HomeMy WebLinkAboutbocc.con.330.2016 STAFF AUTHORIZED
SIGNATURE
{-���e�. 6/4 46/61 cx- h% ,4rngi�c� fh
L �
EMERGENCY RESOLUTION OF THE BOARD OF
COUNTY COMMISSIONERS ("BOCC") OF PITKIN
COUNTY, COLORADO,APPROVING AN
INTERGOVERNMENTAL AGREEMENT
AMENDMENT BETWEEN PITKIN COUNTY
("PITKIN")AND COLORADO DEPARTMENT OF
HUMAN SERVICES FOR THE WORK NUMBER
PROGRAM
RESOLUTION NO.(966 , 2016
RECITALS:
1. Pursuant to Title 29, Article 1,part 2, Colorado Revised Statutes, as amended(the
"Intergovernmental Relations Statutes") and Article XIV, Section 18 of the
Colorado Constitution, governments may contract with one another to provide any
function, service or facility lawfully authorized to each of the contracting units and
any such contract may provide for the joint exercise of the function, service or
facility, including the establishment of a separate legal entity to do so.
2. Pitkin wishes to enter into an Intergovernmental Agreement Amendment for the
purposes of continuing Work Number service in (SFY) 17, and;
3. Both Pitkin and Colorado Department of Human Services are governments
authorized to enter into agreements pursuant to C.R.S. § 29-1-203 for
purposes including the provision of any function, service, or facility lawfully
authorized to each; and
4. The BOCC finds that it is in the best interests of the citizens of Pitkin to enter into
this agreement in order to allow for efficient and speedy work verification for
public assistance benefits; and
5. The BOCC finds that it is in the best interests of the citizens of Pitkin County to
adopt this resolution as an emergency resolution.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Pitkin County, Colorado that: Pitkin County is authorized to enter into an
Intergovernmental Agreement with the Colorado Department of Human Services in
substantially the same form satisfactory to the County Attorney; and authorizes the Chair
or the Director of Health and Human Services to sign the agreement on behalf of the
County and further, authorization for the Director of Health and Human Services to sign
all future amendments to this intergovernmental agreement with approval of such by the
county manager.
1
INTRODUCED, READ AND ADOPTED AS AN EMERGENCY RESOLUTION ON
THE '1M- DAY OF due 2016 AN SET FOR CONFIRMATORY
PUBLIC HEARING ON THE /o - DAY OF uhf , 2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND TITLE AND SHORT
SUMMARY OF THE EMERGENCY RESOLUTION P BLISHED IN THE ASPEN
TIMES WEEKLY ON THE /Yet DAY OF / u 1 ,2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND THE FULL TEXT OF THE
RESOLUTION POSTED ON THE OFFICIAL PITKINN,, COUNTY WEBSITE
www.pi Ikincounty.com ON THE A/ DAY OF /foto Ls l- 2016.
CONFIJ{MED AT A CONFIRMATORY PUBLIC HEARING ON THE /GSL DAY
OF /4-Ls&s i- 2016.
PUBLISHED BY TITLE AND SHORT SUMMARY, Al-I ER CONFIRMATORY
PUI${. C HEARING, IN THE ASPEN TIMES WEEKLY ON THE /�� DAY OF
,2016.
POSTED BY TITLE AND SHORT SUMMARY ON THE OFFICIAL PITKIN COUNTY
WEBSITE www.pitkincountv.com ON THE /`1- DAY OF Sus oc / 2016
ATTEST: BOARD OF COUNTY COMMISSIONERS
q ( ` it
--
Jett :tte Jones Rac el E. Richards, Ch.'r
Delo ty County Clerk'
Date:
APPROVED AS TO FORM: MANAGER APPROVAL
/
John Ely,Count Corney Jon PE_cock, County Manager
7
(AITACHNIENT B) DEPARTMENT OF HUMAN SERVICES j�`
Contract Routing Number: �. I • . 17 IHGA q(r t
CONTRACT
This contract is made and entered into by and between the named parties. In accordance with the
purposes stated herein, it is hereby agreed as follows:
STATE CONTRACTOR
State of Colorado for the use&benefit of the
Department of Human Services Pitkin County Health&Human Services
1575 Sherman Street 0405 Castle Creek Road,Suite 204
Denver,CO 80203 Aspen,CO 81611
CONTRACT MADE DATE; CONTRACTOR'S ENTITY TYPE:
5/11/2016 Government
RQS PRE-ENCUMBRANCE NUMBER:
CONTRACTORS STATE Of INCORPORATION:
N/A
CT/BCCI ENCUMBRANCE NUMBER N/A
N/A BILLING STATEMENTS RECEIVED
TERM
This contract shall be effective upon approval STATUTORY AUTHORITY
by the Smte Controller or designee and upon CR.S.§26-1-111
full execution of substantially the same
CONTRACT PRICE NOT TO EXCEED
agreement with all counties listed in this
contract. The Contract shall end either upon N/A$
termination of the Schedule A as specified in
the Work Number Agreement or termination
as specified in this Contract. AWOMUBI AMOUNT AVAILABLE PER FISCAL YEAR
PROCUREMENT METHOD N/A
Exempt
BID/RFP/UST PRICE AGREEMENT NUMBER
N/A PRICE STRUCTURE
LAW SPECIFIED VENDOR STATUTE 1F.'° .I 1!CIN.
N/A FUND SOURCE-NAmOG FEDERAL PROGRAM/CRAM AND FUNDS ID It
N/A
STATEREPRESENTATIVE
CONTRACTOR REPRESENTATIVE
Barry Pardus Nan Sundeen
CDHS, Office of Economic Security Director of Health and Human Services
1575 Sherman Street, 5'A Floor 0405 Castle Creek Road,Suite 204
Denver,CO 80203
Aspen,CO 81611
RECEIVED41(
For Convect Wizard Version 3.17 Page I of 15 NOV 1 4 2016 Revised 03202015
Colorado Department of Human Services PITKIN COUNTY
Division of Contract Management HEMLTH 8 HUMAN SERVICES
EXHIBITS:
The following exhibits are hereby incorporated:
Exhibit A- Statement of Work
Exhibit B. Universal Membership Agreement
Exhibit C- Schedule A
COORDINATION:
The State warrants that required approval,clearance and coordination has been accomplished from and with
appropriate agencies.
APPROVAL:
In no event shall this contract be deemed valid until it shall have been approved by the State Controller or
his/her designee.
PROCUREMENT:
This contractor has been selected in accordance with the requirements of the Colorado Procurement Code.
PRICE PROVISIONS:
Payments pursuant to this contract shall be made as earned, in whole or in part, from available funds,
encumbered far the purchase of the described services and/or deliverables.The liability of the State at any
time for such payments shall be limited to the encumbered amount remaining of such funds.
Authority exists in the laws and Ponds have been budgeted,appropriated and otherwise made available,and
a sufficient unencumbered balance thereof remains available for payment.
Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds
for that purpose being appropriated,budgeted and otherwise made available.
The Contractor understands and agrees that the State shall not be liable for payment for work or services or
for costs or expenses incurred by the Contractor prior to the proper execution and State Controller approval
of this contract.
For Contract Wizard Version 3.17 Page 2 of IS Revised 032012015
Colorado Department of Human Services
Division of Contract Management
GENERAL PROVISIONS
The following clauses apply to this contract exhibit entitled: "Modifications to the General
Provisions' shall take priority over the General
A. Governmental Immunity:Limitation of Liability:
Provisions of this contract.
Notwithstanding anything herein to the contrary, no E. Notice and Representatives' For the purposes of this
term or condition of this contract shall be construed or contract, the representative for each party is as
interpreted as a waiver,express or implied,of any of
the immunities, rights, benefits, protection, or other designated herein.Any notice required orpermiuedmay
provisions of the"Colorado Governmental Immunity be delivered m person or sent by registered or certified
Act C.R.S.§24-10.101,et seq.,as now or hereinafter mail,return receipt requested,to the parry at the address
amended. The parties understand and agree that the provided,and if sent by mail it is effective when posted
in
liability of the State for claims for injuries to persons a U.S. Mail Depository with sufficient postage
attached
or property arising out of negligence of the Slate of thereto.Notice of change of address or change
or representative shall be treated as any other notice.
Colorado, its departments, institutions, agencies,
boards, officials and employees is controlled and F. Contractor Representations:by the provisions of C.R.S. §24-10-101, et
1 I irenses and Certifications: The Contractor
seq., as now or hereafter amended and the risk
management statutes,C.R.S. §24-30-1501,et seq.,as certifies that, at the time of entering into this
now or hereafter amended. Any liability of the State contract,it and its agents have currently in effect
created under any other provision of this contract, all necessary licenses, certifications, approvals,
whether or not incorporated herein by reference,shall insurance, etc, required to properly provide the
be controlled by, limited to, and otherwise modified services and/or supplies covered by this contract
so as to conform with,the above cited laws. in the stateof Colorado. Proof of such licenses,
certifications, approvals, insurance, etc. shall be
B. Federal Funds Contingency Payment pursuant to this provided upon the State's request. Any
contract, if in federal finds, whether in whole or in revocation, withdrawal or nonrenewal of
part,is subject to and contingent upon the continuing necessary license, certification, approval,
availability of federal funds for the purposes hereof. insurance, etc. required for the Contractor to
In the event that said funds, or any pan thereof, properly perform this contract,shall be grounds
become unavailable, as determined by the State, the for termination of this contract by the State.
2. Ouali
State may immediately terminate this contract or firation:Contractor cenifies that it is qualified
amend it accordingly. to perform such services or provide such
deliverables as delineated in this contract.
C. Hitting Procedures. The State shall establish billing 3. Exclusion. Debarment andror Suspension:
procedures and requirements for payment due the Contractor represents and warrants that Contractor,
Contractor in providing performance pursuant to this or its employees or authorized subcontractors,ere
contract The Contractor shall comply with the not presently excluded from participation,
established billing procedures and requirements for debarred, suspended, proposed for debarment,
submission of billing statements. The State shall declared ineligible, voluntarily excluded, or
comply with CRS 24-30-202(24)when paying vendors otherwise ineligible to participate in a "federal
upon receipt of a correct notice of the amount due for health care program" as defined in 42 U.S.C. §
goods or services provided hereunder. 1320a-7b(t)or in any other government payment
program by any federal or State of Colorado
D. Exhibits- Interpretation: Unless otherwise stated, all department or agency. In the event Contractor,or
one of its employees or authorized subcontractors,
referenced exhibits are incorporated herein and made a is excluded from participation, or becomes
part of this contract And,unless otherwise stated,inon.
the event of conflicts or inconsistencies between this otherwise ineligible to participate in any such
contract and its exhibits or attachments,such conflicts program during the Term,Contractor will notify the
shall be resolved by reference to the documents in the Slate m writing within three (3) days after such
following order of priority. I)the Special Provisions of event. Upon the occurtencemfsuch event,whether
or not such notice is given to Contractor,the State
this contract shall always be controlling over other reserves the right to immediately cease contracting
provisions inthees; 3)bactoram ndmentvisionecontract with Contractor.
"cover" pages; 3) the General Provisions of this
contract;4)the exhibits to this contract,except that any
For Contract Wizard Version 3.17 Page 3 of 15 Revised 03'202015
Colorado Department of Human Services
Division of Convect Management
4. Work Performed Outside the United States or section at all times during the term of this Contract.
Colorado pursuant to C.R.S. 524-102-206: The All policies evidencing the insurance coverage
Contractor cenifies all work performed under this required hereunder shall be issued by insurance
Contract,including any subcontracts,is anticipated companies satisfactory to Contractor and the State.
to be and will be perfonned within the United States I. Contractor
or Colorado, unless otherwise specified in the a. Public Entities: If Contractor is a "public
Statement of Work- If work under this Contract is entity" within the meaning of the Colorado
anticipated to be or will be performed outside the Governmental Immunity Act, CRS §24-10-
United States or Colorado, the countries ardlor 101, et seq., as amended (the "GIA"), then
states where work will be performed, and the Contractor shall maintain at all times duringthe
reasons it is necessary or advantageous to go term of this Contract such liability insurance,
outside the United States or Colorado to perforin by commercial policy or self-insurance, as is
the work are also specified in the Statement of necessary to meet its liabilities under the GIA.
Work Contractor shall show proof of such insurance
satisfactory to the State, if requested by the
G. Legal Authority: The Contractor warrants that it State. Contractor shall require each contract
possesses the legal authority to enter into this contract with a Subcontractor that is a public entity, to
and that it has taken all actions required by its include the insurance requirements necessary
procedures,by-laws,and/or applicable law to exercise to meet such Subcontractor's liabilities under
that authority, and to lawfully authorize its the GIA.
undersigned signatory to execute this contract and b. Non-Public Entities: If Contractor is not a
bind the Contractor to its terms. The person(s) "public entity"within the meaning of the CA,
executing this contract on behalf of the Contractor Contractor shall obtain and maintain during the
warrant(s)that such persons)have full authorization term of this Contract insurance coverage and
to execute this contract. policies meeting the same requirements set
Indemnification' To the extent authorized by law, the forth in provision 1.2 below with respect to
Contractor shall indemnify, save, and hold harmless the Subcontractors that are not"public entities".
State against any and all claims, damages, liability and 2. Contractors-Subcontractors
court awards including costs,expenses,and attorney fees Contractor shall require each contract with
and related costs,incurred as a result of any act or omission Subcontractors other than those that are public
by Contractor,or its employees,agents,subcontractors,or entities, providing Goods or Services in
assignees pursuant to the terms of this contract. No term connection with this Contract, to include
or condition of this contract shall be construed or insurance requirements substantially similar to
interpreted as a waiver, express or implied,of any of the the following:
immunities,rights,benefits,protection,or other provisions a.Workers Compensation: Worker's
for the parties,of the Colorado Governmental Immunity Compensation Insurance as required by State
Act,CRS 24-10-101 et seq.or the federal Tort Claims Act, statute, and Employers Liability Insurance
28 U.S.C. 2671 et seq. as applicable,as now or hereafter covering all of Contractor or Subcontractor
amended. The Contractor, by execution of this contract employees acting within the course and scope
cQnthining this indemnification clause,Cots not waive the of their employment.
operation of any law concerning the panics ability ,o b.General Liability: Commercial General
indemnify. The Contractor does not by this Agreement Liability Insurance written on Igre
)occurrence
«a61y pledge present cash reserves P r payments n form CC 00 0110'01 or equivalent, eavennn
future fiscal years. This Contract is not intended to create premises operations, Ore damage,independent
a mubiplc-fiscal year debt of me Guntraetor. contractors, products mid completed
(Applicable Only to Intergovernmental Contracts( operations, blanket contractual liability,
No tern or condition of this contract shall he personanjury, and advertising liability with
construed or interpreted a: a expres m Oaths as follows:
implied. of any or the immunities,rights. benefits. (a)S 000,000 each occurrence:
protection, or other provisions, of the Colorado (b)11,000,000 general aggregate;
Governmental Immunity Act, CRS e24-1 0.101 et (c) $1,000,000 products and completed
seq.,or the Federal Ton Claims Act,28 U.S.C. 2671 operations aggregate;and
et seq.,as applicable,as now or hereafter amended. (d)$50,000 any one fire.
I. Insurance: Contractor and its Subcontractors shall If any aggregate limit is reduced below
obtain and maintain insurance as specified in this 51,000,000 because of claims made or paid,
For Contract Wizard Version 3.17 Page 4 of 15 Revised 031202015
Colorado Department of Human Services
Division of Contract Management
Subcontractor shall immediately obtain 3.Certificates:Contractor and all Subcontractors shall
additional insurance to restore the full provide certificates showing insurance coverage
aggregate limit and furnish to Contractor a required hereunder to the State within seven
certificate or other document satisfactory to business days of the Effective Date of this Contract.
Contractor showing compliance with this No later than 15 days prior to the expiration date of
provision. any such coverage, Contractor and each
c.Automobile Liability: Automobile Liability Subcontractor shall deliver to the State or
Insurance covering any auto(including owned, Contractor certificates of insurance evidencing
hired and non-owned autos) with a minimum renewals thereof In addition, upon request by the
limit of $1,000,000 each accident combined State at any other time during the term of this
single limit. Contract or any subcontract, Contractor and each
d. Professional Liability: Professional liability Subcontractor shall,within 10 days of such request,
insurance with minimum limits of liability of supply to the State evidence satisfactory to the State
not less than$1,000,000,unless waived by the of compliance with the provisions of this provision
State.
e.Privacy Insurance
If this Contract includes a HIPAA Business 1. Disaster Mannino and Pandemic Outbreaks:The Stam
Associates Addendum exhibit,Contractor shall may require the Contractor to submit a Disaster
obtain and maintain during the term of this Response Plan(Plan)to ensure the delivery hereunder
Contract liability insurance covering all loss of of essential government services during a disaster,
Protected Health Information data and claims declared emergency, and/or pandemic outbreak. The
based upon alleged violations of privacy rights Plan would take precedence over and nullify any
through improper use or disclosure of Protected contractual provision relating to force majeure or
Health Information with a minimum annual "Acts of God." Accordingly, should the work
limit of 51,000,000. performed by the Contractor under this contract
f.Additional Insured:The State shall be named as include the provision of any essential government
additional insured on all Commercial General services, the State may request a Plan from the
Liability and Automobile Liability Insurance Contractor, and, upon such request, the Contractor
policies (leases and construction contracts shall forthwith submit a Plan,and the Contractor shall
require additional insured coverage for be bound to perform hereunder in accordance
completed operations on endorsements CG therewith.
2010 11185, CG 2037, or equivalent)required
of Contractor and any Subcontractors K. Rights in Data,Documents and Computer Software or
hereunder. Other Intellectual Property:
g. Primacy of Coverage: Coverage required of All intellectual property including without limitation,
Contractor and Subcontractor shall be primary databases, software, documents, research, programs
over any insurance or self-insurance program and codes, as well as all, reports, studies, data,
carried by Contractor or the State. photographs,negatives or other documents,drawings
h. Cancellation: The above insurance policies or materials prepared by the contractor in the
shall include provisions preventing performance of its obligations under din contract shall
cancellation or non-renewal without at least 30 be the exclusive property of the State. Unless
days prior notice to Contractor and Contractor otherwise stated,all such materials shall be delivered
shall forward such notice to the State in to the State by the contractor upon completion,
accordance with provision E. Notice and termination, or cancellation of this contract.
Representatives within seven days of Contractor shall not use, willingly allow or cause to
Contractor's receipt of such notice. have such materials used for any purpose other than
i. Sabrogation Waiver. All insurance policies in the performance of the contractor's obligations under
any way related to this Contract and secured this contract without a prior written consent of the
and maintained by Contractor or its State. All documentation, accompanying the
Subcontractors as required herein shall include intellectual property or otherwise,shall comply with
clauses stating that each carrier shall waive all the State requirements which include but is not limited
rights of recovery, under subrogation or to all documentation being in a paper,human readable
otherwise, against Contractor or the State, its format which is useable by one who is reasonably
agencies, institutions, organizations, officers, proficient in the given subject area.
agents,employees,and volunteers.
For Contract Wizard Version 3.17 Page 5 of 15 Revised 0320:2015
Colorado Department of Human Services
Division of Contract Management
L. Proprietary Information:Proprietary information for the
purpose of this contract is information relating to a All such records, documents, communications, and
party's research, development, trade secrets, business other materials shall be the property of the State
affairs,internal operations and management procedures unless otherwise specified herein and shall be
and those of its customers,clients or affiliates,but does maintained by the Contractor,for a period of three
not include information lawfully obtained by third (3) years from the date of final payment or
parties, which is in the public domain, or which is submission of the final federal expenditure report
developed independently. under this contract,unless the State requests that
the records be retained fora longer period,or until
Neither party shall use or disclose directly or indirectly an audit has been completed with the following
without prior written authorization any proprietary qualification. If an audit by or on behalf of the
information concerning the other party obtained as a federal and/or state government has begun but is
result of this contract Any proprietary information not completed at the end of the three (3) year
removed from the State's site by the Contractor in the period,or if audit findings have not been resolved
course of providing services under this contract will be after a three(3)year period,the materials shall be
accorded at least the same precautions as are employed retained until the resolution of the audit findings
by the Contractor for similar information in the course The Contractor shall permit the Stale, any other
of its own business. governmental agency authorized by law, or an
authorized designee thereof, in its sole discretion, to
M. Records Maintenance, Performance Monitoring & monitor all activities conducted by the Contractor
Audits The Contractor shall maintain a complete file pursuant to the teens of this contract.Monitoring may
of all records,documents,communications,and other consist of internal evaluation procedures,
materials that pertain to the operation of the reexamination of program data, special analyses,
program/project or the delivery of services under this on-site verification,formal audit examinations,or any
contract. Such files shall be sufficient to properly other procedures as deemed reasonable and relevant.
reflect all direct and indirect costs of labor,materials, All such monitoring shall be performed in a manner
equipment, supplies and services, and other costs of that will not unduly interfere with contract work.
whatever nature for which a contract payment was
made.These records shall be maintained according to N. Taxes: The State, as purchaser, is exempt from all
generally accepted accounting principles and shall be federal excise taxes under Chapter 32 of the Internal
easily separable from other Contractor records. Revenue Code [No. 84-730123K] and from all state
and local government use taxes [C.R.S. §39- 26-
The Contractor shall protect the confidentiality of all 114(a)and 203,as amended].The contractor is hereby
records and other materials containing personally notified that when materials are purchased for the
identifying information that are maintained in benefit of the State,such exemptions apply except that
accordance with this contract. Except as provided by in certain political subdivisions the vendor may be
law, no information in possession of the Contractor required to pay sales or use taxes even though the
about any individual constituent shall be disclosed in ultimate product or service is provided to the State.
a form including identifying information without the These sales or use taxes will not be reimbursed by the
prior written consent of the person in interest, a state.
minors parent,guardian,or the state.The Contractor
shall have policies governing access to, O. Conflict of Interest' During the teen of this contract,
duplication and dissemination of,all such information the Contractor shall not engage in any business or
and advise its agents, if any, that they are subject to personal activities or practices or maintain any
these confidentiality requirements. The Contractor relationships which conflict in any way with the
shall provide its agents,if any,with a copy or written Contractor fully performing his/her obligations under
explanation of these confidentiality requirements this contract.
before access to confidential data is permitted
The Contractor authorizes the State, the federal Additionally, the Contractor acknowledges that, in
government or their designee,to perform audits and/or governmental contracting, even the appearance of a
inspections of its records,at any reasonable time,to conflict of interest is harmful to the interests of the
assure compliance with the state or federal State. Thus,the Contractor agrees to refrain from any
government's terms and/or to evaluate the Contractor's practices, activities or relationships which could
performance.Any amounts the State paid improperly reasonably be considered to be in conflict with the
shall be immediately returned to the State or may be Contractor's fully performing his/her obligations to
recovered in accordance with other remedies.
For Contract Wizard Version 3.17 Page 6 of 15 Revised 031204015
Colorado Department of Human Services
Division of Contract Management
the State under the terms of this contract,without the • Section 504 of the Rehabilitation Act of 1973,29
prior written approval of the Slate. U.S.C. 794, as amended, and implementing
regulation 45 C.F.R.Part 84;
In the event that the Contractor is uncertain whether • Titles VI&VII of the Civil Rights Act of 1964,42
the appearance of a conflict of interest may reasonably U.S.C.2000(d)&(e);
exist, the Contractor shall submit to the State a full • The Personal Responsibility and WorkOppomtnity
disclosure statement setting forth the relevant details Reconciliation Act of 1996,42 USC 604a,PL 104-
forthe State's consideration and direction. Failure to 193. See also State Executive Order 015 00;
promptly submit a disclosure statement or to follow • Tide IX of the Education Amendments of 1972,20
the State's direction in regard to the apparent conflict U.S.C. 1681 g135q.;
shall be grounds for termination of the contract. • The Uniform Administrative Requirements for
Grants and Cooperative Agreements to State and
Further, the Contractor shall maintain a written code Local Governments(Common Rule),at 45 CFR,
of standards governing the performance of its agent(s) Part 92;
engaged in the award and administration of contracts. • The Uniform Administrative Requirements for
Neither the Contractor nor its agent(s)shall participate Awards and Subawards to Institutions of Higher
in the selection,or in the award or administration ofa Education, Hospitals, Other Non-Profit
contract or subcontract supported by Federal funds if Organizations, and Commercial Organizations
a conflict of interest, real or apparent, would be (Common Rule),at 2 CFR 215;
involved. Such a con0ict would arise when:
• Office of Management and Budget Circulars A-87,
I. The employee,officer or agent; A-21 or A-122,and A-102 or A-110,whichever is
2. Any member of the employee's immediate applicable.
family; • OFFICE OF MANAGEMENT AND BUDGET
3. The employee's partner;or GUIDANCE FOR GRANTS AND
4. An organization which employees,or is about to AGREEMENTS 2 CFR Part 200
employ,any of the above, • The Hatch Act (5 USC 1501-1508) and Civil
has a financial or other interest in the firm selected for
award. Neither the Contractor nor its agent(s) will Service Reform Act, Public Law 95454 Section
solicit nor accept gratuities, favors, or anything of 4728.
monetary value from Contractor's potential • DeparuEducafLebrr,Health and Human Services,
contractors,or parties to subagreements. and Education and Related Agencies
Appropriations Act, 1990, PL 101-166, Section
P. Conformance with Law: The Contractor and its 511.
agent(s) shall at all times during the term of this • 45 CFR Subtitle A, Department of Health and
contract sWc0y adhere to all applicable federal laws, Human Services regulations.
state laws, Executive Orders and implementing • The Single Audit Act Amendments of 1996, 31
regulations as they currently exist and may hereafter USC 7501,Public Law 104-156,0MB Circular A-
be amended. Without limitation, these federal laws 133,and 45 CRF 74.26.
and regulations include: • The Federal Funding Accountability and
• Age Discrimination Act of 1975,42 U.S.C.Section Transparency Act of 2006(Public Law 109-282),
6101 St seq. and its implementing regulation, 45 as amended by §6062 of Public Law 110-252,
C.F.R.Part91; including without limitation all data reporting
• Age Discrimination in Employment Act of 1967, requirements required thereunder. This Act is
29 U.S.C.621 et seq.; also referred to as FFATA.
• Americans with Disabilities Act of1990(ADA),42 • The American Recovery and Reinvestment Act of
U.S.C. 12101 et seq,; 2009 (Public Law 111-5), including without
• The Drug Free Workplace Act of 1988,41 U.S.C. limitation all data reporting requirements required
701 n seq.; thereunder. This Act is also referred to as ARRA
• Equal Pay Act of 1963,29 U.S.C.206;
• Health Insurance Portability and Accountability Restrictions on Public Benefits: Pursuant to House Bill
Act of 1996, 42 U.S.C. § 1320d el seq. and
06S-1023, as codified at C.R.S. i 2476,5-101 Cl seq.,
implementing regulations,45 C.F.R.Parts 160 and exceptxcept as otherwise provided therein or where exempt by
164; federal law, the State is required to verify the lawful
• Immigration Reform and Control Act of 1986, 8 presence in the United States of each natural person 18 years
U.S.C. 13246; of age or older who applies for slate or local public benefits
• Pio-Children Act of 1994,20 U.S.C.6081 et seq.;
or for federal public benefits forthe applicant Accordingly,
For Contract Wizard Version 3.17 Page 7 of 15 Revised 0310:2015
Colorado Department of Human Services
Division of Contract Management
should the work performed by the Contractor under this failure to meet the performance measures
contract include the provision of any of said benefits to any established hereunder, the Executive Director of
natural person IS years of age or older who applies therefore the Colorado Department of Personnel and
for the applicant, the Contractor shall follow the Administration (Executive Director), upon
requirements of said law in the provision of aid benefits as request by the Department of Human Services,
if it were the State. The State will provide the Contractor for good cause shown,may debar Contractor and
with specific instruction on the identification prohibit Contractor from bidding on future
documentation required and the process to be followed by contracts. Contractor may contest the final
the Contractor to properly comply with the law if the work Evaluation and Review and Rating by: (a) filing
done under this contract is subject to these requirements rebuttal statement(s), which may result in either
R. Statewide Contract Management System: removal or correction of the evaluation (CRS
I. When Applicable. If the maximum amount §24-105-102(6)), or (b) under CRS 624-105-
payable to Contractor under this Contract is 102(6), exercising the debarment protest and
5100,000 or greater,either on the Effective Date appeal rights provided in CR5 8824-109-106,
or at anytime thereafter,this provision applies. 107,201 or 202,which may result in the reversal
2. Governing State Statutes. Contractor agrees to be of the debarment and reinstatement of Contractor
governed,and to abide,by the provisions of CRS by the Executive Director upon showing of good
624-102-205, 624-102-206, 624-103-601, 624- cause.
103.5-101 and 824-ID5-102 concerning the 3. CORA Disclosure: To the extent not prohibited
monitoring of vendor performance on state by federal law,this Contract and the performance
contracts and inclusion of contract performance measures and standards under CRS §24-103.5-
information in a statewide contract management 101 are subject to public release through the
system. Colorado Open Records Act,CR5 624.72-101,et
3. Performance Evaluation and Review. seq.
Contractor's performance shall be subject to
Evaluation and Review in accordance with the S. Performance Ratings and Guidelines:
terms and conditions of this Contract, State law The Contractor will be given a Final Contractor
(including without limitation CR5 §24-103.5- Performance Evaluation at the end of the cannel term in
101), and State Fiscal Rules, Policies and accordance with C.R.S. 624-102-205(6) and General
Guidance. Evaluation and Review of Provision R. above. The list of available Performance
Contractor's performance shall be part of the Ratings,along with guidelines for what final rating will be
normal contract administration process and given,are as follows:
Contractor's performance will be systematically I. Above Standard: This rating may be given where
recorded in the statewide Contract Management Contractor consistently performs in a manner that exceeds
System. Areas of Evaluation and Review shall the requirements of this Contract, and where such
include without limitation quality, cost and performance is measurable against objective factors
timeliness. Collection of information relevant to specifically identified for use in achieving the purposes of
the performance of Contractor's obligations this provision. If applicable to work performed under this
under this Contract shall be determined by the Contract,the objective factors and performance required to
bpcelhc requirements or such oulis bons and merit an -'Above Standard" rating are specified in a so
ahall include factors tailored to match the dedicated Exhibit to this Contract,wt,ich duty be included
requirements or Co.w obligationsherein f nen the rt er ow or svbse ntly be
hereunder. Such performance
information shall added by retinal contract amendment at any frme before
be entered into thestatewide Contract the end of the contract term. if there is no such dedicated
Management System al intervals dining the lttm Exhibit included or Subsequently added herein,mid ruling
hereof determined appropriate by the Slate,and a is unavailable.
final Evaluation, Review and Rating shall be 2. Rtandam: This rating will be given where, 1.)
rendered by the Sm1C
within 30 days of die end of Contractor's performance
hereunder meets the
the Contract term.
Contractor shall be notified requirements of this Contract in areas of quality,cost,and
following each performance Evaluation and timeliness:2.)Contractor's work is accepted by the Slate;
Review, and shall address or correct any and 3.) Ml payment hereunder is made to Contractor for
identified problem in a timely manner and such performance.
maintain work progress. 3. Below Standard: This rating may be given where
Gross Failure to Meet Performance Measures. Should Contactor materially fails to perform the requirements of
the final performance Evaluation and Review this Contract and such failure results in the State's
determine that Contactor demonstrated a gross invocation of contract remedies and/or contract
For Contract Wizard Version 3.17 Page 8 of 15 Revised 03202015
Colorado Department of Human Services
Division of Contract Management
termination in accordance with General Provision X. executive officer for resolution. This process is not
below intended to supersede any other process for the
resolution of controversies provided by law.
T. Piscrimination:The Contractor during the performance
of this contract shall: X. Remedies:Acceptance is dependent upon completion
I. not discriminate against any person on the basis of of all applicable inspection procedures. The State
race, color, national origin, age, sex, religion and reserves the right to inspect the goods and/or services
handicap,including Acquired Immune Deficiency provided under this contract at all reasonable times
Syndrome(AIDS)or AIDS related conditions. and places. The Executive Director of the State or
2. not exclude from participation in,or deny benefits • her/his designee may exercise the following remedial
to any qualified individual with a disability, by actions should s/he find the Contractor substantially
reason of such disability. failed to satisfy the scope of work found in this
Any person who thinks he/she has been discriminated contract. Substantial failure to satisfy the scope of
against as related to the performance of this contract work shall be defined to mean substantially
has the right to assert a claim,Colorado Civil Rights insufficient, incorrect or improper activities or
Division,C.R.S.§24-34-302,et seq. inaction by the Contractor. Without limitation, the
State has the right to:
U. Criminal Background Check:Pursuant to C.R.S.§27- I. withhold payment until performance is cured,
90-I11 and Department of Human Services Policy VI- 2. require the vendor to take necessary action to
2.4,any independent contractor,and its agent(s),who ensure that the future performance conforms to
is designated by the Executive Director or the contract requirements,
Executive Director's designee to be a contracting 3. request removal of a Contractor's agent from
employee under C.R.S. §27-90-11 1, who has direct contract work,
contact with vulnerable persons in a state-operated 4. equitably reduce the payment due the vendor to
facility, or who provides state-funded services that reflect the reduced value of the services
involve direct contact with vulnerable persons in the performed,
vulnerable person's home or residence,shall: submit 5. recover payment for work that due to the
to a criminal background check,and report any arrests, Contractor cannot be performed or would be of no
charges,or summonses for any disqualifying offense value to the State,
as specified by C.R.S. §27-90-111 to the State. Any 6. modify or recover payments (from payments
Contractor or its agent(s),who does not comply with under this contract or other contracts between the
C.R.S. §27-90-III and BUS Policy VI-2.4, may, at State and the vendor as a debt due to the State)to
the sole discretion of the Stete, be suspended or correct an error due to omission, error, fraud
terminated. and/or defalcation,
7. terminate the contract
V. Litigation: The Contractor shall within five (5)
calendar days after being served with a summons, These remedies in no way limit the remedies available
complaint,or other pleading which has been filed in to the State in the termination provisions of this contract,
any federal or slate court or administrative agency or remedies otherwise available at law.
notify the State that it is a party defendant in a case
which involves services provided under this contract. Y. Termination:
The Contractor shall deliver copies of such I. Termination for Default!The Slate may terminate
document(s) to the State's Executive Director. The the contract for cause. If the State terminates the
term "litigation" includes an assignment for the contract for cause,it will first give ten(10)days
benefit of creditors, and filings in bankruptcy, prior written notice to the Contractor,stating the
reorganization and/or foreclosure. reasons for cancellation, procedures to correct
problems,if any,and the date the contract will be
W. [lisoulec Except as herein specifically provided terminated in the event problems have not been
otherwise, disputes concerning the performance of corrected.In the event this contract is terminated
this contract which cannot be resolved by the for cause, the State will only reimburse the
designated contract representatives shall be referred in Contractor for accepted work or deliverables
writing to a senior departmental management staff received up to the date of termination.In the event
designated by the department and a senior manager this contract is terminated for cause, final
designated by the Contractor. Failing resolution at payment to the Contractor may be withheld at the
that level,disputes shall be presented in writing to the discretion of the State until completion of final
Executive Director and the Contractor's chief audit.Notwithstanding the above,the Contractor
For Contract Wizard Version 3.17 Page 9 of 15 Revised 03/20:2015
Colorado Department of Human Services
Division of Contract Management
may be liable to the State for the State's damages. c. reasonable profit on the completed but
If it is determined that the Contractor was not in undelivered work up to the date of
default then such termination shall be treated as a termination
termination for convenience as described herein. d. the costs of settling claims arising out of the
2. Termination for Convenience: The State shall termination of subcontracts or orders,not to
have the right to terminate this contract by giving exceed 30 days pay for each subcontractor
the Contractor at least twenty (20) days prior e. reasonable accounting, legal, clerical, and
written notice. If notice is so given,this contract other costs arising out of the termination
shall terminate on the expiration of the specified settlement.
time period, and the liability of the parties
hereunder for further performance of the terms of In no event shall reimbursement under this clause
this contract shall thereupon cease,but the parties exceed the contract amount reduced by amounts
shall not be released from the duty to perform previously paid by the State to the Contractor.
their obligations up to the date of termination.
3. Immediate Termination: This contract is subject Z. Venue: The parties agree that venue for any action
to immediate termination by the Slate in the event related to performance of this contract shall be in the
that the State determines that the health,safety,or City and County of Denver,Colorado.
welfare of persons receiving services may be in
jeopardy. Additionally, the State may AA.Understanding of the Parties:
immediately terminate this contract upon I. Complete Undrrstandinni This contract is
verifying that the Contractor has engaged in or is intended as the complete integration of all
about to participate in fraudulent or other illegal understandings between the parties. No prior or
acts. contemporaneous addition, deletion, or other
4. Termination for Financial Exigency: The State amendment hereto shall have any force or effect
shall have the right to terminate this contract for whatsoever, unless embodied herein in writing.
financial exigency by giving the Contractor at No subsequent novation, renewal, addition,
least thirty(30)days prior written notice.For the deletion, or other amendment hereto shall have
purposes of this provision, a financial exigency any force or effect unless embodied in a written
shall be a determination made by the Colorado contract executed and approved pursuant to the
legislature or its Joint Budget Committee that the State Fiscal Rules. Descriptive headings as used
financial circumstances of the State are such that herein are for convenience and shall not control
it is in the best interest of the State to terminate or affect the meaning or construction of any
this contract. If notice of such termination is so provision of this contract.
given, this contract shall terminate on the 2. Severability:To the extent that this contract may
expiration of the time period specified in the be executed and performance of the obligations of
notice, and the liability of the parties hereunder the panics may be accomplished within the intent
for further performance of the terms of this of the contract, the terms of this contract are
contract shall thereupon cease, but the parties severable, and should any term or provision
shall not be released from the duty to perform hereof be declared invalid or become inoperative
their obligations up to the date of termination. fur any reason,such invalidity or failure shall nut
affect die validity of any other inn or provision
In the event that the State terminates this contmet hereof
under the Termination for Con 3. Benefit and Richt of' Action: Except as herein
Termination for Financial Fxigency provisions, specifically provided otherwise, it is expressly
the Contractor is mined to submit a termination understood and agreed that this contract shall
claim within ten(IV)days or the effective dam of inure to the benefit of and be binding upon the
termination. Thot nation claim shall address panics hereto and their respective a rs and
s
and the State shall consider paying the following assigns. All rights of action relating to
costs: enforcement of the terms and conditions shall be
a. the contract price for performance of work, Strictly reserved to the State and the named
which is accepted by the State, up to the Contractor.Nothing contained in this agreement
effective date of the termination, shall give or allow any claim or right of action
b. reasonable and necessary cosi incurred in whatsoever by any other third person. It is the
preparing to perform the terminated portion express intention of the State and the Contractor
oldie contract that any such person or entity,other than the State
or the Contractor, receiving services or benefits
For Contract Wizard Version 3.17 Page 10 of 15 Revised 03'20:2015
Colorado Department of Human Services
Division of Contract Management
under this agreement shall be deemed an be considered binding upon execution of this contract
incidental beneficiary only. and shall remain in effect during the term of the
4. Waiver: The waiver of' any breach of a term contract including any extensions.
hereof shall not be construed as a waiver of any
other tens, or the same term upon subsequent DD.Colorado Department of Human Services ICDHS1
breach. Fraud Policy The CDHS Fraud Policy addresses the
5. Survival:The State and the Contractor's obligations need for effective and consistent measures for
under this contract shall survive following preventing, detecting, and deterring fraud. The
termination or expiration to the extent necessary to relevant parties discussed in the policy include CDHS
give effect to the intent and understanding of the employees, CDHS management, CDHS appointees,
parties. and community partners, including contractors,
6. Subcontracting: Except as herein specifically grantees, vendors, and other sub-recipients. CDHS
provided otherwise,the duties and obligations of employees, clients, and community partners will all
the Contractor arising hereunder cannot be benefit from an effective fraud prevention,detection,
assigned,delegated,subgranted or subcontracted and deterrence policy because fraud can damage the
except with the express prior written consent of reputation and public trust of CDHS.
the State. The subgrams and subcontracts
permitted by the State shall be subject to the All appointees and employees of the CDHS must
requirements of this contract. The Contractor is comply with the standards of conduct set forth in Title
responsible for all subcontracting arrangements, 24, Anicle IS of the Colorado Revised Statutes,
delivery of services, and performance of any (mown as the Code of Ethics, including exposing
subgrantor or subcontractor. The Contractor corruption or impropriety in government, whenever
warrants and agrees that any subgrant or discovered.The CDHS Fraud Policy outlines how the
subcontract,resulting from its performance under CDHS employees and community partners should
the terms and conditions of this contract. shall report fraud and how fraud will be investigated once it
include a provision that the said subgrantor or is reported.
subcontractor shall abide by the terms and
conditions hereof. Also, the Contractor warrants The full text of the CDHS Fraud Policy, which
and agrees that all subgrants or subcontracts shall Contractor hereby agrees to be subject to and abide by,
include a provision that the subgrantor or can be found on the CDHS Fraud Policy and Training
subcontractor shall indemnify and hold harmless web page at:
the State.The subgrantors or subcontractors must jttpi;www,colorado tovcs'Satellite CDHS-
be certified to work on any equipment for which Emo CBON 1251610724004.
their services are obtained.
EE. Performance Outside the State of Colorado and/or the
BB. Holdover: In the event that the State desires to United States: Not applicable if Contract Funds
continue the services provided for in this Contract and include any federal funds] Following the Effective
a replacement contract has not been fully executed by Date, Contractor shall provide written notice to the
the expiration date of the Contract,this Contract may State, in accordance with General Provision E.
be extended unilaterally by the State for a period of up (Notices and Representatives),within 20 days of the
to two (2) months upon written notice to the earlier to occur of Contractor's decision to perform,or
Contractor under the same terms and conditions of the its execution of an agreement with a Subcontractor to
original Contract including,but not limited to,prices, perform,Services outside the State of Colorado and/or
rates, and service delivery requirements. However, the United States. Such notice shall specify the type
this extension terminates when the replacement of Services to be performed outside the State of
contract becomes effective when signed by the State Colorado and/or the United States and the reason why
Controller or an authorized delegate it is necessary or advantageous to perform such
CC.Health Insurance Portability&Accountability Act of Services at such location or locations. All notices
1996 ("HIPAA"). Federal law and regulations received by the State pursuant to this requirement shall
governing the privacy of certain health information be posted on the Colorado Department of Personnel&
requires a"Business Associate Contract"between the Administration's website. Knowing failure by
State and the Contractor. 45 C.F.R. Section Contractor to provide notice to the State under this
164.504(e). If applicable to this Contract, attached requirement shall constitute a material breach of this
and incorporated herein by reference and agreed to by Contract
the parties is a HIPAA Business Associate Addendum
for HIPAA compliance.Terms of the Addendum shall
For Contract Wizard Version 3.17 Page 11 of 15 Revised 03/20:2015
Colorado Department of Human Services
Division of Contract Management
FF. C-Stat-Performance Based Program Analysis and
Management Straws'fC-Stat Strategyt: For the sole
purpose of providing support to the State's internal
C-Stat Strategy,the parties understand and agree that
upon request from the State,and without any
additional cost to the State,the Contractor shall
collect,maintain,and provide to the State certain
contract performance data determined by the State
during the term hereof to assist the State to measure
and assess the programmatic effectiveness of the
Contractor's performance hereunder,all in suppon of
the State's internal continuous quality improvement
working towards positive outcomes and managing its
performance for the betterment of all Colorado
residents.
For Contract Wizard Version 3.17 Page 12 of 15 Revised 03202015
Colorado Department of Human Services
Division of Contract Management
SPECIAL PROVISIONS
These Special Provisions apply to all contracts except where noted in italics.
I. CONTROLLER'S APPROVAL.CRS§24-30-202(I).This contract shall not be valid until it has been
approved by the Colorado State Controller or designee.
2. FUND AVAILABILITY.CRS§24-30-202(5.5).Financial obligations of the State payable after the current
fiscal year are contingent upon funds for that purpose being appropriated,budgeted,and otherwise made
available.
3. GOVERNMENTAL IMMUNITY.No term or condition of this contract shall be construed or interpreted as
a waiver,express or implied,of any of the immunities,rights,benefits,protections,or other provisions,of the
Colorado Governmental Immunity Act,CRS §24-10-10t et seq.,or the Federal Tort Claims Act,28 U.S.C.
§§1346(b)and 2671 et seq.,as applicable now or hereafter amended.
4. INDEPENDENT CONTRACTOR.Contractor shall perform its duties hereunder as an independent
contractor and not as an employee.Neither Contractor nor any agent or employee of Contractor shall be deemed
to be an agent or employee of the State.Contractor and its employees and agents are not entitled to
unemployment insurance or workers compensation benefits through the State and the State shall not pay for or
otherwise provide such coverage for Contractor or any of its agents or employees.Unemployment insurance
benefits will be available to Contractor and its employees and agents only if such coverage is made available by
Contractor or a third party.Contractor shall pay when due all applicable employment taxes and income taxes and
local head taxes incurred pursuant to this contract.Contractor shall not have authorization,express or implied,to
bind the State to any agreement,liability or understanding,except as expressly set forth herein.Contractor shall
(a)provide and keep in force workers'compensation and unemployment compensation insurance in the amounts
required by law,(b)provide proof thereof when requested by the State,and(c)be solely responsible for its acts
and those of its employees and agents.
5. COMPLIANCE WITH LAW.Contractor shall strictly comply with all applicable federal and State laws,
roles,and regulations in effect or hereafter established,including,without limitation,laws applicable to
discrimination and unfair employment practices.
6. CHOICE OF LAW.Colorado law,and rates and regulations issued pursuant thereto,shall be applied in the
interpretation,execution,and enforcement of this contract.Any provision included or incorporated herein by
reference which conflicts with said laws,rules,and regulations shall be null and void.Any provision incorporated
herein by reference which purports to negate this or any other Special Provision in whole or in part shall not be
valid or enforceable or available in any action at law,whether by way of complaint,defense,or otherwise.Any
provision rendered null and void by the operation of this provision shall not invalidate the remainder of this
contract,to the extent capable of execution.
7. BINDING ARBITRATION PROHIBITED.The State of Colorado does not agree to binding arbitration by
any extra judicial body or person.Any provision to the contrary in this contact or incorporated herein by
reference shall be null and void.
8. SOFTWARE PIRACY PROHIBITION.Governor's Executive Order D 002 00.State or other public
funds payable under this contract shall not be used for the acquisition,operation,or maintenance of computer
software in violation of federal copyright laws or applicable licensing restrictions.Contractor hereby certifies and
warrants that,during the term of this contract and any extensions,Contractor has and shall maintain in place
appropriate systems and controls to prevent such improper use of public funds.If the State determines that
Contractor is in violation of this provision,the State may exercise any remedy available at law or in equity or
under this contract,including,without limitation,immediate termination of this contract and any remedy
consistent with federal copyright laws or applicable licensing restrictions.
9. EMPLOYEE FINANCIAL INTEREST/CONFLICT OF INTEREST.CRS§§24-I8-201 and 24-50-507.
The signatories aver that to their knowledge,no employee of the State has any personal or beneficial interest
For Contract Wizard Version 3.17 Page 13 of 15 Revised 0320'2015
Colorado Department of Human Services
Division of Contact Management
whatsoever in the service or property described in this contract.Contractor has no interest and shall not acquire
any interest,direct or indirect, that would conflict in any manner or degree with the performance ofContractor's
services and Contractor shall not employ any person having such known interests.
10. VENDOR OFFSET.CRS§§24.30-202(I)and 24-30-202.4.[Not Applicable to intergovernmental
agreements)Subject to CRS§24-30-202.4(3.5),the State Controller may withhold payment under the State's
vendor offset intercept system for debts owed to State agencies for:(a)unpaid child support debts or child
support arreamges; (b)unpaid balances of lax,accrued interest,or other charges specified in CRS§39-2I-101,et
seq.;(c)unpaid loans due to the Student Loan Division of the Department of Higher Education;(d)amounts
required to be paid to the Unemployment Compensation Fund;and(e)other unpaid debts owing to the State as a
result of final agency determination or judicial action.
11. PUBLIC CONTRACTS FOR SERVICES.CRS§8-17.5-101.[Not Applicable to agreements relating to
the offer,issuance,or sale of securities,investment advisory services or fund management services,sponsored
projects,intergovernmental agreements,or information technology services or products and services]
Contractor certifies,warrants,and agrees that it does not knowingly employ or contract with an illegal alien who
will perform work under this contract and will confirm the employment eligibility of all employees who are
newly hired for employment in the United States to perform work under this contract,through participation in the
E-Verify Program or the Department program established pursuant to CRS §8-17.5-102(5)(c),Contractor shall
not knowingly employ or contract with an illegal alien to perform work under this contract or enter into a contract
with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or
contract with an illegal alien to perform work under this contract.Contractor(a)shall not use E-Verify Program
or Department program procedures to undertake pre-employment screening of job applicants while this contract
is being performed,(b)shall notify the subcontractor and the contracting State agency within three days if
Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien for work
under this contract,(c)shall terminate the subcontract if a subcontractor does not stop employing or contracting
with the illegal alien within three days of receiving the notice,and(d)shall comply with reasonable requests
made in the course of an investigation,undertaken pursuant to CRS §8-17.5-102(5),by the Colorado Department
of Labor and Employment.If Contractor participates in the Department program,Contractor shall deliver to the
contracting State agency,Institution of Higher Education or political subdivision a written,notarized affirmation,
affirming that Contractor has examined the legal work status of such employee,and shall comply with all of the
other requirements of the Department program.If Contractor fails to comply with any requirement of this
provision or CR5 §8-17.5-101 et seq.,the contracting State agency, institution of higher education or political
subdivision may terminate this contract for breach and,if so terminated,Contractor shall be liable for damages.
12. PUBLIC CONTRACTS WITH NATURAL PERSONS.CRS§24-76.5-101.Contractor,if a natural
person eighteen(18)years of age or older,hereby swears and affirms under penalty of perjury that he or she(a)is
a citizen or otherwise lawfully present in the United States pursuant to federal laws(b)shall comply with the
provisions of CRS§24-76.5-101 ct seq.,and(c)has produced one form of identification re9uired by CR5§24-
96.5-103 prior to the effective date of this contract.
Revised t-1-09
For Contract Wizard Version 3.17 Page 14 of 15 Revised 03202015
Colorado Department of Human Services
Division of Contract Management
Contract Routing Numbs 'o.. ,' t _... . I 17 IHGA
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's behalf and acknowledge
that the State is relying out their representations to that effect.
CONTRACTOR STATE OF COLORADO
Pitkin County Health&Human Services
By: Nan Sundeen John W.Hickenlooper,Governor
Title:Director of Health and Human Services Department of Human Services
Re" e Bicha,Exec/ve Director
k *Signature _. — P, Iu
/ By:Julie Krow, $pm Executivee Director
Date: •7 c( • ( (1 • Signatory avers to the State Controller or delegate that
_ •
"" - - Contractor has not begun performance or that a Statutory
Violation waiver has been req{fIreskd under Fiscal Rules
Date: I Ygat
2nd Contractor Signature if Needed LEGAL REVIEW
By: Cynthia H.Coffman,Attorney General
Title:
By.
_. . . .. ....gnat...__ _. -.. . .
Signature-Assistant Attorney General
'Signature Signature
Date: Date: _..._._._.
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS$2430.202 requires the State Controller to approve all State Contracts.This Contract is not valid until signed and dated below
by the Stale Controller or delegate.Contractor is not authorized to begin performance until such time.If Contractor begins
performing prior thereto,the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or
services provided hereunder.
STATE CONTROLLER
Robert Janos,CPA,MBA,JD
By: //////Wu
Clint Woodruff.Cot o
Date: 0(11 14
For Contract Wizard Version 3.17 Page 15 of 15 Revised 03'2012015
Colorado Department of Human Services
Division of Contact Management
Exhibit A —Statement of Work
A. Background
For purposes of this Exhibit A, Contractor may also be referred to as"County." The Slate has entered into a
contract("Universal Membership Agreement")(State contract routing number 16 THEA 83111)(Exhibit 13)with
'FALX Corporation, a provider of Equifax Verification Services("EVS")and intends to execute an amendment
("Schedule A")(Slate contract routing number 16 THEA 87603)(Exhibit C)to the Universal Membership
Agreement(collectively"Work Number Agreement"). The Work Number Agreement allows EVS to provide
employment verification services directly to Colorado counties. The State acts only as a pass-through entity,
meaning that EVS will hill the State for fees incurred by the counties,and the Slate will then bill the counties
individually.
The Work Number Agreement is between the State and EVS with participating counties each signing
Participation Agreements(see Exhibit I to Universal Membership Agreement). The Work Number Agreement
obligates the counties collectively and Contractor individually to pay EVS via the Slate for services rendered so
the State and County arc entering into this Contract to memorialize the State's and County's responsibilities as
they relate to the Work Number Agreement.
B. Payment
County shall pay the State for County's use of services within the scope of the Work Number Agreement. The
State shall promptly pass through County's payments to EVS in accordance with the Work Number Agreement.
Except within its role as a pass through entity,the State is not liable for County's obligations incurred under this
Contract or the Work Number Agreement. The State shall provide each County an invoice at least 30 days prior
to the date the payment is due to EVS. The State shall ensure that any payment to the Slate is paid over to EVS
prior to the date that payment is due to EVS.
C. Annual Minimum
The Work Number Agreement by the terms of the Schedule A obligates each Participating County,through the
Slate as the pass-through entity, to pay the Participating County's proportionate share of the Annual Minimum
Payment as set forth in this Intergovernmental Agreement and Exhibit I to the Schedule A. The Annual
Minimum Payment is$912256.45, which is based upon an estimated 164,965 income verification requests at
$5.53 per income verification request. County's responsibility for its share of any deficiency survives
termination of this Contract or the Work Number Agreement.
County is responsible for its percentage of the Annual Minimum Payment based upon the following formula:
IVotiHb'L Ave nen Brwimtt ]]heel ) [Total Partte.pahng em,nt;oxt Prev,nus Usage] =County
Parentage
ICounty Percentage] X !Annual Minimum Payment]=County Financial Obligation
u' Cbunly a Actual fllmual I'ayn'cnt is lou than Couoty'3 Financial Obligation,THEIN County in conalUcrcu a
Deficient County and shall pay any deficiency according to the following formula;
'Annual Minimum Payment[— [Total Actual Annual Payment] —Total Deficiency
[County Financial Obligation]— [County Actual Annual Payment] _County Deficiency
'County Deficiency' /'Total counties' Deficiency)=Deficient County Percentage
[Deficient County Percentage' X 'Total Deficiency] =Deficient County Payment to State
rxbibit A-Page I ora
This table represents each county's financial obligation:
County County
County Avenge Financial
Previous Obligation
Usage
Adams 20,445 $113,060.85
Arapahoe 8,177 $45,218.81
Bent 92 $508.76
Boulder 9,920 $54,857.60
Broomfield 831 $4,595.43
Clear Creek 7 $38.71
Conejos 87 $481.11
Crowley 7 $38.71
Delta 364 $2,012.92
Denver 30,040 5166,121.20
Douglas 1,013 $5,601.89
Eagle/Pitkin 551 $3,047.03
El Paso 18,549 $102,575.97
Fremont 814 $4,501.42
Grand 66 $364.98
Gunnison 9 $49.77
Jefferson 20,173 $111,556.69
Kiowa 7 $38.71
Kit Carson 7 $38.71
La Plata 351 $1,941.03
Larimer 21,217 $117,330.01
Las Animas 182 $1,006.46
Mesa 3,914 $21,644.42
Moffat 95 $525.35
Montezuma 476 $2,632.28
Morgan 2,349 $12,989.97
Phillips 12 $66.36
Pueblo 5,198 528,744.94
Rio Grande 101 $558.53
Routt 571 $3,157.63
San Miguel 139 $768.67
Sedgwick 35 $193.55
Summit 38 $210.14
Weld 19,128 $105,777.84
TOTAL 164,965 5912,256.45
Exhibit A•Page 2 of 3
D. Miscellaneous Provisions
I. State is acting as a fiscal agent for County, passing through payment of all costs from County to EVS,
including the Annual Minimum Payment.The Slate shall not be liable for any debt or payment
obligation, including the Annual Minimum Payment,incurred by County pursuant to this Contract or the
Work Number Agreement, provided, however,that any failure by the State to pass through such
payments from County shall constitute a breach of this Contract by the State. The Slate shall be
obligated to pay Myer to EVS any funds received from a County. Upon breach of this agreement by the
State, the County shall have the right to terminate this Contract upon written notice and at least thirty(30)
days in which the Stale may cure the breach or any other remedy allowed by law. If County fails to pay
the Slate for County's costs incurred under this Contract or the Work Number Agreement, the Stale shall
have the right to terminate this Coni ract upon written notice and at least thirty(30)days in which County
may cure the breach.
2. The Work Number Agreement is for the benefit of County. Any amendments or changes to the Work
Number Agreement or any new Schedule A or amendments to Schedule A must he signed by or
approved by a person authorized by the governing body for each County in accordance with the County's
local procedures prior to the amendment or clmnge being effective as to a participating county. The
State shall not execute amendments or revisions to the Work Number Agreement or Schedule A that bind
any participating county without the participating counties'consent as provided herein,
3. County's liability for any unpaid fees owed under this Contract or the Work Number Agreement shall
survive termination of this Contract as to County who has not paid all required fees until the State
receives payment from County.
4. Annual Termination: Unless specified elsewhere in this Contract or the Work Number Agreement, the
State or County may only terminate this Contract,upon 60 days written notice,so as to align with the end
of an annual term stated in the Work Number Agreement. If a County elects to terminate it shall not be
obligated to expend any funds, including any annual minimum payment, for the years following its
termination.
Si .1-13c 5tmc muy cacculu aimilur agrcelnents with new comings not originally pun or lib Contract or the
Work iNumbcr ngrccnucnt. Ink Stale exccule5 a similar acrcC1ncn(with a I1e11'coolly of UMW. Inc
Nate and County will recalculate die annual minimum for Hie subsequent annual term.
END OF EXHIBIT A
Exhibit A-Page 3 ora
UNIVERSAL MEMBERSHIP AGREEMENT
for
The Work Numbers Social Services
This Universal Membership Agreement(the"Agreement')is entered into by and between TALX
Corporation(a provider of Equifax Verification Services),a Missouri Corporation, located at 11432 Lackland Road,St.
Louis, Missouri("EVS"),and the State of Colorado, Colorado Department of Human Services("CONS").
RECITALS:
A. EVS operates The Work Number,a service used to verify employment and income information about an
individual("Consumers"),and various other services used to verify certain Consumer information(EVS's services
are collectively referred to herein as the'Service");and
B. CURS wishes to have Participating Counties use use the Service to verify certain Consumer information.
NOW,THEREFORE,EVS and CDHS agree as follows:
I. SCOPE OF THE AGREEMENT. EVS agrees to allow Colorado's counties to use the Service pursuant to the
terms of this Agreement. In that regard, this Agreement shall be considered a"master agreement" allowing the
said Colorado counties to participate, provided such counties individually execute a Participation Agreement
("Participation Agreement") in the form of Exhibit 1 attached hereto(including Attachment Ito Exhibit I), along
with an applicable Schedule A. II is further acknowledged by the parties that while this Agreement is with the
State of Colorado Department of Human Services, the use by the said counties will be done by each under its
slows as an individual political subdivision of the State and as a separate legal entity pursuant to the terms of this
Agreement;and the Participation Agreement and Schedule A executed by said counties. All references herein,or
any applicable Schedule A,to"party"or"parties"and all references to"Participating County",shall apply equally
and separately to each county executing a Participation Agreement and Schedule A(the"Participating County").
This Agreement consists of the general terms set forth in the body of this Agreement, Exhibit I, Exhibit 2, and
each Schedule A executed by the parties which may contain additional terms. If there is a conflict between the
general terms and conditions of this Agreement and any Exhibit or Schedule, the provisions of the Exhibit or
Schedule will govern and control. This Agreement specifically supersedes and replaces any agreement between
the parties that predates this Agreement and which relates to the Service as provided in each Schedule A even if'
the prior agreement contains an"entire agreement"or"merger'clause,and any such agreements are terminated.
2. EVS OBLIGATIONS. The Service will provide Participating County with automated access to certain
employment and/or income data("Data")furnished to EVS by employers.
3. PARTICIPATING COUNTY OBLIGATIONS.
a. Participating County shall comply with the terms set forth in this Agreement which includes Exhibits I and 2,
and also each Schedule A executed by the parties which may contain additional terms.
b. CDHS shall pay for the Services on behalf of the Participating Counties and shall promptly notify EVS of any
failure by any Participating County to provide CDHS with sufficient funds to cover the cost of Services. Upon
notification from CDHS of such failure, EVS will suspend and/or terminate the Services for such Participating
County.
Except to the extent that Agency has provided an exemption certificate, direct pay permit or other such
appropriate documentation, EVS shall add to each invoice any sales, use, excise,value-added, gross receipts,
services,consumption and other similar transaction taxes however designated that are properly levied by any
taxing authority upon the provision of the Services, excluding, however, any state or local privilege or
franchise taxes,taxes based upon EVS's net income and any taxes or amounts in lieu thereof paid or payable
by EVS as a result of the foregoing excluded items.
If payment is made by credit card, EVS will charge the credit card each month for transactions completed in
the prior month. CDHSwill be invoiced electronically through Equifax's Electronic Invoice Presentation &
Payment (EIPP) program. Requests for paper billing are available upon CDHS's request and are subject to
additional monthly fees. Such fees are subject to modification by EVS at intervals of no less than one year,
upon prior written agreement between CDHS and EVS.
PLEASE FAX TO THE WORK NUMBER SOCIAL SERVICES at 888-708-6816
Auyus:11.2015/CUS')WR UnirandLNembeahip AQrtemeni.The wmk Numbc'Social Sa,lcs Page lot? 2
VVAOA 1.
EVS and CDHS understand and agree that CDHS is acting as a fiscal agent for the Participating Counties,
passing through payment of all costs from the Participating Counties to EVS. CDHS shall not be liable for any
debtor payment obligation incurred by a Participating County pursuant to(his Agreement or any Participation
Agreement,provided, however,that any failure by CDHS to obtain and pass through such payments from any
Particpating County shall constitute a breach of this Agreement by such Participating County; and EVS shall
have the right to terminate this Agreement with respect to such Participating County upon written notice and at
least thirty (30) days in which CDHS may cure the breach. In order to appropriately allocate costs among
Participating Counties using the Service,EVS will provide to CDHS an itemized invoice,detailing activity by
each Panicipating County.
c. Participating County certifies that it will order Data from the Service only when Participating County intends
to use the Data 6) in accordance with the Fair Credit Reporting Act ("FCRA') and all state law FCRA
counterparts as though the Data is a consumer report, and (ii) for one of the following FCRA permissible
purposes: (I) in connection with a credit transaction involving the Consumer on whom the Data is to be
furnished and involving the extension of credit to.or review or collection of an account of,the consumer, (2)
in connection with a determination of the consumers eligibility for a license or other benefit granted by a
governmental instrumentality required by law to consider an applicant's financial responsibility or status, or
(3) when Participating County othenvise has a legitimate business need for the information either in
connection with a business transaction that is initiated by the Consumer,or to review an account to determine
whether the Consumer continues to meet the teen of the account;and for no other purpose.
Participating County agrees to only use the Data consistent with the obligations of users of consumer reports
as provided for in the Consumer Financial Protection Bureau(the"Cf PB")'s Notice Form attached as Exhibit
1•
d. To the extent Participating County orders any Data relating to Vermont residents, Participating County
certifies that it will comply with applicable provisions under Vermont law. In particular.Participating County
certifies that it will order Data relating to Vermont residents only after Participating County has received prior
Consumer consent in accordance with VFCRA Section 2480e and applicable Vermont Rules. Participating
County Further certifies that the attached copy of VFCRA Section 2480e applicable Vermont Rules as
referenced in Exhibit 2 was received from EVS.
c. Participating County may use the Data provided through the Service only as described in this Agreement.
Participating County may reproduce or store the Data obtained from the Service solely for its own use in
accordance with this Agreement, and will hold all Data obtained from the Service under this Agreement in
strict confidence and will not reproduce, reveal, or make it accessible in whole or in part, in any manner
whatsoever, to any others unless required by law, or unless Participating County first obtains EVS's written
consent;provided,however,dial Participating County may discuss Consumer Data with the Data subject when
Participating County has taken adverse action against the subject based on the Data. Participating County will
not provide a copy of the Data to the Consumer,except as may be required or permitted by law or approved in
writing by EVS, except in any state where this contractual prohibition would be invalid. Participating County
will refer the Consumer to EVS whenever the Consumer disputes the Data disclosed by Participating County.
Participating County will not interpret the failure of CYO to rdgm Data ID a alatcmcnt Rigging Iliac
geniamyf 3 mall martial Dame thi Iailarb may RVSull FIVlIl env Yr IIIVIa IiwIvii unrntuwq w credit
wonhocss.
1. Participating County may access, use•and store the Data only at or from locations within the territorial
boundaries or the Unita 5Wtc5,Canada,and the United Mao 181111vtiea yr rustle wise,Guam and Ow virgin
Islands (the "Permitted Termer)"), Participatinb County may 'vt access, u or store the Data or EV5
Confidential Information at or from, orsend the Data or Confidential Information to,any location outside of
the Permitted Territory without Participating County first obtaining EVS's written permission.
g. Participating County represents and warrants it(i) is administering a government funded benefit or program,
(ii) has been given the legal authority to view the Data by the Consumer or by operation of law, and iii) is
re9ucstins the Dan in compliance with all laws.
h. Participating County acknowledges it shall employ decision making processes appropriate to the nature of the
transaction in accordance with commercially reasonable standards and will utilize the Data as part or its
process.
Augua 11.2015 Universal Membership Agreement.The Work Number`Social Services Poge 2 of 7
cusamn
i. Participating County represents and warrants it has written authorization from the Consumer to verify income.
Participating County need not use any particular form of authorization or obtain a separate signature for
verifying income provided that the form constitutes Consumer authorization. Notwithstanding the foregoing,
in the event Participating County is using the Service to collect on defaulted child support obligations,
Participating County is not required to obtain such authorization.
j. Participating County may not allow a third party service provider(hereafter"Service Provider")to access,use,
or store the Service or Data on its behalf without first obtaining EVS's written permission and without the
Service Provider first entering into a Client Service Provider Information Use and Nondisclosure Agreement
with EVS.
k. In order to ensure compliance with this Agreement, applicable law and EVS policies, EVS may conduct
reviews of Participating County activities, from time to time, during normal business hours, at all locations
containing relevant records, with respect to Participating County's requests for Data and/or its use of Data.
Participating County shall provide documentation within a reasonable lime to EVS as reasonably requested for
purposes of such review. Participating County(i)shall cooperate fully with any and all investigations by EVS
of allegations of abuse or misuse of the Services and allow EVS to access its premises, records,and personnel
for purposes of such investigations if EVS deems such access is necessary to complete such investigation(s),
(ii)agrees that any failure to cooperate fully and promptly in the conduct of any audit constitutes grounds for
immediate suspension of the Service and/or termination of the Agreement,and(iii)shall promptly correct any
discrepancy revealed by such investigation(s). Participating County shall include the name and email address
of the appropriate point of contact to whom such request should be made in the space providedin Participating
County's Participation Agreement . Participating County may change its contact information upon written
notice.
I. Additional representations and warranties as may be set forth in each Schedule A.
4. PARTICIPATING COUNTY USE OF SERVICE.
Data on the Service may be accessed by Participating County to verify Consumer's employment status ("The
Work Number Employment Verification") or income ("The Work Number° Income Verification") for the
purposes of determining eligibility for receipt of public aid or assistance, prevention or identification of fraud,
overpayments associated with the receipt of public aid or assistance,or the establishment and enforcement of child
support orders and collecting on defaulted obligations that are in effect and valid.
5. DATA SECURITY. This Section 5 applies to any means through which Participating County orders or accesses
the Service including,without limitation,system-to-system,personal computer or the Internet. For the purposes of
this Section 5,the term"Authorized User" means a Participating County employee that Participating County has
authorized to order or access the Service and who is trained on Participating County's obligations under this
Agreement with respect to the ordering and use of the Service, and the Data provided through same, including
Participating County's FCRA and other obligations with respect to the access and use of Data.
a. Participating County will,with respect to handling any Data provided through the Service:
I. ensure that only Authorized Users having a need to know can order or have access to the Service for an
authorized purpose,
2. ensure that Authorized Users do not order Data for personal reasons or provide Data to any third party
except as permitted by this Agreement,
3. inform Authorized Users that unauthorized access to Data may subject them to civil and criminal liability
under the FCRA and other state and federal privacy laws punishable by fines and imprisonment,
4. ensure that all devices used by Participating County to order or access the Service are placed in a secure
location and are accessible only by Authorized Users, and that such devices are secured when not in use
through such means as screen locks, shutting power controls off, or other commercially reasonable
security procedures,
5. take all necessary measures to prevent unauthorized ordering of or access to the Service by any person
other than an Authorized User for permissible purposes, including, without limitation, (i) limiting the
knowledge of the Participating County security codes, user names, User [Ds, and any passwords
Participating County may use,to those individuals with a need to know. In addition, the User IDs must be
unique to each person,and the sharing of User IDs or passwords is prohibited.
Augurs 11.2015 Universal Membenhip Agreemeni-The Week Number Social Services Part ofr
CUS-30371
6. change Participating County's user passwords at least every ninety (90) days, or sooner if an Authorized
User is no longer responsible for accessing the Service, or if Participating County suspects an
unauthorized person has learned the password. Additionally,perform at least quarterly entitlement reviews
to recertify and validate Authorized User's access privileges,
7. adhere to all security features in the software and hardware Participating County uses to order or access
the Services, including the use of IP restriction,
S. implement secure authentication practices when providing User ID and passwords to Authorized Users,
including but not limited to using individually assigned email addresses and not shared email accounts,
9. in no event access the Services via any unsecured wireless handheld communication device, including but
not limited to, web enabled cell phones, interactive wireless pagers, personal digital assistants (PDAs),
mobile data terminals and portable data terminals
10. only use assets such as personal computer hard drives or portable and/or removable data storage
equipment or media(including but not limited to laptops, zip drives, tapes,disks,CDs,and DVDs)owned
by Participating County to store the Data. In addition, Data must be encrypted when not in use and all
printed Data must be stored in a secure, locked container when not in use, and must be completely
destroyed when no longer needed by cross-cut shredding machines(or other equally effective destruction
method)such that the results are not readable or useable for any purpose. In either case, commercially
reasonable practices for the type of Data received from EVS must he employed,
I I. if Participating County sends, transfers or ships any Data,encrypt the Data using the following minimum
standards, which standards may be modified from time to time by EVS: Advanced Encryption Standard
(AES), minimum 128-bit key or Triple Data Encryption Standard ODES), minimum 168-bit key,
encrypted algorithms,
12. not ship hardware or software between Participating County's locations or to third parties without deleting
all EVS Participating County number(s), security codes, User IDs, passwords, Participating County user
passwords,and any consumer information,or Data,
I]. monitor compliance with the obligations of this Section 5, and immediately notify EVS if Participating
County suspects or knows of any unauthorized access or attempt to access the Service, including, without
limitation,a review or EVS invoices for the purpose of detecting any unauthorized activity,
IJ. if,subject to the terms of this Agreement, Participating County uses a Service Provider to establish access
to the Service, be responsible for the Service Provider's use of Participating County's user names, security
access codes, or passwords, and Participating County will ensure the Service Provider safeguards
Participating County's security access code(s), User IDs, and passwords through the use of security
requirements that are no less stringent than those applicable to Participating County under this Section 5,
15. use commercially reasonable efforts to assure data security when disposing of any Data obtained From
EVS. Such efforts must include the use of those procedures issued by the federal regulatory agency
charged with vyersighl of Participating County's activities (e.g. the Federal Trate Commission, the
applicable banking or credit union regulator)applicable to the disposal or consumer report inlyonativn or
records,
104 tree cvmmcreially reasvnaUle alto to saute Dam Ivhen 5to(ct on servers, 5ub)ecl to the mowing
rc9ui amen : p) , rusts atarillo Data Misr vo separated from 11w Inremel or other public nerwurhs ey
rruwans which arc managed and configured to meet industry accepted best practices, (ii) protect Data
through multiple layers of network security, including but not conned to, industry-recognized erewalls,
routers, and intrusion detedioJvre ention devices (IDS(IPS). (iii) secure ac s (both physical and
network) to systems storing Data. which must include anthem:cation and passwords that are changed at
least every ninety(90)days;and(iv) all servers must be kept current and patched on a timely lanais with
appropriate security-seem hc system patches.as they are available,
17. Dor allow Data to be displayed via the Internet unless utilizing, at a minimum, a three-tier architecture
configured in accordance with industry best practices,
IS. use commercially reasonable efforts to establish procedures and logging mechanisms for systems and
networks that will allow tracking and analysis in the event there is a compromise, and maintain an audit
trail history for at least three(3)months for review,
Augur 11.2015 Uniroyal?lembenhip Agretmcnr-The Work Number'Social Servers Papp 4 or]
CUs-3m72
19. provide immediate notification to EVS of any change in address or office location and are subject to an
onsite visit of the new location by EVS or its designated representative,and
20. in the event Participating County has a security incident involving EVS Confidential Information,
Participating County will fully cooperate with EVS in a security assessment process and promptly
remediate any finding.
b. If EVS reasonably believes that Participating County has violated this Section 5,EVS may,in addition to any
other remedy authorized by this Agreement, with reasonable advance written notice to Participating County
and at EVS's sole expense, conduct, or have a third party conduct on its behalf, an audit of Participating
County's network security systems, facilities, practices and procedures to the extent EVS reasonably deems
necessary, including an on-site inspection,to evaluate Participating County's compliance with the data security
requirements of this Section 5.
6. CONFIDENTIALITY. Each party acknowledges that all materials and information disclosed by a party
("Disclosing Party") to another party("Recipient") in connection with performance of this Agreement consist of
confidential and proprietary data("Confidential Information"). Each Recipient will hold those materials and that
information in strict confidence, and will restrict its use of those materials and that information to the purposes
anticipated in this Agreement. If the law or legal process requires Recipient to disclose confidential and
proprietary data, Recipient will notify the Disclosing Party of the request. Thereafter, the Disclosing Party may
seek a protective order or waive the confidentiality requirements of this Agreement, provided that Recipient may
only disclose the minimum amount of information necessary to comply with the requirement. Recipient will not
he obligated to hold confidential any information from the Disclosing Party which (a) is or becomes publicly
known, (b) is received from any person or entity who, to the best of Recipient's knowledge, has no duty of
confidentiality to the Disclosing Party, (c) was already known to Recipient prior to the disclosure, and that
knowledge was evidenced in writing prior to the date of the other party's disclosure, or(d) is developed by the
Recipient without using any of the Disclosing Party's information. The rights and obligations of this Section 6
with respect to(i)confidential and proprietary data that constitutes a"trade secret'(as defined by applicable law),
will survive termination of this Agreement for so long as such confidential and proprietary information remains a
trade secret under applicable law;and (ii)all other confidential and proprietary data,will survive the termination
of this Agreement for the longer of two (2) years from termination, or the confidentiality period required by
applicable law. Notwithstanding the foregoing, EVS acknowledges that the terms of this Agreement(excluding
any Schedules attached)may be subject to release under the Colorado Open Records Act (the"Act') or similar
acts that may apply to government agencies. If Participating County is compelled to disclose any Confidential
Information under the Act, Participating County will provide EVS with prompt written notice so that EVS may
seek protection of its Confidential Information which may be exempt from disclosure under the Act. If such
protection is not obtained by the date that Participating County must comply with the request,Participating County
will furnish only that portion of the Confidential Information that it is advised by counsel that it is legally required
to furnish, and Client will exercise commercially reasonable efforts to obtain confidential treatment of the
Confidential Information so disclosed.
7. TERM AND TERMINATION. This Agreement shall be for an initial 90-day trial term("Trial Tenn")to allow
CDHS to evaluate the Service. Should CDHS elect to continue using the Service beyond such Evaluation Term,
the Tenn of this Agreement shall be for an annually renewable term, and shall be automatically renewed for
successive one year terms unless either party provides notice to the other party of its intent not to renew the
Agreement at least ninety (90) days prior to the conclusion of the then current term. CDHS may terminate this
Agreement or any Schedule(s). at any time upon thirty(30) days prior written notice to EVS. Any Participating
County may likewise terminate its Participation Agreement upon thirty(30)days notice to EVS. Unless otherwise
provided for in the relevant schedule, EVS may, With thirty(30)days notice,(i)change the price of the Service
once annually, and/or (ii) change the Service Schedule and/or Description as deemed necessary, in EVS's sole
discretion. CDHS's or Participating County's use of the Service after such thirty(30)day period shall constitute
its agreement to such change(s), without prejudice to its right to terminate this Agreement as provided above. If
EVS believes that COWS or Participating County has breached an obligation under this Agreement, EVS may, at
its option and reserving all other rights and remedies,terminate this Agreement and/or any Schedules executed by
Participating County immediately upon notice to CONS and/or Participating County.
8. RIGHTS TO SERVICE. The Service and the Data, including all rights thereto,are proprietary to EVS.
August 11.2015 Univmal Membenbq Agit-ant-10c Wart Numberu Social Service, Pap i of
C[is.30372
9. WARRANTY. EVS warrants that the Service will be performed in all material respects in a reasonable and
workmanlike manner and in compliance with laws and regulations applicable to EVS's performance thereof.
CDHS and Participating County each acknowledge that the ability of EVS to provide accurate information is
dependent upon receipt of accurate information from employers. EVS does not warrant that the Service will be
error free. EXCEPT FOR THE EXPRESS WARRANTIES SET FORTH HEREIN, EVS MAKES NO OTHER
WARRANTIES AS TO THE SERVICE OR THE DATA, EXPRESSED OR IMPLIED, INCLUDING ANY
IMPLIED WARRANTY OF GOOD TITLE,MERCHANTABILITY,AND/OR FITNESS FOR A PARTICULAR
PURPOSE EVEN IF EVS KNOWS OF SUCH PURPOSE.
10. LIMITATION OF LIABILITY. In no event shall EVS be liable to CDHS or any Participating County for
indirect, special incidental, economic, consequential or punitive damages, including but not limited to lost
revenue, lost profits, replacement goods, loss of technology rights or services, loss of data,or interruption or loss
of use of software or any portion thereof regardless of the legal theory under which such damages are sought.
Except for (i) death, personal injury, and property damage, and (ii) EVS's indemnification obligations found
herein, damages of any kind payable by EVS shall not exceed the sum paid by Participating County during the
twelve months prior to the act or occurrence which gives rise to the claim.
11. INDEMNIFICATION. EVS agrees to indemnify, defend and hold harmless ("Indemnify") CDHS, the
Participating Counties and their elected officials, officers,agents, and employees (each, an'Indemnified Party"),
from and against claims,demands, liabilities, suits,damages,expenses and costs, including reasonable attorneys',
experts'and investigators' fees and expenses("Claims")brought by third parties against the Indemnified Parry and
arising from EVS's or its directors',officers' or employees' (i)-negligent or intentional, wrongful actor omission,
(ii)violation of applicable law or(iii)infringement on third party proprietary rights.
12.APPLICABLE LAW. This Agreement shall be governed by the laws of the State of Colorado, without giving
effect to the principles of conflict of laws thereof.
13. FORCE MAJEURE. Neither party will be liable to the other for any delay,or interruption in performance as to
any obligation hereunder resulting from governmental emergency orders, judicial or governmental action,
emergency regulations, sabotage, riots, vandalism, labor strikes or disputes, acts of God, fires, electrical failure,
major computer hardware or software failures, equipment delivery delays, acts of' third parties, or delays or
interruptions in performance beyond its reasonable control.
14. INSURANCE: EVS shall maintain through the Term of this Agreement, at EVS's sole cost and expense,(i)all
insurance coverage required by federal and state laws, including worker's compensation and employer's liability
all with statutory minimum limits, (ii) general and auto liability coverage, and (iii) professional liability (Errors
and Omissions) insurance, with insurance companies with an A.M. Best Rating of at least A-VIII in amounts no
less than those currently in place as of the execution date of this Agreement. Prior to start of work, EVS shall
provide a certificate or adequate proof of the Foregoing insurance. Upon execution of this Agreement, EVS shall
add CDHS as additional insured on all applicable policies except Workers Compensation and Errors and
Omissions.
15. MISCELLANEOUS. This Agreement sets forth the entire ebreement between the panics regarding the Service.
Gx=ept as otherwise provided in this Aar«...ant, this Agreement may be amended only by a subsequent writing
signer;by both parties. This Agreement may not be assigned or transferred by Participating County without EVS's
pro written 'Ms Agreement shall Le freely a s'gnaLle Ly EVS and shalt feto the benefit or and he
hie ding!mom the permitted assignee of either CDIIS or MUS. If any provis;nn of ihisAgreement is Geld to he
invalid or unenforceable under applicable low in any jurisdiction. the validity or enforceability of the remaining
provisions thereof shall be unaffected es to such jurisdiction and such holding shall not affect the validity or
entvrceaonity or such provlsivn in any ether jurisaietivni Tv the wilco{ IMt any prtvision of{Ills Agluement is
held to be invalid or unenforceable because it is overbroad, that provision shall not be void but rather *hall be
limited only to the extent rcyuired by applicable law and enforced as so limited. Any notice under this Agreement
shall be effective upon personal delivery by an overnight or other courier or delivery service,or three(3)days after
pre-paid deposit svhb the postal senAce, either case to the parry's address la rhe Fra sentence of this Agreement
or any substitute therefore provided by notice.
16. COUNTERPARTS/EXECUTION BY FACSIMILE. For the convenience of the panics, copies of this
Agreement and Schedules hereof may be executed in two or more counterparts and signature pages exchanged by
facsimile The parties intend that counterpart copies signed and exchanged as provided in the preceding sentence
August It,1OI5 Unbend Membcnhlp Apccnent-T,Welt Numbct Serial Service Page6or]
Cosdmn
shall be filly binding as an original handwritten executed copy hereof and thereof and all of such copies together
shall constitute one instrument.
CDHS and the Participating County each acknowledge receipt of Exhibit I, 'Notice to Users of Consumer Reports
Obligations of Users". Furthermore, CDHS and the Participating County have read "Notice to Users of Consumer
Reports Obligations of Users"which explains Participating County's obligations under the FCRA as a user of
consumer report information(to be initialed by the person signing on behalf of Participating County).
IN WITNESS WHEREOF,the panics have executed this Agreement on the date indicated below.
STATE OF COLORADO TALX Corporation,
John W.Hickenlooper, GOVERNOR provider of Equifax Verification Services
Colorado Department of Human Services
Reggie Bicha,Executive Director
, ,['� Y
(signature): Cl r`C�I0Y � (signature): /
Name / ,, /,r' Name //
(print): H-W 'YLL &,, '4IL (print): friL / /yaIr
Title: Ory �Jbe(JTp� Title: V r e P/t'cKSrry r - S+ (t) °Pym,
Date: d ' 626• /�S Date: g/13//5
This Agreement is not valid until signed and dated below by the Colorado Department of Human Service?
Controller or Deputy Controller
COLORADO DEPARTMENT OF HUMAN SERVICES
/
CONTROLLER
By:
By: lX4 ['V"'CJ"'�
Clint Woodruff,Controller/Veld Gimple, a uty Controller
atr: X12,7((5
August 11.2015 Universal Membership Agreement-The Work Number'Some]Semmes Per l oft
CUS-30312
UNIVERSAL SERVICE AGREEMENT
Exhibit I
PARTICIPATION AGREEMENT
(Enter County Name) ("Participating County") and TALX Corporation, ("EVS") agree (i) that Participating County
shall receive Services under the provisions of the Universal Membership Agreement dated (the"Agreement"),by
and between EVS and CDHS, which provisions are incorporated herein by reference; and (ii) that each reference to
Participating County in the Agreement shall refer to Participating County separately, as if Participating County had
executed the Agreement itself.
Effective Date:
Participating County Information:
Location ID:
Location Name:
Main Contact:
Main Contact Email Address
Main Contact Phone Number:
Main Contact Fax Number:
Main Contact Address:
Main Contact City: _ _ -- -- —
Main Contact State:
Main Contact Zip:
Audit Contact: _
Audit Contact Email Address:
By signing below, Participating County agrees to each and every term and condition of the Agreement. Each person
signing below represents and warrants that he nr she has the necessary authority to bind the respective party set forth
below.
Agreed:
Particip.ang County TALX Corporation, �///��f
By l.ignetua) By aignetvrt) ��J _
ronnetonnti Nam>1p,lmt 1;Lt I MA
Auguet i1,2015 Unitcnal Membership Ag,eement.The Work Number.Sods]Smlen Pnge I ora
CUSJa312 Exhibit
UNIVERSAL MEMBERSHIP AGREEMENT
for
The Work Number'Social Services
Attachment I to Exhibit I
VERMONT FAIR CREDIT REPORTING CONTRACT CERTIFICATION
The undersigned, [Enter County Name) ("Participating County"), acknowledges that it subscribes to receive various
information services from TALX Corporation, provider of Equifax Verification Services("EVS")in accordance with the
Vermont Fair Credit Reporting Statute,9 V.S.A. §2480e(1999), as amended(the"VFCRA"),and the federal Fair Credit
Reporting AU, 15, U.S.C. 1681 et. seq., as amended (the "FCRA"), and its other state law counterparts. In connection
with Participating County's continued use of EVS services in relation to Vermont consumers,Participating County hereby
certifies as follows:
Vermont Certification. Participating County certifies that it will comply with applicable provisions under Vermont law.
In particular, Participating County certifies that it will order Data relating to Vermont residents, that are credit reports as
defined by the VECRA,only after Participating County has received prior consumer consent in accordance with V FCRA
§ 2480e and applicable Vermont Rules. Participating County further certifies that the attached copy of V FCRA § 2480e
applicable Vermont Rules were received from EVS.
Participating County:
Signed By:
Printed Name and Title:
Account Number:
Date:
Please also include the following information:
Compliance Officer or Person Responsible for Credit Reporting Compliance
Name:
Title:
Mailing Address:
E-Mail Address:
Phone: Fax:
August It,2015 Universal Membership Agrctmmi.te work Number`Sock°Ser Ice, Pace 2 ora
CUS20312 Exhibit I
Vermont Fair Credit Reporting Statute,9 V.S.A.§2480e(1999)
§ 2480e.Consumer consent
(a)A person shall not obtain the credit report of a consumer unless:
(I) the report is obtained in response to the order of a court having jurisdiction to issue such an order;or
(2)the person has secured the consent of the consumer,and the report is used for the purpose consented to by the
consumer.
(b)Credit reporting agencies shall adopt reasonable procedures to assure maximum possible compliance with subsection
(a)of this section.
(c)Nothing in this section shall be construed to affect
(I)the ability of a person who has secured the consent of the consumer pursuant to subdivision(a)(2)of this section to
include in his or her request to the consumer permission to also obtain credit reports, in connection with the same
transaction or extension of credit,for the purpose of reviewing the account,increasing the credit line on the account,for
the purpose of taking collection action on the account,or for other legitimate purposes associated with the account;and
(2)the use of credit information for the purpose of prescreening,as defined and permitted from time to time by the
Federal Trade Commission.
VERMONT RULES •••CURRENT THROUGH JUNE 1999 ""•
AGENCY 06.OFFICE OF THE ATTORNEY GENERAL
SUB-AGENCY 031. CONSUMER PROTECTION DIVISION
CHAPTER 012. Consumer Fraud--Fair Credit Reporting
RULE CF 112 FAIR CREDIT REPORTING
CVR 06-031-012,CF 112.03(1999)
CF 11203 CONSUMER CONSENT
(a)A person required to obtain consumer consent pursuant to 9 V.S.A. §§2480e and 2480g shall obtain said consent in
writing if the consumer has made a written application or written request For credit,insurance,employment,housing or
governmental benefit. If the consumer has applied for or requested credit,insurance,employment,housing or
governmental benefit in a manner other than in writing,then the person required to obtain consumer consent pursuant to 9
V.S.A. §§2480e and 2480g shall obtain said consent in writing or in the same manner in which the consumer made the
application or request.The terms of this rule apply whether the consumer or the person required to obtain consumer
consent initiates the transaction.
(b)Consumer consent required pursuant to 9 V.S.A. §§ 2480e and 2480g shall be deemed to have been obtained in
writing if,alter a clear and adequate written disclosure of the circumstances under which a credit report or credit reports
may be obtained and the purposes for which the credit report or credit reports may be obtained,the consumer indicates his
or her consent by providing his or her signature.
(c)The fact that a clear and adequate written consent form is signed by the consumer niter the consumer's credit report has
Veen u0uainc0 pursuant to some other form of consent shall not affect the validity ofthe earlier consent.
Augmt II,2015 Uni.cnel Membership Agrtememtdhe Work Number'Soclvl Sen len rage of
CUS.30372 Exhibit 1
UNIVERSAL MEMBERSHIP AGREEMENT
for
The Work Numbers Verifier Services
Exhibit 2
All users of consumer reports must comply with all applicable regulations.Information about applicable regulations currently
in effect can be found of the Consumer Financial Protection Bureau's website,www.cansunerMmce.govfearnmore.
NOTICE TO USERS OF CONSUMER REPORTS:OBLIGATIONS OF USERS UNDER THE FCRA
The Fair Credit Reporting Act(FCRA), 15 U.S.C. 1681-168 ly,requires that this notice be provided to inform users of consumer
reports of their legal obligations.State law may impose additional requirements.The text of the FCRA is set forth in hill at the
Consumer Financial Protection Bureau's(CFPB)website at www.consumerfinancegov/leammore. At the end of this document is a
list of United States Code citations for the FCRA. Ocher information about user duties is also available at the CFPB's website.
Users must consult the relevant provisions of the FCRA for details about their obligations under the FCRA.
The first section of this summary sees forth the responsibilities imposed by the FCRA on all users of consumer reports.The subsequent
sections discuss the duties of users of reports that contain specific types of information,or that are used for certain purposes,and the
legal consequences of violations.If you are a furnisher of information to a consumer reporting agency(CRA),you have additional
obligations and will receive a separate notice from the CRA describing your duties as a furnisher.
I.OBLIGATIONS OF ALL USERS OF CONSUMER REPORTS
A. Users Must Hove o Permissible Purpose
Congress has limited the use of consumer reports Co protect consumers'privacy.All users must have a permissible purpose
under the FCRA to obtain a consumer report.Section 604 contains a list of the permissible purposes under the law.These ore;
• As ordered by a court or a federal grand jury subpoena.Section 604(a)(f)
• As instructed by the consumer in writing.Section 604(x)((2)
• For extension of credit as a result of on application from a consumer,or the review or collection of a consumer's
account.Section 604(a)(3)(A)
• For employment purposes,including hiring and promotion decisions,where the consumer has given written permission.
Sections 604(0)(3)(B)and 604(b)
• For the underwriting of'insurance as a result of an application from a consumer.Seddon 604(a)(3)(C)
• When there is a legitimate business need,in connection with a business transaction that is initlaredby the consumer..Section
604(0)(3)(F)(i)
• To review a consumer's account to determine whether the consumer continues to meet the terms of the account.Section
604(c)(3)(F)(ii)
• To Martine a consumer's eligibility for a license or other benefit granted by a governmental insuumenlality required by
law to consider an applicant's financial responsibility or status.Section 604(a)(3)(D)
• For use by a potential investor or servicer.or current insurer,in a valuation or assessment of the credit or prepayment risks
associated with an existing credit obligation.Section 604(a)(3)(E)
• For use by state and local officials in connection with the determination of child support payments,or modifications and
enforcement thereof.Sections 604(4(4)and 604(a)($)
In addition,creditors and insurers may obtain«nain consumer report information for the purpose of making"prescreened"
unsolicited offers of credit or insurance.Section 604(c).The particular obligations of users of"prescreened"information are described
in Section VII below.
B. Users Must Provide Certifications
Section 604(0 prohibits any person from obtaining a consumer report from a consumer reporting agency(CRA)unless the person has
certified to die CRA the permissible purpose(s)for which the report is being obtained and certifies that the report will not be used for
any other purpose.
August 11.2015 Universal Membetship Apautxnt.Tbc Wotk Numbcr Smlel Services Page l 015
CU5 30372 E.rhibit 2
C. Users Must Notify Consumers When Adverse Actions Are Taken
The term"adverse action'is defined very broadly by Section 603."Adverse actions"include all business,credit,and employment
actions affecting consumers that can be considered to have a negative impact as defined by Section 603(k)of the FCRA-such as
denying or canceling credit or insurance,or denying employment or promotion.No adverse action occurs in a credit transaction where
the creditor makes a counteroffer that is accepted by the consumer.
1. Adverse Actions Based on Information Obtained From a CRA
If a user takes any type of adverse action as defined by the FORA that is based at least in part on information contained in a consumer
report,Section 615(a)requires the user to notify the consumer.The notification may be done in writing,orally,or by electronic means.
It must include the following:
• The name,address,and telephone number of the CRA(including a toll-free telephone number,if it is a nationwide CRA)
that provided the report.
• A statement that the CRA did not make the adverse decision and is nor able to explain why the decision was made.
• A statement setting forth the consumers right to obtain o free disclosure of the consumer's file nom the CRA ifthe
consumer makes a request within 60 days.
• A statement setting forth the consumers right to dispute directly with the CRA the accuracy or completeness of any
information provided by the CRA.
2. Adverse Actions Based on Information Obtained From Third Parties Who Are Not Consumer Reporting
Agencies
If a person denies(or increases the charge for)credit for personal,family,or household purposes based either wholly or partly upon
information from a person other then a CRA,and the information is the type of consumer information covered by the FCRA,Section
615(b)(I)requires that the user clearly and accurately disclose to the consumer his or her right to be told the nature of the information
that was relied upon if the consumer makes a written request within 60 days of notification.The user must provide the disclosure
within a reasonable period of time following the consumers written request.
3. Adverse Actions Based on Information Obtained From Affiliates
If a person mkt;an adverse action involving insurance,employment,ora credit transaction initiated by the consumer,based on
information of the type covered by the FCRA,and this information was obtained from an entity affiliated with the user of the
information by common ownership or control,Section 615(3)(2)requires the user to notify the consumer of the adverse action.The
notice must inform the consumer that he or she may obtain a disclosure of the nature of the information relied upon by making a
written request within 60 days of receiving the adverse action notice.If the consumer makes such a request,the user must disclose the
nature of the information not later than 30 days after receiving the request. If consumer report information is shared among affiliates
and then used for an adverse action the user must make an adverse action disclosure as set forth in I.C.I above.
D. Users flare Obligations When Fraud and Active Dory Military Alerts are in Files
When a consumer has placed a fraud alert,including one relating to identity theft,or an active duty military alert with a nationwide
consumer reporting agency as defined in Section 603(p)and resellers,Section 605A(h)imposes limitations en users of reports
obtained from the consumer reporting agency in certain circumstances,including the establishment of a new credit plan end the
issuance of additional credit cards.For initial fraud alerts and active duty alerts,the user must have reasonable policies and procedures
in place to form a belief that the user knows me Rigidity bfihe bpplicani or c nlactthe consumer at a telephone number specified by
thc consunam;in the ease or eam,.dea nano alerts, a user,oust contact the consumer In accordance with me contact information
prondded:n the.u"some..:len.
fir users Imre 0411getlun5 When Null Lid)Of ell ft darns Discrepancy
Section 605(h)requires nationwide CRAB,as defined in Section 601(01.to notify bean shat request records when the address for a
evnsumer prvvidcd by the user in requesting the report is substantially different from the addresses is the consumer's tile.When this
occurs,users must comply.rid,tabulations speciryins the procedures to be rouoweu. Fcdeml rc5ulativus pre ovallnble lit
www con some rn non cc.gouge nom ore.
F. U3err Have Ot hjtarionx non Dispafini,of Defiling
Section 61.A requbec that all users or consumer report information have in place procedures to properly dispose or records containing
this information. Federal regulations have been issued that cover disposal.
August 11.2015 Universal Mamboship Agreement-The Work Number'Social Service, Page 2 of5
CU15.30372 FxhIbil 2
I[. CREDITORS MUST MAKE ADDITIONAL DISCLOSURES
If a person uses a consumer report in connection with art application for,or a grant,extension,or provision of,credit to a consumer on
material teens that am materially less favorable than the most favorable terms available to a substantial proportion of consumers from
or through that person,based in whole or in part on a consumer report,the person must provide a risk-based pricing notice to the
consumer in accordance pith regulations prescribed by the CFPR.Section 609(g)requires a disclosure by all persons that make or
arrange loans secured by residential real property(one to four units)and that use credit scores.
These persons must provide credit scores and other information about credit scores to applicants,including the disclosure set forth in
Section 609(g)(IXD)("Notice to the Home Loan Applicant").
III.OBLIGATIONS OF USERS WHEN CONSUMER REPORTS ARE OBTAINED FOR EMPLOYMENT
PURPOSES
A.Employment Other Than in the Trucking Industry
If information from a CRA is used for employment purposes,the user has specific duties,which are set forth in Section 604(6)of the
FCRA.The user must:
• Make a clear and conspicuous wrinen disclosure to the consumer hefore the report is obtained,in a document that consists
solely of the disclosure,that a consumer report may be obtained.
• Obtain from the consumer prior written authorization.Authorization to access reports during the tern of employment may
be obtained at the time of employment.
• Cenify to the CRA that the above steps have been followed,Thal the information being obtained will not be used in
violation of any federal or state equal opportunity law or regulation,and that,if any adverse action is lobe taken based on
die consumer report,a copy of the report and a summary of the consumer's rights will be provided to the consumer.
• Before laking an adverse action,the user must provide a copy of the report to the consumer as well as the summary of
consumers rights.(The user should receive this summary from the CRA.)A Section 615(a)adverse action notice should be
sent after the adverse action is taken.
An adverse action notice also is required in employment situations if credit information(other than transactions and experience data)
obtained from an affiliate is used to deny employment.Section 615(b)(2)
The procedures for investigative consumer reports and employee misconduct investigations are set forth below.
B.Employment in the Trucking Industry
Special rules apply for truck drivers where the only interaction between the consumer and the potential employer is by mail,
telephone,or computer.In this case,the consumer may provide consent orally or electronically,and an adverse action may be made
orally,in writing,or electronically.The consumer may obtain a copy of any report relied upon by the trucking company by contacting
die company.
IV. OBLIGATIONS WHEN INVESTIGATIVE CONSUMER REPORTS ARE USED
Investigative consumer reports arc a special type of consumer report in which information about a consumers character,general
reputation,personal characteristics,and made of living is obtained through personal interviews by an entity or person that is a
consumer reporting agency.Consumers who are the subjects of such reports are given special rights under the FCRA.If a user intends
to obtain an investigative consumer report,Section 606 requires the fallowing:
• The user must disclose to the consumer that an investigative consumer report may be obtained.This must be done in a
written disclosure that is mailed,or otherwise delivered,to the consumer at some time before or not later than three days
after the dale on which the report was first requested.The disclosure must include a statement informing the consumer of
his or her right to request additional disclosures of the nature and scope of the investigation as described below,and the
summary of consumer rights required by Section 609 of the FCRA,(The summary of consumer rights will be provided by
the CRA that conducts the investigation.)
• The user must certify to the CRA that the disclosures set forth above have been made and that the user will make the
disclosure described below.
• Upon the wrinen request ofa consumer made within a reasonable period of time after the disclosures required above,the
user must make a complete disclosure of the nature and scope of the investigation.This must be made in a written statement
that is mailed,or otherwise delivered,to the consumer no later than five days after the date on which the request was
received from the consumer or the report was first requested,whichever is later in time.
August II,2015 Universal Mcmbcthip Agaement'The wow Number Social Servlet Page)a
CUS)Olaz Exhibit
V. SPECIAL PROCEDURES FOR EMPLOYEE INVESTIGATIONS
Section 603(x)provides special procedures for investigations of suspected misconduct by an employee or for compliance with
Federal,state or Ictal laws and regulations or the rules of a self-regulatory organization,and compliance with written policies of the
employer.These investigations are not treated as consumer reports so long as the employer or its agent complies with the procedures
set forth in Section 603(x),and a summary describing the nature and scope of the inquiry is made to the employee if an adverse action
is taken based on the investigation.
VI.OBLIGATIONS OF USERS OF MEDICAL INFORMATION
Section 604(g)limits the use of medical infomiation obtained from consumer reporting agencies(other than payment information that
appears inn coded form that does not identify the medical provider).If the information is to be used for an insurance transaction,the
consumer must give consent to the user of the report or the information must be coded.If the report is to be used for employment
purposes—or in connection with a credit transaction(except as provided in federal regulations)—the consumer must provide specific
wrinen consent and the medical information must be relevant.Any user who receives medical information shall not disclose the
information to any other person(except where necessary to carry out purpose for which the Information was disclosed,or as
permitted by statute,regulation,or order).
VTI.OBLIGATIONS OF USERS OF''PRESCREENED"LISTS
The FCA permits creditors and insurers to obtain limited consumer report information for use in connection with unsolicited offers
of credit or insurance under certain circumstances.Sections 603(1), 604(c),604(E),and 615(1).This practice is(mown as
"prescreening"and typically involves obtaining from a CRA a list of consumers who meet certain preestablished criteria. If any
person intends to use prescreened lists,that person must(I)before the offer is mode,establish the criteria that will be relied upon to
make We offer and to grant credit or insurance,and(2)maintain such criteria on file for a three-year period beginning on the dote on
which the offer is made to each consumer.In addition,any user must provide with each written solicitation o clear and conspicuous
statement that:
• Information contained in a consumer's CRA file was used in connection with the transaction.
• The consumer received the offer because he or she satisfied the criteria for credit wonhiness or insurability used to screen
for the offer.
• Credit or insurance may not he extended if,after the consumer responds,it is determined that the consumer does not meet
the criteria used for screening or any applicable criteria bearing on credit worthiness or insurability,or the consumer does
not furnish required collateral.
• The consumer may prohibit the use of information in his or her file in connection with future prescreened offers of credit or
insurance by contacting the notification system established by the CRA That provided the report.The statement must
include the address and toll-free telephone number of the appropriate notification system.
In addition,the CFFB has established the format,type size,and manner of the disclosure required by Section 615(d),with
which users must comply. The relevant regulation is 12 CFR 1022.54.
VIII.OBLIGATIONS OF RESELLERS
A.Disclosure and Certification Requirements
section 5°7(c)requires any person wbc°mums a consumer upon for male to lac me fallowing steps:
• nkdose the identity of the end-,ser to the source crew.
▪ Identify to the source CRA each permissible purpose to..which the report..ill be furnished to the end-user.
• rsrahllsk and tallow reasonable procedures to ensure that report are resold only for permknalhle purposes,including
procedures to o6mim
(I) the identity of 511 end-userst
(2) certifications from all users of each purpose for which reports will he used:5nd
(3) certifications that tenons will not be used for any purpose other than the purpose(s)specified to the molter.
Resellers must make reasonable efforts to verify this information before selling the report.
B-Reinvestigations by Resellers
Under Section 611(0,if a consumer disputes the accuracy or completeness of information in a report prepared by a reseller,the
reseller must determine whether this is a result of an action or omission on its pan and,if so,correct or delete the information.If not,
the reseller must send the dispute to the source CRA for reinvestigation. When any CM notifies the reseller of the results of an
investigation,the reseller must Immediately convey the information to the consumer.
August 11,3015 nni.ersal hhmhrsahip Agrennenllhe Wed Number'Social Senirer Page 4 of5
LUSd03ie Exhibit 2
C. Fraud Arens and Resellers
Section 605A(1)requires resellers who receive fraud alerts or active duty alerts from another consumer reporting agency to include
these in their reports.
IX.LIABILITY FOR VIOLATIONS OF THE FCRA
Failure to comply with the ECM can result in state government or federal government enforcement actions,as well as private
lawsuits.Sealant 616,617,and 621.In addition any person who knowingly and willfully obtains a consumer report under false
pretenses may face criminal prosecution.Section 619.
The CFPB's website, www.consumcrfinonce.gov/Ienrnmore,has more Information about the FCRA,including publications
for businesses and the full teat of the FCRA.
Citations for FCRA sections in the U.S.Code,15 U.S.C.§1681 et seq.:
Section 602 15 U.S.C. 1681
Section 603 15 U.S.C. 1681 a
Section 604 15 U.S.C. 1681b
Section 605 15 U.S.C. 1681 c
Section 605A 15 U.S.C. 1681 cA
Section 605B 15 81.5.C. 1681e13
Section 606 15 U.S.C. 1681 d
Section 607 15 U.S.C. 16131e
Section 608 15 U.S.C. 1681 f
Section 609 15 U.S.C. 1681g
Section 610 15 U.S.C. 1681h
Section 611 15 U.S.C. 1681i
Section 612 15 U.S.C. 1681j
Section 613 15 U.S.C. 1681k
Section 614 15 U.S.C. 1681/
Section 615 15 U.S.C. 1681m
Section 616 15 U.S.C. 1681n
Section 617 15 U.S.C. 16810
Section 618 15 U.S.C. 1681p
Section 619 15 U.S.C. 1681q
Section 620 15 U.S.C. I681r
Section 621 15 U.S.C. 1681s
Sectian 622 15 U.S.C. 1681s-1
Section 623 15 U.S.C. 1681s-2
Section 624 15 U.S.C. 1681t
Section 625 15 U.S.C. 1681u
Section 626 15 U.S.C. 1681v
Section 627 15 U.S C. 1681w
Section 628 15 U.S.C. 1681x
Section 629 15 U.S C. 16818
August I I,2015 Universal Membership Agrrcmem-The Work Number'Sethi 5enita Page 5 of 5
CU590372 Eahiba 2
UNIVERSAL MEMBERSHIP AGREEMENT
SCHEDULE A-THE WORK NUMBER.EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
I) AGENCY USE OF SERVICE:
The Work Nurnberg k an employment verification service provided by TALX Corporation (a provider of Equifax
Verification Services).a Missouri corporation("EVS").to its employer clients. Dam on the Service may be accessed by
agency to verify Consumer's employment status("the Work Number"Employment Verification')or income("lie
Work Nurnberg
laconic Verification')for government purposes. EVS shall provide the Service in accordance with the
Universal Membership Agreement("Agreement"),Exhibit I to the Agreement and this Schedule A(which is part of this
Agreement). All defined terms used herein shall have the meaning ascribed to them in the Agreement
a) Product lie Work Number°Employment Verification includes the Consumer's(i)emplo)Cr name and(ii)
employment status. lie Work Number*Income Verification may irdudc,without limitation,the Consumer's(i)
employer address,(ii)employment dates,where available,(iii)position title,(iv)medical and denial infunnm!un,
where available,(v)pay rate,(s i)up m three(3)years of YTD gross income details,and(vii)up to ihree(I)years
of pay period detail-
b) Delivery. The Service provides automated access to requested Data via the Internet or phone. If Data is requested
via the lntemd it will be delivered instantly via the same mode If Data is requested via the phone,it will be
delivered by fax within one(I)business day.
e) Input Requirements. An Agency may request access to Data by providing the Consumer's social security
number..
PRICING: Fees for Services provided under his Shedd lc include:
❑ Onsite Inspection Fee: %lived
Agency Initials:
Verification Fees: Sethi a pricing pion below and initial by the plan you choose
))4 Pilot Pricing-The Work Number will provide unlimited pilot accesi[or 90 dsp. Agency Initials: CA-J
II) PAYMENT TERMS AND TAXES:Invoices are due net fork-five(45)days with ane(l%)percent interest per month
applied over forty five(45)days.Invoices outstanding over forty Fite(45)days will result in loss of access to the
Service.Except to the extent that Agency has pro%ded an exemption certificate,direct pay permit or other such
appropriole documentation.EVS shall add in each invoice any sales,use,excise.value-added,gross receipts,services,
consumption and other similar transaction taxes however designated that ate properly levied by any Luing nuthorily
upon the provision ofthe Services,excluding,however, any slate or thee privilege or franchise tines,taxes based upon
EVS's net income and any toes or amounts in lieu thereof paid or payable by EVS as a result of the foregoing<xduded
items. If payment is made by credit cart EVS will charge the credit card each month(or transactions completed in the
prior month.Client will be invoiced electronically through Equifax'5 Electronic Invoice Presentation&Payment(EIPP)
program.Requests for paper billing arc available upon Client's request and are subject to additional monthly fees.Such
fees are subject to modification by Equifax at Intervals of n0 less than one year,upon prior written notice.
III) MODIFICATION OF SERVICE DESCRIPTION: EVS may modify this Service Description on thirty(30)days
notice to Agency. Agency may terminate the Service within thirty(70)daysafter notice of o modification to the Service
Description on written notice rip EVS. Absence of such terminalion shall constitute Agency's agreement to the
modification.
SIGNATURE MUD FVLLVWS
PLEASE FAX TO THE WORK NUMBER`SOCIAL SERVICES at 888-708-6M6
Dekker I,2014/CU5-30372 SCMdule A-E,Ras Paye I of5
LRO August 11.2015
UNIVERSAL MEMBERSHIP AGREEMENT
SCHEDULE A—THE WORK NUMBER'EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
STATE OF COLORADO TALX Corporation,
John W.Hickenlooper, GOVERNOR provider of Equifax Verification Services
Colorado Department of Human Services
Reggie Bicha,Executive Director G,J/
By
(signature): ce..LC{ � �/(� BY /(1 -./
Name Name
(print): //
(Print): M�GN�P� M/pAr
Tide: f J iretior " Title: ViCG rprcf:rlr+s r-c1rs Operwrrn,
Date: r/.-Pth • Ic Date: "007 ).S
This Agreement is not valid until signed and dated below by the Colorado Department of
Human Services' Controller or Deputy Controller
COLORADO DEPARTMENT OF HUMAN SERVICES
////nn//
CONTROLLER
By: LL Vl/
Clint Woodruff,Controller/Veld Ci/melee,, ty Controller
Dale: ���J I
PLEASE FAX TO THE WORK NUMBER'SOCIAL SERVICES at 888-708-6816
ember 8.2014 t CDSJ0I71 Schedule A-Errors
LAussie 11,201S Pone lafg
RD
UNIVERSAL MEMBERSHIP AGREEMENT
SCHEDULE A—THE WORK NUMBER')EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
AGENCY TYPE:
/State or County Social Service`-/Neuman Services Agency Social Security Admimstr Ion /Medicaid
_Work Program(WIA) J dousing Authority(Federal,State or County) /Child Suppon Enrnaemcn
Low-Income(lousing(ire.Sec.8,Sec.42)
*•weaseprovide proof ofln..inro,ae sgroan"
NOl E:if YOU ARE COMPLETING Tills AGREEMENT FOR AN APARTMENT,
YOU MUST FAX PROOF OF TIME APARTMENT'S LOW-INCOME STATUS
(Ire,APPLICATION,OCCUPANCY GUIDELINES,etc.)WITH THIS SERVICE
AGREEMENT OR YOUR ACCOUNT WILL NOT BE ACTIVATED
OlhcG .
SPECIFIC PROGRAMS Ott DIVISIONS THAT WILL USE THIS SERVICE(Check ALL that apply):
X Food Stamps X TARE X General Cash Assistance X Lo v.Income Energy Assistance
IEVS X Fraud Investigations X Quality Control X Housing Assistance
__ Work-related Assistance X Emergency Assistance Title II Title XVI Tine IV-Ci
Other.Please indicate all other programs that wilt use the service
CONTACT INFORMATION
AgencylOrganizationl r Colorado Department of Human
--- Address 15]5 Sher ,3rd Floor
Company Services t
1
DBA or Management CryDenver •
Company,if different.
il
Wobs'to address: http://Colorado.gov/CDHS State: CO
Ht. _ ____
Main Contact: Samantha O'Neill-Dunbar Zip Code: 80203
Title. Project Manager E mail: Samantha.oneilldunbar@state.co.us
Phone# 1 _ 303.86622864 Fax#: •
l Supervisor
Supervisor Levetta Love PhmeM 303.866.2054
ADDITIONAL USER INFORMATION
POri'CnN'(
1 c the mrsice m S,b,regis,ered bels.... Our.ng the lnetn process.the mo w1 ti be
.,hed t,.'Lk.eg.tc.Jd fax nu,nher.will use
are mandalorv-
ryas, Pa.vs E-mail Addr.-
u=era l
Daer2I _. _. __
. '
_ _ _..
User]:
(herd: I
1 ............
V serS. —
Please provide It.e names,rax numbers and a-mall addresses of up to 5 add'iional users. Note:The"Main Contact"above will
have the ahihly In add ucerF via the webbinnager function WebM2nagers have the ability to add,manage and approve users
within the organization If you have additional users,once Agreement is accepted,you,will iccelne more intonation on now to
register USC!.
PLEASE FAX TO THE WORK NUMBERS SOCIAL SERVICES at 888-708-6816
(Rioter 9,2014,CUS-50171 SenedWe A•Eap,ee Pogo 3 of5
LRD August II,20.15
BILLING INFORMATION
Billing Contact Billing Address:
Billing Contact -- ---'�
Title: City:
Billing Phone #: State:
Billing Fax #: Zip Cede:
Billing E-mail: Your Invwte wi/I be sent da E-mail.
Expected Monthly Usage: Payment Method: 0 Check D Credit Card
How will you perform verification requests? D Wcbsitc 0 Phone
Can we send your Invoice via e-mail? D Yes 0 No
Is your agency Tax Exempt? 0 Yes D No
How did you hear about our Social Services program?
❑ From an employer 0 From an applicant D Through an Internet search
❑ I called the Client Service Center for assistance and the representative gave me this option
o A Work Number representative ailed me and explained the service.
Agency Type:
Federal/State/County/City/Local/Government ❑ Social Security Admin stratlon
o Non-Profit Organization ❑ Housing Authority
❑ For-Profit Drganlzabon 0 Third Party Vendor for Government Agency
D Apartment Complex/Property Management 0 Other: Please specify
Each program requires documented proof. Specific Program(s)that will use this service:
0 Food Stamps ® TANF 0 MEDICAID
® Fraud Investigations ® Child Support Enforcement ® Daycare Assistance
Low-Income Energy Assistance D Pre-Employment 0 Work-related Assistance
Low-Income Housing D Mortgage Loans D Collections
❑ Other: (Please Indicate other programs that will use this service:
If you are an Apartment Cormier{or Property Manaaement Company please answer the following questions:
How many units do you have? How many of those are subsidized units?
tag: Subsidized units are those in which the owner receives funds from Federal, State,County or Local
• Government.
Are you affiliated with City/State Housing Authority? D Yes D No
If yes, please Include the name:
October 8,2011/CL5.30312 Schedule A-Express Page 1 orS
LRD August 11.2015
Oualiflcatlons: In order to process your application,your agency/organization Is required to provide proof
in
(suooa-ta documentation)of your need for employment and income verifications. Please provide the following:
Federal/State/County/City/Local/Government Social Security Administration
1. Copy of program's application 1. Copy of program's application
2. Income guidelines to determine eligibility 2. Income guidelines to determine eligibility
Non-Profit( For-Profit Organizations Third Party Vendor for Government Agency
1. Copy of program's application 1. Copy of program's application
2. Income guidelines to determine eligibility 2. Income guidelines to determine eligibility
3. Affiliation(contract)with a 3. Affiliation(contract)with a
Federal/State/County/City/Local/Government Federal/State/County/City/Local/Government
4. Funding source 5. Funding source.
Housing Authority Apartment Complex/Property Management
1. Copy of tenant's application 1. Copy of tenant's application
2. Income guidelines for low-Income housing 2. income guidelines for low-Income housing
3. Complete HUD Schedule or Rural Development 3. Complete HUD Schedule or Rural
Rent Schedule or L.U.R.A.(Land Use Restriction Development Rent Schedule or L.U.R.A. (Land
Agreement) Use Restriction Agreement)
Failure to provide supporting documentation,which must include the name of your
agency/organization/company name,may delay processing of your agreement or disqualify your
application.
October 8.2014,CU53O372 Schedule A-E.p,ess Page 5 of
LRD August 11,1015
UNIVERSAL MEMBERSHIP AGREEMENT
SCHEDULE A-THE WORK NUMBER"EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
I) I3SE OF SERVICE:
lie Work Number"is an employment v erifcallon ismice provided by)ALX Corporation (a pros ider of Equifax Verification Semmes),a
Missouri corporation("CVS").to its employer clients. CVS shall pros idc the Service in accordancevs ith the Universal Membership Agreement
between EPS and the State of Colorado,Colorado Department of Human n Services("CDIIS"1(the"Agreement"),Exhibit 1 to the Agreement
and this Schedule A (which is part of the Agreement). Data on the Service may be accessed by Participating County(as defined m the
Agreement) to verify Consumer's employment status ("The Work Nmnberlc Employment Verification'")or Inwnte("Tire Work Number
Income Verification') for Government purposes. All defined terms used herein shall lime the meaning ascribed to them in the Agreement
Notwithstanding any conflicting provisions in the Agreement.the panics acknowledge and agree that this Schedule A to the Agreement,any
future Schedule, or.vuendments to Schedule A or amendments to tie Agreement. may he executed by CDHS without requiring separate
signatures of each Pan icipating County only if CDIIS was authorized to take this action through approval by all Participating Counties which n
in writing and signed by a person authorized by lie governing hedy for each Pan lnpating County in accordance with such county's local
procedures CDHS represents to EVS that,prior to executing any such Schedule or amendments to a schedule or the Agreement.CDHS shall
have such written authorization frum each Participating County to take such action.
a) Product. The Work Number` Employment Verification includes the Consumer's U)employer name and(i)employment status The
Work Number*Income Verification may include.w ichomc limitation,tie Consumer's(i)employer address.(u)employment dates.where
available.(iii)position title,(iv)medical and dental information.where as ailabl e,Di pay rate,(Si)up to three(3)year.of TED grow,,
income details,and(vii)up to three(1)years of pay period detail
b) Delis eq. The Senicc provides automated occas to requested Data eta the Internet or phone. If Data is recue.Id via the Internet.It will
be delis crd instantly via the same mode. If Data is requested s%a the phone,it will be delivered by fax within one(f)busine.s day.
c) Input Requirements. A Participating County may request access to Data by pro'tding Ne Consumers social security number.
II) TEEM: Notwithstanding any conflicting terms in Section 7 of the Agreement,this Schedule A shall be for a initial annual inn effecmc
January I.2016—December 31,2111E(the"initial Tenn"):with four(J)optional annual renewal terve("Successo Tunis")as ailable,upon
written agreement between the parties for the as nidance of doubt the Term of the Agreement shall remain in effect as long as there is an
outstanding schedule with a tens then in effect.
III) PRICING: Fees for Services provided under this Schedule include
Verification Fees:
® Annual Minimum Pa)Ment CDHS Initial::.:
Total cost per year Annual
(.en ILcat mon.1 Verification
Ceiling
(total n of
Transaction TsPc sertficac ions) Cost AbmC Ceding
Employment Summary
(SSW Search) FREE UNLIMITED TREE
Income Verification 5912_4501h)per year 165,00(1 5553 per income sen faation
IV) The request by Participating County and the performance by EVS of an Employment Verification(and/or Income Verification,if applicable)
under this Agreement and Schedule A shalt be referred In as'Transaction(s)".Pte Annual Minimum payment shall be charged to CDHS for all
Transactions up to and including the Annual Transaction Ceiling for Transactions charged against the Annual Transaction Ceding,CDHS will
be billed monthly, as transactions occur at the effectixe rate of 55.53 per Transaction. Each Transaction performed above tie Annual
Transaction Ceiling 11 ill bc charged al$5.53 per Transaction and shall also be billed monthly. In the event the Participating Counties do not
collect%.ely use all Transactions allotted under the Annual Transaction Cedilla by the end of any annual term,EVS shall ins ice CDIIS for
each Participating County failing to meet its allotted portion of the Annual Transaction Ceiling(as specified in Exhibit I hereto)during such
annual term,the remaining portion of such Participating County's corresponding Annual Minimum Payment;and CDHS shall remit payment
for such remaining ponion(s)directly to EVS EVS and CODS understand that CDI IS is acting as a fiscal agent for the Panicipating Counties.
passing through payment of all costs from the Panicipating Counties to EVS, including the Annual Ml intmum Payment CDIIS shall not be
liable for any debt or payment obligation. including the Annual Minimum Payment, incurred by a Participating County pursuant to IMI,
Agreement or any Participation Agreement,pro'odd.however.that any failure by CDIIS to obtain and pass through such payments from any
Participating County shall constitute a breach of this Agreement by such Participating County:and EVS shall Imre the right to terminate the:
Agreement with respect to such Participating County upon written notice.and at least thirty(30)days in which CDHS may cure the breach
March 14,20131 emplace Tina enal anta:wiip Agreement-111c‘tor Pardo'Social senior Page l of(i
fT15dt372 yT6 I hl Cot ton Schedule t.RU July 0.2m6
e :\6\ C
Nota nhstanding any conflicting provisions in'he Abatement,EVS shall pros it viten notice of any increase in toes to COI IS at(cast ninety
(90)days prior io the end of the Initial Term,and cad,Successive Tenn.Upon receipt of such notice,CDIIS shall within five(5)business days
notify Participating Counties,and CDI IS or any Participating County shall ham sixty(fill)days alter receipt of notice to notify E VS and CD)IS
of any Participating Counties election to terminate(heir Participation Agreemenp sl. Upon IjVS's receipt of any such notice(s),the Annual
Minimum Payment shall be adyumd accordingly for each remaining Successive Term.and the Annual Transaction Ceiling shall likewise he
adjusted for each remaining Successive Tcrm, by deleting the porn on of t¢ Annual Transaction Ceiling attributable to each Participating
County terminating its Participation Agreement.
Transactions allotted under the Annual Transaction Ceding thai are not used during the Annual Term is ill no, be mailable for use in any
Su: ssn e Terri
SSN Searches will be free and do not count against the annual ceiling_
V) PN'MENTT'ER'IS AND'FAXES: Inv Olces arc due net forty-ft e(45)days Invoices outstanding over forty five(45)days will result in loss
of access mo the Service Except to the ex int anal CD'IS has pros ided an exemption cervi Ecate, direct pay permit or other such appropriate
docs menial ion for each Paniapanng County. EVS shall add to each in'oice any sales, use,excise, .al uc-added. gross receipts, sen ices,
consumption and outer similar tmtm:non taxes honeyor designated that are properly levied by any using authority upon the provision of lie
Sen ices.excluding,however, any state or local privilege or franchise taxes.taus based upon EVS's net income and any taxes or amounts in
lieu thereof paid or payable by EVS as a rmuli of the foregoing excluded items. If pay mem is made by credit card.EX'S will charge the credit
cord each month for transactions completed in the priornth COI vvill be ins art electronically through Equifax's Electronic Invoice
Preseniation& Payment DeWitt program. Requests for pper billing are available upon CDHS's request and are subject io additional monthly
fees Such fees arc subject to modification by Equifax at ronin ahs of no less than one year,upon prior written notice.
VI) MODIFICATION OF SERVICE DESCRIPTION: EVS may modify this Senice Description on ninety(9111 days' prior written notice to
COI IS and shall within Eve(5)business days notify Participating Coun'ices CODS may terminate this Schedule A.or any Pao icipati ng County
may terminate its Pan imitation Agreement,within ninety(90)days aller receipt of notice of a modi0cm ion to the Service Description on%xitmn
notice io EVS and CDI IS: and, upon CDI IS's request, an amendment to memorialize the modification Its the Sen ice Description mny be
executed by the parties Absence of such termination or amendment request shall constitute COIIS'.s and each remaining Participating County's
agreement m the modification
March 14.3013 Tcmnlaie Unwenal blembvnhm Agreonent Me Work Number'Social Sentos rumc2 ofml
CUS.30172 FOR I XISO TION Schedule A 1111)July 1).2016
UNIVERSAL NEN 6ERSIIIP AGREEMENT
SCHEDULE A—THE WORK NUMBER°0 EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
IN WITNESS WHEREOF,the parties have executed this Agreement on the date indicated below.
STATE OF COLORADO TALX Corporation,
John W.Ilickenlaoper, GOVERNOR provider of Equlfaa Verification Sen ices
Colorado Department of I luman Services
Reggie Bicha,Executive Director
By By
(signature): (signature):
Name Name
(print): (print):
Title: Title:
Date: Date:
This Agreement is not valid until signed and dated below by the Colorado Department of Human
Services'Controller or Deputy Controller
COLORADO DEPARTMENT OF DUNIAN SERVICES
CONTROLLER
By:
Clint Woodruff,Controller/Vain Gimple,Deputy Controller
Date:
March 14,1013 tempine Universal htanbaship Agree unl Ric work Number Social Senicn Pact 3 D16
CUSd0372 fOk I$CU I ION tithedik A Lill)July 1).20]
AGENCY TYPE:
® Slate or Caunly Social Serviccsilluman Services Agency g y ❑Social Security Administration Medicaid❑ Program(Ni0 lousing Authority(Federal,Stale or County) 0 Child Support nfor
¢menl
❑ Low.Incoe Ilouoing(ix.Sec.A.See42)
. ..vr..,,erderrm,qoyreemrwataran„
SO IFS IF\no AUL COON Ell This AGNEENI ESIFall AS Arunnau:NI,
VIII MUNI FAX PROOF:OF TIIF APART lENT'S 1.0W.'N Coate SLAT US
(Lc.,APPLICATION,OCCUPANCY CumCuNES.etc.)Watt lids Si..Iturl
AGREE\rF NT OR YOUR ACCOUNT WILL I NO OE ACM VAFEa
❑Other:
SPECIFIC PROGRAMS OR DIVISIONS TIIAT W'ILI. USE TINS SERVICE(Check ALL that apply):
®Food Stamps 0 TAME 0 General Cash Assistance ®Low-Income Energy Assistance
❑ ILEVS ® Fraud Investigations 0 Quality Control 0 I lousing Assistance
❑ Work-related Assistance ®Emergency Assistance ❑Title 11 ❑Title XVI 0 Title IV I)
®Other:Please indicate all other programs mal will use the service:Child Care Assistance and Child Welfare/IV-E
cONTAfT INFORMATION
Agency/Organization/
Company Name. Address:OBA or Management
Company.if different CRY:
Website address'. State:
Main Contact Zip Code:
Title. E-mail:
Phone#: Fax#:
Supervisor: Supervisor
Phone#
ADDITIONAL IISFR INFORMATION
IINPORTAIN:All individuals mho will uIe the service mus!he reektered helm. During the loris nrnee .the user will he osled
ha Muir iebIM lct1 I43 numWf, All Iicld arc mentlatury,
Lir Eia4 E-mail Addr..nn
User': Not Apnlicnhie
userat
User3:
Nser4:
users:
Please provide the names,fan numbers and c-mail addresses of up to 5 additional mors. Now;The"Main Contact-above will hate
the ability to add users via the webManager function.WebNlanagcrs have the ability to add,manage and approve users within the
organization_If you have additional users,once Agreement is accepted,you will receive marc information on how to register users.
Alertli 11.11113 lmnlaie Universal Membership Agreement The Welk Number Sodnl Semites Pape a pfu
(115013p Inti LNFCIITIUN SthcJule A I RD July 13.2016
FULLING INFORMATION
Billing Contact: Billing Address:
Billing Contact _
Tole: City.
Billing Phone#: State:
Billing Fax#: Zip Code: ---
Billing E-mail: Your invoice will be salt via E-mail.
Expected Monthly Usage: Payment Method: 0 Check ❑ Credit Card
It the Expected Monthly Usage is equal or less than 25 ImansaCtons,Me method of payment recommended is Credit Card.
I lore will you perform verification requests'? ®Website 0 Phone
Can we send your Invoice via e-mail? ❑Yes ❑No
Is your agency Tax Exempt? ❑Yes ❑ No
How did you hear about our Social Services program?
❑ From an employer 0 From an applicant ❑ Through an Internet search
❑ I called the Client Service Center for assistance and the representative gave me this option
® A Work Number representative called me and explained the service.
Agency Type:
O Federal/State/County/City/Local/Government ❑ Social Security Administration
❑ Non-Profit Organization 0 Housing Authority
❑ For-Profit Organization ❑ Third Party Vendor for Government Agency
O Apartment Complex/Property Management 0 Other: Please specify
Each program requires documented proof. Specific Program(s)that will use this service:
® Food Stamps ® TANF ® MEDICAID
O Fraud Investigations 0 Child Support Enforcement ® Daycare Assistance
® Low-Income Energy Assistance ❑ Pre-Employment ❑ Work-related Assistance
❑ Low-Income Housing I Mortgage Loans ❑ Collections
O Other: (Please Indicate other programs that will use this service:
If you are an Apartment Complex or Property Management Company please answer the following questions:
How many units do you have?N/A How many of those are subsidized units? NA
Mote: Subsidized units are those In which the owner receives funds from Federal,State, County or Local Government.
Are you affiliated with ay/State Housing Authority? 0 Yes ® No
If yes, please indude the name:
mare 14,2011 1 vnphm Unf.enal Membenlup ANrecmrntAlic Wolk Minty'Social Sen Ices Page 5 of 6
Cos-311372.FOR F Srcu liON SciNuk A 1 nn July 11,1111P
egHIBIT 1 To
migpag y
mparassogALKBAcia
Participating County Transaction Allocation;
County Per County Transaction Allocation Per County Financial Obligation
Adams 20,445 $113,060.85
Arapahoe 8,177 $45,218.81
Bent 92 $508.76
Boulder 9,920 554,857.60
Broomfield 831 $4,595.43
Clear Creek 6 $33.18
Conejos 87 5481.11
Crowley 6 533.18
Delta 364 $2,012.92
Denver 30,039 $166,115.67
Douglas 1,013 $5,601.89
Eagle/Pitkin 551 $3,047.03
El Paso 18,549 $102,575.97
Fremont 814 $4,501.42
Grand 66 $364.98
Gunnison 9 $49.77
Huerfano 6 533.18
Jefferson 20,173 $111,556.69
Kiowa 6 $33.18
Kit Carson 6 $33.18
La Plata 351 $1,941.03
Lorimer 21,216 $117,324.48
Las Animas 182 $1,006.46
Mesa 3,914 $21,644.42
Moffat 95 $525.35
Montezuma 476 $2,632.2$
Montrose 35 $193.55
Morgan 2,349 512,989.97
Phillips 12 $66.36
Pueblo 5.190 $28,74494
Rio Grande/Mineral 101 $558.53
noun 571 $3,157.63
San Miguel 139 $768.67
Sedgwick 35 $193.55
Summit 38 $210.14
Weld 19,128 $105,777.84
TOTAL 165,000 $912,450.00
March 14.2013 Templee llnhenol Memiwnhip Agrcemeni The Wolk Number'Saul Sndrn Page 6 of 6
C115-)IqR I OR CCIAIR ION kpcduk A fahiln I I.RDJuly 1),2016