004-24 - Kitsap County - ContractKC-070-24
AGREEMENT FOR PROVISION OF JUVENILE DETENTION FACILITIES
BETWEEN KITSAP COUNTY AND THE CITY OF PORT ORCHARD
This AGREEMENT FOR THE PROVISION OF JUVENILE DETENTION FACILITIES
("Agreement") is entered into by and between Kitsap County ("County"), a political subdivision of
Washington State, and the City of Port Orchard, a municipal corporation of Washington State ("City").
RECITALS
WHEREAS, the County is authorized by law to operate the Kitsap County Juvenile Detention Facility
("Detention Facility") to confine juvenile offenders;
WHEREAS, the City does not possess sufficient facilities to confine juvenile offenders;
WHEREAS, the County has space available in its Detention Facility and is amenable to making such space
available to confine the City's juvenile offenders, pursuant to the lawful authority of the City, for a rate of
compensation as mutually agreed to by the parties; and
WHEREAS, the County and the City have determined that it would be mutually beneficial to the parties to
enter into this Agreement.
AGREEMENT
NOW, THEREFORE, in consideration of the foregoing recitals which are incorporated herein by this
reference, the parties agree as follows:
SECTION 1 DEFINITIONS
1.1 "Admitted" or" Admission" of the Juvenile by Kitsap County will occur when the Detention
Facility staff has advised City's Representative that the Juvenile presented to the Detention Facility
for confinement has been accepted for admission by the Detention Facility, the booking process
completed, and Kitsap County has taken physical control of the Juvenile.
1.2 "Additional Health Care Services" means any medical, mental health, dental or other form of
health care and/or treatment provided to a Juvenile not routinely provided by Kitsap County's in-
house health care provider in the Detention Facility, regardless of where such services are
provided including, without limitation, emergency medical services, prescriptions, laboratory
tests, medical imaging services, necessary durable medical equipment, and any in -patient or out-
patient treatment or referral.
1.3 "Bed -Day" means any consecutive period of time exceeding 12 hours during which a Juvenile is
in the custody of the Kitsap County Juvenile Department Detention Facility, which includes
booking.
1.4 "Booking" means the process in which the Juvenile's personal data is recorded, the City's
Representative confirms the Juvenile's identity and the lawful basis for confinement, and any
other screening process routinely required by the Detention Facility prior to Admission.
1.5 "City Representative" means an authorized member of the City of Port Orchard Police
Department or other authorized representative of the City.
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1.6 "Detention Facility" means Kitsap CountyJuvenile Department Detention Facility.
1.7 "Detention Manager" means the Manager of the Kitsap County Juvenile Detention Facility or
his/her designee.
1.8 "Gravely Disabled" means a person who, as a result of a mental disorder, is in danger of serious
physical harm resulting from a failure to provide for his/her essential human needs of health or
safety; or manifests severe deterioration in routine functioning evidenced by repeated and
escalating loss of cognitive or volitional control over his/her actions and is not receiving such
care as is essential for his/her health or safety.
1.9 "Juvenile" means a youth under the chronological age of eighteen years of age arrested on a Port
Orchard warrant or by the City's law enforcement officers for violation of a law for which
confinement of a juvenile is lawful.
1.10 "Partial Bed -Day" means any consecutive period of time of 12 hours or less during which a
Juvenile is in the custody of the Kitsap County Juvenile Detention Facility, which includes
Booking.
SECTION 2 SERVICES
2.1 This Agreement is limited to the detention of juveniles for offenses which are within the
jurisdiction of, and charged within, the Pat Orchard Municipal Court under RCW
13.040.030(i)(e)(i i i).
2.2 The County agrees to accept Juveniles for confinement in the Detention Facility and the City
agrees to compensate the County for such services as provided in this Agreement.
2.3 Confinement of a Juvenile will not exceed thirty (30) consecutive calendar days, unless otherwise
agreed to by the County on a case -by -case basis.
2.4 The County will provide the Juveniles confined in the Detention Facility with access to the same
education, medical, dental, and other services provided to other juveniles confined in the Detention
Facility as required by law and County policy and procedures.
2.5 Juvenile Compliance. All Juveniles confined in the Detention Facility shall be subject to and
expected to comply with all Detention Facility rules, including those related to discipline,
emergency, safety and security rules.
2.6 Juveniles Exceeding 18 years. Upon the prior written request from the City, the County may
continue to confine the City's Juveniles in the Detention Facility beyond the age of 18 years, but
in no event older than 21 years of age.
2.7 Right of Refusal. The County at all times and for all purposes under this Agreement retains the
absolute right in its sole discretion to reject, limit, or revoke the acceptance of any or all
Juvenile(s), or ally other person, for confinement in the Detention Facility at any time and for any
reason whatsoever.
2.8 Non -Detention Services. Court services, probation services, or the like, shall continue to be the
sole responsibility of the City and are not subject to this Agreement.
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SECTION 3 TERM
This Agreement shall commence on January 1, 2024, and terminate on December 31, 2024, unless
terminated or extended. This Agreement may be extended for additional consecutive one (1) year periods
at the mutual written agreement of the patties, not to exceed a total of three (3) years. Neither party has an
obligation to extend this Agreement.
SECTION 4 TERMINATION
This Agreement may be terminated by either party, at the mutual convenience of the party, upon 60 days
prior written notice to the Contract Representative of the other party. The notice shall identify the specific
plan for accommodating the removal of the Juveniles affected by the termination. In the event of
termination, the City shall at its own expense, transport the Juveniles from the Detention Facility on or
before the effective date of the termination.
SECTION 5 COMPENSATION AND BILLING
5.1 Bed -Day Rate/Housing. The City shall pay the County a basic fee of One Hundred Fifty Dollars
($150.00) per bed -day for every Juvenile confined in the Detention Facility.
5.2 Partial Bed -Day Rate. The City shall pay the County a partial bed -day fee of Seventy-five
Dollars ($75.00) per partial bed -day for every Juvenile confined in the Detention Facility.
5.3 Method of Billing. County will invoice the City monthly for amounts due the County under this
Agreement for services provided in the previous month. Such fees shall be due and payable by the
City within thirty (30) days from the billing date. Account balances overdue 30 days or more will
be subject to a service charge of 1% per month (12% per annum). Should collection become
necessary, the City shall be responsible for the payment of all collection costs, including reasonable
attorney fees, associated with the collection of late payments.
5.4 Annual Increase. The bed -day and partial bed -day rate shall be increased annually by one hundred
percent (100%) of that percentage increase set forth in the All Urban Consumers Index (CPI-U)
(1982-1984=100) for the Seattle -Tacoma -Bremerton area as is specified by the Bureau of Labor
Statistics, United States Department of Labor for the prior 12-month period ending in December;
provided, however, the increase shall not be more than six percent (6%) of the amount for the
prior year.
5.5 Other Costs. The City shalt promptly pay all other costs, including those for Additional Health
Care Services to the County orthird parties as provided herein.
SECTION 6 PRESENTATION AND ADMISSION
6.1 Prior Verification. Prior to presenting a Juvenile for confinement, the City's Representative shall
contact the Detention Facility and obtain verification from the Detention Manager that the Detention
Facility may Admit the Juvenile for confinement and ensure the order authorizing confinement
contains a provision authorizing the Detention Manager to provide emergency medical treatment to
the Juvenile. Prior verification does not guarantee Admission by the Detention Facility.
6.2 Presentation. When presenting a Juvenile to the County for confinement, the City Representative
shall remain at the Detention Facility with the Juvenile and comply with all requirements of this
Section and all Detention Facility procedures and rules until the Juvenile has been admitted.
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6.3 Prohibitions
A. Any Juvenile who is unconscious, under the influence of alcohol and/or drugs (as
determined by Kitsap County), or Gravely Disabled may not be Admitted into the
Detention Facility.
B. Any Juvenile with significant injuries, or who reports that he/she is currently
experiencing significant medical or mental health issues, may be Admitted in the
Detention Facility only when the Juvenile has been medically cleared for confined
Detention by a medical doctor, nut sepractitioner, or other equivalent medical personnel, and
approved by Kitsap County.
6.4 Certification. The City is at all times solely responsible for determining that all Juveniles
presented by City Representatives to the County for confinement are lawfully detained and
confined, and certifies the same by the act of presenting the Juvenile for confinement to tine
Detention Facility. The City shall defend, indemnify and hold the County harmless as provided
herein for any claim or action resulting from the detention of a Juvenile wrongfully presented by
the City, or its representative, to the County for confinement.
6.5 Intake Assessment. When presenting a Juvenile to the Detention Facility for confinement, the
City's Representative shall provide the Detention Facility staff with the following:
A. Duration/Conditions - provide copies of all records in the possession pertaining to the
Juvenile's confinement, which includes without limitation, all relevant court orders which
identify the duration and other terms of confinement.
B. Emergency Medical Treatment - ensure the order of confinement contains authorization
for Director of Kitsap County Juvenile Detention Facility to provide the Juvenile
emergency medical treatment.
C. Intake Assessment - provide all information requested on the Detention Facility Intake
Assessment attached hereto as Exhibit A.
D. Parental Consent (Medical Treatment) - provide a signed copy of the Parental Consent
for Medical Treatment and a copy of any medical insurance coverage information for the
Juvenile in the event the Juvenile requires medical treatment while in the Detention
Facility. See Exhibit B - Parental Consent for Medical Treatment. The City is and
remains responsible for obtaining all consents and providing medical insurance coverage
information.
E. Medical/Mental Health Status - provide a copy of the Juvenile's medical records in the
City's possession and advise the Detention Facility staff of all information known about a
Juvenile's medical and mental health status (current and historical), including the
Juvenile's psycho -sexual history.
F. Drugs/Alcohol - inform the Detention Facility staff of all information known about the
Juvenile's alcohol and drug usage (current and historical).
G. ADA Accommodations - inform the Detention Facility staff of any known
accommodation needs of the Juvenile consistent with the requirements of the Americans
with Disabilities Act.
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H. Information - provide all relevant information available regarding the Juvenile and such
other information/documentation routinely required by the Detention Facility.
6.6 Admission. The City's Representative transporting the Juvenile to the Detention Facility shall
remain at the Detention Facility with the Juvenile until advised by the Detention Facility staff that
the preliminary portion of the booking procedure has been completed and the Juvenile has been
admitted into the Detention Facility.
6.7 Personal Property. Upon Admission of the Juvenile for confinement, County agrees to accept and
store the Juvenile's personal belongings in an amount not to exceed a day pack or equivalent in
volume. Any personal belongings exceeding this amount will require approval from County. Any
personal property not removed fiom the Detention Facility by the Juvenile upon the Juvenile's
release from the Detention Facility will be deemed to be abandoned and automatically become
the property of the County without the requirement of further court action.
6.8 Notice. The County will use reasonable efforts to advise the City if a Juvenile is being detained
by another law enforcement agency on a warrant issued by the City.
SECTION LEGAL REPRESENTATION -JUVENILE
The City shall be responsible for responding to requests for legal assistance or legal representation made by
the Juvenile confined in the Detention Facility. The County will notify the City of any requests for legal
assistance or legal representation made by a Juvenile to a County detention officer.
SECTION 8 TRANSFER AND RELEASE
8.1 Release. The Juvenile may be released from confinement from the Detention Facility as provided
below:
A. Request by City. The Juvenile may be released to the City's Representative upon written
direction or verified verbal direction from the City's Representative.
B. Court Order/Bail. The Juvenile may be released by valid court order or posting of bail.
C. Treatment. The Juvenile may be released due to medical, mental health, dental treatment
or any other health care services not available within the Detention Facility.
D. Emergency/Catash'o rile. The Juvenile may be released in the event of any emergency or
catastrophic condition occurring that poses a reasonably imminent danger to the safety of
the Juvenile or County personnel. 'file decision to release or remove persons from the
Detention Facility will be at the sole discretion of the County. In such cases, the County
will provide the City reasonable notice of the removal and shall exercise reasonable care
for the safekeeping and custody of the Juvenile(s) so removed.
8.2 Resumption of Custody. The City shall be deemed to have resumed custody of the Juvenile upon
the County's presentation of the Juvenile to the City, or upon the City's Representative taking
Physical control of the Juvenile.
SECTION 9 TRANSPORTATION AND SECURITY
9.1 Transportation. Unless otherwise agreed, the City shall be responsible for all transportation of
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Juveniles, which includes the delivery and pickup of the Juveniles for all purposes under this
Agreement.
9.2 Release. A City Representative shall be promptly available to pick up the Juvenile when released
from the Detention Facility, regardless of the basis of the release. Promptly available means
immediately available, and in no event longer than four (4) )tours after the City receives notice
from the County of the Juvenile's release. Notice for this purpose may be a written or oral notice
from the Detention Facility to the City.
9.3 Reimbursement — Transportation/Security. In the event that Kitsap provides the transportation,
regardless of the reason, the City shall be required to reimburse Kitsap for all costs of
transportation and associated security incurred by Kitsap to secure emergent medical evaluations,
emergency treatment and to support the reasonable necessary operational needs of the Detention
Facility. The cost for transportation and custodial security time performed by Kitsap staff shall
be the Internal Revenue Service mileage rate in effect at the time of the service performed and the
current cost to provide a detention officer (currently $40.14 per officer per hour).
SECTION 10 HEATH CARE
10.1 Services Provided. Upon County's Admission of the Juvenile, the County will provide the
Juvenile at no additional charge the routine medical services that are readily available to other
detainees from the County's in-house third -party health care provider for which the health care
provider does not render a separate billing for providing such service to a detainee. Services for
which a separate billing is provided are considered Additional Health Care Services.
10.2 Reimbursement. The City shall reimburse County for its proportion of all Additional Health Care
Services and associated costs and expenses in providing such services to a Juvenile.
Reimbursement shall be paid directly to the County or third parties, as directed by the County.
10.3 Hospitalization. hi the event a Juvenile is hospitalized, the County will advise the City. The City's
Representative will advise the County if the City will be providing the security or requests the
County to do so. If the City is to provide the custodial security, the Juvenile shall be released to
the custody of the City. If the County agrees to provide the custodial security for the Juvenile, the
City shall be responsible for reimbursing the County for all costs associated with the
transportation and custodial security, as provided in Section 9.
10A Emergency(Non-curer ent Care outside) Facility —Notification. The County will use reasonable
efforts to notify the City within four (4) business hours of transport (Monday- Friday, 9am- Spin)
of emergent care for a Juvenile outside the Detention Facility. For non -emergent care onside of
the facility, the County will use reasonable efforts to notify the City before noon on the next
business day after the transport occurs. Lack of notice will not relieve the City of its
reimbursement obligations to Kitsap County.
10.5 No Waiver of Right to Seek Reimbursement. Nothing in this Agreement shall be construed to
waive the rights of either party to seek reimbursement to)- costs from the Department of Social
and Health Services, or from the Juvenile, his or her parent/guardian, or any other responsible
third -party.
SECTION 11 INSURANCE AND INDEMNIFICATION
11.1 Insurance. The County and City shall maintain, throughout the term of this Agreement,
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insurance adequate to protect both parties against claims that may arise as a result of the
performance of this Agreement. Such insurance shall be placed with responsible insurers,
self -insured, or carried through participation in an insurance pool at levels of coverage
adequate to protect the County and the City against loss, and as ordinarily carried by
municipalities engaged in similar operations. Upon request of the other party, the County and
City shall provide evidence of liability coverage.
11.2 Indemnification. The City agrees to defend, indemnify and hold harmless the County, its
appointed and elected officials, employees and agents from and against all liability, loss,
cost, damage and expense whatsoever, including costs and attorney's fees in defense thereof
because of actions, claims or lawsuits alleging damages sustained by any person or property
including death at any time resulting thereof, arising from or alleged to have arisen from: i) the
City's performance under this Agreement or as a consequence of any wrongful or negligent
acts or omission of the City, its appointed and elected officials, employees and agents; ii) the
wrongful detention of a Juvenile as a result of the City's actions or failure to act; and/or iii)
failure or refusal to timely release a Juvenile as a result of the City's actions or failure to act.
11.3 To the extent the claim, damages, losses and expenses are cause by intentional acts of or by the
concurrent negligence of Kitsap County, its officers, agents, or employees, the City's
indemnification obligation hereunder shall be limited to the City's proportionate share of
liability as agreed to by the parties to this Agreement or determined by a court of competent
jurisdiction.
11.4 Kitsap County agrees to defend, indemnify and hold harmless the City, its appointed and elected
officials, employees and agents from and against all liability, toss, cost, damage and expense
including costs and attorney's fees in defense thereof because of actions, claims or lawsuits
alleging damages sustained by any person or property including death at any time resulting
thereof, arising from, or alleged to have arisen from: i) Kitsap County's performance under this
Agreement or as a consequence of any wrongful or negligent acts or omission of Kitsap County,
its appointed and elected officials, employees and agents; ii) wrongful detention of a Juvenile as a
result of Kitsap County's actions or failure to act; and/or iii) Kitsap County's failure or refusal to
timely release a Juvenile.
11.5 To the extent the claim, damages, losses and expenses are caused by intentional acts of or by the
concurrent negligence of the City, its officers, agents, or employees, Kitsap County's
indemnification obligation hereunder shall be limited to Kitsap County's proportionate share of
liability as agreed to by the parties to this Agreement or determined by a court of competent
jurisdiction.
11.6 Solely for the purposes of this indemnification provision, the City expressly waives any
immunity derived from Title 51 (Industrial Insurance) of the Revised Code of Washington or
the City's equivalent thereof, and acknowledges that this waiver was mutually agreed upon
by the parties.
11.7 Obligations/Notice of Claim. County will provide the City notice of the assertion of liability by
a third party that may give rise to a Claim by County against the City based on the indemnity
contained herein. City shall promptly advise County in writing, which shall in no event
exceed 14 calendar days from the notice date, whether City accepts or denies tender of the
claim. City shall reimburse Comity for all fees and costs of defense whether incurred before or
after the notice of claim. City shall keep County timely and fully informed through all stages of
the defense and promptly respond to and comply with County's requests for information. The
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County at all times reserves the right, but not the obligation, to participate in the defense and such
participation shall not constitute a waiver of City's indemnity and defense obligations under the
Contract.
SECTION 12 GOVERNING LAW
Governing Law/Venue. The Agreement, and the Juvenile(s) confined under this Agreement, shall be made
under, construed in accordance with, and governed by the laws of the State of Washington, without regard
to conflicts of law or choice of law provisions. Any action arising out of, related to or in connection with
this Agreement shall be instituted and maintained only in a court of competent jurisdiction in Kitsap
County, Washington or as provided by RCW 36.01.050.
SECTION 13 CONTRACT REPRESENTATIVES
Unless otherwise provided herein, any required notice will be in writing and deemed given and received
either on the date personally served to the other patty's Contract Representative or on the third day after the
date of the postmark of deposit by registered or certified first-class U.S. mail, postage prepaid and
properly addressed to the Contract Representative as follows:
County
Michael S. Merringer, Director
Kitsap County Juvenile and Family Coma Services
1338 SW Old Clifton Road
Port Orchard, WA 98367
SECTION 14 NON-DISCRIMINATION
0-ty
Matt Brown, Chief of Police
Port Orchard Police Dept.
546 Bay Street
Port Orchard, WA 98366
The parties in the performance of this Agreement shall not discriminate against any person on the basis of
race, color, creed, religion, national origin, age, sex, marital status, sexual orientation, veteran status,
disability, or other circumstance prohibited by federal, state, or local law, and shall comply with Title VI of
the Civil Rights Act of 1964, P.L. 88 354 and Americans with Disabilities Act of 1990.
SECTION 15 INDEPENDENT CONTRACTOR
For all purposes, each party will act in its individual capacity and not as an agent, employee, partner, joint
venture, or associate of the other. An employee, agent, or subcontractor of one party shall not be deemed
or construed to be the employee, agent or subcontractor of the other for any purpose whatsoever
including responsibility for any federal or state tax, industrial insurance or social security liability.
SECTION 16 ACCESS AND RECORDS
16.1 Access - Detention Facility. The City shall have the right to inspect, at mutually agreeable times,
the Detention Facility in order to confirm the County maintains standards acceptable to the City and
that its detainees are treated appropriately. The County agrees to manage, maintain and operate its
Detention Facility consistent with applicable federal, state and local laws.
16.2 Access to Juveniles. City law enforcement shall have the right to interview Juveniles at any
reasonable time within the Detention Facility and the option to use the Detention Facility
interview rooms.
16.3 Records. The County agrees to maintain a system of record keeping relative to the booking and
confinement of each Juvenile consistent with the record keeping by the County for all other
detainees. The County will keep records of all medical, mental health or dental services it
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provides to a Juvenile as required by law. The County agrees to share all information, including
insurance information, regarding a Juvenile with the City as authorized by law.
SECTION 17 GENERAL PROVISIONS
17.1 Force Majeure. Neither party shall be in default by reason of any failure in performance of this
Agreement if such failure arises out of causes beyond their reasonable control and without the
fault or negligence of said party including acts of God, terrorism and other acts of public enemy,
war, epidemics or quarantine restrictions.
17.2 No Waiver. No waiver of any right under this Agreement shall be effective unless made in writing
by an authorized representative of the patty to be bound thereby. Failure to insist upon full
performance on any occasion shall not constitute consent to or waiver of any continuation of
nonperformance or any later nonperformance; nor does payment of a billing or continued
performance, after notice of a deficiency in performance, constitutes acquiescence thereto.
17.3 Priority. The Detention Facility policies and rules shall apply for all purposes, unless they conflict
with the terns and conditions of this Agreement. In the event of conflict, this Agreement will
control.
17.4 Modification. No supplement, modification, or amendment of any term of this Agreement will be
deemed binding or effective unless in writing and signed by both parties.
IT5 Assignment/Dele ag tion. Neither party may assign or delegate its rights, nor its responsibilities
under this Agreement to a third party, without the prior written consent of the other party. Any
purported assignment or delegation in violation of the subsection is void.
17.6 Severabilitv. The provisions of this Agreement are severable. Any term or condition of the
Agreement or application thereof deemed to be illegal, invalid or unenforceable, in whole or in
part, shall not affect any other term or condition of the Agreement and the parties' rights and
obligations will be construed and enforced as if the Agreement did not contain the particular
provision.
17.7 Third -Party 13eneficiarv. Nothing under this Agreement shall be construed to give any rights or
benefits in the Agreement to anyone other than the County and the City, and all duties and
responsibilities undertaken pursuant to this Agreement will be for the sole and exclusive benefit
of the County and the City, and not for the benefit of any other party.
17.8 No Waiver. Either party's failure to insist on strict performance of any term or condition of the
Agreement shall not be deemed a waiver of that term or condition even if the party accepting or
acquiescing in the nonconforming performance knows of the nature of the performance and fails
to object to it.
17.9 Entire Apreennent. The parties acknowledge that this Agreement is the product of negotiation
between the parties and represents the entire agreement of the parties with respect to its subject
matter. All previous agreements and representations, whether oral or written, entered into prior to
this Agreement are hereby revoked and superseded.
17.10 Provisions Required by Law. Each and every provision of law and any clause required by law to
be in the Agreement shall be read and enforced as though it were included herein and if through
mistake or otherwise any such provision is not inserted, or is not correctly inserted, then upon the
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application of either party the Agreement shall forthwith be physically amended to make such
insertion or correction.
17.11 Counterparts/Electronic Signatures. This Agreement may be executed by the parties in any
number of separate counterparts, each of which when executed and delivered shall be deemed an
original, and all such counterparts shall together constitute one original document. All signatures
need not be on the same counterpart. A facsimile, email, or other electronically delivered
signatures of the parties shall be deemed to constitute original signatures and deemed to constitute
duplicate originals.
17.12 Survival. Those provisions of the Agreement that by their sense and purpose should survive
expiration or termination of the Agreement shall so survive such as references to compensation
and indemnification. Those provisions include, but are not limited to, Sections 5 (Compensation
and Billing), 6 (Presentation and Admission), 9 (Transportation and Security), 10 (Health Care),
11 (Insurance and Indemnification), 12 (Governing Law), 15 (Independent Contractor), and 17
(General Provisions).
17.13 Authorization. Any authorizations, actions required, or permitted to be taken, and any document
required or permitted to be executed under this Agreement will be taken or executed only by a
duly authorized representative of the party. Each party warrants and represents to the other that
the person signing below has been properly authorized and empowered to execute this Agreement
on behalf of the Party for whom they sign.
Approved and Executed this _ of 2023
CITY OF PORT ORCHARD
ROB PUTAANSUU, Mayor
ATTEST:
Brandy Wallace, City Clerk
Approved and Executed this
tof Q 'Q t 2023
BOARD OF COUNTY COMMISSIONERS
KITS" C UNTY, WASHINGTON
CHARLOTTE GARRIDO, Chair
KATHE E Ty WALT S, Commissioner
CHRISTINE ROLFES, Commissioner
ATTEST:
Dana Daniels, Clefk of the Board
Page 10 of 11
DocuSign Envelope ID: 4B499115-0979-4325-BAA4-352FC496BO4F
application of either party the Agreement shall forthwith be physically amended to make such
insertion or correction.
17.11 Counterparts/Electronic Signatures. This Agreement may be executed by the parties in any
number of separate counterparts, each of which when executed and delivered shall be deemed an
original, and all such counterparts shall together constitute one original document. All signatures
need not be on the same counterpart. A facsimile, entail, or other electronically delivered
signatures of the parties shall be deemed to constitute original signatures and deemed to constitute
duplicate originals.
17.12 Survival. Those provisions of the Agreement that by their sense and purpose should survive
expiration or termination of the Agreement shall so survive such as references to compensation
and indemnification. Those provisions include, but are not limited to, Sections 5 (Compensation
and Billing), 6 (Presentation and Admission), 9 (Transportation and Security), 10 (Health Care),
11 (Insurance and Indemnification), 12 (Governing Law), 15 (Independent Contractor), and 17
(General Provisions).
17.13 Authorization. Any authorizations, actions required, or permitted to be taken, and any document
required or permitted to be executed under this Agreement will be taken or executed only by a
duly authorized representative of the party. Each party warrants and represents to the other that
the person signing below has been property authorized and empowered to execute this Agreement
on behalf of the Party for whom they sign.
Approved and Executed this _ of 2023
CITY OF PORT ORCHARD
CDocaSfgnetl by:
I�krt PaEaat Sw
AANSUU, Mayo
k
Docusignea by:
t�•, IAaI(.au,
Brani(�S�i cie City Clerk
Approved and Executed this —of , 2023
BOARD OF COUNTY COMMISSIONERS
KITSAP COUNTY, WASHINGTON
CHARLOTTE GARRIDO, Chair
KATHERINE T. WALTERS, Commissioner
CHRISTINE ROLFES, Commissioner
ATTEST:
Dana Daniels,
Page 10 of 11
of the Board
DETFN'I'ION rACIL1TY INTAICG' ASSESSMENT
Juvenile Name:
DOB:
JCS fit:
Address
Phone:
Legal Guardian:
LG DOB:
Address:
LG Phone:
Fxantinnr'c nhcarvatinnc
Vitals:
Temp: Height Weight
1.
Consciousness concerns (e.g. unable to speak smoothly I with coherent thought)
Yes
No
Describe:
2.
Signs of drug or alcohol withdrawals (e.g. seizure, shakes, pinpoint pupils, vomiting)
Yes
No
Last alcohol or substance use (what/when);
3.
Injury I trauma concerns (e.g. sign of head Injury or open wounds)
Yes
No
Describe:
4.
Breathing concerns (e.g. unable to complete sentences, or alters posture to breath)
Yes
No
Describe;
5.
Infection concerns (no fever, night sweats, weight loss, cough, vomiting, diarrhea)
Yes
No
Describe;
6.
Acute skin concerns (e.g. spreading rash, swelling, discharge, needle marks)
Yes
No
Describe:
7.
Currently pregnant
Yes
No
First day of lastperiod:
-*it "Yes" to any, follow tH protocol and mtorm on•call PCHS medical provider that dau.
8.
Acute behavioral concerns (e,g. suicidal ideation or assaultive)
Yes
No
Describe;
4 If "Yes" follow ER protocol and Inform County Behavioral Health Provider that day
9. PHYSICAL HEALTH CONCERNS: (Circle any/all that apply) Yes No
Asthma Diabetes, Seizures, Kidney I Liver problems, HIV, TB hepatitis)
10 MENTAL HEALTH CONCERNS: (Circle any/ail that apply) Yes No
(Bipolar, Eating disorder, PTSD, Psychosis, Overdose history, Suicidal ideation
11. 1 Food, Drug, Latex Allergies (list below) I Yes I , No
Allerav:
Reaction
12. Medications (listbelow) Yes No
Name:
Name:
Dose: I Freq:
Dose: I Free:
IName: I Dose: I Freq:
3 Call PCJ1S at tilne of booking if detainee has predications Gut NOT ivith them
Officer: I Date:
PARENTAL CONSENT FOR MEDICAL TREATMENT
KITSAP COUNTY JUVENILE DETENTION CENTER
HEALTH SERVICES
Parental Consent for Medical Treatment
1, parent/legal guardian of
a detainee at the Kitsap County Juvenile Detention Facility (KCJDF), do hereby give my consent for routine and/or emergent medical or dental
care and/or immunizations, as deemed necessary by the Health Services staff or the Detention Specialist staff.
- In the event my child develops a medical or dental problem beyond the capabilities of the KCJDF Health Services, I authorize the medical or
dental facility and the medical or dental provider to which my child is referred, to evaluate and treat as indicated.
- I further authorize the medical or dental facility and the medical or dental provider to release such information as may be needed for the
completion of hospital claims, to any insurer or to the KCJDF and Health Services staff for the determination of follow-up treatment.
- I also agree to be financially responsible for any and all medical and dental care, including prescriptions that may be necessary for my child.
- I further authorize the ICCJDF staff, under the direction of the Health Services staff; to administer any approved prescription or over-the-
counter medications, to my child pursuant to the prescribed medical indications and directions on the container. All approved medications
given my child shall be appropriately recorded.
*PARENT NOTIFICATION:
HIPAA rights notification available online and/or available for print upon request
— Visitation times and procedure have been explained
Court time and/or probable -cause weekend procedure has been explained
rneocat insurance:
Group:
CARE TEAM:
Primary care provider (PCP): Name:
Specialists
Name:
Case manager (DSHS, school, etc)? Name:
Phone:
Phone:
Phone:
'Health Services staffto note / coordinate efforts with care team outside detention center as able / appropriate.
Other information we should know about your child?
This authorization is valid from this date of this authorization until the minor has completed all detention time order this Cause
Number as ordered by the Court, or until the minor has reached the age of consent.
Parent / Guardian / Other
DO#
Detention Officer/Probation Officer
Date Tnne
Date Time
VERBAL Consent
Verbal consent given by parent and/or legal guardian of named
juvenile, for the medical and/or dental care listed above by telephone conference with the Detention Intake Officer(s).
(Two Detention Officers' signatures are required when receiving verbal medical consent)
Detention Officer 01
Detention Officer #2
Updated for use effective 12/01/2023
DO# Date:
DO# Date:
Time:
Time: