PIP Tribal Agreement Sample.docx

INDIAN NATION

PROGRAM AGREEMENT

Positive Indian Parenting DCYF Agreement Number

1501- Indian Nation Agreement Number

DCYF ADMINISTRATION

Department of Children, Youth, and Families

DCYF DIVISION

Children, Youth and Families

DCYF INDEX NUMBER

DCYF CONTRACT CODE

2000NC-62

DCYF CONTACT NAME AND TITLE

Contract Manager

DCYF CONTACT ADDRESS

1115 Washington St SE

Olympia, WA 98504

DCYF CONTACT TELEPHONE

DCYF CONTACT FAX

Click here to enter text.

DCYF CONTACT E-MAIL

INDIAN NATION NAME

INDIAN NATION ADDRESS

NDIAN NATION CONTACT NAME

INDIAN NATION CONTACT TELEPHONE

INDIAN NATION CONTACT FAX

INDIAN NATION CONTACT E-MAIL

IS THE INDIAN NATION A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM AGREEMENT?

CFDA NUMBERS

PROGRAM AGREEMENT START DATE

PROGRAM AGREEMENT END DATE

MAXIMUM PROGRAM AGREEMENT AMOUNT

EXHIBITS. When the box below is marked with a check () or an X, the following Exhibits are attached and are incorporated into this Indian Nation Program Agreement by reference:

|_| Exhibits (specify): DCYF Indian Nation Data Security Requirements Exhibit A; Statement of Work Exhibit B; Program Requirements Exhibit C; Budget Exhibit D |_| No Exhibits.

By their signatures below, the parties agree to the terms and conditions of this Indian Nation Program Agreement and all documents incorporated by reference. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify that they are authorized, as representatives of their respective governments, to sign this Program Agreement.

INDIAN NATION SIGNATURE

Draft - Please Do Not Sign

PRINTED NAME AND TITLE

DATE SIGNED

DCYF SIGNATURE

Draft - Please Do Not Sign

PRINTED NAME AND TITLE

DATE SIGNED

Special Terms and Conditions

Department of Children, Youth & Families 2019NF Indian Nation Program Agreement (6-24-20) Page 3

1. Definitions Specific to Special Terms. The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions. These definitions are in addition to those definitions in the Indian Nation and DCYF Agreement Regarding General Terms and Conditions referred to above.

a. “Compliance Agreement” means a written plan approved by DCYF which identifies deficiencies in performance, describes the steps the Indian Nation must take to correct the deficiencies, and sets forth timeframes within which such steps must be taken to return the Indian Nation to compliance with the terms of the Agreement.

Crisis Plan/Protective Action Plan: In the context of child safety, a crisis plan/protective action plan is a proactive and structured strategy developed to address and manage situations in which there is a present danger to the safety of the child. It is a crucial component of child welfare and protection, designed to ensure the well-being of a child when there are concerns about their immediate safety due to factors such as abuse, neglect, or other potential dangers. Crisis plans are typically developed and implemented by child protective services, social workers, or other relevant agencies and professionals.

Culturally Responsive: Culture includes the shared social behaviors and norms within a society. This can include shared knowledge, beliefs, laws, arts, customs, habits, priorities, expectations, and many other shared practices. Being Culturally Responsive would involve proactively engaging with people in ways that are appropriate within their cultural values, behaviors, and norms.

Culturally Specific: Proactive learning and engagement regarding the distinct cultural practices of others, referencing specific elements that could be recognized as particular to their cultural ways.

Cultural Adaptations: Modifications made to practices, customs, or expectations to better accommodate a specific culture's values and norms. This includes providing culturally competent training to staff to ensure a comprehensive understanding of local needs, employing linguistically and culturally specific communication and access strategies, and adjusting intervention methods to align with diverse family structures and belief systems.

Project Plan: The project plan that is developed by the providers that aims to guide contracted organizations and DCYF through the planning and execution of the program.

Reason to Know: When there is reason to know children are or may be Indian Children under 2.40.1 Reason to Know https://dcyf.wa.gov/dcyf-policies/2-40-1-reason-know Safety Plan: In the context of Washington's Department of Children, Youth, and Families (DCYF), a safety plan refers to a structured and documented strategy developed to ensure the safety of a child or youth involved with the child welfare system. These plans are typically created by DCYF in situations where there are concerns about a child's safety, often due to the presence of an active safety threat for the child/ren in the household. Safety plans are essential tools used by DCYF to ensure that children and youth are kept safe in situations of vulnerability or potential harm. They serve as a structured framework to coordinate efforts, resources, and interventions to protect and support the child's best interests.

Service Confirmation: Refers to the process by which the contracted provider acknowledges receipt of a referral from the Department of Children, Youth, and Families (DCYF) and confirms through written correspondence the acceptance or declination of services.

1. Purpose. The purpose of this Agreement is to provide Positive Indian Parenting services.

2. Contract Term. The period of performance of this Agreement is for one year ending 02/28/2027 with an option at the sole discretion of DCYF to amend for continuous funding.

3. Data Security Requirements – Exhibit A. The Indian Nation shall protect, segregate, and dispose of data from DCYF as described in Exhibit A.

4. Statement of Work – Exhibit B. The Indian Nation shall provide services and staff as described in the Statement of Work attached as Exhibit B.

5. Program Requirements – Exhibit C. The Indian Nation shall comply with all program and other requirements for providing services under this Agreement, as stated in the Program Requirements attached as Exhibit C.

6. Budget Exhibit – Exhibit D. The Budget for providing services under this Agreement is attached as Exhibit D. Funds may be transferred between budget line items of the Budget subject to the following conditions:

a. Transfer of funds up to 10% of the budget line item must be requested in writing by the Indian Nation and may be made without amending this Agreement;

b. Transfer of funds that exceeds 10% of the budget line item shall require a written amendment to this Agreement prior to the transfer of funds between budget line items.

7. Consideration

a. Maximum Amount. The maximum amount of total consideration payable to the Indian Nation for satisfactory performance of the work under this Agreement is the amount stated on page 1 of this Agreement under “Maximum Program Agreement Amount.”

b. Start-up Funding:

The Indian Nation shall utilize start-up funding the following activities:

Personnel costs related to recruitment and onboarding Recruitment, hiring, and onboarding materials Program advertisement and outreach Initial staff training System costs related to the program including technology for data collection and reporting Consulting and sub-contracting Strategic planning

c. Concrete goods

(1) The Indian Nation shall assist the family in obtaining concrete goods and support services, as follows:

When needed to directly support a family in maintaining child safety and family wellbeing to either prevent placement or achieve reunification;

The Indian Nation shall first seek community resources to provide concrete goods and support services that are available at no cost to the client or the Indian Nation before funds are expended for concrete goods and support services;

If community resources for concrete goods and support services are not available, purchases must be made using the most economical and reasonable approach and may include purchasing items that are gently used or second hand;

DCYF will reimburse the Indian Nation for actual costs of concrete goods and/or support services up to the cumulative total of $500.00 permitted per family.

A description of engagement and a copy of all receipts shall be submitted with billing.

DCYF is not able to pre-pay for any services A Concrete Goods Guide that provides additional direction on Acceptable Concrete Funds can be accessed at https://www.dcyf.wa.gov/sites/default/files/pdf/ConcreteGoodsGuide.pdf Cultural Supplies The Indian Nation shall purchase cultural supplies to support the delivery of Positive Indian Parenting as follows:

To support Positive Indian Parenting session delivery and cultural relevance To support the cultural connection and wellbeing of program participants Cultural Supplies may include but are not limited to:

Drum or rattle making supplies Sewing and beading materials Tools to craft cultural items Items to support cultural ceremony which may include shells, sage, cedar or blankets.

Items to support traditional methods of preparing or gathering food Materials to support indigenous language reclamation efforts including the purchase of books or other media Materials to support traditional methods of infant care and attachment Cultural Consultation:

The Indian Nation shall reimburse cultural experts with lived experience including tribal Elders, community members, and language teachers to support the delivery of Positive Indian Parenting as follows:

To support Positive Indian Parenting session delivery and cultural relevance To support the cultural connection and wellbeing of program participants

8. Billing and Payment The Indian Nation shall submit a monthly invoice for services performed under this Agreement on State of Washington Invoice Voucher forms (Form A-19), prepared in the manner prescribed by DCYF.

a. The invoice shall state the amount of each cost or expense incurred by the Indian Nation in the preceding calendar month that is based on the items listed in the Budget Exhibit attached as Exhibit D. Costs or expenses listed in the invoice must match the corresponding items listed in the Budget Exhibit for costs or expenses that will be incurred by the Indian Nation.

b. The cost or expense billed for each such item shall be charged against the total amount listed for that item in the Budget Exhibit. The cumulative dollar amount for each such item, for all invoices submitted by the Indian Nation, shall not exceed the total dollar amount stated for that item in the Budget Exhibit.

c. The voucher shall clearly indicate that it is “FOR SERVICES RENDERED IN PERFORMANCE UNDER DCYF AGREEMENT NO._________ FOR THE MONTH OF _________, 20__” The A-19 invoice vouchers shall be submitted to:

Tessa Velasco, Culturally Responsive Services Manager Department of Children, Youth and Families tessa.velasco@dcyf.wa.gov

The Indian Nation shall contact the above Program Manager at (360) 918-3518 The rates shall be as specified above in the section titled “Consideration” of this Contract.

d. The Indian Nation shall bill for each month of service on a separate Form A-19. The A-19 shall state the month services were provided.

e. Claims for payment submitted by the Indian Nation shall be paid by DCYF if received by DCYF no later than sixty (60) days from the date services were rendered.

f. DCYF will not be obligated to pay for services submitted more than three (3) months after the calendar month in which the services were performed.

g. DCYF shall make payment within thirty (30) days of receipt of a properly completed invoice for services.

h. DCYF may withhold payment to the Indian Nation if reports required under this Agreement are delinquent, i.e., not submitted within ten (10) working days of the due date, or incomplete.

i. DCYF may, at its sole discretion, withhold payment claimed by the Indian Nation for services rendered if the Indian Nation fails to satisfactorily comply with any term or condition of the Agreement.

9. Services Authorized as Needed DCYF shall request services from the Indian Nation on an as-needed basis. This Agreement does not obligate DCYF to authorize services from the Indian Nation.

10. Payment Only for Authorized Services DCYF shall pay the Indian Nation only for authorized services provided in accordance with this Agreement. If this Agreement is terminated for any reason, DCYF shall pay only for services authorized and provided through the date of termination.

11. Funding Stipulations.

a. Information for Federal Funding. The Indian Nation agrees that it will cooperate in supplying any information to DCYF that may be needed to determine DCYF or the client’s eligibility for federal funding.

b. Duplicate Billing. The Indian Nation agrees that it will not bill other funding sources for services rendered under this Agreement which would result in duplicate billing to different funding sources for the same service. Furthermore, the Indian Nation agrees that it will ensure that no subcontractor bills any other funding sources for services rendered under this Agreement, which would result in duplicate billing to different funding sources for the same service.

c. No Federal Match. The Indian Nation agrees that it will not use funds payable under this Agreement as match toward federal funds without the prior written permission of DCYF.

d. Supplanting. The Indian Nation agrees that it will use these funds to supplement, not supplant the amount of federal, state and local funds otherwise expended for services provided under this Agreement.

12. Recovery of Fees for Noncompliance In the event the Indian Nation bills for services provided and is paid fees for services that DCYF later finds were either (a) not delivered or (b) not delivered in accordance with applicable standards or the requirements of this Agreement, DCYF shall have the right to recover the fees for those services from the Indian Nation, and the Indian Nation agrees that it will fully cooperate during the recovery process.

13. Prohibition of Use of Funds for Lobbying Activities The Indian Nation agrees that it will not use funds payable under this Agreement for lobbying activities of any nature. The Indian Nation certifies that no state or federal funds payable under this Agreement shall be paid to any person to influence, or attempt to influence, either directly or indirectly, an officer or employee of any state or federal agency, or an officer or member of any state or federal legislative body or committee, regarding the award, amendment, modification, extension, or renewal of a state or federal agreement or grant.

Any act by the Indian Nation in violation of this prohibition shall be grounds for termination of this Agreement, at the sole discretion of DCYF and shall subject the Indian Nation to such monetary and other penalties as may be provided by law.

14. Insurance Documentation

a. DCYF certifies it is self-insured under the State’s self-insurance liability program, as provided by RCW 4.92.130, and shall pay for losses for which it is found liable.

b. The Indian Nation shall, upon request by DCYF, submit evidence of coverage to the DCYF contact listed on page 1 of this Agreement either by a Certificate of Insurance or a letter certifying the Indian Nation is self-insured, as stated below in subsection c.

c. Letter of Certification of Self-Insurance shall include:

Legal name of Indian Nation Tax Identification # DCYF Agreement number(s) Level of self-insured retention The letter shall be signed by a duly authorized representative who can warrant and attest to the information contained in the letter.

15. Investigations of Contractor or Related Personnel DCYF may, without prior notice, suspend the Indian Nation’s performance of the Agreement if the Indian Nation, or any partner, officer or director of the Indian Nation, or a subcontractor, or any employee or volunteer of the Indian Nation or a subcontractor, is investigated by DCYF or a local, county, state or federal agency regarding any matter that, if ultimately established, could either:

a. Result in a conviction for violating a local, state or federal law, or

b. In the sole judgment of DCYF, adversely affect the delivery of services under this Agreement or the health, safety or welfare of DCYF clients.

c. DCYF may also take other lesser action, including, but not limited to, disallowing the subject of the investigation, whether an employee, volunteer, or other person associated with the Indian Nation or a subcontractor, from providing services, or from having contact with DCYF clients, until the investigation is concluded and a final determination made by the investigating agency.

16. Removal of Individuals from Performing Services

a. In the event that any of Indian Nation’s employees, subcontractors, or volunteers who provide services under this Agreement do not meet qualifications required by this Agreement or do not perform the services as required in this Agreement, DCYF may require that Indian Nation assure DCYF that such individual will not provide services to DCYF clients under this Agreement.

b. DCYF shall notify the Indian Nation of this decision verbally and in writing and the Indian Nation shall, within twenty-four (24) hours, disallow that person from providing direct services to DCYF clients. Failure to do so may result in a Compliance Agreement and possible suspension or termination of this Agreement.

17. Compliance Agreement In the event that DCYF identifies deficiencies in Indian Nation’s performance under this Agreement, DCYF may, at its option, establish a Compliance Agreement. When presented with a Compliance Agreement, Indian Nation agrees to undertake the actions specified in the plan within the timeframes given to correct the deficiencies. Indian Nation’s failure to do so shall be grounds for termination of this Agreement.

18. Resolution of Differences In the event of any differences between the parties on matters related to the interpretation and implementation of this Agreement, the parties shall first attempt to resolve the difference informally between themselves at the local or regional level, by contacting the DCYF contact on page 1 of this Agreement and following the identified regional conflict resolution process.

If the parties are unable to resolve their difference as stated above, then either party may submit a request for dispute resolution as provided in the Section titled “Disputes” in the Indian Nation and DCYF Agreement Regarding General Terms and Conditions referred to at the beginning of this Agreement.

A copy of the regional conflict resolution process is available from the DCYF contact person listed on page 1 of this Agreement.

19. Disputes

a. Either party who has a dispute concerning this Agreement may submit a written request for dispute resolution. The amount of any rate set by law, regulation, or DCYF policy is not disputable. A party’s written request for dispute resolution must include:

(1) A statement identifying the issue(s) in dispute; and

(2) The Indian Nation’s name, address and agreement number.

b. The request must be mailed to the following address within thirty (30) calendar days after the party could reasonably be expected to have knowledge of the issue, which is disputed.

c. A copy of the current DCYF’s dispute resolution process is available at any time by written request.

d. Requests for dispute resolution or for a copy of the current DCYF’s dispute resolution process should be sent to:

Department of Children, Youth & Families Attention: Contracts and Procurement Office P.O. Box 40983 Olympia, WA 98504-0983

e. This dispute resolution process is the sole administrative remedy available under this Agreement.

20. Emergency Management & Response

a. It may be possible, that during the performance of this Agreement, that DCYF or the State of Washington could issue or declare a State of Emergency. Such an emergency could include, but not be limited to:

(1) Pandemic;

(2) Public Health Emergency;

(3) Natural or manmade disaster; and / or

(4) Civil Unrest.

b. If such a declaration is made, by DCYF or the State of Washington, then DCYF may choose to temporarily modify the service delivery provisions of this agreement. Those modifications will be time limited and will be found here: https://www.dcyf.wa.gov/services/child-welfare-providers/contracted-services

EXHIBIT A

The requirements described in this Contract apply to Confidential Information and Data related to the subject matter of this Contract that is delivered, received, used, shared, acquired, created, developed, revised, modified, or amended by DCYF, the Indian Nation, or Subcontractors.

Public information is information that can be or currently is released to the public. It does not need protection from unauthorized disclosure, but does need integrity and availability protection controls.

(2) Category 2 – Sensitive Information Sensitive information may not be specifically protected from disclosure by law and is for official use only. Sensitive information is generally not released to the public unless specifically requested.

(3) Category 3 – Confidential Information Confidential information is information that is specifically protected from either release or disclosure by law. This includes, but is not limited to:

Confidential information requiring special handling is information that is specifically protected from disclosure by law and for which:

Data stored on local workstation hard disks, access to the Data will be restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards.

1. They have reviewed the data security policy of the cloud service provider; and

2. The cloud service provider meets requirements of Exhibit A in full or with limited exceptions.

Server or workstation hard disks, or

Removable media (e.g. floppies, USB flash drives, portable hard disks) excluding optical discs

Using a “wipe” utility which will overwrite the Data at least three (3) times using either random or single character data, or

Degaussing sufficiently to ensure that the Data cannot be reconstructed, or

Physically destroying the disk