HomeMy WebLinkAboutInteragency Data Sharing Agreement with WA Employment Security Department ESD Agreement # K6135
Other Party Agreement #______
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INTERAGENCY DATA SHARING AGREEMENT
TABLE OF CONTENTS
Sections Page #
1. INTRODUCTION ............................................................................................................................. 2
2. DEFINITIONS .................................................................................................................................. 2
3. PURPOSE ..................................................................................................................................... 2
4. STATEMENT(S) OF WORK ........................................................................................................... 2
5. TERMS AND CONDITIONS ............................................................................................................ 3
6. PERIOD OF PERFORMANCE ........................................................................................................ 3
7. CONSIDERATION........................................................................................................................... 3
8. AGREEMENT MANAGEMENT ...................................................................................................... 3
9. LIMITATION ON ACCESS AND USE ............................................................................................ 3
10. PHYSICAL SAFEGUARDS ............................................................................................................ 4
11. REDISCLOSURE OF INFORMATION............................................................................................ 5
12. DATA CLASSIFICATION ............................................................................................................... 6
13. NO GUARANTEE OF ACCURACY ................................................................................................ 6
14. TERMINATION OF ACCESS .......................................................................................................... 6
15. NONDISCRIMINATION ................................................................................................................... 7
16. RECORDS MAINTENANCE ........................................................................................................... 7
17. INDEMNIFICATION......................................................................................................................... 7
18. DISPUTES ..................................................................................................................................... 7
19. NONDISCLOSURE AGREEMENT ................................................................................................. 8
20. RIGHT OF INSPECTION ................................................................................................................ 8
21. WAIVER ..................................................................................................................................... 8
22. SEVERABILITY............................................................................................................................... 8
23. TERMINATION ................................................................................................................................ 8
24. TERMINATION FOR CAUSE ......................................................................................................... 8
25. JURISDICTION ............................................................................................................................... 9
26. AGREEMENT AMENDMENTS ....................................................................................................... 9
27. ASSURANCES ................................................................................................................................ 9
28. ASSIGNMENT ................................................................................................................................. 9
29. ORDER OF PRECEDENCE ............................................................................................................ 9
30. ELECTRONIC SIGNATURES, COUNTERPARTS, AND DELIVERY ........................................... 9
31. ALL WRITINGS CONTAINED HEREIN ....................................................................................... 10
EXHIBIT A: STATEMENT OF WORK # 1
EXHIBIT B: NOTICE OF NONDISCLOSURE
EXHIBIT C: EQUI FILE LAYOUT
Approved as to form by AGO April 2014
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
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INTERAGENCY DATA SHARING AGREEMENT
BETWEEN
WASHINGTON
EMPLOYMENT SECURITY DEPARTMENT
AND
CITY OF PASCO
1. INTRODUCTION
This Agreement is made and entered into by and between the Washington State
Employment Security Department (hereinafter (“ESD”) and the City of Pasco
(hereinafter called (“City of Pasco”), pursuant to authority granted in chapters
39.34, 50.13 and 50.38 of the Revised Code of Washington (RCW), other
relevant federal statutes, and related regulations.
2. DEFINITIONS
2.1 Confidential Unemployment Insurance Data” or “UI data” means
information in the records of ESD collected from employers and individuals
for the administration of the state unemployment insurance program as set
forth in the federal law (20 CFR 603) and state statutes (chapters 50.13
and 50.38 RCW). “UI/QCEW data” is classified as Category 4 data under
Washington’s OCIO Standards No. 141.10.
2.2 “Authorized user” means any City of Pasco employee approved by both
parties to receive confidential UI data.
3. PURPOSE
The purpose of this Agreement is to:
3.1 Set out the Terms and Conditions under which ESD will share Confidential
UI/QCEW data with City of Pasco as set forth in the federal law (20 CFR
603) and state statutes (chapters 39.34 and 50.13 RCW).
3.2 Define the safeguards against unauthorized use and re-disclosure of
UI/QCEW data by City of Pasco.
4. STATEMENT(S) OF WORK
4.1 The parties shall share data based on the specifications of each numbered
Statement of Work incorporated into this agreement by reference as Exhibit
A.
4.2 Each numbered Statement of Work shall specifically identify the data
requested, the purpose for which it will be used, the legal authority for the
disclosure by ESD to City of Pasco, and will be authorized and signed by
both parties.
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
3
5. TERMS AND CONDITIONS
All rights and obligations of the parties to this Agreement shall be subject to and
governed by the Terms and Conditions contained in this Agreement.
6. PERIOD OF PERFORMANCE
This Agreement shall commence on the date of execution and shall continue
through 12/31/2021, unless terminated sooner by either party as provided herein.
7. CONSIDERATION
City of Pasco agrees to adhere to the requirements of the Consideration clause
stated in each of the numbered Statements of Work incorporated into this
agreement as Exhibit A.
8. AGREEMENT MANAGEMENT
City of Pasco staff member
responsible for the management of
this Agreement is:
ESD staff member responsible for
the management of this
Agreement is:
Name: Stephanie Brock
Customer Service Manager
525 North 3rd Avenue
Pasco, WA 99301
Phone: 509-545-3431
FAX number:
Email address: brocks@pasco.wa.gov
Name: Jeff Robinson
Labor Market Analysis/UI Research &
Forecasting Manager
PO Box 9046
Olympia, WA 98507
Phone: 360-507-9592
FAX number:
Email address: jrobinson@esd.wa.gov
The Agreement Manager or their successor shall provide the assistance and
guidance necessary for the performance of this agreement.
9. LIMITATION ON ACCESS AND USE
City of Pasco agrees to the following limitations on the use of the information
provided by ESD:
9.1 The information provided by ESD will remain the property of ESD and will
be returned to ESD according to the following procedures when the work
for which the information was required, as fully described in Exhibit A,
numbered Statement(s) of Work, has been completed:
9.1.1 All ESD data records or screen prints not admitted as exhibits will
be purged from mainframe systems and individual Personal
Computers (PC).
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
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9.1.2 All paper or compact disc copies will be shredded to a size no
larger than 1/8 by 1 1/8 inch size in a crosscut shredder or
deposited into a locked shredder bin to be shredded by a state
authorized company.
9.1.3 City of Pasco shall be responsible for the destruction of
confidential UI/QCEW data after the work for which the data was
required, as fully described in Exhibit A, numbered Statement(s)
of Work, has been completed.
9.2 The information provided by ESD shall be used and accessed only for the
limited purposes of carrying out activities pursuant to this Agreement as
described in the applicable numbered Statement(s) of Work.
9.3 The information provided by ESD will not be duplicated or re-disclosed
without the written authority of ESD.
9.4 City of Pasco shall not use the information provided for any purpose not
specifically authorized under this Agreement.
9.5 City of Pasco shall protect the confidentiality of the information as
required by the laws cited in this Agreement. City of Pasco shall protect
the confidentiality of the information when sharing UI/QCEW data as
provided under this Agreement.
9.6 City of Pasco shall notify ESD immediately of becoming aware of any
unauthorized access, use or disclosure. If a breach of security occurs that
meets the definition in RCW 42.56.590, Personal information – Notice of
security breaches, City of Pasco is responsible for any notifications to the
affected individuals as required by the law and the cost thereof. Any
breach of this clause may result in termination of this Agreement and the
demand for return of all personal information. City of Pasco shall provide
detailed information, including the nature of the unauthorized activity,
names of individuals involved, work locations where the incident
occurred, and the actions taken by City of Pasco. The information
provided by City of Pasco will enable ESD to conduct its own
investigation, if necessary.
10. PHYSICAL SAFEGUARDS
City of Pasco agrees to the following minimum safeguards for the information
provided by ESD as follows:
10.1 Access to the information provided by ESD will be restricted to only those
authorized personnel who need it to perform their official duties in the
performance of the scope of work fully detailed in Exhibit A, numbered
Statement(s) of Work.
10.2 The information will be stored in areas that are safe from access by
unauthorized persons during regular business hours as well as non -
business hours or when not in use.
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
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10.3 The information will be protected in a manner that prevents unauthorized
persons from retrieving the information by means of computer, remote
terminal or other means.
10.4 City of Pasco shall take precautions to ensure that only authorized
personnel are given access to data files. Electronic access is to be
authorized using hardened passwords that are changed at least every 90
days.
10.5 When applicable City of Pasco shall furnish encryption and decryption
software compatible with ESD’s software to ensure security and
confidentiality.
10.6 City of Pasco will have up-to-date anti-virus software installed and shall
be diligent in the timely updating of this software. This includes the timely
installation of security patches for all information technology assets,
hosts, and networks that process ESD confidential information.
10.7 City of Pasco shall establish an audit trail that logs the activities of
authorized users. City of Pasco shall grant ESD access to the audit trail
upon request for investigative and compliance monitoring purposes.
10.8 City of Pasco shall instruct all authorized personnel regarding the
confidential nature of the information, the requirements of the
LIMITATION ON ACCESS AND USE and PHYSICAL SAFEGUARDS
clauses of this Agreement, and the sanctions specified in chapter 50.13
RCW and other federal and state laws against unauthorized disclosure of
information covered by this Agreement.
10.9 City of Pasco employees shall only access the ESD data provided
through hardware owned by City of Pasco which is located on state
government premises. Data will not be accessed via the following
devices, including but not limited to: cell phones, blackberries, or at
wireless hotspots.
11. REDISCLOSURE OF INFORMATION
11.1 Redisclosure of confidential information received from ESD is prohibited
by chapter 50.13 RCW unless authorized by ESD for the official purpose
for which the information was originally requested.
11.2 Redisclosure of ESD confidential data is authorized for judicial, formal
administrative, or discovery proceedings only by subpoena pursuant to
RCW 50.13.070.
11.3 Parties or individuals redisclosing confidential information in violation of
chapter 50.13 RCW are subject to civil penalty. ESD may pursue criminal
charges against individuals engaged in unauthorized redisclosure of
UI/QCEW data.
11.4 City of Pasco agrees to reimburse ESD for all costs associated with the
criminal referral and conviction of any City of Pasco employee engaged in
any form of unauthorized redisclosure of UI/QCEW data.
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
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12. DATA CLASSIFICATION
According to the Office of the Chief Information Officer (OCIO) Standard
No.141.10, Section 4.2, agencies must classify data into categories based on the
sensitivity of the data. Agency data classifications must translate to or include the
following classification categories:
Category 1 – Public Information
Public information is information that can be or currently is released to the
public. It does not need protection from unauthorized disclosure, but does need
integrity and availability protection controls.
Category 2 – Sensitive Information
Sensitive information may not be specifically protected from disclosure by law
and is for official use only. Sensitive information is generally not released to the
public unless specifically requested.
Category 3 – Confidential Information
Confidential information is information that is specifically protected from
disclosure by law. It may include but is not limited to:
a. Personal information about individuals, regardless of how that information is
obtained.
b. Information concerning employee personnel records.
c. Information regarding IT infrastructure and security of computer and
telecommunications systems.
Category 4 – Confidential Information Requiring Special Handling
Confidential information requiring special handling is information that is
specifically protected from disclosure by law and for which:
a. Especially strict handling requirements are dictated, such as by statutes,
regulations, or agreements.
b. Serious consequences could arise from unauthorized disclosure, such as
threats to health and safety, or legal sanctions.
The information provided to City of Pasco under this Agreement is classified as
Category 4 – Confidential Information Requiring Special Handling.
13. NO GUARANTEE OF ACCURACY
ESD does not guarantee the accuracy of the data provided.
14. TERMINATION OF ACCESS
14.1 ESD may at its discretion disqualify any individual authorized by City of
Pasco from gaining access to UI/QCEW data. Notice of termination of
access to UI/QCEW data will be by written notice and become effective
upon receipt by City of Pasco. Termination of access of one individual by
ESD does not affect other individuals authorized under this Agreement.
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
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14.2 ESD Agreement Manager identified in Section 8 of this Agreement shall
be responsible for informing the City of Pasco Agreement Manager of the
termination of access.
15. NONDISCRIMINATION
No individual shall be excluded from participation in, denied the benefits of,
subjected to discrimination under, or denied employment in the administration of
or in connection with any provision of this Agreement because of race, color,
creed, marital status, religion, sex, national origin, Vietnam-Era or disabled
veteran’s status, age, the presence of any sensory, mental or physical disability,
or political affiliation or belief, provided that the prohibition against discrimination
in employment because of disability shall not apply if the particular disability
prevents the individual from performing the essential functions of his or her
employment position, even with reasonable accommodation. The parties agree
to abide by the standards of responsibility toward the disabled as specified by the
Americans with Disabilities Act and applicable state law. In the event that one of
the parties refuses to comply with the above provision, this Agreement may be
canceled, terminated, or suspended in whole or in part by the other party.
16. RECORDS MAINTENANCE
Both parties shall retain all records, books or documents related to this
Agreement for six (6) years beyond the expiration/termination of this Agreement.
Federal auditors and any persons duly authorized by the parties shall have full
access to and the right to examine any of these materials during this period.
17. INDEMNIFICATION
Each party to this Agreement hereby assumes responsibility for claims and/or
damages to persons and/or property resulting from any act or omissions on the
part of itself, its employees, its officers, and its agents. Neither party assumes
any responsibility to the other party for the consequences of any claim, act, or
omission of any person, agency, firm, or corporation not a party to this
Agreement.
18. DISPUTES
Except as otherwise provided in this Agreement, when a dispute arises between
the parties and it cannot be resolved by direct negotiation, the parties agree to
participate in mediation in good faith. The mediator shall be chosen by
agreement of the parties. If the parties cannot agree on a mediator, the parties
shall use a mediation service that selects the mediator for the parties. Nothing in
this Agreement shall be construed to limit the parties' choice of a mutually
acceptable alternative resolution method such as a disputes hearing, a Dispute
Resolution Board, or arbitration. If both parties are state agencies, either of the
parties may request intervention by the Governor, as provided by RCW
43.17.330, in which event the Governor’s process will control.
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
8
19. NONDISCLOSURE AGREEMENT
City of Pasco agrees that all their authorized personnel who will have access to
the information provided by ESD will sign a Nondisclosure statement, identical to
that in Exhibit B, Nondisclosure Statement. The statement is consistent with the
chapter 50.13 RCW and the Terms and Conditions of this Agreement. No data
may be released to any City of Pasco personnel until ESD receives the
completed Nondisclosure Statement for that individual.
20. RIGHT OF INSPECTION
City of Pasco shall provide access to ESD, or any of its off icers, or to any other
authorized agent or official of the state of Washington or the federal government
at all reasonable times, in order to monitor, evaluate and ensure the
requirements of the state and federal statutes, related regulations, and this
Agreement are being met. City of Pasco agrees to accommodate ESD’s request
for inspection, electronic monitoring, review, or audit and to allow on-site audits
during regular business hours.
21. WAIVER
Any waiver by any party with regard to any of its rights shall be in writing and
shall not constitute a waiver to any other or future rights of the party.
22. SEVERABILITY
If any provision of this Agreement or any provision of any document incorporated
by reference shall be held invalid, such invalidity shall not affect the other
provisions of this Agreement which can be given effect without the invalid
provision, and to this end the provisions of this Agreement are declared to be
severable.
23. TERMINATION
23.1 This Agreement shall remain in full force and effect until terminated as
provided in this Agreement. Either party may terminate this Agreement
by giving ten (10) calendar days’ written notice to the other party. The
obligations of confidentiality shall continue and survive this Agreement.
23.2 In the event of termination of this Agreement, City of Pasco shall be liable
to ESD for payment of services rendered by ESD that met the
requirements of Exhibit A, Statement of Work and shall return UI/QCEW
data to ESD on or before the effective date of termination, unless
destroyed according to section 9.1 of this Agreement.
24. TERMINATION FOR CAUSE
Either party may terminate this Agreement in whole or in part at any time prior to
the date of completion when it is determined that the other party has failed to
comply with the conditions of this Agreement. The cancelling party shall
immediately notify the other party in writing of the termination and the reasons for
termination, together with the effective date of termination.
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
9
25. JURISDICTION
This Agreement shall be construed and interpreted in accordance with the laws
of the State of Washington. The venue of any legal action pertaining to this
agreement shall be the Washington State Superior Court for Thurston County.
26. AGREEMENT AMENDMENTS
This Agreement may be waived, changed, modified, or amended only by mutual
agreement of the parties. Such amendments shall not be binding unless they are
in writing and signed by personnel authorized to bind each of the parties.
27. ASSURANCES
The parties agree that all activity pursuant to this Agreement will be in
accordance with all applicable current or future federal, state and local laws,
rules and regulations.
28. ASSIGNMENT
Neither party shall assign this Agreement in whole or in part.
29. ORDER OF PRECEDENCE
In the event of an inconsistency in this Agreement, unless otherwise provided,
the inconsistency shall be resolved by giving precedence in the following order:
1. Applicable Federal and State Statutes and Regulations;
2. Terms and Conditions as contained in this Agreement;
3. Any other provisions of this Agreement, including the attached Exhibits.
30. ELECTRONIC SIGNATURES, COUNTERPARTS, AND DELIVERY
The parties agree that this contract may be executed in multiple counterparts,
each of which is deemed an original and all of which constitute only one
agreement; and that electronic signature, or e-signature, of this contract shall be
the same as execution of an original ink signature; and that E-mail, electronic, or
facsimile delivery of a signed copy of this contract shall be the same as delivery
of an original.
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
10
31. ALL WRITINGS CONTAINED HEREIN
This Agreement sets forth in full the entire agreement of the parties; and any
other agreement, representation, or understanding, verbal or otherwise, is hereby
deemed null and void and of no force and effect whatsoever.
By signing this Agreement, both parties certify that their policies and procedures
comply with the confidentiality requirements of this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement.
Washington State
Employment Security Department
Steven Ross
City of Pasco
Richa Sigdel
By
By (print name)
Director Finance Director
Title Title
Signature Signature
Date Date
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
1/30/20191/30/2019
ESD Agreement # K6135
Other Party Agreement #______
1
EXHIBIT A
STATEMENT OF WORK #1
1. PURPOSE
This Statement of Work establishes the terms and conditions under which ESD will
share confidential UI/QCEW data with City of Pasco for purpose of determining the
current total of reported FTE’s employed by any business/industry located in the City
of Pasco from December 31st 2017 through current quarter.
2. DATA ELEMENTS TO BE DISCLOSED
ESD shall provide the following data to authorized City of Pasco employees for the
purposes of carrying out activities described in this Statement of Work, Section 1.
Purpose.
3. FREQUENCY OF DATA TRANSFER AND SECURITY
Data will be transferred quarterly through a secure FTP server.
Confidential data must be provided to City of Pasco on a secured medium such as a
secured FTP server. Confidential data stored on City of Pasco system will be
maintained in a secured manner and destroyed after use as specified in Section 9,
LIMITATION ON ACCESS AND USE of the Interagency Agreement.
4. NON DISCLOSURE STATEMENT
Authorized City of Pasco staff that review or work with UI/QCEW data must read and
sign the ESD Non-Disclosure statement prior to viewing or working with the data.
Signed copies of Non-Disclosure statements shall be returned to ESD Statement of
Work Manager. The ESD Non-Disclosure statement is attached hereto and
incorporated by reference to this Agreement as Exhibit “B”.
5. STATEMENT OF WORK AMENDMENTS
This Statement of Work may be waived, changed, modified, or amended only by
mutual agreement of the parties. Such amendments shall not be binding unless they
are in writing and signed by personnel authorized to bind each of the parties.
6. CONSIDERATION
No cost to this contract agreement.
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
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7. AGREEMENT MANAGEMENT
The work described herein shall be performed under the coordination of the
following Statement of Work Managers or their successors, who will provide the
assistance and guidance necessary for the performance of this Statement of Work.
City of Pasco staff member
responsible for the management of
this Statement of Work is:
ESD staff member responsible for
the management of this
Statement of Work is:
Name: Stephanie Brock
Customer Service Manager
525 North 3rd Avenue
Pasco, WA 99301
Phone: 509-545-3431
FAX number:
Email address: brocks@pasco.wa.gov
Name: Jeff Robinson
Labor Market Analysis/UI Research &
Forecasting Manager
PO Box 9046
Olympia, WA 98507
Phone: 360-507-9592
FAX number:
Email address: jrobinson@esd.wa.gov
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
3
8. APPROVAL
Now, therefore, in consideration of the mutual promises and undertakings contained
herein and in the Interagency Agreement it supplements, the parties hereto consent
to the provisions of Exhibit A, Statement of Work # 1.
Washington State
Employment Security Department
Steven Ross
City of Pasco
Richa Sigdel
By
By (print name)
Director Finance Director
Title Title
Signature Signature
Date Date
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
1/30/20191/30/2019
ESD Agreement # K6135
Other Party Agreement #______
WASHINGTON STATE EMPLOYMENT SECURITY DEPARTMENT
NOTICE OF NONDISCLOSURE
As a non-Employment Security Department (ESD) employee, you may be given
access to records or information that is deemed private and confidential by statute.
You may not make any unauthorized disclosure of private or confidential information
about employers, clients/claimants or employees to any person or entity.
Confidential information includes but is not limited to employee’s wages or hours,
unemployment insurance benefit records, and standard industrial classification (sic)
codes of individual employers.
The unauthorized disclosure or abuse of information deemed private and
confidential may subject you to a civil penalty of Five Thousand dollars ($5,000) and
other applicable sanctions under state and federal law. (RCW 50.13)
I have read and understand the above Notice of Nondisclosure.
_____ _ _________ ____________________
Printed Name Job Title or User ID (AAAA000)
____________________ _______________
(Signature) (Date)
The above individual has been informed of the obligations of the above referenced
agreement and Statement of Work including any limitations, use or publishing of
Confidential Data.
____________________ _____________________
Supervisor’s Name Agency Name
____________________ ________________
Supervisor’s Signature (Date)
(An original of this notice must be returned to the Employment Security Department.)
EXHIBIT B
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
EQUI - 1066 file layout
Positions Length Data Element
1 1 transaction code
2-3 2 State FIPS code
4-7 4 Year
8 1 Quarter
9-10 10 UI Account number
19-23 5 Reporting Unit Number (RUN)
24-32 9 EI Number
33-42 10 Predecessor UI Account Number
43-47 5 Predecessor RUN
48-57 10 Successor UI Account Number
58-62 5 Successor RUN
63-97 35 Legal/Corporate Name
98-132 35 Trade Name/DBA
133-167 35 UI Street Address - Line 1
168-202 35 UI Streat Address - Line 2
203-232 30 UI Address - City
233-234 2 UI Address - State
235-239 5 UI Address - ZIP
240-243 4 UI Address - ZIP extension
244-278 35 Physical Location Street Address - Line 1
279-313 35 Physical Location Street Address - Line 2
314-343 30 Physical Location Address - City
344-345 2 Physical Location Address - State
346-350 5 Physical Location Address - ZIP
351-354 4 Physical Location Address - ZIP extension
355-389 35 Mailing/Other Address (MOA) - Line 1
390-424 35 Mailing/Other Address (MOA) - Line 2
425-454 30 Mailing/Other Address (MOA) - City
455-456 2 Mailing/Other Address (MOA) - State
457-461 5 Mailing/Other Address (MOA) - ZIP
462-465 4 Mailing/Other Address (MOA) - ZIP extension
466 1 Mailing/Other Address (MOA) type
467-501 35 Reporting Unit Description
502-504 3 Area Code
505-507 3 Phone Prefix
508-511 4 Phone Suffix
512-515 4 Setup Date - Year
516-517 2 Setup Date - Month
518-519 2 Setup Date - Day
520-523 4 Initial Date of Liability - Year
524-525 2 Initial Date of Liability - Month
526-527 2 Initial Date of Liability - Day
528-531 4 End of Liability Date - year
532-533 2 End of Liability Date - Month
EXHIBIT C
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
534-535 2 End of Liability Date - Day
536-539 4 Reactivation Date - Year
540-541 2 Reactivation Date - Month
542-543 2 Reactivation Date - Day
544 1 Activity Status Code
545 1 CES Indicator
546-547 2 ARS Response Code
548-551 4 ARS Refile Year
552-554 3 Old County Code
555 1 Old Ownership Code
556-559 4 ARS Verification Year
560-562 3 Old Township Code
563-567 5 Maximum Reporting Unit Number
568 1 MWR Mail Indicator
569-574 6 Old NAICS code
575 1 Data Source
567 1 Special Indicator Code
577-580 4 Agent Code
581-584 4 SIC Code
585-590 6 NSTA - mostly blank
591-596 6 NAICS code
597 1 Ownership Code
598 1 Organization Type Code
599-601 3 County Code
602-604 3 Township Code
605 1 Auxiliary Code
606-611 6 First Month Employment
612 1 First Month Employment Indicator
613-618 6 Second Month Employment
619 1 Second Month Employment Indicator
620-625 6 Third Month Employment
626 1 Third Month Employment Indicator
627-637 11 Total Wages
638 1 Total Wage Indicator
639-649 11 Taxable Wages
650-658 9 Contributions Due
659 1 Type of Coverage Code
660 1 MEEI Code
661 1 Reporting Change Indicator
662-663 2 First Comment Code
664-665 2 Second Comment Code
666-667 2 Third Comment Code
668-724 57 Narrative Comment
725-726 2 Collection Mode Indicator
727-728 2 Economic Code Change Indicator (ECCI)
729 1 UI Address Type Code
730-733 4 Date PLA Year Changed
734-735 2 Date PLA Month Changed
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73
ESD Agreement # K6135
Other Party Agreement #______
736-737 2 Date PLA Day Changed
738 1 Geocoding Software
739 1 Geocoding Source
740-743 4 Match Code
744-746 3 Location Code
747-755 9 Latitude
756-766 11 Longitude
767-770 4 Year of New Latitude and Longitude
771 1 Quarter of New Latitude and Longitude
772-776 5 Place Code
777-778 2 Class Code
779-793 15 Census Block
794-797 4 Census Tract
798 1 Address/Contact Source
799 1 P/S Partial/Full Indicator
800-803 4 P/S Transfer Year
804-805 2 P/S Transfer Month
806-807 2 P/S Transfer Day
808 1 Multiple Successors
809 1 Multiple Predecessors
810 1 Predecessor Source
811 1 Successor Source Code
812 1 First Supplemental P/S Identifier
813-822 10 First Supplemental P/S UI Account Number
823-827 5 First Supplemental P/S Reporting Unit Number
828 1 Second Supplemental P/S Identifier
829-838 10 Second Supplemental P/S UI Account Number
839-843 5
Second Supplemental P/S Reporting Unit
Number
844 1 ARS Third Party Agent
845-849 5 Telephone Extension
850-884 35 ES-202 Contact (Attention Line)
885-919 35 Contact Title
920-979 60 Contact e-mail address
980-982 3 Fax Area Code
983-989 7 Fax Phone Number
990-1049 60 Website Address
1050-1066 17 Future Use
DocuSign Envelope ID: 67C0CC9C-AD1F-4F20-82AF-84CFD79ADA73