HomeMy WebLinkAboutAgreement for Human Services with Seattle King County Department of Public Health - Dental Emergency and Restorative TreatmentDocuSign Envelope ID: D646C520-OF34-491C-BDE3-29D10E9ECE76
CITY OF AUBURN
AGREEMENT FOR HUMAN SERVICES ACTIVITIES
�
This Agreement made and entered into on this 4 day ofM(rCl-L 20�,
("Effective Date") by and between SEATTLE KING COUNTY DEPARTMENT OF PUBLIC
HEALTH ("AGENCY") and the CITY OF AUBURN ("CITY"). The parties agree as follows:
1. SCOPE OF SERVICES. Beginning on January 1, 2019, the AGENCY agrees to perform in a
good and professional manner the tasks described in Exhibit "A," the Scope of Services. The
AGENCY will perform all services as an independent contractor and will not be deemed, by
virtue of this Agreement and the performance of, to have entered into any partnership, joint
venture, employment, or other relationship with the CITY.
2. AGENCY REPRESENTATIONS. The AGENCY represents and warrants that it has all
necessary licenses and certifications to perform the services provided for in this Agreement, and
is qualified to perform those services.
3. PAYMENT. The CITY will pay a fee to the AGENCY for services provided in the amount not
to exceed $12,000 per year, paid in quarterly installments of equal amounts, for services
delivered as described in the attached Scope of Services. This fee will be payable in a lump
sum upon receipt of an invoice from the AGENCY with the documentation required in Exhibit
"B." If the AGENCY fails to perform services or a unit of services as defined in the Scope of
Services, the CITY may withhold payment in the amount of such undelivered services.
4. EXPENSE REIMBURSEMENT. The AGENCY will pay all 'but -of -pocket" expenses, and will
not be entitled to reimbursement from the CITY except for specific services, items, or activities
listed in the Scope of Services as reimbursable goods or services.
5. OWNERSHIP AND USE OF DOCUMENTS. All documents, reports, memoranda, diagrams,
sketches, plans, or other materials created or otherwise prepared by the AGENCY as part of its
performance of this Agreement will be owned by the AGENCY. All City -required reporting
information, forms, and documents will become the property of the City and may be used by the
City for any purpose beneficial to the City.
6. TERM/TERMINATION. The term of this Agreement will commence on January 1, 2019, and
will expire on December 31, 2020. Provided that if the Auburn City Council does not allocate
sufficient funding for the 2020 calendar year, this Agreement will terminate on December 31,
2019. This Agreement may be terminated by either party upon thirty (30) days written notice for
any reason.
7. NONDISCRIMINATION. The AGENCY may not discriminate regarding any services or
activities to which this Agreement may apply directly or through contractual, hiring, or other
arrangements on the grounds of race, color, creed, religion, national origin, sex, age, or where
there is the presence of any sensory, mental or physical handicap.
City of Auburn Agreement: GF -19/2030, Seattle King County Department of Public Health — South King County
Mobile Medical Program
January 1, 2019
Page 1 of 4
DocuSign Envelope ID: D646C520-OF34-491C-BDE3-29D10E9ECE76
8. INDEMNIFICATION / HOLD HARMLESS. The AGENCY shall defend, indemnify and hold
the City, its officers, officials, employees, and volunteers harmless from any and all claims,
injuries, damages, losses, or suits including attorney fees, arising out of or in connection with
the performance of this Agreement, except for injuries and damages caused by the negligence
of the CITY.
If a court of competent jurisdiction determines that this Agreement is subject to RCW 4.24.115,
then, in the event of liability for damages arising out of bodily injury to persons or damages to
property caused by or resulting from the concurrent negligence of the AGENCY and the CITY its
officers, officials, employees, and volunteers, the AGENCY'S liability hereunder shall be only to
the extent of the AGENCY'S negligence. It is further specifically and expressly understood that
the indemnification provided herein constitutes the AGENCY's waiver of immunity under
Industrial Insurance, Title 51 RCW, solely for the purposes of this indemnification. This waiver
has been mutually negotiated by the parties. The provisions of this section shall survive the
expiration or termination of this Agreement.
9. INSURANCE. King County, a charter county government under the constitution of the State
of Washington, hereinafter referred to as "AGENCY", maintains a fully funded Self -Insurance
program for the protection and handling of the AGENCY's liabilities including injuries to
persons and damage to property. The CITY acknowledges, agrees and understands that the
AGENCY is self-funded for all of its liability exposures. The AGENCY agrees, at its own
expense, to maintain, through its self-funded program, coverage for all of its liability exposures
for this Agreement. The AGENCY agrees to provide the CITY with at least 30 days prior written
notice of any material change in the AGENCY's self-funded program and will provide the CITY
with a certificate of self-insurance as adequate proof of coverage. The CITY further
acknowledges, agrees and understands that the AGENCY does not purchase Commercial
General Liability insurance and is a self-insured governmental entity; therefore the AGENCY
does not have the ability to add the CITY as an additional insured.
10. ASSIGNMENT. The AGENCY obligations under this Agreement may not be assigned or
transferred to any other person, firm, or corporation without the prior written consent of the
CITY.
11. NOTICES. All notices required or permitted under this Agreement will be in writing and will
be deemed delivered when delivered in person or deposited in the United States mail, postage
prepaid, addressed as follows:
IF for AGENCY: IF for the CITY:
Seattle King County Department of Public Health City of Auburn
Attn: Alicia Benish Community Services Division
401 5th Ave., #1000 25 West Main Street
Seattle, WA 98104 Auburn, WA 98001
Such address may be changed from time to time by either party by providing written notice to
the other in the manner set forth above.
12. AMENDMENT. This Agreement may be modified or amended if the amendment is made
in writing and is signed by both parties.
13. SEVERABILITY. Each provision of this Agreement is intended to be severable. If any
provision of this Agreement is held to be invalid or unenforceable for any reason, the remaining
City of Auburn Agreement: GF -19/2030, Seattle King County Department of Public Health — South King County
Mobile Medical Program
January 1, 2019
Page 2 of 3
DocuSign Envelope ID: D646C520-OF34-491C-BDE3-29D10E9ECE76
provisions will continue to be valid and enforceable.
14. WAIVER OF CONTRACTUAL RIGHT. The failure of either party to enforce any provision
of this Agreement will not be construed as a waiver or limitation of that party's right to
subsequently enforce and compel strict compliance with every provision of this Agreement.
15. APPLICABLE LAW. This Agreement and the rights of the parties will be governed by and
interpreted in accordance with the laws of the State of Washington and venue for any action will
be in the county in Washington State in which the property or project is located, and if not site
specific, then in King County, Washington.
16. ENTIRE AGREEMENT. This Agreement contains the entire agreement of the parties and
there are no other promises or conditions in any other agreement whether oral or written. This
Agreement supersedes any prior written or oral agreements between the parties.
The undersigned have read the above statements, understand them, and agree to abide by
their terms.
Agency City of Auburn
Signed:
DocuSigned by:
C11 (hSr-AL
Signed
Printed:
TJ Cosgrove
Printed
Title:
Director, CHS Division
Title:
Date:
3/2/2019
Date:
Address: 401 Fifth Ave, Suite 1000
Seattle, WA 98104
Phone: 206.263.8352
Address: 25 West Main Street
Auburn, WA 98001
Phone: 253-931-3096
City of Auburn Agreement: GF -19/2030, Seattle King County Department of Public Health — South King County
Mobile Medical Program
January 1, 2019
Page 3 of 3
DocuSign Envelope ID: D646C520-OF34-491C-BDE3-29D10E9ECE76
EXHIBIT B
GF -19/2030
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
Quarterly Report Form — example only
All reports must be submitted via Excel template and emailed to epearson(d,)auburnwa.gov upon
completion.
To: City of Auburn
ATTN: Community Services
25 W Main St.
Auburn, WA 98001-4998
Agency: Seattle King County Department of Public Health
401 5' Ave., #1300
Seattle, WA 98104
Program: South King County Mobile Medical Program
Contact, Title: Alicia Benish
Email/Phone: alicia.benish(a-)kingcounty.gov / 206-477-4029
Amount Requested: $3,000.00
2019 Quarterly Reports due by: 1St Qtr. (January — March) due: April 15, 2019
2nd Qtr. (April — June) due: July 15, 2019
3 d Qtr. (July — September) due: October 15, 2019
4th Qtr. (October — December) due: first week of January, 2020
2020 Quarterly Reports due by: 1 s' Qtr. (January — March) due: April 15, 2020
2nd Qtr. (April — June) due: July 15, 2020
3rd Qtr. (July — September) due: October 15, 2020
4'h Qtr. (October — December) due: first week of January, 2021
Attached report examples: Quarterly Service Unit Report (due with each submittal) — Page 2
Annual Demographics Report (due 4'h quarter) — Page 3
Annual Outcomes Report (due 4'h quarter) — Page 4
The City of Auburn will issue payment upon this invoice within forty-five (45) business days of receipt. To
ensure prompt payment, please submit all required attachments by the date listed above.
FOR CITY OF AUBURN USE ONLY.
Contract amount:
Payment(s) year to date
Payment this invoice
Authorized to pay:
Contract balance: $
Signature Date
DocuSign Envelope ID: D646C520-OF34-491C-BDE3-29D10E9ECE76
EXHIBIT B
GF -19/2030
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
Quarterly Service Unit Report form – example only
Aaencv Information
Seattle King County Department of Public Health
401 511 Ave., #1300
Seattle, WA 98104
Contact, Title: Alicia Benish
Phone: 206-477-4029
Email: alicia.benish@kingcounty.gov
Are professional services (e.g., counseling, case management) provided as part of this Agreement?
Contract Information
Contract Amount: $12,000
Program Name: South Kinq County Mobile Medical Program
Description of Service(s) to be provided:
Reporting Information
Report for: _ 1 s' Qtr./Jan-Mar —2 nd Qtr./Apr-Jun —3 rd Qtr./Jul-Sep —4 1h Qtr./Oct-Dec
Annual Service Units AUBURN RESIDENTS ONLY
Narrative: Please submit other relevant information, including current trends, program developments,
special events, publicity, community educations, etc. If actual units are lower than anticipated, please
explain.
2
Projected
Annual Units
1S' qtr.
2nd qtr.
3rd qtr.
4"' qtr.
Actual
service units
to date
Unduplicated
number of
46
12
12
11
11
Auburn residents
served
Service Unit #1
Dental Care
48
12
12
12
12
Narrative: Please submit other relevant information, including current trends, program developments,
special events, publicity, community educations, etc. If actual units are lower than anticipated, please
explain.
2
DocuSign Envelope ID: D646C520-OF34-491 C-BDE3-29D1 CE9ECE76
EXHIBIT B
GF -19/2030
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
Annual Demographics Report form — example only
Agency: Seattle King County Department of Public Health
Program: South King County Mobile Medical Program
Category
1s' 2nd 3rd 4"' Total YTD
Client
Residence**
Algona
Auburn
Black Diamond
**List all
residents served
Burien
Covington
in this category.
In all other
categories list
Auburn
residents only.
Des Moines
Enumclaw
Federal Way
Kent
Maple Valle
Normandy Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated King Count
Other:
Unknown
TOTAL
Client
30% of median or below
Income
Level
50% of median or below
80% of median or below
Above 80% of median
Unknown
TOTAL
Client
Female
Gender
Male
Client
Age
0-4
5-12
13-17
18-34
35-54
55-74
75+
Unknown
TOTAL
Ethnicity/
Asian/Pacific Islander
Cultural
Black/African American
Background
Hispanic/Latino
Native American/ Alaskan Native
White/Caucasian
Other
Unknown
TOTAL
Condition
Disabling Condition
ESL
Limited English Speaking
Household
Female -Headed Household
DocuSign Envelope ID: D646C520-OF34-491 C-BDE3-29D1 CE9ECE76
EXHIBIT B
GF -19/2030
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
Annual Outcomes Report form — example only
Agency:
Program:
Contact:
Email/Phone:
OUTCOME (What change do you expect to see?):
MEASURABLE INDICATORS (How will you know change has occurred?):
DATA COLLECTION METHOD(S):
OUTCOME RESULTS/NARRATIVE (Highlight your data, include your interpretation of the data and
attach additional information/graphics/etc. if available):
4
DocuSign Envelope ID: D646C520-OF34-491 C-BDE3-29D1 CE9ECE76
GF -19/2030
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
2019-2020 SCOPE OF SERVICES
Agency/Program:
Seattle King County Department
South King County Mobile Medical
of Public Health
Program
Location/Mailing:
Site Address:
Mailing Address:
varies
401 5"' Ave., #1300
Seattle, WA 98104
Annual Funding:
2019:
2020:
$12,000
$12,000
Agency Contact/Title:
Alicia Benish
Phone/Email:
206-477-4029
alicia.benish@kingcounty.gov
City Contact/Title:
Emily J. Pearson
Human Services Program
Coordinator
Phone/Email:
253-931-3096
epearson@auburnwa.gov
Location/Mailing:
Site Address:
Mailing Address:
1 East Main St., 2nd floor
25 West Main St.
Auburn, WA 98002
Auburn, WA 98001-4998
1) Project Summary:
Agency shall utilize City of Auburn funds to provide South King County Mobile Medical Program
services that include: dental emergency and restorative treatment and assistance. Such services shall
be provided in a manner which fully complies with all applicable federal, state and local laws, statutes,
rules and regulation. Agency shall ensure that City of Auburn residents are being provided services
using awarded Human Services funds under this Agreement.
2) Performance Measures:
a. Number Served - the Agency agrees to serve, at minimum, the following unduplicated
number of Auburn residents with awarded Human Services funds.
b. Service Units - the Agency agrees to provide, at minimum, the following service units by
quarter.
DocuSign Envelope ID: D646C520-OF34-491C-BDE3-29D10E9ECE76
GF -19/2030
Number Served
Annual
IlSt Qtr.
2nd Qtr.
3'd Qtr.
4th Qtr.
Goal
JAN—
APRIL-
JULY—
OCT—
1. Dental Care offered in 2019
48
MARCH
JUNE
SEPT
DEC
Number of unduplicated Auburn
46
12
12
11
11
residents assisted in 2019
Number of unduplicated Auburn
46
12
12
11
11
residents assisted in 2020
Service Units
Annual
1St Qtr.
2nd Qtr.
3.d Qtr.
4th Qtr.
Goal
JAN—MAR
APR -JUN
JUL—SEP
OCT—DEC
1. Dental Care offered in 2019
48
12
12
12
12
1. Dental Care offered in 2020
48
12
12
12
12
Definition of Service Units:
1. Dental Care = visits to the Mobile Dental Van
3) Outcome(s):
Individuals will have increased access to basic needs and health.
4) Reporting Requirements:
All data/required forms shall be submitted via Excel form (to be provided). Required forms shall be
submitted quarterly and/or annually; 1St 2nd and 3rd quarterly reports are due no later than the 15th of
the month following the end of each quarter, i.e. April 15, July 15, and October 15.4' quarter reports are
due no later than the first week of January in order to comply with City end -of -year accounting procedures.
City staff will communicate official January due date(s) during the first week of December.
Quarterly Service Unit Report (due with each submittal): Submitted via Excel form, data from this form
will be used to track each program's progress toward meeting the goals stipulated in the Scope of Services.
Reimbursement Request (due with each submittal): Included as the first page of the Excel form, this form
will serve as the invoicing mechanism for payment to your agency/program. Reimbursement requests
must be signed and returned via email to the City of Auburn staff contact as listed in section five (5) of
this Scope of Services.
Annual Demographics Report (due 4'h quarter): Submitted via Excel form, the agency shall collect and
retain data requested on this form from persons served through this Agreement. Data should be tracked
in an ongoing manner and submitted annually in Share1App (by January 15th)
Annual Outcomes Report (due 41h quarter): Submitted via Excel form, data should demonstrate the
program's progress toward Outcomes specified in the Scope of Services. Outcome data shall be submitted
in Share1App annually (by January 15th).
DocuSign Envelope ID: D646C520-OF34-491C-BDE3-29D10E9ECE76
GF -19/2030
5) Compensation:
The Agency agrees that it will meet the specific funding conditions identified and acknowledges that
payment to the Agency will not be made unless the funding conditions are met. Expenses must be
incurred prior to submission of quarterly reimbursement requests. Quarterly reimbursement requests
shall not exceed the estimated payment without prior written approval from the City. Estimated quarterly
payments are contingent upon meeting or exceeding the above performance measure(s) for the
corresponding quarter. This requirement may be waived at the sole discretion of the City with
satisfactory explanation of how the performance measure will be met by year-end in the Service Unit
Report.
The Agency shall submit reimbursement requests in the format requested by the City. Reimbursement
requests must be signed and returned to City of Auburn via email at epearson(cDauburnwa.gov or mail
to:
City of Auburn
Community Services
Attn: Emily J. Pearson
25 West Main St.
Auburn, WA 98001
Estimated Quarterly
Reimbursements:
2019:
$12,000
2020:
$12,000
111 Qtr.
$3,000
1S'
Qtr.
$3,000
2nd Qtr.
$3,000
2nd
Qtr.
$3,000
3rd Qtr.
$3,000
3rd
Qtr.
$3,000
$3,000
4"'
Qtr.
$3,000