters or sections shall include any successor, amended,

or replacement d. "

regulation.

Client" means a person with a developmental disability as defined in Chapter 388- 823 WAC who is currently eligible and active with the Developmental Disabilities Community Services or is an identified PASRR Client.

Competitive Integrated Employment" means work performed by an individual on a parttime or full- time basis, within an integrated setting within the community that meets HCBS settings requirements. The Client must be compensated at minimum wage or higher,

using the higher of the Federal, State, or local rate, and at a rate comparable to the wage paid to non- disabled workers performing the same tasks, including receiving the same benefits and opportunities for advancement. f.

Confidential Information" or" Data" means information that is exempt from disclosure to

the public or other unauthorized persons under Chapter 42. 56 RCW or other federal or state laws. Confidential

information

includes, but is not limited to, Personal Information.

g. "

Debarment" means an action taken by a federal official to exclude a person or business entity from participating in transactions involving certain federal funds.

h. "

DSHS" means the Department of Social and Health Services of the state of Washington.

i. "

Employment Outcome Payment" means a payment to providers for transition students born between specific dates; have high acuity; are authorized for Individual employment; and student obtains a competitive integrated job within a specific timeframes. If the job is a minimum of ten hours of work per week an additional amount will be include in the payment.

j. "

General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. 7 of 52

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GRANT AGREEMENT

ATTACHMENT

High Acuity Client" means a DDCS Client who requires significant and intensive support in the community, often due to complex needs, as determined through the DDCS

assessment.

Medicaid Home and Community Based Services ( HCBS)" means services that occur in

I. "

a Client' s home or community rather than institutions or other isolated settings. These programs serve a variety of targeted populations groups, such as people with intellectual or developmental disabilities, physical disabilities, and/ or mental illness. m. " Preadmission Screening and Resident Review( PASRR)" means individuals with intellectual disabilities or related conditions ( ID/ RC) who have been referred for nursing facility ( NF) care. n.

Person Centered Service Plan or PCSP" means a document that authorizes and

identifies the DDCS paid services to meet a Client' s assessed needs. Formerly referred to as the Individual Support Plan.

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' s license numbers, other identifying numbers, and any financial identifiers. p. " Quality Assurance" means an adherence to all Program Agreement requirements, including DDCS Policy 6. 13, Provider Qualifications for Employment and Day Program Services, County Guidelines and the Criteria for Evaluation, as well as a focus on reasonably expected levels of performance, quality and practice. q. " Quality Improvement" means a focus on activities to improve performance above minimum standards and reasonably expected levels of performance, quality and practice. o.

RCW"

means

the Revised

Code

of Washington.

All references

in this Agreement

and

any Program Agreement to RCW chapters or sections shall include any successor, amended, or replacement statue. Pertinent RCW chapters can be accessed at

http:// apps. leg. wa. gov/ rcw/. Secretary" means the individual appointed by the Governor, State of Washington, as the

head of the DSHS, of his/ her/ their designee.

Secured Area" means an area to which only authorized representatives of the entity possessing the confidential information access. Secured Areas may include buildings, rooms or locked storage container( such as a filing cabinet) within a room, as long as access to the Confidential

Information

is not available to unauthorized

personnel.

Service Provider" is a qualified Client service vendor who is contracted to provide Employment and Day Program services. " Subrecipient" is the service provider receiving the Grant Award from the County to

w. "

provide services. Trusted Systems" include

following methods of physical delivery: ( 1) handdelivery by a person authorized to have access to the Confidential Information with written

acknowledgment

only the

of receipt; ( 2) United

States Postal

Service (" USPS") first class

mail, or USPS delivery services that Tracking, such as Certified Mail, Express Mail or Registered Mail; ( 3) commercial delivery services ( e. g., Fed Ex, UPS, DHL) which offer tracking and receipt confirmation; and ( 4) the Washington State Campus mail system. For electronic transmission,

the Washington State Governmental

Trusted System for communications

Network ( SGN) is a

within that Network.

USC" means the United States Code. All references in this Agreement and any Program Agreement to USC chapters and sections shall include any successor, amended, or

" WAC" means the Washington Administrative Code. All references in this Agreement and

replacement

statute.

any Program Agreement to WAC chapters or sections shall include any successor, amended, or replacement of regulation. accessed

Date

Admin

http://apps.leg.wa.gov/ wac/

at http:// apps. leg. wa. gov/ wac/.

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Purpose. a.

Direct Client Services

Community Inclusion" or" Cl": means individualized services provided in integrated community settings with other individuals without disabilities. The activities are based on Client interests and provide opportunities typically experienced by the general public of similar age in their local community, accessible by public transit or a reasonable commute from their home. The goal of the service is to support clients to participate, contribute, and develop relationships with community members who are not paid staff. These services may be authorized for individuals aged 62 and older. These services may be

i. "

authorized in addition to or instead of employment support ( Individual

Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. ii. "

Individual Supported Employment" or" IE": services are a part of a Client' s pathway to employment and are tailored to individual needs, interests, and abilities, and promote career development. These are individualized services necessary to help persons with developmental disabilities obtain and continue integrated employment at or above the state' s minimum wage in the general workforce. These services may include intake, discovery, assessment, job preparation, job marketing, job supports, record keeping and support to maintain a job.

iii. "

Individualized

iv.

Technical Assistance"

or" ITA": services are a part of an Client' s

pathway to individual employment or community inclusion. This service provides assessment and consultation to the provider to identify and address existing barriers to employment or community inclusion. This is in addition to supports received through supported employment or community inclusion services for Clients who have not yet achieved their goal. Job Foundations Partnership Project is for transition students born between specific dates; have high acuity; are authorized for Individual employment; and student obtains a competitive integrated job within specific timeframes. Job Foundation Report" is a document derived from employment readiness

activities performed by students who are between ages 19 through 20 that identifies actionable next step for employment. The employment service providers developing the Job Foundation report will be supporting students with employment activities on average of 35 hours. b.

Coordination. Working collaboratively, the parties shall administer DD services within the county as set forth below: The DDCS region shall:

iii.

Inform and include the County in the discharge planning of Clients leaving institutions and returning to the community who will need program funding; Inform the County of Clients who have had their waiver status changed; Work with the County when referring Clients for services and will withdraw

iv.

Authorize new service within five ( 5) working days and will extend existing

ii.

referrals when authorization is not issued; service authorization before expiration date; v.

Inform Clients of service changes through Planned Action Notice( s);

vi.

Work with the County to document planned services in the Client' s Person Centered Service Plan including notification of assessment dates; vii. Work with the County when terminating services; viii. Work with the County in participating in evaluation of the Subrecipient. The County shall: ix.

Work with the DDCS Region and the Subrecipient when Clients are referred for services, authorized services, and/ or for support modifications;

Work with DDCS Region and the Subrecipient to document planned services in the Client' s Person Centered Service Plan;

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GRANT AGREEMENT

xi.

xii. xiii.

ATTACHMENT

Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DID Assessment prior to any changes; Work with the DDCS Region and the Subrecipient regarding service termination. Notify and work with the DDCS Regional Employment Specialist when performing evaluations of the Subrecipient.

The Subrecipient shall: xiv. xv.

Facilitate the County' s attendance at employment plan meetings as requested. Work with the DDCS Region and the County when Clients are referred for services;

xvi.

Work with DDCS Region and the County to document planned services in the

xvii.

Assist with informing the DDCS Region and County of any potential service level changes not documented in the individual' s DID Assessment prior to any

Client' s Person Centered Service Plan;

changes; and xviii.

Work with the DDCS Region and the County regarding service termination. Program Outcomes. The Subrecipient shall provide qualified Employment Program Service for consumer support services that include the following program outcomes: a. Monthly Community Inclusion ( CI) service support hours will be based on the Client' s Cl service level per WAC 388- 828- 9310 for all Clients who began receiving CI services July

2011 i.

and forward.

To ensure health and safety, promote positive image and relationships in the community, increase competence and individualized skill- building, and achieve other expected benefits of Cl, services will occur individually or in a group of no more than two ( 2) or three ( 3) Clients with similar interests and needs.

ii.

Cl services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will

not be reimbursed.

Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses. Clients should be supported to average twenty ( 20) hours of community work per week or eighty- six ( 86) hours per month; however, each person' s preferred hours of employment should be taken into consideration. The amount of service a Client receives will be based

on his/ her demonstrated need, acuity level and work history per WAC 388- 828. The Client' s DDCS PCSP is the driver for service. The AWA County Service Authorization ( CSA) and updated Planned Rates information will not exceed the Client' s

DDCS PCSP. Service changes will not occur until the Client has received proper notification from DDCS. d.

f. g.

All Clients will have an Individualized Employment or Community Inclusion plan to identify Client' s preferences. Minimum plan elements are outlined in the reference document Criteria for Evaluation." A copy of the Client' s individualized plan will be provided to the Client, their DDCS Case Resource Manager( CRM), guardian and others as appropriate. Six- month progress reports describing the progress made towards achieving Client' s goal will be provided by the Subrecipient to the CRM, Client, and/ or guardian, if any, within 30 days following the six- month period. The report will summarize activities and outcomes made towards Client' s individualized goal( s). All Clients will be contacted according to Client need and at least once per month. If Clients in Individualized Employment or Group Supported Employment, have not obtained paid employment

at minimum wage or higher within six ( 6) months, the

Subrecipient will assure the following steps are taken: i. Review the progress toward employment goals; ii. Provide evidence of consultation with the Client/ guardian; and iii. Develop additional strategies with the Client/ guardian, County, employment support staff, case manager, and others identified by the Client. Strategies may include providing technical assistance, changing to a new provider, and/ or providing additional resources as needed to support the Client' s pursuit of 10 of 52

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ATTACHMENT

employment. The additional strategies will be documented

for each Client and

kept in the Client' s file( s). h.

j. k.

If after twelve ( 12) months the Client remains unemployed,

an additional review will be

conducted. The Subrecipient will address steps outlined in the previous six month progress report in the next six month progress report. When requesting to participate in Cl, the Client shall communicate directly with his or her DDCS Case Manager. The DDCS Case Manager is responsible for authorizing Cl services. For Individual Employment where the service provider is also the Client' s employer, long term funding will remain available to the service provider employer for six months after the employee DDCS Client' s date of hire. At the end of the six- month period, if the DDCS Client continues to need support on the job, another service provider who is not the employer of record must provide the support unless the County and/ or DDCS issues prior written approval for the service provider to continue to provide long- term supports if needed. If the County and/ or DDCS approves the continuation of long- term supports where the Subrecipient is also the Client' s employer, the County and/ or DDCS will regularly monitor these positions to assure fading efforts occur when appropriate and any potential conflict of interest is addressed. Individual

Employment staff hours must be attributed to the " Individual

Employment and

Billable Activity Phase( s)". Employment and day services must adhere to the Home and Community Based settings HCBS) requirements of 42 C. F. R. Section 441. 301( c)( 4), including that: i. The setting is integrated in the greater community and supports Clients to have full access to the greater community; ii. Ensures the Client receives services in the community to the same degree of access as individuals not receiving Medicaid HCBS; iii. The setting provides opportunities to seek employment and work in competitive integrated settings; and iv.

The setting facilitates individual choice regarding services and supports, and who provides them.

Partnership Project i. A Job Foundation document will be completed per guidelines for eligible students. Eligible students are DDCS clients who were born between: 1.

For fiscal year 2026: 9/ 1/ 05 through 8/ 31/ 06. For fiscal year 2027: 9/ 1/ 06 through 8/ 31/ 07. These students currently attending school and have completed an application to 2.

ii.

participate

in this Value Based Payment ( VBP) project. The VBP project

application will include the following minimum criteria identified in the sample application found at:

https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/Job https:// www. dshs. wa. gov/ sites/ default/files/ DDA/ dda/ documents/ Job% 20Foundati https://www.dshs.wa.gov/sites/default/files/DDA/dda/documen on% 20Application 040720% 20% 28002% 29. docx %20Foundation%20Application_040720%20%28002%29.docx iii. The Subrecipient will collaborate with School District staff to complete the Job ts/Job%20Foundation%20Application_040720%20%28002%2 9.docx Foundation document and then provide a copy to the County. To be a qualified provider for the Partnership

Project the Subrecipient

must have a current contract

with the Division of Vocational Rehabilitation; a contract in good standing with the County and cannot be in provisional status; a minimum of two years' experience providing Individual Employment with demonstrated job placement skills. The Job Foundation recommendation will only have actionable next steps towards integrated competitive employment

Performance monitoring. The County will monitor the Subrecipient' s performance by tracking work progress, reviewing payment requests for applicable costs, and ensuring that all requirements under this Agreement are met. Substandard performance as determined solely by the County constitutes noncompliance with this Agreement.

If action to correct substandard performance is not taken by the Subrecipient within 30 days after being notified by the County, then the County may terminate the Agreement as described herein.

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Additional Requirements:

ATTACHMENT

The Subrecipient will maintain and make available, if requested,

documentation demonstrating accomplishments of the contract. Such documentation may include, but is not limited to, the following: a. Services provided b.

Number of hours of service

Data Collection

Completed evaluation tools

Backup reports/ data for invoicing.

Site Visits: The Subrecipient will coordinate visits with the County Contract Representative for contract compliance, organizational due diligence, program evaluation, technical assistance, and Continuous Quality Improvement. Client Eligibility: Client eligibility and service referral are the responsibility of DDCS under chapter 388- 823 WAC ( Eligibility) and chapter 388- 825 WAC ( Service Rules). Only persons referred by DDCS shall be eligible for direct Client services under this Agreement. It is DDCS' s responsibility to determine and authorize the appropriate direct service( s) type. Direct Client services provided without a current County Service Authorization are not reimbursable under this

Agreement. Credentials and Minimum Requirements:

Sufficient Policies and Procedures for establishment and maintenance of adequate

internal control systems: The Subrecipient will maintain written policy procedural manuals for information systems, personnel, and accounting/ finance in sufficient detail such that operations can continue should staffing change or absences occur. Policies shall be dated and include dates when updated. b.

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees, subcontractors, and/ or volunteers who may have unsupervised

access to vulnerable DSHS Clients, in accordance with RCW 43. 43. 830-

845, RCW 74. 15. 030, and chapter 388 WAC. If the entity reviewing the application elects to hire or retain an individual after receiving notice that the applicant has a conviction for an offense that would disqualify the applicant from having unsupervised access to vulnerable adults as defined in chapter 74. 34 RCW, then the County shall deny payment for any subsequent services rendered by the disqualified individual provider. The DSHS Background c.

Check Central Unit( BCCU) must be utilized to obtain background

clearance.

The Subrecipient shall meet qualifications as outlined in the DDA Policy 6. 13, Program Qualifications for Employment and Day Program Providers. Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The Subrecipient agrees to assign to DDCS its Medicaid billing rights for services to DDCS Clients eligible under Title XIX programs in this Agreement. Written documentation shall be available to the County and/ or DSHS on request. Reporting Abuse and Neglect: The Subrecipient staff who are mandated reporters under RCW 74. 34. 020( 13) must comply with reporting requirements described in RCW 74. 34. 035, . 040 and chapter 26. 44 RCW. If the Subrecipient is notified by the County and/ or DSHS that a staff member is cited or on the registry for a substantiated finding, then that associated staff will be prohibited from providing services under this Agreement. The Subrecipient will promptly report to the County and DSHS per DDCS Policy 6. 08, Incident Management and Reporting Requirements for County and County- Contracted Providers, if: i.

ii.

They have reasonable cause to believe that abandonment, abuse, financial exploitation or neglect( as defined in RCW 74. 34. 020) of a person who has a developmental disability( as defined in RCW 71A. 10. 020) has occurred, and, If they have reason to suspect that sexual or physical assault of such a person has occurred, they shall also immediately report to the appropriate law enforcement

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agency.

Subrecipient is specifically authorized to have data storage on portable devices or media in accordance with Attachment E. Data Security Requirements.

Revised:

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GRANT AGREEMENT

ATTACHMENT

Certification Regarding Ethics. By signing this Agreement, the Subrecipient certifies that the Subrecipient is in compliance with Chapter 42. 23 RCW and shall comply with Chapter 42. 23 RCW throughout the term of this Agreement and any Program Agreement. The Subrecipient shall comply with the following referenced documents found at DDA Internet site https://www.dshs.wa.gov/dda/county-best-p https:// www. dshs.wa. gov/ dda/ county- best- practices under" County Best Practices": a. ractices DDCS Policy 4. 11, County Services for Working Age Adults;

Chapter WAC 388- 850, chapter 388- 828 WAC, WAC 388- 845- 0001, 0030, 0210, 0215, 0220, 0600- 0610, 1030- 1040, 2100, 2110;

Criteria for Evaluation;

DDA Guiding Values; County Guide to Achieve DDA' s Guiding Values; DDA Guidelines for Community Assessments with Employment and Vocational

Programs;

and

Disability Rights Washington ( formerly Washington Protection and Advocacy System) Access Agreement.

The Subrecipient shall ensure that all staff, working with clients receiving Community Access or Individual Employment Services, complete the following DDA online courses upon hire

http://gowise.org/training/wa-state-dda-onlinehttp:// gowise. org/ training/ wa- state- dda- online- courses/ DDA- 5. 06: WA State Client Rights; a. courses/ b.

DDA- 6. 13CG: WA State County Guidelines; DDA- 6. 13ESP: WA State Employment Service Plans for Employment providers or DDA 6. 13CSP: Community Access Service Plans for Community Inclusion providers. d. The Subrecipient shall ensure that all staff working with clients receiving Community Inclusion services receive annual training on Community Inclusion services and plan writing that incorporates the Community Inclusion Quality Review Tool. https:// www. dshs. wa. gov/ dda/ county- best- practices under" Community Inclusion" 10. Qualified Providers: A qualified provider must be an agency contracted with a county or DDCS. 11. Quality Assurance and Service Evaluation: The Subrecipient shall develop and have available an evaluation system to review services. The evaluation system must have both a Quality Assurance and a Quality Improvement component, and both must include objective measures. The objective measures at a minimum will include performance indicators, by acuity, that include the number of new jobs; job loss and reasons for job loss; the percentage employed earning c.

minimum wage or better; and the average number of hours worked. The Subrecipient' s service

evaluation system shall serve as the method to demonstrate to the County that they continue to be a qualified provider. A copy of such evaluation system shall be provided upon request to County for review and approval. 12. Confidentiality. The Subrecipient shall: a.

Follow all requirements as outlined in Attachment E.

Ensure the security of Confidential Information; Not use, publish, transfer, sell or otherwise disclose any Confidential Information gained by reason of this Agreement for any purpose that is not directly connected with the performance of the services contemplated hereunder, except: i. As provided by law; or,

ii.

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. d.

Protect and maintain all Confidential Information gained by reason of this Agreement against unauthorized use, access, disclosure, modification or loss. This duty requires the Subrecipient to employ reasonable security measures, which include restricting access to the Confidential Information by: i. Allowing access only to staff that have an authorized business requirement to view the Confidential ii.

When transporting client records containing Confidential Information outside a Secure Area, one or more of the following as appropriate:

Date

Admin

Use a Trusted Network; or

Encrypting the Confidential Information, including: 13 of 52

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ATTACHMENT

and/ or email

attachments.

iii.

Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices, documents, or other media. Ensure the security of Confidential Information transmitted via fax (facsimile) by: 1. Verifying the recipient phone number to prevent accidental transmittal of Confidential Information to unauthorized persons 2. Communicating with the intended recipient before transmission to ensure that the fax will be received only by an authorized person. 3. Verifying after transmittal that the fax was received by the intended recipient.

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ATTACHMENT

BUDGET

Budget. The County shall reimburse the Subrecipient in an amount not to exceed $ 402, 000 for expenses related to Consumer Services and staff training/ education. Staff training/ education reimbursement may not exceed $ 2, 000 for the contract period, requires approval from the County Coordinator, and is based on availability of funds. Unspent grant proceeds will be reallocated at the discretion of the County.

The Subrecipient shall budget funds awarded in such a manner to ensure availability of services throughout the entire term of this Agreement subject to available funds. 2.

Payment. Subject to Section 1, the County shall reimburse the Subrecipient for costs and expenses necessary to perform activities described

in the Scope of Work for Project and as

indicated in the CCHHS Contractor Toolkit located online at www. co. cowlitz. wa. us/ cchhscontractors, and as updated. The Subrecipient shall ensure that

Invoices. The Subrecipient shall submit invoices using the County' s form, or such other form as approved by the County. Consideration for services shall be payable upon receipt of properly completed invoices which shall be submitted to the County Contract Representative within this Agreement, by the Subrecipient, not more often than monthly. The invoices shall describe and document to the County' s satisfaction a description of the work performed, activities accomplished, the progress of the project, and fees. The Subrecipient shall submit invoices to the County on or before the 15th of the month, regardless of what day of the week the 15th falls on, following the month of services were performed. The final invoice must be received by the County no later than the 15th of the month, regardless of what day of the week the 15th falls on, following the end of this contract. The final invoice due date is subject to change based on funding requirements.

Duplication. The Subrecipient assures that work performed and invoiced does not duplicate work to be charged to the County and State of Washington under any other Contract or agreement with the Subrecipient.

Advance Payment. The County shall not make any payments in advance or in anticipation of the delivery of services to be provided pursuant to this Agreement.

Authorized Services. The County shall pay the Subrecipient only for authorized services provided in accordance with this Agreement. If this Agreement is terminated for any reason, the County shall pay only for services authorized and provided through the date of termination. Any activities related to research and development ( R& D) are not allowable.

Recovery of Costs Claimed in Error. If the Subrecipient claims and the County reimburses for expenditures under this Contract which the County later finds were one ( 1) claimed in error or two 2) not allowable costs under the terms of the Contract, the County shall recover those costs and the Subrecipient shall fully cooperate with the recovery. 15 of 52

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Subrecipient

AGREEMENT

GRANT

ATTACHMENT

is bound to follow all terms and conditions of the Washington

State DSHS

Developmental Disabilities County Services contract which is attached hereto as Attachment F. Additionally, Subrecipient agrees that the Washington State DSHS and the State of Washington are not liable for claims or damages arising from Subrecipient' s performance under this Agreement. 9.

Program Specific Conditions: a.

Consumer Services

The Subrecipient may bill at the rate authorized on the County Service Authorization for the number of unit( s) per consumer per month for: i. Community Inclusion

ii.

Individual Supported

iii.

Individualized Technical Assistance

Employment

The Subrecipient shall transmit client data utilizing a secured method approved by the County. Provide all data described in the Employment Outcomes Instructions and monthly invoice, which is hereby incorporated by reference. Assure the integrity of data submitted to the County. When data is submitted and rejected due to errors or an error is later identified, the Subrecipient will correct and resubmit the data within fifteen ( 15) days.

Reimbursement for Client Services: A claim for each individual is made by indicating the number of service units delivered to each individual listed and the fee per unit. Units are defined

as:

An " Hour" is at least fifty ( 50) minutes of direct service. Partial hour to the quarter may be recorded. The County shall pay for only services to DD referred consumers authorized to receive the direct services( s) type, which the County has agreed to support. Clients will be assisted in accessing DVR services per the DDA/ DVR MOU https:// www. dshs. wa. gov/ sites/ default/ files/ DDA/ dda/ documents/ DVRDDA% 20MOU% 20% 282018% 29- Headquarters. pdf. Client services shall not be reimbursed under this Program Agreement when the same services paid for under Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. Production/ commercial profits generated by the work of County- funded consumers shall be used to support County funded services as needed. The

Individual

Date

Admin

Billable

Activities

document

defines

the individual

delivers

a minimum

of 80% of the authorized hours.

26- 015 Last

Phases &

Client services that the County reimburses. That document is located on the DSHS DDA County Best Practices Web site at https:// www. dshs.wa. gov/ dda/ county- best- practices. High acuity Clients who are authorized for Individual employment, Subrecipient may receive one outcome payment if client obtains a new competitive integrated job at a minimum of ten hours of work per week for a minimum of 4 out of each 6 months during the fiscal year. The Community Inclusion Billable Activities document defines the individual Client services that the County reimburses. That document is located on the DSHS DDA County Best Practices Web site at https:// www. dshs.wa. gov/ dda/ county- best- practices. Client who are authorized for Community Inclusion who have an acuity of F which equals 18 support hours per month or G which equals 20 support hours per month as based on the Support Intensity Scale ( SIS), provider may receive on outcome payment per month if provider

Employment

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AGREEMENT

GRANT

ATTACHMENT

Community Inclusion case notes and 6- month progress report summary review that scores 16 points or more with the " Community Inclusion Case Note Review Tool' when used in conjunction with a Community Inclusion plan that has scored 20+ points with the Community Inclusion plan Quality review tool, Subrecipient may receive an outcome

All outcome payments are described in the " Outcome Payment Table for Individual Employment and Community Inclusion" chart in the DSHS billing instructions found here: https:// www. dshs. wa. gov/ sites/ default/ files/ DDA/ dda/ documents/ AWA% 20Billing% 201 nstr uctions% 207. 1. 2025% 20F1 NAL. pdf Partnership Project:

payment.

The Subrecipient

ii.

Subrecipients with transition students, as outlined in Attachment A, Section 31,

will receive $ 3, 000 per student for each completed

Job

Foundation document that is at a satisfactory or above rating. high acuity transition students who authorized for Individual employment, the Subrecipient may receive one outcome payment if transition student obtains a competitive integrated job approved by the County within the timeframes outlined below. If the job is at a minimum of ten hours of work per week the Subrecipient will be eligible for an additional $ 1, 000 payment. Date

July

1 sc—

October

January April

range

for job

1st— September

1st-

sc—

June

Outcome

Payment

Amount

1, 500 31 st

December March

placement

30'"

1, 000 500

30t"

250

Please note a current County Service Authorization for Individual Employment must be in place prior to outcome payment. q.

Training i.

The

Subrecipient 1.

shall:

Seek prior approval from the County Coordinator for training/ education reimbursement.

Make every effort to minimize the cost of individuals training by seeking out scholarships and stipends, shared transportation and lodging when applicable to help reduce costs. Any additional

3. 4.

costs will be the sole

responsibility of the Subrecipient. Inform individuals of allowable travel and training expenses. Submit copies of itemized receipts, MapQuest directions, travel

itineraries, conference registration including agenda pertaining to all requested reimbursements. Expenses without backup documentation will not be reimbursed.

Seek prior approval from the County Program Manager or designee on additional state approved concurrent services training, implementation activities, and services. Fiscal Responsibility. The Subrecipient must demonstrate the ability to safeguard public funds including maintaining books, records, documents and other materials relevant to the provision of goods and services.

Timeliness of and Modification

to Billings: All initial invoices with signed

documentation must be received by the County within fifteen ( 15) calendar days following the last day of the month in which the service is provided. Corrected invoices and documentation including re- posted billing information will be accepted throughout the fiscal year as long as they are received within thirty ( 30) calendar days of the associated fiscal year unless an extension is approved by the County. Payment will not be made on any invoice submitted past thirty ( 30) calendar days after the Contract period.

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ATTACHMENT

CERTIFICATION

Brandy Gerdes- Schutz 1 am the Senior Director of Compass Career Solutions and I certify that: 1.

I have authority and approval from the governing body on behalf of Compass Career Solutions to accept proceeds from the County per Agreement for services for persons with developmental disabilities by and between the County and Compass Career Solutions.

1 certify the use of funds submitted for reimbursement or payment under this agreement will be used only to cover those costs that: a. Are necessary expenditures incurred in support of services for persons with developmental

disabilities.

Were incurred during the period that begins on July 1, 2026 through June 30, 2027 3.

1 understand Compass Career Solutions receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/ or sales receipts and such documentation shall be produced to the County upon request and may be subject to audit by the State Auditor.

hereby certify that I have read the above certification, and that the information and my statements provided herein by me are true and correct to the best of my knowledge, and by my signature on this document acknowledge my understanding that any intentional or negligent misrepresentation or falsification of any of the information in this document could subject me to punishment under federal, civil liability and/ or in criminal penalties, including but not limited to fine or imprisonment or both under Title 18, United States Code Sec. 1001, et seq. And punishment under Federal law.

Printed

Name

Signature

Title

Date

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GRANT

ATTACHMENT

RETIREMENT

CERTIFICATION

COUNTY RETAINS THIS FORM

Individual contractors and service providers must complete and sign WA Department of Retirement Systems: Independent Contractor Verification and State

Retirement Status Reporting Form [ WAC 415- 02- 110; DRS Email 13- 011; DRS Email 09- 001] SECTION 1:

INDIVIDUAL CONTRACTOR

COMPLETES

THIS SECTION AND SIGNS:

Did you

retire

from

Did you

retire

before age 65 using the 2008 early retirement

Will

you

be receiving direct compensation

Will

you

be receiving indirect

one

of the State of Washington

Retirement Systems? factors ( ERF)?

for your services? for your services?

compensation

YES

CONTRACTOR ( Full, individual name of contractor): Signature: SECTION

Social 2:

COUNTY

COMPLETES

Use Member Reporting 1.

Contractor

has

THIS

Security No.: SECTION

Date:

AND

RETAINS

FOR AUDIT

Verification ( MRV) to verify the past retirement

been

a member

of a Washington

State

Retirement

PURPOSES:

membership] System

YES

If YES, what system and plan? Teachers'

Retirement

System (

TRS)

Planl

Plan

School

Employees'

Retirement

System (

SERS)

Plan

Public

Employees'

Retirement

System (

PERS)

Plan

Public

Safety Employees'

Plan

Law

Enforcement

Washington

Retirement

Officers' &

State Patrol

Fire

System ( PSERS)

Fighters'

Retirement

System (

System ( WSPRS)

Plan

LEOFF)

Plan

Judicial Retirement System ( JRS) 5.

Is the contractor a retiree of a Washington

Did the contractor retire before

age

State Retirement

65 using the 2008

System?

ERF?

Yes

have verified the information above using MRV or by contacting DRS, and I have evaluated the individual Contractor, Independent Contractor or Service Provider under WAC 415- 02- 110 and/ or DRS Form- MS 344

R 5/ 09), and the Internal Revenue Service rules governing independent contractor status.

COUNTY OFFICIAL/ DEPARTMENT

Signature:

REPRESENTATIVE:

Date:

COUNTY RETAINS THIS FORM 19 of 52

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ATTACHMENT

Data Security 1.

Definitions.

Requirements

The words and phrases listed below, as used in this Attachment

E, shall each have

the following definitions: AES" means the Advanced Encryption Standard, a specification

of Federal Information

Processing Standards Publications for the encryption of electronic data issued by the National Institute of Standards and Technology https://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.19 https:// nvlpubs. nist. gov/ nistpubs/ FIPS/ NIST. FI PS. 197- upd 1. pdf).

7-upd1.pdf

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential

Information,

and who has or have been authorized to do so.

Category 4 Data" is data that is confidential and requires special handling due to statutes or regulations that require especially strict protection of the data and from which especially serious consequences may arise in the event of any compromise of such data. For purposes of this contract, data classified as Category 4 refers to data protected by: the Health Insurance Portability and Accountability Act ( HIPAA). d. " Cloud" means data storage on servers hosted by an entity other than the Subrecipient c.

and on a network outside the control of the Subrecipient.

Physical storage of data in the

cloud typically spans multiple servers and often multiple locations. Cloud storage can be divided between consumer grade storage for personal files and enterprise grade for companies and governmental entities. Examples of consumer grade storage would include iCloud, Dropbox, Box. com, and many other entities. Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and Rackspace. e.

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 ( 256 preferred) for symmetric keys, or 2048 bits for asymmetric keys. When a symmetric key is used, the Advanced Encryption Standard ( AES) must be used if available.

Hardened Password" means a string of at least eight characters containing at least three of the following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. " Mobile Device" means a computing device, typically smaller than a notebook, which runs a mobile operating system, such as iOS, Android, or Windows Phone. Mobile Devices include smart phones, most tablets, and other form factors. h. " Multi- factor Authentication" means controlling access to computers and other IT resources by requiring two or more pieces of evidence that the user is who they claim to be. These pieces of evidence consist of something the user knows, such as a password or PIN; something the user has such as a key card, smart card, or physical token; and something the user is, a biometric identifier such as a fingerprint, facial scan, or retinal scan. "

PIN" means a personal

identification

number, a series of numbers which act as a

password for a device. Since PINs are typically only four to six characters, PINs are usually used in conjunction i. "

with another factor of authentication,

such as a fingerprint.

Portable Device" means any computing device with a small form factor, designed to be transported from place to place. Portable devices are primarily battery powered devices with base computing resources in the form of a processor, memory, storage, and network access. Examples include, but are not limited to, mobile phones, tablets, and laptops. Mobile

Device

is a subset

of Portable

Device.

" Portable Media" means any machine readable media that may routinely be stored or moved independently of computing devices. Examples include magnetic tapes, optical discs ( CDs or DVDs), flash memory ( thumb drive) devices, external hard drives, and internal hard drives that have been removed from a computing device. k. " Secure Area" means an area to which only authorized representatives of the entity possessing the Confidential Information have access, and access is controlled through use of a key, card key, combination

lock, or comparable

mechanism.

Secure Areas may

include buildings, rooms or locked storage containers ( such as a filing cabinet or desk drawer) within a room, as long as access to the Confidential Information is not available to unauthorized personnel. In otherwise Secure Areas, such as an office with restricted 20 of 52

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ATTACHMENT

access, the Data must be secured in such a way as to prevent access by non- authorized

staff such as janitorial or facility security staff, when authorized Subrecipient staff are not present to ensure that non- authorized staff cannot access it. I. " Trusted Network" means a network operated and maintained by the Subrecipient, which includes security controls sufficient to protect DSHS Data on that network. Controls would include a firewall between any other networks, access control lists on networking devices such as routers and switches, and other such mechanisms which protect the confidentiality, integrity, and availability of the Data. m. " 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.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency

https://watech.wa.gov/policies?combine=&field_categories_target_id=80&field_ty https:// watech. wa. gov/ policies? combine=& field_ categories_ target_ id= 80& field_ type_ target_ i pe_target_id=All https://wate d= All), and of the DSHS Information Security Policy and Standards Manual. Reference material ch.wa.gov/ related to these requirements can be found here: https:// www. dshs. wa. gov/ ffa/ keeping- dshspolicies?co client- informationprivate- and- secure, which is a site developed by the DSHS Information Security mbine=&fiel Office and hosted by DSHS Central Contracts and Legal Services. 3. d_categorie Administrative Controls. The Subrecipient must have the following controls in place: s_target_ida. A documented security policy governing the secure use of its computer network and =80&field_t systems, and which defines sanctions that may be applied to Subrecipient staff for ype_target violating that policy. b. _id=All If the Data shared under this agreement is classified as Category 4 data, the Subrecipient c.

must be aware of and compliant with the applicable legal or regulatory requirements for that Category 4 Data. If Confidential Information shared under this agreement is classified as Category 4 data, the Subrecipient must have a documented risk assessment for the system( s) housing the Category 4 Data.

Authorization, Authentication, and Access. In order to ensure that access to the Data is

limited to authorized staff, the Subrecipient a.

must:

Have documented policies and procedures governing access to systems with the shared Data.

Restrict access through administrative, physical, and technical controls to authorized staff.

Ensure that user accounts are unique and that any given user account Iogon ID and password combination is known only to the one employee to whom that account is assigned. For purposes of non- repudiation,

it must always be possible to determine

which employee performed a given action on a system housing the Data based solely on the Iogon ID used to perform the action. d. e.

Ensure that only authorized users are capable of accessing the Data. Ensure that an employee' s access to the Data is removed immediately: i.

Upon suspected compromise

ii.

When their employment, or the contract under which the Data is made available to them,

iii.

of the user credentials.

is terminated.

When they no longer need access to the Data to fulfill the requirements of the contract.

Have a process to periodically review and verify that only authorized users have access to systems containing DSHS Confidential Information. When accessing the Data from within the Subrecipient' s network ( the Data stays within the Subrecipient' s network at all times), enforce password and Iogon requirements for users within the Subrecipient' s network, including: i. A minimum length of 8 characters, and containing at least three of the following character classes: uppercase letters, lowercase letters, numerals, and special

characters ii.

such as an asterisk, ampersand,

or exclamation

point.

That a password does not contain a user' s name, Iogon ID, or any form of their full name. 21 of 52

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That a password does not consist of a single dictionary word. A password may be formed as a passphrase which consists of multiple dictionary words. iv. That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. When accessing Confidential Information from an external location ( the Data will traverse iii.

the Internet or otherwise travel outside the Subrecipient' s network), mitigate risk and

enforce password and logon requirements for users by employing measures including: i. Ensuring mitigations applied to the system don' t allow end- user modification. ii. Not allowing the use of dial- up connections. iii. Using industry standard protocols and solutions for remote access. Examples would include RADIUS and Citrix.

Encrypting all remote access traffic from the external workstation to Trusted

iv.

Network or to a component within the Trusted Network. The traffic must be

encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network.

Ensuring that the remote access system prompts for re- authentication or performs automated session termination after no more than 30 minutes of inactivity. vi. Ensuring use of Multi- factor Authentication to connect from the external end point to the internal end point. Passwords or PIN codes may meet a lesser standard if used in conjunction with another v.

authentication mechanism, such as a biometric ( fingerprint, face recognition, iris scan) or token ( software, hardware, smart card, etc.) in that case: i.

The PIN or password

must be at least 5 letters or numbers when used in

conjunction with at least one other authentication factor. Must not be comprised of all the same letter or number( 11111,

ii.

22222, aaaaa,

would not be acceptable). Must not contain a " run" of three or more consecutive numbers ( 12398, 98743

iii.

would not be acceptable).

If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes

used on the device must:

Be a minimum of six alphanumeric characters.

ii.

Contain

at least

three

unique

character

classes (

upper

case,

lower

case,

letter,

number).

iii.

Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable.

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Subrecipient agrees to store Data on one or more of the following media and protect the Data as described:

Hard

disk

drives.

For Data

stored

will be restricted to Authorized

on local

workstation

User( s) by requiring

hard

disks,

access

to the Data

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. For 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 in a Secure Area and otherwise meet the requirements

Date

Admin

Destruction

of the Data, as outlined below in 22 of 52

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Section 8 Data Disposition,

may be deferred until the disks are retired, replaced, or

otherwise taken out of the Secure 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 Secure Area. When not in use for the contracted

purpose, such discs must be Stored in a Secure Area. 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.

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 Secure 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 attached 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 e.

mechanism.

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 Secure

Area.

Access

to Data

on these

discs

will

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

mechanism.

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 ID and Hardened Password) to Authorized Users on Subrecipient' s staff. Subrecipient will notify DSHS staff immediately whenever an Authorized User in possession of such credentials is terminated or

otherwise leaves the employ of the Subrecipient, 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. i. Except where otherwise specified herein, DSHS Data shall not be stored by the Subrecipient 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: 1.

Encrypt

Control access to devices with a Unique User ID and Hardened

the

Data.

Password or stronger authentication method such as a physical token or biometrics.

Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available.

Apply administrative and physical security controls to Portable Devices

Maximum

period of inactivity is 20 minutes.

and Portable Media by: a.

Keeping them in a Secure Area when not in use,

Using check- in/ check- out procedures

when they are shared, and

Taking frequent inventories. When being transported outside of a Secure Area, Portable Devices and c.

ii.

Portable Media with DSHS Confidential

Date

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control of Subrecipient staff with authorization Data h.

to access the Data, even if the

is encrypted

Data stored for backup purposes. i. DSHS Confidential Information may be stored on Portable Media as part of a Subrecipient' 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 ii.

below in Section 8 Data Disposition.

Data may be stored on non- portable media ( e. g. Storage Area Network drives, virtual media, etc.) as part of a Subrecipient' 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

below in Section 8

Data Disposition. i.

Cloud storage. DSHS Confidential Information requires protections equal to or greater than those specified elsewhere within this exhibit. Cloud storage of Data is problematic as neither DSHS nor the Subrecipeint has control of the environment

in which the Data is

stored. For this reason: i.

DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: 1. Subrecipient has written procedures in place governing use of the Cloud storage

and Subrecipient

attest

to the contact

listed

in the contract

and

keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. 2.

The Data will be Encrypted while within the Subrecipient network.

The Data will remain Encrypted during transmission to the Cloud. The Data will remain Encrypted at all times while residing within the

Cloud storage solution. 5.

The Subrecipient will possess a decryption key for the Data, and the decryption key will be possessed only by the Subrecipient. The Data will not be downloaded to non- authorized systems, meaning systems that are not on the Subrecipient

The

Data

will

not be decrypted

the control of an Authorized

until

network.

downloaded

onto

a computer

within

User and within either the DSHS or

Subrecipient' s network. Data will not be stored on an Enterprise Cloud storage solution unless either:

ii.

iii.

The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or,

The Cloud storage solution used is HIPAA compliant.

If the Data includes protected health information covered by the Health Insurance Portability and Accountability Act ( HIPAA), the Cloud provider must sign a Business Associate Agreement prior to Data being stored in their Cloud solution.

System Protection.

To prevent compromise

of systems which contain DSHS Data or through

which that Data passes: a. Systems containing DSHS Data must have all security patches or hotfixes applied within 3 months of being made available. b. The Subrecipient will have a method of ensuring that the requisite patches and hotfixes have c.

been

applied

within

the required

timeframes.

Systems containing DSHS Data shall have an Anti- Malware application, if available, installed.

Anti- Malware software shall be kept up to date. The product, its anti- virus engine, and

any malware database the system uses, will be no more than one update behind current.

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Data Segregation.

DSHS category 4 data must be segregated or otherwise distinguishable from non- DSHS data. This is to ensure that when no longer needed by the Subrecipient, 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. i. DSHS Data will be kept on media ( e. g. hard disk, optical disc, tape, etc.) which will contain no non- DSHS Data. ii.

DSHS Data will be stored in a logical container on electronic media, such as a

partition or folder dedicated to DSHS Data. iii.

DSHS Data will be stored in a database which will contain no non- DSHS data. And/ or,

iv.

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. When stored as physical paper documents, DSHS Data will be physically segregated from non- DSHS data in a drawer, folder, or other container.

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. Data Disposition. When the contracted work has been completed or when the Data is no longer

needed, except as noted above in Section 5. b, 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,

Removable

media ( e. g.

floppies,

USB flash drives,

hard disks)

excluding

optical

portable

discs

Will be destroyed by: Using a " wipe" utility which will overwrite the Data at least three( 3) times using either random or single character

Degaussing cannot

Paper documents

with sensitive or Confidential

data, or

sufficiently to ensure that the Data

be reconstructed,

Ph sicall destroying the disk Recycling through a contracted firm, provided the contract with the recycler assures that the

Information

Paper documents

containing

confidentiality of Data will be protected. On- site shredding, pulping, or incineration

Confidential

Information requiring special handling ( e. g. protected health information Optical

discs ( e. g. CDs

DVDs)

Incineration, shredding, or completely defacing the readable

Magnetic 9.

Notification

tape

of Compromise

or Potential

surface

with a coarse

abrasive

Degaussing, incinerating or crosscut shredding Compromise. The compromise or potential compromise

of DSHS shared Data must be:

Reported to the County Program Manager designated in this Contract within one ( 1) business day of discovery, b. Reported to the DSHS Privacy Officer at mailto:dshsprivacyofficer@d dshsprivacyofficer@dshs. wa. gov within one ( 1) shs.wa.gov business day of discovery, and c. Subrecipient must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS. 10. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If the Subrecipient cannot protect the Data as articulated within this Contract, then the contract with the subcontractor must be submitted to the County Program Manager specified for a.

this contract for review and approval.

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GRANT

AGREEMENT

ATTACHMENT

DSHS Agreement Number

COUNTY

DSHS x

2663. 69480

PROGRAM

sonar

AGREEMENT

DDICS County Services This Program AgreerTlUnt

is by and between

Social and Health Services(

DSHS)

below. and is issued

identified

Administration oT Dlvision

Department of

the State of Washington

and The County

Agreerrton

conjunction with a County and DSHS Agreement On General Terms and Conditions, CS11SADNI

17SJIS

DSHS DIVISIOl

tSTRATION

INDEX

PS* sS CONTRACT

NUMDER

Number CODE

1769C5- 63

1136

Division Df Developmental

Disabilities

Developmental

County ggreament

by reference.

which is incorporated

Nurriber

Disabififies

Admin DSHS CQNTAC1

DSHS

NAME ANO TITLE

C04TAGT

ADDRESS

PO BOX 453i5

Wendi

lrchel

Regional

Business

Manager

QI m - a, WA 98504. 5315 DSHS CONTACT TELEPHONE 7254264

360

08HS

CONTACT FAX

360

586-

V$ HS CONTACT

COUNTY

NAME

COUNTY ADDRESS

Cowlitz

County County DDA County Services

1952

Cowlitz COUNTY

FEDERAL

EMPLOYER

E- NWL

wendi. winchel

6602

dshs. wa.

9th Avenue

I nnfiview.

98632

COUNTY CONTACT NAME

I DENT I= I CAI ION

NuMatR

SUe S'el'Yinn COUNTY

CONTACT

rELEPHONE

360

414- 5599

I5THE

COUNTY A SUBRECIPIENT

CONTACT

COUNTY

FAX

FOR

PURPOSE$

CONTACT

saxtons

f3601501- 1207

ASSISTANCE

TH1S PROGRAM

F- MAIL

cowlitlwa- av

LISPING NUMBERS

AGREEMENT'?

No PROGRAM

AGREEMENT START

DATE

07/ 01 i2026

AGREEMENT

PROGRAM

ENO DATE

MAx1V.UN1 PROGRAM! AGREEMENI

ANIGUN-

2, 745. 890. 40

0613012D27

EXHIBITS. The following Exhibits are attached: Exhibit A— Data Security Requirements; Exhibit B— Budget and Spending

Plan

By their signatures below„ the parties agree to the terms arld conditions of this County Program Agreement ana all

documents incorporated by reference. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement shall be deemed to exist or bind the parties_ The parties signing below certify Mat they are authorized to sign this Program A reomant. COUNTY

PRINTED

SIG" 1ATURE( S)

DATE( S) SIGNED

NAVE( S) AND TITLELS;

BOARD OF COUNTY GOMMISSiONFRS OFCOWLITZCOUN1Y, WASHINGIaN Richard

PRINTED

DSHS SIGNATURE

Dahl, Chairman

NAME

AND TITL

Jessica Barbour, Contract

Specialist

SIGNED

08J1 912026

O WLITZ

caut4T ON o 45+-15 Central CUntmct Services 1769CS County Agreement( 12- 26- 2

26- 015 Last

Form:

rx 04 01

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Special Terms and Conditions 1.

Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "

Acuity Level" means the level of a Client' s abilities and needs as determined

through the DDCS

assessment-

lb- " ALTSA Web Access(

AWA)" means a web- based portal to the Developmental

Disabilities

Community Services CARE system designed to support county services for DDCS clients. c_ "

Additional Consumer Services" refers to indirect Client servicetypes as follows1) "

Community Information

and Education":

Activitiesto inform and/ or educate the general public

about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; community consultation, capacity building and organization activities.

and

2) " Training

To increase the job related skills and knowledge of staff, providers, volunteers, or interning students in the provision of services to people with developmental disabilities. Also to enhance program related skills of board or advisory board members.

3) "

Other Activities" reserved ty pes:

for special

a) Infrastructure

Projects in support of Clients ( services not easily tracked

projects:

projects and demonstrations

categorized

into the following

back to a

sp ecifi c work!ng age Client) o r th at d 1 rectly benefit a Clients) but the Client is not of work! ng age. Examples include planning services like genericjob development e.g." Project Search"_

b) Start- up projects:

Projects that support an agency or directly benefit the agency_ Examples

include equipment purchases and agency administrative support. c) Partnership

Project

Collaborative

partnerships

with school districts,

employment

providers,

DVR, families, employers and other community collaborators needed to providethe employment supports and services young adultswith developmental become employed during the school year they turn twenty- one( 21). d. " Budget and Accounting Reporting System( BARS)" sheet, revenue and expenditure/ expense accounts. e_ "

disabilities

means a master classification

require to

of balance

Client" means a person with a developmental disability as defined in chapter 38B- 823 WAC who is currently eligible and active with the Developmental Disabilities Community Services or is an identified PASRR Client.

f. " Competitive Integrated Employment"

meanswork performed by a Client on a part-time or full- time basis, within an integrated setting within the community that meets HCBS settings requirements_ The Client must be compensated at minimum wage or higher, using the higher of the Federal, State, or local rate, and at a rate comparable to the wage paid to non- disabled workers performing the same tasks, including receiving the same benefits and opportunities for advancement.

g_ " Consumer Support" refers to direct Client service types as follows1) "

Community Inclusion" or" Cl": means individualized services provided in integrated community settings with other individuals without disabilities_ The activities are based on Client interests Page 2

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Special Terms and Conditions

and provide opportunities typically experienced bythegeneral public of similar age in their local community, accessible by public transit or a reasonable commute from their home. The goal of the service is to support clients to participate, contribute, and develop relationships with community members who are not paid staff_ These services may be authorized for individuals age 62 and older. These services may be authorized in addition to or instead of employment

support( Individual Employment or Group Supported Employment) for working age individuals who have received nine months of employment

support.

2) " Child Development Services" or" CDS": Birth to three services are designed to meet the

developmental needs of each eligible child and the needs of the family related to enhancing the child' s development_ Service may include assistive technology, audiology, family training/ home visits, health services, medical services, nursing services, nutrition services, occupational therapy, physical therapy, psychological services, sign language, social work, special

instruction, speechlanguage pathology, vision, and transportation_ Services are provided in natural environments to the maximum extent appropriate. 3) "

the general workforce.

These services

may include intake, discovery,

assessment,

job

preparation, job marketing, job supports, record keeping and support to maintain a job4) " Individualized

individual

Technical Assistance" or" ITA": services are a part of a Client' s pathway to employmentor community inclusion. This service provides assessment and

consultation to the provider to identify and address existing barriers to employment or community inclusion_ This is in addition to supports received through supported community inclusion services for Clients who have not yet achieved their goal_

employment

5) " Group Supported Employment" or" GSE": services are a part of a Client' s pathway to integrated jobs in typical community employment. These services are intended to be short term and offer ongoing supervised employment for groups of no more than eight( 8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading tofurther career development in integrated employment at or above minimum wage_

enclaves, mobile crews, and other business models employing disabilities in integrated employment in community settings_ h. "

County" is the political subdivision

of the state of Washington

Examples include

small groups of workers with

and the county or counties entering

into this program AgreementI- "

DDCS Case Resource Manager( CRM)" means a case manager for DDCS Clients.

j_ " County Service Authorization( CSA)" means an authorization for county services. k. "

Developmental

disabilities(

DD)" means a disability

attributable

to intellectual

disability,

cerebral

palsy, epilepsy, autism, or another neurological or other condition of an individual found by the secretary to be closely related to an intell ectual disability or to require treatm ent similar to that required for individuals with intellectual disabilities, which disability originates before the individual attains age eighteen, which has continued or can be expected to continue indefinitely, and which constitutes a substantial limitation to the individual_ I_ "

Developmental

Disabilities Community

Services" DDCS" means a division within the Department of Page 3

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Special Terms and Conditions Social and Health Services. DDCS Regional office( DDCS Region)" means the regional DDCS office that supports DDCS

m_ "

clients.

Division of Vocational Rehabilitation(

n_ "

DVR)" means a division within the Department of Social and

Health Services o.

Employment

Outcome Payment"

means a paymentto

providers for transition

students barn

between specific dates; have high acuity; are authorized for Individual employment; and student obtains a competitive integrated job within a specifictimeframes_ Ifthejob is a minimum hours of work per week an additional amount will be include in the payment_

often

p_ " General Terms and Conditions"

which govern the contractual

meansthe contractual provisions contained within that agreement, relationship between DSHS and the county.

q_ " High Acuity Client" means a DDCS

Client who requires significant and intensive support community, often dueto complex needs, as determined through the DDCS assessment_

in the

Medicaid Home and Community Based Services( HOBS)" means services thatoccur in a Client' s home or community ratherthan institutions or other isolated settings_ These programs serve a

r. "

variety of targeted populations groups, such as people with intellectual or developmental disabilities,

physical disabilities,

Job Foundation

s_ "

and/ or mental illnesses

Report" is a document derived from employment

readiness

activities

performed

students who are between ages 19 through 20 that identifies actionable next step for employment. The employment service providers developing the Job Foundation report will be supporting students with employment activities on average of 35 hours.

Preadmission Screening and Resident Review( PASRR)" means individuals with intellectual disabilities or related conditions( ID/ RC) who have been referred for nursing facility( NF) care.

t. "

Person

u. "

Centered Service Plan or PCSP" means a document that authorizes and identifes the

DDCS paid services to meet a Client' s assessed needs.

Formerly referred to as the Individual

Support Plan.

Ou ality Assurance" means an adherence to all Program Agreement requirements, including DDCS

v. "

Policy 6. 13, Provider Qualifications for Employment and Day Program Services, County Guidelines and the Criteria for Evaluation, as well as a focus on reasonably expected level s of performance, quality, and practice_ w_ "

Quality Improvement" means a focus on activitiesto improve performance above minimum standards and reasonably expected levels of performance, quality and practice_

Service Provider" is a qualified Client service vendor who is contracted to provide Employment and

Day Program y. " 2.

services.

Subcontractor" is the service provider contracted by the County to provide services.

Purpose: This Program Agreement is entered into between the Developmental Disabilities Community Services and the County in accordance with chapter 71 A_14 RCW_ Its purpose is to advance the state

legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental

disabilities_ Page 4

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GRANT AGREEMENT

ATTACHMENT

Special Terms and Conditions 3.

Client Eligibility: Client eligibility and service referral are the responsibility of DDCS under chapter 398- 923 WAC ( Eligibility) and chapter 398- 825 WAC( Service Rules). Only persons referred by DDCS shall be eligible for direct Client services under this Program Agreement_ It is DDCS' s responsibility to determine and authorize the appropriate direct services) type_ Direct Client services provided without a current County Service Authorization are not reimbursable under this Program Agreement.

Credentials and Minimum Requirements:

Administration

of the developmental

disabilities

County program cannot be subcontracted_

b_ Qualified DID Program Coordinator: A qualified DID program coordinator has a minimum of five years train ing and experience in the ad ministration and/ or the delivery of developmental disabilities services to a community. For a county where the coordinator administers more than one program

area ( e_g_ Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/ or a related Human or Social service may be considered_ c.

Administration Responsibility: The County must demonstrate the ability to administer the program agreement including contract oversight and monitoring, community outreach and education activities, and regular communication with the DDCS Regional Office( DDCS region) and contracted providers_

Fiscal Responsibility: The County must demonstrate the ability to safeguard public funds including maintaining books, records, documents and other materials relevant to the provision of goods and services_

Sufficient Policies and Procedures for establishment and maintenance of adequate internal control

systems: The County will maintain written policy procedural manuaIsfor information systems, personnel, and accounting/ finance in sufficient detail such that operations can continue should staffing change or absen ces occur. Policies shall be dated and include dateswhen updated. f_

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees(

including

DID program County staff), subcontractors,

and/ or

volunteers who may have unsupervised access tovulnerable DSHS Clients, in a ccordan ce with RCW 43. 43. 830- 845, RCW 74. 15. 030, and chapter 388 WAC. If the entity reviewing the application elects to hire or retain an individual after receiving notice that the applicant has a conviction for an offense that would disqualify the applicant from having unsupervised access to vulnerable adults as defined in chapter 74. 34 RCW, then DDCS shall deny payment for any subsequent services rendered bythedisqualified individual provider. The DSHS Background Check Central Unit( BCCU) must be utilized to obtain background clearance.

Qualified Advisory Board Members:

A Developmental

Disabilities

advisory board shall include

members knowledgeable about developmental disabilities_ No board member shall have a contract

with the County to provide Training,

Community

Information

Activities,

and Consumer

Support as

defined in this Program Agreement, and shall not be a board member, officer, or employee of an

agency subcontracting with the County to provide such services. h.

Qualif ed Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6. 13, Program Qualifications for Employment and Day Program Providers.

Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to a ssign to DDCS its Medica id billing rights for Page 5

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Special Terms and Conditions

services to DDCS Clients eligible under Title XIX programs

in this Program Agreement.

Written

documentation shall be available to DSHS on request.

Reporting Abuse and Neglect: The County staff and its subcontractors who are mandated reporters under RCW 74. 34. 020( 13) must com ply with reporting req uirements described in RCW 74. 34. 035, 040 and chapter 26. 44 RCW. If the County is notified by DSHS that a subcontractor staff member is cited or on the registry for a substantiated finding, then that associated staff wi11 be prohibited from providing services under this Program Agreement_

Counties who provide Child Development

Services( birth to three early intervention

services),

must

provide those services under the regulations implementing the Individuals with Disabilities Education Act( IDEA), Part C, and Washington Federally Approved Plan_ I_

State' s Early Support for Infant and Toddler

The County staff who perform evaluations of subcontractor work sites will prom ptly report to DSHS per DDCS Policy 6- 09, tncr'dent Management and Reporting Requirements for County and CountyContracted Providers, if:

2) If they have reason to suspect that sexual or physical assault of such a person has occurred, they sha11 also immediately report to the appropriate law enforcement agency_ m_ Counties are specifically authorized to have data storage on portable devices or media in accordance with the Data Security Requirements. n_

Ord er of Precedence: In the event of any inconsi stency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency

shall be resolved by giving

precedence, in the following order, to: 1)

County Program

Agreement;

and

2) Attached Exhibits. 5.

Duty to Disclose: Under42 CFR§ 455. 104, the Administration must obtain certain disclosures and complete required screenings to ensure the State does not pay federal funds to excluded person or entities. The County is required to provide disclosures from managing employees, specifically the persons in the positions of Developmental Disabilities Director and Fiscal/ Budget Director, i_ e_ the person who authorizes expenditures. A completed Medicaid Provider Disclosure Statement, DSHS Form 27- 094, should be submitted to the Administration to complete the required screenings.

Disclosures must be provided at contract renewal and within thirty- five( 35) days whenever there is a change in the staff holding these management positions[ 42 CFR 455. 104 ( c)( 1)]_ 6.

Statement of Work: The County shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below. Working collaboratively and sharing information as needed for service coordination, the parties shall administer DID serviceswithin

the county as set forth below: a_

The DDCS region shall:

Review subcontractors and shall immediately notify the County of any concerns with the Page S

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subcontractors

identified

bythe County;

2) Inform and include the County in the discharge planning of Client' s leaving institutions and returning to the community who will need program funding; 3) Inform the County of Client' s who have had their waiver status changed; 4) Work with the County when referring Client' s for services and will withdraw referrals when authorization is not issued;

5) Authorize

new service within 5 working days and will extend existing service authorization

before expiration date; 6)

Inform Clients of service changes through Planned Action Notice( s);

7) Work with the County to document planned services in the Client' s Person Centered Plan including notification of assessment dates;

Service

B) Work with the County when terminating services; 9) Work with DDCS Head Quarters

and the County on Spending

Plan adjustments;

and

10) Work with the County in participating in evaluation of direct service providers_ b_ The County shall: 1)

Work with the DDCS Region when Clients are referred for services,

authorized

services,

andlor

for support modifications;

2) Work with the DDCS Region to document planned

services

in the Client' s Person Centered

Service Plan;

3) Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DID Assessment prior to any changes; 4) Work with the DDCS Region regarding

service termination;

5) Work with the DDCS Head Quarters on Spending

Plan adjustments;

6) Inform the DDCS Region of new providers to be included on the ALTSA Web Access( AWA) sy stem;

7) Notify the DDCS Region of any intent to terminate

a subcontractor

who is serving a DDCS

referral;

B) Provide a copy of each subcontractor' s contract upon written request from DDCS; and 9) Notify and work with the DDCS Region al Employment direct service providers. c.

Specialist when performing

evaluations

Compliance with Budget and Accounting Reporting System Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. Page 7

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The County shall comply with the following 1)

referenced

documents:

DDCS Policy 411, County Services for Working Age Adults;

2) Chapter WAC 398- 850, chapter 388- 828 WAC, WAC 388- 845- 0001, 0030, 0210, 0215, 0220, 0600- 0610, 1030- 1040, 2100, 2110: 3) Criteria for Evaluation; 4) DDA Guiding Values: 5) County Guide to Achieve DDA' s Guiding Values; 6)

DDA Guidelines

7) Disability

for Community

Rights Washington (

Assessments

formerly

within Employment

Washington

Protection

and Vocational

and Advocacy

Programs:

System)

and

Access

Agreement.

e_ The County shall develop and submit a comprehensive plan forthe County DID Services as required by WAC 388- 850- 020_ f.

Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The

County shall submit the Service Information Forms( SIF' s) ( provided by DDCS at Internet site https:// www_dshs_wa. gov/ dd a/ cou nty- best- practices) to 1 n d 1 cate the estim ated n umber of people to

be served, targeted outcomes, and identified goals) that focus on quality improvement within the categories ofTraining, Community Information, Direct Client Services, and Oth er Act iviti es w ith i n 30 days of execution of the Program Agreement_ Once approved, the S I F outcomes may be modified only by mutual agreement g.

Solicitation

for Qualified

of the County and the DDCS Region_

Employment

and Day Program

Service Providers:

Requests for

Applications( RFAs), Requests for Information ( RFI' s) and/ or Requests for Proposals( RFPs),

Requests for Qualifications( continuous

RFQ' s) for direct services,

excluding

Child Development,

will be open

enrollment.

Qualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDCS.

Technical Assistance: DDCS contracts with Technical Counties with prior written approval_

Subcontractors: The County will pass on all applicable contractual requirements that are between DDCS and the Cou my to the subcontractor. The County shall immediately notify the DDCS Region of the County' s intent to terminate a subcontractor who is serving a DDCS referral_ Individuals or agencies contracted with a county or DDCS may not subcontract for Employmentor Community

Assistance

providers that may be utilized by

Inclusion services_

The County shall provide or contract with qualified Employment and Day Program Service Providersfor 1)

consumer support services that include thefollowing

Monthly Community

program outcomes-

Inclusion ( CI) service support hours will be based on the Client' s CI service

level per WAC 388- 828- 9310 for all Clients who began receiving CI services July 1, 2011 and forward_

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a) To ensure health and safety, promote positive image and relationships in the community, increase competence and individualized skill- building, and achieve other expected ben efts of CI, services will occur individually or in a group of no more than two( 2) or three( 3) Client' s with similar interests and needs-

b) CI services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will not be reim bursed.

2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses_ Clients

should be supported to average twenty( 20) hours of community work per week or eighty- six 86) hours per month; however,

each person' s preferred

hours of employment

should

be taken

into consideration. The amount of service a Client receives will be based on his/ her

demonstrated

need, acuity level and work history per WAC 388- 828.

3) The Client' s DDCS PCSP is the driver for service_ The AWA County Service Authorization CSA) and updated Planned Rates information will not exceed the Client' s DDCS PCSP.

Service changes will not occur until the Client has received proper notification from DDCS_ 4) All Clients will have an Individualized Employment and/ or Community Inclusion plan to identify Client' s preferences_ Minimum plan elements are outlined in the reference document" Criteria for an Evaluation." A copy of the Client' s individualized plan will be provided to the Client, their DDCS Case Resource Manager( CRM), guardian and others as appropriate. 5) Six- month progress reports describing the progress made towards achieving Client' s goal will be provided by the service provider to the CRM, Client, and/ or guardian, if any, within 30 days following the six- month period. The reportwill summarize activities and outcomes madetowards the Client' s individualized goal( s). AII Clientswill be contacted bytheir service provider according

to Client need and at least once per month6) All Clients will be contacted by their service provider according to Client need and at least once per month. 7) If Clients in Individual Employment or Group Supported Employment, have not obtained paid employment at minimum wage or higher within six( 6) months, the County will assure the following steps are taken:

a) Review the progress toward employment goals; b) Provide evidence of consultation with the Client/ guardian; and c) Develop additional strategies with the Client/ guardian, county staff, employment support staff, case manager, and others identified by the Client_ Strategies may include providing

technical assistance, changing to a new provider, and/ or providing additional resources as needed to supportthe Client' s pursuitof employment. The additional strategies will be documented for each Client and kept in the Client' s fle( s). 8) If after twelve( 12) months the Client remains unemployed,

an additional review will be

conducted. The provider will address steps outlined in the previous six month progress report in the next six month progress report. When requesting to participate in CI, the Client shall communicate directly with his or her DDCS Case Manager. The DDCS Case Manager is

responsible for authorizing CI services_ Page 9 DSHS

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9) For Individual Employment where the service provider is also the Client' s employer, long term funding will remain available to the service provider employer for six months after the employee DDCS Client' s dateof hire- Atthe end ofthe six- month period, ifthe DDCS Client continuesto need support on the job, another service provider who is not the employer of record must provide the support unless the County or DDCS issues prior written approval far the service

provider to continue to provide long- term supports if needed- If the County or DDCS approves the continuation of long- term supports where the service provider is also the Client' s employer, the County or DDCS will regularly monitor these position s to assure fading efforts occur when appropriate

and any potential conflict of interest is addressed.

10) Individual Employment staff hours must be attributed to the " Individual Employment and Billable Activity Phase( s)"

11) For Group Supported Employment( GSE), Clients must have paid work. The total number of direct service staff hours provided to the group should be equal to or greater than the group' s collective amount of individual support monthly base hours- If the direct service staff hours are less than the collective amount, then the provider wil I be reimbursed only for the number of hours staff actually provided.

a) The collectivegroup' s individual hours should bethe minimum staff hours delivered to su pport th e g rou p-

b) A GSE Client must be on- site/ at work at least their base individual hours as a minimum per month. If a Client is not on- site/at work for all of their base hours, the county should verify that the provider delivered the collective group' s individual hours to the group ( what was the number of staff hours provided to the group during the month? 1f it was less than the collective group' s total the provider can only bill for the staff hours that were prov( ded)c) A GSE agency may not bill for a GSE Client who does not receive services during an entire service month-

d) A GSE agency must have a record of which staff is supporting which Clients on anygiven day. e) A GSE agency must have supportive documentation that provides clear evidence of support helping with specific activities as identified in the Client plan to move a Client on their pathway towards their employment goal( s).

f) Running a GSE service is a part of the business operation and not billable to Clients contract procurement,

contract maintenance, or administration

functions associated with

GSE)-

g) Individual time in the community working towards the individual employment goal, separate from the grouptime, must include phase information ( referto Employment Billable Activities- see Phases 1 — 4 for element/ activity description)12) Employment and day services must adheretothe Home and Community HOBS) requirementsof 42 C. F. R. Section 441. 301( c)( 4), including that:

Phases and

Based settings

a) The setting is integrated in the greater community and supports Client' s to havefull access to the greater community; b) Ensures the Client receives services in the community

to the same degree of access as Page 10

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Special Terms and Conditions

individuals

not receiving

Medicaid

HCBS;

c) The setting provides opportunities to seek employment and work in competitive integrated settings;

and

d) The setting facilitates individual choice regarding services and supports, and who provides them_

Quality Assurance

and Service Evaluation:

The County shall develop and have available

evaluation system to review services_ The evaluation system must have both a Quality Assurance and a Quality Improvement component, and both must includeobjective measures_ The objective measures at a minimum will include performance indicators, by acuity, that include the numberof new jobs; job loss and reasons for job loss; the percentage employed earning minimum wage or

better; and the average number of hours worked_ The County' s service evaluation system shall serve as the method by which current providers demonstrate that they continue to be qualified providers. A copy of description of such eva luation system shall be provided upon request to DDCS for review.

m_ Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one visit to each subcontractor

every two

2) years excluding Child Development Services subcontractors. The County shall conduct at least one visit to Child Development Services providers every three( 3) years_ The County shall maintain written documentation of all evaluations, recommendations and corrective action plans for each subcontractor.

Copies of such documentation

will be provided tothe DDCS upon request.

n_ The County shall workwith local developmental disability advisory groups to plan for and coordinate services_

The County shall participate in regularly scheduled meetings between County DID staff and DDCS staff to remain updated and current including ACHS and Regional Meetings.

AWA Data System: In compliance

with the AWA Training Manual,

the County shall use the AWA

data system for all:

Billing requests;

2) Service provider address and phone number maintenance; 3) Evaluation dates; 4) Employment

outcome information;

and

5) Monthly provide all data described in the Billing Instructions Instructions, which is hereby incorporated by reference. q.

and in the Employment Outcomes

Assure the integrity of data submitted to the State. When data is submitted and rejected due to errors or an error is later identified, the County will correct and resubm it the d ata within thirty( 30) days.

Review and respond the AWA" Work List" items within 5 working days including pending Authorization_

Referrals and

Review the AWA" Ticklers" Planned Rate tab and update the planned rate within 5 working d ays Page 11

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Special Terms and Conditions after the Planned Rate start date. t_

Partnership

Project-

1) A Job Foundation document will be completed per guidelines for eligible students.

Eligible

students are DDCS clients who were born between:

a) For fiscal year 2026 9/ 1105 through 8/ 31/ 06 b) For fiscal year 2027 9/ 1106 through 8/ 31/ 07 These students currently

attending

school and have completed

an application

to participate

this Value Based Payment( VPB) project_ The VBP project application will include the following minimum

criteria identified in the sample application found at:

https:// www. d sh s. w a_ gov/ sites/ default/ fi I es/ D DA/ dd a/ d ocu m ents/ J ob`/` 20 Foundation% tlon

2 0APpl i c a

040720% 20% 28002% 29. docx

2) Qualified providers will collaborate with School District staff to complete the Job Foundation document and then provide a copy to the County_ To be a qualified provider for the Partnership Project the Counties must require the provider to have a current contract with the Division of Vocational Rehabilitation; a contract in good standing with the County and cannot be in

provisional status; a minimum oftwoyears' experience providing Individual Employment with demonstrated job placement skills. The Job Foundation recommendation will only have actionable next steps towards integrated competitive employment.

3) County participating in the Partnership Project must have the ability to work collaboratively with School Districtsto identify DDCS students in high school, collect and track information, be proficient in electronic spreadsheets, and ability to evaluate if completed Job Foundation

documents) meet quality standards_ u_

Outcome Payment. Providers, with transition

students born between:

a) For fiscal year 2026 9/ 1103 through 8/ 31104 b) For fiscal year 2027 9/ 1/ 04 through 8/ 31/ 05 2) High acuity transition students who are authorized for Individual employment, the provider may

receive one outcome payment if transition student obtains a competitive integrated job approved by the County within timeframes

described

in the chart in the Billing Instructions_

If the County

is also the service provider DDCS will provide the job approval_ If the job is at a minimum of ten hours of work per week a n additional

amount will be include in the payment-

3) High acuity Clientswho are authorized for Individual employment, provider may receive one outcome payment if client obtains a new competitive integrated job at a minimum of ten hours of work per week for a minimum of 4 out of each 6 months during the fiscal year, 4) Client who are authorized for Community Inclusion who have an acuity of F which equals 18 support hours per month or G which equals 20 support hours per month as based on the Support Intensity Scale( SIS), provider may receive on outcome payment per month if provider delivers

a minimum

of 80% of the authorized hours. Page 12

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Special Terms and Conditions

5) A new Community

Inclusion referral is defined as a Client who has a new County Service Incentive/ outcome payments to accept and support overall increased CSAs billed over the year may be requested from DDCS iffunds are available-

Authorization( CSA).

6) Community Inclusion case notes and 6- month progress report summary review that scores 16 points or more with the" Community Inclusion Case Note Review Tool" when used in conjunction with a Community Inclusion plan that has scored 20+ points with the Community Inclusion plan Quality review tool, provider may receive an outcome payment7) All outcome payments are described in the chart in the Billing Instructions. Consideration:

Fees.

Approval of fees is the responsibility of the DDCS. The DDCS HQ Employment and Day Unit Manager reserves the right to approve fees/ rates for the services being provided_ The County will submit a fee/ rate schedule with the initial Program Agreement_ The County will submit updated fee/ rate schedules to the H0 Employment and Day Unit Manager for approval as changes occur_ The rate schedule will include the following information-

a) County( s) name; b) Time period for which the schedule! s applicable;

and

c) Each contracted direct service( IE, GSE, CI, ITA, CDS) and its associated rate-

Fee Limitations- The Billing Instructions found on the County Best Practices site provides lim itations on the Hourly Rate for each direct service. Hourly rates must be divisi ble by four.

b_ Budget and Spending 1)

Plan, attached

as Exhibit B-

Budget amount listed in Exhibit B- The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement

included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state- only employment and day services to waiver employment and day services-

2) Spending Plan- DDCS will provide the initial spending plan / Program Agreement Budget/ Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The

planned expendituresfor Consumer Support are based on authorized Clients, their acuity level and work history for a given point in time_ To determine the Additional Consumer Support amount, the Consumer Support amount is multiplied by a percentage_ The spending plan may

only be modified by mutual agreement of the parties in writing and shall not require a program agreement

amendment_

a) Funds Designated for Additional Consumer Services- If a County provides Community Information and Education services under additional consumer services, then activities must

include outreach

efforts to federally recognized

local tribes-

b) Funds Designated for Adult Day Care Consumers.

Funds designated for Adult Day Care

Consumers are availableto Clientswho were served between December 1996 and

December 2003 in Adult Day Health agencies and were subsequently determined

ineligible Page 13

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Special Terms and Conditions for Level II or III services(

Adult Day Health). Level II and III services are licensed rehabilitation and skilled nursing services along with socialization. Level I services ( Adult Day Care) are supervised day programs wherefrail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing. These Clients may be referred to services defined in the statement of work, or to an Adult Day Care service other than Level II or III.

If a Client no longer needs and wants services, the fund s

are available for other Clients who are not part of the group of original Clients identified between December 1996 and 2003_ An Adult Day Care service shall only be provided by Adult Day Care agencies certified

by the local Area Agency on Aging. Adult Day Care

service is not a waiver approved service_ c_

Program Agreement Amendments- A County can request an amendment at any time_ An amendment for additional Clients) may be supported when clients exceed the number used to

develop the contract_An amendment for additional service hours authorized may be supported when county provides evidence. An amendment request for expenditures exceeding contract total due to hourly rates paid to service provider may not be supported as the county is responsible to manage contract and rates paid to their providers. d_

Exemptions- The DDCS Assistant program agreement requirement-

Secretary

may approve in writing an exemption

to a specific

Billing and Payment: a.

Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for-

1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration

include personnel

of the Developmental

and overhead

Disabilities Program.

Allowable costs

costs directly related to the administration

and coordination

the program, including such activities as program planning, budgeting, contracting, monitoring, and evaluation_ Also included are departmental and county indirect andlordirect administrative costs, to the extent that such costs are appropriately allocated to the program using an established methodology consistent with grants management guidelines_ For a County whose designated coordinator manages multiple programs, the County must be able to provide evidence of the time the coordinator spent working on the Developmental Disabilities program2) Additional Consumer Services:

a) Training: i.

Staff Training- Costs incurred by the program for planned, structured activities for the purpose of providing, or improving, or enhancing job- related knowledge and skills of staff, providers, volunteers, or interning students in the provision of developmental disabilities services-

Board Training- Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program- related skills of board and advisory committee

members.

b) Community Information and Education: to inform and/ or educate the general public about developmental disabilities and related services_ These may include information and referral services; activities aimed at promoting public awareness and involvement;

and community Page 14

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consultation,

capacity building

and organization

activities.

c) Other Activities_ i.

Infrastructure projects: Projects in support of Clients( services not easily tracked back to a specific working age Client) or that directly benefit a Clients) but the Client is not of working age_ Examples include planning services like generic job development e_g_ Project Search."

ii_

Start- up projects: Projects that support an agency or directly benefit the agency_ Examples include equipment purchases and agency administrative support-

IL Partnership project Collaborative partnerships with school districts, employment providers, Division of Vocational Rehabilitation( DVR), families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the

school year they turn twenty-one( 21). Supports provided should complement and not replace what the student( s) receive through the Individualized Education Program( IEP)_ 3) Consumer Support_

a) Adult Day Care services are available to Clients who were served between December 1996 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible for Level II or III services( Adult Day Health).

Level II and III services are licensed

rehabilitation and skilled nursing services along with socialization. Level I services( Adult Day Care) are supervised day programs wherefrail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing.

b) Community Inclusion Services are individualized and provided in integrated community settings with other individuals without disabilities_ The activities are based on Client

interests and provide opportunities typically experienced by the general public of sim ilar age in their local community,

accessible

by public transit or a reasonable

commute from their

home_The goal of th e service is to support Clients to participate, contribute, and develop relationships with community members who are not paid staff- These services may be authorized for individuals age 62 and older. These services may be authorized in addition to or instead of employment support( Individual Employment or Group Supported Employment) for working age individuals who have received nine month s of employment support. c) Child Development Services are desig ned to m eet the d evelopmental needs of each eligible child and the needs of the family related to enhancing the child' s development. Service may include- assi stive tech nology, audiology, family train! nglhomevisits, health services, medical services, nursing services, nutrition services, occupational therapy, physical therapy, psychological services, sign language, social work, special instruction, speechlanguage pathology, vision, and transportation_ Services are provided in natural environments

to the maximum

extent

appropriate.

d) Individual Supported Employment services are a part of a Client' s pathway to employment and are tailored to individual needs, interests, and abilities to promote career development. These are individualized services necessary to help persons with developmental disabilities obtain and continue integrated employment at or above the state' s minimum wage in the

general workforce. These services may include intake, discovery, assessm ent, j ob preparation, job marketing, job supports, record keeping and support to maintain a job( per Page 15 DSHS

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Special Terms and Conditions the

Individual Employment Phases&

Billable Activities)

e) Individualized Technical Assistance services are a partofa Client' s pathwayto employment or community inclusion. This service provides assessment and consultation tothe provider to identify and address existing barriers to employment or community inclusion. This is in addition to supports received through supported employment or community inclusion services for individuals who have not yet achieved their goal. f) Group Supported Employment services are a part of a Client' s pathway to integrated jobs in typical community employment. These services are intended to be short term and offer

ongoing supervised employment for groups of no more than eight( 8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading tofurther career development in integrated employment ator above minimum wage_

Examples include enclaves, mobile crews, and other business models employing small groups ofworkerswith disabilities in integrated employment community settings_ b_

Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this

Program Agreement.

However, with a Program Agreement amendment, the parties may increase

or decrease the Program Agreement amount_ Counties will work with DDCS HOon amendmentsto the Program Agreement. c_

Monthly Invoice with Signed Documentation: All requests for reimbursement amounts must be entered and posted into the AWA system. The County may post a combined claim of all programs/ services covered by this Program Agreement. DSHS shall make all payments dueto the County for all invoices submitted pursuant to this section within forty five( 45) days following posting of required information.

Clients will be assisted in accessing DVR services perthe DDCS/ DVR MOU. Client services shall not be reimbursed

under this Program Agreement when the same services are paid for under the

Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. e.

Reimbursement

of Client Services:

A claim for each Client is made on the AWA system

indicating the number of service units delivered to each Client listed and the fee per unit_ Units are defined as:

An " Hour" is at least fifty( 50) minutes of direct service. Partial hour to the quarter may be recorded-

2) A" Day" is at leastfour( 4) hours of direct service and will only be used in connection with Adult Day Care reimbursement3) A" Month" represents

a minimum of at least fifty( 50) minutes of direct service for CDS

reimbursement.

Program Administration: The County will provide program administration and coordination including such activities as planning, budgeting, contracting, monitoring, and evaluation. Monthly claimsfor administration

can be 1112 of the maximum amount identified in Exhibit B under Administration or

for the actual costs incurred in the given month but the total Administration billed will be the lesser of the two. Administration cost reimbursement will not exceed 10% unless the Assistant Secretary of DDCS approves a request for an exception under chapter 368- 850 WAC.

The Individual Employment Phases&

Billable Activities document defines the individual Client Page 16

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services that DDCS reimburses.

That document

is located on the DSHS DDCS County Best

Practices Web site at https:// www. dshs. wa. aov/dda/ county- best- practices.

The Community Inclusion Billable Activities document defines the individual Client services DDCS reimburses. That document is located on the DSHS DDCS County Best Practices Web site at httr) s:// www. dshs. wa. aov/ dda/ county- best- practices.

Timeliness of and Modification to Billings: All initial invoices with signed documentation must be

received by the DDCS Region within forty- five( 45) calendar days followi ng the last day of the month in which the service is provided. Corrected invoices and documentation including re- posted billing information will be accepted throughout the fiscal year as long as they are received within sixty( 60) calendar days of the associated fiscal year unless an extension is approved by the DDCS Regional Administrator or designee_ Payment will not be made on any invoice submitted past sixty 60) calendar days after the Program Agreement fiscal year. j_

Recovery of Fees. If the County bills and is paid fees for services that DSHS later finds were( a) not delivered or( b) not delivered in accordance with Program Agreement standards, DSHS shall

recover the fees for those services and the County steal I fully cooperate during the recovery. k_

Preadmission Screening and Resident Review( PASRR) Administration: The County may bill for administration costs as identified in Exhibit B. Monthly claimsfor administration on the actual PASRR expenditures multiplied by 10%_

costwill be based

Reimbursement for Partnership project A claim of$ 3, 000 per student for each completed Job Foundation document that is at a satisfactory or above rating will be requested through the AWA system as other monthly cost

m_ Job Foundation report line item 95 as identified in the ADSA Web Access( AWA) billing system. A copyof the completed Job Foundation documentwill be sent electronically to the shared mailbox located

DDAJobFoundationReportsadshs_

wa_.Qov

Job placement verification for transition students: The AWA Employment Output for Individual Employment will be completed and submitted with payment request to verify employer, job start date, job type, etc.

o. Job Foundation Administration: The County may bill for administration costs as identified in Exhibit B_ Monthly claim sfor administration cost will be based on the actual expenditures 10%. Participating counties will use line item 13. 9.

multiplied by

Intermediate Care Facilities for Intellectual Disabilities( ICF1ID) Agreement. If applicable per 42 CFR 463. 410, the County shall assure that all county- operated or subcontracted

programs serving

persons living in ICF/ ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/ ID resident 10.

Single State Medicaid Agency— Health Care Authority(

HCA):

HCA, as the single state Medicaid

Agency, has administrative authority for Title XIX coverage per 42 CFR 431. 11 DSHS is the operating agency for the Home and Community Based Waivers for services for people with developmental disabilities. The County only has responsibility for services covered in this agreement. 11.

DSHSIDRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDCS is incorporated

by reference_ The County assures that it and its subcontractors

have reviewed

the

Access Agreement_ The agreement covers DRW' s access to individuals with developmental Page 17 DSHS

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disabilities, Clients, programs and records, outreach activities, authorityto investigate allegations abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS

contracted services_ 12.

Confidential Information.

Al Counties and their subcontractors must

Ensure the security of Confidential Information, and

When transporting

client records containing

Confidential

Information

outside a Secure Area, one or

more of the following as appropriate: 1)

U sing a Trusted Network; or

2) Encrypting the Confidential Information, including: a) Email andlor email attachments

b) Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.

Data Security

Requirements. Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization, or transmits more

than

14.

5 records

atone time.

Supersession of Prior Data Security Agreement_ If the Parties hereto have previously entered into a Standalone

Data Security Requirements

Agreement,

both Parties hereby agree that upon mutual

execution said Agreement shall take precedence as the sole Data security Agreement between the Parties_

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Special Terms and Conditions Exhibit A— Data Security 1.

Definitions_

Requirements

The words and phrases listed below, as used in this Exhibit, shall each have the fallowing

definitions: a. "

AES" means the Advanced Encryption Standard, a specif cation of Federal Information Processing Standards Publications for the encryption of electronic data issued by the National Institute of Standards and Technology( https:// nvlpubs. nist_gov/ nistpubs/ FIPS/ NIST_FIPS_ 197- upd 1. pdf)_

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so_ e. "

Category 4 Data" is data that is confidential

and requires special handling due to statutes or

regulations that require especially strict protection of the data and from which especially serious consequences may arise in the event of a ny compromise of such data_ For purposes of this contract, data classified as Category and Accountability Act( HIPAA)_

refers to data protected

by: the Health Insurance

Portability

d_ " Cloud" means data storage on servers hosted by an entity other than the Contractor and on a

network outside the control of the Contractor.

Physical storage of data in the cloud typically spans

multiple servers and often multiple locations.

Cloud storage can be divided between consumer

grade storage for personal files and enterprise grade for companies and governmental entitiesExam pies of con sumer grad e storage wouId include iCloud, Dropbox, Box_com, and many other entities.

Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and

Rackspace_ e_ "

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 a uthorized users.

Encryption

must use a key length of at least 129 bits( 256 preferred)

for symmetri c keys, or

2048 bits for asymmetric keys_ When a symmetric key is used, the Advanced Encryption Standard AES) must be used if available. f. " Hardened

Password"

means a string of at least eight characters

containing

at least three of the

following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. " Mobile Device"

means a computing device, typically small erthan a notebook, which runs a mobile operating system, such as iOS, Android, or Windows Phone_ Mobile Devices include smart phones, most tablets, and other form factors.

h_ " Multi- factor Authentication"

means controlling access to computers and other IT resources by requiring two or more pieces of evidence that the user is who they el aim to be. These pieces of evidence consist of something the user knows, such as a password or PIN; something the user has such as a key card, smart card, or physical token; and something the user is, a biometric identifier such as a fingerprint, facial scan, or retinal scan." PIN" means a personal identification number, a

series of numbers which act as a password for a device_ Since PINS are typically only four to six characters,

PINS are usually used in conjunction

with anotherfactorof

authentication,

such as a

fingerprint1- "

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are not limited to, mobile phones, tablets, and laptops.

Mobile Device is a subset of Portable

Device.

j. "

Portable Media" means any machine readable media that may routinely be stored or moved independently of computing devices_ Examples include magnetic tapes, optical discs( CDs or DVDs), flash memory( thumbdrive) devices, external hard drives, and internal hard drives that have been removed from a computing device.

k_ " Secure Area" means

Confidential

an area to which only authorized representatives of the entity possessing Information have access, and access is controlled through use of a key, card key,

the

combination lock, or comparable mechanism_ Secure Areas may include buildings, rooms or locked storage containers( such as a filing cabinetor desk drawer) within a room, as long as access to the Confidential Information is not avai lable to unauthorized personnel_ In otherwise Secure Areas, such as an office with restricted access, the Data must be secured in such a way as to prevent access by non- authorized staff such asjanitorial or facility security staff, when authorized Contractor staff are not present to en sure that non- authorized staff cannot access it_ I. "

Trusted Network" means a network operated and maintained

by the Contractor, which includes

security controls sufficient to protect DSHS Data on that network_ Controls would include a fiirewall between any other networks, access control lists on networking devices such as routers and switches, and other such mechan isms which protect the confidentiality,

integrity, and availabilityof

the Data. m. "

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.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington

Technology

httns: l/watech_wa_gov/ policies? combine=& field

and of the DSHS Information these requirements

ServicesAgeney

categories

Security Policy and Standards

can be found

target id= 80& field tune target

Manual_

Reference

material

id= All],

related to

here: htti) s:// www. dshs. wa.- govlffa/ keening- dshs- client- information-

private- and- secure, which is a site developed

by the DSHS Information

Security Office and hosted by

DSHS Central Contracts and Legal Services. 3.

Administrative Controls. The Contractor must have the following controls in place: a_

A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy.

b_ If the Data shared under this agreement is classified as Category 4 data, the Contractor must be awareof and compliantwith the applicable legal or regulatory requirements for that Category4 Data. c_

If Confidential Information shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment forth e systems) housing the Category 4 Data.

Authorization, Authentication, and Access. authorized

In order to ensure that access to the Data is limited to

staff, the Contractor must:

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Have documented

policies and procedures

b_ Restrict access th rough administrative,

governing

physical,

access to systems with the shared Data

and technical

controls to authorized

staff_

Ensure that user accounts are unique and that any given user account logon ID and password combination i s known only to the one employee to whom that account is assigned_ For purposes of non- repudiation, it must always be possible to determine which employee performed a given action on a system housing the Data based solely on the logon ID used to perform the action

Ensure that only authorized users are capable of accessing the Data_

e_ Ensure that an employee' s access to the Data is removed immediately:

UWn suspected com promise of the user credentials.

2) When their employment, or the contract under which the Data is made available to them, is terminated_

3) When they no longer need access to the Data to fulfill the requirements of the contract. f.

Have a process to periodically review and verify that only authorized containing DSHS Confidential Information

When accessing the Data from within the Contractor' s network( the Data stays within the Contractor' s network at all times), enforce password and logon requirements for users within the Contractor' s network, including: 1)

A minimum

length of 8 characters,

and containing

users have access to systems

at least three of the following

character

classes: uppercase letters, lowercase letters, numerals, and special characters such as an

asterisk, ampersand, or exclamation point. 2) That a password

does not contain a user' s name, logon ID, or any form of their full name.

3) That a password does not consist of a single dictionary word. passphrase which consists of multiple dictionary words-

A password

may be formed

as a

4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h.

When accessing Confidential Information from an external location( the Data will traverse the Internet or otherwise travel outside the Contractor' s network), mitigate risk and enforce password and logon requirements for users by employing measures including: 1)

Ensuring

mitigations

applied to the system don' t allow end- user modification_

2) Not allowing the use of di al- up connections.

3) Using industry standard protocols and solutions for remote access_ Examples would include RADIUS and Citrix.

4) Encrypting

all remote access traffc from the external workstation

to Trusted

Network or to a

component within the Trusted Network_ The traffic must be encrypted at all times while

traversing any network, including the Internet, which is not a Trusted Network. Page 21 DSHS

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5) Ensuring that the remote access system prompts for re- authentication session termination after no more than 30 minutes of inactivity.

or performs automated

6) Ensuring use of Multi- factor Authentication to connect from the external end point to the internal end point_ i_

Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication

mechanism,

such as a biometric(

fingerprint,

face recognition,

iris scan) or token

software, hardware, smart card, etc.) in that case-

The PIN or password

must be at least 5 letters or numbers when used in conjunction

with at

least one other authentication factor 2) Must not be comprised of all the same letter or number( 11 111, 22222, aaaaa, would not be acceptable)

Must not contain a" run" of three or more consecutive numbers( 12398, 98743 would not be acceptable)

If the contract specifically allows for the storage of Confidential passcodes used on thedevice must 1)

Information on a Mobile Device,

Be a minimum of six alphanumeric characters.

2) Contain

at least three unique character classes( upper case, lower case, letter, number).

3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable_ k. 5

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Contractor protect the Data as described, a_

agrees to store Data on one or more of the following

media and

Hard disk drives_ For Data stared 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 cardslb-

Network server disks_ For 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 I ists 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 mechan isms 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 rem ain in a Secure Area and otherwise meet the requirements listed in the above paragraph_ Destruction of the Data, as outlined below in Section 8 Data Disposition, may be deferred until the di sks are retired, replaced, or otherwise taken out of the Secure Area. Page 22 DSHS

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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 Secure Area_ When not in use for the contracted

purpose, such discs must be

Stored in a Secure Area_ Workstations which access DSHS Data on optical discs must be located

in an area which is accessible only to authorized personnel, key, card key, combination lock, or comparable mechanism d_

Optical discs ( CDs or DVDs) in drives or jukeboxes

with access controlled

attached to servers.

through use of a

Data provided by

DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure 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 biometricsor

smart

cards_ Data on discs attached to such servers must be located in an area, which is accessible only

to authorized

personnel,

comparable

mechanism_

with access controlled

through

use of a key, card key, combination

lock, or

Paper documents. Any paper records must be protected by storing the records in a Secure Area, which 1s only accessible to authorized personnel_ When not in use, such records must be stared in a Secure Area__

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 ID and Hardened Password) to Authorized Users on Contractor' s 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. b) Control accesstodeviceswith

authentication

a Unique User ID and Hardened Password or stronger

method such as a physical token or biometrics.

c) Manually lock devices whenever they are left unattended and set devices to lack automatically after a period of inactivity, if this feature is available_ Maximum period of inactivity is20 minutes. d) Apply administrative by

and physical

security controls to Portable Devices and Portable Media

Keeping them in a Secure Area when not in use,

ii_

Using check- in/ check- out procedures when they are shared, and

iii_ Taking frequent inventories_ Page 23 DSHS

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2) When being transported outside of a Secure Area, Portable Devices and Portable Media with DSHS Confidential Information must be under the physical control of Contractor staff with authorization to access the Data, even if the Data is encrypted_ h_

Data stored for backup purposes-

1) DSHS Confidential Information 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

below in Section

8 Data Disposition.

2) 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 below in Section 8 Data Disposition i.

Cloud storage. DSHS Confidential Information requires protections equal to or greater than those specif ed elsewhere within this exhibit_ Cloud storage of Data is problematic as neither DSHS nor the Contra ctor has control of the environment in which the Data is stored_ For this reason-

1) DSHS Data wi II not be stored in any consumer grade Cloud solution, unless all of the following conditions are met-

a) Contractor has written procedures in place governing use of the Cloud storage and Contractor attest to the contact listed in the contract and keep a copy of that attestation your records in writing that all such procedures will be uniformly followed-

for

b) The Data will be Encrypted while within the Contractor network.

c) The Data will remain Encrypted during transmission to the Cloud. d) The Data will remain Encrypted

at all times while residing within the Cloud storage solution_

e) The Contractor will possess a decryption possessed only by the Contractor. f) The Data will not be downloaded

key for the Data, and the decryption key will be

to non- authorized

systems,

meaning

systems that are not

on the contractor network

g) The Data will not be decrypted until downloaded onto a computer within the control of an Authorized User and within either the DSHS or Contractor' s network. 2) Data will not be stored on an Enterprise Cloud storage solution unless either-

a) The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or, b) The Cloud storage solution used is HIPAA compliant_

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3) If the Data includes protected health information covered by the Health Insurance Portability and Accountability Act( HIPAA), the Cloud provider must sign a Business Associate Agreement prior to Data being stored in their Claud solution_ 6.

System Protection. that Data passes:

To prevent compromise of systems which contain DSHS Data or through which

a. Systems containing DSHS Data must have all security patches or hotfxes applied within 3 months of being made available_

b_ The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes.

c_ Systems containing DSHS Data shall have an Anti- Malware application,

if available, installed.

d. Anti- Ma lware software shall be kept up to date. The product, its anti- virus engine, and any malware database the system uses, will be no more than one update behind currentT.

Data Segregation-

DSHS category 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

DSHS Data will be kept on media ( e. g. hard disk, optical disc, tape, etc.) which will contain no non- DSHS Data-

2) DSHS Data will be stored in a logical container on electronic media, such as a partition or folder dedicated to DSHS Data. 3) DSHS Data will be stored in a database which will contain no non- DSHS data. And/ or,

4) DSHS Data will be stored within a database and will be distinguishable

from non- DSHS data by

the value of a specific fell or fields within database records.

5) When stored as physical

paper documents,

DSHS Data will be physically

segregated

from non-

DSHS data in a drawer, folder, or other container_

b_ 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 asdescribed

this exhibit.

Data Disposition.

When the contracted

work has been completed

or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server or workstation

on:

hard disks, or

Will be destroyed by: Using a " wipe" utility which wi II overwrite the Data at least three( 3) times using either random or single character data, or Page 25

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Removable

media( e. g. Coppies, USB Cash drives,

portable hard disks) excluding optical discs

Degaussing

sufficiently to ensure that the Data

cannot be reconstructed, or

Physically destroying Paper documents with

sensitive

Confidential

Information

the disk

Recycling through a contracted firm, provided the contract with the recycler assures that the

confidentiality of Data will be protected. 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 ta 9.

I Degaussing,

Notification

of Compromise

or Potential Compromise.

incinerating

or crosscut

shredding

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 dshsprivacyoffcer@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_ 10.

Data shared with Subcontractors_ If DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract_ If the

Contractor cannot protect the Data as articulated within this Contract, then the contract with the subContractor must be submitted to the DSHS Contact specified for this contract for review and approval.

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Exhibit B

Program Agreement

Original Budget

Budget

0 Budget Revision

REVENUES Fund Source

Fiscal Year 2026

Fiscal

State and

1, 627, 450

1, 479, 700

Medicaid

1 447 900

1 313 649

Total Rev.

3 075 350

2 793 350

Year

Fund

2027

11; t Revision

Original

State

Source

Original

V Revision

21d Revision

3,d Revision

21d Revision

31d Revision

1 457 352

on ly

1 288 528

Medicaid

Total Rev.

V,745, 890

Job Foundation

PASRR Funds

ADMINISTRATION( 12

Funds

TOTAL

11,

13)

OTHER

Medicaid State Funds

Funds

137, 294

112, 332

249, 626

89, 819

73, 487

163, 306

CONSUMER

SUPPORTS 31, 32, 41, 92, 93, 94, 97) CONSUMER SUPPORT STATE62,

ONLY

64r 65, 67r 69

Child Development

MEDICAID 64 67 r

ROADS

125440

CLIENTS 69

21 D00

1 093 259

1 D93 259

207 518

1, 445, 812

1, 279, 078

Z745, 890

COMMUNITY 62

64 65 r

LIVING 67

TOTAL

21, 000

Page 27 DSHS

Central

Contract

Services

1789CS CauntyAgreement( 12-25- 2025)

26- 015 Last

52 of 52

Date Revised:

Admin

Form:

1615. 2

1/ 09/ 2025

Motion

233326

BOCC

Item

Agenda

Meeting Date: 9/ 15/ 2026 Contract with Employers Overload

Submitted By: Amanda Foshaug, Accounting Specialist II Submitted For: Gena James, HHS Deputy Director Department:

Human

Services

Dept

Information

Subject and Summary Statement

The purpose of this County Contract# 26- 016 with Employers Overload is to provide developmental

disability employment and day services. This contract is paid on a cost reimbursement basis, not to exceed $ 92, 000. 00, during the period July 1,

2026, through June 30, 2027. Funding for this contract is passed through from the County' s contract with State Department

Washington

of Social & Health Services, Developmental Disabilities Administration.

Contract/ SOW Name

Current

Original

Change

Total

92, 000. 00

ITime Period 7/ 01/ 26- 6/ 30/ 27

Staff Attendance Gena

James

Department

It is the

Recommendation

recommendation

Board of Commissioners

of the Cowlitz

County Health& Human Services that the Cowlitz County

move to approve this Contract 26- 016 with Employers Overload.

Attachments

26- 016 DD-

Employers Overload

Form

Task

User

Foshaug,

Amanda

Agenda

Review

Action

Timestamp

Item Submission

Submit

8/ 27/ 2026

10: 32: 00 AM

Approve

8/ 31/ 2026

11: 07: 00 AM

Approve

9/ 1/ 2026

Drake,

Jamie

Preliminary

Review-

James,

Gena

Department

Approver

HHS

11: 09: 00 AM

Review Berger, David

Legal Review

Approve

9/ 4/ 2026 3: 32: 00 PM

Grayson,

Clerk of the Board

Approve

9/ 8/ 2026

Kelly

7: 51: 00 AM

Motion

233326

Review

Item

rz co&

SUBRECIPIENT

GRANT

AGREEMENT

Number: O

ggH NG

26- 016

Purpose of Subrecipient

Grant Agreement. This Subrecipient

Grant Agreement (" Agreement")

is made by and between COWLITZ COUNTY, a political subdivision of the State of Washington, hereinafter called " County" or" Cowlitz County") and Employers Overload ( hereinafter called Subrecipient") to set forth the terms and conditions by which the County will provide the Subrecipient with a grant award to be used to pay or reimburse necessary expenditures incurred for services for persons with developmental disabilities. 2.

Term. This Agreement shall take effect on July 1, 2026 and terminate on June 30, 2027.

Scope of Eligible Expenditures.

Grant funds may only be used to pay or reimburse eligible

expenditures consistent and as detailed in Attachment A- Scope of Work for Project ( the Project").

Grant Award.

The Subrecipient is awarded a total of$ 92, 000.

Budget. The Grant Award shall be expended by the Subrecipient as set forth in Attachment B Budget.

Subrecipient Responsibilities. Subrecipient agrees to administer the Grant Award proceeds consistent with this Agreement. Subrecipient shall provide the County with certification using the form of Attachment C that Grant Award funds will be used for eligible expenditures. Subrecipient

shall request payment from the County as outlined in Attachment B. 7.

Access to and Maintenance of Records. Subrecipient shall maintain internal controls, accounts

terminated, b.

26- 016 Last

Date

Admin

suspended,

or otherwise

lost or impaired

in whole or in part.

Termination for Convenience. Either party may terminate this Agreement for convenience upon giving the other party at least 30 days' advance written notice. In that event, the Subrecipient will be entitled to payment only for those expenses and costs reasonably and actually incurred prior to the effective date of the termination. 1 of 53

Revised:

Form:

1615. 2

01/ 22/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

If the default is not cured within 30 days of notice, the

The following provisions apply in the event that this Agreement is

terminated: a.

The Subrecipient shall cease to perform hereunder as of the effective date of termination and shall comply with all reasonable instructions contained in the notice of termination, if

The Subrecipient shall provide the County with an accounting of authorized services provided through the effective date of termination.

any.

11.

Conflict of Interest. Subrecipient designees, agents, members, officers, employees, consultants,

The Subrecipient will secure at its own expense all labor and materials required to

Gena James

Title:

Deputy Director

Department:

Health &

Address:

1952

(

Fax:

Admin

WA 98632

414- 5599

Employers Overload 700 S. E. Chkalov Drive, Suite 11 Vancouver,

WA 98683

360) 430- 9063

Rosemary@employersoverload. com

UEI:

TZ8RNRDSRNN1

S86TEXHJ2D93

UBI:

08- 300- 3788

600- 597- 972

26- 016 Date

Executive Director Services

HHSContracts( c cowlitzwa. gov mailto:HHSContracts 360) 425- 7531 @cowlitzwa.

E- mail:

Last

360)

Human

Rosemary Boyles

9th Ave

Longview, Telephone:

For the Subrecipient:

County:

Name:

2 of 53 Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

15.

GRANT

AGREEMENT

Bodily injury, including death. Property damage

Per occurrence

1, 000, 000 1, 000, 000

Per occurrence

2, 000, 000

Aggregate

1, 000, 000

Per occurrence

2, 000, 000

Aggregate

ERRORS AND OMISSIONS or PROFESSIONAL

LIABILITY with an Extended Reporting Period

Endorsement(

two year tail).

WORKERS COMPENSATION:

Statutory amount Waiver of Title 51 Rights

EMPLOYER' S LIABILITY/ Stop Gap: Per occurrence

1, 000, 000

AUTOMOBILE:

coverage on owned, non- owned, rented and hired vehicles

Bodily injury, liability, including death and property damage liability 1, 000, 000

Combined Single Limit

All Subrecipient' s and Subrecipient' s subcontractors' insurance policies and additional named insured endorsements

shall provide primary insurance coverage and be non- contributory.

Any

and/ or self- insured

retentions

exceeding $

10, 000 or any stop- loss provisions,

the

County shall have the right to request and review the Subrecipient' s most recent annual financial reports and audited financial statements as a condition of approval.

Subrecipient hereby agrees to waive subrogation with respect to each insurance policy maintained under this Agreement. When required by an insurer, or if a policy condition does not 26- 016 Last

Date

Admin

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1615. 2

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SUBRECIPIENT

GRANT

AGREEMENT

insurance policies by way of endorsement for the full available limits of insurance maintained by the Subrecipient

and subcontractor,

and all coverage shall be primary and non- contributory.

under this Agreement shall be paid by the

Subrecipient.

Compensation and/ or payments due to the Subrecipient under this Agreement are expressly conditioned

upon the Subrecipient' s strict compliance with all insurance requirements.

to the Subrecipient shall be suspended

in the event of noncompliance.

Payment

Upon receipt of evidence

of Subrecipient' s compliance, payments not otherwise subject to withholding or set- off will be released to the Subrecipient.

This Agreement

shall be void ab initio if the proof of coverage

is not

26- 016 Last

Date

Admin

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SUBRECIPIENT

GRANT

18. Debarment

AGREEMENT

Certification.

The Subrecipient,

by signature to this Agreement,

certifies that the

in all

The Subrecipient and its officials, officers, employees, agents, and

If the Subrecipient is a faith- based or religious organization, it retains its

Permissible

Use Warranty.

The Subrecipient

recognizes

and agrees that the Grant Award

Disabilities

Administration.

The Subrecipient

warrants that its planned and actual

permissible

uses

consistent with Attachment A and the pass- through funding requirements discussed immediately above.

This section shall survive termination of this Agreement.

No term or condition of this Agreement shall be deemed waived unless such waiver is

Date

Admin

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SUBRECIPIENT

GRANT

AGREEMENT

Each counterpart

may be executed and delivered by facsimile to the other party. 33. Attachments. The following attachments are incorporated into this Agreement by reference. a. Attachment

A— Scope

b. Attachment

B—

c. Attachment

C— Certification

d. Attachment

D—

Retirement

e. Attachment

E—

f. Attachment

F—

Data Security Requirements DSHS County Program Agreement DDCS County Services

IN WITNESS

WHEREOF,

of Work

for Project

Budget Form Certification

the parties have executed this Agreement

this

day of

BOARD OF COUNTY COMMISSIONERS

SUBRECIPIENT:

OF COWLITZ COUNTY, WASHINGTON

Signature

Richard

Steven L. Ferrell,

Commissioner

Steve

Commissioner

Rader,

ATTEST:

CONTRACT FORM

HAS BEEN APPROVED AS TO

BY COWLITZ

PROSECUTING

COUNTY

ATTORNEY

26- 016 Date

Admin

Chairman

name:

Title:

Last

R. Dahl,

Clerk of the Board Date

6 of 53 Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

SCOPE

OF WORK

FOR

PROJECT

The Subrecipient shall ensure services, and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: 1.

a) Infrastructure

projects: Projects in support of Clients ( services not easily

or replacement d. "

regulation.

Confidential Information" or" Data" means information that is exempt from disclosure to

the public or other unauthorized persons under Chapter 42. 56 RCW or other federal or state laws. Confidential

information

includes, but is not limited to, Personal Information.

g. "

Debarment" means an action taken by a federal official to exclude a person or business entity from participating in transactions involving certain federal funds.

h. "

DSHS" means the Department of Social and Health Services of the state of Washington.

i. "

j. "

General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county.

26- 016 Last

Date

Admin

7 of 53 Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

High Acuity Client" means a DDCS Client who requires significant and intensive support in the community, often due to complex needs, as determined through the DDCS

assessment.

Medicaid Home and Community Based Services ( HCBS)" means services that occur in

I. "

Person Centered Service Plan or PCSP" means a document that authorizes and

identifies the DDCS paid services to meet a Client' s assessed needs. Formerly referred to as the Individual Support Plan.

RCW"

means

the Revised

Code

of Washington.

All references

in this Agreement

and

any Program Agreement to RCW chapters or sections shall include any successor, amended, or replacement statue. Pertinent RCW chapters can be accessed at

http:// apps. leg. wa. gov/ rcw/. Secretary" means the individual appointed by the Governor, State of Washington, as the

head of the DSHS, of his/ her/ their designee.

Information

is not available to unauthorized

personnel.

w. "

provide services. Trusted Systems" include

following methods of physical delivery: ( 1) handdelivery by a person authorized to have access to the Confidential Information with written

acknowledgment

only the

of receipt; ( 2) United

States Postal

Service (" USPS") first class

the Washington State Governmental

Trusted System for communications

Network ( SGN) is a

within that Network.

USC" means the United States Code. All references in this Agreement and any Program Agreement to USC chapters and sections shall include any successor, amended, or

" WAC" means the Washington Administrative Code. All references in this Agreement and

replacement

statute.

any Program Agreement to WAC chapters or sections shall include any successor, amended, or replacement of regulation. accessed

26- 016 Last

Date

Admin

Pertinent WAC chapters or sections can be

http://apps.leg.wa.gov/ wac/

at http:// apps. leg. wa. gov/ wac/.

8 of 53 Revised:

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1615. 2

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Purpose. a.

Direct Client Services

i. "

authorized in addition to or instead of employment support ( Individual

Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. ii. "

iii. "

Individualized

iv.

Technical Assistance"

or" ITA": services are a part of an Client' s

Coordination. Working collaboratively, the parties shall administer DD services within the county as set forth below: The DDCS region shall:

iii.

iv.

Authorize new service within five ( 5) working days and will extend existing

ii.

referrals when authorization is not issued; service authorization before expiration date; v.

Inform Clients of service changes through Planned Action Notice( s);

vi.

Work with the DDCS Region and the Subrecipient when Clients are referred for services, authorized services, and/ or for support modifications;

Work with DDCS Region and the Subrecipient to document planned services in the Client' s Person Centered Service Plan;

26- 016 Last

Date

Admin

9 of 53 Revised:

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1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

xi.

xii. xiii.

ATTACHMENT

The Subrecipient shall: xiv. xv.

Facilitate the County' s attendance at employment plan meetings as requested. Work with the DDCS Region and the County when Clients are referred for services;

xvi.

Work with DDCS Region and the County to document planned services in the

xvii.

Assist with informing the DDCS Region and County of any potential service level changes not documented in the individual' s DID Assessment prior to any

Client' s Person Centered Service Plan;

changes; and xviii.

2011 i.

and forward.

ii.

Cl services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will

not be reimbursed.

DDCS PCSP. Service changes will not occur until the Client has received proper notification from DDCS. d.

f. g.

at minimum wage or higher within six ( 6) months, the

Date

Admin

10 of 53 Revised:

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1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

employment. The additional strategies will be documented

for each Client and

kept in the Client' s file( s). h.

j. k.

If after twelve ( 12) months the Client remains unemployed,

an additional review will be

The setting facilitates individual choice regarding services and supports, and who provides them.

Partnership Project i. A Job Foundation document will be completed per guidelines for eligible students. Eligible students are DDCS clients who were born between: 1.

For fiscal year 2026: 9/ 1/ 05 through 8/ 31/ 06. For fiscal year 2027: 9/ 1/ 06 through 8/ 31/ 07. These students currently attending school and have completed an application to 2.

ii.

participate

in this Value Based Payment ( VBP) project. The VBP project

application will include the following minimum criteria identified in the sample application found at:

https:// www. dshs. wa. gov/ sites/ default/files/ DDA/ dda/ documents/ Job% 20Foundati https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/Job on% 20Application 040720% 20% 28002% 29. docx https://www.dshs.wa.gov/sites/default/files/DDA/dda/document %20Foundation%20Application_040720%20%28002%29.docx iii. The Subrecipient will collaborate with School District staff to complete the Job s/Job%20Foundation%20Application_040720%20%28002% Foundation document and then provide a copy to the County. To be a qualified 29.docx provider for the Partnership

Project the Subrecipient

must have a current contract

If action to correct substandard performance is not taken by the Subrecipient within 30 days after being notified by the County, then the County may terminate the Agreement as described herein.

26- 016 Last

Date

Admin

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1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

Additional Requirements:

ATTACHMENT

The Subrecipient will maintain and make available, if requested,

documentation demonstrating accomplishments of the contract. Such documentation may include, but is not limited to, the following: a. Services provided b.

Number of hours of service

Data Collection

Completed evaluation tools

Backup reports/ data for invoicing.

Agreement. Credentials and Minimum Requirements:

Sufficient Policies and Procedures for establishment and maintenance of adequate

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees, subcontractors, and/ or volunteers who may have unsupervised

access to vulnerable DSHS Clients, in accordance with RCW 43. 43. 830-

Check Central Unit( BCCU) must be utilized to obtain background

clearance.

ii.

26- 016 Last

Date

Admin

agency.

Subrecipient is specifically authorized to have data storage on portable devices or media in accordance with Attachment E. Data Security Requirements.

12 of 53 Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Certification Regarding Ethics. By signing this Agreement, the Subrecipient certifies that the Subrecipient is in compliance with Chapter 42. 23 RCW and shall comply with Chapter 42. 23 RCW throughout the term of this Agreement and any Program Agreement. The Subrecipient shall comply with the following referenced documents found at DDA Internet site https://www.dshs.wa.gov/dda/county-besthttps:// www. dshs.wa. gov/ dda/ county- best- practices under" County Best Practices": a. DDCS Policy 4. 11, County Services for Working Age Adults; practices

Chapter WAC 388- 850, chapter 388- 828 WAC, WAC 388- 845- 0001, 0030, 0210, 0215, 0220, 0600- 0610, 1030- 1040, 2100, 2110;

Criteria for Evaluation;

DDA Guiding Values; County Guide to Achieve DDA' s Guiding Values; DDA Guidelines for Community Assessments with Employment and Vocational

Programs;

and

Disability Rights Washington ( formerly Washington Protection and Advocacy System) Access Agreement.

The Subrecipient shall ensure that all staff, working with clients receiving Community Access or Individual Employment Services, complete the following DDA online courses upon hire http:// gowise. org/ training/ wa- state- dda- online- courses/ http://gowise.org/training/wa-state-dda-onlineDDA- 5. 06: WA State Client Rights; a. courses/ b.

minimum wage or better; and the average number of hours worked. The Subrecipient' s service

Follow all requirements as outlined in Attachment E.

ii.

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. d.

When transporting client records containing Confidential Information outside a Secure Area, one or more of the following as appropriate:

26- 016 Last

Date

Admin

Information.

Use a Trusted Network; or

Encrypting the Confidential Information, including: 13 of 53

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

and/ or email

attachments.

iii.

26- 016 Last

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Admin

14 of 53 Revised:

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01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

BUDGET

Budget. The County shall reimburse the Subrecipient in an amount not to exceed $ 92, 000 for expenses related to Consumer Services, staff training/ education, and Disability Coalition Coordination. Staff training/ education reimbursement may not exceed $ 2, 000 for the contract period, requires approval from the County Coordinator, and is based on availability of funds. Unspent grant proceeds will be reallocated at the discretion of the County.

The Subrecipient shall budget funds awarded in such a manner to ensure availability of services throughout the entire term of this Agreement subject to available funds. 2.

Payment. Subject to Section 1, the County shall reimburse the Subrecipient for costs and expenses necessary to perform activities described

in the Scope of Work for Project and as

indicated in the CCHHS Contractor Toolkit located online at www. co. cowlitz. wa. us/ cchhscontractors, and as updated. The Subrecipient shall ensure that

Advance Payment. The County shall not make any payments in advance or in anticipation of the delivery of services to be provided pursuant to this Agreement.

26- 016 Last

Date

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SUBRECIPIENT

Subrecipient

AGREEMENT

GRANT

ATTACHMENT

is bound to follow all terms and conditions of the Washington

State DSHS

Program Specific Conditions: a.

Consumer Services

The Subrecipient may bill at the rate authorized on the County Service Authorization for the number of unit( s) per consumer per month for: i. Community Inclusion

ii.

Individual Supported

iii.

Individualized Technical Assistance

Employment

Reimbursement for Client Services: A claim for each individual is made by indicating the number of service units delivered to each individual listed and the fee per unit. Units are defined

as:

Individual

Date

Admin

Billable

Activities

document

defines

the individual

delivers

a minimum

of 80% of the authorized hours.

26- 016 Last

Phases &

Employment

16 of 53 Revised:

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SUBRECIPIENT

AGREEMENT

GRANT

ATTACHMENT

payment.

The Subrecipient

ii.

Subrecipients with transition students, as outlined in Attachment A, Section 31,

will receive $ 3, 000 per student for each completed

Job

July

1 sc—

October

January April

range

for job

1st— September

1st-

sc—

June

Outcome

Payment

Amount

1, 500 31 st

December March

placement

30'"

1, 000 500

30t"

250

Please note a current County Service Authorization for Individual Employment must be in place prior to outcome payment. q.

Training i.

The

Subrecipient 1.

shall:

Seek prior approval from the County Coordinator for training/ education reimbursement.

Make every effort to minimize the cost of individuals training by seeking out scholarships and stipends, shared transportation and lodging when applicable to help reduce costs. Any additional

3. 4.

costs will be the sole

responsibility of the Subrecipient. Inform individuals of allowable travel and training expenses. Submit copies of itemized receipts, MapQuest directions, travel

itineraries, conference registration including agenda pertaining to all requested reimbursements. Expenses without backup documentation will not be reimbursed.

Timeliness of and Modification

to Billings: All initial invoices with signed

26- 016 Last

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SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

CERTIFICATION

I, Rosemary Boyles, am the Executive Director of Employers Overload and I certify that: 1.

I have authority and approval from the governing body on behalf of Employers Overload to accept proceeds from the County per Agreement for services for persons with developmental disabilities by and between the County and Employers Overload

disabilities.

Were incurred during the period that begins on July 1, 2026 through June 30, 2027 3.

1 understand Employers Overload receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/ or sales receipts and such documentation shall be produced to the County upon request and may be subject to audit by the State Auditor.

Printed

Name

Signature

Title

Date

26- 016 Last

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SUBRECIPIENT

AGREEMENT

GRANT

ATTACHMENT

RETIREMENT

CERTIFICATION

COUNTY RETAINS THIS FORM

Individual contractors and service providers must complete and sign WA Department of Retirement Systems: Independent Contractor Verification and State

Retirement Status Reporting Form [ WAC 415- 02- 110; DRS Email 13- 011; DRS Email 09- 001] SECTION 1:

INDIVIDUAL CONTRACTOR

COMPLETES

THIS SECTION AND SIGNS:

Did you

retire

from

Did you

retire

before age 65 using the 2008 early retirement

Will

you

be receiving direct compensation

Will

you

be receiving indirect

one

of the State of Washington

Retirement Systems? factors ( ERF)?

for your services? for your services?

compensation

YES

CONTRACTOR ( Full, individual name of contractor): Signature: SECTION

Social 2:

COUNTY

COMPLETES

Use Member Reporting 1.

Contractor

has

Security No.:

THIS

SECTION

Date:

AND

RETAINS

FOR AUDIT

Verification ( MRV) to verify the past retirement

been

a member

of a Washington

State

Retirement

PURPOSES:

membership] System

YES

If YES, what system and plan? Teachers'

Retirement

System (

TRS)

Planl

Plan

School

Employees'

Retirement

System (

SERS)

Plan

Public

Employees'

Retirement

System (

PERS)

Plan

Public

Safety Employees'

Plan

Law

Enforcement

Washington

Retirement

Officers' &

State Patrol

Fire

System ( PSERS)

Fighters'

Retirement

System (

System ( WSPRS)

Plan

LEOFF)

Plan

Judicial Retirement System ( JRS) 5.

Is the contractor a retiree of a Washington

Did the contractor retire before

age

State Retirement

65 using the 2008

System?

ERF?

Yes

R 5/ 09), and the Internal Revenue Service rules governing independent contractor status.

COUNTY OFFICIAL/ DEPARTMENT

Signature:

REPRESENTATIVE:

Date:

COUNTY RETAINS THIS FORM 26- 016 Last

Date

Admin

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SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Data Security 1.

Definitions.

Requirements

The words and phrases listed below, as used in this Attachment

E, shall each have

the following definitions: AES" means the Advanced Encryption Standard, a specification

of Federal Information

7-upd1.pdf

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential

Information,

and who has or have been authorized to do so.

and on a network outside the control of the Subrecipient.

Physical storage of data in the

PIN" means a personal

identification

number, a series of numbers which act as a

password for a device. Since PINs are typically only four to six characters, PINs are usually used in conjunction i. "

with another factor of authentication,

such as a fingerprint.

Device

is a subset

of Portable

Device.

lock, or comparable

mechanism.

Secure Areas may

Date

Admin

20 of 53 Revised:

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SUBRECIPIENT

AGREEMENT

GRANT

ATTACHMENT

access, the Data must be secured in such a way as to prevent access by non- authorized

with a password,

passphrase

or other mechanism,

authenticates

a user to an

information system. 2.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency

https:// watech. wa. gov/ policies? combine=& field_ categories_ target_ id= 80& field_ type_ target_ i https://watech.wa.gov/policies?combine=&field_categories_target_id=80& field_type_target_id=All https://wate d= All), and of the DSHS Information Security Policy and Standards Manual. Reference material ch.wa.gov/ related to these requirements can be found here: https:// www. dshs. wa. gov/ ffa/ keeping- dshsclient- informationprivate- and- secure, which is a site developed by the DSHS Information Security policies? Office and hosted by DSHS Central Contracts and Legal Services. combine=& 3. Administrative Controls. The Subrecipient must have the following controls in place: field_catega. A documented security policy governing the secure use of its computer network and ories_targe systems, and which defines sanctions that may be applied to Subrecipient staff for t_id=80& violating that policy. field_type_tb. If the Data shared under this agreement is classified as Category 4 data, the Subrecipient must be aware of and compliant with the applicable legal or regulatory requirements for arget_id= that Category 4 Data. All c.

If Confidential Information shared under this agreement is classified as Category 4 data, the Subrecipient must have a documented risk assessment for the system( s) housing the Category 4 Data.

Authorization, Authentication, and Access. In order to ensure that access to the Data is

limited to authorized staff, the Subrecipient a.

must:

Have documented policies and procedures governing access to systems with the shared Data.

Restrict access through administrative, physical, and technical controls to authorized staff.

it must always be possible to determine

which employee performed a given action on a system housing the Data based solely on the Iogon ID used to perform the action. d. e.

Ensure that only authorized users are capable of accessing the Data. Ensure that an employee' s access to the Data is removed immediately: i.

Upon suspected compromise

ii.

When their employment, or the contract under which the Data is made available to them,

iii.

of the user credentials.

is terminated.

When they no longer need access to the Data to fulfill the requirements of the contract.

characters ii.

such as an asterisk, ampersand,

or exclamation

point.

That a password does not contain a user' s name, Iogon ID, or any form of their full name.

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the Internet or otherwise travel outside the Subrecipient' s network), mitigate risk and

Encrypting all remote access traffic from the external workstation to Trusted

iv.

Network or to a component within the Trusted Network. The traffic must be

encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network.

authentication mechanism, such as a biometric ( fingerprint, face recognition, iris scan) or token ( software, hardware, smart card, etc.) in that case: i.

The PIN or password

must be at least 5 letters or numbers when used in

conjunction with at least one other authentication factor. Must not be comprised of all the same letter or number( 11111,

ii.

22222, aaaaa,

would not be acceptable). Must not contain a " run" of three or more consecutive numbers ( 12398, 98743

iii.

would not be acceptable).

If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes

used on the device must:

Be a minimum of six alphanumeric characters.

ii.

Contain

at least

three

unique

character

classes (

upper

case,

lower

case,

letter,

number).

iii.

Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable.

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Subrecipient agrees to store Data on one or more of the following media and protect the Data as described:

Hard

disk

drives.

For Data

stored

will be restricted to Authorized

on local

workstation

User( s) by requiring

hard

disks,

access

to the Data

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. For Data stored on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized

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

Date

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listed in the above paragraph.

Destruction

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Section 8 Data Disposition,

may be deferred until the disks are retired, replaced, or

otherwise taken out of the Secure Area. c.

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 Secure 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

mechanism.

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 Secure

Area.

Access

to Data

on these

discs

will

mechanisms which provide

mechanism.

Remote Access. Access to and use of the Data over the State Governmental

Network

otherwise leaves the employ of the Subrecipient, and whenever an Authorized User' s duties change such that the Authorized

User no longer requires access to perform work

for this Contract. g.

Encrypt

Control access to devices with a Unique User ID and Hardened

the

Data.

Password or stronger authentication method such as a physical token or biometrics.

Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available.

Apply administrative and physical security controls to Portable Devices

Maximum

period of inactivity is 20 minutes.

and Portable Media by: a.

Keeping them in a Secure Area when not in use,

Using check- in/ check- out procedures

when they are shared, and

Taking frequent inventories. When being transported outside of a Secure Area, Portable Devices and c.

ii.

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control of Subrecipient staff with authorization Data h.

to access the Data, even if the

is encrypted

Information still exists upon it, such

media will be destroyed at that time in accordance with the disposition requirements ii.

below in Section 8 Data Disposition.

Information still exists upon it, the data will be destroyed

at that time in accordance with the disposition requirements

below in Section 8

Data Disposition. i.

in which the Data is

stored. For this reason: i.

DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: 1. Subrecipient has written procedures in place governing use of the Cloud storage

and Subrecipient

attest

to the contact

listed

in the contract

and

keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. 2.

The Data will be Encrypted while within the Subrecipient network.

The Data will remain Encrypted during transmission to the Cloud. The Data will remain Encrypted at all times while residing within the

Cloud storage solution. 5.

The

Data

will

not be decrypted

the control of an Authorized

until

network.

downloaded

onto

a computer

within

User and within either the DSHS or

Subrecipient' s network. Data will not be stored on an Enterprise Cloud storage solution unless either:

ii.

iii.

The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or,

The Cloud storage solution used is HIPAA compliant.

System Protection.

To prevent compromise

of systems which contain DSHS Data or through

been

applied

within

the required

timeframes.

Systems containing DSHS Data shall have an Anti- Malware application, if available, installed.

Anti- Malware software shall be kept up to date. The product, its anti- virus engine, and

any malware database the system uses, will be no more than one update behind current.

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Data Segregation.

will contain no non- DSHS Data. ii.

DSHS Data will be stored in a logical container on electronic media, such as a

partition or folder dedicated to DSHS Data. iii.

DSHS Data will be stored in a database which will contain no non- DSHS data. And/ or,

iv.

DSHS Data will be stored within a database and will be distinguishable

from non-

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. Data Disposition. When the contracted work has been completed or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server

stored

on:

hard

disks,

or workstation

Removable drives,

media ( e. g.

portable

hard

floppies,

disks)

USB

excluding

flash optical

Will be destroyed by: Using a " wipe" utility which will overwrite the Data at least three ( 3) times using either random or single character data, or

discs

Degaussing sufficiently to ensure that the Data cannot be reconstructed,

Physical y destroying Paper

documents

with

sensitive

Confidential Information Paper

documents

the disk

Recycling through a contracted firm, provided the contract

containing Confidential

with

the recycler

assures

that the

confidentiality of Data will be protected. On- site shredding, pulping, or incineration

Information requiring special handling ( e. g. protected Optical

health information

discs ( e. g. CDs

DVDs)

Incineration, shredding, or completely defacing the readable surface with a coarse abrasive

Magnetic

tape

Degaussing, incinerating or crosscut shredding

Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be: a.

Reported to the County Program Manager designated in this Contract within one ( 1) business day of discovery, Reported to the DSHS Privacy Officer at mailto:dshsprivacyofficer@d dshsprivacyofficer@dshs. wa. gov within one ( 1) shs.wa.gov business day of discovery, and Subrecipient must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS.

10. Data shared with Subrecipient.

If DSHS Data provided

under this Contract is to be shared with a

subcontractor, the Contract with the Subrecipient must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If the Subrecipient cannot protect the Data as articulated within this Contract, then the contract with 26- 016 Last

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the subcontractor must be submitted to the County Program Manager specified for this contract for review and approval.

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ATTACHMENT

DSHS Agreement Number

COUNTY

DSHS x

2663. 69480

PROGRAM

sonar

AGREEMENT

DDICS County Services This Program AgreerTlUnt

is by and between

Social and Health Services(

DSHS)

below. and is issued

identified

Administration oT Dlvision

Department of

the State of Washington

and The County

Agreerrton

conjunction with a County and DSHS Agreement On General Terms and Conditions, CS11SADNI

17SJIS

DSHS DIVISIOl

tSTRATION

INDEX

PS* sS CONTRACT

NUMDER

Number CODE

1769C5- 63

1136

Division Df Developmental

Disabilities

Developmental

County ggreament

by reference.

which is incorporated

Nurriber

Disabififies

Admin DSHS CQNTAC1

DSHS

NAME ANO TITLE

C04TAGT

ADDRESS

PO BOX 453i5

Wendi

lrchel

Regional

Business

Manager

QI m - a, WA 98504. 5315 DSHS CONTACT TELEPHONE 7254264

360

08HS

CONTACT FAX

360

586-

V$ HS CONTACT

COUNTY

NAME

COUNTY ADDRESS

Cowlitz

County County DDA County Services

1952

Cowlitz COUNTY

FEDERAL

EMPLOYER

E- NWL

wendi. winchel

6602

dshs. wa.

9th Avenue

I nnfiview.

98632

COUNTY CONTACT NAME

I DENT I= I CAI ION

NuMatR

SUe S'el'Yinn COUNTY

CONTACT

rELEPHONE

360

414- 5599

I5THE

COUNTY A SUBRECIPIENT

CONTACT

COUNTY

FAX

FOR

PURPOSE$

CONTACT

saxtons

f3601501- 1207

ASSISTANCE

TH1S PROGRAM

F- MAIL

cowlitlwa- av

LISPING NUMBERS

AGREEMENT'?

No PROGRAM

AGREEMENT START

DATE

07/ 01 i2026

AGREEMENT

PROGRAM

ENO DATE

MAx1V.UN1 PROGRAM! AGREEMENI

ANIGUN-

2, 745. 890. 40

0613012D27

EXHIBITS. The following Exhibits are attached: Exhibit A— Data Security Requirements; Exhibit B— Budget and Spending

Plan

By their signatures below„ the parties agree to the terms arld conditions of this County Program Agreement ana all

PRINTED

SIG" 1ATURE( S)

DATE( S) SIGNED

NAVE( S) AND TITLELS;

BOARD OF COUNTY GOMMISSiONFRS OFCOWLITZCOUN1Y, WASHINGIaN Richard

PRINTED

DSHS SIGNATURE

Dahl, Chairman

NAME

AND TITL

Jessica Barbour, Contract

Specialist

SIGNED

08J1 912026

O WLITZ

caut4T ON o 45+-15 Central CUntmct Services 1769CS County Agreement( 12- 26- 2

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Special Terms and Conditions 1.

Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "

Acuity Level" means the level of a Client' s abilities and needs as determined

through the DDCS

assessment-

lb- " ALTSA Web Access(

AWA)" means a web- based portal to the Developmental

Disabilities

Community Services CARE system designed to support county services for DDCS clients. c_ "

Additional Consumer Services" refers to indirect Client servicetypes as follows1) "

Community Information

and Education":

Activitiesto inform and/ or educate the general public

and

2) " Training

3) "

Other Activities" reserved ty pes:

for special

a) Infrastructure

Projects in support of Clients ( services not easily tracked

projects:

projects and demonstrations

categorized

into the following

back to a

sp ecifi c work!ng age Client) o r th at d 1 rectly benefit a Clients) but the Client is not of work! ng age. Examples include planning services like genericjob development e.g." Project Search"_

b) Start- up projects:

Projects that support an agency or directly benefit the agency_ Examples

include equipment purchases and agency administrative support. c) Partnership

Project

Collaborative

partnerships

with school districts,

employment

providers,

disabilities

means a master classification

require to

of balance

Client" means a person with a developmental disability as defined in chapter 388- 823 WAC who is currently eligible and active with the Developmental Disabilities Community Services or is an identified PASRR Client.

f. " Competitive Integrated Employment"

g_ " Consumer Support" refers to direct Client service types as follows1) "

Community Inclusion" or" Cl": means individualized services provided in integrated community settings with other individuals without disabilities_ The activities are based on Client interests Page 2

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Special Terms and Conditions

support( Individual Employment or Group Supported Employment) for working age individuals who have received nine months of employment

support.

2) " Child Development Services" or" CDS": Birth to three services are designed to meet the

instruction, speechlanguage pathology, vision, and transportation_ Services are provided in natural environments to the maximum extent appropriate. 3) "

the general workforce.

These services

may include intake, discovery,

assessment,

job

preparation, job marketing, job supports, record keeping and support to maintain a job4) " Individualized

individual

Technical Assistance" or" ITA": services are a part of a Client' s pathway to employmentor community inclusion. This service provides assessment and

employment

enclaves, mobile crews, and other business models employing disabilities in integrated employment in community settings_ h. "

County" is the political subdivision

of the state of Washington

Examples include

small groups of workers with

and the county or counties entering

into this program AgreementI- "

DDCS Case Resource Manager( CRM)" means a case manager for DDCS Clients.

j_ " County Service Authorization( CSA)" means an authorization for county services. k. "

Developmental

disabilities(

DD)" means a disability

attributable

to intellectual

disability,

cerebral

Developmental

Disabilities Community

Services" DDCS" means a division within the Department of Page 3

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Special Terms and Conditions Social and Health Services. DDCS Regional office( DDCS Region)" means the regional DDCS office that supports DDCS

m_ "

clients.

Division of Vocational Rehabilitation(

n_ "

DVR)" means a division within the Department of Social and

Health Services o.

Employment

Outcome Payment"

means a paymentto

providers for transition

students barn

often

p_ " General Terms and Conditions"

which govern the contractual

meansthe contractual provisions contained within that agreement, relationship between DSHS and the county.

q_ " High Acuity Client" means a DDCS

Client who requires significant and intensive support community, often dueto complex needs, as determined through the DDCS assessment_

in the

Medicaid Home and Community Based Services( HOBS)" means services thatoccur in a Client' s home or community ratherthan institutions or other isolated settings_ These programs serve a

r. "

variety of targeted populations groups, such as people with intellectual or developmental disabilities,

physical disabilities,

Job Foundation

s_ "

and/ or mental illnesses

Report" is a document derived from employment

readiness

activities

performed

Preadmission Screening and Resident Review( PASRR)" means individuals with intellectual disabilities or related conditions( ID/ RC) who have been referred for nursing facility( NF) care.

t. "

Person

u. "

Centered Service Plan or PCSP" means a document that authorizes and identifes the

DDCS paid services to meet a Client' s assessed needs.

Formerly referred to as the Individual

Support Plan.

Ou ality Assurance" means an adherence to all Program Agreement requirements, including DDCS

v. "

Quality Improvement" means a focus on activitiesto improve performance above minimum standards and reasonably expected levels of performance, quality and practice_

Service Provider" is a qualified Client service vendor who is contracted to provide Employment and

Day Program y. " 2.

services.

Subcontractor" is the service provider contracted by the County to provide services.

Purpose: This Program Agreement is entered into between the Developmental Disabilities Community Services and the County in accordance with chapter 71 A_14 RCW_ Its purpose is to advance the state

legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental

disabilities_ Page 4

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Special Terms and Conditions 3.

Credentials and Minimum Requirements:

Administration

of the developmental

disabilities

County program cannot be subcontracted_

area ( e_g_ Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/ or a related Human or Social service may be considered_ c.

Sufficient Policies and Procedures for establishment and maintenance of adequate internal control

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees(

including

DID program County staff), subcontractors,

and/ or

Qualified Advisory Board Members:

A Developmental

Disabilities

advisory board shall include

members knowledgeable about developmental disabilities_ No board member shall have a contract

with the County to provide Training,

Community

Information

Activities,

and Consumer

Support as

defined in this Program Agreement, and shall not be a board member, officer, or employee of an

agency subcontracting with the County to provide such services. h.

Qualif ed Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6. 13, Program Qualifications for Employment and Day Program Providers.

Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to a ssign to DDCS its Medica id billing rights for Page 5

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Special Terms and Conditions

services to DDCS Clients eligible under Title XIX programs

in this Program Agreement.

Written

documentation shall be available to DSHS on request.

Counties who provide Child Development

Services( birth to three early intervention

services),

must

provide those services under the regulations implementing the Individuals with Disabilities Education Act( IDEA), Part C, and Washington Federally Approved Plan_ I_

State' s Early Support for Infant and Toddler

Ord er of Precedence: In the event of any inconsi stency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency

shall be resolved by giving

precedence, in the following order, to: 1)

County Program

Agreement;

and

2) Attached Exhibits. 5.

Disclosures must be provided at contract renewal and within thirty- five( 35) days whenever there is a change in the staff holding these management positions[ 42 CFR 455. 104 ( c)( 1)]_ 6.

the county as set forth below: a_

The DDCS region shall:

Review subcontractors and shall immediately notify the County of any concerns with the Page S

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Special Terms and Conditions

subcontractors

identified

bythe County;

5) Authorize

new service within 5 working days and will extend existing service authorization

before expiration date; 6)

Inform Clients of service changes through Planned Action Notice( s);

7) Work with the County to document planned services in the Client' s Person Centered Plan including notification of assessment dates;

Service

B) Work with the County when terminating services; 9) Work with DDCS Head Quarters

and the County on Spending

Plan adjustments;

and

10) Work with the County in participating in evaluation of direct service providers_ b_ The County shall: 1)

Work with the DDCS Region when Clients are referred for services,

authorized

services,

andlor

for support modifications;

2) Work with the DDCS Region to document planned

services

in the Client' s Person Centered

Service Plan;

3) Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DID Assessment prior to any changes; 4) Work with the DDCS Region regarding

service termination;

5) Work with the DDCS Head Quarters on Spending

Plan adjustments;

6) Inform the DDCS Region of new providers to be included on the ALTSA Web Access( AWA) sy stem;

7) Notify the DDCS Region of any intent to terminate

a subcontractor

who is serving a DDCS

referral;

B) Provide a copy of each subcontractor' s contract upon written request from DDCS; and 9) Notify and work with the DDCS Region al Employment direct service providers. c.

Specialist when performing

evaluations

Compliance with Budget and Accounting Reporting System Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. Page 7

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Special Terms and Conditions

The County shall comply with the following 1)

referenced

documents:

DDCS Policy 411, County Services for Working Age Adults;

DDA Guidelines

7) Disability

for Community

Rights Washington (

Assessments

formerly

within Employment

Washington

Protection

and Vocational

and Advocacy

Programs:

System)

and

Access

Agreement.

e_ The County shall develop and submit a comprehensive plan forthe County DID Services as required by WAC 388- 850- 020_ f.

Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The

County shall submit the Service Information Forms( SIF' s) ( provided by DDCS at Internet site https:// www_dshs_wa. gov/ dd a/ cou ntv- best- practices) to 1 n d 1 cate the estim ated n umber of people to

Solicitation

for Qualified

of the County and the DDCS Region_

Employment

and Day Program

Service Providers:

Requests for

Applications( RFAs), Requests for Information ( RFI' s) and/ or Requests for Proposals( RFPs),

Requests for Qualifications( continuous

RFQ' s) for direct services,

excluding

Child Development,

will be open

enrollment.

Qualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDCS.

Technical Assistance: DDCS contracts with Technical Counties with prior written approval_

Assistance

providers that may be utilized by

Inclusion services_

The County shall provide or contract with qualified Employment and Day Program Service Providersfor 1)

consumer support services that include thefollowing

Monthly Community

program outcomes-

Inclusion ( CI) service support hours will be based on the Client' s CI service

level per WAC 388- 828- 9310 for all Clients who began receiving CI services July 1, 2011 and forward_

Page$ DSHS

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b) CI services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will not be reim bursed.

2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses_ Clients

should be supported to average twenty( 20) hours of community work per week or eighty- six 86) hours per month; however,

each person' s preferred

hours of employment

should

be taken

into consideration. The amount of service a Client receives will be based on his/ her

demonstrated

need, acuity level and work history per WAC 388- 828.

3) The Client' s DDCS PCSP is the driver for service_ The AWA County Service Authorization CSA) and updated Planned Rates information will not exceed the Client' s DDCS PCSP.

an additional review will be

responsible for authorizing CI services_ Page 9 DSHS

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Special Terms and Conditions

and any potential conflict of interest is addressed.

10) Individual Employment staff hours must be attributed to the " Individual Employment and Billable Activity Phase( s)"

a) The collectivegroup' s individual hours should bethe minimum staff hours delivered to su pport th e g rou p-

f) Running a GSE service is a part of the business operation and not billable to Clients contract procurement,

contract maintenance, or administration

functions associated with

GSE)-

Phases and

Based settings

a) The setting is integrated in the greater community and supports Client' s to havefull access to the greater community; b) Ensures the Client receives services in the community

to the same degree of access as Page 10

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Special Terms and Conditions

individuals

not receiving

Medicaid

HCBS;

c) The setting provides opportunities to seek employment and work in competitive integrated settings;

and

d) The setting facilitates individual choice regarding services and supports, and who provides them_

Quality Assurance

and Service Evaluation:

The County shall develop and have available

m_ Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one visit to each subcontractor

every two

Copies of such documentation

will be provided tothe DDCS upon request.

n_ The County shall workwith local developmental disability advisory groups to plan for and coordinate services_

The County shall participate in regularly scheduled meetings between County DID staff and DDCS staff to remain updated and current including ACHS and Regional Meetings.

AWA Data System: In compliance

with the AWA Training Manual,

the County shall use the AWA

data system for all:

Billing requests;

2) Service provider address and phone number maintenance; 3) Evaluation dates; 4) Employment

outcome information;

and

5) Monthly provide all data described in the Billing Instructions Instructions, which is hereby incorporated by reference. q.

and in the Employment Outcomes

Review and respond the AWA" Work List" items within 5 working days including pending Authorization_

Referrals and

Review the AWA" Ticklers" Planned Rate tab and update the planned rate within 5 working d ays Page 11

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Special Terms and Conditions after the Planned Rate start date. t_

Partnership

Project-

1) A Job Foundation document will be completed per guidelines for eligible students.

Eligible

students are DDCS clients who were born between:

a) For fiscal year 2026 9/ 1105 through 8/ 31/ 06 b) For fiscal year 2027 9/ 1106 through 8/ 31/ 07 These students currently

attending

school and have completed

an application

to participate

this Value Based Payment( VPB) project_ The VBP project application will include the following minimum

criteria identified in the sample application found at:

https:// www. d sh s. w a_ gov/ sites/ default/ fi I es/ D DA/ dd a/ d ocu m ents/ J ob`/` 20 Foundation% tlon

2 0APpl i c a

040720% 20% 28002% 29. docx

documents) meet quality standards_ u_

Outcome Payment. Providers, with transition

students born between:

a) For fiscal year 2026 9/ 1103 through 8/ 31104 b) For fiscal year 2027 9/ 1/ 04 through 8/ 31/ 05 2) High acuity transition students who are authorized for Individual employment, the provider may

receive one outcome payment if transition student obtains a competitive integrated job approved by the County within timeframes

described

in the chart in the Billing Instructions_

If the County

is also the service provider DDCS will provide the job approval_ If the job is at a minimum of ten hours of work per week a n additional

amount will be include in the payment-

a minimum

of 80% of the authorized hours. Page 12

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Special Terms and Conditions

5) A new Community

Authorization( CSA).

Fees.

a) County( s) name; b) Time period for which the schedule! s applicable;

and

c) Each contracted direct service( IE, GSE, CI, ITA, CDS) and its associated rate-

Fee Limitations- The Billing Instructions found on the County Best Practices site provides lim itations on the Hourly Rate for each direct service. Hourly rates must be divisi ble by four.

b_ Budget and Spending 1)

Plan, attached

as Exhibit B-

Budget amount listed in Exhibit B- The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement

included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state- only employment and day services to waiver employment and day services-

2) Spending Plan- DDCS will provide the initial spending plan / Program Agreement Budget/ Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The

only be modified by mutual agreement of the parties in writing and shall not require a program agreement

amendment_

a) Funds Designated for Additional Consumer Services- If a County provides Community Information and Education services under additional consumer services, then activities must

include outreach

efforts to federally recognized

local tribes-

b) Funds Designated for Adult Day Care Consumers.

Funds designated for Adult Day Care

Consumers are availableto Clientswho were served between December 19M and

December 2003 in Adult Day Health agencies and were subsequently determined

ineligible Page 13

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Special Terms and Conditions for Level II or III services(

If a Client no longer needs and wants services, the fund s

by the local Area Agency on Aging. Adult Day Care

service is not a waiver approved service_ c_

Program Agreement Amendments- A County can request an amendment at any time_ An amendment for additional Clients) may be supported when clients exceed the number used to

Exemptions- The DDCS Assistant program agreement requirement-

Secretary

may approve in writing an exemption

to a specific

Billing and Payment: a.

Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for-

1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration

include personnel

of the Developmental

and overhead

Disabilities Program.

Allowable costs

costs directly related to the administration

and coordination

a) Training: i.

Board Training- Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program- related skills of board and advisory committee

members.

and community Page 14

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Special Terms and Conditions

consultation,

capacity building

and organization

activities.

c) Other Activities_ i.

ii_

Start- up projects: Projects that support an agency or directly benefit the agency_ Examples include equipment purchases and agency administrative support-

school year they turn twenty-one( 21). Supports provided should complement and not replace what the student( s) receive through the Individualized Education Program( IEP)_ 3) Consumer Support_

Level II and III services are licensed

b) Community Inclusion Services are individualized and provided in integrated community settings with other individuals without disabilities_ The activities are based on Client

interests and provide opportunities typically experienced by the general public of sim ilar age in their local community,

accessible

by public transit or a reasonable

commute from their

to the maximum

extent

appropriate.

general workforce. These services may include intake, discovery, assessm ent, j ob preparation, job marketing, job supports, record keeping and support to maintain a job( per Page 15 DSHS

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Special Terms and Conditions the

Individual Employment Phases&

Billable Activities)

Examples include enclaves, mobile crews, and other business models employing small groups ofworkerswith disabilities in integrated employment community settings_ b_

Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this

Program Agreement.

However, with a Program Agreement amendment, the parties may increase

or decrease the Program Agreement amount_ Counties will work with DDCS HOon amendmentsto the Program Agreement. c_

Clients will be assisted in accessing DVR services perthe DDCS/ DVR MOU. Client services shall not be reimbursed

under this Program Agreement when the same services are paid for under the

Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. e.

Reimbursement

of Client Services:

A claim for each Client is made on the AWA system

indicating the number of service units delivered to each Client listed and the fee per unit_ Units are defined as:

An " Hour" is at least fifty( 50) minutes of direct service. Partial hour to the quarter may be recorded-

2) A" Day" is at leastfour( 4) hours of direct service and will only be used in connection with Adult Day Care reimbursement3) A" Month" represents

a minimum of at least fifty( 50) minutes of direct service for CDS

reimbursement.

can be 1112 of the maximum amount identified in Exhibit B under Administration or

The Individual Employment Phases&

Billable Activities document defines the individual Client Page 16

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Special Terms and Conditions

services that DDCS reimburses.

That document

is located on the DSHS DDCS County Best

Practices Web site at https:// www. dshs. wa. aov/dda/ county- best- practices.

Timeliness of and Modification to Billings: All initial invoices with signed documentation must be

Recovery of Fees. If the County bills and is paid fees for services that DSHS later finds were( a) not delivered or( b) not delivered in accordance with Program Agreement standards, DSHS shall

recover the fees for those services and the County steal I fully cooperate during the recovery. k_

costwill be based

DDAJobFoundationReportsadshs_

wa_.Qov

multiplied by

Intermediate Care Facilities for Intellectual Disabilities( ICF1ID) Agreement. If applicable per 42 CFR 463. 410, the County shall assure that all county- operated or subcontracted

programs serving

persons living in ICF/ ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/ ID resident 10.

Single State Medicaid Agency— Health Care Authority(

HCA):

HCA, as the single state Medicaid

DSHSIDRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDCS is incorporated

by reference_ The County assures that it and its subcontractors

have reviewed

the

Access Agreement_ The agreement covers DRW' s access to individuals with developmental Page 17 DSHS

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Special Terms and Conditions

disabilities, Clients, programs and records, outreach activities, authorityto investigate allegations abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS

contracted services_ 12.

Confidential Information.

Al Counties and their subcontractors must

Ensure the security of Confidential Information, and

When transporting

client records containing

Confidential

Information

outside a Secure Area, one or

more of the following as appropriate: 1)

U sing a Trusted Network; or

2) Encrypting the Confidential Information, including: a) Email andlor email attachments

b) Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.

Data Security

Requirements. Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization, or transmits more

than

14.

5 records

atone time.

Supersession of Prior Data Security Agreement_ If the Parties hereto have previously entered into a Standalone

Data Security Requirements

Agreement,

both Parties hereby agree that upon mutual

execution said Agreement shall take precedence as the sole Data security Agreement between the Parties_

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Special Terms and Conditions Exhibit A— Data Security 1.

Definitions_

Requirements

The words and phrases listed below, as used in this Exhibit, shall each have the fallowing

definitions: a. "

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so_ e. "

Category 4 Data" is data that is confidential

and requires special handling due to statutes or

refers to data protected

by: the Health Insurance

Portability

d_ " Cloud" means data storage on servers hosted by an entity other than the Contractor and on a

network outside the control of the Contractor.

Physical storage of data in the cloud typically spans

multiple servers and often multiple locations.

Cloud storage can be divided between consumer

grade storage for personal files and enterprise grade for companies and governmental entitiesExam pies of con sumer grad e storage wouId include iCloud, Dropbox, Box_com, and many other entities.

Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and

Rackspace_ e_ "

Encryption

must use a key length of at least 129 bits( 256 preferred)

for symmetri c keys, or

2048 bits for asymmetric keys_ When a symmetric key is used, the Advanced Encryption Standard AES) must be used if available. f. " Hardened

Password"

means a string of at least eight characters

containing

at least three of the

following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. " Mobile Device"

h_ " Multi- factor Authentication"

series of numbers which act as a password for a device_ Since PINS are typically only four to six characters,

PINS are usually used in conjunction

with anotherfactorof

authentication,

such as a

fingerprint1- "

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Special Terms and Conditions

are not limited to, mobile phones, tablets, and laptops.

Mobile Device is a subset of Portable

Device.

j. "

k_ " Secure Area" means

Confidential

an area to which only authorized representatives of the entity possessing Information have access, and access is controlled through use of a key, card key,

the

Trusted Network" means a network operated and maintained

by the Contractor, which includes

integrity, and availabilityof

the Data. m. "

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.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington

Technology

httns: l/watech_wa_gov/ policies? combine=& field

and of the DSHS Information these requirements

ServicesAgeney

categories

Security Policy and Standards

can be found

target id= 80& field tune target

Manual_

Reference

material

id= All],

related to

here: htti) s:// www. dshs. wa.- govlffa/ keening- dshs- client- information-

private- and- secure, which is a site developed

by the DSHS Information

Security Office and hosted by

DSHS Central Contracts and Legal Services. 3.

Administrative Controls. The Contractor must have the following controls in place: a_

A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy.

If Confidential Information shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment forth e systems) housing the Category 4 Data.

Authorization, Authentication, and Access. authorized

In order to ensure that access to the Data is limited to

staff, the Contractor must:

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Special Terms and Conditions

Have documented

policies and procedures

b_ Restrict access th rough administrative,

governing

physical,

access to systems with the shared Data

and technical

controls to authorized

staff_

Ensure that only authorized users are capable of accessing the Data_

e_ Ensure that an employee' s access to the Data is removed immediately:

UWn suspected com promise of the user credentials.

2) When their employment, or the contract under which the Data is made available to them, is terminated_

3) When they no longer need access to the Data to fulfill the requirements of the contract. f.

Have a process to periodically review and verify that only authorized containing DSHS Confidential Information

A minimum

length of 8 characters,

and containing

users have access to systems

at least three of the following

character

classes: uppercase letters, lowercase letters, numerals, and special characters such as an

asterisk, ampersand, or exclamation point. 2) That a password

does not contain a user' s name, logon ID, or any form of their full name.

3) That a password does not consist of a single dictionary word. passphrase which consists of multiple dictionary words-

A password

may be formed

as a

4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h.

Ensuring

mitigations

applied to the system don' t allow end- user modification_

2) Not allowing the use of di al- up connections.

3) Using industry standard protocols and solutions for remote access_ Examples would include RADIUS and Citrix.

4) Encrypting

all remote access traffc from the external workstation

to Trusted

Network or to a

component within the Trusted Network_ The traffic must be encrypted at all times while

traversing any network, including the Internet, which is not a Trusted Network. Page 21 DSHS

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Special Terms and Conditions

5) Ensuring that the remote access system prompts for re- authentication session termination after no more than 30 minutes of inactivity.

or performs automated

6) Ensuring use of Multi- factor Authentication to connect from the external end point to the internal end point_ i_

Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication

mechanism,

such as a biometric(

fingerprint,

face recognition,

iris scan) or token

software, hardware, smart card, etc.) in that case-

The PIN or password

must be at least 5 letters or numbers when used in conjunction

with at

least one other authentication factor 2) Must not be comprised of all the same letter or number( 11 111, 22222, aaaaa, would not be acceptable)

Must not contain a" run" of three or more consecutive numbers( 12398, 98743 would not be acceptable)

If the contract specifically allows for the storage of Confidential passcodes used on thedevice must 1)

Information on a Mobile Device,

Be a minimum of six alphanumeric characters.

2) Contain

at least three unique character classes( upper case, lower case, letter, number).

3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable_ k. 5

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Contractor protect the Data as described, a_

agrees to store Data on one or more of the following

media and

Hard disk drives_ For Data stared on local workstation hard disks, access to the Data will be

Network server disks_ For 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

mechanism_

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Special Terms and Conditions

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 Secure Area_ When not in use for the contracted

purpose, such discs must be

Stored in a Secure Area_ Workstations which access DSHS Data on optical discs must be located

in an area which is accessible only to authorized personnel, key, card key, combination lock, or comparable mechanism d_

Optical discs ( CDs or DVDs) in drives or jukeboxes

with access controlled

attached to servers.

through use of a

Data provided by

DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through

smart

cards_ Data on discs attached to such servers must be located in an area, which is accessible only

to authorized

personnel,

comparable

mechanism_

with access controlled

through

use of a key, card key, combination

lock, or

Remote Access.

Access to and use of the Data over the State Governmental Network( SGN) or

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)

authentication

a Unique User ID and Hardened Password or stronger

method such as a physical token or biometrics.

and physical

security controls to Portable Devices and Portable Media

Keeping them in a Secure Area when not in use,

ii_

Using check- in/ check- out procedures when they are shared, and

iii_ Taking frequent inventories_ Page 23 DSHS

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Special Terms and Conditions

Data stored for backup purposes-

below in Section

8 Data Disposition.

1) DSHS Data wi II not be stored in any consumer grade Cloud solution, unless all of the following conditions are met-

for

b) The Data will be Encrypted while within the Contractor network.

c) The Data will remain Encrypted during transmission to the Cloud. d) The Data will remain Encrypted

at all times while residing within the Cloud storage solution_

e) The Contractor will possess a decryption possessed only by the Contractor. f) The Data will not be downloaded

key for the Data, and the decryption key will be

to non- authorized

systems,

meaning

systems that are not

on the contractor network

a) The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or, b) The Cloud storage solution used is HIPAA compliant_

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Special Terms and Conditions

System Protection. that Data passes:

To prevent compromise of systems which contain DSHS Data or through which

a. Systems containing DSHS Data must have all security patches or hotfxes applied within 3 months of being made available_

b_ The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes.

c_ Systems containing DSHS Data shall have an Anti- Malware application,

if available, installed.

d. Anti- Ma lware software shall be kept up to date. The product, its anti- virus engine, and any malware database the system uses, will be no more than one update behind currentT.

Data Segregation-

DSHS Data will be kept on media ( e. g. hard disk, optical disc, tape, etc.) which will contain no non- DSHS Data-

4) DSHS Data will be stored within a database and will be distinguishable

from non- DSHS data by

the value of a specific fell or fields within database records.

5) When stored as physical

paper documents,

DSHS Data will be physically

segregated

from non-

DSHS data in a drawer, folder, or other container_

b_ 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 asdescribed

this exhibit.

Data Disposition.

When the contracted

work has been completed

or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server or workstation

on:

hard disks, or

Will be destroyed by: Using a " wipe" utility which wi II overwrite the Data at least three( 3) times using either random or single character data, or Page 25

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Special Terms and Conditions

Removable

media( e. g. Coppies, USB Cash drives,

portable hard disks) excluding optical discs

Degaussing

sufficiently to ensure that the Data

cannot be reconstructed, or

Physically destroying Paper documents with

sensitive

Confidential

Information

the disk

Recycling through a contracted firm, provided the contract with the recycler assures that the

confidentiality of Data will be protected. 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 ta 9.

I Degaussing,

Notification

of Compromise

or Potential Compromise.

incinerating

or crosscut

shredding

The compromise or potential compromise of

DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one( 1)

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Exhibit B

Program Agreement

Original Budget

Budget

0 Budget Revision

REVENUES Fund Source

Fiscal Year 2026

Fiscal

State and

1, 627, 450

1, 479, 700

Medicaid

1 447 900

1 313 649

Total Rev.

3 075 350

2 793 350

Year

Fund

2027

11; t Revision

Original

State

Source

Original

V Revision

21d Revision

3,d Revision

21d Revision

31d Revision

1 457 352

on ly

1 288 528

Medicaid

Total Rev.

V,745, 890

Job Foundation

PASRR Funds

ADMINISTRATION( 12

Funds

TOTAL

11,

13)

OTHER

Medicaid State Funds

Funds

137, 294

112, 332

249, 626

89, 819

73, 487

163, 306

CONSUMER

SUPPORTS 31, 32, 41, 92, 93, 94, 97) CONSUMER SUPPORT STATE62,

ONLY

64r 65, 67r 69

Child Development

MEDICAID 64 67 r

ROADS

125440

CLIENTS 69

21 D00

1 093 259

1 D93 259

207 518

1, 445, 812

1, 279, 078

Z745, 890

COMMUNITY 62

64 65 r

LIVING 67

TOTAL

21, 000

Page 27 DSHS

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Motion

233360

BOCC

Item

Agenda

Meeting Date: 9/ 15/ 2026 Contract Amendment# 25- 002 ( 7) with WA State Department of Health

Submitted By: Amanda Foshaug, Accounting Specialist II Submitted For: Gena James, HHS Deputy Director Department:

Human

Services

Dept

Information

Subject and Summary Statement

The Consolidated

Contract(

ConCon)#

25- 002 with Washington State Department of Health is a multi-year, multi-program contract which contains key sources of public health funding accompanied by Statements of Work( SOW). An initial contract is received at the beginning of the multi- year agreement with amendments that arrive every 4- 6 weeks which may change funding sources and/ or tasks.

The purpose of this amendment is to update SOW and funding for Emergency Preparedness ( PHEPR) and Perinatal Hepatitis B programs. Prior Total

Change in $

Total Contract

Total$

Period 100, -$

100,

etc.)

Total ConCon SOW Name

3, 939, 293. 00 Source of$

Current $

+$ 31, 000. 00

$ 3, 970, 293. 00

1/ 1/ 25- 12/ 31/ 27

Change in $

Total$

Funding Period

Fed or State)

100, -$

100,

etc.)

PHEPR

State

Perinatal

State

Hepatitis

30, 000 1, 000. 00

30. 000. 00

7/ l/ 26- 6/ 30/ 27

1, 000. 00

7/ l/ 26- 6/ 30/ 27

Staff Attendance Gena

James

Department

It is the

Recommendation

recommendation

Board of Commissioners Department

of the Cowlitz

County Health&

Human Services that the Cowlitz County

move to approve Contract/ Amendment#

25- 002 ( 7) with the Washington

State

of Health.

Attachments

25- 002 ( 7) DOH ConCon, Amend 7 2025- 2027 ConCon DOH ConCon signed, 25- 002 ( 4) DOH ConCon Amend # 2-

signed, 25- 002 ( 1) DOH ConCon

Overview,

signed, CLH32048

25- 002 ( 6) DOH ConCon Cowlitz Amend# 3-

signed, 25- 002 DOH ConCon

signed, 25- 002 ( 5)

signed, CLH32048

Cowlitz

233360

Motion

Form

User

Task

Foshaug, Amanda

Agenda

Item

Submission

Drake,

Jamie

Preliminary

Review-

James,

Gena

Department

Approver

HHS

Review

Action

Timestamp

Submit

8/ 27/ 2026

1: 19: 00 PM

Approve

8/ 31/ 2026

11: 13: 00 AM

Approve

9/ 1/ 2026

11: 14: 00 AM

Review Berger, David

Legal Review

Approve

9/ 4/ 2026

3: 40: 00 PM

Grayson,

Clerk of the Board

Approve

9/ 8/ 2026

7: 51: 00 AM

Kelly

Review

Approved: BOARD

OF COUNTY

OF COWLITZ

COMMISSIONERS

COUNTY,

WASHINGTON

Richard R. Dahl, Chairman

Steve

Rader,

Commissioner

Steven L. Ferrell, Commissioner

Attest:

Clerk of the Board

Item

COWLITZ COUNTY HEALTH &

HUMAN SERVICES

2025- 2027 CONSOLIDATED

CONTRACT

COWLITZ

NUMBER:

CLH32048

HEALTH&

COUNTY

CONTRACT

AMENDMENT

NUMBER:

HUMAN SERVICES, a Local Health Jurisdiction,

the Modifications/ Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto.

IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1.

sharepoint. com/

sites/

doh- ofsfundin, gresources/

home.

sitoages/

aspx?=

e l: 9a94688da2d94d3

ea8Oac7fbc32e4d7c

Adds Statements of Work for the following programs: Foundational

Public Health

Services(

FPHS) -

Effective January 1, 2025 Office of Drinking Water Group B Program- Effective January 1, 2025 Office of Resiliency& Health Security- PHEP- Effective January 1, 2025 Amends Statements of Work for the following programs:

Deletes Statements of Work for the following programs: 2.

Exhibit B- 1 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B- 0 Allocations Increase

of$ 1, 496, 507 for a revised

Decrease

maximum

consideration

as follows:

of$ 1, 496, 507.

for a revised maximum consideration of

No change in the maximum consideration of

Exhibit B Allocations are attached only for informational purposes. 3.

Exhibit

C Federal

Grant Awards

Index, incorporated

by this reference,

and located

in the ConCon,

Funding&

BARS library at

the URL provided above. Unless designated otherwise herein, the effective date of this amendment is the date of execution.

ALL OTHER TERMS AND CONDITIONS

of the original contract and any subsequent amendments

remain in full force and effect.

IN WITNESS WHEREOF, the undersigned has affixed his/ her signature in execution thereof

COWLITZ

COUNTY

HEALTH&

HUMAN

STATE

OF WASHINGTON

SERVICES DEPARTMENT

Signature: tic-k( rzicM1artlR

1(- Jan38, 2,

Signature: dcGl

202512 20251

OF HEALTH

Date:

Jan 28, 2025

Jan 28, 2025 APPROVED

AS TO FORM

Assistant Attorney General

Page

1 of 1

ONLY

EXHIBIT Cowlitz

County Health&

Human Services

B- 1

ALLOCATIONS

Contract Number:

CLH32048

Date:

January 1, 2025

Contract Term: 2025- 2027

Indirect Rate as of January

1, 2025: Direct Allocation

of Costs DOH Use Only Federal Award

BARS

Statement of Work

Assist

Revenue

LHJ Funding

Period

Chart of Accounts

Funding

Chart of

Period

Accounts

Funding Period

Chart of Accounts Program Title

Identification#

Amend#

List#*

Code**

Start Date End Date Start Date End Date

Amount

SubTotal

Total

FFY24 PHEP BPl- CDC- LHJ Partners

NU90TU000055

Amd 1

93. 069

333. 93. 06

01/ O1/ 25

06/ 30/ 25

07/ O1/ 24

06/ 30/ 25

31, 630

Amd 1

N/ A

334. 04. 90

01/ O1/ 25

06/ 30/ 25

07/ O1/ 23

06/ 30/ 25

25, 877

Amd 1

N/ A

336. 04. 25

01/ O1/ 25

06/ 30/ 25

07/ O1/ 24

06/ 30/ 25

1, 439, 000

SFY2 GFS-

Group B

SFY25 FPHS- LHJ Funds- GFS

TOTAL

Total

consideration:

1, 439, 000

1, 496, 507

GRAND TOTAL

1, 4969507

1, 496, 507 GRAND TOTAL

1, 496, 507

Assistance Listing Number fka Catalog of Federal Domestic Assistance Federal revenue

codes begin with" 333".

State revenue

codes begin with"

334".

Page 1 of 1

Total Fed

31, 630

Total State

1, 464, 877

COWLITZ COUNTY HEALTH &

HUMAN SERVICES

2025- 2027 CONSOLIDATED

CONTRACT

PURPOSE

NUMBER:

OF CHANGE:

DOH", and COWLITZ

CONTRACT

CLH32048

AMENDMENT

To amend this contract between

COUNTY

HEALTH&

the DEPARTMENT

OF HEALTH

NUMBER:

hereinafter

referred to as

HUMAN SERVICES, a Local Health Jurisdiction, hereinafter referred to

LHJ",

pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. as"

IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1.

sharepoint.

com/

sites/

doh- ofsfundingresources/

home.

sitepages/

aspx?=

e 1: 9a94688da2d94d3ea8Oac7fbc32e4d7c

Adds Statements of Work for the following programs:

Office of People Services- HR-Public Health Infrastructure Grant - Effective July 1, 2025 Amends Statements of Work for the following programs: Office of Immunization- Perinatal Hepatitis B -

Effective July 1, 2025

Deletes Statements of Work for the following programs: 2.

Exhibit B- 4 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B- 3 Allocations as follows: Increase

of$ 200, 750 for a revised maximum

Decrease of

for a revised maximum

No change in the maximum

consideration

of$ 2, 849, 543.

Exhibit B Allocations are attached only for informational purposes. 3.

Exhibit C Federal Grant Awards Index, incorporated

by this reference, and located in the ConCon, Funding&

BARS

library at the URL provided above. Unless designated otherwise herein, the effective date of this amendment is the date of execution.

ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect.

IN WITNESS

COWLITZ

WHEREOF,

COUNTY

the undersigned

HEALTH&

has affixed his/ her signature in execution thereof.

HUMAN SERVICES

STATE OF WASHINGTON DEPARTMENT

Signature:

Richard

R Dahl(

Nov

202610:

OF HEALTH

Signature:

23: 46

PST)

Date:

Date:Date:

Nov 4, 2025

APPROVED

AS TO FORM ONLY

Assistant Attorney General

Page 1 of 1

EXHIBIT Cowlitz

County Health&

Human Services

B- 4

ALLOCATIONS

Contract Number:

Contract Term: 2025- 2027

Indirect

Rate as of January

1, 2025: Direct Allocation

Date:

CLH32048 October

1, 2025

of Costs DOH Use Only Federal Award

of Work

BARS

Statement

Assist

Revenue

LHJ Funding

Period

Chart of Accounts

Funding

Funding Period

Chart

Period

Accounts Total

Chart of Accounts Program Title

Identification#

Amend#

List#*

Code**

Start Date End Date Start Date End Date

Amount

SubTotal

FFY25 PHEP BP2- CDC- LHJ Partners

NU90TU000055

Amd 3

93. 069

333. 93. 06

07/ O1/ 25

06/ 30/ 26

07/ O1/ 25

06/ 30/ 26

44, 777

FFY24 PHEP BPI- CDC- LHJ Partners

NU90TU000055

Amd 1

93. 069

333. 93. 06

01/ O1/ 25

06/ 30/ 25

07/ O1/ 24

06/ 30/ 25

31, 630

FFY26 Immunizations

1, 000

200, 000

2009000

200, 000

NH231P922680

Amd 4

93. 268

333. 93. 26

07/ O1/ 25

06/ 30/ 26

07/ O1/ 25

06/ 30/ 26

750

FFY26 Immunizations Discre CDC YRl

Discre CDC YRl

NH231P922680

Amd 3

93. 268

333. 93. 26

07/ O1/ 25

06/ 30/ 26

07/ O1/ 25

06/ 30/ 25

250

PH Infrastructure

NEllOE000053

Amd 4

93. 967

333. 93. 96

07/ O1/ 25

11/ 30/ 27

12/ O1/ 22

11/ 30/ 27

Comp Al-LHJ

76, 407

SFY1 GFS-

Group B Proviso

Amd 2

N/A

334. 04. 90

07/ O1/ 25

06/ 30/ 26

07/ O1/ 23

06/ 30/ 25

20, 259

SFY2 GFS-

Group B

Amd I

N/A

334. 04. 90

01/ O1/ 25

06/ 30/ 25

07/ O1/ 23

06/ 30/ 25

25, 877

SFY26 FPHS- LHJ Funds- GFS

Amd 3

N/A

336. 04. 25

07/ O1/ 25

06/ 30/ 26

07/ O1/ 25

06/ 30/ 26

1, 087, 000

2, 526, 000

SFY25 FPHS- LHJ Funds- GFS

Amd 1

N/A

336. 04. 25

01/ O1/ 25

06/ 30/ 25

07/ O1/ 24

06/ 30/ 25

1, 439, 000

2, 849, 543

TOTAL

Total

29648, 793

consideration:

GRAND

TOTAL

2, 849, 543

2009750 GRAND

2, 849, 543

TOTAL

Assistance

Listing Number fka Catalog of Federal Domestic

Federal revenue

codes

begin with" 333".

State revenue

Assistance

codes begin with"

334".

Page 1 of 1

Total Fed

277, 407

Total State

29572, 136

COWLITZ COUNTY HEALTH & HUMAN SERVICES 2025- 2027 CONSOLIDATED

NUMBER:

CONTRACT

CLH32048

AMENDMENT

NUMBER:

PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as DOH", and COWLITZ

COUNTY

HUMAN SERVICES, a Local Health Jurisdiction, hereinafter referred to

HEALTH&

LHJ",

pursuant to the Modifications/ Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. as"

IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1.

Exhibit A Statements of Work, includes the following statements of work, which are incorporated by this reference and located on the DOH Finance SharePoint site in the Upload Center at the following URL: home. aspx?= e 1: 9a94688da2d94d3ea80ac7fbc32e4d7c

http s:// stateofvva. sharepoint. com/ sites/ doh- ofsfundinaesources/ sitepages/

Adds Statements of Work for the following programs: Office of Drinking Water Group A Program - Effective January 1, 2026

Amends Statements of Work for the following programs: Deletes Statements of Work for the following programs: 2.

Exhibit B- 5 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B- 4 Allocations as follows: Increase of$ 2, 750 for a revised maximum consideration

of$ 2, 852, 293.

Decrease of

for a revised maximum

No change in the maximum

consideration

Exhibit B Allocations are attached only for informational purposes. Exhibit C Federal Grant Awards Index, incorporated

by this reference, and located in the ConCon, Funding&

BARS

library at the URL provided above. Unless designated

otherwise

herein, the effective

date of this amendment

is the date of execution.

ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect.

IN WITNESS

COWLITZ

WHEREOF,

COUNTY

the undersigned

HEALTH&

has affixed his/ her signature in execution thereof.

HUMAN

SERVICES

STATE OF WASHINGTON DEPARTMENT

Signature:

Richard

Dahl(

Jan

OF HEALTH

Signature:

13,

203610:

1]:

PST)

Date:

Jan 13, 2026

APPROVED

AS TO FORM

Assistant Attorney General

Page 1 of 1

ONLY

EXHIBIT Cowlitz

County

Health&

Human Services

Contract

Indirect Rate as of January

1, 2025: Direct Allocation

B- 5

ALLOCATIONS

Contract Number:

CLH32048

Date:

December 1, 2025

Term: 2025- 2027

of Costs DOH Use Only Federal Award

BARS

Statement of Work

Assist

Revenue

LHJ Funding

Start Date End Date Start Date

Period

Identification#

Amend#

List#*

Code**

FFY25 PHEP BP2- CDC- LHJ Partners

NU90TU000055

Amd 3

93. 069

333. 93. 06

07/ 01/ 25

06/ 30/ 26

FFY24 PHEP BP1- CDC- LHJ Partners

NU90TU000055

Amd 1

93. 069

333. 93. 06

01/ 01/ 25

06/ 30/ 25

FFY26 Immunizations

Discre CDC YR1

NH231P922680

Amd 4

93. 268

333. 93. 26

07/ 01/ 25

FFY26 Immunizations

Discre CDC YR1

NH231P922680

Amd 3

93. 268

333. 93. 26

07/ 01/ 25

NEl IOE000053

Arad 4

93. 967

333. 93. 96

Chart of Accounts

PH Infrastructure

Program

Title

Comp Al- LHJ

Chart of Accounts

Funding

Chart of

Period

Accounts Total

Funding Period End Date

Amount

SubTotal

07/ 01/ 25

06/ 30/ 26

44, 777

07/ 01/ 24

06/ 30/ 25

31, 630

06/ 30/ 26

07/ 01/ 25

06/ 30/ 26

750

1, 000

06/ 30/ 26

07/ 01/ 25

06/ 30/ 25

250

07/ O1/ 25

11/ 30/ 27

12/ 01/ 22

11/ 30/ 27

200, 000

76, 407

SFY1 GFS-

Group B Proviso

Amd 2

N/ A

334. 04. 90

07/ 01/ 25

06/ 30/ 26

07/ 01/ 23

06/ 30/ 25

20, 259

SFY2

Group B

Amd 1

N/ A

334. 04. 90

01/ 01/ 25

06/ 30/ 25

07/ 01/ 23

06/ 30/ 25

25, 877

SFY26 FPHS- LHJ Funds- GFS

Amd 3

N/ A

336. 04. 25

07/ O1/ 25

06/ 30/ 26

07/ 01/ 25

06/ 30/ 26

1, 087, 000

2, 526, 000

SFY25 FPHS- LHJ Funds- GFS

Arad 1

N/ A

336. 04. 25

01/ O1/ 25

06/ 30/ 25

07/ 01/ 24

06/ 30/ 25

1, 439, 000

GFS-

YR1 Stimulus-

Local Asst( 10%

of 15%)

Amd 5

N/ A

346. 26. 64

01/ O1/ 26

12/ 31/ 27

07/ O1/ 23

06/ 30/ 28

1, 750

YR1 Stimulus-

Local Asst( 10%

of 15%)

Amd 5

N/ A

346. 26. 66

01/ O1/ 26

12/ 31/ 27

07/ O1/ 23

06/ 30/ 28

1, 000

19000

1, 000

TOTAL

Total

2, 852, 293

GRAND

2, 849, 543

consideration:

TOTAI

2, 852, 293

2, 750 GRAND

TOTAL

2, 852, 293

Assistance Listing Number fka Catalog of Federal Domestic Assistance Federal

revenue

codes

begin with" 333".

State revenue codes begin with" 334".

Pagel of 1

Total Fed

277, 407

Total State

2, 574, 886

COWLITZ COUNTY HEALTH & HUMAN SERVICES 2025- 2027 CONSOLIDATED

CONTRACT

NUMBER:

CONTRACT

CLH32048

AMENDMENT

NUMBER:

PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as DOH", and COWLITZ as "

LHJ",

COUNTY

HEALTH&

HUMAN

SERVICES,

a Local Health Jurisdiction,

hereinafter

referred to

pursuant to the Modifications/ Waivers clause, and to make necessary changes within the scope of this contract

and any subsequent amendments thereto. IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1.

https://stateofwa.sharepoint.com/sites/doh-ofsfundingresources/sitepages/home.aspx?=e1:9a946 https: Hstateofwa. sharepoint. com/ sites/ doh- ofsf mdingresources/ sitepages/ home. aspx?= e 1: 9a94688da2d94d3ea8Oac7fbc32e4d7c 88da2d94d3ea80ac7fbc32e4d7c Adds Statements of Work for the following programs:

Foundational Public Health Services - Effective July 1, 2026

Amends Statements of Work for the following programs: Office of Drinking Water Group B Program - Effective July 1, 2025

Deletes Statements of Work for the following programs: 2.

Exhibit B- 6 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B- 5 Allocations as follows: Increase of$ 1, 087, 000 for a revised maximum consideration

Decrease of

for a revised maximum

No change in the maximum

consideration

of$ 3, 939, 293.

Exhibit B Allocations are attached only for informational purposes. 3.

Exhibit C Federal

Grant Awards Index, incorporated

by this reference, and located in the ConCon, Funding&

BARS

library at the URL provided above. Unless designated

otherwise herein, the effective date of this amendment

ALL OTHER TERMS AND CONDITIONS

is the date of execution.

of the original contract and any subsequent amendments remain in full force

and effect.

IN WITNESS

WHEREOF,

the undersigned

COWLITZ COUNTY HEALTH& Signature:

R Dahl(

HUMAN SERVICES

STATE OF WASHINGTON DEPARTMENT

OF HEALTH

Signature:

i d ( https://washingtondoh .na2.adobesign.com/v Date: erifier?tx=CBJCHBCA ABAAt5kbLlfLEvPZKs Jul 14, 2026 sYH6a63YnC225FluT H Richard

has affixed his/ her signature in execution thereof.

Jul

14, 2026

10: 17: 62 PDT)

https://washingtondoh .na2.adobesign.com/v Date: erifier?tx=CBJCHBCA ABAAt5kbLlfLEvPZKs Jul 14, 2026 sYH6a63YnC225FluT H APPROVED AS TO FORM ONLY Assistant Attorney General

Page 1 of 1

EXHIBIT Cowlitz

Health&

County

Human Services

Contract

Indirect Rate as of January

1, 2025: Direct Allocation

B- 6

ALLOCATIONS

Contract Number:

CLH32048

Date:

June 1, 2026

Term: 2025- 2027

of Costs DOH Use Only Federal Award

BARS

Statement of Work

Assist

Revenue

LHJ Funding

Start Date End Date Start Date

Period

Identification#

Amend#

List#*

Code**

FFY25 PHEP BP2- CDC- LHJ Partners

NU90TU000055

Amd 3

93. 069

333. 93. 06

07/ 01/ 25

06/ 30/ 26

FFY24 PHEP BP1- CDC- LHJ Partners

NU90TU000055

Amd 1

93. 069

333. 93. 06

01/ 01/ 25

06/ 30/ 25

FFY26 Immunizations

Discre CDC YRl

NH23lP922680

Amd 4

93. 268

333. 93. 26

07/ 01/ 25

FFY26 Immunizations

Discre CDC YRl

NH231P922680

Amd 3

93. 268

333. 93. 26

07/ 01/ 25

NEI lOE000053

Amd 4

93. 967

333. 93. 96

Chart of Accounts

PH Infrastructure

Program

Title

Comp Al- LHJ

Chart of Accounts

Funding

Chart of

Period

Accounts Total

Period End Date

Amount

SubTotal

07/ 01/ 25

06/ 30/ 26

44, 777

07/ 01/ 24

06/ 30/ 25

31, 630

06/ 30/ 26

07/ 01/ 25

06/ 30/ 26

750

1, 000

06/ 30/ 26

07/ 01/ 25

06/ 30/ 25

250

07/ 01/ 25

11/ 30/ 27

12/ 01/ 22

11/ 30/ 27

200, 000

76, 407

SFYI GFS-

Group B Proviso

Amd 2

N/ A

334. 04. 90

07/ 01/ 25

06/ 30/ 26

07/ 01/ 23

06/ 30/ 25

20, 259

SFY2 GFS-

Group B

Amd

N/ A

334. 04. 90

01/ 01/ 25

06/ 30/ 25

07/ 01/ 23

06/ 30/ 25

25, 877

SFY27 FPHS- LHJ Funds- GFS

Amd 6

N/ A

336. 04. 25

07/ 01/ 26

06/ 30/ 27

07/ 01/ 26

06/ 30/ 27

1, 0879000

1, 087, 000

396139000

SFY26 FPHS- LHJ Funds- GFS

Amd 3

N/A

336. 04. 25

07/ 01/ 25

06/ 30/ 26

07/ 01/ 25

06/ 30/ 26

1, 087, 000

SFY25 FPHS- LHJ Funds- GFS

Amd 1

N/ A

336. 04. 25

01/ 01/ 25

06/ 30/ 25

07/ 01/ 24

06/ 30/ 25

1, 439, 000

YRl Stimulus-

Local Asst( 10%

of 15%)

Amd 5

N/ A

346. 26. 64

01/ 01/ 26

12/ 31/ 27

07/ 01/ 23

06/ 30/ 28

1, 750

YRl Stimulus-

Local Asst( 10% of 15%)

Amd 5

N/A

346. 26. 66

01/ 01/ 26

12/ 31/ 27

07/ 01/ 23

06/ 30/ 28

1, 000

3, 939, 293

TOTAL

Total

2, 852, 293

consideration:

3, 939, 293

GRAND

TOTAI

399399293

1, 087, 000 GRAND

TOTAL

3, 939, 293

Assistance Listing Number flca Catalog of Federal Domestic Assistance Federal

revenue

codes

begin with" 333".

State revenue codes begin with" 334".

Pagel of 1

Total Fed

2779407

Total State

3, 661, 886

COWLITZ COUNTY

HEALTH &

HUMAN SERVICES

2025- 2027 CONSOLIDATED

CONTRACT

PURPOSE

NUMBER:

OF CHANGE:

CLH32048

AMENDMENT

To amend this contract between the DEPARTMENT

DOH", and COWLITZ COUNTY HEALTH & as "

LHJ",

CONTRACT

HUMAN

SERVICES,

OF HEALTH

NUMBER:

hereinafter referred to as

a Local Health Jurisdiction,

hereinafter

referred to

pursuant to the Modifications/ Waivers clause, and to make necessary changes within the scope of this contract

and any subsequent amendments thereto. IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1.

Adds Statements of Work for the following programs: Office of Immunization- Perinatal Office of Resiliency&

Hepatitis B - Effective July 1, 2026 Health Security- PHEP - Effective July 1, 2026

Amends Statements of Work for the following programs: Deletes Statements of Work for the following programs: 2.

Exhibit B- 7 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B- 6 Allocations as follows: Increase

of$ 31, 000 for a revised maximum

Decrease of

for a revised maximum

No change in the maximum

consideration

of$ 3, 970, 293.

consideration

Exhibit B Allocations are attached only for informational purposes. 3.

Exhibit C Federal Grant Awards Index, incorporated

by this reference,

and located in the ConCon,

Funding&

BARS

library at the URL provided above. Unless designated otherwise herein, the effective date of this amendment is the date of execution.

ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect.

IN WITNESS

COWLITZ

WHEREOF,

COUNTY

the undersigned

HEALTH&

has affixed his/ her signature

in execution

thereof.

STATE OF WASHINGTON HUMAN

SERVICES

DEPARTMENT

Signature:

Date:

APPROVED

OF HEALTH

AS TO FORM ONLY

Assistant Attorney General

Page

1 of 1

EXHIBIT Cowlitz

County Health&

Human Services

B- 7

ALLOCATIONS

Contract

Number:

CLH32048

Date:

August 1, 2026

Contract Term: 2025- 2027

Indirect Rate as of January

1, 2025: Direct Allocation

of Costs DOH Use Only Federal Award

BARS

Statement of Work

Assist

Revenue

LHJ Funding

Period

Chart of Accounts

Funding

Chart of

Period

Accounts

Funding Period

Identification#

Amend#

List#*

Code**

Start Date End Date Start Date End Date

Amount

SubTotal

Total

FFY26 PHEP BP3- CDC- LHJ Partners

NU90TU000055

Amd 7

93. 069

333. 93. 06

07/ 01/ 26

06/ 30/ 27

07/ 01/ 26

06/ 30/ 27

30, 000

106, 407

FFY25 PHEP BP2- CDC- LHJ Partners

NTJ90TU000055

Amd 3

93. 069

333. 93. 06

07/ 01/ 25

06/ 30/ 26

07/ 01/ 25

06/ 30/ 26

44, 777

FFY24 PHEP BPI- CDC- LHJ Partners

NTJ90TU000055

Amd 1

93. 069

333. 93. 06

01/ 01/ 25

06/ 30/ 25

07/ 01/ 24

06/ 30/ 25

31, 630

Chart of Accounts Program Title

NH23IP922680

Amd 7

93. 268

333. 93. 26

07/ 01/ 26

06/ 30/ 27

07/ 01/ 26

06/ 30/ 27

1, 000

FFY26 Immunizations

Discre CDC YRl

NH231P922680

Amd 4

93. 268

333. 93. 26

07/ 01/ 25

06/ 30/ 26

07/ 01/ 25

06/ 30/ 26

750

1, 000

FFY26 Immunizations

Discre CDC YRl

NH231P922680

Amd 3

93. 268

333. 93. 26

07/ 01/ 25

06/ 30/ 26

07/ 01/ 25

06/ 30/ 25

250

NEI lOE000053

Amd 4

93. 967

333. 93. 96

07/ 01/ 25

11/ 30/ 27

12/ 01/ 22

11/ 30/ 27

FFY27 Immunizations

PH Infrastructure

Discre CDC YR1

Comp Al- LHJ

2, 000

200, 000

SFY1 GFS-

Group B Proviso

Amd 2

N/ A

334. 04. 90

07/ 01/ 25

06/ 30/ 26

07/ 01/ 23

06/ 30/ 25

20, 259

SFY2 GFS-

Group B

Amd 1

N/ A

334. 04. 90

01/ 01/ 25

06/ 30/ 25

07/ 01/ 23

06/ 30/ 25

25, 877

SFY27 FPHS- LHJ Funds- GFS

Amd 6

N/ A

336. 04. 25

07/ 01/ 26

06/ 30/ 27

07/ 01/ 26

06/ 30/ 27

1, 087, 000

3, 613, 000

SFY26 FPHS- LHJ Funds- GFS

Amd 3

N/ A

336. 04. 25

07/ 01/ 25

06/ 30/ 26

07/ 01/ 25

06/ 30/ 26

1, 087, 000

SFY25 FPHS- LHJ Funds- GFS

Amd

N/ A

336. 04. 25

01/ 01/ 25

06/ 30/ 25

07/ 01/ 24

06/ 30/ 25

1, 439, 000

YRl Stimulus-

Local Asst( 10% of 15%)

Amd 5

N/ A

346. 26. 64

01/ 01/ 26

12/ 31/ 27

07/ 01/ 23

06/ 30/ 28

1, 750

YRl Stimulus-

Local Asst( 10% of 15%)

Amd 5

N/ A

346. 26. 66

01/ 01/ 26

12/ 31/ 27

07/ 01/ 23

06/ 30/ 28

1, 000

TOTAL

Total

3, 970, 293

3, 939, 293

consideration:

3, 9709293

GRAND TOTAL

3, 970, 293

31, 000 GRAND

TOTAL

Assistance

3, 970, 293

Listing Number flea Catalog of Federal Domestic

Federal revenue

codes begin with" 333".

State revenue

Assistance

codes begin with"

334".

Page 1 of 1

Total Fed

308, 407

Total State

3, 6619886

DOH CONTRACT #:

January 1, 2025 — December 31, 2027

CONSOLIDATED CONTRACT Between

STATE OF WASHINGTON DEPARTMENT OF HEALTH And Cowlitz County Health & Human Services

Page 1 of 18

CLH32048

DOH CONTRACT #:

CLH32048

Table of Contents 1.

Purpose.....................................................................................................................................

of Work .................................................................................................................3

Statements

Exhibits....................................................................................................................................

Definitions...............................................................................................................................

Funding

4 and Billing.................................................................................................................

Contract

Management..............................................................................................................

Access

All Writings

to Records....................................................................................................................

Assignment..............................................................................................................................

10.

Assurances...............................................................................................................................

11.

Confidential Information.........................................................................................................

12.

Ethics

13.

Debarment

14.

Disputes ...................................................................................................................................

15.

Equipment

Purchases...............................................................................................................

Contained Herein................................................................................................

and Conflict of Interest.................................................................................................

Certification .......................................................................................................... 6

Governing Law and Venue...................................................................................................... Capacity ..............................................................................................................

17.

Independent

18.

Insurance..................................................................................................................................

19.

Licensing, Accreditation,

20.

Maintenance

16.

and Registration..............................................................................

of Records..........................................................................................................

and Waivers......................................................................................................

21.

Modifications

22.

No Third- Party Rights

23.

Nondiscrimination ...................................................................................................................

24.

Order of Precedence.................................................................................................................

25.

Ownership of Material/ Rights in Data.....................................................................................

26.

Public

27.

Publications..............................................................................................................................

28.

Responsibility

29.

Recapture.................................................................................................................................

30.

Loss

31.

Severability..............................................................................................................................

32.

Subcontracts.............................................................................................................................

33.

Subrecipient.............................................................................................................................

Records

Created................................................................................................

Act..................................................................................................................

8 9

for Actions.......................................................................................................9

Reduction

of Funding .................................................................................................9

34.

9 Survivability.............................................................................................................................

35.

Term.......................................................................................................................................

36.

Termination

for Convenience................................................................................................

37.

Termination

for Default.........................................................................................................

38.

Termination

Procedure ..........................................................................................................

Certifications and Assurances........................................................................

Standard

Federal

Federal Assurances-

Non- Construction

2025- 2027 Consolidated Contract

Programs....................................................................

Page 2 of 18

DOH CONTRACT #:

CONSOLIDATED

CLH32048

CONTRACT

between STATE

OF WASHINGTON

DEPARTMENT

OF HEALTH

Referred to as" DOH") and COWLITZ

COUNTY

HEALTH&

HUMAN

SERVICES

Referred to as " LHJ") for

THE DELIVERY

OF PUBLIC

HEALTH

SERVICES

FOR THE PERIOD OF

January 1, 2025 through December 31, 2027 1.

Purpose

This Contract is entered into in accordance with RCW 43. 70. 512, RCW 43. 70. 515, the general statutory powers of the

Secretary of the Department of Health ( DOH), including but not limited to RCW 43. 70. 020 and RCW 43. 70. 040, the general statutory powers of local health jurisdictions ( LHJs), and RCW 70. 05. 060, RCW 70. 05. 070, RCW 70. 08. 020, and RCW 70. 46. 060, the authority for joint or cooperative action provided for under RCW 39. 34, and any LHJ home rule charter

The purpose

authority.

of this Contract is to define the parties'

joint and cooperative relationship.

The

contract and all Statements of Work adopted under its provisions are intended to facilitate the delivery of public health

services to the people in Washington State. This Contract is the result of cooperative planning efforts between the LHJ and DOH and establishes the terms for reimbursement for services funded by state and federal grants. 2.

Statements of Work

The individual program activities, requirements, and outcomes/ deliverables to be achieved by the parties under this Contract shall be mutually agreed to and issued as Exhibit A, Statements of Work, subsequent to the execution of this Contract. The LHJ shall furnish the necessary personnel, equipment, material and/ or services and otherwise do all things

necessary for or incidental to the performance of the work as set forth. 3.

Exhibits

This Contract shall incorporate

mutually agreed to and issued amendments

throughout

the Contract term, as the

following Exhibits: Exhibit A-

Statements

of Work

Exhibit B— Allocations Exhibit C— Federal Grant Awards Index

Definitions

As used throughout this Contract and unless amended for a particular Statement of Work, the following terms shall have the meanings

set forth below:

Assistance Listing Number": The unique identifying code assigned to a federal assistance program which identifies the awarding agency. Budget,

Accounting,

and

Reporting

System ( BARS)":

The system designed by the State Auditor' s office for

collecting, consolidating, and reporting financial budgeting and accounting information from all local governmental units.

Client":

An agency, firm, organization, individual or other entity applying for or receiving services provided by

the LHJ under this Contract. Confidential

Information":

2025- 2027 Consolidated

Contract

Information protected from disclosure under federal or state law. Page 3 of 18

DOH CONTRACT #: CLH32048

Contract Coordinator": Officer":

Contracting

office authorized Contractor":

Each parry' s designated contact for all notices required or permitted under this Contract. The DOH

Contracts

and Procurement

Office

Director

and his/ her delegates

within

that

to execute this agreement on behalf of DOH.

An entity that provides

business in a competitive

goods

environment,

or services

to DOH and others.

A contractor normally operates its

provides its goods and/ or services to many different purchasers

during

normal business hours, and is not subject to the compliance requirements of the federal program. Equipment":

When used in this Contract is defined as an article of non- expendable, tangible property other than

land, buildings, or fixtures which is used in operations and having a useful life of more than one year and an acquisition

Federal

cost of$ 5, 000 or more ( State), $

Assistance":

10, 000 or more( Federal),

or as otherwise

stated.

Assistance provided by a federal agency in the form of grants, contracts, loans, loan

guarantees, property, cooperative agreements,

interest subsidies, insurance, or direct appropriations,

but does not

include direct federal cash assistance to individuals. Federal

Funding Accountability

and Transparency

Act( FFATA

or the

Transparency

Act)":

A federal act to make

information available online so the public can see how federal funds are spent. Fixed Assets":

Fixed assets are property and/ or equipment obtained through donation, gift, purchase, capital lease,

or construction with a service life of more than one year. Program Contact": resource, respective

Each party' s designated contact for those purposes identified in the Program Contacts List to each Statement

of Work.

Subcontractor":

Any individual or group contracted with the LHJ to perform all or part of the services included This term will also apply to situations where an LHFs subcontractor contracts with another individual or group to perform all or part of the services included in its agreement with the LHJ. in this Contract.

Subrecipient"

or " Subgrantee":

A non- federal entity that receives a subaward of federal grant money or goods directly or indirectly from DOH and makes decisions regarding who can receive what federal assistance; has its performance measured against the objectives contained in the DOH agreement with the federal government; makes decisions on how to operate the program to accomplish the program goals; has the obligation to comply with federal subrecipient requirements; authorizing 5.

and/ or use federal funds to carry out a program for the public purpose specified in the

statute.

Funding and Billing DOH shall pay the LHJ for services as set forth in Exhibit A, Statements of Work, not to exceed funding amounts

as detailed in Exhibit B, Allocations(

as executed).

The LHJ will advise the DOH Program Contact identified for a respective Statement of Work in writing 90 calendar

days prior to the end of the funded period, or as soon as practicable thereafter, if the LHJ anticipates not using all Contract funding. B.

If the Exhibit A, Statement of Work, is supported by federal funds that require compliance with FFATA ( the Transparency Act), the corresponding checkbox on the Statement of Work will be checked.

Total consideration for this Contract shall be modified by mutually agreed to amendments issued on a periodic basis.

The LHJ will submit accurate and timely billings which, for clarity and consistency, will be prepared using the A19 form provided and following the instructions located on the DOH Sharepoint page for LHJs. DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable costs as outlined in the Statement

of Work and/ or budget.

2025- 2027 Consolidated

Contract

Page 4 of 18

DOH CONTRACT #:

CLH32048

The LHJ will submit a DOH BARS Financial Report on a DOH- provided template by April 15th for the prior calendar year.

Contract Management Unless

otherwise

specified

in the Contract, the following individuals

the contacts("

are

Contract Coordinators")

for all

notices required or permitted under this Contract: LHJ Contract

Coordinator:

DOH Contract

Name: Carole Harrison

Name: Brenda Henrikson/ Shannon May

Title:

Director

Address:

Mailing

Contracts Specialist

Mailing Address:

1952 91h Avenue

PO Box 47905

Longview, WA 98632- 4045

Olympia, WA 98504- 7905

Address:

Physical

Same

Physical Address:

111 Israel Rd SE as above

Olympia, WA 98504- 7905

360- 414- 5599

Phone:

harrisonc&

360- 236- 3933/ 360- 236- 3946

Email Address:

Email Address: co. cowlitz.

brenda.henrikson& doh.wa.gov

wa. us

shannon.

A party may change its Contract Coordinator DOH Program

Coordinator:

Contacts

mayA doh.wa. gov

or its Program Contact by providing written notice to the other parry.

can be found in the Program

Contacts

List resource.

Access to Records

To the extent authorized by applicable federal and state law, the parties shall provide access to records relevant to this Contract

to each

other, the Joint Legislative

officials, at no additional cost.

Inspections

Audit

and Review

Committee,

the State

Auditor,

and authorized

federal

shall occur at reasonable times and upon reasonable notice.

All Writings Contained Herein

This Contract contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise,

regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. The individuals signing this Contract, and subsequent

amendments

certify by their signatures that they are authorized to sign this

Contract on behalf of their respective entity. 9.

Assignment

Except for subcontracting as authorized in this Contract, the LHJ shall not assign or delegate, in whole or in part, this Contract or any of its rights, duties, obligations,

or responsibilities,

without the prior written consent of DOH' s

Contracting Officer, which consent shall not be unreasonably withheld. 10. Assurances

The parties agree that all activity pursuant to this Contract shall be in accordance with all applicable current federal, state, and local laws, rules, and regulations.

The LHJ acknowledges its agreement to comply with federal certifications and assurances by signing and returning the following: 1.

Standard Federal Certifications and Assurances( page 12)

2. Federal Assurances for Non- Construction Programs ( page 17)

2025- 2027 Consolidated

Contract

Page 5 of 18

DOH CONTRACT #:

CLH32048

It. Confidential Information

The parties agree to comply with all state and federal statutes and regulations relating to Confidential Information.

DOH

and LHJ will limit access to the Confidential Information to the fewest number of people necessary to complete the work.

Everyone having access to Confidential

Information

covered by this Contract must agree to protect the

confidentiality of the information. Either party to this Contract may designate certain Confidential Requested." Confidential Information/

Information

as " Confidential

Information/ Notice

The designation shall be made by clearly stamping, watermarking, or otherwise marking each page of the If

Information.

Notice Requested,"

third- party

requestor

seeks

information

that

has

been

marked "

Confidential

notice shall be given to the marking party prior to release of the information. Such

notice shall be provided to the program contact no less than five ( 5) business days prior to the date of disclosure, to

allow the parry objecting to disclosure to seek a protective order from the proper tribunal. DOH and LHJ agree to establish, document, and maintain security practices and safeguards consistent with state and federal laws, regulations, standards, and guidelines to prevent unauthorized access, use, or disclosure of Confidential Information in any form. In accordance with federal and state contracting requirements,

DOH may monitor, audit, or

investigate LHJ management of Confidential Information relating to this Contract. Working together, the LHJ and DOH may use any and all tools available to track Contract related Confidential Information.

If one of the parties becomes aware of an actual or suspected breach of confidentiality, that party will promptly notify the Contract Coordinator for the other party of the facts. The parties will work within their respective organizations to

take any steps necessary to determine the scope of the breach and to restore reasonable security to the Confidential Information.

Both parties agree to mitigate any known harmful effects of a breach in confidentiality, including notifying

affected individuals to the extent required by law. The parties will also reasonably cooperate with law enforcement as appropriate.

12. Ethics and Conflict of Interest

Both parties and their officers shall comply with all ethics laws and procurement standards applicable to their activities

under this Contract, including RCW 42. 23 and RCW 42. 52, and 2 CFR 200. 318, and as subsequently amended. The LHJ must maintain and comply with written standards of conduct covering conflicts of interest and governing the actions

of its employees engaged in the selection, award, and administration of subcontracts. The LHJ must comply with the following minimum requirements:

No employee, officer, or agent may participate in the selection, award, or administration of a subcontract supported by a

grant award if they have

real

apparent

conflict

of interest.

Such a conflict of interest would

arise when the

employee, officer, or agent, any member of their immediate family, their partner, or an organization which employs or is about to employ any of the parties indicated herein, has a financial or other interest in or a tangible personal benefit

from a firm considered for a contract. The officers, employees, and agents of the LHJ may neither solicit nor accept gratuities, favors, or anything of monetary value from contractors or parties to subcontracts and must comply with Chapter 39. 26. 020 RCW. However, LHJ may set standards for situations in which the financial interest is not substantial, or the gift is an unsolicited item of nominal value. The standards of conduct must provide for disciplinary actions to be applied for violations of such standards by officers, employees, or agents of the LHJ. If a violation occurs and is not cured within a reasonable time after notice, the other party shall have the right to terminate

this Contract. This section is expressly subject to section 14. Disputes, in this Contract. 13.

Debarment

Certification

The LHJ, by signing this Contract, certifies that the LHJ is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in this Contract by any federal department or agency.

The LHJ also agrees to include the above requirement in all subcontracts into which it enters. The LHJ will notify DOH of any such events that may occur during the term of the Contract.

2025- 2027 Consolidated

Contract

Page 6 of 18

DOH CONTRACT #:

CLH32048

14. Disputes

Except as otherwise provided in this contract, when a dispute arises between the parties and it cannot be resolved by

direct negotiation, the parties agree to participate in good faith in non-binding mediation. The mediator shall be chosen by agreement of the parties.

If the parties cannot agree on a mediator, the parties shall use a mediation service located

in Washington State that selects a qualified mediator for the parties. Each party shall bear its own costs for mediation and each party shall contribute equally to the mediator' s fee, if any.

The parties agree that mediation shall precede any

action in a judicial tribunal. Nothing in this contract shall be construed to limit the parties'

choice of a mutually acceptable

alternate dispute

resolution method in addition to the dispute resolution procedure outlined above. 15. Equipment

Purchases

Equipment purchased by the LHJ for use by the LHJ or its subcontractors during the term of this Contract using federal

funds, in whole or in part, shall be the property of the LHJ. The use, management and disposal of the equipment must comply with federal requirements. These requirements are found in the Office of Management and Budget' s( OMB' s) Uniform Guidance, Title 2 Code of Federal Regulations

Part 200 ( 2 CFR 200)-

Uniform Administrative

Requirements,

Cost Principles, and Audit Requirements for Federal Awards, or are included in the federal funding agency' s regulations.

Equipment purchased by the LHJ for use by the LHJ or its subcontractors during the term of this Contract

using non- federal funds, in whole or in part, shall be the property of the LHJ unless noted otherwise in the respective Statement of Work.

16. Governing Law and Venue

The laws of the state of Washington govern this Contract, venue shall be proper only in Thurston County, Washington. 17. Independent Capacity

The employees or agents of each party who are engaged in the performance of this Contract shall continue to be employees or agents of that party and shall not be considered for any purpose to be employees or agents of the other party. 18. Insurance

The LHJ certifies that it is self- insured, is a member of a risk pool, or maintains insurance coverages sufficient to cover obligations under this Contract. Each party shall pay for losses for which it is found liable. The LHJ agrees to require all

subcontractors to maintain insurance in types and with limits as may be determined by the LHJ and/ or its risk manager, unless the LHJ and DOH agree otherwise.

19. Licensing, Accreditation, and Registration

The LHJ shall comply with all applicable local, state, and federal licensing, accreditation and registration requirements and standards, necessary for the performance of this Contract. 20. Maintenance of Records

Each parry to this Contract shall maintain books, records, documents, and other evidence that sufficiently and properly reflect all direct and indirect costs expended by it. All books, records, documents, and other material relevant to this Contract will be retained for six ( 6) years after expiration unless otherwise required for longer period. If any litigation,

claim, or audit is started before the expiration of the six-year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved.

Each party will use reasonable security procedures and protections to ensure that records and documents provided by the other party

are

not erroneously

disclosed

to third

parties.

Both parties agree to continue protecting records in

accordance with Section 11. Confidential Information, until such time as the information is destroyed in accordance with applicable

state and federal records retention laws.

2025- 2027 Consolidated

Contract

Page 7 of 18

DOH CONTRACT #:

21. Modifications

CLH32048

and Waivers

This Contract, or any term or condition, may be modified only by a written amendment signed by the DOH Contracting

Officer and the authorized representative for the LHJ. Either party may propose an amendment. However, any state or federal law, regulation, or grant funding requirement, including anything amended after the fact, that must be included in

order to receive or expend the grant funding is hereby incorporated by reference, and may be documented by letter amendment

from DOH to the LHJ.

Failure or delay on the part of either party to exercise any right, power, privilege, or remedy provided under this Contract shall not constitute a waiver. No provision of this Contract may be waived by either party except in a writing signed by the

DOH Contracting Officer or the authorized representative of the LHJ. 22.

No Third-Party Rights Created This Contract, or any program hereunder, is entered into solely for the benefit of the two parties thereto and shall not

be construed as giving rise to any right, remedy or expectancy of any kind or nature on the part of any third party. 23.

Nondiscrimination

During the performance of this Contract, the LHJ and DOH shall comply with all federal and state nondiscrimination laws, regulations, and policies.

In the event of the LHJ' s noncompliance or refusal to comply with any nondiscrimination

law,

regulation or policy, this Contract may be rescinded, canceled, or terminated in whole or in part, and the LHJ may be declared ineligible for fixrther contracts with DOH. The LHJ shall, however, be given a reasonable time in which to cure

this noncompliance. Any dispute may be resolved in accordance with the" Disputes" procedure set forth herein. 24. Order of Precedence

In the event of an inconsistency in the terms of this Contract, or between its terms and any applicable statute or rule, the inconsistency shall be resolved by giving precedence in the following order: Applicable state and federal statutes, and local laws, rules, regulations, and funding requirements. Terms and conditions Statements

of this Contract.

of Work.

Any other provisions of this Contract, including other materials incorporated by reference. 25. Ownership of Material/ Rights in Data Records and other documents relevant to this Contract, in any medium, furnished by one party to this Contract to the other

party, will

remain

the property

of the

furnishing party, unless otherwise

the Contract shall be transferred to DOH with a nonexclusive,

agreed.

Data which is delivered

under

royalty- free, perpetual, irrevocable license to publish,

translate, reproduce, modify, deliver, perform, dispose of, and to authorize others to do so; provided that such license shall be limited to the extent which the LHJ has a right to grant such a license. The LHJ shall exert all reasonable effort

to advise DOH, at the time of delivery of data furnished under this Contract, of all known or potential invasions of privacy contained therein and of any portion of such document which was not produced in the performance of this

Contract. DOH shall receive prompt written notice of each notice or claim or copyright infringement received by the LHJ with respect to any data delivered under this Contract. DOH shall have the right to modify or remove any restrictive markings placed upon the data by the LHJ, provided that if DOH modifies or removes such markings without the LHJ' s

approval, it assumes all liability for doing so. 26. Public Records Act

Notwithstanding Sections 11 or 18, the parties to this contract are public bodies subject to the Public Records Act, RCW 42. 56 ( PRA). Under the PRA, all materials relating to the conduct of government or the performance of any governmental or proprietary function prepared, owned, used, or retained by a public body or its functional equivalents are considered public records. The PRA requires that public records responsive to a public records request be promptly produced unless the PRA or an" other statute" exempts such records from production. This Contract is not intended to alter any party' s obligations under the PRA. The parties agree that if one party receives a public records request

receiving party) for files that may include confidential information under General Terms and Conditions Section 11 Confidentiality/ Safeguarding of Information), the receiving party will notify the other party of the request and of the 2025- 2027 Consolidated

Contract

Page 8 of 18

DOH CONTRACT #: CLH32048

date that the records will be released to the requester unless the other party obtains a court order enjoining disclosure. If the other party fails to obtain the court order enjoining disclosure, the receiving party may release the requested

information on the date specified. Ifthe other party obtains a court order from a court of competent jurisdiction enjoining disclosure pursuant to the PRA, the receiving party shall maintain the confidentiality of the information per the court order.

27. Publications

Any program reports, articles, and publications that result from information gathered through use of state and federal

funds must acknowledge receiving support from DOH and/ or the appropriate federal agencies. Correspondingly, such documents resulting from information gathered through use of local funds must acknowledge receipt of such local support.

28. Responsibility for Actions

Each party to this Contract shall be solely responsible for the acts and omissions of its own officers, employees, and agents in the performance of this Contract. Neither party to this Contract will be responsible for the acts and omissions

of entities or individuals not party to this Contract. DOH and the LHJ shall cooperate in the defense of tort lawsuits, when possible. 29. Recapture

In the event that the LHJ fails to perform this contract in accordance with state or federal laws, and/ or the provisions of this Contract,

DOH reserves

the right to recapture

funds in an amount to compensate

DOH for the noncompliance,

including the amount of any grant funds administered pursuant to this contract. 30. Loss or Reduction of Funding

In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after the effective date of this contract and prior to normal completion, DOH may elect to suspend or terminate the contract, in whole or in part, under the " Termination for Convenience" clause with a ten ( 10) business day notice to LHJ, to the extent possible, subject to renegotiation at DOH' s discretion under those new funding limitations and conditions. 31. Severability If any term or condition of this Contract is held invalid, such invalidity shall not affect the validity of the other terms or

conditions of this Contract, provided, however, that the remaining terms and conditions can still fairly be given effect. 32. Subcontracts

Unless specifically noted as not allowable within a Statement of Work, the LHJ may subcontract any or all the services or other obligations specified in this Contract. The LHJ will require the subcontractor to comply with all the applicable terms and conditions of this Contract, including all terms, conditions, certifications, and assurances. The LHJ agrees it is responsible for assuring adequate performance on the part of the subcontractor.

The parties agree that all subcontractors must be responsible for any liabilities created by their actions or omissions. In the event DOH, LHJ, and subcontractor are found by a jury or trier of fact to be jointly and severally liable for personal injury damages arising from any act or omission, then each entity shall be responsible for its proportionate share. 33. Subrecipient

For those activities designated as" subrecipient"

in Exhibit A, Statements of Work, the LHJ must comply with applicable

federal requirements, including but not limited to OMB' s Uniform Guidance at 2 CFR 200, Subparts D ( Post Federal Award Requirements), as

any of these

E ( Cost Principles)

requirements

and F ( Audit Requirements),

may subsequently

be amended.

If the LHJ

and program specific federal regulations, expends $

and

1, 000,000 or more in federal grants

or awards from all sources, it is responsible for obtaining the required single audit. 34. Survivability The terms and conditions contained in this Contract, which by their sense and context are intended to survive the

expiration of the Contract, shall survive. Surviving terms include, but are not limited to: Access to Records, Confidential 2025- 2027 Consolidated

Contract

Page 9 of 18

DOH CONTRACT #: CLH32048

Information, Disputes, Responsibility for Actions, Maintenance of Records, Ownership of Material/Rights in Data, Subcontracts,

Recapture,

Termination

for Convenience,

Termination

for Default, and Termination

Procedure.

35. Term

This Contract will be in effect following execution by the parties from January 1, 2025 through December 31, 2027, unless terminated earlier as provided herein. 36. Termination for Convenience

Except as otherwise provided in this Contract, either party may terminate or suspend this Contract, or any program hereunder, for convenience by providing at least thirty (30) days' advance written notice to the other party. If DOH elects to suspend the Contract, in whole or in part, LHJ shall stop work as of the effective date of DOH' s written notice of suspension.

During suspension, each Party will reasonably notify the other of any conditions that may affect

resumption of performance. Upon DOH' s written notice to resume performance, LHJ shall resume work unless the LHJ provides

notice

to DOH that services

cannot be resumed.

If LHJ cannot resume performance,

the Contract or

affected Exhibit A, Statement of Work, will be deemed terminated upon the date the LHJ received notice to suspend performance. 37. Termination for Default

a) In the event of a default by either party under this Contract, the nondefaulting party may give written notice to the

defaulting party that it intends to terminate this Contract, or any program hereunder, if the default is not cured within thirty( 30) days of the date of the notice, or such longer period of time as may be reasonable under the circumstances.

If the default is not cured within that time, the nondefaulting party may then notify the defaulting party in writing that this Contract is terminated.

In the event of such termination, the nondefaulting party shall have all rights and

remedies available to it under general law. b) A disputed termination for default is expressly subject to the Disputes section of this Contract. 38. Termination

Procedure

Upon termination DOH may require the LHJ to deliver to DOH any non- LHJ- owned equipment, data, or other property specifically produced or acquired for the performance of such part of this Contract as has been terminated.

DOH shall pay to the LHJ the agreed upon price, if separately stated, for completed work and services accepted by DOH. In addition, DOH shall pay the amount determined by DOH' s Contracting Officer for ( a) completed work and

services for which no separate price is stated, ( b) partially completed work and services, ( c) other property or services which are accepted by DOH, and ( d) the protection and preservation of the property. Disagreement by the LHJ with the determination of DOH' s Contracting Officer that relates to the obligations or amounts due to the LHJ shall be considered a dispute within the meaning of the " Disputes" clause of this Contract. DOH may withhold from any amounts due the LHJ for such completed work or services such sum as DOH' s Contracting Officer reasonably determines to be necessary to protect DOH against potential loss or liability. The rights and remedies of DOH provided in this section shall not be exclusive and are in addition to any other rights and remedies provided by law or under this Contract. After receipt of a written notice of termination,

the LHJ shall:

Stop work under the Contract on the date and to the extent specified in the notice. Place no further orders or subcontracts for materials, services, or facilities, except as necessary to complete such portion of the work not terminated. Assign to DOH, to the extent reasonably directed by DOH' s Contracting Officer and to the extent that the LHJ has the legal right to do so, all of the right, title, and interest of the LHJ under the orders and subcontracts in

which case DOH has the right, at its reasonable discretion, to settle or pay any or all claims arising out of the termination

of such orders and subcontracts.

2025- 2027 Consolidated

Contract

Page 10 of 18

DOH CONTRACT #: CLH32048

Settle all outstanding liabilities and all claims arising out of orders or subcontracts, with the approval or ratification of DOH' s Contracting Officer to the extent he/ she may reasonably require, which approval or ratification shall be final for all the purposes of this clause. Transfer title to DOH and deliver, as reasonably directed by DOH' s Contracting Officer, any property which, if the Contract had been completed,

would have been required to be furnished to DOH.

Complete performance of such part of the work not terminated by DOH' s Contracting Officer; and, Take such action as may be necessary, or as DOH' s Contracting Officer may reasonably direct, for the protection

and preservation of the property related to this Contract, which is in the possession of the LHJ, or its subcontractors, and in which DOH has or may acquire an interest.

IN WITNESS WHEREOF, the parties have executed this Contract. COWLITZ

HEALTH &

COUNTY

HUMAN SERVICES

STATE OF WASHINGTON DEPARTMENT

Signature: rcGurycf RicM1artlRDaM1l

Title:

Declo,

Signature:

1aGrL zoze3,

sil

Chairman,

Print Name:

Date:

OF HEALTH

Cowlitz

Richard

Coy

R Dahl

Dec 10, 2024

2025- 2027 Consolidated

Hmnkzon(

Title:

30341

171

Contracts Specialist

Print Name:

Date:

Contract

DK10,

Brenda Henrikson

Dec 10, 2024

Page 11 of 18

DOH CONTRACT #:

CLH32048

Standard Federal Certifications and Assurances

Following are the Assurances, Certifications, and Special Conditions that apply to all federally funded( in whole or in part) agreements administered by the Washington State Department of Health, including but not limited to Exhibit A Statements of Work designated

as" subrecipient"

CERTIFICATIONS 1.

CERTIFICATION

REGARDING

The undersigned ( authorized

DEBARMENT

AND SUSPENSION

official signing for the contracting

organization)

certifies to the best of his or her

knowledge and belief, that the contractor, defined as the primary participant in accordance with 45 CFR Part 76, and its principals:

A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal Department or agency. B.

Have not within a three- year period preceding this contract been convicted of or had a civil judgment rendered

against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public ( Federal, State, or local) transaction or contract under a public transaction; violation of

Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; C.

Are not presently indicted or otherwise criminally or civilly charged by a governmental entity ( Federal, State, or local) with commission of any of the offenses enumerated in paragraph( b) of this certification; and

Have not within a three- year period preceding this contract had one or more public transactions( Federal, State, or local) terminated

for cause or default.

Should the contractor not be able to provide this certification,

an explanation as to why should be placed after the

assurances page in the contract. The contractor agrees by signing this contract that it will include, without modification, the clause titled Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion-- Lower Tier Covered Transactions in all lower tier covered transactions( i.e., transactions with sub- grantees and/or contractors) and in all solicitations for lower tier covered

transactions

in accordance

with 45 CFR Part 76.

CERTIFICATION REGARDING DRUG- FREE WORKPLACE REQUIREMENTS

The undersigned( authorized official signing for the contracting organization) certifies that the contractor will, or will

continue to, provide a drug- free workplace in accordance with 45 CFR Part 76 by: A. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee' s workplace and specifying the actions that will be taken against employees for violation of such prohibition. B.

Establishing an ongoing drug- free awareness program to inform employees about: 1)

The Dangers of drug abuse in the workplace.

The contractor' s policy of maintaining a drug- free workplace.

Any available drug counseling, rehabilitation, and employee assistance programs; and

The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace.

2025- 2027 Consolidated

Contract

Page 12 of 18

DOH CONTRACT #: CLH32048

Making it a requirement that each employee to be engaged in the performance of the contract be given a copy of the statement required by paragraph 1) above.

Notifying

the employee

in the statement

required

by paragraph

1),

above, that, as a condition

of employment

under the contract, the employee will: 1)

Abide by the terms of the statement; and

Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace

no later than five calendar days after such conviction.

Notifying the agency in writing within ten ( 10) calendar days after receiving notice under paragraph D. 2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must

provide notice, including position title, to every contract officer or other designee on whose contract activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such

notices. Notice shall include the identification number( s) of each affected grant. F.

Taking one of the following actions, within 30 calendar days of receiving notice under paragraph D. 2) with

respect to any employee who is so convicted: 1)

Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements

of the Rehabilitation

Act of 1973, as amended;

Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement,

or other appropriate

agency. G.

Making a good faith effort to continue to maintain a drug- free workplace through implementation of paragraphs A),( B), ( C), ( D), ( E), and( F).

For purposes of paragraph( E) regarding agency notification of criminal drug convictions, DOH has designated the following central point for receipt of such notices: Compliance

and Internal

Control

Officer

Department of Health— Office of Financial

Services

PO Box 47901 Olympia, WA

CERTIFICATION

98504- 7901

REGARDING

Title 31, United States Code, Federal

contracting

and

LOBBYING

Section

financial

1352, entitled " Limitation

transactions,"

on use of appropriated

funds to influence

certain

generally prohibits recipients of Federal grants and cooperative

agreements from using Federal( appropriated) funds for lobbying the Executive or Legislative Branches of the Federal

Government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also requires that each person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with

non-Federal( non- appropriated) funds. These requirements apply to grants and cooperative agreements EXCEEDING 100, 000 in total costs( 45 CFR Part 93).

The undersigned ( authorized official signing for the contracting knowledge

organization)

certifies, to the best of his or her

and belief, that:

A. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person

for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any

Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. B.

If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee

of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or 2025- 2027 Consolidated

Contract

Page 13 of 18

DOH CONTRACT #: CLH32048

cooperative agreement, the undersigned shall complete and submit Standard Form- LLL," Disclosure of Lobbying

Activities,"

its instructions,

with

accordance

The undersigned

its

instructions. (

and continuation

If needed,

Standard

Form- LLL, "

sheet are included at the end of the

shall require that the language

of this certification

Disclosure

application

of Lobbying

form.)

be included in the award documents

for all

subcontracts at all tiers( including subcontracts, subcontracts, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering this transaction imposed by Section 1352, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$

10, 000 and not more than$

CERTIFICATION

REGARDING

100, 000 for each such failure.

PROGRAM

FRAUD CIVIL REMEDIES

ACT( PFCRA)

The undersigned( authorized official signing for the contracting organization) certifies that the statements herein are

true, complete, and accurate to the best of his or her knowledge, and that he or she is aware that any false, fictitious, or fraudulent

statements

or claims may subject him or her to criminal, civil, or administrative

penalties.

The

undersigned agrees that the contracting organization will comply with the Public Health Service terms and conditions of award if a contract is awarded.

CERTIFICATION

REGARDING ENVIRONMENTAL

TOBACCO SMOKE

Public Law 103- 227, also known as the Pro- Children Act of 1994 ( Act), requires that smoking not be permitted in

any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under

the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law also applies to children' s services that are provided in indoor

facilities that are constructed, operated, or maintained with such Federal funds. The law does not apply to children' s services provided in private residence, portions of facilities used for inpatient drug or alcohol treatment, service

providers whose sole source of applicable Federal funds is Medicare or Medicaid, or facilities where WIC coupons are redeemed.

Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to

1, 000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. By signing the certification, the undersigned certifies that the contracting organization will comply with the requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision

of services for children as defined by the Act. The contracting organization

agrees that it will require that the language of this certification be included in any

subcontracts which contain provisions for children' s services and that all subrecipients shall certify accordingly. The Public Health Services strongly encourages all recipients to provide a smoke- free workplace and promote the non- use of tobacco products. This is consistent with the PHS mission to protect and advance the physical and mental

health of the American people. 6.

DEBARMENT,

SUSPENSION,

AND

OTHER

RESPONSIBILITY

MATTERS -

INSTRUCTIONS

FOR

CERTIFICATION

By signing and submitting this certification, the prospective contractor is providing the certification set out below. A. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective contractor shall submit an explanation of why it cannot

provide the certification set out below. The certification or explanation will be considered in connection with the department

or agency' s determination

whether to enter this transaction.

However, failure of the prospective

contractor to furnish a certification or an explanation shall disqualify such person from participation in this transaction.

2025- 2027 Consolidated

Contract

Page 14 of 18

DOH CONTRACT #: CLH32048

The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter this transaction. If it is later determined that the prospective contractor

knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause of default. C.

The prospective contractor shall provide immediate written notice to the department or agency to whom this contract is submitted if at any time the prospective contractor learns that its certification was erroneous when

submitted or has become erroneous by reason of changed circumstances. D.

The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the

meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the person to whom this contract is submitted for assistance in obtaining a copy of those regulations. E.

The prospective contractor agrees by submitting this contract that, should the proposed covered transaction be entered, it shall not knowingly enter any lower tier covered transaction with a person who is debarred, suspended,

declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by DOH.

The prospective contractor further agrees by submitting this contract that it will include the clause titled Certification

Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered Transaction, provided by HHS, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. G.

A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier

covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List of excluded parties at https: Hsam. gov/ content/ home. H. Nothing contained in the foregoing shall be construed to require establishment of a system of records to render in

good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 1.

Except for transactions authorized under paragraph F. of these instructions, if a participant in a covered transaction knowingly

enters a lower tier covered transaction with a person who is suspended, debarred, ineligible,

voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, DOH may terminate this transaction for cause or default. 7.

CERTIFICATION MATTERS -

REGARDING

PRIMARY

COVERED

DEBARMENT,

SUSPENSION,

AND

OTHER

RESPONSIBILITY

TRANSACTIONS

A. The contractor certifies to the best of its knowledge and belief, that it and its principals: 1)

Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded

from covered transactions by any Federal department or agency. 2)

Have not within a three- year period preceding this contract been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,

or performing a public( Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement,

theft, forgery, bribery, falsification or

destruction of records, making false statements, or receiving stolen property; 3)

Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity( Federal,

State, or local) with commission of any of the offenses enumerated in paragraph A.2. of this certification; and 4)

Have not within a three- year period preceding this contract had one or more public transactions ( Federal, State, or local) terminated

2025- 2027 Consolidated

Contract

for cause or default.

Page 15 of 18

DOH CONTRACT #: CLH32048

Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective contractor shall attach an explanation

to this contract.

AUTHORIZED SIGNATURE OF AUTHORIZED

CERTIFYING OFFICIAL

Vlc6rayd IVa* u. rna. n a Dahl lox 10,—

Richard

R Dahl

REQUIRED

TITLE

Chairman,

tasi- S

PLEASE

SIGNATURE

OR TYPE NAME:

2025- 2027 Consolidated

Cowlitz Coy

DATE

Dec 10, 2024

Contract

Page 16 of 18

DOH CONTRACT #:

Federal

Assurances —

CLH32048

Non- Construction Programs

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and

reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, Reduction

including suggestions

Project(

PLEASE

0348- 0040),

DO NOT RETURN

BUDGET.

Note:

for reducing this burden, to the Office of Management

Washington,

and Budget, Paperwork

DC 20503.

YOUR COMPLETED

FORM TO THE OFFICE

OF MANAGEMENT

SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING

AND

AGENCY.

Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

As the duly authorized representative of the contractor, I certify that the contractor: 1.

Has the legal authority to apply for Federal assistance,

and the institutional,

managerial,

and financial capability

including funds sufficient to pay the non- Federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2.

Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or

agency directives. 3.

Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the

appearance of personal or organizational conflict of interest, or personal gain. 4.

Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

Will comply with the Intergovernmental

Personnel Act of 1970( 42 U. S. C. § 4728- 4763) relating to prescribed standards

for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards 6.

for a Merit System of Personnel Administration(

5 C. F. R. 900, Subpart F).

Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: ( a) Title VI of the Civil Rights Act of 1964( P. L. 88- 352) which prohibits discrimination on the basis of race, color or national origin; b) Title IX of the Education Amendments

of 1972,

amended (

20 U. S. C. §

1681- 1683,

and

1685- 1686),

which

prohibits discrimination on the basis of sex; ( c) Section 504 of the Rehabilitation Act of 1973, as amended ( 29 U. S. C. 794), which prohibits discrimination on the basis of handicaps; ( d) the Age Discrimination Act of 1975, as amended 42 U.S. C. §

6101- 6107), which prohibits discrimination on the basis of age;( e) the Drug Abuse Office and Treatment

Act of 1972( P. L. 92- 255), as amended, relating to nondiscrimination Alcohol

Abuse

and Alcoholism

Prevention,

relating to nondiscrimination

on the basis

Act of 1912 ( 42 U. S. C. §

290 dd- 3 and 290

patient

records; ( h)

on the basis of drug abuse; ( f) the Comprehensive

Treatment and Rehabilitation

of alcohol ee- 3),

abuse or alcoholism;(

Act of 1970 ( P. L. 91- 616),

as amended,

g) § 523 and 527 of the Public Health Service

as amended, relating to confidentiality of alcohol and drug abuse

Title VIII of the Civil Rights Act of 1968 ( 42 U. S. C. §

3601 et seq.),

as amended, relating to

nondiscrimination in the sale, rental or financing of housing; ( i) any other nondiscrimination provisions in the specific statute( s) under which application for Federal assistance is being made; and 0) the requirements of any other nondiscrimination statute( s) which may apply to the application. 7.

Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 ( P. L. 91- 646) which provide for fair and equitable treatment of

persons displaced or whose property is acquired because of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.

2025- 2027 Consolidated

Contract

Page 17 of 18

DOH CONTRACT #: CLH32048

Will comply,

as applicable,

with the provisions of the Hatch Act ( 5 U.S. C. §

1501- 1508 and 7324- 7328) which limit

the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. Will comply, as applicable, with the provisions of the Davis- Bacon Act( 40 U. S. C. § 276a to 276a- 7), the Copeland Act 40 U. S. C. § 276c and 18 U. S. C. § 874) and the Contract Work Hours and Safety Standards Act( 40 U. S. C. § 327- 333),

regarding labor standards for federally assisted construction sub- agreements.

10. Will comply, if applicable, with flood insurance purchase requirements of Section 102( a) of the Flood Disaster Protection Act of 1973 ( P. L. 93- 234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $ 10, 000 or more. 11.

Will

comply with

environmental

which

may be

prescribed pursuant

quality control measures under the National Environmental

Executive Order ( EO)

pursuant

standards

to EO

11514; ( b)

of violating facilities

notification

pursuant

11990; ( d) evaluation of flood hazards in floodplains

to the

following: ( a) institution

Policy Act of 1969 ( P. L. 91- 190) and to EO

11738; (

c) protection of wetlands

in accordance with EO 11988; ( e) assurance

project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 ( 16 U. S. C. § 1451 et seq.); ( f)conformity of Federal actions to State( Clear Air) Implementation Plans under Section 176( c) of the Clean Air Act of 1955, as amended ( 42 U. S. C. § 7401 et seq.); ( g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, ( P. L. 93- 523); and ( h) protection of endangered

species under the Endangered

Species Act of 1973, as amended, ( P. L. 93- 205).

12. Will comply with the Wild and Scenic Rivers Act of 1968 ( 16 U. S. C. §

1721 et seq.) related to protecting components

or potential components of the national wild and scenic rivers system.

13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966,

amended (

Archaeological

16 U. S. C. §

470),

11593 ( identification

and protection

and Historic Preservation Act of 1974( 16 U. S. C. § 469a- 1

of historic

properties),

and

the

et seq.).

14. Will comply with P. L. 93- 348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. Animal Welfare Act of 1966 ( P. L. 89- 544, as amended, 7 U. S. C. § 2131 et seq.) pertaining to the care, handling, and treatment of warm- blooded animals held for research, teaching, or other activities

15. Will comply with the Laboratory

supported by this award of assistance. 16. Will comply with the Lead- Based Paint Poisoning Prevention Act( 42 U.S. C. § 4801

et seq.) which prohibits the use of

lead- based paint in construction or rehabilitation of residence structures.

17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit requirements in OMB Uniform Guidance at 2 CFR 200, Subpart F, and any subsequent amendment. 18. Will comply with 2 CFR 200. 216, and any subsequent video surveillance

services

amendment—

Prohibition

on certain

telecommunications

and

or equipment.

19. Will comply with all applicable requirements

of all other Federal laws, executive orders, regulations,

and policies

governing this program. AUTHORIZED SIGNATURE OF AUTHORIZED

CERTIFYING OFFICIAL

Plchakd Pa* R., h

10, MN

Richard

R Dahl

REQUIRED

TITLE

Chairman,

13: 57 PST)

PLEASE

SIGNATURE

OR TYPE NAME:

2025- 2027 Consolidated

Cowlitz

Coy

DATE

Dec 10, 2024

Contract

Page 18 of 18

COWLITZ

Consolidated 2025-

15,

local

Contract Overview

2027Source

Under1

lTz Co(,

Go'

COUNTY

health

boards

and

health

officers

are

considered

extensions

QS1iINGS a

of Funds: State/ Federal

State Department of Health. Local health departments are responsible for supporting the preservation of life and health of all

residentsWashington

n. This responsibilityincludes:

INFORM

THE PUBLIC

about the causes,

MITIGATE &

nature,

and prevention of diseases and disabilities.

TAKE

PREVENT

the spread of dangerous

and

infectious diseases and nuisances

that are detrimental

EDUCATE

MEASURES

to promote overall

public

health and

public

maintain

health and

sanitation.

and enforce state

public health statutes, rules, and regulations.

to public health. Public

Health

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This includes everything up to Amendment 7 PHONE:

•

ILongview, Updated

08/ 25/ 2026

COWLITZ COUNTY HEALTH & HUMAN SERVICES 2025- 2027 CONSOLIDATED

NUMBER:

CONTRACT

CLH32048

AMENDMENT

NUMBER:

PURPOSE OF CHANGE: To amend this contract between the DEPARTMENT OF HEALTH hereinafter referred to as DOH", and COWLITZ

COUNTY

HUMAN SERVICES, a Local Health Jurisdiction, hereinafter referred to

HEALTH&

LHJ",

pursuant to the Modifications/ Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. as "

IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1.

Adds Statements of Work for the following programs: Office of Drinking Water Group B Program- Effective July 1, 2025 Amends Statements of Work for the following programs: Deletes Statements of Work for the following programs: 2.

Exhibit B- 2 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B- 1 Allocations as follows:

Increase of$ 20, 259 for a revised maximum consideration of$ 1, 516, 766. Decrease

for a revised maximum

consideration

No change in the maximum consideration of

Exhibit B Allocations are attached only for informational purposes. 3.

Exhibit C Federal

Grant Awards Index, incorporated

by this reference, and located in the ConCon, Funding&

BARS

library at the URL provided above. Unless

designated

otherwise

herein, the effective

date of this amendment

is the date of execution.

ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect.

IN WITNESS

COWLITZ

WHEREOF,

COUNTY

the undersigned

HEALTH&

has affixed his/ her signature

HUMAN

SERVICES

Signature:

in execution

thereof.

STATE OF WASHINGTON DEPARTMENT

OF HEALTH

Signature:

Richard R Dahl( Hug 12, 20251158: 09 PDT)

Date:

Aug 12, 2025

Aug 12, 2025 APPROVED

AS TO FORM ONLY

Assistant Attorney General

Page

1 of 1

EXHIBIT B- 2 Cowlitz

County Health&

Human Services

ALLOCATIONS Contract

Indirect

Rate as of January

1, 2025: Direct Allocation

Contract Number:

CLH32048

Date:

July 1, 2025

Term: 2025- 2027

of Costs DOH Use Only Federal Award

Chart of Accounts

Program Title

FFY24 PHEP BPI- CDC- LHJ Partners

BARS

Statement

Assist

Revenue

LHJ Funding

of Work Period

Chart of Accounts

Funding

Funding Period

Chart

Period

Accounts

Identification#

Amend#

List#*

Code**

Start Date End Date Start Date

End Date

Amount

SubTotal

Total

NU90TU000055

Amd 1

93. 069

333. 93. 06

01/ 01/ 25

06/ 30/ 25

07/ 01/ 24

06/ 30/ 25

31, 630

SFY1 GFS-

Group B Proviso

Amd 2

N/ A

334. 04. 90

07/ O1/ 25

06/ 30/ 26

07/ O1/ 23

06/ 30/ 25

20, 259

SFY2 GFS-

Group B

Amd 1

N/ A

334. 04. 90

01/ 01/ 25

06/ 30/ 25

07/ 01/ 23

06/ 30/ 25

25, 877

Amd 1

N/ A

336. 04. 25

01/ 01/ 25

06/ 30/ 25

07/ 01/ 24

06/ 30/ 25

1, 439, 000

SFY25 FPHS- LHJ Funds- GFS

TOTAL

Total consideration:

1, 496, 507

1, 439, 000

1, 516, 766

GRAND

TOTAL

1, 516, 766

20, 259 GRAND

TOTAL

1, 516, 766

Total Fed Total State

Assistance Listing Number fka Catalog of Federal Domestic Assistance Federal

revenue

codes

begin with" 333".

State revenue

codes begin with" 334".

Page 1 of 1

31, 630 1, 485, 136

COWLITZ COUNTY HEALTH &

HUMAN SERVICES

2025- 2027 CONSOLIDATED

CONTRACT

PURPOSE

NUMBER:

OF CHANGE:

DOH", and COWLITZ

CONTRACT

CLH32048

AMENDMENT

To amend this contract between

COUNTY

HEALTH&

the DEPARTMENT

OF HEALTH

NUMBER:

hereinafter

referred to as

HUMAN SERVICES, a Local Health Jurisdiction, hereinafter referred to

LHJ",

pursuant to the Modifications/Waivers clause, and to make necessary changes within the scope of this contract and any subsequent amendments thereto. as"

IT IS MUTUALLY AGREED: That the contract is hereby amended as follows: 1.

sharepoint.

com/

sites/

doh- ofsfundingresources/

home.

sitepages/

aspx?=

e 1: 9a94688da2d94d3ea8Oac7fbc32e4d7c

Adds Statements of Work for the following programs:

Foundational Public Health Services - Effective July 1, 2025 Office of Immunization- Perinatal Hepatitis B - Effective Office of Resiliency&

July 1, 2025

Health Security- PHEP- Effective July 1, 2025

Amends Statements of Work for the following programs:

Deletes Statements of Work for the following programs: 2.

Exhibit B- 3 Allocations, attached and incorporated by this reference, amends and replaces Exhibit B- 2 Allocations as follows: Increase of$ 1, 132, 027 for a revised maximum consideration

Decrease

for a revised maximum

No change in the maximum

consideration

of$ 2, 648, 793.

Exhibit B Allocations are attached only for informational purposes. 3.

Exhibit C Federal Grant Awards Index, incorporated

by this reference, and located in the ConCon, Funding&

BARS

library at the URL provided above. Unless designated

otherwise herein, the effective date of this amendment

ALL OTHER TERMS AND CONDITIONS

is the date of execution.

of the original contract and any subsequent amendments remain in full force

and effect.

IN WITNESS

COWLITZ

WHEREOF,

COUNTY

Signature: Richard

the undersigned

HEALTH&

has affixed his/ her signature in execution thereof.

HUMAN SERVICES

STATE OF WASHINGTON DEPARTMENT

OF HEALTH

Signature:

n-`

Richard R Dahh( Sep(Sepp 9, 202510: 45:41 PDT)

Date:

Sep 9, 2025

Sep 9, 2025 APPROVED AS TO FORM ONLY

Assistant Attorney General

Page 1 of 1

EXHIBIT Cowlitz

County Health&

Human Services

B- 3

ALLOCATIONS

Contract Number:

CLH32048

Date:

August 1, 2025

Contract Term: 2025- 2027

Indirect

Rate as of January

1, 2025: Direct Allocation

of Costs DOH Use Only Federal Award

Chart of Accounts Program Title

of Work

BARS

Statement

Assist

Revenue

LHJ Funding

Period

Chart of Accounts

Funding

Funding Period

Chart

Period

Accounts Total

Identification#

Amend#

List#*

Code**

Start Date End Date Start Date End Date

Amount

SubTotal

FFY25 PHEP BP2- CDC- LHJ Partners

NU90TU000055

Amd 3

93. 069

333. 93. 06

07/ O1/ 25

06/ 30/ 26

07/ O1/ 25

06/ 30/ 26

44, 777

FFY24 PHEP BP1- CDC- LHJ Partners

NU90TU000055

Amd 1

93. 069

333. 93. 06

01/ O1/ 25

06/ 30/ 25

07/ O1/ 24

06/ 30/ 25

31, 630

FFY26 Immunizations

NGA Not Received

Amd 3

93. 268

333. 93. 26

07/ O1/ 25

06/ 30/ 26

07/ O1/ 25

06/ 30/ 25

5250

250

Group B Proviso

Amd 2

N/A

334. 04. 90

07/ O1/ 25

06/ 30/ 26

07/ O1/ 23

06/ 30/ 25

20, 259

Group B

Amd 1

N/A

334. 04. 90

01/ O1/ 25

06/ 30/ 25

07/ O1/ 23

06/ 30/ 25

25, 877

SFY26 FPHS- LHJ Funds- GFS

Amd 3

N/ A

336. 04. 25

07/ O1/ 25

06/ 30/ 26

07/ O1/ 25

06/ 30/ 26

1, 0879000

190879000

2, 526, 000

SFY25 FPHS- LHJ Funds- GFS

Amd 1

N/A

336. 04. 25

01/ O1/ 25

06/ 30/ 25

07/ O1/ 24

06/ 30/ 25

1, 439, 000

29648, 793

2, 648, 793

SFY1

GFS-

SFY2 GFS-

Discre CDC YR1

TOTAL

Total

consideration:

1, 516, 766

GRAND TOTAL

76, 407

2, 648, 793

1, 132, 027 GRAND

TOTAL

2, 648, 793

Total Fed Total State

Assistance

Listing Number fka Catalog of Federal Domestic Assistance codes begin with" 333". State revenue codes begin with" 334".

Federal revenue

Page 1 of 1

769657 2, 5729136

233342

BOCC

Motion

Item

Agenda

Meeting Date: 9/ 15/ 2026 Contract with Progress Center

Submitted By: Amanda Foshaug, Accounting Specialist II Submitted For: Gena James, HHS Deputy Director Department:

Human

Services

Dept

Information

Subject and Summary Statement

The purpose of this County Contract# 26- 020 with Progress Center is to provide developmental

disability child development services. is paid on a cost

This contract

reimbursement

basis, not

exceed $ 126, 940. 00, during

the period July 1,

2026, through June 30, 2027. Funding for this contract is passed through from the County' s contract with State Department

Washington

of Social & Health Services, Developmental Disabilities Administration.

Contract/ SOW Name

Current

Original

Change

Total

126, 940. 00

ITime Period 7/ 01/ 26- 6/ 30/ 27

Staff Attendance Gena James

Department

It is the

Recommendation

recommendation

of the Cowlitz County Health&

Human Services that the Cowlitz County

Board of Commissioners move to approve this Contract 26- 020 with Progress Center. Attachments 26- 020

DD-

Progress

Center

Form

Task

User

Foshaug,

Amanda

Agenda

Item

Submission

Drake,

Jamie

Preliminary

Review-

James,

Gena

Department

Approver

HHS

Review

Action

Timestamp

Submit

8/ 27/ 2026

Approve

8/ 31/ 2026

Approve

9/ 1/ 2026

11: 11: 00 AM

11: 30: 00 AM 11: 09: 00 AM

Review Berger, David

Legal Review

Approve

9/ 4/ 2026

3: 30: 00 PM

Grayson,

Clerk of the Board

Approve

9/ 8/ 2026

7: 51: 00 AM

Kelly

Review

233342

Motion

Item

rz co&

SUBRECIPIENT

GRANT

AGREEMENT

Number:

gS1uNG G

26- 020

Purpose of Subrecipient

Grant Agreement. This Subrecipient

Grant Agreement (" Agreement")

is made by and between COWLITZ COUNTY, a political subdivision of the State of Washington, hereinafter called " County" or" Cowlitz County") and Progress Center( hereinafter called Subrecipient") to set forth the terms and conditions by which the County will provide the Subrecipient with a grant award to be used to pay or reimburse necessary expenditures incurred for services for persons with developmental disabilities. 2.

Term.

Scope of Eligible Expenditures. Grant funds may only be used to pay or reimburse eligible

This Agreement

expenditures

shall take effect on July 1, 2026 and terminate on June 30, 2027.

consistent and as detailed in Attachment A-

Scope of Work for Project ( the

Project").

Grant Award.

The Subrecipient is awarded a total of$ 126, 940.

Budget. The Grant Award shall be expended by the Subrecipient as set forth in Attachment B Budget.

Subrecipient

Responsibilities.

Subrecipient

agrees to administer the Grant Award proceeds

consistent with this Agreement. Subrecipient shall provide the County with certification using the form of Attachment C that Grant Award funds will be used for eligible expenditures. Subrecipient

shall request payment from the County as outlined in Attachment B. 7.

Access to and Maintenance of Records. Subrecipient shall maintain internal controls, accounts

terminated, b.

suspended,

or otherwise

Termination for Convenience. convenience

lost or impaired

in whole or in part.

Either party may terminate this Agreement for

upon giving the other party at least 30 days' advance written notice.

In that

event, the Subrecipient will be entitled to payment only for those expenses and costs reasonably and actually incurred prior to the effective date of the termination. 1 of 51

26- 020 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 22/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

If the default is not cured within 30 days of notice, the

The following provisions apply in the event that this Agreement is

terminated: a.

The Subrecipient shall cease to perform hereunder as of the effective date of termination and shall comply with all reasonable instructions contained in the notice of termination, if

The Subrecipient shall provide the County with an accounting of authorized services provided through the effective date of termination.

any.

11.

Conflict of Interest. Subrecipient designees, agents, members, officers, employees, consultants,

The Subrecipient will secure at its own expense all labor and materials required to

Name:

Deputy

Director

Department:

Health &

Human

1952

Telephone:

(

414- 5599

HHSContracts(

Fax:

Director

Progress Center 1600

WA 98632

Third

Longview,

Ave. WA 98632

360) 425- 9810

mailto:HHSContracts 360) 425- 7531 @cowlitzwa.

E- mail:

cowlitzwa. gov

KHarris@theprogresscenter.

UEI:

TZ8RNRDSRNN1

M153NWCWRlV

UBI:

08- 300- 3788

601- 141- 782

org

2 of 51

26- 020 Admin

360)

Executive

Services

9th Ave

Longview,

Date

Kara Harris

Title: Address:

Last

For the Subrecipient:

County:

Gena James

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

15.

GRANT

AGREEMENT

Bodily injury, including death. Property damage

Per occurrence

1, 000, 000 1, 000, 000

Per occurrence

2, 000, 000

Aggregate

1, 000, 000

Per occurrence

2, 000, 000

Aggregate

ERRORS AND OMISSIONS or PROFESSIONAL

LIABILITY with an Extended Reporting Period

Endorsement(

two year tail).

WORKERS COMPENSATION:

Statutory amount Waiver of Title 51 Rights

EMPLOYER' S LIABILITY/ Stop Gap: Per occurrence

1, 000, 000

AUTOMOBILE:

coverage on owned, non- owned, rented and hired vehicles

Bodily injury, liability, including death and property damage liability 1, 000, 000

Combined Single Limit

All Subrecipient' s and Subrecipient' s subcontractors' insurance policies and additional named insured endorsements

shall provide primary insurance coverage and be non- contributory.

Any

and/ or self- insured

retentions

exceeding $

10, 000 or any stop- loss provisions,

the

County shall have the right to request and review the Subrecipient' s most recent annual financial reports and audited financial statements as a condition of approval.

Subrecipient hereby agrees to waive subrogation with respect to each insurance policy maintained under this Agreement. When required by an insurer, or if a policy condition does not 3 of 51

26- 020 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

insurance policies by way of endorsement for the full available limits of insurance maintained by the Subrecipient

and subcontractor,

and all coverage shall be primary and non- contributory.

state or notion of additional insured status on a Certificate of Insurance shall not satisfy these requirements. [ This endorsement shall not be required if the Subrecipient is a governmental entity and is insured through a governmental entity risk pool authorized by the State of Washington.] The Subrecipient shall, for each required insurance policy, provide a Certificate of Insurance, with endorsements attached, evidencing all required coverages, limits, deductibles, self- insured retentions and endorsements and which is conditioned upon the County receiving thirty ( 30) days prior written notice of reduction in coverages, cancellation or non- renewal. Each Certificate of Insurance and all insurance notices shall be provided to: ATTN: County Project Manager, Cowlitz County Health & Human Services, 1952 9th Avenue, Longview, WA 98632. This Agreement shall be void ab initio if the proof of coverage is not timely supplied. The insurance maintained under this Agreement shall not in any manner limit or qualify the liabilities or obligations of the Subrecipient under this Agreement. All insurance policy deductibles and self- insured retentions for policies maintained

under this Agreement shall be paid by the

Subrecipient.

Compensation and/ or payments due to the Subrecipient under this Agreement are expressly conditioned

upon the Subrecipient' s strict compliance with all insurance requirements.

to the Subrecipient shall be suspended

in the event of noncompliance.

Payment

Upon receipt of evidence

of Subrecipient' s compliance, payments not otherwise subject to withholding or set- off will be released to the Subrecipient.

This Agreement

shall be void ab initio if the proof of coverage

is not

4 of 51

26- 020 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

18. Debarment

AGREEMENT

Certification.

The Subrecipient,

by signature to this Agreement,

certifies that the

in all

The Subrecipient and its officials, officers, employees, agents, and

If the Subrecipient is a faith- based or religious organization, it retains its

Permissible

Use Warranty.

The Subrecipient

recognizes

and agrees that the Grant Award

Disabilities

Administration.

The Subrecipient

warrants that its planned and actual

permissible

uses

consistent with Attachment A and the pass- through funding requirements discussed immediately above.

This section shall survive termination of this Agreement

No term or condition of this Agreement shall be deemed waived unless such waiver is

5 of 51

26- 020 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

Each counterpart

may be executed and delivered by facsimile to the other party. 33. Attachments. The following attachments are incorporated into this Agreement by reference. a. Attachment

A— Scope

b. Attachment

B—

c. Attachment

C— Certification

d. Attachment

D—

Retirement

e. Attachment

E—

f. Attachment

F—

Data Security Requirements DSHS County Program Agreement DDCS County Services

IN WITNESS

WHEREOF,

of Work

for Project

Budget Form Certification

the parties have executed this Agreement

this

day of

BOARD OF COUNTY COMMISSIONERS

SUBRECIPIENT:

OF COWLITZ COUNTY, WASHINGTON

Signature

Richard

Steven L. Ferrell,

Commissioner

Steve

Commissioner

Rader,

ATTEST:

CONTRACT FORM

HAS BEEN APPROVED AS TO

BY COWLITZ

PROSECUTING

COUNTY

ATTORNEY

Date

Clerk of the Board Date

6 of 51

26- 020 Admin

Chairman

name:

Title:

Last

R. Dahl,

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

SCOPE

OF WORK

FOR

PROJECT

The Subrecipient shall ensure services, and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: 1.

1) " Community Information and Education": Activities to inform and/ or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities. 2) " Training": To increase the job related skills and knowledge of staff, providers, volunteers, or interning students in the provision of services to people with developmental disabilities. Also to enhance program related skills of board or advisory board members. 3) " Other Activities" reserved for special projects and demonstrations categorized into the following types:

a) Infrastructure

projects: Projects in support of Clients ( services not easily

or replacement d. "

regulation.

Confidential Information" or" Data" means information that is exempt from disclosure to

the public or other unauthorized persons under Chapter 42. 56 RCW or other federal or state laws. Confidential

information

includes, but is not limited to, Personal Information.

g. "

Debarment" means an action taken by a federal official to exclude a person or business entity from participating in transactions involving certain federal funds.

h. "

DSHS" means the Department of Social and Health Services of the state of Washington.

i. "

j. "

General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. 7 of 51

26- 020 Last

Date

Admin

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

High Acuity Client" means a DDCS Client who requires significant and intensive support in the community, often due to complex needs, as determined through the DDCS

assessment.

Medicaid Home and Community Based Services ( HCBS)" means services that occur in

I. "

Person Centered Service Plan or PCSP" means a document that authorizes and

identifies the DDCS paid services to meet a Client' s assessed needs. Formerly referred to as the Individual Support Plan.

RCW"

means

the Revised

Code

of Washington.

All references

in this Agreement

and

any Program Agreement to RCW chapters or sections shall include any successor, amended, or replacement statue. Pertinent RCW chapters can be accessed at

http:// apps. leg. wa. gov/ rcw/. Secretary" means the individual appointed by the Governor, State of Washington, as the

head of the DSHS, of his/ her/ their designee.

Information

is not available to unauthorized

personnel.

w. "

provide services. Trusted Systems" include

following methods of physical delivery: ( 1) handdelivery by a person authorized to have access to the Confidential Information with written

acknowledgment

only the

of receipt; ( 2) United

States Postal

Service (" USPS") first class

the Washington State Governmental

Trusted System for communications

Network ( SGN) is a

within that Network.

USC" means the United States Code. All references in this Agreement and any Program Agreement to USC chapters and sections shall include any successor, amended, or

" WAC" means the Washington Administrative Code. All references in this Agreement and

replacement

statute.

any Program Agreement to WAC chapters or sections shall include any successor, amended, or replacement of regulation.

Pertinent WAC chapters or sections can be

accessed at http://apps.leg.wa.gov/ http:// apps. leg. wa. gov/ wac/. wac/

8 of 51

26- 020 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

AGREEMENT

GRANT

ATTACHMENT

Purpose. a.

Direct Client Services i.

Child Development

Services are designed to meet the developmental

needs of

each eligible child and the needs of the family related to enhancing the child' s development. Service may include assistive technology, audiology, family training/ home visits, health services, medical psychological

services, sign

language, social work, special instruction, speechlanguage pathology, vision, and transportation. Services are provided in natural environments to the maximum

extent

appropriate.

Coordination. Working collaboratively, the parties shall administer DD services within the county as set forth below: The DDCS region shall: i.

ii. iii.

iv.

Authorize new service within five ( 5) working days and will extend existing service authorization before expiration date;

Inform Clients of service changes through Planned Action Notice( s);

vi.

Work with the DDCS Region and the Subrecipient when Clients are referred for

Work with DDCS Region and the Subrecipient

services,

authorized

services,

and/ or for support

modifications;

to document planned services in

the Client' s Person Centered Service Plan; A.

xii. xiii.

Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DD Assessment prior to any changes; Work with the DDCS Region and the Subrecipient regarding service termination. Notify and work with the DDCS Regional Employment Specialist when performing evaluations of the Subrecipient.

The Subrecipient shall: xiv. xv.

Facilitate the County' s attendance at service plan meetings as requested. Work with the DDCS Region and the County when Clients are referred for services;

xvi.

Work with DDCS Region and the County to document planned services in the

xvii.

Assist with informing the DDCS Region and County of any potential service level changes not documented in the individual' s DD Assessment prior to any

Client' s Person Centered Service Plan;

changes; and xviii.

Work with the DDCS Region and the County regarding service termination. Performance monitoring. The County will monitor the Subrecipient' s performance by tracking work progress, reviewing payment requests for applicable costs, and ensuring that all requirements under this Agreement are met. Substandard performance as determined solely by the County constitutes noncompliance with this Agreement.

If action to correct substandard performance is not taken by the Subrecipient within 30 days after being notified by the County, then the County may terminate the Agreement as described herein. Additional Requirements:

The Subrecipient will maintain and make available, if requested,

documentation demonstrating accomplishments of the contract. Such documentation may include, but is not limited to, the following: 9 of 51

26- 020 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Services provided

Number of hours of service

Data Collection

Completed evaluation tools

Backup reports/ data for invoicing.

Agreement. Credentials and Minimum

Requirements:

Sufficient Policies and Procedures for establishment and maintenance of adequate

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees, subcontractors, and/ or volunteers who may have unsupervised access to vulnerable DSHS Clients, in accordance with RCW 43. 43. 830-

Check Central Unit( BCCU) must be utilized to obtain background

clearance.

enforcement agency. 9.

Subrecipient is specifically authorized to have data storage on portable devices or media in accordance with Attachment E. Data Security Requirements. 10. Certification Regarding Ethics. By signing this Agreement, the Subrecipient certifies that the Subrecipient is in compliance with Chapter 42. 23 RCW and shall comply with Chapter 42. 23 RCW throughout the term of this Agreement and any Program Agreement.

10 of 51

26- 020 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

AGREEMENT

GRANT

ATTACHMENT

11. The Subrecipient shall comply with the following referenced documents found at DDA Internet site https://www.dshs.wa.gov/dda/county-best-p https:// www. dshs.wa. gov/ dda/ county- best- practices under" County Best Practices" as

ractices

applicable: a.

DDCS Policy 4. 11, County Services for Working Age Adults;

Chapter WAC 388- 850, chapter 388- 828 WAC, WAC 388- 845- 0001, 0030, 0210, 0215, 0220, 0600- 0610, 1030- 1040, 2100, 2110;

Criteria for Evaluation;

DDA Guiding Values; County Guide to Achieve DDA' s Guiding Values; DDA Guidelines for Community Assessments with Employment and Vocational

Programs;

and

Disability Rights Washington ( formerly Washington Protection and Advocacy System) Access

Agreement.

12. The Subrecipient shall ensure that all staff, working with clients receiving Community Access or Individual Employment Services, complete the following DDA online courses upon hire

http://gowise.org/training/wa-state-dda-onlinehttp:// gowise. org/ training/ wa- state- dda- online- courses/ as applicable: a. DDA- 5. 06: WA State Client Rights; courses/ b.

DDA- 6. 13CG: WA State County Guidelines; DDA- 6. 13ESP: WA State Employment Service Plans for Employment providers or DDA 6. 13CSP: Community Access Service Plans for Community Inclusion providers. d. The Subrecipient shall ensure that all staff working with clients receiving Community Inclusion services receive annual training on Community Inclusion services and plan writing that incorporates the Community Inclusion Quality Review Tool. https:// www. dshs. wa. gov/ dda/ county- best- practices under" Community Inclusion" 13. Qualified Providers: A qualified provider must be an agency contracted with a county or DDCS. 14. Quality Assurance and Service Evaluation: The Subrecipient shall develop and have available an evaluation system to review services. The evaluation system must have both a Quality Assurance and a Quality Improvement component, and both must include objective measures. The objective measures at a minimum will include performance indicators, by acuity, that include the number of new jobs; job loss and reasons for job loss; the percentage employed earning c.

minimum wage or better; and the average number of hours worked. The Subrecipient' s service

i. ii.

all requirements

as outlined

in Attachment

As provided by law; or,

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. d.

When transporting client records containing Confidential Information outside a Secure Area, one or more of the following as appropriate: 1.

Use a Trusted Network; or

Encrypting the Confidential Information, including: a.

11 of 51

26- 020 Last

Date

Admin

Email and/ or email attachments.

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices, documents, or other media. Ensure the security of Confidential Information transmitted via fax ( facsimile) by: 1. Verifying the recipient phone number to prevent accidental transmittal of Confidential Information to unauthorized persons 2. Communicating with the intended recipient before transmission to ensure that the fax will be received only by an authorized person. 3. Verifying after transmittal that the fax was received by the intended b.

iii.

recipient.

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01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

BUDGET

The County shall reimburse the Subrecipient in an amount not to exceed $ Unspent grant proceeds will be reallocated at the discretion of the County.

Budget.

126, 940

Budget Budget Lines

Total

Consumer Services

125, 440 1, 500

Training Total

126, 940

The Subrecipient shall budget funds awarded in such a manner to ensure availability of services throughout the entire term of this Agreement subject to available funds.

The Subrecipient may submit, in writing to the County Contract Representative, a request to adjust the budget at any time during the agreement period. The County will respond to all request in writing with determination. Requests may:

Change

Not change

the individual the total

line

budget,

agreement

award.

Payment. Subject to Section 1, the County shall reimburse the Subrecipient for costs and expenses necessary to perform activities described in the Scope of Work for Project and as indicated in the CCHHS Contractor Toolkit located online at www. co. cowlitz. wa. us/ cchhscontractors,

and as updated. The Subrecipient shall ensure that

requests for reimbursements are based on billings supported by appropriate documentation of costs and expenses actually incurred. Additionally, the Subrecipient shall ensure that invoices include receipts, reports, and other detailed documentation of charges as requested by the County Contract Representative. The County will not process any payments for invoices received after the 15th of the month following the end of this agreement, unless prior approval from the County. Invoices. The Subrecipient shall submit invoices using the County' s form, or such other form as approved by the County. Consideration for services shall be payable upon receipt of properly completed invoices which shall be submitted to the County Contract Representative within this Agreement, by the Subrecipient, not more often than monthly. The invoices shall describe and document to the County' s satisfaction a description of the work performed, activities

accomplished,

the progress of the project, and fees.

The Subrecipient shall submit invoices to the County on or before the 15th of the month, regardless of what day of the week the 15th falls on, following the month of services were performed.

The final invoice must be received by the County no later than the 15th of the month, regardless of what day of the week the 15th falls on, following the end of this contract. The final invoice due date is subject to change based on funding requirements. 4.

Duplication.

The Subrecipient

assures that work performed

and invoiced does not duplicate work

to be charged to the County and State of Washington under any other Contract or agreement with the Subrecipient. 5.

Advance Payment. The County shall not make any payments in advance or in anticipation of the delivery of services to be provided pursuant to this Agreement.

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GRANT AGREEMENT

ATTACHMENT

Any activities related to research and development ( R& D) are not allowable. 7.

Subrecipient

is bound to follow all terms and conditions of the Washington

State DSHS

Consumer

Services

The Subrecipient may bill at the rate authorized on the County Service Authorization for the number of unit( s) per consumer per month for: i. b.

Child Development

Services

The Subrecipient shall transmit client data utilizing a secured method approved by the County. Assure the integrity of data submitted to the County. When data is submitted and rejected due to errors or an error is later identified, the Subrecipient will correct and resubmit the data within fifteen ( 15) days.

Reimbursement for Client Services: A claim for each individual is made by indicating the number of service units delivered to each individual listed and the fee per unit. Units are defined as: i.

An " Month" represents a minimum of at least fifty( 50) minutes of direct service for CDS reimbursement.

The County shall pay for only services to DD referred consumers authorized to receive the direct services( s) type, which the County has agreed to support. Production/ commercial profits generated by the work of County- funded consumers shall be used to support County funded services as needed. Training i.

The Subrecipient shall: 1.

Seek prior approval from the County Coordinator for training/ education reimbursement.

Make every effort to minimize the cost of individuals training by seeking out scholarships

and stipends, shared transportation

and lodging when

applicable to help reduce costs. Any additional costs will be the sole responsibility of the Subrecipient. Inform individuals of allowable travel and training expenses.

Submit copies of itemized receipts, MapQuest directions, travel

itineraries, conference registration including agenda pertaining to all requested

reimbursements.

Expenses without backup documentation

will

not be reimbursed. h.

Fiscal Responsibility. The Subrecipient must demonstrate the ability to safeguard public funds including maintaining books, records, documents and other materials relevant to the provision of goods and services.

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GRANT AGREEMENT

Timeliness

of and

ATTACHMENT

Modification

to Billings:

All initial

invoices

with

signed

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

CERTIFICATION

Kara Harris 1 am the Executive Director of Progress Center and I certify that: 2.

1 have authority and approval from the governing body on behalf of Progress Center to accept proceeds from the County per Agreement for services for persons with developmental disabilities by and between the County and Progress Center.

disabilities.

Were incurred during the period that begins on July 1, 2026 through June 30, 2027 4.

1 understand Progress Center receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/ or sales receipts and such documentation shall be produced to the County upon request and may be subject to audit by the State Auditor.

Printed

Name

Signature

Title

Date

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GRANT AGREEMENT

ATTACHMENT

RETIREMENT

CERTIFICATION

COUNTY RETAINS THIS FORM

Individual contractors and service providers must complete and sign WA Department of Retirement Systems: Independent Contractor Verification and State

Retirement Status Reporting Form [ WAC 415- 02- 110; DRS Email 13- 011; DRS Email 09- 001] SECTION 1:

INDIVIDUAL CONTRACTOR

COMPLETES

THIS SECTION AND SIGNS:

Did you

retire

from

Did you

retire

before age 65 using the 2008 early retirement

Will

you

be receiving direct compensation

Will

you

be receiving indirect

one

of the State of Washington

Retirement Systems? factors ( ERF)?

for your services? for your services?

compensation

YES

CONTRACTOR ( Full, individual name of contractor): Signature: SECTION

Social 2:

COUNTY

COMPLETES

Use Member Reporting 1.

Contractor

has

THIS

Security No.: SECTION

Date:

AND

RETAINS

FOR AUDIT

Verification ( MRV) to verify the past retirement

been

a member

of a Washington

State

Retirement

PURPOSES:

membership] System

YES

If YES, what system and plan? Teachers'

Retirement

System (

TRS)

Planl

Plan

School

Employees'

Retirement

System (

SERS)

Plan

Public

Employees'

Retirement

System (

PERS)

Plan

Public

Safety Employees'

Plan

Law

Enforcement

Washington

Retirement

Officers' &

State Patrol

Fire

System ( PSERS)

Fighters'

Retirement

System (

System ( WSPRS)

Plan

LEOFF)

Plan

Judicial Retirement System ( JRS) 5.

Is the contractor a retiree of a Washington

Did the contractor retire before

age

State Retirement

65 using the 2008

System?

ERF?

Yes

R 5/ 09), and the Internal Revenue Service rules governing independent contractor status.

COUNTY OFFICIAL/ DEPARTMENT

Signature:

REPRESENTATIVE:

Date:

COUNTY RETAINS THIS FORM 17 of 51

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Data Security 1.

Definitions.

Requirements

The words and phrases listed below, as used in this Attachment

E, shall each have

the following definitions: AES" means the Advanced Encryption Standard, a specification

of Federal Information

7-upd1.pdf

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential

Information,

and who has or have been authorized to do so.

and on a network outside the control of the Subrecipient.

Physical storage of data in the

PIN" means a personal

identification

number, a series of numbers which act as a

password for a device. Since PINs are typically only four to six characters, PINs are usually used in conjunction i. "

with another factor of authentication,

such as a fingerprint.

Device

is a subset

of Portable

Device.

lock, or comparable

mechanism.

Secure Areas may

26- 020 Last

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

access, the Data must be secured in such a way as to prevent access by non- authorized

with a password,

passphrase

or other mechanism,

authenticates

a user to an

information system. 2.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency

Authorization, Authentication, and Access. In order to ensure that access to the Data is

limited to authorized staff, the Subrecipient a.

must:

Have documented policies and procedures governing access to systems with the shared Data.

Restrict access through administrative, physical, and technical controls to authorized staff.

it must always be possible to determine

which employee performed a given action on a system housing the Data based solely on the Iogon ID used to perform the action. d. e.

Ensure that only authorized users are capable of accessing the Data. Ensure that an employee' s access to the Data is removed immediately: i.

Upon suspected compromise

ii.

When their employment, or the contract under which the Data is made available to them,

iii.

of the user credentials.

is terminated.

When they no longer need access to the Data to fulfill the requirements of the contract.

characters ii.

such as an asterisk, ampersand,

or exclamation

point.

That a password does not contain a user' s name, Iogon ID, or any form of their full name. 19 of 51

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GRANT AGREEMENT

ATTACHMENT

the Internet or otherwise travel outside the Subrecipient' s network), mitigate risk and

Encrypting all remote access traffic from the external workstation to Trusted

iv.

Network or to a component within the Trusted Network. The traffic must be

encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network.

authentication mechanism, such as a biometric ( fingerprint, face recognition, iris scan) or token ( software, hardware, smart card, etc.) in that case: i.

The PIN or password

must be at least 5 letters or numbers when used in

conjunction with at least one other authentication factor. Must not be comprised of all the same letter or number( 11111,

ii.

22222, aaaaa,

would not be acceptable). Must not contain a " run" of three or more consecutive numbers ( 12398, 98743

iii.

would not be acceptable).

If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes

used on the device must:

Be a minimum of six alphanumeric characters.

ii.

Contain

at least

three

unique

character

classes (

upper

case,

lower

case,

letter,

number).

iii.

Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable.

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Subrecipient agrees to store Data on one or more of the following media and protect the Data as described:

Hard

disk

drives.

For Data

stored

will be restricted to Authorized

on local

workstation

User( s) by requiring

hard

disks,

access

to the Data

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. For Data stored on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized

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

Date

Admin

Destruction

of the Data, as outlined below in 20 of 51

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Revised:

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Section 8 Data Disposition,

may be deferred until the disks are retired, replaced, or

otherwise taken out of the Secure Area. c.

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 Secure 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

mechanism.

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 Secure

Area.

Access

to Data

on these

discs

will

mechanisms which provide

mechanism.

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 ID and Hardened Password) to Authorized Users on Subrecipient staff. Subrecipient will notify DSHS staff immediately whenever an Authorized User in possession of such credentials is terminated or

otherwise leaves the employ of the Subrecipient, and whenever an Authorized User' s duties change such that the Authorized User no longer requires access to perform work for this Contract. g.

Encrypt

Control access to devices with a Unique User ID and Hardened

the

Data.

Password or stronger authentication method such as a physical token or biometrics.

Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available.

Apply administrative and physical security controls to Portable Devices

Maximum

period of inactivity is 20 minutes.

and Portable Media by: a.

Keeping them in a Secure Area when not in use,

Using check- in/ check- out procedures

when they are shared, and

Taking frequent inventories. When being transported outside of a Secure Area, Portable Devices and c.

ii.

Portable Media with DSHS Confidential

Date

Admin

must be under the physical 21 of 51

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

control of Subrecipient staff with authorization Data h.

to access the Data, even if the

is encrypted

Information still exists upon it, such

media will be destroyed at that time in accordance with the disposition requirements ii.

below in Section 8 Data Disposition.

Information still exists upon it, the data will be destroyed

at that time in accordance with the disposition requirements

below in Section 8

Data Disposition. i.

in which the Data is

stored. For this reason: i.

DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: 1. Subrecipient has written procedures in place governing use of the Cloud storage

and Subrecipient

attest

to the contact

listed

in the contract

and

keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. 2.

The Data will be Encrypted while within the Subrecipient network.

The Data will remain Encrypted during transmission to the Cloud. The Data will remain Encrypted at all times while residing within the

Cloud storage solution. 5.

The

Data

will

not be decrypted

the control of an Authorized

until

network.

downloaded

onto

a computer

within

User and within either the DSHS or

Subrecipient' s network. Data will not be stored on an Enterprise Cloud storage solution unless either:

ii.

iii.

The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or,

The Cloud storage solution used is HIPAA compliant.

System Protection.

To prevent compromise

of systems which contain DSHS Data or through

been

applied

within

the required

timeframes.

Systems containing DSHS Data shall have an Anti- Malware application, if available, installed.

Anti- Malware software shall be kept up to date. The product, its anti- virus engine, and

any malware database the system uses, will be no more than one update behind current.

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Data Segregation.

will contain no non- DSHS Data. ii.

DSHS Data will be stored in a logical container on electronic media, such as a

partition or folder dedicated to DSHS Data. iii.

DSHS Data will be stored in a database which will contain no non- DSHS data. And/ or,

iv.

DSHS Data will be stored within a database and will be distinguishable

from non-

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. Data Disposition. When the contracted work has been completed or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server

stored

on:

hard

disks,

or workstation

Removable drives,

media ( e. g.

portable

hard

floppies,

disks)

USB

excluding

flash optical

Will be destroyed by: Using a " wipe" utility which will overwrite the Data at least three ( 3) times using either random or single character data, or

discs

Degaussing sufficiently to ensure that the Data cannot be reconstructed,

Physical y destroying Paper

documents

with

sensitive

Confidential Information Paper

documents

the disk

Recycling through a contracted firm, provided the contract

containing Confidential

with

the recycler

assures

that the

confidentiality of Data will be protected. On- site shredding, pulping, or incineration

Information requiring special handling ( e. g. protected Optical

health information

discs ( e. g. CDs

DVDs)

Incineration, shredding, or completely defacing the readable surface with a coarse abrasive

Magnetic

tape

Degaussing, incinerating or crosscut shredding

Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be: a.

10. Data shared with Subcontractors.

If DSHS Data provided under this Contract is to be shared with

a subcontractor, the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If the Subrecipient cannot protect the Data as articulated within this Contract, then the 23 of 51

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GRANT AGREEMENT

contract with the subcontractor

ATTACHMENT

must be submitted

to the County Program Manager specified for

this contract for review and approval.

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SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

DSHS Agreement Number

COUNTY

DSHS x

2663. 69480

PROGRAM

sonar

AGREEMENT

DDICS County Services This Program AgreerTlUnt

is by and between

Social and Health Services(

DSHS)

below. and is issued

identified

Administration oT Dlvision

Department of

the State of Washington

and The County

Agreerrton

conjunction with a County and DSHS Agreement On General Terms and Conditions, CS11SADNI

17SJIS

DSHS DIVISIOl

tSTRATION

INDEX

PS* sS CONTRACT

NUMDER

Number CODE

1769C5- 63

1136

Division Df Developmental

Disabilities

Developmental

County ggreament

by reference.

which is incorporated

Nurriber

Disabififies

Admin DSHS CQNTAC1

DSHS

NAME ANO TITLE

C04TAGT

ADDRESS

PO BOX 453i5

Wendi

lrchel

Regional

Business

Manager

QI m - a, WA 98504. 5315 DSHS CONTACT TELEPHONE 7254264

360

08HS

CONTACT FAX

360

586-

V$ HS CONTACT

COUNTY

NAME

COUNTY ADDRESS

Cowlitz

County County DDA County Services

1952

Cowlitz COUNTY

FEDERAL

EMPLOYER

E- NWL

wendi. winchel

6602

dshs. wa.

9th Avenue

I nnfiview.

98632

COUNTY CONTACT NAME

I DENT I= I CAI ION

NuMatR

SUe S'el'Yinn COUNTY

CONTACT

rELEPHONE

360

414- 5599

I5THE

COUNTY A SUBRECIPIENT

CONTACT

COUNTY

FAX

FOR

PURPOSE$

CONTACT

saxtons

f3601501- 1207

ASSISTANCE

TH1S PROGRAM

F- MAIL

cowlitlwa- av

LISPING NUMBERS

AGREEMENT'?

No PROGRAM

AGREEMENT START

DATE

07/ 01 i2026

AGREEMENT

PROGRAM

ENO DATE

MAx1V.UN1 PROGRAM! AGREEMENI

ANIGUN-

2, 745. 890. 40

0613012D27

EXHIBITS. The following Exhibits are attached: Exhibit A— Data Security Requirements; Exhibit B— Budget and Spending

Plan

By their signatures below„ the parties agree to the terms arld conditions of this County Program Agreement ana all

PRINTED

SIG" 1ATURE( S)

DATE( S) SIGNED

NAVE( S) AND TITLELS;

BOARD OF COUNTY GOMMISSiONFRS OFCOWLITZCOUN1Y, WASHINGIaN Richard

PRINTED

DSHS SIGNATURE

Dahl, Chairman

NAME

AND TITL

Jessica Barbour, Contract

Specialist

SIGNED

08J1 912026

O WLITZ

caut4T ON o 45+-15 Central CUntmct Services 1769CS County Agreement( 12- 26- 2

26- 020 Last

Form:

rx 04 01

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ATTACHMENT

Special Terms and Conditions 1.

Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "

Acuity Level" means the level of a Client' s abilities and needs as determined

through the DDCS

assessment-

lb- " ALTSA Web Access(

AWA)" means a web- based portal to the Developmental

Disabilities

Community Services CARE system designed to support county services for DDCS clients. c_ "

Additional Consumer Services" refers to indirect Client servicetypes as follows1) "

Community Information

and Education":

Activitiesto inform and/ or educate the general public

and

2) " Training

3) "

Other Activities" reserved ty pes:

for special

a) Infrastructure

Projects in support of Clients ( services not easily tracked

projects:

projects and demonstrations

categorized

into the following

back to a

sp ecifi c work!ng age Client) o r th at d 1 rectly benefit a Clients) but the Client is not of work! ng age. Examples include planning services like genericjob development e.g." Project Search"_

b) Start- up projects:

Projects that support an agency or directly benefit the agency_ Examples

include equipment purchases and agency administrative support. c) Partnership

Project

Collaborative

partnerships

with school districts,

employment

providers,

disabilities

means a master classification

require to

of balance

f. " Competitive Integrated Employment"

g_ " Consumer Support" refers to direct Client service types as follows1) "

Community Inclusion" or" Cl": means individualized services provided in integrated community settings with other individuals without disabilities_ The activities are based on Client interests Page 2

DSHS

1789CS

Central

Contract

Services

County Agreement(

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GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

support( Individual Employment or Group Supported Employment) for working age individuals who have received nine months of employment

support.

2) " Child Development Services" or" CDS": Birth to three services are designed to meet the

instruction, speechlanguage pathology, vision, and transportation_ Services are provided in natural environments to the maximum extent appropriate. 3) "

the general workforce.

These services

may include intake, discovery,

assessment,

job

preparation, job marketing, job supports, record keeping and support to maintain a job4) " Individualized

individual

Technical Assistance" or" ITA": services are a part of a Client' s pathway to employmentor community inclusion. This service provides assessment and

employment

enclaves, mobile crews, and other business models employing disabilities in integrated employment in community settings_ h. "

County" is the political subdivision

of the state of Washington

Examples include

small groups of workers with

and the county or counties entering

into this program AgreementI- "

DDCS Case Resource Manager( CRM)" means a case manager for DDCS Clients.

j_ " County Service Authorization( CSA)" means an authorization for county services. k. "

Developmental

disabilities(

DD)" means a disability

attributable

to intellectual

disability,

cerebral

Developmental

Disabilities Community

Services" DDCS" means a division within the Department of Page 3

DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 020 Last

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GRANT AGREEMENT

ATTACHMENT

Special Terms and Conditions Social and Health Services. DDCS Regional office( DDCS Region)" means the regional DDCS office that supports DDCS

m_ "

clients.

Division of Vocational Rehabilitation(

n_ "

DVR)" means a division within the Department of Social and

Health Services o.

Employment

Outcome Payment"

means a paymentto

providers for transition

students barn

often

p_ " General Terms and Conditions"

which govern the contractual

meansthe contractual provisions contained within that agreement, relationship between DSHS and the county.

q_ " High Acuity Client" means a DDCS

Client who requires significant and intensive support community, often dueto complex needs, as determined through the DDCS assessment_

in the

Medicaid Home and Community Based Services( HOBS)" means services thatoccur in a Client' s home or community ratherthan institutions or other isolated settings_ These programs serve a

r. "

variety of targeted populations groups, such as people with intellectual or developmental disabilities,

physical disabilities,

Job Foundation

s_ "

and/ or mental illnesses

Report" is a document derived from employment

readiness

activities

performed

Preadmission Screening and Resident Review( PASRR)" means individuals with intellectual disabilities or related conditions( ID/ RC) who have been referred for nursing facility( NF) care.

t. "

Person

u. "

Centered Service Plan or PCSP" means a document that authorizes and identifes the

DDCS paid services to meet a Client' s assessed needs.

Formerly referred to as the Individual

Support Plan.

Ou ality Assurance" means an adherence to all Program Agreement requirements, including DDCS

v. "

Quality Improvement" means a focus on activitiesto improve performance above minimum standards and reasonably expected levels of performance, quality and practice_

Service Provider" is a qualified Client service vendor who is contracted to provide Employment and

Day Program y. " 2.

services.

Subcontractor" is the service provider contracted by the County to provide services.

Purpose: This Program Agreement is entered into between the Developmental Disabilities Community Services and the County in accordance with chapter 71 A_14 RCW_ Its purpose is to advance the state

legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental

disabilities_ Page 4

DSHS

1789CS

Central

Contract

Services

County Agreement(

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GRANT AGREEMENT

ATTACHMENT

Special Terms and Conditions 3.

Credentials and Minimum Requirements:

Administration

of the developmental

disabilities

County program cannot be subcontracted_

area ( e_g_ Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/ or a related Human or Social service may be considered_ c.

Sufficient Policies and Procedures for establishment and maintenance of adequate internal control

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees(

including

DID program County staff), subcontractors,

and/ or

Qualified Advisory Board Members:

A Developmental

Disabilities

advisory board shall include

members knowledgeable about developmental disabilities_ No board member shall have a contract

with the County to provide Training,

Community

Information

Activities,

and Consumer

Support as

defined in this Program Agreement, and shall not be a board member, officer, or employee of an

agency subcontracting with the County to provide such services. h.

Qualif ed Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6. 13, Program Qualifications for Employment and Day Program Providers.

Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to a ssign to DDCS its Medica id billing rights for Page 5

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Special Terms and Conditions

services to DDCS Clients eligible under Title XIX programs

in this Program Agreement.

Written

documentation shall be available to DSHS on request.

Counties who provide Child Development

Services( birth to three early intervention

services),

must

provide those services under the regulations implementing the Individuals with Disabilities Education Act( IDEA), Part C, and Washington Federally Approved Plan_ I_

State' s Early Support for Infant and Toddler

Ord er of Precedence: In the event of any inconsi stency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency

shall be resolved by giving

precedence, in the following order, to: 1)

County Program

Agreement;

and

2) Attached Exhibits. 5.

Disclosures must be provided at contract renewal and within thirty- five( 35) days whenever there is a change in the staff holding these management positions[ 42 CFR 455. 104 ( c)( 1)]_ 6.

the county as set forth below: a_

The DDCS region shall:

Review subcontractors and shall immediately notify the County of any concerns with the Page S

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subcontractors

identified

bythe County;

5) Authorize

new service within 5 working days and will extend existing service authorization

before expiration date; 6)

Inform Clients of service changes through Planned Action Notice( s);

7) Work with the County to document planned services in the Client' s Person Centered Plan including notification of assessment dates;

Service

B) Work with the County when terminating services; 9) Work with DDCS Head Quarters

and the County on Spending

Plan adjustments;

and

10) Work with the County in participating in evaluation of direct service providers_ b_ The County shall: 1)

Work with the DDCS Region when Clients are referred for services,

authorized

services,

andlor

for support modifications;

2) Work with the DDCS Region to document planned

services

in the Client' s Person Centered

Service Plan;

3) Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DID Assessment prior to any changes; 4) Work with the DDCS Region regarding

service termination;

5) Work with the DDCS Head Quarters on Spending

Plan adjustments;

6) Inform the DDCS Region of new providers to be included on the ALTSA Web Access( AWA) sy stem;

7) Notify the DDCS Region of any intent to terminate

a subcontractor

who is serving a DDCS

referral;

B) Provide a copy of each subcontractor' s contract upon written request from DDCS; and 9) Notify and work with the DDCS Region al Employment direct service providers. c.

Specialist when performing

evaluations

Compliance with Budget and Accounting Reporting System Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. Page 7

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Special Terms and Conditions

The County shall comply with the following 1)

referenced

documents:

DDCS Policy 411, County Services for Working Age Adults;

DDA Guidelines

7) Disability

for Community

Rights Washington (

Assessments

formerly

within Employment

Washington

Protection

and Vocational

and Advocacy

Programs:

System)

and

Access

Agreement.

e_ The County shall develop and submit a comprehensive plan forthe County DID Services as required by WAC 388- 850- 020_ f.

Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The

Solicitation

for Qualified

of the County and the DDCS Region_

Employment

and Day Program

Service Providers:

Requests for

Applications( RFAs), Requests for Information ( RFI' s) and/ or Requests for Proposals( RFPs),

Requests for Qualifications( continuous

RFQ' s) for direct services,

excluding

Child Development,

will be open

enrollment.

Qualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDCS.

Technical Assistance: DDCS contracts with Technical Counties with prior written approval_

Assistance

providers that may be utilized by

Inclusion services_

The County shall provide or contract with qualified Employment and Day Program Service Providersfor 1)

consumer support services that include thefollowing

Monthly Community

program outcomes-

Inclusion ( CI) service support hours will be based on the Client' s CI service

level per WAC 388- 828- 9310 for all Clients who began receiving CI services July 1, 2011 and forward_

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b) CI services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will not be reim bursed.

2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses_ Clients

should be supported to average twenty( 20) hours of community work per week or eighty- six 86) hours per month; however,

each person' s preferred

hours of employment

should

be taken

into consideration. The amount of service a Client receives will be based on his/ her

demonstrated

need, acuity level and work history per WAC 388- 828.

3) The Client' s DDCS PCSP is the driver for service_ The AWA County Service Authorization CSA) and updated Planned Rates information will not exceed the Client' s DDCS PCSP.

an additional review will be

responsible for authorizing CI services_ Page 9 DSHS

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and any potential conflict of interest is addressed.

10) Individual Employment staff hours must be attributed to the " Individual Employment and Billable Activity Phase( s)"

a) The collectivegroup' s individual hours should bethe minimum staff hours delivered to su pport th e g rou p-

f) Running a GSE service is a part of the business operation and not billable to Clients contract procurement,

contract maintenance, or administration

functions associated with

GSE)-

Phases and

Based settings

a) The setting is integrated in the greater community and supports Client' s to havefull access to the greater community; b) Ensures the Client receives services in the community

to the same degree of access as Page 10

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Special Terms and Conditions

individuals

not receiving

Medicaid

HCBS;

c) The setting provides opportunities to seek employment and work in competitive integrated settings;

and

d) The setting facilitates individual choice regarding services and supports, and who provides them_

Quality Assurance

and Service Evaluation:

The County shall develop and have available

m_ Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one visit to each subcontractor

every two

Copies of such documentation

will be provided tothe DDCS upon request.

n_ The County shall workwith local developmental disability advisory groups to plan for and coordinate services_

The County shall participate in regularly scheduled meetings between County DID staff and DDCS staff to remain updated and current including ACHS and Regional Meetings.

AWA Data System: In compliance

with the AWA Training Manual,

the County shall use the AWA

data system for all:

Billing requests;

2) Service provider address and phone number maintenance; 3) Evaluation dates; 4) Employment

outcome information;

and

5) Monthly provide all data described in the Billing Instructions Instructions, which is hereby incorporated by reference. q.

and in the Employment Outcomes

Review and respond the AWA" Work List" items within 5 working days including pending Authorization_

Referrals and

Review the AWA" Ticklers" Planned Rate tab and update the planned rate within 5 working d ays Page 11

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Special Terms and Conditions after the Planned Rate start date. t_

Partnership

Project-

1) A Job Foundation document will be completed per guidelines for eligible students.

Eligible

students are DDCS clients who were born between:

a) For fiscal year 2026 9/ 1105 through 8/ 31/ 06 b) For fiscal year 2027 9/ 1106 through 8/ 31/ 07 These students currently

attending

school and have completed

an application

to participate

this Value Based Payment( VPB) project_ The VBP project application will include the following minimum

criteria identified in the sample application found at:

https:// www. d sh s. w a_ gov/ sites/ default/ fi I es/ D DA/ dd a/ d ocu m ents/ J ob`/` 20 Foundation% tlon

2 0APpl i c a

040720% 20% 28002% 29. docx

documents) meet quality standards_ u_

Outcome Payment. Providers, with transition

students born between:

a) For fiscal year 2026 9/ 1103 through 8/ 31104 b) For fiscal year 2027 9/ 1/ 04 through 8/ 31/ 05 2) High acuity transition students who are authorized for Individual employment, the provider may

receive one outcome payment if transition student obtains a competitive integrated job approved by the County within timeframes

described

in the chart in the Billing Instructions_

If the County

is also the service provider DDCS will provide the job approval_ If the job is at a minimum of ten hours of work per week a n additional

amount will be include in the payment-

a minimum

of 80% of the authorized hours. Page 12

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Special Terms and Conditions

5) A new Community

Authorization( CSA).

Fees.

a) County( s) name; b) Time period for which the schedule! s applicable;

and

c) Each contracted direct service( IE, GSE, CI, ITA, CDS) and its associated rate-

Fee Limitations- The Billing Instructions found on the County Best Practices site provides lim itations on the Hourly Rate for each direct service. Hourly rates must be divisi ble by four.

b_ Budget and Spending 1)

Plan, attached

as Exhibit B-

Budget amount listed in Exhibit B- The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement

included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state- only employment and day services to waiver employment and day services-

2) Spending Plan- DDCS will provide the initial spending plan / Program Agreement Budget/ Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The

only be modified by mutual agreement of the parties in writing and shall not require a program agreement

amendment_

a) Funds Designated for Additional Consumer Services- If a County provides Community Information and Education services under additional consumer services, then activities must

include outreach

efforts to federally recognized

local tribes-

b) Funds Designated for Adult Day Care Consumers.

Funds designated for Adult Day Care

Consumers are availableto Clientswho were served between December 1996 and

December 2003 in Adult Day Health agencies and were subsequently determined

ineligible Page 13

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Special Terms and Conditions for Level II or III services(

If a Client no longer needs and wants services, the fund s

by the local Area Agency on Aging. Adult Day Care

service is not a waiver approved service_ c_

Program Agreement Amendments- A County can request an amendment at any time_ An amendment for additional Clients) may be supported when clients exceed the number used to

Exemptions- The DDCS Assistant program agreement requirement-

Secretary

may approve in writing an exemption

to a specific

Billing and Payment: a.

Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for-

1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration

include personnel

of the Developmental

and overhead

Disabilities Program.

Allowable costs

costs directly related to the administration

and coordination

a) Training: i.

Board Training- Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program- related skills of board and advisory committee

members.

and community Page 14

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Special Terms and Conditions

consultation,

capacity building

and organization

activities.

c) Other Activities_ i.

ii_

Start- up projects: Projects that support an agency or directly benefit the agency_ Examples include equipment purchases and agency administrative support-

school year they turn twenty-one( 21). Supports provided should complement and not replace what the student( s) receive through the Individualized Education Program( IEP)_ 3) Consumer Support_

Level II and III services are licensed

b) Community Inclusion Services are individualized and provided in integrated community settings with other individuals without disabilities_ The activities are based on Client

interests and provide opportunities typically experienced by the general public of sim ilar age in their local community,

accessible

by public transit or a reasonable

commute from their

to the maximum

extent

appropriate.

general workforce. These services may include intake, discovery, assessm ent, j ob preparation, job marketing, job supports, record keeping and support to maintain a job( per Page 15 DSHS

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Special Terms and Conditions the

Individual Employment Phases&

Billable Activities)

Examples include enclaves, mobile crews, and other business models employing small groups ofworkerswith disabilities in integrated employment community settings_ b_

Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this

Program Agreement.

However, with a Program Agreement amendment, the parties may increase

or decrease the Program Agreement amount_ Counties will work with DDCS HOon amendmentsto the Program Agreement. c_

Clients will be assisted in accessing DVR services perthe DDCS/ DVR MOU. Client services shall not be reimbursed

under this Program Agreement when the same services are paid for under the

Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. e.

Reimbursement

of Client Services:

A claim for each Client is made on the AWA system

indicating the number of service units delivered to each Client listed and the fee per unit_ Units are defined as:

An " Hour" is at least fifty( 50) minutes of direct service. Partial hour to the quarter may be recorded-

2) A" Day" is at leastfour( 4) hours of direct service and will only be used in connection with Adult Day Care reimbursement3) A" Month" represents

a minimum of at least fifty( 50) minutes of direct service for CDS

reimbursement.

can be 1112 of the maximum amount identified in Exhibit B under Administration or

The Individual Employment Phases&

Billable Activities document defines the individual Client Page 16

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Special Terms and Conditions

services that DDCS reimburses.

That document

is located on the DSHS DDCS County Best

Practices Web site at https:// www. dshs. wa. aov/dda/ county- best- practices.

Timeliness of and Modification to Billings: All initial invoices with signed documentation must be

Recovery of Fees. If the County bills and is paid fees for services that DSHS later finds were( a) not delivered or( b) not delivered in accordance with Program Agreement standards, DSHS shall

recover the fees for those services and the County steal I fully cooperate during the recovery. k_

costwill be based

DDAJobFoundationReportsadshs_

wa_.Qov

multiplied by

Intermediate Care Facilities for Intellectual Disabilities( ICF1ID) Agreement. If applicable per 42 CFR 463. 410, the County shall assure that all county- operated or subcontracted

programs serving

persons living in ICF/ ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/ ID resident 10.

Single State Medicaid Agency— Health Care Authority(

HCA):

HCA, as the single state Medicaid

DSHSIDRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDCS is incorporated

by reference_ The County assures that it and its subcontractors

have reviewed

the

Access Agreement_ The agreement covers DRW' s access to individuals with developmental Page 17 DSHS

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Special Terms and Conditions

disabilities, Clients, programs and records, outreach activities, authorityto investigate allegations abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS

contracted services_ 12.

Confidential Information.

Al Counties and their subcontractors must

Ensure the security of Confidential Information, and

When transporting

client records containing

Confidential

Information

outside a Secure Area, one or

more of the following as appropriate: 1)

U sing a Trusted Network; or

2) Encrypting the Confidential Information, including: a) Email andlor email attachments

b) Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.

Data Security

Requirements. Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization, or transmits more

than

14.

5 records

atone time.

Supersession of Prior Data Security Agreement_ If the Parties hereto have previously entered into a Standalone

Data Security Requirements

Agreement,

both Parties hereby agree that upon mutual

execution said Agreement shall take precedence as the sole Data security Agreement between the Parties_

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Special Terms and Conditions Exhibit A— Data Security 1.

Definitions_

Requirements

The words and phrases listed below, as used in this Exhibit, shall each have the fallowing

definitions: a. "

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so_ e. "

Category 4 Data" is data that is confidential

and requires special handling due to statutes or

refers to data protected

by: the Health Insurance

Portability

d_ " Cloud" means data storage on servers hosted by an entity other than the Contractor and on a

network outside the control of the Contractor.

Physical storage of data in the cloud typically spans

multiple servers and often multiple locations.

Cloud storage can be divided between consumer

grade storage for personal files and enterprise grade for companies and governmental entitiesExam pies of con sumer grad e storage wouId include iCloud, Dropbox, Box_com, and many other entities.

Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and

Rackspace_ e_ "

Encryption

must use a key length of at least 129 bits( 256 preferred)

for symmetri c keys, or

2048 bits for asymmetric keys_ When a symmetric key is used, the Advanced Encryption Standard AES) must be used if available. f. " Hardened

Password"

means a string of at least eight characters

containing

at least three of the

following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. " Mobile Device"

h_ " Multi- factor Authentication"

series of numbers which act as a password for a device_ Since PINS are typically only four to six characters,

PINS are usually used in conjunction

with anotherfactorof

authentication,

such as a

fingerprint1- "

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Special Terms and Conditions

are not limited to, mobile phones, tablets, and laptops.

Mobile Device is a subset of Portable

Device.

j. "

k_ " Secure Area" means

Confidential

an area to which only authorized representatives of the entity possessing Information have access, and access is controlled through use of a key, card key,

the

Trusted Network" means a network operated and maintained

by the Contractor, which includes

integrity, and availabilityof

the Data. m. "

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.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington

Technology

httns: l/watech_wa_gov/ policies? combine=& field

and of the DSHS Information these requirements

ServicesAgeney

categories

Security Policy and Standards

can be found

target id= 80& field tune target

Manual_

Reference

material

id= All],

related to

here: htti) s:// www. dshs. wa.- govlffa/ keening- dshs- client- information-

private- and- secure, which is a site developed

by the DSHS Information

Security Office and hosted by

DSHS Central Contracts and Legal Services. 3.

Administrative Controls. The Contractor must have the following controls in place: a_

A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy.

If Confidential Information shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment forth e systems) housing the Category 4 Data.

Authorization, Authentication, and Access. authorized

In order to ensure that access to the Data is limited to

staff, the Contractor must:

Page 20 DSHS

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Special Terms and Conditions

Have documented

policies and procedures

b_ Restrict access th rough administrative,

governing

physical,

access to systems with the shared Data

and technical

controls to authorized

staff_

Ensure that only authorized users are capable of accessing the Data_

e_ Ensure that an employee' s access to the Data is removed immediately:

UWn suspected com promise of the user credentials.

2) When their employment, or the contract under which the Data is made available to them, is terminated_

3) When they no longer need access to the Data to fulfill the requirements of the contract. f.

Have a process to periodically review and verify that only authorized containing DSHS Confidential Information

A minimum

length of 8 characters,

and containing

users have access to systems

at least three of the following

character

classes: uppercase letters, lowercase letters, numerals, and special characters such as an

asterisk, ampersand, or exclamation point. 2) That a password

does not contain a user' s name, logon ID, or any form of their full name.

3) That a password does not consist of a single dictionary word. passphrase which consists of multiple dictionary words-

A password

may be formed

as a

4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h.

Ensuring

mitigations

applied to the system don' t allow end- user modification_

2) Not allowing the use of di al- up connections.

3) Using industry standard protocols and solutions for remote access_ Examples would include RADIUS and Citrix.

4) Encrypting

all remote access traffc from the external workstation

to Trusted

Network or to a

component within the Trusted Network_ The traffic must be encrypted at all times while

traversing any network, including the Internet, which is not a Trusted Network. Page 21 DSHS

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Special Terms and Conditions

5) Ensuring that the remote access system prompts for re- authentication session termination after no more than 30 minutes of inactivity.

or performs automated

6) Ensuring use of Multi- factor Authentication to connect from the external end point to the internal end point_ i_

Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication

mechanism,

such as a biometric(

fingerprint,

face recognition,

iris scan) or token

software, hardware, smart card, etc.) in that case-

The PIN or password

must be at least 5 letters or numbers when used in conjunction

with at

least one other authentication factor 2) Must not be comprised of all the same letter or number( 11 111, 22222, aaaaa, would not be acceptable)

Must not contain a" run" of three or more consecutive numbers( 12398, 98743 would not be acceptable)

If the contract specifically allows for the storage of Confidential passcodes used on thedevice must 1)

Information on a Mobile Device,

Be a minimum of six alphanumeric characters.

2) Contain

at least three unique character classes( upper case, lower case, letter, number).

3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable_ k. 5

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Contractor protect the Data as described, a_

agrees to store Data on one or more of the following

media and

Hard disk drives_ For Data stared on local workstation hard disks, access to the Data will be

Network server disks_ For 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

mechanism_

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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 Secure Area_ When not in use for the contracted

purpose, such discs must be

Stored in a Secure Area_ Workstations which access DSHS Data on optical discs must be located

in an area which is accessible only to authorized personnel, key, card key, combination lock, or comparable mechanism d_

Optical discs ( CDs or DVDs) in drives or jukeboxes

with access controlled

attached to servers.

through use of a

Data provided by

DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through

smart

cards_ Data on discs attached to such servers must be located in an area, which is accessible only

to authorized

personnel,

comparable

mechanism_

with access controlled

through

use of a key, card key, combination

lock, or

Remote Access.

Access to and use of the Data over the State Governmental Network( SGN) or

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)

authentication

a Unique User ID and Hardened Password or stronger

method such as a physical token or biometrics.

and physical

security controls to Portable Devices and Portable Media

Keeping them in a Secure Area when not in use,

ii_

Using check- in/ check- out procedures when they are shared, and

iii_ Taking frequent inventories_ Page 23 DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 020 Last

47 of 51

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

Data stored for backup purposes-

below in Section

8 Data Disposition.

1) DSHS Data wi II not be stored in any consumer grade Cloud solution, unless all of the following conditions are met-

for

b) The Data will be Encrypted while within the Contractor network.

c) The Data will remain Encrypted during transmission to the Cloud. d) The Data will remain Encrypted

at all times while residing within the Cloud storage solution_

e) The Contractor will possess a decryption possessed only by the Contractor. f) The Data will not be downloaded

key for the Data, and the decryption key will be

to non- authorized

systems,

meaning

systems that are not

on the contractor network

a) The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or, b) The Cloud storage solution used is HIPAA compliant_

Page 24 DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 020 Last

48 of 51

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

System Protection. that Data passes:

To prevent compromise of systems which contain DSHS Data or through which

a. Systems containing DSHS Data must have all security patches or hotfxes applied within 3 months of being made available_

b_ The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes.

c_ Systems containing DSHS Data shall have an Anti- Malware application,

if available, installed.

d. Anti- Ma lware software shall be kept up to date. The product, its anti- virus engine, and any malware database the system uses, will be no more than one update behind currentT.

Data Segregation-

DSHS Data will be kept on media ( e. g. hard disk, optical disc, tape, etc.) which will contain no non- DSHS Data-

4) DSHS Data will be stored within a database and will be distinguishable

from non- DSHS data by

the value of a specific fell or fields within database records.

5) When stored as physical

paper documents,

DSHS Data will be physically

segregated

from non-

DSHS data in a drawer, folder, or other container_

b_ 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 asdescribed

this exhibit.

Data Disposition.

When the contracted

work has been completed

or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server or workstation

on:

hard disks, or

Will be destroyed by: Using a " wipe" utility which wi II overwrite the Data at least three( 3) times using either random or single character data, or Page 25

DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 020 Last

49 of 51

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

Removable

media( e. g. Coppies, USB Cash drives,

portable hard disks) excluding optical discs

Degaussing

sufficiently to ensure that the Data

cannot be reconstructed, or

Physically destroying Paper documents with

sensitive

Confidential

Information

the disk

Recycling through a contracted firm, provided the contract with the recycler assures that the

confidentiality of Data will be protected. 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 ta 9.

I Degaussing,

Notification

of Compromise

or Potential Compromise.

incinerating

or crosscut

shredding

The compromise or potential compromise of

DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one( 1)

Page 26 DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 020 Last

50 of 51

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Exhibit B

Program Agreement

Original Budget

Budget

0 Budget Revision

REVENUES Fund Source

Fiscal Year 2026

Fiscal

State and

1, 627, 450

1, 479, 700

Medicaid

1 447 900

1 313 649

Total Rev.

3 075 350

2 793 350

Year

Fund

2027

11; t Revision

Original

State

Source

Original

V Revision

21d Revision

3,d Revision

21d Revision

31d Revision

1 457 352

on ly

1 288 528

Medicaid

Total Rev.

V,745, 890

Job Foundation

PASRR Funds

ADMINISTRATION( 12

Funds

TOTAL

11,

13)

OTHER

Medicaid State Funds

Funds

137, 294

112, 332

249, 626

89, 819

73, 487

163, 306

CONSUMER

SUPPORTS 31, 32, 41, 92, 93, 94, 97) CONSUMER SUPPORT STATE62,

ONLY

64r 65, 67r 69

Child Development

MEDICAID 64 67 r

ROADS

125440

CLIENTS 69

21 D00

1 093 259

1 D93 259

207 518

1, 445, 812

1, 279, 078

Z745, 890

COMMUNITY 62

64 65 r

LIVING 67

TOTAL

21, 000

Page 27 DSHS

Central

Contract

Services

1789CS CauntyAgreement( 12-25- 2025)

26- 020 Last

51 of 51

Date Revised:

Admin

Form:

1615. 2

1/ 09/ 2025

Motion

233345

BOCC

Item

Agenda

Meeting Date: 9/ 15/ 2026 Contract with Washington

Initiative for Supported

Employment ( WISE)

Submitted By: Amanda Foshaug, Accounting Specialist II Submitted For: Gena James, HHS Deputy Director Department:

Human

Services

Dept

Information

Subject and Summary Statement

The purpose of this County Contract# 26- 021 with WISE is to provide developmental disability

employment and day services and technical assistance. This contract is paid on a cost reimbursement basis, not to exceed $ 30, 000. 00, during the period July 1,

2026, through June 30, 2027. Funding for this contract is passed through from the County' s contract with State Department

Washington

of Social & Health Services, Developmental Disabilities Administration.

Contract/ SOW Name

Current

Original

Change

Total

30, 000. 00

Time Period 7/ 01/ 26- 6/ 30/ 27

Staff Attendance Gena James

Department

It is the

Recommendation

recommendation

of the Cowlitz County Health&

Human Services that the Cowlitz County

Board of Commissioners move to approve this Contract 26- 021 with WISE. Attachments 26- 021

DD-

WISE

Form

Task

User

Foshaug,

Amanda

Agenda

Item

Submission

Drake,

Jamie

Preliminary

Review-

James,

Gena

Department

Approver

HHS

Review

Action

Timestamp

Submit

8/ 27/ 2026

Approve

8/ 31/ 2026

Approve

9/ 1/ 2026

11: 12: 00 AM

11: 36: 00 AM 11: 09: 00 AM

Review Berger, David

Legal Review

Approve

9/ 4/ 2026

3: 30: 00 PM

Grayson,

Clerk of the Board

Approve

9/ 8/ 2026

7: 51: 00 AM

Kelly

Review

233345

Motion

Item

rz co&

SUBRECIPIENT

GRANT

AGREEMENT

Number:

gS1IlNG G

26- 021

Purpose of Subrecipient

Grant Agreement. This Subrecipient

Grant Agreement (" Agreement")

is made by and between COWLITZ COUNTY, a political subdivision of the State of Washington, hereinafter called " County" or" Cowlitz County") and Washington Initiative for Supported Employment ( hereinafter called " Subrecipient") to set forth the terms and conditions by which the County will provide the Subrecipient with a grant award to be used to pay or reimburse necessary expenditures incurred for services for persons with developmental disabilities. 2.

Term.

Scope of Eligible Expenditures. Grant funds may only be used to pay or reimburse eligible

This Agreement

shall take effect on July 1, 2026 and terminate on June 30, 2027.

expenditures consistent and as detailed in Attachment A- Scope of Work for Project ( the Project").

Grant Award.

The Subrecipient is awarded a total of$ 30, 000.

Budget. The Grant Award shall be expended by the Subrecipient as set forth in Attachment B Budget.

Subrecipient

Responsibilities.

Subrecipient

agrees to administer the Grant Award proceeds

consistent with this Agreement. Subrecipient shall provide the County with certification using the form of Attachment C that Grant Award funds will be used for eligible expenditures. Subrecipient

shall request payment from the County as outlined in Attachment B. 7.

Access to and Maintenance of Records. Subrecipient shall maintain internal controls, accounts

terminated, b.

suspended,

or otherwise

Termination for Convenience. convenience

lost or impaired

in whole or in part.

Either party may terminate this Agreement for

upon giving the other party at least 30 days' advance written notice.

In that

event, the Subrecipient will be entitled to payment only for those expenses and costs reasonably and actually incurred prior to the effective date of the termination. 1 of 51

26- 021 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 22/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

If the default is not cured within 30 days of notice, the

The following provisions apply in the event that this Agreement is

terminated: a.

The Subrecipient shall cease to perform hereunder as of the effective date of termination and shall comply with all reasonable instructions contained in the notice of termination, if

The Subrecipient shall provide the County with an accounting of authorized services provided through the effective date of termination.

any.

11.

Conflict of Interest. Subrecipient designees, agents, members, officers, employees, consultants,

The Subrecipient will secure at its own expense all labor and materials required to

For the Subrecipient:

County:

Name:

Gena James

Title:

Deputy Director

Department:

Health &

Human

Cesilee Coulson Executive

Services

Director

Washington

Initiative for Supported

Employment

Address:

1952

91" Ave

Longview, Telephone:

(

Admin

206- 786- 0239

Fax: UEI:

TZ8RNRDSRNN1

L7CZKEGMMFA

UBI:

08- 300- 3788

601- 222- 124

cesilee@gowise.

org

2 of 51

26- 021 Date

360) 414- 5599

16000 Christensen Road, Ste 308 Tukwila, WA 98188

mailto:HHSContracts HHSContracts( a cowlitzwa. gov 360) 425- 7531 @cowlitzwa.

E- mail:

Last

WA 98632

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

15.

GRANT

AGREEMENT

Bodily injury, including death. Property damage

Per occurrence

1, 000, 000 1, 000, 000

Per occurrence

2, 000, 000

Aggregate

1, 000, 000

Per occurrence

2, 000, 000

Aggregate

ERRORS AND OMISSIONS or PROFESSIONAL

LIABILITY with an Extended Reporting Period

Endorsement(

two year tail).

WORKERS COMPENSATION:

Statutory amount Waiver of Title 51 Rights

EMPLOYER' S LIABILITY/ Stop Gap: Per occurrence

1, 000, 000

AUTOMOBILE:

coverage on owned, non- owned, rented and hired vehicles

Bodily injury, liability, including death and property damage liability 1, 000, 000

Combined Single Limit

All Subrecipient' s and Subrecipient' s subcontractors' insurance policies and additional named insured endorsements

shall provide primary insurance coverage and be non- contributory.

Any

and/ or self- insured

retentions

exceeding $

10, 000 or any stop- loss provisions,

the

County shall have the right to request and review the Subrecipient' s most recent annual financial reports and audited financial statements as a condition of approval.

Subrecipient hereby agrees to waive subrogation with respect to each insurance policy maintained under this Agreement. When required by an insurer, or if a policy condition does not 3 of 51

26- 021 Last

Date

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Revised:

Form:

1615. 2

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SUBRECIPIENT

GRANT

AGREEMENT

insurance policies by way of endorsement for the full available limits of insurance maintained by the Subrecipient

and subcontractor,

and all coverage shall be primary and non- contributory.

state or notion of additional insured status on a Certificate of Insurance shall not satisfy these requirements. [ This endorsement shall not be required if the Subrecipient is a governmental entity and is insured through a governmental entity risk pool authorized by the State of Washington.] The Subrecipient shall, for each required insurance policy, provide a Certificate of Insurance, with endorsements attached, evidencing all required coverages, limits, deductibles, self- insured retentions and endorsements and which is conditioned upon the County receiving thirty ( 30) days prior written notice of reduction in coverages, cancellation or non- renewal. Each Certificate of Insurance and all insurance notices shall be provided to: ATTN: County Project Manager, Cowlitz County Health & Human Services, 1952 9th Avenue, Longview, WA 98632. This Agreement shall be void ab initio if the proof of coverage is not timely supplied. The insurance maintained under this Agreement shall not in any manner limit or qualify the liabilities or obligations of the Subrecipient under this Agreement. All insurance policy deductibles and self- insured retentions for policies maintained

under this Agreement shall be paid by the

Subrecipient.

Compensation and/ or payments due to the Subrecipient under this Agreement are expressly conditioned

upon the Subrecipient' s strict compliance with all insurance requirements.

to the Subrecipient shall be suspended

in the event of noncompliance.

Payment

Upon receipt of evidence

of Subrecipient' s compliance, payments not otherwise subject to withholding or set- off will be released to the Subrecipient.

This Agreement

shall be void ab initio if the proof of coverage

is not

4 of 51

26- 021 Last

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

18. Debarment

AGREEMENT

Certification.

The Subrecipient,

by signature to this Agreement,

certifies that the

in all

The Subrecipient and its officials, officers, employees, agents, and

If the Subrecipient is a faith- based or religious organization, it retains its

Permissible

Use Warranty.

The Subrecipient

recognizes

and agrees that the Grant Award

Disabilities

Administration.

The Subrecipient

warrants that its planned and actual

permissible

uses

consistent with Attachment A and the pass- through funding requirements discussed immediately above.

This section shall survive termination of this Agreement

No term or condition of this Agreement shall be deemed waived unless such waiver is

5 of 51

26- 021 Last

Date

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

Each counterpart

may be executed and delivered by facsimile to the other party. 33. Attachments. The following attachments are incorporated into this Agreement by reference. a. Attachment

A— Scope

b. Attachment

B—

c. Attachment

C— Certification

d. Attachment

D—

Retirement

e. Attachment

E—

f. Attachment

F—

Data Security Requirements DSHS County Program Agreement DDCS County Services

IN WITNESS

WHEREOF,

of Work

for Project

Budget Form Certification

the parties have executed this Agreement

this

day of

BOARD OF COUNTY COMMISSIONERS

SUBRECIPIENT:

OF COWLITZ COUNTY, WASHINGTON

Signature

Richard

Steven L. Ferrell,

Commissioner

Steve

Commissioner

Rader,

ATTEST:

CONTRACT FORM

HAS BEEN APPROVED AS TO

BY COWLITZ

PROSECUTING

COUNTY

ATTORNEY

Date

Clerk of the Board Date

6 of 51

26- 021 Admin

Chairman

name:

Title:

Last

R. Dahl,

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

SCOPE

OF WORK

FOR

PROJECT

The Subrecipient shall ensure services, and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: 1.

a) Infrastructure

projects: Projects in support of Clients ( services not easily

or replacement d. "

regulation.

Confidential Information" or" Data" means information that is exempt from disclosure to

the public or other unauthorized persons under Chapter 42. 56 RCW or other federal or state laws. Confidential

information

includes, but is not limited to, Personal Information.

g. "

Debarment" means an action taken by a federal official to exclude a person or business entity from participating in transactions involving certain federal funds.

h. "

DSHS" means the Department of Social and Health Services of the state of Washington.

i. "

j. "

General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. 7 of 51

26- 021 Last

Date

Admin

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

High Acuity Client" means a DDCS Client who requires significant and intensive support in the community, often due to complex needs, as determined through the DDCS

assessment.

Medicaid Home and Community Based Services ( HCBS)" means services that occur in

I. "

Person Centered Service Plan or PCSP" means a document that authorizes and

identifies the DDCS paid services to meet a Client' s assessed needs. Formerly referred to as the Individual Support Plan.

RCW"

means

the Revised

Code

of Washington.

All references

in this Agreement

and

any Program Agreement to RCW chapters or sections shall include any successor, amended, or replacement statue. Pertinent RCW chapters can be accessed at

http:// apps. leg. wa. gov/ rcw/. Secretary" means the individual appointed by the Governor, State of Washington, as the

head of the DSHS, of his/ her/ their designee.

Information

is not available to unauthorized

personnel.

w. "

provide services. Trusted Systems" include

following methods of physical delivery: ( 1) handdelivery by a person authorized to have access to the Confidential Information with written

acknowledgment

only the

of receipt; ( 2) United

States Postal

Service (" USPS") first class

the Washington State Governmental

Trusted System for communications

Network ( SGN) is a

within that Network.

USC" means the United States Code. All references in this Agreement and any Program Agreement to USC chapters and sections shall include any successor, amended, or

" WAC" means the Washington Administrative Code. All references in this Agreement and

replacement

statute.

any Program Agreement to WAC chapters or sections shall include any successor, amended, or replacement of regulation.

Pertinent WAC chapters or sections can be

accessed at http://apps.leg.wa.gov/ http:// apps. leg. wa. gov/ wac/. wac/

8 of 51

26- 021 Last

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Purpose. a.

The Subrecipient shall deliver the following services: Individualized

i. "

Technical

Assistance"

ITA":

services are a part of a Client' s pathway to employment or community inclusion. This service provides assessment and consultation to the employment provider to identify and address existing barriers to employment or community inclusion. This is in addition to supports received through supported employment or community inclusion services for individuals who have not yet achieved their goal. ii. Training and Technical Assistance: services that are initiated and requested by Cowlitz County Health and Human Services and in alignment with the Cowlitz County Training/ TA Priorities for FY27. Coordination. Working collaboratively, the parties shall administer DID services within the county as set forth below: or"

The DDCS region shall: i.

ii. iii.

iv.

Authorize new service within five ( 5) working days and will extend existing service authorization before expiration date;

Inform

Clients

of service

changes

through

Planned

Action

Notice( s);

vi.

Work with the DDCS Region and the Subrecipient when Clients are referred for services, authorized services, and/ or for support modifications;

ii.

Work with DDCS Region and the Subrecipient to document planned services in

iii.

the Client' s Person Centered Service Plan;

iv.

termination. V.

Notify and work with the DDCS Regional Employment Specialist when performing evaluations of the Subrecipient.

The Subrecipient shall: ii.

Facilitate the County' s attendance at employment plan meetings as requested. Work with the DDCS Region and the County when Clients are referred for

iii.

Work with DDCS Region and the County to document planned services in the

iv.

Assist with informing the DDCS Region and County of any potential service level changes not documented in the individual' s DID Assessment prior to any

services;

Client' s Person Centered Service Plan;

changes;

and

If action to correct substandard performance is not taken by the Subrecipient within 30 days after being notified by the County, then the County may terminate the Agreement as described herein.

9 of 51

26- 021 Last

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

Additional Requirements:

ATTACHMENT

The Subrecipient will maintain and make available, if requested,

documentation demonstrating accomplishments of the contract. Such documentation may include, but is not limited to, the following: a. Services provided b.

Number of hours of service

Data Collection

Completed evaluation tools

Backup reports/ data for invoicing.

Agreement. Credentials and Minimum Requirements:

Sufficient Policies and Procedures for establishment and maintenance of adequate

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees, subcontractors, and/ or volunteers who may have unsupervised

access to vulnerable DSHS Clients, in accordance with RCW 43. 43. 830-

Check Central Unit( BCCU) must be utilized to obtain background

clearance.

exploitation or neglect( as defined in RCW 74. 34. 020) of a person who has a developmental disability( as defined in RCW 71A. 10. 020) has occurred, and, ii.

If they have reason to suspect that sexual or physical assault of such a person has occurred, they shall also immediately enforcement agency.

10 of 51

26- 021 Date

Admin

law

Subrecipient is specifically authorized to have data storage on portable devices or media in accordance with Attachment E. Data Security Requirements.

Last

report to the appropriate

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

10. Certification Regarding Ethics. By signing this Agreement, the Subrecipient certifies that the Subrecipient is in compliance with Chapter 42. 23 RCW and shall comply with Chapter 42. 23 RCW throughout the term of this Agreement and any Program Agreement. 11. The Subrecipient shall comply with the following referenced documents found at DDA Internet site https://www.dshs.wa.gov/dda/county-best-p https:// www. dshs.wa. gov/ dda/ county- best- practices under" County Best Practices": a. ractices DDCS Policy 4. 11, County Services for Working Age Adults; b.

Chapter WAC 388- 850, chapter 388- 828 WAC, WAC 388- 845- 0001, 0030, 0210, 0215, 0220, 0600- 0610, 1030- 1040, 2100, 2110;

Criteria for Evaluation;

DDA Guiding Values; County Guide to Achieve DDA' s Guiding Values; DDA Guidelines for Community Assessments with Employment and Vocational

Programs;

and

Disability Rights Washington ( formerly Washington Protection and Advocacy System) Access Agreement.

12. The Subrecipient shall ensure that all staff, working with clients receiving Community Access or Individual Employment Services, complete the following DDA online courses upon hire

http://gowise.org/training/wa-state-dda-onlinehttp:// gowise. org/ training/ wa- state- dda- online- courses/ DDA- 5. 06: WA State Client Rights; a. courses/ b.

DDA- 6. 13CG: WA State County Guidelines; DDA- 6. 13ESP: WA State Employment Service Plans for Employment providers or DDA 6. 13CSP: Community Access Service Plans for Community Inclusion providers. d. The Subrecipient shall ensure that all staff working with clients receiving Community Inclusion services receive annual training on Community Inclusion services and plan writing that incorporates the Community Inclusion Quality Review Tool. https:// www. dshs. wa. gov/ dda/ county- best- practices under" Community Inclusion" 13. Qualified Providers: A qualified provider must be an agency contracted with a county or DDCS. 14. Quality Assurance and Service Evaluation: The Subrecipient shall develop and have available an evaluation system to review services. The evaluation system must have both a Quality Assurance and a Quality Improvement component, and both must include objective measures. The objective measures at a minimum will include performance indicators, by acuity, that include the number of new jobs; job loss and reasons for job loss; the percentage employed earning c.

minimum wage or better; and the average number of hours worked. The Subrecipient' s service

Follow all requirements as outlined in Attachment E.

ii.

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. d.

When transporting client records containing Confidential Information outside a Secure Area, one or more of the following as appropriate:

Date

Admin

Use a Trusted Network; or

Encrypting the Confidential Information, including: 11 of 51

26- 021 Last

Information.

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

and/ or email

attachments.

iii.

12 of 51

26- 021 Last

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Revised:

Form:

1615. 2

01/ 09/ 2025

GRANT

AGREEMENT

ATTACHMENT

BUDGET

Budget. The County shall reimburse the Subrecipient in an amount not to exceed $ 30, 000 for expenses related to County requested Individual Technical Assistance and Training/ Technical Assistance. Reimbursement requires approval from the County Coordinator and is based on availability of funds. Unspent grant proceeds will be reallocated at the discretion of the County.

The Subrecipient shall budget funds awarded in such a manner to ensure availability of services throughout the entire term of this Agreement subject to available funds.

Payment. Subject to Section 1, the County shall reimburse the Subrecipient for costs and expenses necessary to perform activities described in the Scope of Work for Project and as

indicated in the CCHHS Contractor Toolkit located online at www. co. cowlitz. wa. us/ cchhscontractors,

and as updated. The Subrecipient shall ensure that

Invoices. The Subrecipient shall submit invoices using the County' s form, or such other form as approved by the County. Consideration for services shall be payable upon receipt of properly completed

invoices which shall be submitted to the County Contract Representative

within this

Advance Payment. The County shall not make any payments in advance or in anticipation of the delivery of services to be provided pursuant to this Agreement.

13 of 51

26- 021 Last

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Revised:

Form:

1615. 2

1/ 09/ 2025

GRANT

AGREEMENT

Subrecipient

ATTACHMENT

is bound to follow all terms and conditions of the Washington

State DSHS

Program Specific Conditions: a.

Consumer Services

The Subrecipient may bill at rates authorized on the County Service Authorization for the number of unit( s) per consumer per month for: 1.

Individualized

Technical

Assistance

The Subrecipient shall transmit client data utilizing a secured method approved by the County.

ii.

Provide all data described in the Employment Outcomes Instructions and

iii.

monthly invoice, which is hereby incorporated by reference. Assure the integrity of data submitted to the county. When data is submitted and rejected due to errors or an error is later identified, the Subrecipient will correct and resubmit the data within fifteen ( 15) days.

iv.

Reimbursement for Client Services: A claim for each individual is made by indicating the number of service units delivered to each individual listed and the fee per unit. Units are defined as: 1. An " Hour" is at least fifty ( 50) minutes of direct service. Partial hour to the quarter may be recorded. v. The County shall pay for only services to DD referred consumers authorized to receive the direct services ( s) type, which the County has agreed to support. vi. Clients will be assisted in accessing DVR services per the DDA/ DVR MOU https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/DV https:// www. dshs. wa. gov/ sites/ default/ files/ DDA/ dda/ documents/ DVRDDA% 20MOU% 20% 282018% 29- Headquarters. pdf. Client services shall not be https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents R-DDA%20MOU%20%282018%29-Headquarters.pdf /DVR-DDA%20MOU%20%282018%29-Headquarters.pdf reimbursed under this Program Agreement when the same services paid for under Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source or public or private funding. vii. Production/ commercial profits generated by the work of County- funded consumers shall be used to support County funded services as needed. viii.

ix.

The

Individual

Employment

Phases &

Billable Activities document defines the

individual Client services that the County reimburses. That document is located on the DSHS DDA County Best Practices Web site at https:// www. dshs. wa. gov/ dda/ county- best- practices. The Community Inclusion Billable Activities document defines the individual Client services that the County reimburses. That document is located on the DSHS DDA County Best Practices Web site at

https://www.dshs.wa.gov/dda/county-best-p https:// www. dshs. wa. gov/ dda/ county- best- practices. b.

Training ractices The Subrecipient shall: i.

Make every effort to minimize the cost of individuals training by seeking out scholarships and stipends, shared transportation and lodging when applicable to help reduce costs. Any additional costs will be the sole responsibility of the Subrecipient.

ii.

iii.

Ensure all costs for services provided, including training and technical assistance, are preapproved by the County. Inform individuals of allowable travel and training expenses.

iv.

Submit copies of itemized receipts, MapQuest directions, travel itineraries,

conference registration including agenda pertaining to all requested reimbursements.

Expenses without backup documentation

will not be

reimbursed.

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Timeliness of and Modification to Billings: All initial invoices with signed

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CERTIFICATION

I, Cesilee Coulson, am the Executive Director of Washington

Initiative for Supported Employment

and I

certify that: 1.

I have authority and approval from the governing body on behalf of Washington Initiative for Supported Employment to accept proceeds from the County per Agreement for services for persons with developmental disabilities by and between the County and Washington Initiative for Supported

Employment

disabilities.

Were incurred during the period that begins on July 1, 2026 through June 30, 2027 3.

1 understand Washington Initiative for Supported Employment receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/ or sales receipts and such documentation shall be produced to the County upon request and may be subject to audit by the State Auditor.

Printed

Signature

Name

Title

Date

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RETIREMENT

CERTIFICATION

COUNTY RETAINS THIS FORM

Individual contractors and service providers must complete and sign WA Department of Retirement Systems: Independent Contractor Verification and State

Retirement Status Reporting Form [ WAC 415- 02- 110; DRS Email 13- 011; DRS Email 09- 001] SECTION 1:

INDIVIDUAL CONTRACTOR

COMPLETES

THIS SECTION AND SIGNS:

Did you

retire

from

Did you

retire

before age 65 using the 2008 early retirement

Will

you

be receiving direct compensation

Will

you

be receiving indirect

one

of the State of Washington

Retirement Systems? factors ( ERF)?

for your services? for your services?

compensation

YES

CONTRACTOR ( Full, individual name of contractor): Signature: SECTION

Social 2:

COUNTY

COMPLETES

Use Member Reporting 1.

Contractor

has

Security No.:

THIS

SECTION

Date:

AND

RETAINS

FOR AUDIT

Verification ( MRV) to verify the past retirement

been

a member

of a Washington

State

Retirement

PURPOSES:

membership] System

YES

If YES, what system and plan? Teachers'

Retirement

System (

TRS)

Planl

Plan

School

Employees'

Retirement

System (

SERS)

Plan

Public

Employees'

Retirement

System (

PERS)

Plan

Public

Safety Employees'

Plan

Law

Enforcement

Washington

Retirement

Officers' &

State Patrol

Fire

System ( PSERS)

Fighters'

Retirement

System (

System ( WSPRS)

Plan

LEOFF)

Plan

Judicial Retirement System ( JRS) 5.

Is the contractor a retiree of a Washington

Did the contractor retire before

age

State Retirement

65 using the 2008

System?

ERF?

Yes

R 5/ 09), and the Internal Revenue Service rules governing independent contractor status.

COUNTY OFFICIAL/ DEPARTMENT

Signature:

REPRESENTATIVE:

Date:

COUNTY RETAINS THIS FORM 17 of 51

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ATTACHMENT

Data Security 1.

Definitions.

Requirements

The words and phrases listed below, as used in this Attachment

E, shall each have

the following definitions: AES" means the Advanced Encryption Standard, a specification

of Federal Information

7-upd1.pdf

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential

Information,

and who has or have been authorized to do so.

and on a network outside the control of the Subrecipient.

Physical storage of data in the

PIN" means a personal

identification

number, a series of numbers which act as a

password for a device. Since PINs are typically only four to six characters, PINs are usually used in conjunction i. "

with another factor of authentication,

such as a fingerprint.

Device

is a subset

of Portable

Device.

lock, or comparable

mechanism.

Secure Areas may

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access, the Data must be secured in such a way as to prevent access by non- authorized

with a password,

passphrase

or other mechanism,

authenticates

a user to an

information system. 2.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency

Authorization, Authentication, and Access. In order to ensure that access to the Data is

limited to authorized staff, the Subrecipient a.

must:

Have documented policies and procedures governing access to systems with the shared Data.

Restrict access through administrative, physical, and technical controls to authorized staff.

it must always be possible to determine

which employee performed a given action on a system housing the Data based solely on the Iogon ID used to perform the action. d. e.

Ensure that only authorized users are capable of accessing the Data. Ensure that an employee' s access to the Data is removed immediately: i.

Upon suspected compromise

ii.

When their employment, or the contract under which the Data is made available to them,

iii.

of the user credentials.

is terminated.

When they no longer need access to the Data to fulfill the requirements of the contract.

characters ii.

such as an asterisk, ampersand,

or exclamation

point.

That a password does not contain a user' s name, Iogon ID, or any form of their full name. 19 of 51

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the Internet or otherwise travel outside the Subrecipient' s network), mitigate risk and

Encrypting all remote access traffic from the external workstation to Trusted

iv.

Network or to a component within the Trusted Network. The traffic must be

encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network.

authentication mechanism, such as a biometric ( fingerprint, face recognition, iris scan) or token ( software, hardware, smart card, etc.) in that case: i.

The PIN or password

must be at least 5 letters or numbers when used in

conjunction with at least one other authentication factor. Must not be comprised of all the same letter or number( 11111,

ii.

22222, aaaaa,

would not be acceptable). Must not contain a " run" of three or more consecutive numbers ( 12398, 98743

iii.

would not be acceptable).

If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes

used on the device must:

Be a minimum of six alphanumeric characters.

ii.

Contain

at least

three

unique

character

classes (

upper

case,

lower

case,

letter,

number).

iii.

Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable.

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Subrecipient agrees to store Data on one or more of the following media and protect the Data as described:

Hard

disk

drives.

For Data

stored

will be restricted to Authorized

on local

workstation

User( s) by requiring

hard

disks,

access

to the Data

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. For Data stored on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized

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

Date

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Section 8 Data Disposition, may be deferred until the disks are retired, replaced, or otherwise taken out of the Secure Area. c.

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 Secure 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

mechanism.

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 Secure

Area.

Access

to Data

on these

discs

will

mechanisms which provide

mechanism.

Remote Access. Access to and use of the Data over the State Governmental

Network

otherwise leaves the employ of the Subrecipient, and whenever an Authorized User' s duties change such that the Authorized

User no longer requires access to perform work

for this Contract. g.

Encrypt

Control access to devices with a Unique User ID and Hardened

the

Data.

Password or stronger authentication method such as a physical token or biometrics.

Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available.

Apply administrative and physical security controls to Portable Devices

Maximum

period of inactivity is 20 minutes.

and Portable Media by: a.

Keeping them in a Secure Area when not in use,

Using check- in/ check- out procedures

when they are shared, and

Taking frequent inventories. When being transported outside of a Secure Area, Portable Devices and c.

ii.

Portable Media with DSHS Confidential

Date

Admin

must be under the physical 21 of 51

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control of Subrecipient staff with authorization Data h.

to access the Data, even if the

is encrypted

Information still exists upon it, such

media will be destroyed at that time in accordance with the disposition requirements ii.

below in Section 8 Data Disposition.

Information still exists upon it, the data will be destroyed

at that time in accordance with the disposition requirements

below in Section 8

Data Disposition. i.

in which the Data is

stored. For this reason: i.

DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: 1. Subrecipient has written procedures in place governing use of the Cloud storage

and Subrecipient

attest

to the contact

listed

in the contract

and

keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. 2.

The Data will be Encrypted while within the Subrecipient network.

The Data will remain Encrypted during transmission to the Cloud. The Data will remain Encrypted at all times while residing within the

Cloud storage solution. 5.

The

Data

will

not be decrypted

the control of an Authorized

until

downloaded

onto

a computer

within

User and within either the DSHS or

Subrecipient' s network. Data will not be stored on an Enterprise Cloud storage solution unless either:

ii.

iii.

The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or,

The Cloud storage solution used is HIPAA compliant.

System Protection.

To prevent compromise

of systems which contain DSHS Data or through

been

applied

within

the required

timeframes.

Systems containing DSHS Data shall have an Anti- Malware application, if available, installed.

Anti- Malware software shall be kept up to date. The product, its anti- virus engine, and

any malware database the system uses, will be no more than one update behind current.

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Data Segregation.

will contain no non- DSHS Data. ii.

DSHS Data will be stored in a logical container on electronic media, such as a

partition or folder dedicated to DSHS Data. iii.

DSHS Data will be stored in a database which will contain no non- DSHS data. And/ or,

iv.

DSHS Data will be stored within a database and will be distinguishable

from non-

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. Data Disposition. When the contracted work has been completed or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server

stored

on:

hard

disks,

or workstation

Removable drives,

media ( e. g.

portable

hard

floppies,

disks)

USB

excluding

flash optical

Will be destroyed by: Using a " wipe" utility which will overwrite the Data at least three ( 3) times using either random or single character data, or

discs

Degaussing sufficiently to ensure that the Data cannot be reconstructed,

Physical y destroying Paper

documents

with

sensitive

Confidential Information Paper

documents

the disk

Recycling through a contracted firm, provided the contract

containing Confidential

with

the recycler

assures

that the

confidentiality of Data will be protected. On- site shredding, pulping, or incineration

Information requiring special handling ( e. g. protected Optical

health information

discs ( e. g. CDs

DVDs)

Incineration, shredding, or completely defacing the readable surface with a coarse abrasive

Magnetic

tape

Degaussing, incinerating or crosscut shredding

Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be: a.

10. Data shared with Subcontractors.

If DSHS Data provided under this Contract is to be shared with

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contract with the subcontractor

ATTACHMENT

must be submitted

to the County Program Manager specified for

this contract for review and approval.

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DSHS Agreement Number

COUNTY

DSHS x

2663. 69480

PROGRAM

sonar

AGREEMENT

DDICS County Services This Program AgreerTlUnt

is by and between

Social and Health Services(

DSHS)

below. and is issued

identified

Administration oT Dlvision

Department of

the State of Washington

and The County

Agreerrton

conjunction with a County and DSHS Agreement On General Terms and Conditions, CS11SADNI

17SJIS

DSHS DIVISIOl

tSTRATION

INDEX

PS* sS CONTRACT

NUMDER

Number CODE

1769C5- 63

1136

Division Df Developmental

Disabilities

Developmental

County ggreament

by reference.

which is incorporated

Nurriber

Disabififies

Admin DSHS CQNTAC1

DSHS

NAME ANO TITLE

C04TAGT

ADDRESS

PO BOX 453i5

Wendi

lrchel

Regional

Business

Manager

QI m - a, WA 98504. 5315 DSHS CONTACT TELEPHONE 7254264

360

08HS

CONTACT FAX

360

586-

V$ HS CONTACT

COUNTY

NAME

COUNTY ADDRESS

Cowlitz

County County DDA County Services

1952

Cowlitz COUNTY

FEDERAL

EMPLOYER

E- NWL

wendi. winchel

6602

dshs. wa.

9th Avenue

I nnfiview.

98632

COUNTY CONTACT NAME

I DENT I= I CAI ION

NuMatR

SUe S'el'Yinn COUNTY

CONTACT

rELEPHONE

360

414- 5599

I5THE

COUNTY A SUI3RECIPIENT

CONTACT

COUNTY

FAX

FOR

PURPOSE$

CONTACT

saxtons

f3601501- 1207

ASSISTANCE

TH1S PROGRAM

F- MAIL

cowlitlwa- av

LISPING NUMBERS

AGREEMENT'?

No PROGRAM

AGREEMENT START

DATE

07/ 01 i2026

AGREEMENT

PROGRAM

ENO DATE

MAx1V.UN1 PROGRAM! AGREEMENI

ANIGUN-

2. 745, 890. 40

0613012D27

EXHIBITS. The following Exhibits are attached: Exhibit A— Data Security Requirements; Exhibit B— Budget and Spending

Plan

By their signatures below„ the parties agree to the terms arld conditions of this County Program Agreement ana all

PRINTED

SIG" 1ATURE( S)

DATE( S) SIGNED

NAVE( S) AND TITLELS;

BOARD OF COUNTY GOMMISSiONFRS OFCOWLITZCOUN1Y, WASHINGIaN Richard

PRINTED

DSHS SIGNATURE

Dahl, Chairman

NAME

AND TITL

Jessica Barbour, Contract

Specialist

SIGNED

08J1 912026

O WLITZ

caut4T ON o 45+-15 Central CUntmct Services 1769CS County Agreement( 12- 26- 2

26- 021 Last

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Special Terms and Conditions 1.

Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "

Acuity Level" means the level of a Client' s abilities and needs as determined

through the DDCS

assessment-

lb- " ALTSA Web Access(

AWA)" means a web- based portal to the Developmental

Disabilities

Community Services CARE system designed to support county services for DDCS clients. c_ "

Additional Consumer Services" refers to indirect Client servicetypes as follows1) "

Community Information

and Education":

Activitiesto inform and/ or educate the general public

and

2) " Training

3) "

Other Activities" reserved ty pes:

for special

a) Infrastructure

Projects in support of Clients ( services not easily tracked

projects:

projects and demonstrations

categorized

into the following

back to a

sp ecifi c work!ng age Client) o r th at d 1 rectly benefit a Clients) but the Client is not of work! ng age. Examples include planning services like genericjob development e.g." Project Search"_

b) Start- up projects:

Projects that support an agency or directly benefit the agency_ Examples

include equipment purchases and agency administrative support. c) Partnership

Project

Collaborative

partnerships

with school districts,

employment

providers,

disabilities

means a master classification

require to

of balance

f. " Competitive Integrated Employment"

g_ " Consumer Support" refers to direct Client service types as follows1) "

Community Inclusion" or" Cl": means individualized services provided in integrated community settings with other individuals without disabilities_ The activities are based on Client interests Page 2

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County Agreement(

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Special Terms and Conditions

support( Individual Employment or Group Supported Employment) for working age individuals who have received nine months of employment

support.

2) " Child Development Services" or" CDS": Birth to three services are designed to meet the

instruction, speechlanguage pathology, vision, and transportation_ Services are provided in natural environments to the maximum extent appropriate. 3) "

the general workforce.

These services

may include intake, discovery,

assessment,

job

preparation, job marketing, job supports, record keeping and support to maintain a job4) " Individualized

individual

Technical Assistance" or" ITA": services are a part of a Client' s pathway to employmentor community inclusion. This service provides assessment and

employment

enclaves, mobile crews, and other business models employing disabilities in integrated employment in community settings_ h. "

County" is the political subdivision

of the state of Washington

Examples include

small groups of workers with

and the county or counties entering

into this program AgreementI- "

DDCS Case Resource Manager( CRM)" means a case manager for DDCS Clients.

j_ " County Service Authorization( CSA)" means an authorization for county services. k. "

Developmental

disabilities(

DD)" means a disability

attributable

to intellectual

disability,

cerebral

Developmental

Disabilities Community

Services" DDCS" means a division within the Department of Page 3

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Special Terms and Conditions Social and Health Services. DDCS Regional office( DDCS Region)" means the regional DDCS office that supports DDCS

m_ "

clients.

Division of Vocational Rehabilitation(

n_ "

DVR)" means a division within the Department of Social and

Health Services o.

Employment

Outcome Payment"

means a paymentto

providers for transition

students barn

often

p_ " General Terms and Conditions"

which govern the contractual

meansthe contractual provisions contained within that agreement, relationship between DSHS and the county.

q_ " High Acuity Client" means a DDCS

Client who requires significant and intensive support community, often dueto complex needs, as determined through the DDCS assessment_

in the

Medicaid Home and Community Based Services( HOBS)" means services thatoccur in a Client' s home or community ratherthan institutions or other isolated settings_ These programs serve a

r. "

variety of targeted populations groups, such as people with intellectual or developmental disabilities,

physical disabilities,

Job Foundation

s_ "

and/ or mental illnesses

Report" is a document derived from employment

readiness

activities

performed

Preadmission Screening and Resident Review( PASRR)" means individuals with intellectual disabilities or related conditions( ID/ RC) who have been referred for nursing facility( NF) care.

t. "

Person

u. "

Centered Service Plan or PCSP" means a document that authorizes and identifes the

DDCS paid services to meet a Client' s assessed needs.

Formerly referred to as the Individual

Support Plan.

Ou ality Assurance" means an adherence to all Program Agreement requirements, including DDCS

v. "

Quality Improvement" means a focus on activitiesto improve performance above minimum standards and reasonably expected levels of performance, quality and practice_

Service Provider" is a qualified Client service vendor who is contracted to provide Employment and

Day Program y. " 2.

services.

Subcontractor" is the service provider contracted by the County to provide services.

Purpose: This Program Agreement is entered into between the Developmental Disabilities Community Services and the County in accordance with chapter 71 A_14 RCW_ Its purpose is to advance the state

legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental

disabilities_ Page 4

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Special Terms and Conditions 3.

Credentials and Minimum Requirements:

Administration

of the developmental

disabilities

County program cannot be subcontracted_

area ( e_g_ Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/ or a related Human or Social service may be considered_ c.

Sufficient Policies and Procedures for establishment and maintenance of adequate internal control

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees(

including

DID program County staff), subcontractors,

and/ or

Qualified Advisory Board Members:

A Developmental

Disabilities

advisory board shall include

members knowledgeable about developmental disabilities_ No board member shall have a contract

with the County to provide Training,

Community

Information

Activities,

and Consumer

Support as

defined in this Program Agreement, and shall not be a board member, officer, or employee of an

agency subcontracting with the County to provide such services. h.

Qualif ed Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6. 13, Program Qualifications for Employment and Day Program Providers.

Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to a ssign to DDCS its Medica id billing rights for Page 5

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Special Terms and Conditions

services to DDCS Clients eligible under Title XIX programs

in this Program Agreement.

Written

documentation shall be available to DSHS on request.

Counties who provide Child Development

Services( birth to three early intervention

services),

must

provide those services under the regulations implementing the Individuals with Disabilities Education Act( IDEA), Part C, and Washington Federally Approved Plan_ I_

State' s Early Support for Infant and Toddler

Ord er of Precedence: In the event of any inconsi stency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency

shall be resolved by giving

precedence, in the following order, to: 1)

County Program

Agreement;

and

2) Attached Exhibits. 5.

Disclosures must be provided at contract renewal and within thirty- five( 35) days whenever there is a change in the staff holding these management positions[ 42 CFR 455. 104 ( c)( 1)]_ 6.

the county as set forth below: a_

The DDCS region shall:

Review subcontractors and shall immediately notify the County of any concerns with the Page S

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Special Terms and Conditions

subcontractors

identified

bythe County;

5) Authorize

new service within 5 working days and will extend existing service authorization

before expiration date; 6)

Inform Clients of service changes through Planned Action Notice( s);

7) Work with the County to document planned services in the Client' s Person Centered Plan including notification of assessment dates;

Service

8) Work with the County when terminating services; 9) Work with DDCS Head Quarters

and the County on Spending

Plan adjustments;

and

10) Work with the County in participating in evaluation of direct service providers_ b_ The County shall: 1)

Work with the DDCS Region when Clients are referred for services,

authorized

services,

and/ or

for support modifications;

2) Work with the DDCS Region to document planned

services

in the Client' s Person Centered

Service Plan;

3) Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DID Assessment prior to any changes; 4) Work with the DDCS Region regarding

service termination;

5) Work with the DDCS Head Quarters on Spending

Plan adjustments;

6) Inform the DDCS Region of new providers to be included on the ALTSA Web Access( AWA) sy stem;

7) Notify the DDCS Region of any intent to terminate

a subcontractor

who is serving a DDCS

referral;

8) Provide a copy of each subcontractor' s contract upon written request from DDCS; and 9) Notify and work with the DDCS Region al Employment direct service providers. c.

Specialist when performing

evaluations

Compliance with Budget and Accounting Reporting System Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. Page 7

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The County shall comply with the following 1)

referenced

documents:

DDCS Policy 411, County Services for Working Age Adults;

DDA Guidelines

7) Disability

for Community

Rights Washington (

Assessments

formerly

within Employment

Washington

Protection

and Vocational

and Advocacy

Programs:

System)

and

Access

Agreement.

e_ The County shall develop and submit a comprehensive plan forthe County DID Services as required by WAC 388- 850- 020_ f.

Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The

Solicitation

for Qualified

of the County and the DDCS Region_

Employment

and Day Program

Service Providers:

Requests for

Applications( RFAs), Requests for Information ( RFI' s) and/ or Requests for Proposals( RFPs),

Requests for Qualifications( continuous

RFD' s) for direct services,

excluding

Child Development,

will be open

enrollment.

Oualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDCS.

Technical Assistance: DDCS contracts with Technical Counties with prior written approval_

Assistance

providers that may be utilized by

Inclusion services_

The County shall provide or contract with qualified Employment and Day Program Service Providersfor 1)

consumer support services that include thefollowing

Monthly Community

program outcomes-

Inclusion ( CI) service support hours will be based on the Client' s CI service

level per WAC 388- 828- 9310 for all Clients who began receiving CI services July 1, 2011 and forward_

Page$ DSHS

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b) CI services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will not be reim bursed.

2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses_ Clients

should be supported to average twenty( 20) hours of community work per week or eighty- six 86) hours per month; however,

each person' s preferred

hours of employment

should

be taken

into consideration. The amount of service a Client receives will be based on his/ her

demonstrated

need, acuity level and work history per WAC 388- 828.

3) The Client' s DDCS PCSP is the driver for service_ The AWA County Service Authorization CSA) and updated Planned Rates information will not exceed the Client' s DDCS PCSP.

Service changes will not occur until the Client has received proper notification from DDCS_ 4) All Clients will have an Individualized Employment and/ or Community Inclusion plan to identify Client' s preferences_ Minimum plan elements are outlined in the reference document" Criteria for an Evaluation." A copy of the Client' s individualized plan will be provided to the Client, their DDCS Case Resource Manager( CRM), guardian and others as appropriate. 5) Six- month progress reports describing the progress made towards achieving Client' s goal will be provided by the service provider to the CRM, Client, and/ or guardian, if any, within 30 days following the six- month period. The reportwill summarize activities and outcomes madetowards the Client' s individualized goal( s). All Clientswill be contacted bytheir service provider according

an additional review will be

responsible for authorizing CI services_ Page 9 DSHS

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Special Terms and Conditions

9) For Individual Employment where the service provider is also the Client' s employer, long term funding will remain available to the service provider employer far six months after the employee DDCS Client' s dateof hire- Atthe end ofthe six- month period, ifthe DDCS Client continuesto need support on the job, another service provider who is not the employer of record must provide the support unless the County or DDCS issues prior written approval far the service

and any potential conflict of interest is addressed.

10) Individual Employment staff hours must be attributed to the " Individual Employment and Billable Activity Phase( s)"

a) The collectivegroup' s individual hours should bethe minimum staff hours delivered to su pport th e g rou p-

f) Running a GSE service is a part of the business operation and not billable to Clients contract procurement,

contract maintenance, or administration

functions associated with

GSE)-

g) Individual time in the community working towards the individual employment goal, separate from the grouptime, must include phase information ( referto Employment Billable Activities- see Phases 1 — 4 for element/ activity description)12) Employment and day services must adheretothe Home and Community HCBS) requirementsof 42 C. F. R. Section 441. 301( c)( 4), including that:

Phases and

Based settings

a) The setting is integrated in the greater community and supports Client' s to havefull access to the greater community; b) Ensures the Client receives services in the community

to the same degree of access as Page 10

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Special Terms and Conditions

individuals

not receiving

Medicaid

HCBS;

c) The setting provides opportunities to seek employment and work in competitive integrated settings;

and

d) The setting facilitates individual choice regarding services and supports, and who provides them_

Quality Assurance

and Service Evaluation:

The County shall develop and have available

m_ Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one visit to each subcontractor

every two

Copies of such documentation

will be provided tothe DDCS upon request.

n_ The County shall workwith local developmental disability advisory groups to plan for and coordinate services_

The County shall participate in regularly scheduled meetings between County DID staff and DDCS staff to remain updated and current including ACHS and Regional Meetings.

AWA Data System: In compliance

with the AWA Training Manual,

the County shall use the AWA

data system for all:

Billing requests;

2) Service provider address and phone number maintenance; 3) Evaluation dates; 4) Employment

outcome information;

and

5) Monthly provide all data described in the Billing Instructions Instructions, which is hereby incorporated by reference. q.

and in the Employment Outcomes

Review and respond the AWA" Work List" items within 5 working days including pending Authorization_

Referrals and

Review the AWA" Ticklers" Planned Rate tab and update the planned rate within 5 working d ays Page 11

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Special Terms and Conditions after the Planned Rate start date. t_

Partnership

Project-

1) A Job Foundation document will be completed per guidelines for eligible students.

Eligible

students are DDCS clients who were born between:

a) For fiscal year 2026 9/ 1105 through 8/ 31/ 06 b) For fiscal year 2027 9/ 1106 through 8/ 31/ 07 These students currently

attending

school and have completed

an application

to participate

this Value Based Payment( VPB) project_ The VBP project application will include the following minimum

criteria identified in the sample application found at:

https:// www. d sh s. w a_ gov/ sites/ default/ fi I es/ D DA/ dd a/ d ocu m ents/ J ob`/` 20 Foundation% tlon

2 0APpl i c a

040720% 20% 28002% 29. docx

documents) meet quality standards_ u_

Outcome Payment. Providers, with transition

students born between:

a) For fiscal year 2026 9/ 1103 through 8/ 31104 b) For fiscal year 2027 9/ 1/ 04 through 8/ 31/ 05 2) High acuity transition students who are authorized for Individual employment, the provider may

receive one outcome payment if transition student obtains a competitive integrated job approved by the County within timeframes

described

in the chart in the Billing Instructions_

If the County

is also the service provider DDCS will provide the job approval_ If the job is at a minimum of ten hours of work per week a n additional

amount will be include in the payment-

a minimum

of 80% of the authorized hours. Page 12

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Special Terms and Conditions

5) A new Community

Authorization( CSA).

Fees.

Approval of fees is the responsibility of the DDCS. The DDCS HO Employment and Day Unit Manager reserves the right to approve fees/ rates for the services being provided_ The County will submit a fee/ rate schedule with the initial Program Agreement_ The County will submit updated fee/ rate schedules to the HQ Employment and Day Unit Manager for approval as changes occur_ The rate schedule will include the following information-

a) County( s) name; b) Time period for which the schedule! s applicable;

and

c) Each contracted direct service( IE, GSE, CI, ITA, CDS) and its associated rate-

Fee Limitations- The Billing Instructions found on the County Best Practices site provides lim itations on the Hourly Rate for each direct service. Hourly rates must be divisi ble by four.

b_ Budget and Spending 1)

Plan, attached

as Exhibit B-

Budget amount listed in Exhibit B- The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement

included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state- only employment and day services to waiver employment and day services-

2) Spending Plan- DDCS will provide the initial spending plan / Program Agreement Budget/ Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The

only be modified by mutual agreement of the parties in writing and shall not require a program agreement

amendment_

a) Funds Designated for Additional Consumer Services- If a County provides Community Information and Education services under additional consumer services, then activities must

include outreach

efforts to federally recognized

local tribes-

b) Funds Designated for Adult Day Care Consumers.

Funds designated for Adult Day Care

Consumers are availableto Clientswho were served between December 19M and

December 2003 in Adult Day Health agencies and were subsequently determined

ineligible Page 13

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County Agreement(

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ATTACHMENT

Special Terms and Conditions for Level II or III services(

If a Client no longer needs and wants services, the fund s

by the local Area Agency on Aging. Adult Day Care

service is not a waiver approved service_ c_

Program Agreement Amendments- A County can request an amendment at any time_ An amendment for additional Clients) may be supported when clients exceed the number used to

Exemptions- The DDCS Assistant program agreement requirement-

Secretary

may approve in writing an exemption

to a specific

Billing and Payment: a.

Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for-

1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration

include personnel

of the Developmental

and overhead

Disabilities Program.

Allowable costs

costs directly related to the administration

and coordination

a) Training: i.

Board Training- Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program- related skills of board and advisory committee

members.

and community Page 14

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Special Terms and Conditions

consultation,

capacity building

and organization

activities.

c) Other Activities_ i.

ii_

Start- up projects: Projects that support an agency or directly benefit the agency_ Examples include equipment purchases and agency administrative support-

school year they turn twenty-one( 21). Supports provided should complement and not replace what the student( s) receive through the Individualized Education Program( IEP)_ 3) Consumer Support_

Level II and III services are licensed

b) Community Inclusion Services are individualized and provided in integrated community settings with other individuals without disabilities_ The activities are based on Client

interests and provide opportunities typically experienced by the general public of sim ilar age in their local community,

accessible

by public transit or a reasonable

commute from their

to the maximum

extent

appropriate.

general workforce. These services may include intake, discovery, assessm ent, j ob preparation, job marketing, job supports, record keeping and support to maintain a job( per Page 15 DSHS

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Special Terms and Conditions the

Individual Employment Phases&

Billable Activities)

Examples include enclaves, mobile crews, and other business models employing small groups ofworkerswith disabilities in integrated employment community settings_ b_

Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this

Program Agreement.

However, with a Program Agreement amendment, the parties may increase

or decrease the Program Agreement amount_ Counties will work with DDCS HOon amendmentsto the Program Agreement. c_

Clients will be assisted in accessing DVR services perthe DDCS/ DVR MOU. Client services shall not be reimbursed

under this Program Agreement when the same services are paid for under the

Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. e.

Reimbursement

of Client Services:

A claim for each Client is made on the AWA system

indicating the number of service units delivered to each Client listed and the fee per unit_ Units are defined as:

An " Hour" is at least fifty( 50) minutes of direct service. Partial hour to the quarter may be recorded-

2) A" Day" is at leastfour( 4) hours of direct service and will only be used in connection with Adult Day Care reimbursement3) A" Month" represents

a minimum of at least fifty( 50) minutes of direct service for CDS

reimbursement.

can be 1112 of the maximum amount identified in Exhibit B under Administration or

The Individual Employment Phases&

Billable Activities document defines the individual Client Page 16

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Special Terms and Conditions

services that DDCS reimburses.

That document

is located on the DSHS DDCS County Best

Practices Web site at https:// www. dshs. wa. aov/dda/ county- best- practices.

Timeliness of and Modification to Billings: All initial invoices with signed documentation must be

Recovery of Fees. If the County bills and is paid fees for services that DSHS later finds were( a) not delivered or( b) not delivered in accordance with Program Agreement standards, DSHS shall

recover the fees for those services and the County steal I fully cooperate during the recovery. k_

costwill be based

DDAJobFoundationReportsadshs_

wa_.Qov

multiplied by

Intermediate Care Facilities for Intellectual Disabilities( ICF1ID) Agreement. If applicable per 42 CFR 463. 410, the County shall assure that all county- operated or subcontracted

programs serving

persons living in ICF/ ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/ ID resident 10.

Single State Medicaid Agency— Health Care Authority(

HCA):

HCA, as the single state Medicaid

DSHSIDRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDCS is incorporated

by reference_ The County assures that it and its subcontractors

have reviewed

the

Access Agreement_ The agreement covers DRW' s access to individuals with developmental Page 17 DSHS

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Special Terms and Conditions

disabilities, Clients, programs and records, outreach activities, authorityto investigate allegations abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS

contracted services_ 12.

Confidential Information.

All Counties and their subcontractors must

Ensure the security of Confidential Information, and

When transporting

client records containing

Confidential

Information

outside a Secure Area, one or

more of the following as appropriate: 1)

U sing a Trusted Network; or

2) Encrypting the Confidential Information, including: a) Email andlor email attachments

b) Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.

Data Security

Requirements. Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization, or transmits more

than

14.

5 records

atone time.

Supersession of Prior Data Security Agreement_ If the Parties hereto have previously entered into a Standalone

Data Security Requirements

Agreement,

both Parties hereby agree that upon mutual

execution said Agreement shall take precedence as the sole Data security Agreement between the Parties_

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Special Terms and Conditions Exhibit A— Data Security 1.

Definitions_

Requirements

The words and phrases listed below, as used in this Exhibit, shall each have the fallowing

definitions: a. "

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so_ e. "

Category 4 Data" is data that is confidential

and requires special handling due to statutes or

refers to data protected

by: the Health Insurance

Portability

d_ " Cloud" means data storage on servers hosted by an entity other than the Contractor and on a

network outside the control of the Contractor.

Physical storage of data in the cloud typically spans

multiple servers and often multiple locations.

Cloud storage can be divided between consumer

grade storage for personal files and enterprise grade for companies and governmental entitiesExam pies of con sumer grad e storage wouId include iCloud, Dropbox, Box_com, and many other entities.

Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and

Rackspace_ e_ "

Encryption

must use a key length of at least 129 bits( 256 preferred)

for symmetri c keys, or

2048 bits for asymmetric keys_ When a symmetric key is used, the Advanced Encryption Standard AES) must be used if available. f. " Hardened

Password"

means a string of at least eight characters

containing

at least three of the

following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. " Mobile Device"

h_ " Multi- factor Authentication"

series of numbers which act as a password for a device_ Since PINS are typically only four to six characters,

PINS are usually used in conjunction

with anotherfactorof

authentication,

such as a

fingerprint1- "

DSHS

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Special Terms and Conditions

are not limited to, mobile phones, tablets, and laptops.

Mobile Device is a subset of Portable

Device.

j. "

k_ " Secure Area" means

Confidential

an area to which only authorized representatives of the entity possessing Information have access, and access is controlled through use of a key, card key,

the

Trusted Network" means a network operated and maintained

by the Contractor, which includes

integrity, and availabilityof

the Data. m. "

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.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington

Technology

httns: l/watech_wa_gov/ policies? combine=& field

and of the DSHS Information these requirements

ServicesAgeney

categories

Security Policy and Standards

can be found

target id= 80& field tune target

Manual_

Reference

material

id= All],

related to

here: htti) s:// www. dshs. wa.- govlffa/ keening- dshs- client- information-

private- and- secure, which is a site developed

by the DSHS Information

Security Office and hosted by

DSHS Central Contracts and Legal Services. 3.

Administrative Controls. The Contractor must have the following controls in place: a_

A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy.

If Confidential Information shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment forth e systems) housing the Category 4 Data.

Authorization, Authentication, and Access. authorized

In order to ensure that access to the Data is limited to

staff, the Contractor must:

Page 20 DSHS

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Special Terms and Conditions

Have documented

policies and procedures

b_ Restrict access th rough administrative,

governing

physical,

access to systems with the shared Data

and technical

controls to authorized

staff_

Ensure that only authorized users are capable of accessing the Data_

e_ Ensure that an employee' s access to the Data is removed immediately:

UWn suspected com promise of the user credentials.

2) When their employment, or the contract under which the Data is made available to them, is terminated_

3) When they no longer need access to the Data to fulfill the requirements of the contract. f.

Have a process to periodically review and verify that only authorized containing DSHS Confidential Information

A minimum

length of 8 characters,

and containing

users have access to systems

at least three of the following

character

classes: uppercase letters, lowercase letters, numerals, and special characters such as an

asterisk, ampersand, or exclamation point. 2) That a password

does not contain a user' s name, logon ID, or any form of their full name.

3) That a password does not consist of a single dictionary word. passphrase which consists of multiple dictionary words-

A password

may be formed

as a

4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h.

Ensuring

mitigations

applied to the system don' t allow end- user modification_

2) Not allowing the use of di al- up connections.

3) Using industry standard protocols and solutions for remote access_ Examples would include RADIUS and Citrix.

4) Encrypting

all remote access traffc from the external workstation

to Trusted

Network or to a

component within the Trusted Network_ The traffic must be encrypted at all times while

traversing any network, including the Internet, which is not a Trusted Network. Page 21 DSHS

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Special Terms and Conditions

5) Ensuring that the remote access system prompts for re- authentication session termination after no more than 30 minutes of inactivity.

or performs automated

6) Ensuring use of Multi- factor Authentication to connect from the external end point to the internal end point_ i_

Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication

mechanism,

such as a biometric(

fingerprint,

face recognition,

iris scan) or token

software, hardware, smart card, etc.) in that case-

The PIN or password

must be at least 5 letters or numbers when used in conjunction

with at

least one other authentication factor 2) Must not be comprised of all the same letter or number( 11 111, 22222, aaaaa, would not be acceptable)

Must not contain a" run" of three or more consecutive numbers( 12398, 98743 would not be acceptable)

If the contract specifically allows for the storage of Confidential passcodes used on thedevice must 1)

Information on a Mobile Device,

Be a minimum of six alphanumeric characters.

2) Contain

at least three unique character classes( upper case, lower case, letter, number).

3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable_ k. 5

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Contractor protect the Data as described, a_

agrees to store Data on one or more of the following

media and

Hard disk drives_ For Data stared on local workstation hard disks, access to the Data will be

Network server disks_ For 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

mechanism_

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Special Terms and Conditions

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 Secure Area_ When not in use for the contracted

purpose, such discs must be

Stored in a Secure Area_ Workstations which access DSHS Data on optical discs must be located

in an area which is accessible only to authorized personnel, key, card key, combination lock, or comparable mechanism d_

Optical discs ( CDs or DVDs) in drives or jukeboxes

with access controlled

attached to servers.

through use of a

Data provided by

DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through

smart

cards_ Data on discs attached to such servers must be located in an area, which is accessible only

to authorized

personnel,

comparable

mechanism_

with access controlled

through

use of a key, card key, combination

lock, or

Remote Access.

Access to and use of the Data over the State Governmental Network( SGN) or

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)

authentication

a Unique User ID and Hardened Password or stronger

method such as a physical token or biometrics.

and physical

security controls to Portable Devices and Portable Media

Keeping them in a Secure Area when not in use,

ii_

Using check- in/ check- out procedures when they are shared, and

iii_ Taking frequent inventories_ Page 23 DSHS

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Central

Contract

Services

County Agreement(

26- 021 Last

47 of 51

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

PROFESSIONAL

SERVICES

AGREEMENT

ATTACHMENT

Special Terms and Conditions

Data stored for backup purposes-

below in Section

8 Data Disposition.

1) DSHS Data wi II not be stored in any consumer grade Cloud solution, unless all of the following conditions are met-

for

b) The Data will be Encrypted while within the Contractor network.

c) The Data will remain Encrypted during transmission to the Cloud. d) The Data will remain Encrypted

at all times while residing within the Cloud storage solution_

e) The Contractor will possess a decryption possessed only by the Contractor. f) The Data will not be downloaded

key for the Data, and the decryption key will be

to non- authorized

systems,

meaning

systems that are not

on the contractor network

a) The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or, b) The Cloud storage solution used is HIPAA compliant_

Page 24 DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 021 Last

48 of 51

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

PROFESSIONAL

SERVICES

AGREEMENT

ATTACHMENT

Special Terms and Conditions

System Protection. that Data passes:

To prevent compromise of systems which contain DSHS Data or through which

a. Systems containing DSHS Data must have all security patches or hotfxes applied within 3 months of being made available_

b_ The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes.

c_ Systems containing DSHS Data shall have an Anti- Malware application,

if available, installed.

d. Anti- Ma lware software shall be kept up to date. The product, its anti- virus engine, and any malware database the system uses, will be no more than one update behind currentT.

Data Segregation-

DSHS Data will be kept on media ( e. g. hard disk, optical disc, tape, etc.) which will contain no non- DSHS Data-

4) DSHS Data will be stored within a database and will be distinguishable

from non- DSHS data by

the value of a specific fell or fields within database records.

5) When stored as physical

paper documents,

DSHS Data will be physically

segregated

from non-

DSHS data in a drawer, folder, or other container_

b_ 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 asdescribed

this exhibit.

Data Disposition.

When the contracted

work has been completed

or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server or workstation

on:

hard disks, or

Will be destroyed by: Using a " wipe" utility which wi II overwrite the Data at least three( 3) times using either random or single character data, or Page 25

DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 021 Last

49 of 51

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

PROFESSIONAL

SERVICES

AGREEMENT

ATTACHMENT

Special Terms and Conditions

Removable

media( e. g. Coppies, USB Cash drives,

portable hard disks) excluding optical discs

Degaussing

sufficiently to ensure that the Data

cannot be reconstructed, or

Physically destroying Paper documents with

sensitive

Confidential

Information

the disk

Recycling through a contracted firm, provided the contract with the recycler assures that the

confidentiality of Data will be protected. 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 ta 9.

I Degaussing,

Notification

of Compromise

or Potential Compromise.

incinerating

or crosscut

shredding

The compromise or potential compromise of

DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one( 1)

Page 26 DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 021 Last

50 of 51

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

PROFESSIONAL

SERVICES

AGREEMENT

ATTACHMENT

Exhibit B

Program Agreement

Original Budget

Budget

0 Budget Revision

REVENUES Fund Source

Fiscal Year 2026

Fiscal

State and

1, 627, 450

1, 479, 700

Medicaid

1 447 900

1 313 649

Total Rev.

3 075 350

2 793 350

Year

Fund

2027

11; t Revision

Original

State

Source

Original

V Revision

21d Revision

3,d Revision

21d Revision

31d Revision

1 457 352

on ly

1 288 528

Medicaid

Total Rev.

V,745, 890

Job Foundation

PASRR Funds

ADMINISTRATION( 12

Funds

TOTAL

11,

13)

OTHER

Medicaid State Funds

Funds

137, 294

112, 332

249, 626

89, 819

73, 487

163, 306

CONSUMER

SUPPORTS 31, 32, 41, 92, 93, 94, 97) CONSUMER SUPPORT STATE62,

ONLY

64r 65, 67r 69

Child Development

MEDICAID 64 67 r

ROADS

125440

CLIENTS 69

21 D00

1 093 259

1 D93 259

207 518

1, 445, 812

1, 279, 078

Z745, 890

COMMUNITY 62

64 65 r

LIVING 67

TOTAL

21, 000

Page 27 DSHS

Central

Contract

Services

1789CS CauntyAgreement( 12-25- 2025)

26- 021 Last

51 of 51

Date Revised:

Admin

Form:

1615. 2

1/ 09/ 2025

233337

BOCC

Motion

Item

Agenda

Meeting Date: 9/ 15/ 2026 Contract with iEmbrace

Submitted By: Amanda Foshaug, Accounting Specialist II Submitted For: Gena James, HHS Deputy Director Department:

Human

Services

Dept

Information

Subject and Summary Statement

The purpose of this County Contract# 26- 018 with iEmbrace is to provide developmental disability

employment and day services This contract is paid on a cost reimbursement basis, not to exceed $ 77, 000. 00, during the period July 1,

2026, through June 30, 2027. Funding for this contract is passed through from the County' s contract with State Department

Washington

of Social & Health Services, Developmental Disabilities Administration.

Contract/ SOW Name

Current

Original

Change

Total

77, 000. 00

Time Period 7/ 01/ 26- 6/ 30/ 27

Staff Attendance Gena

James

Department

It is the

Recommendation

recommendation

Board of Commissioners

of the Cowlitz

County Health& Human Services that the Cowlitz County

move to approve this Contract 26- 018 with iEmbrace.

Attachments 26- 018

DD-

iEmbrace

Form

Task

User

Foshaug,

Amanda

Agenda

Review

Action

Timestamp

Item Submission

Submit

8/ 27/ 2026

11: 14: 00 AM

Approve

8/ 31/ 2026

11: 08: 00 AM

Approve

9/ 1/ 2026

Drake,

Jamie

Preliminary

Review-

James,

Gena

Department

Approver

HHS

11: 10: 00 AM

Review Berger, David

Legal Review

Approve

9/ 4/ 2026 3: 26: 00 PM

Grayson,

Clerk of the Board

Approve

9/ 8/ 2026

Kelly

7: 52: 00 AM

233337

Motion

Review

Item

rz co&

SUBRECIPIENT

GRANT

AGREEMENT

Number:

gSM1NG G

26- 018

Purpose of Subrecipient

Grant Agreement. This Subrecipient

Grant Agreement (" Agreement")

is made by and between COWLITZ COUNTY, a political subdivision of the State of Washington, hereinafter called " County" or" Cowlitz County") and iEmbrace ( hereinafter called Subrecipient") to set forth the terms and conditions by which the County will provide the Subrecipient with a grant award to be used to pay or reimburse necessary expenditures incurred for services for persons with developmental disabilities. 2.

Term.

Scope of Eligible Expenditures. Grant funds may only be used to pay or reimburse eligible

This Agreement

expenditures

shall take effect on July 1, 2026 and terminate on June 30, 2027.

consistent and as detailed in Attachment A-

Scope of Work for Project ( the

Project").

Grant Award.

The Subrecipient is awarded a total of$ 77, 000.

Budget. The Grant Award shall be expended by the Subrecipient as set forth in Attachment B Budget.

Subrecipient

Responsibilities.

Subrecipient

agrees to administer the Grant Award proceeds

consistent with this Agreement. Subrecipient shall provide the County with certification using the form of Attachment C that Grant Award funds will be used for eligible expenditures. Subrecipient

shall request payment from the County as outlined in Attachment B. 7.

Access to and Maintenance of Records. Subrecipient shall maintain internal controls, accounts

terminated, b.

suspended,

or otherwise

Termination for Convenience. convenience

lost or impaired

in whole or in part.

Either party may terminate this Agreement for

upon giving the other party at least 30 days' advance written notice.

In that

event, the Subrecipient will be entitled to payment only for those expenses and costs reasonably and actually incurred prior to the effective date of the termination. 1 of 53

26- 018 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 22/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

If the default is not cured within 30 days of notice, the

The following provisions apply in the event that this Agreement is

terminated: a.

The Subrecipient shall cease to perform hereunder as of the effective date of termination and shall comply with all reasonable instructions contained in the notice of termination, if

The Subrecipient shall provide the County with an accounting of authorized services provided through the effective date of termination.

any.

11.

Conflict of Interest. Subrecipient designees, agents, members, officers, employees, consultants,

The Subrecipient will secure at its own expense all labor and materials required to

Name: Title:

Deputy

Director

Department:

Health &

Human

Address:

1952

Telephone:

(

Fax:

WA 98632

414- 5599

iEmbrace

1801 1st Ave Longview, 360)

WA 98632

560- 5553

Lonni@iembracelIc. com

UEI:

TZ8RNRDSRNN1

FZMMAT2F41G6

UBI:

08- 300- 3788

604 08 3569 2 of 53

26- 018 Admin

Director

Services

HHSContracts( c cowlitzwa. gov mailto:HHSContracts 360) 425- 7531 @cowlitzwa.

E- mail:

Date

360)

Lonnie Bowers

9tn Ave

Longview,

Last

For the Subrecipient:

County:

Gena James

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

15.

GRANT

AGREEMENT

Bodily injury, including death. Property damage

Per occurrence

1, 000, 000 1, 000, 000

Per occurrence

2, 000, 000

Aggregate

1, 000, 000

Per occurrence

2, 000, 000

Aggregate

ERRORS AND OMISSIONS or PROFESSIONAL

LIABILITY with an Extended Reporting Period

Endorsement(

two year tail).

WORKERS COMPENSATION:

Statutory amount Waiver of Title 51 Rights

EMPLOYER' S LIABILITY/ Stop Gap: Per occurrence

1, 000, 000

AUTOMOBILE:

coverage on owned, non- owned, rented and hired vehicles

Bodily injury, liability, including death and property damage liability 1, 000, 000

Combined Single Limit

All Subrecipient' s and Subrecipient' s subcontractors' insurance policies and additional named insured endorsements

shall provide primary insurance coverage and be non- contributory.

Any

and/ or self- insured

retentions

exceeding $

10, 000 or any stop- loss provisions,

the

County shall have the right to request and review the Subrecipient' s most recent annual financial reports and audited financial statements as a condition of approval.

Subrecipient hereby agrees to waive subrogation with respect to each insurance policy maintained under this Agreement. When required by an insurer, or if a policy condition does not 3 of 53

26- 018 Last

Date

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

insurance policies by way of endorsement for the full available limits of insurance maintained by the Subrecipient

and subcontractor,

and all coverage shall be primary and non- contributory.

state or notion of additional insured status on a Certificate of Insurance shall not satisfy these requirements. [ This endorsement shall not be required if the Subrecipient is a governmental entity and is insured through a governmental entity risk pool authorized by the State of Washington.] The Subrecipient shall, for each required insurance policy, provide a Certificate of Insurance, with endorsements attached, evidencing all required coverages, limits, deductibles, self- insured retentions and endorsements and which is conditioned upon the County receiving thirty ( 30) days prior written notice of reduction in coverages, cancellation or non- renewal. Each Certificate of Insurance and all insurance notices shall be provided to: ATTN: County Project Manager, Cowlitz County Health & Human Services, 1952 9th Avenue, Longview, WA 98632. This Agreement shall be void ab initio if the proof of coverage is not timely supplied. The insurance maintained under this Agreement shall not in any manner limit or qualify the liabilities or obligations of the Subrecipient under this Agreement. All insurance policy deductibles and self- insured retentions for policies maintained

under this Agreement shall be paid by the

Subrecipient.

Compensation and/ or payments due to the Subrecipient under this Agreement are expressly conditioned

upon the Subrecipient' s strict compliance with all insurance requirements.

to the Subrecipient shall be suspended

in the event of noncompliance.

Payment

Upon receipt of evidence

of Subrecipient' s compliance, payments not otherwise subject to withholding or set- off will be released to the Subrecipient.

This Agreement

shall be void ab initio if the proof of coverage

is not

4 of 53

26- 018 Last

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

18. Debarment

AGREEMENT

Certification.

The Subrecipient,

by signature to this Agreement,

certifies that the

in all

The Subrecipient and its officials, officers, employees, agents, and

If the Subrecipient is a faith- based or religious organization, it retains its

Permissible

Use Warranty.

The Subrecipient

recognizes

and agrees that the Grant Award

Disabilities

Administration.

The Subrecipient

warrants that its planned and actual

permissible

uses

consistent with Attachment A and the pass- through funding requirements discussed immediately above.

This section shall survive termination of this Agreement.

No term or condition of this Agreement shall be deemed waived unless such waiver is

5 of 53

26- 018 Last

Date

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

Each counterpart

may be executed and delivered by facsimile to the other party. 33. Attachments. The following attachments are incorporated into this Agreement by reference. a. Attachment

A— Scope

b. Attachment

B—

c. Attachment

C— Certification

d. Attachment

D—

Retirement

e. Attachment

E—

f. Attachment

F—

Data Security Requirements DSHS County Program Agreement DDCS County Services

IN WITNESS

WHEREOF,

of Work

for Project

Budget Form Certification

the parties have executed this Agreement

this

day of

BOARD OF COUNTY COMMISSIONERS

SUBRECIPIENT:

OF COWLITZ COUNTY, WASHINGTON

Signature

Richard

Steven L. Ferrell,

Commissioner

Steve

Commissioner

Rader,

ATTEST:

CONTRACT FORM

HAS BEEN APPROVED AS TO

BY COWLITZ

PROSECUTING

COUNTY

ATTORNEY

Date

Clerk of the Board Date

6 of 53

26- 018 Admin

Chairman

name:

Title:

Last

R. Dahl,

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

SCOPE

OF WORK

FOR

PROJECT

The Subrecipient shall ensure services, and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: 1.

a) Infrastructure

projects: Projects in support of Clients ( services not easily

or replacement d. "

regulation.

Confidential Information" or" Data" means information that is exempt from disclosure to

the public or other unauthorized persons under Chapter 42. 56 RCW or other federal or state laws. Confidential

information

includes, but is not limited to, Personal Information.

g. "

Debarment" means an action taken by a federal official to exclude a person or business entity from participating in transactions involving certain federal funds.

h. "

DSHS" means the Department of Social and Health Services of the state of Washington.

i. "

j. "

General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. 7 of 53

26- 018 Last

Date

Admin

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

High Acuity Client" means a DDCS Client who requires significant and intensive support in the community, often due to complex needs, as determined through the DDCS

assessment.

Medicaid Home and Community Based Services ( HCBS)" means services that occur in

I. "

Person Centered Service Plan or PCSP" means a document that authorizes and

identifies the DDCS paid services to meet a Client' s assessed needs. Formerly referred to as the Individual Support Plan.

RCW"

means

the Revised

Code

of Washington.

All references

in this Agreement

and

any Program Agreement to RCW chapters or sections shall include any successor, amended, or replacement statue. Pertinent RCW chapters can be accessed at

http:// apps. leg. wa. gov/ rcw/. Secretary" means the individual appointed by the Governor, State of Washington, as the

head of the DSHS, of his/ her/ their designee.

Information

is not available to unauthorized

personnel.

w. "

provide services. Trusted Systems" include

following methods of physical delivery: ( 1) handdelivery by a person authorized to have access to the Confidential Information with written

acknowledgment

only the

of receipt; ( 2) United

States Postal

Service (" USPS") first class

the Washington State Governmental

Trusted System for communications

Network ( SGN) is a

within that Network.

USC" means the United States Code. All references in this Agreement and any Program Agreement to USC chapters and sections shall include any successor, amended, or

" WAC" means the Washington Administrative Code. All references in this Agreement and

replacement

statute.

any Program Agreement to WAC chapters or sections shall include any successor, amended, or replacement of regulation.

Pertinent WAC chapters or sections can be

accessed at http://apps.leg.wa.gov/ http:// apps. leg. wa. gov/ wac/. wac/

8 of 53

26- 018 Last

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1615. 2

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Purpose. a.

Direct Client Services

i. "

authorized in addition to or instead of employment support ( Individual

Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. ii. "

iii. "

Individualized

iv.

Technical Assistance"

or" ITA": services are a part of an Client' s

Coordination. Working collaboratively, the parties shall administer DD services within the county as set forth below: The DDCS region shall:

iii.

iv.

Authorize new service within five ( 5) working days and will extend existing

ii.

referrals when authorization is not issued; service authorization before expiration date; v.

Inform Clients of service changes through Planned Action Notice( s);

vi.

Work with the DDCS Region and the Subrecipient when Clients are referred for services, authorized services, and/ or for support modifications;

Work with DDCS Region and the Subrecipient

to document planned services in

the Client' s Person Centered Service Plan;

9 of 53

26- 018 Last

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

xi.

xii. xiii.

ATTACHMENT

The Subrecipient shall: xiv. xv.

Facilitate the County' s attendance at employment plan meetings as requested. Work with the DDCS Region and the County when Clients are referred for services;

xvi.

Work with DDCS Region and the County to document planned services in the

xvii.

Assist with informing the DDCS Region and County of any potential service level changes not documented in the individual' s DID Assessment prior to any

Client' s Person Centered Service Plan;

changes; and xviii.

2011 i.

and forward.

ii.

Cl services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will

not be reimbursed.

DDCS PCSP. Service changes will not occur until the Client has received proper notification from DDCS. d.

f. g.

at minimum wage or higher within six ( 6) months, the

26- 018 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

employment. The additional strategies will be documented

for each Client and

kept in the Client' s file( s). h.

j. k.

If after twelve ( 12) months the Client remains unemployed,

an additional review will be

The setting facilitates individual choice regarding services and supports, and who provides them.

Partnership Project i. A Job Foundation document will be completed per guidelines for eligible students. Eligible students are DDCS clients who were born between: 1.

For fiscal year 2026: 9/ 1/ 05 through 8/ 31/ 06. For fiscal year 2027: 9/ 1/ 06 through 8/ 31/ 07. These students currently attending school and have completed an application to 2.

ii.

participate

in this Value Based Payment ( VBP) project. The VBP project

application will include the following minimum criteria identified in the sample application found at:

Project the Subrecipient

must have a current contract

If action to correct substandard performance is not taken by the Subrecipient within 30 days after being notified by the County, then the County may terminate the Agreement as described herein.

11 of 53

26- 018 Last

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

Additional Requirements:

ATTACHMENT

The Subrecipient will maintain and make available, if requested,

documentation demonstrating accomplishments of the contract. Such documentation may include, but is not limited to, the following: a. Services provided b.

Number of hours of service

Data Collection

Completed evaluation tools

Backup reports/ data for invoicing.

Agreement. Credentials and Minimum Requirements:

Sufficient Policies and Procedures for establishment and maintenance of adequate

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees, subcontractors, and/ or volunteers who may have unsupervised

access to vulnerable DSHS Clients, in accordance with RCW 43. 43. 830-

Check Central Unit( BCCU) must be utilized to obtain background

clearance.

ii.

12 of 53

26- 018 Last

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agency.

Subrecipient is specifically authorized to have data storage on portable devices or media in accordance with Attachment E. Data Security Requirements.

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Chapter WAC 388- 850, chapter 388- 828 WAC, WAC 388- 845- 0001, 0030, 0210, 0215, 0220, 0600- 0610, 1030- 1040, 2100, 2110;

Criteria for Evaluation;

DDA Guiding Values; County Guide to Achieve DDA' s Guiding Values; DDA Guidelines for Community Assessments with Employment and Vocational

Programs;

and

Disability Rights Washington ( formerly Washington Protection and Advocacy System) Access Agreement.

The Subrecipient shall ensure that all staff, working with clients receiving Community Access or Individual Employment Services, complete the following DDA online courses upon hire

http://gowise.org/training/wa-state-dda-onlinehttp:// gowise. org/ training/ wa- state- dda- online- courses/ DDA- 5. 06: WA State Client Rights; a. courses/ b.

minimum wage or better; and the average number of hours worked. The Subrecipient' s service

Follow all requirements as outlined in Attachment E.

ii.

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. d.

When transporting client records containing Confidential Information outside a Secure Area, one or more of the following as appropriate:

Date

Admin

Use a Trusted Network; or

Encrypting the Confidential Information, including: 13 of 53

26- 018 Last

Information.

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

and/ or email

attachments.

iii.

14 of 53

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

BUDGET

Budget. The County shall reimburse the Subrecipient in an amount not to exceed $ 77, 000 for expenses related to Consumer Services and staff training/ education. Staff training/ education reimbursement may not exceed $ 2, 000 for the contract period, requires approval from the County Coordinator, and is based on availability of funds. Unspent grant proceeds will be reallocated at the discretion of the County.

The Subrecipient shall budget funds awarded in such a manner to ensure availability of services throughout the entire term of this Agreement subject to available funds. 2.

Payment. Subject to Section 1, the County shall reimburse the Subrecipient for costs and expenses necessary to perform activities described

in the Scope of Work for Project and as

indicated in the CCHHS Contractor Toolkit located online at www. co. cowlitz. wa. us/ cchhscontractors, and as updated. The Subrecipient shall ensure that

Invoices. The Subrecipient shall submit invoices using the County' s form, or such other form as approved by the County. Consideration for services shall be payable upon receipt of properly completed

invoices which shall be submitted to the County Contract Representative

within this

Agreement, by the Subrecipient, not more often than monthly. The invoices shall describe and document to the County' s satisfaction a description of the work performed, activities accomplished, the progress of the project, and fees. The Subrecipient shall submit invoices to the County on or before the 15th of the month, regardless of what day of the week the 15th falls on, following the month of services were performed. The final invoice must be received by the County no later than the 15th of the month, regardless of what day of the week the 15th falls on, following the end of this contract. The final invoice due date is subject to change based on funding requirements. 4.

Advance Payment. The County shall not make any payments in advance or in anticipation of the delivery of services to be provided pursuant to this Agreement.

26- 018 Last

Date

Admin

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

Subrecipient

ATTACHMENT

is bound to follow all terms and conditions of the Washington State DSHS

Program Specific Conditions: a.

Consumer Services

The Subrecipient may bill at the rate authorized on the County Service Authorization for the number of unit( s) per consumer per month for: i. Community Inclusion

ii.

Individual Supported

iii.

Individualized Technical Assistance

Employment

Reimbursement for Client Services: A claim for each individual is made by indicating the number of service units delivered to each individual listed and the fee per unit. Units are defined

as:

Individual

Date

Admin

Billable

Activities

document

defines

the individual

delivers

a minimum

of 80% of the authorized hours.

26- 018 Last

Phases &

Client services that the County reimburses. That document is located on the DSHS DDA County Best Practices Web site at https:// www.dshs. wa. gov/ dda/ county- best- practices. High acuity Clients who are authorized for Individual employment, Subrecipient may receive one outcome payment if client obtains a new competitive integrated job at a minimum of ten hours of work per week for a minimum of 4 out of each 6 months during the fiscal year. The Community Inclusion Billable Activities document defines the individual Client services that the County reimburses. That document is located on the DSHS DDA County Best Practices Web site at https:// www.dshs. wa. gov/ dda/ county- best- practices. Client who are authorized for Community Inclusion who have an acuity of F which equals 18 support hours per month or G which equals 20 support hours per month as based on the Support Intensity Scale ( SIS), provider may receive on outcome payment per month if provider

Employment

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

payment.

The Subrecipient

ii.

Subrecipients with transition students, as outlined in Attachment A, Section 31,

will receive $ 3, 000 per student for each completed

Job

July

1 sc—

October

January April

range

for job

1st— September

1st-

sc—

June

Outcome

Payment

Amount

1, 500 31 st

December March

placement

30'"

1, 000 500

30t"

250

Please note a current County Service Authorization for Individual Employment must be in place prior to outcome payment. q.

Training i.

The

Subrecipient 1.

shall:

Seek prior approval from the County Coordinator for training/ education reimbursement.

Make every effort to minimize the cost of individuals training by seeking out scholarships and stipends, shared transportation and lodging when applicable to help reduce costs. Any additional

3. 4.

costs will be the sole

responsibility of the Subrecipient. Inform individuals of allowable travel and training expenses. Submit copies of itemized receipts, MapQuest directions, travel

itineraries, conference registration including agenda pertaining to all requested reimbursements. Expenses without backup documentation will not be reimbursed.

Timeliness of and Modification

to Billings: All initial invoices with signed

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GRANT AGREEMENT

ATTACHMENT

CERTIFICATION

I, Lonnie Bowers, am the Director of iEmbrace and I certify that: 1.

I have authority and approval from the governing body on behalf of iEmbrace to accept proceeds from the County per Agreement for services for persons with developmental disabilities by and between the County and iEmbrace

disabilities.

Were incurred during the period that begins on July 1, 2026 through June 30, 2027 3.

1 understand iEmbrace receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/ or sales receipts and such documentation shall be produced to the County upon request and may be subject to audit by the State Auditor.

Printed

Name

Signature

Title

Date

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GRANT AGREEMENT

ATTACHMENT

RETIREMENT

CERTIFICATION

COUNTY RETAINS THIS FORM

Individual contractors and service providers must complete and sign WA Department of Retirement Systems: Independent Contractor Verification and State

Retirement Status Reporting Form [ WAC 415- 02- 110; DRS Email 13- 011; DRS Email 09- 001] SECTION 1:

INDIVIDUAL CONTRACTOR

COMPLETES

THIS SECTION AND SIGNS:

Did you

retire

from

Did you

retire

before age 65 using the 2008 early retirement

Will

you

be receiving direct compensation

Will

you

be receiving indirect

one

of the State of Washington

Retirement Systems? factors ( ERF)?

for your services? for your services?

compensation

YES

CONTRACTOR ( Full, individual name of contractor): Signature: SECTION

Social 2:

COUNTY

COMPLETES

Use Member Reporting 1.

Contractor

has

THIS

Security No.: SECTION

Date:

AND

RETAINS

FOR AUDIT

Verification ( MRV) to verify the past retirement

been

a member

of a Washington

State

Retirement

PURPOSES:

membership] System

YES

If YES, what system and plan? Teachers'

Retirement

System (

TRS)

Planl

Plan

School

Employees'

Retirement

System (

SERS)

Plan

Public

Employees'

Retirement

System (

PERS)

Plan

Public

Safety Employees'

Plan

Law

Enforcement

Washington

Retirement

Officers' &

State Patrol

Fire

System ( PSERS)

Fighters'

Retirement

System (

System ( WSPRS)

Plan

LEOFF)

Plan

Judicial Retirement System ( JRS) 5.

Is the contractor a retiree of a Washington

Did the contractor retire before

age

State Retirement

65 using the 2008

System?

ERF?

Yes

R 5/ 09), and the Internal Revenue Service rules governing independent contractor status.

COUNTY OFFICIAL/ DEPARTMENT

Signature:

REPRESENTATIVE:

Date:

COUNTY RETAINS THIS FORM 19 of 53

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GRANT AGREEMENT

ATTACHMENT

Data Security 1.

Definitions.

Requirements

The words and phrases listed below, as used in this Attachment

E, shall each have

the following definitions: AES" means the Advanced Encryption Standard, a specification

of Federal Information

7-upd1.pdf

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential

Information,

and who has or have been authorized to do so.

and on a network outside the control of the Subrecipient.

Physical storage of data in the

PIN" means a personal

identification

number, a series of numbers which act as a

password for a device. Since PINs are typically only four to six characters, PINs are usually used in conjunction i. "

with another factor of authentication,

such as a fingerprint.

Device

is a subset

of Portable

Device.

lock, or comparable

mechanism.

Secure Areas may

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GRANT AGREEMENT

ATTACHMENT

access, the Data must be secured in such a way as to prevent access by non- authorized

with a password,

passphrase

or other mechanism,

authenticates

a user to an

information system. 2.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency

Authorization, Authentication, and Access. In order to ensure that access to the Data is

limited to authorized staff, the Subrecipient a.

must:

Have documented policies and procedures governing access to systems with the shared Data.

Restrict access through administrative, physical, and technical controls to authorized staff.

it must always be possible to determine

which employee performed a given action on a system housing the Data based solely on the Iogon ID used to perform the action. d. e.

Ensure that only authorized users are capable of accessing the Data. Ensure that an employee' s access to the Data is removed immediately: i.

Upon suspected compromise

ii.

When their employment, or the contract under which the Data is made available to them,

iii.

of the user credentials.

is terminated.

When they no longer need access to the Data to fulfill the requirements of the contract.

characters ii.

such as an asterisk, ampersand,

or exclamation

point.

That a password does not contain a user' s name, Iogon ID, or any form of their full name. 21 of 53

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ATTACHMENT

the Internet or otherwise travel outside the Subrecipient' s network), mitigate risk and

Encrypting all remote access traffic from the external workstation to Trusted

iv.

Network or to a component within the Trusted Network. The traffic must be

encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network.

authentication mechanism, such as a biometric ( fingerprint, face recognition, iris scan) or token ( software, hardware, smart card, etc.) in that case: i.

The PIN or password

must be at least 5 letters or numbers when used in

conjunction with at least one other authentication factor. Must not be comprised of all the same letter or number( 11111,

ii.

22222, aaaaa,

would not be acceptable). Must not contain a " run" of three or more consecutive numbers ( 12398, 98743

iii.

would not be acceptable).

If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes

used on the device must:

Be a minimum of six alphanumeric characters.

ii.

Contain

at least

three

unique

character

classes (

upper

case,

lower

case,

letter,

number).

iii.

Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable.

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Subrecipient agrees to store Data on one or more of the following media and protect the Data as described:

Hard

disk

drives.

For Data

stored

will be restricted to Authorized

on local

workstation

User( s) by requiring

hard

disks,

access

to the Data

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. For Data stored on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized

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

Date

Admin

Destruction

of the Data, as outlined below in 22 of 53

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listed in the above paragraph.

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GRANT AGREEMENT

ATTACHMENT

Section 8 Data Disposition,

may be deferred until the disks are retired, replaced, or

otherwise taken out of the Secure Area. c.

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 Secure 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

mechanism.

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 Secure

Area.

Access

to Data

on these

discs

will

mechanisms which provide

mechanism.

Remote Access. Access to and use of the Data over the State Governmental

Network

otherwise leaves the employ of the Subrecipient, and whenever an Authorized User' s duties change such that the Authorized User no longer requires access to perform work for this Contract. g.

Encrypt

Control access to devices with a Unique User ID and Hardened

the

Data.

Password or stronger authentication method such as a physical token or biometrics.

Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available.

Apply administrative and physical security controls to Portable Devices

Maximum

period of inactivity is 20 minutes.

and Portable Media by: a.

Keeping them in a Secure Area when not in use,

Using check- in/ check- out procedures

when they are shared, and

Taking frequent inventories. When being transported outside of a Secure Area, Portable Devices and c.

ii.

Portable Media with DSHS Confidential

Date

Admin

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GRANT AGREEMENT

ATTACHMENT

control of Subrecipient staff with authorization Data

to access the Data, even if the

is encrypted

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 ii.

below in Section 8 Data Disposition.

Information still exists upon it, the data will be destroyed

at that time in accordance with the disposition requirements

below in Section 8

Data Disposition. i.

DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: 1. Subrecipient has written procedures in place governing use of the Cloud storage

and Subrecipient

attest

to the contact

listed

in the contract

and

keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. 2.

The Data will be Encrypted while within the Subrecipient network.

The Data will remain Encrypted during transmission to the Cloud. The Data will remain Encrypted at all times while residing within the

Cloud storage solution. 5.

The

Data

will

not be decrypted

the control of an Authorized

until

downloaded

onto

a computer

within

User and within either the DSHS or

Subrecipient' s network. Data will not be stored on an Enterprise Cloud storage solution unless either:

ii.

iii.

The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or,

The Cloud storage solution used is HIPAA compliant.

System Protection.

To prevent compromise

of systems which contain DSHS Data or through

been

applied

within

the required

timeframes.

Systems containing DSHS Data shall have an Anti- Malware application, if available, installed.

Anti- Malware software shall be kept up to date. The product, its anti- virus engine, and

any malware database the system uses, will be no more than one update behind current. 7.

Data

Segregation.

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GRANT AGREEMENT

ATTACHMENT

will contain no non- DSHS Data. DSHS Data will be stored in a logical container on electronic media, such as a

ii.

partition or folder dedicated to DSHS Data. DSHS Data will be stored in a database which will contain no non- DSHS data.

iii.

And/ or, DSHS Data will be stored within a database and will be distinguishable

iv.

from non-

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. Data Disposition. When the contracted work has been completed or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server

stored

on:

hard

disks,

or workstation

Removable drives,

media ( e. g.

hard

portable

floppies,

disks)

flash

Will be destroyed by: Using a " wipe" utility which will overwrite the Data at least three ( 3) times using either

optical

random or single character data, or

USB

excluding

discs

Degaussing sufficiently to ensure that the Data cannot be reconstructed,

Paper

documents

Confidential

Paper

with

sensitive

Physical y destroying the disk Recycling through a contracted firm, provided the contract with the recycler assures that the

Information

documents

containing Confidential

confidentiality of Data will be protected. On- site shredding, pulping, or incineration

Information requiring special handling ( e. g. protected health information Optical

discs ( e. g. CDs

DVDs)

Incineration, shredding, or completely defacing the readable surface with a coarse abrasive

Magnetic

Degaussing, incinerating or crosscut

tape

shredding

Notification of Compromise or Potential Compromise. The compromise or potential compromise

of DSHS shared Data must be:

Reported to the County Program Manager designated in this Contract within one ( 1) business day of discovery, b. Reported to the DSHS Privacy Officer at mailto:dshsprivacyofficer@d dshsprivacyofficer@dshs. wa. gov within one ( 1) shs.wa.gov business day of discovery, and c. Subrecipient must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS. 10. Data shared with Subrecipient. If DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the Subrecipient must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If a.

the Subrecipient

Date

Admin

within this Contract, then the contract with

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GRANT AGREEMENT

ATTACHMENT

the subcontractor must be submitted to the County Program Manager specified for this contract for review and approval.

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GRANT

AGREEMENT

ATTACHMENT

DSHS Agreement Number

COUNTY

DSHS x

2663. 69480

PROGRAM

sonar

AGREEMENT

DDICS County Services This Program AgreerTlUnt

is by and between

Social and Health Services(

DSHS)

below. and is issued

identified

Administration oT Dlvision

Department of

the State of Washington

and The County

Agreerrton

conjunction with a County and DSHS Agreement On General Terms and Conditions, CS11SADNI

17SJIS

DSHS DIVISIOl

tSTRATION

INDEX

PS* sS CONTRACT

NUMDER

Number CODE

1769C5- 63

1136

Division Df Developmental

Disabilities

Developmental

County ggreament

by reference.

which is incorporated

Nurriber

Disabififies

Admin DSHS CQNTAC1

DSHS

NAME ANO TITLE

C04TAGT

ADDRESS

PO BOX 453i5

Wendi

lrchel

Regional

Business

Manager

QI m - a, WA 98504. 5315 DSHS CONTACT TELEPHONE 7254264

360

08HS

CONTACT FAX

360

586-

V$ HS CONTACT

COUNTY

NAME

COUNTY ADDRESS

Cowlitz

County County DDA County Services

1952

Cowlitz COUNTY

FEDERAL

EMPLOYER

E- NWL

wendi. winchel

6602

dshs. wa.

9th Avenue

I nnfiview.

98632

COUNTY CONTACT NAME

I DENT I= I CAI ION

NuMatR

SUe S'el'Yinn COUNTY

CONTACT

rELEPHONE

360

414- 5599

I5THE

COUNTY A SUBRECIPIENT

CONTACT

COUNTY

FAX

FOR

PURPOSE$

CONTACT

saxtons

f3601501- 1207

ASSISTANCE

TH1S PROGRAM

F- MAIL

cowlitlwa- av

LISPING NUMBERS

AGREEMENT'?

No PROGRAM

AGREEMENT START

DATE

07/ 01 i2026

AGREEMENT

PROGRAM

ENO DATE

MAx1V.UN1 PROGRAM! AGREEMENI

ANIGUN-

2, 745. 890. 40

0613012D27

EXHIBITS. The following Exhibits are attached: Exhibit A— Data Security Requirements; Exhibit B— Budget and Spending

Plan

By their signatures below„ the parties agree to the terms arld conditions of this County Program Agreement ana all

PRINTED

SIG" 1ATURE( S)

DATE( S) SIGNED

NAVE( S) AND TITLELS;

BOARD OF COUNTY GOMMISSiONFRS OFCOWLITZCOUN1Y, WASHINGIaN Richard

PRINTED

DSHS SIGNATURE

Dahl, Chairman

NAME

AND TITL

Jessica Barbour, Contract

Specialist

SIGNED

08J1 912026

O WLITZ

caut4T ON o 45+-15 Central CUntmct Services 1769CS County Agreement( 12- 26- 2

26- 018 Last

Form:

rx 04 01

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ATTACHMENT

Special Terms and Conditions 1.

Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "

Acuity Level" means the level of a Client' s abilities and needs as determined

through the DDCS

assessment-

lb- " ALTSA Web Access(

AWA)" means a web- based portal to the Developmental

Disabilities

Community Services CARE system designed to support county services for DDCS clients. c_ "

Additional Consumer Services" refers to indirect Client servicetypes as follows1) "

Community Information

and Education":

Activitiesto inform and/ or educate the general public

and

2) " Training

3) "

Other Activities" reserved ty pes:

for special

a) Infrastructure

Projects in support of Clients ( services not easily tracked

projects:

projects and demonstrations

categorized

into the following

back to a

sp ecifi c work!ng age Client) o r th at d 1 rectly benefit a Clients) but the Client is not of work! ng age. Examples include planning services like genericjob development e.g." Project Search"_

b) Start- up projects:

Projects that support an agency or directly benefit the agency_ Examples

include equipment purchases and agency administrative support. c) Partnership

Project

Collaborative

partnerships

with school districts,

employment

providers,

disabilities

means a master classification

require to

of balance

f. " Competitive Integrated Employment"

g_ " Consumer Support" refers to direct Client service types as follows1) "

Community Inclusion" or" Cl": means individualized services provided in integrated community settings with other individuals without disabilities_ The activities are based on Client interests Page 2

DSHS

1789CS

Central

Contract

Services

County Agreement(

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GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

support( Individual Employment or Group Supported Employment) for working age individuals who have received nine months of employment

support.

2) " Child Development Services" or" CDS": Birth to three services are designed to meet the

instruction, speechlanguage pathology, vision, and transportation_ Services are provided in natural environments to the maximum extent appropriate. 3) "

the general workforce.

These services

may include intake, discovery,

assessment,

job

preparation, job marketing, job supports, record keeping and support to maintain a job4) " Individualized

individual

Technical Assistance" or" ITA": services are a part of a Client' s pathway to employmentor community inclusion. This service provides assessment and

employment

enclaves, mobile crews, and other business models employing disabilities in integrated employment in community settings_ h. "

County" is the political subdivision

of the state of Washington

Examples include

small groups of workers with

and the county or counties entering

into this program AgreementI- "

DDCS Case Resource Manager( CRM)" means a case manager for DDCS Clients.

j_ " County Service Authorization( CSA)" means an authorization for county services. k. "

Developmental

disabilities(

DD)" means a disability

attributable

to intellectual

disability,

cerebral

Developmental

Disabilities Community

Services" DDCS" means a division within the Department of Page 3

DSHS

1789CS

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Contract

Services

County Agreement(

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Special Terms and Conditions Social and Health Services. DDCS Regional office( DDCS Region)" means the regional DDCS office that supports DDCS

m_ "

clients.

Division of Vocational Rehabilitation(

n_ "

DVR)" means a division within the Department of Social and

Health Services o.

Employment

Outcome Payment"

means a paymentto

providers for transition

students barn

often

p_ " General Terms and Conditions"

which govern the contractual

meansthe contractual provisions contained within that agreement, relationship between DSHS and the county.

q_ " High Acuity Client" means a DDCS

Client who requires significant and intensive support community, often dueto complex needs, as determined through the DDCS assessment_

in the

Medicaid Home and Community Based Services( HOBS)" means services thatoccur in a Client' s home or community ratherthan institutions or other isolated settings_ These programs serve a

r. "

variety of targeted populations groups, such as people with intellectual or developmental disabilities,

physical disabilities,

Job Foundation

s_ "

and/ or mental illnesses

Report" is a document derived from employment

readiness

activities

performed

Preadmission Screening and Resident Review( PASRR)" means individuals with intellectual disabilities or related conditions( ID/ RC) who have been referred for nursing facility( NF) care.

t. "

Person

u. "

Centered Service Plan or PCSP" means a document that authorizes and identifes the

DDCS paid services to meet a Client' s assessed needs.

Formerly referred to as the Individual

Support Plan.

Ou ality Assurance" means an adherence to all Program Agreement requirements, including DDCS

v. "

Quality Improvement" means a focus on activitiesto improve performance above minimum standards and reasonably expected levels of performance, quality and practice_

Service Provider" is a qualified Client service vendor who is contracted to provide Employment and

Day Program y. " 2.

services.

Subcontractor" is the service provider contracted by the County to provide services.

Purpose: This Program Agreement is entered into between the Developmental Disabilities Community Services and the County in accordance with chapter 71 A_14 RCW_ Its purpose is to advance the state

legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental

disabilities_ Page 4

DSHS

1789CS

Central

Contract

Services

County Agreement(

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GRANT AGREEMENT

ATTACHMENT

Special Terms and Conditions 3.

Credentials and Minimum Requirements:

Administration

of the developmental

disabilities

County program cannot be subcontracted_

area ( e_g_ Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/ or a related Human or Social service may be considered_ c.

Sufficient Policies and Procedures for establishment and maintenance of adequate internal control

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees(

including

DID program County staff), subcontractors,

and/ or

Qualified Advisory Board Members:

A Developmental

Disabilities

advisory board shall include

members knowledgeable about developmental disabilities_ No board member shall have a contract

with the County to provide Training,

Community

Information

Activities,

and Consumer

Support as

defined in this Program Agreement, and shall not be a board member, officer, or employee of an

agency subcontracting with the County to provide such services. h.

Qualif ed Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6. 13, Program Qualifications for Employment and Day Program Providers.

Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to a ssign to DDCS its Medica id billing rights for Page 5

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1789CS

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County Agreement(

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GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

services to DDCS Clients eligible under Title XIX programs

in this Program Agreement.

Written

documentation shall be available to DSHS on request.

Counties who provide Child Development

Services( birth to three early intervention

services),

must

provide those services under the regulations implementing the Individuals with Disabilities Education Act( IDEA), Part C, and Washington Federally Approved Plan_ I_

State' s Early Support for Infant and Toddler

Ord er of Precedence: In the event of any inconsi stency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency

shall be resolved by giving

precedence, in the following order, to: 1)

County Program

Agreement;

and

2) Attached Exhibits. 5.

Disclosures must be provided at contract renewal and within thirty- five( 35) days whenever there is a change in the staff holding these management positions[ 42 CFR 455. 104 ( c)( 1)]_ 6.

the county as set forth below: a_

The DDCS region shall:

Review subcontractors and shall immediately notify the County of any concerns with the Page S

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AGREEMENT

ATTACHMENT

Special Terms and Conditions

subcontractors

identified

bythe County;

5) Authorize

new service within 5 working days and will extend existing service authorization

before expiration date; 6)

Inform Clients of service changes through Planned Action Notice( s);

7) Work with the County to document planned services in the Client' s Person Centered Plan including notification of assessment dates;

Service

B) Work with the County when terminating services; 9) Work with DDCS Head Quarters

and the County on Spending

Plan adjustments;

and

10) Work with the County in participating in evaluation of direct service providers_ b_ The County shall: 1)

Work with the DDCS Region when Clients are referred for services,

authorized

services,

andlor

for support modifications;

2) Work with the DDCS Region to document planned

services

in the Client' s Person Centered

Service Plan;

3) Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DID Assessment prior to any changes; 4) Work with the DDCS Region regarding

service termination;

5) Work with the DDCS Head Quarters on Spending

Plan adjustments;

6) Inform the DDCS Region of new providers to be included on the ALTSA Web Access( AWA) sy stem;

7) Notify the DDCS Region of any intent to terminate

a subcontractor

who is serving a DDCS

referral;

B) Provide a copy of each subcontractor' s contract upon written request from DDCS; and 9) Notify and work with the DDCS Region al Employment direct service providers. c.

Specialist when performing

evaluations

Compliance with Budget and Accounting Reporting System Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. Page 7

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The County shall comply with the following 1)

referenced

documents:

DDCS Policy 411, County Services for Working Age Adults;

DDA Guidelines

7) Disability

for Community

Rights Washington (

Assessments

formerly

within Employment

Washington

Protection

and Vocational

and Advocacy

Programs:

System)

and

Access

Agreement.

e_ The County shall develop and submit a comprehensive plan forthe County DID Services as required by WAC 388- 850- 020_ f.

Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The

Solicitation

for Qualified

of the County and the DDCS Region_

Employment

and Day Program

Service Providers:

Requests for

Applications( RFAs), Requests for Information ( RFI' s) and/ or Requests for Proposals( RFPs),

Requests for Qualifications( continuous

RFQ' s) for direct services,

excluding

Child Development,

will be open

enrollment.

Qualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDCS.

Technical Assistance: DDCS contracts with Technical Counties with prior written approval_

Assistance

providers that may be utilized by

Inclusion services_

The County shall provide or contract with qualified Employment and Day Program Service Providersfor 1)

consumer support services that include thefollowing

Monthly Community

program outcomes-

Inclusion ( CI) service support hours will be based on the Client' s CI service

level per WAC 388- 828- 9310 for all Clients who began receiving CI services July 1, 2011 and forward_

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b) CI services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will not be reim bursed.

2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses_ Clients

should be supported to average twenty( 20) hours of community work per week or eighty- six 86) hours per month; however,

each person' s preferred

hours of employment

should

be taken

into consideration. The amount of service a Client receives will be based on his/ her

demonstrated

need, acuity level and work history per WAC 388- 828.

3) The Client' s DDCS PCSP is the driver for service_ The AWA County Service Authorization CSA) and updated Planned Rates information will not exceed the Client' s DDCS PCSP.

an additional review will be

responsible for authorizing CI services_ Page 9 DSHS

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and any potential conflict of interest is addressed.

10) Individual Employment staff hours must be attributed to the " Individual Employment and Billable Activity Phase( s)"

a) The collectivegroup' s individual hours should bethe minimum staff hours delivered to su pport th e g rou p-

f) Running a GSE service is a part of the business operation and not billable to Clients contract procurement,

contract maintenance, or administration

functions associated with

GSE)-

Phases and

Based settings

a) The setting is integrated in the greater community and supports Client' s to havefull access to the greater community; b) Ensures the Client receives services in the community

to the same degree of access as Page 10

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Special Terms and Conditions

individuals

not receiving

Medicaid

HCBS;

c) The setting provides opportunities to seek employment and work in competitive integrated settings;

and

d) The setting facilitates individual choice regarding services and supports, and who provides them_

Quality Assurance

and Service Evaluation:

The County shall develop and have available

m_ Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one visit to each subcontractor

every two

Copies of such documentation

will be provided tothe DDCS upon request.

n_ The County shall workwith local developmental disability advisory groups to plan for and coordinate services_

The County shall participate in regularly scheduled meetings between County DID staff and DDCS staff to remain updated and current including ACHS and Regional Meetings.

AWA Data System: In compliance

with the AWA Training Manual,

the County shall use the AWA

data system for all:

Billing requests;

2) Service provider address and phone number maintenance; 3) Evaluation dates; 4) Employment

outcome information;

and

5) Monthly provide all data described in the Billing Instructions Instructions, which is hereby incorporated by reference. q.

and in the Employment Outcomes

Review and respond the AWA" Work List" items within 5 working days including pending Authorization_

Referrals and

Review the AWA" Ticklers" Planned Rate tab and update the planned rate within 5 working d ays Page 11

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Special Terms and Conditions after the Planned Rate start date. t_

Partnership

Project-

1) A Job Foundation document will be completed per guidelines for eligible students.

Eligible

students are DDCS clients who were born between:

a) For fiscal year 2026 9/ 1105 through 8/ 31/ 06 b) For fiscal year 2027 9/ 1106 through 8/ 31/ 07 These students currently

attending

school and have completed

an application

to participate

this Value Based Payment( VPB) project_ The VBP project application will include the following minimum

criteria identified in the sample application found at:

https:// www. d sh s. w a_ gov/ sites/ default/ fi I es/ D DA/ dd a/ d ocu m ents/ J ob`/` 20 Foundation% tlon

2 0APpl i c a

040720% 20% 28002% 29. docx

documents) meet quality standards_ u_

Outcome Payment. Providers, with transition

students born between:

a) For fiscal year 2026 9/ 1103 through 8/ 31104 b) For fiscal year 2027 9/ 1/ 04 through 8/ 31/ 05 2) High acuity transition students who are authorized for Individual employment, the provider may

receive one outcome payment if transition student obtains a competitive integrated job approved by the County within timeframes

described

in the chart in the Billing Instructions_

If the County

is also the service provider DDCS will provide the job approval_ If the job is at a minimum of ten hours of work per week a n additional

amount will be include in the payment-

a minimum

of 80% of the authorized hours. Page 12

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Special Terms and Conditions

5) A new Community

Authorization( CSA).

Fees.

a) County( s) name; b) Time period for which the schedule! s applicable;

and

c) Each contracted direct service( IE, GSE, CI, ITA, CDS) and its associated rate-

Fee Limitations- The Billing Instructions found on the County Best Practices site provides lim itations on the Hourly Rate for each direct service. Hourly rates must be divisi ble by four.

b_ Budget and Spending 1)

Plan, attached

as Exhibit B-

Budget amount listed in Exhibit B- The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement

included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state- only employment and day services to waiver employment and day services-

2) Spending Plan- DDCS will provide the initial spending plan / Program Agreement Budget/ Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The

only be modified by mutual agreement of the parties in writing and shall not require a program agreement

amendment_

a) Funds Designated for Additional Consumer Services- If a County provides Community Information and Education services under additional consumer services, then activities must

include outreach

efforts to federally recognized

local tribes-

b) Funds Designated for Adult Day Care Consumers.

Funds designated for Adult Day Care

Consumers are availableto Clientswho were served between December 1996 and

December 2003 in Adult Day Health agencies and were subsequently determined

ineligible Page 13

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Special Terms and Conditions for Level II or III services(

If a Client no longer needs and wants services, the fund s

by the local Area Agency on Aging. Adult Day Care

service is not a waiver approved service_ c_

Program Agreement Amendments- A County can request an amendment at any time_ An amendment for additional Clients) may be supported when clients exceed the number used to

Exemptions- The DDCS Assistant program agreement requirement-

Secretary

may approve in writing an exemption

to a specific

Billing and Payment: a.

Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for-

1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration

include personnel

of the Developmental

and overhead

Disabilities Program.

Allowable costs

costs directly related to the administration

and coordination

a) Training: i.

Board Training- Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program- related skills of board and advisory committee

members.

and community Page 14

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consultation,

capacity building

and organization

activities.

c) Other Activities_ i.

ii_

Start- up projects: Projects that support an agency or directly benefit the agency_ Examples include equipment purchases and agency administrative support-

school year they turn twenty-one( 21). Supports provided should complement and not replace what the student( s) receive through the Individualized Education Program( IEP)_ 3) Consumer Support_

Level II and III services are licensed

b) Community Inclusion Services are individualized and provided in integrated community settings with other individuals without disabilities_ The activities are based on Client

interests and provide opportunities typically experienced by the general public of sim ilar age in their local community,

accessible

by public transit or a reasonable

commute from their

to the maximum

extent

appropriate.

general workforce. These services may include intake, discovery, assessm ent, j ob preparation, job marketing, job supports, record keeping and support to maintain a job( per Page 15 DSHS

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Special Terms and Conditions the

Individual Employment Phases&

Billable Activities)

Examples include enclaves, mobile crews, and other business models employing small groups ofworkerswith disabilities in integrated employment community settings_ b_

Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this

Program Agreement.

However, with a Program Agreement amendment, the parties may increase

or decrease the Program Agreement amount_ Counties will work with DDCS HOon amendmentsto the Program Agreement. c_

Clients will be assisted in accessing DVR services perthe DDCS/ DVR MOU. Client services shall not be reimbursed

under this Program Agreement when the same services are paid for under the

Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. e.

Reimbursement

of Client Services:

A claim for each Client is made on the AWA system

indicating the number of service units delivered to each Client listed and the fee per unit_ Units are defined as:

An " Hour" is at least fifty( 50) minutes of direct service. Partial hour to the quarter may be recorded-

2) A" Day" is at leastfour( 4) hours of direct service and will only be used in connection with Adult Day Care reimbursement3) A" Month" represents

a minimum of at least fifty( 50) minutes of direct service for CDS

reimbursement.

can be 1112 of the maximum amount identified in Exhibit B under Administration or

The Individual Employment Phases&

Billable Activities document defines the individual Client Page 16

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Special Terms and Conditions

services that DDCS reimburses.

That document

is located on the DSHS DDCS County Best

Practices Web site at https:// www. dshs. wa. aov/dda/ county- best- practices.

Timeliness of and Modification to Billings: All initial invoices with signed documentation must be

Recovery of Fees. If the County bills and is paid fees for services that DSHS later finds were( a) not delivered or( b) not delivered in accordance with Program Agreement standards, DSHS shall

recover the fees for those services and the County steal I fully cooperate during the recovery. k_

costwill be based

DDAJobFoundationReportsadshs_

wa_.Qov

multiplied by

Intermediate Care Facilities for Intellectual Disabilities( ICF1ID) Agreement. If applicable per 42 CFR 463. 410, the County shall assure that all county- operated or subcontracted

programs serving

persons living in ICF/ ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/ ID resident 10.

Single State Medicaid Agency— Health Care Authority(

HCA):

HCA, as the single state Medicaid

DSHSIDRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDCS is incorporated

by reference_ The County assures that it and its subcontractors

have reviewed

the

Access Agreement_ The agreement covers DRW' s access to individuals with developmental Page 17 DSHS

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Special Terms and Conditions

disabilities, Clients, programs and records, outreach activities, authorityto investigate allegations abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS

contracted services_ 12.

Confidential Information.

Al Counties and their subcontractors must

Ensure the security of Confidential Information, and

When transporting

client records containing

Confidential

Information

outside a Secure Area, one or

more of the following as appropriate: 1)

U sing a Trusted Network; or

2) Encrypting the Confidential Information, including: a) Email andlor email attachments

b) Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.

Data Security

Requirements. Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization, or transmits more

than

14.

5 records

atone time.

Supersession of Prior Data Security Agreement_ If the Parties hereto have previously entered into a Standalone

Data Security Requirements

Agreement,

both Parties hereby agree that upon mutual

execution said Agreement shall take precedence as the sole Data security Agreement between the Parties_

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Special Terms and Conditions Exhibit A— Data Security 1.

Definitions_

Requirements

The words and phrases listed below, as used in this Exhibit, shall each have the fallowing

definitions: a. "

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so_ e. "

Category 4 Data" is data that is confidential

and requires special handling due to statutes or

refers to data protected

by: the Health Insurance

Portability

d_ " Cloud" means data storage on servers hosted by an entity other than the Contractor and on a

network outside the control of the Contractor.

Physical storage of data in the cloud typically spans

multiple servers and often multiple locations.

Cloud storage can be divided between consumer

grade storage for personal files and enterprise grade for companies and governmental entitiesExam pies of con sumer grad e storage wouId include iCloud, Dropbox, Box_com, and many other entities.

Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and

Rackspace_ e_ "

Encryption

must use a key length of at least 129 bits( 256 preferred)

for symmetri c keys, or

2048 bits for asymmetric keys_ When a symmetric key is used, the Advanced Encryption Standard AES) must be used if available. f. " Hardened

Password"

means a string of at least eight characters

containing

at least three of the

following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. " Mobile Device"

h_ " Multi- factor Authentication"

series of numbers which act as a password for a device_ Since PINS are typically only four to six characters,

PINS are usually used in conjunction

with anotherfactorof

authentication,

such as a

fingerprint1- "

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Special Terms and Conditions

are not limited to, mobile phones, tablets, and laptops.

Mobile Device is a subset of Portable

Device.

j. "

k_ " Secure Area" means

Confidential

an area to which only authorized representatives of the entity possessing Information have access, and access is controlled through use of a key, card key,

the

Trusted Network" means a network operated and maintained

by the Contractor, which includes

integrity, and availabilityof

the Data. m. "

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.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington

Technology

httns: l/watech_wa_gov/ policies? combine=& field

and of the DSHS Information these requirements

ServicesAgeney

categories

Security Policy and Standards

can be found

target id= 80& field tune target

Manual_

Reference

material

id= All],

related to

here: htti) s:// www. dshs. wa.- govlffa/ keening- dshs- client- information-

private- and- secure, which is a site developed

by the DSHS Information

Security Office and hosted by

DSHS Central Contracts and Legal Services. 3.

Administrative Controls. The Contractor must have the following controls in place: a_

A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy.

If Confidential Information shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment forth e systems) housing the Category 4 Data.

Authorization, Authentication, and Access. authorized

In order to ensure that access to the Data is limited to

staff, the Contractor must:

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Have documented

policies and procedures

b_ Restrict access th rough administrative,

governing

physical,

access to systems with the shared Data

and technical

controls to authorized

staff_

Ensure that only authorized users are capable of accessing the Data_

e_ Ensure that an employee' s access to the Data is removed immediately:

UWn suspected com promise of the user credentials.

2) When their employment, or the contract under which the Data is made available to them, is terminated_

3) When they no longer need access to the Data to fulfill the requirements of the contract. f.

Have a process to periodically review and verify that only authorized containing DSHS Confidential Information

A minimum

length of 8 characters,

and containing

users have access to systems

at least three of the following

character

classes: uppercase letters, lowercase letters, numerals, and special characters such as an

asterisk, ampersand, or exclamation point. 2) That a password

does not contain a user' s name, logon ID, or any form of their full name.

3) That a password does not consist of a single dictionary word. passphrase which consists of multiple dictionary words-

A password

may be formed

as a

4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h.

Ensuring

mitigations

applied to the system don' t allow end- user modification_

2) Not allowing the use of di al- up connections.

3) Using industry standard protocols and solutions for remote access_ Examples would include RADIUS and Citrix.

4) Encrypting

all remote access traffc from the external workstation

to Trusted

Network or to a

component within the Trusted Network_ The traffic must be encrypted at all times while

traversing any network, including the Internet, which is not a Trusted Network. Page 21 DSHS

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5) Ensuring that the remote access system prompts for re- authentication session termination after no more than 30 minutes of inactivity.

or performs automated

6) Ensuring use of Multi- factor Authentication to connect from the external end point to the internal end point_ i_

Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication

mechanism,

such as a biometric(

fingerprint,

face recognition,

iris scan) or token

software, hardware, smart card, etc.) in that case-

The PIN or password

must be at least 5 letters or numbers when used in conjunction

with at

least one other authentication factor 2) Must not be comprised of all the same letter or number( 11 111, 22222, aaaaa, would not be acceptable)

Must not contain a" run" of three or more consecutive numbers( 12398, 98743 would not be acceptable)

If the contract specifically allows for the storage of Confidential passcodes used on thedevice must 1)

Information on a Mobile Device,

Be a minimum of six alphanumeric characters.

2) Contain

at least three unique character classes( upper case, lower case, letter, number).

3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable_ k. 5

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Contractor protect the Data as described, a_

agrees to store Data on one or more of the following

media and

Hard disk drives_ For Data stared on local workstation hard disks, access to the Data will be

Network server disks_ For 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

mechanism_

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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 Secure Area_ When not in use for the contracted

purpose, such discs must be

Stored in a Secure Area_ Workstations which access DSHS Data on optical discs must be located

in an area which is accessible only to authorized personnel, key, card key, combination lock, or comparable mechanism d_

Optical discs ( CDs or DVDs) in drives or jukeboxes

with access controlled

attached to servers.

through use of a

Data provided by

DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through

smart

cards_ Data on discs attached to such servers must be located in an area, which is accessible only

to authorized

personnel,

comparable

mechanism_

with access controlled

through

use of a key, card key, combination

lock, or

Remote Access.

Access to and use of the Data over the State Governmental Network( SGN) or

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)

authentication

a Unique User ID and Hardened Password or stronger

method such as a physical token or biometrics.

and physical

security controls to Portable Devices and Portable Media

Keeping them in a Secure Area when not in use,

ii_

Using check- in/ check- out procedures when they are shared, and

iii_ Taking frequent inventories_ Page 23 DSHS

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Special Terms and Conditions

Data stored for backup purposes-

below in Section

8 Data Disposition.

1) DSHS Data wi II not be stored in any consumer grade Cloud solution, unless all of the following conditions are met-

for

b) The Data will be Encrypted while within the Contractor network.

c) The Data will remain Encrypted during transmission to the Cloud. d) The Data will remain Encrypted

at all times while residing within the Cloud storage solution_

e) The Contractor will possess a decryption possessed only by the Contractor. f) The Data will not be downloaded

key for the Data, and the decryption key will be

to non- authorized

systems,

meaning

systems that are not

on the contractor network

a) The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or, b) The Cloud storage solution used is HIPAA compliant_

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Special Terms and Conditions

System Protection. that Data passes:

To prevent compromise of systems which contain DSHS Data or through which

a. Systems containing DSHS Data must have all security patches or hotfxes applied within 3 months of being made available_

b_ The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes.

c_ Systems containing DSHS Data shall have an Anti- Malware application,

if available, installed.

d. Anti- Ma lware software shall be kept up to date. The product, its anti- virus engine, and any malware database the system uses, will be no more than one update behind currentT.

Data Segregation-

DSHS Data will be kept on media ( e. g. hard disk, optical disc, tape, etc.) which will contain no non- DSHS Data-

4) DSHS Data will be stored within a database and will be distinguishable

from non- DSHS data by

the value of a specific fell or fields within database records.

5) When stored as physical

paper documents,

DSHS Data will be physically

segregated

from non-

DSHS data in a drawer, folder, or other container_

b_ 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 asdescribed

this exhibit.

Data Disposition.

When the contracted

work has been completed

or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server or workstation

on:

hard disks, or

Will be destroyed by: Using a " wipe" utility which wi II overwrite the Data at least three( 3) times using either random or single character data, or Page 25

DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 018 Last

51 of 53

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

Removable

media( e. g. Coppies, USB Cash drives,

portable hard disks) excluding optical discs

Degaussing

sufficiently to ensure that the Data

cannot be reconstructed, or

Physically destroying Paper documents with

sensitive

Confidential

Information

the disk

Recycling through a contracted firm, provided the contract with the recycler assures that the

confidentiality of Data will be protected. 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 ta 9.

I Degaussing,

Notification

of Compromise

or Potential Compromise.

incinerating

or crosscut

shredding

The compromise or potential compromise of

DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one( 1)

Page 26 DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 018 Last

52 of 53

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

ATTACHMENT

Exhibit B

Program Agreement

Original Budget

Budget

0 Budget Revision

REVENUES Fund Source

Fiscal Year 2026

Fiscal

State and

1, 627, 450

1, 479, 700

Medicaid

1 447 900

1 313 649

Total Rev.

3 075 350

2 793 350

Year

Fund

2027

11; t Revision

Original

State

Source

Original

V Revision

21d Revision

3,d Revision

21d Revision

31d Revision

1 457 352

on ly

1 288 528

Medicaid

Total Rev.

V,745, 890

Job Foundation

PASRR Funds

ADMINISTRATION( 12

Funds

TOTAL

11,

13)

OTHER

Medicaid State Funds

Funds

137, 294

112, 332

249, 626

89, 819

73, 487

163, 306

CONSUMER

SUPPORTS 31, 32, 41, 92, 93, 94, 97) CONSUMER SUPPORT STATE62,

ONLY

64r 65, 67r 69

Child Development

MEDICAID 64 67 r

ROADS

125440

CLIENTS 69

21 D00

1 093 259

1 D93 259

207 518

1, 445, 812

1, 279, 078

Z745, 890

COMMUNITY 62

64 65 r

LIVING 67

TOTAL

21, 000

Page 27 DSHS

Central

Contract

Services

1789CS CauntyAgreement( 12-25- 2025)

26- 018 Last

53 of 53

Date Revised:

Admin

Form:

1615. 2

1/ 09/ 2025

Motion

233340

BOCC

Item

Agenda

Meeting Date: 9/ 15/ 2026 Contract with Lifeworks

Submitted By: Amanda Foshaug, Accounting Specialist II Submitted For: Gena James, HHS Deputy Director Department:

Human

Services

Dept

Information

Subject and Summary Statement

The purpose of this County Contract# 26- 019 with Lifeworks is to provide developmental disability

employment and day services. is paid on a cost

This contract

reimbursement

basis, not

exceed $ 1, 427, 000. 00, during

the period July

1, 2026, through June 30, 2027. Funding for this contract is passed through from the County' s contract with Washington

State Department

of Social & Health Services, Developmental Disabilities

Administration.

Contract/ SOW Name

Current

Original

Change

Total

1, 427, 000. 00

1, 427, 040. 00

Time Period

7/ 01/ 26- 6/ 30/ 27

Staff Attendance Gena

James

Department

It is the

Recommendation

recommendation

Board of Commissioners

of the Cowlitz

County Health&

Human Services that the Cowlitz County

move to approve this Contract 26- 019 with Lifeworks.

Attachments 26- 019

DD-

Lifeworks

Form

Task

User

Foshaug,

Amanda

Agenda

Review

Action

Timestamp

Item Submission

Submit

8/ 27/ 2026 11: 22: 00 AM

Approve

8/ 31/ 2026

Approve

9/ 1/ 2026

Drake,

Jamie

Preliminary

Review-

James,

Gena

Department

Approver

HHS

11: 09: 00 AM 11: 10: 00 AM

Review Berger, David

Legal Review

Approve

9/ 4/ 2026 3: 28: 00 PM

Grayson,

Clerk of the Board

Approve

9/ 8/ 2026

Kelly

Review

7: 51: 00 AM

233340

Motion

Item

rz co&

SUBRECIPIENT

GRANT

AGREEMENT

Number:

gSM1NG O

26- 019

Purpose of Subrecipient

Grant Agreement. This Subrecipient

Grant Agreement (" Agreement")

is made by and between COWLITZ COUNTY, a political subdivision of the State of Washington, hereinafter called " County" or" Cowlitz County") and Lifeworks ( hereinafter called Subrecipient") to set forth the terms and conditions by which the County will provide the Subrecipient with a grant award to be used to pay or reimburse necessary expenditures incurred for services for persons with developmental disabilities. 2.

Term.

Scope of Eligible Expenditures. Grant funds may only be used to pay or reimburse eligible

This Agreement

expenditures

shall take effect on July 1, 2026 and terminate on June 30, 2027.

consistent and as detailed in Attachment A-

Scope of Work for Project ( the

Project").

Grant Award.

The Subrecipient is awarded a total of$ $ 1, 427, 000.

Budget. The Grant Award shall be expended by the Subrecipient as set forth in Attachment B Budget.

Subrecipient

Responsibilities.

Subrecipient

agrees to administer the Grant Award proceeds

consistent with this Agreement. Subrecipient shall provide the County with certification using the form of Attachment C that Grant Award funds will be used for eligible expenditures. Subrecipient

shall request payment from the County as outlined in Attachment B. 7.

Access to and Maintenance of Records. Subrecipient shall maintain internal controls, accounts

terminated, b.

suspended,

or otherwise

Termination for Convenience. convenience

lost or impaired

in whole or in part.

Either party may terminate this Agreement for

upon giving the other party at least 30 days' advance written notice.

In that

event, the Subrecipient will be entitled to payment only for those expenses and costs reasonably and actually incurred prior to the effective date of the termination. 1 of 54

26- 019 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 22/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

If the default is not cured within 30 days of notice, the

The following provisions apply in the event that this Agreement is

terminated: a.

The Subrecipient shall cease to perform hereunder as of the effective date of termination and shall comply with all reasonable instructions contained in the notice of termination, if

The Subrecipient shall provide the County with an accounting of authorized services provided through the effective date of termination.

any.

11.

Conflict of Interest. Subrecipient designees, agents, members, officers, employees, consultants,

The Subrecipient will secure at its own expense all labor and materials required to

Name: Title:

Deputy

Director

Department:

Health &

Human

Address:

1952

(

Fax:

WA 98632

414- 5599

Lifeworks

906 New York St Longview, 360)

WA 98632

577- 9093

Dhill@LifeWorksWA.

UEI:

TZ8RNRDSRNN1

XLSHUJNQVK47

UBI:

08- 300- 3788

601- 149- 791

org

2 of 54

26- 019 Admin

Executive Director Services

HHSContracts( c cowlitzwa. gov mailto:HHSContracts 360) 425- 7531 @cowlitzwa.

E- mail:

Date

360)

Dave Hill

9th Ave

Longview, Telephone:

Last

For the Subrecipient:

County:

Gena James

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

15.

GRANT

AGREEMENT

Bodily injury, including death. Property damage

Per occurrence

1, 000, 000 1, 000, 000

Per occurrence

2, 000, 000

Aggregate

1, 000, 000

Per occurrence

2, 000, 000

Aggregate

ERRORS AND OMISSIONS or PROFESSIONAL

LIABILITY with an Extended Reporting Period

Endorsement(

two year tail).

WORKERS COMPENSATION:

Statutory amount Waiver of Title 51 Rights

EMPLOYER' S LIABILITY/ Stop Gap: Per occurrence

1, 000, 000

AUTOMOBILE:

coverage on owned, non- owned, rented and hired vehicles

Bodily injury, liability, including death and property damage liability 1, 000, 000

Combined Single Limit

All Subrecipient' s and Subrecipient' s subcontractors' insurance policies and additional named insured endorsements

shall provide primary insurance coverage and be non- contributory.

Any

and/ or self- insured

retentions

exceeding $

10, 000 or any stop- loss provisions,

the

County shall have the right to request and review the Subrecipient' s most recent annual financial reports and audited financial statements as a condition of approval.

Subrecipient hereby agrees to waive subrogation with respect to each insurance policy maintained under this Agreement. When required by an insurer, or if a policy condition does not 3 of 54

26- 019 Last

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

insurance policies by way of endorsement for the full available limits of insurance maintained by the Subrecipient

and subcontractor,

and all coverage shall be primary and non- contributory.

state or notion of additional insured status on a Certificate of Insurance shall not satisfy these requirements. [ This endorsement shall not be required if the Subrecipient is a governmental entity and is insured through a governmental entity risk pool authorized by the State of Washington.] The Subrecipient shall, for each required insurance policy, provide a Certificate of Insurance, with endorsements attached, evidencing all required coverages, limits, deductibles, self- insured retentions and endorsements and which is conditioned upon the County receiving thirty ( 30) days prior written notice of reduction in coverages, cancellation or non- renewal. Each Certificate of Insurance and all insurance notices shall be provided to: ATTN: County Project Manager, Cowlitz County Health & Human Services, 1952 9th Avenue, Longview, WA 98632. This Agreement shall be void ab initio if the proof of coverage is not timely supplied. The insurance maintained under this Agreement shall not in any manner limit or qualify the liabilities or obligations of the Subrecipient under this Agreement. All insurance policy deductibles and self- insured retentions for policies maintained

under this Agreement shall be paid by the

Subrecipient.

Compensation and/ or payments due to the Subrecipient under this Agreement are expressly conditioned

upon the Subrecipient' s strict compliance with all insurance requirements.

to the Subrecipient shall be suspended

in the event of noncompliance.

Payment

Upon receipt of evidence

of Subrecipient' s compliance, payments not otherwise subject to withholding or set- off will be released to the Subrecipient.

This Agreement

shall be void ab initio if the proof of coverage

is not

4 of 54

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

18. Debarment

AGREEMENT

Certification.

The Subrecipient,

by signature to this Agreement,

certifies that the

in all

The Subrecipient and its officials, officers, employees, agents, and

If the Subrecipient is a faith- based or religious organization, it retains its

Permissible

Use Warranty.

The Subrecipient

recognizes

and agrees that the Grant Award

Disabilities

Administration.

The Subrecipient

warrants that its planned and actual

permissible

uses

consistent with Attachment A and the pass- through funding requirements discussed immediately above.

This section shall survive termination of this Agreement.

No term or condition of this Agreement shall be deemed waived unless such waiver is

5 of 54

26- 019 Last

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

Each counterpart

may be executed and delivered by facsimile to the other party. 33. Attachments. The following attachments are incorporated into this Agreement by reference. a. Attachment

A— Scope

b. Attachment

B—

c. Attachment

C— Certification

d. Attachment

D—

Retirement

e. Attachment

E—

f. Attachment

F—

Data Security Requirements DSHS County Program Agreement DDCS County Services

IN WITNESS

WHEREOF,

of Work

for Project

Budget Form Certification

the parties have executed this Agreement

this

day of

BOARD OF COUNTY COMMISSIONERS

SUBRECIPIENT:

OF COWLITZ

Signature

Richard

Chairman

Steven L. Ferrell,

Commissioner

Steve

Commissioner

Rader,

ATTEST:

CONTRACT FORM

HAS BEEN APPROVED AS TO

BY COWLITZ

PROSECUTING

COUNTY

ATTORNEY

Date

Clerk of the Board Date

6 of 54

26- 019 Admin

R. Dahl,

WASHINGTON

name:

Title:

Last

COUNTY,

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

SCOPE

OF WORK

FOR

PROJECT

The Subrecipient shall ensure services, and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: 1.

a) Infrastructure

projects: Projects in support of Clients ( services not easily

or replacement d. "

regulation.

Confidential Information" or" Data" means information that is exempt from disclosure to

the public or other unauthorized persons under Chapter 42. 56 RCW or other federal or state laws. Confidential

information

includes, but is not limited to, Personal Information.

g. "

Debarment" means an action taken by a federal official to exclude a person or business entity from participating in transactions involving certain federal funds.

h. "

DSHS" means the Department of Social and Health Services of the state of Washington.

i. "

j. "

General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. 7 of 54

26- 019 Last

Date

Admin

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

High Acuity Client" means a DDCS Client who requires significant and intensive support in the community, often due to complex needs, as determined through the DDCS

assessment.

Medicaid Home and Community Based Services ( HCBS)" means services that occur in

I. "

Person Centered Service Plan or PCSP" means a document that authorizes and

identifies the DDCS paid services to meet a Client' s assessed needs. Formerly referred to as the Individual Support Plan.

RCW"

means

the Revised

Code

of Washington.

All references

in this Agreement

and

any Program Agreement to RCW chapters or sections shall include any successor, amended, or replacement statue. Pertinent RCW chapters can be accessed at

http:// apps. leg. wa. gov/ rcw/. Secretary" means the individual appointed by the Governor, State of Washington, as the

head of the DSHS, of his/ her/ their designee.

Information

is not available to unauthorized

personnel.

w. "

provide services. Trusted Systems" include

following methods of physical delivery: ( 1) handdelivery by a person authorized to have access to the Confidential Information with written

acknowledgment

only the

of receipt; ( 2) United

States Postal

Service (" USPS") first class

the Washington State Governmental

Trusted System for communications

Network ( SGN) is a

within that Network.

USC" means the United States Code. All references in this Agreement and any Program Agreement to USC chapters and sections shall include any successor, amended, or

" WAC" means the Washington Administrative Code. All references in this Agreement and

replacement

statute.

any Program Agreement to WAC chapters or sections shall include any successor, amended, or replacement of regulation.

Pertinent WAC chapters or sections can be

accessed at http://apps.leg.wa.gov/ http:// apps. leg. wa. gov/ wac/. wac/

8 of 54

26- 019 Last

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Purpose. a.

Direct Client Services

i. "

authorized in addition to or instead of employment support ( Individual

Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. ii. "

iii. "

Individualized

iv.

Technical Assistance"

or" ITA": services are a part of an Client' s

Coordination. Working collaboratively, the parties shall administer DD services within the county as set forth below: The DDCS region shall:

iii.

iv.

Authorize new service within five ( 5) working days and will extend existing

ii.

referrals when authorization is not issued; service authorization before expiration date; v.

Inform Clients of service changes through Planned Action Notice( s);

vi.

Work with the DDCS Region and the Subrecipient when Clients are referred for services, authorized services, and/ or for support modifications;

Work with DDCS Region and the Subrecipient

to document planned services in

the Client' s Person Centered Service Plan;

9 of 54

26- 019 Last

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

xi.

xii. xiii.

ATTACHMENT

The Subrecipient shall: xiv. xv.

Facilitate the County' s attendance at employment plan meetings as requested. Work with the DDCS Region and the County when Clients are referred for services;

xvi.

Work with DDCS Region and the County to document planned services in the

xvii.

Assist with informing the DDCS Region and County of any potential service level changes not documented in the individual' s DID Assessment prior to any

Client' s Person Centered Service Plan;

changes; and xviii.

2011 i.

and forward.

ii.

Cl services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will

not be reimbursed.

DDCS PCSP. Service changes will not occur until the Client has received proper notification from DDCS. d.

f. g.

at minimum wage or higher within six ( 6) months, the

26- 019 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

employment. The additional strategies will be documented

for each Client and

kept in the Client' s file( s). h.

j. k.

If after twelve ( 12) months the Client remains unemployed,

an additional review will be

The setting facilitates individual choice regarding services and supports, and who provides them.

Partnership Project i. A Job Foundation document will be completed per guidelines for eligible students. Eligible students are DDCS clients who were born between: 1.

For fiscal year 2026: 9/ 1/ 05 through 8/ 31/ 06. For fiscal year 2027: 9/ 1/ 06 through 8/ 31/ 07. These students currently attending school and have completed an application to 2.

ii.

participate

in this Value Based Payment ( VBP) project. The VBP project

application will include the following minimum criteria identified in the sample application found at:

Project the Subrecipient

must have a current contract

If action to correct substandard performance is not taken by the Subrecipient within 30 days after being notified by the County, then the County may terminate the Agreement as described herein.

11 of 54

26- 019 Last

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

Additional Requirements:

ATTACHMENT

The Subrecipient will maintain and make available, if requested,

documentation demonstrating accomplishments of the contract. Such documentation may include, but is not limited to, the following: a. Services provided b.

Number of hours of service

Data Collection

Completed evaluation tools

Backup reports/ data for invoicing.

Agreement. Credentials and Minimum Requirements:

Sufficient Policies and Procedures for establishment and maintenance of adequate

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees, subcontractors, and/ or volunteers who may have unsupervised

access to vulnerable DSHS Clients, in accordance with RCW 43. 43. 830-

Check Central Unit( BCCU) must be utilized to obtain background

clearance.

ii.

12 of 54

26- 019 Last

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agency.

Subrecipient is specifically authorized to have data storage on portable devices or media in accordance with Attachment E. Data Security Requirements.

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Chapter WAC 388- 850, chapter 388- 828 WAC, WAC 388- 845- 0001, 0030, 0210, 0215, 0220, 0600- 0610, 1030- 1040, 2100, 2110;

Criteria for Evaluation;

DDA Guiding Values; County Guide to Achieve DDA' s Guiding Values; DDA Guidelines for Community Assessments with Employment and Vocational

Programs;

and

Disability Rights Washington ( formerly Washington Protection and Advocacy System) Access Agreement.

The Subrecipient shall ensure that all staff, working with clients receiving Community Access or Individual Employment Services, complete the following DDA online courses upon hire

http://gowise.org/training/wa-state-dda-onlinehttp:// gowise. org/ training/ wa- state- dda- online- courses/ DDA- 5. 06: WA State Client Rights; a. courses/ b.

minimum wage or better; and the average number of hours worked. The Subrecipient' s service

Follow all requirements as outlined in Attachment E.

ii.

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. d.

When transporting client records containing Confidential Information outside a Secure Area, one or more of the following as appropriate:

Date

Admin

Use a Trusted Network; or

Encrypting the Confidential Information, including: 13 of 54

26- 019 Last

Information.

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

and/ or email

attachments.

iii.

14 of 54

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

BUDGET

Budget. The County shall reimburse the Subrecipient in an amount not to exceed $ 1, 427, 000 for expenses related to Consumer Services, staff training/ education, and ARC Services. Staff training/ education reimbursement may not exceed $ 2, 000 for the contract period, requires approval from the County Coordinator, and is based on availability of funds. Unspent grant proceeds will be reallocated at the discretion of the County.

Budget Budget Lines

Total

Consumer Services and staff training/ education ( up to $ 2, 000 for staff train in /

1, 327, 000

education)

ARC Services

100, 000 1, 427, 000

Total

The Subrecipient shall budget funds awarded in such a manner to ensure availability of services throughout

the entire

term

of this Agreement

subject

to available

funds.

Change the individual line budget,

Not change the total agreement award.

and

as updated.

The

Subrecipient

shall

ensure

that

the progress of the project, and fees.

The Subrecipient shall submit invoices to the County on or before the 15th of the month, regardless of what day of the week the 15th falls on, following the month of services were performed.

26- 019 Last

Date

Admin

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Advance Payment. The County shall not make any payments in advance or in anticipation of the delivery of services to be provided pursuant to this Agreement.

Subrecipient

is bound to follow all terms and conditions of the Washington State DSHS

Program a.

Specific

Conditions:

Consumer

Services

The Subrecipient may bill at the rate authorized on the County Service Authorization for the number of unit( s) per consumer per month for: i. Community Inclusion

ii.

Individual Supported

iii.

Individualized

Employment

Technical Assistance

Reimbursement for Client Services: A claim for each individual is made by indicating the number of service units delivered to each individual

listed and the fee per unit. Units are

defined as: i.

under this Program Agreement when the same services paid for under

Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. Production/ commercial profits generated by the work of County- funded consumers shall be used to support County funded services as needed. The

Individual

Employment

Phases &

Billable

Activities

document

defines

the individual

Client services that the County reimburses. That document is located on the DSHS DDA County Best Practices Web site at https:// www. dshs. wa. gov/ dda/ county- best- practices. 16 of 54

26- 019 Last

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Form:

1615. 2

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SUBRECIPIENT

GRANT AGREEMENT

High acuity Clients who are authorized for Individual employment, Subrecipient may receive one outcome payment if client obtains a new competitive integrated job at a minimum of ten hours of work per week for a minimum of 4 out of each 6 months during the fiscal year. The Community Inclusion Billable Activities document defines the individual Client services that the County reimburses. That document is located on the DSHS DDA County Best Practices Web site at https:// www. dshs. wa. gov/ dda/ county- best- practices. Client who are authorized for Community Inclusion who have an acuity of F which equals 18 support hours per month or G which equals 20 support hours per month as based on the Support Intensity Scale ( SIS), provider may receive on outcome payment per month if delivers

provider m.

ATTACHMENT

a minimum

of 80%

of the authorized hours.

A new Community Inclusion referral is defined as a Client who has a new County Service Authorization ( CSA). Incentive/ outcome payment to accept and support overall increased CSAs billed over the year may be requested from DDA if funds are available. Community Inclusion case notes and 6- month progress report summary review that scores 16 points or more with the " Community Inclusion Case Note Review Tool' when used in conjunction with a Community Inclusion plan that has scored 20+ points with the Community Inclusion plan Quality review tool, Subrecipient may receive an outcome payment.

All outcome payments are described in the " Outcome Payment Table for Individual Employment and Community Inclusion" chart in the DSHS billing instructions found here: https:// www.dshs. wa. gov/ sites/ default/files/ DDA/ dda/ documents/ AWA% 20Billing% 201 nstr uctions% 207. 1. 2025% 20F1 NAL. pdf Partnership Project: i.

The Subrecipient will receive $ 3, 000 per student for each completed Job

ii.

Subrecipients with transition students, as outlined in Attachment A, Section 31,

July

st—

range

for job

October

st—

December

January

st—

March

April

1st-

June

placement

Outcome Payment Amount

30t"

September

1, 500

1, 000 500

30t"

250

Please note a current County Service Authorization for Individual Employment must be in place prior to outcome payment. q.

Training i.

The

Subrecipient

shall:

Seek prior approval from the County Coordinator for training/ education reimbursement.

Make every effort to minimize the cost of individuals training by seeking out scholarships

and stipends, shared transportation

and lodging when

applicable to help reduce costs. Any additional costs will be the sole responsibility of the Subrecipient. Inform individuals of allowable travel and training expenses.

Submit copies of itemized receipts, MapQuest directions, travel

itineraries, conference registration including agenda pertaining to all

17 of 54

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Form:

1615. 2

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

requested

reimbursements.

Expenses without backup documentation

will

not be reimbursed. r.

Timeliness

of and

Modification

to Billings:

All initial

invoices

with

signed

18 of 54

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Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

CERTIFICATION

I, Dave Hill, am the Executive Director of Lifeworks and I certify that: 2.

1 have authority and approval from the governing body on behalf of Lifeworks to accept proceeds from the County per Agreement for services for persons with developmental disabilities by and between the County and Lifeworks

disabilities.

Were incurred during the period that begins on July 1, 2026 through June 30, 2027 4.

1 understand Lifeworks receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/ or sales receipts and such documentation shall be produced to the County upon request and may be subject to audit by the State Auditor.

Printed

Name

Signature

Title

Date

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RETIREMENT

CERTIFICATION

COUNTY RETAINS THIS FORM

Individual contractors and service providers must complete and sign WA Department of Retirement Systems: Independent Contractor Verification and State

Retirement Status Reporting Form [ WAC 415- 02- 110; DRS Email 13- 011; DRS Email 09- 001] SECTION 1:

INDIVIDUAL CONTRACTOR

COMPLETES

THIS SECTION AND SIGNS:

Did you

retire

from

Did you

retire

before age 65 using the 2008 early retirement

Will

you

be receiving direct compensation

Will

you

be receiving indirect

one

of the State of Washington

Retirement Systems? factors ( ERF)?

for your services? for your services?

compensation

YES

CONTRACTOR ( Full, individual name of contractor): Signature: SECTION

Social 2:

COUNTY

COMPLETES

Use Member Reporting 1.

Contractor

has

Security No.:

THIS

SECTION

Date:

AND

RETAINS

FOR AUDIT

Verification ( MRV) to verify the past retirement

been

a member

of a Washington

State

Retirement

PURPOSES:

membership] System

YES

If YES, what system and plan? Teachers'

Retirement

System (

TRS)

Planl

Plan

School

Employees'

Retirement

System (

SERS)

Plan

Public

Employees'

Retirement

System (

PERS)

Plan

Public

Safety Employees'

Plan

Law

Enforcement

Washington

Retirement

Officers' &

State Patrol

Fire

System ( PSERS)

Fighters'

Retirement

System (

System ( WSPRS)

Plan

LEOFF)

Plan

Judicial Retirement System ( JRS) 5.

Is the contractor a retiree of a Washington

Did the contractor retire before

age

State Retirement

65 using the 2008

System?

ERF?

Yes

R 5/ 09), and the Internal Revenue Service rules governing independent contractor status.

COUNTY OFFICIAL/ DEPARTMENT

Signature:

REPRESENTATIVE:

Date:

COUNTY RETAINS THIS FORM 20 of 54

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ATTACHMENT

Data Security 1.

Definitions.

Requirements

The words and phrases listed below, as used in this Attachment

E, shall each have

the following definitions: AES" means the Advanced Encryption Standard, a specification

of Federal Information

7-upd1.pdf

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential

Information,

and who has or have been authorized to do so.

and on a network outside the control of the Subrecipient.

Physical storage of data in the

PIN" means a personal

identification

number, a series of numbers which act as a

password for a device. Since PINs are typically only four to six characters, PINs are usually used in conjunction i. "

with another factor of authentication,

such as a fingerprint.

Device

is a subset

of Portable

Device.

lock, or comparable

mechanism.

Secure Areas may

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access, the Data must be secured in such a way as to prevent access by non- authorized

with a password,

passphrase

or other mechanism,

authenticates

a user to an

information system. 2.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency

Authorization, Authentication, and Access. In order to ensure that access to the Data is

limited to authorized staff, the Subrecipient a.

must:

Have documented policies and procedures governing access to systems with the shared Data.

Restrict access through administrative, physical, and technical controls to authorized staff.

it must always be possible to determine

which employee performed a given action on a system housing the Data based solely on the Iogon ID used to perform the action. d. e.

Ensure that only authorized users are capable of accessing the Data. Ensure that an employee' s access to the Data is removed immediately: i.

Upon suspected compromise

ii.

When their employment, or the contract under which the Data is made available to them,

iii.

of the user credentials.

is terminated.

When they no longer need access to the Data to fulfill the requirements of the contract.

characters ii.

such as an asterisk, ampersand,

or exclamation

point.

That a password does not contain a user' s name, Iogon ID, or any form of their full name. 22 of 54

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the Internet or otherwise travel outside the Subrecipient' s network), mitigate risk and

Encrypting all remote access traffic from the external workstation to Trusted

iv.

Network or to a component within the Trusted Network. The traffic must be

encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network.

authentication mechanism, such as a biometric ( fingerprint, face recognition, iris scan) or token ( software, hardware, smart card, etc.) in that case: i.

The PIN or password

must be at least 5 letters or numbers when used in

conjunction with at least one other authentication factor. Must not be comprised of all the same letter or number( 11111,

ii.

22222, aaaaa,

would not be acceptable). Must not contain a " run" of three or more consecutive numbers ( 12398, 98743

iii.

would not be acceptable).

If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes

used on the device must:

Be a minimum of six alphanumeric characters.

ii.

Contain

at least

three

unique

character

classes (

upper

case,

lower

case,

letter,

number).

iii.

Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable.

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Subrecipient agrees to store Data on one or more of the following media and protect the Data as described:

Hard

disk

drives.

For Data

stored

will be restricted to Authorized

on local

workstation

User( s) by requiring

hard

disks,

access

to the Data

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. For Data stored on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized

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

Date

Admin

Destruction

of the Data, as outlined below in 23 of 54

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listed in the above paragraph.

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Section 8 Data Disposition,

may be deferred until the disks are retired, replaced, or

otherwise taken out of the Secure Area. c.

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 Secure 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

mechanism.

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 Secure

Area.

Access

to Data

on these

discs

will

mechanisms which provide

mechanism.

Remote Access. Access to and use of the Data over the State Governmental

Network

otherwise leaves the employ of the Subrecipient, and whenever an Authorized User' s duties change such that the Authorized

User no longer requires access to perform work

for this Contract. g.

Encrypt

Control access to devices with a Unique User ID and Hardened

the

Data.

Password or stronger authentication method such as a physical token or biometrics.

Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available.

Apply administrative and physical security controls to Portable Devices

Maximum

period of inactivity is 20 minutes.

and Portable Media by: a.

Keeping them in a Secure Area when not in use,

Using check- in/ check- out procedures

when they are shared, and

Taking frequent inventories. When being transported outside of a Secure Area, Portable Devices and c.

ii.

Portable Media with DSHS Confidential

Date

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ATTACHMENT

control of Subrecipient staff with authorization Data

to access the Data, even if the

is encrypted

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 ii.

below in Section 8 Data Disposition.

Information still exists upon it, the data will be destroyed

at that time in accordance with the disposition requirements

below in Section 8

Data Disposition. i.

DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: 1. Subrecipient has written procedures in place governing use of the Cloud storage

and Subrecipient

attest

to the contact

listed

in the contract

and

keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. 2.

The Data will be Encrypted while within the Subrecipient network.

The Data will remain Encrypted during transmission to the Cloud. The Data will remain Encrypted at all times while residing within the

Cloud storage solution. 5.

The

Data

will

not be decrypted

the control of an Authorized

until

downloaded

onto

a computer

within

User and within either the DSHS or

Subrecipient' s network. Data will not be stored on an Enterprise Cloud storage solution unless either:

ii.

iii.

The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or,

The Cloud storage solution used is HIPAA compliant.

System Protection.

To prevent compromise

of systems which contain DSHS Data or through

been

applied

within

the required

timeframes.

Systems containing DSHS Data shall have an Anti- Malware application, if available, installed.

Anti- Malware software shall be kept up to date. The product, its anti- virus engine, and

any malware database the system uses, will be no more than one update behind current. 7.

Data

Segregation.

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will contain no non- DSHS Data. DSHS Data will be stored in a logical container on electronic media, such as a

ii.

partition or folder dedicated to DSHS Data. DSHS Data will be stored in a database which will contain no non- DSHS data.

iii.

And/ or, DSHS Data will be stored within a database and will be distinguishable

iv.

from non-

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. Data Disposition. When the contracted work has been completed or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server

stored

on:

hard

disks,

or workstation

Removable drives,

media ( e. g.

hard

portable

floppies,

disks)

flash

Will be destroyed by: Using a " wipe" utility which will overwrite the Data at least three ( 3) times using either

optical

random or single character data, or

USB

excluding

discs

Degaussing sufficiently to ensure that the Data cannot be reconstructed,

Paper

documents

Confidential

Paper

with

sensitive

Physical y destroying the disk Recycling through a contracted firm, provided the contract with the recycler assures that the

Information

documents

containing Confidential

confidentiality of Data will be protected. On- site shredding, pulping, or incineration

Information requiring special handling ( e. g. protected health information Optical

discs ( e. g. CDs

DVDs)

Incineration, shredding, or completely defacing the readable surface with a coarse abrasive

Magnetic

Degaussing, incinerating or crosscut

tape

shredding

Notification of Compromise or Potential Compromise. The compromise or potential compromise

of DSHS shared Data must be:

Reported to the County Program Manager designated in this Contract within one ( 1) business day of discovery, b. Reported to the DSHS Privacy Officer at mailto:dshsprivacyofficer@d dshsprivacyofficer@dshs. wa. gov within one ( 1) shs.wa.gov business day of discovery, and c. Subrecipient must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS. Data shared with Subrecipient. If DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the Subrecipient must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If a.

the Subrecipient

Date

Admin

within this Contract, then the contract with

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the subcontractor must be submitted to the County Program Manager specified for this contract for review and approval.

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ATTACHMENT

DSHS Agreement Number

COUNTY

DSHS x

2663. 69480

PROGRAM

sonar

AGREEMENT

DDICS County Services This Program AgreerTlUnt

is by and between

Social and Health Services(

USH8)

conjunction with a County and

51H5 Agreement On General Terms and Conditions, 17SJIS

DSHS DIVISIOl

tSTRATION

INDEX

Nurriber

County ggreament PS* sS CONTRACT

NUMDER

Number CODE

1769C5- 63

1136

Division Df Developmental

Disabilities

Developmental

Agreerrton

by reference.

which is incorporated CS11SADNI

below. and is issued

identified

Administration oT Dlvision

Department of

the State of Washington

and The County

Disabififies

Admin DSHS CQNTAC1

DSHS

NAME ANO TITLE

C04TAGT

ADDRESS

PO BOX 453i5

Wendi

lrchel

Regional

Business

Manager

QI m - a, WA 98504. 5315 DSHS CONTACT TELEPHONE 7254264

360

08HS

CONTACT FAX

360

586-

V$ HS CONTACT

COUNTY

NAME

COUNTY ADDRESS

Cowlitz

County County DDA County Services

1952

Cowlitz COUNTY

FEDERAL

EMPLOYER

E- NWL

wendi. winchel

6602

dshs. wa.

9th Avenue

I nnfiview.

98632

COUNTY CONTACT NAME

I DENT I= I CAI ION

NuMatR

SUe S'el'Yinn COUNTY

CONTACT

rELEPHONE

360

414- 5599

I5THE

COUNTY A SUBRECIPIENT

CONTACT

COUNTY

FAX

FOR

PURPOSE$

CONTACT

saxtons

f3601501- 1207

ASSISTANCE

TH1S PROGRAM

F- MAIL

cowlitlwa- av

LISPING NUMBERS

AGREEMENT'?

No PROGRAM

AGREEMENT START

DATE

07/ 01 i2026

AGREEMENT

PROGRAM

ENO DATE

MAx1V.UN1 PROGRAM! AGREEMENI

ANIGUN-

2, 745. 890. 40

0613012D27

EXHIBITS. The following Exhibits are attached: Exhibit A— Data Security Requirements; Exhibit B— Budget and Spending

Plan

By their signatures below„ the parties agree to the terms arld conditions of this County Program Agreement ana all

PRINTED

SIG" 1ATURE( S)

DATE( S) SIGNED

NAVE( S) AND TITLELS;

BOARD OF COUNTY GOMMISSiONFRS OFCOWLITZCOUN1Y, WASHINGIaN Richard

PRINTED

DSHS SIGNATURE

Dahl, Chairman

NAME

AND TITL

Jessica Barbour, Contract

Specialist

SIGNED

08J1 912026

O WLITZ

caut4T ON o 45+-15 Central CUntmct Services 1769CS County Agreement( 12- 26- 2

26- 019 Last

Form:

rx 04 01

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Special Terms and Conditions 1.

Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "

Acuity Level" means the level of a Client' s abilities and needs as determined

through the DDCS

assessment-

lb- " ALTSA Web Access(

AWA)" means a web- based portal to the Developmental

Disabilities

Community Services CARE system designed to support county services for DDCS clients. c_ "

Additional Consumer Services" refers to indirect Client servicetypes as follows1) "

Community Information

and Education":

Activitiesto inform and/ or educate the general public

and

2) " Training

3) "

Other Activities" reserved ty pes:

for special

a) Infrastructure

Projects in support of Clients ( services not easily tracked

projects:

projects and demonstrations

categorized

into the following

back to a

sp ecifi c work!ng age Client) o r th at d 1 rectly benefit a Clients) but the Client is not of work! ng age. Examples include planning services like genericjob development e.g." Project Search"_

b) Start- up projects:

Projects that support an agency or directly benefit the agency_ Examples

include equipment purchases and agency administrative support. c) Partnership

Project

Collaborative

partnerships

with school districts,

employment

providers,

disabilities

means a master classification

require to

of balance

f. " Competitive Integrated Employment"

g_ " Consumer Support" refers to direct Client service types as follows1) "

Community Inclusion" or" Cl": means individualized services provided in integrated community settings with other individuals without disabilities_ The activities are based on Client interests Page 2

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Special Terms and Conditions

support( Individual Employment or Group Supported Employment) for working age individuals who have received nine months of employment

support.

2) " Child Development Services" or" CDS": Birth to three services are designed to meet the

instruction, speechlanguage pathology, vision, and transportation_ Services are provided in natural environments to the maximum extent appropriate. 3) "

the general workforce.

These services

may include intake, discovery,

assessment,

job

preparation, job marketing, job supports, record keeping and support to maintain a job4) " Individualized

individual

Technical Assistance" or" ITA": services are a part of a Client' s pathway to employmentor community inclusion. This service provides assessment and

employment

enclaves, mobile crews, and other business models employing disabilities in integrated employment in community settings_ h. "

County" is the political subdivision

of the state of Washington

Examples include

small groups of workers with

and the county or counties entering

into this program AgreementI- "

DDCS Case Resource Manager( CRM)" means a case manager for DDCS Clients.

j_ " County Service Authorization( CSA)" means an authorization for county services. k. "

Developmental

disabilities(

DD)" means a disability

attributable

to intellectual

disability,

cerebral

Developmental

Disabilities Community

Services" DDCS" means a division within the Department of Page 3

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Special Terms and Conditions Social and Health Services. DDCS Regional office( DDCS Region)" means the regional DDCS office that supports DDCS

m_ "

clients.

Division of Vocational Rehabilitation(

n_ "

DVR)" means a division within the Department of Social and

Health Services o.

Employment

Outcome Payment"

means a paymentto

providers for transition

students barn

often

p_ " General Terms and Conditions"

which govern the contractual

meansthe contractual provisions contained within that agreement, relationship between DSHS and the county.

q_ " High Acuity Client" means a DDCS

Client who requires significant and intensive support community, often dueto complex needs, as determined through the DDCS assessment_

in the

Medicaid Home and Community Based Services( HOBS)" means services thatoccur in a Client' s home or community ratherthan institutions or other isolated settings_ These programs serve a

r. "

variety of targeted populations groups, such as people with intellectual or developmental disabilities,

physical disabilities,

Job Foundation

s_ "

and/ or mental illnesses

Report" is a document derived from employment

readiness

activities

performed

Preadmission Screening and Resident Review( PASRR)" means individuals with intellectual disabilities or related conditions( ID/ RC) who have been referred for nursing facility( NF) care.

t. "

Person

u. "

Centered Service Plan or PCSP" means a document that authorizes and identifes the

DDCS paid services to meet a Client' s assessed needs.

Formerly referred to as the Individual

Support Plan.

Ou ality Assurance" means an adherence to all Program Agreement requirements, including DDCS

v. "

Quality Improvement" means a focus on activitiesto improve performance above minimum standards and reasonably expected levels of performance, quality and practice_

Service Provider" is a qualified Client service vendor who is contracted to provide Employment and

Day Program y. " 2.

services.

Subcontractor" is the service provider contracted by the County to provide services.

Purpose: This Program Agreement is entered into between the Developmental Disabilities Community Services and the County in accordance with chapter 71 A_14 RCW_ Its purpose is to advance the state

legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental

disabilities_ Page 4

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Special Terms and Conditions 3.

Credentials and Minimum Requirements:

Administration

of the developmental

disabilities

County program cannot be subcontracted_

area ( e_g_ Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/ or a related Human or Social service may be considered_ c.

Sufficient Policies and Procedures for establishment and maintenance of adequate internal control

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees(

including

DID program County staff), subcontractors,

and/ or

Qualified Advisory Board Members:

A Developmental

Disabilities

advisory board shall include

members knowledgeable about developmental disabilities_ No board member shall have a contract

with the County to provide Training,

Community

Information

Activities,

and Consumer

Support as

defined in this Program Agreement, and shall not be a board member, officer, or employee of an

agency subcontracting with the County to provide such services. h.

Qualif ed Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6. 13, Program Qualifications for Employment and Day Program Providers.

Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to a ssign to DDCS its Medica id billing rights for Page 5

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Special Terms and Conditions

services to DDCS Clients eligible under Title XIX programs

in this Program Agreement.

Written

documentation shall be available to DSHS on request.

Counties who provide Child Development

Services( birth to three early intervention

services),

must

provide those services under the regulations implementing the Individuals with Disabilities Education Act( IDEA), Part C, and Washington Federally Approved Plan_ I_

State' s Early Support for Infant and Toddler

Ord er of Precedence: In the event of any inconsi stency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency

shall be resolved by giving

precedence, in the following order, to: 1)

County Program

Agreement;

and

2) Attached Exhibits. 5.

Disclosures must be provided at contract renewal and within thirty- five( 35) days whenever there is a change in the staff holding these management positions[ 42 CFR 455. 104 ( c)( 1)]_ 6.

the county as set forth below: a_

The DDCS region shall:

Review subcontractors and shall immediately notify the County of any concerns with the Page S

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Special Terms and Conditions

subcontractors

identified

bythe County;

5) Authorize

new service within 5 working days and will extend existing service authorization

before expiration date; 6)

Inform Clients of service changes through Planned Action Notice( s);

7) Work with the County to document planned services in the Client' s Person Centered Plan including notification of assessment dates;

Service

B) Work with the County when terminating services; 9) Work with DDCS Head Quarters

and the County on Spending

Plan adjustments;

and

10) Work with the County in participating in evaluation of direct service providers_ b_ The County shall: 1)

Work with the DDCS Region when Clients are referred for services,

authorized

services,

andlor

for support modifications;

2) Work with the DDCS Region to document planned

services

in the Client' s Person Centered

Service Plan;

3) Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DID Assessment prior to any changes; 4) Work with the DDCS Region regarding

service termination;

5) Work with the DDCS Head Quarters on Spending

Plan adjustments;

6) Inform the DDCS Region of new providers to be included on the ALTSA Web Access( AWA) sy stem;

7) Notify the DDCS Region of any intent to terminate

a subcontractor

who is serving a DDCS

referral;

B) Provide a copy of each subcontractor' s contract upon written request from DDCS; and 9) Notify and work with the DDCS Region al Employment direct service providers. c.

Specialist when performing

evaluations

Compliance with Budget and Accounting Reporting System Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. Page 7

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Special Terms and Conditions

The County shall comply with the following 1)

referenced

documents:

DDCS Policy 411, County Services for Working Age Adults;

DDA Guidelines

7) Disability

for Community

Rights Washington (

Assessments

formerly

within Employment

Washington

Protection

and Vocational

and Advocacy

Programs:

System)

and

Access

Agreement.

e_ The County shall develop and submit a comprehensive plan forthe County DID Services as required by WAC 388- 850- 020_ f.

Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The

Solicitation

for Qualified

of the County and the DDCS Region_

Employment

and Day Program

Service Providers:

Requests for

Applications( RFAs), Requests for Information ( RFI' s) and/ or Requests for Proposals( RFPs),

Requests for Qualifications( continuous

RFQ' s) for direct services,

excluding

Child Development,

will be open

enrollment.

Qualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDCS.

Technical Assistance: DDCS contracts with Technical Counties with prior written approval_

Assistance

providers that may be utilized by

Inclusion services_

The County shall provide or contract with qualified Employment and Day Program Service Providersfor 1)

consumer support services that include thefollowing

Monthly Community

program outcomes-

Inclusion ( CI) service support hours will be based on the Client' s CI service

level per WAC 388- 828- 9310 for all Clients who began receiving CI services July 1, 2011 and forward_

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b) CI services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will not be reim bursed.

2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses_ Clients

should be supported to average twenty( 20) hours of community work per week or eighty- six 86) hours per month; however,

each person' s preferred

hours of employment

should

be taken

into consideration. The amount of service a Client receives will be based on his/ her

demonstrated

need, acuity level and work history per WAC 388- 828.

3) The Client' s DDCS PCSP is the driver for service_ The AWA County Service Authorization CSA) and updated Planned Rates information will not exceed the Client' s DDCS PCSP.

an additional review will be

responsible for authorizing CI services_ Page 9 DSHS

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and any potential conflict of interest is addressed.

10) Individual Employment staff hours must be attributed to the " Individual Employment and Billable Activity Phase( s)"

a) The collectivegroup' s individual hours should bethe minimum staff hours delivered to su pport th e g rou p-

f) Running a GSE service is a part of the business operation and not billable to Clients contract procurement,

contract maintenance, or administration

functions associated with

GSE)-

Phases and

Based settings

a) The setting is integrated in the greater community and supports Client' s to havefull access to the greater community; b) Ensures the Client receives services in the community

to the same degree of access as Page 10

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individuals

not receiving

Medicaid

HCBS;

c) The setting provides opportunities to seek employment and work in competitive integrated settings;

and

d) The setting facilitates individual choice regarding services and supports, and who provides them_

Quality Assurance

and Service Evaluation:

The County shall develop and have available

m_ Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one visit to each subcontractor

every two

Copies of such documentation

will be provided tothe DDCS upon request.

n_ The County shall workwith local developmental disability advisory groups to plan for and coordinate services_

The County shall participate in regularly scheduled meetings between County DID staff and DDCS staff to remain updated and current including ACHS and Regional Meetings.

AWA Data System: In compliance

with the AWA Training Manual,

the County shall use the AWA

data system for all:

Billing requests;

2) Service provider address and phone number maintenance; 3) Evaluation dates; 4) Employment

outcome information;

and

5) Monthly provide all data described in the Billing Instructions Instructions, which is hereby incorporated by reference. q.

and in the Employment Outcomes

Review and respond the AWA" Work List" items within 5 working days including pending Authorization_

Referrals and

Review the AWA" Ticklers" Planned Rate tab and update the planned rate within 5 working d ays Page 11

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Special Terms and Conditions after the Planned Rate start date. t_

Partnership

Project-

1) A Job Foundation document will be completed per guidelines for eligible students.

Eligible

students are DDCS clients who were born between:

a) For fiscal year 2026 9/ 1105 through 8/ 31/ 06 b) For fiscal year 2027 9/ 1106 through 8/ 31/ 07 These students currently

attending

school and have completed

an application

to participate

this Value Based Payment( VPB) project_ The VBP project application will include the following minimum

criteria identified in the sample application found at:

https:// www. d sh s. w a_ gov/ sites/ default/ fi I es/ D DA/ dd a/ d ocu m ents/ J ob`/` 20 Foundation% tlon

2 0APpl i c a

040720% 20% 28002% 29. docx

documents) meet quality standards_ u_

Outcome Payment. Providers, with transition

students born between:

a) For fiscal year 2026 9/ 1103 through 8/ 31104 b) For fiscal year 2027 9/ 1/ 04 through 8/ 31/ 05 2) High acuity transition students who are authorized for Individual employment, the provider may

receive one outcome payment if transition student obtains a competitive integrated job approved by the County within timeframes

described

in the chart in the Billing Instructions_

If the County

is also the service provider DDCS will provide the job approval_ If the job is at a minimum of ten hours of work per week a n additional

amount will be include in the payment-

a minimum

of 80% of the authorized hours. Page 12

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Special Terms and Conditions

5) A new Community

Authorization( CSA).

Fees.

Approval of fees is the responsibility of the DDCS. The DDCS HQ Employment and Day Unit Manager reserves the right to approve fees/ rates for the services being provided_ The County will submit a fee/ rate schedule with the initial Program Agreement_ The County will submit updated fee/ rate schedules to the HQ Employment and Day Unit Manager for approval as changes occur_ The rate schedule will include the following information-

a) County( s) name; b) Time period for which the schedule! s applicable;

and

c) Each contracted direct service( IE, GSE, CI, ITA, CDS) and its associated rate-

Fee Limitations- The Billing Instructions found on the County Best Practices site provides lim itations on the Hourly Rate for each direct service. Hourly rates must be divisi ble by four.

b_ Budget and Spending 1)

Plan, attached

as Exhibit B-

Budget amount listed in Exhibit B- The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement

included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state- only employment and day services to waiver employment and day services-

2) Spending Plan- DDCS will provide the initial spending plan / Program Agreement Budget/ Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The

only be modified by mutual agreement of the parties in writing and shall not require a program agreement

amendment_

a) Funds Designated for Additional Consumer Services- If a County provides Community Information and Education services under additional consumer services, then activities must

include outreach

efforts to federally recognized

local tribes-

b) Funds Designated for Adult Day Care Consumers.

Funds designated for Adult Day Care

Consumers are availableto Clientswho were served between December 1996 and

December 2003 in Adult Day Health agencies and were subsequently determined

ineligible Page 13

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Special Terms and Conditions for Level II or III services(

If a Client no longer needs and wants services, the fund s

by the local Area Agency on Aging. Adult Day Care

service is not a waiver approved service_ c_

Program Agreement Amendments- A County can request an amendment at any time_ An amendment for additional Clients) may be supported when clients exceed the number used to

Exemptions- The DDCS Assistant program agreement requirement-

Secretary

may approve in writing an exemption

to a specific

Billing and Payment: a.

Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for-

1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration

include personnel

of the Developmental

and overhead

Disabilities Program.

Allowable costs

costs directly related to the administration

and coordination

a) Training: i.

Board Training- Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program- related skills of board and advisory committee

members.

and community Page 14

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consultation,

capacity building

and organization

activities.

c) Other Activities_ i.

ii_

Start- up projects: Projects that support an agency or directly benefit the agency_ Examples include equipment purchases and agency administrative support-

school year they turn twenty-one( 21). Supports provided should complement and not replace what the student( s) receive through the Individualized Education Program( IEP)_ 3) Consumer Support_

Level II and III services are licensed

b) Community Inclusion Services are individualized and provided in integrated community settings with other individuals without disabilities_ The activities are based on Client

interests and provide opportunities typically experienced by the general public of sim ilar age in their local community,

accessible

by public transit or a reasonable

commute from their

to the maximum

extent

appropriate.

general workforce. These services may include intake, discovery, assessm ent, j ob preparation, job marketing, job supports, record keeping and support to maintain a job( per Page 15 DSHS

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Special Terms and Conditions the

Individual Employment Phases&

Billable Activities)

Examples include enclaves, mobile crews, and other business models employing small groups ofworkerswith disabilities in integrated employment community settings_ b_

Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this

Program Agreement.

However, with a Program Agreement amendment, the parties may increase

or decrease the Program Agreement amount_ Counties will work with DDCS HOon amendmentsto the Program Agreement. c_

Clients will be assisted in accessing DVR services perthe DDCS/ DVR MOU. Client services shall not be reimbursed

under this Program Agreement when the same services are paid for under the

Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. e.

Reimbursement

of Client Services:

A claim for each Client is made on the AWA system

indicating the number of service units delivered to each Client listed and the fee per unit_ Units are defined as:

An " Hour" is at least fifty( 50) minutes of direct service. Partial hour to the quarter may be recorded-

2) A" Day" is at leastfour( 4) hours of direct service and will only be used in connection with Adult Day Care reimbursement3) A" Month" represents

a minimum of at least fifty( 50) minutes of direct service for CDS

reimbursement.

can be 1112 of the maximum amount identified in Exhibit B under Administration or

The Individual Employment Phases&

Billable Activities document defines the individual Client Page 16

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Special Terms and Conditions

services that DDCS reimburses.

That document

is located on the DSHS DDCS County Best

Practices Web site at https:// www. dshs. wa. aov/dda/ county- best- practices.

Timeliness of and Modification to Billings: All initial invoices with signed documentation must be

Recovery of Fees. If the County bills and is paid fees for services that DSHS later finds were( a) not delivered or( b) not delivered in accordance with Program Agreement standards, DSHS shall

recover the fees for those services and the County steal I fully cooperate during the recovery. k_

costwill be based

DDAJobFoundationReportsadshs_

wa_.Qov

multiplied by

Intermediate Care Facilities for Intellectual Disabilities( ICF1ID) Agreement. If applicable per 42 CFR 463. 410, the County shall assure that all county- operated or subcontracted

programs serving

persons living in ICF/ ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/ ID resident 10.

Single State Medicaid Agency— Health Care Authority(

HCA):

HCA, as the single state Medicaid

DSHSIDRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDCS is incorporated

by reference_ The County assures that it and its subcontractors

have reviewed

the

Access Agreement_ The agreement covers DRW' s access to individuals with developmental Page 17 DSHS

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disabilities, Clients, programs and records, outreach activities, authorityto investigate allegations abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS

contracted services_ 12.

Confidential Information.

Al Counties and their subcontractors must

Ensure the security of Confidential Information, and

When transporting

client records containing

Confidential

Information

outside a Secure Area, one or

more of the following as appropriate: 1)

U sing a Trusted Network; or

2) Encrypting the Confidential Information, including: a) Email andlor email attachments

b) Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.

Data Security

Requirements. Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization, or transmits more

than

14.

5 records

atone time.

Supersession of Prior Data Security Agreement_ If the Parties hereto have previously entered into a Standalone

Data Security Requirements

Agreement,

both Parties hereby agree that upon mutual

execution said Agreement shall take precedence as the sole Data security Agreement between the Parties_

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Special Terms and Conditions Exhibit A— Data Security 1.

Definitions_

Requirements

The words and phrases listed below, as used in this Exhibit, shall each have the fallowing

definitions: a. "

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so_ e. "

Category 4 Data" is data that is confidential

and requires special handling due to statutes or

refers to data protected

by: the Health Insurance

Portability

d_ " Cloud" means data storage on servers hosted by an entity other than the Contractor and on a

network outside the control of the Contractor.

Physical storage of data in the cloud typically spans

multiple servers and often multiple locations.

Cloud storage can be divided between consumer

grade storage for personal files and enterprise grade for companies and governmental entitiesExam pies of con sumer grad e storage wouId include iCloud, Dropbox, Box_com, and many other entities.

Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and

Rackspace_ e_ "

Encryption

must use a key length of at least 129 bits( 256 preferred)

for symmetri c keys, or

2048 bits for asymmetric keys_ When a symmetric key is used, the Advanced Encryption Standard AES) must be used if available. f. " Hardened

Password"

means a string of at least eight characters

containing

at least three of the

following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. " Mobile Device"

h_ " Multi- factor Authentication"

series of numbers which act as a password for a device_ Since PINS are typically only four to six characters,

PINS are usually used in conjunction

with anotherfactorof

authentication,

such as a

fingerprint1- "

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are not limited to, mobile phones, tablets, and laptops.

Mobile Device is a subset of Portable

Device.

j. "

k_ " Secure Area" means

Confidential

an area to which only authorized representatives of the entity possessing Information have access, and access is controlled through use of a key, card key,

the

Trusted Network" means a network operated and maintained

by the Contractor, which includes

integrity, and availabilityof

the Data. m. "

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.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington

Technology

httns: l/watech_wa_gov/ policies? combine=& field

and of the DSHS Information these requirements

ServicesAgeney

categories

Security Policy and Standards

can be found

target id= 80& field tune target

Manual_

Reference

material

id= All],

related to

here: htti) s:// www. dshs. wa.- govlffa/ keening- dshs- client- information-

private- and- secure, which is a site developed

by the DSHS Information

Security Office and hosted by

DSHS Central Contracts and Legal Services. 3.

Administrative Controls. The Contractor must have the following controls in place: a_

A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy.

If Confidential Information shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment forth e systems) housing the Category 4 Data.

Authorization, Authentication, and Access. authorized

In order to ensure that access to the Data is limited to

staff, the Contractor must:

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Have documented

policies and procedures

b_ Restrict access th rough administrative,

governing

physical,

access to systems with the shared Data

and technical

controls to authorized

staff_

Ensure that only authorized users are capable of accessing the Data_

e_ Ensure that an employee' s access to the Data is removed immediately:

UWn suspected com promise of the user credentials.

2) When their employment, or the contract under which the Data is made available to them, is terminated_

3) When they no longer need access to the Data to fulfill the requirements of the contract. f.

Have a process to periodically review and verify that only authorized containing DSHS Confidential Information

A minimum

length of 8 characters,

and containing

users have access to systems

at least three of the following

character

classes: uppercase letters, lowercase letters, numerals, and special characters such as an

asterisk, ampersand, or exclamation point. 2) That a password

does not contain a user' s name, logon ID, or any form of their full name.

3) That a password does not consist of a single dictionary word. passphrase which consists of multiple dictionary words-

A password

may be formed

as a

4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h.

Ensuring

mitigations

applied to the system don' t allow end- user modification_

2) Not allowing the use of di al- up connections.

3) Using industry standard protocols and solutions for remote access_ Examples would include RADIUS and Citrix.

4) Encrypting

all remote access traffc from the external workstation

to Trusted

Network or to a

component within the Trusted Network_ The traffic must be encrypted at all times while

traversing any network, including the Internet, which is not a Trusted Network. Page 21 DSHS

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5) Ensuring that the remote access system prompts for re- authentication session termination after no more than 30 minutes of inactivity.

or performs automated

6) Ensuring use of Multi- factor Authentication to connect from the external end point to the internal end point_ i_

Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication

mechanism,

such as a biometric(

fingerprint,

face recognition,

iris scan) or token

software, hardware, smart card, etc.) in that case-

The PIN or password

must be at least 5 letters or numbers when used in conjunction

with at

least one other authentication factor 2) Must not be comprised of all the same letter or number( 11 111, 22222, aaaaa, would not be acceptable)

Must not contain a" run" of three or more consecutive numbers( 12398, 98743 would not be acceptable)

If the contract specifically allows for the storage of Confidential passcodes used on thedevice must 1)

Information on a Mobile Device,

Be a minimum of six alphanumeric characters.

2) Contain

at least three unique character classes( upper case, lower case, letter, number).

3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable_ k. 5

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Contractor protect the Data as described, a_

agrees to store Data on one or more of the following

media and

Hard disk drives_ For Data stared on local workstation hard disks, access to the Data will be

Network server disks_ For Data stared on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized Users through

mechanism_

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Special Terms and Conditions

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 Secure Area_ When not in use for the contracted

purpose, such discs must be

Stored in a Secure Area_ Workstations which access DSHS Data on optical discs must be located

in an area which is accessible only to authorized personnel, key, card key, combination lock, or comparable mechanism d_

Optical discs ( CDs or DVDs) in drives or jukeboxes

with access controlled

attached to servers.

through use of a

Data provided by

DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through

smart

cards_ Data on discs attached to such servers must be located in an area, which is accessible only

to authorized

personnel,

comparable

mechanism_

with access controlled

through

use of a key, card key, combination

lock, or

Remote Access.

Access to and use of the Data over the State Governmental Network( SGN) or

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)

authentication

a Unique User ID and Hardened Password or stronger

method such as a physical token or biometrics.

and physical

security controls to Portable Devices and Portable Media

Keeping them in a Secure Area when not in use,

ii_

Using check- in/ check- out procedures when they are shared, and

iii_ Taking frequent inventories_ Page 23 DSHS

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Special Terms and Conditions

Data stored for backup purposes-

below in Section

8 Data Disposition.

1) DSHS Data wi II not be stored in any consumer grade Cloud solution, unless all of the following conditions are met-

for

b) The Data will be Encrypted while within the Contractor network.

c) The Data will remain Encrypted during transmission to the Cloud. d) The Data will remain Encrypted

at all times while residing within the Cloud storage solution_

e) The Contractor will possess a decryption possessed only by the Contractor. f) The Data will not be downloaded

key for the Data, and the decryption key will be

to non- authorized

systems,

meaning

systems that are not

on the contractor network

a) The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or, b) The Cloud storage solution used is HIPAA compliant_

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Special Terms and Conditions

System Protection. that Data passes:

To prevent compromise of systems which contain DSHS Data or through which

a. Systems containing DSHS Data must have all security patches or hotfxes applied within 3 months of being made available_

b_ The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes.

c_ Systems containing DSHS Data shall have an Anti- Malware application,

if available, installed.

d. Anti- Ma lware software shall be kept up to date. The product, its anti- virus engine, and any malware database the system uses, will be no more than one update behind currentT.

Data Segregation-

DSHS Data will be kept on media ( e. g. hard disk, optical disc, tape, etc.) which will contain no non- DSHS Data-

4) DSHS Data will be stored within a database and will be distinguishable

from non- DSHS data by

the value of a specific fell or fields within database records.

5) When stored as physical

paper documents,

DSHS Data will be physically

segregated

from non-

DSHS data in a drawer, folder, or other container_

b_ 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 asdescribed

this exhibit.

Data Disposition.

When the contracted

work has been completed

or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server or workstation

on:

hard disks, or

Will be destroyed by: Using a " wipe" utility which wi II overwrite the Data at least three( 3) times using either random or single character data, or Page 25

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Special Terms and Conditions

Removable

media( e. g. Coppies, USB Cash drives,

portable hard disks) excluding optical discs

Degaussing

sufficiently to ensure that the Data

cannot be reconstructed, or

Physically destroying Paper documents with

sensitive

Confidential

Information

the disk

Recycling through a contracted firm, provided the contract with the recycler assures that the

confidentiality of Data will be protected. 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 ta 9.

I Degaussing,

Notification

of Compromise

or Potential Compromise.

incinerating

or crosscut

shredding

The compromise or potential compromise of

DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one( 1)

Page 26 DSHS

1789CS

Central

Contract

Services

County Agreement(

26- 019 Last

53 of 54

Date Revised:

Admin

Form:

12- 25- 2025)

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Exhibit B

Program Agreement

Original Budget

Budget

0 Budget Revision

REVENUES Fund Source

Fiscal Year 2026

Fiscal

State and

1, 627, 450

1, 479, 700

Medicaid

1 447 900

1 313 649

Tfltal Rev.

3 075 350

2 793 350

Year

Fund

2027

11; t Revision

Original

State

Source

Original

V Revision

21d Revision

3,d Revision

21d Revision

31d Revision

1 457 352

on ly

1 288 528

Medicaid

Total Rev.

V,745, 890

Job Foundation

PASRR Funds

ADMINISTRATION( 12

Funds

TOTAL

11,

13)

OTHER

Medicaid State Funds

Funds

137, 294

112, 332

249, 626

89, 819

73, 487

163, 306

CONSUMER

SUPPORTS 31, 32, 41, 92, 93, 94, 97) CONSUMER SUPPORT STATE62,

ONLY

64r 65, 67r 69

Child Development

MEDICAID 62

64 67 r

ROADS

125440

CLIENTS 69

21 D00

1 093 259

1 D93 259

207 518

1, 445, 812

1, 279, 078

Z745, 890

COMMUNITY 62

64 65 r

LIVING 67

TOTAL

21, 000

Page 27 DSHS

Central

Contract

Services

1789CS CauntyAgreement( 12-25- 2025)

54 of 54

26- 019 Last

Date

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Revised:

Form:

1615. 2

1/ 09/ 2025

Motion

233336

BOCC

Item

Agenda

Meeting Date: 9/ 15/ 2026 Contract with Goodwill of the Olympic and Rainier Region

Submitted By: Amanda Foshaug, Accounting Specialist II Submitted For: Gena James, HHS Deputy Director Department:

Human

Services

Dept

Information

Subject and Summary Statement

The purpose of this County Contract# 26- 017 with Goodwill is to provide developmental disability

employment and day services. This contract is paid on a cost reimbursement basis, not to exceed $ 72, 000. 00, during the period July 1,

2026, through June 30, 2027. Funding for this contract is passed through from the County' s contract with State Department

Washington

of Social & Health Services, Developmental Disabilities Administration.

Contract/ SOW Name

Current

Original

Change

Total

72, 000. 00

ITime Period 7/ 01/ 26- 6/ 30/ 27

Staff Attendance Gena

James

Department

It is the

Recommendation

recommendation

Board of Commissioners

of the Cowlitz

County Health& Human Services that the Cowlitz County

move to approve this Contract 26- 017 with Goodwill.

Attachments

26- 017 DID-

Goodwill

Form

Task

User

Foshaug,

Amanda

Agenda

Review

Action

Timestamp

Item Submission

Submit

8/ 27/ 2026

11: 07: 00 AM

Approve

8/ 31/ 2026

11: 08: 00 AM

Approve

9/ 1/ 2026

Drake,

Jamie

Preliminary

Review-

James,

Gena

Department

Approver

HHS

11: 09: 00 AM

Review Berger, David

Legal Review

Approve

9/ 4/ 2026 3: 24: 00 PM

Grayson,

Clerk of the Board

Approve

9/ 8/ 2026

Kelly

7: 52: 00 AM

Motion

233336

Review

Item

rz co&

SUBRECIPIENT

GRANT

AGREEMENT

Number:

gS1IlNG G

26- 017

Purpose of Subrecipient

Grant Agreement. This Subrecipient

Grant Agreement (" Agreement")

is made by and between COWLITZ COUNTY, a political subdivision of the State of Washington, hereinafter called " County" or" Cowlitz County") and Goodwill of the Olympics and Rainier Region ( hereinafter called " Subrecipient") to set forth the terms and conditions by which the County will provide the Subrecipient with a grant award to be used to pay or reimburse necessary expenditures incurred for services for persons with developmental disabilities. 2.

Term.

Scope of Eligible Expenditures. Grant funds may only be used to pay or reimburse eligible

This Agreement

expenditures

shall take effect on July 1, 2026 and terminate on June 30, 2027.

consistent and as detailed in Attachment A-

Scope of Work for Project ( the

Project").

Grant Award.

The Subrecipient is awarded a total of$ 72, 000.

Budget. The Grant Award shall be expended by the Subrecipient as set forth in Attachment B Budget.

Subrecipient

Responsibilities.

Subrecipient

agrees to administer the Grant Award proceeds

consistent with this Agreement. Subrecipient shall provide the County with certification using the form of Attachment C that Grant Award funds will be used for eligible expenditures. Subrecipient

shall request payment from the County as outlined in Attachment B. 7.

Access to and Maintenance of Records. Subrecipient shall maintain internal controls, accounts

terminated, b.

suspended,

or otherwise

Termination for Convenience. convenience

lost or impaired

in whole or in part.

Either party may terminate this Agreement for

upon giving the other party at least 30 days' advance written notice.

In that

event, the Subrecipient will be entitled to payment only for those expenses and costs reasonably and actually incurred prior to the effective date of the termination. 1 of 53

26- 017 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 22/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

If the default is not cured within 30 days of notice, the

The following provisions apply in the event that this Agreement is

terminated: a.

The Subrecipient shall cease to perform hereunder as of the effective date of termination and shall comply with all reasonable instructions contained in the notice of termination, if

The Subrecipient shall provide the County with an accounting of authorized services provided through the effective date of termination.

any.

11.

Conflict of Interest. Subrecipient designees, agents, members, officers, employees, consultants,

The Subrecipient will secure at its own expense all labor and materials required to

Name: Title:

Deputy

Director

Department:

Health &

Human

Address:

1952

Telephone:

(

WA 98632

414- 5599

Goodwill 1030 15th Ave. Ste 300 Longview, 360)

WA 98632

501- 8340

mailto:HHSContracts HHSContracts( a cowlitzwa. gov 360) 425- 7531 @cowlitzwa.

UEI:

TZ8RNRDSRNN1

FMJGRH7NFLA4

UBI:

08- 300- 3788

278- 004- 647

LoriFH@goodwillwa.

org

2 of 53

26- 017 Admin

President and CEO Services

Fax:

E- mail:

Date

360)

Lori Forte Harnick

9tn Ave

Longview,

Last

For the Subrecipient:

County:

Gena James

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

15.

GRANT

AGREEMENT

Bodily injury, including death. Property damage

Per occurrence

1, 000, 000 1, 000, 000

Per occurrence

2, 000, 000

Aggregate

1, 000, 000

Per occurrence

2, 000, 000

Aggregate

ERRORS AND OMISSIONS or PROFESSIONAL

LIABILITY with an Extended Reporting Period

Endorsement(

two year tail).

WORKERS COMPENSATION:

Statutory amount Waiver of Title 51 Rights

EMPLOYER' S LIABILITY/ Stop Gap: Per occurrence

1, 000, 000

AUTOMOBILE:

coverage on owned, non- owned, rented and hired vehicles

Bodily injury, liability, including death and property damage liability 1, 000, 000

Combined Single Limit

All Subrecipient' s and Subrecipient' s subcontractors' insurance policies and additional named insured endorsements

shall provide primary insurance coverage and be non- contributory.

Any

and/ or self- insured

retentions

exceeding $

10, 000 or any stop- loss provisions,

the

County shall have the right to request and review the Subrecipient' s most recent annual financial reports and audited financial statements as a condition of approval.

Subrecipient hereby agrees to waive subrogation with respect to each insurance policy maintained under this Agreement. When required by an insurer, or if a policy condition does not 3 of 53

26- 017 Last

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Form:

1615. 2

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SUBRECIPIENT

GRANT

AGREEMENT

insurance policies by way of endorsement for the full available limits of insurance maintained by the Subrecipient

and subcontractor,

and all coverage shall be primary and non- contributory.

under this Agreement shall be paid by the

Subrecipient.

Compensation and/ or payments due to the Subrecipient under this Agreement are expressly conditioned

upon the Subrecipient' s strict compliance with all insurance requirements.

to the Subrecipient shall be suspended

in the event of noncompliance.

Payment

Upon receipt of evidence

of Subrecipient' s compliance, payments not otherwise subject to withholding or set- off will be released to the Subrecipient.

This Agreement

shall be void ab initio if the proof of coverage

is not

4 of 53

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1615. 2

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SUBRECIPIENT

GRANT

18. Debarment

AGREEMENT

Certification.

The Subrecipient,

by signature to this Agreement,

certifies that the

in all

The Subrecipient and its officials, officers, employees, agents, and

If the Subrecipient is a faith- based or religious organization, it retains its

Permissible

Use Warranty.

The Subrecipient

recognizes

and agrees that the Grant Award

Disabilities

Administration.

The Subrecipient

warrants that its planned and actual

permissible

uses

consistent with Attachment A and the pass- through funding requirements discussed immediately above.

This section shall survive termination of this Agreement.

No term or condition of this Agreement shall be deemed waived unless such waiver is

5 of 53

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Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT

AGREEMENT

Each counterpart

may be executed and delivered by facsimile to the other party. 33. Attachments. The following attachments are incorporated into this Agreement by reference. a. Attachment

A— Scope

b. Attachment

B—

c. Attachment

C— Certification

d. Attachment

D—

Retirement

e. Attachment

E—

f. Attachment

F—

Data Security Requirements DSHS County Program Agreement DDCS County Services

IN WITNESS

WHEREOF,

of Work

for Project

Budget Form Certification

the parties have executed this Agreement

this

day of

BOARD OF COUNTY COMMISSIONERS

SUBRECIPIENT:

OF COWLITZ COUNTY, WASHINGTON

Signature

Richard

Steven L. Ferrell,

Commissioner

Steve

Commissioner

Rader,

ATTEST:

CONTRACT FORM

HAS BEEN APPROVED AS TO

BY COWLITZ

PROSECUTING

COUNTY

ATTORNEY

Date

Clerk of the Board Date

6 of 53

26- 017 Admin

Chairman

name:

Title:

Last

R. Dahl,

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

SCOPE

OF WORK

FOR

PROJECT

The Subrecipient shall ensure services, and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: 1.

a) Infrastructure

projects: Projects in support of Clients ( services not easily

or replacement d. "

regulation.

Confidential Information" or" Data" means information that is exempt from disclosure to

the public or other unauthorized persons under Chapter 42. 56 RCW or other federal or state laws. Confidential

information

includes, but is not limited to, Personal Information.

g. "

Debarment" means an action taken by a federal official to exclude a person or business entity from participating in transactions involving certain federal funds.

h. "

DSHS" means the Department of Social and Health Services of the state of Washington.

i. "

j. "

General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. 7 of 53

26- 017 Last

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Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

High Acuity Client" means a DDCS Client who requires significant and intensive support in the community, often due to complex needs, as determined through the DDCS

assessment.

Medicaid Home and Community Based Services ( HCBS)" means services that occur in

I. "

Person Centered Service Plan or PCSP" means a document that authorizes and

identifies the DDCS paid services to meet a Client' s assessed needs. Formerly referred to as the Individual Support Plan.

RCW"

means

the Revised

Code

of Washington.

All references

in this Agreement

and

any Program Agreement to RCW chapters or sections shall include any successor, amended, or replacement statue. Pertinent RCW chapters can be accessed at

http:// apps. leg. wa. gov/ rcw/. Secretary" means the individual appointed by the Governor, State of Washington, as the

head of the DSHS, of his/ her/ their designee.

Information

is not available to unauthorized

personnel.

w. "

provide services. Trusted Systems" include

following methods of physical delivery: ( 1) handdelivery by a person authorized to have access to the Confidential Information with written

acknowledgment

only the

of receipt; ( 2) United

States Postal

Service (" USPS") first class

the Washington State Governmental

Trusted System for communications

Network ( SGN) is a

within that Network.

USC" means the United States Code. All references in this Agreement and any Program Agreement to USC chapters and sections shall include any successor, amended, or

" WAC" means the Washington Administrative Code. All references in this Agreement and

replacement

statute.

any Program Agreement to WAC chapters or sections shall include any successor, amended, or replacement of regulation.

Pertinent WAC chapters or sections can be

accessed at http://apps.leg.wa.gov/ http:// apps. leg. wa. gov/ wac/. wac/

8 of 53

26- 017 Last

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1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Purpose. a.

Direct Client Services

i. "

authorized in addition to or instead of employment support ( Individual

Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. ii. "

iii. "

Individualized

iv.

Technical Assistance"

or" ITA": services are a part of an Client' s

Coordination. Working collaboratively, the parties shall administer DD services within the county as set forth below: The DDCS region shall:

iii.

iv.

Authorize new service within five ( 5) working days and will extend existing

ii.

referrals when authorization is not issued; service authorization before expiration date; v.

Inform Clients of service changes through Planned Action Notice( s);

vi.

Work with the DDCS Region and the Subrecipient when Clients are referred for services, authorized services, and/ or for support modifications;

Work with DDCS Region and the Subrecipient to document planned services in the Client' s Person Centered Service Plan;

9 of 53

26- 017 Last

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

xi.

xii. xiii.

ATTACHMENT

The Subrecipient shall: xiv. xv.

Facilitate the County' s attendance at employment plan meetings as requested. Work with the DDCS Region and the County when Clients are referred for services;

xvi.

Work with DDCS Region and the County to document planned services in the

xvii.

Assist with informing the DDCS Region and County of any potential service level changes not documented in the individual' s DID Assessment prior to any

Client' s Person Centered Service Plan;

changes; and xviii.

2011 i.

and forward.

ii.

Cl services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will

not be reimbursed.

DDCS PCSP. Service changes will not occur until the Client has received proper notification from DDCS. d.

f. g.

at minimum wage or higher within six ( 6) months, the

26- 017 Last

Date

Admin

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

employment. The additional strategies will be documented

for each Client and

kept in the Client' s file( s). h.

j. k.

If after twelve ( 12) months the Client remains unemployed,

an additional review will be

The setting facilitates individual choice regarding services and supports, and who provides them.

Partnership Project i. A Job Foundation document will be completed per guidelines for eligible students. Eligible students are DDCS clients who were born between: 1.

For fiscal year 2026: 9/ 1/ 05 through 8/ 31/ 06. For fiscal year 2027: 9/ 1/ 06 through 8/ 31/ 07. These students currently attending school and have completed an application to 2.

ii.

participate

in this Value Based Payment ( VBP) project. The VBP project

application will include the following minimum criteria identified in the sample application found at:

Project the Subrecipient

must have a current contract

If action to correct substandard performance is not taken by the Subrecipient within 30 days after being notified by the County, then the County may terminate the Agreement as described herein.

11 of 53

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1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

Additional Requirements:

ATTACHMENT

The Subrecipient will maintain and make available, if requested,

documentation demonstrating accomplishments of the contract. Such documentation may include, but is not limited to, the following: a. Services provided b.

Number of hours of service

Data Collection

Completed evaluation tools

Backup reports/ data for invoicing.

Agreement. Credentials and Minimum Requirements:

Sufficient Policies and Procedures for establishment and maintenance of adequate

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees, subcontractors, and/ or volunteers who may have unsupervised

access to vulnerable DSHS Clients, in accordance with RCW 43. 43. 830-

Check Central Unit( BCCU) must be utilized to obtain background

clearance.

ii.

12 of 53

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agency.

Subrecipient is specifically authorized to have data storage on portable devices or media in accordance with Attachment E. Data Security Requirements.

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Chapter WAC 388- 850, chapter 388- 828 WAC, WAC 388- 845- 0001, 0030, 0210, 0215, 0220, 0600- 0610, 1030- 1040, 2100, 2110;

Criteria for Evaluation;

DDA Guiding Values; County Guide to Achieve DDA' s Guiding Values; DDA Guidelines for Community Assessments with Employment and Vocational

Programs;

and

Disability Rights Washington ( formerly Washington Protection and Advocacy System) Access Agreement.

The Subrecipient shall ensure that all staff, working with clients receiving Community Access or Individual Employment Services, complete the following DDA online courses upon hire

http://gowise.org/training/wa-state-dda-onlinehttp:// gowise. org/ training/ wa- state- dda- online- courses/ DDA- 5. 06: WA State Client Rights; a. courses/ b.

minimum wage or better; and the average number of hours worked. The Subrecipient' s service

Follow all requirements as outlined in Attachment E.

ii.

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. d.

When transporting client records containing Confidential Information outside a Secure Area, one or more of the following as appropriate:

Date

Admin

Use a Trusted Network; or

Encrypting the Confidential Information, including: 13 of 53

26- 017 Last

Information.

Revised:

Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

and/ or email

attachments.

iii.

14 of 53

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Form:

1615. 2

01/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

BUDGET

Budget. The County shall reimburse the Subrecipient in an amount not to exceed $ 72, 000 for expenses related to Consumer Services and staff training/ education. Staff training/ education reimbursement may not exceed $ 2, 000 for the contract period, requires approval from the County Coordinator, and is based on availability of funds. Unspent grant proceeds will be reallocated at the discretion of the County.

The Subrecipient shall budget funds awarded in such a manner to ensure availability of services throughout the entire term of this Agreement subject to available funds. 2.

Payment. Subject to Section 1, the County shall reimburse the Subrecipient for costs and expenses necessary to perform activities described

in the Scope of Work for Project and as

indicated in the CCHHS Contractor Toolkit located online at www. co. cowlitz. wa. us/ cchhscontractors, and as updated. The Subrecipient shall ensure that

Advance Payment. The County shall not make any payments in advance or in anticipation of the delivery of services to be provided pursuant to this Agreement.

26- 017 Last

Date

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Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

Subrecipient

ATTACHMENT

is bound to follow all terms and conditions of the Washington

State DSHS

Program Specific Conditions: a.

Consumer Services

The Subrecipient may bill at the rate authorized on the County Service Authorization for the number of unit( s) per consumer per month for: i. Community Inclusion

ii.

Individual Supported

iii.

Individualized Technical Assistance

Employment

Reimbursement for Client Services: A claim for each individual is made by indicating the number of service units delivered to each individual listed and the fee per unit. Units are defined

as:

Individual

Date

Admin

Billable

Activities

document

defines

the individual

delivers

a minimum

of 80% of the authorized hours.

26- 017 Last

Phases &

Employment

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

payment.

The Subrecipient

ii.

Subrecipients with transition students, as outlined in Attachment A, Section 31,

will receive $ 3, 000 per student for each completed

Job

July

1 sc—

October

January April

range

for job

1st— September

1st-

sc—

June

Outcome

Payment

Amount

1, 500 31 st

December March

placement

30'"

1, 000 500

30t"

250

Please note a current County Service Authorization for Individual Employment must be in place prior to outcome payment. q.

Training i.

The

Subrecipient 1.

shall:

Seek prior approval from the County Coordinator for training/ education reimbursement.

Make every effort to minimize the cost of individuals training by seeking out scholarships and stipends, shared transportation and lodging when applicable to help reduce costs. Any additional

3. 4.

costs will be the sole

responsibility of the Subrecipient. Inform individuals of allowable travel and training expenses. Submit copies of itemized receipts, MapQuest directions, travel

itineraries, conference registration including agenda pertaining to all requested reimbursements. Expenses without backup documentation will not be reimbursed.

Timeliness of and Modification

to Billings: All initial invoices with signed

17 of 53

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1615. 2

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

CERTIFICATION

I, Lori Forte Harnick, am the President and CEO of Goodwill of the Olympics and Rainier Region and I

certify that: 1.

I have authority and approval from the governing body on behalf of Goodwill of the Olympics and Rainier Region to accept proceeds from the County per Agreement for services for persons with developmental disabilities by and between the County and Goodwill of the Olympic and Rainier Region.

disabilities.

Were incurred during the period that begins on July 1, 2026 through June 30, 2027 3.

1 understand Goodwill of the Olympic and Rainier Region receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/ or sales receipts and such documentation shall be produced to the County upon request and may be subject to audit by the State Auditor.

Printed

Signature

Name

Title

Date

18 of 53

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

RETIREMENT

CERTIFICATION

COUNTY RETAINS THIS FORM

Individual contractors and service providers must complete and sign WA Department of Retirement Systems: Independent Contractor Verification and State

Retirement Status Reporting Form [ WAC 415- 02- 110; DRS Email 13- 011; DRS Email 09- 001] SECTION 1:

INDIVIDUAL CONTRACTOR

COMPLETES

THIS SECTION AND SIGNS:

Did you

retire

from

Did you

retire

before age 65 using the 2008 early retirement

Will

you

be receiving direct compensation

Will

you

be receiving indirect

one

of the State of Washington

Retirement Systems? factors ( ERF)?

for your services? for your services?

compensation

YES

CONTRACTOR ( Full, individual name of contractor): Signature: SECTION

Social 2:

COUNTY

COMPLETES

Use Member Reporting 1.

Contractor

has

Security No.:

THIS

SECTION

Date:

AND

RETAINS

FOR AUDIT

Verification ( MRV) to verify the past retirement

been

a member

of a Washington

State

Retirement

PURPOSES:

membership] System

YES

If YES, what system and plan? Teachers'

Retirement

System (

TRS)

Planl

Plan

School

Employees'

Retirement

System (

SERS)

Plan

Public

Employees'

Retirement

System (

PERS)

Plan

Public

Safety Employees'

Plan

Law

Enforcement

Washington

Retirement

Officers' &

State Patrol

Fire

System ( PSERS)

Fighters'

Retirement

System (

System ( WSPRS)

Plan

LEOFF)

Plan

Judicial Retirement System ( JRS) 5.

Is the contractor a retiree of a Washington

Did the contractor retire before

age

State Retirement

65 using the 2008

System?

ERF?

Yes

R 5/ 09), and the Internal Revenue Service rules governing independent contractor status.

COUNTY OFFICIAL/ DEPARTMENT

Signature:

REPRESENTATIVE:

Date:

COUNTY RETAINS THIS FORM 19 of 53

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1615. 2

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SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

Data Security 1.

Definitions.

Requirements

The words and phrases listed below, as used in this Attachment

E, shall each have

the following definitions: AES" means the Advanced Encryption Standard, a specification

of Federal Information

7-upd1.pdf

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential

Information,

and who has or have been authorized to do so.

and on a network outside the control of the Subrecipient.

Physical storage of data in the

PIN" means a personal

identification

number, a series of numbers which act as a

password for a device. Since PINs are typically only four to six characters, PINs are usually used in conjunction i. "

with another factor of authentication,

such as a fingerprint.

Device

is a subset

of Portable

Device.

lock, or comparable

mechanism.

Secure Areas may

26- 017 Last

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Admin

Revised:

Form:

1615. 2

1/ 09/ 2025

SUBRECIPIENT

GRANT AGREEMENT

ATTACHMENT

access, the Data must be secured in such a way as to prevent access by non- authorized

with a password,

passphrase

or other mechanism,

authenticates

a user to an

information system. 2.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington Technology Services Agency

Authorization, Authentication, and Access. In order to ensure that access to the Data is

limited to authorized staff, the Subrecipient a.

must:

Have documented policies and procedures governing access to systems with the shared Data.

Restrict access through administrative, physical, and technical controls to authorized staff.

it must always be possible to determine

which employee performed a given action on a system housing the Data based solely on the Iogon ID used to perform the action. d. e.

Ensure that only authorized users are capable of accessing the Data. Ensure that an employee' s access to the Data is removed immediately: i.

Upon suspected compromise

ii.

When their employment, or the contract under which the Data is made available to them,

iii.

of the user credentials.

is terminated.

When they no longer need access to the Data to fulfill the requirements of the contract.

characters ii.

such as an asterisk, ampersand,

or exclamation

point.

That a password does not contain a user' s name, Iogon ID, or any form of their full name. 21 of 53

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the Internet or otherwise travel outside the Subrecipient' s network), mitigate risk and

Encrypting all remote access traffic from the external workstation to Trusted

iv.

Network or to a component within the Trusted Network. The traffic must be

encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network.

authentication mechanism, such as a biometric ( fingerprint, face recognition, iris scan) or token ( software, hardware, smart card, etc.) in that case: i.

The PIN or password

must be at least 5 letters or numbers when used in

conjunction with at least one other authentication factor. Must not be comprised of all the same letter or number( 11111,

ii.

22222, aaaaa,

would not be acceptable). Must not contain a " run" of three or more consecutive numbers ( 12398, 98743

iii.

would not be acceptable).

If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes

used on the device must:

Be a minimum of six alphanumeric characters.

ii.

Contain

at least

three

unique

character

classes (

upper

case,

lower

case,

letter,

number).

iii.

Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable.

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Subrecipient agrees to store Data on one or more of the following media and protect the Data as described:

Hard

disk

drives.

For Data

stored

will be restricted to Authorized

on local

workstation

User( s) by requiring

hard

disks,

access

to the Data

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. For Data stored on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized

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

Date

Admin

Destruction

of the Data, as outlined below in 22 of 53

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GRANT AGREEMENT

ATTACHMENT

Section 8 Data Disposition,

may be deferred until the disks are retired, replaced, or

otherwise taken out of the Secure Area. c.

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 Secure 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

mechanism.

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 Secure

Area.

Access

to Data

on these

discs

will

mechanisms which provide

mechanism.

Remote Access. Access to and use of the Data over the State Governmental

Network

otherwise leaves the employ of the Subrecipient, and whenever an Authorized User' s duties change such that the Authorized

User no longer requires access to perform work

for this Contract. g.

Encrypt

Control access to devices with a Unique User ID and Hardened

the

Data.

Password or stronger authentication method such as a physical token or biometrics.

Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available.

Apply administrative and physical security controls to Portable Devices

Maximum

period of inactivity is 20 minutes.

and Portable Media by: a.

Keeping them in a Secure Area when not in use,

Using check- in/ check- out procedures

when they are shared, and

Taking frequent inventories. When being transported outside of a Secure Area, Portable Devices and c.

ii.

Portable Media with DSHS Confidential

Date

Admin

must be under the physical 23 of 53

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ATTACHMENT

control of Subrecipient staff with authorization Data h.

to access the Data, even if the

is encrypted

Information still exists upon it, such

media will be destroyed at that time in accordance with the disposition requirements ii.

below in Section 8 Data Disposition.

Information still exists upon it, the data will be destroyed

at that time in accordance with the disposition requirements

below in Section 8

Data Disposition. i.

in which the Data is

stored. For this reason: i.

DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: 1. Subrecipient has written procedures in place governing use of the Cloud storage

and Subrecipient

attest

to the contact

listed

in the contract

and

keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. 2.

The Data will be Encrypted while within the Subrecipient network.

The Data will remain Encrypted during transmission to the Cloud. The Data will remain Encrypted at all times while residing within the

Cloud storage solution. 5.

The

Data

will

not be decrypted

the control of an Authorized

until

network.

downloaded

onto

a computer

within

User and within either the DSHS or

Subrecipient' s network. Data will not be stored on an Enterprise Cloud storage solution unless either:

ii.

iii.

The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or,

The Cloud storage solution used is HIPAA compliant.

System Protection.

To prevent compromise

of systems which contain DSHS Data or through

been

applied

within

the required

timeframes.

Systems containing DSHS Data shall have an Anti- Malware application, if available, installed.

Anti- Malware software shall be kept up to date. The product, its anti- virus engine, and

any malware database the system uses, will be no more than one update behind current.

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Data Segregation.

will contain no non- DSHS Data. ii.

DSHS Data will be stored in a logical container on electronic media, such as a

partition or folder dedicated to DSHS Data. iii.

DSHS Data will be stored in a database which will contain no non- DSHS data. And/ or,

iv.

DSHS Data will be stored within a database and will be distinguishable

from non-

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. Data Disposition. When the contracted work has been completed or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server

stored

on:

hard

disks,

or workstation

Removable drives,

media ( e. g.

portable

hard

floppies,

disks)

USB

excluding

flash optical

Will be destroyed by: Using a " wipe" utility which will overwrite the Data at least three ( 3) times using either random or single character data, or

discs

Degaussing sufficiently to ensure that the Data cannot be reconstructed,

Physical y destroying Paper

documents

with

sensitive

Confidential Information Paper

documents

the disk

Recycling through a contracted firm, provided the contract

containing Confidential

with

the recycler

assures

that the

confidentiality of Data will be protected. On- site shredding, pulping, or incineration

Information requiring special handling ( e. g. protected Optical

health information

discs ( e. g. CDs

DVDs)

Incineration, shredding, or completely defacing the readable surface with a coarse abrasive

Magnetic

tape

Degaussing, incinerating or crosscut shredding

Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be: a.

10. Data shared with Subrecipient.

If DSHS Data provided

under this Contract is to be shared with a

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the subcontractor must be submitted to the County Program Manager specified for this contract for review and approval.

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GRANT

AGREEMENT

ATTACHMENT

DSHS Agreement Number

COUNTY

DSHS x

2663. 69480

PROGRAM

sonar

AGREEMENT

DDICS County Services This Program AgreerTlUnt

is by and between

Social and Health Services(

DSHS)

below. and is issued

identified

Administration oT Dlvision

Department of

the State of Washington

and The County

Agreerrton

conjunction with a County and DSHS Agreement On General Terms and Conditions, CS11SADNI

17SJIS

DSHS DIVISIOl

tSTRATION

INDEX

PS* sS CONTRACT

NUMDER

Number CODE

1769C5- 63

1136

Division Df Developmental

Disabilities

Developmental

County ggreament

by reference.

which is incorporated

Nurriber

Disabififies

Admin DSHS CQNTAC1

DSHS

NAME ANO TITLE

C04TAGT

ADDRESS

PO BOX 453i5

Wendi

lrchel

Regional

Business

Manager

QI m - a, WA 98504. 5315 DSHS CONTACT TELEPHONE 7254264

360

08HS

CONTACT FAX

360

586-

V$ HS CONTACT

COUNTY

NAME

COUNTY ADDRESS

Cowlitz

County County DDA County Services

1952

Cowlitz COUNTY

FEDERAL

EMPLOYER

E- NWL

wendi. winchel

6602

dshs. wa.

9th Avenue

I nnfiview.

98632

COUNTY CONTACT NAME

I DENT I= I CAI ION

NuMatR

SUe S'el'Yinn COUNTY

CONTACT

rELEPHONE

360

414- 5599

I5THE

COUNTY A SUBRECIPIENT

CONTACT

COUNTY

FAX

FOR

PURPOSE$

CONTACT

saxtons

f3601501- 1207

ASSISTANCE

TH1S PROGRAM

F- MAIL

cowlitlwa- av

LISPING NUMBERS

AGREEMENT'?

No PROGRAM

AGREEMENT START

DATE

07/ 01 i2026

AGREEMENT

PROGRAM

ENO DATE

MAx1V.UN1 PROGRAM! AGREEMENI

ANIGUN-

2, 745. 890. 40

0613012D27

EXHIBITS. The following Exhibits are attached: Exhibit A— Data Security Requirements; Exhibit B— Budget and Spending

Plan

By their signatures below„ the parties agree to the terms arld conditions of this County Program Agreement ana all

PRINTED

SIG" 1ATURE( S)

DATE( S) SIGNED

NAVE( S) AND TITLELS;

BOARD OF COUNTY GOMMISSiONFRS OFCOWLITZCOUN1Y, WASHINGIaN Richard

PRINTED

DSHS SIGNATURE

Dahl, Chairman

NAME

AND TITL

Jessica Barbour, Contract

Specialist

SIGNED

08J1 912026

O WLITZ

caut4T ON o 45+-15 Central CUntmct Services 1769CS County Agreement( 12- 26- 2

26- 017 Last

Form:

rx 04 01

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Special Terms and Conditions 1.

Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "

Acuity Level" means the level of a Client' s abilities and needs as determined

through the DDCS

assessment-

lb- " ALTSA Web Access(

AWA)" means a web- based portal to the Developmental

Disabilities

Community Services CARE system designed to support county services for DDCS clients. c_ "

Additional Consumer Services" refers to indirect Client servicetypes as follows1) "

Community Information

and Education":

Activitiesto inform and/ or educate the general public

and

2) " Training

3) "

Other Activities" reserved ty pes:

for special

a) Infrastructure

Projects in support of Clients ( services not easily tracked

projects:

projects and demonstrations

categorized

into the following

back to a

sp ecifi c work!ng age Client) o r th at d 1 rectly benefit a Clients) but the Client is not of work! ng age. Examples include planning services like genericjob development e.g." Project Search"_

b) Start- up projects:

Projects that support an agency or directly benefit the agency_ Examples

include equipment purchases and agency administrative support. c) Partnership

Project

Collaborative

partnerships

with school districts,

employment

providers,

disabilities

means a master classification

require to

of balance

f. " Competitive Integrated Employment"

g_ " Consumer Support" refers to direct Client service types as follows1) "

Community Inclusion" or" Cl": means individualized services provided in integrated community settings with other individuals without disabilities_ The activities are based on Client interests Page 2

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GRANT

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Special Terms and Conditions

support( Individual Employment or Group Supported Employment) for working age individuals who have received nine months of employment

support.

2) " Child Development Services" or" CDS": Birth to three services are designed to meet the

instruction, speechlanguage pathology, vision, and transportation_ Services are provided in natural environments to the maximum extent appropriate. 3) "

the general workforce.

These services

may include intake, discovery,

assessment,

job

preparation, job marketing, job supports, record keeping and support to maintain a job4) " Individualized

individual

Technical Assistance" or" ITA": services are a part of a Client' s pathway to employmentor community inclusion. This service provides assessment and

employment

enclaves, mobile crews, and other business models employing disabilities in integrated employment in community settings_ h. "

County" is the political subdivision

of the state of Washington

Examples include

small groups of workers with

and the county or counties entering

into this program AgreementI- "

DDCS Case Resource Manager( CRM)" means a case manager for DDCS Clients.

j_ " County Service Authorization( CSA)" means an authorization for county services. k. "

Developmental

disabilities(

DD)" means a disability

attributable

to intellectual

disability,

cerebral

Developmental

Disabilities Community

Services" DDCS" means a division within the Department of Page 3

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Special Terms and Conditions Social and Health Services. DDCS Regional office( DDCS Region)" means the regional DDCS office that supports DDCS

m_ "

clients.

Division of Vocational Rehabilitation(

n_ "

DVR)" means a division within the Department of Social and

Health Services o.

Employment

Outcome Payment"

means a paymentto

providers for transition

students barn

often

p_ " General Terms and Conditions"

which govern the contractual

meansthe contractual provisions contained within that agreement, relationship between DSHS and the county.

q_ " High Acuity Client" means a DDCS

Client who requires significant and intensive support community, often dueto complex needs, as determined through the DDCS assessment_

in the

Medicaid Home and Community Based Services( HOBS)" means services thatoccur in a Client' s home or community ratherthan institutions or other isolated settings_ These programs serve a

r. "

variety of targeted populations groups, such as people with intellectual or developmental disabilities,

physical disabilities,

Job Foundation

s_ "

and/ or mental illnesses

Report" is a document derived from employment

readiness

activities

performed

Preadmission Screening and Resident Review( PASRR)" means individuals with intellectual disabilities or related conditions( ID/ RC) who have been referred for nursing facility( NF) care.

t. "

Person

u. "

Centered Service Plan or PCSP" means a document that authorizes and identifes the

DDCS paid services to meet a Client' s assessed needs.

Formerly referred to as the Individual

Support Plan.

Ou ality Assurance" means an adherence to all Program Agreement requirements, including DDCS

v. "

Quality Improvement" means a focus on activitiesto improve performance above minimum standards and reasonably expected levels of performance, quality and practice_

Service Provider" is a qualified Client service vendor who is contracted to provide Employment and

Day Program y. " 2.

services.

Subcontractor" is the service provider contracted by the County to provide services.

Purpose: This Program Agreement is entered into between the Developmental Disabilities Community Services and the County in accordance with chapter 71 A_14 RCW_ Its purpose is to advance the state

legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental

disabilities_ Page 4

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GRANT AGREEMENT

ATTACHMENT

Special Terms and Conditions 3.

Credentials and Minimum Requirements:

Administration

of the developmental

disabilities

County program cannot be subcontracted_

area ( e_g_ Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/ or a related Human or Social service may be considered_ c.

Sufficient Policies and Procedures for establishment and maintenance of adequate internal control

Background/ Criminal History Check: A background/ criminal history clearance is required every three years for all employees(

including

DID program County staff), subcontractors,

and/ or

Qualified Advisory Board Members:

A Developmental

Disabilities

advisory board shall include

members knowledgeable about developmental disabilities_ No board member shall have a contract

with the County to provide Training,

Community

Information

Activities,

and Consumer

Support as

defined in this Program Agreement, and shall not be a board member, officer, or employee of an

agency subcontracting with the County to provide such services. h.

Qualif ed Service Providers: The County assures that all service providers meet qualifications as outlined in the DDCS Policy 6. 13, Program Qualifications for Employment and Day Program Providers.

Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to a ssign to DDCS its Medica id billing rights for Page 5

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GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

services to DDCS Clients eligible under Title XIX programs

in this Program Agreement.

Written

documentation shall be available to DSHS on request.

Counties who provide Child Development

Services( birth to three early intervention

services),

must

provide those services under the regulations implementing the Individuals with Disabilities Education Act( IDEA), Part C, and Washington Federally Approved Plan_ I_

State' s Early Support for Infant and Toddler

Ord er of Precedence: In the event of any inconsi stency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency

shall be resolved by giving

precedence, in the following order, to: 1)

County Program

Agreement;

and

2) Attached Exhibits. 5.

Disclosures must be provided at contract renewal and within thirty- five( 35) days whenever there is a change in the staff holding these management positions[ 42 CFR 455. 104 ( c)( 1)]_ 6.

the county as set forth below: a_

The DDCS region shall:

Review subcontractors and shall immediately notify the County of any concerns with the Page S

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Special Terms and Conditions

subcontractors

identified

bythe County;

5) Authorize

new service within 5 working days and will extend existing service authorization

before expiration date; 6)

Inform Clients of service changes through Planned Action Notice( s);

7) Work with the County to document planned services in the Client' s Person Centered Plan including notification of assessment dates;

Service

B) Work with the County when terminating services; 9) Work with DDCS Head Quarters

and the County on Spending

Plan adjustments;

and

10) Work with the County in participating in evaluation of direct service providers_ b_ The County shall: 1)

Work with the DDCS Region when Clients are referred for services,

authorized

services,

andlor

for support modifications;

2) Work with the DDCS Region to document planned

services

in the Client' s Person Centered

Service Plan;

3) Assist with informing the DDCS Region of any potential service level changes not documented in the Client' s DID Assessment prior to any changes; 4) Work with the DDCS Region regarding

service termination;

5) Work with the DDCS Head Quarters on Spending

Plan adjustments;

6) Inform the DDCS Region of new providers to be included on the ALTSA Web Access( AWA) sy stem;

7) Notify the DDCS Region of any intent to terminate

a subcontractor

who is serving a DDCS

referral;

B) Provide a copy of each subcontractor' s contract upon written request from DDCS; and 9) Notify and work with the DDCS Region al Employment direct service providers. c.

Specialist when performing

evaluations

Compliance with Budget and Accounting Reporting System Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. Page 7

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ATTACHMENT

Special Terms and Conditions

The County shall comply with the following 1)

referenced

documents:

DDCS Policy 411, County Services for Working Age Adults;

DDA Guidelines

7) Disability

for Community

Rights Washington (

Assessments

formerly

within Employment

Washington

Protection

and Vocational

and Advocacy

Programs:

System)

and

Access

Agreement.

e_ The County shall develop and submit a comprehensive plan forthe County DID Services as required by WAC 388- 850- 020_ f.

Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The

Solicitation

for Qualified

of the County and the DDCS Region_

Employment

and Day Program

Service Providers:

Requests for

Applications( RFAs), Requests for Information ( RFI' s) and/ or Requests for Proposals( RFPs),

Requests for Qualifications( continuous

RFQ' s) for direct services,

excluding

Child Development,

will be open

enrollment.

Qualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDCS.

Technical Assistance: DDCS contracts with Technical Counties with prior written approval_

Assistance

providers that may be utilized by

Inclusion services_

The County shall provide or contract with qualified Employment and Day Program Service Providersfor 1)

consumer support services that include thefollowing

Monthly Community

program outcomes-

Inclusion ( CI) service support hours will be based on the Client' s CI service

level per WAC 388- 828- 9310 for all Clients who began receiving CI services July 1, 2011 and forward_

Page$ DSHS

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Special Terms and Conditions

b) CI services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/ or specialized activities will not be reim bursed.

2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable a Client to meet or exceed living expenses_ Clients

should be supported to average twenty( 20) hours of community work per week or eighty- six 86) hours per month; however,

each person' s preferred

hours of employment

should

be taken

into consideration. The amount of service a Client receives will be based on his/ her

demonstrated

need, acuity level and work history per WAC 388- 828.

3) The Client' s DDCS PCSP is the driver for service_ The AWA County Service Authorization CSA) and updated Planned Rates information will not exceed the Client' s DDCS PCSP.

an additional review will be

responsible for authorizing CI services_ Page 9 DSHS

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Special Terms and Conditions

and any potential conflict of interest is addressed.

10) Individual Employment staff hours must be attributed to the " Individual Employment and Billable Activity Phase( s)"

a) The collectivegroup' s individual hours should bethe minimum staff hours delivered to su pport th e g rou p-

f) Running a GSE service is a part of the business operation and not billable to Clients contract procurement,

contract maintenance, or administration

functions associated with

GSE)-

Phases and

Based settings

a) The setting is integrated in the greater community and supports Client' s to havefull access to the greater community; b) Ensures the Client receives services in the community

to the same degree of access as Page 10

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Special Terms and Conditions

individuals

not receiving

Medicaid

HCBS;

c) The setting provides opportunities to seek employment and work in competitive integrated settings;

and

d) The setting facilitates individual choice regarding services and supports, and who provides them_

Quality Assurance

and Service Evaluation:

The County shall develop and have available

m_ Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one visit to each subcontractor

every two

Copies of such documentation

will be provided tothe DDCS upon request.

n_ The County shall workwith local developmental disability advisory groups to plan for and coordinate services_

The County shall participate in regularly scheduled meetings between County DID staff and DDCS staff to remain updated and current including ACHS and Regional Meetings.

AWA Data System: In compliance

with the AWA Training Manual,

the County shall use the AWA

data system for all:

Billing requests;

2) Service provider address and phone number maintenance; 3) Evaluation dates; 4) Employment

outcome information;

and

5) Monthly provide all data described in the Billing Instructions Instructions, which is hereby incorporated by reference. q.

and in the Employment Outcomes

Review and respond the AWA" Work List" items within 5 working days including pending Authorization_

Referrals and

Review the AWA" Ticklers" Planned Rate tab and update the planned rate within 5 working d ays Page 11

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GRANT

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ATTACHMENT

Special Terms and Conditions after the Planned Rate start date. t_

Partnership

Project-

1) A Job Foundation document will be completed per guidelines for eligible students.

Eligible

students are DDCS clients who were born between:

a) For fiscal year 2026 9/ 1105 through 8/ 31/ 06 b) For fiscal year 2027 9/ 1106 through 8/ 31/ 07 These students currently

attending

school and have completed

an application

to participate

this Value Based Payment( VPB) project_ The VBP project application will include the following minimum

criteria identified in the sample application found at:

https:// www. d sh s. w a_ gov/ sites/ default/ fi I es/ D DA/ dd a/ d ocu m ents/ J ob`/` 20 Foundation% tlon

2 0APpl i c a

040720% 20% 28002% 29. docx

documents) meet quality standards_ u_

Outcome Payment. Providers, with transition

students born between:

a) For fiscal year 2026 9/ 1103 through 8/ 31104 b) For fiscal year 2027 9/ 1/ 04 through 8/ 31/ 05 2) High acuity transition students who are authorized for Individual employment, the provider may

receive one outcome payment if transition student obtains a competitive integrated job approved by the County within timeframes

described

in the chart in the Billing Instructions_

If the County

is also the service provider DDCS will provide the job approval_ If the job is at a minimum of ten hours of work per week a n additional

amount will be include in the payment-

a minimum

of 80% of the authorized hours. Page 12

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ATTACHMENT

Special Terms and Conditions

5) A new Community

Authorization( CSA).

Fees.

a) County( s) name; b) Time period for which the schedule! s applicable;

and

c) Each contracted direct service( IE, GSE, CI, ITA, CDS) and its associated rate-

Fee Limitations- The Billing Instructions found on the County Best Practices site provides lim itations on the Hourly Rate for each direct service. Hourly rates must be divisi ble by four.

b_ Budget and Spending 1)

Plan, attached

as Exhibit B-

Budget amount listed in Exhibit B- The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement

included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state- only employment and day services to waiver employment and day services-

2) Spending Plan- DDCS will provide the initial spending plan / Program Agreement Budget/ Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The

only be modified by mutual agreement of the parties in writing and shall not require a program agreement

amendment_

a) Funds Designated for Additional Consumer Services- If a County provides Community Information and Education services under additional consumer services, then activities must

include outreach

efforts to federally recognized

local tribes-

b) Funds Designated for Adult Day Care Consumers.

Funds designated for Adult Day Care

Consumers are availableto Clientswho were served between December 1996 and

December 2003 in Adult Day Health agencies and were subsequently determined

ineligible Page 13

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GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions for Level II or III services(

If a Client no longer needs and wants services, the fund s

by the local Area Agency on Aging. Adult Day Care

service is not a waiver approved service_ c_

Program Agreement Amendments- A County can request an amendment at any time_ An amendment for additional Clients) may be supported when clients exceed the number used to

Exemptions- The DDCS Assistant program agreement requirement-

Secretary

may approve in writing an exemption

to a specific

Billing and Payment: a.

Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDCS as cost incurred by the program for-

1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration

include personnel

of the Developmental

and overhead

Disabilities Program.

Allowable costs

costs directly related to the administration

and coordination

a) Training: i.

Board Training- Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program- related skills of board and advisory committee

members.

and community Page 14

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Special Terms and Conditions

consultation,

capacity building

and organization

activities.

c) Other Activities_ i.

ii_

Start- up projects: Projects that support an agency or directly benefit the agency_ Examples include equipment purchases and agency administrative support-

school year they turn twenty-one( 21). Supports provided should complement and not replace what the student( s) receive through the Individualized Education Program( IEP)_ 3) Consumer Support_

Level II and III services are licensed

b) Community Inclusion Services are individualized and provided in integrated community settings with other individuals without disabilities_ The activities are based on Client

interests and provide opportunities typically experienced by the general public of sim ilar age in their local community,

accessible

by public transit or a reasonable

commute from their

to the maximum

extent

appropriate.

general workforce. These services may include intake, discovery, assessm ent, j ob preparation, job marketing, job supports, record keeping and support to maintain a job( per Page 15 DSHS

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ATTACHMENT

Special Terms and Conditions the

Individual Employment Phases&

Billable Activities)

Examples include enclaves, mobile crews, and other business models employing small groups ofworkerswith disabilities in integrated employment community settings_ b_

Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this

Program Agreement.

However, with a Program Agreement amendment, the parties may increase

or decrease the Program Agreement amount_ Counties will work with DDCS HOon amendmentsto the Program Agreement. c_

Clients will be assisted in accessing DVR services perthe DDCS/ DVR MOU. Client services shall not be reimbursed

under this Program Agreement when the same services are paid for under the

Rehabilitation Act of 1973 by DVR, Public Law 94- 142 or any other source of public or private funding. e.

Reimbursement

of Client Services:

A claim for each Client is made on the AWA system

indicating the number of service units delivered to each Client listed and the fee per unit_ Units are defined as:

An " Hour" is at least fifty( 50) minutes of direct service. Partial hour to the quarter may be recorded-

2) A" Day" is at leastfour( 4) hours of direct service and will only be used in connection with Adult Day Care reimbursement3) A" Month" represents

a minimum of at least fifty( 50) minutes of direct service for CDS

reimbursement.

can be 1112 of the maximum amount identified in Exhibit B under Administration or

The Individual Employment Phases&

Billable Activities document defines the individual Client Page 16

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GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

services that DDCS reimburses.

That document

is located on the DSHS DDCS County Best

Practices Web site at https:// www. dshs. wa. aov/dda/ county- best- practices.

Timeliness of and Modification to Billings: All initial invoices with signed documentation must be

Recovery of Fees. If the County bills and is paid fees for services that DSHS later finds were( a) not delivered or( b) not delivered in accordance with Program Agreement standards, DSHS shall

recover the fees for those services and the County steal I fully cooperate during the recovery. k_

costwill be based

DDAJobFoundationReportsadshs_

wa_.Qov

multiplied by

Intermediate Care Facilities for Intellectual Disabilities( ICF1ID) Agreement. If applicable per 42 CFR 463. 410, the County shall assure that all county- operated or subcontracted

programs serving

persons living in ICF/ ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/ ID resident 10.

Single State Medicaid Agency— Health Care Authority(

HCA):

HCA, as the single state Medicaid

DSHSIDRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDCS is incorporated

by reference_ The County assures that it and its subcontractors

have reviewed

the

Access Agreement_ The agreement covers DRW' s access to individuals with developmental Page 17 DSHS

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AGREEMENT

ATTACHMENT

Special Terms and Conditions

disabilities, Clients, programs and records, outreach activities, authorityto investigate allegations abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS

contracted services_ 12.

Confidential Information.

Al Counties and their subcontractors must

Ensure the security of Confidential Information, and

When transporting

client records containing

Confidential

Information

outside a Secure Area, one or

more of the following as appropriate: 1)

U sing a Trusted Network; or

2) Encrypting the Confidential Information, including: a) Email andlor email attachments

b) Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.

Data Security

Requirements. Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization, or transmits more

than

14.

5 records

atone time.

Supersession of Prior Data Security Agreement_ If the Parties hereto have previously entered into a Standalone

Data Security Requirements

Agreement,

both Parties hereby agree that upon mutual

execution said Agreement shall take precedence as the sole Data security Agreement between the Parties_

Page 1$ DSHS

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ATTACHMENT

Special Terms and Conditions Exhibit A— Data Security 1.

Definitions_

Requirements

The words and phrases listed below, as used in this Exhibit, shall each have the fallowing

definitions: a. "

b. " Authorized Users( s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so_ e. "

Category 4 Data" is data that is confidential

and requires special handling due to statutes or

refers to data protected

by: the Health Insurance

Portability

d_ " Cloud" means data storage on servers hosted by an entity other than the Contractor and on a

network outside the control of the Contractor.

Physical storage of data in the cloud typically spans

multiple servers and often multiple locations.

Cloud storage can be divided between consumer

grade storage for personal files and enterprise grade for companies and governmental entitiesExam pies of con sumer grad e storage wouId include iCloud, Dropbox, Box_com, and many other entities.

Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and

Rackspace_ e_ "

Encryption

must use a key length of at least 129 bits( 256 preferred)

for symmetri c keys, or

2048 bits for asymmetric keys_ When a symmetric key is used, the Advanced Encryption Standard AES) must be used if available. f. " Hardened

Password"

means a string of at least eight characters

containing

at least three of the

following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. " Mobile Device"

h_ " Multi- factor Authentication"

series of numbers which act as a password for a device_ Since PINS are typically only four to six characters,

PINS are usually used in conjunction

with anotherfactorof

authentication,

such as a

fingerprint1- "

DSHS

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GRANT

AGREEMENT

ATTACHMENT

Special Terms and Conditions

are not limited to, mobile phones, tablets, and laptops.

Mobile Device is a subset of Portable

Device.

j. "

k_ " Secure Area" means

Confidential

an area to which only authorized representatives of the entity possessing Information have access, and access is controlled through use of a key, card key,

the

Trusted Network" means a network operated and maintained

by the Contractor, which includes

integrity, and availabilityof

the Data. m. "

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.

Authority. The security requirements described in this document reflect the applicable requirements of policies and standards of the Washington

Technology

httns: l/watech_wa_gov/ policies? combine=& field

and of the DSHS Information these requirements

ServicesAgeney

categories

Security Policy and Standards

can be found

target id= 80& field tune target

Manual_

Reference

material

id= All],

related to

here: htti) s:// www. dshs. wa.- govlffa/ keening- dshs- client- information-

private- and- secure, which is a site developed

by the DSHS Information

Security Office and hosted by

DSHS Central Contracts and Legal Services. 3.

Administrative Controls. The Contractor must have the following controls in place: a_

A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy.

If Confidential Information shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment forth e systems) housing the Category 4 Data.

Authorization, Authentication, and Access. authorized

In order to ensure that access to the Data is limited to

staff, the Contractor must:

Page 20 DSHS

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Special Terms and Conditions

Have documented

policies and procedures

b_ Restrict access th rough administrative,

governing

physical,

access to systems with the shared Data

and technical

controls to authorized

staff_

Ensure that only authorized users are capable of accessing the Data_

e_ Ensure that an employee' s access to the Data is removed immediately:

UWn suspected com promise of the user credentials.

2) When their employment, or the contract under which the Data is made available to them, is terminated_

3) When they no longer need access to the Data to fulfill the requirements of the contract. f.

Have a process to periodically review and verify that only authorized containing DSHS Confidential Information

A minimum

length of 8 characters,

and containing

users have access to systems

at least three of the following

character

classes: uppercase letters, lowercase letters, numerals, and special characters such as an

asterisk, ampersand, or exclamation point. 2) That a password

does not contain a user' s name, logon ID, or any form of their full name.

3) That a password does not consist of a single dictionary word. passphrase which consists of multiple dictionary words-

A password

may be formed

as a

4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h.

Ensuring

mitigations

applied to the system don' t allow end- user modification_

2) Not allowing the use of di al- up connections.

3) Using industry standard protocols and solutions for remote access_ Examples would include RADIUS and Citrix.

4) Encrypting

all remote access traffc from the external workstation

to Trusted

Network or to a

component within the Trusted Network_ The traffic must be encrypted at all times while

traversing any network, including the Internet, which is not a Trusted Network. Page 21 DSHS

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Special Terms and Conditions

5) Ensuring that the remote access system prompts for re- authentication session termination after no more than 30 minutes of inactivity.

or performs automated

6) Ensuring use of Multi- factor Authentication to connect from the external end point to the internal end point_ i_

Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication

mechanism,

such as a biometric(

fingerprint,

face recognition,

iris scan) or token

software, hardware, smart card, etc.) in that case-

The PIN or password

must be at least 5 letters or numbers when used in conjunction

with at

least one other authentication factor 2) Must not be comprised of all the same letter or number( 11 111, 22222, aaaaa, would not be acceptable)

Must not contain a" run" of three or more consecutive numbers( 12398, 98743 would not be acceptable)

If the contract specifically allows for the storage of Confidential passcodes used on thedevice must 1)

Information on a Mobile Device,

Be a minimum of six alphanumeric characters.

2) Contain

at least three unique character classes( upper case, lower case, letter, number).

3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable_ k. 5

Render the device unusable after a maximum of 10 failed logon attempts.

Protection of Data. The Contractor protect the Data as described, a_

agrees to store Data on one or more of the following

media and

Hard disk drives_ For Data stared on local workstation hard disks, access to the Data will be

Network server disks_ For 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

mechanism_

1789CS

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ATTACHMENT

Special Terms and Conditions

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 Secure Area_ When not in use for the contracted

purpose, such discs must be

Stored in a Secure Area_ Workstations which access DSHS Data on optical discs must be located

in an area which is accessible only to authorized personnel, key, card key, combination lock, or comparable mechanism d_

Optical discs ( CDs or DVDs) in drives or jukeboxes

with access controlled

attached to servers.

through use of a

Data provided by

DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through

smart

cards_ Data on discs attached to such servers must be located in an area, which is accessible only

to authorized

personnel,

comparable

mechanism_

with access controlled

through

use of a key, card key, combination

lock, or

Remote Access.

Access to and use of the Data over the State Governmental Network( SGN) or

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)

authentication

a Unique User ID and Hardened Password or stronger

method such as a physical token or biometrics.

and physical

security controls to Portable Devices and Portable Media

Keeping them in a Secure Area when not in use,

ii_

Using check- in/ check- out procedures when they are shared, and

iii_ Taking frequent inventories_ Page 23 DSHS

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ATTACHMENT

Special Terms and Conditions

Data stored for backup purposes-

below in Section

8 Data Disposition.

1) DSHS Data wi II not be stored in any consumer grade Cloud solution, unless all of the following conditions are met-

for

b) The Data will be Encrypted while within the Contractor network.

c) The Data will remain Encrypted during transmission to the Cloud. d) The Data will remain Encrypted

at all times while residing within the Cloud storage solution_

e) The Contractor will possess a decryption possessed only by the Contractor. f) The Data will not be downloaded

key for the Data, and the decryption key will be

to non- authorized

systems,

meaning

systems that are not

on the contractor network

a) The Cloud storage provider is treated as any other Sub- Contractor, and agrees in writing to all of the requirements within this exhibit; or, b) The Cloud storage solution used is HIPAA compliant_

Page 24 DSHS

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ATTACHMENT

Special Terms and Conditions

System Protection. that Data passes:

To prevent compromise of systems which contain DSHS Data or through which

a. Systems containing DSHS Data must have all security patches or hotfxes applied within 3 months of being made available_

b_ The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes.

c_ Systems containing DSHS Data shall have an Anti- Malware application,

if available, installed.

d. Anti- Ma lware software shall be kept up to date. The product, its anti- virus engine, and any malware database the system uses, will be no more than one update behind currentT.

Data Segregation-

DSHS Data will be kept on media ( e. g. hard disk, optical disc, tape, etc.) which will contain no non- DSHS Data-

4) DSHS Data will be stored within a database and will be distinguishable

from non- DSHS data by

the value of a specific fell or fields within database records.

5) When stored as physical

paper documents,

DSHS Data will be physically

segregated

from non-

DSHS data in a drawer, folder, or other container_

b_ 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 asdescribed

this exhibit.

Data Disposition.

When the contracted

work has been completed

or when the Data is no longer

needed, except as noted above in Section 5. b, 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 Server or workstation

on:

hard disks, or

Will be destroyed by: Using a " wipe" utility which wi II overwrite the Data at least three( 3) times using either random or single character data, or Page 25

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ATTACHMENT

Special Terms and Conditions

Removable

media( e. g. Coppies, USB Cash drives,

portable hard disks) excluding optical discs

Degaussing

sufficiently to ensure that the Data

cannot be reconstructed, or

Physically destroying Paper documents with

sensitive

Confidential

Information

the disk

Recycling through a contracted firm, provided the contract with the recycler assures that the

confidentiality of Data will be protected. 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 ta 9.

I Degaussing,

Notification

of Compromise

or Potential Compromise.

incinerating

or crosscut

shredding

The compromise or potential compromise of

DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one( 1)

Page 26 DSHS

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GRANT

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ATTACHMENT

Exhibit B

Program Agreement

Original Budget

Budget

0 Budget Revision

REVENUES Fund Source

Fiscal Year 2026

Fiscal

State and

1, 627, 450

1, 479, 700

Medicaid

1 447 900

1 313 649

Total Rev.

3 075 350

2 793 350

Year

Fund

2027

11; t Revision

Original

State

Source

Original

V Revision

21d Revision

3,d Revision

21d Revision

31d Revision

1 457 352

on ly

1 288 528

Medicaid

Total Rev.

V,745, 890

Job Foundation

PASRR Funds

ADMINISTRATION( 12

Funds

TOTAL

11,

13)

OTHER

Medicaid State Funds

Funds

137, 294

112, 332

249, 626

89, 819

73, 487

163, 306

CONSUMER

SUPPORTS 31, 32, 41, 92, 93, 94, 97) CONSUMER SUPPORT STATE62,

ONLY

64r 65, 67r 69

Child Development

MEDICAID 64 67 r

ROADS

125440

CLIENTS 69

21 D00

1 093 259

1 D93 259

207 518

1, 445, 812

1, 279, 078

Z745, 890

COMMUNITY 62

64 65 r

LIVING 67

TOTAL

21, 000

Page 27 DSHS

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234052

BOCC

Motion

Item

Agenda

Meeting Date: 9/ 15/ 2026 Bid Award and Authorization—

2026- 0041- 01— W Canyonview

Drive

Repairs—

Lakeside

Industries

Inc.

Submitted By: Ashley Claussen, Purchasing Supervisor Submitted For: Mike Moss, Director of Public Services Department:

Roads

Administration

Information

Subject and Summary Statement

On August 21, 2026, Purchasing Services requested bids from companies listed on MRSC Rosters for roadway repairs to W Canyonview Drive. On September 8, 2025, eight bids were received as outlined in the attached bid tabulation. Lakeside Industries Inc. submitted the lowest, responsive bid in the amount of$ 70, 221. 80. Staff Attendance Mike

Moss

Department

Recommendation

It is the recommendation of the Department of Public Works that the Board move to award an

agreement in the amount of$ 70, 221. 80 for W Canyonview Drive roadway repairs to the lowest responsive bidder, Lakeside Industries, and authorize the Director of Public Works to execute the agreement.

Attachments

Bid Tab- Canyonview Drive Repairs

Form

User

Task

Claussen,

Ashley

Agenda

Claussen,

Ashley

Preliminary

Item

Review

Action

Timestamp

Submit

9/ 8/ 2026 4: 39: 00 PM

Review-

Submit

9/ 8/ 2026

4: 56: 00 PM

Approver

Approve

9/ 9/ 2026

3: 59: 00 PM

Approve

9/ 9/ 2026

4: 00: 00 PM

Submission

PW1 Clement,

Savannah B.

Department Review

Reed, Pervie

Clerk of the Board Review

Approved: BOARD

OF COUNTY

OF COWLITZ

COMMISSIONERS

COUNTY,

WASHINGTON

234052

Richard

Steve

Motion

R. Dahl, Chairman

Rader,

Commissioner

Steven L. Ferrell, Commissioner

Attest:

Clerk of the Board

Item

BID TABULATION

Cowlitz

County

Canyonview

Bids Due:

Department

of Public Works

Drive Repairs

September

8, 2026

at 4: 00 PM Evergreen

BID TAB

M3 LLC

2911 NE 116th Vancouver, Bid Item

Item

Unit

Quantity

No.

National Facility Contractors 12613 Ingraham Rd

Ave

Snohomish, WA 98290

Unit

Total

Unit

Total

Price

Amount

Price

Amount

Mobilization

7, 000. 00

8, 750. 00

Traffic Control

7, 000. 00

3, 750. 00

Pre- Level

Paving

18, 000. 00

36, 923. 75

Asphalt

Overlay

32, 500. 00

103, 283. 10

Manhole/ Valve Risers

5, 500. 00

4, 150. 00

SUB- TOTAL WASHINGTON

70, 000. 00 8. 2%

SALES TAX

BID TOTAL

Clark County

BID TAB

Paving

Battle Item

Bid Item

Unit

Quantity

No. 1

Mobilization Traffic

Pre- Level

Asphalt

Overlay

Manhole/

Valve

Control

Paving

Risers

12, 862. 26

75, 740. 00

169, 719. 11

Inc

Construction

Company

Ground, WA 98604

Vancouver,

WA 98683

Unit

Total

Unit

Total

Price

Amount

Price

Amount

6, 000. 00

5, 000. 00

3, 415. 00

5, 000. 00

17, 584. 88

21, 000. 00

41, 131. 00

60, 000. 00

1, 795. 00

4, 000. 00

69, 925. 88 8. 2%

SALES TAX

BID TOTAL

Page 1

Granite

16821 SE McGillvray Blvd Ste 210B

SUB- TOTAL WASHINGTON

156, 856. 85

5, 740. 00

PO Box 1858

8, 750. 00

of 2

5, 000. 00

95, 000. 00

5, 733. 92

7, 790. 00

75, 659. 80

102, 790. 00

BID TABULATION

Cowlitz County Department of Public Works Canyonview

Bids Due:

Drive

Repairs

September

8, 2026

at 4: 00 PM

BID TAB

International

GoldRock Invt LLC

Hwy S Apt B207

16232 Bothell Everett Hwy 1031

Green

Diamond

21800

Pacific

Des Moines, Bid Item

Item

WA 98198

Mill Creek, WA 98012

Unit

Total

Unit

Total

Price

Amount

Price

Amount

Unit

Quantity

6, 000. 00

15, 000. 00

6, 000. 00

10, 000. 00

Paving

17, 000. 00

35, 000. 00

No. 1

Mobilization

Traffic

Pre- Level

Asphalt

Overlay

40, 000. 00

60, 000. 00

Manhole/ Valve Risers

3, 600. 00

6, 000. 00

Control

SUB- TOTAL WASHINGTON

72, 600. 00 8. 2%

SALES TAX

BID TOTAL

Lakeside

BID TAB

Industries

500 Tennant

Bid Item

Unit

Quantity

No.

126, 000. 00

5, 953. 20

10, 332. 00

78, 553. 20

136, 332. 00

Inc

Western United Civil Group PO Box 236

Way

Longview, WA 98632 Item

15, 000. 00

Yacolt, WA 98675

Unit

Total

Unit

Total

Price

Amount

Price

Amount

Mobilization

5, 000. 00

8, 000. 00

Traffic

5, 000. 00

9, 000. 00

Pre- Level

18, 400. 00

19, 561. 00

Asphalt

33, 500. 00

39, 000. 00

Manhole/

3, 000. 00

5, 500. 00

Control

Paving

Overlay Valve

Risers

64, 900. 00

SUB- TOTAL WASHINGTON

8. 2%

SALES TAX

BID TOTAL

Page 2 of 2

8, 000. 00

81, 061. 00

5, 321. 80

6, 647. 00

70, 221. 80

87, 708. 00

Motion

234053

BOCC

Item

Agenda

Meeting Date: 9/ 15/ 2026 Intent

to Negotiate—

2026- 0033- 01— Geomorphic

Assessment—

Wolf Water Resources

Submitted By: Ashley Claussen, Purchasing Supervisor Submitted For: Susan Eugenis, County Engineer Department:

Roads

Administration

Information

Subject and Summary Statement

On July 28, 2026, Request for Qualifications No. 2026- 0033- 01 was issued for the purpose of selecting

a firm to provide a professional geomorphic assessment of the lower Toutle and Cowlitz Rivers. Statements of Qualifications from the following three firms were received on the due date of August 19, 2026: Verdantas

Watershed Science &

Engineering

Wolf Water Resources

Submittals were evaluated and scored in accordance with the criteria established in the RFQ documents. Based on the evaluation, Wolf Water Resources received the highest overall score and is the recommended

firm for the project.

Funding for the project is anticipated to be provided solely through a grant in an amount not to exceed $ 200, 000. The Department is requesting authorization to proceed with negotiations with Wolf

Water Resources and authorization for the Director of Public Works to negotiate and execute the resulting agreement in an amount not to exceed the grant award. Execution of the agreement shall be contingent

upon the formal award and availability of grant funding and compliance with all applicable grant requirements. In the event the grant is not awarded, the Department will not proceed with execution of the

agreement, and no further action will be taken pursuant to this authorization. Staff Attendance Susan

Eugenis

Department

Recommendation

It is the recommendation

of the Department of Public Works that the Board move to authorize the

department to proceed with negotiations with Wolf Water Resources for a geomorphic assessment of the lower Toutle and Cowlitz Rivers. The department further recommends

authorizing

the Director

of Public

234053

Motion

Item

Works to execute the agreement in an amount not to exceed $ 200, 000, contingent upon the formal award

and availability of grant funding and subject to compliance with all applicable grant requirements. Attachments

Form

User

Task

Claussen,

Agenda

Ashley

Claussen,

Ashley

Item

Preliminary

Review

Action

Timestamp

Submit

9/ 8/ 2026 4: 48: 00 PM

Review-

Submit

9/ 8/ 2026 5: 17: 00 PM

Approver

Approve

9/ 8/ 2026 5: 23: 00 PM

Approve

9/ 9/ 2026

Submission

PW1 Eugenis,

Susan

Department Review

Reed, Pervie

Clerk of the Board Review

Approved: BOARD

OF COUNTY

OF COWLITZ

COMMISSIONERS

COUNTY,

WASHINGTON

Richard R. Dahl, Chairman

Steve

Rader,

Commissioner

Steven L. Ferrell, Commissioner

Attest:

Clerk of the Board

8: 35: 00 AM

Timed Item

233965

BOCC

Agenda

Meeting Date: 9/ 15/ 2026 RESOLUTION -

Public

Hearing ( 10 a. m.) - Proposed

Resolution -

No Parking on a Portion of Kalama River Road

Submitted By: Averie Mejia, Administrative Assistant III Submitted For: Susan Eugenis, County Engineer Department:

Roads

Administration

Information

Subject and Summary Statement

A public hearing was scheduled for September 1, 2026 at 10: 00 a. m., on the proposed resolution related to establishing a portion of Kalama River Road as a " No Parking Zone". The Hearing was continued to September 15, 2026. Staff Attendance Susan

Eugenis

Department

Recommendation

It is the recommendation of the Department of Public Works that the Board move to adopt the proposed resolution in the establishment of a No Parking Zone on the portion of Kalama River Road between milepost 5. 98 and milepost 6. 02. Attachments

No Parking Resolution Kalama River Road MP 6, KRR No Parking Zone Petition, No Parking KRR- Vicinity Map

Form

Task

User Mejia,

Averie

Eugenis,

Susan

Agenda

Item

Preliminary

Review

Action

Timestamp

Submit

9/ 8/ 2026

10: 27: 00 AM

Review-

Submit

9/ 8/ 2026

3: 06: 00 PM

Approver

Approve

9/ 8/ 2026

5: 24: 00 PM

Approve

9/ 9/ 2026 8: 32: 00 AM

Submission

PW1 Eugenis,

Susan

Department Review

Reed, Pervie

Clerk of the Board Review

PETITION TO THE COWLITZ COUNTY BOARD OF COMMISSIONERS

Re: Establishment of a No Parking Zone at 2425 Kalama River Road, Cowlitz County, WA

98625

We, the undersigned residents and concerned citizens of Cowlitz County, Washington, respectfully petition the Cowlitz County Board of Commissioners to establish a designated No

Parking zone along Kalama River Road at 2425 Kalama River Road, Cowlitz County, WA 98625 within Cowlitz County jurisdiction. GROUNDS FOR THIS PETITION: 1. Public Safety—

Vehicles parked at this location are a hazard. Any occupants within those

vehicles are also at danger. This location is on a sharp curve both eastbound and westbound_

In the past 5 years there have been at least two vehicle crashes at this location. Both of these incidents resulted in damage to the guard rails which required repair. One incident was so bad that the vehicle went through the guardrail and down the steep embankment. 2. Traffic

Hazards—

Vehicles parked at this location cause a hazard for other motorists using the private road that tees off Kalama River Road at the same location. Residents along the private road are concerned with visibility and the ability to turn eastbound from the private road

onto Kalama River Road.

3. Blocking of Services to Residents-

Due to the hazards noted in ( 2) The United States Postal

Service (LISPS) has ceased delivery of packages to residents along the private road near this

location. They have notified residents along the private road of the dangers caused' by parking here and, as a result, will not deliver packages to residents along the road, causing an

inconvenience for all residents along the private road. In order to get packages that are shipped via LISPS, residents must make a 20- minute round trip drive to the Kalama Post Office to collect their packages. In addition, garbage ser: ice through Waste Control has not occurred on occasion due to vehicles parked at this location. 4. Additional

Dangers

Resulting

from

Parking at this Location - The United Parcel Service

UPS) does still deliver packages to residents along the private road. But, on at least one occasion, this was done by the UPS driver stopping in the middle of the westbound lane of

Kalama River Road, turning on his flashers, and planning to walls down the private road to hand- deliver the package. This would' ve left the UPS truck stopped in the westbound lane of Kalama River Road. It was facing downhill between two blind curves. It would have been there for at least a couple of minutes as the driver walked down the private road to deliver the packages. Wesley Johnson happened to be here at this time and the driver said this was necessary due to parked vehicles at this location for the same concerns from ( 2). This is

extremely dangerous with logging trucks also coming down that hill and around those corners on weekdays.

Emergency Access— Parked vehicles limit the ability of fire, medical, and law enforcement personnel to respond quickly and safely in emergency situations.

REQUESTED

ACTION:

We respectfully request that the Board of Commissioners: Direct the Cowlitz County Public Works Department to conduct a traffic and safety study of the affected section of Kalama River Road. Work with the Washington

State Department of Transportation

and local stakeholders to

identify appropriate boundaries for a No Parking zone. Post clear, enforceable No Parking signage along the designated stretch. Coordinate with the Cowlitz County Sheriffs Office to enforce the restriction. We believe these measures are necessary to protect the safety and well- being of all who live, work, and travel along Kalama River Road. We urge the Board to take prompt action on this matter.

Respectfully submitted, Name

Address

I Signature I Date

r11

R,_J,--

j3S , 1 z`>

FZ _'? a

n n t

fie+' ,

y Lil I

z•-a

Ll - Z

w4wicliC

V•:

I I

Submit completed petitions to: Cowlitz County Board of Commissioners 207 4th Avenue North, Kelso, WA 98626 Phone: ( 360) 577- 3016

czk

ACRES O

RRO

GReµ

PROPOSED

PARKING ZONE 5

n O

L. DESIGNED

S. M. DRAWN

PROPOSED

NO PARKING

ZONE

Cp ti,

Go`

2400 BLOCK OF KALAMA RIVER RD BY

6/ 3/ 2026

160013th AVENUE SOUTH

VICINITY MAP SCALE:

1" =

5000'

OF PUBLIC WORKS

APPROVED

DEPARTMENT

gSHING-' G'

KELS , O,

0WAG26HINGTON

SHEET

1 OF

BEFORE COWLITZ COUNTY, BOARD

A RESOLUTION DESIGNATING " ZONE"

ON A PORTION

KALAMA

RIVER

ROAD

IN COWLITZ

OF COMMISSIONERS

PARKING

WASHINGTON

RESOLUTION

NO.

RIGHT- OF- WAY

COUNTY,

WASHINGTON

WHEREAS, the Board of County Commissioners of Cowlitz County, Washington, in compliance with Cowlitz County Code Ch. 11. 32, may designate a ' No Parking Zones' along county road rights of way; and WHEREAS, the County Engineer of Cowlitz County has investigated and found that vehicular parking along the portion of Kalama River Road, as set forth in the schedule below, in Cowlitz County is

risk

the

safety

of the

traveling

and

public

has

recommended

Parking

Zone"

established thereon; and,

WHEREAS, it appears to this Board, following public hearing, that it is in the best interest of public safety and in compliance with the laws of Washington and Cowlitz County Code Ch. 11. 32, that

of Kalama

portion

River Road,

set forth

below,

be designated

as '

Parking

Zone';

and

BE IT RESOLVED by the Board of County Commissioners of Cowlitz County, Washington: Section

Designated

Locations.

The following portions of county road rights- of-way are hereby designated as " no parking zones" on both sides of the county road as noted below, with violations thereof subject to the penalties set forth within CCC 11. 32. 030:

Road

Item

Section —

Road

Milepost

Number

From

Name

Description

Township — Range

Kalama

River

40000

5. 98

1- 6N- 1W

All Vehicles

6. 02

Road

2- 6N- 1W

Section 2. The provisions of this Resolution shall not be codified and shall become effective upon the Department of Public Works erecting ' No Parking Zone' signage in accordance with CCC 11. 32. 020,

and

the "

Manual

Uniform

Traffic

Control

Devices

for Streets

and

Highways"

adopted and amended by the Washington State Department of Transportation, and with the Department thereafter maintaining the signage. Section 3.

The provisions of this Resolution are declared separate and severable shall not affect the validity of any portion of Ch. 11. 32 CCC, and the ' no parking zones' along portions of Kalama River Road shall be added to the official No Parking Zone List of the County pursuant to CCC 11. 32. 050.

NO PARKING ZONE RESOLUTION — 2026

Page 1

APPROVED THIS 15t day of September 2026, after public hearing on September 1, 2026, pursuant to Notice published on the 20t" day of August 2026 in The Daily News.

BOARD

OF COUNTY

COMMISSIONERS

OF COWLITZ COUNTY, WASHINGTON

ATTEST:

Richard R. Dahl, Chairman

Kelly Grayson

Steve

Rader, Commissioner

Clerk of the Board

Steven L. Ferrell, Commissioner

APPROVED

AS TO FORM:

Cowlitz County Prosecuting Attorney

Douglas Jensen, Chief Civil Deputy

NO PARKING ZONE RESOLUTION—

2026

Page 2