ESBD_450514_1756484693149_696-PD-25-P006 Exhibits.pdf

Texas Department of Criminal Justice Required Contract Clauses

In this document, the terms Contractor and Vendor, when referring to the following affirmations (whether framed as certifications, representations, warranties, or in other terms) refer to Respondent, and the affirmations apply to all Respondents regardless of their business form (e.g., individual, partnership, corporation).

Respondent represents and warrants all certifications, representations, warranties, and other provisions in this Affirmations and Solicitation Acceptance apply to Respondent and all of Respondent's principals, officers, directors, shareholders, partners, owners, agents, employees, subcontractors, independent contractors, and any other representatives who may provide services under, who have a financial interest in, or otherwise are interested in this Solicitation or any Contract resulting from this Solicitation.

Respondent must provide information, as applicable, and affirms, without exception, as follows:

1. Terms and Conditions Attached to Response. Any terms and conditions attached to a Response will not be considered unless specifically referred to in the Response.

2. Complete and Accurate Information. Respondent represents and warrants all statements and information provided to the TDCJ are current, complete, and accurate. This includes all statements and information in this Solicitation Response.

3. Public Information Act. Respondent understands the TDCJ will comply with the Texas Public Information Act (Chapter 552 of the Texas Government Code) as interpreted by judicial rulings and opinions of the Attorney General of the State of Texas. Information, documentation, and other material prepared and submitted in connection with this Solicitation, or any resulting Contract may be subject to public disclosure pursuant to the Texas Public Information Act. In accordance with Section 2252.907 of the Texas Government Code, Respondent is required to make any information created or exchanged with the State pursuant to the Contract, and not otherwise excepted from disclosure under the Texas Public Information Act, available in a format that is accessible by the public at no additional charge to the State.

4. Contracting Information Responsibilities. Respondent represents and warrants it will comply with the requirements of Section 552.372(a) of the Texas Government Code. Except as provided by Section 552.374(c) of the Texas Government Code, the requirements of Subchapter J (Additional Provisions Related to Contracting Information), Chapter 552 of the Government Code, may apply to the Contract and the Respondent agrees the Contract can be terminated if the Respondent knowingly or intentionally fails to comply with a requirement of that subchapter.

5. Assignment. Respondent shall not assign its rights under the Contract or delegate the performance of its duties under the Contract without prior written approval from the TDCJ. Any attempted assignment in violation of this provision is void and without effect.

6. Texas Bidder. Respondent certifies that if a Texas address is shown as the address of the Respondent on this Response, the Respondent qualifies as a Texas Bidder as defined in Section 2155.444(c) of the Texas Government Code.

7. Dealings with Public Servants. Respondent has not given, has not offered to give, and does not intend to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with this Solicitation Response, this Solicitation, or any Contract resulting from this Solicitation.

696-PD-25-P006 Exhibit J.1

8. Prior Disaster Relief Contract Violation. Sections 2155.006 and 2261.053 of the Texas Government Code, prohibit state agencies from accepting a Response or awarding a Contract that includes proposed financial participation by a person who, in the past five years, has been convicted of violating a federal law or assessed a penalty in connection with a contract involving relief for Hurricane Rita, Hurricane Katrina, or any other disaster, as defined by Section 418.004 of the Texas Government Code, occurring after September 24, 2005. Under Sections 2155.006 and 2261.053 of the Texas Government Code, Respondent certifies the individual or business entity named in this Response or Contract is not ineligible to receive the specified Contract and acknowledges this Contract may be terminated and payment withheld if this certification is inaccurate.

9. Child Support Obligation. Under Section 231.006(d) of the Texas Family Code regarding child support, Respondent certifies the individual or business entity named in this Response is not ineligible to receive the specified payment and acknowledges the Contract may be terminated and payment may be withheld if this certification is inaccurate. Furthermore, any Respondent subject to Section 231.006 of the Texas Family Code, must include in the Response the names and social security numbers of each person with at least 25% ownership of the business entity submitting the Response. Enter name and social security numbers for each person. This information must be provided prior to Contract award.

Name:

SSN:

FEDERAL PRIVACY ACT NOTICE: This notice is given pursuant to the Federal Privacy Act.

Disclosure of requested social security numbers is required under Section 231.006(c) and Section 231.302(c)(2) of the Texas Family Code. The social security numbers will be used to identify persons that may owe child support and will be kept confidential to the fullest extent permitted by law. If submitted by email, Responses containing social security numbers must be encrypted. Failure by a Respondent to provide or encrypt the social security numbers as required may result in disqualification of the Respondent's Response.

10. Suspension and Debarment. Respondent certifies that it and its principals are not suspended or debarred from doing business with the state or federal government as listed on the State of Texas Debarred Vendor List maintained by the Texas Comptroller of Public Accounts and the System for Award Management (SAM) maintained by the General Services Administration.

11. Excluded Parties. Respondent certifies that it is not listed in the prohibited vendors list authorized by Executive Order Number 13224, “Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Commit, or Support Terrorism,” published by the United States Department of the Treasury, Office of Foreign Assets Control.

12. Foreign Terrorist Organizations. Respondent represents and warrants that it is not engaged in business with Iran, Sudan, or a foreign terrorist organization, as prohibited by Section 2252.152 of the Texas Government Code.

13. Foreign Adversaries. Respondent certifies that neither it, nor its holding companies or subsidiaries, is (1) listed in Section 889 of the 2019 National Defense Authorization Act; (2) listed in Section 1260H of the 2021 National Defense Authorization Act; or (3) owned by the government of a country on the United States Department of Commerce’s foreign adversaries list under 15 C.F.R Section 791.4; or (4) controlled by any governing or regulatory body located in a country on the United States Department of Commerce’s foreign adversaries list under 15 C.F.R Section 791.4, as authorized by Executive Order Number GA-48.

14. Executive Head of a State Agency. In accordance with Section 669.003 of the Texas Government

Code, relating to contracting with the executive head of a state agency, Respondent certifies it is not

(1) the executive head of the TDCJ, (2) a person who at any time during the four years before the date of the Contract was the executive head of the TDCJ, or (3) a person who employs a current or former executive head of the TDCJ.

15. Human Trafficking Prohibition. Under Section 2155.0061 of the Texas Government Code, the Respondent certifies the individual or business entity named in this Response or Contract is not ineligible to receive the specified Contract and acknowledges this Contract may be terminated and payment withheld if this certification is inaccurate.

16. Debts and Delinquencies. Respondent agrees any payments due under any Contract resulting from this Solicitation, shall be applied towards any debt or delinquency that is owed to the State of Texas.

17. Lobbying Prohibition. Respondent represents and warrants payments to Respondent and Respondent's receipt of appropriated or other funds under any Contract resulting from this Solicitation, are not prohibited by Sections 556.005, 556.0055, or 556.008 of the Texas Government Code (relating to use of appropriated money or state funds to employ or pay lobbyists, lobbying expenses, or influence legislation).

18. Buy Texas. Respondent agrees to comply with Section 2155.4441 of the Texas Government Code, requiring the purchase of products and materials produced in the State of Texas in performing service contracts.

19. Disaster Recovery Plan. Respondent agrees that upon request of the TDCJ, Respondent shall provide copies of its most recent business continuity and disaster recovery plans.

20. Computer Equipment Recycling Program. If Respondent is submitting a Response for the purchase or lease of computer equipment, then Respondent certifies it is in compliance with Subchapter Y, Chapter 361 of the Texas Health and Safety Code related to the Computer Equipment Recycling Program and the Texas Commission on Environmental Quality rules in 30 TAC Chapter 328.

21. Cybersecurity Training. Respondent represents and warrants it will comply with the requirements of Section 2054.5192 of the Texas Government Code relating to cybersecurity training and required verification of completion of the training program.

22. Restricted Employment for Certain State Personnel. Respondent acknowledges that, pursuant to Section 572.069 of the Texas Government Code, a former state officer or employee of a state agency who during the period of state service or employment participated on behalf of a state agency in a procurement or contract negotiation involving Respondent may not accept employment from Respondent before the second anniversary of the date the Contract is signed, or the procurement is terminated or withdrawn. This certification only applies to former state officers or employees whose state service or employment ceased on or after September 1, 2015.

23. No Conflicts of Interest. Respondent represents and warrants it has no actual or potential conflicts of interest in providing the requested goods or services to the TDCJ under this Solicitation and any resulting Contract and that Respondent’s provision of the requested goods and/or services under this Solicitation and any resulting Contract will not constitute an actual or potential conflict of interest or reasonably create an appearance of impropriety.

24. Dispute Resolution. Any dispute arising under this Contract, which is not disposed of by mutual agreement between the TDCJ and the Respondent shall be resolved in accordance with Texas Government Code, Chapter 2260. At all times during the dispute resolution process, the Respondent shall continue providing services in a diligent manner and without delay, according to all applicable provisions of this Contract.

25. Excess Obligations Prohibited. The Contract is subject to termination or cancellation, without penalty to the TDCJ, either in whole or in part, subject to the availability of state funds. The TDCJ is a state agency whose authority and appropriations are subject to actions of the Texas Legislature. If the TDCJ becomes subject to a legislative change, revocation of statutory authority, or lack of appropriated funds which would render either the TDCJ’s or Respondent’s delivery or performance under the Contract impossible or unnecessary, the Contract will be terminated or cancelled and be deemed null and void.

In the event of a termination or cancellation under this Section, the TDCJ will not be liable to the Respondent for any damages, that are caused or associated with such termination, or cancellation, and the TDCJ will not be required to give prior notice.

26. Governing Law. The Contract shall be governed by and construed in accordance with the laws of the State of Texas, without regard to the conflicts of law provisions. The venue of any suit arising under the Contract is fixed in any court of competent jurisdiction of Travis County, Texas, unless the specific venue is otherwise identified in a statute which directly names or otherwise identifies its applicability to the TDCJ.

27. Antitrust. The undersigned affirms under penalty of perjury of the laws of the State of Texas that (a) in connection with this Response, neither I nor any representative of the Respondent has violated any provision of the Texas Free Enterprise and Antitrust Act, Texas Business and Commerce Code, Chapter 15; (b) in connection with this Response, neither I nor any representative of the Respondent has violated any federal antitrust law; and (c) neither I nor any representative of the Respondent has directly or indirectly communicated any of the contents of this Response to a competitor of the Respondent or any other company, corporation, firm, partnership or individual engaged in the same line of business as the Respondent.

28. Indemnification. THE RESPONDENT SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS

THE STATE OF TEXAS, THE TDCJ, THE TBCJ, AND/OR THEIR OFFICERS, AGENTS,

EMPLOYEES, REPRESENTATIVES, CONTRACTORS, ASSIGNEES, AND/OR DESIGNEES

FROM ANY AND ALL LIABILITY, ACTIONS, CLAIMS, DEMANDS, OR SUITS, AND ALL

RELATED COSTS, ATTORNEY FEES, AND EXPENSES ARISING OUT OF, OR RESULTING

FROM ANY ACTS OR OMISSIONS OF THE RESPONDENT OR ITS AGENTS, EMPLOYEES,

SUBCONTRACTORS, ORDER FULFILLERS, OR SUPPLIERS OF SUBCONTRACTORS IN THE

EXECUTION OR PERFORMANCE OF THE CONTRACT AND ANY PURCHASE ORDERS

ISSUED UNDER THE CONTRACT. THE DEFENSE SHALL BE COORDINATED BY THE

CONTRACTOR WITH THE OFFICE OF THE ATTORNEY GENERAL WHEN TEXAS STATE

AGENCIES ARE NAMED DEFENDANTS IN ANY LAWSUIT AND THE RESPONDENT MAY

NOT AGREE TO ANY SETTLEMENT WITHOUT FIRST OBTAINING THE CONCURRENCE

FROM THE OFFICE OF THE ATTORNEY GENERAL. THE RESPONDENT AND THE

DEPARTMENT AGREE TO FURNISH TIMELY WRITTEN NOTICE TO EACH OTHER OF ANY

SUCH CLAIM.

THE TDCJ SHALL NOT INDEMNIFY RESPONDENT OR ANY OTHER ENTITY UNDER THE

CONTRACT.

29. E-Verify. Respondent certifies that for contracts for services, Respondent shall utilize the U.S.

Department of Homeland Security’s E-Verify system during the term of the Contract to determine the eligibility of:

1. All persons employed by the Respondent to perform duties within Texas; and

2. All persons, including subcontractors, assigned by the Respondent to perform work pursuant to the Contract within the United States of America.

30. Former Agency Employees. If this Solicitation is for an employment contract, a professional services contract or a consulting services contract under Chapter 2254 of the Texas Government Code, Respondent represents and warrants that neither Respondent nor any of Respondent’s employees including, but not limited to, those authorized to provide services under the Contract, were former employees of the TDCJ during the twelve (12) month period immediately prior to the date of the execution of the Contract.

31. Disclosure of Prior State Employment – Consulting Services. In accordance with Section 2254.033 of the Texas Government Code, relating to consulting services, Respondent certifies it does not employ an individual who has been employed by the TDCJ or another agency at any time during the two years preceding the submission of the Response or, in the alternative, Respondent has disclosed in its Response the following:

1. The nature of the previous employment with the TDCJ or the other State of Texas agency:

2. The date the employment was terminated and the reason for the termination:

3. The annual rate of compensation for the employment at the time of its termination:

32. Entities that Boycott Israel. Pursuant to Section 2271.002 of the Texas Government Code, Respondent certifies that either (1) it meets an exemption criterion under Section 2271.002; or (2) it does not boycott Israel and will not boycott Israel during the term of the Contract resulting from this Solicitation. If Respondent refuses to make that certification, Respondent shall state here any facts that make it exempt from the boycott certification:

33. Abortion Funding Limitation. Respondent understands, acknowledges, and agrees that, pursuant to Article IX of the General Appropriations Act (the Act), to the extent allowed by federal and state law, money appropriated by the Texas Legislature may not be distributed to any individual or entity that, during the period for which funds are appropriated under the Act:

1. Performs an abortion procedure that is not reimbursable under the state’s Medicaid program;

2. Is commonly owned, managed, or controlled by an entity that performs an abortion procedure that is not reimbursable under the state’s Medicaid program; or

3. Is a franchise or affiliate of an entity that performs an abortion procedure that is not reimbursable under the state’s Medicaid program. The provision does not apply to a hospital licensed under Chapter 241, Health and Safety Code, or an office exempt under Section 245.004(2), Health and Safety Code. Respondent represents and warrants that it is not ineligible, nor will it be ineligible during the term of the Contract resulting from this Solicitation, to receive appropriated funding pursuant to Article IX.

34. Funding Eligibility. Respondent understands, acknowledges, and agrees that, pursuant to Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code, except as exempted under that Chapter, the TDCJ cannot contract with an abortion provider or an affiliate of an abortion provider.

Respondent certifies it is not ineligible to contract with the TDCJ under the terms of Chapter 2272 (eff.

Sept. 1, 2021, Ch. 2273) of the Texas Government Code. If Respondent refuses to make that certification, Respondent shall state here any facts that make it exempt from the certification:

35. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment (2 CFR 200.216). Respondent certifies the individual or business entity named in this Response or Contract is not ineligible to receive the specified Contract or funding pursuant to 2 CFR 200.216.

36. Financial Participation Prohibited. Pursuant to Section 2155.004(b) of the Texas Government Code, Respondent certifies the individual or business entity named in this Response or Contract is not ineligible to receive the specified Contract and acknowledges the Contract may be terminated and payment withheld if this certification is inaccurate.

37. COVID-19 Vaccine Passports. Pursuant to Texas Health and Safety Code, Section 161.0085(c), Respondent certifies it does not require its customers to provide any documentation certifying the customer’s COVID-19 vaccination or post-transmission recovery on entry to, to gain access to, or to receive service from the Respondent’s business. The Respondent acknowledges such a vaccine or recovery requirement would make Respondent ineligible for a state-funded contract.

38. Energy Company Boycotts. If Respondent is required to make a verification pursuant to Section

2276.002 of the Texas Government Code, Respondent verifies Respondent does not boycott energy companies and will not boycott energy companies during the term of the Contract. If Respondent does not make that verification, Respondent must so indicate in its Response and state why the verification is not required.

39. Entities that Discriminate Against Firearm and Ammunition Industries. If Respondent is required to make a verification pursuant to Section 2274.002 of the Texas Government Code (relating to prohibition on contracts with companies that discriminate against firearm and ammunition industries), Respondent verifies it (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and (2) will not discriminate during the term of the Contract against a firearm entity or firearm trade association. If the Respondent does not make that verification, Respondent must state here why the verification is not required:

40. State Auditor’s Right to Audit. The state auditor may conduct an audit or investigation of any entity receiving funds from the state directly under the Contract or indirectly through a subcontract under the Contract. The acceptance of funds directly under the Contract or indirectly through a subcontract under the Contract acts as acceptance of the authority of the state auditor, under the direction of the legislative audit committee, to conduct an audit or investigation in connection with those funds. Under the direction of the legislative audit committee, an entity that is the subject of an audit or investigation by the state auditor must provide the state auditor with access to any information the state auditor considers relevant to the investigation or audit.

41. Critical Infrastructure. Pursuant to Texas Government Code, Section 2275.0102, Respondent certifies neither it nor its parent company, nor any affiliate of Respondent or its parent company, is: (1) majority owned or controlled by citizens or governmental entities of China, Iran, North Korea, Russia, or any other country designated by the Governor under Texas Government Code, Section 2275.0103, or (2) headquartered in any of those countries.

42. Enforcement of Certain Federal Firearms Laws Prohibited. In accordance with House Bill 957, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 2.101 is applicable to the Respondent, the Respondent certifies it is not ineligible to receive state grant funds pursuant to Texas Government Code, Section 2.103.

43. Permits and Licenses. Respondent represents and warrants it will comply with all applicable laws and maintain all permits and licenses required by applicable city, county, state, and federal rules, regulations, statutes, codes, and other laws that pertain to any Contract resulting from this Solicitation.

44. False Statements. Respondent represents and warrants all statements and information prepared and submitted in this document are current, complete, true, and accurate. Submitting a Response with a false statement or material misrepresentations made during the performance of a contract is a material breach of contract and may void the submitted Response and any resulting contract.

45. Artificial Intelligence. The contractor agrees not to use any artificial intelligence in the performance of this contract without prior written consent of the TDCJ.

46. Signature Authority. By submitting this Response, the Respondent represents and warrants the individual submitting this document and the documents made part of this Response is authorized to sign such documents on behalf of the Respondent and to bind the Respondent under any Contract that may result from the submission of this Response.

Respondent represents and certifies each of the above numbered statements, except to the extent that its Response specifically identifies one or more of the statements and describes each fact and circumstance which prevent it from making the representation and certification. Furthermore, Respondent promises to promptly notify the Comptroller if any of these representations or certifications are no longer true. The Respondent makes the foregoing Representations and Certifications as part of its Response.

Failure to complete, sign and submit this form will disqualify the Response.

_________________________________ Authorized Respondent/Company Representative Signature Required

Printed Name: _______________________________ Date: ___________________________

696-PD-25-P006 Exhibit J.3

Compliance Standards and Remedies Sex Offender Treatment Services

Standard Acceptable Unacceptable Payment Adjustment/Remedy

1. Treatment Providers shall have valid licenses as established by the Council on Sex Offender Treatment

(CSOT) and other Texas State Board of Licensing regulatory entities.

100% Less than 100% Services performed by an unlicensed Treatment

Provider will not be paid for and the contract may be terminated. A Vendor Performance report will be done.

2. Evaluation Report shall be submitted to the Billing Unit and Parole Officer within thirty (30) Days from the date the evaluation was completed. The Contractor shall provide sufficient email documentation to be included in the billing packet, if they are unable to provide the invoice in a timely manner in order to avoid possible reduction of Payment.

Thirty (30) Days Greater than thirty (30) Days Reduce $25 for every day the Contractor is late.

Maximum of $200.

3. Individual sessions shall be approved through the Parole Officer to the Program Supervisor. 100% Less than 100% No invoices will be processed or paid for Services not approved.

4. Weekly group sessions less than ninety (90) minutes requires approval by the Director of Specialized Programs, or designee.

Ninety (90) minutes Less than ninety (90) minutes No invoices will be processed or paid for Services not approved.

5. The Contractor shall submit the TDCJ-PD Sex Offender Treatment Attendance Roster and Billing Invoice (PMS-41) to the Unit Supervisor by the fifth (5th) Day of each month for the prior month. The Contractor shall provide sufficient email documentation to be included in the billing packet, if they are unable to provide the invoice in a timely manner to avoid possible reduction of Payment.

Fifth (5th) Day Greater than fifth (5th) Day Reduce $25 for every day the Contractor is late.

Maximum of $200.

6. Initial and Annual evaluations shall not be completed prior to subsidy approval. 100% Less than 100% No invoice will be processed or paid for services performed prior to subsidy approval.

7. Services shall only be conducted at locations approved by the Director of Specialized Programs, or designee. 100% Less than 100% No invoice will be processed or paid for Services performed at unapproved location(s).

8. Unauthorized Services as defined. 100% Less than 100% A 5% deduction will be applied to applicable invoices.

9. Contractor shall submit Quarterly Performance Measures worksheet by Dec. 30th, March 30th, June 30th and Sept. 30th.

100% Less than 100% No invoice will be processed or paid for Services until provided.

10. Contractors shall submit Treatment Progress Report (PMS-31) to the Parole Officer by the tenth (10th) Day after the Client's first (1st) full month of enrollment and every three (3) months thereafter. If the Parole Officer requests an unscheduled progress report, the Contractor shall provide within five (5) Days of request. Supporting email documentation shall be included in the billing packet if the Contractor is unable to provide the invoice in a timely manner in order to avoid possible reduction of Payment.

Tenth (10th) Day after Client's first (1st) full month and every three (3) months thereafter; and five (5) Days upon request for unscheduled.

Greater than tenth (10th) Day after Client's first (1st) full month; greater than every three (3) months thereafter;

and greater than five (5) Days upon request for unscheduled.

Reduce $25 for every day the Contractor is late.

Maximum of $200.

11. Contractors shall provide a written treatment plan to the Parole Officer within thirty (30) Days after the Client's enrollment in the program.

Thirty (30) Days Greater than thirty (30) Days Reduce $25 for every day the Contractor is late.

Maximum of $200.

12. The Contractor shall notify the Parole Officer or the Officer's Unit Supervisor within two (2) business days when any Client fails to attend, refuses to pay, displays disruptive behavior, or manifests signs of re-offending.

Two (2) Days Greater than two (2) Days Reduce $25 for every day the Contractor is late.

Maximum of $200.

13. Services shall only be conducted virtually with approval by the Director of Specialized Programs, or designee. 100% Less than 100% No invoice will be processed or paid for Services performed without approval.

14. The Contractor or Provider shall not provide services without both CSOT licenses and Professional licenses being updated online.

100% Less Than 100% The Contract may be terminated.

The Fiscal Operations Department has the right to withhold the monthly Payment or temporarily suspend some or all of the Payment adjustments identified in the above table.

Decisions and notifications to suspend and/or reinstate Payment adjustments will be made by the TDCJ-PD Fiscal Operations Section Director and will be conveyed to the Contractor by letter.

696-PD-25-P006 Exhibit J.4

Specialized Programs Revised 04.2025

Child Safety Zone Certification

Texas Department of Criminal Justice

_X__ Sex Offender Treatment Location

_____ Contracted Community Residential Facility

_____ Outpatient Treatment Facility

Facility (or Contractor) Name and Location:

The Parole Division has conducted a physical view of the above listed facility. The facility _____ is [or] _______ is not located in a child safety zone, designated as any area within 500 feet from premises where children commonly gather, including schools, day-care facilities, playgrounds, public or private youth centers, swimming pools or video arcades.

In accordance with Health and Safety Code Chapter 481.134, "Premises" means real property and all buildings and appurtenances pertaining to the real property.

Parole Division Authorized Signature

Print Name and Title

Date

Contractor Authorized Signature

Print Name and Title

Date

Section Director, Specialized Programs Signature

Day of Week

Client Name/TDCJ/SID# Week 1 Week 2 Week 3 Week 4 Week 5

DATE →

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No

Subsidy:

Yes No Yes

X________________________________

Co-payment No X________________________________

Participant’s Initials Here→ Comments:

District Parole Office Received Date: _________________________________

Unit Supervisor’s Printed Name: _____________________________________________________________

Name/Title of Person Who Received: _________________________________Total Number of Clients Billed: ______________________________________________________

Date Delivered to the Billing Unit: _________________________________________________________

By my signature above, I certify this is an accurate listing of those who attended sex offender treatment for the date, time, and location provided.

Therapist’s Signature:________________________________________________ Date: __________________ Unit Supervisor’s Signature:__________________________________________ Date: __________________

This verifies the above subsidized clients are either within the initial subsidy period or a current extension has been approved in the OIMS.

Therapist’s Printed Name: ___________________________________________________________________

TEXAS DEPARTMENT OF CRIMINAL JUSTICE - PAROLE DIVISION ATTENDANCE ROSTER & BILLING INVOICE

Parole Officer’s Verification of Subsidy, Signature, and Comments

This area is to be completed by the Therapist. The Participant shall initial under the date for each attendance. Completed by the Parole Officer

Contract Provider Name and Contract Number Month/Year Treatment Site

Parole Officer

Name and

District Parole

Office C o d e s a n d

T e r m in a ti o n

Start Time End Time (AM/PM)

PMS-41 (Rev. 2/9/2021)

696-PD-25-P006 Exhibit J.5

A. The Treatment Provider Shall:

1. At the top of the form, enter the contract provider’s name and number, the day of the week (Monday, Tuesday, Wednesday …), the month and year, the time of the group session, and the physical address of treatment services site. The time of the group shall include the time the group starts and the time the group ends.

2. Print or type the full names and TDCJ and SID numbers of the participants who are enrolled and scheduled to attend the session. Note: All group participants’ names shall be typed or legibly printed on this form.

3. Enter the parole officer’s name and District Parole Office.

4. For each session attended in the month, mark “Yes” for subsidized clients and “No” for self-pay clients.

5. Enter the co-payment a client paid for that session.

6. Maintain one monthly roster for each group of participants.

7. If applicable, enter the corresponding Problem, Progress or the Termination Code in the space provided in the

“Codes and Termination” column.

Problem Codes: Progress Codes:

11 = Admits to offense

12 = Submits homework on time

13 = Accepts feedback well

14 = Provides good feedback

15 = Appropriately participates in group discussion

16 = Follows group rules

17 = Client is progressing at an acceptable pace

Terminate Code:

T = Terminated from group session: List any terminations by entering

“T” and the applicable problem code (For example, T-7). If other, please specify.

TS = Terminated from

Subsidy. The client will remain in the treatment program as a self-pay client.

A = Absent

M = Make up session

1 = Missed initial appointment

2 = Two successive absences

3 = Late to group (10 minutes or more)

4 = Left group early (10 minutes or more)

5 = Failed to pay established fee

6 = Intoxicated / Drug use

7 = Displayed disruptive behavior

8 = Showed signs of re-offending

9 = Did not complete homework

10 = Other, Specify – Can be used for problem or progress

8. If a client is attending a session for a make-up class, enter “M” in the “Codes and Termination” column and the date of the session a client is making-up. For example, if a client missed group in Week 2 on 1/14/2021 and made the session up the following week, Week 3 on 1/21/2021, the therapist shall enter M-1/14/2021 in the Codes and Termination field. If a client missed group in Week 4 on 1/28/2021 (January invoice) and made up the session in Week 1 on 2/4/2021, enter M-1/28/2021 in the Codes and Termination field for that invoice

(February).

NOTE: Even if services were not provided during the month, a termination code must be entered.

9. Have participants initial the roster in the shaded area at the time of each session. Enter an “A” in the “Codes and Termination” column for participants who are absent; The blank initial field also indicates that the participant was absent.

10. By the fifth day following the month of service, sign and submit the entire previous month’s original signed rosters to the referring District Parole Office Specialized Unit Supervisor, who shall maintain a copy. If services are being provided for clients from different offices, copies of the PMS-41 must be sent to each referring office. The therapist shall not send invoices directly to Accounts Payable. If the vendor chooses to

696-PD-25-P006 Exhibit J.5 submit the invoices weekly, the District Parole Office shall enter the received date on the date the entire month’s invoices have been received.

11. In the field, “Total Number of Clients Billed,” enter the number of units for the month they are requesting reimbursement for.

12. If more than one page is needed for the group, please number the total number of pages per site. For example, “1 of 2.”

13. Leave the “Completed by the Parole Officer” field blank.

B. District Parole Office Staff Shall:

1. In the field, “Name/Title of Person who Received,” enter the name and title of the person who received the invoices.

2. In the field, “District Parole Office Received Date,” enter the date the invoices were received. Please note: if rosters are submitted weekly, the date entered will be the date when the entire month’s invoices were received.

C. The Parole Officer Shall:

1. Review the submitted rosters within three calendar days after the invoices are received at the District Parole

Office and sign the column “Completed by the Parole Officer.” The parole officer shall use the sign-in sheet to verify a client’s attendance and subsidy eligibility. The officer shall verify a client’s subsidy eligibility by marking “Yes” or “No” and sign for each client listed on the invoice. The signature verifies a client is subsidy eligible, that a client name and SID number are correct, a client was referred to therapy, and a client’s initials appear to be valid. Please note: if a client did not attend, the officer shall still verify subsidy eligibility by marking “Yes” or “No” and sign for each client. Vendors may be reimbursed for up to four absences a year.

Therefore, in any event, a signature is needed to verify subsidy status. Payment will be made only for those entries where the vendor and the parole officer have indicated that a client is subsidy eligible. If the provider is billing for a client who is no longer on subsidy, the parole officer shall indicate next to their signature the date the provider was notified by an SP-0507 that the client was terminated from subsidy. The date shall match the date that was entered into the OIMS.

2. Review the roster for any problems noted and take action if appropriate.

3. Use the “Comments” section under their name to provide information that may be necessary, such as “In

Custody 11/6/2020.”

4. Correct any incomplete invoices if the necessary information is available. Return incomplete invoicesthe provider to make corrections. If the parole officer is making a correction for the vendor, they shall inform the vendor about the correction. The parole officer shall initial any corrections they make. No incomplete or inaccurate invoices shall be submitted for payment.

C. The Specialized Unit Supervisor Shall:

1. Review the submitted rosters within three calendar days of receipt and sign and print their name in the section at the bottom right of the form. This signature indicates that either a client is within their initial 60 days of subsidy or a current extension has been approved in the OIMS.

2. Scan the signed rosters into OnBase using the instructions found in the “Procedure for Scanning PMS-41

Invoices to File.”

3. Submit the signed rosters by email within seven calendar days of receipt from the vendor to:

Specialized Programs Billing Unit sotp.invoices@tdcj.texas.gov

4. Maintain all rosters in the District Parole Office for future reference.

696-PD-25-P006 Exhibit J.5 mailto:sotp.invoices@tdcj.texas.gov mailto:sotp.invoices@tdcj.texas.gov mailto:sotp.invoices@tdcj.texas.gov mailto:sotp.invoices@tdcj.texas.gov

696-PD-25-P006 Exhibit J.6

TEXAS DEPARTMENT OF CRIMINAL JUSTICE

PAROLE DIVISION

Sex Offender Treatment Progress Report

PMS-31 (Rev. 07/19/12) Page 1 of 3

From: _________________________________________ To: __________________________________________ Therapist Parole Officer

Re: ________________________________________________ __________________/___________________ Client TDCJ # / SID #

Date of Report: _________________________ Period Covered: _________________ to __________________

Response Key Codes:

1 = Yes 3 = Effort being made 5 = Not applicable 2 = No 4 = More effort needed 0 = Unknown

I. Attendance __________ 1. Arrives on time for sessions

__________ 2. Number of sessions tardy by 10 or more minutes

__________ 3. Number of sessions client leaves before session ends

II. Treatment Participation __________ 4. Completes homework assignments as required

__________ 5. Appropriately participates in group discussion

If not, explain: ___________________________________________________________________

__________ 6. Accepts feedback from other group members

If not, explain: ___________________________________________________________________

__________ 7. Pays established fee. Balance: $ ______________________

__________ 8. Accepts responsibility for sexual behavior

__________ 9. Currently working on the following treatment components (check all that apply):

____ Sex offense cycle ____ Thinking errors ____ Victim empathy ____ Relapse prevention

____ Owns victimization issues ____ Social skills training ____ Aftercare planning

____ Substance abuse education (or proper referral made) ____ Other (specify) ________________

__________ 10. Has completed the following treatment components (check all that apply):

____ Sex offense cycle ____ Thinking errors ____ Victim empathy ____ Relapse prevention

____ Owns victimization issues ____ Social skills training ____ Aftercare planning

____ Substance abuse education (or proper referral made) ____ Other (specify) _____________

PAROLE DIVISION

Sex Offender Treatment Progress Report

PMS-31 (Rev. 07/19/12) Page 2 of 3

__________ 11. Follows treatment program rules

__________ 12. Displays the following thinking errors (list all that apply):

__________ 13. Client reports violating treatment and/or supervision rules

__________ 14. Client has shown progress in treatment by: _________________________________________

III. Recommendations __________ Modification of attendance frequency is needed.

__________ Other treatment referral is necessary.

__________ Treatment goals need to be revised.

__________ Termination/Discharge from treatment program to be discussed.

__________ Therapeutic evaluation/testing needed.

__________ Conditions of release need to be imposed/modified/withdrawn.

__________ Individual sessions are necessary.

__________ Parole violations need to be discussed.

Comments: __________________________________________________________________________________

I have discussed this report with my therapist.

Client’s Signature: _____________________________________________ Date: ________________________

Dist: Parole Officer Therapist Client Sex Offender Treatment Progress Report

Termination/Discharge Summary (Indicate if participant successfully or unsuccessfully leaves your program and recommendations concerning treatment and supervision needs):

PAROLE DIVISION

Sex Offender Treatment Progress Report

PMS-31 (Rev. 07/19/12) Page 3 of 3

INSTRUCTIONS

Enter the name of the therapist who has been treating the client, the supervising parole officer, the client, TDCJ #, and SID #. Enter the current date and the date the report period covers.

I. Attendance

1. Enter the appropriate response key code.

2. Enter the actual number of sessions the client was tardy by more than 10 minutes.

3. Enter the actual number of sessions the client left before the session ended.

II. Treatment Participation

4. Enter the appropriate response key code.

5. Enter the appropriate response key code. Explain how the client is not participating appropriately in group discussions.

6. Enter the appropriate response key code. Explain how the client does not accept feedback.

7. Enter the appropriate response key code. If client owes therapist money, indicate the current balance.

8. Enter the appropriate response key code.

9. Indicate the treatment components on which the client is currently working.

10. Indicate the treatment components that the client has completed.

11. Enter the appropriate response key code.

12. List the participant’s identified thinking errors.

13. Enter the appropriate response key code.

14. Specify how the client is showing progress in treatment (e.g., accepting responsibility, completing homework, attending regularly, passing the polygraph, etc.)

III. Recommendations Check all recommendations that apply to the specific client. If a recommendation is not listed, write it in the comments section.

Comments Write additional information not covered on the form that the supervising parole officer has a need to know.

Termination/Discharge Summary State if the client has been successfully or unsuccessfully terminated from the treatment program. If unsuccessful, state the reason for the termination. Include any follow-up recommendations that may impact supervision or treatment needs of the client.

Review the information with the client, and have the client sign and date the form. Send a copy to the parole officer and give a copy to the client. Maintain the original in the therapist’s file.

696-PD-25-P006 Exhibit J.7

PMS-27 (Rev. 01/17/13) Page 1 of 2

Subsidy Eligible TEXAS DEPARTMENT OF CRIMINAL JUSTICE

PAROLE DIVISION

SEX OFFENDER TREATMENT/POLYGRAPH REFERRAL INFORMATION Self-Pay

Date Referred to Treatment: Date Referred to Polygrapher:

A. Offender’s Name: DOB: TDCJ#: SID#:

Address: With Whom:

Telephone: (H) (W) if available:

Names / Ages of children (indicated if they are in home):

B. Conviction History (current offense listed first):

1.

2.

3.

C. Release Date: Discharge Date:

D. Description of sexually criminal / deviant / offensive behavior for which referral is made (include age of victim, relationship to victim, weapons used, physical harm to victim, # of victims, etc.

E. Offender Admits: (check one) All Some None F. Mental health issues /diagnoses:

Other treatment programs attended (include any program attended before, during and since incarceration, length of time attended and completion data):

To: Treatment Provider or Polygraph Examiner:

Name:

Address: Telephone #:

For additional treatment/education information, the treatment provider may call:

From: Parole Officer:

Name: DPO:

Address: Telephone #:

Attachments: (Check all that are included)

Criminal History Signed Disclosure of Information & Waiver of Confidentiality

Social History Case Summary, Release Certificate, including Special Conditions

Polygraph reports SOTP Closing Summary

Prior Evaluations Other (specify):

Attended in-prison SOTP

Attended in-prison SOEP

For Additional treatment/education information call:

E1 - Ellis Unit 936-295-5756 GR - Goree Unit 936-295-6331 HI - Hightower Unit 936-258-8013

HT - Hilltop Unit 254-865-8901 HV - Huntsville Unit 936-437-1555 R2 - Stringfellow Unit 281-595-3413

* Please note: A copy of the evaluation and polygraph report will be provided to offenders who are entitled to the notice and hearing process.

cc: Therapist/Polygraph Examiner & Offender’s file

696-PD-25-P006 Exhibit J.7

PMS-27 (Rev. 01/17/13) Page 2 of 2

TEXAS DEPARTMENT OF CRIMINAL JUSTICE

PAROLE DIVISION

SEX OFFENDER TREATMENT/POLYGRAPH REFERRAL INFORMATION INSTRUCTIONS

I. Subsidy Eligible/Self-Pay:

Check the appropriate Box. If the offender is subsidy eligible, the 60-day subsidy period will begin on date it was entered into the Offender Information Management System (OIMS). In the event the offender becomes subsidy eligible subsequent to the initial referral, a printed copy of the OIMS subsidy referral shall be provided to the contract therapist providing proof that the therapist may bill for subsidy. Referrals for subsidized polygraphs and evaluations are approved by the Sex Offender Program Supervisor via e-mail and the PMS-34 is the method utilized for subsidized polygraph examinations and evaluations. Officers may copy the original form used for the referral to treatment and provide a copy to the polygraph examiner filling in the referral date to the polygrapher. There is no need to complete another form to refer to a polygraph examiner.

II. Offender information:

A. Enter the date the referral is being made to treatment or the polygrapher. Enter the offender’s identifying information. If the offender has children list their names and ages and whether these children live with the offender.

B. Enter the offense name and year of conviction beginning with the offense(s) for which the offender is currently being supervised. Be sure to enter all sexual conviction information in this area.

C. Enter the release and discharge dates of the current period of supervision.

D. Describe the sexually criminal/deviant/offensive behavior the offender has engaged in. State the sex and age of victims, the offender's relationship with the victim, whether the victim was physically injured, weapons used, the number of known victims and any other pertinent information that may be useful to the therapist about the offense(s).

E. Indicate if the offender admits to all, some, or none of the sexually criminal/deviant/offensive behavior.

F. List any known mental health issues or diagnoses, i.e., depression, suicidal attempts or threats, mentally retarded, schizophrenia, etc.