MOU RE REFUGEE RESETTLEMENT PROGRAM WITH ADES.PDF

DEPARTMENT OF ECONOMIC SECURITY
Your Partner ,For A Strouger rtrizanu
MEMORANDUM OF UNDERSTANDING
(IVIOU)
VISTA Project Number:
DES Number:
Between the Sponsor:
State of Arizona
Department of Economic Security
Division of Aging and Adult Services
Melanie K. Stems, Assistant Director
1789 West Jefferson Site Code 950A
Phoenix, Arizona 85007
602-542-6365
And the Participating Agency:
Maricopa County Department of Public Health_
1645 E. Roosevelt St
Phoenix, AZ 85006
This document defines the responsibilities of the Sponsor and the Participating Agency with respect to the assignment of
AmeriCorps*VISTA member(s) to perform services to strengthen and supplement efforts to eliminate poverty and poverty-
related human, social and environmental problems. The Sponsor and the Participating Agency shall ensure that all services
provided are culturally relevant and linguistically appropriate to the population to be served. Due to the refugee-specifie
experience and knowledge required to perform these services, it is in the best interest of the Sponsor to contract with
Participating Agencies who have met the criteria for participation in the project and have expressed an interest to participate
with the AmeriCorps*VIS TA Project (Criteria listed in Participating Agency section 4.)

Duration
This Memorandum of Understanding (MOU) shall be in effect on the date of last signature and shall terminate on
September 6, 2014.
2. Modifications
2.1 This MOU may be amended at any time in writing with an executed amendment signed by authorized representatives
of the Sponsor and the Participating Agency.
Termination
3.1 The Sponsor or the Participating Agency may terminate this MOU at any time by giving at least thirty (30) days
notice in writing to the Sponsor or the contractor of its intent. Further, this MOU will terminate if the Participating
Agency materially fails to comply with any of its terms.
4. Responsibilities
4.1 The Sponsor will:
a. Assist AmeriCorps*VISTA Participating Agencies in developing work plans for each assignment.
b. Assist in the provision of pre-service, early service, and in-service training.
c. Plan meetings for project supervisors and for AmeriCorps*VISTA member(s) ongoing training as needed or
recommended by the Corporation for National and Community Service (CN CS).
d. Provide a current listing of Participating Agencies to be used for collaboration with other refugee-serving
Participating Agencies in developing and delivering services under this contract.
e, Assign AmeriCorps*VISTA member(s) to Participating Agencies, matching interests and skills with tasks
outlined in the work plan.
f. Provide support and supervision to Participating Agencies in administrative matters such as project assignments
and monthly reporting.
g. Retain full responsibility for the management and semi-annual reporting of the AmeriCorps*VISTA Project as
outlined by the Corporation for National and Community Service AmeriCorps*VISTA program.
h. Transfer an ArneriCorps*VISTA member(s) from one placement to another consistent with the work plan and
Participating Agency needs.
i. Retain fall responsibility for media contacts about member(s) and their work.
j. Provide Participating Agency evaluations.
k. Provide member(s) support
1. Conduct fingerprinting, as required in Section 19.
m. Conduct background checks on AmeriCorps*VISTA member(s).
4.2 The Participating Agency will:
a. Provide services to refugees and other eligible beneficiaries.
b. Leverage local, national and global resources to accommodate the need resulting from the increasingly
unpredictable United States refugee admission trends in recent years and a greater array of arriving refugees with
corresponding unique needs.
c. Submit proof of their non-profit status which can be any one of the following:
• A reference to the applicant organization's listing in the IRS's most recent list of tax-exempt organizations
described in the IRS Code.
• A copy of a currently valid IRS tax-exemption certificate.
• A statement from a State taxing body, State attorney general, or other appropriate State official certifying
that the applicant organization has non-profit status and that none of the net earnings accrue to any private
shareholders or individuals.
• A certified copy of the organization's certificate of incorporation or similar document that clearly establishes
non-profit status.
• Any of the items in the subparagraphs immediately above and a statement signed by the organization that the
applicant organization is a local non-profit affiliate,
d. Provide quarterly written reports of collaboration with other refugee-serving agencies in developing and
delivering services under this contract.
e. Develop an ArrieriCoips*VISTA Assignment Description (VAD) (Attachment A) that corresponds to the
milestones in the Refugee Resettlement Program (RRP) Project Plan (Attachment B).

4.3 The Participating Agency will designate a site supervisor who will attend an ArneriCorps*VISTA supervisor training
as required by AmeriCorps*VISTA program and who will:
a. Within 10 days after date of last signature, and prior to the placement of the AmeriCorps*VISTA member(s), the
Participating Agency shall submit a VAD to RRP for approval. The VAD will include a schedule for completing
the work and a budget. (Attachment C.) These items shall be in sufficient detail to provide a sound basis for the
Sponsor to effectively monitor performance under this MOU.
The approved VAD may be revised with the approval of RRP.
b. Provide day-to-day supervision of the activities of the AmeriCorps*VISTA member(s).
c. Provide AmeriCorps*VISTA member(s) with timely information and supervision to ensure the bi-weekly time
sheets and a quarterly report template can be completed and sent to the Sponsor on or before due dates.
d. Provide reimbursement for public transportation or mileage for AnaeriCorps*VISTA member(s) if the havel is
part of the work plan.
e. Provide materials and supplies related to the performance of assignments and adequate working space to permit
AmeriCorps*VIS'FA member(s) to perform their assigned duties.
Cooperate with the Sponsor in implementing the individual career development plan for each
AmeriCorps*VISTA member(s).
g. Assist, when requested by the Sponsor, in reviewing performance of ArneriCorps*VISTA member(s).
h. Notify the Sponsor immediately regarding unscheduled termination of ArneriCorps*VISTA member(s) and
in scheduled changes of status and conditions of AmeriCorps*VISTA member(s), such as arrests, hospitalization,
and absence without leave.
i. Maintain records regarding time sheets and reports and investigations concerning matters involving
AmeriCorps*VISTA member(s). The Participating Agency agrees to retain such records as the Sponsor may
require for a period of five years after completion or termination of the project, or longer if required for
administrative proceedings and/or litigation purposes, and to provide access to such records to the Sponsor for
the purpose of litigation, audit or examination. All records shall be subject to inspection and audit by the State at
reasonable times. Upon request, the Participating Agencies shall produce a legible copy of any or all such
records.
J. Allow AmeriCorps*VISTA member(s) to participate in local emergency disaster relief efforts if needed.
k. Allow AmeriCorps*VISTA member(s) to participate in Days of Service, i.e., Martin Luther King Holiday,
National Volunteer Week, World Refugee Day, should activities be organized in the communities where the
member(s) is (are) in service.
4,4 The Participating Agency further agrees not to:
a. Carry out projects resulting in the identification of such projects with partisan or non-partisan political activities,
including voter registration activities, or providing voters transportation to the polls.
b. Assign AmeriCorps*VISTA member(s) to activities that would result in the firing of or result in the
displacement of employed workers, or impair existing contracts for services.
C. Accept, or permit the acceptance of compensation from the AmeriCorps*VISTA member(s) or from
beneficiaries for the service of the Arneriforps*VISTA member(s).
d. Approve the involvement of any AmeriCorps*V1STA member(s) assigned to it in planning, initiating,
participating in, or otherwise siding or assisting in any demonstrations whatsoever in their capacity as an
ArneriCorps*VISTA member.
4.5 Both parties to this Memorandum of Understanding shall:
a. Make every reasonable effort to ensure that the health and safety of the AineriCorps*VISTA member(s) is (are)
protected during the perfonnanee of their assigned duties. Neither the Sponsor nor the Participating Agency
shall assign or require AmeriCorps*VISTA members to perform duties which would jeopardize their safety or
cause them to sustain injuries.
b. Ensure that persons selected as AmeriCorps*V1STA members are not related by blood or marriage to project
staff) sponsor staff; officers or members of the sponsor's Board of Directors, or responsible Corporation program
staff.
5. Supplemental Payments Prohibited
5.1 Monetary subsistence allowances provided to AmeriCorps*VISTA members are designed to permit
AmeriCorps*VISTA member(s) to live at or below the economic level of the persons served, as required by law.
Both the Sponsor and the Participating Agency are strictly prohibited from supplementing these allowances.

6. Notices
6.1 The Participating Agency shall address all correspondence regarding this agreement to the Refugee Resettlement
Program AtneriCorps*VISTA Project coordinator at:
Department of Economic Security
Division of Aging and Adult Services
Refugee Resettlement Program
1789 West Jefferson, Site Code 950A
Phoenix, Arizona 85007
602-542-6365
6.2 The Sponsor shall address all correspondence regarding this agreement to:
Maricopa County Department of Public Health
Angelito Bravo
1645 E. Roosevelt
Phoenix, AZ 85006
AngelitoBravo@mail.maricopa.gov
7. Payments
7.1 The Participating Agency shalt not be reimbursed for any expenses within the AmeriCorps* VISTA project grant
cycle.
8. Applicable Law
8.1 This MOU shall be governed and interpreted by the laws of the State of Arizona.
9. Arbitration
9,1 The parties to this MOLT agree to resolve all disputes arising out of or relating to this MOU through arbitration, after
exhausting applicable administrative review, to the extent required by A.R.S. § 12-1518, except as may be required
by other applicable statutes (Title 41).
9.2 The parties agree that should a dispute arise between them concerning this Agreement and no party seeks affirmative
relief other than money damages in the amount of Fifty Thousand Dollars ($50,000) or less, exclusive of interest,
costs and attorneys' fees, the parties shall submit the matter to arbitration pursuant to the Revised Uniform
Arbitration Act, A.R.S §12-3001 et seq. (the "Act") whose rules shall govern the interpretation, enforcement, and
proceedings pursuant to this section. Except as otherwise provided in the Act, the decision of the arbitrator(s) shall
be final and binding upon the parties.
10. Non-Availability of Funds
10.1 Every payment obligation of the State under the MOU is conditioned upon the availability of funds appropriated or
allocated for payment of such obligation. If funds are not allocated and available for the continuance of this MOU,
this MOU may be terminated by the State at the end of the period for which funds are available. No liability shall
accrue to the State in the event this provision is exercised, and the State shalt not be obligated or liable for any future
payments of for any damages as a result of termination under this paragraph.
11. Availability of Funds for the Current State Fiscal Year
11.1 Should the State Legislature enter into session and reduce the appropriations or for any reason and these goods or
services are not funded, the ADES may take any of the following actions:
• Reduce the number of AmeriCoips*VISTA members authorized;
• Cancel the MOLT
• Cancel the MOU and re-write the requirements.
12. Availability of Funds for the Next State Fiscal Year
12.1 Funds may not presently be available for performance under this MOU beyond the current state fiscal year. If funds
are not allocated and available for the continuance of this MOU, this MOU may be terminated by the Sponsor at the
end of the period for which funds are available.

12.2 No liability shall accrue to the Sponsor in the event this pro -vision is exercised, and the DES shall not be obligated or
liable for any future payments of for any damages as a result of termination under this paragraph.
13. Cancellation for Conflict of Interest
13.1 Pursuant to A.R.S. §38-511, the State, its political subdivisions or any department or agency of either may, within
three years after its execution, cancel any MOU without penalty or further obligation, made by the State, its political
subdivisions or any department or agency of either if any person significantly involved in initiating, negotiating,
securing, drafting or creating the MOU on behalf of the State, its political subdivisions or any department or agency
of either is, at any time while the MOU or any extension of the MOU is in effect, an employee or agent of any other
party to the MOU in any capacity or a consultant to any other party to the MOU with respect to the matter of the
MOU. A cancellation made pursuant to this provision shall be effective when the Participating Agency received
written notice of the cancellation, unless the notice specifies a later time.
14. Culturally Relevant and Linguistically Appropriate
14.1 The Participating Agency shall ensure that all services provided are culturally relevant and linguistically appropriate
to the population to be served.
15. Iran and Sudan
15.1 in accordance with A.R.S. § 35-393.06, the Participating Agency certifies that the Participating Agency does not have
scrutinized business operations in Iran.
15.2 In accordance with A.R.S. § 35-391.06, the Participating Agency certifies that the Participating Agency does not have
scrutinized business operations in Sudan.
16, Data Sharing Agreement
16.1 When determined by the Sponsor that sharing of confidential data will occur with the Participating Agency, the
Participating Agency shall complete the DES Data Sharing Request Agreement and submit the completed Agreement
to the Sponsor program designated staff prior to any work commencing or data shared. A separate Data Sharing
Request Agreement shall be required between the Participating Agency and each sponsor program sharing
confidential data.
17. E-Verify
17.1 The Participating Agency certifies compliance with all Federal immigration laws and regulations relating to
AmeriCorps*VISTA Member(s) and certifies its compliance with Section A.R.S. § 23-214, subsection A. (That
subsection reads: "After December 31, 2007, every employer, after hiring an employee, shall verify the employment
eligibility of the employee through the E-Verify program.")
17.2 A breach of a certification regarding compliance with immigration laws and regulations shall be deemed a material
breach of the MOU and the Participating Agency may be subject to penalties up to and including termination of the
MOU.
17,3 Failure to comply with a State audit process to randomly verify the records of Participating Agency and
subcontractors shall be deemed a material breach of the MOU and the Participating Agency may be subject to
penalties up to and including termination of the MOU.
17.4 The Sponsor retains the legal right to inspect the papers of any AmeriCorps*VISTA member who works on the MOU
to ensure that the Participating Agency or subcontractor is complying with the certifications under the first paragraph.
18. Federal Immigration and Nationality Act
18.1 By entering into the MOU, the Participating Agency certifies compliance with the Federal immigration and
Nationality Act. (FINA) and all other Federal immigration laws and regulations related to the immigration status of
its AmeriCorps*VISTA member(s). The Participating Agency shall obtain statements from its subcontractors
certifying compliance and shall furnish the statements to the Procurement Officer upon request. These certifications
shall remain in effect through the term of the MOU. The Participating Agency and its subcontractors shall also
maintain Employment Eligibility Verification forms (I-9) as required by the U.S. Department of Labor's Immigration
and Control Act, for all AmeriCorps*VISTA member(s) performing work under the MOU. 1-9 forms are available
for download at USCIS.GOV .

18.2 The State may request verification of compliance for any Participating Agency or subcontractor performing work
under the MOU. Should the State suspect or find that the Participating Agency or any of its subcontractors are riot in
compliance, the State may pursue any and all remedies allowed by law, including, but not limited to suspension of
work, termination of the MOU for default, and suspension and/or debarment of the Participating Agency. All costs
necessary to verify compliance are the responsibility of the Participating Agency.
19. Fingerprinting
19.1 Participating Agency shall ensure that AmeriCorps*VISTA member(s) comply with all applicable (current and
future) legal requirements relating to fingerprinting, fingerprint clearance cards, certifications regarding pending or
past criminal matters, and criminal records checks that relate to contract performance.
19.2 Applicable legal requirements relating to fmgerprinting,, certification, and criminal background checks may include,
but are not limited, to the following: A.R.S. §§ 36-594.01, 36-3008, 41-1964, and 46-141. All applicable legal
requirements relating to fingerprinting, fingerprint clearance cards, certifications regarding pending or past criminal
matters, and criminal records checks are hereby incorporated in their entirety as provisions of this contract. The
Participating Agency is responsible for knowing which legal requirements relating to fingerprinting, fingerprint
clearance cards, certifications regarding pending or past criminal matters, and criminal records checks relate to MOU
performance.
19.3 To the extent A.R.S. § 46-141 is applicable to contract performance or the services provided under this MOU, the
following provisions apply:
19.3.1 AmeriCorps*V1STA member(s) who are employed by the Participating Agency, whether paid or not, and who are
required or allowed to provide services directly to juveniles or vulnerable adults shall submit a full set of fingerprints
to the Sponsor for the purposes of obtaining a State and federal criminal records check pursuant to section 41-1750
and Public Law 92-544 or shall apply for a fingerprint clearance card within seven working days of employment.
19.3.2 Except as provided in A.R.S. § 46-141, this MOU may be cancelled or terminated immediately if an
AmeriCorps*VISTA member employed by the Participating Agency and who has contact with juveniles certifies
pursuant to the provisions of A.R.S. § 46-141 (as may be amended) that the AmeriCorps*VISTA member is awaiting
trial or has been convicted of any of the offenses listed therein in this State, or of acts committed in another state that
would be offenses in this State, or it' the AmeriCorps*VISTA member does not possess or is denied issuance of a
valid fingerprint clearance card.
20. Background Cheeks for Employment through the Central Registry. If providing direct services to children or
vulnerable adults, the following shall apply:
20.1 The provisions of A.R.S. § 8-804 (as may be amended) are hereby incorporated in its entirety as provisions of this
IVIOU.
20.2 The Sponsor will conduct Central Registry Background Checks and will use the information contained in the Central
Registry as a factor to determine qualifications for AmeriCorps*VISTA members that provide direct service to
children or vulnerable adults for:
1. Any person who applies for a contract with this State and that person's employees;
2. All employees of a contractor;
3. A subcontractor of a contractor and the subcontractor's employees; and
4. Prospective employees of the contractor or subcontractor at the request of the prospective employer.
20.3 AmeriCorps*VISTA members who provide direct services to children or vulnerable adults shall have a Central
Registry Background Check (Attachment D as may be amended) which is to be used as a factor to determine
qualifications for their positions.
20.4 1. An AmeriCcaps*VISTA member who is disqualified because of a Central Registry Background Check may
apply to the Board of Fingerprinting for a Central Registry exception pursuant to A.R.S. § 41-619.57. An
AnteriCorps*VISTA member who is granted a Central Registry exception pursuant to A.R.S. § 41-619.57 is
not entitled to a contract, employment, licensure, certification or other benefit because the person has been
granted a Central Registry exception.
2. Before being employed or vobinteering in a position that provides direct services to children or vulnerable
adults, AmeriCorps*VISTA members shall certify on forms that are provided by the Sponsor whether an

allegation of abuse or neglect was made against them and was substantiated. The completed forms are to be
maintained as confidential.
20.5 The AmeriCorps*VISTA member shall not provide direct services to Sponsor clients until the results of the Central
Registry Background Check are complete and the results indicate that the AmeriCoips*VISTA member has no
disqualifying acts that would prohibit him/her from providing services to Sponsor clients. If the Central Registry
Background Check specifies any disqualifying act and the AmeriCorps*VISTA member does not have a Central
Registry exception, the AmeriCorps*VISTA member shall be prohibited from providing direct services to Sponsor
clients.
20.6 The Participating Agency shall maintain the Central Registry Background Check results and any related forms or
documents in a confidential file for five (5) years after termination of the MOU.
21. Non-Discrimination
21.1 No person with responsibilities in the operation of the project shall discriminate against any AmeriCorps*VISTA
member(s), or member(s) of the staff of, or beneficiary of the project, with respect to any aspect of the project on the
basis of race, religion, color, national origin, sex, age, disability, or political affiliation.
22. Offshore Performance of Work Prohibited
22.1 Due to security and identity protection concerns, direct services under this contract shall be performed within the
borders of the United States. Any services that are described in the specifications or scope of work that directly serve
the State of Arizona or its clients and may involve access to secure or sensitive data or personal client data or
development or modification of software for the State shall be performed within the borders of the United States.
Unless specifically stated otherwise in the specifications, this definition does not apply to indirect or "overhead"
services, redundant back-up services or services that are incidental to the performance of the contract. This provision
applies to work performed by subcontractors at all tiers.
23. Pandemic Contractual Performance
23.1 The State shall require a written plan that illustrates how the Participating Agency shall perform up to contractual
standards in the event of a pandemic. The state may require a copy of the plan at anytime prior or post award of a
contract.
23.2 At a minimum, the pandemic performance plan shall include:
a. Key succession and performance planning if there is a sudden significant decrease in the Project
Station's workforce.
b. Alternative methods to ensure there are services or products in the supply chain.
c. An up to date list of company contacts and organizational chart.
233 In the event of a pandemic, as declared by the Governor of Arizona, 'U.S. Government or the World Health
Organization, which makes performance of any term under this contract impossible or impracticable, the State shall
have the following rights:
a. After the official declaration of a pandemic, the State may temporally void the contract(s) in whole or specific
sections if the Participating Agency cannot perform to the standards agreed upon in the initial terms.
b. The State shall not incur any liability if a pandemic is declared and emergency procurements are authorized by
the Director of the Arizona Department of Administration per A.R.S. § 41-2537 of the Arizona Procurement
Code.
c. Once the pandemic is officially declared over and/or the Participating Agency can demonstrate the ability to
perform, the State, at its sole discretion may reinstate the temporarily voided contract(s).
24. Legal Restrictions
24.1 The Participating Agency agrees that no AmeriCorps*VISTA member(s) assigned under this MOU shall participate
in the following activities when they would result in the identification of such programs with:
a, Partisan and non-partisan political activities, including voter registration.
b. Direct or indirect attempts to influence passage or defeat of legislation or proposals by initiative petition.
c, Labor or anti-labor organization or related activities,
d. Religious instruction, worship services, proselytization, or any other religious activity as an official part of their
duties.

SPONSOR: PARTICIPATING AGENCY:
The State of Arizona Maricopa County Department of Public Health
Department of Economic Security 1645 E. Roosevelt St.
Division of Business and Finance Phoenix, AZ 85006
Office of Procurement
1789 West Jefferson, Site Code 805Z
Phoenix, Arizona 85007
By: By:
Max Porter
Title: Chief Procurement Officer Title: _p_eppty Director
Date: Date: 3/r//-4 /_____

MOU with Department of Economic Security
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Maricopa County
Date

Arizona Refugee Resettlement Program (RRP)— VISTA Project
(Sponsor Agency)
Maricopa County Department of Public Health
Member Name: TBD PSO Date: April 14-17, 2014
Assignment: Refugee Health Care Coordination Project Year: First Year
Arizona Refugee Resettlement Program VISTA Project - Mission
The Arizona Refugee Resettlement Program (RRP) is partnering with the Corporation for National and Community Service (CNCS)
to develop the Arizona Refugee Resettlement VISTA Project (Project). The proposed five year Project's goal is to provide
opportunities for non-profit agencies in Central and Southern Arizona to develop capacity building VISTA assignments that sustain
and enhance effective refugee resettlement and integration.
Agencies that partner with RRP in this Project will become known as participating agencies, and will develop VISTA assignments that
contribute to the effective resettlement of refugees and other eligible beneficiaries - including their achieving the goal of economic
self-sufficiency as quickly as possible after arrival in the 'United States, in accordance with Title IV, chapter 2, Sec. 411. (8 U.S.C.
1521) of the Immigration and Nationality Act (INA). To promote their effective resettlement and attainment of self-sUfficiency,
refugees and other eligible beneficiaries, particularly those who are newly arrived in the United States and the recipients of Refugee
Cash Assistance (RCA) and Temporary Assistance for Needy Families (TANP), need specialized services that are directed toward
their securin!, _ em 'lament as soon as oossible after arrival in the 'United States.
Program Milestones (7rote: Not all Ws in the VET / 1 project will track beta milestones. Some projects will track only one milestone.)
Milestone #1: Resources: Increase donations or volunteer participation that will lead to refugees obtaining economic self-
sufficiency.
Participating agencies will report on the increase in resource development of their VISTA assignment by tracking the number of
refugees obtaining employment or receiving assistance or services that address barriers to economic self-sufficiency. Participating
agencies will also track the number of volunteers participating in the assignment and the total number of volunteer service hours
provided by each volunteer. Volunteers will provide service hours by participate in economic self-sufficiency programs for refugees.
The number of Refugees who will receive assistance or services through the VISTA assignments will be tracked and some Refugees
are projected to secure employment,
Milestone #2: Programs: Design, Develop & implement Programs that promote self-sufficiency or address a barrier to self-
sufficiency.
Programs are designed, developed and implemented that provide services to refugees and are linked to programs that support
employability services or other services that address barriers to employment. Participating agencies will report the increase of
program development of their VISTA assignment by tracking the numbers of refugees who participate in the program, receive
assistance through the program and secure employment because of the services of the program. Participating agencies will report the
outcomes f2rt assist ation or addresseiLL arr o ._,Il en EEL .
Participating ncy _ Maricopa County Department of Public Health
Envisioned Goal or Agency Mission
The mission of the Maricopa County Department of Public Health (MCDPII) is to protect and promote the
health and well-being of Maricopa County residents and visitors. The goal of the Refugee Health Screening
Program under the Clinical Services Division of MCDPH is to control communicable diseases among, and
resulting from, the arrival of new refugees through preventive health screening and making referrals, as
ap ro fate. .
VISTA assignment goal
This VISTA assignment will develop a system for newly arrived refugees to enter the health services system
and link to mainstream treatment and intervention services for refugees undergoing preventive health screenings
in the Refugee Health Screening Program. The VISTA member will serve as a liaison between refugee
relocation agencies, providers and the Refugee Clinic to ensure that referral orders are carried out and patient
needs are addressed in a timely manner.
VISTA Assignment Description

Arizona Refugee Resettlement Program (RRP)— VISTA Project
(Sponsor Agency)
How will this VISTA assignment contribute to the goal How will you measure the impact?
of economic self-sufficiency? The VISTA member will meet regularly with the
The refugee health screening process determines any site supervisor. The VISTA member will work
health problems that a refugee may have, which may closely with the nurse case manager and will
prevent them from getting employment or going to receive guidance from the Refugee Health
school. Timely completion of treatment and intervention Screening Program Manager. Completion of
referrals is an integral part of the resettlement of referrals will be assessed to see if they were done in
refu ees. a timely manner.
Objective 1: Imeline:
Coordinate referrals for refugee clients requiring follow-up for either medical, behavioral
or other needs, as a e•ro 'date.
Activities:
- Monitor refugee clients' response to intervention and treatment plans of providers in the Refugee Health
Screening Program.
- Perform on-going assessment of needs as necessary throughout the referral period and document any relevant
information in the patient's medical record, according to MCDPH standards, while maintaining confidentially
and srivac of the patient/famil
Goals or expected results: Measurement:
Referrals are completed in a timely manner. Review of medical records to assess timeliness of
completion of referrals.
Links to overall project milestones:
6th Month Report
Evidenced Based:
Perfoimance Measurement:
End Report
Evidenced Based:
Performance Measurement:
_
Objective 2: Timeline:
Develop and foster relationships with refugee relocation agencies (VOLAGs) and health
care providers to ensure that referrals are completed.
Activities:
- Maintain correspondence with relocation agencies (VOLAGs), health care providers and patients to ensure
continuity of care.
- Develop and maintain referral networks for mental health, behavioral health and other relevant needs of
refugee clients.
Goals or expected results: Measurement:
Develop a list of networks to coordinate appropriate Review list of partners for coordinating referrals.
referrals for refugee clients.
Links to overall project milestones:
6th Month Report
Evidenced Based:
Performance Measurement:
End Report
VISTA Assignment Description

Arizona Refugee Resettlement Program (RRP)— VISTA Project
(Sponsor Agency)
Evidenced Based:
Performance Measurement:
Objective 3: Timeline:
Activities:
Goals or expected results: Measurement:
Links to overall project milestones:
6th Month Report
Evidenced Based:
Performance Measurement:
End Report
Evidenced Based:
Performance Measurement:
Objective 5:
Activities:
Goals or expected results: Measurement:
inks to overall ro ect milestones:
6th Month Report
Evidenced Based:
Performance Measurement:
End Report
Evidenced Based:
Performance Measurement
rObjective 6: Timeline:
Activities:
Goals or expected results: Measurement:
Links to overall • -o ect milestones:
6th Month Report
Evidenced Based:
Perfoimance Measurement:
End Report
Evidenced Based:
Performance Measurement:
VISTA Assignment Description

Arizona Refugee Resettiement Program (RRP)— VISTA Project
(Sponsor Agency)
VISTA Assignment Description

Attachment B
Arizona Refugee Resettlement AmeriCorps*VISTA Project
June 16, 2013 June 28, 2014
PROJECT PLAN
Summary
The Arizona Refugee Resettlement Program (RRP) is partnering with the Corporation for National and
Community Service (CNCS) Co develop the Arizona Refugee Resettlement VISTA Project (Project). The
goal of the Project is to provide opportunities for non-profit agencies in Central and Southern Arizona to
develop capacity building VISTA assignments that sustain and enhance effective refugee resettlement
and integration.
Agencies that partner with RRP in this Project are known as participating agencies, and will develop
VISTA assignments that contribute to the effective resettlement of refugees and other eligible
beneficiaries - including their achieving the goal of economic self-sufficiency as quickly as possible after
arrival in the United States (U.S.), in accordance with Title IV, Chapter 2, Sec. 411. (8 U.S.C. 1521) of
the Immigration and Nationality Act (INA). To promote their effective resettlement and attainment of
self-sufficiency, refugees and other eligible beneficiaries, particularly those who are newly arrived in the
U.S. and the recipients of Refugee Cash Assistance (RCA) and Temporary Assistance for Needy
Families (TANF), need specialized services that are directed toward their securing employment as soon
as possible after arrival in the U.S.
It is essential that refugees and other eligible beneficiaries receive a holistic and seamless delivery of
linguistically relevant and culturally appropriate services that best help them integrate into their new
home and attain economic self-sufficiency. Participating agencies will engage refugees as they plan,
develop, implement and evaluate the VISTA assignments. Participating agencies will develop
assignments for capacity building programs that support the following refugee resettlement service
areas: employment and case management, English Language Training (ELT), medical services, and
assignments that build linkages to related supportive services, such as childcare and transportation.
VISTA assignments may also be developed to support specific RRP discretionary programs, such as
services to older refugees, K-12 refugee school impact, and preventive and behavioral health service
programs.
Assignments will focus on the CNCS key anti-poverty principles of economic development, educational
development and healthy futures. The Project will provide both free and cost-share VISTA member
resources to approximately 20 participating agencies that provide refugee-specific services in the areas
of Resource Development and Strategic Planning and Program Design.
Resource Development
Goal Statement: The resource development goal for Year Five is to increase the number of volunteers,
the number of service hours, and the in-kind and cash resources that can be directly linked to refugees
obtaining self-sufficiency or employment by ten percent. Resource development will include volunteer
recruitment and fundraising for programs with an end goal of providing assistance to refugees that will
lead to economic self-sufficiency.

Milestone #1: Increase Volunteer Participation that will lead to refugees obtaining economic self-
sufficiency.
Participating agencies will report on the increase in resource development of their VISTA assignment by
tracking the number of refugees obtaining employment or receiving assistance or services that address
barriers to economic self-sufficiency. Participating agencies will also track the number of volunteers
participating in the assignment and the total number of volunteer service hours provided by each
volunteer, During Year Five of the grant, 335 volunteers will participate in economic self-sufficiency
programs for refugees, with those volunteers providing a combined total of 4,500 volunteer services
hours. More than 1,500 refugees will receive assistance or services through the VISTA assignments,
with a corresponding 45 refugees projected to secure employment.
Milestone # 2: Increase Donations
Participating agencies will realize an increase in both cash and in-kind resources to support existing and
new programming that serve refugees in efforts to attain economic self-sufficiency. During Year Five of
the Project, cash resources will increase to $4,500 and in-kind resources will increase to $215,000. The
donations will be linked to programs that support employability services and other services that address
barriers to employment - as noted above.
Strategic Planning and Program Design
Goal Statement: The Project will strengthen the capacity of public and private non-profit agencies to
deliver services that encourage and support refugees' economic self-sufficiency. These efforts will
include new or expanded existing programs that focus on the CNCS key anti-poverty principles of
economic development, educational development and healthy futures.
Milestone #1: Design, Develop & Implement Programs
Programs are designed, developed, and implemented that provide services to refugees and are linked to
programs that support employability services and other services that address barriers to employment.
Participating agencies will report on the increase of program development of their VISTA assignment by
tracking the numbers of refugees who secure employment, receive assistance, or services, More than
1,500 refugees will receive assistance or services through the VISTA assignments and a corresponding
45 refugees are projected to secure employment.

Attachment C
BUDGET - STANDARD
1.i
GRANTEE PERSONNEL (2) (3) (4)
EXPENSES Annual % Time Spent Total Cost Federal Funds
Position Title Salary on Project Requested
(cash grant)
TOTAL PERSONNEL EXPENSES
. FRINGE BENEFITS
b. (1) GRANTEE STAFF LOCAL TRAVEL
(2)GRANTEE STAFF LONG DISTANCE TRAVEL
Fe. EQUIPMENT
d. SUPPLIES
. CONTRACTUAL SERVICE
OTHER
Communication
Printing
Logistics
g. INDIRECT COSTS
TOTAL VOLUNTEER SUPPORT EXPENSES
31AAL
as
a. PERSONNEL EXPENSES
Fingerprint Cost
TRAVEL
Reimbursemen
c. TRAINING OR CONFERENCES
Registration
7
d. OTHER:
Cost Shale (if named Subrecipient)
TOTAL VOLUNTEER EXPENSES ...
TOTAL COST
PERCENTAGES
Corporation Fo 424-AA (5/04) Modi SF 424A (5/04)

ACY., 1288A FORFF (8.12)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY Attachment D
Administration for Children, Youth and Families
REQUEST FOR SEARCH OF
CENTRAL REGISTRY FOR BACKGROUND CHECK
This document and any files transmitted with it are confidential and intended solely for the use of the individual or entity to which
they are addressed. If you have received this information in error, please notify the sender and destroy the information. The
information contained in the Arizona Department of Economic Security, Child Protective Services (CPS) Central Registry and any
attached files shall be used as a factor to determine qualifications for individuals applying for contracts with this state, including
employees of the prospective contractor, contractors, and subcontractors for positions that provide direct services to children or
vulnerable adults, The information contained in the Central Registry for Background Check and any attached files is
confidential and shall not be further disseminated or shared.
PLEASE FILL OUT THE INFORMATION BELOW. All fields must be completed, accurately and legibly.
Ii0:6001(,700044.
Contract Number: ADES
Tracking # (You must provide your unique tracking number. This Check One:
number will be used to identij) and track this document and the 0 New
individuals linked to it.):
D Extension
Phone Number
Mailing Address Email Address
Name of Person Authorized to Submit Request (Print/Type)
Requester's Signature Date of Request
DES Division: Division of Aging and Adult Services Division Contact Person: +DAAS CR
SUBMIT YOUR COMPLETED CENTRAL REGISTRY REQUEST THROUGH ONE OF THE FOLLOWING METHODS:
Mail to:
DCYF Contracts Unit
Attention: CENTRAL REGISTRY REQUEST
Arizona Department of Economic Security
1789 W. Jefferson Street, SITE CODE 940A
Phoenix, AZ 85007
Fax to: CENTRAL REGISTRY REQUEST at 602-542-3330
E mail fen crypted) to DCYFCentraiRegistryCheek@azdes.gov
RESULTS of this check will he:
1. EMAILED to the address above indicating that one or more individuals on the request was (were) unable to be processed with the
information provided; or
2. EMAILED to the address above if all names are cleared; or
3. EMAILED to the address above with information on individuals who are found to have substantiated reports; and
4. MAILED to the individual who is found to have a substantiated report.
Internal Use Only:
For Solicitations Only: DES Designated Staff (Office of Procurement):
For Contracts: Notify DES Designated Staff (Program):
See last page for EOE/ADA/LEP/GINA disclosures

REQUEST FOR SEARCH OF CENTRAL REGISTRY FOR BACKGROUND CHECK
Oil fields must be completec4 accurately and legibly.)
NAME I ALIAS (Previously used name(s))
SOC. SEC. NO. DATE OF BIRTH
ADDRESS (No., Street, City, State, ZIP)
(Seit'411 iegUlts)
Reports: Yes Number: [See attached document(s)] No Date of Search:
NAME OF PERSON COMPLETING SEARCH SIGNATURE
IViti):041:3$1..100.10MIT
NAME ALIAS (Previously used name(s))
SOC. SEC. NO. DATE OF BIRTh
ADDRESS (No., Street City, State, ZIP)
TE1 " NEN (Seareivregli
Reports: Yes Number: [See attached document(s)] No Date of Search:
NAME OF PERSON COMPLETING SEARCH SIGNATURE
1ST tniMATI
NAME ALIAS (Previously used name (a))
SOC. SEC. NO. DATE OF BERTH
ADDRESS (Na, Street, City, State, ZIP)
'TE
Reports: Yes Number: [See attached document(s)] No Date of Search;
NAME OF PERSON COMPLETING SEAR SIGNATURE
iii1V111:0102tiNit'
NAME ALIAS (Previously used name(s))
SOC. SEC, NO. ATE OF BIRTH
ADDRESS (No., Street, City, State, ZIP)
, (Search .
Reports: Yes Number: [See attached document(s)] No Date of Search:
NAME OF PERSON COMPLETING SEARCH SIGNATURE

DISQUALIFICATION ACTS
A person is disqualified from providing services to DES clients in a direct service position if he/she is identified as the subject of the
substantiated report for any of the following.
1 24 Child death due to alleged abuse or neglect, or suspicious death
25 injuries requiring emergency medical treatment
i
27 Child age 24 months is shaken (shaken baby syndrome)
33 Untreated life threatening condition, Infant Doe, Non-organic ITT
37 Imminent harm to child under the age of six (6) due to lack of supervision by parent/caretaker
38 Neglect results in injury/illness requiring emergency medical treatment
39 Imminent harm to child due to health or safety hazards in living environment/exposure to the elements
40 Child diagnosed as suicidal by mental health professions, parent refused to allow treatment
41 Physical evidence of sexual abuse reported by a medical doctor or child reporting sexual abuse within the past seven days
42 Child reporting vaginal or anal penetration or oral sexual contact within past 72 hours and has not been examined
43 Abandoned, no parent willing to provide immediate care for a child and child is with a caregiver unable or unwilling to provide care now
45 Injuries may require medical treatment
46 P3 Injury to child under age six years
50 Living environment presents health or safety hazards to a child under the age of six
51 Sexual conduct/physical injury between children due to inadequate supervision
54 Sexual behavior within the past 8-14 days
55 Child diagnosed by mental health professional with behavior consistent with emotional abuse
56 Abandoned, no parent willing to care for a child, child with caretaker unable or unwilling to care for child less than one week
66 Significant developmental delays due to neglect
69 Attempted sexual behavior or sexual behavior, 14 days to three years r last occur 'midtown
72 Parent, guardian or custodian suggests or entices child to engage in sexual behavior, no touching
76 Use of child by parent, guardian or custodian for material gain
82 Parent, guardian or custodian sexually abused a child in past ; now in home with a child
83 Attempted sexual behavior or sexual behavioral when last occurred more than three years
101 Death of a child due to neglect
111 Death of a child due to physical abuse or suspicious death
201 Physical abuse high risk
202 Physical abuse moderate risk
301 Neglect, high risk
302 Neglect, moderate risk
401 Sexual abuse, high risk
402 Sexual abuse, moderate risk
403 Sexual Abuse, low risk
404 Sexual Abuse, response 4
501 Emotion Abuse, high risk
502 Emotional abuse, moderate risk

Equal Opportunity Employer/Program Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans
with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II
of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs,
services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The
Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity.
For example, this means if necessary, the Department must provide sign. language interpreters for people who are deaf, a wheelchair
accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you
to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will
not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in
advance if at all possible. To request this document in alternative format or for further information about this policy, contact your local
office; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request.

J-110 DSA 02/201 3) ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Information Security Achninistration,
1720 W. Madison St., Site 820Z
Phoenix, AZ 85007
Phone: (602) 771-2670 ° Fax: (602) 364-0481
DATA-SHARING REQUEST/AGREEMENT
BETWEEN
REQUESTING ENTITY:
Maricopa County Department of Public Health
(DES Dtvision/Administration/Program/Office Name or External Organization Name.)
AND
DATA MANAGER: ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DAAS Refugee Resettlement Program
(Division/Administration/Program/Office Name)
Effective Date: Agreement No.:
Equal Opportunity Employer/Program
This document available in alternative fonnats by contacting; (602) 771-2670.

J-119 DSA (0212013) - PAGE 2 Agreement No.:
SEcTION. -I. l.R.-.Q11 E51.':(..0/0P:10.e.ft ki,::0:(Wstihglj'p;iity)
;- iii'e 6i66i-iirieni .:ii:rs: -/ '::' ..
a. PURPOSE OF THIS REQUEST (Whet information is being requested and why? How will it be used? Cive deteils/spevfics )
The only secure data that is requested will be for the purpose of recruiting and interviewing a VISTA
member. This data will be limited to name, address, and information needed for e -verify.
lb. INFORMATION TECHNOLOGY AND CONNECTIVITY
When data (on-line or other media) is required as a result of this contract (see Lb. reference), then this
business justification will be amended.
The requester enters all information required for successful communication between the requesting entity and the DES IT
Staff.
Contact Name (1): Max Porter Phone: ( ) -
Contact Name (2): Angelito Brave Phone: (602) 372-1013
Contact Address: 1645 E. Roosevelt St. Phoenix, AZ 85006
Contact (1) E-Mail Address: Contact (2) E -Mail Address:
AngelitoBravo@mail.maricopa.gov
Contact Fax No: (602) 372 -0342

J-119 DSA (0212013) - PAGE 3 Agreement No:
!.5rgakci.N.).:: :(- 0.40. :1 . 4. -0Ory.p-WW .0::.k6p4iyiiii.:itiiiiii; .,
' - . . .. :..: 'poioa .00-vbf:k6i:*4.i:i::
2. CITE LAW, REGULATION, DIRECTIVE OR OTHER BASIS FOR THIS REQUEST
MOU between the ADES/DAAS and Maricopa County Department of Public Health - VISTA Project
number: 09VSWAZ005.
3. WILL OTHER ENTITIES INTERFACE WITH YOUR AGENCY?
EYDS 2 No If Yes, identify entity and reason(s):
4. WILL IINFORMATION BE DISCLOSED SHARED WITH ANOThER ENTITY?
Ej Yes Ej No If Yes, identify entity and reason(s) for disclosure:
S. WILL DES DATA BE RFPACKAGED/INOLUDED IM OTHER DATA BASES, FILES, TAPES, ETC.
DYes 1 No if Yes, identify entity and reason(s):
B. DESIRED OUTPUT (Printout, tape, terminal access/display, etc.)
N/A
7. DESCRIBE SAFEGUARDS IN PLACE TO GUARD AGAINST UNAUTHORIZED ACCESS/DISCLOSURE OF THE INFORMATION
Secure email will be used to transmit data.
PRINT NAME AND TITLE OF AUTHORIZED CONTACT PHONE NO. ( ) - . DATE
Max Porter FAX (602) 372-0342
Deputy Director E-MAIL
MAILING ADDRESS/SITE CODE CITY' STATE ZIP CODE
1645 E. Roosevelt St Phoenix AZ 85006-

• -- , --- •••
J-119 OSA (02/2013) - PAGE 4 Agreement No.:
St:Q.T.M)1:,111 NTIQNS 1?,X.c•-VRD .L.7 OF INFORMATION'
STIPULATIONS APPLICABLE TO THE REQUESTING ENTITY:
1. Disclosure of the data provided to the Requesting Entity is not permitted unless specifically authorized.
2. Repackaging or redistribution of data or screens, or creation of separate files will not be permitted unless specifically authorized.
3. The data shall be used only to assist in valid administrative needs as stated in Section 1, item 1 of this Agreement.
4. All data shall be stored in a physically secure facility.
5. All data in electronic format shall be stored or processed so that mauthorized persons cannot retrieve the information by means of a
computer, remote access, or other means.
6. Only authorized staff wit be given access needed to accomplish the purpose(s) specified in Section 1 , item 1 of this Agreement.
7. All staff shall attend an authorized data security awareness training class, where they will be instructed on confidentiality, privacy
laws and penalties imposed when compliance is breached. All staff with access to DES systems and/or applications must complete
an annual recertification security awareness training class as scheduled by DES.
8. A Request for Terminal Access and Other Activity (J-125) shall be used to request specific access for each authorized staff
member and must be signed by the staff supervisor or designee.
9. All authorized staff is required to sign a User Affirmation Statement (J-129), as a condition for using requested data. This
affirmation statement must be resigned at three (3) year intervals as scheduled by DES.
10. Any personnel changes requiring change or removal of access as described in Section I, item 1 of this Agreement, shall be reported
promptly to the respective data security analyst.
11. Federal and state audit and data security personnel may have access to offices and records of the requesting entity to monitor or
verify compliance with this agreement.
12. This Data-Sharing Agreement will remain in effect for 10 years from the effective date unless otherwise stipulated in Section III
or overridden by the Contract, a Memorandum Of Understanding or an InterAgency Agreement. If length is overridden by another
document, please reference the document in Section III.
STIPULATIONS APPLICABLE TO PROVIDER:
1. DES will use the Requesting Entity employee identifying information solely for the purpose of establishing on-line access,
2. Only authorized DES employees will have access to requesting agency employee data.
3. In accordance with applicable federal, state, and/or local privacy regulations, DES will protect all information collected from the
Requesting Entity.
STIPULATIONS APPLICABLE TO HIPAA — HEALTH ENSURANCE PORTABILITY 8z ACCOUNTABILITY ACT:
1. All staff shall attend an authorized I-EPAA awareness training class, where they will be instructed on confidentiality, privacy,
information safeguards and penalties imposed when compliance is breached,
2. If applicable, there is a "Business Associate Contract" [45 CPR 164.502(e), 154,504(e), 164.532(d) & (e)] on file and will be
attached to this data sharing agreement as an addendum,

-
J-115 DM (02/2013) - PAGE 5 Agreement No.:
'SECTION .I1 I,. ADDITIONAL INFORMATION!
Print Name PHONE NO, DATE
Signature
SECTION: R(.. .q,9,111 11.1!-NDATP.ISTc9171P1,q0.bii..tho.q00 rnanaging.kO6ram)
Recommend APPROVAL
0 Request is not recommended for approval,
Print Name Charles Shipman SITE CODE PHONE NO. 177477
950A (602) 542-6614
Signature
1-11PAARPPQMMENPATIPNS-(cdrhpleteillikSh011' 1PAA DIVISION PRIVAC Y OFFICER)
111 Recommend APPROVAL
LI Request is not recommended for approval,
Print Name SITE COD HONE NO. DATE
Signature •

J.119 RSA (2/2016) PAGE 6
:
Sgc .fION . ,V::"A0Pkb1 I 04 (6.0hpkte6' .,. , by the requesting eoilik ii4 the — data pla001,4:program „ . .
I attest to the correctness of the information provided in Section 1 and agree to the stipulations and costs listed in
Section It and III. I agree to comply with all provisions of the DES Data Security Policy. Should any violations of the
DES Data Security Policy occur, this Agreement may be terminated. I further understand that DES will periodically
review the terms of the Agreement to ensure it conforms with DES Policies and Procedures. In the event changes in
either federal or state law or regulations occur that conflict with the terms of the Agreement or render the terms of the
Agreement void, impracticable, or otherwise impossible, this Agreement will terminate immediately. A new Agreement
or an amendment to the existing Agreement will be initiated to provide for any changes, which cannot be
accommodated within the provisions of the existing Agreement. The Requesting Entity shall hold harmless and
indemnify the State of Arizona and its Department of Economic Security for any liability resulting from acts or
ommissions attributable to the Requesting Entity.
IN WITNESS HERETO : the PARTIES have executed this Agreement by signature of their duly authorized officials:
Fathe:RectOeStInglEntitY:; .
Entity Name Maricopa County Department of Public Health
Print Stqnztry Name Max Porter
Tile Deputy Director
Date 3/ 574(
: Fookiepepp.ithiOt :000 50.10,0,0#10:
Entity Name Division of Aging and Adult Services
P"'I'm''''"'" Melanie K. Sterns
Title Assistant Director
Signature
Date
SECTION Vlj':APPROVAL: !(CiimPleted by Mb- Information Security Aeliii in Isiration
This signed Agreement meets all requirements necessary to permit the controlled sharing of the DES data while
simultaneously providing for the protection of the data. I certify that:
El THIS AGREEMENT CONFORMS to DES Information Security Policy.
El THIS AGREEMENT DOES NOT CONFORM to the DES Information Security Policy. Implementation of
this Agreement cannot proceed until the following action is taken:
Carl Carpenter
DES Chief Information Security Officer
(Signature) int% (OA i.)

FACILITY LOCATION CHART
Name of Facility, Address Contract S Days and Hours Geographic
U
Phone and Fax Number Service(s) B of Operation Coverage
The facility(s) listed above will not be open on those holidays marked below (Check box for applicable holidays):
New Year's Day 0 Good Friday El President's Day Li Yom Kippur El Washington's Birthday
E Martin Luther King Jr's Birthday El Memorial Day El Rosh Hashanah 0 Columbus Day 0 Labor Day
Li Lincoln's Birthday El Independence Day 0 Christmas Li Veteran's Day El Thanksgiving Day
0 Other El Other 0 Other Ei Other Li Other