220224 ANIMAL CRUELTY DIVERSION CONTRACT SIGNED 2-17-22 (003).PDF
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CONTRACT MARICOPA COUNTY ATTORNEY ANIMAL CRUELTY DIVERSION PROGRAM 220224-C1 This contract is entered into this 23rd day of February 2022 between the Maricopa County, acting through the Maricopa County Attorney’s Office (MCAO), and SAGE Counseling Inc. (Contractor), to govern the Contractor’s participation in the Animal Cruelty Diversion Program administered by MCAO. 1.0 CONTRACT TERM 1.1 This contract is for a term of one year and ten months, beginning on the 23rd day of February 2022 and ending the 31st day of December 2024. 1.2 The County may, at its option and with the agreement of the Contractor, renew the term of this contract for additional terms up to a maximum of one additional year. The County shall notify the Contractor in writing of its intent to extend the contract term at least thirty calendar days prior to the expiration of the original contract term, or any additional term thereafter. 1.3 CONTRACT TERMINATION Upon termination of this contract for any reason, the Contractor shall make all reasonable efforts for an orderly transition of its duties and responsibilities to another provider and/or to the County or MCAO. This may include, but is not limited to, preparation of a transition plan and cooperation with the County or MCAO or other providers in the transition and completion of services initiated but not completed prior to the date of termination. The transition includes the transfer of all records and other data in the possession, custody, or control of Contractor required to be provided to the County or MCAO either by the terms of this agreement or as a matter of law. The provisions of this clause shall survive the expiration or termination of this agreement. 2.0 FEE ADJUSTMENTS 2.1 Any request for a reasonable fee adjustment must be submitted not less than 60 calendar days prior to the current contract expiration date. Any adjustment is only applicable once a new contract year begins. Requests for adjustment must be supported by appropriate documentation. If the County agrees to the adjusted fee, the County shall issue written approval of the change which will be effective upon renewal or new contract. Requests submitted after the 60-calendar day deadline will not be considered. 3.0 PAYMENTS 3.1 As consideration for performance of the duties described herein, County shall pay Contractor the sum(s) stated in Exhibit “A.” 3.2 Payment shall be made upon the County’s receipt of a properly completed invoice. SERIAL# 220224-CI 3.3 INVOICES 3.3.1 The Contractor shall submit one legible copy of their detailed invoice before payment(s) will be made. Incomplete invoices will not be processed. At a minimum, the invoice must provide the following information: • Company name, address, and contact information • County bill-to name and contact information • Contract serial number • County purchase order number • Invoice number and date • Payment terms • Date of service • Quantity (number of days or weeks or sessions) • Contract Item number(s) • Description of Purchase (services) • Extended price • Total Amount Due 3.3.2 Problems regarding billing or invoicing shall be directed to the department as listed on the purchase order. 3.3.3 Payment shall only be made to the Contractor by Accounts Payable through the Maricopa County Vendor Express Payment Program. This is an electronic funds transfer (EFT) process. After contract award, the Contractor shall complete the Vendor Registration Form accessible from the County Department of Finance Vendor Registration Web Site https://www.maricopa.gov/5169/Vendor- Information. 3.3.4 Discounts offered in the contract shall be calculated based on the date a properly completed invoice is received by the County. 3.3.5 EFT payments to the routing and account numbers designated by the Contractor will include the details on the specific invoices that the payment covers. The Contractor is required to discuss remittance delivery capabilities with their designated financial institution for access to those details. 4.0 APPLICABLE TAXES 4.1 Payment of Taxes: The Contractor shall pay all applicable taxes. 4.2 Tax Indemnification: Contractor and all subcontractors shall pay all Federal, state, and local taxes applicable to its operation and any persons employed by the Contractor. Contractor shall require all subcontractors to hold MCAO and Maricopa County harmless from any responsibility for taxes, damages and interest, if applicable, contributions required under Federal, and/or state and local laws and regulations and any other costs including transaction privilege taxes, unemployment compensation insurance, Social Security and Worker’s Compensation. 5.0 AVAILABILITY OF FUNDS 5.1 The provisions of this contract relating to payment for services shall become effective when funds assigned for the purpose of compensating the Contractor as herein provided are actually available to County for disbursement. The County shall be the sole judge and authority in determining the availability of funds under this contract. County shall keep the Contractor fully informed as to the availability of funds. 5.2 If any action is taken by, any State agency, Federal department, or any other agency or instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in SERIAL# 220224-CI connection with, this contract, County may amend, suspend, decrease, or terminate its obligations under, or in connection with, this contract. In the event of termination, County shall be liable for payment only for services rendered prior to the effective date of the termination, provided that such services are performed in accordance with the provisions of this contract. County shall give written notice of the effective date of any suspension, amendment, or termination under this section, at least 10 days in advance. 6.0 DUTIES The Contractor shall perform all duties stated in Exhibit B”, Scope of Work, or as otherwise agreed to by the parties and directed in writing by MCAO. 7.0 TERMS and CONDITIONS 7.1 INDEMNIFICATION INDEMNIFICATION. Each Party to this Agreement shall hold harmless, and indemnify the other Party and its directors, officers, agents, sub-contractors, employees and volunteers against any and all losses, liabilities, damages, injuries, claims, suits, demands and legal proceedings including any direct, indirect or consequential loss, liability, damage, or expense, but not including attorneys’ fees, unless awarded by a court of competent jurisdiction, arising out of or in connection with the intentional, willful, wanton, reckless or negligent conduct arising from or to the extent alleged to be in connection with the Services to any Indemnified Party and any third party. However, neither Party shall be indemnified hereunder for any loss, liability, damage, or expense resulting from its sole negligence or willful misconduct. Any claim involving contributory negligence shall be handled so that each party is responsible and liable for its share of the damages and defense cost associated therewith, in proportion to its share of negligence. 7.1.1 The amount and type of insurance coverage requirements set forth herein will in no way be construed as limiting the scope of the indemnity in this section. 7.2 INSURANCE 7.2.1 Contractor, at Contractor’s own expense, shall purchase and maintain, at a minimum, the herein stipulated insurance from a company or companies duly licensed by the State of Arizona and possessing a current AM Best, Inc. category rating of B++. In lieu of State of Arizona licensing, the stipulated insurance may be purchased from a company or companies, which are authorized to do business in the State of Arizona, provided that said insurance companies meet the approval of The County. The form of any insurance policies and forms must be acceptable to the County. 7.2.2 All insurance required herein shall be maintained in full force and effect until all work or service required to be performed under the terms of the contract is satisfactorily completed and formally accepted. Failure to do so may, at the sole discretion of the County, constitute a material breach of this contract. 7.2.3 In the event that the insurance required is written on a claims-made basis, Contractor warrants that any retroactive date under the policy shall precede the effective date of this contract and either continuous coverage will be maintained, or an extended discovery period will be exercised for a period of two years beginning at the time work under this contract is completed. 7.2.4 Contractor’s insurance shall be primary insurance as respects County, and any insurance or self-insurance maintained by County shall not contribute to it. SERIAL# 220224-CI 7.2.5 Any failure to comply with the claim reporting provisions of the insurance policies or any breach of an insurance policy warranty shall not affect the County’s right to coverage afforded under the insurance policies. 7.2.6 The insurance policies may provide coverage that contains deductibles or self- insured retentions. Such deductible and/or self-insured retentions shall not be applicable with respect to the coverage provided to the County under such policies. Contractor shall be solely responsible for the deductible and/or self- insured retention and County, at its option, may require Contractor to secure payment of such deductibles or self-insured retentions by a surety bond or an irrevocable and unconditional letter of credit. 7.2.7 The insurance policies required by this contract, except Workers’ Compensation and Errors and Omissions, shall name County, its agents, representatives, officers, directors, officials, and employees as additional insureds. 7.2.8 The policies required hereunder, except Workers’ Compensation and Errors and Omissions, shall contain a waiver of transfer of rights of recovery (subrogation) against County, its agents, representatives, officers, directors, officials, and employees for any claims arising out of Contractor’s work or service. 7.2.9 If available, the insurance policies required by this contract may be combined with Commercial Umbrella Insurance policies to meet the minimum limit requirements. If a Commercial Umbrella insurance policy is utilized to meet insurance requirements, the Certificate of Insurance shall indicate which lines the Commercial Umbrella Insurance covers. 7.2.9.1 Commercial General Liability Commercial General Liability (CGL) insurance and, if necessary, Commercial Umbrella insurance with a limit of not less than $1,000,000 for each occurrence, $2,000,000 Products/Completed Operations Aggregate, and $2,000,000 General Aggregate Limit. The policy shall include coverage for premises liability, bodily injury, broad form property damage, personal injury, products and completed operations and blanket contractual coverage, and shall not contain any provisions which would serve to limit third party action over claims. There shall be no endorsement or modifications of the CGL limiting the scope of coverage for liability arising from explosion, collapse, or underground property damage. 7.2.9.2 Sexual molestation and physical abuse When services involve working with these groups of individuals, the insurance requirements in the contract need to be revised to include coverage for "sexual molestation and physical abuse". Coverage for this type of claim, or allegation, is excluded from standard general liability policies. Therefore, contractors whose services include working with and/or caring for children/elderly and disabled persons should have their policies specifically endorsed to include this coverage. 7.2.9.3 Commercial General Liability – Occurrence Form Policy shall include bodily injury, property damage and broad form contractual liability coverage. a. The policy shall be endorsed to include coverage for physical/sexual abuse and molestation/criminal sexual SERIAL# 220224-CI misconduct, with limits of no less than $5,000,000 for each claim (see 7.2.9.1) b. The policy shall be endorsed to include the following additional insured language: "Maricopa County, its subsidiary, parent, associated and/or affiliated entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers shall be named as additional insureds with respect to liability arising out of the activities performed by, or on behalf of the Contractor". 7.2.9.4 Professional Liability Professional Liability insurance and, if necessary, Commercial Umbrella insurance, which will insure and provide coverage for Professional Liability of the Contractor, with limits of no less than $5,000,000 for each claim. 7.2.10 Certificates of Insurance 7.2.10.1 Prior to contract award, Contractor shall furnish the County with valid and complete Certificates of Insurance, or formal endorsements as required by the contract in the form provided by the County, issued by Contractor’s insurer(s), as evidence that policies providing the required coverage, conditions and limits required by this contract are in full force and effect. Such certificates shall identify this contract number and title. 7.2.10.2 In the event any insurance policy(ies) required by this contract is (are) written on a claims-made basis, coverage shall extend for two years past completion and acceptance of Contractor’s work or services and as evidenced by annual certificates of insurance. 7.2.10.3 If a policy does expire during the life of the contract, a renewal certificate must be sent to the County 15 calendar days prior to the expiration date. 7.2.10.4 Certificates of Insurance shall identify Maricopa County as the additional insured/certificate holder as follows: Maricopa County c/o Risk Management 301 W Jefferson St, Suite 910 Phoenix, AZ 85003 7.2.11 Cancellation and Expiration Notice Applicable to all insurance policies required within the insurance requirements of this contract, Contractor’s insurance shall not be permitted to expire, be suspended, be canceled, or be materially changed for any reason without 30 days prior written notice to Maricopa County. Contractor must provide to Maricopa County, within two business days of receipt, if they receive notice of a policy that has been or will be suspended, canceled, materially changed for any reason, has expired, or will be expiring. Such notice shall be sent directly to Maricopa County Office of Procurement Services and shall be mailed, or hand delivered to 160 S. 4th Avenue, Phoenix, AZ 85003, or emailed to the procurement officer noted in solicitation. 7.3 INCIDENT REPORTING REQUIREMENT The Contractor shall ensure incidents involving clients are reported according to this Section. SERIAL# 220224-CI 7.3.1 Definitions 7.3.1.1 “Incident” means an unusual or significant event involving client(s) and/or staff, which requires notification to the designated authorities. 7.3.1.2 “Incident Report” means a report that is verbal or written communication to the MCAO as described below. 7.3.2 Notification 7.3.2.1 The Contractor shall report incidents to the MCAO by telephone at 602- 372-7300 by 5:00 pm on the next business day after the incident occurs or after becoming aware of the incident. The Contractor shall also submit a written incident report as described in Section 7.3.5 below. 7.3.2.2 The Contractor shall report incidents to law enforcement as required by law and according to the Contractor’s policies and procedures. 7.3.3 Health, Safety, and Welfare Incidents: The Contractor shall immediately report all incidents impacting the health, safety, and welfare of clients served under this contract to the MCAO. The Contractor shall notify MCAO of any death or significant physical injury occurring at any SAGE facility. Health, safety, and welfare incidents include the following when they occur while a client was in a contract service and the event occurred on Contractor premises: a. Physical assault that requires medical treatment beyond first aid; b. Any medical treatment beyond first aid; c. Emergency room or urgent care visits; d. Request for emergency mental health stabilization provided by first responders and/or crisis intervention teams; e. Use of seclusion and/or restraint; f. Actions which pose an immediate and serious threat directed toward self, others, and/or individuals in the Contractor’s care and/or Contractor’s staff; g. Acts of inappropriate discipline or sexual behavior (consensual or not) between staff and clients; h. Any event that Contractor is aware of and is likely to have media interest. 7.3.4 Significant Incidents: The Contractor shall report the following significant incidents involving clients served under this contract: a. Death of a client that occurs while client was in a contract service; b. Weapons possession while in a contract service; c. Acts by clients or staff where the Contractor involves law enforcement; d. Traffic accidents involving clients transported by the Contractor or its personnel, non-employees or transport contractor. 7.3.5 Incident Report Form: The Contractor shall use the MCAO approved Incident Report form to complete and submit incident reports. The Contractor must submit a written report to the MCAO via email to mcaodiv@mcao.maricopa.gov not later than three calendar days after the incident occurs or after becoming aware of the incident. All reports must be legible and be signed by the staff who prepared the report as well as by the staff who approved the report. The Contractor shall maintain a file of written incident reports that are available for review under this contract. SERIAL# 220224-CI 7.3.6 Response to Incident Reports: All incident reports will be maintained by MCAO’s Diversion Strategies Group as directed by the Director. Upon notification of an incident the Director or his or her designee will do the following: 7.3.6.1 Review the information to determine if the incident requires further investigation; 7.3.6.2 As necessary, request additional information and direct corrective action to comply with this contract; 7.3.6.3 Refer the matter to any relevant authorities if necessary. 7.4 INSPECTION AND EVALUATION OF SERVICES/FACILITIES 7.4.1 The Contractor shall provide and maintain an inspection system that continuously ensures the services under this contract. Complete records of all inspection work performed by the Contractor shall be maintained and made available to MCAO during contract performance and for as long afterwards as the contract requires. 7.4.2 MCAO has the right to inspect all services and facilities called for by the contract, to the extent practicable at all times and places during the term of the contract. MCAO shall perform inspections in a manner that will not unduly delay the work. 7.4.3 If any of the services or facilities do not conform to contract requirements, MCAO may require the Contractor to perform the services again in conformity with contract requirements, at no cost to the County or MCAO. When the defects in services cannot be corrected by re-performance, the County or MCAO may: 7.4.3.1 require the Contractor to take necessary action to ensure that future performance conforms to contract requirements. 7.4.4 If the Contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with contract requirements, the County may terminate the contract for default. 7.4.5 MCAO may design and implement a system of program evaluation to use to determine the Contractor’s performance as contemplated by this contract. Such evaluations may, in MCAO’s sole discretion, be shared with the Contractor. 7.5 NO MINIMUM OR MAXIMUM PURCHASE OBLIGATION This contract does not guarantee any minimum or maximum number of referrals of offenders to be made by MCAO to Contractor. 7.6 BACKGROUND CHECK Contractors need to be aware that there may be multiple background checks (Sheriff’s Office, County Attorney's Office, Courts, as well as Maricopa County general government) to determine if the Contractor’s employees or sub-contractors (including employees of such sub-contractors) are acceptable to do business with the County or MCAO with respect to providing the services contemplated by this contract. Contractor agrees to cause such background checks to be completed and to forward the results to MCAO, as requested. Contractor shall not allow any person who has not satisfactorily passed all required background checks to provide the services contemplated by this contract. Failure to meet these requirements may lead to termination of the contract. SERIAL# 220224-CI 7.7 SUSPENSION OF WORK The County may order the Contractor, in writing, to suspend, delay, or interrupt all or any part of the work of this contract for the period of time that the County determines appropriate for the convenience of the County. 7.8 STOP WORK ORDER 7.8.1 The County may, at any time, by written order to the Contractor, require the Contractor to stop all, or any part, of the work called for by this contract. The order shall be specifically identified as a stop work order issued under this clause. After a stop-work is delivered to the Contractor, the County shall either— 7.8.1.1 cancel the stop-work order; or 7.8.1.2 terminate the work covered by the order as provided in the Termination for Default or the Termination for Convenience, clause of this contract. 7.9 TERMINATION FOR CONVENIENCE Maricopa County may terminate the resultant contract for convenience without further obligation by providing 60 calendar day notice to the Contractor. The Contractor may terminate the resultant contract for convenience without further obligation by providing a six months’ notice to the County and MCAO. 7.10 TERMINATION FOR DEFAULT 7.10.1 The County may, by written Notice of Default to the Contractor, terminate this contract in whole or in part if the Contractor fails to: 7.10.1.1 perform the services required in accordance with the terms of this contract or any extension; 7.10.1.2 perform the services required within the time frame specified in this contract or any extension; 7.10.1.3 perform any of the other provisions of this contract; or 7.10.1.4 if the Contractor should be adjudged bankrupt or should make a general assignment for the benefits of its creditors, or if a receiver should be appointed because of its insolvency. 7.10.2 The County’s right to terminate this contract under these subparagraphs may be exercised if the Contractor does not cure such failure within 10 business days (or more if authorized in writing by the County) after receipt of a Notice to Cure from the procurement officer specifying the failure. 7.10.3 Upon termination under this paragraph, all goods, materials, documents, data and reports prepared by the Contractor under the contract shall become the property of and be delivered to the County on demand. 7.10.4 The County may, upon termination of this contract, procure, on terms and in the manner that it deems appropriate, materials or services to replace those under this contract. The Contractor shall be liable to the County for any excess costs incurred by the County in procuring materials or services in substitution for those due from the Contractor. Any claim for excess costs incurred arising out of this paragraph shall be itemized with descriptive detail and submitted to Contractor for review and acceptance. In any event no claim shall exceed $10,000. SERIAL# 220224-CI 7.10.5 The Contractor shall continue to perform, in accordance with the requirements of the contract, up to the date of termination, or as directed in the termination notice. 7.11 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST Notice is given that, pursuant to A.R.S. § 38-511, the County may cancel any contract without penalty or further obligation within three years after execution of the contract, if any person significantly involved in initiating, negotiating, securing, drafting, or creating the contract on behalf of the County is at any time while the contract or any extension of the contract is in effect, an employee or agent of any other party to the contract in any capacity or consultant to any other party of the contract with respect to the subject matter of the contract. Additionally, pursuant to A.R.S. §38-511, the County may recoup any fee or commission paid or due to any person significantly involved in initiating, negotiation, securing, drafting, or creating the contract on behalf of the County from any other party to the contract arising as the result of the contract. 7.12 CONTRACTOR LICENSE REQUIREMENT The Contractor shall procure all permits, insurance, and licenses, and pay the charges and fees necessary and incidental to the lawful conduct of his/her business, and as necessary complete any requirements, by any and all governmental or non-governmental entities as mandated to maintain compliance with and in good standing. The Contractor shall keep fully informed of existing and future trade or industry requirements, Federal, State, and local laws, ordinances, and regulations which in any manner affect the fulfillment of a contract and shall comply with the same. Contractor shall immediately notify both Office of Procurement Services and the department of any and all changes concerning permits, insurance, or licenses. 7.13 OFFSET FOR DAMAGES In addition to all other remedies at Law or Equity, the County may offset from any money due to the Contractor any amounts Contractor owes to the County for damages resulting from breach or deficiencies in performance of the contract. 7.14 SUBCONTRACTING The Contractor may not assign to another Contractor or subcontract to another party for performance of the terms and conditions hereof without the written consent of the County. 7.15 AMENDMENTS All amendments to this contract shall be in writing and approved/signed by both parties. Maricopa County Office of Procurement Services shall be responsible for approving all amendments for Maricopa County. 7.16 ADDITIONS/DELETIONS OF REQUIREMENTS The County reserves the right to add and/or delete services to a contract. If a service requirement is deleted, payment to the Contractor will be reduced proportionately to the amount of service reduced in accordance with the bid price. If additional services are requested from a contract, prices for such additions will be negotiated between the Contractor and the County. SERIAL# 220224-CI 7.17 STRICT COMPLIANCE Acceptance by County of a performance that is not in strict compliance with the terms of the contract shall not be deemed to be a waiver of strict compliance with respect to all other terms of the contract. 7.18 VALIDITY The invalidity, in whole or in part, of any provision of this contract shall not void or affect the validity of any other provision of the contract. 7.19 SEVERABILITY The removal, in whole or in part, of any provision of this contract shall not void or affect the validity of any other provision of this contract. 7.20 RIGHTS IN DATA 7.20.1 The County shall have the use of data and reports resulting from a contract without additional cost or other restriction except as may be established by law or applicable regulation. Each party shall supply to the other party, upon request, any available information that is relevant to a contract and to the performance thereunder. 7.20.2 Data, records, reports, and all other information generated for the County by a third party as the result of a contract are the property of the County and shall be provided in a format designated by the County or shall be and remain accessible to the County into perpetuity. 7.21 NON-DISCRIMINATION Contractor agrees to comply with all provisions and requirements of Arizona Executive Order 2009-09, including flow down of all provisions and requirements to any subcontractors. Executive Order 2009-09 supersedes Executive Order 99-4 and amends Executive Order 75-5 and is hereby incorporated into this contract as if set forth in full herein. During the performance of this contract, Contractor shall not discriminate against any employee, client, or any other individual in any way because of that person’s age, race, creed, color, religion, sex, disability, or national origin. (Arizona Executive Order 2009-09 can be downloaded from the Arizona Memory Project at http://azmemory.azlibrary.gov/cdm/singleitem/collection/execorders/id/680/rec/1.) 7.22 WRITTEN CERTIFICATION PURSUANT to A.R.S. § 35-393.01 If vendor engages in for-profit activity and has 10 or more employees, and if this agreement has a value of $100,000 or more, vendor certifies it is not currently engaged in, and agrees for the duration of this agreement to not engage in, a boycott of goods or services from Israel. This certification does not apply to a boycott prohibited by 50 U.S.C. § 4842 or a regulation issued pursuant to 50 U.S.C. § 4842. 7.23 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION 7.23.1 The undersigned (authorized official signing for the Contractor) certifies to the best of his or her knowledge and belief, that the Contractor, its current officers, and directors: 7.23.1.1 are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from being awarded any contract or grant by any United States department or agency or any state, or local jurisdiction; SERIAL# 220224-CI 7.23.1.2 have not within 3-year period preceding this contract: 7.23.1.2.1 been convicted of fraud or any criminal offense in connection with obtaining, attempting to obtain, or as the result of performing a government entity (Federal, State or local) transaction or contract; or 7.23.1.2.2 been convicted of violation of any Federal or State antitrust statutes or conviction for embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property regarding a government entity transaction or contract; 7.23.1.3 are not presently indicted or criminally charged by a government entity (Federal, State or local) with commission of any criminal offenses in connection with obtaining, attempting to obtain, or as the result of performing a government entity public (Federal, State or local) transaction or contract; 7.23.1.4 are not presently facing any civil charges from any governmental entity regarding obtaining, attempting to obtain, or from performing any governmental entity contract or other transaction; and 7.23.1.4 have not within a three-year period preceding this contract any public transaction (Federal, State or local) terminated for cause of default. 7.23.2 If any of the above circumstances described in the paragraph are applicable to the entity submitting a bid for this requirement, include with your bid an explanation of the matter including any final resolution. 7.23.3 The Contractor shall include, without modification, this clause in all lower tier covered transactions (i.e. transactions with subcontractors or sub-subcontractors) and in all solicitations for lower tier covered transactions related to this contract. 7.24 VERIFICATION REGARDING COMPLIANCE WITH ARIZONA REVISED STATUTES § 41-4401 AND FEDERAL IMMIGRATION LAWS AND REGULATIONS 7.24.1 By entering into the contract, the Contractor warrants compliance with the Immigration and Nationality Act (INA using E-Verify) and all other Federal immigration laws and regulations related to the immigration status of its employees and A.R.S. § 23-214(A). The contractor shall obtain statements from its subcontractors certifying compliance and shall furnish the statements to the procurement officer upon request. These warranties shall remain in effect through the term of the contract. The Contractor and its subcontractors shall also maintain Employment Eligibility Verification forms (I-9) as required by the Immigration Reform and Control Act of 1986, as amended from time to time, for all employees performing work under the contract and verify employee compliance using the E- Verify system and shall keep a record of the verification for the duration of the employee’s employment or at least three years, whichever is longer. I-9 forms are available for download at www.uscis.gov. 7.24.2 The County retains the legal right to inspect contractor and subcontractor employee documents performing work under this contract to verify compliance with paragraph 7.24.1 of this section. Contractor and subcontractor shall be given reasonable notice of the County’s intent to inspect and shall make the documents available at the time and date specified. Should the County suspect or find that the Contractor or any of its subcontractors are not in compliance, the County will consider this a material breach of the contract and may pursue any and all remedies allowed by SERIAL# 220224-CI law, including, but not limited to: suspension of work, termination of the contract for default, and suspension and/or debarment of the Contractor. All costs necessary to verify compliance are the responsibility of the Contractor. 7.25 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND REQUIREMENT TO INFORM EMPLOYEES OF WHISTLEBLOWER RIGHTS 7.25.1 The parties agree that this contract and employees working on this contract will be subject to the Contractor employee whistleblower protections established by Title 41 U.S.C. § 4712 and Section 3.908 of the Federal Acquisition Regulation. 7.25.2 Contractor shall inform its employees in writing, in the predominant language of the workforce, of employee whistleblower rights and protections under 41 U.S.C. § 4712, as described in Section 3.908 of the Federal Acquisition Regulation. Documentation of such employee notification must be kept on file by Contractor and copies provided to County upon request. 7.25.3 Contractor shall insert the substance of this clause, including this paragraph, in all subcontracts over the simplified acquisition threshold ($250,000 as of fiscal year 2018). 7.26 INFLUENCE 7.26.1 As prescribed in MC1-1203 of the Maricopa County Procurement Code, any effort to influence an employee or agent to breach the Maricopa County or MCAO Ethical Code of Conduct or any ethical conduct may be grounds for disbarment or suspension under MC1-902. 7.26.2 An attempt to influence includes, but is not limited to: 7.26.2.1 A person offering or providing a gratuity, gift, tip, present, donation, money, entertainment or educational passes or tickets, or any type of valuable contribution or subsidy that is offered or given with the intent to influence a decision, obtain a contract, garner favorable treatment, or gain favorable consideration of any kind. 7.26.3 If a person attempts to influence any employee or agent of Maricopa County, the chief procurement officer, or his designee, reserves the right to seek any remedy provided by the Maricopa County Procurement code, any remedy in equity or in the law, or any remedy provided by this contract. 7.27 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR OTHER REVIEW 7.27.1 In accordance with Section MC1-373 of the Maricopa County Procurement Code, Contractor agrees to retain all books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this contract for six years after final payment or until after the resolution of any audit questions which could be more than six years, whichever is latest. The County, Federal or State auditors and any other persons duly authorized by the department shall have full access to, and the right to examine, copy, and make use of, any and all said materials except those materials containing materials protected under privacy laws. 7.27.2 If the Contractor’s books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this contract are not sufficient to support and document that requested services were provided, the Contractor shall reimburse Maricopa County for the services not so adequately supported and documented. SERIAL# 220224-CI 7.28 CONFIDENTIAL INFORMATION 7.28.1 Any information obtained in the course of performing this contract may include information that is proprietary or confidential to the County, MCAO or to the person or persons who are the recipients of the services being provided by the Contractor. This provision establishes the contractor’s obligation regarding such information. 7.28.2 The Contractor shall establish and maintain procedures and controls that are adequate to assure that no information contained in its records and/or obtained from the County, MCAO or from others in carrying out its functions (services) under the contract shall be used by or disclosed by it, its agents, officers, or employees, except as required to efficiently perform duties under the contract. The Contractor’s procedures and controls, at a minimum, must be the same procedures and controls it uses to protect its own proprietary or confidential information. If, at any time during the duration of the contract, the County or MCAO determines that the procedures and controls in place are not adequate, the Contractor shall institute any new and/or additional measures requested by the County within 15 calendar days of the written request to do so. 7.28.3 Any requests to the Contractor for County or MCAO proprietary or confidential information shall be referred to the County or the MCAO custodian of records for review and approval, prior to any dissemination. 7.29 PUBLIC RECORDS Under Arizona law, all offers submitted and opened are public records and must be retained by the County at the Maricopa County Office of Procurement Services according to retention polices. Offers shall be open to public inspection and copying after contract award and execution, except for such offers or sections thereof determined to contain proprietary or confidential information by the Office of Procurement Services. If an offeror believes that information in its offer or any resulting contract should not be released in response to a public record request under Arizona law, the offeror shall indicate the specific information deemed confidential or proprietary and submit a statement with its offer detailing the reasons that the information should not be disclosed. Such reasons shall include the specific harm or prejudice which may arise from disclosure. The records manager of the Office of Procurement Services shall determine whether the identified information is confidential pursuant to the Maricopa County Procurement Code. 7.30 FEES Contractor warrants that fees extended to the County under this contract are no higher than those paid by any other customer for these services. Fees charged shall be reasonable and are established at the beginning of the contract period. Any request for an increase in fee shall be subject to approval by the County. 7.31 AUDIT DISALLOWANCES If at any time, County determines that a cost for which payment has been made is a disallowed cost, such as overpayment, the County shall notify the Contractor in writing of the disallowance. County shall also state the means of correction, which may be but shall not be limited to adjustment of any future claim submitted by the Contractor by the amount of the disallowance, or to require repayment of the disallowed amount by the Contractor. SERIAL# 220224-CI 7.32 INTEGRATION This contract represents the entire and integrated agreement between the parties and supersedes all prior negotiations, proposals, communications, understandings, representations, or agreements, whether oral or written, expressed, or implied. 7.33 RELATIONSHIPS In the performance of the services described herein, the Contractor shall act solely as an independent contractor, and nothing herein or implied herein shall at any time be construed as to create the relationship of employer and employee, co-employee, partnership, principal and agent, or joint venture between the County and the Contractor. 7.34 UNIFORM ADMINISTRATIVE REQUIREMENTS By entering into this contract, the Contractor agrees to comply with all applicable provisions of Title 2, Subtitle A, Chapter II, Part 200—UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained in Title 2 C.F.R. § 200 et seq. 7.35 GOVERNING LAW This contract shall be governed by the laws of the state of Arizona. Venue for any actions or lawsuits involving this contract will be in Maricopa County Superior Court, sitting in Phoenix, Arizona 7.36 ORDER OF PRECEDENCE In the event of a conflict in the provisions of this contract, scope of work, and request for proposal, if applicable, the terms of this contract shall prevail. 7.37 DISPUTES Any matter which cannot be resolved by the parties will be submitted for review to the Maricopa County Attorney or designee. The decision of the Maricopa County Attorney or designee is the final determination of the matter. The parties retain the right to pursue any judicial remedies available under Arizona law. 7.38 INCORPORATION OF DOCUMENTS The following are to be attached to and made part of this contract: 7.38.1 Exhibit A, Vendor Information and Fees; 7.38.2 Exhibit B, Scope of Work; 7.38.3 Exhibit C, MCAO Consent Form; 7.38.4 Exhibit D, SAGE Provider Application & Agreement (Third Party Administrator); 7.38.5 Exhibit E, MCAO Financial Agreement Form NOTICES: All notices given pursuant to the terms of this contract shall be addressed to MCAO with a copy going to Office of Procurement Services: SERIAL# 220224-CI For MCAO: Maricopa County Attorney’s Office Administration Division Grant and Contract Administrator 225 W Madison St, 6th Floor Phoenix, Arizona 85003 For Office of Procurement Services: Maricopa County Office of Procurement Services 160 S. 4th Avenue Phoenix, Arizona 85003-1647 For Contractor: SAGE Counseling, Inc. 1830 South Alma School Road, #104 Mesa, AZ 85210 SERIAL# 220224-CI IN WITNESS WHEREOF, this Contract is executed on the date set forth above. CONTRACTOR ________________________________________________ AUTHORIZED SIGNATURE ________________________________________________ PRINTED NAME AND TITLE ________________________________________________ ADDRESS ________________________________________________ DATE MARICOPA COUNTY CHAIRMAN, BOARD OF SUPERVISORS DATE ATTESTED: CLERK OF THE BOARD DATE APPROVED AS TO FORM: DEPUTY COUNTY ATTORNEY DATE Linda Cowan, COO 1830 South Alma School Rd., Mesa, AZ 85201 02/17/2022 2/17/2022 SERIAL# 220224-CI EXHIBIT A VENDOR INFORMATION AND FEES SERIAL 220224-CI NIGP CODE: RESPONDENT'S NAME: SAGE Counseling, Inc. COUNTY VENDOR NUMBER: VC0000008662 ADDRESS: 1830 S. Alma School Rd., Suite 101 Mesa, AZ 85210 P.O. ADDRESS: TELEPHONE NUMBER: 480-649-3352 FACSIMILE NUMBER: 480-649-3358 WEB SITE: www.sagecounseling.net CONTACT (REPRESENTATIVE): Stephen Grams REPRESENTATIVE'S E-MAIL ADDRESS: info@sagecounseling.net PAYMENT TERMS: Net 30 1.0 PRICING: Fee/Rate Per Class Assessment Fees $150.00 Assessment Update $55.00 Assessment Rescheduling Fee n/a Group Fees $40.00 IOP Group Fees n/a Weekend Education (fee/day) $55.00 Individual Sessions $65.00 Case Coordination Fee (Out of State/Out of County) per Month $80.00 SERIAL# 220224-CI EXHIBIT B SCOPE OF WORK 1.0 COUNTY ATTORNEY AUTHORITY AND REFERRALS; PURPOSE 1.1 Pursuant to A.R.S. §§ 11-361 et seq., the Maricopa County Attorney (“County Attorney”) has the authority, as an alternative to prosecution, to divert or defer, before a guilty plea or a trial, the prosecution of an eligible person who is accused of committing a crime. Per this authority, the County Attorney has established the MCAO Animal Cruelty Diversion Program. The purpose of this Scope of Work (SOW) is for the Contractor to provide treatment services to eligible adult felony offenders referred to the Contractor by the County Attorney after the filing of charges for specific felony offenses. 1.2 The County Attorney is solely responsible for determining which offenders are eligible for the MCAO Animal Cruelty Diversion Program. 1.3 The MCAO Animal Cruelty Diversion Program is available to eligible offenders only after charges are filed in state court (post-file cases). 1.4 The Contractor, as further defined in this SOW, shall conduct a comprehensive validated assessment of the referred offender, and recommend and institute a treatment plan with the goal that the offender successfully completes the program. 1.5 The County Attorney may rescind an offender’s participation in MCAO Animal Cruelty Diversion Program at any time. If the County Attorney directs removal of any offender from MCAO Animal Cruelty Program, the Contractor shall promptly cease providing any further diversion services to the offender and close the offender’s diversion file without making any determination regarding the offender’s completion of the diversion program. In these cases, the Contractor will be advised/directed by MCAO on how to discharge the case. 1.6 For those offenders who successfully complete the MCAO Animal Cruelty Diversion Program, the County Attorney will dismiss the charges with prejudice. 1.7 If an offender fails to successfully complete the MCAO Animal Cruelty Diversion Program, MCAO shall review the reasons for the offender’s unsuccessful termination and decide what action should be taken depending on the circumstances presented. If it appears that the termination is solely due to an offender’s non-payment of program costs and fees (not including restitution), MCAO shall consult with the Contractor to review the offender’s financial assessment application, financial responsibility determination, and any other available information regarding the offender’s financial circumstances. MCAO shall determine whether to reinstate prosecution or undertake alternatives thereto. 2.0 PROGRAM REQUIREMENTS The Contractor shall: 2.1 Upon receipt of referral to the MCAO Animal Cruelty Diversion Program, administer a comprehensive and validated assessment tool: the Ohio Risk Assessment System – Community Supervision Tool (ORAS-CST) for offender assessment and rehabilitation. The ORAS-CST shall assess the offender’s overall risk to reoffend, risk level score, and identify targeted criminogenic needs and domains. It is the responsibility of the Contractor to have certified end users in the ORAS-CST. The Contractor may use additional assessment tools in conjunction with the ORAS pertinent to the offender’s specific needs. 2.2 Develop an individualized treatment plan and goals relative to the targeted criminogenic needs and domains so the service is beneficial and appropriate for the offender’s learning style, motivation, abilities, and strengths. SERIAL# 220224-CI 2.3 Upon the completion of the ORAS, assign all offenders to an appropriate treatment “Level” based upon overall risk to reoffend. 2.3.1 LEVEL 1 – for all offenders who are assessed to be of Low Risk to reoffend and determined to require only basic animal welfare education. The program shall consist of: 2.3.1.1 One (1) 4-hour education class; 2.3.1.2 Class covers minimum standards of animal care, knowledge of companion animals’ basic needs, and interactive exercises to explore perspectives and to build empathy; and 2.3.1.3 Evidence-Based Curriculum: The Identification, Assessment, and Treatment of Adults Who Abuse Animals, The AniCare Approach model and Animal and Society Institute’s (ASI) Companion Animal Responsibility and Care (CARE). 2.3.2 LEVEL 2 – for all offenders who are determined as Low, Moderate, or High Risk to reoffend with a higher level of animal neglect/abuse needs. The program shall consist of: 2.3.2.1 Sixteen (16) 1-2 hour open entry group counseling sessions; 2.3.2.2 Groups to address: accountability and factors that motivated the animal abuse or neglect, including attitudes, beliefs, and other risk factors; dealing with resistance, clarifying values related to animals, and teaching self-management skills (such as empathy, attachment, accommodation, reciprocity, and nurturance); providing knowledge on proper animal care and well-being; improving self-awareness and self- management of emotions, and having a positive relationship towards animals; 2.3.2.3 Evidence-Based Curriculum: The Identification, Assessment, and Treatment of Adults Who Abuse Animals, The AniCare Approach model and ASI’s Behavior, Accountability, Responsibility, and Knowledge (BARK); and 2.3.2.4 Individual counseling sessions may be substituted for group counseling sessions requirements if therapeutically indicated. 2.3.3 LEVEL 3: for all offenders who score as Moderate or High Risk to reoffend with a higher level of animal neglect/abuse needs and with co-occurring issues. The program shall consist of: 2.3.3.1 One-on-one psychological therapy focusing on the animal abuse and co-occurring issues, such as substance abuse, domestic violence, child abuse, and hoarding. Intervention focused on accountability, empathy, perspective taking, compassion, interpersonal skills, and animal welfare. Includes interactive exercises and homework assignments to reinforce the skills learned in sessions; 2.3.3.2 Levels 2 and 3 requirements may be combined to meet the needs of the offender. Individual counseling sessions may be substituted for group counseling sessions requirements if therapeutically indicated; and 2.3.3.3 Evidence-Based Curriculum: The Identification, Assessment, and Treatment of Adults Who Abuse Animals, The AniCare Approach model. SERIAL# 220224-CI 2.3.4 The ability for the Contractor to deliver the Animal and Society Institute curriculum requires training. The Contractor shall notify MCAO within 90 days if it anticipates a lack of trained facilitators and therefore the curriculum cannot be delivered with fidelity. In this case, the parties shall determine if mutual agreements are available to resolve the issue prior to termination of the contract. 2.4 For those offenders owing restitution, per the Consent Agreement (attached as Exhibit C hereto) signed by the offender and filed in court, the collection of restitution payments from offenders is mandatory. Per the Consent Agreement, the offender agreed to pay 50% of the restitution balance owed within thirty (30) days following the first day of services as specified in the offender’s treatment plan in the MCAO Animal Cruelty Diversion Program. In the event the offender fails to pay 50% of the restitution balance by the 30-day deadline established by the Consent Agreement, the Contractor must notify MCAO. MCAO will determine if the Contractor needs to take any additional action at that time. The remaining restitution balance owed can be paid in installment payments with due date as determined by the Contractor. The Contractor shall notify MCAO if the offender fails to make installments payments for the remaining restitution balance by the determined due date(s). MCAO will determine whether any additional action needs to be taken at that time by the Contractor. Per the Consent Agreement, the offender’s failure to pay restitution as owed by the determined due date may result in an unsuccessful termination from the program. No offender can be successfully discharged from the program until restitution is paid in full. Treatment shall not be extended solely because of unpaid restitution unless otherwise authorized by the Director of Diversion Strategies Group. 2.5 Service delivery options: 2.5.1 Provide services in a community-based setting in Maricopa County. If increased referral numbers necessitate additional groups, provide services at other locations throughout Maricopa County. 2.5.2 In the event that in-person community-based services are not provided by the Contractor, the Contractor shall provide virtual/telehealth services. When in- person services resume, the default option shall be that the offender will return to in-person services for the duration of their treatment; however, the Contractor agrees to allow for a virtual/telehealth services option if there is an identified and verified hardship that would be of detriment to the offender’s completion of in- person treatment. 2.5.3 For offenders who do not live near the Contractor’s site for services (outside the State of Arizona or outside of Maricopa County Arizona): 2.5.3.1 It shall be the responsibility of the offender to locate a Third-Party Administrator (TPA) in their jurisdiction that can provide comparable services with consideration for the practicality and locality of the jurisdiction as determined by the Contractor. 2.5.3.2 The Contractor shall be authorized to provide monthly case coordination services and charge a monthly case coordination fee to the offender as described in Exhibit A. 2.5.3.3 Provided the Contractor and the TPA enter into the Contractor’s Provider Application and Agreement in the form (attached as Exhibit D hereto) without any amendments or modifications thereto, the TPA shall be considered to be approved by the County Attorney. An executed copy of the Contractor Provider Application and Agreement shall be maintained in the offender’s file. SERIAL# 220224-CI 2.6 Service provisions such as: offender/group setting, virtual/telehealth group setting, closed/open format as prescribed by the Level curriculum, length and frequency of service, hours of operation (including weeknights and weekend availability consideration), and the staff to offender ratio shall safely and effectively meet the needs of offenders. Conduct classes and treatment accordance with an established and published schedule. 2.7 Service delivery shall be culturally relevant and linguistically appropriate to the population served and consistently delivered in a structured and supportive learning environment that promotes attainment of treatment goals. 2.8 Preference is for an individual who holds a master’s degree in a human services-related field and licensed to practice independently by the Arizona Board of Behavioral Health Examiners or is exempt from licensure pursuant to A.R.S. Title 32, Chapter 33 to deliver services. However, services may also be delivered by Behavioral Health Technicians under the supervision of a master’s level clinician. 2.9 Attend workshops or training, at the Contractor’s expense, sponsored by the MCAO if required by the County Attorney. Provide training at no additional cost to MCAO personnel as requested by the Director of the MCAO Diversion Strategies Group, the County Attorney or her duly authorized employees, agents, or assigns (“MCAO Authorized Persons”). 2.10 Designate and update as needed, one (1) point of contact at the staff level for purposes of communication regarding MCAO Diversion cases. 2.11 All Contractor forms (to include informational flyers, brochures, working documents, etc.) used and given to offenders for any MCAO diversion program shall be submitted to the County Attorney in advance and approved by the County Attorney prior to implementation. The Contractor shall not in any manner represent the County Attorney, MCAO Animal Cruelty Diversion Program or MCAO. 2.12 Establish reasonable treatment and non-treatment Contractor fees. Accept multiple forms of payment such as: cash, debit cards, and credit cards as payment for services and/or the ability to bill private insurance or AHCCCS to cover treatment or education costs. 2.13 If applicable to the case, the offender shall make restitution payments via the MCAO Diversion Payment Portal or mail payments directly to MCAO using the approved payment methods. The Contractor shall ascertain if co-defendants were ordered to pay as joint and several liability requirements and verify restitution payments via the MCAO Diversion Payment Portal prior to discharging the offender from MCAO Animal Cruelty Diversion Program. Full restitution shall be paid for a successful discharge. The total amount of restitution paid shall be documented on the MCAO Discharge Report, whether successful or unsuccessful discharge. 2.14 Financial Assessment Process 2.14.1 The Contractor shall establish a financial assessment process and make financial responsibility determinations based upon current Federal Poverty Guidelines (FPLs) and a Sliding Scale established by the Contractor for all program service fees. Per the financial assessment process, the Contractor shall make financial responsibility determinations, so an offender's finances do not preclude the offender’s opportunity to participate in the program per program requirements. 2.14.2 The Contractor shall establish a policy which outlines a standardized financial assessment process. The Contractor shall provide a copy of this policy to the County Attorney via the MCAO Diversion Strategies Group. The policy shall be approved by the County Attorney. SERIAL# 220224-CI 2.14.3 The Contractor shall establish an offender financial assessment application and instructions, a Contractor Sliding Scale (attached as Exhibit A), and a listing of fees. The Contractor shall provide a copy of these documents to the County Attorney via the MCAO Diversion Strategies Group. The documents shall be approved by the County Attorney. 2.14.4 The standardized financial assessment process and financial responsibility determination, including written notification by the Contractor to the offender of the offender’s financial responsibility for payment of program service fees, shall occur prior to the commencement of any service to an offender who has notified the Contractor that the offender is requesting financial assessment and financial responsibility determination per the process described herein. 2.14.5 As prescribed in the Consent Agreement filed with the court (attached as Exhibit C) wherein the offender agrees to participate in the MCAO Animal Cruelty Diversion Program, the Contractor shall contact the offender within seven (7) business days of receiving the referral from the MCAO. The Contractor shall contact the offender via email or phone, review initial program information, and verify insurance status. If unable to contact the offender after several outreach attempts, the Contractor shall unsuccessfully discharge the offender from the program. 2.14.6 During the meeting referenced in Section 2.14.5, the Contractor shall ask the offender whether he or she is insured with AHCCCS. Upon an offender’s claim that he or she is insured with AHCCCS, the Contractor shall verify the accuracy of such claim by obtaining AHCCCS’ documented response verifying current enrollment. 2.14.7 The Contractor shall not charge any program service fees for AHCCCS members for any AHCCCS approved service. If any AHCCCS health plan denies coverage for the diversion program treatment, the Contractor shall review the AHCCCS health plan decision to determine if an appeal of the decision can be submitted. If the AHCCCS health plan decision is not appealed or not reversed by appeal, the Contractor shall implement in Exhibit A of this Scope of Work, the Sliding Scale tier for any uncovered services for AHCCCS members. 2.14.8 An offender’s inability to provide an AHCCCS insurance card shall not disqualify the offender from AHCCCS approved coverage or discount of program service fees as may be applicable under Section 2.14.7. 2.14.9 During the meeting referenced in Section 2.14.5 above, upon the offender’s claim that he or she is not insured with AHCCCS, or upon verification that the offender is not insured by AHCCCS, the Contractor shall provide to the offender a financial assessment application and application instructions with a due date of seven (7) business days from receipt. The Contractor shall explain the instructions and shall assist the offender with the financial assessment application to further the offender’s understanding and completion of the application, while emphasizing it is the sole responsibility of the offender to complete the application and to provide necessary supporting documentation (e.g.: tax returns, pay stubs, statements showing income from Social Security, Medicaid, SNAP, pension, annuity, veterans’ benefits, alimony, child support, military benefits, businesses, rent, interest, dividends, and any other income) by the required deadline. The offender may submit the completed financial assessment application and necessary supporting documentation to the Contractor via email, physical mail, or personal delivery. 2.14.10 Full service fees (as described in Exhibit A and the Sliding Scale) shall be assessed at the time of service if the offender fails to complete the financial SERIAL# 220224-CI assessment application and/or fails to provide necessary supporting documentation within seven (7) business days from the date of receipt of the application and instructions per Section 2.14.9. 2.14.11 If the offender submits the completed financial assessment application and necessary supporting documentation within the required seven (7) business days deadline, the Contractor shall make a determination regarding the offender’s financial responsibility within five (5) business days of receipt of the completed financial assessment application and necessary supporting documentation. The Contractor shall provide the offender with written notification of the financial responsibility determination. 2.14.12 Upon receiving written notice of the Contractor’s financial responsibility determination, the offender may submit a written request, including supporting documentation, to the Contractor, requesting re-assessment of financial responsibility on the basis of factual error, such as incorrect salary amount, incorrect number of members of household, as objectively demonstrated by supporting documentation supplied by the offender. The offender shall submit such written submittal and supporting documentation to the Contractor within five (5) business days of receipt of written notice of the Contractor’s financial responsibility determination. If the offender does not submit such request within the required deadline, the Contractor’s financial responsibility determination shall be final, absent the offender completing the processes required for an intervening change of circumstances per Section 2.15. If the offender does make such submittal within the required deadline, the Contractor shall provide the offender with written notice regarding its decision on the submittal’s request and to the extent applicable, provide written notice of any correction to the financial responsibility determination, which shall be final. 2.14.13 Upon providing written notification to the offender regarding the financial responsibility determination, the Contractor and the offender shall enter into a Financial Responsibility Agreement in the form (attached as Exhibit E). The Financial Responsibility Agreement shall govern the offender’s fee payment obligations for successful completion of the program, unless and until there may be a revised financial responsibility determination resulting from the offender’s report of an intervening change in circumstances per Section 2.15 hereto. In circumstances where the offender fails to make the fee payments provided in the financial responsibility determination and agreed in the Financial Responsibility Agreement, and where there is not a revised financial responsibility determination resulting from the offender’s report of an intervening change in circumstances per Section 2.15 hereto, the Contractor may refuse to provide services to the offender, may terminate the offender’s program, and may return the offender to MCAO for determination whether to reinstate prosecution. In no event shall the Contractor refuse to provide services, terminate the offender’s program or return the offender to MCAO for prosecution, solely because the offender failed to pay fees in excess of the fees applicable to and agreed by the offender per the financial assessment process, financial responsibility determination and Financial Responsibility Agreement (attached as Exhibit E). If it appears that the termination is solely due to an offender’s non-payment of program costs and fees (not including restitution), MCAO will consult with the Contractor to review the offender’s financial assessment application, financial responsibility determination, and any other available information regarding the offender’s financial circumstances. MCAO will determine whether to reinstate prosecution or undertake alternatives thereto. 2.14.14 If as a result of the financial assessment process, the Contractor determines the offender may be AHCCCS eligible, the Contractor shall assist the offender in their application to AHCCCS. If the AHCCCS eligible offender refuses to SERIAL# 220224-CI submit an application to AHCCCS, the Contractor shall document such refusal in writing and the Contractor is not obligated to waive or reduce program service fees. 2.14.15 If as a result of the financial assessment process, the Contractor determines the offender is qualified for AHCCCS approved coverage per the applicable Sliding Scale, such insurance coverage will be applied retroactively to the 1st day of the month of the date of submittal of the completed and approved financial assessment application. Any payments of fees made on or after submittal of the completed application shall be refunded by the Contractor to the offender. These refunds apply to any overpayment by the offender due to their AHCCCS healthcare plan coverage or unless the offender loses their AHCCCS coverage in the future. 2.14.16 If as a result of the financial assessment process, the Contractor determines the offender is qualified for fee discount per the applicable Sliding Scale, such discount will be applied retroactively to the to the date of submittal of the completed financial assessment application. Any overpayment of fees made on or after submittal of the completed application shall be applied in the form of a credit towards future fees or refunded to the offender, whichever is preferable to the Contractor. 2.14.17 Upon the completion of the financial assessment process and the Financial Responsibility Agreement, the Contractor shall schedule the offender for an appointment for an Intake/Assessment. 2.14.18 Completed financial assessment applications and supporting documentation, written financial responsibility determinations, and Financial Responsibility Agreements shall be maintained in the offender’s program file, and shall be made available to MCAO upon request. Additionally, the following aggregated data/metrics shall be regularly maintained by the Contractor and shall be made available in electronic format to MCAO upon request: 2.14.18.1 Total number of offenders admitted to the Program. 2.14.18.2 Total number of offenders verified to be AHCCCS insureds or AHCCCS eligible. 2.14.18.3 Total number of offenders who received financial assessment applications and instructions. 2.14.18.4 Total number of offenders who submitted financial assessment applications and supporting documentation per the required financial assessment process. 2.14.18.5 Total number of offenders whose financial assessment applications and supporting documentation were determined not to qualify for AHCCCS approved coverage or discount of fees under the applicable Sliding Scale. 2.14.18.6 Total number of offenders whose financial assessment applications and supporting documentation were determined to qualify for AHCCCS approved coverage of fees under the applicable Sliding Scale. 2.14.18.7 Total number of offenders whose financial assessment applications and supporting documentation were determined to qualify for discount of fees under the applicable Sliding Scale, and for such offenders, total number of offenders qualifying for discounts under each Sliding Scale tier. SERIAL# 220224-CI 2.14.19 The Contractor shall require payment at the time of service based upon program service fees as determined by the financial assessment process, financial responsibility determination and Financial Responsibility Agreement. 2.15 Intervening Change in Circumstances: 2.15.1 If during the course of the program, the offender has an intervening loss of AHCCCS eligibility, the Contractor shall assist the offender with re-enrollment into AHCCCS. If such offender is determined by AHCCCS not to be AHCCCS- eligible, the Contractor shall provide the financial assessment application and instructions to the offender per Section 2.14.9. The offender must complete the application and provide necessary supporting documentation (e.g.: tax returns, pay stubs, statements showing income from Social Security, Medicaid, SNAP, pension, annuity, veteran’s benefits, alimony, child support, military benefits, businesses, rent, interest, dividends, and any other income), no later than seven (7) business days after receipt. If such application and documentation are received by the Contractor within the required deadline, the Contractor shall make the financial responsibility determination within five (5) business days of receipt and shall provide written notification to the offender regarding the financial responsibility determination. The Contractor and the offender shall enter into a Financial Responsibility Agreement with obligations, requirements, and processes per Section 2.14.13. The processes set forth in Section 2.14.12 shall apply. If the offender does not complete such application and provide such documentation within the required deadline, the Contractor shall notify the offender in writing that the offender shall be financially responsible for payment of full fees. 2.15.2 If during the course of the program, the offender notifies the Contractor of alleged diminishment of the offender’s financial circumstances, the Contractor shall provide the financial assessment application and instructions to the offender per Section 2.14.9. The offender must complete the application and provide necessary supporting documentation (e.g.: tax returns, pay stubs, statements showing income from Social Security, Medicaid, SNAP, pension, annuity, veteran’s benefits, alimony, child support, military benefits, businesses, rent, interest, dividends, and any other income), no later than seven (7) business days after receipt. If received by the Contractor within the required deadline, the Contractor shall make the financial responsibility determination within five (5) business days of receipt and shall provide written notification to the offender regarding the financial responsibility determination. The Contractor and the offender shall enter into a revised Financial Responsibility Agreement with obligations, requirements, and processes per Section 2.14.13. The processes set forth in Section 2.14.12 shall apply. If the offender does not complete such application and provide such documentation within the required deadline, the Contractor shall notify the offender in writing that the offender shall continue to be financially responsible for the same fee amounts established by the financial assessment process, financial responsibility determination and Financial Responsibility Agreement applicable at the time of the reported intervening change in circumstances. 2.15.3 Should public monies become available to the MCAO for diversion programs, these funds may at the discretion of the County Attorney be used in whole or part to offset discounts provided by the Contractor to the offender for program service fees, based upon their approved Sliding Scale under Section 2.14.1. The Contractor shall invoice MCAO on a monthly basis for the preceding month for reimbursement. The invoice shall include: specific diversion program, offender name, offender date of birth, date of service, type of service, quantity of service(s), billed amount, and offender payment. The use of public monies is subject to applicable legal requirements, applicable approval processes/requirements, SERIAL# 220224-CI fiscal agent conditions and requirements, expiration date, and available balance. Contractor reimbursement is contingent on the availability of funds. 2.16 Direct Service Standards: 2.16.1 Inform the offender of program rules, which includes but is not limited to confidentiality, offender rights, and expected behavior; obtain their written consent for Release of Information. Document in offender’s case file; 2.16.2 Inform the offender of program requirements for successful completion of the MCAO Animal Cruelty Diversion Program so the offender understands expected performance and criteria for successful completion. Document in offender’s case file; 2.16.3 Inform the offender of the financial obligations to participate in the program; to include: programmatic fees or copays, methods of acceptable payment (AHCCCS, private insurance, self-pay), and payment schedules and due dates for remittance of payment. Document in the offender’s case file; 2.16.4 Use of the ORAS with identified criminogenic needs and domains targeted shall be addressed throughout the course of the treatment and recorded in the offender’s case file. Additionally, the ORAS tool and its supporting/collateral documentation (interview notes, interview guide, self-report form, scoring guide) shall be retained in the offender’s case file. Digital upload of ORAS documentation into Contractor’s case management system shall suffice; 2.16.5 The treatment plan shall be updated as needed with information demonstrating structured sessions occurred for a specific and authorized period that works toward the attainment of treatment goals. Document offender progress and participation in the offender’s case file; and 2.16.6 Identify community resources and natural supports for the offender upon successful release from treatment. Document in offender’s case file. 2.17 Retain adequate accounting and case reconciliation records for review purposes by the County Attorney and/or MCAO Authorized Persons. 3.0 CONTRACTOR QUALIFICATION REQUIREMENTS 3.1 The Contractor shall hold and maintain during the performance of this contract, a current, applicable Arizona Department of Health Services license that is in good standing, for each facility from which services shall be provided. 3.2 The Contractor shall be an AHCCCS provider. The Contractor shall maintain contracts with all AHCCCS Complete Care Plans serving the Central Region Geographical Service Area. 4.0 CONTRACTOR REPORTING REQUIREMENTS: OFFENDER ENROLLMENT AND TERMINATION 4.1 The Contractor shall provide immediate notification to the County Attorney via the MCAO Diversion Strategies Group when an offender is enrolled and when terminated: successfully completes or unsuccessfully completes (defined as either meeting or not meeting program requirements) the MCAO Animal Cruelty Diversion Program. Immediate notification is defined by as the next business day but no longer than three (3) business days after enrollment or termination. 4.1.1. Upon termination from the MCAO Animal Cruelty Diversion Program, the Contractor shall complete and provide to the County Attorney via the MCAO Diversion Strategies Group: SERIAL# 220224-CI 4.1.1.1 The MCAO Discharge Report documenting: the ORAS overall risk level, the ORAS top three (3) identified criminogenic needs and domains, treatment goals, offender participation, financial obligation compliance (fees, copays, and restitution if applicable), reasons for successful or unsuccessful completion, and documented attempts by Contractor to engage the offender in the MCAO Animal Cruelty Diversion Program. 4.1.1.2 For unsuccessful discharges, the Contractor shall also document on the MCAO Discharge Report whether the offender would be considered for future reentry. 4.2 Contractor shall have the capability to transmit updates regarding MCAO Animal Cruelty Diversion Program enrollment and discharge via one or more of the following: 1) Manual email to: mcaodiv@mcao.maricopa.gov 2) Manual entry into the MCAO Private Agency Portal when available, 3) Automatically via Extensible Markup Language (XML), or 4) Automatically or manually via a delimited file. Contractor transmitting information using Options 3 or 4 must do so using a schema/format to be provided by MCAO. 4.3 By the end of the fifth business day of each month, the Contractor shall provide to the County Attorney via the MCAO Animal Cruelty Diversion Program the following statistical information. Contractor shall email information to: mcaodiv@mcao.maricopa.gov with “Monthly Stats” in the subject line. 4.3.1 Number of new offenders enrolled (never been in the program before) in the MCAO Animal Cruelty Diversion Program for the prior month by assigned Level and risk level (based on ORAS risk level and determination for the number of sessions); 4.3.2 Number of offenders enrolled in the MCAO Animal Cruelty Diversion Program for the prior month who had previously been enrolled in the Program one or more times by assigned Level and risk level; 4.3.3 Total number of offenders enrolled in the MCAO Animal Cruelty Diversion Program by Level and risk level; 4.3.4 Number of offenders who were unsuccessfully terminated from the MCAO Animal Cruelty Program for the prior month by assigned Level and risk level; and 4.3.5 Number of offenders who successfully completed the MCAO Animal Cruelty Program for the prior month by assigned Level and risk level. 4.4 The Contractor shall provide annual (fiscal year: July 1-June 30) reports to MCAO with the aggregate statistical information described in subsection 4.3; additional relevant data may also be submitted with these reports. 4.5 The Contractor shall provide additional data and information to the County Attorney and MCAO Authorized Persons, as requested. 5.0 CONTRACTOR PERFORMANCE REQUIREMENTS 5.1 Service milestones shall be based on the needs of the offender; however, desired outcomes are: 5.1.1 Offender shall have exhibited progress on treatment goals as outlined in treatment plan; 5.1.2 Offender shall have improved daily functioning, and SERIAL# 220224-CI 5.1.3 Identified community supports are part of the discharge plan that is put in place for the offender to help maintain stability and resilience in the community. 5.2 At a minimum, all reasonable efforts are made to deliver services to the offender in a timely manner to meet the needs of the offender. 5.3 The Contractor shall comply with all professional and ethical obligations and code of conduct of licensure and maintain good standing with the Arizona Bureau of Medical Facilities Licensing (BMFL). Further, the Contractor shall protect information and records protected by federal confidentiality rules (e.g., 42 CFR Part 2 and HIPAA Rules at 45 CFR Parts 160, 162, and 164) and state confidentiality rules (e.g., A.R.S. §§ 12-2291 et seq.), and ensure that Contractor and its employees and subcontractors comply with said rules and employ all administrative and physical safeguards as may be required by law to protect confidential information. The Contractor shall be responsible for ensuring the execution of any business associate agreements, qualified service organization agreements, and nondisclosure/confidentiality agreements that may be required under federal and state confidentiality rules. 5.4 The MCAO Grants and Contract Administrator shall act as Contract Administrator. 5.5 Successful performance shall be determined by Contractor compliance with the terms of the contract. 5.6 Contractor failure to comply with the terms of this contract may result in suspension of work or termination of the contract at the discretion of the Maricopa County. SERIAL# 220224-CI EXHIBIT C MCAO CONSENT FORM IN THE SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF MARICOPA THE STATE OF ARIZONA, CR______________________ Plaintiff, DEFENDANT’S CONSENT TO PARTICIPATE IN DEFERRED PROSECUTION PROGRAM vs. AND ACKNOWLEDGEMENT Defendant. I, _______________________, the Defendant in this case, agree to participate in the Animal Cruelty Diversion Program, a deferred prosecution program, and I give my consent to the Maricopa County Attorney’s Office to apply to the Court for suspension of prosecution of this matter. I understand that my participation in the program is contingent upon my acceptance. If accepted, I will adhere to the regulations of the program and the directives of the program provider, SAGE Counseling Inc. Successful completion of the program will be determined by SAGE Counseling, Inc. and the Maricopa County Attorney’s Office. If I successfully complete this program, I acknowledge that the criminal case currently pending against me in the above referenced cause number will be dismissed with prejudice. By agreeing to participate in this deferred prosecution program, I acknowledge and agree that: ___ 1. I have been given a description of the program that I am agreeing to enter and I understand that it will consist of education or therapeutic treatment as directed by SAGE Counseling, Inc. I understand that successful completion of this program will require me to follow all of the steps that will be outlined in my treatment plan that will be developed specifically for me following my initial intake session. ___ 2. I agree to contact SAGE Counseling Inc. at 1616 East Alma School Road, # 150, Phoenix, Arizona. Five (5) days from today’s date, _____________, I will call SAGE Counseling at 480- 649-3342 to schedule an appointment date and time. I understand that a failure to contact SAGE Counseling, Inc. or to complete my assessment on the date scheduled will be considered unsuccessful completion of the diversion program and the criminal prosecution will be resumed. I will not call any sooner than five days with the understanding that SAGE Counseling needs additional time to receive my referral. ___ 3. I understand and agree that this consent will, by necessity, cause a delay in the prosecution of this case, and I waive my right to a speedy trial as guaranteed by the Revised: 10/6/21 United States Constitution and Rule 8 of the Arizona Rules of Criminal Procedure. Prosecution may be suspended for up to two years. ___ 4. I promise to appear at any and all future court dates. If the prosecutor seeks to resume prosecution against me, I will be notified of my next court date by mail. Because the Court will issue a warrant for my arrest if I fail to appear at future court dates, I agree to notify SAGE Counseling, my attorney, the prosecutor and the Court of my current address until this case is completely resolved. My current correct best contact information is as follows: Address: ______________________________________________ Street Address including Apt. number if applicable __________________________________________________________ City State Zip Email Address: _________________________________________ SERIAL# 220224-CI Phone Number or Cell Number where I can receive text messages: ____________________________________ ___ 5. I do not contest my guilt in this matter. I admit that I committed the charged offenses as further explained in the factual basis that I signed and provided to the State. I acknowledge and agree that this admission of guilt and factual basis may be used against me if I do not successfully complete the deferred prosecution program and I decide to have a trial in this matter. ___ 6. I have reviewed the following statements with my attorney and the each of the following statements are true. I understand and agree that if any of these statements are not true, I am not eligible for this deferred prosecution program and the prosecution against me will be resumed: a. I have no prior conviction for a serious offense as defined in A.R.S. § 13-706. b. I have no prior conviction for any offenses under A.R.S. Title 13, Chapter 14. c. I have no prior conviction for any dangerous offense as defined in A.R.S. § 13-105. d. I have no prior conviction for any dangerous crime against children as defined in A.R.S. § 13-705. e. I have no prior conviction for child abuse as defined in A.R.S. §13-3623. f. I have no prior conviction for domestic violence as defined in A.R.S. §13- 3601 within the previous five years. g. I have no prior felony convictions within the last five years, and no historical prior felony convictions. However, if the offender has only one prior felony conviction and that conviction is an Aggravated DUI that was committed more than five years before the current offense, excluding any time spent incarcerated, that historical prior will not bar participation in this program. h. I do not have any other pending criminal charges. i. If I am charged with multiple counts, those offenses must have occurred on the same occasion. j. I am not on felony probation or on release for a felony offense when the offense was committed. k. I have not completed any felony or misdemeanor diversion program within the last five years. l. I have not been charged with any offenses that involve the use of a firearm or the infliction of significant physical injury. m. I do not have holds or detainers that would prevent the completion of the program. ___ 7. I understand that while the prosecution is suspended in this matter I will be released on my own recognizance under the conditions set by the court. I further understand that should I commit a new felony offense while released on my own recognizance that I may be held without bond on the new offense. ___ 8. I will / will not need the services of an interpreter. I understand that there may be additional fees associated with interpreter services and any such fees will be fully explained during my intake session with SAGE Counseling Inc. Language: __________________________ ___ 9. I acknowledge and agree that to successfully complete this program, I must remain crime free. Therefore, I understand and agree that I will not be in compliance with the requirements of this Animal Cruelty Diversion Program if I am subsequently arrested for or charged with a new offense before a Motion and Order to Dismiss this case is filed and signed by the Court and, if that occurs, MCAO may reinstate prosecution in this case. ___ 10. By signing below, I authorize SAGE Counseling Inc. to share confidential information with the Maricopa County Attorney’s Office including but not limited to: information related to my assessment, treatment recommendations, participation and compliance in the Animal Cruelty Diversion Program. I further authorize and acknowledge that this confidential information may contain information related to alcohol and/or drug abuse (Federal Law references 42 U.S.C. 290 dd-3 –Federal Regulation reference CFR, Part 2) and the information may be disclosed for purposes of case prosecution to defense attorneys, the Court, and all other relevant parties. SERIAL# 220224-CI FINANCIAL OBLIGATIONS __ 11. FOR DEFENDANTS OWING RESTITUTION: I understand and agree that successful completion of this program requires me to pay full restitution to any and all victims in this matter in a total amount of $_______ and that I am required to pay 50% of that total, which is $________, within 30 days following the first day of services as specified in the offender’s treatment plan. I understand and agree that if I fail to make restitution payments by required deadlines, MCAO will decide what additional action may be taken in respect to my program which may include reinstatement of the prosecution against me. I also understand and agree that if I do not successfully complete the program that any restitution paid belongs to the victim(s) and will not be returned to me, but any amounts paid will be credited against any future restitution orders in this case. Restitution must be paid in full by the completion of my treatment depending upon my assigned treatment level. My treatment will not be extended for the purpose of meeting my restitution obligation. I have considered this prior to agreeing to this Diversion offer. __ 12. In addition to any restitution, I understand and agree that I will be responsible for paying for the education and treatment program. These fees and costs will be fully explained to me when the treatment program is developed. I understand and agree that if I decide not to pay the fees and costs for the program, I may voluntarily end my participation in the program and the criminal prosecution in this matter will be resumed. In addition, I understand and agree that if I fail to pay agreed fees and costs for the program I may be terminated unsuccessfully from the program and criminal prosecution in this matter may be resumed. I understand and agree that any payments made for program fees and costs will not be returned to me. __ 13. Fees and costs for the program may be reduced through either AHCCCS coverage for provided services or through a financial assessment and responsibility determination. AHCCCS ELIGIBLE DEFENDANTS: If I am eligible for AHCCCS coverage for program services, the fees and costs of the services may be covered. If needed SAGE Counseling, Inc. will assist me to help determine if I am AHCCCS eligible, verify my AHCCCS coverage, and assist me with AHCCCS registration if necessary. I understand and agree that some services may be required in this program that are not covered by AHCCCS and in that event, I will be responsible for the fees and costs of those services at a significantly reduced rate. DEFENDANTS NOT ELIGIBLE FOR AHCCCS COVERAGE: If I am not eligible for AHCCCS coverage for program services, I will be given the opportunity to complete a financial assessment process to determine if I am eligible for reduced fees and costs for services. I acknowledge and agree that although I am not required to disclose any financial information unless I wish to do so, I am required to sign an attestation form with my defense attorney to acknowledge that I will be offered a financial assessment application and instructions by SAGE Counseling Inc. On the attestation form I must also indicate if I am interested in a financial assessment for the purpose of determining a discount on program fees or if I am not interested in completing the financial application. This choice must be indicated on the attestation form and signed by me. Failure to indicate my choice and sign the attestation form will result in my case being returned to the Maricopa County Attorney’s Office for prosecution. PERTAINS TO CURRENT AND POSSIBLE OUT OF STATE/OUT OF COUNTY DEFENDANTS (MUST ACKNOWLEDGE ALL SECTIONS): __ 14. I acknowledge that treatment services for the Animal Cruelty Diversion Program through SAGE Counseling are delivered in Maricopa County, Arizona and despite residing outside of Maricopa County, Arizona I have the option of attending treatment services in Maricopa County, Arizona without incurring additional fees. SERIAL# 220224-CI __ 15. I acknowledge that if I elect to attend treatment services outside of Maricopa County Arizona, now or in the future, I will incur additional fees to SAGE Counseling for monthly case coordination with a third-party behavioral health organization. __ 16. I acknowledge that if I elect to attend treatment services outside of Maricopa County, Arizona, now or in the future, I am responsible for contacting SAGE Counseling as required in paragraph #2 to schedule my assessment appointment if not previously completed. __ 17. I understand that upon completion of my assessment through SAGE Counseling, if now or in the future I reside outside of Maricopa County, Arizona, I will be given my general assessment information and I am responsible for locating a third-party behavioral health organization in my jurisdiction that can provide comparable treatment services to the Animal Cruelty Diversion Program. Before beginning treatment services, SAGE Counseling must approve my participation in these services with this third-party behavioral health organization. __ 18. I understand that if I elect to use a third-party behavioral health organization outside of Maricopa County, Arizona, I am responsible for all fees charged by the third-party behavioral health organization for treatment. My attorney has reviewed this entire agreement with me and has fully explained each and every paragraph of this agreement including each statement in paragraph 6. I understand that I am under no obligation to agree to this program. I freely and voluntarily agree to participate in this deferred prosecution program. ___________________________ ______________________________________ Date Name of Defendant I have explained this Consent to Participate in the MCAO Animal Cruelty Diversion Program & Acknowledgement to the Defendant. ________________________________ ________________________________________ Date , # Defense Counsel SERIAL# 220224-CI EXHIBIT D SAGE PROVIDER APPLICATION & AGREEMENT (THIRD-PARTY ADMINISTRATOR) (see pdf document 220224-CI Exhibit D SAGE Provider App) SERIAL# 220224-CI EXHIBIT E MCAO FINANCIAL AGREEMENT FORM MCAO DIVERSION PROGRAM FINANCIAL RESPONSIBILITY AGREEMENT DATE: _______________ CLIENT NAME: ___________________________________ CLIENT PROGRAM ID: _____________ On __________, ______________________ (“Client”) received written notification of the Financial Responsibility Determination applicable to Client’s participation in the MCAO Diversion Program (“Client’s Financial Responsibility Determination”). Client’s Financial Responsibility Determination is effective ________. Client understands and agrees that Client’s Financial Responsibility Determination shall remain in full force and effect throughout Client’s participation in the MCAO Diversion Program. Client understands and agrees that Client’s Financial Responsibility Determination is not subject to amendment or modification other than through completion of the applicable procedures for a revised Financial Responsibility Determination. Client understands and agrees that Client shall pay costs and fees for services applicable to Client’s treatment plan. Such costs and fees are identified in the applicable fee schedules previously provided to Client, as Client acknowledged and agreed in Paragraphs 1, 12 and 13 of Defendant’s Consent to Participate in Deferred Prosecution Program and Acknowledgement, filed in Client’s criminal case. Client understands and agrees that the amount of costs and fees for services provided by SAGE Counseling, Inc. (“SAGE Counseling”) shall be assessed per the applicable SAGE Counseling fee schedule in conjunction with Client’s Financial Responsibility Determination. Client understands and agrees that the amount of costs and fees for drug testing services shall be assessed per the applicable drug testing fee schedule. Client understands and agrees that Client’s failure to pay agreed costs and fees may result in Client being precluded from obtaining services for which Client has not made the agreed payment, and/or Client being terminated unsuccessfully from the MCAO Diversion Program and criminal prosecution in Client’s criminal case may be resumed. Client understands and agrees that any payments made for program fees and costs will not be returned to Client. Client agrees that Client has full understanding of the terms and provisions of this Financial Responsibility Agreement. Client freely and voluntarily agrees and enters into this Financial Responsibility Agreement without any degree of duress or compulsion whatsoever. ______________________________________________/DATE __________________ CLIENT SIGNATURE ______________________________________________/PROGRAM ID ___________ PRINTED CLIENT NAME _______________________________________________/DATE _________________ SIGNATURE, AUTHORIZED REPRESENTATIVE OF SAGE COUNSELING INC. __________________________________________________ PRINTED NAME, AUTHORIZED REPRESENTATIVE OF SAGE COUNSELING INC