HomeMy WebLinkAboutGF 21-2205.pdf
Auburn Respite
Carrie Stahlecker
808 9th St. SE
Auburn, WA 98002
Subject: City of Auburn General Fund Human Services Contract for 2021-2022
Dear Carrie Stahlecker,
The City of Auburn is pleased to announce Auburn Respite was approved for funding in the City’s
2021-2022 biennial budget process of which $5,000.00 is included annually, for two consecutive
years, in the Human Services budget.
Enclosed is your two-year contract; please sign and return via Docusign for execution of the
contract.
I am grateful for your agency’s work in Auburn and what we are able to accomplish together.
Sincerely,
Kyla Wright
Human Services Program Coordinator
City of Auburn
25 W Main St.
Auburn, WA 98001
253-931-3096
kwright@auburnwa.gov
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
City of Auburn Agreement: GF-21/2205, Auburn Respite Program
January 1, 2021
Page 1 of 4
CITY OF AUBURN
AGREEMENT FOR HUMAN SERVICES ACTIVITIES
This Agreement made and entered into on this ____day of _______________, 20____,
(“Effective Date”) by and between AUBURN RESPITE PROGRAM (“AGENCY”) and the CITY OF
AUBURN (“CITY”). The parties agree as follows:
1. SCOPE OF SERVICES. Beginning on January 1, 2021, 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 $5,000.00 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. For agencies receiving
more than $25,000 in City of Auburn funding, educational equity training must be timely
completed; if agency fails to timely complete and provide documentation of training, the City may
withhold 4th Quarter payment until such documentation is provided.
4. EXPENSE REIMBURSEMENT. The AGENCY will pay all "out-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 and 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, 2021, and
will expire on December 31, 2021. Provided that if the Auburn City Council does not allocate
sufficient funding for the 2022 calendar year, this Agreement will terminate on December 31,
2021. This Agreement may be terminated by either party upon ten (10) days written notice should
the other party fail substantially to perform in accordance with its terms through no fault of the
other.
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.
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
12/11/2020
City of Auburn Agreement: GF-21/2205, Auburn Respite Program
January 1, 2021
Page 2 of 4
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
resulting from the acts, errors or omissions of the AGENCY in performance of this
Agreement, except for injuries and damages caused by the sole negligence of the CITY.
However, should a court of competent jurisdiction determine 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, including the duty and cost to defend, 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. The AGENCY will procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of this Agreement by the AGENCY, its agents, representatives,
or employees.
1. Minimum Scope of Insurance, the AGENCY shall obtain insurance of the
types described below:
1. Automobile Liability insurance covering all owned, non-owned, hired, and leased
vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or
a substitute form providing equivalent liability coverage. If necessary, the policy shall be
endorsed to provide contractual liability coverage.
2. Commercial General Liability insurance shall be written on ISO occurrence form CG
00 01 and shall cover liability arising from premises, operations, independent contractors,
and personal injury and advertising injury. The City shall be named as an insured under
the AGENCY’s Commercial General Liability insurance policy with respect to the work
performed for the City.
3. Workers’ Compensation coverage as required by the Industrial Insurance laws of the
State of Washington.
4. Professional Liability insurance appropriate to the AGENCY profession.
2. Minimum Amounts of Insurance: The AGENCY shall maintain the
following insurance limits:
3. Automobile Liability insurance with a minimum combined single limit for bodily injury
and property damage of $1,000,000 per accident.
4. Commercial General Liability insurance shall be written with limits no less than
$2,000,000 each occurrence, $2,000,000 general aggregate.
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
City of Auburn Agreement: GF-21/2205, Auburn Respite Program
January 1, 2021
Page 3 of 4
5. Professional Liability insurance shall be written with limits no less than $2,000,000 per
claim and $2,000,000 policy aggregate limit.
6. Other Insurance Provisions: The insurance policies are to contain, or be
endorsed to contain, the following provisions for Automobile Liability,
Professional Liability, and Commercial General Liability insurance:
1. The AGENCY’S maintenance of insurance as required will not be construed to limit
the liability of the AGENCY to the coverage provided by such insurance or otherwise limit
the CITY’s recourse to any remedy available at law or in equity.
2. The AGENCY’s insurance policies are to contain, or be endorsed to contain as
statement that they will be primary insurance and any insurance, self-insurance, or
insurance pool coverage maintained by the City shall be excess of the AGENCY’s
insurance and shall not contribute with it.
3. The AGENCY’s insurance shall be endorsed to state that coverage shall not be
cancelled by either party, except after thirty (30) days prior written notice by certified mail,
return receipt requested, has been given to the City.
D. Acceptability of Insurers: Insurance is to be placed with insurers with a current A.M.
Best rating of not less than A: VII.
E. Verification of Coverage: The AGENCY shall furnish the City with original certificates
and a copy of the amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of the AGENCY
before commencement of the work.
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:
Auburn Respite Program
Attn: Carrie Stahlecker
808 9th St. SE
Auburn, WA 98002
IF for the CITY:
City of Auburn
Community Services Division
25 West Main Street
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
provisions will continue to be valid and enforceable.
14. WAIVER OF CONTRACTUAL RIGHT. The failure of either party to enforce any provision of
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
City of Auburn Agreement: GF-21/2205, Auburn Respite Program
January 1, 2021
Page 4 of 4
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.
Signed:
Agency
Signed:
City of Auburn
Printed: Printed:
Title: Title:
Date: Date:
Address:
Address: 25 West Main Street
Auburn, WA 98001
Phone: Phone: 253-931-3096
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
214 Hi Crest Dr
Vice President
Auburn WA 98001
Sue Miller
12/11/2020
206-617-9920
Mayor
Nancy Backus
12/11/2020
EXHIBIT B
GF-21/2205
1
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
Quarterly Report Form – example only
All reports must be submitted via Excel template uploaded to Share1 upon completion.
To: City of Auburn
ATTN: Community Services
25 W Main St.
Auburn, WA 98001-4998
Agency: Auburn Respite Program
808 9th St. SE
Auburn, WA 98002
Program: Auburn Respite Program
Contact, Title: Carrie Stahlecker
Email/Phone: stahlecker.carrie@yahoo.com / 253-350-8891
Amount Requested: $1,250.00
2021 Quarterly Reports due by: 1st Qtr. (January – March) due: April 15, 2021
2nd Qtr. (April – June) due: July 15, 2021
3rd Qtr. (July – September) due: October 15, 2021
4th Qtr. (October – December) due: first week of January, 2022
2022 Quarterly Reports due by: 1st Qtr. (January – March) due: April 15, 2022
2nd Qtr. (April – June) due: July 15, 2022
3rd Qtr. (July – September) due: October 15, 2022
4th Qtr. (October – December) due: first week of January, 2023
Attached report examples: Quarterly Service Unit Report (due with each submittal) – Page 2
Annual Demographics Report (due 4th quarter) – Page 3
Annual Outcomes Report (due 4th 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: $____________________ Contract balance: $____________________
Authorized to pay:
Signature Date
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
EXHIBIT B
GF-21/2205
2
Quarterly Service Unit Report form – example only
Agency Information
Auburn Respite Program
808 9th St. SE
Auburn, WA 98002
Contact, Title: Carrie Stahlecker, Director
Phone: 253-350-8891
Email: stahlecker.carrie@yahoo.com
Are professional services (e.g., counseling, case management) provided as part of this Agreement? _____
Contract Information
Contract Amount: $5,000.00
Program Name: Auburn Respite Program
Description of Service(s) to be provided: ____________________________________________________
____________________________________________________________________________________
Reporting Information
Report for: 1st Qtr./Jan-Mar 2nd Qtr./Apr-Jun 3rd Qtr./Jul-Sep 4th Qtr./Oct-Dec
Annual Service Units AUBURN RESIDENTS ONLY
Projected
Annual Units
1st qtr.
2nd qtr.
3rd qtr.
4th qtr.
Actual
service units
to date
Unduplicated
number of Auburn
residents served 2 0 1 0 1
Adult Day Care
47
12 12 12 11
Meals for Adult
Day Care
47
12 12 12 11
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.
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
EXHIBIT B
GF-21/2205
3
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
Annual Demographics Report form – example only
Agency: Auburn Respite Program
Program: Auburn Respite Program
Category 1st 2nd 3rd 4th Total YTD
Client
Residence**
**List all
residents served
in this category.
In all other
categories list
Auburn
residents only.
Algona
Auburn
Black Diamond
Burien
Covington
Des Moines
Enumclaw
Federal Way
Kent
Maple Valley
Normandy Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated King County
Other:
Unknown
TOTAL
Client 30% of median or below
Income 50% of median or below
Level 80% of median or below
Above 80% of median
Unknown
TOTAL
Client Female
Gender Male
Client 0-4
Age 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: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
EXHIBIT B
GF-21/2205
4
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):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
EXHIBIT A
GF-21/2205
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICES ACTIVITIES
2021-2022 SCOPE OF SERVICES
Agency/Program:
Auburn Respite
Auburn Respite Program
Location/Mailing: Site Address:
808 9th St. SE
Auburn, WA 98002
Mailing Address:
808 9th St. SE
Auburn, WA 98002
Annual Funding:
2021:
$5,000.00
2022:
$5,000.00
Agency Contact/Title:
Carrie Stahlecker Director
Phone/Email:
253-350-8891 stahlecker.carrie@yahoo.com
City Contact/Title:
Kyla Wright Human Services Program
Coordinator
Phone/Email:
253-931-3096 kwright@auburnwa.gov
Location/Mailing: Site Address:
1 East Main St., 2nd floor
Auburn, WA 98002
Mailing Address:
25 West Main St.
Auburn, WA 98001-4998
1) Project Summary:
Agency shall utilize City of Auburn funds to provide Auburn Respite Program services that include:
adult daycare for seniors with dementia. Such services shall be provided in a professional 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.
Contractors/Grant recipients are prohibited from making any program servic es, resources, assistance,
or housing conditional on clients participating in any sort of religious activity. No funding provided
through the City may be used to support or engage in any explicitly religious activities, including
activities that involve overt religious content such as worship, religious instruction, or proselytization.
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: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
EXHIBIT A
GF-21/2205
Number Served
Annual
Goal
1st Qtr.
JAN–
MARCH
2nd Qtr.
APRIL-
JUNE
3rd Qtr.
JULY–
SEPT
4th Qtr.
OCT–
DEC
Number of unduplicated Auburn
residents assisted in 2021 2 0 1 0 1
Number of unduplicated Auburn
residents assisted in 2022 2 0 1 0 1
Definition of Service Units:
1. Days of care provided to senior participants
2. Meals provided to program participants
3) Outcome(s):
Program strives to keep seniors connected with their families through their participation in the program.
The outcome goal is to maintain 50% participation in the program.
4) Reporting Requirements:
Service Units
Annual
Goal
1st Qtr.
JAN–MAR
2nd Qtr.
APR-JUN
3rd Qtr.
JUL–SEP
4th Qtr.
OCT–DEC
1. Adult Day Care offered in 2021
47
12 12 12 11
1. Adult Day Care offered in 2022
47
12 12 12 11
2. Meals for Adult Day Care
offered in 2021
47
12 12 12 11
2. Meals for Adult Day Care
offered in 2022
47
12 12 12 11
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
EXHIBIT A
GF-21/2205
All data/required forms shall be submitted using Excel template found and submitted via Share1
(instructions 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. 4th 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 4th 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 4th 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).
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 and equity training consistent, if
applicable, 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 submitted with Quarterly Report through Share1.
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1
EXHIBIT A
GF-21/2205
Estimated Quarterly Reimbursements:
2021: $5,000.00 2022: $5,000.00
1st Qtr. $1,250.00 1st Qtr. $1,250.00
2nd Qtr. $1,250.00 2nd Qtr. $1,250.00
3rd Qtr. $1,250.00 3rd Qtr. $1,250.00
4th Qtr. $1,250.00 4th Qtr. $1,250.00
DocuSign Envelope ID: 2C90CAF3-41AB-485C-8C84-35CA96067CB1