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ÐServices€(Ô_ÔDHSÔ_Ô),€Office€of€Information€Services€(Ô_ÔOISÔ_Ô),€Project€Management€Office€(Ô_ÔPMOÔ_Ô),€and€the€Office€of€Contracts€and€Ô_ÔProcurementsÔ_Ô€(OC&P)Ïfor€use€as€an€example€of€contracts€content€information.€€The€intent€of€the€contract€example€is€to€assist€staff€with€contract€creation€by€providingÏPersonal€Service€Contract€examples,€guidelines,€and€standards.Ì€ÌNeither€the€Ô_ÔDHSÔ_Ô,€Ô_ÔOISÔ_Ô,€Ô_ÔPMOÔ_Ô,€Ô_ÔOCPÔ_Ô,€Ô_ÔDOJÔ_Ô,€DAS,€Ô_ÔIRMDÔ_Ô€nor€any€other€agency€or€entities€thereof,€assumes€any€legal€liability€or€responsibility€for€theÏaccuracy,€completeness,€or€usefulness€of€any€information,€product€or€process€disclosed€in€these€examples.ÌÌReference€herein€to€any€specific€commercial€product,€process,€service€by€trade€name,€trademark,€manufacturer,€vendor,€or€otherwise,€does€notÏconstitute€or€imply€its€endorsement,€recommendation,€or€favoring€by€the€Department€of€Human€Services,€the€State€of€Oregon,€or€any€entities€thereof.ÌÌThe€views€and€opinions€of€the€originators€expressed€therein€do€not€necessarily€state€or€reflect€those€of€the€Ô_ÔDHSÔ_Ô,€Ô_ÔOISÔ_Ô,€Ô_ÔPMOÔ_Ô,€Ô_ÔOCPÔ_Ô,€or€any€agency€orÏentities€thereof.€€Text€taken€from€these€examples€and€used€to€develop€similar€solicitations€and€contracts€will€not€replace€the€appropriate€stepsÏnecessary€for€Ô_Ôapproval.Ô#†XåSXÂÂÆÉÿ#Ôò òñìññíñÐ H ð  ÐñíñÔ_ÔÔ_ÔñíñÐ H ð  ÐñíñÔ_ÔÔ_ÔñíñÐ H ð  ÐñíñÔ_Ôà ` àà ¸ àà  àÐ H ð  Ðà ° àà  àà ` àà ¸ àà  àà h àà À àà  àà p àÌà ° àà  àà ` àÌÌContract€#€100155ó óÐ ¼d  Ðà ° àà  àà ` àà ¸ àà  àà h àà À àà  àà p àà È àà  àà x àà Ð àÌò òÓ  ÓÌState€of€OregonÌPersonal/Professional€Services€Contractó óÐ l ÐÓ² ÓÌÓ  ÓThis€contract€is€between€the€State€of€Oregon€acting€by€and€through€its€Department€of€Human€Services,€Office€ofÏInformation€Services,€hereinafter€referred€to€as€ð ðò òÔ_ÔDHSÔ_Ôó ó,ðð€and€Ð 0Ø ÐÔ‡ÂÆÉÂXXåSÔ€Ô#†XåSXÂÂÆÉ#ÔÐ  È ÐÓ  Óò òDavid€Ô_ÔHowitzÔ_ÔÐ Ðx Ð13825€Melrose€PlaceÌLake€Oswego€OR€97035ó óÐ ¨P Ðò òÓoÓó óÌhereinafter€referred€to€as€"Contractorðð.ÌÌò òÓ'X,X˜X°œX'ÓI.à0  àEFFECTIVE€DATE€and€DURATIONó óÐX €%€% ÐThis€contract€shall€become€effective€on€the€date€this€contract€has€been€signed€by€every€party€hereto,€and,€whenÏrequired,€approved€by€Department€of€Administrative€Services€and€Department€of€Justice.€Unless€terminated€orÏextended,€this€contract€shall€expire€when€Ô_ÔDHSÔ_Ô€accepts€Contractorððs€completed€performance€or€onò ò€September€11,Ð Ä# Ð2001ó ó,€whichever€date€occurs€first.€€Expiration€shall€not€extinguish€or€prejudice€Ô_ÔDHSÔ_Ôððs€right€to€enforce€this€contractÐ  ´$ Ðwith€respect€to€any€breach€of€a€Contractorððs€warranty€or€any€default€or€defect€in€Contractor€performance€that€hasÏnot€been€cured.ÌÌò òII.à0  àPURPOSEó óÐÀ#h!(€%€% ÐThis€contract€provides€for€Information€Technology€services€to€enhance€and/or€maintain€Ô_ÔDHSÔ_Ôððs€systems€includingÏanalyzing,€designing,€construction,€testing€and€implementing€identified€system€changes€and€providing€requiredÏdocumentation.ÌÌò òIII.à0  àSTATEMENT€of€WORKó óÐ\(&-€%€% ÐThe€statement€of€work€(the€ð ðWorkðð)€including€the€delivery€schedule€for€such€work€is€contained€in€Exhibit€A,Ïattached€and€incorporated€by€reference€into€this€contract.€€Contractor€agrees€to€perform€the€work€in€accordance€withÏthe€terms€and€conditions€of€this€contract.ÌÔ_ÔÌâ âò òIV.à0  àCONSIDERATIONó óÐø, *2€%€% ÐÑ$[ÇÑâ $âÑTRXà3Ø' LetterY$3Ø'letterhead3Ø' Letter3Ø'letterheadTÑÑÑÑ  ÑÖ€ÿÿÖâ $âÑ  Ñò òAó ó.à0  àDHS€agrees€to€pay€Contractor€for€accomplishing€the€Work€as€required€by€this€contract,€plus€any€allowableÐ X Ðâ âexpenses€and€any€travel€and€other€expense€reimbursement€when€noted€herein.€€Payment€for€all€work€performedÏunder€this€contract€shall€be€subject€to€the€provisions€of€ORS€293.462€and€shall€not€exceed€the€total€maximumÏsum€of€$5,000.00.Ð €%€% Ðò òÔ‡&Y%XXåSÔB.)ó óà0  àÔ#†XåSX%&Y#ÔInterim€payments€shall€be€made€to€Contractor€following€DHSððs€review€and€approval€of€invoices€submittedÐ ¨+P)- Ðby€Contractor.Ð €%€% Ðâ âà  àÐ €-(+/ ÐÑ$[ÇÑâ $âÑTRXà3Ø' LetterY$3Ø'letterhead3Ø' Letter3Ø'letterheadTÑÑÑÑ  ÑÖ€ÿÿÖâ $âÑ  Ñò òCó ó.à0  àContractor€shall€not€submit€invoices€for,€and€DHS€will€not€pay,€any€amount€in€excess€of€the€maximumÐ   Ðâ âcompensation€amount€set€forth€above.€€If€this€maximum€compensation€amount€is€increased€by€amendment€ofÏthis€contract,€the€amendment€must€be€fully€effective€before€Contractor€performs€work€subject€to€theÏamendment.€€Contractor€shall€notify€DHS's€Contract€Administrator€in€writing€thirty€(30)€calendar€days€beforeÏthis€contract€expires,€of€the€upcoming€expiration€of€the€contract.€No€payment€will€be€made€for€any€servicesÏperformed€before€the€beginning€date€or€after€the€expiration€date€of€this€contract,€as€it€may€be€amended€fromÔ‡&Y%XXåSÔò òЭ €%€% ÐÔ#†XåSX%&Y–#Ôó ó€à  àtime€to€time€in€accordance€with€its€terms.€Ð ™Œ Ðò òÌD.ó óà0  àContractor€shall€submit€monthly€invoices€for€work€performed.€€The€invoices€shall€describe€all€work€performedÐ q d Ðwith€particularity€and€by€whom€it€was€performed€and€shall€itemize€and€explain€all€expenses€for€whichÏreimbursement€is€claimed.€€The€invoices€shall€also€include€the€total€amount€invoiced€to€date€by€ContractorÏprior€to€current€invoice.€€Contractor€will€specifically€note€the€appropriate€invoice€when€one„third€and€two„¼thirds€of€the€maximum€contract€amount,€including€expense€reimbursement,€has€been€expended.€€ContractorÏshall€send€invoices€to€DHSððs€Contract€Administrator€(see€E.,€below).Ð €%€% ÐÌò òE.ó óà0  àThe€DHS€employee€assigned€to€monitor€contract€compliance,€authorize€payment€and€act€as€DHSððs€ContractÐ éÜ  ÐAdministrator€on€matters€concerning€this€contract€shall€be:Ð €%€% ÐÌà  àKristen€Duus€or€delegateÌà  àOffice€of€Information€ServicesÌà  àOregon€Department€of€Human€ServicesÌà  à500€Summer€St,€NEÌà  àSalem€OR€97310Ìà  àÔ‡&Y%XXåSÔà  àÌò òÔ#†XåSX%&YŒ#ÔV.à0  àTRAVEL€and€PER€DIEMÔ‡&Y%XXåSÔÐ%€%€% Ðó óÔ#†XåSX%&Yÿ#ÔNo€travel€or€other€expenses€shall€be€paid€in€addition€to€the€cost€herein.Ð  Ðò òÌVI.à0  àCONTRACT€in€its€ENTIRETYó óÐéÜ€%€% ÐÓ3X,XÏS` —XX,X˜X3ÓThis€Contract€consists€of€this€document€and€includes€the€following€listed€exhibits€which€are€listed€in€descendingÏorder€of€precedence€and€are€attached€and€incorporated€into€this€Contract€by€reference:Ìò òÌA.ó óà0 Ï àExhibit€A:à0SÏ€%Ï€%àStatement€of€WorkЙŒS€%S€% Ðò òB.ó óà0 Ï àExhibit€B:à0SÏ€%Ï€%àGeneral€ProvisionsЉ| S€%S€% Ðò òC.ó óà0 Ï àExhibit€C:à0SÏ€%Ï€%àCertification€Statement€for€Independent€ContractorÐy l!S€%S€% Ðò òD.ó óà Ï àExhibit€D:à0 S àConfidentiality€AgreementÐi!\"S€%S€% ÐØØÓL€ 4º½(3 LÓÝ ‚3£ ÝÝ  Ýò òÝ‚3£ ÝÔ2º½ÔÚ  ÚEÚ  Ú.Ô3  Ôà0 Ï àÝ  Ýó óExhibit€E:à0SÏ€%Ï€%àCriminal€History€Agreement݃3£ NÝŒÐY"L #S€%S€% ÐŒÝ  ÝØØÓL€ ª½((4LÓò òF.ó óà Ï àExhibitò ò€ó óF:à0 S àContractorððs€ProposalÐI##ÔÔ‡&¢%%XX±èÔò òÌÔ#†X±èX%&¢% ?#ÔÔ‡&¢%%XX±èÔC.à0  àÔ#†X±èX%&¢%O?#ÔÓ€š:>ÓÓš€ÓÔ‡&¢%%XX±èÔREVIEWED:Ô#†X±èX%&¢%Ç?#ÔÔ‡&¢%%XX±èÔó óÐB%5#1€%€% Ðò òÔ#†X±èX%&¢%@#ÔÔ‡^Ô_XX±èÔÌó óÔ#†X±èX_^Ôy@#ÔÔ‡&¢%%XX±èÔà  àBy:òò€à Ò àà * àà ‚ àà  àà 2 àóóà Š àDate:_______________€€Ô#†X±èX%&¢%¿@#ÔÔ‡&¢%%XX±èÔà ê$ à€Ð É&¼$3 Ðà  à€Ô#†X±èX%&¢%uA#ÔÔ‡ôÙÒ õXX±èÔDwight€Endicott,€DHS/OIS€Contracts€Coordinator,€Department€of€Human€Services,€or€delegateÓ€šµ?ÓÔ#†X±èX õôÙÒæA#Ôò òó óÐ »'®%4 ÐÓ  ÓÓš€ÓÓ¼ÓÑ8€»òòdÊXXdê8Ñò òÐ  )ø&6 ÐÑ3P+Ñâ 3âÑ‚Ñâ 3âÑ  ÑExhibit€AÌStatement€of€WorkÌÓ²BÓòòAcknowledged€and€Agreed€by€the€Parties:òòóóó óÐ ©œ ÐóóÓ¼ÐBÓÓ€š¾BÓÓ€ÓThe€Contractor€shall€provide€system€design€and€programming€services,€including€GUI€design,€PowerBuilder€7.0,Ð wj ÐSybase€Adaptive€Server€Enterprise,€Direct€Connect,€and€Sybase€Open€Server€for€CICS,€CICS,€VSAM€file€structures€Ïand€DB2€databases.Ìà  àÌThe€tasks€shall€be€performed€using€established€DHS/OIS€development,€maintenance€and€acceptance€criteriaÏmethodologies€set€forth€in€DHSððs€Information€Systems€Standards€and€Procedures€Manual.€€Written€€documentationÏshall€be€€updated€and€stored€€in€established€DHS/OIS€libraries€using€existing€DHS/OIS€documentation€standards€setÏforth€in€DHSððs€Information€Systems€Standards€and€Procedures€Manual.€ÌÌò òó óIn€the€absence€of€established€DHS/OIS€development,€maintenance€and€acceptance€criteria€methodologies,€€ContractorÐ ± ¤  Ðshall€complete€all€work€described€in€the€Statement€of€Work€according€to€methodologies€and€standards€that€conformÏto€documentation€standards,€definitions,€and€recommended€practices€known€to€be€generally€accepted€in€the€industry,Ïunless€otherwise€approved€in€writing€by€DHS.ò òÐ ob  ÐÌTask€#1:ó ó€Ð E8 ÐÓL‡ 5h((LÓØØThe€Contractor€shall€implement€DHS€business€rules€for€the€integration€of€TRACS€and€JOBS€Automated€SystemÏ(JAS)€including€required€stored€procedures€and€application€coding€within€TRACS.Ìò òÔ‡)Xø›XXX±èÔó óÌÔ#†X±èXX)Xø›ÆI#Ôò òÔ‡'X±èXXX±èÔDeliverable:Ô#†X±èXX'X±èJ#Ôó ó€The€Contractor€shall€deliver€software€modifications€consistent€with€requirements€of€Task€#1€to€DHSÐ ïâ ÐProject€Manager€for€acceptance€and€approval.€€Make€corrections€approved€by€DHS€Project€Manager.ò òÐ ÛÎ ÐÌØ#ëH#ØÓP† ª½((ŸHPÓÔ‡)Xø›XXX±èÔÓN"  îe A ¡xG"ÿÿ  wÒ‚X2‚XY’"ŠXNÓÌDeliverable€Due€Dateó ó:€Ô#†X±èXX)Xø›ÃK#Ôò òAugust€31,€2001ó óÔ‡)Xø›XXX±èÔà0 ¡ àà0¡€%¡€%àò òÔ#†X±èXX)Xø›‚L#ÔÔ‡%X±èXXX±èÔNot„to„Exceed€Dollars:€$5,000.00ó óÔ#†X±èXX%X±èçL#ÔÔ‡)Xø›XXX±èÔÐ›Ž€%€% ÐÔ#†X±èXX)Xø›LM#Ôò òÌó óÌÌÌÐ  1$ Ðò òÓTÓÑ€&ÝÑÑ‚ÑExhibit€BÐ   ÐGeneral€Provisionsó óÐ ùì ÐÌÓVLÓò òÓ  Ó1.à0 î àIndependent€Contractor;€Responsibility€for€Taxes€and€Withholdingó óÐÏÂî€%î€% ÐÓQ(X „°uÍÚ}ÕL¤Ý"ŠX  îe A ¡xG"QÓà0 9 àò òa.ó óà0e9€%9€%àContractor€shall€perform€all€required€Work€as€an€independent€contractor.€€Although€DHS€reserves€the€rightÐ »® Ðto€(1)€determine€(and€modify)€the€delivery€schedule€for€the€Work€to€be€performed€and€(2)€evaluate€the€qualityÏof€the€completed€performance,€DHS€cannot€and€will€not€control€the€means€or€manner€of€Contractor'sÏperformance.€€Contractor€is€responsible€for€determining€the€appropriate€means€and€manner€of€performing€theÏWork.Ð e€%e€% ÐÌà0 9 àò òb.ó óà0e9€%9€%àIf€Contractor€is€currently€performing€work€for€the€State€of€Oregon€or€the€federal€government,€Contractor€byÐ 9 ,  Ðsignature€to€this€contract€declares€and€certifies€that:€Contractorððs€Work€to€be€performed€under€this€contractÏcreates€no€potential€or€actual€conflict€of€interest€as€defined€by€ORS€244€and€no€rules€or€regulations€ofÏContractorððs€employing€agency€(state€or€federal)€would€prohibit€Contractorððs€Work€under€this€contract.€ÏContractor€is€not€an€ð ðofficer,ðð€ð ðemployee,ðð€or€ð ðagentðð€of€DHS,€as€those€terms€are€used€in€ORS€30.265.Ð e€%e€% ÐÌà0 9 àò òc.ó óà0e9€%9€%àContractor€shall€be€responsible€for€all€federal€or€state€taxes€applicable€to€compensation€or€payments€paid€toÐ ·ª ÐContractor€under€this€contract€and,€unless€Contractor€is€subject€to€backup€withholding,€DHS€will€notÏwithhold€from€such€compensation€or€payments€any€amount(s)€to€cover€Contractorððs€federal€or€state€taxÏobligations.€€Contractor€is€not€eligible€for€any€Social€Security,€unemployment€insurance€or€workersððÏcompensation€benefits€from€compensation€or€payments€paid€to€Contractor€under€this€contract,€except€as€aÏself„employed€individual.Ð e€%e€% ÐÌò ò2.à0 9 àSubcontracts€and€Assignment;€Successors€in€Interestó óÐ9€%9€% ÐÌà0 9 àò òa.ó óà0e9€%9€%àContractor€shall€not€enter€into€any€subcontracts€for€any€of€the€Work€required€by€this€contract,€or€assign€orÐ õè Ðtransfer€any€of€its€interest€in€this€contract,€without€the€prior€written€consent€of€DHS.€€In€addition€to€any€otherÏprovisions€DHS€may€require,€Contractor€shall€include€in€any€permitted€subcontracts€under€this€contract€aÏrequirement€that€the€subcontractor€be€bound€by€Sections€2,€6,€7,€11,€€and€13€of€this€exhibit€as€if€theÏsubcontractor€were€the€Contractor.€€DHSððs€consent€to€any€subcontract€shall€not€relieve€Contractor€of€any€ofÏits€duties€or€obligations€under€this€contract.Ð e€%e€% ÐÌà0 9 àò òb.ó óà0e9€%9€%àThe€provisions€of€this€contract€shall€be€binding€upon€and€shall€inure€to€the€benefit€of€the€parties€hereto,€andÐ ]P  Ðtheir€respective€successors€and€permitted€assigns,€if€any.Ð e€%e€% ÐÌò ò3.à0 9 àNo€Third€Party€Beneficiaries.€€ó óDHS€and€Contractor€are€the€only€parties€to€this€contract€and€are€the€only€partiesÐ " # Ðentitled€to€enforce€its€terms.€€Nothing€in€this€contract€gives,€is€intended€to€give,€or€shall€be€construed€to€give€orÏprovide€any€benefit€or€right,€whether€directly,€indirectly€or€otherwise,€to€third€persons€unless€such€third€personsÏare€individually€identified€by€name€herein€and€expressly€described€as€intended€beneficiaries€of€the€terms€of€thisÏcontract.Ð 9€%9€% ÐÌò ò4.à0 9 àFunds€Available€and€Authorized;€Paymentsó óЛ'Ž%)9€%9€% Ðà0 9 àò òa.ó óà0e9€%9€%àContractor€shall€not€be€compensated€for€Work€performed€under€this€contract€by€any€other€agency€orÐ ‡(z&* Ðdepartment€of€the€State€of€Oregon.€€DHS€has€sufficient€funds€currently€available€and€authorized€forÏexpenditure€to€finance€the€costs€of€this€contract€within€DHS's€biennial€appropriation€or€limitation.€€ContractorÏunderstands€and€agrees€that€DHS's€payment€of€amounts€under€this€contract€attributable€to€Work€performedÏafter€the€last€day€of€the€current€biennium€is€contingent€on€DHS€receiving€from€the€Oregon€LegislativeÏAssembly€appropriations,€limitations,€or€other€expenditure€authority€sufficient€to€allow€DHS,€in€the€exerciseÏof€its€reasonable€administrative€discretion,€to€continue€to€make€payments€under€this€contract.Ð e€%e€% Ðà0 9 àò òb.ó óà0e9€%9€%àDHS€will€only€pay€for€completed€work€that€is€accepted€by€DHS.ò òÐï.â,1e€%e€% ÐÑ&ÝÑâ &âÑ XÑÑÑâ &âÑ  ÑÌà w àà È àà w à€€€5.à w àà 9 àà w à€€à0 9 àRepresentations€and€Warrantiesó óÐùì9€%9€% ÐÌà0 9 àò òa.à0e9€%9€%àContractorððs€Representation€and€Warrantiesó ó:€Contractor€represents€and€warrants€to€DHS€that€(1)Ð ® ÐContractor€has€the€power€and€authority€to€enter€into€and€perform€this€contract,€(2)€this€contract,€whenÏexecuted€and€delivered,€shall€be€a€valid€and€binding€obligation€of€Contractor€enforceable€in€accordance€withÏits€terms,€(3)€the€Work€under€this€contract€shall€be€performed€in€a€good€and€workmanlike€manner€and€inÏaccordance€with€the€highest€professional€standards,€(4)€Contractor€shall,€at€all€times€during€the€term€of€thisÏcontract,€be€qualified,€professionally€competent€and€duly€licensed€to€perform€the€Work,€(5)€all€computerÏhardware€and€software€delivered€under€this€contract€will,€individually€and€in€combination,€correctly€process,Ïsequence,€and€calculate€all€date€and€date„related€data€for€all€dates€prior€to,€through€and€after€January€1,€2000Ïand€(6)€any€software€products€delivered€under€this€contract€that€process€date€or€date„related€data€shallÏrecognize,€store€and€transmit€date€data€in€a€format€which€explicitly€and€€unambiguously€specifies€the€correctÏcentury.Ð e€%e€% ÐÌà0 9 àò òb.à0e9€%9€%àContractorððs€Limitation€of€Liabilityó ó:€Contractorððs€liability€with€respect€to€items€(5)€and€(6)€of€subsectionÐ ¨ Ð5a€above€shall€not€exceed:€(1)€twice€the€total€contract€amount€(including€any€amendments)€or€(2)€$100,000Ïwhichever€is€greater.Ð e€%e€% ÐÌà0 9 àò òc.à0e9€%9€%àWarranties€Cumulativeó ó:€The€warranties€set€forth€in€this€section€are€in€addition€to,€and€not€in€lieu€of,€anyÐ ªR Ðother€warranties€provided.Ð e€%e€% ÐÌò ò6.à0 9 àOwnership€of€Work€Product.ó ó€€All€work€product€of€Contractor€that€results€from€this€contract€("the€WorkÐ j ÐProduct")€is€the€exclusive€property€of€DHS.€DHS€and€Contractor€intend€that€such€Work€Product€be€deemedÏð ðwork€made€for€hireðð€of€which€DHS€shall€be€deemed€the€author.€€If€for€any€reason€the€Work€Product€is€notÏdeemed€ð ðwork€made€for€hire,ðð€Contractor€hereby€irrevocably€assigns€to€DHS€all€of€its€right,€title,€and€interestÏin€and€to€any€and€all€of€the€Work€Product,€whether€arising€from€copyright,€patent,€trademark,€trade€secret,€or€anyÏother€state€or€federal€intellectual€property€law€or€doctrine.€€Contractor€shall€execute€such€further€documents€andÏinstruments€as€DHS€may€reasonably€request€in€order€to€fully€vest€such€rights€in€DHS.€€Contractor€forever€waivesÏany€and€all€rights€relating€to€the€Work€Product,€including€without€limitation,€any€and€all€rights€arising€under€17ÏUSC€106A€or€any€other€rights€of€identification€of€authorship€or€rights€of€approval,€restriction€or€limitation€onÏuse€or€subsequent€modifications.Ð 9€%9€% ÐÌò ò7.à0 9 àIndemnity.ó ó€Ðz!""9€%9€% Ðà 9 àò òÔ‡X¸”XXX1‡Ôa.€General€Indemnity:ó ó€€Contractor€shall€defend,€hold€harmless€and€indemnify€the€State€of€Oregon,€DHS€€and€Ð f" # Ðà0 9 àits€agencies,€subdivisions,€officers,€employees€and€agents€from€and€against€all€claims,€suits,€actions,€losses,Ïdamages,€liabilities,€costs€and€expenses€of€any€nature€resulting€from,€arising€out€of,€or€relating€to€the€activitiesÏof€Contractor€or€its€officers,€employees,€subcontractors,€or€agents€under€this€Contract.Ð 9€%9€% ÐÌà 9 àò òb.€Intellectual€Property€Indemnity:ó ó€€Without€limiting€the€general€indemnity€provision,€Contractor€expressly€Ð ø& $( Ðà0 9 àagrees€to€defend,€hold€harmless€and€indemnify€the€State€of€Oregon,€DHS€€and€its€agencies,€subdivisions,€officers,Ïemployees€and€agents€from€and€against€all€claims,€suits,€actions,€losses,€damages,€liabilities,€costs€and€expensesÏof€any€nature€resulting€from€or€in€connection€with€any€claims€that€the€Work,€Developments,€System€orÏDeliverables€or€use€thereof€infringe€any€patent,€copyright,€trade€secret,€or€other€proprietary€right€(referred€to€asÏ"Intellectual€Property€Rights")€of€any€third€party;€provided,€that€DHS€shall€provide€Contractor€with€promptÏwritten€notice€of€any€infringement€claim.€€Contractor€shall€have€control€of€the€defense€and€settlement€of€theÏclaim;€provided€that€the€State€of€Oregon€or€DHS€may€assume€its€own€defense€and€settlement€in€the€event€thatÏthe€State€of€Oregon€or€DHS€determines€that€Contractor€is€not€adequately€defending€its€interest€or€that€anÏimportant€governmental€principle€is€at€issue€and€the€State€of€Oregon€or€DHS€desires€to€assume€its€own€defense.€Ð 2/Ú,1 ÐIf€Contractor,€in€its€sole€discretion,€believes€at€any€time€that€the€Work,€Developments,€System€or€DeliverablesÏinfringe€a€third€party's€Intellectual€Property€Rights,€Contractor€may,€at€its€own€expense€and€option€and€uponÏreceipt€of€DHS's€prior€written€consent,€replace€an€infringing€item€with€a€non„infringing€item€that€meets€orÏexceeds€the€performance€and€functionality€of€the€replaced€item.Ô#†X1‡XXX¸”_k#Ôо9€%9€% ÐÌò ò8.à0 9 àInsuranceó óÐê’9€%9€% Ðà0 9 àò òa.ó óà0e9€%9€%àDuring€the€term€of€this€contract€Contractor€shall€maintain€in€force€at€its€own€expense,€each€insurance€notedÐ Ö~ Ðbelow:Ð e€%e€% ÐÓ]+X „°'uÍÚ}ÕL¤Ý"ŠXX „°uÍÚ}ÕL¤Ý"ŠX]Óà0 9 àà0e9€%9€%àò ò(1)ó óà0Üe€%e€%àWorkersðð€Compensation€insurance€in€compliance€with€ORS€656.017,€which€requires€subject€employersÐ ¬ T Ðto€provide€Oregon€workersðð€compensation€coverage€for€all€their€subject€workers.€€Ð Ü€%Ü€% Ðà w àà È àà0 w àà09w€%w€%àÐ 9€%9€% Ðà 9 àà e àò ò(2)ó óà0 Ü àGeneral€Liability€insurance€with€a€combined€single€limit,€or€the€equivalent,€of€not€less€than€$1,000,000Ð l   Ðeach€occurrence€for€Bodily€Injury€and€Property€Damage.€€It€shall€include€contractual€liability€coverageÏfor€the€indemnity€provided€under€this€contract.€€It€shall€provide€that€the€State€of€Oregon,€Department€ofÏHuman€Services,€and€their€divisions,€officers€and€employees€are€Additional€Insureds€but€only€withÏrespect€to€the€Contractorððs€services€to€be€provided€under€this€contract.Р܀%Ü€% ÐÌò òà0 9 àà e à(3)à0Ü9€%9€%àó óAutomobile€Liability€insurance€as€required€by€the€Oregon€Financial€Responsibility€Law€(ORS€806.060),Ð ê’ Ðincluding€coverage€for€owned,€hired€or€non„owned€vehicles,€as€applicable.ò òÔ‡&b0%XX1‡ÔÐÖ~Ü€%Ü€% ÐÌÔ#†X1‡X%&b0Èy#Ôà0 9 àà e à(4)à0Ü9€%9€%àó óProfessional€Liability€insurance€with€a€combined€single€limit,€or€the€equivalent,€of€not€less€thanÐ ˜@ Ð$1,000,000€each€claim,€incident€or€occurrence.€€This€is€to€cover€damages€caused€by€error,€omission€orÏnegligent€acts€related€to€the€professional€services€to€be€provided€under€this€contract.ò òó óÐnÜ€%Ü€% Ðà0 9 àà0e9€%9€%àÐ e€%e€% Ðà0 9 àò òb.ó óà0e9€%9€%àò òNotice€of€Cancellation€or€Change:ó ó€There€shall€be€no€cancellation,€material€change,€reduction€of€limits€orÐ Bê Ðintent€not€to€renew€the€insurance€coverage(s)€without€30€days€prior€written€notice€from€Contractor€or€itsÏinsurer(s)€to€Contracts€Coordinator,€Oregon€Department€of€Human€Services.Ð e€%e€% ÐÌà0 9 àò òc.ó óà0e9€%9€%àò òCertificates€of€Insurance:ó ó€As€evidence€of€the€insurance€coverages€required€by€this€contract,€Contractor€shallÐ ì” Ðfurnish€acceptable€insurance€certificates€to€Contracts€Coordinator,€Oregon€Department€of€Human€ServicesÏprior€to€commencing€the€Work.€€The€certificate€will€specify€all€of€the€parties€who€are€Additional€Insureds.€ÏInsuring€companies€or€entities€are€subject€to€State€acceptance.€€If€requested,€complete€copies€of€insuranceÏpolicies,€trust€agreements,€etc.,€shall€be€provided€to€the€State.€€Contractor€shall€be€financially€responsible€forÏall€pertinent€deductibles,€self„insured€retentions€and/or€self„insurance.Ð e€%e€% ÐÌò ò9.à0 9 àTerminationó óÐT"ü#9€%9€% ÐÌà0 9 àò òa.à0e9€%9€%àPartiesðð€Right€to€Terminate€for€Convenienceó ó:€This€contract€may€be€terminated€at€any€time€by€mutualÐ *$Ò!% Ðwritten€consent€of€the€parties.Ð e€%e€% ÐÌà0 9 àò òb.à0e9€%9€%àDHSððs€Right€to€Terminate€for€Convenienceó ó:€DHS€may,€at€its€sole€discretion,€terminate€this€contract,€inÐ ê&’$( Ðwhole€or€in€part,€upon€30€days€notice€to€Contractor.Ð e€%e€% ÐÌà0 9 àò òc.à0e9€%9€%àDHSððs€Right€to€Terminate€for€Causeó ó:€DHS€may€terminate€this€contract,€in€whole€or€in€part,€immediatelyÐ ª)R'+ Ðupon€notice€to€Contractor,€or€at€such€later€date€as€DHS€may€establish€in€such€notice,€upon€the€occurrence€ofÏany€of€the€following€events:Ð e€%e€% ÐÌà0 9 àà0e9€%9€%àò ò(1)à0Üe€%e€%àó óDHS€fails€to€receive€funding,€or€appropriations,€limitations€or€other€expenditure€authority€at€levelsÐ T-ü*/ Ðsufficient€to€pay€for€Contractorððs€Work;Р܀%Ü€% ÐÐ */Ò,1 Ðà0 9 àà0e9€%9€%àò ò(2)à0Üe€%e€%àó óFederal€or€State€laws,€regulations€or€guidelines€are€modified€or€interpreted€in€such€a€way€that€either€theÐ Â ÐWork€under€this€contract€is€prohibited€or€DHS€is€prohibited€from€paying€for€such€Work€from€the€plannedÏfunding€source;Р܀%Ü€% ÐÌà0 9 àà0e9€%9€%àò ò(3)à0Üe€%e€%àó óContractor€no€longer€holds€any€license€or€certificate€that€is€required€to€perform€the€Work;€orÐlªÜ€%Ü€% ÐÌà0 9 àà0e9€%9€%àò ò(4)ó óà0Üe€%e€%àContractor€commits€any€material€breach€or€default€of€any€covenant,€warranty,€obligation€or€agreementÐ B€ Ðunder€this€contract,€fails€to€perform€the€Work€under€this€contract€within€the€time€specified€herein€or€anyÏextension€thereof,€or€so€fails€to€pursue€the€Work€as€to€endanger€Contractorððs€performance€under€thisÏcontract€in€accordance€with€its€terms,€and€such€breach,€default€or€failure€is€not€cured€within€10€businessÏdays€after€delivery€of€DHSððs€notice,€or€such€longer€period€as€DHS€may€specify€in€such€notice.Р܀%Ü€% ÐÌà0 9 àò òd.à0e9€%9€%àContractorððs€Right€to€Terminate€for€Causeó ó:€Contractor€may€terminate€this€contract€upon€30€daysðð€noticeÐ À þ  Ðto€DHS€if€DHS€fails€to€pay€Contractor€pursuant€to€the€terms€of€this€contract€and€DHS€fails€to€cure€within€30Ïdays€after€receipt€of€Contractorððs€notice,€or€such€longer€period€of€cure€as€Contractor€may€specify€in€suchÏnotice.Ð e€%e€% ÐÌò òà 9 àe.à0 e àRemediesó ó:ÐT’e€%e€% Ðà 9 àà e àò ò(1)ó óà0 Ü àIn€the€event€of€termination€pursuant€to€Sections€9a,€9b,€9c(1),€9c(2)€or€9d€of€this€exhibit,€ContractorððsÐ @~ Ðsole€remedy€shall€be€a€claim€for€the€sum€designated€for€accomplishing€the€Work€multiplied€by€theÏpercentage€of€Work€completed€and€accepted€by€DHS,€less€previous€amounts€paid€and€any€claim(s)Ïwhich€State€has€against€Contractor.€€If€previous€amounts€paid€to€Contractor€exceed€the€amount€due€toÏContractor€under€this€Section,€Contractor€shall€pay€any€excess€to€DHS€upon€demand.Р܀%Ü€% ÐÌò òà 9 àà0 e à(2)à0Üe€%e€%àó óIn€the€event€of€termination€pursuant€to€Section€9c(3)€or€9c(4)€of€this€exhibit,€DHS€shall€have€any€remedyÐ ¾ü Ðavailable€to€it€in€law€or€equity.€€If€it€is€determined€for€any€reason€that€Contractor€was€not€in€default€underÏSection€9c(3)€or€9c(4)€of€this€exhibit,€the€rights€and€obligations€of€the€parties€shall€be€the€same€as€if€theÏcontract€was€terminated€pursuant€to€Section€9b€of€this€exhibit.Р܀%Ü€% ÐÌò òà 9 àf.à0 e àContractorððs€Tender€Upon€Termination:€ó óUpon€receiving€a€notice€of€termination€of€this€contract,Ð R ÐContractor€shall€immediately€cease€all€activities€under€this€contract,€unless€DHS€expressly€directs€otherwiseÏin€such€notice€of€termination.€€Upon€termination€of€this€contract,€Contractor€shall€deliver€to€DHS€allÏdocuments,€information,€works„in„progress€and€other€property€that€are€or€would€be€deliverables€had€theÏcontract€been€completed.€€Upon€DHSððs€request,€Contractor€shall€surrender€to€anyone€DHS€designates,€allÏdocuments,€research€or€objects€or€other€tangible€things€needed€to€complete€the€Work.Ð e€%e€% ÐñÒñÌñÒñò òñÒñÐ  f" # ÐñÒññÓñÌñÓñÑÂXÑÑw Ñ10.à0 9 àLimitation€of€Liabilities.€€EXCEPT€FOR€LIABILITY€ARISING€UNDER€OR€RELATED€TO€Ð ¼"ú $ ÐSECTION5a€OR€9e(2)€OF€THIS€EXHIBIT,€NEITHER€PARTY€SHALL€BE€LIABLE€FOR€(A)€ANYÏINDIRECT,€INCIDENTAL,€CONSEQUENTIAL€OR€SPECIAL€DAMAGES€UNDER€THE€CONTRACTÏOR€(B)€ANY€DAMAGES€OF€ANY€SORT€ARISING€SOLELY€FROM€THE€TERMINATION€OF€THISÏCONTRACT€IN€ACCORDANCE€WITH€ITS€TERMS.ó óÐl&ª$(9€%9€% ÐÌò ò11.à0 9 àRecords€Maintenance;€Access.€€ó óContractor€shall€maintain€all€fiscal€records€relating€to€this€contract€inÐ B(€&* Ðaccordance€with€generally€accepted€accounting€principles.€€In€addition,€Contractor€shall€maintain€any€otherÏrecords€pertinent€to€this€contract€in€such€a€manner€as€to€clearly€document€Contractor's€performance.€€ContractorÏacknowledges€and€agrees€that€DHS,€the€Oregon€Secretary€of€State's€Office,€the€Federal€Government,€and€theirÏduly€authorized€representatives€shall€have€access€to€such€fiscal€records€and€all€other€books,€documents,€papers,Ïplans,€and€writings€of€the€Contractor€that€are€pertinent€to€this€contract€for€the€purpose€of€performing€examinationsÏand€audits,€and€making€excerpts€and€transcripts.€€ñÖñÐ À-þ+09€%9€% Ðà0 9 àñÖñContractor€shall€retain€and€keep€accessible€all€such€fiscal€records,€books,€documents,€papers,€plans,€and€writingsÏfor€a€minimum€of€three€(3)€years,€or€such€longer€period€as€may€be€required€by€applicable€law,€following€finalÏpayment€and€termination€of€this€contract,€or€until€the€conclusion€of€any€audit,€controversy€or€litigation€arisingÏout€of€or€related€to€this€contract,€whichever€date€is€later.Ð 9€%9€% ÐÌò ò12.à0 9 àCompliance€with€Applicable€Law.ó ó€€Contractor€shall€comply€with€all€federal,€state€and€local€laws,€regulations,Ð T’ Ðexecutive€orders€and€ordinances€applicable€to€the€Work€under€this€contract.€€Without€limiting€the€generality€ofÏthe€foregoing,€Contractor€expressly€agrees€to€comply€with:€(i)€Title€VI€of€Civil€Rights€Act€of€1964;€(ii)€SectionÏV€of€the€Rehabilitation€Act€of€1973;€(iii)€the€Americans€with€Disabilities€Act€of€1990€and€ORS€659.425;€(iv)€allÏregulations€and€administrative€rules€established€pursuant€to€the€foregoing€laws;€and€(v)€all€other€applicableÏrequirements€of€federal€and€state€civil€rights€and€rehabilitation€statutes,€rules€and€regulations.€€DHSððsÏperformance€under€this€contract€is€conditioned€upon€Contractorððs€compliance€with€the€provisions€of€ORSÏ279.312,€279.314,€279.316,€279.320,€and€279.555,€which€are€incorporated€by€reference€herein.Ð 9€%9€% ÐÌò ò13.à0 9 àForeign€Contractor.ó óIf€Contractor€is€not€domiciled€in€or€registered€to€do€business€in€the€State€of€Oregon,Ð Î  ÐContractor€shall€promptly€provide€to€the€Oregon€Department€of€Revenue€and€the€Secretary€of€State€CorporationÏDivision€all€information€required€by€those€agencies€relative€to€this€contract.€€Contractor€shall€demonstrate€itsÏlegal€capacity€to€perform€the€Work€under€this€contract€in€the€State€of€Oregon€prior€to€entering€into€this€contract.Ð 9€%9€% ÐÌò ò14.à0 9 àForce€Majeure.ó ó€€Neither€DHS€nor€Contractor€shall€be€held€responsible€for€delay€or€default€caused€by€fire,€riot,Ð $b Ðnatural€disasters,€or€war€where€such€cause€was€beyond€the€reasonable€control€of€DHS€or€Contractor,€respectively.€ÏContractor€shall,€however,€make€all€reasonable€efforts€to€remove€or€eliminate€such€a€cause€of€delay€or€defaultÏand€shall,€upon€the€cessation€of€the€cause,€diligently€pursue€performance€of€its€obligations€under€this€contract.Ð 9€%9€% ÐÌò ò15.à0 9 àSurvival.ó óAll€rights€and€obligations€shall€cease€upon€termination€or€expiration€of€this€contract,€except€for€theÐ ¸ö Ðrights€and€obligations€set€forth€in€the€Contract€Section€I.€€EFFECTIVE€DATE€AND€DURATION,€and€inÏparagraphs€5,€6,€7,€9,€10,€11,€15€and€21€of€this€exhibit.Ð 9€%9€% ÐÌò ò16.à0 9 àTime€is€of€the€Essence.ó ó€Contractor€agrees€that€time€is€of€the€essence€under€this€contract.Ðb 9€%9€% ÐÌò ò17.à0 9 àWritten€Notice.ó óAll€notices€regarding€this€contract€must€be€given€to€the€parties€in€writing€by€personal€deliveryÐ 8v Ðor€mailing€the€same,€postage€prepaid,€to€the€following€addresses:Ð 9€%9€% Ðà 9 àÓ`+X „'žuÍÚ}ÕL¤Ý"ŠXX „°'uÍÚ}ÕL¤Ý"ŠX`ÓDHS:à0 Ü àà S àDwight€Endicott,€Contracts€Coordinator,€or€delegateÐL Ü€%Ü€% Ðà0 9 àà Ü àà S àOregon€Department€of€Human€ServicesÐ 9€%9€% Ðà0 9 àà Ü àà S à500€Summer€Street€NE€/€Mailing€Code€E03Ð 9€%9€% Ðà0 9 àà Ü àà S àSalem€OR€97310„1080Ð 9€%9€% ÐÓ`+X „'žÅ ÍÚ}ÕL¤Ý"ŠXX „'žuÍÚ}ÕL¤Ý"ŠX`Óà 9 àà Ü àà S àFacsimile€Number:€503„373„7365Ìà 9 àà Ü àà S àPhone€Number:€503„945„6156Ìà0 9 àñÚñÐ 9€%9€% Ðà 9 àñÚñContractor:€ò òà S àó óñ×ñProfessional€Data€ExchangeЊ$È"&9€%9€% Ðà 9 àà0 Ü àà0SÜ€%Ü€%à222€SW€Columbia,€Suite€500Ð S€%S€% Ðà 9 àà0 Ü àà0SÜ€%Ü€%àPortland,€OR€97201Ð S€%S€% Ðà 9 àà Ü àà S àFacsimile€Number:€(503)721„9958Ìà 9 àà0 Ü àà0SÜ€%Ü€%àPhone€Number:€(800)545„6375ñ×ññ×ñDavid€HowitzÐ t%²#' Ðà 9 àà0 Ü àà0SÜ€%Ü€%àñ×ññØññ×ñà0z S€%S€%àà0z S€%S€%àñ×ññØññ×ñ13825€Melrose€PlaceÐ S€%S€% Ðà 9 àà0 Ü àà0SÜ€%Ü€%àñ×ññÙññ×ñà0z S€%S€%àà0z S€%S€%àñ×ññÙññ×ñLake€Oswego€OR€97035€/€Telephone:€503.699.9708ñ×ñÐ S€%S€% ÐÌà0 9 àAny€notice€delivered€by€facsimile€shall€be€deemed€to€be€given€when€receipt€of€the€transmission€is€generated€byÏthe€transmitting€machine.€€To€be€effective€against€DHS,€such€facsimile€transmission€must€be€confirmed€byÏtelephone€notice€to€DHSððs€Contract€Administrator.Ð 9€%9€% Ðò òÌ18.à0 9 àSeverability.ó óThe€parties€agree€that€if€any€term€or€provision€of€this€contract€is€declared€by€a€court€of€competentÐ Æ,+/ Ðjurisdiction€to€be€illegal€or€in€conflict€with€any€law,€the€validity€of€the€remaining€terms€and€provisions€shall€notÏbe€affected,€and€the€rights€and€obligations€of€the€parties€shall€be€construed€and€enforced€as€if€the€contract€did€notÏcontain€the€particular€term€or€provision€held€to€be€invalid.І/Ä-29€%9€% Їò ò19.à0 9 àCounterparts.ó óThis€contract€may€be€executed€in€several€counterparts,€all€of€which€when€taken€together€shallÐ Â Ðconstitute€one€agreement€binding€on€all€parties,€notwithstanding€that€all€parties€are€not€signatories€to€the€sameÏcounterpart.€€Each€copy€of€the€contract€so€executed€shall€constitute€an€original.Ð 9€%9€% Ðò òÌ20.à0 9 àDisclosure€of€Social€Security€Number.ó óContractor€must€provide€Contractorððs€Social€Security€number€unlessÐ n¬ ÐContractor€provides€a€federal€tax€I„€number.€€This€number€is€requested€pursuant€to€ORS€305.385,€OAR€125„20„¼410(3)€and€OAR€150„305.100.€€Social€Security€numbers€provided€pursuant€to€this€authority€will€be€used€for€theÏadministration€of€state,€federal€and€local€tax€laws.Ð 9€%9€% ÐÌò ò21.à0 9 àGoverning€Law;€Venue;€Consent€to€Jurisdiction.ó óThis€contract€shall€be€governed€by€and€construed€inÐ  @  Ðaccordance€with€the€laws€of€the€State€of€Oregon€without€regard€to€principles€of€conflicts€of€law.€€Any€claim,Ïaction,€suit€or€proceeding€(collectively,€"Claim")€between€DHS€(and/or€any€other€agency€or€department€of€theÏState€of€Oregon)€and€Contractor€that€arises€from€or€relates€to€this€contract€shall€be€brought€and€conducted€solelyÏand€exclusively€within€the€Circuit€Court€of€Marion€County€for€the€State€of€Oregon;€provided,€however,€if€theÏclaim€must€be€brought€in€a€federal€forum,€then€it€shall€be€brought€and€conducted€solely€and€exclusively€withinÏthe€United€States€District€Court€for€the€District€of€Oregon.€€CONTRACTOR,€BY€THE€EXECUTION€OF€THISÏCONTRACT,€HEREBY€CONSENTS€TO€THE€IN€PERSONAM€JURISDICTION€OF€SAID€COURTS.Ð 9€%9€% ÐÌò ò22.à0 9 àAmendment.ó óThe€terms€of€this€contract€may€not€be€waived,€altered,€modified,€supplemented€or€amended,€inÐ >| Ðany€manner€whatsoever,€except€by€written€agreement€signed€by€the€parties.€€This€contract€will€not€be€amendedÏafter€the€expiration€date.Ð 9€%9€% Ðò òÌ23.à0 9 àConfidentiality€of€Client€Informationó óÐê(9€%9€% ÐÌÓ](X „°uÍÚ}ÕL¤Ý"ŠXX „'žÅ ÍÚ}ÕL¤Ý"ŠX]Óà0 9 àò òa.ó óà0e9€%9€%àAll€information€as€to€personal€facts€and€circumstances€obtained€by€the€Contractor€on€the€client€shall€beÐ Àþ Ðtreated€as€privileged€communications,€shall€be€held€confidential,€and€shall€not€be€divulged€without€the€writtenÏconsent€of€the€client,€his€or€her€attorney,€the€responsible€parent€of€a€minor€child,€or€his€or€her€guardian€exceptÏas€required€by€other€terms€of€this€contract.€€Nothing€prohibits€the€disclosure€of€information€in€summaries,Ïstatistical,€or€other€form€which€does€not€identify€particular€individuals.Ð e€%e€% ÐÌà0 9 àò òb.ó óà0e9€%9€%àThe€use€or€disclosure€of€information€concerning€clients€shall€be€limited€to€persons€directly€connected€withÐ >| Ðthe€administration€of€this€contract.€€Confidentiality€policies€shall€be€applied€to€all€requests€from€outsideÏsources.€€à * àà ‚ àÐR e€%e€% Ðà0 9 àò òc.ó óà0e9€%9€%àDHS,€Contractor€and€any€subcontractor€will€share€information€as€necessary€to€effectively€serve€DHS€clients.Ðþ<!e€%e€% ÐÌò ò24.à0 9 àCompliance€with€Applicable€Federal€Law.ó óContractor€agrees€to€comply€with€all€federal€laws€and€regulationsÐ Ô! # Ðapplicable€to€work€performed€under€this€contract€inclusive€of€but€not€limited€to:Ð 9€%9€% ÐÌà0 9 àò òa.à0e9€%9€%àó óTo€the€extent€it€is€required€to€do€so€by€law,€Contractor€shall€abide€by€all€mandatory€standards€and€policiesÐ ”$Ò"& Ðwhich€relate€to€energy€efficiency€and€which€are€contained€in€the€state€of€Oregon€energy€conservation€planÏwhich€was€issued€in€compliance€with€the€Energy€Policy€and€Conservation€Act€(PL94-163).€€All€subcontractsÏshall€also€be€in€compliance€with€the€foregoing.Ð e€%e€% Ðà0 9 àÐ 9€%9€% Ðò òà0 9 àb.ó óà0e9€%9€%àBy€signature€on€this€contract,€the€undersigned€certifies,€to€the€best€of€his€or€her€knowledge€and€belief,€that:Ð()f'+e€%e€% ÐÌÓZ(X „‚wuÍÚ}ÕL¤Ý"ŠXX „°uÍÚ}ÕL¤Ý"ŠXZÓà0 9 àà0°9€%9€%àò ò(1)à0'°€%°€%àó óNo€federally€appropriated€funds€have€been€paid€or€will€be€paid,€by€or€on€behalf€of€Contractor,€to€anyÐ þ*<)- Ðperson€for€influencing€or€attempting€to€influence€an€officer€or€employee€of€any€agency,€a€member€ofÏCongress,€an€officer€or€employee€of€Congress,€or€an€employee€of€a€member€of€Congress€in€connectionÏwith€the€awarding€of€any€federal€contract,€the€making€of€any€federal€grant,€the€making€of€any€federalÏloan,€the€entering€into€of€any€cooperative€agreement,€and€the€extension,€continuation,€renewal,Ïamendment,€or€modification€of€any€federal€contract,€grant,€loan,€or€cooperative€agreement.Ð’/Ð-2'€%'€% ЇÓZ(X „°'ÍÚ}ÕL¤Ý"ŠXX „‚wuÍÚ}ÕL¤Ý"ŠXZÓà0 9 àà0e9€%9€%àò ò(2)à0Üe€%e€%àó óIf€any€funds€other€than€federally€appropriated€funds€have€been€paid€or€will€be€paid€to€any€person€forÐ Â Ðinfluencing€or€attempting€to€influence€an€officer€or€employee€of€any€agency,€a€member€of€Congress,€anÏofficer€or€employee€of€Congress,€or€an€employee€of€a€member€of€Congress€in€connection€with€thisÏfederal€contract,€grant,€loan,€or€cooperative€agreement,€Contractor€agrees€to€complete€and€submitÏStandard€Form„LLL€"Disclosure€Form€to€Report€Lobbying,"€in€accordance€with€its€instructions.Р܀%Ü€% ÐÌà0 9 àà0e9€%9€%àò ò(3)ó óà0Üe€%e€%àThe€undersigned€shall€require€that€the€language€of€this€certification€be€included€in€the€award€documentsÐ @~ Ðfor€all€subawards€at€all€tiers€(including€subcontracts,€subgrants,€and€contracts€under€grants,€loans,€andÏcooperative€agreements)€and€that€all€subrecipients€shall€certify€and€disclose€accordingly.€Ð Ü€%Ü€% ÐÌà0 9 àà0e9€%9€%àThis€certification€is€a€material€representation€of€fact€upon€which€reliance€was€placed€when€this€transactionÏwas€made€or€entered€into.€Submission€of€this€certification€is€a€prerequisite€for€making€or€entering€into€thisÏtransaction€imposed€by€section€1352,€title€31,€U.S.€Code.€€Any€person€who€fails€to€file€the€requiredÏcertification€shall€be€subject€to€a€civil€penalty€of€not€less€than€$10,000€and€not€more€than€$100,000€for€eachÏsuch€failure.Ð e€%e€% ÐÌà0 9 àò òc.ó óà0e9€%9€%àContractor€agrees€to€comply€with€Executive€Order€11246€entitled€Equal€Employment€Opportunity€asÐ f¤ Ðamended€by€Executive€Orders€11375€and€12086€and€as€supplemented€in€Department€of€Labor€RegulationÏ41€CFR€part€60.€€All€subcontracts€shall€also€comply€with€these€provisions.Ð e€%e€% Ðò òÌà 9 àd.ó óà0 e àIf€the€sum€payable€under€this€contract€exceeds€or€may€exceed€$100,000,€Contractor€shall€provide€DHS€aÐ P Ðwritten€assurance€that€Contractor€will€comply€with€all€applicable€standards,€orders,€or€requirements€issuedÏunder€Section€306€of€the€Clean€Air€Act€(42€USC€7401€et.seq.),€the€Federal€Water€Pollution€Control€Act,€asÏamended€(33€USC€1251€et.seq.),€Section€508€of€the€Clean€Water€Act€(33€USC€1368),€Executive€Order€11738Ïand€Environmental€Protection€Agency€regulations€(40€CFR€Part€15).€€Contractor€further€agrees€to€promptlyÏreport€all€infractions€to€the€State€of€Oregon,€and€to€the€Department€of€Health€and€Human€Services,€and€to€theÏU.S.€Regional€Office€of€the€Environmental€Protection€Agency.€€All€subcontracts€shall€also€be€in€complianceÏwith€these€provisions.Ð e€%e€% ÐÌò ò25.à0 9 àYear€2000.ó ó€€In€the€event€Contractor€learns€or€has€reason€to€believe€that€DHSððs€computer€hardware€or€softwareÐ NŒ Ðenvironment€fails€to€use€a€date€format€that€explicitly€specifies€century€in€any€date€data,€Contractor€shall€promptlyÏadvise€DHS€of€such€failure.Ð 9€%9€% ÐÌò ò26.à0 9 àDepartment€of€Justice€Approval.€€€ó óWhen€the€contract€or€amendments€thereto€cause€the€contract€payment€to€beÐ ø6! Ðin€excess€of€$75,000,€the€Department€of€Justice€must€approve€the€contract€and€any€amendments€as€to€LegalÏSufficiency.€€Such€approval€is€required€before€any€work€may€begin€under€this€contract€or€amendments€thereto,Ïor€the€contract€is€not€binding€on€the€State€of€Oregon€or€DHS.Ð 9€%9€% ÐÌò ò27.à0 9 àKey€Person.€ó óContractor€acknowledges€and€agrees€that€DHS€selected€Contractor,€and€is€entering€into€thisÐ Œ$Ê"& ÐContract,€because€of€the€special€qualifications€of€Contractorððs€ð ðKey€Person(s)ðð.€In€particular,€DHS€through€thisÏContract,€is€engaging€the€expertise,€experience,€judgment€and€personal€attention€of€ñÝñDavid€HowitzñÝññÝñClark€HuddlestonñÝñ(ð ðKey€Personðð).ÏContractorððs€Key€Person€shall€not€delegate€performance€of€the€responsibilities€he/she€is€required€to€provide€underÏthis€Contract€to€another€(other)€of€Contractorððs€employee(s)€without€first€obtaining€the€written€consent€of€DHS.ÏFurther,€Contractor€shall€not€re-assign€or€transfer€any€Key€Person€to€other€duties€or€positions€such€that€any€KeyÏPerson€is€no€longer€available€to€provide€DHS€with€his/her€expertise,€experience,€judgment,€and€personalÏattention,€without€first€obtaining€DHSððs€prior€written€consent€to€such€re-assignment€or€transfer.€In€the€eventÏContractor€requests€that€DHS€approve€a€re-assignment€or€transfer€of€any€Key€Person,€DHS€shall€have€the€rightÏto€interview,€review€the€qualifications€of,€and€approve€or€disapprove€the€proposed€replacement€for€the€KeyÏPerson.€Any€approved€substitute€or€replacement€for€a€Key€Person€shall€be€deemed€a€Key€Person€under€thisÏContract.€ñÞñÐ œ.Ú,19€%9€% Ðà0 9 àñÞñIn€addition,€Ô‡ X1‡XXX1‡Ôthe€Contractor€must€provide€a€replacement€for€any€Consultant€who€ceases€affiliation€with€theÐ Â ÐContractor,€whom€DHS€deems€is€not€performing€at€an€acceptable€level€or€is€hindering€the€successful€completionÏof€assignment(s),€is€unable€to€perform€assigned€work,€or€as€required€by€DHS.€Transition€schedule€must€beÏapproved€by€DHS.€In€the€event€that€DHS€requires€such€replacement,€the€Contractor€shall€promptly€substitute€orÏengage€other€qualified€individuals.€All€such€replacements€are€subject€to€DHSððs€prior€review€and€acceptance.€InÏthe€event€that€Contractor€is€unable€to€meet€its€obligation€to€furnish€a€replacement€Consultant,€DHS€may,€at€itsÏoption,€terminate€that€portion€of€the€Contract€without€liability,€or€to€continue€the€Contract€without€replacement.Ô#†X1‡XX X1‡ùÒ#ÔÐ >|9€%9€% ÐÔ‡X¸”XXX1‡ÔÔ‡&³Õ%XX¸”Ôò òÓ  ÓExhibit€CÐ Â ÐÔ#†X¸”X%&³ÕƒÖ#ÔÓ¥ÖÓÔ#†X1‡XXX¸”dÖ#ÔÓ  ÓIndependent€Contractor€Certificationó óÐ žÜ ÐÓ  ÓÌÔ€&b0%XX1‡ÔÔ‡ôYæ õ%&b0Ôò òÓžÓThis€form€is€to€be€completed€by€Contractor;€Corporations€are€not€required€to€complete€this€form.Ð t² Ðó óORS€670.600€Independent€Contractor;€standards.€€As€used€in€various€provisions€of€ORS€chapters€316,€656,€657€and€701,€an€individualÐ P Ðor€business€entity€that€performs€labor€or€services€for€renumeration's€shall€be€considered€to€perform€the€labor€or€services€as€an€IndependentÏContractor€if€the€standards€of€this€section€are€met:ÌÒàXÒÒà ÒÌò òContractor€understands€€that:Ð ŠÈ ÐÓ PûÓó óÓBîÏÜŠXX „°'ÍÚ}ÕL¤Ý"ŠXBÓ1.à0 Ï àThe€individual€or€business€entity€providing€the€labor€or€services€is€free€from€direction€and€control€over€the€means€and€manner€ofÐ (f  Ðproviding€the€labor€or€services,€subject€only€to€the€right€of€the€Agency€for€whom€the€labor€or€services€are€provided€to€specify€theÏdesired€results;Ð Ïø%Ïø% ÐÌ2.à0 Ï àThe€individual€or€business€entity€providing€labor€or€services€is€responsible€for€obtaining€all€assumed€business€registrations€orÐ   Þ  Ðprofessional€occupation€licenses€required€by€state€law€or€local€government€ordinances€for€the€individual€or€business€entity€to€conductÏthe€business;Ð Ïø%Ïø% ÐÌ3.à0 Ï àThe€individual€or€business€entity€providing€labor€or€services€furnishes€the€tools€or€equipment€necessary€for€performance€of€theÐ  V  Ðcontracted€labor€or€services;Ð Ïø%Ïø% ÐÌ4.à0 Ï àThe€individual€or€business€entity€providing€labor€or€services€has€the€authority€to€hire€and€fire€employees€to€perform€the€labor€orÐ ò0  Ðservices;Ð Ïø%Ïø% ÐÌ5.à0 Ï àPayment€for€the€labor€or€services€is€made€upon€completion€of€the€performance€of€specific€portions€of€the€project€or€is€made€on€theÐ Ì  Ðbasis€of€an€annual€periodic€retainer.Ð Ïø%Ïø% ÐÓ*îÏŠXîÏÜŠX*ÓÌ6.à0 Ï àThe€individual€or€business€entity€providing€labor€or€service€is€registered€under€ORS€chapter€701,€if€the€individual€or€business€entityÐ ¦ä Ðprovides€labor€or€services€for€which€such€registration€is€required;Ð Ïø%Ïø% ÐÌ7.à0 Ï àFederal€and€state€income€tax€returns€in€the€name€of€the€business€or€a€business€Schedule€C€or€farm€Schedule€F€as€part€of€the€personalÐ €¾ Ðincome€tax€return€were€filed€for€the€previous€year€if€the€individual€or€business€entity€performed€labor€or€services€as€an€independentÏcontractor€in€the€previous€year;€andÐ Ïø%Ïø% ÐÌ8.à0 Ï àThe€individual€or€business€entity€represents€to€the€public€that€the€labor€or€services€are€to€be€provided€by€an€independently€establishedÐ ø6! Ðbusiness.€€Except€when€an€individual€€or€business€entity€files€a€Schedule€F€as€part€of€the€personal€income€tax€returns€and€the€individualÏor€business€entity€performs€farm€labor€or€services€that€are€reportable€on€Schedule€C,€an€individual€or€business€entity€is€consideredÏto€be€engaged€in€an€independently€established€business€when€four€or€more€of€the€following€circumstances€exist.€€Contractor€must€meetÏfour€(4)€or€more€of€the€following:Ð Ïø%Ïø% ÐòòÓ*îÏûÊîÏŠX*ÓÌà Ï àóóA.à0 û àThe€labor€or€services€are€primarily€carried€out€at€a€location€that€is€separate€from€the€residence€of€an€individual€who€performs€theÐ ¬ê' Ðlabor€or€services,€or€are€primarily€carried€out€in€a€specific€portion€of€the€residence,€which€portion€is€set€aside€as€the€location€ofÏthe€business;Ð ûø%ûø% ÐÌòòà Ï àóóB.à0 û àCommercial€advertising€or€business€cards€as€is€customary€in€operation€of€similar€businesses€are€purchased€for€the€business,€orÐ $b+ Ðthe€individual€or€business€entity€has€a€trade€association€membership;Ð ûø%ûø% ÐÌòòà Ï àóóC.à0 û àTelephone€listing€and€service€are€used€for€the€business€that€is€separate€from€the€personal€residence€listing€and€service€used€byÐ þ<. Ðan€individual€who€performs€the€labor€or€services;Ð ûø%ûø% ÐÌòòà Ï àóóD.à0 û àLabor€or€services€are€performed€only€pursuant€to€written€contracts;ÐØ 1ûø%ûø% ÐÌòòà Ï àóóE.à0 û àLabor€or€services€are€performed€for€two€or€more€different€persons€within€a€period€of€one€year;€orÐ"R 3ûø%ûø% ÐÌòòà Ï àóóF.à0 û àThe€individual€or€business€entity€assumes€financial€responsibility€for€defective€workmanship€or€for€service€not€provided€asÐ P#Ž!5 Ðevidenced€by€the€ownership€of€performance€bonds,€warranties,€errors€and€omission€insurance€or€liability€insurance€relating€toÏthe€labor€or€services€to€be€performed.Ð ûø%ûø% ÐÌ9.à0 Ï àPursuant€to€OAR€125„020„0410(4),€the€contract€shall€provide€that€the€Contractor€is€responsible€for€federal€Social€Security,€exceptÐ È%$9 Ðthose€categories€excluded€by€law,€and€for€any€federal€or€state€taxes€applicable€to€the€contract€payment.Ð Ïø%Ïø% Ðò òÌIndependent€Contractor€certifies€he/she€meets€the€above€standards€and€agrees€to€perform€the€labor€or€services€required€by€thisÏcontract€as€an€Independent€Contractor.Ìó óÓ PûÓÓ' ÀÐ îÏûÂ'ÓòòÌóóÓ*î™ ÀÈÐ À¸ *ÓÌÌContractor€Signatureà ™ à________________________________________________Date_________________Ð ¸*ö(A ÐÌÓ' î™ Ð î™ ÀÈ'ÓÌÒ à¨ÙÒÒH ÒÒXàšÙÒÒHXÒEntity€Name€(printed€or€typed):à ™ à_____________________________________________________________________Ð ’,Ð*D ÐÒ H†íÒÒXH¦íÒÔ#†&b0% õôYæ™×#ÔÓž»×ÓÐ  0-n+E Ðò òÔ‡X1‡X%&b0ÔÓ  ÓExhibit€DÐ Â ÐConfidentiality€AgreementÔ#†&b0%XX1‡ªî#ÔÔ‡ôYæ õ%&b0Ôó óÐ ®ì ÐÔ#†&b0% õôYæ/ï#ÔÓÉîÓÔ‡ôYæ õ%&b0ÔÓžÓTo€all€contractors€working€on€Oregon€Department€of€Human€Services€(DHS)€projects:Ð šØ ÐFor€the€purposes€of€this€certificate€the€term€ð ðcontractorðð€will€mean€all€Consultants€assigned€to€the€project€by€the€contractor.ÌÌOregonððs€laws€contain€provisions€relation€to€confidentiality€of€records,€lists€and€information€about€client€applicants/clients/recipients€andÏabout€State€employees.€€These€laws,€and€the€penalties€for€violation€of€them,€pertain€to€every€contractor€working€on€DHS€projects,€at€allÏlevels€and€in€any€capacity.€€As€a€condition€of€your€continued€work€for€DHS,€you€are€required€to€complete€the€confidentiality€trainingÏexercise€and€sign€this€certificate€verifying€that€you€understand€the€laws€and€are€aware€of€the€penalties€for€violation.€€If€at€some€future€date,Ïyou€have€doubts€about€the€legality€of€an€action€you€may€be€about€to€take,€ask€the€respective€project€manager€for€an€interpretation.€€òòYouÐ ì*  Ðpersonally€are€legally€responsible€for€any€violation€of€these€laws.óóÐ ŠÈ  ÐÌòòò òConfidentiality€of€Personnel€Informationó óóó:€ORS€192.500€ò òòòThe€Public€Recordsóóó ó€Act€contains€a€number€of€exemptions€for€informationÐ Æ   Ðmaintained€on€State€employees€including€a€ð ðpersonal€privacy€exemptionðð€which€states:€ð ðThe€following€public€records€are€exempt€fromÏdisclosure...Information€of€a€personal€nature€such€as€that€kept€in€a€personal,€medical€or€similar€file,€if€the€public€disclosure€thereof€wouldÏconstitute€an€unreasonable€invasion€of€privacy,€unless€the€public€interest€by€clear€and€convincing€evidence€requires€disclosure€in€theÏparticular€instance.€€The€party€seeking€disclosure€shall€have€the€burden€of€showing€that€public€disclosure€would€not€constitute€anÏunreasonable€invasion€of€privacy.ðð€€(ORS€196.500€(2)(b))ÌÌò òòòConfidentiality€of€Welfare€Applicants/Recipients€Informationóóó ó:€ORS€411.300€ò òòòRegulations€concerning€use€and€custody€of€records.óóó ó€Ð V  Ð(1)€DHS€shall€make€and€enforce€reasonable€rules€and€regulations€governing€the€custody,€use€and€preservation€of€the€records,€tapes,€filesÏand€communications€of€DHS.€€The€use€of€such€records,€papers,€files€and€communications€by€any€other€agency€or€department€of€governmentÏor€person€to€which€they€may€be€furnished€shall€be€limited€to€the€purposes€for€which€they€are€furnished€and€by€the€provisions€of€the€lawÏunder€which€they€may€be€furnished.ÌÌORS€411.320€ò òòòDisclosure€and€use€of€records€limited;€contents€as€a€privileged€communication.óóó ó€€For€the€protection€of€clients,€DHSÐ Ì  Ðcontractors...shall€not€disclose€or€use€the€contents€of€any€records,€files,€papers€or€communications€for€purposes€other€than€those€directlyÏconnected€with€the€administration€of€the€public€assistance€laws€of€Oregon,€and€these€records,€files€papers€and€communication€areÏconsidered€confidential€subject€to€the€rules€and€regulations€of€DHS€and€its€Divisions,€except€as€otherwise€provided€in€ORS€411.325€toÏ411.335.€€In€any€judicial€proceedings,€except€proceedings€directly€connected€with€the€administration€of€public€assistance€laws,€their€contentsÏare€considered€privileged€communications.€€(Note:€ORS€421.325€and€411.330€have€been€voided€by€court€action.)ÌÌORS€411.335€òòò òProhibited€use€of€lists€or€names.óóó ó€€No€person€or€agency€shall€solicit,€disclose,€receive,€make€use€of€,€or€authorize,€knowinglyÐ \  Ðpermit,€participate€in€aor€acquiesce€in€the€use€of,€any€lists€of€names€for€commercial€or€political€purposes€of€any€nature,€for€any€purposeÏnot€directly€connected€with€the€administration€of€public€assistance€laws.€€(Note:€ORS€411.325€and€41.330€have€been€voided€by€courtÏaction.)ÌÌORS€411.990€ò òòòPenaltiesóóó ó€(1)€Violation€of€ORS€411.320€to€411.335€is€punishable,€upon€conviction,€by€a€fine€of€not€more€than€$1,000€or€byÐ 4r% Ðimprisonment€in€the€county€jail€for€not€more€than€60€days,€or€by€both.€€Violation€of€ORS€192.500€is€cause€for€disciplinary€action€underÏORS€240.555.ÌÌò òòòInstructions:óóó ó€Contractor€and€supervisor€will€sign€prior€to€start€of€work.€€Return€original€to€the€DHS€Project€Manager€or€designee.Ð ¬ê) ÐÌI€certify€that€I€have€read€the€foregoing.€My€signature€below€means€that€I€understand€the€provisions€of€law€pertaining€to€the€confidentialityÏof€DHS€records€and€information.€I€also€understand€that€these€laws€may€change€from€time€to€time€and€that€it€is€my€responsibility€to€readÏand€understand€these€changes€as€I€am€notified€of€them.ÌÓ9%X ,X9eûr4¸ ñh”Xî™ 79ÓÓ  ÓÌÌName€(please€print):à é à___________________________________________________________________________Ð þ<0 ÐÌÌSignature:€_______________________________________________à Í àDate€_____________________Ð Ø! 3 ÐÌÌSupervisorððs€Signature:________________________________________________Date€_____________________¹Ó§ÓÔ#†&b0% õôYæ™ï#ÔÐ  P$Ž"7 ÐÒX Òò òó óÓ  Óà @F àà @r àà @ àà @ àà @A àà @Å àà @þ àà @u àÔ‡X1‡X%&b0Ôà0 @Í àò òÔ#†&b0%XX1‡Û#Ôó óÔ‡X1‡X%&b0Ôà0@%Í(#Í(#àò òExhibit€EòòÐ Â ÐÔ €7 ÔINFORMATION€FOR€CRIMINAL€HISTORY€CHECKÔ#†&b0%XX1‡/#ÔÔ‡ÂÂ%&b0Ôóóó óÐ `ž ÐÌÔ*‹ƒ8F9Xddd Xdd Xdd XX€%X€%‹ÔÔ,m dd ÔÔ,dd ÔÔ,ö dd ÔÔ+  ÔÐ %€¹ œÚ ……%Ðà@K K à*€*€*€€ò òÔ‡5‘ÛÂÂÂÔHIRING€SUPERVISOR€TO€COMPLETE€THIS€SECTIONó ó€Ô#†ÂÂÂ5‘Û>#Ô*€*€*ˆÐ * >¹ ‹‹*ÐÔÃÿõ32pÔName€of€DHS€SupervisorÔ=2põ3ÔÌÐ $Ð $ÐÔÃÿõ32pÔAgency/AddressÔ=2põ3ÔÌÐ  Ð ‹‹ÐÔÃÿõ32pÔPhone€Number/ExtensionÔ=2põ3ÔÌÐ(Ð    (ÐÔ*‹ƒ:F;dXdm dd m dd ö dd ö 8F9X€%X€%‹ÔÔ,s#dd ÔÔ+  ÔÐ !€¹ žÜ  !Ðà@º º à*€*€*€€€Ô‡5‘ÛÂÂÂÔò òTO€BE€COMPLETED€BY€APPLICANT/EMPLOYEEó ó€€Ô#†ÂÂÂ5‘Ûè#Ô*€*€*ˆÐ(@  ¹ (ÐÓšÓÌÓšÓÓKX°« ¸ ‡XÃÐ (#X ,X9eûr4¸ ñh”XKÓÓ  ÓName€(Please€Print)à « àLastà ¸ àà  àà h àFirstà À àà  àà p àMiddleà È àà  àDate€of€BirthÐ ß  ÐÌßA€F<) °°xdEX (#AßÐ  Y ÐOther€Name(s)€Used:€€(Maiden€Name,€Previous€Married€Name(s),€Aliases,€Legal€Name€Changes,€Assumed€Names,€etc.)ÌÔ#†&b0%ÂÂÜ#ÔÔ‡X1‡X%&b0ÔÌßA€F<)V' s#dEV' s#AßÔ#†&b0%XX1‡š #ÔÔ‡ÂÂ%&b0ÔÌÌÔÃÿô 2 1 o ÔÔ#†&b0% #ÔÔ‡È~^ É%&b0ÔÓ33ÓÌÔ#†&b0% ÉÈ~^w #ÔÓ33– ÓÔ‡ÂÂ%&b0ÔSexà ° àà  àà « àSocial€Security€Number€€€(Per€Signed€Consent€Below)à p àà È àà  àDriverððs€License€Number/Issuing€StateÐ  Q  ÐÔŸÿP Ž ± ï ÔÔ#†&b0%ÂÂâ #ÔÔ‡ÂÂ%&b0ÔÌÌòòððóó€MaleÔ#†&b0%ÂÂô #ÔÔ‡ÂÂ%&b0Ôà ° àòòðð€óóFemaleÔ#†&b0%ÂÂG#ÔÔ‡ÂÂ%&b0Ôà « àÔ#†&b0%¦#ÔÔ‡ÂÂ%&b0ÔÐ Œ Ê  ÐßA€F<)Vás#dEVás#AßÌò òÔ%í+ È ÔWARNING:€€Falsely€responding€to€any€of€the€questions€listed€below€disqualifies€your€application€by€law.ó óÐ í+  ÐÓ€ÓÓEX „°« ¸ ‡XÃÐ (#X°« ¸ ‡XÃÐ XEÓÓŒžÓ1.à „ àòòððóó€Yesà  àòòððóó€Noà0 « àHave€you€lived€outside€the€State€of€Oregon€any€time€during€the€five€(5)€year€prior€todayððs€date?Ð‹É « €%« €% ÐÌÓžŒXÓÌÓ€Ó2.à „ àòòððóó€Yesà  àòòððóó€Noà0 « àHave€you€ever€been€convicted€of€any€crime€listed€on€the€back€of€this€form€(or€the€substantial€equivalent€of€any€of€theÐ f¤ Ðcrime(s)€if€the€conviction€occurred€in€another€jurisdiction€or€in€Oregon€under€a€different€statutory€name€or€number)?Ð « €%« €% ÐÌIf€YES,€place€an€(X)€in€the€box€beside€the€crime€(or€the€substantially€equivalent€crime)€and,€on€a€separate€sheet€of€paper,€describe€the€circumstancesÏby€which€you€were€convicted€of€the€crime(s)€and€provide€any€information€you€have€to€help€us€understand€why€you€believe€your€conviction(s)€WILLÏNOT€pose€a€risk€to€persons€in€the€care€of€or€receiving€services€from€DHS,€or€other€prevent€you€from€fulfilling€the€responsibilities€of€your€job.ÌÌÓ€Ó3.à „ àòòððóó€Yesà  àòòððóó€Noà0 « àDo€you€have€a€concealed€handgun€license?иö$« €%« €% ÐÌÌÓ€Óà@T T ìàÔ%Ê¥ãÔò òòòÔ‡5‘ÛÂÂÂÔAUTHORIZATION€TO€DISCLOSE€SOCIAL€SECURITY€NUMBERÔ#†ÂÂÂ5‘Û;#Ôóóó óˆÐ Ê' ÐÔ%Ëh¦ÔOAR€410„07„0000€authorizes€DHS€to€request€you€to€voluntarily€provide€your€Social€Security€Number€to€DHS€for€use€as€an€identification€numberÏfor€criminal€record€checks.€€Failure€to€provide€your€Social€Security€Number€will€not€be€used€as€a€basis€to€deny€you€any€right€or€benefit,€or€privilegeÏprovided€by€law.€€If€you€provide€your€Social€Security€Number€and€consent€to€its€use,€it€will€be€used€only€for€the€purpose€stated€above€and€will€notÏbe€given€to€the€general€public.€€By€signing€this€consent€to€disclose€your€Social€Security€Number,€you€authorize€DHS€to€disclose€your€Social€SecurityÏNumber€to€others€if€such€disclosure€is€necessary€for€the€purpose€stated€above.ÌÌ______________________________________________________________________________________________________________________ÌConsultantððs€€Signatureà « àà ¸ àà  àà h à€€€€€€€à À àà  àà p à€à È àà  àà à àDateÐ ß/ ÐÔ%¢à}»Ôà@ ìàò òòòÔ‡5‘ÛÂÂÂÔAFFIRMATION€OF€ACCURATE€INFORMATIONÔ#†ÂÂÂ5‘ÛÑ#Ôóóó óˆÐ ¢à0 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