HomeMy WebLinkAboutIGA - State - Drinking Water ProgramDeschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701 -1960 (541) 388 -6570 - Fax (541) 385 -3202 - www.deschutes.org AGENDA REQUEST & STAFF REPORT For Board Business Meeting of 10:00 AM, Monday, June 22, 2009 Please see directions for completing this document on the next page. DATE: 6/18/09 FROM: Tom Anderson Community Development (CDD) Phone #x 1708 TITLE OF AGENDA ITEM: CONSIDERATION of Approval of Document No. 2009 -350, renewal of the Intergovernmental Agreement between Deschutes County and the State of Oregon for administration of the drinking v rater program by Deschutes County. PUBLIC HEARING ON THIS DATE? No. BACKGROUND AND POLICY IMPLICATIONS: The Intergovernmental Agreement allows CDD to continue to administer the Drinking Water Prog -am for the State of Oregon. These services include sanitary surveys, follow up on required water samplings, consultation and public education. FISCAL IMPLICATIONS: Revenue for this program has been budgeted for FY 09 -10. The program is federally funded through the State of Oregon. RECOMMENDATION & ACTION REQUESTED: Approval and signature of Document No. 2009 -350 ATTENDANCE: Tom Anderson, Director DISTRIBUTION OF DOCUMENTS: Two originals to Doreen, will pick up, x 3193. DESCHUTES COUNTY DOCUMENT SUMMARY (NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form electronically to the Board Secretary.) Date: 6/16/09 Please complete all sections above the Official Review line. Department: Contractor /Supplier /Consultant Name: Contractor Contact: 5818 Connie Theis Community Development(CDD) Oregon Department of Human Services Contractor Phone #: Type of Document: Intergovernmental Agreement No. 2009 -350 (503)945- Goods and/or Services: Administration of the Drinking Water Systems Program Background & History: This document is a renewal of the Intergovernmental Agreement (IGA) between Deschutes County and the State of Oregon. The IGA allows CDD to continue to administer the Drinking Water Systems Program for the State of Oregon. These services include sanitary surveys, follow up on required water samplings, consultation and public education. Agreement Starting Date: 7/1/09 Ending Date: Annual Value or Total Payment: $187,725 E Insurance Certificate Received check box) Insurance Expiration Date: 6/30/11 Check all that apply: n RFP, Solicitation or Bid Process U Informal quotes ( <$150K) Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37) Funding Source: (Included in current budget? ® Yes L] No If No, has budget amendment been submitted? _. Yes U No Is this a Grant Agreement providing revenue to the County? E Yes X No Special conditions attached to this grant: Deadlines for reporting to the grantor: 6/16. 2009 If a new FTE will be hired with grant funds, confirm that Personnel has been notified that it is a grant- funded position so that this will be noted in the offer letter: Yes ® No Contact information for the person responsible for grant compliance: Name: Phone #: n/7<t Departmental Contact and Title: Jeff Freund Department Director Approval: Phone #: x6563 Distribution of Document: Who gets the original document and /or copies after it has been signed? Include complete information if the document is to be mailed. Official Review: County Signature Required (check one): OCC ❑ Department Director (if <$25K) ❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. Legal Review 0.44A .�,� `Date Document Number ;2009- 3,50 6/16/ :009 [E-Z-OCR was unable to OCR this page] [E-Z-OCR was unable to OCR this page] [E-Z-OCR was unable to OCR this page] [E-Z-OCR was unable to OCR this page] LPHA, BY EXECUTION OF THIS AGREEMENT, HEREBY ACKNOWLEDGES THAT LPHA HAS READ THIS AGREEMENT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. AGENCIES: YOU WILL NOT BE PAID FOR SERVICES RENDERED PRIOR TO NECESSARY STATE APPROVALS IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the dates set forth below their respective signatures. APPROVED: STATE OF OREGON ACTING BY AND THROUGH ITS DEPARTMENT OF HUMAN SERVICES (DEPARTMENT) By: Name: Title: Date: DESCHUTES COUNTY ACTING BY AND THROUGH ITS DESCHUTES COUNTY HUMAN SERVICES (LPHA) By: Name: Title: Date: Tammy Baney, Chair Deschutes County Board of Commissioners DEPARTMENT OF JUSTICE — APPROVED FOR LEGAL SUFFICIENCY Approved by Shannon O'Fallon, Assistant Attorney General per OAR 137 -045- 0015(3) on June 11, 2009. Copy of entailed approval on file at DHS, OC&P. REVIEWED: DEPARTMENT OF HUMAN SERVICES, PUBLIC HEALTH DIVISION By: Name: Jeffrey A. Carlson Title: Program Support Manager Date: DEPARTMENT OF HUMAN SERVICES, OFFICE OF CONTRACTS & PROCUREMENT By: Name: Phillip G. McCoy, OPBC Title: Contract Specialist Date: 2009 -2011 IGA for Safe Drinking Water Program Services Page 5 of 58 128887 pgm - Deschutes County DHS 2009 -2011 INTERGOVERNMENTAL AGREEMENT RE: SAFE DRINKING WATER PROGRAM EXHIBIT A Part 1 Definitions As used in this Agreement, the following words and phrases shall have the indicated meanings. Certain additional words and phrases may be defined elsewhere in the Agreement in relation to a specific topic or context. When a word or phrase is defined elsewhere in this Agreement, the word or phrase shall not necessarily have the ascribed meaning in any part of the Agreement other than the specific subject area or context in which it is defined. The following definitions are established for the purposes of interpreting this Intergovernmental Agreement and for performing the Work required under this Agreement, as set forth in Exhibit A, Part 2: Statement of Work: 1. Base Funds: Funds used for required program services that build capacity to respond to emergencies, take independent enforcement actions, maintain access via computer to DHS' computerized drinking water system database (SDWIS), and to provide regulatory assistance. 2. DHS: The Oregon Department of Human Services. 3. Community Water System: A public water system that has 15 or more service connections used by year -round residents, or that regularly serves 25 or more year -round residents. 4. Ground water: Water obtained from below the ground surface. 5. Invoiced Funds: Funds used for specific water system related tasks, as distinguished from the tasks for which base funds are used, which require the submission of an invoice in order to be paid. 6. Major Monitoring or Reporting (M /R) Violation: Major Monitoring or Reporting violations occur when a public water system fails to take any routine samples for a particular contaminant or report any treatment performance data during a compliance period, or fails to take any repeat samples following a coliform positive routine or where the public water system has failed to report the results of analyses to DHS for a compliance period. An M/R violation is classified as major if DHS or its agent receives no monitoring report or receives a report indicating that no monitoring was conducted. 7. Maximum Contaminant Level (MCL) Violation: MCL violations occur when a public water system's water quality test results demonstrate a level of a contaminant that is greater than the established Maximum Contaminant Level. 8. Minor Monitoring or Reporting (M /R) Violation: Minor Monitoring or Reporting violations occur when a public water system takes some but not all of the routine samples for a particular contaminant or collects partial treatment performance data or insufficient numbers of repeat samples following a coliform positive routine sample during a compliance period, and reports those partial results to DHS or its agent. 2009 -2011 IGA for Safe Drinking Water Program Services Page 6 of 58 128887 pgm - Deschutes County 9. Non -EPA Water System: A public water system serving 4 -14 connections or 10 -24 people at least 60 days per year (also known as a "non- public" water system by EPA). 10. Nontransient Noncommunity Water System (NTNCWS): A public water system that is not a Community Water System and that regularly serves at least 25 of the same persons over 6 months per year. 11. Professional Engineer (PE): A person currently registered as a Professional Engineer by the Oregon State Board of Examiners for Engineering and Land Surveying. 12. Registered Environmental Health Specialist (REHS): A person currently registered as an Environmental Health Specialist by the Oregon Environmental Health Registration Board. 13. Regulated Contaminants: Drinking water contaminants for which Maximum Contaminant Levels or Water Treatment Performance Levels have been established under OAR 333.061. 14. SDWIS: DHS' computerized safe drinking water information system database. 15. Significant Noncomplier (SNC): Any public water system meeting specific deficiency criteria as currently defined by EPA. 16. Transient Noncommunity Water Systems (TNCWS): A public water system that serves a transient population of 25 or more persons. 17. Trihalomethanes (THMs): By- products of chlorine disinfection. 18. USEPA or EPA: The US Environmental Protection Agency. 19. Water Quality Alerts: A report generated by the SDWIS data system containing a single water quality sample result from a public water system that exceeds one -half of the MCL for inorganic or radiological contaminants, or any positive detection of a microbiological or organic contaminant or any exceedance of lead or copper action levels. 20. Water System Information Form: A report form to update information on a public water system for the purpose of maintaining a computer database inventory record that is current, accurate, and complete. 21. Water System Survey: A comprehensive on -site evaluation of a public water system carried out by LPHA to identify and recommend corrective action to prevent a potentially adverse affect on the quality of drinking water provided to the public. 22. Water Treatment Performance Level Violation: Water treatment performance violations occur when a public water system fails to meet established minimum treatment performance levels during a compliance period. 2009 -2011 IGA for Safe Drinking Water Program Services Page 7 of 58 128887 pgm - Deschutes County DHS 2009 -2011 INTERGOVERNMENTAL AGREEMENT RE: SAFE DRINKING WATER PROGRAM EXHIBIT A Part 2 Statement of Work 1. Purpose of the Drinking Water Program. The purpose of the drinking water program is to provide services to public water systems that result in reduced health risk and increased compliance with drinking water monitoring and maximum contaminant level requirements. The drinking water program includes investigation of occurrences of waterborne illness, drinking . water contamination events, response to spills, emergencies, and inspection of water system facilities. The drinking water program includes reporting of data to DHS necessary for program management and to meet federal EPA Safe Drinking Water Act program requirements. a. Contract funds are intended to enable LPHA to assume primary responsibility for the quality of drinking water provided by most of the public water systems located within LPHA's jurisdiction. The work described herein is designed to meet the following EPA. National Drinking Water Objective by 2015: "91% of the population served by community water systems will receive water that meets all applicable health -based drinking water standards during the year; and 90% of the community water systems will provide water that meets all applicable health -based drinking water standards during the year." b. Public drinking water systems covered in this contract include community water systems serving 3,300 or fewer people and using ground water sources only, all nontransient noncommunity drinking water systems, all transient noncommunity drinking water systems. and all non -EPA water systems. c. Responsibility for public water systems that purchase their water from other public water suppliers is assigned to the state or Agency according to which Agency is responsible for the public water system that sells water to the purchaser. 2. Description of Services, Staffing and Documentation /Reporting Requirements, and Performance Measures. a. Service Guidelines and Activities Allowed under the Drinking Water Program. (1.) Required Program Services using Base Funds: The following required program services are supported by Base Funds, which are used to build program capacity to undertake the following services: (a.) Emergency Response: LPHA shall develop, maintain, and carry out a response plan for public water system emergencies, including disease outbreaks, spills. operational failures, and water system contamination. LPHA shall notify DHS in a timely manner of emergencies that may affect drinking water supplies. [Citations: ORS Chapter 448, Water Systems; State /EPA Agreement (FY 0598)] 2009 -2011 IGA for Safe Drinking Water Program Services Page 8 of 58 128887 pgm - Deschutes County (b.) Independent Enforcement Actions: LPHA shall take independent enforcement actions against DHS- licensed facilities that are also public water systems as covered under the following OARs: 333 -029, 333 -030, 333 -031, 333 -039, 333- 060, 333 -062, 333 -150, 333 -162, 333 -170; and against Oregon Department of Agriculture licensed facilities that are also public water systems as covered under the following OARs: 603 -13, 603 -21, 603 -22, 603 -24, 603 -25, 603 -28, and 603 -100. LPHA shall report independent enforcement actions taken and water system status to DHS using the documentation and reporting requirements specified in this contract. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility. (EPA Primacy Regulations)] (c.) Computerized Drinking Water System Data Base: LPHA shall maintain access via computer to DHS' computerized safe drinking water information system database (SDWIS). Access via computer to DHS' computerized drinking water system database is considered essential to carry out the program effectively. LPHA shall make timely changes to DHS' SDWIS computer database inventory records of public water systems to keep DHS' records current. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility. (EPA Primacy Regulations)] (d.) Regulatory Assistance: LPHA shall provide regulatory assistance in response to requests from water system operators for information on and interpretation of regulatory requirements. LPHA shall respond to water system complaints received as appropriate or as requested by DHS. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility. (EPA Primacy Regulations)] (2.) Required Program Services using Invoiced Funds: The following required program activities are supported by Invoiced Funds: (a.) Investigation of Water Quality Alerts: LPHA shall investigate all water quality alerts for detections of regulated contaminants at community, nontransient noncommunity, transient noncommunity, and non -EPA water systems. LPHA shall consult with and provide advice to the subject water system operator on appropriate actions to assure that follow -up sampling is completed and to assure that any confirmed water quality violations are corrected or resolved. LPHA shall provide advice to the subject water system operator on the correct method for issuing public notification and /or advisory to users on protective action as necessary or as requested by DHS. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility. (EPA Primacy Regulations)] 2009 -2011 1GA for Safe Drinking Water Program Services Page 9 of 58 128887 pgm - Deschutes County (b.) Investigation and Resolution of Significant Noncompliers (SNCs): LPHA shall contact and provide assistance to community, nontransient noncommunity, and transient noncommunity water systems that are significant noncompliers (SNCs). [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility (EPA Primacy Regulations)] as follows: i. Within thirty (30) days of the date LPHA is notified that a water system is designated as a SNC by DHS, LPHA shall take the following actions: (a.) Contact the water supplier, determine the reasons for all aspects of noncompliance, and inform the water supplier on ways to correct the noncompliance. Confirm that database information is current and accurate on ownership and water system classification. (b.) Advise the owner /operator to carry out public notification as required. (c.) Send copies of the public notices received, and contact reports on LPHA follow -up actions to DHS. ii. Within ninety (90) days of the date LPHA is notified that a water system is designated as a SNC by DHS, LPHA shall take the following actions: (a.) Determine that the subject water system's violations or non- compliance has been addressed using an enforcement response procedure as currently defined by the EPA, OR. (b.) Determine that the subject water system needs an enforcement action by DHS. Prepare and submit to the DHS a written request for an enforcement action, including LPHA's evaluation of the reasons for noncompliance by the water supplier. The request shall include the current owner name and address, a draft compliance schedule listing corrective actions required, and a proposed deadline for each action. LPHA shall distribute a copy of the request to the person(s) responsible for the subject water system's operation to ensure that persons' understanding of the required corrective actions. (c.) Enforcement Action Tracking and Follow -up: After DHS issues an enforcement action, enforcement action, LPHA shall monitor the corrective action schedule contained in the action, and verify completion of each corrective action by the water supplier. LPHA shall document all contacts and verifications and submit documentation to the DHS. LPHA shall document any failure by the water supplier to meet any correction date and notify the DHS within 30 days. LPHA shall notify DHS when all corrections are complete, within 30 days. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility. (EPA Primacy Regulations)] 2009 -2011 IGA for Safe Drinking Water Program Services Page 10 of 58 128887 pgm - Deschutes County (d.) Water System Surveys: LPHA shall conduct a survey of each community water system within LPHA's jurisdiction every three (3) years, or as otherwise scheduled by DHS; and each nontransient noncommunity, transient noncommunity, and non -EPA water system within LPHA's jurisdiction every five (5) years, or as otherwise scheduled by DHS. A water system survey must include the source of a public water system, the water intake, treatment system, storage and distribution facilities, operation and maintenance, water system records, and compliance with applicable drinking water regulations. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility (EPA Primacy Regulations)]. (e.) LPHA shall use the following procedure for conducting a Water System Survey: i. Contact the subject public water system owner /operator to schedule an appointment and explain the information required to complete the water system survey. ii. Review the subject public water system file information, water quality history, and data base inventory information. iii. Conduct an on -site review of the water system source, treatment, storage, and distribution facilities; review its operation, management, and compliance with regulations; and determine deficiencies, if any, that could result in unsafe drinking water. (a.) Complete water system survey forms. (b.) Collect coliform sample(s) at LPHA's discretion or as requested by DHS. (c.) Verbally inform the owner and /or operator of the subject public water system deficiencies and recommended corrective actions. (d.) Complete a Water System Information Form for each public water system survey completed, showing all changes needed to make data base inventory information complete and accurate. iv. Verify that water system survey and Water System Information Form are complete. v. Prepare cover letter that contains the requirements for the subject public water system and the recommended corrective actions for identified water system deficiencies. vi. Mail cover letter, water system survey report, Water System lnfonnatior Form, and any coliform sample result(s) to the subject public water system. 2009 -2011 1GA for Safe Drinking Water Program Services Page 11 of 58 128887 pgm - Deschutes County (3.) (f.) (g.) vii. Send a copy of the cover letter, water system survey report, Water System Information Form, and any coliform sample result(s) to DHS. Emergency Response Plan Development Assistance: LPHA shall assist water suppliers to complete their Emergency Response Plans, and assure that completed plans meet DHS standards. [Citations: ORS 448.160 Emergency Plans; OAR 333 - 061 - 0064.] Investigation and Resolution of Violations: LPHA shall contact and provide assistance at community, nontransient noncommunity, transient noncommunity, and non -EPA water systems to resolve violations for bacteriological, chemical, and radiological monitoring and reporting violations, and surface water treatment violations, as applicable. Violation responses must be prioritized according to type of violation and type of water system. [Citations: ORS Chapter 448, Water Systems]. i. Contact the water supplier, determine the reasons for the noncompliance, consult with and provide advice to the subject water system operator on appropriate actions to assure that violations are corrected in a timely manner. ii. Provide copies to DHS of contact reports, analytical results, or other appropriate LPHA documents, regarding follow -up actions to resolve the violation. (h.) Inventory and Documentation of New Water Systems: As existing water systems that are not in the DHS inventory are discovered, they shall be inventoried using the forms designated by DHS, and the documentation shall be provided to DHS within 60 days of identification of the system. Alternatively, a water system survey may be performed to collect the required inventory information, rather than submitting the aforementioned forms. [Citation: ORS Chapter 448, Water Systems]. Supplemental Program Services using Invoiced Funds: In order for the LPHA to be eligible for payment for supplemental services: (1) Required Program Services using Invoiced Funds must be completed and current; (2) The LPHA must have a record of responding promptly to water quality alerts to DHS' satisfaction; (3) The LPHA must demonstrate that enforcement actions and SNCs have been resolved or adequate progress has been made towards resolution; and (4) The LPHA must demonstrate that water system surveys are conducted on the appropriate schedule. (a.) Follow -Up on Water System Deficiencies Noted on Water System Surveys: LPHA may conduct one on -site visit between surveys to verify that significant deficiencies have been resolved. LPHA must prepare a list of significant deficiencies checked and the date they were corrected or note the progress towards correction. Deficiencies are those currently defined by DHS in the Drinking Water Program publication titled Water System Survey Reference Manual (July 1999, Reprinted May 2006). [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility 2009 -2011 IGA for Safe Drinking Water Program Services Page 12 of 58 128887 pgm - Deschutes County (EPA Primacy Regulations)]. (b.) Engineering Plan Review Inspections: LPHA may inspect construction or major modifications of public water systems to determine conformance to engineering plans reviewed and approved by the DHS. Inspections must consist of an on -site visit or visits to verify construction is completed in accordance with the approved plans. LPHA shall document in outline form the facilities checked and any differences between the constructed facilities and the approved plans. The scope of the inspection may include but is not limited to: new water sources, treatment facilities, storage reservoirs, and water mains. Inspections shall be completed and documentation forwarded to DHS within 30 days of receipt of the inspection request. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility (EPA Primacy Regulations)]. (c.) Post -SNC Follow -up Work: LPHA may assist public water systems, during the six -month period after the water system achieves full compliance with drinking water standards, to assure that the public water system remains in compliance with drinking water monitoring and reporting requirements and Maximum Contaminant Levels. LPHA shall document the purpose for the contacts or site visits and agreements or observations made. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility (EPA Primacy Regulations)]. (d.) Customized and Negotiated Work: LPHA may conduct such customized and negotiated work as required or requested by DHS to maintain safe and efficient public water system operations. LPHA shall prepare and submit for DHS review and approval a proposal for the customized and negotiated work including a detailed task list and a listing of expected outcomes. LPHA's task list must include the cost of each task. DHS must approve the proposal for customized and negotiated work including the DHS' payment to LPHA prior to LPHA performing such work. [Citations: ORS Chapter 448, Water Systems; 40 CFR, Chapter I, Part 142 National Primary Drinking Water Regulations Implementation. Subpart B, primary enforcement responsibility (EPA Primacy Regulations)]. (4.) Work Priorities: LPHA shall prioritize all work according to the relative health risk with the health -based standards receiving the highest priority, and according to system type with community water systems receiving the highest priority. b. Staffing Requirements and Qualifications, and Documentation and Reporting Requirements. (1.) LPHA shall develop and maintain staff expertise necessary to carry out the services described herein. 2009 -2011 IGA for Safe Drinking Water Program Services Page 13 ol'58 128887 pgm - Deschutes County (2.) LPHA staff shall maintain and assimilate program and technical information provided by DHS, attend drinking water training events provided by DHS, and maintain access to information sources as necessary to maintain and improve staff expertise. (3.) LPHA shall hire or contract with personnel registered as Environmental Health Specialists or Professional Engineers with experience in environmental health to carry out the services described herein. (4.) Documentation of Field Activities and Water System Contacts: LPHA shall prepare and maintain adequate documentation of field activities and water system contacts as required to: (5.) (a.) Maintain accurate and current public water system inventory information. (b.) Support formal enforcement actions. (c.) Describe current regulatory status of water systems. (d.) Evaluate the performance and effectiveness of the drinking water program. (e.) Guide and plan program activities. Minimum Standard for Documentation: LPHA shall, at a minimum, prepare and maintain the following required documentation (see forms provided in the Attachments): (a.) Water system surveys and significant deficiencies. (b.) Water System Information (Inventory), Entry Structure Diagram, and Source Information updates. (c.) Field and office contacts in response to complaints, water quality alerts, SNCs, violations, enforcement actions, regulatory assistance, requests for regulatory information, and plan review follow -up. (d.) Waterborne illness reports and investigations. (e.) All correspondence with public water systems under LPHA's jurisdiction and DHS. (f.) Documentation regarding reports and investigations of spills and other emergencies affecting or potentially affecting water systems. (g.) Copies of public notices received from water systems. (6.) Monthly Reporting: LPHA shall submit to DHS on a monthly basis the information ir, Section B above in order for DHS to maintain state primacy for the federal safe drinking water program 2009 -2011 IGA for Safe Drinking Water Program Services Page 14 of 58 128887 pgm - Deschutes County (7.) DHS Audits: LPHA shall give DHS free access to all LPHA records and documentation pertinent to this contract for the purpose of DHS audits. c. Performance Measures. DHS will use four (4) performance measures to evaluate LPHA's performance: (1) water system surveys completed, (2) alert responses, (3) investigation and resolution of significant non - complying systems (SNCs), and (4) violation responses. (1.) Water system surveys completed. Calculation: number of surveys completed divided by the number of surveys required. (2.) Alert responses. Calculation: number of alerts responded to divided by the number of alerts generated. (3.) Investigation and resolution of SNCs. Calculation: number of SNCs responded to divided by the total number of SNCs. (4.) Violation responses. Calculation: number of violations resolved divided by the total number of violations. d. Responsibilities of DHS. This Agreement is intended to enable LPHA to independently conduct an effective local drinking water program. DHS recognizes its role to provide assistance and program support to LPHA to foster uniformity of statewide services. DHS agrees to provide the following services to LPHA: (1.) DHS will distribute drinking water program and technical information on a monthly basis to LPHA. (2.) DHS will sponsor at least one annual 8 -hour workshop for LPHA drinking water program staff at a central location and date to be determined by DHS. DHS will provide workshop registration, on -site lodging, meals, and arrange for continuing education unit (CEU) credits. LPHA is responsible for travel expenses for LPHA staff to attend. (3.) DHS will sponsor at least one regional 4 -hr workshop at three (3) locations at locations and dates to be determined by DHS to supplement the annual workshop. DHS will provide training materials and meeting rooms. LPHA is responsible for travel expenses for its staff to attend. (4.) DHS will provide LPHA with the following information from the public water system database: (a.) Immediately: Alert data. (b.) Quarterly: Listings of SNCs. (c.) Quarterly: Performance data. (d.) Upon request: Individual water system inventory and water quality data. 2009 -2011 IGA for Safe Drinking Water Program Services Page 15 of 58 128887 pgm - Deschutes County (5.) DHS will support electronic communications and data transfer between DHS and LPHA to reduce time delays, mailing costs and generation of hard copy reports. (6.) DHS will maintain sufficient technical staff capacity to assist LPHA staff with unusual drinking water problems that require either more staff than is available to LPHA for a short time period, such as a major emergency, or problems whose technical nature or complexity exceed the capability of LPHA staff. When on -site assistance from DHS is requested, LPHA is responsible for: scheduling DHS assistance, making arrangements to involve the water system operator, being present when DHS assistance is conducted in the field, and conducting follow -up work as necessary after the on -site assistance. (7.) DHS will refer to LPHA all routine inquiries or requests for assistance received from public water system operators for which LPHA is responsible. (8.) DHS will prepare formal enforcement actions against public water systems in the subject LPHA, except for licensed facilities, according to the priorities contained in the current State /EPA agreement. DHS will prepare other actions against water systems as requested by LPHA and as agreed by DHS. THEREiIAINDER OF THIS PAGEISINT6NTIONALLY LEFT BLANK 2009 -2011 IGA for Safe Drinking Water Program Services Page 16 of 58 128887 pgm - Deschutes County DHS 2009 -2011 INTERGOVERNMENTAL AGREEMENT RE: SAFE DRINKING WATER PROGRAM EXHIBIT A Part 3 Payment and Financial Reporting 1. Required Program Services using Base Funds: For the time period commencing July 1, 2009 through June 30, 2011, DHS will make eight (8) equal quarterly payments in the amount of $9,386.00 for a total not -to- exceed amount of $75,090.00 in Required Program Services using Base Funds. 2. Required Program Services and Supplemental Program Services using Invoiced Funds: DHS will pay, pursuant to an invoice that is submitted by LPHA and that is accepted and approved by DHS, for Invoiced services provided by LPHA and as set forth in this Contract. DHS payments to LPHA for Invoiced Services under this Contract shall not exceed the amount of $112,635.00 for the time period July 1, 2009 through June 30, 2011. When invoicing, itemization of the work performed with non -EPA water systems must be separated from the work performed with EPA water systems. All invoices for work performed under this contract must be delivered to DHS no later than 60 days after the end of this contract. Invoicing received after the 60 day period will not be paid, unless prior arrangements have been made. Each invoice must include complete documentation of the itemized actions taken. a. Investigation of Water Quality Alerts: LPHA may submit an invoice to DHS for $210.00 for each investigation of a water quality alert for a regulated contaminant. b. Investigation and Resolution of Significant Noncompliers (SNCs) with MCL water quality violations: (1.) Initial Payment: LPHA may submit an invoice to DHS for $1,050.00 for work completed under Exhibit A, Part 2, Section 2.a.(2.)(b.)i. for each significant noncomplier with MCL water quality violations. (2.) Final Payment: LPHA may submit an invoice to DHS for $350.00 for a final payment of work completed under Exhibit A, Part 2, Section 2.a.(2.)(b.)i. or the work completed under Exhibit A, Part 2, Section 2.a.(2.)(b.)ii.for each significant noncompliers with MCL violations. c. Investigation and Resolution of Significant Noncompliers (SNCs) with monitoring and reporting violations only, no MCL water quality violations: (1.) Initial Payment: LPHA may submit an invoice to DHS for $420.00 for work completed under Exhibit A, Part 2, Section 2.a.(2.)(b.)i.for each significant noncompliet with monitoring and reporting violations. (2.) Final Payment: LPHA may submit an invoice to DHS for $140.00 for a final payment of work completed under Exhibit A, Part 2, Section 2.a.(2.)(b.)i.or the work completed 2009 -2011 EGA for Safe Drinking Water Program Services Page 17 of 58 128887 pgm - Deschutes County under Exhibit A, Part 2, Section 2.a.(2.)(b.)ii.for each significant noncompliers with monitoring and reporting violations. d. Enforcement Action Tracking and Follow -up: LPHA may submit an invoice to DHS for $1400 for the completion of all corrections listed in a DHS enforcement action for a community and nontransient noncommunity water system. LPHA may submit an invoice to DHS for $560.00 for completion of enforcement at a transient noncommunity or non -EPA water system. e. Water System Surveys: LPHA may submit an invoice to DHS for $1,120.00 for each Water System Survey completed of a community and nontransient noncommunity water system. LPHA may submit an invoice to DHS for $560.00 for each Water System Survey of a transient noncommunity and non -EPA water system. f. Emergency Response Plan Development Assistance: (1.) LPHA may submit an invoice to DHS for $140.00 for technical assistance provided by telephone, email or US mail to a public water system for developing an Emergency Response Plan. LPHA may only submit one invoice per public water system consulted. DHS will not pay more than $140.00 per public water system consulted regardless of the number of consultations. (2.) LPHA may submit an invoice to DHS for $350.00 for technical assistance provided at the public water system site for developing an Emergency Response Plan. LPHA may only submit one invoice per public water system consulted. DHS will not pay more than $350.00 per public water system site visit regardless of the number of consultation site visits. (3.) g. LPHA may submit an invoice to DHS for $350.00 for each completed Emergency Response Plan received by LPHA if, after LPHA review, it is determined that the Emergency Response Plan meets minimum requirements. LPHA may only submit one invoice per public water system consulted. DHS will not pay more than $350.00 per completed Emergency Response Plan received by LPHA regardless of the number of Emergency Response Plans received from a single, subject public water system. Violations: LPHA may submit an invoice to DHS for $210.00 for each monitoring and reporting violation that is investigated and resolved. The invoice shall include the analytical results and other appropriate documentation demonstrating the violation is corrected. h. Inventory and Documentation of New Water Systems: LPHA may submit an invoice to DHS for $700.00 for the identification of a water system that is not in the DHS inventory. This task applies only to existing systems that are not in the DHS inventory and that have not had a water system survey performed to gather the necessary inventory information. If a survey is used to collect the inventory information, this task does not apply and is not payable. 2009 -2011 1GA for Safe Drinking Water Program Services Page 18 of 58 128887 pgm - Deschutes County J• Follow -Up on Public Water System Defects Or Deficiencies Noted on Water System Surveys: LPHA may submit an invoice to DHS for each on -site visit conducted between water system surveys to assure that identified items listed on the corrective action plan deficiencies have been corrected. DHS will pay $280.00 for each transient noncommunity and non -EPA public system. DHS will pay $560.00 for each community and nontransient, noncommunity public water system. LPHA's invoice for payment must list deficiencies list corrective action plan items checked and the date they were corrected or note the progress towards correction. When applicable, monitoring and management deficiencies must be invoiced under Basic Services, rather than as a deficiency follow up. Invoicing for the same work in more than one way is not allowed. Engineering Plan Review Inspections: LPHA may submit an invoice to DHS for $420.00 for each public water system corrective action plan reviewed plan review inspection completed. k. Post -SNC Follow -up Work: LPHA may submit an invoice to DHS for $420.00 for one on -site, follow -up visit to a water system. LPHA invoice shall include documentation of the post -SNC follow -up work conducted. The maximum payment is $420.00 per SNC for follow -up work conducted during the six -month period after the SNC has achieved compliance with drinking water standards. Customized and Negotiated Work: LPHA may submit an invoice to DHS for payment of customized and negotiated work. LPHA must submit documentation of progress on achieving each of the expected outcomes for each task listed on the DHS approved proposal. DHS will make payment only when the outcomes are documented as completed and approved by DHS. 3. LPHA shall submit monthly invoices for services provided, along with supporting documentation, in a format acceptable to DHS. 4. TRAVEL and OTHER EXPENSES. DHS shall not reimburse LPHA for any travel or additional expenses under this Contract. 5. CONTRACT ADMINISTRATOR. The DHS employee assigned to monitor Contract compliance, authorize payment, and act as DHS' Contract Administrator on matters concerning this Contract shall be: DHS, Public Health Division Environmental Public Health, Drinking Water Program Attn: Mr. Thomas Mitchell 800 NE Oregon St. Portland, OR 97232 Phone: 971- 673 -0417 Fax: 971- 673 -0694 Email: thomas.j.mitchell@state.or.us T//EA'EMAINDEA' OFTfI /SP./16EIS/NTLNT/ON9LLYLEFT BLANK 2009 -2011 IGA for Safe Drinking Water Program Services Page 19 of 58 128887 pgm - Deschutes County EXHIBIT B STANDARD TERMS & CONDITIONS 1. Governing Law, Consent to Jurisdiction. This Agreement shall be governed by and construed in accordance with the laws of the State of Oregon without regard to principles of conflicts of law. Any claim, action, suit or proceeding (collectively, "Claim ") between the parties that arise from or relate to this Agreement shall be brought and conducted solely and exclusively within a circuit court in the State of Oregon of proper jurisdiction. THE PARTIES, BY EXECUTION OF THIS AGREEMENT, HEREBY CONSENT TO THE IN PERSONAM JURISDICTION OF SAID COURTS. Except as provided in this section, neither party waives any form of defense or immunity, whether sovereign immunity, governmental immunity, immunity based on the eleventh amendment to the Constitution of the United States or otherwise, from any Claim or from the jurisdiction of any court. The parties acknowledge that this is a binding and enforceable Agreement and, to the extent permitted by law, expressly waive any defense alleging that either party does not have the right to seek judicial enforcement of this Agreement. 2. Compliance with Law. Both parties shall comply with all state and local laws, regulations, executive orders and ordinances applicable to the Agreement or to the Work. Without limiting the generality of the foregoing, both parties expressly agree to comply with the following laws, regulations and executive orders to the extent they are applicable to the Agreement: (a) all applicable requirements of state civil rights and rehabilitation statutes, rules and regulations; (b all state laws requiring reporting of Client abuse; (c) ORS 659A.400 to 659A.409, ORS 659A.145 and all regulations and administrative rules established pursuant to those laws in the construction, remodeling, maintenance and operation of any structures and facilities, and in the conduct of all programs, services and training associated with the Work. These laws, regulations and executive orders are incorporated by reference herein to the extent that they are applicable to the Agreement and required by law to be so incorporated. All employers, including LPHA and DHS, that employ subject workers who provide services in the State of Oregon shall comply with ORS 656.017 and provide the required Workers' Compensation coverage, unless such employers are exempt under ORS 656.126. 3. Independent Contractors. The parties agree and acknowledge that their relationship is that of independent contracting parties and that LPHA is not an officer, employee, or agent of the State of Oregon as those terms are used in ORS 30.265 or otherwise. 4. Representations and Warranties. a. LPHA represents and warrants as follows: (1.) Organization and Authority. LPHA is a political subdivision of the State of Oregon duly organized and validly existing under the laws of the State of Oregon. LPHA has full power, authority and legal right to make this Agreement and to incur and perform its obligations hereunder. (2.) Due Authorization. The making and performance by LPHA of this Agreement (1) have been duly authorized by all necessary action by LPHA and (2) do not and will not violate any provision of any applicable law, rule, regulation, or order of any court, 2009 -2011 IGA for Safe Drinking Water Program Services Page 20 of 58 128887 pgm - Deschutes County (3.) regulatory commission, board, or other administrative LPHA or any provision of LPHA's charter or other organizational document and (3) do not and will not result in the breach of, or constitute a default or require any consent under any other Agreement or instrument to which LPHA is a party or by which LPHA may be bound or affected. No authorization, consent, license, approval of, filing or registration with or notification to any governmental body or regulatory or supervisory authority is required for the execution, delivery or performance by LPHA of this Agreement. Binding Obligation. This Agreement has been duly executed and delivered by LPHA and constitutes a legal, valid and binding obligation of LPHA, enforceable in accordance with its terms subject to the laws of bankruptcy, insolvency, or other similar laws affecting the enforcement of creditors' rights generally. (4.) LPHA has the skill and knowledge possessed by well - informed members of its industry, trade or profession and LPHA will apply that skill and knowledge with care and diligence to perform the Work in a professional manner and in accordance with standards prevalent in LPHA's industry, trade or profession; (5.) LPHA shall, at all times during the term of this Agreement, be qualified, professionally competent, and duly licensed to perform the Work; and (6.) LPHA prepared its proposal related to this Agreement, if any, independently from all other proposers, and without collusion, fraud, or other dishonesty. b. DHS represents and warrants as follows: (1.) Organization and Authority. DHS has full power, authority and legal right to make this Agreement and to incur and perform its obligations hereunder. (2.) Due Authorization. The making and performance by DHS of this Agreement (1) have been duly authorized by all necessary action by DHS and (2) do not and will not violate any provision of any applicable law, rule, regulation, or order of any court, regulatory commission, board, or other administrative LPHA and (3) do not and will not result in the breach of, or constitute a default or require any consent under any other Agreement or instrument to which DHS is a party or by which DHS may be bound or affected. No authorization, consent, license, approval of, filing or registration with or notification to any governmental body or regulatory or supervisory authority is required for the execution, delivery or performance by DHS of this Agreement, other than approval by the Department of Justice if required by law. (3.) Binding Obligation. This Agreement has been duly executed and delivered by DHS and constitutes a legal, valid and binding obligation of DHS, enforceable in accordance with its terms subject to the laws of bankruptcy, insolvency, or other similar laws affecting the enforcement of creditors' rights generally. c. Warranties Cumulative. The warranties set forth in this section are in addition to, and not in lieu of, any other warranties provided. 2009 -2011 LGA for Safe Drinking Water Program Services Page 21 of 58 128887 pgm - Deschutes County 5. Funds Available and Authorized; Payments. LPHA shall not be compensated for Work performed under this Agreement by any other LPHA or Department of the State of Oregon or the federal government. DHS certifies that it has sufficient funds currently authorized for expenditure to finance the costs of this Agreement within DHS' current biennial appropriation or limitation. LPHA understands and agrees that DHS' payment of amounts under this Agreement is contingent on DHS receiving appropriations, limitations, allotments or other expenditure authority sufficient to allow DHS, in the exercise of its reasonable administrative discretion, to continue to make payments under this Agreement, subject to Section 7 below. 6. Recovery of Overpayments. If billings under this Agreement, or under any other Agreement between LPHA and DHS, result in payments to LPHA to which LPHA is not entitled, DHS, after giving to LPHA written notification and an opportunity to object, may withhold from payments due to LPHA such amounts, over such periods of time, as are necessary to recover the amount of the overpayment, subject to Section 7 below. Prior to withholding, if LPHA objects to the withholding or the amount proposed to be withheld, LPHA shall notify DHS that it wishes to engage in dispute resolution in accordance with Section 19 of this Agreement. 7. Nothing in this Agreement shall require LPHA or DHS to act in violation of state or federal law or the Constitution of the State of Oregon. 8. Ownership of Intellectual Property. a. Except as otherwise expressly provided herein, or as otherwise required by state or federal law, DHS will not own the right, title and interest in any intellectual property created or delivered by LPHA or a subcontractor in connection with the Work. With respect to that portion of the intellectual property that the LPHA owns, LPHA grants to DHS a perpetual, worldwide, non - exclusive, royalty -free and irrevocable license, subject to any provisions in the Agreement that restrict or prohibit dissemination or disclosure of information, to (i) use, reproduce, prepare derivative works based upon, distribute copies of, perform and display the intellectual property, (ii) authorize third parties to exercise the rights set forth in Section 8.a(i) on DHS' behalf, and (iii) sublicense to third parties the rights set forth in Section 8.a(i). b. If state or federal law requires that DHS or LPHA grant to the United States a license to any intellectual property, or if state or federal law requires that the DHS or the United States own the intellectual property, then LPHA shall execute such further documents and instruments as DHS may reasonably request in order to make any such grant or to assign ownership in the intellectual property to the United States or DHS. To the extent that DHS becomes the owner of any intellectual property created or delivered by LPHA in connection with the Work, DHS will grant a perpetual, worldwide, non - exclusive, royalty -free and irrevocable license, subject to any provisions in the Agreement that restrict or prohibit dissemination or disclosure of information, to LPHA to use, copy, distribute, display, build upon and improve the intellectual property. c. LPHA shall include in its subcontracts terms and conditions necessary to require that subcontractors execute such further documents and instruments as DHS may reasonably request in order to make any grant of license or assignment of ownership that may be required by federal or state law. 2009 -2011 IGA for Safe Drinking Water Program Services Page 22 of 58 128887 pgm - Deschutes County 9. LPHA Default. LPHA shall be in default under this Agreement upon the occurrence of any of the following events: a. LPHA fails to perform, observe or discharge any of its covenants, Agreements or obligations set forth herein; b. Any representation, warranty or statement made by LPHA herein or in any documents or reports relied upon by DHS to measure the delivery of Work, the expenditure of payments or the performance by LPHA is untrue in any material respect when made; c. LPHA (i) applies for or consents to the appointment of, or taking of possession by, a receiver, custodian, trustee, or liquidator of itself or all of its property, (ii) admits in writing its inability, or is generally unable, to pay its debts as they become due, (iii) makes a general assignment for the benefit of its creditors, (iv) is adjudicated a bankrupt or insolvent, (v) commences a voluntary case under the Federal Bankruptcy Code (as now or hereafter in effect), (vi) files a petition seeking to take advantage of any other law relating to bankruptcy, insolvency, reorganization, winding -up, or composition or adjustment of debts, (vii) fails to controvert in a timely and appropriate manner, or acquiesces in writing to, any petition filed against it in an involuntary case under the Bankruptcy Code, or (viii) takes any action for the purpose of effecting any of the foregoing; or d. A proceeding or case is commenced, without the application or consent of LPHA, in any court of competent jurisdiction, seeking (i) the liquidation, dissolution or winding -up, or the composition or readjustment of debts, of LPHA, (ii) the appointment of a trustee, receiver, custodian, liquidator, or the like of LPHA or of all or any substantial part of its assets, or (iii) similar relief in respect to LPHA under any law relating to bankruptcy, insolvency, reorganization, winding -up, or composition or adjustment of debts, and such proceeding or case continues undismissed, or an order, judgment, or decree approving or ordering any of the foregoing is entered and continues unstayed and in effect for a period of sixty consecutive days, or an order for relief against LPHA is entered in an involuntary case under the Federal Bankruptcy Code (as now or hereafter in effect). 10. DHS Default. DHS shall be in default under this Agreement upon the occurrence of any of the following events: a. DHS fails to perform, observe or discharge any of its covenants, Agreements, or obligations set forth herein; or b. Any representation, warranty or statement made by DHS herein or in any documents or reports relied upon by LPHA to measure performance by DHS is untrue in any material respect when made. 11. Termination. a. LPHA Termination. LPHA may terminate this Agreement: (1.) For its convenience, upon at least 30 days advance written notice to DHS; 2009 -2011 1GA for Safe Drinking Water Program Services Page 23 of 58 128887 pgm - Deschutes County (2.) Upon 45 days advance written notice to DHS, if LPHA does not obtain funding, appropriations and other expenditure authorizations from LPHA's governing body, federal, state or other sources sufficient to permit LPHA to satisfy its performance obligations under this Agreement, as determined by LPHA in the reasonable exercise of its administrative discretion; (3.) Upon 30 days advance written notice to DHS, if DHS is in default under this Agreement and such default remains uncured at the end of said 30 day period or such longer period, if any, as LPHA may specify in the notice; or (4.) Immediately upon written notice to DHS, if Oregon statutes or federal laws, regulations or guidelines are modified, changed or interpreted by the Oregon Legislative Assembly, the federal government or a court in such a way that LPHA no longer has the authority to meet its obligations under this Agreement. b. DHS Termination. DHS may terminate this Agreement: (1.) For its convenience, upon at least 30 days advance written notice to LPHA; (2.) Upon 45 days advance written notice to LPHA, if DHS does not obtain funding, appropriations and other expenditure authorizations from federal, state or other sources sufficient to meet the payment obligations of DHS under this Agreement, as determined by DHS in the reasonable exercise of its administrative discretion. Notwithstanding the preceding sentence, DHS may terminate this Agreement, immediately upon written notice to LPHA or at such other time as it may determine if action by the Oregon Legislative Assembly or Emergency Board reduces DHS' legislative authorization for expenditure of funds to such a degree that DHS will no longer have sufficient expenditure authority to meet its payment obligations under this Agreement, as determined by DHS in the reasonable exercise of its administrative discretion, and the effective date for such reduction in expenditure authorization is less than 45 days from the date the action is taken; (3.) Immediately upon written notice to LPHA if Oregon statutes or federal laws, regulations or guidelines are modified, changed or interpreted by the Oregon Legislative Assembly, the federal government or a court in such a way that DHS no longer has the authority to meet its obligations under this Agreement or no longer has the authority to provide payment from the funding source it had planned to use; (4.) Upon 30 days advance written notice to LPHA, if LPHA is in default under this Agreement and such default remains uncured at the end of said 30 day period or such longer period, if any, as DHS may specify in the notice; (5.) Immediately upon written notice to LPHA, if any license or certificate required by law or regulation to be held by LPHA or a subcontractor to perform the Work is for any reason denied, revoked, suspended, not renewed or changed in such a way that LPHA or a subcontractor no longer meets requirements to perform the Work. This termination right may only be exercised with respect to the particular part of the Work impacted by loss of necessary licensure or certification; 2009 -2011 IGA for Safe Drinking Water Program Services Page 24 of 58 128887 pgm - Deschutes County (6.) Immediately upon written notice to LPHA, if DHS determines that LPHA or any of its subcontractors have endangered or are endangering the health or safety of a client or others in performing work covered by this Agreement. c. Mutual Termination. This Agreement may be terminated immediately upon mutual written consent of the parties or at such other time as the parties may agree in the written consent. 12. Effect of Termination. a. Entire Agreement. Upon termination of this Agreement, DHS shall have no further obligation to pay LPHA under this Agreement. (2.) Upon termination of this Agreement, LPHA shall have no further obligation to perform Work under this Agreement. b. Obligations and Liabilities. Notwithstanding Section 12.a., any termination of this Agreement shall not prejudice any obligations or liabilities of either party accrued prior to such termination. 13. Limitation of Liabilities. NEITHER PARTY SHALL BE LIABLE TO THE OTHER FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR RELATED TO THIS AGREEMENT. NEITHER PARTY SHALL BE LIABLE FOR ANY DAMAGES OF ANY SORT ARISING SOLELY FROM THE TERMINATION OF THIS AGREEMENT OR ANY PART HEREOF IN ACCORDANCE WITH ITS TERMS. 14. Insurance. LPHA shall maintain insurance as set forth in Exhibit C, which is attached hereto. 15. Records Maintenance; Access. LPHA shall maintain all financial records relating to this Agreement in accordance with generally accepted accounting principles. In addition, LPHA shall maintain any other records, books, documents, papers, plans, records of shipments and payments and writings of LPHA, whether in paper, electronic or other fore, that are pertinent to this Agreement in such a manner as to clearly document LPHA's performance. All financial records, other records, books, documents, papers, plans, records of shipments and payments and writings of LPHA whether in paper, electronic or other form, that are pertinent to this Agreement, are collectively referred to as "Records." LPHA acknowledges and agrees that DHS and the Oregon Secretary of State's Office and the federal government and their duly authorized representatives shall have access to all Records to perform examinations and audits and make excerpts and transcripts. LPHA shall retain and keep accessible all Records for a minimum of six (6) years, or such longer period as may be required by applicable law, following final payment and termination of this Agreement, or until the conclusion of any audit, controversy or litigation arising out of or related to this Agreement, whichever date is later. LPHA shall maintain Records in accordance with the records retention schedules set forth in OAR Chapter 166. 2009 -2011 IGA for Safe Drinking Water Program Services Page 25 of 58 128887 pgrn - Deschutes County 16. Information Privacy /Security /Access a. If the Work performed under this Agreement requires LPHA to have access to or use of any DHS computer system or other DHS Information Asset for which DHS imposes security requirements, and DHS grants LPHA access to DHS Information Assets or Systems, LPHA shall comply and require any subcontractors to comply with the information security requirements imposed under this section. For purposes of this section, the following terms have the following meanings. All other terms not defined in this section shall have the meaning used in the HIPAA Security Rules, 45 CFR § 164.304: (1.) "Access" means the ability or the means necessary to read, communicate data/inforination, or otherwise use any Information Asset(s) and DHS Network and Information System(s). (2.) "Client Record(s)" means any client, applicant, or participant information regardless of the media or source, provided by DHS to the LPHA. (3.) "DHS Network and Information System(s)" is the DHS computer infrastructure which provides personal communications, Client Records, regional, wide area, and local networks, and the internetworking of various types of networks. (4.) "Incident" means the attempted or successful unauthorized access, use, disclosure, modification or destruction of DHS Network and Information System(s) and DHS Information Asset(s) including, but not limited to: unauthorized disclosure of information, failure to protect user ID's, theft of computer equipment or Client Records, etc. (5.) "Individual User Profile (IUP)" refers to DHS form(s) used to authorize a User, identify their job assignment and the required access to DHS Network and Information System(s). It generates a unique alpha /numeric code used to access the DHS Network and Information Systems. (6.) "Information Asset(s)" refers to all information provided through DHS, regardless of the source, which requires measures for security and privacy of the information. (7.) "User" means any individual authorized by DHS to access Network and Information Systems and who has a DHS assigned unique log -on identifier. User may be LPHA, or an employee, officer or agent of LPHA, including a subcontractor of LPHA at the request of LPHA. b. Access. If LPHA, including any subcontractor of LPHA when authorized by DHS, requires Access to the DHS Network and Information System, LPHA shall complete an IUP request for each person for whom Access is requested. DHS shall notify LPHA whether an IUP is approved or denied and when approved, provide User with any unique log -on identifier necessary for Access. LPHA shall immediately notify DHS when LPHA or its Users no Longer require Access. 2009 -2011 1GA for Safe Drinking Water Program Services Page 26 of 58 128887 pgm - Deschutes County c. (2.) Except as provided in this subsection 16.b.(1.) of this Exhibit B, Access to Information Asset(s) may be by IUP or such other process as DHS may establish. Security and Privacy. (1.) No User shall Access Information Assets for any purpose other than those specifically authorized under this Agreement and outlined in the User's IUP or other DHS Access - controlled process. (2.) Except as specified or approved by DHS, neither the LPHA nor its Users shall alter, delete or destroy any Information Assets. (3.) LPHA shall prohibit any unauthorized access to DHS Network and Information Systems by its Users and by unauthorized persons. (4.) LPHA shall develop a security risk management plan (the "Plan "). The LPHA shall ensure the Plan: (5.) (a.) Will have established in place privacy and security measures that meet or exceed the standards established by this Agreement and in accordance with DHS Privacy and Information Security Incident policies, policy number AS- 090 -005, available at: http: / /www.dhs. state .or.us /policy /admin/security /090 005.htm and HIPAA Security Rules, 45 CFR Parts 160 and 164, applicable to Users regarding the security and privacy of Client Records, all Information Assets, and Network and Information Systems; and (b.) that it documents LPHA's privacy and security measures. LPHA shall make its Plan available to DHS for review upon request. LPHA shall maintain security of equipment and storage of all Information Assets accessed through this Agreement to prevent inadvertent destruction, disclosure or loss. (6.) LPHA shall safeguard and ensure the security of all Information Assets, regardless of the media. (7.) LPHA shall keep any DHS- assigned access control requirements such as identification of authorized user(s) and access - control information in a secure location until access is terminated. LPHA shall make available to DHS upon request all information about LPHA's use or application of access - controlled DHS computer systems or information Assets. (8.) LPHA shall, and shall require each subcontractor and agent, to properly handle, store, and dispose of any Information Assets obtained or reproduced, when the authorized use of that information ends, consistent with the record retention requirements otherwise applicable to this Agreement. (9.) LPHA and its Users shall comply with all security and privacy federal and state laws, rules, and regulations applicable to the Access granted under this Agreement. 2009 -2011 IGA for Safe Drinking Water Program Services Page 27 of 58 128887 pgm - Deschutes County (10.) DHS reserves the right to request additional information from LPHA related to LPHA's security measures. If DHS determines that LPHA's security measures or actions required under this section are inadequate to address the security requirements of DHS, DHS will notify the LPHA. DHS and LPHA agree to discuss appropriate security measures or action. If security measures or corrective actions acceptable to DHS cannot be agreed upon, DHS reserves the right to take such actions as it detennines appropriate under the circumstances. Actions may include, but are not limited to: restricting LPHA or User access, or amending or terminating the Agreement or the individual User access granted there under. d. User Disclosure of Information. Wrongful use of DHS Network and Information System(s), or wrongful use or disclosure of Information Assets by LPHA, its officers, employees, or agents, including LPHA' s subcontractors, may cause the immediate suspension or revocation of any Access granted through this Agreement, in the sole discretion of DHS. DHS may also pursue any other legal remedies provided under the law. (2.) LPHA will report to the DHS, Information Security Office, at the following contact information: dhsinfo.security @state.or.us, and to the DHS contract administrator, any privacy or security Incidents by LPHA, its officers, employees, agents or subcontractors that compromise, damage, or cause a loss of protection to the DHS Information Assets or DHS Network and Information System(s). LPHA shall report in the following manner: (3.) (a.) Report to the DHS, Infonnation Security Office, and to the DHS contract administrator, as soon as possible, but not later than five (5) business days from the date on which LPHA becomes aware of such Incident; and, (b.) Provide the DHS, Infonnation Security Office, and the DHS contract administrator, the results of the Incident assessment findings and resolution strategies. LPHA will comply with DHS requests for corrective action concerning a privacy or security incident, and with laws requiring mitigation of harm caused by the unauthorized use or disclosure of confidential infonnation, if any. The LPHA shall have established privacy and security measures in place that meet or exceed the standards set in the DHS Privacy and Information Security Policies regarding LPHA's disclosure of Information Asset(s). (4.) LPHA's use and disclosure of any Information Asset(s) is strictly limited to the minimum information necessary to perform the Work required under the Agreement. (5.) LPHA shall administer, control, and monitor its Users' Access. LPHA shall require that any User the LPHA includes in the request for Access is held to the salve confidentiality standards as the LPHA. 2009 -2011 IGA for Safe Drinking Water Program Services Page 28 of 58 128887 pgm - Deschutes County (6.) LPHA shall be a custodian of any Inforination Assets it maintains in its possession. Nothing in this provision shall be construed as requiring the LPHA to violate Oregon Public Records law or a court or administrative order to disclose, or prohibiting authorized disclosures under the law covered by this Agreement. e. Costs. Costs related to the acquisition of all LPHA equipment, software, data lines or connections necessary to provide LPHA with Access are the sole responsibility of the LPHA, unless otherwise agreed to by all parties in writing. 17. Force Majeure. Neither DHS nor LPHA shall be held responsible for delay or default caused by fire, riot, acts of nature, power outage, government fiat, terrorist acts or other acts of political sabotage, civil unrest, labor unrest, or war, where such cause is beyond the reasonable control of DHS or LPHA. Each party shall, however, make all reasonable efforts to remove or eliminate such cause of delay or default and shall, upon the cessation of the cause, diligently pursue performance of its obligations under this Agreement. For purposes of this section, an "act of nature" is a natural occurrence of extraordinary and unprecedented proportions not foreshadowed by the usual course of nature, whose magnitude and destructiveness could not have been anticipated or provided against by exercise of ordinary foresight. 18. Assignment of Agreement, Successors in Interest. a. LPHA shall not assign or transfer its interest in this Agreement without prior written approval of DHS. Any such assignment or transfer, if approved, is subject to such conditions and provisions as DHS may deem necessary. No approval by DHS of any assignment or transfer of interest shall be deemed to create any obligation of DHS in addition to those set forth in the Agreement. b. The provisions of this Agreement shall be binding upon and shall inure to the benefit of the parties hereto, and their respective successors and permitted assigns. 19. Resolution of Disputes, Generally. In the event a dispute arises under this Agreement, either party may notify the other party that it wishes to engage in a dispute resolution process. Upon such notification, the parties shall engage in non - binding discussion to resolve the dispute. If the parties do not reach Agreement as a result of non - binding discussion, the parties may agree to consider further appropriate dispute resolution processes, including, subject to Department of Justice and LPHA Counsel approval, binding arbitration. The rights and remedies set forth in the Agreement are not intended to be exhaustive and the exercise by either party of any right or remedy does not preclude the exercise of any other rights or remedies at law or in equity. 20. Subcontracts. LPHA shall not enter into any subcontracts for any of the Work required by this Agreement without DHS' prior written consent. In addition to any other provisions DHS may require, LPHA shall include in any permitted subcontract under this Agreement provisions to require that DHS will receive the benefit of subcontractor performance as if the subcontractor were the LPHA with respect to Sections 1, 2, 3, 4, 8, 15, 16, 18, 21, and 23 of this Exhibit B. DHS' consent to any subcontract shall not relieve LPHA of any of its duties or obligations under this Agreement. 2009 -2011 1GA for Safe Drinking Water Program Services Page 29 of 58 128887 pgm - Deschutes County 21. No Third Party Beneficiaries. DHS and LPHA are the only parties to this Agreement and are the only parties entitled to enforce its terms. The parties agree that LPHA 's performance under this Agreement is solely for the benefit of DHS to assist and enable DHS to accomplish its statutory mission. Nothing in this Agreement gives, is intended to give, or shall be construed to give or provide any benefit or right, whether directly, indirectly or otherwise, to third persons any greater than the rights and benefits enjoyed by the general public unless such third persons are individually identified by name herein and expressly described as intended beneficiaries of the terns of this Agreement. 22. Amendment. No amendment, modification or change of terms of this Agreement shall bind either party unless in writing and signed by both parties and when required the Department of Administrative Services and Department of Justice. Such amendment, modification or change, if made, shall be effective only in the specific instance and for the specific purpose given. The parties, by signature of its authorized representative, hereby acknowledge that they have read this Agreement, understand it, and agree to be bound by its terms and conditions. 23. Severability. The parties agree that if any tern or provision of this Agreement is declared by a court of competent jurisdiction to be illegal or in conflict with any law, the validity of the remaining terms and provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular term or provision held to be invalid. 24. Survival. Sections 1, 4, 5, 6, 7, 8, 12, 13, 14, 15, 16, 19, 21, 22, 23, 24, 25, 26, 28, and 29 of this Exhibit B shall survive Agreement expiration or termination as well as those the provisions of this Agreement that by their context are meant to survive. Agreement expiration or termination shall not extinguish or prejudice either party's right to enforce this Agreement with respect to any default by the other party that has not been cured. 25. Notice. Except as otherwise expressly provided in this Agreement, any communications between the parties hereto or notices to be given hereunder shall be given in writing by personal delivery, facsimile, or mailing the salve, postage prepaid to LPHA or DHS at the address or number set forth below, or to such other addresses or numbers as either party may indicate pursuant to this section. Any communication or notice so addressed and mailed shall be effective five (5) days after mailing. Any communication or notice delivered by facsimile shall be effective on the day the transmitting machine generates a receipt of the successful transmission, if transmission was during normal business hours of the recipient, or on the next business day, if transmission was outside normal business hours of the recipient. To be effective against the other party, any notice transmitted by facsimile must be confirmed by telephone notice to the other party at number listed below. Any communication or notice given by personal delivery shall be effective when actually delivered to the addressee. DHS: Public Health Division Office of Environmental Public Health Contract Administrator: Thomas Mitchell 800 Northeast Oregon Street, Suite 611 Portland, OR 97232 Phone number: (971) 673 -0417 Fax number: (971) 673 -0457 thomas.j .mitchellA state. onus. 2009 -2011 IGA for Safe Drinking Water Program Services Page 30 of 58 128887 pgm - Deschutes County LP HA: Deschutes County Deschutes County Human Services Attn: Mr. Jeff Freund 117 NW Lafayette Avenue Bend, OR 97701 Phone number: (541) 388 -6563 Fax number: (541) 385 -1764 jefff @co.deschutes.or.us 26. Headings. The headings and captions to sections of this Agreement have been inserted for identification and reference purposes only and shall not be used to construe the meaning or to interpret this Agreement. 27. Counterparts. This Agreement may be executed in several counterparts, all of which when taken together shall constitute one Agreement binding on all parties, notwithstanding that all parties are not signatories to the same counterpart. Each copy of this Agreement so executed shall constitute an original. 28. Waiver. The failure of either party to enforce any provision of this Agreement shall not constitute a waiver by that party of that or any other provision. No waiver or consent shall be effective unless in writing and signed by the party against whom it is asserted. 29. Construction. [Reserved] TIIERLN/A/NDLR OFTI TSPAGE /S/NTENT /ON9LLI "LEA BLANK 2009 -2011 IGA for Safe Drinking Water Program Services Page 31 of 58 128887 pgm - Deschutes County EXHIBIT C INSURANCE REQUIREMENTS During the term of this Agreement, LPHA shall maintain in force at its own expense, each kind of insurance noted below: 1. Required by DHS of Agencies with one or more workers, as defined by ORS 656.027. Workers' Compensation: All employers, including LPHA, that employ subject workers, as defined in ORS 656.027, shall comply with ORS 656.017 and shall provide workers' compensation insurance coverage for those workers, unless they meet the requirement for an exemption under ORS 656.126(2). LPHA shall require and ensure that each of its subcontractors complies with these requirements. 2. [ ] Required by DHS [ X ] Not required by DHS. Professional Liability insurance with a combined single limit, or the equivalent, of not less than $0.00 each claim, incident or occurrence, and $0.00 in the aggregate. This is to cover damages caused by error, omission or negligent acts related to the professional services to be provided under this Agreement. 3. [ 1 Required by DHS [ X ] Not required by DHS. General Liability insurance with a combined single limit, or the equivalent, of not less than $0.00 each occurrence for Bodily Injury and Property Damage. It shall provide that the State of Oregon, Department of Human Services and their divisions, officers and employees are Additional Insureds but only with respect to the LPHA's Work to be provided under this Agreement; 4. [ ] Required by DHS [ X ] Not required by DHS. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Oregon Financial Responsibility Law (ORS 806.060), each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non -owned vehicles, as applicable. It shall provide that the State of Oregon, Department of Human Services and their divisions, officers and employees are Additional Insureds but only with respect to the LPHA's Work to be provided under this Agreement; 5. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or intent not to renew the insurance coverage(s) without 30 days prior written notice from the LPHA or its insurer(s) to Department of Human Services; 6. Certificates of insurance. As evidence of the insurance coverages required by this Agreement, the LPHA shall furnish acceptable insurance certificates to Department of Human Services upon request. The certificate will specify all of the parties who are Additional Insureds. Insuring companies or entities are subject to State acceptance. If requested, complete copies of insurance policies, trust Agreements, etc. shall be provided to the State. The LPHA shall be financially responsible for all pertinent deductibles, self - insured retentions or self - insurance, as applicable. 7. Self - insurance. LPHA may fulfill its insurance obligations herein through a program of self insurance, provided that LPHA's self insurance program complies with all applicable laws, and provides insurance coverage equivalent in both type and level of coverage to that in ORS 30.270. 2009 -2011 IGA for Safe Drinking Water Program Services Page 32 of 58 128887 pgm - Deschutes County EXHIBIT D REQUIRED FEDERAL TERMS AND CONDITIONS In addition to any other requirements prescribed in Exhibit A, LPHA shall comply and, as indicated, require all subcontractors to comply with the following federal requirements. For purposes of this Agreement, all references to federal and state laws are references to federal and state laws as they may be amended from time to time. 1. Miscellaneous Federal Provisions. LPHA shall comply and require all subcontractors to comply with all federal laws, regulations, and executive orders applicable to the Agreement or to the delivery of Work. Without limiting the generality of the foregoing, LPHA expressly agrees to comply and require all subcontractors to comply with the following laws, regulations and executive orders to the extent they are applicable to the Agreement: (a) Title VI and VII of the Civil Rights Act of 1964, as amended, (b) Sections 503 and 504 of the Rehabilitation Act of 1973, as amended, (c) the Americans with Disabilities Act of 1990, as amended, (d) Executive Order 11246, as amended, (e) the Health Insurance Portability and Accountability Act of 1996, (f) the Age Discrimination in Employment Act of 1967, as amended, and the Age Discrimination Act of 1975, as amended, (g) the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended, (h) all regulations and administrative rules established pursuant to the foregoing laws, (i) all other applicable requirements of federal civil rights and rehabilitation statutes, rules and regulations, (j) all federal law governing operation of Community Mental Health Programs, including without limitation, all federal laws requiring reporting of Client abuse. These laws, regulations and executive orders are incorporated by reference herein to the extent that they are applicable to the Agreement and required by law to be so incorporated. No federal funds may be used to provide Work in violation of 42 USC 14402. 2. Equal Employment Opportunity. If this Agreement, including amendments, is for more than $10,000, then LPHA shall comply and require all subcontractors to comply with Executive Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and as supplemented in Department of Labor regulations (41 CFR Part 60). 3. Clean Air, Clean Water, EPA Regulations. if this Agreement, including amendments, exceeds $100,000 then LPHA shall comply and require all subcontractors to comply with all applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 U.S.C. 1857(h)), the Federal Water Pollution Control Act as amended (commonly known as the Clean Water Act) (33 U.S.C. 1251 to 1387), specifically including, but not limited to Section 508 (33 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency regulations (40 CFR Part 3), which prohibit the use under non - exempt Federal contracts, grants or loans of facilities included on the EPA List of Violating Facilities. Violations shall be reported to DHS, HHS and the appropriate Regional Office of the Environmental Protection Agency. LPHA shall include and require all subcontractors to include in all contracts with subcontractors receiving more than $100,000, language requiring the subcontractor to comply with the federal laws identified in this section. 2009 -2011 IGA for Safe Drinking Water Program Services Page 33 of 58 128887 pgm - Deschutes County 4. Energy Efficiency. LPHA shall comply and require all subcontractors to comply with applicable mandatory standards and policies relating to energy efficiency that are contained in the Oregon energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94 -163). 5. Truth in Lobbying. The LPHA certifies, to the best of the LPHA's knowledge and belief that: a. No federal appropriated funds have been paid or will be paid, by or on behalf of LPHA, to any person for influencing or attempting to influence an officer or employee of an Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative Agreement, and the extension, continuation, renewal, amendment or modification of any federal contract, grant, loan or cooperative Agreement. b. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection_with this federal contract, grant, loan or cooperative Agreement, the LPHA shall complete and submit Standard Form LLL, "Disclosure Form to Report Lobbying" in accordance with its instructions. c. The LPHA shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative Agreements) and that all subrecipients and subcontractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Agreement was made or entered into. Submission of this certification is a prerequisite for making or entering into this Agreement imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 6. HIPAA Compliance. If the Work provided under this Agreement are covered by the Health Insurance Portability and Accountability Act or the federal regulations implementing the Act (collectively referred to as HIPAA), LPHA agrees to deliver the Work in compliance with HIPAA. Without limiting the generality of the foregoing, Work funded in whole or in part with payment provided under this Agreement is covered by HIPAA. LPHA shall comply and require all subcontractors to comply with the following: a. Privacy and Security Of Individually Identifiable Health Information Individually Identifiable Health Information about specific individuals is confidential. Individually Identifiable Health Information relating to specific individuals may be exchanged between LPHA and DHS for purposes directly related to the provision of services to Clients which are funded in whole or in part under this Agreement. However, LPHA shall not use or disclose any Individually Identifiable Health Information about specific individuals in a manner that would violate DHS Privacy Rules, OAR 410 - 014 -0000 et. seq., or DHS Notice of Privacy Practices, if done by DHS. 2009 -2011 IGA for Safe Drinking Water Program Services Page 34 of 58 128887 pgm - Deschutes County A copy of the most recent DHS Notice of Privacy Practices is posted on the DHS web site at: htttp :llwww.dhs.state.or.usl policy ladminlinfosecuritylist.htm or may be obtained from DHS. b. Data Transactions Systems. If LPHA intends to exchange electronic data transactions with DHS in connection with claims or encounter data, eligibility or enrollment information, authorizations or other electronic transaction, LPHA shall execute an EDI Trading Partner Agreement with DHS and shall comply with DHS EDI Rules. c. Consultation and Testing If LPHA reasonably believes that the LPHA's or DHS' data transactions system or other application of HIPAA privacy or security compliance policy may result in a violation of HIPAA requirements, LPHA shall promptly consult the DHS Information Security Office. LPHA or DHS may initiate a request for testing of HIPAA transaction requirements, subject to available resources and the DHS testing schedule. 7. Resource Conservation and Recovery. LPHA shall comply and require all subcontractors to comply with all mandatory standards and policies that relate to resource conservation and recovery pursuant to the Resource Conservation and Recovery Act (codified at 42 USC 6901 et. seq.). Section 6002 of that Act (codified at 42 USC 6962) requires that preference be given in procurement programs to the purchase of specific products containing recycled materials identified in guidelines developed by the Environmental Protection Agency. Current guidelines are set forth in 40 CFR Parts 247 -253. 8. Audits. LPHA shall comply and, if applicable, require a subcontractor to comply, with the applicable audit requirements and responsibilities set forth in the Office of Management and Budget Circular A -133 entitled "Audits of States, Local Governments and Non -Profit Organizations." 9. Debarment and Suspension. LPHA shall not permit any person or entity to be a subcontractor if the person or entity is listed on the non - procurement portion of the General Service Administration's "List of Parties Excluded from Federal Procurement or Nonprocurement Programs" in accordance with Executive Orders No. 12549 and No. 12689, "Debarment and Suspension ". (See 45 CFR part 76.) This list contains the names of parties debarred, suspended, or otherwise excluded by agencies, and contractors declared ineligible under statutory authority other than Executive Order No. 12549. Subcontractors with awards that exceed the simplified acquisition threshold shall provide the required certification regarding their exclusion status and that of their principals prior to award. 10. Drug -Free Workplace. LPHA shall comply and require all subcontractors to comply with the following provisions to maintain a drug -free workplace: (i) LPHA certifies that it will provide a drug -free workplace by publishing a statement notifying its employees that the unlawful manufacture, distribution, dispensation, possession or use of a controlled substance, except as may be present in lawfully prescribed or over - the - counter medications, is prohibited in LPHA's workplace or while providing services to the DHS Clients. LPHA's notice shall specify the actions that will be taken by LPHA against its employees for violation of such prohibitions; (ii) Establish a drug -free awareness program to inform its employees about: The dangers of drug abuse in the workplace, LPHA's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations; (iii) Provide each employee to be engaged in the performance of Work under this Agreement a copy of the statement mentioned 2009 -2011 1GA for Safe Drinking Water Program Services Page 35 of 58 128887 pgm - Deschutes County in paragraph (i) above; (iv) Notify each employee in the statement required by paragraph (i) that, as a condition of employment to perform Work under this Agreement, the employee will: abide by the terms of the statement, and notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five (5) days after such conviction; (v) Notify DHS within ten (10) days after receiving notice under subparagraph (iv) from an employee or otherwise receiving actual notice of such conviction; (vi) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program by any employee who is so convicted as required by Section 5154 of the Drug -Free Workplace Act of 1988; (vii) Make a good -faith effort to continue a drug -free workplace through implementation of subparagraphs (i) through (vi); (viii) Require any subcontractor to comply with subparagraphs (i) through (vii); (ix) Neither LPHA, or any of LPHA's employees, officers, agents or subcontractors may perform any Work required under this Agreement while under the influence of drugs. For purposes of this provision, "under the influence" means: observed abnormal behavior or impairments in mental or physical performance leading a reasonable person to believe the LPHA or LPHA's employee, officer, agent or subcontractor has used a controlled substance, prescription or non - prescription medication that impairs the LPHA or LPHA's employee, officer, agent or subcontractor's performance of essential job function or creates a direct threat to the DHS Clients or others. Examples of abnormal behavior include, but are not limited to: hallucinations, paranoia or violent outbursts. Examples of impairments in physical or mental performance include, but are not limited to: slurred speech, difficulty walking or performing job activities; (x) Violation of any provision of this subsection may result in termination of the Agreement. 11. Pro - Children Act. LPHA shall comply and require all subcontractors to comply with the Pro - Children Act of 1994 (codified at 20 USC section 6081 et. seq.). 12. Medicaid Services. LPHA shall comply with all applicable federal and state laws and regulation pertaining to the provision of Medicaid Services under the Medicaid Act, Title XIX, 42 USC Section 1396 et. seq., including without limitation: a. Keep such records as are necessary to fully disclose the extent of the services provided to individuals receiving Medicaid assistance and shall furnish such information to any state or federal LPHA responsible for administering the Medicaid program regarding any payments claimed by such person or institution for providing Medicaid Services as the state or federal LPHA may from time to time request. 42 USC Section 1396a(a)(27); 42 CFR 431.107(b)(1) & (2). b. Comply with all disclosure requirements of 42 CFR 1002.3(a) and 42 CFR 455 Subpart (B). c. Maintain written notices and procedures respecting advance directives in compliance with 42 USC Section 1396(a)(57) and (w), 42 CFR 431.107(b)(4), and 42 CFR 489 subpart I. d. Certify when submitting any claim for the provision of Medicaid Services that the information submitted is true, accurate and complete. LPHA shall acknowledge LPHA's understanding that payment of the claim will be from federal and state funds and that any falsification or concealment of a material fact may be prosecuted under federal and state laws. 2009 -2011 1GA for Safe Drinking Water Program Services Page 36 of 58 128887 pgm - Deschutes County e. Entities receiving $5 million or more annually (under this contract and any other Medicaid contract) for furnishing Medicaid health care items or services shall, as a condition of receiving such payments, adopt written fraud, waste and abuse policies and procedures and inform employees, contractors and agents about the policies and procedures in compliance with Section 6032 of the Deficit Reduction Act of 2005, 42 USC § 1396a(a)(68). 13. Agency -based Voter Registration. LPHA shall comply with the Agency -based Voter Registration sections of the National Voter Registration Act of 1993 that require voter registration opportunities be offered to applicants for services. THEA'EAL4INDEA' OFTHI ISPdCELSJNTFNT'OX4LLY LEFT MANX 2009 -2011 IGA for Safe Drinking Water Program Services Page 37 of 58 128887 pgm - Deschutes County EXHIBIT E Required Sub - Contractor Provisions 1. Subcontractor shall comply with all applicable provisions of that certain Agreement (the "agreement ") between the State of Oregon acting by and through its Department of Human Services ( "DHS ") and Deschutes County Deschutes County Human Services ( "LPHA "). 2. Subcontractor shall comply with all applicable federal, state and local laws, administrative rules, ordinances, and regulations. 3. Subcontractor shall make available to DHS or to any Client, any and all written materials in alternate formats in compliance with DHS' policies or administrative rules. For the purposes of the foregoing, "written materials" includes, without limitation, all work product and subcontracts related to this contract. 4. Unless Subcontractor is a State of Oregon governmental Agency, Subcontractor agrees that it is an independent contractor and not an agent of the State of Oregon, DHS or LPHA. 5. To the extent permitted by applicable law, Subcontractor shall defend, save and hold harmless the State of Oregon, DHS, LPHA, and their officers, employees, and agents from and against all claims, suits, actions, losses, damages, liabilities, costs and expenses of any nature whatsoever resulting from, arising out of or relating to the operations of the Subcontractor, including but not limited to the activities of Subcontractor or its officers, employees, subcontractors or agents under this contract. 6. Subcontractor shall obtain, at Subcontractor's expense, and maintain in effect with respect to all occurrences taking place during the term of the contract, automobile liability insurance with a combined single limit per occurrence of not less than $500,000. 7. Subcontractor shall obtain, at Subcontractor's expense, and maintain in effect with respect to all occurrences taking place during the term of the contract, comprehensive or commercial general liability insurance covering bodily injury and property damage. This insurance shall include personal injury coverage and contractual liability coverage for the indemnity provided under this contract. The combined single limit per occurrence shall not be less than $500,000 or the equivalent. Each annual aggregate limit shall not be less than $500,000 when applicable. 8. All employers, including Subcontractor, that employ subject workers who work under this contract in the State of Oregon shall comply with ORS 656.017 and provide the required Workers' Compensation coverage, unless such employers are exempt under ORS 656.126. Subcontractor shall ensure that each of its subcontractors complies with these requirements. 9. Subcontractor shall name the State of Oregon, DHS, LPHA, and their divisions, officers, and employees as additional insureds on any insurance policies required herein with respect to Subcontractor's activities being performed under the contract. Such insurance shall be evidenced by a certificate of insurance, issued by an insurance company licensed to do business in the State of Oregon and shall contain a 30 -day notice of cancellation endorsement. Subcontractor shall forward a copy of the certificate(s) of insurance to LPHA prior to commencement of the services under this contract. In addition, in the event of unilateral 2009 -2011 FGA for Safe Drinking Water Program Services Page 38 of 58 128887 pgm - Deschutes County cancellation or restriction by Subcontractor's insurance company of any insurance coverage required herein, Subcontractor shall immediately notify LPHA orally of the cancellation or restriction and shall confirm the oral notification in writing within three days of notification by the insurance company to Subcontractor. 10. Subcontractor may fulfill its obligations set forth in Sections 6 through 9 through a program of self insurance; provided that Subcontractor's self insurance program complies with all applicable laws, and provides insurance coverage equivalent in both type and level of coverage to that specified in Sections 6 through 9. THE REMAINDER OF THIS PACE IS INTENT lONALLYLEFTBLANZI 2009 -2011 IGA for Safe Drinking Water Program Services Page 39 of 58 128887 pgm - Deschutes County Al '1' 1AC;111V1 EIN'1 1 'age 11of14 Page of Distribution. System information DHS Drinking Water Program Sanitary Survey System: PWS ID: 41 Service Area and Facility Map Yes No ❑ ❑ Does the system have a Service Area and Facility Map with the following features: ❑ Booster Pumps ❑ Sources -wells & withdrawal points ❑ Pressure Reducing Valves ❑ Storage Facilities (reservoirs) ❑ Pressure Zone ❑ Treatment Facilities ❑ Sampling Points ❑ Water Lines (including size and material) Distribution Data Comments Yes No • • System pressure> 20 psi: • • System metered? (what % ?) • • Water system leakage< 10 %? • • Waterline depth > 30 "? ■ • Piping looped? • • Hydrants or adequate blowoffs on all dead ends? • • Routine flushing? (how often ?) ■ • Adequate vaiving? • • Routine valve turning? ( how often ?) Comments: Cross Connection Program (Community systems only) Comments Yes No ❑ ❑ •Ordinance or enabling authority? ❑ ❑ List of installed devices? ❑ ❑ Are devices tested annually? If > 300 Connections: •Certified inspector? Comments: Booster Pumps Number Narne (location) Deficiencies Noted or Comments HP GPM Aux Power Y • N • Y N] Y ❑N❑ Y❑ N 1 • N❑ • N■ • N■ Comments: 2009 -2011 IGA for Safe Drinking Water Program Services 128887 pgm - Deschutes County Page 40 of 58 Page 12 of 14 Page of Water Quality Monitoring DHS Drinking Program Sanitary Survey System: PWS ID: 41 Contaminant/Location: N/A Frequency Next Test Due At Entry Point: Nitrate ❑ Inorganic Chemicals (SW) ❑ Inorganic Chemicals (GW) Arsenic soc's • VOC s (SW) • vacs (GW) ■ Radiological In Distribution: Coliform Bacteria ❑ 1 Lead & Copper (## of sites: • Asbestos ❑ TTHM- ❑ HAASs ■ Other: Turbidity ❑ TOC &Alkalinity (Cony WTP) ❑ Source Water Microbiological ❑ Maximum Residual Disinfectant Level • Yes No �{- ❑ ❑ ® Is all required monitoring current? Comments: ❑ ❑ Has the system experienced chemical (last 5 years) or bacteriological (last 2 years) detections? If yes, what contaminant and when? ❑ • *Have all MCL violations been addressed? ❑ ❑ Does the system have any monitoring reductions granted? Explain: ❑ ❑ 0Does the system have a written coliform sampling plan? Does the plan include: Yes No Yes No • ❑ Brief narrative? ❑ ❑ Rotation schedule? ❑ ❑ Distribution map? ❑ ❑ Repeat locations? ❑ ❑ Sample site locations? • ❑ 0Are TTHM & HAAS samples taken at location of maximum residence time? Comments: 2009 -2011 IGA for Safe Drinking Water Program Services 128887 pgm - Deschutes County Page 41 of 58 2009 -2011 IGA for Safe Drinking Water Program Services 128887 pgm - Deschutes County Page 41 of 58 ATTACIIMENT 1 Page 13 of 14 Page of Management & Operations DHS Drinking Water Program Sanitary Survey System: PINS ID: Management Operations Yes No ❑ • • Does system have an operation and maintenance manual? • • • Does system have an emergency response plan? Operator Certification Certification Number Water Treatment Level Water Distribution Level Filtration Endorsement Small GW DRC*? Operator's Name • ❑ • ❑ - ❑ " DRC= direct responsible charge. Attach additional sheets if necessary to list all certified personnel. Yes No ❑ 0 Is DRC identified? • • • is DRC certified at appropriate level? • • • Does system have written standard operating protocols for other operators? If contract operator for DRC: • • Does DWP have contract on file? How does contract operator work with system? Comments: Plan Review /Master Plan ❑ • • Have all major modifications (since 8121181) been approved by OHD? ❑ • Does system have a current plan review exemption for water main extension? ❑ ❑ • Does the system have a current ( <20yr.(Old) master plan? (❑ Not required if < 300 connections) What year was the plan completed? Yes No • • Does the master plan include a water conservation plan? Compliance Status • • Is water system in compliance (all Administrative Orders and Notices of Violation resolved)? How many violations has the system had in the past two years? • ❑ • Does the system issue Public Notice for Violations as required? Other ❑ • Has a capacity assessment been completed by OHD? If yes, list deficiencies noted: ❑ • • Are consumer confidence reports sent to users each year? Comments: 2009 -2011 IGA for Safe Drinking Water Program Services 128887 pgm - Deschutes County Page 42 of 58 A2 (DHS Water System Information 41 Dreg„, Dei srt:nen: of Human Services ATTACHMENT 2 System: Contact with: DHS Drinking Water Program PWS ID �f New system - Flll out inventory and Source Change forms. Built before 8/21/81 Phone: ( ) County: Staff member: Date: ❑ State ❑ County [] Dept. of Agriculture ❑ Other Change system name: New name [] Change system statistics: Type * ❑ Community (C) ❑ Non- transient non - community (P) ❑ Transient non - community (N) ❑ State regulated (S) * see reverse for details Certification WT- WD- EFE? Size, Etc. Population: [ Connections: [ Service Chars *: [ I n Ownership *: County: License Season ❑ All year ❑ Seasonal Begins: Ends: mm /dd mm /dd Coliform Sampling Period: ❑ Monthly ❑ Quarterly Samples Required: Responsible Agency ❑ Not IIc. ❑ DHS ❑ Ag. ❑ State ❑ County ❑ Dept. of Ag. [] Contact change: ❑ Also Owner ❑ Also Operator ❑ Also Direct Responsible Charge (DRC) Name & Title: Mailing Address: City: State: Zip: Phone: ( ) [] Alternate contact change: ❑ Owner ❑ Operator ❑ Direct Responsible Charge (DRC) Name & Title: Mailing Address: City: State: Zip: Phone: ( ) [� Activate / Deactivate: Date of activation / deactivation (required): ❑ Deactivate System - Reason: 11100B/temp. closed (N) ❑ Merged (M) - PSW id: (not seasonal closure) ❑ Duplicate (D) (has another ID) ❑ Activate System [ j Notes: 41 ❑ Abandoned (A) ❑ No longer qualifies (S) Pop. drop, split, etc.) ❑ Never qualified (1J) (Incorrectly given ID) Signature: Date: Copies to State and County Page 1- of 2 OHS 8304 1/05 2009 -2011 1GA for Safe Drinking Water Program Services Page 43 of 58 128887 pgrn - Deschutes County How to Create a New System. Doctunent the Water System • Mark New System box (upper right corner). • If built prior to August 21, 1981, mark the box (upper right corner). • If built after 1981 date, ensure that plan review and approval is initiated and/or completed. • Fill in the name of the person you had contact with. • Fill in the System Name, System Statistics and Contact sections. • Contact changes must include the current mailing address and phone number. • If the address is a PO Box and you want to include the physical address, use the 'Alternate contact changes" section. • If the owner address is not the same as contact address, document in either Alternate Contact or Notes section. Document the Source(s) On the Source Change form, fill in the New Source Info. Land Use section and the appropriate sections based on source type. If you happen to have some of the information in the Aquifer Section, please add it. If you made an effort to get information and it isn't available, please state that in the Notes section of the form, or write NA over that field. For sources developed after 1981, well logs must be included and. latitude /longitude data provided. Documenting Multiple Sources If the system has multiple sources, hill out a source page for each, and complete an entry structure diagram. Receiving a P1n'S ID To have DWS assign a PINS ID, you must fill in the Name, Statistics and Contact sections completely. You roust also get as much information about the sources as possible. If you can't get information about the source immediately, please indicate in the Notes section that you will follow up. Determining System Type Pop/ Daily Use Number of Connections > 25 Same Daily Users > 25Year Round Residents System Type < 10 < 4 No No Not a System 10 -24- 4 -14 — — State Regulated 25+ — No No Transient Non- community �+ — Yes No Non - transient Non-community 95-1 151 Yes Yes Community Copies to State and County 2009 -2011 IGA for Safe Drinking Water Program Services 128887 pgm - Deschutes County Page 2 of 2 Service Characteristics Primary- Secondary Code Residental city or Town RI Mobile Horne Park R2 Subdivision R3 Rural R4 Other R9 Transient Recreation (parks, campgrounds, beaches, ski areas, marinas) T1 Service Station T2 Summer Camp T3 Restaurant / Store T4 Highway Rest Area T5 Hotel /Motel, B &B T6 Other (Visitor Center, Church) T9 Semi, Residential School St Institution S2 Medical Facility S3 Industrial/ Agricultural 54 Day Care Center 55 Other S9 Other Interstate Carrier 01 Wholesaler (sells water) 02 Other Area 03 Owner Type Owner Code Federal Government Private 2 State Government 3 Local Government 4 Mired Public !Private 5 DHS 8304 1/05 Page 44 of 58 A3 ATTACHMENT 3 • = Entry Structure Diagram DHS DHS Drinking Water Program tririnapan47er System: Contact with: Staff Member: 3 Entry Points Slate 0 County 0 Dept. (.1 Agricultun Other 411 PWS ID County: Date: ['Treatment Changes Only , 1 Source Type t'FIEEitt- M1. I • 7 P i P i ID Name Availability P ' Season 1 1 P ." 0 Begins' Ends w "°-e 4 Treatment Codes Designated Sample Point (if different ,4 from Ell A None A inutorroc 1 / in El El 0 EICEMEEIn ' i une0 0 MEE EiErlE1 1 1 El M rl 0 0 : ElciDETIEL i / n CC 0 0 non ElErIE i / El El El 0 0 Owner= / / ri min n 0 g Diagram Entry Points i(Show piping structure from sources thru ently points to distribution. Mark sources and entry points with ID, names.) ; I ; I 1 I I I I I I 1 I I I 1 1 L L 1 1-,- Ti 13 ...„.....,„ a 1 1 1 1 —T L L . , . Sources (IDs for sources on an EP start with the EP ID: BC for 3rd source on EP B) • ID Name AA Comments Sign: 1 Date: 1 Page I. of 2 DHS 5306 (IWO) 209-2611 JGA for Safe Drinking Water Program Services Page 45 of 58 128887 pgm - Deschutes County Instructions: • For each set of sources that combine before entering the distribution system, list an entry point. This point should be after any treatment and prior to the first customer. • For each entry point, record the type, availability, and treatment. If an entry point has both surface and groundwaters, the type must be listed as surface water. If the entry point is only used seasonally, dates of likely operation must be listed. Use treatment codes as listed below. If there is a specially designated sampling point (such as one well in a welifield), record it. Otherwise, leave blank. • Label each entry point with a letter code: A, B, C.... • For sources, list each source contributing to an entry point. Label each source with a two letter code beginning with the entry point letter code, for example: • EP A: EP for Wells • Source AA: Well #1 • Source AB: Well #2 • EP 8: EP for Spring • Source BA: Spring • List all entry points and sources, including emergency sources. If a source physically disconnected, indicate that by checking the appropriate box. • Draw a simple schematic drawing showing how each source contributes to treatment or a tank before the first user, draw that too. Label each source, first user or distribution system. Corrosion Control C143 Aeration, Diffused C145 Aeration, Packed Tower C445 Inhibitor, Orthophosphate C447 Inhibitor, OrthoPolyphasphate Blend C449 Inhibitor, Silicate C501 pH /Alkalinity Adjustment -Lime C502 pH /Alkalinity Adj -Soda Ash C503 pH /Alkalinity Adjustment- Caustic Soda C505 pH /Alkalinity Adjustment - Calcite Contactor Disinfection D200 0401 0403 0421 D423 0541 D543 D720 D800 Chloramines Gaseous Chlorination, Post Gaseous Chlorination, Pre Hypochlorination, Post Hypochlorination, Pre Ozonation, Post ()zonation, Pre Ultraviolet Radiation Mixed Oxidants Disinfection By- products Control B121 Activated Carbon, Granular B600 Rapid Mix B742 pH Adjustment, Pre Non- Treatment N000 No Treatment / Not Applicable N349 Unfiltered, Avoiding Filtration N350 Unfiltered, Must Install Filter N996 Treatment Applied by Seller Treatment Codes (SDWIS) Inorganics Removal 1344 Filtration, Pressure Sand 1360 Flocculation 1460 Ion Exchange 1600 Rapid Mix 1640 Reverse Osmosis 1660 Sedimentation 1742 pH Adjustment, Pre Iron Removal F343 Filtration, Greensand F344 Filtration, Pressure Sand F345 Filtration, Rapid Sand F403 Gaseous Chlorination, Pre F421 Hypochlorination, Post F423 Hypochlorination, Pre F543 Ozonation, Pre F560 Permanganate F640 Reverse Osmosis F680 Sequestration F740 pH Adjustment Manganese Removal M343 Filtration, Greensand M423 Hypochlorination, Pre M680 Sequestration Organics Removal 0121 Activated Carbon, Granular 0145 Aeration, Packed Tower 0160 Algae Control 0423 Hypochlorination, Pre 0560 Permanganate Page 2 of 2 has been abandoned or each entry point. If there is entry point, treatment, tank, and Particulate Removal P240 Coagulation P341 Filtration, Cartridge P342 Filtration, Diatomaceous Earth P344 Filtration, Pressure Sand P345 Filtration, Rapid Sand P346 Filtration, Slow Sand P347 Filtration, Membrane P349 Natural Filtration P360 Flocculation P520 Microscreening P600 Rapid Mix P660 Sedimentation P700 Sludge Treatment P742 pH Adjustment, Pre Taste I Odor Control T121 Activated Carbon, Granular T125 Activated Carbon, Powdered T141 Aeration, Cascade T143 Aeration, Diffused T149 Aeration, Spray T160 Algae Control T403 Gaseous Chlorination, Pre T423 Hypochlorination, Pre T560 Permanganate Other Z380 Fluoridation X401 Residual Maintenance, Gas Chlorination X421 Residual Maintenance, Hypochlorination Z550 LCCA for L/C D1IS t306 (10/05) 2009 -2011 1GA for Safe Drinking Water Program Services Page 46 of 58 128887 pgm - Deschutes County A4 ATTACHMENT 4 Source Info OHD Drinking Water Program System: Source Name: Contact with Staff Member. County: Date: YYD�''SS `<...... _. ...... .. r 0 t (:`o �t1:.... Lel.it, A��il,,fitln(. i_thi.r New Source 9 j Pre 81 (] Plan Review Needs Plan F Modify fy Source E Abandon /Disconnect Source Approved Review L— New Source Info Availability ❑ Permanent 0 Seasonal ❑ Emergency Entry Point L System has single source Structure 0 Source on EP by itself 9 Other (please fill out EP diagram) Latitude: Longitude: I Capacity: Yr Installed: Basin Name: L 1Land Use 0 Pristine Purest (A) Q ragated Crops IB) \on- Irrig. Crops (C) ❑Pasture (o) o Light Industry (E) Q Hoary industry (H 0 Urban Sewerod -Area (G) Q Rurel On-Site Sew. Hisp. (ii) o Urban nn-Site. Se.w. nisp. (I) !� Rangeland N l� Managed Forest 11 O Commercial (t) L_J Recreation Use iivq Purchased Water Or Intertie Info Waters:0 Surface [] Ground 9 Both i Seller 41 El LL i, 1 Surface Water Info Watershed Nan: 0 Yes Q No Recharge Zone Slze: Intake Location: i I { Other/Notes I �_. Groundwater Info Source Type 9 Well 0 Spring Water Resource — r 1� � Well ID: i t Depth to 1st Wtr'"" Bearing Zit Addtnl WBZs: D Yes 0 No i7 Unk. Static Water LA: L y j;; Source Elevation: Casing Seal: Q Yes [} No fl Unk. Seal Depth: Screen Type: {] Screened IJ Perforated 0 None WI-IPA delineated: in Yes 0 No 0 CPR S Nam. Method j] Puialyueal /HM 0 Other Aquifer Info Aquifer Name: Q alluvium tr1J confirwd CJ vnlraruc Q leaky r.tnrined 0 sedimentary 0 urlcmrae L� Frnnnrred a unknown 0 unknown Geological Barrier: 9 j Yes 9 No 9 Unknown Depth: Thickness: Hydraulic Connection: 9 Yes 0 No 9 Unknown srreem 0 lagoon 0 lake /peel 0 wedad ° unkee wn • Sign. Dare: 2009 -2011 IGA for Safe Drinking Water Program Services Page 47 of 58 128887 pgm - Deschutes County ATTACHMENT 5 A5 Sanitary Survey Significant Deficiency Follow -up Code: 1F Public Water System: Public Water System ID: #41 Staff: Original Survey Date: Follow -up Date: Field or Office? Findings: (Include the deficiencies checked, state if corrected or not, and if not corrected document any progress made towards correction) Signature: Date: 2009 -2011 IGA for Safe Drinking Water Program Services Page 48 of 58 128887 pgm - Deschutes County A6 ATTACHMENT 6 Contact Report /Assistance Actions DHS - Drinking Water Program Water System Name: Contact and Phone: Date: Who Responded: Staff: [ ] State Contact Location: [ ] By Phone SUMMARY: Assistance Action Type [ ] Alerts —Water Quality (2I)* 1-1 Formal Enforcement (2V)* [ ] Emergency Resp/ OERS (2E) [ ] Boil Water (2B)* [ ] Complaint Investigation (2C) [ ] Disease Investigation (2D) [ ] Capacity Development (2P) [ ] DW Protection (2W) ] Plan Review (2G) [ ] Monitoring &Reporting (2R)* [ ] Regulatory Assistance (2H) [ ] Training -non DHS(2A) [ ] Treatment Plant Site Visit(ID)* [ ] ERP Completed (1 J) [ ] Other (20) * Mark Assistance Reason Details: Action Needed: (Rev, ) 2009 -2011 IGA for Safe Drinking Water Program Services 128887 pgm - Deschutes County [ ] County [] In Office PWS ID: County: [ ] Dept. of Agriculture [ ] In Field Reason [ ] Coliform (TCR) [ ] Nitrate (NO3) [ ] Surface Water Treatment (SWTR) [ ] Disinfection By Products (DBPs) [ ] Lead & Copper (LCR) I: ] Arsenic (AS) []IOC [ ] VOC []SOC [ ] Rads [ ] Operations [] Page 49 of 58 o 00 ATTACHMENT 7 OERS incident # EMERGENCY RESPONSE FORM PERSON REPORTING INCIDENT Narne: MATERIAL(S) DESCRIPTION & QUANTITY ON SCENE CONTACT PERSON Name: Company /Agency Company /Agency Phone No. Phone No. Date Date WHERE /WHEN INCIDENT OCCURRED HOW INCIDENT OCCURRED Inhalation Location: Skin contact Ingestion Comments County: Date: Time: Any Risk to Public Waters or Shellfish Growing Areas? Administrator? Date Time Action Taken: Who? DEQ? Date Time Possible Water System(s) Involved? Who? Co HD? Date Time Shellfish growing areas involved Who? Poison Control Center? Date Time Who? Office of Public Ileaith? Date Time Who? OARS? Report Taken by: Who? Report Referred to: Fox /Forms /OERS Incident.doc ATTACHMENT 8 System name: 41 County: System type: C P N SNC 1D #: Circle violation type and contaminant category or rule: A8 SNC Investigation Report Department of Human Services /Drinking Water Program MCI_ /AI.. M/R BACTI NO3 S©CA/OC /IOC L &C RADS SWTR Discussed with: ❑ Operator Name & ❑ Owner Address: Public Notice: ❑ Issued? ❑ Attached? Basis for SNC status: Follow -up actions taken by investigator and dates: Corrective actions taken by water system and dates: Draft compliance schedule (if applicable): Actions Required Due Dates 1. 2. 3. Investigated by: Phone#: Your signature: Date: (Revised 11/21/05) 2009 -2011 1GA for Safe Drinking Water Program Services 128887 pgm - Deschutes County Page 51 of 58 A9 ATTACHMENT 9 SNC Resolution Report Department of Human Services /Drinking Water Program System name: 41 County: System type: C P N SNC ID #: Circle violation type and contaminant category or rule: MCLIAL M/R BACTI NO3 SOCNOCIIOC L &C RADS SWTR Discussed with: ❑ Operator Name & ❑ Owner Address: Public Notice: 0 Issued? ❑ Attached? Basis for SNC status: Follow -up actions taken by investigator and dates: Corrective actions taken by water system and dates: Describe how compliance was achieved: Attach all contact reports, letters, and other documentation not submitted previously. Investigated by: Phone #: Your signature: Date: (Revised 11/21/05) 2009 -2011 IGA for Safe Drinking Water Program Services 128887 pgm - Deschutes County Page 52 of 58 A10 ATTACHMENT 10 CHECKLIST FOR WATER SYSTEM PLAN REVIEW Page 1 of 5 Wells Name of System: Date Plan Received: Name of Project: Date Plan Reviewed: Project Review#: PWS #: Engineer County: BEFORE CONSTRUCTION (before well is drilled): Plan Review Field Visit General; Y N Y N Appropriate plan review fee received F F Land use compatibility statement or equivalent,.. F F Water Right Permit required Y/N Submitted F F Site Plan: Is land use around well controlled by water supplier r F r r Is sewage disposal prohibited within 100' of the well F 1'....,....F F Is there a roadway within 100' of well site F F....... F F Is site prone to flooding F F F F Surface water source within 500' of well — route to Kari if yes (name) F 1' .1' 1' Recommendations regarding pump test sent 1' F Construction specifications (casing\seal placement- DN or JF): Well construction approved 1, 1' AFTER CONSTRUCTION: Well Log: Is well drillers log provided 1' F [' I' Is thickness of casing at least 0.25" r r 1' r Is there an annular cement grout seal around the casing F F 1' 1' Does the seal meet construction recommendations 1' I' Is the yield of the well suffcient to meet daily demand r 1' Was well test pumped, if so when - Date: The duration of the pump test Hours Depth of well? Pumping rate was GPM Confined aquifer? Drawdown was feet Specific yield GPM/ft drawdown Intakes (screens /perf.,etc.) Wellhead Plans: Is reinforced concrete slab provided around well J' I' h I' Does casing extend 12" above the slab I' 1 I' I Is a water tight sanitary seal provided F I 1' I7 Provision made for disinfection I 1, 1' I' Are provisions made for measuring to water level 1' F t,1, Is a sample tap provided I-17 I' r Can the output of well be pumped to waste i, I'........ F 1' Is there a flow meter provided on the pump discharge 1' F I' 1 Is the concrete slab properly drained 1, F F 1' Is the pump house lighted, heated, lockable, etc I' 1'.........1, F Is well house constructed to allow pump removal 1' T I' 1' Is a casing vent with a screened return bend provided I' F 1' 1' CHEMICAL ANALYSIS RECEIVED: Inventory Updated? .1 17 I' 1' Bacteriological Yes No N/A Inorganic Yes No N/A VOC Yes No N/A Radiological Yes No N/A SOC Yes No N/A Review 13y: Date: Field Visit By: Date: 2009 -2011 1GA for Safe Drinking Water Program Services Page 53 of 58 128887 pgm - Deschutes County All ATTACHMENT 10 CHECKLIST FOR WATER SYSTEM PLAN REVIEW Page 2 of 5 Springs Name of System: Date Plan Received: Name of Project: Date Plan Reviewed: Project Review#: *PWS #: Engineer County: Plan Review Field Visit BEFORE CONSTRUCTION: Y N Y N Appropriate plan review fee received 11 Land use compatibility statement or equivalent 1' I' Has area been surveyed for sources of comatmination 11 T 1 If Yes, identify sources Does owner have a 100 ft. radius of control around site 11' T 1 If no, is there a perpetual restrictive easement P 1 .11 If no, is this site in a public road r:o.w F 1 1' 1 Is there a public road within 100 ft of site 11 1 1 If yes, will site be protected from surface runoff 11 1' 1' Is the flow constant year around 1' 1 Describe typical soil strata: Type of Spring: CONSTRUCTION SPECIFICATIONS; Springbox Details: Is construction material concrete 117... .... ..11 If no, identify impervious material: Is box watertight 11 11 Is there an access manhold 11 11 If so, is there an overlapping hatch cover T 1 11 If so, is there curbing 11 .11 Is there a bottom drain to waste 1 F 1 1 Is there an overflow with a flap valve or screen 11.........11 Is area graded such that runoff drains away 11 11 Inflow Piping: Was perforated pipe installed 1' 1' Are perforations located on underside of pipe 11 Was packed gravel bed installed around perforated pipe 11 If so, was it disinfected after installation 11 Is there an impervious layer above intake 11 Outlet Piping: Is outlet pipe located above the floor bottom 171 If so, how fax? Is it screened 1' 1 Is there a valve near the springbox 11 11' Is there a sample tap 117.........1' 1 Is piping sized correctly 11 Identify size and type of pipe f' 1 F 1 Is adequate cover (30 in) provided for the pipe 11 1 I' GENERAL AREA OF SPRING: Is there an interceptor ditch uphill 11.........11 Is the area fenced with a locked gate 11 11 Racti and Chem Analysis Rec'd? 11' Inventory Updated? 11 11 Review By: Date: Field Visit By: Date: 2009 -2011 lGA for Safe Drinking Water Program Services Page 54 of 58 128887 pgm - Deschutes County ATTACHMENT 10 CHECKLIST FOR WATER SYSTEM PLAN REVIEW Page 3 of 5 Storage Facilities Name of System: Date Plan Received: Name of Project: Date Plan Reviewed: Project Review# PWS# Engineer: County: CONSTRUCTION: Plan Review Field Visit SITE PLAN: Y N Y N Geologic evaluation r r Foundation adequate (undisturbed soil, bedrock, etc.) I' I' Provisions for a fence or other vandal deterrence F F I' 1' CONSTRUCTION SPECIFICATIONS: What is the capacity gallons What material is the storage facility made of If it is redwood, are continuous chlorination provisions made F F F F If it is redwood, is there a reinforced concrete base r I 1- F If it is concrete, is sufficient reinforcement supplied F F 11' If it is partially below ground, are footings drains provided 1' F F 1' Is there a screened vent F 1' r 1' Is there a drain to daylight 1' F.......1' 17 Is there a flap valve at the end of the overflow I' Are overflow and drain common pipe F F 1' 1' Is there a separate inlet/outlet pipe F 1' 1-1' If a single inlet/outlet pipe, is there sufficient mixing F r Is the facility baffled for contact time enhancement 1' 1' If so to what degree _ 1) Effective Volume 2) Estimated contact time 3) Contact time from traces study Was a tracer study performed 1' F 1' 1° Is there a water level indicator F I' F 1, Is there an access manhole Is there curbing and lockable watertight lid I F F F Is there a silt at the outlet piping 1 F Does the interior coating meet with NSF requirements F F PRESSURE TANKS: Is it installed above normal ground surface 1" F 1' 1 Is bypass piping provided 1 r 1' F if it is greater than 1000 gallons, is there a manhole 1' 1' F F Is there a drain, pressure gauge, and air blow -off valve 1' 1- I' 1' Is there means for adding air F F 1' 1 Are there switches to control pumps 1' F 1' I' Is the tank constructed of steel I' F 1' 1 Conditions /Comments: Reviewed by: Date: Field Visit By: Date: 2009 -2011 IGA for Safe Drinking Water Program Services Page 55 of 58 128887 pgm - Deschutes County Page 4 of 5 ATTACHMENT 10 CHECKLIST FOR WATER SYSTEM PLAN REVIEW Continuous Disinfection Name of System: Date Plan Received: Name of Project: Date Plan Reviewed: Project Review# PWS# Engineer County: Plan Field CONSTRUCTION: Review Visit General: Y N Y N Reason for Disinfection Has well construction been approved/ ..❑ ❑ Appropriate plan review fee received ❑ ❑ Type of Disinfectant, (Chlorine gas, hypochlorite, ozone, mixed oxidants) ❑ D. .0 ❑ Type of feed system (Electric pump, meter drive, erosion gas) I❑ ❑ ❑ 0 Site Plan: Is unit to be placed upstream from storage ❑ D ❑ ❑ Construction Specifications: Sample tap prior to disinfection ❑ 0 CI ❑ Sample tap after disinfection ❑ ❑ ❑ ❑ Low level alarm ❑ ❑ ❑ 0 Proportional to flow ❑ ❑ 0 0 Chlorine Analyzer ❑ 0 ❑ Is a DPD test kit to be used to check residual 0 ❑ ❑ ❑ is there adequate contact time under [di flow conditions ❑ 0. o ❑ Are all equipment and chemicals NSF approved or equivalent ❑ ❑ ❑ ❑ Contact Time Calculation: Maximum system flow: gallons /minute Verified C7 ❑ Amount of storage: gallons Verified ❑ ❑ Contact Time available: minutes GAS CHLORINATORS Is storage area enclosed ❑ ❑ ❑ 11 Is storage area separated from other operating areas ❑ ❑ ❑ ❑ Are provisions made for chaining cylinders ❑ ❑ ❑ ❑ Is room containing cylinders above ground 0 ❑ ❑ ❑ Does the room have doors which open outward ❑ 0. .0 L7 Is the room ventilated with air intake above exhaust ❑ ❑ ❑ f ] If released, will gas flow into ventilation system ❑ ❑ ❑ ❑ Are ventilation and lighting switches located outside ❑ ❑ ❑ ❑ Are ventilation and lighting switches corrosion resistant ❑ ❑ ❑ ❑ Provisions made to measure weight of cylinder Q ❑ ❑ ❑ SOURCE OF SUPPLY Groundwater 0 ❑ ❑ ❑ Surface Water ❑ 0 ❑ ❑ Water Quality Problem ❑ ❑ ❑ ❑ Explain: Conditions / Comments: Calculations: Reviewed by:_ Field Visit by: Inventory Updated (required for payment) ...... ❑ i.7 ❑ Date: Date: 2009 -2011 IGA for Safe Drinking Water Program Services Page 56 of 58 128887 pgm - Deschutes County ATTACHMENT 10 CHECKLIST FOR WATER SYSTEM PLAN REVIEW Page 5 of 5 Treatment— UV or Corrosion Control Name of System: Date Plan Received: Name of Project: Date Plan Reviewed: Project Review#: PWS #: Engineer County: ULTRAVIOLET LIGHT: Plan Review Field Visit YN YN Appropriate plan review fee received F F Installation: Does the Unit meet the specs of NSF Standard 55 Class A F F .F F Make and Model Failsafe set point at 38mJ /cm2 (Dosage) r r r r ....... of Unit mWicrn2 ..... Unit Design Flow Rate UV Lamps insulated from direct contact with water r r T r UV Lamps are removable F F .F F Fixed flow rate control (set at gpm) r F F F UV sensor with alarm to measure lamp intensity F r F r Automatic water flow shut -off if intensity drops below 38mJ /cm2 I' F F F Visual verification of operation of lamps r r r r Equipment able to withstand working pressure of at least 100 -psig r r Accessible for cleaning and replacement of lamp sleeves and sensor Fr I' r Lamps changed per manufacturer's recommendation, or at least annually F I' F r Shutoff valves at inlet and outlet F r F I' NO Bypass around UV system (yes = no bypass) r r .r r Comments: CORROSION CONTROL: Appropriate treatment based on WQP's and Guidance Manual r F Type (circle): Soda Ash, Caustic Soda, Aeration, Calcite Contactor, Lime, Orthophosphate, Sodium Bi- Carbonate If Aeration, is chlorination practiced downstream F F r r Schematic drawing showing where chemicals are injected F F Are chemicals injected separately r F .1' r NSF Certified Additives and Equipment F IT T F Feed pump acceptable F F Testing equipment available for testing WQP's I r .F r Operation and maintenance manual or plan T r IT I' Letter sent with instructions on sampling and setting minimum WQP F F Comments: Review By: Field Visit By: Inventory Updated? I' F Fr Date: Date: 2009 -2011 1GA for Safe Drinking Water Program Services Page 57 of 58 128887 pgm - Deschutes County ATTACHMENT 11 System: Contact with: Staff Member: Chemical Monitoring Schedule Change Form DHS Drinking Water Program PWS ID #41 (_ ) _ - , County: Date: System Type (check Dept. of one): ❑ State ❑ County ❑ Ag ❑ Other ❑ Community (C) ❑ Non - Transient Non Cotnmmnity (NTNC) ❑ Transient Non - Community. (NC) Regulated t P) ❑ State Check if New System or Sample For new systems, include all necessary chemicals and sarrlpling points. Pt: ❑ Sample Point ID (Entry ID or Distribution Sampling Point P 9 ID) Chemical Groups 5P: NO3, NO2, IOC; VOC, SOG, AS, ` LPH' URA' RADL etc. -see. reverse tor complete list & descriptions Frequency Duration c O z nr m (7 r, c ¢ to T m y 1 ,, m g E to y 0 B w m m ,} /— m. m > C ul w y O m m T e iu y y O Begin Date _ End Date (Leave Blank if Monitoring i5 in be Continuous) Entry ID (In SDWIS Entry ID "A' will appear as Facility ID "EP-A", Entry ID "D" will appear as "EP-8", etc.) ❑ ❑ ❑ ❑ r ❑ ❑ ❑ ❑ / i / / ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ / / / / ❑ 0 ❑ ❑ ❑ ❑ ❑ ❑ / / / I ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ / / / / ❑ ❑ ❑ ❑ ❑ 0 ❑ ❑ 1 1 / / ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ / / / / ❑ ❑ ❑ ❑ 0 ❑ ❑ ❑ / / / / ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ / / / / Distribution Sampling Point ID ❑ ❑ ❑ 0 Q ❑ ❑ ❑ / / / / (In SDWIS Distrib. Sampling Point "A" will be identified as' Facility ID "DIST -A ) (DBP Sample Points must indicate either DBPMAX or DBP## (e g. DBP01 at 5050 SE Stark St, DBPO2 at 800 NE Oregon St, etc.)) DIST -A ar DBPMAX01, DBP01, etc. Sample Site ID or Street Address (Enter For DBP@ only this address will be used to tie sample results to the site) DBP, LCR, or ASBD Quarterly - n E c w a 2 31 >._ Once Every 3 Years Once Every 6 Years a H > m I-14 } O °' Begin Date End Date ❑ ❑ ❑ ❑ ❑ / / / / ❑ ❑ ❑ ❑ ❑ ❑ / / 1 1 ❑ ❑ ❑ ❑ ❑ ❑ / / r / L ❑ ❑ ❑ ❑ ❑ ❑ / / r r Signature: Date: 2009 -2011 IGA for Sate Drinking Water Program Services Page 58 of 58 128887 pgm - Deschutes County