DEPUTY DIRECTOR KIRK CALDWELL PAMELA A. WIrrY-OAKLAND

DEPARTMENT OF COMMUNITY SERVICES

CITY AND COUNTY OF HONOLULU925 DILLINGHAM BOULEVARD. SUITE 200 • HONOLULU, HAWAII 96817

PHONE: (808) 768-7762 • FAX: (808) 768-7792w.w. ho fbI u u . gay/dos

KIRK CALDWELL PAMELA A. WIrrY-OAKLANDMAYOR DIRECTOR

REBECCAJ. ‘I. SOONDEPUTY DIRECTOR

June 26, 2019

The Honorable Ikaika AndersonChair and Presiding Officer

and MembersHonolulu City Council530 South King Street, Room 202Honolulu, Hawaii 96813

Dear Chair Anderson and Councilmembers:

SUBJECT: Receipt and Expenditure of Limited Purpose Monies

Pursuant to Section 12(b) and 12(d), Ordinance No. 18-23, we are requesting approval .

for the receipt and expenditure of an award of limited purpose monies to be received from the j.State of Hawaii (State), Department of Human Services, in the amount of $4,500,000.00 to the ‘,

City and County of Honolulu (City) Department of Community Services. There is intent of both, Zthe State and the City to enter into a contract to provide services for the Permanent SupportiveHousing Program to provide housing services and case management to homeless households. S

Should you have questions, please contact me at 768-7760.

Attachment

APPROVED:

Roy K(Amerniya, Jr. ‘

Managing Director

DEPT. COM. 432

June15

CONIRACTNO DHS-1 9-GOV-0086

STATE OF HAWAPICONTRACT FOR HEALTH AND HUMAN SERVICES:

TRANSACTIONS EXEMPT FROM CHAPTER 103F, HRS

This Contract, executed on the respective dates indicated below, is effective as of

Department of Human Services20 19 between the

(Nwne of the slate department. agency board or coetImtssson)

State of Hawai’i (“STATE”), by its Directormile orpenair stgmng far the 5T4 FE)

whose address is: 1390 Miller Street, Room 209 Honolulu, HI 96813

and City and County of Honolulu(Name of PRO I’IDER

(“PROVIDERj, a government entity or agency(Legal/ann of PROVIDER i.e. Corporation. Lb’,uec? Liobitty Company. etc.)

under the laws of the State of Hawaii whose business street address and taxpayer

identification numbers are as follows:

Business street address:

925 Dillingham Boulevard, Suite 200

Honolulu, HI 96617

Mailing address if different than business Street address:

Federal employer identificationnumber: 99-6001257

Hawai’i general excise tax number: W40494814-O1

EXEMPT TRANSACTIONSPage 1 of 6

AG Form 103F6 (02 09)

CONTRACCNO. DHS-1 9-GOV-0086

RECITALS

A. This Contract is for a purchase of health and human services that is exempt from therequirements of chapter 103F, Hawai’i Revised Statutes, (“HRS”), because:

this Contract is between or among government agencies as provided inSection 103F-I01(a)(2), HRS;

this Contract is to award grants or subsidies of slate funds appropriatedby the legislature to a specific organization as provided in sectionlO3F - lOl(a)(l), I-IRS, and section 3-141-503(a)(2), HawaiiAdministrative Rules, or to award subawards and subgrants to specificorganizations directed by the funding source as provided in section3-141-5 03 (a)( I);

this Contract is wholly or partly funded from federal sources that conflictwith the procedures and requirements established by chapter lOW, I-IRS,and its implementing regulations;

this Contract is wholly or partly funded from federal sources that(I) identifies a target class of beneficiaries, (2) defines the requirementsfor a provider to be qualified to participate in the federal program, and(3) has the price of the provided health and human services dictated byfederal law;

this Contract is for an affiliation agreement with hospitals and otherhealth care providers required for University of 1-lawaii clinical programs;

El this Contract is for the services of psychiatrists or psychologists incriminal or civil proceedings as required by a court order or by the rulesof the court;

this Contract is for a transaction covered by a written exemptionfrom the Chief Procurement Officer for the STATE dated

_____________________

,20______

B. The STATE needs the health and human services described in this Contract andits attachments (“Required Services”) and the PROVIDER agrees to provide the RequiredServices,

EXEMPT TRANSACTIONSPage2 of6

AG Form 103F6 (02 09)

CONTRACT NO. DHS-1 9-GOV-0086

C. Money is available to fund this Contract pursuant to:

(I) HMS9O4; Act 2091 SLH 2018; Act 53, SLH 2015(Idenub’ slate Sources)

in the amount r$4500O00.OO ,or(swiefundrng)

(2)((dent,fyfrderal sauens)

in the amount of , or both.(federolfundusgi

D. The STATE is authorized to enter into this Contract pursuant to:Sections 346-14 & 346-3, Hawaii Revised Statutes; Act 209, SD-I 2018

(Legal aiithori0’ for Contra

E. The undersigned representative of the PROVIDER represents, and the STATErelies upon such representation, that he or she has authority to sign this Contract by virtue of(check any or all that apply):

D corporate resolutions of the PROVI DER or other authorizing documentssuch as partnership resolutions;

LI corporate by-laws of the PROVIDER, or other similar operatingdocuments of the PROVIDER, such as a partnership contract or limitedliability company operating contract;

EJ the PROVIDER is a sole proprietor and as such does not require anyauthorizing documents to sign this Contract;

The PROVIDER is a government entity, and the undersignedrepresentative of the PROVIDER is duly-authorized to execute contractson behalf of such government entity;

LI other evidence of authority to sign:—

F. The PROVIDER has provided a “Certificate of Insurance” to theshows to the satisfaction of the STATE that the PROVI ained liability insurancewhich complies with para e General Conditions of this Contract and with anyrelevat al condition of this Contract.

G. The PROVIDER produced, and the ST ected, a tax clearance certificateas required bjsc&rTt1T537HRSE’


AG Form 103F6 (02)09)

CONTRACT NO. OHS-i 9-GOV-0086

NOW, THEREFORE, in consideration of the promises contained in this Contract, theSTATE and the PROVIDER agree as follows:

I. Scope of Services. The PROVIDER shall, in a proper and satisfactory manner asdetermined by the STATE, provide the Required Services set forth in Attachment “I” to thisContract, which is hereby made a part of this Contract, and the Request for Proposals (“REP”),and the PROVIDER’s Proposal, which are incorporated in this Contract by reference. In theevent that there is a conflict among the terms of this Contract, and either the Proposal or theREP, or both, then the terms of this Contract shall control.

2. Time of Performance. The PROVIDER shall provide the Required Services fromJune15 .2019 ,toJunel4 ,2022 ,assetforth in Attachment “2” to this Contract, which is hereby made a part of this Contract.

3. Compensation. The PROVIDER shall be compensated

in a total amount for all required services not to exceedFour Million Five Hundred Thousand and NO! 100 DOLLARS

($4,500,000.00 ), which amount includes all fees and costsincurred and any federal, state and local taxes as set forth in attachment“3” to this Contract, which is hereby made a part of this Contract.

D based upon referrals to the PROVIDER from the STATE, paymentfor each such referral shall be made according to Attachment “3”.The STATE shall provide a minimum of referrals tothe PROVIDER.

4. Reporting Requirements. In addition to whatever other reports may be requiredelsewhere in this Contract, the PROVIDER shall also submit a Final Project Report, by (date)July 31 .2022

. No amendment to the PROVIDER’s

Final Project Report shall be considered after (date) July 31 2022

5. Certificate of Exemption from Civil Service. The Certificate of Exemption fromCivil Service is attached and made a part of this Contract.

6 Standards of Conduct Declaration. The Standards of Conduct Declaration of thePROVIDER is attached and made a part of this Contract.

EXEMPT TRANSACTIONSPage4 oft

AG Form 103F6 (0209)

CONTRACT NO. DHS-1 9-GOV-0086

7. General and SDecial Conditions. The General Conditions for Health and 1-luman

Services Contracts (“General Conditions”) and any Special Conditions are

attached hereto and made a part of this Contract. In the event ofa conflict

between the General Conditions and the Special Conditions, the Special

Conditions shall control.

K Notices. Any written notice required to be given by any party under this Contractshall be (a) delivered personally, or (b) sent by United States first class mail,postage prepaid.

Notice required to be given to the STATE shall be sent to:

Hawaii State Capitol, Room 415 Honolulu, HI 96813

ATTN: Governors Coordinator on Homelessness

Notice to the PROVIDER shall be sent to the mailing address as indicated on page I. A notice

shall he deemed to have been received three (3) days after mailing or at the time of actualreceipt, whichever is earlier, The PROVIDER is responsible for notiing the STATE in writingof any change of address.

[N VIEW OF THE ABOVE, the parties execute this Contract by their signatures below.

STATE

By

__________________________________

(Signature,)

Print Name Pankaj Bhanot

Print TitleDirector

Date

________________________________________________

FUNDING AGENCY (to be signed by head offundngagency if other than the Contracting Agency)

By

__________________________________

(Signature)

Print Name

__________________________________

Print Title

_______________________________________

Date

____________________________________________

EXEMPT TRANSACTIONSPage 5 o16

AG Form 103F6 (02109)

CONTRACT NO. DHS-1 9-GOv-ooa6

CORPORATE SEAL(if available)

PROVIDER

By

________________________________

tYsgnansrr)

Print Name

____________________________________

Print Title

_________________________________________

Date

APPROVED AS TO FORM:

Deputy Attorney General

APPROVED AS TO FORM & LEGALITY:

Deputy Corporation Counsel


AG Form 103P6 (02 09)

CONTRACT NO. DHS-19-GOV-0086

PROVIDER’S ACKNOWLEDGMENT

STATE OF

________________________

) SS.

___________

COUNTY OF

____________

On this

______________________

day of

________________________

, 20 , before

me appeared

and

_____________________________________________________________

, to me known, to be the

person(s) described in and, who, being by me duly sworn, did say that he/she/they is/are the

____________________________________________

and

______________________________________________

of

the PROVIDER named in the foregoing instrument, and that he/she/they is/are authorized to sign said

instrument on behalf of the PROVIDER, and acknowledges that he/she/they executed said instrument

as the free act and deed of the PROVIDER.

By

___________________________________

(Notary Seal) (Sgnaiure’

Print Name

__________________________________

Date

_____________________________________________

Notary Public, State of

______________________

My commission expires:

________________________

Dcc. Date:

_________________________

# Pages:

________

Notary Name:

_______________________

Circuit

Doc. Description:

________________________________________

(Noar\ Sainp )r Seal)

Notary Signature Date

NOTARY CERTIFICATION

AG Form 103F7 (10:08)

DHS-1 9-GOV-0086CONTRACT NO.

PROVIDER’SSTANDARDS OF CONDUCT DECLARATION

For the purposes of this declaration:

“Agency” means and includes the State, the legislature and its committees, all executive departments,boards, commissions, committees, bureaus, offices; and all independent commissions and otherestablishments of the state government but excluding the courts.

“Controlling interest” means an interest in a business or other undertaking which is sufficient in fact tocontrol, whether the interest is greater or less than fifty per cent (50%).

“Employee” means any nominated, appointed, or elected officer or employee of the State, includingmembers of boards, commissions, and committees, and employees under contract to the State or of theconstitutional convention, but excluding legislators, delegates to the constitutional convention, justices,and judges. (Section 84-3, HRS).

On behalf of:

City & County of Honolulu(Name of PROVIDER1

PROVIDER, the undersigned does declare as follows:

I. PROVIDER D fl is not a legislator or an employee or a business in which a legislatoror an employee has a controlling interest. (Section 84-15(a), I-IRS).

2. PROVIDER has not been represented or assisted personally in the matter by an individual who hasbeen an employee of the agency awarding this Contract within the preceding two years and whoparticipated while so employed in the matter with which the Contract is directly concerned. (Section84-15(b), FIRS).

3. PROVIDER has not been assisted or represented by a legislator or employee for a fee or othercompensation to obtain this Contract and will not be assisted or represented by a legislator oremployee for a fee or other compensation in the performance of this Contract, if the legislator oremployee had been involved in the development or award of the Contract. (Section 84-14 (d),FIRS).

4. PROVIDER has not been represented on matters related to this Contract, for a fee or otherconsideration by an individual who, within the past twelve (12) months, has been an agencyemployee, or in the case of the Legislature, a legislator, and participated while an employee orlegislator on matters related to this Contract. (Sections 84-18(b) and (c), HRS).

PROVIDER understands that the Contract to which this document is attached is voidable on behalf of theSTATE if this Contract was entered into in violation of any provision of chapter 84, Hawaii RevisedStatutes, commonly referred to as the Code of Ethics, including the provisions which are the source of the

Reminder to agency: If the “is” block is checked and if the Coniract involves goods or services of a value in excess of $10,000, theContract may not be awarded unless the agency posts a notice of its intent to award it and files a copy of the notice with the StateEthics Commission. (Section 84-15(a), [IRS).

AG Form l03F9 (10 08)Standards of Conduct Declaration

Page 1 of


declarations above. Additionally, any fee, compensation, gift, or profit received by any person as a result ofa violation of the Code of Ethics may be recovered by the STATE.

PROVIDER

By(Signoiure;

Print

Print

Date

Name

Title

AG Form 103F9 (10 08)Standards of Conduct Dec)aration

Page 2 of

CONTRACT NO.OH S-i 9-GOV-0086

CERTIFICATE OF EXEMPTION FROM CIVIL SERVICE

1. By Heads of Departments or Agencies as Delegated by the Director of Human

Resources Development’.

Pursuant to the delegation of the authorityDevelopment, I certify that the services providedproviding the services under this Contract are exemptHawai’i Revised Statutes (“I-IRS”).

(Signature)

(Prini Nanie)

(Print Title)

by the Director of Human Resourcesunder this Contract, and the person(s)

from the civil service, pursuant to §76-16,

(Date)

This pail of the form may be used by all department heads and others to whom the Director of HumanResources Development (DHRD) has delegated authority to cerlify §76-16, 1-IRS, civil service exemptions. Thespecific paragraph(s) of §76-16, HRS, upon which an exemplion is based should be noted in the contract file.NOTE: Authority 10 certify exemptions under § 76-16(2), 76-16(12), and 76-16(15), I-IRS, has not beendelegated; only the Director of DHRD may certify §76-1 6(2), 76-16(1 2), and 76-1605) exemptions.

2. By the Director of Human Resources Development, State of Hawai’i.

I certify that the services tothe services under this Contract are

S,gi,aitire)

(P4w Name)

be provided under this Contract, and the person(s) providingexempt from the civil service, pursuant to §76-16, I-IRS.

(Date)

AG Form lOWS (908)Competitive

(Print rule, ifdesignee of the Direcior of DHI?D,)

Page 1 of 1

CONTRACT NO. .JJHS- I 9-GOV-0086Attachment I

SCOPE OF SERVICESRequired Services

Name of Provider: City and County of HonoluluAddress: 925 Dillingham Boulevard Suite 200 Honolulu, HI 96817

Name of Program; Ohana Zone — Honolulu Permanent Supportive Housing

Type of Program: Ohana ZoneType of Service: Providing permanent supportive housing at County owned

facilities on the island of Oahu.

Time of Performance: June 15, 2019 to June 14, 2022Amount of Contract: $4,500,000.00

Purpose. The purpose of this Contract is to implement Homeless services.

II. Interchanaeable Terms. The following terms are one and the same:

1 “CONTRACTOR” and ‘PROVIDER”

2. “STATE” and “DHS”

Ill. Exhibits. In addition to the Paragraph 1. Scope of Services on page 4 of the ContractForm (AG Form 103F6), this Contract shall include the following:

1. Sample Facilities Description, attached and incorporated as Exhibit A.

2. Budget Forms, attached and incorporated as Exhibit B.

3. Sample Invoice and Forms, attached and incorporated as Exhibit C.

4. Language Access Reporting Tool, attached and incorporated as Exhibit D.

5. State Special Conditions AG Form 103F14 (10/08), attached and incorporated asExhibit E.

6. State General Conditions AG Form 103F (10/06), attached and incorporated asExhibit F.

7. Principles for Purchases of Health and Human Services, SPOH-201 (Revised9/11), attached and incorporated as Exhibit G.

IV. Definitions.

1. “Administrative Costs” means costs for general management, oversight,coordination, evaluation and reporting on contracted services. Such costs do notinclude costs directly related to carrying out contracted services, since thosecosts are eligible as Operating Costs (see below).

city & couiny— P5K— Scope of Services Page I of 22 AG Form 103F10 (10/08)06/25/2019

SOS .City OZ. PS 1-1.20 9

CONTRACT NO. _DHS-19-GOV-0086Attachment I

2. “Chronically Homeless” means an individual or Family that: (i) Is Homeless andlives or residences in a place not meant for human habitation, a safe haven, or inan Emergency Shelter; and (H) Has been Homeless and living or residing in aplace not meant for human habitation, a safe haven, or in an Emergency Sheltercontinuously for at least one year or on at least four separate occasions in thelast three years where those occasions cumulatively total at least 12 months; and(Hi) Has an adult head of Household (or a minor head of Household if no adult ispresent in the Household) with a diagnosable substance use disorder, seriousmental illness, developmental disability, post-traumatic stress disorder, cognitiveimpairments resulting from a brain injury, or chronic physical illness or disability,including the co-occurrence of two or more of those conditions; the disability isexpected to be long-continuing or of indefinite duration and substantially impedesthe individual’s ability to live independently.

3. Continuum of Care” and ‘CoC” are used interchangeably in this Contract andmean the planning bodies required by the United States Department of Housingand Urban Development (HUD) to carry out the responsibilities defined under 24Code of Federal Regulations (CFR) Part 578--Continuum of Care Program. ACoC is a group composed of representatives of organizations, including nonprofitservice providers for the Homeless, victim service providers, faith-basedorganizations, governments, businesses, advocates, public housing agencies,school districts, social service providers, mental health agencies, hospitals,universities, affordable housing developers, law enforcement, organizations thatserve Homeless and formerly Homeless veterans, and Homeless and formerlyHomeless persons to the extent these groups are represented within thegeographic area and are available to participate. A CoC is responsible forcoordinating funding, policies, strategies and activities toward endingHomelessness in a designated geographic region, including but not limited toplans and oversight for use of HUD Ccc funding,

4. “Emergency Shelter” means any facility, the primary purpose of which is toprovide a temporary shelter for the Homeless in general or for specificpopulations of people experiencing Homelessness and which does not requireoccupants to sign leases or occupancy agreements.

5. “Family” means:

a. Two or more persons who live or intend to live together as a unit, one ofwhom is a minor, under 18 years of age, related by b’ood, marriage, oroperation of law, including foster children and hanai children; or

b. A person who is pregnant or in the process of securing legal custody of aminor child or children.

6. “Homeless” means:

a. An individual or Family who lacks a fixed, regular, and adequate nighttimeresidence, including, but not limited to, the following:

City & County — PSH Scope or Services Page 2 of 22 AG Form I 03F1 0(10/08)0612512019

SOS-City-OZ-PSFI-2019

CONTRACT NO. DHS-19-GOV-0086Auachrnent I

i. An individual who is exiting an institution where he or she residedfor 90 days or less and who resided in an Emergency Shelter orplace not meant for human habitation immediately before enteringthat institution;

ii. An individual or Family who will imminently lose their primarynighttime residence, provided that: (i) The primary nighttimeresidence will be lost within 14 days of the date of application forHomeless assistance; (N) No subsequent residence has beenidentified; and (Hi) The individual or Family lacks the resources orsupport networks, e.g. Family, friends, faith-based or other socialnetworks, needed to obtain other Permanent Housing.; or

Hi. Any individual or Family who: (I) is fleeing, or is attempting to flee,domestic violence, dating violence, sexual assault, stalking, orother dangerous or life-threatening conditions that relate toviolence against the individual or a Family member, including achild, that has either taken place within the individual’s or Family’sprimary nighttime residence or has made the individual or Familyafraid to return to their primary nighttime residence; (N) Has noother residence; and (Hi) Lacks the resources or support networks,e.g. Family, friends, faith-based or other social networks, needed toobtain other Permanent Housing.

b. An individual or Family who has a primary nighttime residence that is:

i. A supervised publicly or privately operated shelter designated toprovide temporary living arrangements (including, but not limitedto, congregate shelters, transitional housing, and hotels andmotels paid for by charitable organizations or by federal, state, orlocal government programs for low income individuals);

H. An institution that provides temporary residence for individualsintended to be institutionalized; or

iii. A public or private place not designed for or ordinarily used as asleeping accommodations for human beings (including, but notlimited to, a car, park, abandoned building, bus or train station,airport, or camping ground).

This term does not include any individual imprisoned or otherwise detained underan act of Congress or a state law.

7. “Homeless Management Information System” and “HMIS” are usedinterchangeably in this Contract and mean the information system designated bythe CoC to comply with the HMIS requirements prescribed by HUD.

8. “l-lomelessness” refers to the state or condition of being homelessriess.

9. “Household” means all the people who live or intend to live together as a unit. A

Ciiy&Couniy—PSK-- ScopeolServices Page 3 of22 AG Form 103F10(10108)0612512019

SOS-City-OZ-PSH-2019

CONTRACT NO. DHS-19-GOV-0086Attachment I

Household can include related Family members and other unrelated people, ifany, such as lodgers, foster children, wards, or employees who live together as aunit. A person lives alone in a unit, or a group of unrelated people sharing a unitsuch as partners or roomers, are also counted as a Household.

10. “Housing First’ means an approach to quickly and successfully connectindividuals and families experiencing Homelessness to Permanent Housingwithout preconditions and barriers to entry, such as sobriety, treatment or serviceparticipation requirements. This approach is guided by the belief that peopleneed basic necessities like food and a place to live before attending to anythingless critical, such as getting a job, budgeting property, or attending to substanceuse issues. Additionally, Housing First is based on the theory that Participantchoice is valuable in housing selection and supportive service participation, andthat exercising that choice is likely to make a Participant more successful inremaining housed and improving their life.

11. “Operating Costs” means non-personnel costs directly related to the operationand to the provision of contracted services.

12. “Outreach” means services related to reaching out to unsheltered Homelessindividuals and families to connect them with Emergency Shelter or TransitionalShelter, Permanent Housing, or other Social Services, and providing them withurgent, non-facility-based care.

13. “Participant’ means a person who receives Homeless services and is enrolledinto a Homeless program.

14. “Partners In Care” is the official name for Hawaii’s Continuum of Care on Oahu.This regional planning body coordinates housing and services funding forHomeless families and individuals residing in the City and County of Honolulu.

15. “Permanent Housing” means that there is no time limit on how long you canreside in the housing or receive the housing assistance. It is meant to be long-term. Permanent Housing includes but not limited to the following: rental orownership of a home with or without ongoing housing subsidy; staying withFamily or friends on a permanent tenure; long-term nursing home or care facility;and Permanent Supportive Housing projects for formerly Homeless persons.

16. “Permanent Supportive Housing” and “P5K” are used interchangeably in thisContract and means a service delivery model that combines low-barrieraffordable housing, health care, and supportive services to enable Homelesspersons to attain and maintain Permanent Housing. PSH programs typicallytarget Chronically Homeless persons or Homeless persons who experiencemultiple barriers to housing and are unable to maintain housing stability withoutsupportive services.

17. “Personnel Costs” mean costs incurred for operations and social servicespersonnel in the provision of contracted services and include salaries and wages,payroll taxes and fringe benefits.

18. “Program” refers to the program being implemented by the provide under thisCity & County — PSH Scope olServices Page 4 of22 AG Form 103F10 (10/08)06/2513019

SOS-Ciiy-OZ-PSH-2019

CONTRACT NO. DEIS-19-GOV-0086AlEachmenl I

contract.

19. “PRO VIDER” and “Contractor” are used interchangeably in this Contractand means the organization selected by the Department of Human Services toreceive funds and provide Program services under this contract.

20. “Social Services’ includes but are not limited to case management, job training,housing search assistance, housing placement, assistance in obtainingmainstream entitlement benefits, counseling and referrals, education, life skillstraining, child care, transportation or substance abuse counseling, which may beprovided directly by PROVIDER or by arrangement with other public or privateservice providers. Social Services shall be offered in the context of a harmreduction model of intervention.

21. “Transitional Shelter” means a facility designed to provide housing andsupportive services to Homeless persons to facilitate movement to independentliving within 24 months, or a longer period upon approval.

V. Target Population. The target population for the Ohana Zone — Honolulu PermanentSupportive Housing (PSH) Program are the documented unsheltered, most vulnerableChronically Homeless individuals living on the island of Oahu. The documentation ofchronicity will be accomplished to the extent possible, via the HMIS, while the “level ofcare” determination will be established using the Vulnerability Index ServicePrioritization Decision Assistance Tool (“Vl-SPDAT”).

VI. Program Services and Activities. PROVIDER shall provide no less than 60 units ofPSH at a minimum of three (3) separate locations, or scattered sites, on the island ofOahu, and shall ensure that its sub-contractors and the staff of its sub-contractorsprovide the following services:

1. Execute at least annually leases with each Participant that conform to locallandlord-tenant laws and federal fair housing requirements and provide eachParticipant with a copy of his/her current lease.

2. Comply with all state and local health, safety, building, and fire code laws,regulations and standards.

3. Ensure that participant retention in housing is contingent only on leasecompliance and only use the legal court eviction process to terminate participantsfrom Permanent Housing or negotiate mutual terms for the termination of a leasein order to prevent the Participant from having an eviction record.

4. Have, or ensure, policies and procedures in place that are adequate toreasonably protect the health and safety of all residents and staff.

5. Provide, or ensure provision of, security measures and equipment to protect thehealth and safety of all residents and staff.

6. Provide, or ensure provision of, maintenance services and equipment, to the

Cily & County — P511 - Scope olServices PageS of22 AG Form 103F10 (10/08)06/25/20 19

SOS-City.OZ-PSH-2019


extent necessary, and have policies and procedures in place to reasonablymaintain each unit and all common areas and to protect the health and safety ofall residents and staff.

7. Provide, directly or through its sub-contractors, case management services thatinclude, but are not limited to, the following:

a. PROVIDER shall complete an initial assessment of Participant’s serviceneeds within seven (7) days of Program entry, update the assessment atleast monthly, and ensure assessments are signed by the Participant,case manager, and supervisor and are dated. Assessments shall focuson Participant strengths and barriers to housing stability.

b. PROVIDER shall complete an initial housing plan for each Participantwithin seven (7) days of engagement in services, update the plan at leastmonthly, ensure plans are signed by the Participant, staff, and supervisorand are dated, and ensure that goals are person-centered, specific andmeasurable, and that plans indicate who is responsible for indicatedaction steps and when those action steps will occur. Plans must outlinesteps to secure Permanent Housing as quickly as possible and addressbarriers to accessing housing and achieving housing stability.

c. PROVIDER shall attempt to provide face-to-face case managementservices to all Participants at least two (2) times per month.

d. Case management services shall be flexible in response to Participantneeds and preferences and shall offer a variety of meeting times,locations and services.

e. Case notes shall document contact attempts, services provided, includingactivities aimed at assisting Participants to meet their housing plan goals,and efforts to help Participants establish links to other service providers,community resources, and support from friends and Family.

VII. Program Requirements. PROVIDER, including its staff and sub-contractors, shallensure that the Program is implemented as listed below and as required under thisContract:

Housing First Approach. PROVIDER shall utilize a Housing First approachthat not only aims for individuals to be independently housed, but for individualsto be supported through a successful transition to independence and self-sufficiency. The Housing First approach specific for the Program shall ensureParticipant choice and self-determination. In this model, individuals shall beoffered individualized, Participant-driven support.

2. Low Barriers to Entry and Ongoing Program Participation. PROVIDER shalloffer Homeless individuals immediate access to Outreach, Emergency Shelter,Transitional Shelter, and Permanent Housing as appropriate withoutunnecessary prerequisites, and shall provide ongoing access to services untilParticipants secure placement into Emergency Shelter, Transitional Shelter,

City & Cou’ny — P511 — Scope of Services Page 6 of 22 AG Form 03F10 (10/OK)06/25)2019

S0S.City-OZ-PSH-2019

CONTRACT NO. mIS- I 9-GoV-0086Attachment I

Permanent Housing or another housing or treatment option. This includes, but isnot limited to:

a. In consultation with the STATE, PROVIDER shall establish admissionpractices that are welcoming, low barrier and do not require abstinencefrom substances, completion of or compliance with treatment, orparticipation in services.

b. Not rejecting Participants on the basis of credit, rental history, criminalhistory, or other factors that might indicate a lack of “housing readiness.”PROVIDER shall consider criminal history and other factors on a case-by-case basis as necessary to ensure the safety of Participants and staff.

c. PROVIDER shall not establish arbitrary time limits on length of Programparticipation.

d. In consultation with the STATE, PROVIDER shall limit Program rules to abrief list of requirements that are necessary to ensure Participant andstaff health and safety, allowing Participants who may be under theinfluence of drugs and/or alcohol to remain in the Program as long astheir behavior does not present a health or safety threat, and notremoving Participants for non-participation in services.

e. PROVIDER shall assess Participant openness to and supportingbehavioral change to assist the Participant in meeting Program healthand safety expectations.

f. Participants shall be removed from a Program(s) only for as long asnecessary to ensure the health and safety of the Participants or staff andto connect the Participant to appropriate services and resources.

g. PROVIDER shall ensure that an independent appeals process is in placeand Participants are notified of the process verbally and in writing to allowParticipants to contest involuntary temporary removal or discharge fromthe Program.

3. Housing Access and Retention. PROVIDER, directly or through its subcontractors, shall provide services focused on helping Participants to accessPermanent Housing as rapidly as possible and preventing returns toHomelessness. This includes, but is not limited to, the following:

a, Focus on rapid development of a housing plan to assist with quicklylocating and accessing housing, obtaining necessary documents,accessing income and benefits, and connecting to community servicesand supports to promote stability and prevent returns to Homelessness.

b. Focus on securing Permanent Housing for Participants who have beenHomeless the longest and have the most intensive service needs.

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c. Providing services and supports to help Participants understand andcomply with lease obligations, reduce risks to stable tenancy, and preventeviction.

d. Continuing to serve and re-house individuals and families who have losttheir Permanent Housing and helping them to overcome barriers to stabletenancy.

4. Community Integration and Recovery. PROVIDER shall make efforts tointegrate the Program into the community and offer Participants ampleopportunity and support to form connections outside of the Program. Thisincludes, but is not limited to, the following and ensuring that:

a. Services are located in neighborhoods that are accessible to communityresources and services.

b. Services are designed to help Participants build supportive relationships,engage in personally meaningful activities, and regain or develop newroles in their families and communities.

c. Services are recovery-based and designed to help Participants to gaincontrol of their own lives, define their personal values, preferences,visions for the future, establish meaningful individual short and long-termgoals, and build hope.

d. Efforts are made to make programs look and feel similar to other types ofhousing in the community and to avoid distinguishing the PSH Programas a Program that serves people with special needs.

5. Participant Choice. PROVIDER, directly or through its sub-contractors, shallmake efforts to understand Participant preferences and priorities withoutjudgment and to assertively engage Participants in services that are non-coerciveto help Participants achieve their personal goals. This includes, but is not limitedto, the following:

a. Offering choices regarding type, frequency, timing, location, and intensityof services and, whenever possible, choice of neighborhoods,apartments, furniture, and decor.

b. Helping Participants to understand risks and reduce harm caused tothemselves and others by risky behavior.

c. Understanding the clinical and legal limits to choice and intervening asnecessary when Participants present a danger to self or others.

d. Providing meaningful opportunities for Participant input and involvementwhen designing Programs, planning activities, and determining policies.

6. Separation of Housing and Services. PROVIDER shall design the Program insuch a manner that the roles of operations and property management staff (e.g.maintenance, re[pairs, security, laundry, rent collection, and eviction) and

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supportive services statf are clearly defined and distinct. This includes, but is notlimited to, ensuring that:

a. Property management and support service functions are provided eitherby separate legal entities or by staff members whose roles do not overlap.

b. There are defined processes for communication and coordination acrossthe two functions to support stable tenancy.

c. Those processes are designed to protect Participant confidentiality andshare confidential information only as allowable and on a need to knowbasis only.

7. Assertive Engagement. PROVIDER shall ensure that Participants areassertively engaged in Program services. This includes, but is not limited to:

a. Scheduling a one-to-one meeting with assessment and navigation staffwithin three (3) business days of a Participant’s Program entry to begin tobuild rapport and offer support in Emergency Shelter, Transitional Shelter,Permanent Housing or other housing or treatment options.

b. Holding community meetings at project-based locations to support goodcommunication, empowered problem-solving, healthy and supportiverelationships, and Participant input into Program policies, procedures,service design, and activities.

c. Using assertive, low barrier, culturally competent and trauma informedengagement strategies that focus on building a respectful, trustingrelationship with Participants.

d. Creating an inviting and safe culture for Participants to overcomegrief/loss, build trust, disclose sensitive information, and identify reasonsto engage in services that are personally meaningful.

e. To the extent possible, provide Participants with supplies to supportengagement and assist in meeting basic needs, only if Participants do nothave these items. This includes food, clothing, and personal hygienesupplies.

8. Housing-Focused Case Management. PROVIDER shall ensure that Participantsreceive housing-focused case management. This includes, but is not limited to,the following:

a. Participants receive assistance in securing Permanent Housing as rapidlyas possible. This includes helping participants to obtain identification andother necessary documents, complete housing applications, accessfinancial assistance, identify and view apartments, and meet withlandlords/property managers.

b. Housing placements shall be prioritized for Participants who have beenHomeless the longest and who have the most intensive service needs.

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C. Participants receive assistance to achieve well-being and to prevent andmanage crises.

d. PROVIDER shall collect, maintain, and update records of availablemainstream and community resources for Program Participants. Thisincludes community resources that can reduce burdens on income,including employment opportunities, food banks, thrift stores, low-incomeutility programs, and others.

e. Participants shall receive assistance in increasing income and assets,including:

i. Screening and/or assistance in obtaining screening for publicbenefits eligibility.

H. Assistance to apply for benefits as indicated.

Hi. Assistance to connect to a SSI/SSDI Outreach, Access, andRecovery (SOAR) trained case manager as appropriate andavailable.

iv. Assistance to connect to services, such as financial literacy,banking, budgeting, tax preparation, and credit repair.

v. Assistance to connect to educational and vocational services andopportunities, including literacy, GED and computer skills classes,resume development, interview coaching, mentoring, job training.higher education, job placement, and supported employmentservices.

f. PROVIDER shall have clearly defined relationships with employment andincome support programs that they can connect program participants towhen appropriate.

g. Participants shall receive assistance in connecting to services to addresshealth, mental health, addiction, and legal needs. This includes, but isnot limited to:

i. Accessing health insurance and establishing linkages to primaryhealth, specialist, dental, mental health, and addiction services asneeded.

ii. Accessing emergency health care, mental health crisis, and/orpublic safety services immediately in situations that present animminent risk to Participant or staff health and/or safety.

Hi. Accessing legal services, including immigration, recordexpungement, addressing pending charges, and legal services forthose fleeing or attempting to flee domestic violence, dating

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violence, sexual assault, stalking, trafficking or other dangerous orlife-threatening conditions.

h. Participants shall receive assistance to use community resources (e.g.schools, libraries, houses of worship, grocery stores, parks, etc.).

Participants shall receive assistance to access the Internet throughlinkages to accessible internet resources located in the community.

j. PROVIDER shall provide services that are designed to help Participantsbuild motivation for change. This includes, but is not limited to:

i. Helping Participants to gain control of their own lives, define theirpersonal values, preferences, and visions for the future, andestablish meaningful individual short and long-term goals.

ii. Helping Participants to develop discrepancy between theirpersonal goals or values and their current behavior.

iD. Helping Participants to build confidence, self-efficacy, and hopethat the things they want out of life are attainable.

iv. Helping staff to develop services that are attractive andmeaningful to Participants and that they are responsive to theirneeds and preferences.

v. Helping staff to see that Participant reluctance to engage inservices means they need to adjust the intervention to make itappealing to the person being served.

k. Where Participants are young adults, PROVIDER shall focus on youngadult’s strengths and on helping them to build:

i. Competence: the core academic, cognitive, social, emotional andvocational competencies they need to succeed.

ii. Confidence: a sense of self-worth and efficacy.

Hi. Connections: a sense of belonging and positive bonds withsupportive peers and adults and social institutions.

iv. Character: respect for society and cultural rules and an innermoral compass.

v. Caring: a sense of sympathy and empathy for others.

vi. Contribution: active participation and leadership in efforts to bringabout change in social and civic life.

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I. PROVIDER shall engage Participants in offering their expertise andperspectives in the design and implementation of services, programs, andactivities available to them.

m. PROVIDER shall include an assessment of Participant strengths andneeds when completing any required assessments and housing plans.

n. PROVIDER shall collect, maintain, and update records of availablemainstream and community resources that include community resourcesfor young adults.

o. PROVIDER shall provide and/or assist Participants to connect to servicesto address Participants’ health, mental health, addiction, and legal needs.

p. PROVIDER shall provide and/or assist Participants to connect tochildcare services to support employment opportunities.

q. PROVIDER shall help Participants to identify individuals with whom theywish to maintain or establish a relationship, assess the appropriateness ofsuch involvement and facilitate an active connection between parentsother important persons when appropriate.

r. PROVIDER shall provide services aimed at strengthening Familycommunication and support and at promoting families’ acceptance ofLGBTQ+ Participants.

s. PROVIDER shall ensure that Participants are helped to understand theireducational rights and that they are connected to services to help themsucceed in school, as outlined below under “EducationalResponsibilities.”

9. Facilities. PROVIDER shall ensure that facilities for the Ohana ZoneProgram are safe and appropriate for Participants as described below:

a. PROVIDER shall provide a description of the facilities, including adescription of how the facilities meet ADA requirements, as applicable,and any special equipment that may be required for services (see ExhibitA).

b. PROVIDER shall implement facility usage in a non-discriminatorymanner, which includes, but is not limited to, sanitary facilities in item e.below.

c. PROVIDER shall comply with all STATE and local health, safety, building,and fire code laws, regulations and standards.

d. PROVIDER shall ensure that Participants have 24-hour access, 7 daysper week, to the Program.

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e. PROVIDER shall provide access to sufficient sanitary facilities that are inproper operating condition, provides reasonable expectation of privacy,and are adequate for personal cleanliness and the disposal of humanwaste.

I. PROVIDER shall provide at least one well-balanced and nutritious mealper day.

g. PROVIDER shall provide security services and shall have policies andprocedures in place that are adequate to reasonably protect the healthand safety of all Participants and staff.

h. PROVIDER shall provide maintenance services and equipment and shallhave policies and procedures in place to reasonably maintain each unitand all common areas and to protect the health and safety of allParticipants and staff.

10. Educational Responsibilities. PROVIDER shall be responsible for: ensuringthat Participants are helped to understand their educational rights establishedunder Subtitle Vll-B of the McKinney-Vento Homeless Assistance Act and mostrecently reauthorized by the Every Student Succeeds Act; ensuring that childrenand young adults are immediately enrolled in school, as required by federal andState law; and to ensure that they are connected to educational services to helpthem succeed in school. This includes, but is not limited to the following;

a. Ensuring that all housing, whether temporary or permanent is located inneighborhoods that are accessible to community resources and services,including schools, libraries, and other educational services.

b. PROVIDER shall ensure that:

i. Families participating in the Program are informed about theireducational rights and their eligibility for educational services atintake and as necessary thereafter.

ii. No matter where they live, how long they have lived there, or howlong they plan to stay, all children and youth participating in theProgram are enrolled in school immediately, even if they lack thepaperwork normally required. Students have the right to enroll inschool and attend classes while the school gathers neededdocuments. Enrollment shall occur immediately and within nomore than 48 hours of program entry. Children and youth who arenot required by State law to enroll in school, shall be encouragedbut not required to enroll.

ui. Advocacy is provided for Homeless children and youth asnecessary to ensure that they receive the services for which theyare eligible according to their needs and comparable to thoseprovided to other students, including assistance from the localschool district’s Homelessness education liaison, services fordisabled students, services for English language learners, gifted

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and talented services, career and technical education, summerlearning, online learning, and referrals to health, mental health,dental, and other services.

iv. Children and youth receive the help they need to succeed inschool, and get help from the local Homeless education liaison asnecessary.

v. Relationships are developed with colleges to access highereducation services specifically for Homeless youth.

vi. A staff person is designated to be responsible for:

1. Helping Participants to understand their educational rights.2. Ensuring that children and youth are enrolled in school and

connected to services.3. Ensuring that children and youth receive the transportation

services to which they are entitled (e.g. school districts mustprovide transportation to and from schools or origin, asnecessary).

vU. The designated stafi person is involved in the development ofParticipants’ service plans where there are extensive or significantunmet educational needs.

viii. No policies, procedures, or practices are inconsistent or interferewith the educational rights established under State or Federal laware adopted by the Program.

11. Facilities. PROVIDER shall, directly or through its sub-contractors, ensure thatfacilities for the PSH Program are safe and appropriate for Participants asdescribed below:

a. PROVIDER shall provide a description of the facilities, including adescription of how the facilities meet ADA requirements, as applicable,and any special equipment that may be required for services (see ExhibitA).

b. PROVIDER shall implement facility usage in a non-discriminatorymanner, which includes, but is not limited to, sanitary facilities in item e.below.

c. PROVIDER shall comply with all STATE and local health, safety, building,and fire code laws, regulations and standards.

d. PROVIDER shall ensure that Participants have 24-hour access, seven (7)days per week, to the KAHHF facility.

e. PROVIDER shall provide access to sanitary facilities that are in properoperating condition, may be used in private, and are adequate forpersonal cleanliness and the disposal of human waste.

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f. PROVIDER shall provide adequate cooking and food storage facilities.

g. PROVIDER shall provide security services and, shall have policies andprocedures in place to reasonably protect the health and safety of allParticipants and staff.

h. PROVIDER shall provide maintenance services and equipment and, shallhave policies and procedures in place to reasonably maintain each unitand all common areas and to protect the health and safety of Participantsand staff.

PROVIDER shall provide a mailing address tor use by Participants andmanage the prompt, orderly, and secure collection, storage anddistribution of Participant mail.

12. Supervision. PROVIDER shall ensure that its staff and the staff of any subcontractors are provided with appropriate supervision, including but not limited to:

PROVIDER shall provide direct service staff with at least one hour ofindividual supervision bi-weekly that helps them to develop low barrier,assertive engagement skills, build Participant motivation, conductthorough assessments, establish meaningful service plans, ensureParticipant and staff safety, and support self-care.

ii. PROVIDER shall have a case review process to help staff problem solvearound particular case management challenges and to informassessments, housing plans, and discharges.

PROVIDER shall maintain on-call supervisory coverage to managecritical incidents and other emergencies 24 hours per day, 7 days perweek.

VIII. Program Outcomes. PROVIDER shall track and report to the STATE on the targetedoutcomes below:

1. Occupancy/bed utilization will average 75% of the point in time capacity duringquarterly and one-year reporting periods.

2. 60% of all Participants are placed in a Permanent Housing unit within 30 days ofProgram entry.

3. 85% of all Participants remained in or exited to other Permanent Housing within aone-year reporting period.

4. 75% of all Participants were connected to other Social Services.

IX. Program Performance. PROVIDER agrees to work with the STATE on an on-goingbasis to identify: (a) targets for successful Program performance; (b) timetables forProgram performance and milestones; (c) strategies and data systems to measure

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progress towards performance targets; and (d) areas of non-compliance and strategiesto cure non-compliance and to improve Program services.

X. Administrative Requirements.

Due Process and Grievance Procedures. PROVIDER shall have a formal anddocumented process that provides due process to Participants, includinggrievance procedures. This shall at a minimum consist of the following:

a. Written notification containing a clear statement of the reasons fortermination or denial of assistance, the specific date for which assistancewill cease, the right of the Participant to have a review of the decision,instructions on how the Participant is to evoke this review, the right ot theParticipant to review the records, and the right to counsel at the soleexpense of the Participant during this review.

b. Upon request by the Participant, a review of the decision with theopportunity to present written or oral objections and to be represented bycounsel at his or her own expense before a person other than the personwho made or approved the termination or denial decision. TheParticipant shall have the opportunity to question witnesses and presentevidence.

c. Prompt service of the final decision in writing to the Participant aftercompletion of the review.

d. PROVIDER’s grievance procedures shall include language that afterexhausting PROVIDER’S grievance process, if the Participant is notsatisfied with PROVIDER’s final determination, the Participant mayrequest of the STATE a review of PROVIDER’s decision. The reviewLetter shall be mailed to:

Governor’s Coordinator on HomelessnessHawaii State Capitol415 South Beretania Street, Room 415Honolulu, HI 96813

2. Reporting. In addition to the Reporting Requirements in section 1.6 of theattached General Conditions, PROVIDER shall provide to the STATE requiredreports in a timely manner as follows:

a. Submit written quarterly activity reports to indicate the numbers servicedand services provided to Participants through the Program. The reportshall include:

i. Number of Participants referred for the PSH Program.

ii. Number of Participants who received PSH Program services.

iii. Number of Participants enrolled for the PSH Program who exitedthe Program, including the reasons for exit.

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iv. Number of Participants who transitioned from the PSH Programinto other Permanent Housing options.

b. Submit quarterly financial reports, which include the listing ofexpenditures actually incurred in the performance of this Contract foreach quarterly report period. The quarterly financial report shall includethe annual approved budget, budget for the reporting quarter, actualexpenditures for the reporting quarter, year-to-date expenditures, andvariance percentages. Personnel and Administrative Costs need to bebroken out and listed on the financial report. Variance percentage of ÷1-15% shall be explained in writing.

c. Submit a final Program financial report that reflects line item expendituresand the aggregate total of the line tern expenditures. The final financialreport shall include an approved budget, year-to-date expenditures, andvariance percentages. Budget and actual costs for personnel andAdministrative Costs shall be broken out and listed on the final financialreport. Variance percentages of +1- 15% shall be explained in writing.Explanation of the variance does not guarantee that the STATE willreimburse your agency for expenses beyond the approved budget.

d. Deadlines for the submission of activity and financial reports are:

Quarterly Submission Period of Report Report Due DatesQuarter 1 June 15, 2019 to August 31,2019 September 30, 2019Quarter 2 September 1, 2019 to November 30, 2019 December31, 2019Quarter 3 December 1 2019 to February 29, 2020 March31, 2020Quarter 4 March 1, 2020 to May31, 2020 June 30, 2020QuarterS June 1, 2020 to August31, 2020 September 30, 2020Quarter 6 September 1, 2020 to November 30, 2020 December 31, 2020Quarter 7 December 1, 2020 to February 28, 2021 March 31, 2021QuarterS March 1, 2021 to May 31,2021 June 30, 2021Quarter 9 June 1,2021 to August 31, 2021 September30, 2021Quarter 10 September 1, 2021 to November 30, 2021 December 31, 2021Quarter 11 December 1, 2021 to February 28, 2022 March 31, 2022Quarter 12 March 1, 2022 to June 14, 2022 July31, 2022

e. PROVIDER shall submit other information or records as may berequested from time to time by DHS in the form required by DHS,including but not limited to: demographic and Program activityinformation for use in a centralized database and/or any community-based planning efforts.

3. Contract Monitoring and Evaluation. The criteria by which the performance of theContract shall be monitored and evaluated are:

a. Performance/Outcome Measuresb. Input and Output Measuresc. Quality of Care/Quality of Servicesd. Financial Management

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e. Administrative Requirements

4. Coordination of services. PROVIDER shall implement and provide servicesconsistent with the OHS Ohana Nui approach, which creates partnerships amongmultiple agencies to offer Participants the necessary assistance to keep themsafe, healthy, sheltered, trained and employed. PROVIDER shall offer acomprehensive level of support for multi-generational families by:

a. Coordinating services and resources with other agencies in the community.

b. Coordinating and integrating Homeless programs with other mainstreamhealth, Social Services, and employment programs for which Homelesspopulations may be eligible, including Medicaid, Children’s Health InsuranceProgram (CHIP), Temporary Assistance to Needy Families (TANF) orTemporary Assistance to Other Needy Families (TAONF), SupplementalNutrition Assistance Program (SNAP), and services funding through themental health and substance abuse block grant, Workforce Innovation andOpportunity Act (WIOA) and the Welfare-to-Work grant program.

c. Participating in their local Continuum of Care (CoC) and complying with allCoC written standards, policies and procedures.

5. Personnel. In addition to section 3.5 Personnel Requirements of the GeneralConditions, PROVIDER shall establish minimum qualifications for eachrespective position, and shall ensure that all staff and volunteers of PROVIDERand any sub-contractors are fully qualified to perform the required services:

a, PROVIDER shall ensure all replacement staff are provided with anextensive orientation regarding PROVIDER’s written policies andprocedures and Program goals.

b. In the event of staff vacancies, PROVIDER shall establish a plan for itand any sub-contractors to address staff vacancies to ensure the deliveryof services under this Contract and to minimize the disruption of services.

c. PROVIDER shall ensure that employment and reference checks on allemployment applicants, including applicants recruited by its subcontractors.

d. PROVIDER and its sub-contractors shall develop policies that describethe grounds and circumstances for denial of employment or termination ofcurrent employees who have been found to have convictions or pendingcharges upon completion of any criminal history check or otherinvestigation.

e. PROVIDER shall ensure that adequate staffing and supportive servicesare provided on a day-to-day basis to meet the requirements of thisContract.

f. PROVIDER shall have a system in place to ensure compliance with:

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i. Affirmative action standards.H. Equal opportunity employment standards.

Ui. Limited English Proficiencyiv. State of Hawaii Civil Rights Awareness Training Curriculumv. Administrative Assurances

g. Direct service staff shall have at least one hour of individual supervisionbi-weekly to help them to develop low barrier, assertive engagementskills, build Participant motivation, conduct thorough assessments,establish meaningful service plans, ensure Participant and staff safety,and support self-care.

6. Training. PROVIDER and its sub-contractors shall submit a training plan for staffand contracted personnel who have direct contact with Participants. The trainingplan shall identify areas of training, how training will be structured, and howtraining will be provided.

a. Staff training shall include, but is not limited to the following:

i. Agency orientation, including but not limited to, policy andprocedures addressing:1. Service planning;2. Documentation requirements;3. Confidentiality and ethics; and4. Disaster preparedness

ii. Community resources available to support Homelessness,independence, and wellbeing, such as, but not limited to, housingresources, financial/employment resources, health/mental healthservices, legal/advocacy services, LGBTQ and Limited EnglishProficiency (LEP) services.

Ui. Homeless Management Information System (HMIS) training forend users and agency administration by the CoC HMISAdministrator. Training will include but is not limited to thefollowing:1. Data security and quality standards;2. Program entry and exits;3. On-going assessments (such as income and health insurance

status); and4. New system features

b. A training record shall be maintained and updated in the staff, volunteers,and contracted personnel file.

7. Compliance with Laws and DHS Rules. PROVIDER shall comply with all laws,ordinances, codes, rules and regulations of the federal,, state, and localgovernments, which in any way affect its operations and to adhere to instructionsprescribed by DHS for the effective administration of the Program.

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8. Confidentiality. PROVIDER and its sub-contractors shall have written poilciesand procedures regarding the management of Participant files and otherconfidential information that comply with the attached General Conditions,including but not limited to section 2.1 Confidentiality of Material and section 8.Confidentiality of Personal Information, the attached Special Conditions, andrelevant federal and state laws. PROVIDER and its sub-contractors shall complywith all federal, state, and local confidentiality laws.

a. PROVIDER shall also be required to comply with applicable provisionsand mandates of the Health Insurance Portability and Accountability Act(HIPAA) of 1996. The HIPAA regu’ates how individually identifiablehealth (medical and mental health) information is handled to ensureconfidentiality.

9. Emercjency Disaster Preparedness Policies and Procedures. PROVIDER shallestablish and maintain emergency disaster preparedness policies andprocedures and ensure that these policies and procedures are explained to allstaff and Participants.

10. Admission Criteria. PROVIDER shall establish and maintain a written admissioncriteria for the Program.

11. House Rules. PROVIDER shall ensure facilities maintain written house rules andpolicies on conduct for Participants and their guests.

12. Americans with Disabilities Act. PROVIDER shall comply with the Americanswith Disabilities Act (ADA), and shall ensure that Homeless persons withdisabilities are provided with reasonable access to services.

13. Administrative, Personnel and Operatinu Costs. Administrative Costs are eligiblefor reimbursements not to exceed 15% from Contract funds. Personnel Costsand Operating Costs related to the PSH Program are allowed reimbursement asdetermined by the Contract budget.

14. Data and Continuous Quality Improvement. PROVIDER shall ensure that datawill be collected to inform Program development and continuous qualityimprovement, including not limited to the following:

a. PROVIDER shall collect and enter all required Participant level data usingthe HMIS in accordance with all data standards, policies and proceduresas determined by the CoC.

b. PROVIDER shall complete data entry within 24 hours of activity orservice: e.g. Program entry, Program exit, assessment, provision ofassistance, etc.

c. PROVIDER shall track and report outcome data at least quarterly and usethat data to provide continuous quality improvement efforts aimed atstrengthening outcomes, such as decreasing length of Homelessness,rapidly securing alternative shelter and housing placements, andconnecting Participants to existing community resources.

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d. PROVIDER shall have and implement a comprehensive policy andprocedures for reporting, resolving, and documenting and reviewingcritical incidents. PROVIDER shall make adjustments to policies,procedures, facilities, and Program design as needed to improveParticipant well-being and promote health and safety for Participants andstaff.

e. PROVIDER shall seek input from people with lived experience ofHomelessriess and, when applicable, landlords. Such input can beobtained through means determined by PROVIDER, which may includeinterviews, focus groups, third party evaluations, surveys, and/orconsumer advisory boards, and will guide Program design andoperations.

f. PROVIDER shall have and implement a comprehensive policy andprocedures for surveying Program Participants, at least annually, toassess satisfaction with and obtain input regarding Program services,staffing and facilities. PROVIDER shall make adjustments to policies,procedures, facilities and program design as needed to improveParticipant satisfaction.

15. Quality Assurance and Evaluation Specifications. PROVIDER shall ensurequality assurance and appropriate evaluation of the Program through thefollowing:

a. Performance of PROVIDER will be monitored on an ongoing basis byDHS through file reviews, site inspections, and other methods.

b. Failure to comply with reporting requirements or to adequately addressmonitoring findings may result in the suspension or cancellation ofpayments or this Contract. Upon request, PROVIDER shall promptlymake Participant files available to the STATE for the purposes ofmonitoring.

c. The STATE and any of their authorized representatives, thecommittees and their staffs of the Legislature of the State of HawaN, andthe Legislative Auditor shall have the right of access to any book,document, paper, file, or other record of PROVIDER and its subcontractors that relate to the performance of services in order to conductan audit or other examination or to make excerpts and transcripts for thepurposes of monitoring and evaluating PROVIDER’s performance ofservices and PROVIDER’S Program, management, and fiscal practices.The right of access shall not be limited to the required retention period,but shall last as long as the records are retained.

d. PROVIDER shall be required to retain all records for at least three (3)years. except if any litigation, investigation, audit or other action isunderway for an addition of one year after completion of due process,litigation, investigation, audit, or other actions,

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16. Continuum of Care. PROVIDER shall ensure that its staff and any subcontractors actively participate in the Continuum of Care (CoC), a Homelesscommunity-based planning group, by attending the regularly scheduled CoCmeetings and serving on committees of the CoC. The CoC on Oahu is PartnersIn Care.

17. Homeless Management Information System. PROVIDER shall ensure thatParticipant information for Program and Outreach services shall be inputted intothe Homeless Management Information System (HMIS)I which is a statewidedatabase for Households receiving Homeless services.

18. Vl-SPDAT. PROVIDER shall ensure that Participants complete the VulnerabilityIndex Service Prioritization Decision Assistance Tool (Vl-SPDAT), which is acommon assessment tool adopted by the CoC.

City & County — P514 Scope or Services Page 22 of 22 AG Form I OJFIO (10108)06/2512019

SOS-City-OZ-PSH20t9


Attachment 2

TIME OF PERFORMANCE


Name of Program: Ohana Zone — Honolulu Permanent Supportive Housing



Time of Performance: June 15, 2019 to June 14. 2022Amount of Contract: $4,500,000.00

Time of Performance.

PROVIDER shall provide the required services under this Contract from June 15, 2019through and including June 14, 2022, subject to availability of funds or unless thisContract is sooner terminated.

PROVIDER shall not provide any service until this Contract is fully and properlyexecuted.

Any work performed prior to the receipt of a fully and properly executed Contract shallbe at PROVIDER’s own risk and expense. The STATE shall not be liable for any workcontract costs, loss of profits or damages whatsoever incurred by PROVIDER prior tothe receipt of a fully and executed Contract.

II. Oition to Extend.

Unless terminated, this Contract may be extended for an additional time period not toexceed six months. This option to extend the time of performance is a “no-costextension’ that will not include any additional funding exceeding the contract amount.

Ill. Termination of Contract.

This contract may be terminated earlier than June 14, 2022 by either party through awritten notice sent at least thirty (30) calendar days prior to the termination date thatincludes a brief statement of the reason for termination in accordance with the attachedGeneral Conditions and Special Conditions.

City & County - P511 Time of Performance Page I of I AG Eorm I O3FI 1 (10/08)0612512019

TOP-CiLy-OZ-PSl-1-2019

CONTRACT NO. DM5- I 9-GOV-0086

Ataehmenc 3

COMPENSATION AND PAYMENT SCHEDULE

Name of Provider: City and County of HonoluluAddress: 925 Dillirigham Boulevard Suite 200 Honolulu, HI 96817




Time of Performance: June 15, 2019 to June 14,2022Amount of Contract: $4,500,000.00

Sums to be Paid. In full consideration for the services satisfactorily received andperformed by PROVIDER under this Contract, the STATE agrees to pay PROVIDERthe total sum of money not to exceed FOUR MILLION FIVE HUNDRED THOUSANDand 00/100 Dollars ($4,500,000.00) for this Contract period from June 15, 2019through June 14, 2022. Such payments shall include PROVIDERs costs and expensesincurred in performing the services under this Contract that are in accordance with theSTATE’S Cost Principles. See Exhibit C.

II. Method of Payment. Payments shall be paid in accordance with and subject to thefollowing:

1. Budget. Compensation shall be paid in accordance with the “Budget’ attachedas Exhibit S.

This Contract constitutes approval for the expenditure of funds for specific itemsin the attached Budget. Any budget revision to the approved Budget requestedby PROVIDER shall be in writing and shall be subject to the STATE’s approval.If an amount of reported expenditure is subsequently determined by the STATEto be inappropriate, unallowable, or not made in accordance with the approvedrevised Budget, the STATE may require that an equivalent amount of monies berefunded by PROVIDER to the STATE.

2. Invoicing. Payment shall be made upon submission of an original invoice andone (1) copy. The invoice shall include PROVIDER’s official name andcompany letterhead; date of letter; contract number(s); total amount claimed;itemization or timesheet of claimed amounts; receipts if any; and a statementcertifying that the expenses were for services performed by PROVIDER inaccordance with this Contract. Invoices for payments shall be the all-inclusivecost, including the application of general excise tax.

Invoices shall be sent to:

Department of Human ServicesATTN: Governor’s Coordinator on Homelessness

City & County of Honolulu PSH Comp & Payment Page I of 3 AG Form 10319 2 (10/OS)06125/2019

CrS-City-OZ-PSH-2019

CONTRACT NC, DHS-t9-GOV-0086

Attachment 3

415 South Beretania Street, Room 415Honolulu, HI 96813

See Exhibit C for a sample invoice and forms as requested.

The STATE shall pay PROVIDER within thirty (30) calendar days after theSTATE’s receipt of a proper written request for payment that includes the invoiceand certification documenting the satisfactory performance of the services,unless a delay in payment is due to circumstances provided for in section 103-101 HAS, including but not limited to, a bona fide dispute between the STATEand PROVIDER concerning the services contracted for, or any circumstancesbeyond the control of the STATE.

3. Payment Schedule shall be based upon the following:

Upon execution of the Contract, an advanced payment will be paid toPROVIDER in the amount of THREE HUNDRED SEVENTY FIVE THOUSANDand NO/100 Dollars ($375,000.00) to pay for mutually agreed upon advancedprogram services. PROVIDER shall subsequently submit documentation, inaccordance with the Invoicing section above, specifying the amount accountingfor the initial start-up costs and expenses. Any remaining balance of theadvanced payment shall be applied to the next reimbursement payment(s) untilthe initial advanced payment is expended.

Subsequent payments shall be made to PROVIDER in monthly installments,upon submission by PROVIDER of written requests for payment in accordancewith the Invoicing section above.

4. Final Payment may be subject to:

a. Submission and acceptance of reports (including annual report) and othermaterials to be submitted by PROVIDER to the STATE: and

b. Resolution of all discrepancies in performance of services and completionof all other outstanding matters under this Contract.

An amount equal to PROVIDER’s administrative fee equal to five percent(5%) of the total Contract amount or the last monthly payment, whichever isgreater under this Contract, shall be withheld.

In accordance with the General Conditions section f6 Reporting Requirementand the Scope of Services section X. 2. Reporting, PROVIDER must submit afinal written report to the STATE, which includes the listing of expendituresactually incurred in the performance of this Contract during the final quarterperiod, by the indicated Report Due Date as stated in the Scope of Servicessection X. 2. Reporting. PROVIDER shall return any unexpended funds to theSTATE.

5. Sub-contractor Payment. Any money paid to PROVIDER shall be disbursed tosub-contractors within ten (10) days after receipt of the money in accordance

City & County of Honolulu— PSH Comp & Paynwnc Page 2 of 3 AG Form I03F12 (10/08)06/25/2019

CPS-Ciiy-OZ-PSH-20 19

CONTRACT NO. OHS-19-GOV-0086

AtLachment 3

with the terms of the sub-contract; provided that the sub-contractor has met allthe terms and conditions of the sub-contract and there are no bona fide disputes.

Ill. Fiscal Reporting.

1. Quarterly Reporting. In accordance with the Scope of Services section X. 2.Reporting, quarterly financial reports shall be reviewed by the STATE and shallbe subject to the STATE’s preliminary determination of appropriateness, andallowability of the reported expenditures. Each reported expenditure may besubject to subsequent verification and audit.

2. Unallowable Expenditures. If an amount of reported expenditure is subsequentlydetermined by the STATE to be inappropriate, unallowable, or not made inaccordance with the approved Budget, federal and state regulations, the STATEmay choose not to reimburse the expenditure and require PROVIDER toresubmit another invoice accounting for only the expenditures allowed. IfPROVIDER has already been paid, the STATE may require that an equivalentamount of monies be credited back in the next invoice submitted or refunded byPROVIDER to the STATE for the specified amount. If after payment of the lastinstallment, investigation and examination reveal additional expenditures that aredetermined by the STATE to be inappropriate and unallowable, the STATE mayrequire that an equivalent amount of monies be refunded to the STATEnotwithstanding the STATE’s preliminary determination of appropriateness andallowability.

IV. Availability of Funds. Payments to PROVIDER are subject to availability of funds andallotment by the State in accordance with funds awarded to the State of Hawaii,Department of Human Services. In the event that state funds are not appropriated andnot received by the STATE, the STATE shall not be liable for the payment of anyservices rendered by PROVIDER.

Cily & County of Honolulu PSH — Comp & Payment Page 3 cr3 AG Form !03F1 2(10/08)06125/20 19

CPS.City-OZ-PSH-2019

Contract No.: DHS-19-GOV-0086FACILITIES DESCRIPTION

Complete one Facilities Description, per homeless facility

Facility Name: Ohana Zone - PSI-IC Emergency C Transitional

Other: Rental Housing (Permanent Supportive Housing’)

Facility Address: To be determined.

A. Total Living Units:Complete the following table for the total number of units (Entire Site).

(1) - ‘J(2) f (3)Size of living I # of units Range of

Type of living unit unit available persons(square feet)

Sample One-bedroom ZE

202 4

____

1

Total Number of Living Units: 60 units

Living Units;Complete the following table for GCH funded units.

(2) (3)Size of living N of units

unit available(square feet)

500SL

-

‘Type of living unit” means dorm room, studio, one-bedroom, two-bedroom, common sleeping room, etc.Self-explanatory.“Number of units availabl& means the number of living units, which are being applied for under the StipendProgram.Range of persons” means the number of individuals who can reside in each living unit type/size.

S&f-explanatory. If program fee changed is by formula (based on income, for example), then indicate formula,any minimum or maximum fees charged, and any income limits enforced.

(5)Program

Feechargedfor unit

None

(1)

Type of living unit

Saajplc One-bedroom

Total Number of Living Units funded by OCH:

f (4) - (5)Range of Programpersons Fee

chargedforunit

T 2-4 None

2.3.

4.

60 units

Scope of Services, ExhibitsExhibit A - Sample Facilities Description

Page 1 of 2

Contract No.: OHS-I 9-GOV-0086

B. Minimum Services:Complete the following for each homeless facility.

Facility Name: Ohana Zone — PSHEl Emergency C Transitional

Other: Rental Housing (Permanent Supportive Housing)

1. Will the facility have 24-hour access to living units?DYES EJNQ

2. Will the facility provide on-site phone access for participants in the event of anemergency?YES ONO

3. Does this facilit have a mailing address available for participants?YES NO

4. Does this facility have locked storage space for participants?ØYES

5. Will the facility meet or exceed the minimum level of sanitation needs required inSection VII, 9, e. of the Scope of Services?YES CNO

6. Will his facility require health clearances, first aid, CPR and other emergencytraining for staff andlor volunteers?ZYES DNO

C. Plans to Upgrade:Describe any plans to upgrade facilities, equipment, or health and safety precautions atthe homeless facility.

Scope of Services, ExhibitsExhibit A - Sample Facilities Description

Page 2 of 2

BUDGET(Period June 15, 2019 to June 14, 2022)

ApplicantlProvider: City & County of Honolulu

RFPNo.: N/AContract No. (As Applicable): DHS-19-GOV-0085

BUDGET Budget Year 1 Year2 YearSCAT E G OR I ES Request (6/15/19-6/14/20) (6/15/20-6/14/21) (6/15/21-6/14/22)

(a) (b) (c) (d)

A. PERSONNEL COST1. Salaries 217.010 71.862 71,151 73,9972. Payroll Taxes & Assessments 23,090 7.646 7570 7.8743. Fringe Benets 81 .422 26,963 26,696 27.763

TOTAL PERSONNEL COST 321,522 106,471 105,417 109,634

B. OTHER CURRENT EXPENSES1. Airfare,_Inter-Island2. Airfare,_Out-al-State3. AudIt_Services4. Contractual Services - Administrative5. Contractual Services - Sutcontracts 4,178.476 1,178,478 1,500.000 1,500,0006. Insurance 07. Lease/Rental of Egun,ent 08. Lease/Rental_of Motor Vehicle9. Lease/Rental of Space 010. Mileage1 1. Postage, Freight & Delivery 012. Publication & Printing 013. Repair& Maintenance 014. Staff Training 015. SubstancelPer Diem16. Supplies 017. Telecommunication 018. Transportation 019. Utilities 020. Program Activities21. Recurring Costs22.23.

TOTAL OTHER CURRENT EXPENSES 4,178.478 1.178,478 1,500,000 1,500,000C. EQUIPMENT PURCHASES 0

0. MOTOR VEHICLE PURCHASES 0

TOTAL (A+B+C+D) 4,500,000 1,284,949 1,605,417 1,609,634Budget Preped By;

SOURCES OF FUNDING Rebecca .1. 1. Soon 768-5863

(a) Budget Request 4,500,000 Phone

(b)

(c) ..Ig lure of Authonze del Date

Rebecca J. ‘I. Soon. Deouty Director. oca of Ca,,muNfy SeMce,(ci) Name and TtUe (Please type or prfr,t)

ror Slate Agency Use Only

TOTAL REVENUE 4,500,0005:gnattra of ReAeer 0.4.

Exhibit B - BudgetForm SPO-H-205 (EffectivelOIOlI98)

BUDGET JUSTIFICATION

PERSONNEL - SALARIES AND WAGES

Applicant/Provider: City and County of I-iononolu.RFP No.;

____________________________________

Period; June 15, 2019 to June 14, 2020 Date Prepared: June 15, 2019Contract No. DF1S-19-GOV-0086(As Applicable):

FULL TiME ANNUAL SALARY V. OF TIME TOTAL SALARYPOSITION POSITION TITLE EQUIVALENT TO INCLUDING BUDGETED BUDGETED TO BUDGETED

NO. ORGANIZATION SALARY INCREASE THE CONTRACT TO ThE CONTRACTA B AxS

SR24 Project Manager - Planner V FTE 10 max 5,811 69732.00 100.00% 58,110.00

SRIO Senior Clerk Typist FTE 10 max 2,722 32,664.00 20.00% — 5,444.00

SR2B Supervisor - Planner VI FTE 10 mo x 6268 75432.00 10.00% 6268.00

SR2O Accountant Ill FTE 10 mo x 4,079 — 40,790.00 5.00% 2,040.00

- -4----- -_____

-—-- --------— ——

TOTAL.. 37186ao0

JUSTIFICATIONICOMMENTS:Salaries per Bargaining Unit 13 Salary Schedule Effective Date: 07(0112018

Form SPO.H-206A (Effective 10101198)

BUDGET JUSTIFICATIONPERSONNEL - SALARIES AND WAGES

ApplicantlProvider: City and County of Hononolu,REP No.:Contract No. DHS-19-GOV-D086

Peñod: June 15, 2019 to June 14,2020 Date Prepared: June 15, 2019

(As Applicable):

I FULL TIME ANNUAL SALARY V. OF TIME TOTAL SALARYPOSITION POSITION TITLE EQUIVALENT TO INCLUDING BUDGETED BUDGETED TO BUDGETED

NO. ORGANIZATION SAlARY INCREASE THE CONTRACT TO THE CONTRACTA B Axe

SR24 Project Manager - Planner V FTE 12 mo x 6,043 72521.28 75.00% 54,391.00

SRI 0 Senior Clerk Typist FTE 12 max 2831 33,970.56 20.00% 6,794.00

SR26 Supervisor - Planner VI ETE 12 mo x 6519 78.449,28 10.00% 7,845.00

SR2O Accountant Ill FTE 12 max 3,535 42,421.60 5.00% 2,121.00

-..-.—..—

—- —....t—-----. ------

..-

TOTAL I $7115100,JUSTIFICATIONICQMMENTS:Salaries per Bargaining Unit 13 Salary Schedule Effective Date: 07i0112018 plus 4% annuni step-up

—--

Form SPO-H-206A(Effeetlve 10101198)


:tn

Applicant/Provider: City and County of Horcnolu.RFP No.:

___________________

Contract No. DHS-19-GOV-0056(As Applicable):

Period: June 15, 2019 to June 14, 2020 Date Prepared: June 15, 2019

FULL TIME ANNUAL SALARY ¼ OF TIME TOTAL SALARYPOSITION POSITION liThE EQUIVALENT TO INCLUDING BUDGETED BUDGETED TO BUDGETED

NO. ORGANIZATION SAlARY INCREASE ThE CONTRACT TO THE CONTRACTA B AxB

SR24 Project Manager - Planner V FTE 12 mc x 6,043 721j.28 7500% j4J?91.00

SRIO Senior Clerk Typist FTE 12 mc x 2,831 33,970.56 20.00% 6,794.00

SR26 Supervisor - Planner VI FTE 12 mc x 6,519 78,449.28 10.00% 7,845.00

SR20 Accountant III FTE 12 mc x 3,535 42,421.60 5.00% 2,121.00

TOTAL: ‘:i:::::.. :“z::z, $71,151.00

JUSTIFlCATlQNICOMMENTSSalaries per Bargaining Unit 13 Salary Schedule Effective Date: 07)01 /2018 plus 4% annual step-up

Form SPQ-H-206A (Effective 10701 798)


FULL TIME ANNUAL SALARY % OF TiME TOTAL SALARYPOSITION POSITION TITLE EQUIVALENT TO INCLUDING BUDGETED OUDGETED TO BUDGETED

NO. ORGANIZATION SALARY INCREASE THE CONTRACT TO THE CONTRACTA B AxB

SR24 Project Manager - Planner V FTE12 mc x 6.285 75,421.84 75.00% 56566.00

SRIO Senior Clerk Typist FTE l2rnox2,944 ?a%8 20.00% 7066.00

SR26 Super’isor - Planner VI ETE 12 mo x 6,780 81,586.96 10.00% 8,159.00SR2O Accountant Ill FTE 12 mc x 3,677 — 44118.88 5.00% 2,206.00

L—____ -

TOTAI L.. $7399700JUSTIFICAT1ON/COMMENTS:Salaries per Bsrgaininq Unit 13 Salary Schedule Effective Date: 07/01/2018 plus 4% annual step-up

Applicant/Provider:RFP No.:Contract No.(As Applicable):

City and County of Hononolu,

OHS-is-GOV-0086Period: June 15, 2Q19 to June 14.2020 Date Prepared: June 15, 2019

Farm SPO-H-206A (EffectIve 11)101198)

BUDGET JUSTIFICATIONPERSONNEL: PAYROLL TAXES, ASSESSMENTS, AND FRINGE BENEFITS

Applicant)Provider: City and County of Honolulu.

RFP No.;

_____________________

Period: June 15, 2019 to June 14, 2020 Date Prepared: June 15, 2019

Contract No.: DHS-19-GOV-0086(As Applicable)

BASIS OF

ASSESSMENTS OR OFTYPE FRINGE BENEFITS SALARY TOTAL

PAYROLL TAXES&ASSESSMENTS:. ., ,,.....

Social Security As required by law 7.65% $ 5,497.00

Unemployment Insurance (Federal) As required by law 0.00%

Unemployment Insurance (State) As required by law 004% $ 29.00

Worker’s Compensation As required by law 2.95% $ 2,120.00

Temporary Disability Insurance As required bylaw 00Q%

SUBTOTAL: - :$ 7,646.00

FRINGE BENEFITS

Health Insurance As required by law 18.52% $ 13,309.00

Retirement As required by law 19.00% $ 13,654.00

As required_by law

suBToTAL

JUSTIFICATION/COMMENTS:

Effective July 1, 2018, the City’s employee fringe benefit rate at 48.16%. Rate is subject to change.

Form SPO-H-206B lEffective 10101(93)


AppicanVProvidec: City and County of Honolulu.

RFP No.:

_______________________

Period: June 15,2019 to June 14. 2020 Date Prepared: June 15, 2019Contraci No.: DHS-1 9-GOV-0086(As Applicable)

J BASISOF J %ASSESSMENTS OR OF

TYPE FRINGE BENEFITS SALARY TOTAL

PAYROLLTAXES&ASSESSMENTS ‘ rJiSocial Security As requred by law 7.65% $ 5,443.00Unemployment Insurance (Federal) As requred by law 0 00%

Unemployment Insurance (State) As required by law 0.04% $ 28.00Worker’s Compensation As racaed by law 2.95% 2,099.00Temporary Disability Insurance As rAred by law 0.00%

r(t”.:c ‘mlSUBTOTAL: 1’t :*

- :‘ $ 7,570.00FRINGE BENEFITS -, r 4

Health Insurance AsrequLredby;aw 18.52% $ 13,177.00Retirement As regwred by law 19.00% $ 13,519.00

Asre ufreabi, law... ..,.* ..

SUBTOTAL:. ..

. . $ 26,696.00TOTAL: ‘ . . . .

,. $ 34,266.00JUSTIFICATIONICOMMENTS:

Effective July 1, 2018. the employee fringe benefit rate at 48.16%

Form SPO-H-206B (Effective 10101198)


Applicant/Provider:

RFP No:

Cofit ract No.:(As Applicable)

City and County of Honolulu,

DHS-1 9-GOV-0086

Period: June 15, 2019 to June 14, 2020 Date Prepared: June 15. 2019

BASISOF 1ASSESSMENTS OR OFTYPE FRINGE BENEFITS SALARY TOTAL

PAYROLL TAXES & ASSESSMENTS IIJtItk& .a -a ... -.

Social Security As required by law 7.65% $ 5,661.00

Unemployment Insurance (Federal) As requ:red by law 0.00%

Unemployment Insurance (State) As required by 0.04% $ 30.00

Workers Compensation As reqtnred by :aw 2.95% $ 2,183.00

Temporary Disability Insurance As reed by law 0.00%

SUBTOTAL I $ 787400FRINGE BENEFITS

Health Insurance ASedla . 1852 $ 13,704.00Retirement As requ:red by k 19.00% $ 14,059.00

As requ:reri by ;aw

SUBTOTAL $ 2776300TOTAL: $ 35,637.00

JUSTIFICATION/COMMENTS:

Effective July 1, 2018, the employee fringe benefit rate at 48.16%

Form SPO-H.206B (Effective 10/01/98)

AppltcantlPro’sider: City and County of 1-lonolulu,

BUDGET JUSTIFICATIONCONTRACTUAL SERVICES - SUBCONTRACTS

RFP No.: Period: June 15, 2019 to June 14, 2022 Date Prepared: June 15, 2019Contract No.MS MppICaOIeJ

DHS-1 9-GOV-0086

SERVICESNAME OF BUSINESS OR INDIVIDUAL TOTAL BUDGETED PROVIDED JUSTIFICATION/COMMENTS

Direct management and operation of theThe sub-contractor will be required

. . to have prior experience related to. . permanent supportive housing voucherNonprofit organization(s) selected by the delivery of homeless servicesthe PROVIDER $ 4,178,478 ‘ and especially case management

:

TOTAL $4,178 478 ,..,. — J ZLt P2 LL it — .Form ariJ-n.tvcr ttnaviive IWUJWC)

(Copy form onto Agency letterhead)PAYMENT REQUEST FORM

OHANA ZONE — PSH PROGRAMForm No. GCH OZ-PSH-01, (06/201 9)

(‘Dated

(Director’s Name)Director, Department of Human ServicesOffice of the Governor’s Coordinator on Homelessness415 South Beretania Street, Room 415Honolulu, Hawaii 96813

Attention: Governor’s Coordinator on Homelessness (GCH)

To Whom It May Concern:

RE: OHANA ZONE - LIFT MOBILE NAVIGATION CENTERCONTRACT NO.:

____

PAYMENT REQUEST NO.:

________________

I hereby request payment under the above stated contract for the Ohana Zone — PermanentSupportive Housing (PSH) Program in the amount of

dollars ($ ). This amount represents the payment for the period covering

from to of my agency’s

total allocation for the Ohana Zone — PSH Program for the contract period

from to

I certify that the services for which the payment is being made will be and are being

satisfactorily rendered and that all contractual obligations under the contract identified above are

being duly fulfilled.

Authorized RepresentativePrinted Name:Title:

Attach Supporting Documentation

Scope of Services, ExhibitsExhibit C, Sample Invoice and Forms

Page lof2Form No. OZ-LMNC-01, 05/2019

Suborantees Invoice And ExDenditure Report

1.Recipierit Organization: 2. Funding Source:

State of Hawaii) Department of Human Services3. Address: 4. Contract Number: 5. Contract Amount:

6. Purpose

A. Initial Advance C. ReimbursementB Periodic_Advance_D.________Final_Invoice

7. Contract Period: 8. Period Covered By This Report:

9, Cash Transaction Data:

a. Total Cash Received To Date $0.001. Total Received $0.00 $0.002. Total InvoIced $0.00

b. Total Disbursmentc. Cash On Hand/Deposit $0.00d. Estimated Disbursement From:e Amount of Cash Requested Herewith $0.00

Contract Expenditures: Expenditures: Percent of10. Categories: Budget Current Year to Date Budget

Period ExpendedPersonnel Costs $0.00 $0.00 $0.00 #Dl ViolService Fees $0.00 0.00%Supplies $0.00 $0.00 $0.00 #01 VIOl‘rogxam.supporl, development, activities, volunteers $0.00 0.00%Advertising & Marketing $0.00 0.00%Board Meeting $0.00 0.00°ADues Subscriptions $0.00 0.00%Employee Training $0.00 $0.00 $0.00 #01 ViOlEmployee Tra el $0.00 $0.00 $0.00 #D1V/OlEquipment Purchase $0.00 $0.00 $0.00 #01 VIa!Equipment Repair and Maintenance $0.00 0.00%Insurance $0.00 $0.00 $0.00 #01 VIOlMiscellaneous $0.00 0.00%Custodial Services $0.00 0.00%Lease Rent $0.00 $0.00 $0.00 #DIVIO!Utilities $0.00 $0.00 $0.00 #01 VIOlPostage $0.00 0.00%Punting & Publications $0.00 $0.00 $0.00 #01 VIOlProfessional Fees $0.00 $0.00 0.00%

TOTAL $ . $0.00 $0.00 #DIV/0!

11. Comments:

12. Certification: Certify to the best of my knowledge and betel that this report is true in all respects and that all

Signature Date ReportedDateReviewed By:,,,,,,, (signature. Program Specielisi)

Reviewed By: (Signature ‘Program Specialist) Date_____________________Page 2 of 2

LANGUAGE ACCESS REPORTING TOOLLEP Services by LanguageContact Person

Canionese

CtaScese

Hawsian

Uokarto

Jaçsanese

Korean

Kosraean

LEP Hearing Impaired

Mandann

Marabatese

Porluquess

Samoan

Spah

Tagaioq

Thai

lIebflt.

Period Covered (QuarterlFv)

5

5:rr Leirt E&P din. (5)

f I 1II : !I.

a---;4’’V7 ;4 -*

$

$

$

$

$

$

$

____

S .. -

$

$ *

$

$

Scope of Services, ExhibitsExhibit D - Language Reportffig Tool V4, 8/2008

DepartmentiAgency

lype of Senices Prolded to LEPCustomers

(I)

Language

Phone No,4

fCCz0UauJ0.Ui-I

0*

Type of Oral Lergo.geSavlceLitII.dL

Si

5,ina

C

C

C2

.2 53

—F

IdH

a

a

a

aS

Ue4.

t

rossl: [9 0 0 0 0 0 - 0of Total: I #04V111 sDIV1O’ #0W/a’ iDIWU #DIV/O? 0.0% 00%,. 1000%

—

II

It - --

- ---4

H- ------

$ -

#DIviot igw IDIVM #OMVI

Den—

___ ____ ____

S

_Ett

-r

Page I


Exhibit E

SPECIAL CONDITIONS





Time of Performance: June 15, 2019 to June 14,2022Amount of Contract: $4,500,000.00

The General Conditions are attached to and made a part of this Contract. In the event of aconflict between the General Conditions and the Special Conditions, the Special Conditionsshall control.

Reguired Services. Paragraph 1. Scope of Services on page 4 of the Contract Form(AG Form 103F6) is amended by the following:

1. Delete the reference to “Request for Proposals” (“REP”); and

2. The last sentence, which reads, “In the event that there is a conflict among theterms of this Contract, and either the Proposal or the RFP, or both, then theterms of this Contract shall control,” is replaced with the following sentence:

“In the event that there is a conflict among the terms of this Contract andPROVIDER’s Proposal, then the terms of this Contract shall control.”

II. Annual Performance Audits. In addition to the requirements under this Contract,PROVIDER shall submit a financial audit and report upon request by the STATE. Theaudit shall be conducted by a certified public accounting firm and shall containinformation specific to funds received under this Contract. The audit shall includerecommendations to address any problems found.

III. Language Assistance. PROVIDER shall offer language assistance to individuals withlimited English proficiency at no cost to the STATE and the individual or family. Inaddition, PROVIDER:

1. Shall document the offer of language assistance and whether the individualdeclined or accepted the language assistance;

2. Is prohibited from requiring individuals to bring their own interpreters with them toassessments, training sessions, or other appointments;

3. Shall be responsible for the cost of language assistance, which may be claimedas an expense in accordance with PROVIDER’s budget;

City & County PSH — Special Conditions Page 1 of 7 AG Form I 03F14 (10/OS)06125/20 9

SC.City.OZ.PSH-201 9

CONTRACT NO. DHS-19-Gov-0056

Exhibit E

4. Shall submit to the STATE, the Office of Language Access (OLA)’s LanguageAccess Reporting Tool. See Exhibit 0. PROVIDER shall submit the report to theSTATE not later than thirty (30) calendar days following the end of each six-month period of the State fiscal year. Semi-annual periods shall be based on thefiscal year (July-June); and

5. Shall ensure that any sub-contractors comply with these language assistanceprovisions as applicable.

IV. Insurance and Indemnity Requirements. Section 1.4 Insurance Requirements on page2 of the attached General Conditions is amended by deleting the language in thissection and replacing with the following:

‘PROVIDER shall indemnify the STATE, DHS, and its elected and appointed officials,and employees. PROVIDER shall also be self-insured, or obtain, maintain, and keep inforce throughout the period of this Contract, $2,000,000.00 comprehensive coverage forbodily injury and property damage and the following insurance:

Automobile Liability:

Bodily Injury $1,000,000.00 (per person)Property Damage $1,000,000.00 (per occurrence)Per Accident $1,000,000.00orCombined Single Limit $2,000,000.00 (each accident)

If applicable, any and all service providers shall maintain Professional Liability (Errorsand Omissions) coverage with a minimum limit of $1,000,000.00 per claim and$2000000.00 aggregate.

1. Failure of PROVIDER to provide and keep in force such insurance shall be amaterial default under this Contract. The STATE shall be entitled to exercise anyand all of the remedies provided in this Contract and by law for default byPROVIDER.

2. The provision of such insurance shall not be construed to limit PROVIDER’sliability here under or to fulfill the indemnification provisions and requirements ofthis Contract, Notwithstanding such insurance, PROVIDER shall be obligated forthe full and total amount of damage, injury, or loss caused by negligence orneglect connected with this Contract.

3. PROVIDER shall notify the STATE in writing of any cancellation or change ininsurance provisions thirty calendar days prior to the effective date of suchcancellation or change.

4. OHS is a self insured State agency. PROVIDER’s insurance shall be primary.Any insurance maintained by the State of Hawaii shall apply in excess of, andshall not contribute with insurance provided by PROVIDER.”

V. PROVIDER’s ResDonsibilities. Paragraph 3.4.4 PROVIDER’s Responsibilities of theaftached General Conditions is amended by deleting paragraph four, which reads ‘The

City & County PSH — Special Conditions Page 2 of 7 AG Form 103F14 (10/OR)06/25/2019

SC-City-OZ-PSH-2019


Exhibit E

PROVIDER shall obtain a general excise tax license from the Department of Taxation,State of Hawaii, in accordance with section 237-9, HAS, and shall comply with allrequirements thereof. The PROVIDER shall obtain a tax clearance certificate from theDirector of Taxation, State of I-f awai’i, and the Internal Revenue Service showing alldelinquent taxes, if any, levied or accrued under state law against the PROVIDER havebeen paid and submit the same to the STATE prior to commencing any performanceunder this Contract. The PROVIDER shall also be solely responsible for meeting allrequirements necessary to obtain the tax clearance certificate required for final paymentunder section 103-53, HAS, and these General Conditions.”

VI. Tax Clearance. Paragraph 4.1.3 Tax Clearance of the attached General Conditions isdeleted.

VII. Subcontracts. In addition to the requirements under section 3.2 Subcontracts andAssignments of the attached General Conditions, PROVIDER must obtain the STATE’sprior written consent of all sub-contracts within thirty (30) calendar days after theeffective date of this Contract, in order to ensure timely implementation of services.PROVIDER must obtain the STATE’s prior written approval of any amendments,modifications, and/or changes to the existing sub-contracts. PROVIDER shall submitrevised Form SPO-H 206F identifying the names of the selected sub-contractors andamounts awarded to each selected sub-contractor.

PROVIDER shall ensure that each sub-contractor meets all of the followingrequirements:

1. Must be a non-profit organization registered and compliant with the Departmentof Commerce and Consumer Affairs;

2. Currently compliant with the charitable solicitation laws of chapter 4678, HawaiiRevised Statutes;

3. Currently tax-exempt with the Internal Revenue Services;

4. Organized and operating in the state of Hawaii; and

5. Has been in operation providing homeless services in Hawaii for minimally oneyear.

PROVIDER shall ensure that the sub-contractors provide the services in a mannerconsistent with the minimum standards established in this Contract.

All sub-contracts shall be in writing and shall specify the activities and responsibilitiesdelegated to the sub-contractor. The contracts must include provisions for revokingdelegation or imposing other sanctions if the sub-contractor’s performance isinadequate. The STATE reserves the right to inspect all sub-contracts and provideragreements at any time during the contract period. PROVIDER’s sub-contractors shallsubmit to PROVIDER a tax clearance certificate from the Director of Department ofTaxation, State of Hawafl, showing that all delinquent taxes, if any, levied or accruedunder state law against the sub-contractor have been paid.

City & county PSI-I Special Conditions Page 3 of 7 AG Form 103F1 4(10/08)U6I252DI9

SC-City-OZ-PSI-{-2O19

CONTRACT NO. DHS- I 9-GOV-0086

Exhibit E

In compliance with section 3.4.4 of the General Conditions, PROVIDER shall beresponsible for the accuracy, completeness, and adequacy of PROVIDER’s and anysub-contractors’ performance under this Contract. PROVIDER warrants that the“Required Services” set form in Attachment 1, Scope of Services, shall be provided in aproper and satisfactory manner as determined by the STATE, regardless of whetherPROVIDER sub-contracted any and all of the “Required Services” set forth inAttachment 1 of this Contract. No sub-contract or agreement that a PROVIDER entersinto with respect to the performance under this Contract shall in any way waive ofPROVIDER’s duties, obligations, and/or liabilities under this Contract.

PROVIDER agrees that PROVIDER shall do either of the following:

1. Include all sub-contractors as insured under all insurance set forth in the Contractand the General Conditions; or

2. Cause each sub-contractor hired by PROVIDER to purchase and maintaininsurance of the types specified herein, which includes adding the State ofHawaii as an additional insured on the sub-contractors’ policies. PROVIDERshall obtain and maintain evidence of each sub-contractor’s insurance and ifrequested by the STATE, PROVIDER shall furnish copies of certificates ofinsurance evidencing coverage for each sub-contractor.

PROVIDER shall provide a statement or document from each sub-contractor, signed byan individual authorized to legally bind the sub-contractor that states:

1. The general scope of work to be performed by the sub-contractor; and

2. The sub-contractor’s willingness to perform for the indicated.

PROVIDER shall notify the STATE at least fifteen (15) days prior to adding or deletingsub-contracts or making any change to any sub-contract, which may materially affectPROVIDER’s ability to fulfill the terms of this Contract.

All sub-contracts shall require that the sub-contractor agree to comply with theconfidentiality and records retention requirements imposed by this Contract to the extentsub-contractors render services or perform functions under this Contract.

PROVIDER shall ensure that during the duration of this Contract, the sub-contractorsare in compliance with the laws as identified in the attached General Conditions, and allfederal, state, and county laws, ordinances, codes, rules, and regulations, as the samemay be amended from time to time, that in any way affect PROVIDER’s and subcontractors’ performance of this Contract or sub-contract.

PROVIDER shall ensure that the sub-contractors are in compliance with the provisionscontained in the attached General Conditions to the extent sub-contractors renderservices or perform functions under this Contract.

VIII. Cost Principles. PROVIDER shall comply with the chapter 103F, HRS, Cost Principlesfor Purchases of Health and Human Services identified in SPOH-201 (Revised 9/11),which is aftached as Exhibit G.

Cily & Counry PSH Special Condilions Page 4 of 7 AG Form 103F14 (10/08)06/25/20 19

SC-City- OZ-PSH-20 19

CONTRACT NO. DHS-l9-GOV-OO86

Exhibit E

IX. Liability. In addition to the General Conditions section 3.4.4. PROVIDER’sResponsibilities, PROVIDER shall be liable for claims arising from the negligence, actsor omissions, or willful misconduct of PROVIDER or PROVIDER’s employees, agentsor sub-contractors.

X. Additional Material and Documentation. Upon request horn the STATE, PROVIDERshall submit any additional materials and documentation reasonably required by theSTATE for evaluating PROVIDER’s and any sub-contractors’ performance.

XI. Right to Inspection and Audit of Books and Records of PROVIDER. The STATE may,at reasonable times and places, audit the books and records of PROVIDER,prospective contractor, sub-contractor, or prospective sub-contractor, which are relatedto the cost or pricing data, and a state contract, including sub-contracts.

The STATE shall have the general right to inspect work in progress to determinewhether, in the STATE’s opinion, the services are being performed by PROVIDER andits sub-contractors in compliance with this Contract.

XII. Campaign Contributions. PROVIDER is hereby notified of the applicability of section11-355, FIRS, which states that campaign contributions are prohibited from specifiedstate or county government contractors during the terms of their contracts if thecontractors are paid with funds appropriated by a legislative body.

XIII. Wages and Labor Law Compliance. PROVIDER certifies that PROVIDER and its subcontractors are in compliance with section 103-55, HAS, Wages, hours and workingconditions of employees of contractors performing services.

XIV. Compliance with all Applicable State Business and Employment Laws. PROVIDERshall comply with all laws governing entities doing business in the State.

Each of PROVIDER’s sub-contractors shall obtain a certificate of good standing issuedby the Department of Commerce and Consumer Affairs, State of Hawaii that is currentwithin six months of the date of issuance.

Each of PROVIDER’s sub-contractors shall obtain a certificate of compliance issued bythe Department of Labor and Industrial Relations, State of Hawaii that is current withinsix months of the date of issuance.

In accordance with General Conditions section 3.4.4 PROVIDER’s Responsibilities,each of PROVIDER’s sub-contractors shall obtain a tax clearance certificate from theDirector of Taxation, State of Hawaü, and the Internal Revenue Service, U.S.Department of the Treasury, showing that all delinquent taxes, if any, levied or accruedunder state law and the Internal Revenue Code of 1986, as amended, against suchsub-contractor have been paid and submit the same to the STATE prior to commencingany performance under this Contract. PROVIDER shall also be solely responsible formeeting all requirements necessary to obtain the tax clearance certified required forfinal payment under section 103-53, FIRS.

In lieu of the above certificates from the Department of Taxation, Labor and IndustrialRelations, and Commerce and Consumer Affairs, each of PROVIDER’s sub-contractorsmay submit proof of compliance through Hawaii Compliance Express (HCE).

City & Couny PSI] — Special Conditions Page 5cr 7 AG Form I 03F14 (10/08)06/25/20 19

SCCity-OZ-PSH-2Ol9

CONTRACT NO. DHS-I9.GOV-0086

Exhibit E

Upon request by the STATE, PROVIDER shall provide sub-contractors’ proof ofcompliance of such laws.

XV. Conflicts of Interest. PROVIDER represents that neither PROVIDER, not anyemployee, agent, or sub-contractor of PROVIDER, presently has any interest, andpromises that no such interest, direct or indirect, shall be acquired, that would or mightconflict in any manner or degree with PROVIDER’s performance under this Contract.

XVI. Equipment. PROVIDER shall ensure that any equipment it or its sub-contractorsacquired under this Contract that is directly related or used in the delivery of participantservices is managed in accordance with STATE laws and procedures, unless otherwiseinstructed by the STATE. Following the termination of this Contract for whateverreason, all equipment shall be included in the final report to the STATE.

XVII. Disputes. It is the State’s policy to try to resolve all controversies by mutual agreement,if possible, without litigation. Such steps may include, but are not limited to, the STATEnotifying PROVIDER in writing of a perceived failure to perform under this Contract anda time period to cure.

The following shall apply:

1, All controversies between the STATE and PROVIDER, which are not resolved bymutual agreement, shall be decided by the procurement officer in writing, withinninety (90) days after a written request by PROVIDER br a final decisionconcerning the controversy; provided that if the procurement officer does notissue a written decision within ninety (90) days after written request for a finaldecision, or within such longer period as may be agreed upon by the parties,then PROVIDER may proceed as if an adverse decision has been received.

2. The procurement officer shall immediately furnish a copy of the decision toPROVIDER, by certified mail, return receipt requested, or by any other methodthat provides evidence of receipt.

3. Any such decision shall be final and conclusive, unless fraudulent, or unlessPROVIDER brings an action seeking judicial review of the decision in a circuitcourt of the State of Hawaii within six months from the date of the receipt of thedecision.

4. PROVIDER shall comply with any decision of the procurement officer andproceed diligently with performance of this Contract pending final resolution by acircuit court of the State of Hawaii of any controversy arising under, or by virtueof this Contract, except where there has been a material breach of this Contractby the STATE; provided that in any event PROVIDER shall proceed diligentlywith the performance of this Contract where the procurement officer has made awritten determination that continuation of work under this Contract 1 essential tothe public health and safety.

XVIII. Public Records. Notwithstanding the above, PROVIDER acknowledges that thisContract and/or other documents may constitute a public record(s) under state law. Tothe extent consistent with state and federal law, each party will maintain the

Chy & County PSH Special Conditions Page 6 of 7 AG Form lO3Fl4 (10/08)06125/20 19

SC-Cicy-OZ-PSH-20 19

CONTRACT NO, DHS- 19-GOV-0086

Exhibit F

confidentiality of all confidential information. If a request is made to view PROVIDER’sconfidential information, the STATE will notify PROVIDER of the request and of thedate that any such records will be released to the requester unless PROVIDER obtainsa court order enjoining that disclosure or other appropriate remedy. If PROVIDER failsto obtain the court order enjoining disclosure prior to the deadline for responding to therequest for documents, the STATE may release the identified requested information onthe date specified without penalty or liability. The STATE reserves the right to alsoseek reimbursement for all costs and expenses incurred by the STATE in PROVIDER’srefusal to produce PROVIDER’s documents.

XIX. Attorney’s Fees. In addition to costs of litigation provided for under General Conditionsection 5, in the event the STATE should prevail in any legal action arising out of theperformance or non-performance of this Contract, PROVIDER shall pay, in addition toany damages, all expenses of such action including reasonable attorney’s fees andcosts. The term “legal action” shall be deemed to include administrative proceedings ofall kinds, as well as aU actions at law or equity.

XX. Notice of Litigation. PROVIDER shall promptly notify the STATE in the eventPROVIDER becomes aware of any actual litigation in which it is a party in a case, whichinvolves services provided under this Contract. PROVIDER shall promptly, after beingserved with a summons, complaint, or other pleading which has been filed in anyfederal or state court or administrative agency, deliver copies of such document(s) tothe STATE. The term “litigation” includes but is not limited to an assignment for thebenefit of creditors and filings in bankruptcy, reorganization or foreclosure.

XXI. Authority. Each party has full power and authority to enter into and perform thisContract, and the person signing this Contract on behalf of each party certifies that suchperson has been properly authorized and empowered to enter into this Contract. Eachparty further acknowledges that it has read this Contract, understands it, and agrees tobe bound by it.

XXII. Limited Purpose Monies. The STATE and PROVIDER acknowledge that, underPROVIDER’s Fiscal Year operating budget ordinances, the STATE funds ascontemplated by this Contract are ‘limited purpose monies” whose receipt andexpenditures by the City are subject to approval by the Honolulu City Council (Council).The STATE agrees that PROVIDER shall have no obligation to receive or expend theSTATE funds that are required to perform under this Contract until PROVIDER obtainsCouncil approval, which is automatically given after 15 days of notice unless aCouncilmember tiles a written objection. Notice was filed with the Council on June 26,2019. Council approval is expected by July 11, 2019.

City & County PSH — Special Conditions Page 7 of? AG Form I 03194 (10/08)06/2512019

SC-City-OZ-PSH-20 19

GENERAL CONDITIONS FOR HEALTH & HUMAN SERVICES CONTRACTS

Representations and Conditions Precedent

1.1 Contract Subject to the Availability of State and Federal Funds.

1.1.1 State Funds. This Contract is, at all times, subject to the appropriation and allotment ofstate funds, and may be terminated without liability to either the PROVIDER or theSTATE in the event that state funds are not appropriated or available.

1.1.2 Federal Funds. To the extent that this Contract is funded partly or wholly by federalfunds, this Contract is subject to the availability of such federal funds. The portion of thisContract that is to be funded federally shall be deemed severable, and such federallyfunded portion may be terminated without liability to either the PROVIDER or theSTATE in the event that federal funds are not available. In any case, this Contract shallnot be construed to obligate the STATE to expend state funds to cover any shortfallcreated by the unavailability of anticipated federal funds

1.2 Representations of the PROVIDER. As a necessary condition to the formation of this Contract,the PROVIDER makes the representations contained in this paragraph, and the STATE reliesupon such representations as a material inducement to entering into this Contract.

1.2.1 Compliance with Laws. As of the date of this Contract, the PROViDER complies withall federal, state, and county laws, ordinances, codes, rules, and regulations, as the samemay be amended from time to time, that in any way affect the PROVIDER’s performanceof this Contract.

1.2.2 Licensing and Accreditation. As of the date of this Contract, the PROVIDER holds alllicenses and accreditations required under applicable federal, state, and county laws,ordinances, codes, rules, and regulations to provide the Required Services under thisContract.

1-3 Compliance with Laws. The PROVIDER shall comply with all federal, state, and county laws,ordinances, codes, rules, and regulations, as the same may be amended from time to time, that inany way affect the PROVIDER’s performance of this Contract, including but not limited to thelaws specifically enumerated in this paragraph:

1.3.1 Smoking Policy. The PROVIDER shall implement and maintain a written smokingpolicy as required by Chapter 328K, Hawaii Revised Statutes (HRS), or its successorprovision.

1.3.2 Drug Free Workplace. The PROVIDER shall implement and maintain a drug freeworkplace as required by the Drug Free Workplace Act of 1988.

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CONTRACT NO.DHS-19-GOV-0086

1.3.3 Persons with Disabilities. The PROVIDER shall implement and maintain all practices,policies, and procedures required by federal, state, or county law, including but notlimited to the Americans with Disabilities Act (42 U.s.c. §12)01, et çg.), and theRehabilitation Act (29 U.S.C.70I, et seq.).

1.3.4 Nondiscrimination. No person performing work under this Contract, including anysubcontractor, employee, or agent of the PROVIDER, shall engage in any discriminationthat is prohibited by any applicable federal, state, or county law.

1.4 Insurance Requirements. The PROVIDER shall obtain from a company authorized by law toissue such insurance in the State of Hawai’i commercial general liabiLity insurance (liabilityinsurance”) in an amount of at least TWO MILLION AND NO/I 00 DOLLARS ($2000000.00)coverage for bodily injury and property damage resulting from the PROVIDER’s performanceunder this Contract. The PROVIDER shall maintain in effect this liability insurance until theSTATE certifies that the PROVIDER’s work under the Contract has been completedsatisfactorily.

The liability insurance shall be primary and shall cover the insured for all work to be performedunder the Contract, including changes, and all work performed incidental thereto or directly orindirectly connected therewith.

A certificate of the liability insurance shall be given to the STATE by the PROVIDER. Thecertificate shall provide that the STATE and its officers and employees are Additional Insureds.The certificate shall provide that the coverages being certified will not be cancelled or materiallychanged without giving the STATE at least 30 days prior written notice by registered mail.

Should the “liability insurance” coverages be cancelled before the PROVIDER’s work under theContract is certified by the STATE to have been completed satisfactorily, the PROVIDER shallimmediately procure replacement insurance that complies in all respects with the requirements ofthis section.

Nothing in the insurance requirements of this Contract shall be construed as limiting the extentof PROVIDER’s responsibility for payment of damages resulting from its operations under thisContract, including the PROVIDER’s separate and independent duty to defend, indemnii’, andhold the STATE and its officers and employees harmless pursuant to other provisions of thisContract.

1.5 Notice to Clients. Provided that the term of this Contract is at least one year in duration, within180 days after the effective date of this Contract, the PROVIDER shall create written proceduresfor the orderly termination of services to any clients receiving the Required Services under thisContract, and for the transition to services supplied by another provider upon termination of thisContract, regardless of the circumstances of such termination. These procedures shall include, at

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CONTRACT NO. DH519430V0086

the minimum, timely notice to such clients of the termination of this Contract, and appropriatecounseling.

1.6 Reporting Requirements. The PROVIDER shall submit a Final Project Report to the STATEcontaining the information specified in this Contract if applicable, or otherwise satisfactory to theSTATE, documenting the PROVIDER’s overall efforts toward meeting the requirements of thisContract, and listing expenditures actually incurred in the performance of this Contract. ThePROVIDER shall return any unexpended funds to the STATE.

1.7 Conflicts of Interest. In addition to the Certification provided in the Standards of ConductDeclaration to this Contract, the PROVIDER represents that neither the PROVIDER nor anyemployee or agent of the PROVIDER, presently has any interest, and promises that no suchinterest, direct or indirect, shall be acquired, that would or might conflict in any manner ordegree with the PROVIDER’s performance under this Contract.

2. Documents and Files

2.1 Confidentiality of Material.

2.1.1 Proprietary or Confidential Information. All material given to or made available to thePROVIDER by virtue of this Contract that is identified as proprietary or confidentialinformation shall be safeguarded by the PROVIDER and shall not be disclosed to anyindividual or organization without the prior written approval of the STATE.

2.1.2 Uniform Information Practices Act. All infornrntion, data, or other material provided bythe PROVIDER to the STATE shall be subject to the Uniform Information Practices Act,chapter 92F, I-IRS, and any other applicable law concerning information practices orconfidentiality.

2.2 Ownership Rights and Copyright. The STATE shall have complete ownership of all material.both finished and unfinished that is developed, prepared, assembled, or conceived by thePROVIDER pursuant to this Contract, and all such material shall be considered ‘works made forhire.” All such material shall be delivered to the STATE upon expiration or termination of thisContract. The STATE, in its sole discretion, shall have the exclusive right to copyright anyproduct, concept, or material developed, prepared, assembled, or conceived by the PROVIDERpursuant to this Contract.

2.3 Records Retention. The PROVIDER and any subcontractors shall maintain the books andrecords that relate to the Contract, and any cost or pricing data for three (3) years from the dateof final payment under the Contract. In the event that any litigation, claim, investigation, audit,or other action involving the records retained under this provision arises, then such records shallbe retained for three (3) years from the date of final payment, or the date of the resolution of theaction, whichever occurs later. During the period that records are retained under this section, the

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CONTRACT NO DHS-19-OOV0086

PROVIDER and any subcontractors shall allow the STATE free and unrestricted access to suchrecords.

3. Relatidnshin between Parties

3.1 Coordination of Services by the STATE. The STATE shall coordinate the services to beprovided by the PROVIDER in order to complete the performance required in the Contract. ThePROVIDER shall maintain communications with the STATE at all stages of the PROVIDER’swork, and submit to the STATE for resolution any questions which may arise as to theperformance of this Contract.

3.2 Subcontracts and Assignments. The PROVIDER may assign or subcontract any of thePROVIDER’s duties, obligations, or interests under this Contract, but only if 0) the PROVIDERobtains the prior written consent of the STATE and (ii) the PROVIDER’s assignee orsubcontractor submits to the STATE a tax clearance certificate from the Director of Taxation,State of l-lawai’i, and the Internal Revenue Service showing that all delinquent taxes, if any,levied or accrued under state law against the PROVIDER’s assignee or subcontractor have beenpaid. Additionally, no assignment by the PROVIDER of the PROVIDER’s right tocompensation under this Contract shall be effective unless and until the assignment is approvedby the Comptroller of the State of Hawai’i, as provided in section 40-58, MRS.

3.3 Change of Name. When the PROVIDER asks to change the name in which it holds thisContract, the STATE, shall, upon receipt ofa document acceptable or satisfactory to the STATEindicating such change of name such as an amendment to the PROVIDER’s articles ofincorporation, enter into an amendment to this Contract with the PROVIDER to effect thechange of name. Such amendment to this Contract changing the PROVIDER’s name shallspecifically indicate that no other terms and conditions of this Contract are thereby changed,unless the change of name amendment is incorporated with a modification or amendment to theContract under paragraph 4.1 of these General Conditions.

3.4 Independent Contractor Status and Responsibilities, Including Tax Responsibilities.

3.4.1 Independent Contractor. In the performance of services required under this Contract, thePROVIDER is an “independent contractor,” with the authority and responsibility tocontrol and direct the performance and details of the work and services required underthis Contract; however, the STATE shall have a general right to inspect work in progressto determine whether, in the STATE’s opinion, the services are being performed by thePROVIDER in compliance with this Contract.

3.4.2 Contracts with Other Individuals and Entities. Unless otherwise provided by specialcondition, the STATE shall be free to contract with other individuals and entities toprovide services similar to those performed by the Provider under this Contract, and the

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AGFonn IOJF(lnO8)General Condlllons

c0NTRAa NO. 59-00’-0086

PROVIDER shall be free to contract to provide services to other individuals or entitieswhile under contract with the STATE.

3.4.3 PROVIDER’s Employees and Agents. The PROVIDER and the PROVIDER’semployees and agents are not by reason of this Contract, agents or employees of the Statefor any purpose. The PROVIDER and the PROVIDER’s employees and agents shall notbe entitled to claim or receive from the STATE any vacation, sick leave, retirement,workers’ compensation, unemployment insurance, or other benefits provided to stateemployees. Unless specifically authorized in writing by the STATE, the PROVIDER andthe PROVIDER’s employees and agents are not authorized to speak on behalf and nostatement or admission made by the PROVIDER or the PROVIDER’s employees oragents shall be attributed to the STATE, unless specifically adopted by the STATE inwriting.

3.4.4 PROVIDER’s Responsibilities. The PROVIDER shall be responsible for the accuracy,completeness, and adequacy ofthe PROVIDER’s performance under this Contract.

Furthermore, the PROVIDER intentionally, voluntarily, and knowingly assumes the soleand entire liability to the PROVIDER’s employees and agents, and to any individual nota party to this Contract, for all loss, damage, or injury caused by the PROVIDER, or thePROVIDER’s employees or agents in the course of their employment.

The PROVIDER shall be responsible for payment of all applicable federal, state, andcounty taxes and fees which may become due and owing by the PROVIDER by reason ofthis Contract, including but not limited to (i) income taxes, (ii) employment related fees,assessments, and taxes, and (iii) general excise taxes. The PROVIDER also isresponsible for obtaining all licenses, permits, and certificates that may be required inorder to perform this Contract.

The PROVIDER shall obtain a general excise tax license from the Department ofTaxation, State of Hawai’i, in accordance with section 237-9, FIRS, and shall complywith all requirements thereof. The PROVIDER shall obtain a tax clearance certificatefrom the Director of Taxation, State of Hawaii, and the Internal Revenue Serviceshowing that all delinquent taxes, if any, levied or accrued under state law against thePROVIDER have been paid and submit the same to the STATE prior tocommencing anyperformance under this Contract. The PROVIDER shall also be solely responsible formeeting all requirements necessary to obtain the tax clearance certificate required forfinal payment under section 103-53, HRS, and these Genera! Conditions.

The PROVIDER is responsible for securing all employee-related insurance coverage forthe PROVIDER and the PROVIDER’s employees and agents that is or may be requiredby law, and for payment of all premiums, costs, and other liabilities associated withsecuring the insurance coverage.

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CONTRACT NO. DHS.I9-GOVOOR6

3.5 Personnel Requirements.

3.5.1 Personnel. The PROVIDER shall secure, at the PROVIDER’S own expense, all personnelrequired to perform this Contract, unless otherwise provided in this Contract.

3.5.2 Requirements. The PROVIDER shall ensure that die PROVIDER’s employees or agentsare experienced and fully qualified to engage in the activities and perform the servicesrequired under this Contract, and that all applicable licensing and operating requirementsimposed or required under federal, state, or county law, and all applicable accreditationand other standards of quality generally accepted in the field of the activities of suchemployees and agents are complied with and satisfied.

4. Modification and Termination of Contract

4.1 Modification of Contract.

4.1.1 In Writing. Any modification, alteration, amendment, change, or extension of any term,provision, or condition of this Contract permitted by this Contract shall be made bywritten amendment to this Contract, signed by the PROVIDER and the STATE.

4.1.2 No Oral Modification. No oral modification, alteration, amendment, change, orextension of any term, provision or condition of this Contract shall be permitted.

4.1.3 Tax Clearance. The STATE may, at its discretion, require the PROVIDER to submit tothe STATE, prior to the STATE’s approval of any modification, alteration, amendment.change, or extension of any term, provision, or condition of this Contract, a tax clearancefrom the Director of Taxation, State of Hawaii, and the Internal Revenue Serviceshowing that all delinquent taxes, if any, levied or accrued under state and federal lawagainst the PROVIDER have been paid.

4.2 Termination in General. This Contract may be terminated in whole or in part because of areduction of funds available to pay the PROVIDER, or when, in its sole discretion, the STATEdetermines (1) that there has been a change in the conditions upon which the need for theRequired Services was based, or (ii) that the PROVIDER has failed to provide the RequiredServices adequately or satisfactorily, or (iii) that other good cause for the whole or partialtennination of this Contract exists. Termination under this section shall be made by a writtennotice sent to the PROVIDER ten (10) working days prior to the termination date that includes abrief statement of the reason for the termination. If the Contract is terminated under thisparagraph, the PROVIDER shall cooperate with the STATE to effect an orderly transition ofservices to clients.

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CONTRACT NO DHS-19•GOV-OO86

4.3 Termination for Necessity or Convenience. If the STATE determines, in its sole discretion, thatit is necessary or convenient, this Contract may be terminated in whole or in part at the option ofthe STATE upon ten (10) working days’ written notice to the PROVIDER. If the STATE electsto terminate under this paragraph, the PROVIDER shall be entitled to reasonable payment asdetermined by the STATE for satisfactory services rendered under this Contract up to the time oftermination, Ifthe STATE elects to terminate under this section, the PROVIDER shall cooperatewith the STATE to effect an orderly transition of services to clients.

4.4 Termination by PROVIDER. The PROVIDER may withdraw from this Contract after obtainingthe written consent of the STATE. The STATE, upon the PROVIDER’s withdrawal, shalldetermine whether payment is due to the PROVIDER, and the amount that is due, If the STATEconsents to a termination under this paragraph, the PROVIDER shall cooperate with the STATEto effect an orderly transition olservices to clients.

4.5 STATE’s Right of Offset. The STATE may offset against any monies or other obligations thatSTATE owes to the PROVIDER under this Contract, any amounts owed to the State of Hawaiiby the PROVIDER under this Contract, or any other contract, or pursuant to any law or otherobligation owed to the State of Hawaii by the PROVIDER, including but not limited to thepayment of any taxes or levies of any kind or nature. The STATE shall notify the PROVIDERin writing of any exercise of its right of offset and the nature and amount of such offset. Forpurposes of this paragraph, amounts owed to the State of Hawaii shall not include debts orobligations which have been liquidated by contract with the PROVIDER, and that are covered byan installment payment or other settlement plan approved by the State of Hawai’i, provided,however, that the PROVIDER shall be entitled to such exclusion only to the extent that thePROVIDER is current, and in compliance with, and not delinquent on, any payments,obligations, or duties owed to the State ofHawai’i under such payment or other settlement plan.

5. Indemnification

5.1 Indemnification and Defense. The PROVIDER shall defend, indemnify, and hold harmless theState of Hawaii, the contracting agency, and their officers, employees, and agents from andagainst any and all liability, loss, damage, cost, expense, including all attorneys’ fees, claims,suits, and demands arising out of or in connection with the acts or omissions of the PROVIDERor the PROVIDER’s employees, officers, agents, or subcontractors under this Contract. Theprovisions of this paragraph shall remain in full force and effect notwithstanding the expirationor early termination of this Contract.

5.2 Cost of Litigation. In case the STATE shall, without any fault on its part, be made a party to anylitigation commenced by or against the PROVIDER in connection with this Contract, thePROVIDER shall pay any cost and expense incurred by or imposed on the STATE, includingattorneys’ fees.

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AG Form 1o3F(IaOS)General Conditions

CONTRACT NO. DHS)9G0VOO86

6. Publicity

6.1 Acknowledgment of State Support. The PROVIDER shall, in all news releases, publicstatements, announcements, broadcasts, posters, programs, computer postings, and other printed,published, or electronically disseminated materials relating to the PROVIDER’s performanceunder this Contract, acknowledge the support by the State of Hawai’i and the purchasing agency.

6.2 PROVIDER’s Publicirv Not Related to Contract. The PROVIDER shall not refer to the STATE,or any office, agency, or officer thereof, or any state employee, or to the services or goods, orboth provided under this Contract, in any of the PROVIDER’s publicity not related to thePROVIDER’s performance under this Contract, including but not limited to commercialadvertisements, recruiting materials, and solicitations for charitable donations.

7. Miscellaneous Provisions

7.] Nondiscrimination. No person performing work under this Contract, including anysubcontractor, employee, or agent of the PROVIDER, shall engage in any discrimination that isprohibited by any applicable federal, state, or county law.

7.2 Paragraph Headings. The paragraph headings appearing in this Contract have been inserted forthe purpose of convenience and ready reference. They shall not be used to define, limit, orextend the scope or intent of the sections to which they pertain.

7.3 Antitrust Claims. The STATE and the PROVIDER recognize that in actual economic practice,overcharges resulting from antitrust violations are in fact usually borne by the purchaser.Therefore, the PROVIDER hereby assigns to the STATE any and all claims for overcharges as togoods and materials purchased in connection with this Contract, except as to overcharges whichresult from violations commencing after the price is established under this Contract and whichare not passed on to the STATE under an escalation clause.

7.4 Governing Law. The validity of this Contract and any of its terms or provisions, as well as therights and duties of the parties to this Contract, shall be governed by the laws of the State ofHawaPi. Any action at law or in equity to enforce or interpret the provisions of this ContractshalL be brought in a state court of competent jurisdiction in Honolulu, Hawai’i.

7.5 Conflict between General Conditions and Procurement Rules. In the event of a conflict betweenthe General Conditions and the Procurement Rules or a Procurement Directive, the ProcurementRules or any Procurement Directive in effect on the date this Contract became effective shallcontrol and are hereby incorporated by reference.

7.6 Entire Contract. This Contract sets forth all of the contracts, conditions, understandings,promises, warranties, and representations between the STATE and the PROVIDER relative tothis Contract. This Contract supersedes all prior agreements, conditions, understandings,

Page 8 of II

AG Form 103F(loOX)Generat Conditions

CONTRACT NO. DNS-l9GOV-O0R6

promises, warranties, and representations, which shall have no further force or effect, There areno contracts, conditions, understandings, promises, warranties, or representations, oral or written.express or implied, between the STATE and the PROVIDER other than as set forth or as referredto herein.

7.7 Severabiliti.. In the event that any provision of this Contract is declared invalid or unenforceableby a court, such invalidity or unenforceability shall not affect the validity or enforceability of theremaining terms of this Contract.

7.8 Waiver. The failure of the STATE to insist upon the strict compliance with any term, provision,or condition of this Contract shall not constitute or be deemed to constitute a waiver orrelinquishment of the STATE’s right to enforce the same in accordance with this Contract. Thefact that the STATE specifically refers to one provision of the Procurement Rules or one sectionof the Hawai’i Revised Statutes, and does not include other provisions or statutory sections inthis Contract shall not constitute a waiver or relinquishment of the STATE’s rights or thePROVIDER’s obligations under the Procurement Rules or statutes.

7.9 Execution in Counterparts. This Contract may be executed in several counterparts, each ofwhich shall be regarded as an original and all of which shall constitute one instrument.

8. Confidentiality of Personal Information

8.1 Definitions.

8.1.1 Personal Information. “Personal Information” means an individual’s first name or firstinitial and last name in combination with any one or more of the following data elements, wheneither name or data elements are not encrypted:

I) Social Security number;

2) Driver’s license number or Hawaii identification card number; or

3) Account number, credit or debit card number, access code, or password thatwould permit access to an individual’s financial information.

Personal information does not include publicly available information that is lawfullymade available to the general public from federal, state, or local government records.

8.1.2 Technological Safeeuards. “Technological safeguards” means the technology and thepolicy and procedures for use of the technology to protect and control access to personalinformation.

Page 9 of I

AGFonu 103Fc1008)General Cop.diEions

CONTRACT NO. DHStg-GOV0086

8.2 Confidentiality of Material.

8.2.1 Safeguarding of Material. All material given to or made available to the PROVIDER bythe STATE by virtue of this Contract which is identified as personal information, shall besafeguarded by the PROVIDER and shall not be disclosed without the prior written approval ofthe STATE.

8.2.2 Retention. Use, or Disclosure. PROVIDER agrees not to retain, use, or disclose personalinformation for any purpose other than as permitted or required by this Contract.

8.2.3 lrnnlementation of Technological Safeguards. PROVIDER agrees to implementappropriate “technological safeguards1’ that are acceptable to the STATE to reduce the risk ofunauthorized access to personal information.

8.2.4 Reporting of Security Breaches. PROVIDER shall report to the STATE in a prompt andcomplete manner any security breaches involving personal information.

8.2.5 Mitigation of Harmful Effect. PROVIDER agrees to mitigate, to the extent practicable,any harmful effect that is known to PROVIDER because ofa use or disclosure of personalinformation by PROVIDER in violation of the requirements of this paragraph.

8.2.6 Log of Disclosures. PROVIDER shall complete and retain a log of all disclosures madeof personal information received from the STATE, or personal information created or receivedby PROVIDER on behalfof the STATE.

8.3 Security Awareness Training and Confidentiality Agreements.

8.3.1 Certification of Comoleted Training. PROVIDER certifies that all of its employees whowill have access to the personal information have completed training on security awarenesstopics related to protecting persona) information.

8.3.2 Certification of Confidentiality Agreements. PROVIDER certifies that confidentialityagreements have been signed by all of its employees who will have access to the personalinformation acknowledging that:

I) The personal information collected, used, or maintained by the PROV IDER willbe treated as confidential;

2) Access to the personal information will be allowed only as necessary to performthe Contract; and

3) Use of the personal information will be restricted to uses consistent with theservices subject to this Contract.

Page 10 of I I

AGFonn 103F(1008)General Conditions

CONTRACT NO. DHS•19GOV•OOB6

8.4 Termination for Cause. In addition to any other remedies provided for by this Contract, if theSTATE learns ofa material breach by PROVIDER of this paragraph by PROVIDER, theSTATE may at its sole discretion:

I) Provide an opportunity for the PROVIDER to cure the breach or end the violation; or

2) Immediately terminate this Contract.

In either instance, the PROVIDER and the STATE shall follow chapter 487N, HRS, with respect tonotification of a security breach of personal information.

8.5 Records Retention.

8.5.1 Destruction of Personal Information. Upon any termination of this Contract, PROVIDERshall, pursuant to chapter 487R. HRS, destroy all copies (paper or electronic form) ofpersonal information received from the STATE.

8.5.2 Maintenance of Files. Books. Records. The PROVIDER and any subcontractors shallmaintain the flies, books, and records, that relate to the Contract, including any personalinformation created or received by the PROVIDER on behalf of the STATE, and any costor pricing data, for three (3) years after the date of final payment under the Contract, Thepersonal information shall continue to be confidential and shall not be disclosed withoutthe prior written approval of the STATE. After the three (3) year retention period hasended, the files, books, and records that contain personal information shall be destroyedpursuant to chapter 487R, HRS.

Page II of II

AGFonn IoJF(IOO8)Genen3l Conditions

CONTRACT NO. — DHS-19-GOV’COSG

GENERAL CONDIT IONS FOR HEALTH & HUMAN SERVICES CONTRACTSTABLE OF CONTENTS

Paue(s)

Representations and Conditions Precedent

1.1 Contract Subject to the Availability of State and Federal Funds

1.1,1 StateFunds

I .1 .2 Federal Funds

1.2 Representations of the PROVIDER

1.2.1 Compliance with Laws

1.2.2 Licensing and Accreditation

1.3 Compliance with Laws I

1.3.1 Smoking Policy

1.3,2 Drug Free Workplace

1.3.3 Persons with Disabilities 2

1.3.4 Nondiscrimination 2

1.4 Insurance Requirements 2

1.5 Notice to Clients 2

1.6 Reporting Requirements 3

1.7 Conflicts of Interest 3

2. Documents and Files 3

2.1 Confidentiality of Material 3

2.1.1 Proprietary or Confidential Information 3

2.1.2 Uniform Information Practices Act 3

2,2 Ownership Rights and Copyright 3

2.3 Records Retention 3

3. Relationship between Parties 4

3.1 Coordination of Services by the STATE 4

3.2 Subcontracts and Assignments 4

3.3 Change of Name 4

3.4 Independent Contractor Status and Responsibilities, Including Tax Responsibilities 4

3.4.1 Independent Contractor 4

AGFonn 103F(1008)Gtnen,I Condkions

TuNe or Contents

CONTRAcr NO. OHS.t 900V-0086

3.4.2 Contracts with other individuals and entities 4

3.4.3 PROVIDER’s employees and agents 5

3.4.4 PROVIDER’s Responsibilites 5

3.5 Personnel Requirements 6

3.5.! Personnel 6

3.5.2 Requirements 6

4. Modification and Termination of Contract 6

4.1 Modifications of Contract 6

4.1.1 In writing 6

4,1.2 No oral modification 6

4.1.3 Tax clearance 6

4.2 Termination in General 6

4.3 Termination for Necessity or Convenience 7

4.4 Termination by PROVIDER 7

4.5 STATE’s Right of Offset 7

5. Indemnification 7

5.l Indemnification and Defense 7

5.2 Cost of Litigation 7

6. Publicity 8

6.1 Ac1nowledgment of State Support 8

6.2 PROVIDER’s publicity not related to contract 8

7. Miscellaneous Provisions 8

7.] Nondiscrimination 8

7.2 Paragraph Headings 8

7.3 Antitrust Claims 8

7.4 Governing Law 8

7.5 Conflict between General Conditions and Procurement Rules 8

7.6 Entire Contract 8

7.7 Severability 9

7.8 Waiver 9

AGFonn 103F(LOO8)General Conditions

Table orcontents

It

CONTRACT No. DHSI9•GOV-O085

7.9 Execution in Counterparts 9

8. Confidentiality of Personal Information 9

8.1 Definitions 9

8,1.1 Personal Information 9

8.1.2 Technological Safeguards 9

8.2 Confidentiality of Material 10

8.2.1 Safeguarding of Material 10

8.2.2 Retention, Use, or Disclosure 10

8.2.3 Implementation of Technological Safeguards 10

8.2.4 Reporting of Security Breaches 10

8.2.5 Mitigation of I-larmful Effeci 10

8.2.6 LogofDisclosures 10

8.3 Security Awareness Training and Confidentiality Agreements tO

8.3.1 Certification of Completed Training 10

8.3.2 Certification ofConfidentialiry Agreements [0

8.4 Termination for Cause II

8.5 Records Retention II

8.5.1 Destruction of Personal Information II

8.5.2 Maintenance of Files, Books, Records ii

AGFonn 103F([008)Oenral Conditions

Tobie f Consents

III

STATE OF HAWAII

STATE PROCUREMENT OFFICE

COST PRINCIPLES

HRS Chapter 103F

Purchases of Health and Human Services

September 2011

EXHIBIT C - COST PRINCIPLES

SPOH-2O1 (Revised 9/11)

HRS CHAPTER 103F

COST PRINCIPLESTable of Contents

SECtiON 1: ABOUT COST PRINCIPLES

1. Purpose 1

2. Federal Cost Principles 1

3. Factors Affecting the Allowability of Costs 1

3.1 Criteria 13.2 Reasonable Costs 13.3 Allocable Costs 23.4 Conforrnto Limitations or Exclusion 23.5 Consistent Costing Treatment 23.6. Generally Accepted Accounting Principles (GAAP) 2

4. Direct Costs 2

5. Indirect Costs (Joint Costs) 2

6, Negotiated Federal Indirect Cost Rates 3

7. Method of Allocation 3

7.1 Basis and Documentation 37.2 Allocation to Cost Objective 37.3 Basis for Allocation 37.4 Unallowable Allocation of Costs 3

8. Unallowable Costs 3

8.1 Bad Debts 38.2 Contingencies 48.3 Capital Expenditures for Land or Buildings 48.4 Capital Expenditures for Improvement 48.5 Entertainment 48.5. Fines and Penalties 4

SPOH-201 (Revised 9/11)

HRS CHAPTER 103FCOST PRINCIPLESTable of Contents

8. Unallowable Cost (continued)

8.7 Fund Raising 48.8 Gifts, Contributions and Donations 48.9 Income Taxes 48.10 Lobbying 58.11 Losses Incurred Under Other Contracts 58.12 Organization Costs 58.13 Perquisite 58.14 Security Deposits 58.15 Idle Facilities 5

9. Definition of Column Titles for Form SPOH-201 S

9.1 “Cost Item” 59.2 “Description” S9.3 “Allowable/Unallowable” 69.4 “Remarks” 6

SECTION 2: COST PRINCIPLES TABLE

CATEGORY A: Personnel Costs 7Compensation for Personal Services Currently Paid or Accrued 7

Salaries and Wages, Overtime, Salary Increases, Vacation Leave, Sick Leave, Bonuses, Severance Pay,Excessive Compensation, Accrued Leave Payout for Terminating Employees

Payroll Taxes and Assessment All Federal and State Requirements 8RCA, Workers Compensation, Unemployment Insurance, Temporary Disability Insurance, Fines and Penalties

Fringe Benefits 8Health Care Insurance, Retirement Plans, Perquisites

CATEGORY B: Operating Costs 8Air Fare 8

Audit Services 9Federal Funds, State Funds


HRS CHAPTER 103FCOST PRINCIPLESTable of Contents

Category B: Operating Costs (continued)

Contractual Services - Administrative 9Professional and Consultant Services, Legal Fees

Contractual Services - Subcontracts 10Professional and Consultant Services

Depreciation 10Equipment Motor Vehicles, Buildings and Capital Improvements, Idle Facilities,Assets Acquired Through State or Federal Government

Food 10Meals and Snacks

Indirect Costs (Negotiated Federal Rate) 11General Operating Costs, Indirect Costs

Insurance 11Indemnification Coverage, General Liability, Bonding, Automobiles, fire, Hurricane, Flood, Life Insurance Premiums

Interest 12Interest on Borrowed Capital, Other Interest Rates

lease/Rental of Equipment 12Lease Rental of Program Equipment, Security Deposits, Loan Payments

Lease/Rental of Motor Vehicles 12Leased Vehicles, Security Deposits, Loan Payments

Lease/Rental of Space 13Office lease Rental, Common Area Charges, Security Deposits, Unused Space

Mileage 13Mileage Reimbursement, Monthly Allowances, Relocation Costs, Reimbursement for Personal Use

Postage, Freight and Delivery 13Stamps, Mailing Costs, Delivery Charges

Program Activities 14Other Cost Items to Deliver Services

IIISPOH-201 (Revised 9/11)

HRS cHAPrER 103FCOST PRINCIPLESTable of Contents

Category B: Operating Costs (continued)

Publication, Printing and Advertising 14Printing, Binding, Subscriptions, Media Services, Media Advertising, Books and Journals, Recruitment of Personnel

Repairs and Maintenance 14Facilities and Equipment, Leased Space, Capital Asset

Staff rraining 15Registration and Tuition, Materials, Out-of-State Training, Administrative Personnel Entertainment, Training Courses

Subsistence/Per Diem 15Room and Board, Tips and Gratuities

Supplies 16Office, Vehicle, Education, Medical, Recreational, Janitorial Program

Telecommunication 16Telephone, Facsimile, Long Distance, Installation

Transportation 16Taxi, Bus, Auto Rental, parking, Tips and Gratuities, Parking Tickets and Fines

Utilities 16Water/Sewer, Electricity, Gas, Refuse

CATEGORY C: Equipment Purchases 17

CATEGORY D: Motor Vehicle Purchases 17

ivSPOH-201 (Revised 9/11)

HRS CHAPTER 103F

PURCHASES OF HEALTH AND HUMAN SERVICES

COST PRINCIPLESSECTION 1: ABOUT COST PRINCIPLES

1. PURPOSE

To provide uniform cost principles among state purchasing agencies in procuring health arid human services under HRS Chapter 103F. These costprinciples repre5ent guidelines for determining which types of expenditures will be allowable. These cost principles are intended for use when managingcontracts executed under HRS Chapter 103F, for Purchases of Health and Human Services and should be used to guide decisions regarding:• proposal budgets submitted by providers in response to Request for Proposals (RFP);• contract budgets and unit casts negotiated between state purchasing agencies and providers;• financial reporting requirements established by state purchasing agencies; and• fiscal monitoring requirements established by state purchasing agencies.

2. FEDERAL COST PRINCIPLES

Providers receiving Federal funds must comply with applicable Federal requirements. Therefore, to the extent that Federal cost principles conflict withthese cost principles, the Federal requirements, if more restrictive, shall control.

3. FACTORS AFFECTING THE ALLOWABILITY OF COSTS

3.1 ro be allowable, costs must meet the following criteria:a. Be reasonable for the performance of the contract and be allocable under these cost principles;b. Conform to any limitations or exclusions set forth in these cost principles or in the contract as to type or amount of cost items;c. Be consistent with policies and procedures that apply uniformly to the contract and other activities of the organization;d. Be accorded consistent treatment;

e. Be determined in accordance with generally accepted accounting principles (GAAP; andf. Be adequately documented.

3.2 Reasonable Costs

A cost is reasonable if, in its nature or amount it does not exceed that which would be incurred by a prudent person under the circumstancesprevailing at the time the decision was made to incur the costs. In determining the reasonableness of a given cost consideration shall be given to:a. Whether the cost is a type generally recognized as ordinary and necessary forthe operation of the provider or the performance of the contract;b. The restraints or requirements imposed by such factors as generally accepted sound business practices, arms length bargaining, State laws and

regulations, and terms and conditions of the contract; andc. Significant deviations from the established practices of the organization which may unjustifiably increase the contract costs.

1SPOH-201 (Revised 9/11)

COST PRINCIPLES

HRS Chapter 103F

3.3 Allocable Costs

a. A cost is allocable to a particular cost objective, such as a grant, contract project, service, or other activity, in accordance with the relativebenefits received. A cost is allocable if it is treated consistently with other costs incurred for the same purpose in like circumstances and if it:(1) Is incurred specifically for the contract;

(2) Benefits both the contract and other work arid can be distributed in reasonable proportion to the benefits received; or(3) Is necessary to the overall operation of the provider, although a direct relationship to any particular cost objectives cannot be shown.

b. Any cost allocable to a particular contract award or other cost objective under these principles may not be shifted to other State contracts toovercome funding deficiencies, or to avoid restrictions imposed by law or by the terms of the contract.

3.4 Conform to Limitations or Exclusion

Many costs are subject to various restrictions, conditions, and/or documentation requirements that must be followed before such cost is allowable.Certain types of costs require prior approval before they are allowable, while other types of costs are unallowable.

3.S Consistent Costing TreatmentThe budgeting, recording and reporting of all costs of a particular nature must be done in the same manner regardless of the source of funding (i.e.,Federal or Non-Federal) associated with a project or activity.

3.6 Generally Accepted Accounting Principles (GAAP)These are standards and guidelines promulgated by the Financial Accounting Standards Board and the Governmental Accounting Standard Board,depending upon the type of organization involved. These principles direct how and when they should recognize costs on accounting records andfinancial statements.

4. DIRECT COSTS

Direct costs are those that can be identified specifically with a particular final cost objective, i.e., a particular award, project, service, or other directactivity of an organization. Costs identified specifically with a final cost objective of the organization are direct costs of that cost objective and are not tobe assigned to other cost objectives directly or indirectly.

5. INDIRECT COSTS (JOINT COSTS)Indirect costs are those that have been incurred for common joint objectives and cannot be readily identified with a particular final cost objective.

SPOH-201 (Revised 9/11) 2

COST PRINCIPLES

HRSChapterlO3F

6. NEGOTIATED FEDERAL INDIRECT COST RATESIndirect costs are equitably distributed to benefiting cost objectives by using current rate(s) negotiated with the federal government. To utilize theindirect cost rate, the rate must be approved by the cognizant federal agency.

7. METHOD OF ALLOCATION (Must be used by organizations without a negotiated federal indirect cost rate)7.1 Basis and Documentation

Organizations incurring costs that benefit more than one cost objective such as a grant, contract, project, services, or other activity must allocatethese costs using a reasonable base. Organizations must have a written cost allocation plan.

7.2 Allocation to Cost Objective

Joint costs, such as depreciation, rental costs, operation and maintenance of facilities, telephone expenses, administrative salaries, and the likemust be allocated individually to each objective using a base most appropriate to the particular cost being allocated. An allocation for any expenseitem exceeding 100% of its total cast, or its depreciation value, is unallowable.

7.3 Basis for Allocation

Each joint cost must be allocated using a base which accurately measures the benefits provided to each cost objective. The bases must beestablished in accordance with reasonable criteria and be supported by current data. Actual conditions must be taken into account in selecting abase to be used in allocating the joint costs. In general, any cost element or cost related factor associated with the organization’s work ispotentially adaptable for use as an allocation base, provided:a. It can readily be expressed in terms of dollars or other quantitative measures (total direct costs, direct salaries and wages, staff hours applied,

square feet used, hours of usage, number of documents processed, population served, and the like); andb. It is common to the benefiting functions during the base period.

7.4 Allocation of costs based on forecasts, revenues received, budgeted revenues, budgeted costs, or anticipated contract reimbursements are notacceptable or allowable.

8. UNALLOWABLE COSTS

The following costs are unallowable:8.1 Bad Debts

Any portion of the accounts receivable which has been determined to be uncollectible, is termed “Bad Debts.” Any losses arising from uncollectibleaccounts, other claims and related costs that are actual or estimated are unallowable.

SPOH.201 (Revised 9/11) 3

COST PRINCIPLES

HRS Chapter 103F

8.2 Contingencies

Contingency costs are contributions to a reserve account for unforeseen costs, Contingency costs are unallowable because they are speculative innature and do not represent an actual incurred cost.

8.3 Capital Expenditures for Land or Buildings

Capital expenditures for acquisition of land or buildings are unallowable. This does not apply to costs associated with Capital Improvement Project(CIP) funds received from the State for that purpose. (Interest on debt incurred is allowable as specified in the cost principle table.)

8.4 Capital Expenditures for Improvements

Capital expenditures for improvements to land or buildings which materially increase their value or useful life is unallowable. This does not applyto cost associated with Capital Improvement Project (CIP) funds received from the State for that purpose.

8.5 Entertainment

Costs unrelated to service delivery, client activities or client programs, such as costs related to public relations, social activities and incidental costsrelating thereto, including meals, beverages, tips and gratuities are unallowable.

8.6 Fines and Penalties

Fines and penalties include all costs resulting from violations of, or failure to comply with, Federal, State, local laws and regulations, and contractrequirements. Fines and penalties are unallowable.

8.7 Fund Raising

All costs of fund raising, including financial campaigns, endowment drives, solicitation of gifts and bequests, and similar expenses incurred solely toraise capital or obtain contributions are unallowable.

8.8 Gifts, Contributions and Donations

Agift is property transferred without receiving return consideration ofequivalentvalue. Contributions and donations are property transferredwhich are not transferred in exchange for supplies or services of equivalent fair market value. Gifts, contributions and donations are unallowable.

8.9 Income Taxes

Federal and State income taxes are unallowable


cosr PRINCIPLES

HRS Chapter 103F

8.10 Lobbying

AD costs associated with attempts to influence the enactment or modification of any pending legislation through communication with any memberor employee of the state legislature, or with any government official or employee concerning a decision to sign or veto enrolled legislation areunallowable.

8.11 Losses Incurred Under Other Contracts

A loss incurred under one contract may not be charged to any other contract. Losses incurred another contracts are unallowable.

8.12 Organization Costs

Costs incurred under one contract may not be charged to any other contract. Losses incurred on other contracts are unallowable.

813 Perquisite

A privilege furnished or a service rendered by an organization to an employee, officer, director, or member of that organization to reduce theindividual’s personal expenses is unallowable.

8.14 Security Deposits

Funds held as a guaranty or assurance required by agreement is unallowable

8.15 Idle Facilities

Facilities that are not being used are unallowable.

9. DEFINITION OF COLUMN TITLES FOR FORM SPOH-2O19.1 “Cost Item”

“Cost item” refers to the items within budget categories. For example, “Compensation for Personal Services,” should appear within the budgetelement category for “Personnel Costs.”

9.2 “Description”

A description of each line item is provided to briefly characterize applicable costs within the category. Descriptions are intended to be informative.


COST PRINCIPLES

I-IRS Chapter 103F

9.3 “Allowable/Unallowable”

Costs are allowable when they are reasonable, allocable, lawful, and for costs invoiced for reimbursement, actually incurred or accrued andaccounted for in accordance with generally accepted accounting principles, for contract related expenditures. Certain costs are treated speciallyand are specifically identified as “Allowable” or “Unallowable” costs. The list of unallowable costs is not all-inclusive.• Costs indentified as “Allowable with Prior Approval” are generally unallowable. Providers must receive approvalof these costs, prior to

expenditure. The head of the state purchasing agency may approve “unallowable” costs, if it is in the best interests of the State and all costsare reasonable, lawful and allocable.

9.4 “Remarks”

This column describes special instructions, restrictions on the allowable limits, and required documentation that the State purchasing agency mayrequire. All required documentation should be available upon request by the state purchasing agency. RFPs may require that certain documentsbe submitted at the time of application.

5P0H-201 (Revised 9/11) 6

COST PRINCIPLES

HRS Chapter 103F

sECTION 2: COST PRINCIPLES TABLE

1.. Any cost charged to the Agreement must be reasonable, appropriate, lawful and allocable to the contract.2. To the maximum extent practicable, the suggested terminology should be used consistently in all phases of budgeting, accounting, and reporting.3. This list represents selected cost items and is not an all inclusive list of costs which may be prescribed by federal and or State laws or regulations4. Although a cost may be allowable under federal guidelines, the state purchasing agency has the discretion to limit or disallow the cost due to unavailability of funds, funding restrictions, or its

inappropriateness to the contract.5. In cases where certain items, definitions, explanations or requirements are difficult to understand, the applicant/provider should seek written clarification from the state purchasing agency.5. Required cost documentation shall be kept by the provider and submitted at the request of the purchasing agency.

Cost Item Description — Allowable/Unallowable RemarksCATEGORY A: Compensation for personal servicesPersonnel Costs currently paid or accrued

• Salaries and Wages Allowable to the extent that the range is Required Documentation:reasonable for the services rendered Schedule detailing total annual salaryfor

• Overtime Allowable with prior approval each position, computation of each positionsRE and service site.• Salary Increases

Reports reflecting the distribution of activityof each employee must be maintained for allstaff members whose compensation ischarged, in whole or in part, directly to thecontract(s). The reports must reflect an after-the-fact determination of the total actualactivity of each employee and signed by theindividual employee, or by a responsiblesupervisory official having firsthandknowledge of the activities performed by theemployee that the distribution of activityrepresents a reasonable estimate of theactual work performed by the employeeduring the periods covered by the reports.Note: The State S requests that adequaterecords supporting the allocation of salariesbe maintained and not necessarily detailedtimesheets, e.g., accounting for each quarterhour for each employee.)

Personnel policies and procedures governingvacation leave, sick leave, and overtime pa’,.

SPOF-l-201 (Revised 9/11) 7

COST PRINCIPLES

HRS Chapter 103F

Cost Item Description Allowable/Unallowable Remarks

CATEGORY A: Compensation for personal servicesPersonnel Costs currently paid or accrued (cont’d)

• Vacation Leave Unallowable payment for leave in lieu of• Sick Leave leave not taken. Bonuses Unallowable• Severance Pay• Excessive Compensationa Accrued leave payout for terminating

employees

Payroll Taxes and Assessments

All Federal and State requirementsa Employer’s portion of rICA, workers Allowable Required Documentation:

compensation, unemployment Schedule detailing applicable percentages ofinsurance and temporary disability statutory ceilings for each payroll tax,insurance, insurance and other costs.

• Fines and penalties due to late filing Unallowableand/or_payment

Fringe Benefits:

Employers’ portion of health care

and retirement benefits

a Health care insurance Allowable Required Documentation:a Retirement plans Allowable with prior approval Each benefit should be dearly detailed in the

personnel policies and prncedure&All costs considered as perquisites (e.g., Unallowablenon-wage compensations providedto employees in addition to theirnormal or salaries)

____________

CATEGORY B: Airfare (Inter-Island)

__________________________________________________________

Operating Costs • Costs for airline tickets or coupons Allowable with prior approval. Required Documentation:schedule of inter-island travel detailing staff,destination, purpose, fare costs, perdiem/subsistence and dates of travel.

Personnel policies and procedures governingtravel.

Cost of cancelled travel shall not be chargedto the contract.

• First class travel Unallowable


COST PRINCIPLES

lIPS Chapter 103F

Cost Item Desaiption Allowable/Unallowable Remarks

CATEGORY B:

Operating Costs Airfare (Out-of-State)

• Costs for airline tickets Allowable with prior approval Required Documentation:Schedule of out-of-state travel detailing staff,destination, purpose, fare costs, perdiem/subsistence and dates of travel.

Personnel policies and procedures governingtravel.

Cost of cancelled travel shall not be chargedto the contract.

• First class travel Unallowable

Audit ServicesCost of an audit by an independentcertified public accountant• Federal funds Allowable Required Documentation:

a. Audits completed in accordance with Financial statements and schedule of0MB Circular A-133, required for expenditures of federal awards, summaryproviders expending $300,000 or schedule of prior audit findings, auditor’smore in federal funds during the reports, and corrective action plans. If thefiscal year. audit does not contain questioned costs or

b. Limited scope audits arranged and audit findings related to the pass throughpaid for by pass through entities to federal funds, a notification letter may bemonitor subrecipients. sent to the pass through entity (see 0MB

Circular A-133, Subpart C.)

Copy of limited scope audit report.• State funds only Allowable Copies of the audit report and management

a. Financial audits of the organization letter issued by the auditor.b._Special_audits_required_by_the_State

Contractual Services -

Administrative

• Costs of administrative professional and Allowable Required Documentation:consultant services, which cannot be Schedule detailing business or individual’sperformed by the applicant/provider’s name, description of the service, and contractstaff, e.g., accounting, bookkeeping, amount or fee.payroll, and secretarial services.Legal fees for defense and prosecution Unallowableof criminal and civil proceedings.

____________________________________________

Retainer_payments_to_attorneys.

_____________


COST PRINCIPLES

HRS Chapter 103F

Cost Item Description Allowable/Unallowable RemarksCATEGORY B:Operating Costs Contractual Services -

SubcontractsCosts of professional and consultant services Allowable with prior approval Required Documentation:necessary for the delivery of the primary Justification for contractual servicescontracted services, which cannot be proposed.performed by the applicant/providers staff. Schedule detailing subcontracted

organization or individuals name, descriptionof the service, and contract amount or fee.Executed agreements between thecontracting parties.

DepreciationDepreciation expense is the method ofallocattng the cost of a capital asset over theestimated useful life of the asset as it relatesto the contract.• Depreciation of equipment, motor Allowable Required Documentation:

vehicles, and buildings and capital Depreciation schedule, cost allocation bases,improvements, required for the program, previous depreciation taken, and budgetede.g., renovations in connection with the depreciation expense.program for office and programrequirements.

• Idle facilities Unallowables Assets acquired through the State or

Federal_government

Food. Provisions for meals and snacks. Food Allowable with prior approval Required Documentation:

provided as part ol the services for clients Schedule detailing description and cost.as specified in the contract.Food costs covered by SSI or other funds. Unallowable


COST PRINCIPLES

HRS Chapter 103F

Indirect Costs jNegotiated FederalRate)Costs incurred for common or joint objectivesthat cannot be readily identified with aparticular final cost abjective, e.g.. generaladministration and general expenses, such asthe salaries and expenses of executiveofficers, personnel administration, andaccounting.

• Life insurance premiums of officers,employees, or Board members where theapplicant/provider is the beneficiary

CATEGORY B:Operating Costs

Cast Item Description Allowable/Unallowable Remarks

• General operating costs equitably Allowable Required Documentation:distributed to benefiting objectives by A valid copy of the written agreement withusing a current rate negotiated with the the federal agency for the negotiated rate.federal government. Attach to Proposal Budget if used.

• Indirect costs based on a rate that has not Unallowablebeen negotiated with the federagovernment.

InsuranceCost of insurance required or approvedpursuant to the contract.• Indemnification Coverage Allowable Required Documentation:• General Liability A valid Certificate of Insurance which shows• Bonding the following:. Applicant/Provider’s Automobiles 1. Policy in effect during the contract period.• Fire 2. Liability coverage(s) as specified In the• Hurricane agreement.

• Flood 3. The contracted services or type ofservices.

4. The State of Hawaii and the statepurchasing agency as the certificateholder.

S. Address of the state purchasing agency.6. The State of Hawaii named as additionally

insured.

Unallowable


COST PRINCIPLES

HRS Chapter 103F

InterestCosts incurred for interest on borrowedcapital

Interest on debt incurred after May 14,1997 to acquire or replace capital assets(including renovations, alterations,equipment, and, and capital assetsacquired through capital leases), acquiredafter May 14, 1997 and used in support ofthe State contracts.

• Security deposits• Loan payments made in connection with

purchase of vehicle

Required Dowmentation for prior approval:A statement of purpose and justification forfacility acquisition or replacement.A statement as to why current facilities arenot adequate.A statement of planned future use of thefacility.A description of the financing agreement tobe arranged for the facility.A summary of the building contract withestimated cost information and statement ofsource and use of funds.A lease/purchase analysis which shows that afinanced purchase or capital lease is lesscostly to the organization than other leasingalternatives (See 0MB Circular A-122.)

Reimbursements will be limited to the leastcostly alternative.

CATEGORY B:Operating Costs


Allowable with prior approval

• All other interest costs Unallowable

Lease/Rental of EquipmentLease rent of program equipment used forcontractual services. Rental or lease cost in connection with the Allowable with prior approval Required Documentation:

program for office and program Schedule detailing item, purpose, cost andrequirements. Usage.

Lease/rental agreement.• Security deposits Unallowable• Loan payments made in connection with

purchase_of equipment

Lease/Rental of Motor VehiclesMotor vehicle lease costs related tocontracted services• Leasing costs of vehicles used directly in Allowable with prior approval Required Documentation:

connection with the program Schedule detailing vehicle, purpose, cost andusage. Lease/rental agreement.

Unallowable


COST PRINCIPLES

HRS Chapter 103F

I Cost Item Description Allowable/Unallowable Remarks

CATEGORY B: Lease/Rental of Space

Operating Costs Lease rental of office and program facilityspace• Lease rent paid for office and program Allowable with prEor approval Required Documentation:

requirements lease/rental agreement.. Common area charges Payments must be made to a third party and

comparable to other properties in the area.Rental costs under sale and leasebackarrangements are allowable only up to theamount that would be allowed had theorganization continued to own the property.

. Security deposits Unallowable• Unused space

MileageTravel allowances based on staffs mileageactually incurred.Reimbursement to staff using their privatevehicles for business related to the contract.a Mileage reimbursement not to exceed Allowable Required Documentation:

federal (IRS) allowances Schedule for mileage detailing position ofstaff, destination, purpose and total milesclaimed.

A record of business miles traveled for eachtrip using employees’ personal vehicle.

• Monthly auto allowances Unallowable• Relocation costs• Reimbursement for personal use or non-

contract related mileage

Postage, Freight and DeliveryMailing, shipping and delivery costs relatingto the contract• Postage stamps Allowable• Costs for mailing, e.g., certified mail• Delivery charges for goods purchased

__________


COST PRINCIPLES

MRS Chapter 103F


Program Activities

• All other cost items directly related to orrequired in order to deliver services toclients, e.g., client incentives, clientexcursions, training wages, andclient/volunteer stipends.

Publication, Printing and

Advertising

Required Documentation:A schedule detailing:1. Description of program activity.2. Frequency of activity.3. Number of participants.4. Cost per person.

Restrictions:All program activities are limited to contractprovisions and costs must be incurred onbehalf of clients.

CATEGORY B:

Operating Cost5

Allowable with prior approval

Costs of printing and binding, and Allowable Required Docurnentatirni:subscriptions. Schedule providing basis for estimating costCosts of media services, of postage, printing and copying.Media advertising includes magaznes, Schedule for subscriptions and publicationsnewspapers, radio and television programs, detailing titles and costs.direct mail, exhibit arid the like.• Publications used directly in the program• Professional books and journals• Recruitment of personnel• Procurement of goods and services -

• Advertisements specifically required bycontract

Repairs and Maintenance

Necessary maintenance, repar and upkeepof_facilities,_buildings_and_equipment.• Costs incurred for repair and Allowable

maintenance of facilities and equipmente.g., lanitorial services, painting,plumbing and electrical repairs

• For leased space, allowed for lessee ifresponsibility by lessor is not specified inthe rental_agreement.

• Expenditures which will increae the life Unallowableof a capital asset

SPDhl-2U1 (Revised 9/11) 14

COST PRINCIPLES

HRS Chapter 103F

Cast Item 1 Description Allowable/Unallowable Remarks

CATEGORY B:

Operating Costs Staff Training

Cost of preparation and maintenance of on- Allowable Required Documentation:the-job, classroom and other training to Schedule detailing title of training, date,increase the employees’ vocational persons attending and purpose.effectiveness.• Registration and tuition costs• Costs of materials, including booksTraining for staff who provide direct service Allowable with prior approvalto recipients.Conference and workshops for the purposeof dissemination of technical information toimprove the delivery of the service.• Out of State training• Training for administrative personnel• Entertainment costs, e.g., office parties Unallowable. Training courses taken by an employee to

acquire basic skills which should havebeen brought to the job or to qualify forduties_other_than the_position_held.

Subsistence/Per Diem

Costs for room and board while on officialtravel Status• Subsistence or per diem rates may be Allowable Required Documentation:

used. Travel policies and procedures.. Receipts for subsistence payments.

For overnight accommodations, room ratesmust be reasonable and ordinary in relationto accommodations within the surroundingarea and type of accommodation.

Restriction:Not to exceed State per diem allowances

All tips and gratuities Unallowable


COST PRINCIPLES

F-IRS Chapter 103F

Supplies

Cost of materials and other consumablesupplies necessary for the performance of thecontract.

CATEGORY B:

Operating Costs


• Office supplies Allowable• Motor vehicle supplies. Educational supplies. Medical suppNes. Recreational suppliess Janitorial suppliesS Program supplies

Telecommunication

Cost of telephone service, equipment rentals,telefacsimile, and long distance charges. (Fortelephone equipment purchases, seeEquipment Purchases.)

• Normal monthly charges including Allowable Required Documentation:telefacsimile lines Schedule detailing phone installation,

. Inter-island calls monthly rates, inter-island calls, number ofS Long-distance mainland calls lines and instruments to support budget• Installation costs request.

Transportation

cost of ground transportation while onofficial travel status• Taxi fare Allowable Required Documentation:• Bus fare ReceiptsS Auto rentals. Parking fees• All tips and gratuities Unallowable• Parking tickets and fines

Utilities• Water/Sewer• Electricity• Gas• Refuse

AllowaLii Required Documentation:Schedule detailing monthly and annual costsfor each item.

SPOIl-Wi (Revised 9/11) 16

COST PRINCIPLES

HRS Chapter 11SF


CATEGORY C: Purchase of an item costing more than

Equipment Purchases$1000 and having a useful life of more thanone year• Equipment required for the program Allowable with prior approval Required Documentation;

Schedule detailing cost, use, and clear

justification.

Restrictions:

Purchased equipment must be primarily for

contracted services and critical to the delivery

of services to the target population.

Purchased equipment is the property of the

State and may be collected upon termination

of the contract. Purchases must in

accordance with the Department ofAccounting and General Services’ accountingprinciples.

CATEGORY D: Purchase of autos, vans, trucks and buses, Allowable with prior approval Required Documentation:Motor Vehicle Purchases Motor vehicles required for the program. Schedule detailing cost, use, and clear

justification.

Restrictions:Purchased vehicle must be for contractedservices and critical to the delivery of servicesto the target population. Purchased motorvehicles are the property of the State andmay be collected upon termination of the

contract.

SPDH-2D1 (Revised 9/11) 17