ARKANSAS DEPARTMENT OF HUMAN SERVICES CHILD CARE SYSTEM
PARTICIPANT AGREEMENT
Section I
: Provider Information
Facility Name:
________________________________________________________________________________
Mailing Address:
________________________________________________________________________________
City: ___________________________________________
State:________________ Zip Code:
________________
Taxpayer Identification Number (Social Security Number or
Employer Identification
Number):__________________________________________________________________________________________
Facility Owner: ________________________________ Phone
Number: (_______)________________________
Name of Board
President/Chairman:_______________________________________________________________
Board President/Chairman
Address:_______________________________________________________________
City: ____________________ State:________
Zip Code: ___________Phone Number:
(______)________________
Section II
: Purpose and
Performance off the Agreement
The purpose of this Agreement is to establish eligibility for
Provider participation in the Child Care System and to set forth Department and
Provider responsibilities and assurances. The Child Care System provides
eligible clients who receive child care services funded through the Department
of Human Services (DHS) the opportunity to select a child care provider from a
list of eligible participants.
The Provider must comply with state and federal regulations. If
any statute or regulation is enacted or promulgated requiring changes in this
Agreement, both parties will consider this Agreement to be automatically
amended to comply with the newly enacted statute or regulation as of the
effective date of the statute or regulation. DHS shall notify the Provider in
writing within thirty (30) days of the receipt of any necessary changes or
amendments to this Agreement resulting from newly enacted state or federal
statutes or regulations.
Section
III
:
Definitions
A.
Absentee Billing: Billing when a child is authorized to attend but is absent,
if according to the provider's written policy, the Provider would charge a
private pay client for that day. To charge for absent days, the Provider must
have a written absentee policy that is applied in the same way to all
parties.
B. Agreement: The Child
Care System Participant Agreement (Form DHS-9800).
C. Age Groups: For billing purposes, age
groups are as follows:
I (Infants) 0-18 months
T (Toddlers) 18-36 months
D (Preschoolers) 30-71 months
S (Schoolage) 60-155 months
D. Certificate of Authorization: A document
establishing DHS financial obligation to pay the Provider after delivery of
specified child care services. The Certificate of Authorization includes
information such as the total dollar amount authorized for the child named on
the form, the designated facility selected by the parent which the child is
approved to attend, and the duration of the authorization period.
E. Client: The parent, custodian, or guardian
(or in the case of a child in DHS custody, the child's primary caseworker) of
the child receiving child care services.
F. Daily Rates: Daily rates are determined by
dividing the weekly rate by five (5). DHS will not pay drop-in rates as the
daily rate.
G. Department or DHS:
The Arkansas Department of Human Services.
H. Early Departure: The provider will be paid
at the normal rate when a child is picked up earlier than usual. For instance,
if a child is scheduled for full-time but only attends half-time on a
particular day because of a doctor's appointment, etc., DHS will pay the
full-time rate since that is the normal time of attendance. These days will not
be billed as absentee days. If the temporary situation of early departure will
exist longer than two (2) consecutive weeks, then a new authorization with the
correct service code shall be written.
I. Facility/License Number: The number
assigned to the license or registration certificate issued by the Child Care
Licensing Unit to each specific site name and address providing child care
services. Licensure adverse action is defined as the revocation, suspension, or
denial of a license or registration.
J. Full Day Care: Greater than five (5) hours
up to ten (10) hours daily. A client may submit documentation to an Eligibility
Worker that more hours are needed and request the Supervisor to approve a
specific number of additional hours per day.
K. Halftime - between three (3) and five (5)
total hours per day. It is not necessary for these hours to be
consecutive.
L. Holiday Billing:
Allowable holidays are these: New Year's Day, Dr. Martin Luther King, Jr.,
Birthday, President's Day, Memorial Day, Independence Day, Labor Day, Veteran's
Day, Thanksgiving Day and Christmas Day. The Provider may bill absentee for the
above listed holidays if the holiday falls on a day when the child is scheduled
to attend, regardless if the Provider is open or not. Any holiday billed as
absentee will count towards the maximum billed absentee days of seven (7) per
month. Observed holidays are considered holiday billing. For example, if July
4th follows on Sunday and the state observes July
4th on Monday, billing can occur for Monday instead
of Sunday.
M. Hours of care: The
time the child becomes the responsibility of the facility. This includes
transportation if provided by the facility.
N. Night Care: Care provided between the
hours of 6:00 P.M. and 5:59 A.M. on a weekday. Over one-half of the total care
must be provided after 6:00 P.M. for an authorization to be keyed for night
care.
O. Part-Time: less than three
(3) hours but not including three (3) hours. The hours may or may not be
consecutive.
P. Provider: The name
of the owner or business name of the organization providing child care
services. DHS reserves the right to require a "Provider" to certify the name of
the facility via the Arkansas Secretary of State.
Q. Personal Identification Number (PIN):
Password for billing and electronic signature. The signature must be the person
responsible for billing.
R. Spring
Break: Spring Break is also considered a part of the seven absentee days, if a
child is absent. DHS considers Spring Break as no more than five (5)
days.
S. Taxpayer Identification
Number (TIN): A number issued by the Internal Revenue Service to report income
paid to an individual. This TIN may be either an individual's social security
number or employer identification number.
T. Temporary Absence: The absence of a child
from the child care facility when the provider expects the child to return.
Payment for temporary absences may not exceed seven (7) calendar days per
month.
U. Weekend Care: Care
provided on Saturday and/or Sunday.
Section IV
: PHS
Responsibilities and Assurances
A. DHS agrees to make available to the
Provider
mandatory
bi-annual training, new facility
owners mandatory training within 60 days of signing the Agreement, and other
reasonable technical assistance concerning departmental policy (including this
Agreement), records requirements, and billing processes for the Child Care
System.
B. DHS shall determine
client eligibility, client fees and provide authorizations for clients served
under the Child Care System. DHS will provide a written approval notice before
the child begins attending. A Certificate of Authorization will be sent to the
selected Provider within seven days of the written, faxed or electronic mail
approval notice^ In addition, the Billing Worksheets will be provided no later
than fifteen (15) days after the first day of attendance. DHS is not obligated
to pay past the ending date of the Certificate of Authorization.
C. DHS agrees to establish a public register
of all Providers participating in the Child Care System at each Department
County Office. Eligible clients will select a child care Provider from the
register.
D. DHS agrees to
reimburse the Provider for services delivered in compliance with this Agreement
after the Certificate of Authorization has been received and services are
rendered. A Provider cannot bill or receive payment for services until this
Agreement has been signed by the Provider and certified by the Department.
DHS reserves the right to prohibit the Provider, regardless of
the name or structure of the facility, from future participation in the
program. This Agreement is subject to the DHS Participation Exclusion Rule. The
Provider is responsible for all overpayments, fraud or legal proceedings
against the Provider for noncompliance.
DHS reserves the right to recoup payments through current and
subsequent payments to the Provider.
E.
DHS is not obligated to pay
any bills received more than thirty (30) calendar days after the expiration of
the Certificate of Authorization unless the Unit Administrator
grants a written waiver before the authorization expires. DHS is
not liable for untimely billing. DHS will not permit billing when the facility
is closed unless it is an observed holiday or inclement
weather.
F. DHS will
permit billing for a temporarily absent child if the billing conforms to the
requirements of the federal or state funding source. DHS will inform the
Provider if a certain funding source
does not allow
for absentee billing prior to writing an authorization on that funding source.
All absentee billing must be submitted in accordance with the requirements set
out below:
1. DHS recognizes that a client's
child may be temporarily absent from the facility because of illness or some
reason connected with the plan of service. The intent of the absentee billing
policy is to avoid penalizing either the client (by filling the child's slot in
the program due to temporary absence) or the Provider (by not allowing
reimbursement for the child's slot while it is held open pending the child's
return). The facility must be open and the billed services available before
billing for a temporarily absent child is allowable, except in the case of
holiday absences. (See definition of absentee billing.)
2. Billing for a temporarily absent child is
allowed only when the child is absent on a day the child is scheduled to attend
and there is a reasonable expectation the child will return to the program.
Billing for an absent child may not exceed seven (7) days per calendar month.
Billing for an absent child is not allowed if the child is not scheduled by DHS
to attend or if the Provider has been notified by the client or DHS that care
is no longer needed. If a child is enrolled to attend only Monday, Wednesday
and Friday, the Provider may not use absentee billing for Tuesday and Thursday.
The Provider may bill for an observedjioliday, if the observed holiday falls on
a day when the child would have been scheduled to attend, regardless whether
Provider is open or not. (See definition of Holiday Billing) The Provider may
not bill absentee days to compensate for the lack of an advance notice being
given prior to ending the child care arrangement. If the child is not expected
to return to the facility, billing must cease on the date the child leaves the
facility. The Provider may not charge the client for absentee days over the
seven days allowed. The provider agrees to notify DHS whenever a client's child
has accrued seven consecutive absentee days in any given month per child. DHS
will not pay more than seven days absentees per month per child. Absentee
billing is not allowable for Christmas Break. DHS agrees to pay for Spring
Break when a child is absent due to client being on spring break.
G. DHS will permit inclement
weather billing, if allowable through the designated federal or state funding
source and billed in accordance with the requirements set out below:
1. DHS realizes that facilities may be forced
to close due to inclement weather. DHS Inclement Weather Policy allows
Providers to bill for those operational days lost due to severe weather
conditions; however, the policy may only be applied when public schools in the
Provider's area have been forced to close or whenever other extraordinary
weather related conditions exist. "Extraordinary weather related conditions"
exist whenever it can be demonstrated that clients were unable to reach the
premises or the Provider could not open due to circumstances beyond the control
of the Provider. This does not mean that a Provider must close when local
schools close.
2. Documentation of
the specific reason for closure, the specific days the facility was closed, and
the manner in which the days billed were calculated will be provided to DHS
upon request.
H. DHS
shall notify Providers when a child becomes ineligible for continued payment.
Notice shall be provided by phone within one working day of the eligibility
determination. Telephone notice will be followed by written notice posted by
regular mail within seven working days of the date of the telephone notice. DHS
agrees to document the name of the individual they spoke with at the facility
and the time of the phone call when informing a provider about an ineligible
child.
Section V :
Child Care Provider Responsibilities and Assurances
A. The Provider agrees to comply with all the
requirements set forth in this Agreement. Failure to comply is grounds for
termination of participation in the Child Care System and for possible further
action by DHS.
B. The Provider
agrees
to attend DHS-sponsored mandatory bi-annual
training concerning this Agreement
and to comply
with all the requirements set forth in this Agreement. Failure to comply is
grounds for termination of participation in the Child Care System and for
possible further action by DHS. New facility owners must complete mandatory
training within 60 days of signing the Agreement.
C. The Provider agrees to maintain a child
care facility license or registration and to comply with child care licensing
or registration standards. This Agreement terminates upon any final agency
determination of adverse action against the facility's license. Licensure
adverse action is defined as the revocation, suspension, or denial of a license
or registration. The termination of this Agreement because of adverse licensing
action is effective immediately upon the action being taken, and remains
effective notwithstanding any appeal of the adverse action. If a facility's
compliance with licensing or registration rules cannot be determined because
the facility does not submit required information or does not permit reasonable
access to the facility, this Agreement will be terminated upon written
notification to the Provider.
D.
The Provider may hire a client if the Licensing Specialist verifies a second
caregiver is needed. The client's children must be less than fifty percent
(50%) of the current attendance.
E.
The Provider agrees to accept the DHS Certificate of Authorization as
authorization to provide and bill for services. The Provider agrees to accept
reimbursement received from DHS as
payment in full for
all services, which includes transportation (if available) to and from the day
care facility, covered by this Agreement except the collection of fees
expressly authorized by DHS. This does not preclude reasonable charges to
parents for special events outside the usual daily program costs or the
application of sliding fee scales promulgated by DHS.
The Provider may charge the client additional reasonable fees
such as registration, insurance and materials. Any reasonable charges must be
fully disclosed in a document provided to the client and DHS. The client must
have adequate time to pay the charges. Adequate time for payment of the
registration, insurance, or material fees should be a semester (four to five
months).
The Provider agrees to waive all registration, insurance,
materials and fee charges for Transitional Employment Assistance (TEA) clients
WHO ARE NOT EMPLOYED but participate in work
activities, education or training components.
In addition, the Provider agrees not to charge the client for
absentee days over the seven days allowed.
The Provider agrees that DHS does not pay Providers when the
facility is closed unless it is an observed holiday or inclement weather. The
Provider understands that DHS will not pay for Christmas Break.
The Provider agrees not to accept child(ren) without written
approval from an authorized DHS representative or Certificate of Authorization
obligating DHS.
F. The
Provider agrees that DHS will not pay Providers retroactive to the date of a
client's application or any other date other than the first day DHS can
determine the client has met all eligibility factors and is approved for
assistance.
G. The Provider agrees
to allow the client unlimited access to the client's child when the child is in
the facility.
H. The Provider must
submit a bill for actual services performed to receive payment, utilizing
state-approved billing methods.
I.
The Provider agrees that the billing for children/authorizations must be keyed
to the facility where services are provided. Providers who provide services at
one facility but bills an authorization written to another facility under the
Provider's TIN will be charged with an overpayment.
J. The Provider agrees to submit billing
within thirty (30) days of the dates the services were actually delivered to
eligible clients. No exceptions will be allowed unless a previously written
Wavier is obtained from the Unit Administrator.
K. The Provider agrees that only the
directors, owners, or authorized representatives will submit bills to DHS. If
the Provider chooses to submit bills to DHS through the automated billing
method, DHS will assign a Personal Identification Number (or PIN) to the
Provider. The Provider accepts liability for all bills submitted to DHS using
the PIN. This PIN is non-transferable. A change in Taxpayer Identification
Number (TIN) or Facility Number will require a new PIN. The Provider should
contact the local DCC Eligibility Worker or call 1-800-322 -8176 to obtain the
form, DHS-9805, Provider Billing Personal Identification Number Assignment and
Certification Statement.
L. The
Provider agrees to bill for no more than the DHS's annually published rate for
the county in which the facility is located. The Provider will charge the
client the portion of that rate established by DHS as the client's assessed fee
as stated on the Worksheet. If the Provider's normal rate is higher than the
published rate, the Provider will not charge the client the
difference between the two rates. All rate changes must be given
to DHS in writing. DHS has ten (10) days, from the date of receipt, in which to
input new rates in the day care system. Rate changes will only affect new
authorizations written after the rate change.
M. The Provider agrees that private pay
clients, receiving substantially the same services, shall not be charged at a
rate less than that paid for by clients under this Agreement. The Provider
agrees that DHS does not recognize employee's discount or multi-child
discount.
N. The Provider agrees to
notify the DHS Authorized Representative by telephone when a child withdraws
from the Child Care Voucher Program. Notice, in the form of fax, telephone or
electronic mailj shall be provided no later than the next working day after the
child withdraws. The Provider agrees that DHS does not provide pre-notification
of withdrawal from the child care voucher program. The facility shall de-enroll
a child immediately upon notice of withdrawal from the client or DHS
representative and the Provider understands and agrees that DHS or DHS clients
are not responsible for a drop period, regardless of the Provider's policy
concerning a drop notice.
O. The
Provider understands that DHS will issue authorizations which are valid only
for days that clients are eligible to receive assistance as determined by DHS.
If a client is a full-time student, the Provider understands that DHS will pay
for child care during a student's Spring Break.
P. The Provider agrees to follow absentee and
inclement weather billing procedures for children temporarily absent from the
program. (See Section
IV, Paragraphs F and G). In cases
where the client is responsible for assessed fees, the Provider is responsible
for collecting the parent co-pay amount for the absentee days and inclement
weather days.
Q. The Provider
agrees to promptly correct all billing or payment errors. In addition to any
other remedy, which may exist in law, equity, or administrative procedures, DHS
may, after proper notification, effect correction through adjustments in
current and subsequent payments to the Provider and/or other measures as
necessary. Payments may be withheld until verification of attendance records.
Current State Fiscal Year attendance records must be presented when requested
by DHS staff or authorized representatives within approximately one (1) hour of
the request. All other attendance records must be submitted by 10:00 a.m. the
day following the request from DHS staff or authorized representative. Site
visits by DHS staff or authorized representatives may be unannounced.
R. The Provider agrees to retain all books,
records, and other documents relating to expenditures, services rendered, or
individuals served under this Agreement for five (5) years from the date this
Agreement expires. If an audit is pending at the end of the five year period,
information shall be retained until resolution of the audit or any issues,
disputes or appeals raised by or resulting from the audit. Any person
authorized by DHS will have full access to these materials during this
period.
S. The Provider agrees to
document and maintain attendance records for a period of five years. Attendance
records must include the child's name, dates child was present or absent, and
signature of staff person. Attendance records must reconcile with billing
records. Provider must use a DHS-approved attendance form. The Providers will
be responsible for making additional copies of the attendance form. No
exception will be allowed, except electronic attendance records as approved by
DHS. If attendance records are not available, DHS will consider the payment in
question to be an overpayment. The approved DHS attendance forms are available
on
www.arkansas.gov/childcare/familysupport.html.
T. The Provider will maintain all client
records in a confidential manner. Upon request, access to Provider records will
be made available to DHS employees, DHS designated agents, or any agency of
state or federal government for purposes of auditing or any other reason
connected with DHS service programs. When needed to verify the Provider's cost
allocation of non-duplication of payment, the Provider will make statistical
records on expenditures charged to other funding sources available. The
Provider may require official identification prior to allowing records access.
This restriction does not apply to disclosures made with the informed, written
consent of the client. If the client is not an adult, the client's parent,
custodian, or guardian may consent on the client's behalf. If the client is an
adult, but has been declared incompetent by a probate court, the client's
guardian may consent on the client's behalf.
U. The Provider agrees to have an annual
audit in accordance with the "Guidelines for Financial and Compliance Audits of
Programs Funded by DHS" effective for the period of this Agreement. A copy of
the "Guidelines" will be provided upon request. An audit is required:
1. If the Provider is a state or local
government
2. If the Provider is a
non-profit institution and receives more than $100,000 a year in federal,
state, or combined federal and state awards and/or payments.
3. If fraud or a pattern of incorrect billing
is suspected.
Failure to submit an audit will result in the Provider losing
the privilege to participate in the voucher program until the issue is
resolved, and may result in the Provider's exclusion from all DHS programs.
(Notice will be provided in writing with specific timeframes for submission of
the audit.)
Submission of falsified records or participation in any form of
fraud by a Provider will result in exclusion from DHS programs.
V. The Provider agrees
not to discriminate against any employee or applicant for employment. Upon a
final determination by a court or administrative body having proper
jurisdiction that the Provider has violated state or federal laws and
regulations regarding discrimination, DHS may impose a range of appropriate
remedies, up to and including termination of the Agreement and exclusion from
all DHS programs.
The provider agrees to comply with Titles VI and VII of the
Civil Rights Act and to operate, manage and deliver services without regard to
age, religion, disability, political affiliation, veteran status, sex, race,
color or national origin.
W.
The Provider agrees to comply with Executive Order 98-04 (Guidelines for
Employment, Grants, Contracts, and Purchasing) by completing and returning the
appropriate Disclosure Forms to the Department. Failure to make any disclosure
required by Executive Order 98-04, or any violation of any rule, regulation, or
policy adopted pursuant to that Order, shall be a material breach of the terms
of this Agreement. Any Provider, whether an individual or entity, who fails to
make the required disclosure or who violates any rule, regulation, or policy
shall be subject to all legal remedies available to the DHS.
X. The Provider agrees to comply with
Public
Law 101-121 (Anti-Lobbying Act):
1. If the Provider receives more than
$100,000 per award of appropriated federal funds in any Agreement period (July
1 - June 30), the Provider must certify that these funds will not be used to
pay for lobbying activities by completing a Certification Regarding Lobbying
Form (DHS-9350) and submitting the form to the Department.
2. If the Provider has paid or will pay for
lobbying using funds other than appropriated federal funds, Standard Form-LLL
(Disclosure of Lobbying Activities) must be completed and submitted to the
Department.
The Provider (referred to as the lower tier participant in the
following clause) agrees to comply with Executive Order 12549 (Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion - Lower
Tier Covered Transactions), which states:
By signing and submitting this lower tier proposal (this
Agreement), the prospective lower tier participant, as defined in 45 CFR Part
76, certifies to the best of its knowledge and belief that it and its
principals:
1. Are not presently
debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any federal
department or agency.
2. Where the
prospective lower tier participant is unable to certify to any of the above,
such prospective participant shall attach an explanation to this
proposal.
Y.
The Provider agrees that it will indemnify and hold harmless DHS against any
and all liability, loss, damages, costs or expenses which DHS may sustain,
incur or be required to pay as a result of any act or omission of the
Provider.
Z. The Provider agrees to
notify DHS immediately of any change in ownership, change in business
structure, facility site location, change in employer identification number or
closure of the facility. The Provider agrees to provide DHS with a copy of the
notice from the Internal Revenue Service verifying any change in a Taxpayer
Identification Number.
AA. The
Provider may not delegate, assign, or subcontract the performance of any
obligations contained in this Agreement.
BB. The Provider agrees that all facilities
holding a valid license and all license categories under this ownership,
whether present and future, will participate in the child care system.
(See Attachment I)
CC. The Provider agrees to notify and submit
a new Contract and Grant Disclosure and Certification Form to DHS within ten
(10) days of the beginning of employment should the owner, a member of the
owner's immediate family, or an authorized representative of the facility
accept employment with the State of Arkansas. If a member of the Provider's
Board of Directors is employed by the Provider and then accepts employment or
does additional business with the State of Arkansas, the board member must
submit a Contract and Grant Disclosure and Certification Form to DHS within ten
(10) days of state employment or other business with the State of
Arkansas.
DD. The Provider
understands that this Agreement does not create an employer - employee
relationship.
EE. The Provider
agrees that it is responsible for the reporting of funds received through DHS
each calendar year. The Provider is responsible for the payment of all required
federal and state taxes accrued.
FF. Providers who are incorporated must be
registered with the Secretary of State's office and must remain in good
standing to participate in the Child Care System.
Section VI :
Cancellation of the
Agreement
A. The Agreement
expires June 30 of the state biennium (2007J. The Provider must
submit a new Agreement upon expiration.
B. This Agreement is not transferable, and
automatically terminates without DHS action if the ownership or fifty percent
(50%) or more of the ownership interest in the facility is transferred to a new
owner, if the facility closes, if the facility relocates, or if the provider's
employer identification number changes.
The Provider may change its Taxpayer Identification Number
(TIN) from a social security number to an Employer Identification Number (EIN)
issued by the IRS by submitting a new W-9 and letter requesting the change to
the address listed on the signature page. Any change in TIN must be accompanied
by written verification from the IRS. All authorizations written under the old
TIN will be automatically cancelled and de-obligated when the TIN is changed,
regardless of the reason for changing the TIN.
Providers changing their existing EIN to a new EIN must obtain
a new facility number and submit a new DHS-9800 agreement packet. All
authorizations written under the old TIN will be automatically cancelled and
de-obligated when the EIN is changed, regardless of the reason for changing the
EIN.
C. Either party may
cancel this Agreement unilaterally, at any time, by giving the other party
thirty (30) calendar days written notice, and delivering notice of cancellation
either in person or by certified mail, return receipt requested, restricted
delivery. If the Provider is the party canceling the Agreement, such
notification must be sent to the Director of the Division of Child Care and
Early Childhood Education.
D. DHS
may cancel this Agreement pursuant to DHS Policy 1088,
by giving the other party ten (10) calendar days written notice, and delivering
notice of cancellation either in person or by certified mail, return receipt
requested, restricted delivery. (DHS Policy 1088 refers to the Exclusion of any
provider/vendor by any Division of DHS.) This exclusion to participate includes
immediate family, (blood relative, by marriage, etc) for anyone affiliated with
your facility (sharing common ownership, board members, or any other
interest).
E. If DHS determines
there is immediate jeopardy to the health and safety of children receiving
services from the provider, DHS may cancel the Agreement immediately upon
notice to the Provider.
F. DHS may
cancel this Agreement at any time for cause if it has reason to believe the
Provider has not fully performed all its responsibilities in accordance with
this Agreement with ten (10) calendar days written notice.
G. Any written notice from the Department to
the Provider canceling this Agreement shall specify the reason for
cancellation.
Section
VII
: Administrative Appeal
Procedure
A. The Provider
may appeal any adverse action taken by DHS (including audit, billing, payment,
termination, etc.) by filing a written notice of appeal within thirty (30) days
from the Provider's receipt of DHS notification in accordance with DHS
Administrative Appeal/Hearing Procedures. A copy of the appeal procedures will
be provided by DHS upon request.
B.
The Provider agrees to notify the Division of Child Care and Early Childhood
Education of any legal controversies with any local, state or federal
governmental agency including other agencies within the DHS.
Section VIII :
Certification and Signature
By signature below, I request to participate in the Child Care
System and certify that all documentation presented is true and correct. I
understand and accept all the assurances and responsibilities outlined in this
Agreement. I further attest that I am either the owner of this facility or I am
authorized by the Board of Directors or other governing authority to sign this
document on behalf of the Provider. I will notify the Division of Child Care
and Early Childhood Education of any changes in the documentation I have
presented. (All incorporated Providers must attach the name and address of the
registered agent and a list of current Board Members with titles, addresses and
term limits and a copy of the minutes designating the name of the individual
authorized to sign the Agreement.)
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ATTACHMENT I
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