DOH26-004C ATTACHMENT D - SAMPLE CONTRACT

DOH26-004C RFQQ Page 1 of 5 May 2026. Attachment D: Sample Contract. v6. 05/27/2026.

CONTRACT NUMBER:

SUBRECIPIENT

YES NO

THIS AGREEMENT is made by and between the State of Washington Department of Health, hereinafter referred to as DOH, and the party whose name appears below, hereinafter referred to as Contractor.

CONTRACTOR NAME and ADDRESS:

SAMPLE CONTRACT

SAMPLE CONTRACT

UNIQUE ENTITY IDENTIFIER# or FEDERAL TAX ID#:

STATEWIDE VENDOR#:

PURPOSE: The Washington State Department of Health – Office of Drinking Water (ODW) is transitioning from their own Non-SDWIS data platform (Sentry) to EPA’s Safe Drinking Water Information System (SDWIS) State application suite. This transition will include migration of data and adopting the SDWIS State application suite, along with ODW specific requests to fulfill business needs and objectives. The initial contract includes hosting, maintenance, licensing fees, taxes, etc. as applicable, for 5 years.

IT IS MUTUALLY AGREED THAT:

STATEMENT OF WORK: The Contractor shall provide all the necessary personnel, equipment, materials, goods and services and otherwise do all things necessary for or incidental to the performance of the work as described in Exhibit A, attached hereto and incorporated herein.

PERIOD OF PERFORMANCE: Subject to its other provisions, the period of performance under this contract shall be from Date of Execution through June 30, 2032 unless sooner terminated as provided herein. Any work done outside of the period of performance shall be provided at no cost to DOH.

DOH reserves the right to extend the contract for up to five additional one-year periods, or in whatever increments meet DOH business needs, not to exceed ten years total after the completion of the transition to

SDWIS.

DEPARTMENT OF ENTERPRISE SERVICES APPROVAL: This contract may be required to be filed with the Department of Enterprise Services (DES) for approval under the provisions of Chapter 39.26 RCW. No contract or amendment required to be so filed is effective and no work thereunder shall be commenced nor payment made therefore until fifteen (15) working days following the date of filing, and, if required, until approved by DES. In the event DES fails to approve the contract or amendment, the contract shall be null and void.

DOH26-004C RFQQ Page 2 of 5

FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA): If federal funds are included in this contract as indicated below, this contract requires compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how federal funds are spent.

To comply with the act and be eligible to enter into this contract, your organization must have a Unique Entity Identifier (UEI) number. A UEI number provides a method to verify data about your organization.

If you do not already have one, you may receive a UEI number free of charge by contacting System for Award Management (SAM) at SAM.GOV.

Information about your organization and this contract will be made available on www.USASpending.gov by DOH as required by P.L. 109-282.

CONSIDERATION: The maximum consideration available under this contract shall not exceed $ TBD without a properly executed written amendment signed by representatives of both parties authorized to do so. Consideration includes but is not limited to all taxes, fees, surcharges, etc.

Source of Funds:

Federal: $ State: $ Other: $ TOTAL: $

Contractor agrees to comply with all applicable rules and regulations associated with these funds.

Unless otherwise indicated in this contract, any State funds which are unexpended as of June 30th will not be available for carry over into the next State fiscal year (July – June).

INVOICES AND PAYMENT: Contractor will submit invoices to the DOH Contract Manager for all amounts to be paid within 30 days of the month of service, or the submission date of deliverables with an associated cost, as specified in the Statement of Work (SOW). Refer to the SOW, Exhibit A, for invoice due dates on any budget/funding period(s) that end during the contract period of performance. DOH must receive correct and complete FINAL invoices no later than 45 days after the contract expiration date. Invoices must reference the contract number and provide detailed information as required. All invoices must be approved by DOH prior to payment; approval will not be unreasonably withheld. DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable costs as outlined in the statement of work and/or budget. DOH will return all incorrect or incomplete invoices and will not pay for services that occur outside the period of performance. The Contractor will not invoice for services if they are entitled to payment, have been, or will be paid, by any other source for that service.

DOH will issue payment within 30 days of receiving a correct and complete invoice and approving the deliverable(s). Late invoices will be paid at the discretion of DOH and are contingent upon the availability of funds. Failure to submit a properly completed IRS form W-9 may result in delayed payments.

GOVERNANCE: In the event of an inconsistency in this contract, unless otherwise provided herein, the inconsistency shall be resolved by giving precedence in the following order:

1. Federal statutes and regulations

2. State statutes and regulations

3. Contract amendments

4. The contract (in this order)

A. Special Terms and Conditions (Exhibit C if used) https://sam.gov/content/home https://www.usaspending.gov/Pages/default.aspx

DOH26-004C RFQQ Page 3 of 5

B. Primary document (document that includes the signature page) C. Standard/General Terms and Conditions (Exhibit B) D. Statement of Work (Exhibit A) (Updated)

a. Fed Reporting List Not Reported (Updated)

b. Remaining Sentry Fields to be Mapped to SDWIS State (Updated)

c. SDWIS Functional & Non-Functional Requirements (Updated)

E. RFQQ 26-004C and the Contractor’s Bid response incorporated herein by this reference F. Subcontractor Utilization Form (Attachment 1) G. All other attachments

UNDERSTANDING: This contract, including referenced exhibits, attachments and documents included herein by reference, contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this contract shall exist or bind any of the parties hereto.

APPROVAL: This contract shall be subject to the written approval of DOH Contracting Officer and shall not be binding until so approved. Only the Contracting Officer or his/her designee, by written delegation made prior to action, shall have the expressed, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this contract. Furthermore, any alteration, amendment, modification, or waiver of any clause or condition of this contract is not effective or binding unless made in writing and signed by the Contracting Officer.

IN WITNESS WHEREOF: DOH and the Contractor have signed this contract.

This document has been approved as to form only by the Assistant Attorney General.

CONTRACTOR SIGNATURE

{{Sig_es_:signer1:signature}}

DATE

{{Dte_es_:signer1:date}}

PRINT OR TYPE NAME

{{N_es_:signer1:fullname}}

TITLE

{{*Ttl_es_:signer1:title}}

DOH CONTRACTING OFFICER SIGNATURE

{{Sig_es_:signer2:signature}}

DATE

{{Dte_es_:signer2:date}}

EXHIBIT A

STATEMENT OF WORK

DOH Contract XXXXX

DOH26-004C RFQQ Page 4 of 5

The final contract Statement of Work will be finalized as part of the RFQQ award process.

PURPOSE

DOH entered into this Contract as the result of RFQQ DOH26-004C and the Contractor’s Bid Response.

(a) DOH incorporates by reference RFQQ DOH26-004C, including all Amendments and Attachments.

(b) DOH incorporates by reference the Contractor’s written response, including any written appendices submitted in response to RFQQ DOH 26-004C. These documents are hereby made part of this Contract as though fully set forth herein.

BACKGROUND:

[Insert brief programmatic or funding context here. Example:] The Department of Health seeks to support statewide efforts related to [program area], funded through [grant/funding source]. The Contractor was selected based on demonstrated capacity, experience, and alignment with the objectives outlined in RFQQ DOH 26-004C.

SCOPE OF WORK

The Contractor shall provide all services, personnel, materials, equipment, and administrative support necessary to perform the work described in this Contract. The Contractor shall perform all tasks necessary or incidental to fulfilling the requirements outlined below.

CONSIDERATIONS.

Total consideration payable to Contractor for satisfactory performance of the work under this Contract is up to a maximum of Final amount TBD.

ATTACHMENT 1

SUBCONTRACTOR UTILIZATION FORM

DOH CONTRACT XXXXX

DOH26-004C RFQQ Page 5 of 5

1. DOH Contract No.

2. Name of Contractor

3. Does the Contractor plan to utilize subcontractors? {{*Sub_es_:signer1:dropdown(options="Yes,No”)}}

4. If Yes, complete Section 5

5. Proposed Subcontractors {{field1_es_:signer1}} {{field2_es_:signer1}} {{field3_es_:signer1}} {{field4_es_:signer1}} {{field5_es_:signer1}} {{field6_es_:signer1}} {{field7_es_:signer1}} {{field8_es_:signer1}} {{field9_es_:signer1}}

6. Contractor understands and acknowledges, by signing below, that:

• Contractor without subcontractors at this time understands the requirement to report to DOH if subcontractors are engaged during the contract term; and acknowledges the requirements set forth herein.

• Contractor shall ensure, and shall require of its subcontractor, that services provided by the subcontractor are provided in accordance with the Contract; and Contractor is responsible for the acts and omissions of the subcontractor (per Contract general terms and conditions).

• The Contractor and all subcontractors shall report and confirm receipt of payments made to the Contractor and each subcontractor through Access Equity (per Contract Subcontractors subsection).

• Contractor is responsible to ensure that all terms, conditions, assurances, and certifications set forth in this Contract are included in the subcontract (per Contract general terms and conditions), including all confidentiality, data security requirements, and federal guidelines if applicable.

• All contract terms in the above-referenced contract remain in full force and effect and nothing in this form shall be construed as a waiver of terms in the above-referenced Contract.

• DOH has the right to withdraw approval for subcontracting if terms of the Contract are not adhered to.

CONTRACTOR SIGNATURE

{{Sig_es_:signer1:signature}}

DATE

{{Dte_es_:signer1:date}}