Attachment A
COUNTY OF ALAMEDA
STANDARD SERVICES AGREEMENT
This Standard Services Agreement (“Agreement”), dated as of_____________________________, is by and between the County of Alameda, hereinafter referred to as the “County”, and the City of Oakland on behalf its Department of Violence Prevention, Oakland Unified School District, Alameda County Office of Education, and The National Institute for Criminal Justice Reform hereinafter collectively referred to as the “Contractor”.
WITNESSETH
Whereas, County desires to establish a High-Risk Youth Data Sharing Collaboration which are more fully described in Exhibit A hereto (“Definition of Services”); and
Whereas, Contractor is professionally qualified to provide such services and is willing to provide same to County; and
Now, therefore it is agreed that County does hereby retain Contractor to establish a High-Risk Youth Data Sharing Multidisciplinary Team, and Contractor accepts such engagement, on the General Terms and Conditions hereinafter specified in this Agreement, the Additional Provisions attached hereto, and the following described exhibits, all of which are incorporated into this Agreement by this reference:
Exhibit A Definition of Services
Exhibit A-1 Justice-Involved Youth
Exhibit A-2 Youth in Community
Exhibit B Payment Term
Exhibit C Insurance Requirements
Exhibit D Debarment and Suspension Certification
Exhibit E Parent/Guardian Consent for Release of Information Sample
The term of this Agreement shall be from February 1, 2025 through January 31, 2028.
The compensation payable to Contractor hereunder shall not exceed Zero dollars ($0) for the term of this Agreement. The County neither warrants nor guarantees any minimum compensation to the Contractor under this Agreement. Payment to Contractor shall be based on actual services performed on behalf of the County.
Attachment A
By signing above, signatory warrants and
represents that he/she executed this
Agreement in his/her authorized capacity
and that by his/her signature on this
Agreement, he/she or the entity upon behalf
of which he/she acted, executed this
Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first above written.
ALAMEDA COUNTY PROBATION DEPARTMENT ALAMEDA COUNTY OFFICE OF EDUCATION
By:
Signature
By:
Signature
Name: Brian K. Ford
(Printed)
Name: Alysse Castro
(Printed)
Title: Chief Probation Officer
Title: Superintendent Of Schools
Date:
Date:
CITY OF OAKLAND on behalf of its DEPARTMENT OF VIOLENCE
PREVENTION
OAKLAND UNIFIED SCHOOL DISTRICT
By:
Signature
By:
Signature
Name: Holly Joshi
(Printed)
Name:
(Printed)
Title: Chief of Violence Prevention
Title:
Date:
Date:
NATIONAL INSTITUTE FOR CRIMINAL JUSTICE REFORM
By:
Signature
Name: David Muhammad
(Printed)
Title: Executive Director
Date:
Approved as to Form:
Donna R. Ziegler, County Counsel
By:
K. Joon Oh, Deputy County Counsel
Attachment A
GENERAL TERMS AND CONDITIONS
1. INDEPENDENT CONTRACTOR: No relationship of employer and employee is created by this Agreement; it being understood and agreed that Contractor is an independent contractor.
Contractor is not the agent or employee of the County in any capacity whatsoever, and County shall not be liable for any acts or omissions by Contractor nor for any obligations or liabilities incurred by Contractor.
Contractor shall have no claim under this Agreement or otherwise, for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance medical care, hospital care, retirement benefits, social security, disability, Workers’ Compensation, or unemployment insurance benefits, civil service protection, or employee benefits of any kind.
Contractor shall be solely liable for and obligated to pay directly all applicable payroll taxes (including federal and state income taxes) or contributions for unemployment insurance or old age pensions or annuities which are imposed by any governmental entity in connection with the labor used or which are measured by wages, salaries or other remuneration paid to its officers, agents or employees and agrees to indemnify and hold County harmless from any and all liability which County may incur because of Contractor’s failure to pay such amounts.
In carrying out the work contemplated herein, Contractor shall comply with all applicable federal and state workers’ compensation and liability laws and regulations with respect to the officers, agents and/or employees conducting and participating in the work; and agrees that such officers, agents, and/or employees will be considered as independent contractors and shall not be treated or considered in any way as officers, agents and/or employees of County.
Contractor does, by this Agreement, agree to perform his/her said work and functions at all times in strict accordance with currently approved methods and practices in his/her field and that the sole interest of County is to insure that said service shall be performed and rendered in a competent, efficient, timely and satisfactory manner and in accordance with the standards required by the County agency concerned.
Notwithstanding the foregoing, if the County determines that pursuant to state and federal law Contractor is an employee for purposes of income tax withholding, County may upon two week’s notice to Contractor, withhold from payments to Contractor hereunder federal and state income taxes and pay said sums to the federal and state governments.
2. INDEMNIFICATION: To the fullest extent permitted by law, Contractor shall hold harmless, defend and indemnify the County of Alameda, its Board of Supervisors and Directors, employees and agents from and against any and all claims, losses, damages, liabilities and expenses, including but not limited to attorneys’ fees, arising out of or resulting from the performance of services under this Agreement, provided that any such claim, loss, damage, liability or expense is attributable to bodily injury, sickness, disease, death or to injury to or destruction of property, including the loss therefrom, or to any violation of federal, state or municipal law or regulation, which arises out of or is any way connected with the performance Attachment A
of this agreement (collectively “Liabilities”) except where such Liabilities are caused solely by the negligence or willful misconduct of any indemnitee. The County may participate in the defense of any such claim without relieving Contractor of any obligation hereunder. The obligations of this indemnity shall be for the full amount of all damage to County, including defense costs, and shall not be limited by any insurance limits.
In the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement is determined by a court of competent jurisdiction or the Alameda County Employees’ Retirement Association (ACERA) or California Public Employees’ Retirement System (PERS) to be eligible for enrollment in ACERA and PERS as an employee of County, Contractor shall indemnify, defend, and hold harmless County for the payment of any employee and/or employer contributions for ACERA and PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of County.
3. INSURANCE AND BOND: Contractor shall at all times during the term of the Agreement with the County maintain in force, at minimum, those insurance policies and bonds as designated in the attached Exhibit C, and will comply with all those requirements as stated therein. The County and all parties as set forth on Exhibit C shall be considered an additional insured or loss payee if applicable. All of Contractor’s available insurance coverage and proceeds in excess of the specified minimum limits shall be available to satisfy any and all claims of the County, including defense costs and damages. Any insurance limitations are independent of and shall not limit the indemnification terms of this Agreement. Contractor’s insurance policies, including excess and umbrella insurance policies, shall include an endorsement and be primary and non-contributory and will not seek contribution from any other insurance (or self- insurance) available to County. Contractor’s excess and umbrella insurance shall also apply on a primary and non-contributory basis for the benefit of the County before County’s own insurance policy or self-insurance shall be called upon to protect it as a named insured.
4. PREVAILING WAGES: Pursuant to Labor Code Sections 1770 et seq., Contractor shall pay to persons performing labor in and about Work provided for in Contract not less than the general prevailing rate of per diem wages for work of a similar character in the locality in which the Work is performed, and not less than the general prevailing rate of per diem wages for legal holiday and overtime work in said locality, which per diem wages shall not be less than the stipulated rates contained in a schedule thereof which has been ascertained and determined by the Director of the State Department of Industrial Relations to be the general prevailing rate of per diem wages for each craft or type of workman or mechanic needed to execute this contract.
5. WORKERS’ COMPENSATION: Contractor shall provide Workers' Compensation insurance, as applicable, at Contractor's own cost and expense and further, neither the Contractor nor its carrier shall be entitled to recover from County any costs, settlements, or expenses of Workers' Compensation claims arising out of this Agreement.
6. CONFORMITY WITH LAW AND SAFETY:
Attachment A
a. In performing services under this Agreement, Contractor shall observe and comply with all applicable laws, ordinances, codes and regulations of governmental agencies, including federal, state, municipal, and local governing bodies, having jurisdiction over the scope of services, including all applicable provisions of the California Occupational Safety and Health Act. Contractor shall indemnify and hold County harmless from any and all liability, fines, penalties and consequences from any of Contractor’s failures to comply with such laws, ordinances, codes and regulations. b. Accidents: If a death, serious personal injury, or substantial property damage occurs in connection with Contractor’s performance of this Agreement, Contractor shall immediately notify the Alameda County Risk Manager's Office by telephone. Contractor shall promptly submit to County a written report, in such form as may be required by County of all accidents which occur in connection with this Agreement. This report must include the following information: (1) name and address of the injured or deceased person(s); (2) name and address of Contractor's sub-Contractor, if any; (3) name and address of Contractor's liability insurance carrier; and (4) a detailed description of the accident and whether any of County's equipment, tools, material, or staff were involved. c. Contractor further agrees to take all reasonable steps to preserve all physical evidence and information which may be relevant to the circumstances surrounding a potential claim, while maintaining public safety, and to grant to the County the opportunity to review and inspect such evidence, including the scene of the accident.
7. DEBARMENT AND SUSPENSION CERTIFICATION: (Applicable to all agreements funded in part or whole with federal funds and contracts over $25,000). a. By signing this agreement and Exhibit D, Debarment and Suspension Certification, Contractor/Grantee agrees to comply with applicable federal suspension and debarment regulations, including but not limited to 7 Code of Federal Regulations (CFR) 3016.35, 28 CFR 66.35, 29 CFR 97.35, 34 CFR 80.35, 45 CFR 92.35 and Executive Order 12549.
b. By signing this agreement, Contractor certifies to the best of its knowledge and belief, that it and its principals:
(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntary excluded by any federal department or agency; (2) Shall not knowingly enter into any covered transaction with a person who is proposed for debarment under federal regulations, debarred, suspended, declared ineligible, or voluntarily excluded from participation in such transaction.
8. PAYMENT: For services performed in accordance with this Agreement, payment shall be made to Contractor as provided in Exhibit B hereto.
Attachment A
9. TRAVEL EXPENSES: Contractor shall not be allowed or paid travel expenses unless set forth in this Agreement.
10. TAXES: Payment of all applicable federal, state, and local taxes shall be the sole responsibility of the Contractor.
11. OWNERSHIP OF DOCUMENTS: Contractor hereby assigns to the County and its assignees all copyright and other use rights in any and all proposals, plans, specification, designs, drawings, sketches, renderings, models, reports and related documents (including computerized or electronic copies) respecting in any way the subject matter of this Agreement, whether prepared by the County, the Contractor, the Contractor’s sub-Contractors or third parties at the request of the Contractor (collectively, “Documents and Materials”). This explicitly includes the electronic copies of all above stated documentation.
Contractor also hereby assigns to the County and its assignees all copyright and other use rights in any Documents and Materials including electronic copies stored in Contractor’s Information System, respecting in any way the subject matter of this Agreement.
Contractor shall be permitted to retain copies, including reproducible copies and computerized copies, of said Documents and Materials. Contractor agrees to take such further steps as may be reasonably requested by County to implement the aforesaid assignment. If for any reason said assignment is not effective, Contractor hereby grants the County and any assignee of the County an express royalty – free license to retain and use said Documents and Materials. The County’s rights under this paragraph shall apply regardless of the degree of completion of the Documents and Materials and whether or not Contractor’s services as set forth in Exhibit “A” of this Agreement have been fully performed or paid for.
In Contractor’s contracts with other Contractors, Contractor shall expressly obligate its Sub- Contractors to grant the County the aforesaid assignment and license rights as to that Contractor’s Documents and Materials. Contractor agrees to defend, indemnify, and hold the County harmless from any damage caused by a failure of the Contractor to obtain such rights from its Contractors and/or Sub-Contractors.
Contractor shall pay all royalties and license fees which may be due for any patented or copyrighted materials, methods or systems selected by the Contractor and incorporated into the work as set forth in Exhibit “A”, and shall defend, indemnify and hold the County harmless from any claims for infringement of patent or copyright arising out of such selection. The County’s rights under this Paragraph 11 shall not extend to any computer software used to create such Documents and Materials.
12. CONFLICT OF INTEREST; CONFIDENTIALITY: The Contractor covenants that it presently has no interest, and shall not have any interest, direct or indirect, which would conflict in any manner with the performance of services required under this Agreement. Without limitation, Contractor represents to and agrees with the County that Contractor has no present, and will have no future, conflict of interest between providing the County services hereunder and any Attachment A
other person or entity (including but not limited to any federal or state wildlife, environmental or regulatory agency) which has any interest adverse or potentially adverse to the County, as determined in the reasonable judgment of the Board of Supervisors of the County.
The Contractor agrees that any information, whether proprietary or not, made known to or discovered by it during the performance of or in connection with this Agreement for the County will be kept confidential and not be disclosed to any other person. The Contractor agrees to immediately notify the County by notices provided in accordance with Paragraph 13 of this Agreement, if it is requested to disclose any information made known to or discovered by it during the performance of or in connection with this Agreement. These conflict of interest and future service provisions and limitations shall remain fully effective five (5) years after termination of services to the County hereunder.
13. NOTICES: All notices, requests, demands, or other communications under this Agreement shall be in writing. Notices shall be given for all purposes as follows:
Personal delivery: When personally delivered to the recipient, notices are effective on delivery.
First Class Mail: When mailed first class to the last address of the recipient known to the party giving notice, notice is effective three (3) mail delivery days after deposit in a United States Postal Service office or mailbox. Certified Mail: When mailed certified mail, return receipt requested, notice is effective on receipt, if delivery is confirmed by a return receipt.
Overnight Delivery: When delivered by overnight delivery (Federal Express/Airborne/United Parcel Service/DHL WorldWide Express) with charges prepaid or charged to the sender’s account, notice is effective on delivery, if delivery is confirmed by the delivery service. Telex or facsimile transmission: When sent by telex or facsimile to the last telex or facsimile number of the recipient known to the party giving notice, notice is effective on receipt, provided that (a) a duplicate copy of the notice is promptly given by first-class or certified mail or by overnight delivery, or (b) the receiving party delivers a written confirmation of receipt. Any notice given by telex or facsimile shall be deemed received on the next business day if it is received after 5:00 p.m. (recipient’s time) or on a non-business day.
Addresses for purpose of giving notice are as follows:
To County: ALAMEDA COUNTY PROBATION DEPARTMENT
1111 Jackson Street, 8th Floor
Oakland, CA 94607
Attn: Dante Cercone, Deputy Chief Probation Officer
To Contractor: ALAMEDA COUNTY OFFICE OF EDUCATION 313 West Winton Avenue
Hayward, CA 94544
Attn: Alysse Castro, Superintendent of Schools
Attachment A
CITY OF OAKLAND
DEPARTMENT OF VIOLENCE PREVENTION
250 Frank H Ogawa Plaza, # 6300
Oakland, CA 94612
Attn: Holly Joshi, Chief of Violence Prevention
OAKLAND POLICE DEPARTMENT
455 7th Street
Oakland, CA 94607
Attn: Floyd Mitchell, Chief of Police
OAKLAND UNIFIED SCHOOL DISTRICT
1011 Union Street
Oakland, CA 94607
NATIONAL INSTITUTE FOR CRIMINAL JUSTICE REFORM
2618 Martin Luther King Jr Way
Berkeley, CA 94704
Attn: David Muhammad, Executive Director
Any correctly addressed notice that is refused, unclaimed, or undeliverable because of an act or omission of the party to be notified shall be deemed effective as of the first date that said notice was refused, unclaimed, or deemed undeliverable by the postal authorities, messenger, or overnight delivery service.
Any party may change its address or telex or facsimile number by giving the other party notice of the change in any manner permitted by this Agreement.
14. USE OF COUNTY PROPERTY: Contractor shall not use County property (including equipment, instruments and supplies) or personnel for any purpose other than in the performance of his/her obligations under this Agreement.
15. EQUAL EMPLOYMENT OPPORTUNITY PRACTICES PROVISIONS: Contractor assures that he/she/it will comply with Title VII of the Civil Rights Act of 1964 and that no person shall, on the grounds of race, creed, color, disability, sex, sexual orientation, national origin, age, religion, Vietnam era Veteran’s status, political affiliation, or any other non-merit factor, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under this Agreement.
a. Contractor shall, in all solicitations or advertisements for applicants for employment placed as a result of this Agreement, state that it is an “Equal Opportunity Employer” or that all qualified applicants will receive consideration for employment without regard to Attachment A
their race, creed, color, disability, sex, sexual orientation, national origin, age, religion, Vietnam era Veteran’s status, political affiliation, or any other non-merit factor. b. Contractor shall, if requested to so do by the County, certify that it has not, in the performance of this Agreement, discriminated against applicants or employees because of their race, creed, color, disability, sex, sexual orientation, national origin, age, religion, Vietnam era Veteran’s status, political affiliation, or any other non-merit factor. c. If requested to do so by the County, Contractor shall provide the County with access to copies of all of its records pertaining or relating to its employment practices, except to the extent such records or portions of such records are confidential or privileged under state or federal law.
d. Contractor shall recruit vigorously and encourage minority - and women-owned businesses to bid its subcontracts.
e. Nothing contained in this Agreement shall be construed in any manner so as to require or permit any act, which is prohibited by law.
f. The Contractor shall include the provisions set forth in paragraphs A through E (above) in each of its subcontracts.
16. DRUG-FREE WORKPLACE: Contractor and Contractor's employees shall comply with the County's policy of maintaining a drug-free workplace. Neither Contractor nor Contractor's employees shall unlawfully manufacture, distribute, dispense, possess or use controlled substances, as defined in 21 U.S. Code § 812, including, but not limited to, marijuana, heroin, cocaine, and amphetamines, at any County facility or work site. If Contractor or any employee of Contractor is convicted or pleads nolo contendere to a criminal drug statute violation occurring at a County facility or work site, the Contractor within five days thereafter shall notify the head of the County department/agency for which the contract services are performed.
Violation of this provision shall constitute a material breach of this Agreement.
17. AUDITS; ACCESS TO RECORDS: The Contractor shall make available to the County, its authorized agents, officers, or employees, for examination any and all ledgers, books of accounts, invoices, vouchers, cancelled checks, and other records or documents evidencing or relating to the expenditures and disbursements charged to the County, and shall furnish to the County, its authorized agents, officers or employees such other evidence or information as the County may require with regard to any such expenditure or disbursement charged by the Contractor.
The Contractor shall maintain full and adequate records in accordance with County requirements to show the actual costs incurred by the Contractor in the performance of this Agreement. If such books and records are not kept and maintained by Contractor within the County of Alameda, California, Contractor shall, upon request of the County, make such books and records available to the County for inspection at a location within County or Contractor Attachment A
shall pay to the County the reasonable, and necessary costs incurred by the County in inspecting Contractor’s books and records, including, but not limited to, travel, lodging and subsistence costs. Contractor shall provide such assistance as may be reasonably required in the course of such inspection. The County further reserves the right to examine and reexamine said books, records and data during the three (3) year period following termination of this Agreement or completion of all work hereunder, as evidenced in writing by the County, and the Contractor shall in no event dispose of, destroy, alter, or mutilate said books, records, accounts, and data in any manner whatsoever for three (3) years after the County makes the final or last payment or within three (3) years after any pending issues between the County and Contractor with respect to this Agreement are closed, whichever is later.
18. DOCUMENTS AND MATERIALS: Contractor shall maintain and make available to County for its inspection and use during the term of this Agreement, all Documents and Materials, as defined in Paragraph 11 of this Agreement. Contractor’s obligations under the preceding sentence shall continue for three (3) years following termination or expiration of this Agreement or the completion of all work hereunder (as evidenced in writing by County), and Contractor shall in no event dispose of, destroy, alter or mutilate said Documents and Materials, for three (3) years following the County’s last payment to Contractor under this Agreement.
19. TIME OF ESSENCE: Time is of the essence in respect to all provisions of this Agreement that specify a time for performance; provided, however, that the foregoing shall not be construed to limit or deprive a party of the benefits of any grace or use period allowed in this Agreement.
20. TERMINATION: The County has and reserves the right to suspend, terminate, or abandon the execution of any work by the Contractor without cause at any time upon giving to the Contractor prior written notice. In the event that the County should abandon, terminate, or suspend the Contractor’s work, the Contractor shall be entitled to payment for services provided hereunder prior to the effective date of said suspension, termination, or abandonment. Said payment shall be computed in accordance with Exhibit B hereto, provided that the maximum amount payable to Contractor for its High-Risk Youth Data Sharing Multidisciplinary Team Services shall not exceed $0 payment for services provided hereunder prior to the effective date of said suspension, termination or abandonment. [SEE ADDITIONAL PROVISIONS]
21. SMALL LOCAL AND EMERGING BUSINESS (SLEB) PARTICIPATION:
Contractor is approved by County to participate in contract without SLEB participation. As a result, there is no requirement to be certified or subcontract with another business in order to satisfy the County’s Small and Emerging Locally owned Business provision. The approval is based on the Contractor as a government agency, which is a SLEB Exempt Entity.
However, if circumstances or the terms of the contract should change, Contractor may be required to immediately comply with the County’s Small and Emerging Local Business provisions, including but not limited to:
Attachment A
a. Contractor must be a certified small or emerging local business(es) or subcontract a minimum 20% with a certified small or emerging local business(es). b. SLEB subcontractor(s) is independently owned and operated (i.e., is not owned or operated in any way by Prime), nor do any employees of either entity work for the other.
c. Small and/or Emerging Local Business participation and current SLEB certification status must be maintained for the term of the contract. Contractor shall ensure that their own certification status and/or that of participating subcontractors (as is applicable) are maintained in compliance with the SLEB Program.
d. Contractor shall not substitute or add any small and/or emerging local business(s) listed in this agreement without prior written approval from the County. Said requests to substitute or add a small and/or emerging local business shall be submitted in writing to the County department contract representative identified under Item #13 above.
Contractor will not be able to substitute the subcontractor without prior written approval from the Alameda County Auditor Controller Agency, Office of Contract Compliance & Reporting (OCCR).
e. All SLEB participation, except for SLEB prime contractor, must be tracked and monitored utilizing the Elation web-based compliance system (see Exhibit E).
County will be under no obligation to pay contractor for the percent committed to a SLEB (whether SLEB is a prime or subcontractor) if the work is not performed by the listed small and/or emerging local business.
For further information regarding the Small Local Emerging Business participation requirements and utilization of the Alameda County Contract Compliance System contact OCCR via e-mail at [email protected].
22. FIRST SOURCE PROGRAM: For contracts over $100,000, Contractor shall provide County ten (10) working days to refer to Contractor, potential candidates to be considered by Contractor to fill any new or vacant positions that are necessary to fulfill their contractual obligations to the County that Contractor has available during the contract term before advertising to the general public.
23. CHOICE OF LAW: This Agreement shall be governed by the laws of the State of California.
24. WAIVER: No waiver of a breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right, or remedy. No waiver of any breach, failure, right or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
Attachment A
25. ENTIRE AGREEMENT: This Agreement, including all attachments, exhibits, and any other documents specifically incorporated into this Agreement, shall constitute the entire agreement between County and Contractor relating to the subject matter of this Agreement. As used herein, Agreement refers to and includes any documents incorporated herein by reference and any exhibits or attachments. This Agreement supersedes and merges all previous understandings, and all other agreements, written or oral, between the parties and sets forth the entire understanding of the parties regarding the subject matter thereof. The Agreement may not be modified except by a written document signed by both parties.
26. HEADINGS herein are for convenience of reference only and shall in no way affect interpretation of the Agreement.
27. ADVERTISING OR PUBLICITY: Contractor shall not use the name of County, its officers, directors, employees or agents, in advertising or publicity releases or otherwise without securing the prior written consent of County in each instance.
28. MODIFICATION OF AGREEMENT: This Agreement may be supplemented, amended, or modified only by the mutual agreement of the parties. No supplement, amendment, or modification of this Agreement shall be binding unless it is in writing and signed by authorized representatives of both parties.
29. ASSURANCE OF PERFORMANCE: If at any time County believes Contractor may not be adequately performing its obligations under this Agreement or that Contractor may fail to complete the Services as required by this Agreement, County may request from Contractor prompt written assurances of performance and a written plan acceptable to County, to correct the observed deficiencies in Contractor’s performance. Contractor shall provide such written assurances and written plan within ten (10) calendar days of its receipt of County’s request and shall thereafter diligently commence and fully perform such written plan. Contractor acknowledges and agrees that any failure to provide such written assurances and written plan within the required time is a material breach under this Agreement.
30. SUBCONTRACTING/ASSIGNMENT: Contractor shall not subcontract, assign, or delegate any portion of this Agreement or any duties or obligations hereunder without the County’s prior written approval.
a. Neither party shall, on the basis of this Agreement, contract on behalf of or in the name of the other party. Any agreement that violates this Paragraph shall confer no rights on any party and shall be null and void.
b. Contractor shall use the subcontractors identified in Exhibit A and shall not substitute subcontractors without County’s prior written approval. c. Contractor shall require all subcontractors to comply with all indemnification and insurance requirements of this agreement, including, without limitation, Exhibit C.
Contractor shall verify subcontractor’s compliance.
Attachment A
d. Contractor shall remain fully responsible for compliance by its subcontractors with all the terms of this Agreement, regardless of the terms of any agreement between Contractor and its subcontractors.
31. SURVIVAL: The obligations of this Agreement, which by their nature would continue beyond the termination on expiration of the Agreement, including without limitation, the obligations regarding Indemnification (Paragraph 2), Ownership of Documents (Paragraph 11), and Conflict of Interest (Paragraph 12), shall survive termination or expiration.
32. SEVERABILITY: If a court of competent jurisdiction holds any provision of this Agreement to be illegal, unenforceable, or invalid in whole or in part for any reason, the validity and enforceability of the remaining provisions, or portions of them, will not be affected, unless an essential purpose of this Agreement would be defeated by the loss of the illegal, unenforceable, or invalid provision.
33. PATENT AND COPYRIGHT INDEMNITY: Contractor represents that it knows of no allegations, claims, or threatened claims that the materials, services, hardware or software (“Contractor Products”) provided to County under this Agreement infringe any patent, copyright or other proprietary right. Contractor shall defend, indemnify and hold harmless County of, from and against all losses, claims, damages, liabilities, costs expenses and amounts (collectively, “Losses”) arising out of or in connection with an assertion that any Contractor Products or the use thereof, infringe any patent, copyright or other proprietary right of any third party. County will: (1) notify Contractor promptly of such claim, suit, or assertion; (2) permit Contractor to defend, compromise, or settle the claim; and, (3) provide, on a reasonable basis, information to enable Contractor to do so. Contractor shall not agree without County’s prior written consent, to any settlement, which would require County to pay money or perform some affirmative act in order to continue using the Contractor Products.
a. If Contractor is obligated to defend County pursuant to this Paragraph 33 and fails to do so after reasonable notice from County, County may defend itself and/or settle such proceeding, and Contractor shall pay to County any and all losses, damages and expenses (including attorney’s fees and costs) incurred in relationship with County’s defense and/or settlement of such proceeding.
b. In the case of any such claim of infringement, Contractor shall either, at its option, (1) procure for County the right to continue using the Contractor Products; or (2) replace or modify the Contractor Products so that that they become non-infringing, but equivalent in functionality and performance.
c. Notwithstanding this Paragraph 33, County retains the right and ability to defend itself, at its own expense, against any claims that Contractor Products infringe any patent, copyright, or other intellectual property right.
34. OTHER AGENCIES: Other tax supported agencies within the State of California who have not contracted for their own requirements may desire to participate in this contract. The Attachment A
Contractor is requested to service these agencies and will be given the opportunity to accept or reject the additional requirements. If the Contractor elects to supply other agencies, orders will be placed directly by the agency and payments made directly by the agency.
35. EXTENSION: This agreement may be extended for 1 year by mutual agreement of the County and the Contractor. [SEE ADDITIONAL PROVISIONS]
36. SIGNATORY: By signing this agreement, signatory warrants and represents that he/she executed this Agreement in his/her authorized capacity and that by his/her signature on this Agreement, he/she or the entity upon behalf of which he/she acted, executed this Agreement. [END OF GENERAL TERMS AND CONDITIONS]
Attachment A
Additional Provisions
ADDITIONAL PROVISIONS
Revision to the General Terms and Conditions of this Agreement are hereby noted below.
Section 20, TERMINATION, is deleted in its entirety and replaced with the following:
The County has and reserves the right to suspend, terminate, or abandon the execution of any work by the Contractor without cause at any time upon giving to the Contractor prior written notice. In the event that the County should abandon, terminate, or suspend the Contractor’s work, the Contractor shall be entitled to payment for services provided hereunder prior to the effective date of said suspension, termination, or abandonment. Said payment shall be computed in accordance with Exhibit B hereto, provided that the maximum amount payable to Contractor for its High-Risk Youth Data Sharing Multidisciplinary Team Services shall not exceed $0 payment for services provided hereunder prior to the effective date of said suspension, termination or abandonment. Any party may terminate this Agreement with 90 days' written notice to all the other parties.
Section 35, EXTENSION, is deleted in its entirety and replaced with the following:
Following the initial three-year term, this Agreement shall renew annually for up to an additional two (2) years.
Approved as to Form:
Donna R. Ziegler, County Counsel
By:
K. Joon Oh, Deputy County Counsel
Attachment A
Exhibit A
EXHIBIT A
DEFINITION OF SERVICES
1. This Agreement shall establish a collective multidisciplinary team (MDT) called the Oakland Citywide Coordination of Service Team (COST) with respect to sharing data of justice-involved youth and youth in the community of Oakland set on this Exhibit A, consisting of the following:
Exhibit A-1 Justice-Involved Youth
Exhibit A-2 Youth in Community
2. The COST shall consist of the following parties, as applicable during the term of this Agreement:
a. City of Oakland, Department of Violence Prevention (DVP)
b. Alameda County Probation Department (ACPD)
c. Alameda County District Attorney’s Office (ACDA)
d. Alameda County Office of Education (ACOE)
e. Oakland Unified School District (OUSD)
f. The National Institute for Criminal Justice Reform (NICJR)
3. As a collective objective, the COST shall share information concerning justice-involved youth under the supervisor of ACPD and high-risk youth in City of Oakland with the sole purpose of providing support and services for students and their families at an MDT level.
The Parties shall have two MDT meetings targeting justice-involved youth and high-risk youth in City of Oakland respectively. The meetings shall adhere to the corresponding protocol, as expressed in Exhibit A-1 and A-2, based on the discussed population, to effectively coordinate resources and services that address the needs of the targeted populations in Oakland while complying with applicable laws and regulations.
Attachment A
Exhibit A-1
EXHIBIT A-1
JUSTICE-INVOLVED YOUTH
1. The Parties shall share information about justice-involved youth under the supervision of ACPD with the goal of coordinating the deployment of resources and services to address their needs and prevent ongoing crime and violence. Subject to applicable laws and regulations, the data shared between all parties under this Agreement shall not be used for punitive, enforcement, or other surveillance decisions by any agency stated in this Agreement, unless is mandated by law.
Welfare and Institutions Code section 830.1 provides that:
“members of a juvenile justice multidisciplinary team engaged in the prevention, identification, and control of crime, including, but not limited to, criminal street gang activity, may disclose and exchange nonprivileged information and writings to and with one another relating to any incidents of juvenile crime, including criminal street gang activity, that may also be part of a juvenile court record or otherwise designated as confidential under state law if the member of the team having that information or writing reasonably believes it is generally relevant to the prevention, identification, or control of juvenile crime or criminal street gang activity.
Every member of a juvenile justice multidisciplinary team who receives such information or writings shall be under the same privacy and confidentiality obligations and subject to the same penalties for violating those obligations as the person disclosing or providing the information or writings.
The information obtained shall be maintained in a manner which ensures the protection of confidentiality.”
Welfare and Institutions Code section 830.1 further provides that:
“As used in this section, “multidisciplinary team” means any team of three or more persons, the members of which are trained in the prevention, identification, and control of juvenile crime, including, but not limited to, criminal street gang activity, and are qualified to provide a broad range of services related to the problems posed by juvenile crime and criminal street gangs. The team may include, but is not limited to:
a. Police officers or other law enforcement agents
b. Prosecutors
c. Deputy Probation Officers
Attachment A
Exhibit A-1
d. School district personnel with experience or training in juvenile crime or criminal street gang control
e. Counseling personnel with experience or training in juvenile crime or criminal street gang control
f. State, county, city, or special district recreation specialists with experience or training in juvenile crime or criminal street gang control”
2. Scope
a. The Parties that will serve as referral agencies agree to share information related to high- risk youth, including:
(1) Identifying Information (e.g., name(s), date of birth, phone number, address)
(2) Demographic information (e.g., age, gender, race/ethnicity)
(3) Academic performance and attendance
(4) Behavioral incidents
(5) Involvement in criminal activity
(6) Participation in programs and services
b. The scope of this Agreement is designed for student data sharing information for the sole purpose of providing additional support and interventions for students/families. Each team member is subject to sharing information in the following ways:
(1) Non-law-enforcement providers of services will share specific student information solely for the purpose of providing support and services to youth.
(2) Law enforcement agencies attending any meeting under this Agreement will not use any student-level information* for enforcement purposes, unless mandated by applicable law or regulation.
*Student Level Information includes, but is not limited to, name, date of birth, home address, newcomer status, parent/guardian information, disciplinary history and/or interaction with law enforcement, and health information.
3. Data Sharing Guidelines
Attachment A
Exhibit A-1
a. Confidentiality: All shared information shall be treated as confidential and shall be used solely for the purposes outlined in this Agreement.
b. Compliance with Laws: The parties shall comply with all applicable state and federal laws regarding data privacy and security, including without limitations the California Consumer Privacy Act (CCPA), the Family Educational Rights and Privacy Act (FERPA), and Welfare and Institutions Code sections 825 - 832.
c. Data Security: The parties shall implement appropriate security measures to protect the confidentiality, integrity, and availability of shared data.
4. Collaboration and Coordination
a. The parties agree to establish a joint working group to oversee the implementation of this Agreement and address any issues that may arise.
b. The working group shall develop protocols for data sharing, including data formats, frequency of updates, and dispute resolution mechanisms.
c. The parties shall coordinate their efforts to ensure that resources and services are effectively deployed to address the needs of high-risk youth.
Attachment A
Exhibit A-2
EXHIBIT A-2
YOUTH IN COMMUNITY
1. The Parties shall share information about high-risk youth in the City of Oakland with the goal of coordinating the deployment of resources and services to address their needs and prevent ongoing legal system involvement and violence. The Parties shall obtain a valid consent from parent or guardian of the youth prior to the MDT meeting.
2. Scope
a. The Parties that will serve as referral agencies agree to share information related to high-risk youth, including:
*NOTE: OUSD must receive written parental/guardian consent prior to sharing any information about youth or families.
(1) Identifying Information (e.g., name(s), date of birth, phone number, address)
(2) Demographic information (e.g., age, gender, race/ethnicity)
(3) Academic performance and attendance
(4) Behavioral incidents
(5) Involvement in violence perpetration or victimization
(6) Participation in programs and services
b. The scope of this Agreement is designed for student data sharing information for the sole purpose of providing additional support and interventions for students/families.
Each team is subject to sharing information in the following ways:
(1) OUSD is required to receive written parental/guardian consent prior to sharing any student or family information.
(2) Non-law-enforcement providers of services will share specific student information solely for the purpose of providing support and services to youth.
(3) Subject to applicable laws and regulations, law enforcement agencies attending any meeting under this Agreement will not use any student-level information* for enforcement purposes.
Attachment A
Exhibit A-2
*Student Level Information includes, but is not limited to, name, date of birth, home address, newcomer status, parent/guardian information, disciplinary history and/or interaction with law enforcement, and health information.
3. Citywide COST
a. OUSD will partner with the members of Youth Violence Reduction Committee (CITYWIDE COST) with the sole focus of establishing a collaborative space for community agencies to provide coordinated support and interventions to OUSD’s most high-risk students to prevent their involvement in violence perpetration or victimization.
OUSD MUST obtain written permission from the parent/guardian before OUSD representatives can share any student information with members of the CITYWIDE COST.
OUSD representatives at the CITYWIDE COST MUST NOT use any information gathered at the CITYWIDE COST to negatively impact staff, programming, or experiences at the students' school site.
b. Referral
(1) Referrals Submission to Citywide COST
Three of the five Parties will identify and recommend youth for discussion by the CITYWIDE COST based on behaviors or circumstances that put the youth at high risk for violence perpetration or victimization. OUSD must obtain parental/guardian consent prior to recommending youth for discussion. Parties that make youth referrals to CITYWIDE COST will share the following information with CITYWIDE COST members for the purpose of facilitating referrals to services:
(a) Name and contact information
(b) Contact information for parents/guardians
(c) Demographic information (e.g., age, gender, race/ethnicity) (d) Family dynamics and living situation
(e) Network/group impacted
(f) Academic performance and attendance (including Special Education accommodations)
(g) School disciplinary history and behavioral incidents Attachment A
Exhibit A-2
(h) Involvement in violence perpetration or victimization (i) Participation in programs and services
(2) Referral Receipt from Citywide COST
Five of the five Parties will use referral information about youth discussed by the CITYWIDE COST for the purpose of connecting youth to helpful support services delivered by or funded by the Party. Service referrals will be discussed and agreed upon by the CITYWIDE COST prior to being made.
Examples of services that each of the five Parties may refer youth to are provided in Table 2. Parties that receive youth referrals from CITYWIDE COST will be able to share information with the CITYWIDE COST about whether the youth engaged in services and the duration of service engagement. These parties will not share any other information about service delivery with the CITYWIDE COST.
(3) Referral Reference
Table 1. Referral Role of Each Party
Party Submit Youth Referrals to
CITYWIDE COST
Receive Youth Referrals from
CITYWIDE COST
ACOE Yes Yes
ACPD Yes Yes
DVP No Yes
NICJR No Yes
OUSD Yes Yes
Table 2. Examples of Services Available to CITYWIDE COST Youth Through Party Referrals
Party Examples of Available Services
OUSD Enrollment, school re-entry/re-engagement (i.e. conflict mediation and restorative justice) academic supports and other school-based services (counseling, therapeutic services, internships, expanded learning/after- school opportunities)
ACOE
ACPD
DVP Life coaching, employment navigation, housing navigation, therapy, relocation, gender-based violence intervention
NICJR Diversion services, Relocation, CITYWIDE COST Coordination/Facilitation
4. Communication Data Sharing Guidelines
Attachment A
Exhibit A-2
a. Confidentiality: All shared information shall be treated as confidential and shall be used solely for the purposes outlined in this Agreement.
b. Compliance with Laws: The parties shall comply with all applicable state and federal laws regarding data privacy and security, including the California Consumer Privacy Act (CCPA) and the Family Educational Rights and Privacy Act (FERPA).
c. Data Security: The parties shall implement appropriate security measures to protect the confidentiality, integrity, and availability of shared data.
d. Consent: When sharing personally identifiable information (PII) about minors, the parties shall obtain appropriate consent from parents or guardians, in accordance with applicable laws.
e. Use of Data: Subject to applicable laws and regulations, the data shared between all parties under this Agreement shall not be used for punitive, enforcement, or other surveillance decisions by any agency stated in this Agreement
5. Collaboration and Coordination
a. The parties agree to establish a joint working group to oversee the implementation of this Agreement and address any issues that may arise.
b. The working group shall develop protocols for data sharing, including data formats, frequency of updates, and dispute resolution mechanisms.
c. The parties shall coordinate their efforts to ensure that resources and services are effectively deployed to address the needs of high-risk youth Attachment A
Exhibit B
EXHIBIT B
PAYMENT TERM
The compensation payable to Contractor hereunder shall not exceed Zero dollars ($0) for the term of this Agreement. This cost includes all taxes and all other charges.
Attachment A
Exhibit C
EXHIBIT C
INSURANCE REQUIREMENTS
Without limiting any other obligation or liability under this Agreement, the Contractor, at its sole cost and expense, shall secure and keep in force during the entire term of the Agreement or longer, as may be specified below, the following minimum insurance coverage, limits and endorsements:
TYPE OF INSURANCE COVERAGES MINIMUM LIMITS
A Commercial General Liability
Premises Liability; Products and Completed Operations; Contractual Liability; Personal Injury and Advertising Liability
$1,000,000 per occurrence (CSL) Bodily
Injury and Property Damage
B Commercial or Business Automobile Liability
All owned vehicles, hired or leased vehicles, non-owned, borrowed and permissive uses. Personal Automobile Liability is acceptable for
individual contractors with no transportation or hauling related activities $1,000,000 per occurrence (CSL) Any
Auto
Bodily Injury and Property Damage
C Workers’ Compensation (WC) and Employers Liability (EL) Required for all contractors with employees
WC: Statutory Limits
EL: $1,000,000 per accident for bodily injury or disease D Professional Liability including Technology Professional Liability (Errors and Omissions) Insurance appropriate to the Consultant’s profession. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by Consultant in this agreement and shall include, but not be limited to, claims involving infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of private information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations.
a. The Policy shall include, or be endorsed to include, property damage liability coverage for damage to, alteration of, loss of, or destruction of electronic data and/or information “property” of the County in the care, custody, or control of the Consultant. If not covered under the Consultant’s liability policy, such “property” coverage of the Consultant may be endorsed onto the Consultant’s Cyber Liability Policy as covered property as follows:
b. Cyber Liability coverage in an amount sufficient to cover the full replacement value of damage to, alteration of, loss of, or destruction of electronic data and/or information “property” of the County that will be in the care, custody, or control of Consultant.
The Insurance obligations under this agreement shall be the greater of 1—all the Insurance coverage and limits carried by or available to the Vendor; or 2—the minimum Insurance requirements shown in this agreement. Any insurance proceeds in excess of the specified limits and coverage required, which are applicable to a given loss, shall be available to Agency. No representation is made that the minimum Insurance requirements of this agreement are sufficient to cover the indemnity or other obligations of the Vendor under this agreement.
$1,000,000 per occurrence
$2,000,000 project aggregate
Attachment A
Exhibit C
E Endorsements and Conditions:
1. ADDITIONAL INSURED: All insurance required above with the exception of Professional Liability, Commercial or Business Automobile Liability, Workers’ Compensation and Employers Liability, shall be endorsed to name as additional insured: County of Alameda, its Board of Supervisors, the individual members thereof, and all County officers, agents, employees, volunteers, and representatives. The Additional Insured endorsement shall be at least as broad as ISO Form Number CG 20 38 04 13.
2. DURATION OF COVERAGE: All required insurance shall be maintained during the entire term of the Agreement. In addition, Insurance policies and coverage(s) written on a claims-made basis shall be maintained during the entire term of the Agreement and until 3 years following the later of termination of the Agreement and acceptance of all work provided under the Agreement, with the retroactive date of said insurance (as may be applicable) concurrent with the commencement of activities pursuant to this Agreement.
3. REDUCTION OR LIMIT OF OBLIGATION: All insurance policies, including excess and umbrella insurance policies, shall include an endorsement and be primary and non-contributory and will not seek contribution from any other insurance (or self- insurance) available to the County. The primary and non-contributory endorsement shall be at least as broad as ISO Form 20 01 04 13. Pursuant to the provisions of this Agreement insurance effected or procured by the Contractor shall not reduce or limit Contractor’s contractual obligation to indemnify and defend the Indemnified Parties.
4. INSURER FINANCIAL RATING: Insurance shall be maintained through an insurer with a A.M. Best Rating of no less than A:VII or equivalent, shall be admitted to the State of California unless otherwise waived by Risk Management, and with deductible amounts acceptable to the County.
Acceptance of Contractor’s insurance by County shall not relieve or decrease the liability of Contractor hereunder. Any deductible or self-insured retention amount or other similar obligation under the policies shall be the sole responsibility of the Contractor.
5. SUBCONTRACTORS: Contractor shall include all subcontractors as an insured (covered party) under its policies or shall verify that the subcontractor, under its own policies and endorsements, has complied with the insurance requirements in this Agreement, including this Exhibit.
The additional Insured endorsement shall be at least as broad as ISO Form Number CG 20 38 04 13.
6. JOINT VENTURES: If Contractor is an association, partnership or other joint business venture, required insurance shall be provided by one of the following methods:
– Separate insurance policies issued for each individual entity, with each entity included as a “Named Insured” (covered party), or at minimum named as an “Additional Insured” on the other’s policies. Coverage shall be at least as broad as in the ISO Forms named above. – Joint insurance program with the association, partnership or other joint business venture included as a “Named Insured”.
7. CANCELLATION OF INSURANCE: All insurance shall be required to provide thirty (30) days advance written notice to the County of cancellation.
8. CERTIFICATE OF INSURANCE: Before commencing operations under this Agreement, Contractor shall provide Certificate(s) of Insurance and applicable insurance endorsements, in form and satisfactory to County, evidencing that all required insurance coverage is in effect. The County reserves the rights to require the Contractor to provide complete, certified copies of all required insurance policies. The required certificate(s) and endorsements must be sent as set forth in the Notices provision.
Attachment A
Exhibit D
EXHIBIT D
DEBARMENT AND SUSPENSION CERTIFICATION
The contractor, under penalty of perjury, certifies that, except as noted below, contractor, its principals, and any named and unnamed subcontractor:
• Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency;
• Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past three years;
• Does not have a proposed debarment pending; and
• Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past three years.
If there are any exceptions to this certification, insert the exceptions in the following space. For any exception noted, indicate to whom it applies, initiating agency, and dates of action. Exceptions will not necessarily result in denial of award, but will be considered in determining Contractor responsibility.
Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Standard Services Agreement. Signing this Standard Services Agreement on the signature portion thereof shall also constitute signature of this Certification.
CONTRACTOR:
ALAMEDA COUNTY OFFICE OF EDUCATION CITY OF OAKLAND on behalf of its DEPARTMENT OF VIOLENCE
PREVENTION
By:
Signature
By:
Signature
Name: Alysse Castro
(Printed)
Name: Holly Joshi
(Printed)
Title: Superintendent Of Schools
Title: Chief of Violence Prevention
Date:
Date: ________
Attachment A
Exhibit D
OAKLAND UNIFIED SCHOOL DISTRICT THE NATIONAL INSTITUTE FOR CRIMINAL JUSTICE REFORM
By:
Signature
By:
Signature
Name:
(Printed)
Name: David Muhammad
(Printed)
Title:
Title: Executive Director
Date: ________
Date: ___________________________________________
Attachment A
Exhibit E
EXHIBIT E
PARENT/GUARDIAN CONSENT FOR RELEASE OF INFORMATION SAMPLE
Citywide Coordination of Services Team (COST)
Youth's Full Name: ____________________________________________________________________
Additional Sibling(s) in Need of Support (if applicable)
Sibling’s Full Name & Relationship to Youth:__________________________________________ Sibling’s Full Name & Relationship to Youth:__________________________________________ Sibling’s Full Name & Relationship to Youth:__________________________________________
Date of Birth: ________________________________________________________________________ Gender: _____________________________________________________________________________ School/Organization (if applicable): _______________________________________________________ As the parent/legal guardian of the above-named youth, I hereby authorize the sharing and discussion of information regarding my child among the members of the Youth Violence Reduction Coordination Team (CITYWIDE COST) for the purpose of developing and implementing a coordinated strategy to reduce violence and address high-risk behaviors.
1. Purpose of Disclosure:
To facilitate a collaborative approach in assessing needs, reducing risk behaviors, and providing appropriate services and interventions for the youth listed above.
2. Parties Authorized to Share and Receive Information:
Information may be shared among members of the CITYWIDE COST, including but not limited to:
● Oakland Unified School District (OUSD)
● Alameda County Probation Department (ACPD)
● Alameda County District Attorney’s Office
● The City of Oakland Department of Violence Prevention (DVP)
● The National Institute of Criminal Justice Reform (NICJR) Attachment A
Exhibit E
3. Types of Information to be Disclosed:
● Name and contact information
● Contact information for parents/guardians
● Demographic information (e.g., age, gender, race/ethnicity)
● Family dynamics and living situation
● Peer associations
● Academic performance and attendance (including Special Education accommodations)
● School disciplinary history and behavioral incidents
● Involvement in violence perpetration or victimization
● Participation in programs and services
4. Confidentiality and Security of Information:
All information shared will be treated as confidential and used solely for the purposes of providing additional support and interventions for students/families. Information will not be disclosed beyond CITYWIDE COST. Information shared shall not be used for punitive, enforcement, or other surveillance decisions by any agency.
5. Expiration and Revocation:
This release will remain in effect for one year from the date of signature unless revoked in writing earlier. I understand that I may revoke this consent at any time by submitting written notice to any CITYWIDE COST participating agency.
6. Acknowledgment:
I understand the nature of this release and the purpose for which the information will be used. I understand that I have the right to inspect the disclosed information and that refusal to sign this form may limit my child’s access to coordinated services.
Parent/Guardian Name (Printed): ________________________________________________________ Relationship to Youth: _________________________________________________________________ Attachment A
Exhibit E
Parent/Guardian Signature: _____________________________________________________________ Date: _______________________________________________________________________________ Youth Signature (if age-appropriate): _____________________________________________________ Date: _______________________________________________________________________________