STATE OF NEBRASKA COMMISSION FOR THE BLIND AND VISUALLY IMPAIRED

CONTRACT FOR PROFESSIONAL SERVICES WITH

(For the period , through )

AGENCY CONTRACT NO.

This contract is entered into between the State of Nebraska Commission for the Blind and Visually Impaired (“NCBVI”), and

, (“Contractor”), upon the date of signature by both parties.

RECITALS:

A. The Nebraska Commission for the Blind and Visually Impaired (“NCBVI”) is a duly empowered state agency whose mission is to provide Vocational Rehabilitation (VR) and Independent Living (IL) services for the blind and visually impaired, as well as develop new services when necessary, in order to enable blind and visually impaired clients to achieve high-quality employment.

B. As a state agency, the Commission is subject to the rules and regulations of the

Department of Administrative Services and applicable Nebraska law.

C. Accordingly, the Commission must comply with rules, regulations, and laws not applicable to private businesses or individuals.

D. This contract is intended to detail the terms of the services to be provided by the Contractor, and the agreement by the Commission to pay for such services.

AGREEMENT:

Premised on the Recitals above, and in consideration of the mutual promises and understandings of the parties set forth below, the parties agree as follows:

1. Incorporation of RECITALS Paragraphs as Agreed Terms of Contract. The enumerated Paragraphs of the RECITALS above are hereby incorporated as agreed provisions of this contract.

2. Term of Contract. The term of this contract is set forth on Attachment A.

Services performed by the Contractor within that time window will be eligible for payment under this contract. The effective date of the contract (determined by the date when both parties have signed) does not alter or limit the specified term of the contract, but rather, the effective date simply signifies the date when the parties have formally reached written agreement.

NCBVI Form 100 Page 1 of 19 Rev. 08/2016

3. Services to be Delivered. The Contractor will put forth its best efforts in delivering the services as set for on Attachment A, incorporated by reference herein.

4. General Representations and Warranties of Contractor. The Contractor represents and warrants that it will substantially comply with the following requirements in providing services under this contract:

a. The Contractor is ready, willing, and able to provide the services performed on Attachment A.

b. The Contractor has received and read the “Background Screening Requirements” set forth on Attachment B and, if applicable, shall comply therewith.

c. The Contractor has received and read the “Verification of Lawful

Presence in the United States” requirements set forth on Attachment C and shall comply therewith.

d. Personnel employed by the Contractor to provide the services in this contract will be qualified, in accordance with any applicable national or state approved or recognized certification, licensing, or registration requirements, or, in the absence of these requirements, other comparable requirements (including State personnel requirements), that apply to the profession or discipline in which that category of personnel is providing vocational rehabilitation services.

e. The Contractor will include among its personnel, or reasonably obtain the services of, persons able to communicate in the native languages of persons served who have limited English speaking ability; and ensure use of appropriate modes of communication for all persons served under this contract.

f. The Contractor will take affirmative action to employ and advance in employment qualified persons with visual disabilities in the performance of this contract

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g. The Contractor shall give notice to NCBVI within three (3) working days of the date of any arrest for a felony or misdemeanor involving neglect or abuse of a child or vulnerable adult, of a staff member engaged in direct service provision.

h. At NCBVI’s request, the Contractor shall provide NCBVI information needed to enable persons with disabilities to make informed choices about the services provided. At a minimum, this must include information relating to: accessibility of services;

duration of services; consumer satisfaction with services; the qualifications of Contractors; and the degree to which services are provided in settings in which persons being served have regular contact with persons who have disabilities.

i. The Contractor should have adequate and appropriate policies and procedures to prevent fraud, waste, and abuse. At NCBVI’s written request, the Contractor shall deliver copies of such policies to

NCBVI within thirty (30) calendar days.

j. At NCBVI’s request, the Contractor shall provide or make available to NCBVI, the Auditor of Public Accounts, the U. S. Department of

Education, the Comptroller General of the United States, or any of their duly authorized representatives access to individual service records, reports and fiscal records for purposes of quality assurance, fiscal audit, or program evaluation.

5. NCBVI Representations and Warranties. The NCBVI represents and warrants that it will substantially comply with the following requirements in receiving services under this contract:

a. Determine the nature, scope, and extent of the services needed by each person to be served and communicate the same to the

Contractor;

b. Authorize service(s) for the person to be served in advance and send an authorization form to the provider if necessary to the performance of this contract.

c. Honor claims and make payments for services authorized and approved under this contract.

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6. Cost of Services and Method of Payment by the Department. The

Contractor will bill NCBVI only for authorized services that have been authorized and provided. Bills or invoices must identify the person served and the dates, amounts, and types of each service provided during the billing period.

7. Contractor Indirect or F&A Costs. Contractors, who have an approved indirect cost rate or Facilities and Administration cost rate(s), shall record as direct costs their costs paid from the proceeds of this contract, excluding proceeds for Indirect or F&A Costs.

8. Work Paid by Other Public Funds. Services or work to be performed under this contract shall not be performed on time that is paid for by other public (i.e. any government) funds.

9. Recordkeeping and Access to Records. The Contractor shall maintain accurate records regarding the expenditures of funds provided by NCBVI under this contract. The Contractor shall allow free access at reasonable times by authorized representatives of

NCBVI and the funding Federal Agency and United States

Comptroller General, if appropriate, to all records generated and/or maintained as a result of this contract. Such access to records by the above shall continue beyond termination of this contract for a period of three (3) years.

10.Independent Contractor Relationship. If the Contractor is a non-resident of the State of Nebraska and is maintaining an office or transacting business within Nebraska and is to receive a monetary consideration beyond expenses or multiple monetary considerations totaling more than $600, the contractor must obtain a W-4NA form from NCBVI. The contractor shall complete the W-4NA form, and submit the form with their invoice to NCBVI. If the contract specifies multiple payments are to be made to the contractor, a W-4 NA form shall be submitted with each invoice and request for payment.

11.No Assignment or Transfer. The Contractor shall not assign or transfer any interest, rights, or duties in this contract to any person, firm, or corporation without prior written authorization of NCBVI. Subcontractors

NCBVI Form 100 Page 4 of 19 may not be used in the performance of this Contract without the prior written authorization of NCBVI

12.Debarment / Suspension Certification. (This certification is only applicable to federally funded contracts for amounts of $25,000 or greater.) The Contractor shall, by signature on this contract represent and warrant that neither it nor its principals is presently debarred, suspended, recommended for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

If the Contractor is unable to certify to any of the statements in this certification, the Contractor will attach an explanation to this contract

(Reference 2 CFR 200.213).

13.Conflict of Interest. Contractors shall not have any undisclosed interest, financial or otherwise, or engage in any business transaction or professional activity which creates a conflict of interest without the prior written consent of NCBVI. A conflict of interest exists when financial or other personal considerations may compromise, or have the appearance of compromising the provider’s professional judgment working with consumers under their service contract and shall include the following actions:

a. Assisting or encouraging consumers in an endeavor that directly benefits the provider, the provider’s family, or a business with which the provider is associated.

b. Having a financial interest in the consumer’s business or employment arrangement.

c. Providing financial or personal assistance to consumers beyond that which the provider has agreed to provide under this Contract.

d. Using information gathered under this Contract for personal financial gain.

e. Recommending purchases to consumers or employees of NCBVI from companies in which the provider or the provider’s family has any financial interest.

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f. Using their position to secure personal or business privileges or favors from consumers or employees of NCBVI.

g. Offering or giving to consumers or employees of NCBVI anything of value, including a gift, loan, contribution, or reward.

h. Soliciting or accepting from consumers or employees of NCBVI anything of value, including a gift, loan, contribution, or reward.

14.Non-discrimination. The Contractor shall comply substantially with Title

VI of the Civil Rights Act of 1964, as amended, and the Nebraska Fair

Employment Practice Act, as amended, in that there shall be no discrimination against any employee who is employed in the performance of this contract, or against any applicant for such employment, because of age, color, national origin, race, religion, creed, disability, or sex. This provision shall include, but not be limited to, employment, promotion, demotion, transfer, recruitment, layoff termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. The Contractor shall insert a similar provision in all subcontracts for services allowed under contract. If the Contractor is entering into a contract with NCBVI for operation of any educational program or activity that is authorized or extended by the United State

Department of Education, contractor shall comply with Title IX of the

Education Amendments of 1972 (20 U.S.C. 1681-1688), regarding the prohibition of the following: the exclusion of any person from participation in, denying the benefits of, or subjection to discrimination in any such program or activity on the basis of sex.

15.Americans with Disabilities Act. The Contractor shall substantially comply with the Americans with Disabilities Act (29 CFR 1601, 28 CFR

35), as applicable. Moreover, any facility in which services are provided will be accessible to persons receiving services and will comply with the requirements of the Architectural Barriers Act of 1968, the Uniform

Accessibility Standards and their implementing regulations in 41 CFR Part

101, Subpart 101-19.6, the Americans with Disabilities Act of 1990, as amended, and sections 504 and 508 of the Rehabilitation Act.

16.Drug-Free Workplace. The Contractor shall operate a drug-free workplace and, during the terms of this contract, shall substantially comply with the provisions of the Drug-Free Workplace Act of 1988.

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17.Workers Compensation. If the Contractor has employees or subcontractors, the Contractor shall attach a copy of the Certificate of

Insurance for Worker's Compensation or the waiver permitted by §48-115

RRS 1993 within thirty (30) calendar days of the effective date of this contract.

18.Technology Access. All contracts, that include provisions of technology products, systems, and services, including data, voice, and video technologies, as well as information dissemination methods, for the state of Nebraska will comply with the Nebraska Technology Access Standards adopted pursuant to Neb. Rev. Stat. § 73-205. These Standards are available for viewing at NCBVI and on the Web at http://nitc.ne.gov/standards/2-201.html, and are incorporated into this contract as if fully set forth therein.

19.Presentation/Workshop Requirements. The following provisions apply to contracts in which the Contractor makes a presentation or conducts a workshop:

a. The Contractor shall provide NCBVI in formats complying with

Section 508 or greater, copies of all materials used in the workshop to staff in advance of, or immediately following the workshop, in electronic format that can be read and navigated with screen access technology using off the shelf software; and grant NCBVI permission to translate these materials into Braille upon request. In the case of copyrighted materials, the Contractor must clearly identify the materials that are copyrighted and specify conditions/limitations of distribution.

b. The Contractor gives permission to NCBVI to videotape all presentations. Subsequent use of the videotape by NCBVI will only be for quality control and archive purposes and not for future training activities, unless specifically provided for elsewhere in this contract.

c. The Contractor and/or speakers will clearly distinguish their personal opinions from NCBVI positions.

NCBVI Form 100 Page 7 of 19 http://nitc.ne.gov/standards/2-201.html

20.Product Ownership and Proprietary Information.

a. Any physical or digital writing, document, or electronic record produced, developed, prepared, or created under the terms of this contract shall become the property of NCBVI.

b. The contents of this contract, and all documentation provided therein, shall become the property of the NCBVI and the State of

Nebraska, and the data becomes public information when the contract is executed. Pursuant to Neb. Rev. Stat. §84-602.02(3)(a), beginning July 1, 2014, a copy of all state contracts active on or after January 1, 2014 that are the basis for an expenditure of state funds will be publicly available on a web site maintained by the

Nebraska Department of Administrative Services. The web site data base will also include any amendments to such contracts and any documents incorporated by reference in such contracts. The web site will also contain a data base that includes copies of all expired contracts which were previously included in the data base of active contracts. If the Contractor wishes to have any information withheld from the public, such information must fall within the definition of proprietary information contained within Nebraska’s public record statutes. All information in this contract that the

Contractor believes constitutes proprietary information that it wishes to have withhold from the public must be described in writing together with the basis for that belief and submitted to

NCBVI prior to the time this contract is executed. Contractors may not have the entire contract deemed as proprietary. Contract amounts are not proprietary information. Failure of the Contractor to follow these instructions regarding proprietary information may result in the information being viewed by other businesses and the public. Proprietary information is defined as trade secrets, academic and scientific research work which is in progress and unpublished, and other proprietary and commercial information which if released would give advantage to business competitors and serve no public purpose (see Neb. Rev. Stat. §84-

712.05(3)). In accordance with Attorney General Opinions 92068 and 97033, contractors submitting a written statement that information is proprietary may be required to prove specific, named competitor(s) who would be advantaged by release of the information and the specific advantage the competitor(s) would

NCBVI Form 100 Page 8 of 19 receive. Although an effort may be made to withhold information that is properly submitted as proprietary and meets the State’s definition of proprietary information, the State is under no obligation to maintain the confidentiality of proprietary information and accepts no liability for the release of such information.

21.Copyright. NCBVI shall retain the right to copyright any materials produced under this contract unless otherwise provided in this contract. If the contract is federally funded, the federal awarding agency reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for Federal Government purposes:

a. The copyright in any work developed under the contract; and

b. Any rights of copyright to which NCBVI purchases ownership with federal funding support.

22.Confidentiality. Any and all information gathered in the performance of this contract, either independently or through NCBVI, shall be held in the strictest confidence and shall be released to no one other than to NCBVI without prior written authorization of NCBVI. Only provisions contained in this contract authorizing specific exceptions to this general confidentiality provision shall allow the Contractor to release information as provided without the prior written authorization of NCBVI. Provided, however, either party to this contract may exchange information needed to plan, coordinate, and evaluate services to an individual receiving services hereunder.

23.Amendment. This contract may be amended, in writing, at any time upon the agreement of both parties.

24.Cancellation and Termination.

a. Except as otherwise provided herein, this contract may be canceled by either party with thirty (30) days written notice. Settlement for such cancellation shall be negotiated between the parties based upon specified deliverables completed by the Contractor and accepted and usable by NCBVI. Settlement shall be based on the date of termination notice if the Contractor initiates termination or

NCBVI Form 100 Page 9 of 19 the identifiable percentage effort expended by the Contractor if

NCBVI initiates termination.

b. This contract may be cancelled immediately by NCBVI in the event that:

i. NCBVI determines that the results of any background checks reveal information about the Contractor that NCBVI determines is an unacceptable result for the continuation of the employment relationship;

ii. NCBVI determines that the Contractor engaged in any behavior or activity that is cause for termination of employment under the NCBVI Personnel Rules; or

iii. NCBVI determines that the Contractor has failed to perform satisfactorily.

c. If the Contractor violates any material provisions of this contract, NCBVI may, at its option, terminate the contract immediately upon three (3) calendar day’s written notice to the Contractor. NCBVI shall pay the Contractor only for such performance as has been properly completed and is of use to NCBVI. NCBVI may, at its discretion, contract for provision of the services required to complete this contract and hold the Contractor liable for all expenses incurred in such additional contract over and above the total cost of performance set forth herein. This provision shall not preclude the pursuit of other remedies for breach of contract as allowed by law.

d. Due to possible future reductions in State and/or Federal funds, NCBVI cannot guarantee the continued availability of funding of this contract notwithstanding the consideration stated above. In the event funds to finance this contract become unavailable, either in full or in part, due to such reductions, NCBVI may terminate the contract or reduce the consideration upon thirty (30) days written notice to the Contractor. Said notice shall be delivered by certified mail (return receipt requested) or in person (with proof of delivery).

NCBVI shall be the final authority as to the availability of funds. The effective date of such contract termination or reduction in consideration shall be the actual effective date of the elimination or reduction of funding. In the event of a reduction in consideration, NCBVI Form 100 Page 10 of 19

[REMAINDER OF THE PAGE INTENTIONALLY LEFT BLANK]

the Contractor may cancel this contract as of the effective date of the proposed reduction upon the provision of advance written notice to NCBVI.

e. The notice requirement under this Section may be waived by

NCBVI in case of emergencies, such as illness, death, injury, or force major.

25.Severability. If any term or condition of this contract, or the application thereof to any person or circumstance, is held invalid by a court of competent jurisdiction, such invalidity shall not affect other portions of the contract which can be given effect without the invalid term or condition, the terms and conditions of this contract being hereby declared severable.

26.Executed Contract Constitutes the Entire Agreement; Counterparts;

Binding on Successors. This instrument—the executed contract

(including any items incorporated by reference)—constitutes the entire agreement of the parties and any representations or promises not contained herein will not be binding upon the parties. This contract, or any amendment of this contract, may be signed in any number of counterparts, each of which will be an original, but all of which taken together will constitute one agreement (or amendment, as the case may be). This contract shall bind to, and will inure to the benefit of, the successors, assigns, and legal representatives of the parties.

27.Governing Language. This contract shall be governed by the English language. For the convenience of the parties, non-authoritative translations of this contract may be prepared and added as a clarifying attachment.

28.Governing Law. This contract shall be governed by and subject to the laws of the State of Nebraska.

NCBVI Form 100 Page 11 of 19

ACCEPTANCE PROVISIONS.

The parties acknowledge they have read and understand this contract and agree to its provisions, and that it will be effective on the date when both parties have signed.

Nebraska Commission for the Blind and

Visually Impaired (NCBVI)

By:_______________________________

Name (Printed):

Title:

Date:

CONTRACTOR:

By:_______________________________

Name (Printed):

Title:

Date:

NCBVI Form 100 Page 12 of 19

CONTRACT FOR SERVICES

Attachment A

Nebraska Commission for the Blind and Visually Impaired

This is a an attachment to a contract for services between the Nebraska Commission for the Blind and Visually Impaired (NCBVI), an Agency of the State of Nebraska

(FTIN 47-0491233), and , the Contractor, to provide services described below to the State of Nebraska.

Contractor Name:

Contractor Address:

Contact Name:

Address Book Number:

The contract begins on this date:

The contract ends on this date:

Contract Renewal:

This contract cannot be renewed:

This contract may be renewed by mutual agreement of the parties:

Scope of Services:

Objectives of Service:

NCBVI Form 100 Page 13 of 19

Attachment A (page 2)

Nebraska Commission for the Blind and Visually Impaired

Contract Certification Page

Location of Services:

Additional Information:

Terms of Payment:

Unit of Measure:

Cost Per Unit:

Total Contract Not to Exceed:

Other Contractor Expenses (Who Pays?) (Detailed Receipts are required for Payment.)

Mileage NCBVI; Contractor

Transportation NCBVI; Contractor

Room and Board NCBVI; Contractor

Supplies NCBVI; Contractor

Equipment NCBVI; Contractor

Other(specify) NCBVI; Contractor

Vendor is a Corporation Not a Corporation

NCBVI Form 100 Page 14 of 19

Attachment A (page 3)

Nebraska Commission for the Blind and Visually Impaired

Contract Certification Page

Author

Name:

Signature: _______________________________

Date:

Leadership (Deputy Dir. or Bus Mgr.) Approval

Executive Director Approval >$20,000

For the Contractor:

Printed Name:

NCBVI Form 100 Page 15 of 19

Attachment A (page 4)

Nebraska Commission for the Blind and Visually Impaired

Contract Certification Page

Agency Use Only

Contractor:

Service:

EnterpriseOne (Accounting) Contract #

Address Book #

Account Numbers

1.

2.

3.

Legal Review Performed by , on

Signature of Reviewing Legal Professional: ___________________________

This contract form was prepared by___________________________ of the Johnson, Flodman, Guenzel & Widger Law Firm.

NCBVI Form 100 Page 16 of 19

Background Screening Requirement

Attachment B

Nebraska Commission for the Blind and Visually Impaired

This requirement applies if this contract includes driving, reading, job coaching, individual supported employment, crew supported employment, job coaching/placement, self-employment consultation, small business technical assistance, and/or independent living training.

1. If this contract is with an individual, or the Contractor's owner(s) or business principles will provide these direct services, NCBVI may choose to conduct a background screen, which will take approximately two (2) weeks, and may include checks of State Patrol criminal records, Nebraska Sex Offender

Registry, HHS Adult and Child Protective Services Central Registries, and DMV driving records (if the provider will transport consumers).

No services can be provided until the provider passes the background screen unless an exception request is approved.

2. If this contract is with a Contractor employing individuals who will provide direct services, the authorized representative's signature on this contract gives written assurance that the persons the Contractor employs to provide these direct services have not been convicted of a felony or misdemeanor involving neglect or abuse of a child or vulnerable adult.

I, , have received a copy of the NCBVI

Background Screening requirement and have acknowledged that I understand its contents.

By: _______________________________

Name (Printed):

Title:

Date:

NCBVI Form 100 Page 17 of 19

Verification of Lawful Presence in the United States

Attachment C

Nebraska Commission for the Blind and Visually Impaired

The Contractor is required and hereby agrees by the provider’s signature below that, as a pre-condition for performance under this service contract and for payment for services, the provider will use a federal immigration verification system to determine the work eligibility status of new employees physically performing services within the State of Nebraska.

A federal immigration verification system means the electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant

Responsibility Act of 1996, 8 U.S.C. 1324a, known as the E-Verify Program, or an equivalent federal program designated by the United States Department of

Homeland Security or other federal agency authorized to verify the work eligibility status of a newly hired employee.

If the Contractor is an individual or sole proprietorship, by their dated signature below, attests that he/she: (CHECK ONE)

Is a citizen of the United States: ; OR

Is a qualified alien under the federal Immigration and Nationality Act:

My immigration status and alien number are as follows:

I agree to provide a copy of the US Citizenship and Immigration Service documentation to verify my lawful presence in the United States using the

Systematic Alien Verification for Entitlements (SAVE) Program.

Receipt of this documentation is required for this contract to be effective and no work under this contract is to begin, nor will NCBVI issue the provider any payment until the documentation is provided to NCBVI.

As a pre-condition of performance and payment under this contract, the Contractor understands and agrees that lawful presence in the United States is required and the Contractor may be disqualified or the contract terminated if such lawful presence cannot be verified.

NCBVI Form 100 Page 18 of 19

Verification of Lawful Presence in the United States

Attachment C (Page 2)

Nebraska Commission for the Blind and Visually Impaired

I, , have received a copy of the NCBVI

Verification of Lawful Presence in the United States Form and have acknowledged that I understand its contents.

By: _______________________________

Name (Printed):

Title:

NCBVI Form 100 Page 19 of 19

402-430-8183 advancedbreakroom@gmail.com

machine questions/issues and training to vendors on basic maintenance of their vending machines. On-site repairs well be done with prior approval by a designated NCBVI staff person with a repair request and authorization form submitted to Advanced Breakroom Service with the specific information needed to repair the vending machines.

Objective of Service: This contract is intended to provide for timely repairs of machines requiring service beyond normal maintenance. Advanced Breakroom will provide hands-on training to vendors on basic maintenance of vending machines. The desired outcome is well maintained vending machines resulting in the need for fewer service calls.

approval by the designated staff person from NCBVI with a repair request and authorization form submitted to Advanced Breakroom.