Common use of Exhibit D - Debarment Certification Clause in Contracts

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any The Contractor to this Contract and any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. •  The certification in this clause is a material representation of fact relied upon by County. •  The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. •  Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: •  Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; •  Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; •  Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); •  Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. •  The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any  The Contractor to this Contract and any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. •  The certification in this clause is a material representation of fact relied upon by CountyDistrict. •  The Contractor shall provide immediate written notice to County District if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed changes circumstances. •  Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: •  Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; •  Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; •  Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); •  Have not had one or more public transactions transaction (Federal, State, or Local) terminated within the preceding three-years for cause or default. •  The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. •  Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. •  The certification in this clause is a material representation of fact relied upon by County. •  The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. •  Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: •  Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; •  Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; •  Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); •  Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. •  The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. •  Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed changes circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions transaction (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by CountyDistrict. • The Contractor shall provide immediate written notice to County District if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed changes circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions transaction (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. •  The certification in this clause is a material representation of fact relied upon by County. •  The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed changes circumstances. •  Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: •  Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; •  Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; •  Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); •  Have not had one or more public transactions transaction (Federal, State, or Local) terminated within the preceding three-years for cause or default. •  The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. •  Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. EXAMPLE By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by CountyAgency. • The Contractor shall provide immediate written notice to County Agency if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: 4 Revised 20110922 • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.Contractor: Homeward Bound of Marin Contract Services: Independent Living and Case Management

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any The Contractor to this Contract and any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.. x Exhibit N: Privacy and Security EXHIBIT “A” SCOPE OF SERVICES Administrative Responsibilities • CONTRACTOR will ensure funding is utilized according to funding requirements. • CONTRACTOR will accept referrals and provide case management services during all 12 months FY 21-22. • CONTRACTOR will maintain an up-to-date Homeless Management Information System (HMIS) record keeping system to track program entry/exit, VI-SPDAT scores, input data in accordance with HMIS and COUNTY HSP policy, comply with data standard requirements, and provide a timely response to requests for data. • CONTRACTOR will enter case management notes into HMIS within three (3) business days of client contact. o Case notes will include an overview of clients’ housing plan goals and barriers to goal completion. o Case notes will be brief and will only include details pertinent to the clients’ housing goals/needs. o Rental assistance will be followed by a case note stating the client’s total rent cost, followed by the amount paid by the contractor and the percentage of rent the contractor is paying during the respective month. o Credit repair payments will be documented in HMIS. This will include the total amount paid by the contractor and will detail the debt/s that were paid. • CONTRACTOR will document Outcome information in HMIS within three (3) business days of client contact. All client records will be current in HMIS prior to submitting monthly invoice. • CONTRACTOR will submit reports as outlined below and meet with HHS staff to review outcomes, data and evaluate progress in meeting contract requirements. Programs and Services

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. Page 4 Revised 20150105 • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • ● The certification in this clause is a material representation of fact relied upon by County. • ● The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • ● Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • ▪ Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • ▪ Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • ▪ Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • ▪ Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • ● The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • ● Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. SCOPE: The following is the twelve-month scope of work that details the deliverables, associated activities, and costs. Project Management Framework Timeframe September 2021 Key Activities: • Any subcontractor Project Kickoff - Virtual • Identify Key Stakeholder and Workgroups • Detailed Project Plan o NOTE: Xpio Health will collaborate with BHRS during this period, and will adjust as necessary the requisite activities, schedules, and milestones that will comprise the effort going forward. o Throughout the duration of the project, BHRS and Xpio Health may mutually agree in writing to changes in the plan and schedules (project and payment) • Communications Plan • Change Management Plan • Inclusiveness Plan (racial equity lens) • Roles and Responsibility Matrices, including decision making governance • Beta Testing Plan • Validate/define metrics for assessing and managing project performance • Set up collaboration and document management environment • Confirm rules of engagement for Procurement, including staff that are eligible to serve as Evaluators Assumptions: • Continued pandemic travel or shelter in place restrictions preclude the ability to collaborate on site until cleared by Marin County • County Procurement and HHS Privacy and Compliance involvement required at the beginning of the effort • Xpio Health will adopt local standards, methods, and tools for project management and reporting (as necessary) • BHRS will provide a debarment certification primary point of contact to serve as local project manager • Sometimes stakeholders have differing ideas regarding what is necessary / what is important. Therefore, it is important that includes processes for governance are established, and a decision-maker is identified to help keep the debarment clause effort on target – especially if there are many stakeholders involved in the process. • Government procurement efforts require formal processes and rules to ensure bidders have equal and fair opportunities to win the opportunity. Not understanding such rules – for example, understanding which team members are eligible to serve as noted an evaluator – can have an adverse impact on the right solution being selected if that team member inadvertently is declared ineligible because they participated in preceding bullets abovea conflicting activity (such as writing the RFP itself). It is important to confirm county procurement rules up front to make sure they are communicated and understood. Comprehensive Assessment Report / Requirement and Workflow Analysis Timeframe September – November 2021 Key Activities: • Schedule interviews • Conduct interviews • Documentation of workflows, without modification.current gaps, EHR needs, and key requirements • Creation of consolidated findings report Assumptions: • Assumes 32 interview sessions with key county departments and contracted provider stakeholders across all lines of care. Each session requires an average of 5 hours for scheduling and preparation, conducting of the interview, and post-interview documentation • Key stakeholders and workgroups to be jointly determined with BHRS • Establishing requirements for the respective departments requires input from multiple key staff. Should the staff not be able to participate, the resulting RFP document may not include relevant information that will become important later. To mitigate, Xpio Health will confirm with leadership upfront the availability of stakeholders and establish that this work is a priority. State and Federal Impact Report Timeframe October – November 2021 Key Activities: • As defined in RFP, review statewide and federal behavioral health policies and other regulatory requirements that inform or impact planning and decision- making processes, such as the Office of the National Coordinator for Health Information Technology (ONC) 21st Century CURES Act and Center for Medicare and Medicaid Services (CMS) Interoperability and Patient Access Final Rule • Xpio Health will also collaborate with BHRS and monitor the CalMHSA activities underway to identify and implement an EHR that is anticipated to serve the needs of multiple California counties. Vendor Short List Timeframe November 2021 Key Activities: • Identify vendors present or emerging in California • Keep informed of and follow CalMHSA activities regarding the pursuit of a statewide EHR system, and advise BHRS accordingly • Confirm/refine list based on collaboration with BHRS team • Xpio Health is familiar with most of these vendors; however, we will conduct additional research and leverage our network to determine if additional viable vendors are entering the market. Assumptions: • None. Beta Test Session Findings Report Should vendor demonstrations be scheduled, Xpio Health will interview teams for feedback and update specifications and RFP document sets accordingly. Data Management / Integrated Reporting Strategy Timeframe November 2021 – April 2022 Xpio Health will collaborate with BHRS to define requirements and a workplan for integrated data reporting and ongoing data management in an interoperable data ecosystem. Requirements for such an environment will be incorporated into the RFP document as appropriate. The following is a summary of the anticipated primary deliverables: • A Business and Technology Requirements and Strategy document that addresses the initial reporting needs of the respective BHRS departments, including but not limited to, the following: o Provide ability to determine a client’s participation in one or more BHRS programs, and an ability to organize by a variety of demographic or other reporting criteria o Establish program specific outcomes or performance measures

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed changes circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions transaction (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.. Page 4 Revised 00000000 Contractor Contact Information. Contractor: Next Steps Marketing Address: 0000 Xxxxxx Xxxxxx, Xxxxx 000, Xxx Xxxxxxxxx, XX 00000 Executive Director: Xxxx Xxxxx, Principal Telephone / Email: 000-000-0000 SCOPE OF WORK Communication and Marketing Plan Goals The implemented Plan will:

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-three- years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any The Contractor to this Contract and any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification. EXHIBIT A SCOPE OF SERVICES Key Activities / Timeline of Deliverables – Marin WPC IT and Data Management Intrepid Ascent will perform the following activities during the 2019 contract period. Key Activities Deliverables Timeline 1. IT System Implementation Management Support Jan. 1, 2019 – Dec. 31, 2019 Provide guidance and project management for the implementation of IT systems supporting WPC: Verbal and written communication with HHS staff and vendors Monthly WIZARD implementation status review and recommendations Quarterly WIZARD vendor contract compliance review Quarterly WIZARD- Gateway integration status review and recommendations WIZARD SSO Assessment and Recommendations • Implementation planning and support for subsequent phases of WIZARD roll-out • Monitor vendor contract compliance and provide quarterly status report • Support change order process as required, or communication and planning with relevant vendors (RWMN, Bitfocus Clarity, Diamond Sapphire, etc.) • In lieu of full integration, support implementing and testing batch processing (single or bi-directional) with files from other data systems, such as Marin General Hospital, MEDS, etc. Advise on integration of implemented technology solutions for WPC through: • Supporting expanded integration with Marin Health Gateway o Curated medical and behavioral health information o Shared Care Plan o Additional data sources (EMS, Jail EHR data, etc.) March 31, 2019 • HMIS and/or other relevant systems Assess need for single sign-on integrations with clinical partners for WIZARD tool and identify implementation options. 2. Data Governance and Organizational Development Jan. 1, 2019 -– Dec. 15, 2019 Work with the County to creaat more operational data sharing Policies and Procedures for Whole Person Care that support secure, high quality data entry into the system and use of that data (examples: policies around training new users, removal of Updated Policies & Procedures June 30, 2019 accounts when users leave, periodic monitoring of a sample of user activity, etc.) and future system integrations (HIE, HMIS, others). Develop and implement plan for the collection and appropriate sharing of Substance Use Disorder (SUD) treatment information within WIZARD and via HIE in compliance with 42CFR Part 2. • Conduct analysis of current and potential future state for SUD data sharing SUD Treatment data sharing plan Verbal and written communication with HHS staff September 30, 2019 • Ongoing communication and collaboration with SUD Services and Compliance staff • Revise ROI • Develop P&P for SUD Treatment data sharing including permissions guidance for WIZARD and the Marin Health Gateway • Additional WIZARD / Marin Health Gateway design to accommodate SUD Treatment information sharing Develop a sustainability plan assessing options for continued use of WIZARD beyond life of WPC program that is aligned with both the Marin Health Gateway Strategic Plan and the Whole Person Care program sustainability plan. Develop process for data quality monitoring and improvement Sustainability plan Process for data quality monitoring and improvement December 15, 2019 February 28, 2019 3. User Onboarding Planning and Support Jan. 1, 2019 – Dec. 31, 2019 Assist in developing a sustainable, ongoing training program that is informed by data quality monitoring. Finalize ongoing train-the-trainer plan Develop supporting materials using the train-the-trainer approach Updated training manual (Feb-March) • Updated training manual • Record click-throughs (video/audio) for up to six high- impact workflows Recorded click- throughs (up to six) • Conduct trainings with WIZARD super-users / trainers / users Training Sessions (up to six) Assess applicability and utility of additional HIE use cases, such as CURES (prescription drug monitoring program), PULSE (disaster response), and POLST (Physician Orders for Life-Sustaining Treatment) Assessment of Additional HIE Use Cases Development of revised workflows for participants in support of new or refined WPC use cases Assist with WIZARD user onboarding and user experience optimization Revised workflows for new or refined use cases (up to six) • Quarterly user experience mixed-methods assessment and “mini-PDSA” recommendations for improvement • One quarterly “mini-PDSA” intervention to improve user experience and effectiveness User experience assessments / recommendations (four) • Host eight WIZARD user best practice webinars for all interested users • Following training and onboarding, conduct small- group or individual WIZARD optimization sessions (generally remote) with users to address questions, refine workflows, and optimize use of available tools ‘Mini-PDSA” user experience interventions (four) User best practice webinars (8) Small-group user optimization sessions (up to 12) 4. Technology Strategic Planning Assessment of IT systems capacity to conduct analytics for WPC reporting and to inform WPC Plan-Do-Study-Act cycles Summary of analytics and reporting assessment findings / recommendations April 30, 2019 Assess analytics needs and options, including data collection with staff and potential vendors; Analytics assessment and recommendations, including annotated vendor short-list March 31, 2019 Develop report on emerging data sharing technologies, such as FHIR, and applicable strategies for Whole Person Care and the Marin Health Gateway to leverage these technologies Emerging Technologies Strategy Brief March 31, 2019 EXHIBIT B FEES AND PAYMENT SCHEDULE Proposed Budget The proposed budget is based on the completion of the deliverables provided above. Activity Cost Activity 1: IT and Data Integration Management Support • Implementation Management / Communications with HHS staff ($1,500 per quarter, $6,000 total) • Monthly WIZARD-Gateway implementation status review and recommendations ($2,000 per month, $24,000 total) • Quarterly WIZARD vendor contract compliance review ($4,000 per quarter, $16,000 total) • Quarterly WIZARD-Gateway integration status review and recommendations ($3,000 per quarter, $12,000 total) • WIZARD SSO Assessment ($4,000) $62,000 Activity 2: Data Governance and Policy Development • Verbal and written communication with HHS staff and vendors ($1,000 per quarter, $4,000 total) • Updated Policies & Procedures ($8,000) • SUD Treatement data sharing plan ($15,000) • Sustainability Plan ($5,000) • Process for data quality monitoring and improvement ($5,000) $37,000 Activity 3: User Onboarding and User Experience Optimization • Finalized train-the-trainer plan ($4,000) • Updated training manual ($4,000) • Recorded workflow click-throughs ($2,500 x 6 click-throughs = $15,000) • Training sessions ($2,000 x 6 sessions = $12,000) • Assessment of Additional HIE Use Cases ($7,500) • Revised workflows for partners to support new WPC use cases ($4,000 x 4 use cases = $16,000) • User experience assessments / recommendations ($4,000 x 4 = $16,000) • Mini-PDSA user experience interventions ($4,000 x 4 = $16,000) • User best practice webinars ($1,500 x 8 = $12,000) • Small-group user optimization sessions ($1,000 x 8 = $8,000) $110,500 Activity 4: Technology Strategic Planning • Analytics and reporting assessment and recommendations o Analytics Assessment and Recommendations ($12,500) o Technical Requirements and Vendor Scope Documentation ($5,000) o Annotated Vendor Short-List ($2,500) • Emerging Technologies Strategy Brief ($5,000) $25,000 Total Not-to-Exceed $234,500 EXHIBIT B FEES AND PAYMENT SCHEDULE • Upon receipt of an invoice acceptable to County and confirmation that services have been performed, payment will be made by County to Contractor in accordance with its Net 30 payment terms. • County shall pay a total amount not to exceed TWO HUNDRED THIRTY-FOUR THOUSAND FIVE HUNDRED DOLLARS ($234,500.00) for services provided during the term of the agreement. In no event shall total compensation paid to Contractor exceed $234,500 without an amendment to this agreement approved by the County of Marin. • County will not reimburse Contractor for any mileage or travel expenses associated with the services provided under this contract. • Services performed by the Contractor and not authorized in this agreement shall not be paid for by County. Payment for additional services shall be made to Contractor by County if, and only if, this agreement is amended by both parties in advance of performing additional services. EXHIBIT D CONTRACTOR’S DEBARMENT CERTIFICATION EXHIBIT M: BUSINESS ASSOCIATE AGREEMENT TERMS AND CONDITIONS To the extent Contractor is a business associate as defined under the Federal Health Insurance Portability and Accountability Act (“HIPAA”) and the HITECH Act, Contractor shall comply with the additional terms and conditions set forth in this Exhibit (“M”) to the Professional Services Contract (“PSC” or “Contract”). This Business Associate Agreement Exhibit “M” supplements and is made a part of the Contract by and between the County of Marin, referred to herein as Covered Entity (“CE”), and Intrepid Ascent, LLC, referred to herein as Business Associate (“BA”), to which this Exhibit “M” is an incorporated attachment.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by CountyDistrict. • The Contractor shall provide immediate written notice to County District if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed changes circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions transaction (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The EXHIBIT “A” SCOPE OF SERVICES (required) Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will shall provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.following services:

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets aboveEXHIBIT A July 1, without modification.2022 – June 30, 2023

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

Exhibit D - Debarment Certification. By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any The Contractor to this Contract and any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.. EXHIBIT A SCOPE OF SERVICES July 1, 2021 – June 30, 2022