HomeMy WebLinkAboutbocc.res.056.2016 STAFF AUTHORIZED
�G SIGNATURE q �
CONTRA ��. GI2 (gi d a OW kike1K1`11443
J.+k4 "e
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.d66 ,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. § 291-203 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 2'?64- DAY OF ado/`� 2016 AN SET FOR CONFIRMATORY
PUBLIC HEARING ON THE 1041 DAY OF Usf ,2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND TITLE AND SHORT
SUMMARY OF THE EMERGENCY RESOLUTION P BLISHED IN THE ASPEN
TIMES WEEKLY ON THE /131"41- DAY OF / rr 1 , 2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND THE FULL TEXT OF THE
RESOLUTION POSTED ON THE OFFICIAL PITKIJ COUNTY WEBSITE
m
www.pitkincounty.coON THE i/d- DAY OF 1 O$-cs 2016.
CONFIRMED AT A CONFIRMATORY PUBLIC HEARING ON THE /G DAY
OF f4-tv5 2016.
PUBLISHED BY TITLE AND SHORT SUMMARY, AFTER CONFIRMATORY
PU IC HEARING, IN THE ASPEN TIMES WEEKLY ON THE /Q"1- DAY OF
u csE , 2016.
POSTED BY TITLE AND SHORT SUMMARY ON THE OFFICIAL PITKIN COUNTY
WEBSITE www.pitkincounty.com ON THE /0-3'1-DAY OF j4� r.< f 2016
ATTEST: BOARD OF COUNTY COMMISSIONERS
-lei
Jean tte Jones Rac el E. Richards, Ch "r
Deri ty County Clerk
Date:
APPROVED AS TO FORM: MANAGER APPROVAL
John Ely, Count Corney Jon Pejcock, County Manager
2
(ATTACHMENT B) DEPARTMENT OF HUMAN SERVICES
Contract RumNumber Routing NumbE.. 17IHGA 9I-j�)"r
Xn
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: CONTRACTORS ENTITY TYPE:
5/11/2016 Government
RQS PRE-ENCUMBRANCE NUMBER:
N/`, CONTRACTOR'S STATE OF INCORPORATION:
CT/CTOGI ENCUMBRANCE NUMBER N/A
N/A BILLING STATEMENTS RECEIVED
TERM
This contract shall be effective upon approval STATUTORY AUTHORITY
by the SLTte Controller or designee and upon C.R.S.§26-1-111
full execution of substantially the same CONTRACT PRICE NOT TO EXCEED
agreement with all counties listed in this
contract The Contact shall end either upon N/AS
termination of the Schedule A as specified in
the Work Number Agreement or temtination
as specified in this Contact MAXIMUM AMOUNT AVAILABLE PER HSCALYEAI
PROCUREMENT METHOD N/A
Exempt
BID/RFP/UST PRICE AGREEMENT NUMBER
N/A PRICE STRUCTURE
LAWSPEOAED VENDORSEATUI= 1 r. . ..0 nrl'a
N/A FUND SOURCE-NAME OF FEDERAL PROGRAM/GRANT AND FUNDS IDN
N/A
STATE REPRESENTATNE CONTRACTOR REPRESENTATIVE
Barry Pardus Nan Sundeen
CDHS, Office of Economic Security Director of Health and Human Services
1575 Sherman Street, 5th Floor
Denver,CO 80203 0405 Castle Creek Road,Suite 204
Aspen,CO 81611
RECEIVED
T.
For Contract Wizard Version 3.17 Page I of IS NOV 1 4 2016 Revised 03'202015
Colorado Department of Human Services MUMCOUNTY
Division of Contract Management HEALTH 8 HUMAN SERVICES
OCHIBRS:
The following exhibits are hereby incorporated:
Exhibit A. Statement of Work
Exhibit 13. 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 for 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 funds 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 15 Revised 03/2012015
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
term or condition of this contract shrill be construed or E. Notice and Revresentatives: For the purposes of this
contract, the representative for each party is as
interpreted as a waiver,express or implied,of any of
other designated herein.Any notice required orpern fitted may
the immunities, rights, benefits, rn protection, or other be delivered in person or sent by registered or certified
provisions of the"Colorado Governmental Immunity mail return receipt requested,to the at the address
amended. The
et seq.,as now or hereinafter provided,and if sent mail it is effective when posted
amended. The parties understand and agree that the
liability of the State for claims for injuries to persons in a U.S. Mail Depository with sufficient postage
or property arising out of negligence of the State of attached thereto.Notice of change of address or change
Colorado, its departments, institutions, agencies, or representative shall be treated as any other notice.
boards, officials and employees is controlled and F. Contractor Representations'
limited by the provisions of C.R.S. §24-10-101, et 1 Licenses and Certifications: The Contractor
seq., as now or hereafter amended and the risk
management statutes,C.R.S. q24-30-1501,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, ell 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 state of Colorado. Proof of such licenses,
certifications, approvals, insurance, etc. shall be
B. Eederal Funds Contingence Payment pursuant to this provided upon the State's request. Any
contract, if in federal funds, 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 part thereof, properly perform this contract,shall be grounds
become unavailable, as determined by the State, the for termination of this contract by the State.
State may immediately terminate this contract or 2. Oualification:Contractorcertifies that it is qualified
amend it accordingly to perforin such services or provide such
deliverables as delineated in this contract.
C. Billing Procedures: The State shall establish billing 3. Exclusion. Debarment andlor Suspension'
procedures and requirements for payment due the Contractor represents and warrants that Contractor,
Contractor in providing performance pursuant to this or its employee or authorized subcontractors,are
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.correct §
goods or services provided hereunder.
1320a-7b(1)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
referenced exhibits are incorporated herein and made a one of its employees or authorized subcontractors,
part of this contract And,unless otherwise stated,in is excluded from participation, or becomes
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 State in writing within three (3) days after such
following order of priority I)the Special Provisions of event. Upon the occurrence of such event,whether
this contract shall always be controlling over other or not such notice is given to Contractor,the State
provisions in the contract or amendments;2)thecontract reserves the right to immediately cease contracting
"covet" pages; 3) the General Provisions of this with Contractor.
contract;4)the exhibits to this contract,except that any
For Contract Wizard Version 3.17 Page 3 of 15 Revised 03:20:2015
Colorado Department of Human Services
Division of Contract 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. 824-102-206: The All policies evidencing the insurance coverage
Contractor certifies 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 performed within the United Slates 1. 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 824-10-
United States or Colorado, the countries and/or 101, et seq., as amended (the "GIA"), then
states where work will be performed, and the Contractor shall maintain at all times during the
reasons it is necessary or advantageous to go term of this Contract such liability insurance,
outside the United States or Colorado to perform 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 GIA,
executing this contract on behalf of the Contractor Contractor shall obtain and maintain during the
warrant(s)that such person(s)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.Worker's 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 die federal Tort Claims Act, statute, and Employer's 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 contact employees acting within the course and scope
containing this indemnification clause,does not waive the of their employment.
operation of any law concerning the panics' ability to b.General Liability. Commercial General
indemnify. The Contractor does not by this AgreementLiability Insurancewritten on 1SG occurrence
irrevocably pledge present cash reserves for payments in form CG 00 01097or equivalent, covering
future fiscal years. This Contract is not intended to create premises operations,fire damage,independent
a multiple-fiscal year debt of the Contractor. contractors, products and completed
(Applicable Only to Intergovernmental Contracts/ operations, blanket contractual liability,
No term or condition of this contract shall be personal injury, and advertising liability with
construed or interpreted as a waiver, express or minimum limits as follows:
implied, of any of the immunities, rights, benefits, (a)51,000,000 each occurrence;
protection, or other provisions, of the Colorado (b)51,000,000 general aggregate;
Governmental Immunity Act, CRS §24-10-101 et (c) $1,000,000 products and completed
seq.,or the Federal Tort Claims Act,28 U.S.C.2671 operations aggregate;and
et seq.-as applicable,as now or hereafter amended. (d)550,000 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 $1,000,000 because of claims made or paid,
For Contract Wizard Version 3.17 Page 4 of 15 Revised 03:204015
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 SI,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 51,000,000,unless waived by the of compliance with the provisions of this provision
State. 1.
e.Privacy Insurance
If this Contract includes a HIPAA Business 1. Disaster Plannine and Pandemic Outbreaks:The State
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
bawd 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 SI,000,000. performed by the Contractor under this contract
1.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. Riahts 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 this 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. Subrogation Waives 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 03202015
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 Stale requests that
the records be retained for a 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 alter 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 State, 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 terms 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 ofservices 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,
minor's parent,guardian,or the State,The Contractor
shall have written policies governing access to, O. Conflict of Interest. During the term 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 hisfher obligations to
recovered in accordance with other remedies.
For Contract Wizard Version 3.17 Page 6 of 15 Revised 03'202015
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 State. 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 fill • The Personal Responsibility and Work Opportunity
disclosure statement setting forth the relevant details Reconciliation Act of 1996,42 USC 604a,PL 104-
for the State's consideration and direction. Failure to 193. See also State Executive Order D 015 00;
promptly submit a disclosure statement or to follow • Title IX of the Education Amendments of 1972,20
the State's direction in regard to the apparent conflict U.S.C. 1681set w.;
shall be grounds for termination of the contract. •
The Uniform Administrative Requirements for
Grants and Cooperative Agreements to Stale 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 of a 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 conflict 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;
3. The employee's partner;or • OFFICE OF MANAGEMENT AND BUDGET
4. An organization which employees,or is about to GUIDANCE FOR GRANTS AND
employ,any of the above,
AGREEMENTS.2 CFR Pan 200,
has a financial or other interest in the firm selected for • The Hatch Act (5 USC 1501-1508) and Civil
award. Neither the Contractor nor its agent(s) will Service Reform Act, Public Law 95-454 Section
solicit nor accept gratuities, favors, or anything of 4728'
monetary value from Contractor's potential • DeParunen Education r,Hwlth and Human Services,
contractors,or parties to subagreements. and 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 strictly 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,OMB 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 et seq. and its implementing regulation, 45 as amended by §6062 of Public Law 110-252,
C.F.R.Pan 91; 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 of 1990(ADA),42 • The American Recovery and Reinvestment Act of
U.S.C. 12101 et sect; 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 tsFg; thereunder. This Act is also referred to as ARRA
• Equal Pay Act of 1963,29 U.S.C.206; Restrictions on Public Benefits: Pursuant to House Bill
• Health Insurance Portability and Accountability 065-1023, as codified at C.R.S. § 24-76.5-101 el seq.,
Act of 1996, 42 U.S.C. § 1320d el seq. and
implementing regulations,45 C.F.R.Parts 160 and except 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 IS years
U.S.C. 1324b; of age or older who applies for state or local public benefits
• Pro-Children Act of 1994,20 U.S.C.6081 et sec.;
or for federal public benefits for the applicant. Accordingly,
For Contract Wizard Version 3.17 Page 7 of 15 Revised 03'20.2015
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 18 years of age orolder 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 said 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) tiling
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 Anolicable. If the maximum amount §24-105-102(6)), or (h) under CRS §24-105-
payable to Contractor under this Contract is 102(6), exercising the debarment protest and
SI00,000 or greater,either on the Effective Date appeal rights provided in CRS §424-109-106,
or at anytime thereafter,this provision applies. 107,201 or 202,which may result in the reversal
2. Govemine 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
§24-102-205, §24-102-206, 424-103-601, §24- cause.
103.5-101 and 424-105-102 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,CRS§24-72-10 I,et
3. Performance Evaluation and Review. seq.
Contractor's performance shall be subject to
Evaluation and Review in accordance with the S. Performance Retinas and Guidelines'
terms and conditions of this Contract, State law The Contractor will he given a Final Contractor
(including without limitation CRS 424-103.5- Performance Evaluation at the end of the contract term in
101), and State Fiscal Rules, Policies and accordance with C.R.S. §24-102-205(6) and General
Guidance. Evaluation and Review of Provision R. above. The list of available Performance
Contractor's performance shall he 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
specific requirements of such obligations and merit an "Above Standard" rating are specified in a so
shall include factors tailored to match the dedicated Exhibit to this Contract,which may be included
requirements of Contractor's obligations herein from the scan of the contract or subsequently be
hereunder. Such performance information shall added by formal contract amendment at any time before
be entered into the statewide Contract the end of the contract term. If there is no such dedicated
Management System at intervals during the term Exhibit included or subsequently added herein,this rating
hereof determined appropriate by the State,and a is unavailable.
final Evaluation, Review and Rating shall be 2. standard: This rating will be given where: I.)
rendered by the State within 30 days of the 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 State;
Review, and shall address or correct any and 3.) full payment hereunder is made to Contractor for
identified problem in a timely manner and such performance.
maintain wok progress. 3. Below Standard: This rating may be given where
Gross Failure to Meet Performance Measures. Should Contractor 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 Contractor demonstrated a gross invocation of contract remedies and/or contract
For Contract Wizard Version 3.17 Page 8 of 15 Revised 03,202015
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_ Discrimination: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 Nis contract at all reasonable times
Syndrome(AIDS)or AIDS related condition'. and places. The Executive Director of the Stam 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
Stale has the right to:
U. Criminal Rackpround Check:Pursuant to C.R.S.§27- 1. withhold payment until performance is cured,
90-Ill 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 Contractors agent from
employee under C.R.S. §27-90-1I I, 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 DHS Policy VI-2.4, may, at State and the vendor as a debt due to the State)to
the sole discretion of the State, 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 state 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 1. Termination for Default:The State 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. Disputes: 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 maybe 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 I5 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 dale of termination.
3. Immediate Termination: This contract is subject Z. Venue: The parties agree that venue for any action
to immediate termination by the State 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 Panics:
immediately terminate this contract upon I. Complete Understanding: 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 mode 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 parties 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, for any reason,such invalidity or failure shall not
affect the validity of any other term or provision
to me event that the State terminates this contract hereof.
under the Termination for Convenience or 3. Benefit and Right of Action: Except as herein
Termination for Financial Exigency provisions. specifically provided otherwise, it is expressly
the Contractor is entitled to submit a termination understood and agreed That this contract shall
claim within ten 00)days of the effective dale of inure to the benefit of and be binding upon the
termination. The termination claim shall address parties hereto and their respective successors and
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 costs 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 term, or the same term upon subsequent DD.Colorado Department of Human Services (CDHSI
breach. Fraud Policy. The CDHS Fraud Policy addresses the
5. Sunival: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 Skate. The subgrants 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, Article IS of the Colorado Revised Statutes,
delivery of services, and performance of any known 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 hltn:iiwww rolorado.aov:cs'SatelliteCDtIS-
be certified to work on any equipment for which Emp CBON:1251610724004.
their services are obtained.
EE. Performance Outside the State of Colorado and/or jhe
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 Slate, 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"I. 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 Be
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 Strategy(C-Stat Strategy); 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 lean hereof to assist the State to measure
and assess the programmatic effectiveness of the
Contractor's performance hereunder,all in support 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 Slate 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 §24-10-101 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,
niles,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 rules 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 01202015
Colorado Department of Human Services
Division of Contract 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 of Contractor's
services and Contractor shall not employ any person having such known interests.
10. VENDOR OFFSET.CRS 0024-30-202(1)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 arrearages; (b)unpaid balances of tax,accrued interest,or other charges specified in CRS §39-21.101,et
seq.;(e)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 perforin 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 CRS §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 law,(b)shall comply with the
provisions of CRS g24-76.5-t01 et seq.,and(c)has produced one form of identification required by CRS§24-
76.5-103 prior to the effective date of this contract.
Revised 1-1-09
For Contract Wizard Version 3.17 Page 14 of 15 Revised 0320.2015
Colorado Department of Human Services
Division of Contract Management
Contract Routing Numbcr 11,.',,..' r 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 en their representations to that effect.
CONTRACTOR STATE OF COLORADO
Pilkin County Health&Human Services
By: Nan Sundeen John W.Hickenlooper,Governor
Title:Director of Health and Human Services Department of Human Services
By: Re ti e
Jul�g;zpw h,Exec
`ec/vDirector
I Cp Cel
1
`•Signature�J 9 _ _ / Ise VJ. =
Executive Director
Date: -2 -7 4 • ( (e) Signatory avers to the State Controller or delegate that
Contractor has not begun performance or that a Statutory
Violation waiver has beenreq es ted under Fiscal Rules
Date:__... Idl �20 __ __
2nd Contractor Signature if Needed LEGAL REVIEW
By: Cynthia H.Coffman,Attorney General
Title:
By
Signature-Assistant Attorney General
*Signature
Date
ALL CONTRACTS REOUIRE APPROVAL BY THE STATE CONTROLLER
CRS§24-30-202 requires the State Controller to approve all State Contracts.This Contract is not valid until signed and dated below
by the State 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
Jarros,n/CPGA,MBA,B/ JO
Ro
By: l/'w " 142-3 '_
Clint Woodruff,Contra
Date: (0/l9/k� I
For Contract Wizard Version 3.17 Page 15 of 15 Revised 03202015
Colorado Department of Human Services
Division of Contract Management
Exhibit A —Statement of Work
A. Background
For purposes of this Exhibit A, Contractor may also be referred to as"County." The State has entered into a
contract("Universal Membership Agrcement")(State contract routing number 16 IHEA 831 11)(Exhibit B)with
TALX Corporation,a provider of Equifax Verification Set-vices("EVS")and intends to execute an amendment
("Schedule A")(Slate contract routing number 16 BIM 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 bill the State for fees incurred by the counties,and the State 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 ] to Universal Membership Agreement). The Work Number Agreement
obligates the counties collectively and Contractor individually to pay[VS via the State for services rendered so
the State and County arc entering into this Contract to memorialize the Slate's and County's responsibilities us
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 State 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 1 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 Contractor the Work Number Agreement.
County is responsible for its percentage or the Annual Minimum Payment based upon the following formula:
ICouni's Average Previous U regal )(Taal Parilclpafing counties' Previous Ueagel _County
Percentage
[County Percentage! X 'Annual Minimum Payn]entl=County Financial Obligation
If County's Actual Annual Payment is less than County's Financial Obligation,"a1EN County is conaidercU a
Dcneicnt County and shall pay any deliciency according to the lullow'inb formula;
!Annual Minimum Payment]— [Total Actual Annual rayment] —Total Deficiency
'County Financial Obligationl— '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
Exhibit A-Page 1 ar3
This table represents each county's financial obligation:
County County
County Average 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 $166,121.20
Douglas 1,013 $5,601.89
Eagle/Pitkin 551 $3,047.03
El Paso 18,549 $102,575.97
Fremont 814 54,501.42
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 51,006.46
Mesa 3,914 $21,644.42
Moffat 95 $525.35
Montezuma 476 $2,632.28
Morgan 2,349 512,989.97
Phillips 12 $66.36
Pueblo 5,198 $28,744.94
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 $912,256.45
Exhibit A-Pagc 2 o13
D. Miscellaneous Provisions
I. Stale is acting as a fiscal agent for County,passing through payment of all costs from County to IEVS,
including the Annual Minimum Payment.The State 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 State shall be
obligated to pay over to CVS 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 last thirty(30)
days in which the Stale may cure the breach or any other remedy allowed by law. If County fails to pay
the State for County's costs incurred under this Contract or the Work Number Agreement, the State shall
have the right to terminate this Contract 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 change being effective as to a participating county. The
Stale shall not execute amendments or revisions to the Work Number Agreement or Schedule A that hind
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. Ifa County elects to terminate it shall not be
obligated to expend any funds, including any annual minimum payment, for the years following its
termination.
3. The Slate ntay execute similar agreements with new cuumirs nut origindily pan ur MIN Contract or tllc
Work Number Agreement. Irthe Slate executes a similar agreement with a new county or counties.the
Slate and County will recalculate the annual minimum for the subsequent annual term.
FIND Or EXHIBIT A
Exhihh A-Page 3 al
• UNIVERSAL MEMBERSHIP AGREEMENT
for
The Work Number'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("CDHS").
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. CDHS 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 It 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
status 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 (, 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 1 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 Cuunty 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 ony 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
August I I,2015/CUSJ0372 UniseneLNembenhip Agreement-The Work Numbs,'Social S vias Pate I11oiil(l
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
debt or payment obligation incurred by a Participating County pursuant to this Agreement or any Panicipation
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
Panicipating Counties using the Service, EVS will provide to CDHS an itemized invoice,detailing activity by
each Participating County.
c. Participating County certifies that it will order Data from the Service only when Participating County intends
to use the Data (i) 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 consumer's 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 turns 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"CFPB")'s Notice Form attached as Exhibit
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,that 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 contracnml 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 EYS to remm Data as a statement regarding (hat
consumers credit worlhinc55, occau5c the failure may malt from ane or more factors enrcluLN Iv irigit
worthiness,
L Participating County may access, use and store the Data only at or from locations within the territorial
boundaries of me United 51atc5,Canada,and thc United 5tatc5 mrrildrie5 of Moo Rico,Guam and the Virgin
Islands (the "Permitted Terirvey"), ra4icipaling county niay nut access, use or scare Ole Data Cr tvs
Confidential Information at or from, or send the Data or Confidential Information to,any location oumide of
thc Permitted Territory without Participating County first obtaining EVS's written permission.
g. Participating County represents and wafrants it(i) 13 administering a government funded benefit or program,
(n) has been given the legal authority to view the Data by the Consumer or by operation or law, and iii) is
requcstins the Data 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 of its
preeeda.
August 11.2015 Universal Membership Agreement.Pa Walk Number`Social Services Page 2 of 2
CUSdmR
i. Participating County represents and warrants it Ims written authorization from the Consumer to verify income.
Participating County need not use any particular forth 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 parry 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 o 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 IDs, 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.
Augue 1 t,x015 Universal Ltanbcnhhip Macmms-The Work Number'Social Services Parr 3 of
CUS-303)1
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,
8. 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 hand-held 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 he encrypted when not in use and all
printed Data must he stored in a secure, locked container when riot 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 far any purpose. In either case, commercially
reasonable practices for the type of Data received from F.VS must he employed,
11. 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 (3DES), 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,
13. 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 of EVS invoices for the purpose of detecting any unauthorized activity,
14, 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 oversight of Participating County's activities (e.g. the Federal Trade Commission, the
applicaulc panhing yr credit union regulator)applicable to the disposal of consumer report information or
records,
I0. use commercially reasonable Wens to secure Data when stored on servers, subject to the following
requirements; (i) servers storing Data mat hG scpa@lea from the lnrenl:t or other public nCtwOrliS by
firewalls which arc numbed and cord-loured to meet industry accepted best practices, (ii) proteet Data
through multiple layers of network security, acs's% but not limited to, industry-recognized firewalls,
routers. and intrusion detection/prevention devices (IDS/IPS), (iii) s access (bath physical and
network) to systemsstoring Data. which must include authentication and passwords that are changed at
least every ninety(90) days; and(iv)all servers must be kept current and patched on a timely Innis .vith
appropriate security-specific system patches,as they are available.
17. 091 allow Data lo be displayed via the Internet unless utilizing, at a minimum, a three-tier architecture
configured in accordance with industry best practices,
IH. 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,
,Wpu11 I.2015 Universal Membership Aertemrnt-The Work Number Social Services Pate,1 or 7
cusaom
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
be 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"Ace') 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 famish 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 Term")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 CDHS 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 CDHS and/or Participating County.
8. RIGHTS TO SERVICE. The Service and the Data, including all rights thereto,are proprietary to EVS.
August 11,2015 Unirmal Membership ggrurcno The Wort Number'Social Swims Par 5 of
CUS-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 fur
indirect, special, incidental, economic, consequential or punitive damages, including but not limited to lost
revenue, lost profits, replacement goods, loss of technology rights et 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',
expels'and investigators' fees and expenses("Claims")brought by third parties against the Indemnified Party and
arising from EVS's or its directors',officers' or employees' (i)-negligent or intentional, wrongful act or omission,
(ii)violation of applicable law or(iii)infringement on third party proprietary rights.
It 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 CURS as additional insured on all applicable policies except Workers Compensation and Errors and
Omissions.
IS. MISCELLANEOUS. This Agreement sets forth the entire o5rccment between the parties re5ordin5 the Service.
Except as otherwise provided in this Agreement, this Agreement may be amended only by a subseyue , writing
signed by both parties. This Agreement may not be assigned or transferred by Panicipettng County without EVS's
orto.written consent. Phis Agreement shall fie freely...tenable by IVS and shallethe hence.,or and be
binding upon the permitted designee of either CDHS or PVS. !Noy provision orthis Agreement ;a held to he
invalid or unenforceable under applicable in in any jurisdietion, the validity or enforceability of Ole remaining
provisions thereof shall be undirected as to such jurisdiction and such holding shall not affect the validity or
enforccobility of such Provision in tiny UAW TU the Mont that an]" pruvi ipn of ilio AgIWInenl li
held to be invalid or unenforceable because it is overbroad, that Prevision shall net be void but rather shall be
limited only to the extent required by applicable low and enforced as so limited. Any notice under this Agremocnt
shall be effective upon personal delivery by an emight or other courier or delivery service,ar Wr a(3)days over
pre-paid deposit with the postal service. either ease to the party's address in the first sentence otdds Agreement
or any substitute therefore provided by notice.
16. COUNTERPARTS/EXECUTION nil FACSIMILE. For the convenience of the parties, 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 Il.HIS Universal Membenhip Apeemenb M Work Number!5o.aI smites Page 6 era
C11510372
shall be fully 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, CONS 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 he initialed by the person signing on behalf of Participating County).
IN WITNESS WHEREOF,the parties 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
By ,(/�
By `f
(signature): An (signature): /
Name "' ' Name
(print): X..tS[/ ��.Live- (print): /tli6./ /Taf✓
Title: 01.-- /aerkir Title: V r e j/tfrc/ervr - S, le) Open..
Date: d '026• Date: '-/13//5
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
CONTROLLER
By:
lay
Clint Woodruff,Controller/Valrl Gimple, a uty Controller
Dale: `6I7:21.15
August 11.2015 Universal Membership Ayeemmi-The Work Number'Social Servions Pege 7 of r
CUS-7018
UNIVERSAL SERVICE AGREEMENT
Exhibit 1
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 arc 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 or she has the necessary authority to bind the respective party set forth
below.
Agreed:
Participating county TALC Corporation,
By(sig^rwre) By nignatmt) I2a /
N[hum,,,,.,, . N. p.nu /11;,4-.dv l r4 ,A�
Augmu1,2015 UnL tnai nkmbenhip Ag,amem.The Wo Numbd Sona l Servicer Page I or)
CUSd0112 ExhibitI
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 Act, 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 VFCRA,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 VFCRA § 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 11,1015 Universal Membership Agreement-1h[Work Moniker'Soda,Servloe Pak<2 of
CUS30]12 E,Mbnl
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 o 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 ofa 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 112.03 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,after 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.
(e)The fact that a clear and adequate written consent form is signed by the consumer after the consumer's credit report has
been obtained pursuant to some other form of consent shall not affect the validity of the earlier consent.
Augual II,2aI Univvul Membersblp Agreemem.Thc WmF Number'Sods'Seri ees Page l ora
CU5.30]72 Exht it I
UNIVERSAL MEMBERSHIP AGREEMENT
far
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 at the Consumer Financial Protection Bureau's website,www.cnnsumerfinmee.govdearnmore.
NOTICE TO USERS OF CONSUMER REPORTS:OBLIGATIONS OF USERS UNDER THE FCRA
The Fair Credit Reporting Act(FCRA), IS U.S.C. 1681-1681y,requires that this notice be provided to inform users of consumer
reports of their legal obligations.Stale law may impose additional requirements.The text of the FCRA is set forth in full at the
Consumer Financial Protection Bureau's(CFPB)website al www.cansumerfinance.govlleammore. At end of this document is a
list of United States Code citations for the FCRA. Other 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 FORA.
The first section of this summary sets forth the responsibilities imposed by the FCRA on all users of consumer reports.The subsequent
sections discuss the duties of users()Nepalis 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. Wen Must Have a Permissible Purpose
Congress has limited the use ofconsumer reports to 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 arc;
• As ordered by a court or a federal grand jury subpoena.Section 60400(0
• As instmcted by the consumer in writing.Section 604(x)((2)
• For the extension of credit as a result of an application from a consumer,or the review or collection of a consumer's
account.Section 604(a)(3)(4)
• For employment purposes,including hiring and promotion decisions,where the consumer has given written permission.
Sections 604(o)(3)(8)and 604(6)
• For the underwriting of insurance as a result of an application from a consumer.Section 604(o)(3)(C)
• When there is a legitimate business need,in connection with a business transaction that is initiated by the consumer..Section
604O(3)(F)0)
• To review a consumer's account to determine whether the consumer continues to meet the terms of the account.Section
604(a)(3)(F)(ii)
• To determine a consumer's eligibility for a license or other benefit granted by a governmental instrumentality required by
law to consider an applicant's financial responsibility or status.Section 604(0)(310)
• For use by a potential investor or servicer,or current insurer,in a valuation or assessment of the creditor prepayment risks
associated with an existing credit obligation.Section 60d(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(a)(4)and 604(a)(5)
In addition.creditors and insurers may obtain certain consumer report information for the purpose of making"prescreened"
unsolicited offers of credit or insurance.Section 601(c),The particular obligations of users of"prescreened"information are described
in Section VII below.
13. 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 the 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.
Angus'1I.2015 Universal Membership A{rtmemdbe Work Number'Social smicer Page I of 5
CUS 30312 Exhibit 2
C. Users Must Notify Cousunrers When Adverse Actions Are Taken
The teen"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)ur 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 FCRA that is based at least in pan 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 not able to explain why the decision was made.
• A statement setting forth the consumer's right to obtain a free disclosure of the consumer's rile from the CRA if the
consumer makes a request within 60 days.
• A statement setting forth the consumer's right to dispute directly with the CRA the accuracy or completeness afany
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 than a CRA,and the information is the type of consumer information covered by the FCRA,Section
61506)(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 consumer's written request.
3. Adverse Actions Based on Information Obtained From Affiliates
If a person takes 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(b)(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 Have Obligations When Fraud and Active Duty Military Alerts are hi Files
When o consumer has placed a fraud alert, including one relating to identity then,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 on users of reports
obtained from the consumer reporting agency in certain circumstances,including the establishment of a new credit plan and 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 Calm a 1;041114111C OW anon me igconly at Inc applicant co contact the consumer ata telephone number specified by
.n the.nse nr eoremed gaud alerts,the Doter mutt contact the consumer in accordance watt me contact information
provided in the consumer's alert.
EI them flare Obligations When Notified of an Adams Discrepancy
Section 605(h)requires nationwide CRAB.M defined in Sedien 607(0).to notify users fiat reduest reports whenthe address for a
consumer provioed by the user in requesting the report is substantially different from the addresses in the consumer's file.Wnen this
OCCIIFS,USCTS1111L51COMpi7 Math resmations spccifi'ins the procedures to be rvilvwcd. Federal rebulatioria arc arailavIc at
My Mvw.consum era n an ce.go vnea mm are
F. Users Have Obligations When Disposing al Records
Section 62g requires that all users orconsumcr report information have In place procedures to properly dispose or records containing
this information. Federal regulations have been issued that cover disposal.
August I I,2015 Uni•nsal Membership AgreemmbThe Work Numbers Social Servo Page 2 of 5
MIS-30312 HAM
II. CREDITORS MUST MAKE ADDITIONAL DISCLOSURES
If a person uses a consumer report in connection with an application for,or a grant,extension,or provision of,credit to a consumer on
motedal terms that arc materially less favorable than the most favorable terms available to a substantial proportion of ronsunters 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 with regulations prescribed by the CFPB.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)(I)(D)("Notice to the Home Loan Applicant").
IH.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(b)of the
FCRA.The user must:
• Make a clear and conspicuous written disclosure to the consumer before 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 term of employment may
be obtained at the time of employment.
• Certify to the CRA that the above steps have been followed,that 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 to be taken based on
the consumer report,a copy of the report and a summary of the consumers rights will be provided to the consumer.
• Before taking an adverse action,the user must provide a copy of the report to the consumer as well as the summary of
consumer's 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)(?)
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
the company.
IV. OBLIGATIONS WHEN INVESTIGATIVE CONSUMER REPORTS ARE USED
Investigative consumer reports arca special type of consumer report in which information about a consumers character,general
reputation,personal characteristics,and mode 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 we given special rights under the FCRA.If a user intends
to obtain an investigative consumer report,Section 606 requires the following:
• The user must disclose to the consumer that an investigative consumer report may be obtained.This must he 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 date 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 es described below,and the
summary afconsumer 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 11.3015 Universal Mcmbctship Agreement:Mc Work Number'Snell!Service, Page 3 015
C515.30M2 Exhibit 2
V.SPECIAL PROCEDURES FOR EMPLOYEE LNYESTIGATIONS
Section 603(x)provides special procedures for investigations of suspected misconduct by an employee or for compliance with
Federal,state or local 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 004(g)limits the use of medical information obtained from con5lnner reporting agencies(other than payment information that
appears in a coded form that docs not identify the medical provider).If the information is to be used for art insurance transaction,the
consumer must give consent to die user of the report or the information must be coded, lithe 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
written 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 the purpose for which the information was disclosed,or as
permitted by statute,regulation,or order).
VII.OBLIGATIONS OF USERS OF"PRESCREENED"LISTS
The FCRA permits creditors and insurers to obtain limited consumerreport information for use in connection with unsolicited offers
of credit or insurance under certain eircumstances.Semon..603(O604(c), 604(E),and 615(d).This practice is known 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 made,establish the criteria that will be relied upon to
mac the offer and to grant credit or insurance,and(2)maintain such criteria on ale for o three-year period beginning an the date on
which the offer is made to each consumer.In addition,any user must provide with each written solicitation a clear and conspicuous
statement Mat:
• Information contained in a consumer's CRA file was used in connection with the transaction.
• Theconsumer received the offer because he or she satisfied the criteria for credit worthiness or insurability used to screen
for the offer.
• Credit or insurance may not be extended if,after the consumer responds,itis 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 1022.5e.
VIII.OBLIGATIONS OF RESELLERS
A.Disclosure and Certification Requirements
5eenon 007(c)requites any person who obtains a consumer report for resale Io lake the following steps:
- m,.ao.e the identity or the end user to the source CPA.
• Identify to the source CRA cacti permissible purpose for which the'sport will be furnished to the enthused
• Establish and follow reasonable procedures to ensure chat repons ore retold only for pem,isslble purpose.,including
procedures to obminm
(I) the identity doll end-user
(2) eedifientiene from all usen of end,purpose for which reports will he used:nod
(3) certifications that reports will not he used for any purpose other thin the purpose(s)speeified to the reedier.
Resellers must make reasonable efforts to verify this information before selling the repos.
D.Reinvestigation.by Resellers
Under Section 6110.if a consumer disputes the aeeuracy 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,Ilse.correct or delete the information.If not,
the reseller must send the dispute to Inc source CM for reinvestigation When any CRA notifies the reseller of the results of an
investigation,the reseller must Immediately convey the Information to the consumer.
August 11.201$ Universal Membership Agreement-The Work Number'Sodnl Serrleo Page a of
CUS 30JR Exhibit 2
C. Fraud Alerts and Resellers
Section 605A(I)requires resellers who receive fraud alerts or active duly alerts from another consumer reponing agency to include
these in their reports.
LX.LIABILITY FOR VIOLATIONS OF THE FCRA
Failure to comply with the FCRA can result in slate eovemment or federal government enforcement actions,as well as private
lawsuits.Sections 616,617,and 621.In addition,any person who knowingly and willPolly obtains a consumer report under false
pretenses may face criminal prosecution.Section 619.
The CFFB's website, www.ronsumerlinance.gov/learnmore, hes more Information about the FORA, including publications
for businesses and the full text 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 6D3 15 U.S.C. 1681 a
Section 604 15 U.S.C. 1681b
Section 605 15 U.S.C. 1681c
Section 605A 15 U.S.C. 1681 cA
Section 605B 15 U.S.C. 168lc0
Section 606 15 U.S.C. 1681d
Section 607 15 U.S.C. 1681e
Section 608 15 U.S.C.1681f
Section 609 15 U.S.C. 1681g
Section 610 15 U.S.C. 1681h
Section 611 15 U.S.C. 1681 1
Section 612 15 U.S.C. 168Ij
Section 613 15 U.S.C. 1681 k
Section 619 15 U.S.C. 1681/
Section 615 15 U.S.C. 16/11m
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. 1681r
Section 621 15 U.S.C. 1681s
Section 622 15 U.S.C. 1681s-1
Section 623 15 U.S.C. 1681s-2
Section 624 15 U.S C. 16811
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. 1681 y
August 11,2015 Univemal Membership Apt-01=141ie Wolk Number'Salmi SenIca I' ge 1 ol5
CUS-30372 Eabibn 2
UNIVERSAL MEMBERSHIP AGREEMENT
SCHEDULE A—THE WORK NUI\'IRER&EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
I) AGENCY USE OF SERVICE;
The Work Number° is an mnplayment verification service provided by TA LX Corporation (0 provider of Equine(
Verification Services),a Missouri corporation("EVS"),to its employer clients. Data on the Service may be accessed by
agency to verify Consumer's employment status ('the Work Number*Employment Verification')or income rite
Work Numbers Income Verification')for gob mmant purposes. EVS shall provide the Service in accordance with the
Universal Membership Agreement("Agreement"),Exhibit Ito the Agreement and this Schedule A(which is part of this
Agreement). All defined terms used herein shall have IIIc meaning ascribed to them in the AgleemenL
a) Praduet. The Work Number°Employment Verification includes the Consumer's 0)employer name and(ii)
employment status. The Work Numbei Income Verification may include,without limitation.the Consumer's(i)
employer address,(ii)employment dates,where available,(iii)position title,(iv)medical mud dental information,
where available,(v)pay rate,(spup m three(1)years of VTD gross income details.and(vii)up to three(3)years
of pay period detail.
b) Delivery. The Service provides automated access to requested Dota via the Internet or phone. If Data is requested
via the Internet,it will be delivered instantly via the same mode. If Data is requcscd via the phone,it will be
delivered by fax within one(l)business day.
c) Input Req uiremen O. An Agency may request access to Data by providing the Consumer's social security
number..
PRICING: Fees for Services provided under this Schedule Include:
❑ Onslle Inspection Fee: Waived
Agency Initials:
Verification Fees: Select a pricing plan below and initial by the plan you choose
Pilot Pricing—The Work Number will provide unlimited pilot access for 90 days. Agency Initials: (-4- 1
II) PAYMENT TERMS AND TAXES:Invoices are due net forty-bve(45)days with one(t%)percent interest per month
applied over forty five(45)days.invoices outstanding over forty Clic(45)days will result in loss of access to the
Sen-ice.Except lo the extent that Agency has provided an exemption certificate,direct pay permit or other Lich
appropriate documentation,EVS shall add to mach invoice any sales,use,excise.value-added,grass 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/pal odaliege or franchise tuxes,tams based upon
f:VS's net income and any taxes or amounts in lieu thereof paid or payable by EVS as a result of the foregoing excluded
items. ICpayment is made by credit card,EVS will charge the credit card each month for transactions completed in the
prior month.Client will be invoiced electronically through Equifax'a Electronic Invoice Presentation 3 Payment(EIPP)
program. Requests for paper billing are available upon Client's request and are subject to additional monthly fees.Such
fees arc subject to modification by Equifax m Intervals of no 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 Cann irate the Senior within shiny(30)days after notice or a modification to the Service
Description on written notice to EVS. Absence of such terminmiun shall constitute Agency's agreement to the
modification.
DIUFIA1UIl/MOM FULLWY
PLEASE FAX TO THE WORK NUMHEK"SOCIAL SERVICES at 8SS•708.6616
octane,9,role/CVS-'0372 sthemle A-E.prew Patc l of•
LRDAugtm 11,1015
UNIVERSAL MEMBERSHIP AGREEMENT
SCHEDULE A-THE WORK NUMBER'EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
STATE OF COLORADO TALX Corporation,
John W.Hlckeolooper, GOVERNOR provider of Equifax Verification Services
Colorado Department of Human Services
Reggie Bicha,Executiveutiv� Director ,J�
(signature): / .P(/-C Qj/� (signature):( ,%r� / F-
Namc "JJ/ „// Name
(print): /ec' /v (print): �i6iw�./P/ no Le-
(
Tide: lits/nDr� Title: V'i✓C G Pres:ha r-S.�ry OQCrrt,*,
Date: 7 -atp • 1S Dale: D /13/ iS
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
�CONTROLLER
By:
Clint Woodruff,Controller l Veld Clmple, eputy Controller
Dote: ebJ/e-7 /
PLEASE FAX TO THE WORK NUMBER*SOCIAL SERVICES at 888-708-6816
Orman 8,2014/CW.3072 Sclsdule A-Eaves Pqe l ors
IAD August 11.2015
UNIVERSAL MEMBERSHIP AGREEMENT
SCHEDULE A—TILE WORK NUMBERS EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
AGENCY TYPE'
y/ Smlc or County Social Service.U�fuman Services Agency Social Secunty Administr ton ✓Oletllxa:d
_Work Program IA) I Housing Authority(Federal,State or County) ‘7 Child Suppon Enforcement
Low-Income Housing(i.e.Sec.9,Scc.42)
• `•Pleaseproride proof ollo'fncome Sato,"
NO l E:IF YOU ARE CO.IPLETING THIS AGREEMENT FOR AN Al ABTrIENF,
YOU MUST FAC PROOF OF TILE APARTMENT'S LOW-INCOME STATUS
Re.,APPLICATION,OCCUPANCY GUIDELINES,etc.)MITA MIS SERVICE
AGREEMENT'OR YOUR ACCOUNT WILL NOT BE ACTIVATED
Oilier.
SPECIFIC PROGRAMS OR DIVISIONS THAT WILL USE THIS SERVICE(Check ALL,hal apply):
X Food Stamps XTANP X General Cash Assistance X Low-Income Energy Assistance
__ IEVS X Fraud Investigations .X_Quality Control X Housing Assistance
Work-related Asstsiance X Emergency Assistance Title II Title XVI Title IV-D
Other.Please indicate all other programs that will use the service
CONTACT INFORMATION
Agency/Organization/ Colorado Department of Human
Company Name: Services Address: 1575 Sherman 5k,3rd Floor
OEM or Management
City: Denver
Company,it different. _
Wobsito address: http://Colorado.gov/CDHS State: CO
j
Main Contact: Samantha O'Neill-Dunbar Zip Code: 80203
TIM Project Manager [mall: samantha.oneilldunbar@state.co.us
Phone#. l 303.866.22864 Fax#:
Supervisor Layette Love Supervl<or 303.866.2054
Pnone#
ADDITIONAL USER INFORMATION
IMPORTANT All indumluels whs.w.ll use the arnice must be registered below During:he login proccne.the.•aer'aill br
embed far d,err reordered Fax trumher. All fell are numb.,l.,r/.
Hnm- Prix* E-mall A0drra.
Overt:
_. . ._..
USerI: C _
Uaer4-
Users.
Please pra,dde Me names.fax numbers and a-mal addresses orup to 5 addnbnal users. Note:The"Alain Comate"above will
have the ability to add users via the n'ebMnnager function Webblanngers have the ability to odd,manage and approve users
within the organization.If you have additional users,once Agreement is accepted,you will receive mote infomlalion on how to
register users.
PLEASE FAX TO THE WORK NUMBER'SOCIAL SERVICES at 888-708-6816
October a,]014 ICUS-3Oal3 Scho1Wc A•EM1165 Pogc 3 af5
LW Austral 11,2015
BILLING INFORMATION
Billing Contact: Billing Address:
Billing Contact City:
Title:
Billing Phone he: State:
Billing Fax#: Zip Cede:
Billing E-mail: Your nwlce Itn7/be sent via E-mail.
Expected Monthly Usage: Payment Method: ❑ Check ❑ Credit Card
How will you perform verification requests? 0 Website 0 Phone
Can we send your invoice via e-mail? ❑Yes ❑No
Is your agency Tax Exempt? ❑Ycs ❑ No
Haw did you hear about our Social Services program?
❑ From an employer ❑ From an applicant 0 Through an Internet search
❑ I called the Client Service Center for assistance and the representative gave me this option
❑ A Work Number representative tailed me and explained the service.
Agency Type:
• FederaVState/County/City/local/Government D Soca:Security Admin stration
❑ Non-Profit Organization 0 Housing Authority
❑ For-Profit Organization 0 Third Party Vendor(or Government Agency
❑ Apartrnent Complex/Property Management 0 Other: Please specify
Each program requires documented proof. Specific Program(s)that will use this service:
O Food Stamps ® TANF ® MEDICAID
® Fraud Investigations ® Child Support Enforcement ® Daycare Assistance
® Low-Income Energy Assistance 0 Pre-Employment ❑ Work-related Assistance
® Low-Income Housing 0 Mortgage Loans 0 Collections
❑ 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? How many of those are subsidized units?
Ngt : 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? ❑ Yes 0 tic
If yes, please include the name:
Oduhr t,3g111CUS4O372 5511cduk A-Lspass Page a of
LRO August It.7015
Qualifications: In order to process your application, your agency/organization is required to provide proof
(suobortinn dorumentationl 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
9. Funding source S. 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 i CUS30)tt Schedule A-Epur Page S ors
LRD Augurs I I,WI)
UNIVERSAL MEMBERSHIP AGREEMENT
SCHEDULE A—THE WORK NUMBER EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
I) USE OF SERVICE:
1 b Work Number`is an employment sad-tendon urvice provided by TA LX Corporation(a pros ider of Equifax Verification Senlce.), a
Missouri corporation("EVS").to its employer clients. E VS shall pros ide the Service in accordance is ith the Universal Membership Agreement
bens eel)EVS and the Stale of Colorado,Colorado Department of Human Services("CDIIS")(die"Agreement").Exhibit 1 to the Agreement
and 'Ins Schedule A Prhich is pad of the Agreement). Data on the Service may be accessed by Panicipaling County(as defined in the
Agreement) to reify Consumers employment status("The Work Number% Employment Verification")or income ("The Work Numbers
Income Verification') for gm ernmenI purposes. Ail defined terns used heroin shall has e the meaning ascribed to them in the Agrecmeni
Notwithstanding any con Rioting prolusions in die Agreement,the parties acknowledge and agree that this Schedule A to the Agreement,any
future Schedule, or amendments to Schedule A or amendments to the Agreement. may be executed by CORS sellout requiring separate
signatures of each Participating County only if CDIIS was authorized to take this action through apprusal by all Participating Counties which'
in ting and signed by a person authorized by the governing body for each Participating County in accordance with such county's local
procedures CURS represents to CVS that,prior to executing any such Schedule or amendments to a schedule or the Atmeement,CDIIS .hall
brae such scniten authorization from each Participating County to take such anion.
a) Product. The Work Number Employment Verification includes die Consumer's(i)employer name and (n)employment status The
Work Number"Income Verification nay include,sr i'bout limitation.the Consumer's(I)employer address,(it)employment dates,it here
available,(iii)position idle.(a)medical and dental information,"Imre mailable.(v)pay rale.(s i)up to three(3)year'of YID gip-
income
scone details,and(vii)up to duce(3)years of pay period detail
b) Relit cry. The Sac ice provides automated access to requested Dam via the Intent or phone. If Data is requested via the Internet.n rill
be deli'Bred instantly via the sane mode. If Data is requested sin the plane,it w ill be delivered by fax within one(I)business day.
c) Input Requirements. A Participating County may request access to Data by pros[ding die Consumer's social security number.
It) TERM: Notwithstanding any conflicting terms in Section 7 of the Agreement,this Schedule A shall be for an initial annual temp efeclne
January I.3016—December 31,2016(the"Initial Tenn`);w'@ four(4)optional annual renewal tears("Succeszne Terms")as nil able,upon
xritten agreement benacan Mc parries For'he as Wance of doubt the Terni of Mc Agreement shall remain in effect as long as there r;an
outstanding schedule with a tern then in effect.
III) PRICING: Fees for Services providedunder this Schedule include
Verification Fees:
0 Annual Minimum Pay merit CUBS Initials:
'Intal cost per year Annual
(verification.) Verification
Coling
mid dot
Transaction Typc tcrifcat ions) Cosi Abaw Cci lisp
Employment Summary
(SSNSenrdi) FREE UNLIMITED I RCE
Income Verification 5917,451110 per you 165,000 3553 per income cridcaion
IV) The request by Participating County and'he performance by EVS of an Employment Verification(and/or Income Verification,if applicable)
under this Agreement and Schedule A shall be referred to as"lransamlon(s)".The Annual Minimum payment shall be charged to CUHS fix all
Transactions up to and including the Annual Transaction Ceiling For Transactions charged against the Annual Transaction Ceding,CDIIS will
be billed monthly, as transactions occur at the effective rate of 55.53 per Transaction. Each Transaction performed above the Annual
Transaction felling will be charged ai 55.53 per Transaction and shall also be billed monthly. In the es en' the Put eipating Counties do not
collect's ely use all Transactions allotted under the Annual Transaction Coling by die end of any annual term,EVS shall invoice CDIIS for
each Participating County failing to meet its allotted portion of the Annual Transaction Ceiling(as specified in Exhibit 1 hereto)during such
annual ami,the remaining portion of such Participating County's corresponding Annual Minimum Payment,and CDIIS gall renes payment
for such remaining porlion(s)directly to EVS EVS and COBS understand that CDIIS is acting as a fiscal agent for the Participating Counties.
passing through payment of all costs from the Participating Counites to EVS,including the Annual Minimum Payment CDIIS shall not be
liable for arty debt or payment obligation, including the Annual Minimum Payment, incurred by a Participating County pur.uant m this
Agreement or any Participation Agreement,pros ided.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 base the right to eminate this
Agreement with respect to such Participating County upon written notice and at least thirty(30)days in which CDHS may cure tlhe breach
March 14,2013'template Unit ersal Membership Agreement-11w P nm NumberSocial Settles Page iofn
(IJS-3t1372 TOR I XI CFI ION ScheduleA LRUJuly I3,201M1
NA;\d,k C
Notwithstanding any conflicting provisions in the Agreement,EVS shall provide written notice of my increase in foes to COI IS at least ninety
(9x1 days prior io the end of Ilio Initial Tenth and each Successive Tam_Upon receipt of such nonce.CDIIS shall within five(51 business days
notify Participating Counties,and CDIIS or any Participating County shall have sixty(60)days after receipt of notice to notify EVS and CDIIS
of any I'an¢Ipaling Counties'election to terminate their 'anicipal ion Agreementls), Upon EVS's receipt of any such notice(s),the Annual
Nmimum Payment shall be adjusted accordingly for each Ientam ing Successive Term.and the Annual Transaction Ceiling shall like"ise be
adjusted far each remaining Successive Term, by deleting the portion of the Annual Transaction Ceiling audbwable in each Parklinatne
County terminating its Pan inpahon Agreement.
Transactions allotted under the Annual Transaction Ceiling Thal are not used during the Annual Term will not be available for use in any
Success''c Tenn
SSN Searcher will be free and do nut count against the annual ceiling.
V) PATIENT TERMS ANI)TAXES: Enrolees are due ncl bony-fire(a5l days Int ones outstanding over bony frac(45)days will result in loss
of access to lie Service. Except to the extent that CDIIS has provided an emptin cert ifemc direct pay permii or mho such appropriate
docnmeniatton for each Panicnpaling County, EVS shall odd to each invoice any ales, use, excise. value-added. gross receipts. Services.
consumption and other similar transaction lases however designated that arc properly levied by any taxing authority upon the provision of the
Sen ices,excluding,hoover, any slate or local privilege or franchise tares,tares based upon EVS's net in carne and any taxes or amounts in
hen thereof paid or payable by EVS as a result of the foregoing excluded Ilems. If payment is made by credit card,EVS will charge the credit
card each month (or tranaclians completed in the prior month CPUS will be invoiced electronically through Equifax's Electronic Invoice
Presentation&Payment(EIPP)program Requoas for paper killing arc available upon CDH S's request and arc subject to additional monthly
fees Such fees re subject In modification by Equifax :hien alsof no less than one year.upon prior written notice.
VI) MODIFICATION OF SERVICE DESCRIPTION: EVS may modify this Sen ice Description on ninny(901 days prior v.riitca nonce to
CDIIS and alien within five(5)business days notify l'adicipal mg Counties. CDIIS may terminate this Schedule A.or any Participating County
may terminate its Pan icipal ion Agreement,within ninety(911)days after receipt of notice of a modificaton In the Service Description on wane'.
,ioticc to VS and CDIIS:and. upon CDI IS's request. an amendment to memo ria0a the modification to the Senicc Descripi ion may be
executed by the panes Absence of such tenni nation or amendment request shall constipate CDIIS's and each remaining Participating County's
agreement to me modification
Aire!'14,2013 Template Univenal hlcmbenlup Agreement the vllM:Number'Serial Serxices Page 2 of6
()5.3037„i raw Xtrl n IONN minima A tilt)jWr 13,2016
UNIVERSAL ItIEMOERSIIIP AGREEMENT
SCHEDULE A—TIIE WORK NUMBER EXPRESS SOCIAL SERVICE
FEES AND SERVICE DESCRIPTION
IN WITNESS'VII EREOF,the parties have executed this Agreement on the date indicated below.
STATE OF COLORADO TALX Corporation,
John W.Ilickenlooper, GOVERNOR provider f Equlfes Verification Sen ices
Colorado Department of Human Services
Reggie Riche,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 HUMAN SERVICES
CONTROLLER
By:
Clint Woodruff,Controller/Valri Gimpiq Deputy Controller
Dale:
tmnh 11.2013 template Uni coal Alemlkmhip Agreement The Work Number Social Seni[a Page 3 of 6
CIIS.30372 IDR l: OCU HON Schedule A I.R n July IJ.701➢
AGENCY TYPE:
N State or County Social Services4luman Services Agency 0 Social Security Administration N Medicaid
O Work Program(IVIA) 01 lousing Authority(Federal,State or County) N Child Support Enforcement
0 Low-Income'lousing(i.e.Sec.A,Sec.42)
• 1'ha.e p once proof lm„,neao,e nm o.to
NOTE:IF VOn Atilt COSI PI kThC MIS AGREE1l EMT FOU ANA P.Urr.WiNT.
VOL Marl ELS ru001:01:rev APARTMENT'S 1.0W-INCOME SIAL US
0.c.,APPLICATION,OCCUPANCY GUIDELINES,00 FI1 THUSSf.Il ICI
ACID::I Alt NT Ott YOUR ACCOUNT WILE NITr RE nen VATEI
0 Other:
SPECIFIC PROGRAMS OR DIVISIONS THAT WILL USE THIS lS SERVICE(Check ALL that apply):
N Food Stamps N TANI' N General Cash Assistan:e N Low-Income Energy Assistance
❑ IEVS 0 Fraud Investigations N Quality Control 0!lousing Assistance
❑ Work.related Assistance N Emergency Assistance 0 Title II 0 Title XVI ®Title IV U
N Other:Please indicate all other programs that will use the service Child Care Assistance and Child Welfare/IV-E
CONTACT INFORMATION
Agency/Organization/
Company Name. Address:
DBA or Management _
Company,if different CIN'
Website address: State;
Main Contact Zip Code:
Title. E-mail:
Phone ti: Fax#:
Supervisor. Supervisor
Phone#
ADDITIONAL USER INFORMATION
IMPORTANT: All individuals who will use the service must he registered below_ During IIM login process.the user mill he asked
lar their rcgoigcd lak num6sr. Alle muntlaiary,
Nam. Maeda E-mail Adeno
°seri: Not Mmlieablc
Uccr2:
User3:
User4:
users:
r----
Phrase provide thea s,fox numbersand c addresses ail addre of up to 5 additional users. Note:The"blain Contact-above will have
the ability to add usersvia be uebManager function.VVebManagers have the ability to add,manage and approve users within the
organivalion.If you have additional users.once Agreement is accepted,you will receive more information on how to register livers.
March 14.2013 Template Universal Mcmbctslup Aencmcm lbe Work Number'Social Settlers Page 4 cifh
CI15.30372 FOR LCr.Ct1 I ION SohVIRlk A I RD July 13 21110
PILLING INFORMATION
Billing Contact: Billing Address:
Billing Contact Cit:
Title:
Billing Phone#: State:
Billing Fax#: Zip Code: -
Billing E-mail: Your inwtire wHI be sant via E-mail.
Expected Monthly Usage: Payment Method: 0 Check ❑ Credit Card
11 the Expected Monthly Usage is equal or less than 25 transactions,Me method of payment recommended is Credit Card
flow will you perform verification requests? ®Website ❑Phone
Can we send your Invoice via c-mail? 0 Yes 0 No
Is your agency Tax Exempt! 0 Yes ❑ No
How did you hear about our Social Services program?
❑ From an employer ❑ From an applicant ❑ Through an Internet search
❑ 1 called the Client Serece Center for assistance and the representative gave me this option
® A Work Number representative called me and explained the service.
Agency Type:
• Federal/State/County/City/Local/Government ❑ Social Security Administration
❑ Non-Profit Organization ❑ Housing Authority
❑ ForProfit Organization 0 Third Party Vendor for Government Agency
❑ 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
® Fraud Investigations ® Child Support Enforcement ® Daycare Assistance
• low-Income Energy Assistance Cl Pre-Employment 0 Work-related Assistance
❑ Low-Income Housing ❑ Mortgage Loans ❑ Collections
❑ 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? NN A
Mg: Subsidized units are those In which the owner receives funds from Federal,State, County or Local Government.
Are you affiliated with Oty/State Housing Authority? ❑ Yes ® No
If yes,please indude the name:
larch H.20O'emplaic Universal Mcmlrnuip Agrcemanuna Wolk Nunaw±Rods Serdecs Page s orb
C15-3037 FOR r XrCU1ION SJmJuk A I RD July U,2011,
FXHIBIT 1 TO
SCHEpUI.E A—THE WORK NUMBER'EXPRESS SOCIAL SERVICE
Participating County Transaction Allocation%
County Per County Transaction Allocation Per County Financial Obligation
Adams 20,445 $113,060.85
Arapahoe 8,177 545,218.81
Bent 92 $508.76
Boulder 9,920 $54,857.60
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 5102,575,97
Fremont 814 54,501.42
Grand 66 5364.98
Gunnison 9 $49.77
Huerfano 6 $33.18
Jefferson 20,173 $111,556.69
Kiowa 6 $33.18
Kit Carson 6 $33.18
La Plata 351 51,941.03
Larimer 21,216 $117,324.48
Las Animas 182 $1,006.46
Mesa 3,914 $21,644.42
Moffat 95 $525.35
Montezuma 476 $2,632.28
Montrose 35 $193.55
Morgan 2,349 512,989.97
Phillips 12 866_16
Pueblo 5.198 $28,744.94
Rio Grande/Mineral 101 5558.53
Routt 571 $3,157.63
San Miguel 139 5768.67
Sedgwick 35 $193.55
Summit 38 5210.14
Weld 19,128 S105,777.84
TOTAL 165,000 $912,450.00
March 14.2013 Tomwlnc (lni'nal Mcmlanhip ASrtamrnblhe Wort Number'Social Sankt) Pagc 6 of 6
CIG-30372 I OR EXISII f ION S,hcduk A f chain I I RI)July I),'MM