Prison Phone Justice

-

NASPO ValuePoint

PARTICIPATING ADDENDUM

A

INMATE KIOSKS AND COMMUNICATION

NASPO

ValuePoint

Led by the State of Nevada

Master Agreement#: 99SWC-S26
Contractor:

SECURUS TECHNOLOGIES, INC

Participating Entity: STATE OF NEVADA
The following products or services are included in this contract portfolio:

•

Category 4.1 Inmate Phone System

Master Agreement Terms and Conditions:
1. Scope: This addendum covers the Inmate Kiosks and Communications contract led by
the State of Nevada for use by state agencies and other entities located in the Participating
./State or State Entity authorized by that State's statutes to utilize State contracts with the
. : prior approval of the State's Chief Procurement Official.

2. Participation: This NASPO ValuePoint Master Agreement may be used by all state
agencies, institutions of higher institution, political subdivisions and other entities authorized
to use statewide contracts in the State of Nevada. Issues of interpretation and eligibility for
participation are solely within the authority of the State Chief Procurement Official.

3. Primary Contacts: The primary contact individuals for this Participating Addendum are as
follows (or their named successors):
Contractor
Name:

Securus Technologies, Inc.

Address:

4000 International Parkway, Carrolltron, TX 75007

Telephone:

972-277-0300

Fax:

972-277-0514

Email:

bQickens@securustechnologies.com

Page 1 of 6

NASPO ValuePoint

PARTICIPATING ADDENDUM

A

INMATE KIOSKS AND COMMUNICATION

NASPO

Value Point

Led by the State of Nevada

Participating State Contact:
Name:

Ronda Miller

Address:

515 E. Musser St, Rm 300, Carson City, NV 89701

Telephone:

775-684-0182

Fax:

775-684-0188

Email:

rlmiller@admin.nv.gov

Participating Entity
Name:

Nevada Department of Corrections
ATTN: Venus Fajota

Address:

5500 Snyder Avenue, Building 17, Carson City, NV 89701

Telephone:

775-887-3234

Fax:

775-887-3343

Email:

vfajota@doc.nv.gov

4. PARTICIPATING ENTITY MODIFICATIONS OR ADDITIONS To THE MASTER
AGREEMENT
These modifications or additions apply only to actions and relationships within the
Participating. Entity.
Participating Entity must check one of the boxes below.

LJ No changes to the terms and conditions of the Master Agreement are required.
[XX] The following changes are modifying or supplementing the Master Agreement terms
and conditions.

Page 2 of 6

NASPO ValuePoint

PARTICIPATING ADDENDUM
INMATE KIOSKS AND COMMUNICATION

NASPO

Value Point

Led by the State of Nevada

A. Term:
•

The initial term of this Master Agreement is for three (3) years (upon BOE approval
anticipated to be January 8, 2019 through January 7, 2022). Agreement may be
extended beyond the original contract period up to one (1) additional year at the
Lead State's discretion and by mutual agreement and upon review of requirements
of Participating Entities, current market conditions, and Contractor performance.

B. Consideration:
The parties agree that Contractor will provide the services specified in the Scope of
Work and Incorporated Documents at a total revenue of $13,500,000 ($5,000,000 each
for years 1 and 2 and $3,500,000 in year 3).
C. Incorporated Documents:
•
•
•
•
•

Exhibit 1
Exhibit 2
Exhibit 3
Exhibit 4
Exhibit 5

Negotiated Items
Security Regulations
Contractor Background Check Application
PREA Zero Tolerance Policy
PREA Contractor and Volunteer Questionnaire.

D. Administrative Fee: (Informational Section only)
The State reserves the right to implement section below upon additional Nevada
municipalities' participation. The State will notify the Contractor in writing 30 days prior to
the implementation of this section.
1.1

Contractor shall pay a quarterly administrative fee payable to the "State of
Nevada Purchasing Division." The administrative fee is one percent (1%) and
applies to all payments (net of returns, credits, or adjustments) received by the
Contractor for all products and services provided under the contract during the
quarter beginning the date of implementation of this section.

1.2

Applicable administrative fees shall not be included on the invoice as an
individual line item.

1.3

All administrative fee payments shall include the contract number on the required
documents. If submitting an administrative fee payment for more than one
contract, then a separate payment and associated documents shall be submitted
by the Contractor for each contract.

Page 3 of 6

NASPO ValuePoint

NASPO ·

PARTICIPATING ADDENDUM

Value Point

INMATE KIOSKS AND COMMUNICATION
Led by the State of Nevada

1.4

The State will not issue an invoice for the administrative fee owed to the State. It
is the responsibility of the Contractor to pay the administrative fee with no
prompting from the State. Contractor shall pay the quarterly administrative fee
within forty-five (45) calendar days of quarter end (refer to Section 1.8).

1.5

The template for the required Quarterly Administrative Fee & Usage Report
outlined below in Sections 2 and 3 may be downloaded from the Purchasing
Division website http://purchasing.nv.gov/vendors/DBINV/. The report must be
submitted via email to: NVQtlyReport@admin.nv.gov

1.6

Contractor shall complete the Statewide Contract Quarterly Administrative Fee
Report. The report shall identify total payments (minus returns and credits)
received by Contractor from state agencies, the university and community
college system, the Legislative Counsel Bureau, political subdivisions, and other
authorized entities that were made pursuant to the contract.

1. 7

Contractor shall complete the Statewide Contract Quarterly Usage Report to
include at a minimum the data element information listed below:
. ·. Date:! Elernenf ·

.....

'.··,·.

•· Descriptic;m ··
'.,

:.

'

,·

•·

..

'

Customer Name

Name of entity making the purchase-if customer has
multiple locations, please use the main entity name.

Customer Type

Indicate the type of entity making the purchase:
S=State Agency
E=University and Community College
P=Political Subdivision
O=Other Entity

PO # or Other
Authorization
Type

Number provided by the customer to authorize the
purchase. If purchase was made with a credit card
enter
P-Card.

Page 4 of 6 ·

Purchase
Description

Description of the product or service purchased.

Quantity

Quantities (excluding returns) of products delivered-

·

NASPO

NASPO ValuePoint

PARTICIPATING ADDENDUM

ValuePoint

INMATE KIOSKS AND COMMUNICATION
Letil by the State of Nevada

enter a quantity of one (1) for a service.
Unit Price

Unit price charged (excluding credits) for the product or
service purchased.

Total Cost

Total cost of the purchase-quantity delivered x unit
price charged.
.,,,

1.8

1.9

1.1 O

Contractor shall pay the administrative fee quarterly, if owed, and provide the
Quarterly Administrative Fee & Usage· Report to the Purchasing Division even if
no payments are made in a quarter in accordance with the following schedule:

Period End

Report Due

March 31

May 15

June 30

August 14

September 30

November 14

December 31

February 14

The Purchasing Division reserves the right to modify the requested format and
contents of the Quarterly Administrative Fee & Usage Report by providing thirty
(30) calendar days written notice to Contractor. The Purchasing Division may
unilaterally amend the contract, with (30) calendar days written notice to the
Contractor to change the timing for submission of the Quarterly Administrative
Fee & Usage Report. Contractor understands and agrees that if such an
amendment is issued by the Purchasing Division, Contractor shall comply with all
contract terms, as amended.

If the administrative fee is not paid and quarterly report is not received within
forty-five (45) calendar days of quarter end, then Contractor will be in material
breach of this contract.

5. Lease Agreements: Agencies utilizing leasing must follow all rules and regulations within
NAC 333 and NRS 333.
6. Subcontractors: All contactors, dealers, and resellers authorized in the State of Nevada, as
shown on the dedicated Contractor (cooperative contract) website, are approved to provide
sales and service support to participants in the NASPO ValuePoint Master Agreement. The
contractor's dealer participation will be in accordance with the terms and conditions set forth
in the aforementioned Master Agreement.
Page 5 of 6

NASPO ValuePoint

NASPO

PARTICIPATING ADDENDUM

Value Point

INMATE KIOSKS AND COMMUNICATION
Led by the State of Nevada

7. Orders: Any order placed by a Participating Entity or Purchasing Entity for a product and/or
service available from this Master Agreement shall be deemed to be a sale under (and
governed by the prices and other terms and conditions) of the Master Agreement unless the
parties to the order agree in writing that another contract or agreement applies to such
order.

~)et

<(

CPO, NV State Purchasing Administrator

~~+-tt-~~-----+----->.,-~~~~~~~~~~~-

Date

Title

APPROVED BY BOARD OF EXAMINERS
Signature - Board of Examiners

On:
Date

Approved as to form by:
On:

?J~
Date

Page 6 of 6

99SWC-S26

EXHIBIT 1

Exhibit 1
CETS/CONTRACT # 99SWC-S26

NEGOTIATED CONTRACT TERMS AND SCOPE OF WORK BETWEEN
NEVADA DEPARTMENT OF CORRECTIONS (NDOC) AND
SECURUS TECHNOLOGIES (VENDOR)
Contractor shall perform the services described below for all NDOC facilities located
statewide.

1.

SCOPE OF WORK
1.1 Inmate Telephone Services (ITS) to be offered by vendor:
1.1.1

Secure Call Platform (SCP) ITS;

1.1.2

Securus SCP ITS/NextGen;

1.1.3

No change to existing per minute phone rates (as detailed below) -

Local

$0.14

Debit and
Prepaid Collect
$0.11

Intralata

$0.14

$0.11

Interlata

$0.14

$0.11

Interstate

$0.14

$0.11

Call Type

1.1.4

Collect

Annual Commission Payment as follows: Years 1 and 2: $5M, Year 3:
$3.5M
1.1.4 .1 The first commission payment to NDOC shall be made within 45 60 days of contract approval and by the end of April each year of
contract term.
1.1.4.2 Upon contract approval, NDOC will provide the direct deposit
account information to where the vendor shall process the annual
commission payments.

1.1.5

Investigator Pro Biometrics with voice search and integrated data analytics;

1.1.6

Threads Data Analytics with Community Sharing;

1.1. 7

Automated Information Services [Interactive Voice Response (IVR)] with
debit funding and voice messaging;

1.1. 8 Inmate to Inmate Call Detection - Inmate Inter-Communications Evaluation
and Reporting (ICER);
1.1.9

Video Relay Service (VRS) - Purple/Securus;

1.1.10 Investigative Assistance (Guarded Exchange);
Page 1of5

Exhibit 1
CETS/CONTRACT # 99SWC-S26

1.1.11 In State Forensics and Investigative Service Lab with full time dedicated
personnel;
1.1.12 Call Monitoring Services (routine);
1.1.12.1

Five (5) percent or more of all completed inmate calls from
NDOC prisons.
1.1.12.1.1 Percentage of calls monitored to be based on average
number of call minutes.

1.1.12.2

Provide NDOC investigators with detailed investigative reports
identifying actionable intelligence.

1.1.13 Emergency Call Monitoring Services (specific to emergent event);
1.1.14 Cell Phone Detection/Forensics;
1.1.15 15 mo bile assessments;
1.1.16 Investigative forensics and data analytics through Threads;
1.1.17 Cell phone data extraction (72-hour turnaround);
1.1.18 Data and Security
1.1.18 .1

Private multi-protocol label switching (MPLS) network for ITS

1.1.18.2

Three-year direct access data retention, life of contract data
storage

1.1.18.3

Fully backed-up and redundant data storage

1.1.19 Service
1.1.19.1

24x7x365 Dallas based friends and family customer service
center

1.1.19.2

24x7x365 Dallas based technical facility assistance customer
service center

1.1.19 .3

Securus employee certified service personnel for facility service

1.1.19. 4

Emergency response security team

1.1.20 Account Management
1.1.20.l

Dedicated Account Business Manager
Page 2of5

Exhibit 1
CETS/CONTRACT # 99SWC-S26

1.1.20.2

Quarterly Account Business Meetings

1.1.20.3

Dedicated Customer Client Manager

1.1.21 Training
1.1.21.1

Onsite ITS and kiosk training

1.1.21.2

Quarterly web based training

1.1.21.3

Annual Elevate Educational Seminar

1.1.21.4

Onsite and remote investigative services technology training

1.1.21.5

Multi-agency investigative services consultation for sharing of
investigative information

1.1.22 Any Inmate Kiosks and MP3 players will be discussed at a later time, at
NDOC's discretion, and addressed through a separate agreement.
1.2

To be completed by the Vendor:

1.2.1 The vendor will work with the authorized DOC staff and the incumbent
vendor to ensure an orderly transition of the ITS and responsibilities under
the Master Service Agreement and ensure the continuity of the ITS required
by the DOC.
1.2.2 At no cost to NDOC, provide the labor, equipment, materials and tools to
install inmate telephone system at all NDOC correctional facilities and all
other applications and services mentioned in Section 1.1.
1.2.3 NDOC will not reimburse the vendor for price adjustments or overtime
labor caused by delays due to security. Delays due to security include but
are not limited to:
o
o
o
o

Institution lockdown,
Prison escapes, attempted escapes,
No or limited Correctional Officer coverage,
Contraband, as listed in the NDOC Security Regulations
Aclmowledgment form (DOC 047) (Refer to Exhibit 2)
o Sally-port inspections;
o Offender counts and miscounts
o Any potential risk to the welfare and/or security of the institution and
its staff, offenders, and visitors.
1.2.4 Site surveys and installation work must be coordinated and approved by
appropriate NDOC staff.
Page 3of5

Exhibit 1
CETS/CONTRACT # 99SWC-S26
1.2.5 Prior to the completion of work, the vendor shall remove all unnecessary
equipment and materials belonging to the contractor from NDOC premises.
1.2.6 Upon completion of the work, the contractor shall leave the site in a clean
and neat condition satisfactory to NDOC.
1.2. 7 The vendor will provide the necessary labor, equipment, parts, materials,
and transportation to maintain all proposed telephones in good working
order and in compliance with the equipment manufacturer's specifications
tlu·oughout the life of the Contract. No charge will be made to the DOC for
maintenance of the ITS.

2.

3.

4.

HEALTH AND SAFETY STANDARDS
2.1

Contractor shall comply with all applicable federal, state, and local requirements for
protecting the safety of NDOC employees, offenders, building occupants, and the
environment.

2.2

All applicable standards of the Occupational Safety and Health Administration
(OSHA) shall be followed when working in accordance of this contract.

LICENSING I PERMIT REQUIREMENTS
3 .1

Prior to conducting business, verification of a valid Nevada State Business License.

3.2

Contractor must comply with all applicable Federal, State, and local laws,
regulations, and policies.

INSURANCE
4.1

5.

Please refer to Insurance Schedule (RFP 99SWC-S26 Section 21) for the insurance
limits the contractor and will be required to maintain for the life of the contract.
The contractor shall not commence work before:
•

They have provided the required evidence of insurance to NDOC; and

•

The Department has approved the insurance policies provided.

SUBCONTRACTOR INFORMATION
5 .1 The contractor shall identify any subcontractors that will be used to perform
services.
5 .2 The contractor shall identify how the subcontractor will be supervised and ensure
the subcontractor remains in compliance with the terms of the contract.
5.3 The contractor shall not allow any subcontractor to commence work until all
insurance, licensing and permit requirements are provided to NDOC.
Page 4of5

Exhibit 1
CETS/CONTRACT # 99SWC-S26

6.

CRIMINAL HISTORY RECORD CHECK I SECURITY REGULATIONS
6.1 Pursuant to Administrative Regulation 212, contractors/vendors are required to
complete a mandatory background check annually.
6.2

At least ten (10) working days prior to beginning work, each employee and/or
subcontractor of the contractor who will be working under this contract and
entering prison grounds are required to submit a completed:
o NDOC Security Regulations Acknowledgement f01m (DOC 04 7) (Exhibit 2),

6.3

o

Prison Rape Elimination Act (PREA) Contractor and Volunteer Questionnaire
Form (DOC 1952) (Exhibit 5),

o

Agency PREA Zero Tolerance Policy (DOC 1953) (Exhibit 4), and

o

Consent for Release of Criminal History Records form (DOC 560) (Exhibit 3)
for the purpose of background clearance approval.

FORMS MUST BE SENT TO:
Nevada Department of Coll'ections
Attn: ContractorNendor Background Checks
P.O. Box 7011, Carson City, NV 89702
5500 Snyder Avenue, Bldg 17, Carson City, NV 89701
Fax (775) 887-3343 I Email: vendors@doc.nv.gov

E-mailed forms will be accepted, but the original forms must be sent by US
postal mail within three (3) days or clearance may be revoked.
6.4

Personnel convicted of a felony will not be permitted to enter a correctional
facility or institution.

6.5

If a PREA allegation of sexual abuse or sexual harassment is filed by an inmate
against a contracted employee, contractor or vendor, including their employees
and subcontractors, the NDOC, Office of the Inspector General will contact the
contractor, or the immediate supervisor of the contracted individual, regarding the
allegation.

Based on the severity of the allegation, NDOC will have the authority to deny
access of any contract employee, contractor or vendor, including their employees
and subcontractors, from entering any coll'ectional facility or institution.

Page 5of5

99SWC-S26
EXHIBIT 2

Nevada Department of Corrections (NDOC)
Security Regulations Acknowledgement

Printed Name of the Employing Company

Printed Employee Name

All outside contractors/subcontractors should understand that they are corning into a correctional facility (or institution) to
work. As such, safety and security are our primary responsibility. It is the responsibility of each contractor/subcontractor
to adhere to the facility's security regulations. These regulations are not all inclusive. Goodjudgrnent and
cornrnunication should be used at all times. Violations of these regulations rnay result in irnrnediate removal frorn the
premises or possible prosecution under applicable State laws NRS 209.417, 212.100, 212.140, 212.150, 212.160, 212.165,
212.170 & 212.187.
Please read and initial every item and sign at bottom to indicate you understand and will follow these regulations.
This form is required before a background check will be processed.

General Rules
_ _ 1. Background checks will be completed prior to access to any NDOC facility property. Access will not be granted
until a background check is passed. Applicants are approved under the company narne on the application only.
A.Background checks will be renewed each year to ensure both the NDOC and contractor have the rnost up-todate information. Contractors will disclose on the background application if they know an incarcerated
individual.
B. Ex-felons will not be allowed entry to prison grounds without the express written approval of the Director of
the Department of Corrections or the Warden of the institution.
2. Any contractor who finds he/she knows an inmate incarcerated at the institution he/she is working at rnust
report it immediately to the facility and Northern Administration (where the background checks are done) so it
can be documented.
A. Access to the institution, if an inmate is known, will be Approved/Denied by the Warden.
3. Contractors will not communicate (talk) or fraternize with inmates unless required.
4. Items that are prohibited (forbidden/illegal) frorn a State Correctional property which includes inside AND
outside of the fence include, but are not limited to:
A. All Tobacco Products;
B. All Narcotics, Drugs, Alcohol, Firearms, Explosives or other Weapons;
C. Cameras are not allowed without prior written permission from the Warden of the institution;
D. Metal or Glass Objects (e.g., Eating Utensils, Bottles, etc.); and
E. Do not bring valuables onto institutional property. These items rnust be locked in your vehicle outside.
_ _ 5. Telecommunications devices including, but not limited to Cell Phones and Laptop Computers will only be
allowed upon prior written approval from the NDOC Director. Approvals from the Warden or Associate
Warden(s) are on a per visit basis only.
A. NDOC forms DOC 003 and DOC 006 must be filled out, signed, and approved prior to bringing any
telecommunications or computer items in to any correctional facility.
6. Non-essential keys should not be brought into the institution (e.g., multiple key rings.)
Page 1 of 3

DOC 047 (Rev. 12/16)

(NDOC Security Regulations Continued)
_ _ 7. Any unauthorized items will be secured in the contractor vehicle at all times.

Vehicles
_ _ 1. All contractor vehicles entering and leaving the institution are subject to search.
_ _ 2. Vehicles may be searched while on the facility's grounds as well.
_ _ 3. All contractor vehicles will be parked in employee parking lot (in front of the gatehouse)

4. All vehicles will remain locked when unattended.
_ _ 5. Keys will remain with owner/operator of the vehicle.
_ _ 6. If the facility allows you to use your vehicle to transport tools or materials, your vehicle will be searched
before and after delivery and immediately returned to the employee parking lot after such delivery.

_ _ 7. Do not exceed posted speed limits around perimeter or on facility property.
_ _ 8. Vehicle traffic must be kept to a minimum. Please carpool whenever possible.

Access To and From Facility Property
_ _ 1. ALL Blue clothing is strictly prohibited (e.g., Blue Jeans, Blue Shirts, Blue Shorts). Orange Jumpsuits are

also prohibited.
2. All contractors will:
A. Sign in and out at the Gatehouse
B. Show and surrender his/her picture identification (Driver's License or ID Card) to the Gatehouse Officer. This
item will be returned upon departure.
C. Submit personal items for inspection (e.g., Tool Bags, Lunch Boxes, etc.). A written inventory of tools is
required.
3. Contractors will be under escort at all times.

Tool Control
_ _ 1. Contractors/Subcontractors are responsible for all tools, equipment and materials brought onto facility property.
_ _ 2. All loose tools and equipment MUST be secured within a locked vehicle or assigned storage area.
A. All hand tools MUST be stored outside the security area overnight.
_ _ 3. Construction materials and equipment may be stored at the facility site in a designated secure area only.
A. The NDOC Facility Supervisor will advise contractors/subcontractors of the designated area(s).
B. Construction huts/Buildings outside the perimeter MUST be a minimum of 100 feet away from fence.
C. Equipment on the inside of the perimeter fence MUST be a minimum of 50 feet away from fence.
D. Placement of"Job Boxes" will be determined by the NDOC Facility Supervisor.

_ _ 4. All Power Tools will be inventoried in and out each day.

Page 2 of3

DOC 047 (Rev. 12/16)

(NDOC Security Regulations Continued)
_ _ 5. Contractors/Subcontractors are responsible for ensuring all storage areas are secured prior to depmting from the
facility.
_ _ 6. Items that are lost or turn up missing will be repo1ted immediately to the Associate W arden(s) of Operations
(A WO) or shift command.

_ _ 7. Contractors should maintain a clean and orderly workplace at all times and remove all refuse daily.
_ _ 8. Work schedules will be established and NDOC (Warden at institution or Camp Lt.) must be notified 48
hours in advance of any change.
In signing this form, I have read and understand the security rules and regulations that have been brought to
my attention. I understand that should I break any of these rules I may be escorted off prison property,
banned from prison property or prosecuted under NRS 209.417, 212.100, 212.140, 212.150, 212.160, 212.165,
212.170, & NRS 212.187.

Vendor (Employee) Signature

Date

Printed Vendor (Employee) Name

Company Fax Number

Company Phone Number

This form must be accompanied by Contractor Background Clearance Application (DOC 560) and PREA
Contractor and Volunteer Questionnaire Form (DOC 052) and mailed to:
NDOC Nmthern Administration
ContractorNendors
P.O. Box 7011
Carson City, NV 89702

Page 3 of3

DOC 047 (Rev. 12/16)

99SWC-S26
EXHIBIT 3

Nevada Department of Corrections

Mail Applications To:
NDOC Contracts
P.O. Box 7011
Carson City, NV 89702

Phone (775) 887-3252
Or
(775) 887-3345
Fax (775) 887-3225

Attn: Contracts
Contractor Background Check Application

Please PRINT all information

1. NAMES/ADDRESSES/PROJECT
Applicant Name
Last

First

MI

Please complete this questionnaire in its ENTIRETY and mail it back to the address listed above. BE ADVISED: ANY omission or
false statement is SUFFICENT REASON FOR DENIAL.
List any other names (alias) you are known by. Include your maiden name and any nicknames, if applicable)
(Failure to include all names will result in denial)

Current Physical Address
Full Street

City

State

Zip

Full Street

City

State

Zip

Full Street

City

State

Zip

Current Mailing Address
Previous Address
Home Phone Number (

)

List any other states you have lived in:
Occupation or Business
Business Phone (

Employer
)

Contact Name:

Have you worked/volunteered in a correctional setting?

D

Yes

D

No

IfYes, When/Where?

Will your project/duties involve direct inmate contact?

D

Yes

D

No

If Yes, in what capacity?

Indicate which institutions you will work at:

2.

IDENTIFIERS

Drivers License and or ID number

State

Date of Birth

Place of Birth

SSN

Gender:

Male

Race

Marital Status:

Married

Height

Weight

Age

Hair Color

D

Female

D

Single

D
D

Eye Color

Scars Marks or Tattoos

For NDOC Use Only

Application Review
Approved

D

Denied

Signature of Authorized Personnel

D
Date
DOC 560 (6/18)

Please complete the znd page

3.

Criminal History: ALL arrests must be listed 2 whether there was a conviction or not. You must also list arrests in other
states and countries. Do not exclude anything; any omission of an arrest is grounds for an automatic denial.

D
Have you EVER been convicted of a Felony? Yes D
Have you EVER been arrested? Yes

D

or No

or No

D

If yes, complete the following, attach additional sheets if necessary.

Charge

Disposition

Date of Arrest

City/State

Charge

Disposition

Date of Arrest

City/State

Charge

Disposition

Date of Arrest

City/State

Charge

Disposition

Date of Arrest

City/State

Charge

Disposition

Date of Arrest

City/State

Are you currently on Probation? Yes

D

or No

D

If yes, in what state?

4.

Do you or have you ever visited or corresponded with an inmate incarcerated in a Nevada Department of
Corrections Facility?
Yes D or No D
If yes, complete the following section and attach additional sheets if necessary.
Name and Back Number

5.

Relationship

Indicate whether you visit or
write this inmate

Authorization

Chapter 179A of the Nevada Revised Statutes permits an Agency of the Criminal Justice to obtain records of criminal history
regarding a prospective employee. Consent is not required in order to obtain infonnation reflecting only convictions. Consent is
required in order to obtain a complete record of criminal history.
The applicant's signature on this consent form will permit the Department of Corrections to obtain complete
information regarding arrests, detention, indictments, information or other formal criminal charges and disposition of charges,
including dismissals, acquittals, convictions, sentences, correctional supervision and release.
This information will be used only for purposes of determining employability. Chapter l 79A ofNRS prohibits an employer
from dissemination of this infmmation.

Applicants Signature

Agency Authorization for Records Check

Date

Date

DOC 560 (6/18)

99SWC-S26
EXHIBIT 4

State of Nevada Department of Corrections
PREA Zero Tolerance Policy

The Nevada Department of Corrections, in compliance with the Department of Justice, National
Standards to Prevent, Detect, and Respond to Prison Rape 42 U.S.C. § 15601, et seq. and 28
C.F.R., §115.32 requires volunteers and contractors be advised of the agency Zero Tolerance
Policy and how to report violations of this policy.
The Department of Corrections has a Zero Tolerance policy for any form of sexual misconduct
to include staff/contractor/or volunteer on inmate or inmate on inmate sexual harassment,
sexual assault, sexual abusive contact and consensual sex. Any staff
member/contractor/volunteer who engages in, fails to report, or knowingly condones sexual
harassment or sexual contact with or between inmates shall be subject to disciplinary action
and may be subject to criminal prosecution. The Department shall take a proactive approach
regarding the prevention, detection, response and punishment of any type of sexual contact.
You are required to report if you hear of, observe, or receive a report of any of the above
actions by staff towards inmates or inmates towards another inmate. You can report to any
NDOC employee and/or by the options listed below.
NDOC PREA Hotline: 775-887-3152
Email: prea@doc.nv.gov
Mail: NDOC, Office of the Inspector General, P.O. Box 7011, Carson City, NV 89702
www.doc.nv.gov: Inspector General, PREA management division, PREA incident report form
I acknowledge I have read and understand NDOC has a "Zero Tolerance" policy, I was given an
opportunity to ask questions and that I am required to report.

I also understand failure to

abide by the Zero Tolerance policy could result in removal as a NDOC volunteer/contractor.

Signature: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Date: _ _ _ _ _ _ __

Print Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

DOC 1953 {9-17)

99SWC-S26
EXHIBIT 5

State of Nevada Department of Corrections
PREA Contractor and Volunteer Questionnaire
The Nevada Department of Corrections, in compliance with the Department of Justice, National
Standards to Prevent, Detect, and Respond to Prison Rape 42 U.S.C. § 15601, et seq. and 28
C.F.R., §115.17 (a} requires all contractors and volunteers who may have contact with inmates
to complete this questionnaire.
Providing false or misleading statements, including material omissions regarding such
misconduct shall be grounds for termination from entry into all NDOC institutions and
volunteer/contractor status will be rescinded.
1. Have you engaged in sexual abuse in a prison, jail, lockup, community confinement
facility, juvenile facility, or other institution, or have you been convicted of engaging or
attempting to engage in sexual activity in the community facilitated by force, overt or
implied threats of force, or coercion, or if the victim did not consent or was unable
to consent or refuse, or have you been civilly or administratively adjudicated to have
engaged in the activity described in any part of this question?
YES D

NOD

2. Have you been adjudicated as having engaged in any type of inmate Sexual Harassment,
which includes as a staff member, volunteer, contractor, or as any type of service
provider coming in contact with an inmate in the facilities mentioned in
question 1? Sexual Harassment includes but is not limited to:
•
•
•
•

Repeated verbal comments of a sexual nature to an inmate; or
Demeaning references to gender; or
Derogatory comments about body or clothing; or
Repeated profane or obscene language or gestures

YES D

Signature

NOD

Date

Print Name

DOC 1952 (9/17)