exhibit a special provisions a-1. … · exhibit a – special provisions ... the provider shall...

CF Standard

Integrated Contract 2016 1 Contract No.

EXHIBIT A – SPECIAL PROVISIONS

The following provisions supplement or modify the provisions of Items 1 through 9 of the Integrated Standard Contract, as provided herein:

A-1. ENGAGEMENT, TERM AND CONTRACT DOCUMENT

Program or Service Specific Terms. In addition to the provisions of Section 1.4.1 hereof, the following definitions apply to this contract.

A-1.1 Automated Community Connection to Economic Self-Sufficiency (ACCESS) Florida Systems – The computer systems used in the State of Florida for the public assistance programs administered by the Department of Children and Families (DCF), Office of Economic Self-Sufficiency (ESS), including Supplemental Nutrition Assistance Program (SNAP) and Temporary Cash Assistance (TCA). These systems are used to determine eligibility and support ESS services. They include primarily, but not exclusively, the Florida Online Recipient Integrated Data Access (FLORIDA) System, ACCESS Management System (AMS, and the Self Service Portal.

A-1.2 Downtime – Any unscheduled service outage that occurs during the defined system or database operation hours. Service outage causes such as force majeure events, failure of elements of the Internet, and outages on the Department systems or networks are not considered a part of downtime.

A-1.3 Employment and income (EIV) database – A database housing information on employment, employer, and income that can be queried at the individual level.

A-1.4 Employment and income verification (EIV) system – A web service interface that provides real time data on employment and income from the EIV database.

A-1.5 File Transfer Protocol (FTP) A standard procedure that allows one computer to transfer files to and from another over a network such as the Internet.

A-1.6 Information Technology Resources – Equipment, data or work processing hardware, software, programs, services, supplies, contracted personnel, facilities, network, infrastructure, maintenance, or technology-related training.

A-1.7 Interface – Points of interaction between the component of the system, applicable at the level of both hardware and software.

A-1.8 Match – A transaction that includes the transmission of a query from the Department that results in an employment and income record being found for the individual identified in the query in the EIV database and the transmission and receipt of the record back to the Department. There are two (2) types of matches to which all the above criteria apply as well as the specific criteria described in the type of matches below:

A-1.8.1 EIV system match – A record is only considered a match in the EIV system when the most recent 90 days information, prior to the date of the query, and all required data elements are found and returned on the subject of the query.

A-1.8.2 Portal match - A record found through the portal has no historical time limit and is considered a match when both employment and income verification and all required data elements are found and returned on the subject of the query.

A-1.9 National Institute of Standards and Technology (NIST) Guidelines – The U.S. Department of Commerce’s National Institute of Standards and Technology that determines the recognized industry standard definition of security.

A-1.10 Portal – an electronic application that allows users granted permission access with query functionality to the Provider’s EIV database.

A-1.11 Pre-Production – The initial phase of the project that includes the system development life cycle (including systems and user acceptance testing), proof of concept, and pilot prior to full implementation of the Provider’s EIV system with the Department.

A-1.12 Production – Includes implementation of the EIV system and the corresponding ongoing operations and maintenance of the system.

A-1.13 Scheduled Maintenance – Periodic prescribed and scheduled inspection and/or servicing of equipment.

A-1.14 Secure Socket Layer (SSL) – A protocol for encrypting information over the Internet.

A-1.15 Simple Object Access Protocol (SOAP) – A protocol specification for exchanging structured information in the implementation of Web Services in computer networks.

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A-1.16 Transaction – The transmission and processing, including the provision of required data, of an EIV request from the Department to the Provider and the corresponding return transmission(s) to the Department. A new request is required for each transaction.

A-1.17 Web Services Definition Language (WSDL) – An XML-based language that is used for describing the functionality offered by a web service.

A-2. STATEMENT OF WORK

There are no additional provisions to this Section of the Standard Contract.

A-3. PAYMENT, INVOICE AND RELATED TERMS


A-4. GENERAL TERMS AND CONDITIONS GOVERNING PERFORMANCE

A-4. Ownership of Products. In addition to the provisions of Section 4.7 hereof, the following Intellectual Property provision applies to this contract.

A-4.1 Ownership of Products. The EIV system application, interfaces, hardware and related features to be developed, hosted and maintained by Provider are the property of the Provider. The data generated from the EIV system and transmitted to the Department is the property of the Department and such data, including the elements supplied to Provider for any EIV inquiry, remains under the Department’s control for the period of retention permitted under the contract.

A-5. RECORDS, AUDITS AND DATA SECURITY

A-5 Data Security. In addition to the provisions of Section 5.5 hereof, the following Data Security provisions apply to this contract.

A-5.1 NIST SP800-53 addresses minimum security controls that must be followed during Production. The web site is http://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-53Ar4.pdf.

A-5.2 NIST has numerous publications providing specific requirements and guidelines about each area of security. The most “general” document describing the security and requirements that must be followed is NIST FIPS PUB 200 and the web site is http://csrc.nist.gov/publications/fips/fips200/FIPS-200-final-march.pdf.

A-5.3 On and after Production, the minimum security requirements will cover 17 security-related areas with regard to protecting the confidentiality, integrity, and availability of Federal information systems and the information processed, stored, and transmitted by those systems. The security-related areas include: access control, awareness and training; audit and accountability; certification, accreditation, and security assessments; configuration management; contingency planning; identification and authentication; incident response; maintenance; media protection; physical and environmental protection; planning; personnel security; risk assessment; systems and services acquisition; system and communications protection; and system and information integrity. The seventeen areas represent a broad-based, balanced information security program that addresses the management, operational, and technical aspects of protecting federal information and information systems.

A-5.4 Policies and procedures play an important role in the effective implementation of enterprise-wide information security programs within the Federal government and the success of the resulting security measures employed to protect Federal information and information systems. Thus, organizations must develop and promulgate formal, documented policies and procedures governing the minimum security requirements set forth in this standard and must ensure their effective implementation.

A-6. PENALTIES, TERMINATION AND DISPUTE RESOLUTION


A-7. OTHER TERMS


http://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-53Ar4.pdf

http://csrc.nist.gov/publications/fips/fips200/FIPS-200-final-march.pdf

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EXHIBIT B - SCOPE OF WORK

B-1. SCOPE OF SERVICE

The Provider shall provide automated and secure employment and income verification (EIV) services to the Department. The individual activities within the scope of the services and deliverables are described below. In performing these tasks and activities, the primary responsibility of the Provider will be providing a secure automated web service interface with the Department’s ACCESS systems database of current and historical employment and payroll data from employers in Florida and across the country and additional access to the database through an on-line real-time portal. The services shall be provided on an ongoing basis throughout the contract term and any extensions or renewals thereof.

B-2. MAJOR CONTRACT GOALS

B-3. The EIV services will furnish essential information for the following activities of the Department: eligibility determination for public assistance benefits, recovery of overpayments of public assistance benefits, and detection and prevention of public assistance fraud, waste and abuse.

B-4. SERVICE AREA/LOCATIONS/TIMES

B-4.1. Service Area. Services shall be delivered statewide in Florida.

B-4.2. Service Location. The Provider’s administrative offices, facilities, servers, corporate offices and customer service offices and representatives to be used to conduct business under this contract shall be located in the United States of America (USA). The Provider’s administrative offices shall be located at the address specified in the response to proposals. If Providers administrative office relocates, the Provider shall provide notice to the Department of the location change at minimum 30 days prior to relocation. Portal access service must be available from all Department locations, including telecommute locations.

B-4.3. Service Times

B-4.3.1 The Provider’s administrative office shall be available 8:00 AM to 6:00 PM (Eastern Time) Monday through Friday. The Provider’s administrative office may be closed only on state approved holidays, unless prior written approval is given by the Department. The Provider shall submit a written request to the Department for approval of office closure a minimum of 10 days prior to beginning date of closure.

B-4.3.2 The Provider’s automated EIV system shall be available, accessible and operational 24 hours a day, 7 days a week, 365/366 days per year.

B-4.3.3 The Provider’s automated portal access shall be available and operational at a minimum, from 7 AM to 7 PM, Eastern Time, Monday through Friday.

B-4.3.4 The Provider’s customer service and technical assistance representation for use by the Department shall be available 7:00 AM to 6:00 PM (Eastern time), Monday through Friday (excluding State of Florida approved holidays).

B-5. CLIENTS TO BE SERVED

This is a non-client contract.

B-6. CLIENT ELIGIBILITY


B-7. CLIENT DETERMINATION


B-8. EQUIPMENT

All equipment, hardware and software, and supplies necessary for the provision of services shall be furnished by the Provider.

B-9. CONTRACT LIMITS

The Provider shall only provide services within the scope of this contract. Additional tasks may be required of the Provider as the project evolves. Additional tasks not requiring and amendment shall be submitted in writing and must be agreed upon in writing, between both the Department and the Provider.

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EXHIBIT C - TASK LIST

The Provider shall perform all functions necessary for the proper delivery of services including, but not limited to, the following:

C-1. SERVICE TASKS

The Provider shall provide the following tasks for the provision of EIV services and document completion of described by completing and delivering all reports as specified in Section C-2.5:

C-1.1. Comply with the Department’s Project Management Process and take the necessary actions to meet timelines, milestones, and deliverables identified in the Project Schedule for an automated EIV system interface compatible with the ACCESS Florida systems and implement the Pre-Production Project Management Process.

C-1.1.1. Submit a Project Schedule that defines the project timeline and includes key project milestones and deliverables for Department review and approval. The Project Schedule and any updates shall be incorporated into this Contract by reference, effective upon Department approval, and will be maintained in the Department’s Contract file. The Project Schedule must include, at a minimum, the following elements:

C-1.1.1.1. Detailed schedule that includes activities, tasks, estimated start and end dates, durations, deliverables, and assigned resources to establish the processes, procedures, and infrastructure needed for the service provision. The final deliverable schedule shall be coordinated with the Department.

C-1.1.1.2. Description of the deliverables produced as a result of implementation and service delivery activities.

C-1.1.2. Perform ongoing project monitoring activities and review and validate issues, deficiencies, and/or risks identified by the project management team.

C-1.1.3. Submit updates to the Project Schedule for Department review and approval according to the schedule in Section C-2.5.1.

C-1.1.4. Submit all deliverables listed in the Project Schedule to the Department for review and approval on or before the due date in the Project Schedule.

C-1.1.5. Complete all activities specified in the Readiness Assessment Plan submitted with the response to the RFP in the manner specified therein.

C-1.1.6. Complete implementation of the services, including all activities and associated milestones necessary to develop, test, and correct any deficiencies, in accordance with the Project Schedule and Department requirements. Pre-implementation activities shall be conducted in a manner to successfully develop and achieve written Department approval to place a fully functional EIV system into production by the date specified in the Department’s Project Management Plan.

C-1.2. Complete the following pre-production tasks in accordance with the approved Pre-Production Project Management Plan:

C-1.2.1. Provide a 90 day proof of concept using portal access by Department staff. The proof of concept may run concurrent with system requirements sessions and development.

C-1.2.2. Provide an EIV database meeting the requirements of Section C-1.3.1.

C-1.2.3. Develop and implement a production ready EIV system, as defined herein, meeting the requirements of Section C-1.3.2.

C-1.2.4. Pre-production activities shall include systems and user acceptance testing of the system interface in a testing environment as directed by the Department and in accordance with the Project Management Plan.

C-1.2.5. Implement customer service representation for use by the Department that provides technical assistance and system problem reporting meeting the requirements of Section C-1.3.7.

C-1.3. Complete the following production tasks:

C-1.3.1. Maintain an EIV database that includes and reports the following information (below). The database/system must have functionality to request and collect all of the following data elements from employers and the functionality to respond with all of the data elements in every instance the employers have provided the data. Employee data must be updated each pay period.

C-1.3.1.1. At minimum, these data elements are essential and must be requested and collected from employers and provided in response to a query:

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C-1.3.1.1.1. Employee name

C-1.3.1.1.2. Employee date of birth

C-1.3.1.1.3. Employee social security number

C-1.3.1.1.4. Employer name

C-1.3.1.1.5. Employer address

C-1.3.1.1.6. Employment status

C-1.3.1.1.7. Position title

C-1.3.1.1.8. Employment dates, including most recent hire date and termination date (if terminated)

C-1.3.1.1.9. Reason for termination, if terminated

C-1.3.1.1.10. Pay rate(s)

C-1.3.1.1.11. Gross earnings, including tips and bonuses

C-1.3.1.1.12. Pay frequency (e.g. hourly)

C-1.3.1.1.13. Pay cycle (e.g. monthly) and pay dates

C-1.3.1.1.14. Number of hours worked in a pay period

C-1.3.1.1.15. Medical insurance information

C-1.3.1.2. These data elements must be provided if collected and available:

C-1.3.1.2.1. Employee address

C-1.3.1.2.2. Employee phone number

C-1.3.1.2.3. Phone number for the custodian of records for the employer

C-1.3.1.3. The EIV database shall have an employer network that shall include the following (below). The Provider shall provide a report of such to the Department. The Provider shall maintain at a minimum the employer levels and types listed in its response to the RFP over the life of the contract.

C-1.3.1.3.1. Large (Fortune 500 companies) as well as smaller companies that employ many individuals at minimum wage or low hourly rates including but not limited to those within the following Standard Occupational Classification (SOC) Major Occupation Groups below and all detailed occupations aggregation levels thereafter, as defined: http://www.bls.gov/soc/soc_structure_2010.pdf

21-0000 Community and Social Services Occupations

31-0000 Healthcare Support Occupations

33-0000 Protective Service Occupations

35-0000 Food Preparation and Serving Related Occupations

37-0000 Building and Grounds Cleaning and Maintenance Occupations

39-0000 Personal Care and Service Occupations

41-0000 Sales and Related Occupations

43-0000 Office and Administrative Support Occupations

45-0000 Farming, Fishing, and Forestry Occupations

49-0000 Instillation, Maintenance, and Repair Occupations

51-0000 Production Occupations

53-0000 Transportation and Material Moving Occupations

http://www.bls.gov/soc/soc_structure_2010.pdf

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C-1.3.1.3.2. Employers nationwide, with a substantial number of employers having a dense statewide presence of jobs in Florida, and a statewide presence in Georgia, and Alabama;

C-1.3.1.3.3. A reliable, aggressive, and effective process for recruiting employers and expanding the number of employers in the network, with a particular focus on recruiting and expanding within Florida, Georgia, and Alabama and including both large and small employers to increase employer participation as outlined in the Employer Network Recruitment and Retention Plan submitted with the proposal to the RFP; implemented over the life of the Contract;

C-1.3.1.3.4. A reliable and effective process for retaining employers in the network as described in the response to the RFP, implemented over the life of the Contract; and

C-1.3.1.3.5. A reliable and effective process for increasing the quantity and improving the accuracy of information in the database as described in the response to the RFP, implemented over the life of the Contract.

C-1.3.2. Provide and operate an EIV system that shall:

C-1.3.2.1. Include an electronic application/interface from the EIV system to employers with the capability to provide both electronic submission of requests to employers and electronic receipt of responses from employers. The service shall not be based on mailing or faxing paper-based employment and income records but shall have the capability to send and receive paper-based employment and income records for those employers without electronic submission capability.

C-1.3.2.2. Include the ability to support a Secure Socket Layer enabled web service based interface that may be invoked by the Department’s systems using Simple Object Access Protocol.

C-1.3.2.3. Provide automated access to the database and an electronic response to an EIV service request (query) through a Department approved interface with the ACCESS Florida systems. Provide a real-time response through the interface for each request sent to the EIV system in accordance with the process identified in a detailed requirements document approved by the Department which will be incorporated into the contract by reference.

C-1.3.2.4. Include the ability to detect employment and income records, using SSN and other limited non-HIPAA demographic information, for verification requests sent by the Department.

C-1.3.2.5. For each individual queried, the EIV system must return a response to the Department even if a match is not found. If a match is found the data elements shall be provided. If a match is not found, the system shall respond likewise. If certain data elements are not available, the system shall respond likewise, however a response of not available will not be considered as a data element provided.

C-1.3.2.6. The system shall return a response for each query that includes, at a minimum:


C-1.3.2.6.2. Date of birth


C-1.3.2.6.4. Employer address

C-1.3.2.6.5. Employment status


C-1.3.2.6.7. Employment dates, including most recent hire date and termination date (if terminated)

C-1.3.2.6.8. Reason for termination, if terminated

C-1.3.2.6.9. Pay rate(s)

C-1.3.2.6.10. Gross earnings, including tips and bonuses

C-1.3.2.6.11. Pay frequency and pay cycle

C-1.3.2.6.12. Pay dates


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C-1.3.2.6.14. Most recent pay period detail which includes pay period beginning and end date, pay date, number of hours worked within pay period, and gross earnings (including tips and bonus, if any) within pay period.

C-1.3.2.6.15. Last 90 days of pay period detail, which includes all items in section C-1.3.2.6.14 (above).

C-1.3.2.7. Include the ability to collect and report current and previous employment and income information going back 90 days. For the EIV system, the Provider shall not consider data a match if all of the information is older than 90 days. If all of the data is older than 90 days for an individual queried, the EIV system shall consider the query not matched and shall respond likewise.

C-1.3.3. Provide an on-line portal with access for Department staff to query the EIV database that provides an immediate real-time response to an EIV service request query from the Department. The portal shall have the capability to provide unique user profiles for Department staff, including an administrator profile that can assign unique user IDs to Department staff and complete password reset. The portal access shall allow queries for current and historical employment data. Portal queries do not have a historical time frame limit; all results must be reported. Results from online queries must be provided in real-time. This portal access shall:

C-1.3.3.1. Initially provide an employment summary that provides evidence of employment, which includes, at a minimum, the following information (below) in response to a query using only the social security number of a client and the option to select a response for further information. This initial employment summary will only be for portal queries and does not constitute a match. Should a response be selected for the detailed employment and income information identified in Section C-1.3.3.2, this will then initiate a billable match.


C-1.3.3.1.2. Date of birth


C-1.3.3.1.4. Employment status of the subject of the query

C-1.3.3.1.5. Last pay period

C-1.3.3.1.6. Provide the option to select further employment and income detail that includes the elements in Section C-1.3.3.2 (below).

C-1.3.3.2. Provide employment and income verification services that include, at a minimum, the following information in response to a query:

C-1.3.3.2.1. Name, address, and phone number for the custodian of records for the employer

C-1.3.3.2.2. Employment start and/or termination date(s)

C-1.3.3.2.3. Length of employment


C-1.3.3.2.5. Yearly gross income

C-1.3.3.2.6. Pay rate(s)

C-1.3.3.2.7. All available current and historical Year To Date gross and net income details, including first and last pay dates and intermittent pay history


C-1.3.3.2.9. Medical information

C-1.3.4. Upon request, provide three (3) web based user training sessions for portal users each contract year at no cost to the Department.

C-1.3.5. Maintain a tracking mechanism that provides data on user access to specific information through the portal. Provide a report (an audit file) of all views or requests of data through the portal.

C-1.3.6. The EIV system and portal access shall be available and operational according to the times listed in section B-4.3., above, excluding scheduled maintenance provided the maintenance is scheduled and the Department is notified pursuant to section C-1.3.6.1, below.

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C-1.3.6.1. Report scheduled maintenance that results in a service outage in writing at least 10 business days in advance of the scheduled maintenance. Maintenance shall be scheduled in a manner that will have the least impact to the Department’s business, during non-peak hours (peak hours are 6:30 AM to 5:00 PM, Monday through Friday). Maintenance schedules must be approved by the Department prior to scheduled maintenance occurring.

C-1.3.6.2. Inform the Department of downtime in writing, preferably by email, immediately upon discovery of the downtime occurring. Provide a Downtime Report within five (5) business days of the downtime that includes the time of the downtime, the duration, a root cause analysis, and resolution.

C-1.3.6.3. Resolution of downtime incidents (complete functioning restored) shall be completed with utmost urgency and shall not exceed the time frame specified in the severity level chart below. During the downtime the Provider shall provide the Department a point of contact with sufficient technical knowledge and authority to resolve downtime issues. The Department will assign a severity level to each incident as defined in the chart below.

Resolution Time Severity Level Tier

Description Resolution

Severity 1 Incidents (Critical)

System processing has stopped, and Department users are unable to perform. No workaround, bypass, or alternative is available. Major service delivery impact condition exists.

Not to exceed 4 hours

Severity 2 Incidents (High)

Key component, application, or critical system is unavailable, degraded or unusable. Processing is severely impacted and no acceptable workaround, alternative or bypass exists.


Severity 3 Incidents (Medium)

Component, minor application or procedure is unavailable or unusable. There is some operational impact, but no immediate impact on service delivery. An acceptable workaround, alternative or bypass exists.


Severity 4 Incidents (Low)

Component, procedure or application (not critical to the Department) is not usable. No impact to business, single incident failure, and a workaround, alternative or bypass is available. Deferred maintenance is acceptable.

Not to exceed 7 business days

C-1.3.6.4. Inform the Department within 24 hours of any downtime or issues the Provider has with its data collection, including but not limited to, interfaces with employers or other data sources.

C-1.3.7. Maintain customer service representation for use the by the Department that provides technical assistance and system problem reporting that shall include, but is not limited to:

C-1.3.7.1. A toll free telephone number and electronic mail address

C-1.3.7.2. Accept and track reports of system outages through resolution

C-1.3.7.3. Acknowledges severity levels and assigns appropriate escalation of incident tickets.

C-1.3.7.4. Technical troubleshooting or operational issues

C-1.3.7.5. Special maintenance functions assistance

C-1.3.7.6. Assistance with security issues

C-1.3.8. Collect data and submit performance measure results as specified in Exhibit D, Deliverables. The Provider shall work with the Department to ensure the reliability of data collected through established reporting formats appropriate to the program.

C-2. ADMINISTRATIVE TASKS

C-2.1. Staffing

C-2.1.1. Staffing Levels.

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C-2.1.1.1. Provider Representative. The Provider shall have a representative, identified in Section 1.2 of the Standard Integrated Contract Part 1, Official Payee and Party Representatives, assigned to administer all aspects of the Contract.

C-2.1.1.2. Project Manager. The Provider shall have a Project Manager with sufficient experience managing projects of this magnitude and nature assigned to oversee provider related activities related to the implementation of an EIV system interface and work with the Department’s Project Manager to ensure the successful implementation of the project.

C-2.1.1.3. The Provider shall maintain, at minimum, the staffing levels specified in the Provider’s response to the RFP. The Provider shall employ sufficient staff to ensure all requirements under this Contract are met in a timely and accurate manner even in the case of absence of staff due to vacations, illness, or other reasons.

C-2.1.1.4. If the Provider cannot meet the tasks and deliverables listed in this contract, the Department may mandate additional staff be added in order to meet the tasks, deliverables, and requirements of the contract in a timely and accurate manner.

C-2.1.2. Staffing Changes. Changes to Provider staff associated with this Contract must be approved by the Department. Upon change or vacancy in any of the full time equivalent staff positions described above or in the Provider’s response to the RFP, the Provider shall notify the Contract Manager, in writing, within five (5) calendar days of the change or vacancy, however any change to the Provider Representative shall be notified within 24 hours of the change, in writing, to the Contract Manager. No changes to primary staff shall be considered final until approved by the Department.

C-2.2. Professional Qualifications

The minimum qualifications of staff described in Section C-2.1.1., above, are described in the position descriptions within the Provider’s response to the RFP.

The Provider’s Project Manager shall have a minimum of five (5) years of experience managing technology related projects, a minimum of five (5) years of experience developing and utilizing project management tools, and possess effective communication skills. It is mandatory that the Project Manager possess a Project Management Professional Certification.

C-2.3. Subcontracting. This Contract allows the Provider to subcontract for the provision services under this contract. Subcontracting shall in no way relieve the Provider of any responsibility for performance of its duties under the terms of this contract. All subcontracting is subject the provisions of Section 4.3 of the Standard Integrated Contract Part 1, Independent Contractor, Subcontracting, and Assignments, of the Contract. Any subcontracting must be approved in advance by the Department’s Contract Manager.

C-2.4. Records and Documentation. The Provider shall maintain the following records and documentation:

C-2.4.1. All source documents or supporting documentation used to determine compliance with performance measures and deliverables.

C-2.4.2. Copies of time documentation for each staff member performing direct services under this contract who is paid in whole or in part with these contract funds to support staff effort.

C-2.5. Reports (programmatic and to support payment)

The Provider shall submit the following report deliverables to the Contract Manager to document the completion of tasks as specified in the units of service Exhibit F, Method of Payment. Pre-Production deliverables shall also be submitted to the Department’s Project Manager. The reports must be received by the Contract Manager in accordance with the listed schedule and prior to the Request for Payment (invoice) and must be approved by the Contract Manager prior to authorizing payment. If the due date for a report falls on a State of Florida approved holiday or weekend, the report shall be due the next business day.

C-2.5.1. Pre-Production Deliverables

# Title Due Date # Copies Contents

1. Project Schedule

Within 15 calendar days of the Contract start date and weekly on Friday’s through the end of the production month.

1 electronic Project Schedule detailing the tasks and deliverables associated with the following: System Development

Interface Document

Design Document

Integration Test Plan

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System and Integration Testing Results

User Acceptance Testing

User Acceptance Testing Approval

System Deployment Plan

Proof of Concept Deployment (if requested)

Data Dictionary

Technical and Design Architecture

Security Plan

Implementation Plan

System Requirements Document

2. System Development Deliverables

Each deliverable identified within the Project Schedule shall be delivered by the date specified in the Project Schedule.

1 electronic each

All deliverables and documents listed under System Development, above, and any other deliverables identified in the Project Schedule.

3. Status Report Within 15 calendar days of the Contract start date and weekly on Fridays by NOON through the end of the production month

1 electronic Report on the following:

Project Performance (Schedule, Risks, Issues)

Key Activities Completed

Upcoming Key Activities

4. Proof of Concept Report

Within 15 calendar days following each month of the POC

For EIV POC include monthly metrics for:

Total queries during reporting period

Number of queries sent

Total number of responses with employment income data provided (matches)

Total number of responses with no match found

Percent of queries matched

Percent of responses within 10 seconds of the request

Portal availability

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C-2.5.2. Production Deliverables


1. Employer Network Report

Due the 15th of every month for the previous calendar month

1 electronic Status of Employer Network including at a minimum:

Reporting period

Total # of employers in network

Total # of employment positions

The number and % of employers and employment positions with a presence in Florida

The number and % of employers and employment positions with a presence in Georgia

The number and % of employers and employment positions with a presence in Alabama

The number and % of employers and employment positions with a presence in all other states combined

The number and % of employers and employment positions within each of the SOC major occupation groups as defined by C-1.3.1.3.1

The combined total number and % of employers and employment positions within said SOC major occupation groups as defined by C-1.3.1.3.1

Status of Recruitment and Retention:

The number and % of increase or decrease of employers in network, as compared to Network levels in RFP response, and as compared to the previous reporting period following the initial reporting period.

The number and % of increase or decrease of employment positions in network, as compared to Network levels in RFP response, and as compared to the previous reporting period following the initial reporting period.

Major employers, large numbers of employment positions and data sources added or deleted during the reporting period

2. EIV System Report

Due weekly on Mondays by NOON beginning the week of implementation, then bi-weekly thereafter

1 electronic For EIV system interface include weekly metrics for:

Reporting period (Sunday – Saturday)

Total number of requests (queries)

Total number of matches

Total number of no matches found

Overall total number of responses

Total # of and Percent of responses within 10 seconds of the request

Number of hours/minutes of EIV System availability per day and summed by week and month, as required by section B-4.3.2.

Date, time, duration (minutes/hours) of scheduled maintenance that occurred during reporting period.

Number and % of required data elements returned as “available” to the Department and containing the data information requested, for EIV System matches calculated by week and by month.

Number and % of required data elements in the query matches that returned EIV information as deemed not available

List the top 3 required data elements that are returned as not

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available

3. Downtime Report Due within 5 days of downtime occurrences.

1 electronic Report includes (at a minimum):

Date and time outage occurred

Date and time system was restored

The duration of outage

The time that it took to identify service delivery deficiencies

The root cause analysis of such deficiencies

The resolution identification and implementation plan

4. Technical Support and Customer Service Resolution Report



Date and time incident reported by the department

Incident ticket number (or unique identifier)

Severity Level Assigned

# of minutes/hours between each escalation

# of minutes/hours/days from report to resolution

Resolution action description for each incident

Total # of Incident tickets per month per Severity Level

Total # of Incidents and percent resolved per Severity Level within the timeframes stipulated in section C-1.3.6.3.

5. Portal Report Due the 15th of every month for the previous calendar month

1 electronic For EIV portal include monthly metrics for:

Total queries during reporting period

Number of employment data requests by user

Number of income data requests by user

Total number of responses with employment summary provided

Total number of responses with employment and income data provided (matches)

Total number of responses with no employment found

Percent of responses within 10 seconds of the request

Number of hours/minutes of portal availability per day and summed by week and month, as required by section B-4.3.3.

Date, time, duration (minutes/hours) of scheduled maintenance that occurred during reporting period.

Number and % of required data elements returned as “available” to the Department and containing the data information requested, for Portal matches calculated by week and by month.

Number and % of data elements in the query matches that returned EIV information as deemed not available

6. Portal User Tracking Report

Due the 15th of every month for the previous calendar month and as requested


User name

User ID/ account name

Record accessed/viewed (last 4 of social security number)

Date and time was accessed/ viewed

7. Monthly Production Performance Measure Compliance Report


1 electronic Exhibit E, Section E-3, Monthly Production Performance Measure Compliance Report

C-2.6. Delivery of reports shall not be construed to mean acceptance of those reports; acceptance of required reports shall constitute a separate act and must be approved by the Contract Manager as such.

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C-2.7. The Department reserves the right to reject reports as incomplete, inadequate, or unacceptable. The Provider shall, without additional compensation, correct or revise any incomplete, inadequate, or unacceptable reports. The Department, at its option, may allow additional time for the Provider to remedy the objections noted by the Department, or the Department may, after giving the Provider a reasonable opportunity to make a report complete, adequate, or acceptable to the Department declare this contract to be in default.

C-2.8. The Provider shall work with the Department to ensure the reliability of data collected through established reporting formats appropriate to the program.

C-2.9. The Provider shall deliver the following documents to the Contract Manager each state fiscal year. If the due date for a document falls on a State of Florida approved holiday or weekend, the document shall be due the next business day.


1. General Liability Insurance

Within 30 days of policy expiration date thereafter

1 PDF Begin and end dates and statement of General Liability insurance

2. Employment Screening Affidavit

By June 30 of each state fiscal year

1 PDF Provided by Contract Manager

3. Civil Rights Checklist

By June 30 of each state fiscal year

1 PDF Form 946

4. Financial and Compliance Audit

Per Financial and Compliance Audit Attachment I

Per Attachment I

Per Financial and Compliance Audit Attachment I

C-3. STANDARD CONTRACT REQUIREMENTS Provider will perform all acts required by Sections 4, 5, 7, 8 and 9 of the Standard Contract.

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EXHIBIT D – DELIVERABLES

D-1. Deliverables. The production units of service (matches) are defined in section A-1.8. Units of service include all tasks associated with production and ongoing services (Exhibit C). Each unit of service shall be delivered in accordance with terms and conditions of this Contract and performed in a manner acceptable to the Department. There are two types of matches, EIV System matches and portal matches.

D-2. Performance Requirements. The Provider shall demonstrate satisfactory delivery of service in accordance with Exhibit C, Service Tasks, through submission of the Reports listed under Pre-production and Production Deliverables specified in Exhibit C, Section C-2.5, Reports.

D-3. Minimum Performance Levels. See Exhibit E – Minimum Performance Measures.

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EXHIBIT E – MINIMUM PERFORMANCE MEASURES

E-1. MINIMUM PERFORMANCE MEASURES. See Section E-3, Monthly Production Performance Measure Compliance, for the description of performance measures.

E-2. Performance Evaluation Methodology

E-2.1. Mathematical Formula - See Section E-3 Monthly Production Performance Measure Compliance Report.

E-2.2. Collection Methodology - See Section E-3, Monthly Production Performance Measure Compliance Report.

E-3. Monthly Production Performance Measure Compliance Report. The Provider will use the Monthly Production Performance Measure Compliance Report below for performance reporting.

Monthly Production Performance Measure Compliance Report for Month/Year: ______________.

# Production Performance Measures

Performance Evaluation Methodology

Collection Methodology

Performance Measure Results

Liquidated Damage for Failure to Meet %

Compliance

1 Response Time Metrics for the EIV System Complete query responses shall be received within 10 seconds of transmission request 99.5% of the time.

The number of query responses received within 10 seconds of request divided by the total number of queries sent during the reporting period. Calculations are reported per calendar month.

EIV Systems Report

In the event that less than 99.5% of total number of transactions per month are not received in 10 seconds or less, the Department shall be entitled to deduct 10% per 0.5 (1/2) percentage point below the 99.5% threshold, from the total dollar amount invoiced on the monthly Request for Payment (invoice).

2 Response Time Metrics for the EIV Portal Complete query responses shall be received within 10 seconds of transmission request 98% of the time.

The number of portal query responses received within 10 seconds of request divided by the total number of queries sent during the reporting period. Calculations are reported per calendar month.

Portal Report In the event the response times do not meet 10 seconds for 98% of the requests, the Department shall be entitled to deduct 10% per 1 percentage point below the 98% threshold, from the total dollar amount invoiced on the monthly Request for Payment (invoice).

3 EIV System Data Elements Of the EIV System queries retuned to the Department as a “match”, a minimum of 80% of the required data elements shall be provided and contain the data information requested, as defined in sections C-1.3.2.6 of the Contract.

The total number of required data elements queried through the EIV System divided by the total number of required data elements returned containing the data information requested, for the EIV System matches per reporting period. Calculations are reported per calendar month.

EIV System Report

In the event less than 80% of the required data elements are returned the Department shall be entitled to deduct 3% from the total dollar amount invoiced on the monthly Request for Payment (invoice) and an additional 2% per 5 percentage points below 80%.

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Compliance

4 Portal Data Elements Of the EIV Portal queries retuned to the Department as a “match”, a minimum of 80% of the required data elements shall be provided and contain the data information requested, as defined in sections C-1.3.3.2 of the Contract.

The total number of required data elements queried through the EIV Portal divided by the total number of required data elements returned containing the data information requested, for Portal matches per reporting period. Calculations are reported per calendar month.

Portal Report In the event less than 80% of the required data elements are returned the Department shall be entitled to deduct 3% from the total dollar amount invoiced on the monthly Request for Payment (invoice) and an additional 2% per 5 percentage points below 80%.

5 Employer Network Employers Minimum of a 10% increase annually of employers providing EIV information for jobs in Florida within the provider’s employer network

The number of employers in the provider’s employment network, providing EIV information for jobs within Florida at the start of the reporting period divided by the number of employers in the provider’s employment network providing EIV information for jobs within Florida at the end of the 12 month reporting period.

Employer Network Report

In the event that the number of employers, in the Provider’s network, providing EIV information for jobs within Florida with does not increase by at least 10% per 12 months, from the effective date of the contract the Department shall be entitled to deduct 3% per percentage point below the targeted measure from the total dollar amount invoiced on the monthly Request for Payment (invoice).

6 Employer Network Employment Positions Minimum of a 10% increase annually in the number of employment positions, providing EIV information for jobs within Florida within the provider’s employer network.

The number of employment positions in the provider’s employment network providing EIV information for jobs within Florida at the start of the reporting period divided by the number of employment positions in the provider’s employment network providing EIV information for jobs within Florida at the end of the 12 month reporting period.

Employer Network Report

In the event the number of employment positions in the provider’s employment network, providing EIV information for jobs within Florida does not increase by at least 10% per 12 months, from the effective date of the contract the Department shall be entitled to deduct 3% per percentage point below the targeted measure from the total dollar amount invoiced on the monthly Request for Payment (invoice).

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Compliance

7 Systems Availability a) The EIV system shall have an overall system up time of at least 99.9% or less than 43 minutes of unscheduled downtime per month and b) the portal shall have an overall system up time and be accessible at least 95% of the time, equaling less than 12 hours of unscheduled downtime per month. Any scheduled maintenance that occurs without written prior approval of the Department will be considered as unscheduled downtime and could reflect as system unavailability and shall be remedied as such.

a) Total # of minutes the EIV System is available divided by the total number of minutes of scheduled uptime per calendar month and b) total # of minutes the portal is available and accessible divided by the total number of minutes of scheduled uptime per calendar month. Scheduled Uptime is the total number of minutes that month during the scheduled operational hour’s availability windows as defined for the EIV System in section B-4.3.2. of the contract and as defined in section B-4.3.3. for the portal, minus the total number of minutes that each system is unavailable as a result of scheduled downtime

EIV System Report and Portal Report

a) In the event the Provider’s EIV System is available less than 99.9% of the time (excluding approved schedule maintenance), the Department shall be entitled to deduct 10% of the service month amount per 0.10 percentage point below such thresholds from the monthly Provider’s Request for Payment (invoice). This reduction shall occur until the performance measures are met. And b) in the event the Provider’s EIV System is available less than 95% of the scheduled operational hours, the Department shall be entitled to deduct 10% of the service month amount per 0.5 (½) percentage point below such thresholds from the Provider’s monthly Request for Payment (invoice). This reduction shall occur until the performance measures are met

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Compliance

8

Technology Resolution Time shall have an incident resolution time based on the following severity levels: 1) Severity 1 - Critical 100% of incidents shall be resolved within 4 hours of incident report.

2) Severity 2 - High 100% of incidents shall be resolved within 8 hours of incident report.

3) Severity 3 - Medium 98% of incidents shall be resolved or have an “approved workaround” within 36 hours of incident report.

4) Severity 4 - Low 80% of incidents shall be resolved or have an “approved workaround” within 7 business days of incident report.

Total number of incidents by severity level resolved within specified timeframe divided by the total number of incidents by severity level. Calculated by incidents per calendar month.

.

Technical Support and Customer Service Resolution Report

If the Provider fails to resolve the required percentage of incidents within the specified time frames the Department shall be entitled to deduct the percentage below, listed by severity level, from the monthly Request for Payment (invoice). 1) Severity 1 - 10% 2) Severity 2 - 8% 3) Severity 3 - 5% 4) Severity 4 - 2%

Authorized Signature Date

E-4. Corrective Action. In the event Provider fails to meet any of the eight (8) enumerated Performance Measures and the Department has subsequently notified the Provider in writing that it intends to apply the liquidated damages applicable to such failure as set forth on this Exhibit E, Section E-3, then, the Provider shall submit a written plan documenting its intentions to provide a root cause analysis and to correct the specific Performance Measure deficiencies within the following three consecutive months and the specific actions it will take to do so.

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EXHIBIT F - METHOD OF PAYMENT

F-1. All Pre-Production tasks shall be performed by the Provider at no cost to the Department, including any proof of concept activities.

F-2. No Production tasks for which payment is expected under this contract shall be completed until the Provider is notified in writing by the Department’s Contract Manager of the Department’s approval of the system for production.

F-3. This is a fixed price (unit cost) contract. The Department will pay the Provider for the delivery of service units provided in accordance with the terms and conditions of this contract for a total dollar amount not to exceed the following:

F-3.1. $1,500,000.00 for state fiscal year 2016-2017, subject to the availability of funds;

F-3.2. $TBD for state fiscal year 2017-2018, subject to the availability of funds;

F-3.3. $TBD for state fiscal year 2018-2019, subject to the availability of funds; and

F-3.4. $TBD for state fiscal year 2019-2020, subject to the availability of funds, for a total contract amount not to exceed $TBD.

F-4. This contract is funded by FY 2016-2017 Appropriation Line Item 364.

F-5. The Department will pay for the service units at the unit prices and limits listed below:

F-5.1. State Fiscal Year 2016-2017 (Dec. 16 – Jun. 30)

Service Unit Unit Price Maximum # of units Total

EIV system matches

Completion of each EIV System employment and income verification match; documented through the approved EIV System Report

$TBD $TBD

Portal matches

Completion of each employment and income verification match through the portal; documented through the approved Portal Report

Total $TBD

F-5.2. State Fiscal Year 2017-2018


EIV system matches


$TBD $TBD

Portal matches


Total $TBD

F-5.3. State Fiscal Year 2018-2019

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EIV system matches


$TBD $TBD

Portal matches


Total $TBD

F-5.4. State Fiscal Year 2018-2019 (Jul. 1 – Dec. 15)


EIV system matches


$TBD $TBD

Portal matches


Total $TBD

F-6. Invoice Requirements

F-6.1. The Provider shall request payment for service units, as defined by Exhibit F, on a monthly basis within 15 calendar days following the end of the month for which payment is being requested.

F-6.2. Payments may be authorized only for service units on the invoice, which are in accord with the above list, and other terms and conditions of this contract. The service units for which payment is requested may not either by themselves, or cumulatively by totaling service units on previous invoices, exceed the total number of units authorized by this contract.

F-7. REFER TO EXHIBIT F1 (Optional)

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EXHIBIT F1 –ADDITIONAL FINANCIAL CONSEQUENCES (Optional)

The following financial consequences apply in addition to the Financial Consequences provided in Section 6.1 of this Contract

F1-1. See Liquidated Damage for Failure to Meet % Compliance in Section E-3, Monthly Production Performance Measure Compliance Report.

F1-2.

F1-3.

F1-4.

F1-5.

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ATTACHMENT 1

The administration of resources awarded by the Department of Children & Families to the provider may be subject to audits as described in this attachment.

MONITORING

In addition to reviews of audits conducted in accordance with 2 Code of Federal Regulations (CFR) §§ 200.500- 200.521 and § 215.97, F.S., as revised, the Department may monitor or conduct oversight reviews to evaluate compliance with contract, management and programmatic requirements. Such monitoring or other oversight procedures may include, but not be limited to, on-site visits by Department staff, agreed-upon procedures engagements as described in 2 CFR § 200.425 or other procedures. By entering into this agreement, the recipient agrees to comply and cooperate with any monitoring procedures deemed appropriate by the Department. In the event the Department determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the Department regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Department’s inspector general, the state’s Chief Financial Officer or the Auditor General.

AUDITS

PART I: FEDERAL REQUIREMENTS

This part is applicable if the recipient is a State or local government or a non-profit organization as defined in 2 CFR §§ 200.500-200.521.

In the event the recipient expends $500,000 ($750,000 for fiscal years beginning on or after December 26, 2014) or more in Federal awards during its fiscal year, the recipient must have a single or program-specific audit conducted in accordance with the provisions of 2 CFR §§ 200.500-200.521. The recipient agrees to provide a copy of the single audit to the Department’s Single Audit Unit and its contract manager. In the event the recipient expends less than $500,000 ($750,000 for fiscal years beginning on or after December 26, 2014) in Federal awards during its fiscal year, the recipient agrees to provide certification to the Department’s Single Audit Unit and its contract manager that a single audit was not required. In determining the Federal awards expended during its fiscal year, the recipient shall consider all sources of Federal awards, including Federal resources received from the Department of Children & Families, Federal government (direct), other state agencies, and other non-state entities. The determination of amounts of Federal awards expended should be in accordance with guidelines established by 2 CFR §§ 200.500-200.521. An audit of the recipient conducted by the Auditor General in accordance with the provisions of 2 CFR Part 200 §§ 200.500-200.521 will meet the requirements of this part. In connection with the above audit requirements, the recipient shall fulfill the requirements relative to auditee responsibilities as provided in 2 CFR § 200.508.

The schedule of expenditures should disclose the expenditures by contract number for each contract with the Department in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department shall be fully disclosed in the audit report package with reference to the specific contract number.

PART II: STATE REQUIREMENTS

This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2), Florida Statutes.

In the event the recipient expends $500,000 or more in state financial assistance during its fiscal year, the recipient must have a State single or project-specific audit conducted in accordance with Section 215.97, Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. The recipient agrees to provide a copy of the single audit to the Department’s Single Audit Unit and its contract manager. In the event the recipient expends less than $500,000 in State financial assistance during its fiscal year, the recipient agrees to provide certification to the Department’s Single Audit Unit and its contract manager that a single audit was not required. In determining the state financial assistance expended during its fiscal year, the recipient shall consider all sources of state financial assistance, including state financial assistance received from the Department of Children & Families, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements.

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In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 or 10.650, Rules of the Auditor General.

The schedule of expenditures should disclose the expenditures by contract number for each contract with the Department in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due the Department shall be fully disclosed in the audit report package with reference to the specific contract number.

PART III: REPORT SUBMISSION

Any reports, management letters, or other information required to be submitted to the Department pursuant to this agreement shall be submitted within 180 days after the end of the provider’s fiscal year or within 30 (federal) or 45 (State) days of the recipient’s receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes:

A. Contract manager for this contract (1 copy)

B. Department of Children & Families ( 1 electronic copy and management letter, if issued )

Office of the Inspector General Single Audit Unit Building 5, Room 237 1317 Winewood Boulevard Tallahassee, FL 32399-0700

Email address: [email protected]

C. Reporting packages for audits conducted in accordance with 2 CFR Part 200 §§ 200.500-200.521, and required by Part I of this agreement shall be submitted, when required by § 200.512 (d) by or on behalf of the recipient directly to the Federal Audit Clearinghouse using the Federal Audit Clearinghouse’s Internet Data Entry System at:

http://harvester.census.gov/fac/collect/ddeindex.html and other Federal agencies and pass-through entities in accordance with 2 CFR § 200.512.

D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address:

Auditor General Local Government Audits/342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399-1450 Email address: [email protected]

Providers, when submitting audit report packages to the Department for audits done in accordance with 2 CFR §§ 200.500-200.521, or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for-profit organizations), Rules of the Auditor General, should include, when available, correspondence from the auditor indicating the date the audit report package was delivered to them. When such correspondence is not available, the date that the audit report package was delivered by the auditor to the provider must be indicated in correspondence submitted to the Department in accordance with Chapter 10.558(3) or Chapter 10.657(2), Rules of the Auditor General.

PART IV: RECORD RETENTION

The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years from the date the audit report is issued and shall allow the Department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the Department or its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by the Department.

CF 1120 (CF-1120-1516)

Effective April 2016

mailto:[email protected]

http://harvester.census.gov/fac/collect/ddeindex.html

mailto:[email protected]

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ATTACHMENT 2

CERTIFICATION REGARDING LOBBYING

CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature:____________________________________

Date:_______________

Application or Contract ID Number:_________________________________________________________ Name of Authorized Individual Application or Contractor:________________________________________ Address of Organization:_________________________________________________________________ _____________________________________________________________________________________ CF 1123 (CF-1123-1516) Effective July 2015

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ATTACHMENT 3

Contract No. __________

CERTIFICATION REGARDING

DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION

CONTRACTS/SUBCONTRACTS

This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, signed February 18, 1986. The guidelines were published in the May 29, 1987 Federal Register (52 Fed. Reg., pages 20360 - 20369).

INSTRUCTIONS 1. Each provider whose contract/subcontract equals or exceeds $25,000 in federal moneys must sign this certification prior to execution

of each contract/subcontract. Additionally, providers who audit federal programs must also sign, regardless of the contract amount. The Department of Children and Families cannot contract with these types of providers if they are debarred or suspended by the federal government.

2. This certification is a material representation of fact upon which reliance is placed when this contract/subcontract is entered into. If it is later determined that the signer knowingly rendered an erroneous certification, the Federal Government may pursue available remedies, including suspension and/or debarment.

3. The provider shall provide immediate written notice to the contract manager at any time the provider learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

4. The terms “debarred”, “suspended”, “ineligible”, “person”, “principal”, and “voluntarily excluded”, as used in this certification, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the department’s contract manager for assistance in obtaining a copy of those regulations.

5. The provider agrees by submitting this certification that, it shall not knowingly enter into any subcontract with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this contract/subcontract unless authorized by the Federal Government.

6. The provider further agrees by submitting this certification that it will require each subcontractor of this contract/subcontract, whose payment will equal or exceed $25,000 in federal moneys, to submit a signed copy of this certification.

7. The Department of Children and Families may rely upon a certification of a provider that it is not debarred, suspended, ineligible, or voluntarily excluded from contracting/subcontracting unless it knows that the certification is erroneous.

8. This signed certification must be kept in the contract manager’s contract file. Subcontractor’s certification must be kept at the provider’s business location.

CERTIFICATION (1) The prospective provider certifies, by signing this certification, that neither he nor his principals is presently debarred, suspended,

proposed for debarment, declared ineligible, or voluntarily excluded from participation in this contract/subcontract by any federal department or agency.

(2) Where the prospective provider is unable to certify to any of the statements in this certification, such prospective provider shall attach an explanation to this certification.

_______________________________________________________________ _____________________

Signature Date

__________________________________________________ ____________________________________

Name (type or print) Title

CF 1125 (CF-1125-1516)

Effective July 2015

exhibit a special provisions a-1. … · exhibit a – special provisions ... the provider shall...

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