HomeMy WebLinkAboutGriefworks GF0925A 3.(G .t i
AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this ~~day of
, 2009, by and between the CITY OF AUBURN, a municipal
- ali)~ corporation of the State of Washington, hereafter referred to as "CITY", and
GRIEFWORKS which is located at PO BOX 912. Auburn, Washinqton 98071-9420, a
non-profit corporation organized under the laws of the State of Washington, hereafter
referred to as "AGENCY."
WHEREAS, The AGENCY provides a valuable service to the CITY and its
residents through the provision of healthcare for patients who are suffering from a
debilitating illness; and
WHEREAS, the CITY is interested in continuing support of the GRIEFWORKS,
including development of additional resources and service sites, for low income Auburn
residents;
NOW, THEREFORE, In consideration of the covenants and conditions of this
Agreement, the parties agree as follows:
I. PURPOSE.
The purpose of this Agreement is to provide for an appropriation to the AGENCY
for providing services as set forth in Exhibit 1 through 4, and incorporated herein by this
reference as if fully set forth, to Auburn residents during the 2009 term. This support is in
recognition of the fact that the demand for the services delivered by the AGENCY
continues to rise.
Agreement - GF - 0925, Griefworks
January 1, 2009
Page 1 of 9
II. SCOPE OF SERVICES.
A. The parties agree and understand that the AGENCY agrees to provide services,
as described in Exhibits 1 through 4, which may include development of new resources,
to low income Auburn residents. Services to be provided are set forth in Exhibits 1
through 4 to this agreement, and incorporated herein by this reference as if fully set forth.
B. The Agency agrees to provide at a minimum the services outlined in the Exhibits.
Said services are to be completed no later than December 31, 2009.
III. TERM.
The term of this Agreement shall commence on January 1, 2009 and shall expire
on December 31, 2009.
IV. PERFORMANCE REPORTS AND COMPENSATION
A. The AGENCY shall provide to the City within 15 days of the close of each
calendar quarter a status report containing program statistics regarding the type and level
of services provided to the City of Auburn, as well as financial information pertaining to
the contract agreement and expenditures. The final report, which may include estimated
service levels, shall be submitted no later than December 12, 2009. Format and contents
of these reports are set forth in Exhibits 1 to 4 to this Agreement, which are incorporated
herein by this reference.
B. The Agency shall prepare and submit to the City two program evaluation reports in
the format commonly referred to as "outcomes reports" which will show the intended
linkages between the activities conducted and the changes the activities will produce.
These reports shall contain information as set forth in Exhibit 4 to this Agreement, which
is incorporated herein by this reference, and shall be submitted to the City at the end of
the first quarter and within sixty days following the close of the calendar year.
Agreement - GF 0925, Griefworks
January l, 2009
Page 2 of 9
C. As full and total payment for the services provided under this Agreement, the
CITY aqrees to pav the AGENCY the total amount of $10,000.00 as set forth in
Exhibit 1. The CITY will pay an amount equal to one-quarter of the total amount within
thirty (30) days following the CITY's receipt of quarterly invoices. The required format and
content of quarterly invoices is set forth in the Exhibits to this Agreement, and is
incorporated herein by this reference.
VI. INDEMNIFICATION.
The AGENCY agrees to defend, indemnify, and hold harmless the CITY, its
elected and appointed officials, employees and agents from and against any and all
claims, demands and/or causes of action of any kind or character whatsoever arising out
of or relating to services provided by the AGENCY, its employees, volunteers or agents
concerning any and all claims by any persons for alleged injury or damage to persons or
property to the extent caused by the negligent acts, errors or omissions of the AGENCY,
its employees, volunteers or agents or representatives. In the event that any suit or claim
for damages based upon such claim, action, loss or damage is brought against the CITY,
the AGENCY shall defend the same as its sole costs and expense; provided that the
CITY retains the right to participate in said suit if any principle of governmental or public
law is involved; and if final judgment be rendered against the CITY and/or its officers,
elected officials, agents and employees or any of them or jointly against the CITY and the
AGENCY and their respective officers, agents, volunteers, employees or any of them, the
AGENCY shall fully satisfy the same and shall reimburse the CITY any costs and
expense which the CITY has incurred as a result of such claim or suit. The provisions of
this section shall survive the expiration or termination of this Agreement.
Agreement - GF - 0925, Griefworks
January 1, 2009
Page 3 of 9
VII. INDEPENDENT CONTRACTOR/ASSIGNMENT.
The parties agree and understand that the AGENCY is an independent contractor
and not the agent or employee of the CITY and that no liability shall attach to the CITY by
reason of entering into this Agreement except as provided herein. The services required
under this Agreement may not be assigned or subcontracted by the AGENCY without the
prior written consent of the CITY.
VIII. INSURANCE.
The AGENCY shall procure and maintain for the duration of this Agreement
insurance against claims for injuries to persons or property which may arise from or in
connection with services provided by the AGENCY, it agents, employees or volunteers
under this Agreement. The AGENCY agrees to provide comprehensive general liability
insurance and shall maintain liability limits of not less than ONE MILLION DOLLARS
($1,000,000) combined single limit coverage per occurrence for bodily injury, personal
injury and property damage. Where professional services are provided as part of the
services rendered pursuant to this Agreement, as shown in Exhibit 1, the AGENCY shall
also provide and maintain professional liability coverage including errors and omissions
coverage in the minimum liability amount of ONE MILLION DOLLARS ($1,000,000)
combined single limit per occurrence for bodily injury, personal injury and property
damage. Any deductibles or self insured retentions in either policy must be declared to
and approved by the CITY. At the option of the CITY either: The insurer shall reduce or
eliminate such deductibles or self insured retentions as respects the CITY, its officials and
employees; or, The AGENCY shall procure a bond guaranteeing payment of losses and
related investigations, claim administration and defense expenses. The policies are to
contain or be endorsed to contain the following provisions:
Agreement - GF 0925, Griefworks
January 1, 2009
Page 4 of 9
1) GENERAL LIABILITY COVERAGE:
The CITY, its elected and appointed officials, employees and agents are to be
covered as additional insureds as respects: Liability arising out of services and
activities performed by or on behalf of AGENCY, its employees, agents and
volunteers. The coverage shall contain no special limitations on the scope of
protection afforded to the CITY, its elected and appointed officials, employees or
agents.
2) GENERAL LIABILITY AND PROFESSIONAL LIABILITY COVERAGES:
(a) The AGENCY's insurance coverage shall be primary insurance as respects the
CITY, its officials, employees and agents. Any insurance or self insurance
maintained by the CITY, its officials, employees or agents shall be in excess of
the AGENCY's insurance and shall not contribute with it.
(b) Any failure to comply with reporting provisions of the policy shall not affect
coverage provided to the CITY, its officials, employees or agents.
(c) Coverage shall state that the AGENCY's insurance shall apply separately to
each insured against whom claim is bought or suit is brought except with
respect to the limits to the insurer's liability.
(d) Each insurance policy required by this clause shall be endorsed to state that
coverage shall not be suspended, voided, canceled, reduced in coverage, or in
limits except after thirty (30) days prior written notice by certified mail return
receipt requested has been given to the CITY. The AGENCY agrees to
provide copies of the Certificates of Insurance to the CITY at the time that this
Agreement takes effect.
Agreement - GF - 0925, Griefworks
January 1, 2009
Page 5 of 9
(e) The AGENCY shall furnish the CITY with Certificates of Insurance and with
original endorsements affecting coverage required by this clause. The
certificate and endorsements for each insurance policy are to be signed by a
person authorized by that insurer to bind coverage on its behalf. The CITY
reserves the right to require complete, certified copies of all required insurance
policies at any time.
(f) The AGENCY shall include all volunteers, employees and agents under its
policies or shall furnish separate certificates and endorsements for each. All
coverages for volunteers shall be subject to all the requirements stated herein.
IX. NONDISCRIMINATION.
The AGENCY shall not discriminate under any services or programs to which this
Agreement may apply directly or through contractual or other arrangements on the
grounds of race, color, creed, religion, national origin, sex, age, or the presence of any
sensory, mental or physical handicap.
X. BOOKS AND RECORDS.
The AGENCY agrees to maintain separate accounts and records in accordance
with State Auditor's procedures, including personnel, property, financial and programmatic
records which sufficiently reflect direct and indirect costs and services perFormed under
this Agreement. The AGENCY agrees to maintain all books and records relating to this
Agreement for a period of three (3) years following the date that this Agreement is expired
or otherwise terminated. The parties agree that the CITY OF AUBURN may inspect such
documents upon good cause at any reasonable time within the three (3) year period.
Agreement - GF 0925, Griefworks
January l, 2009
Page 6 of 9
XI. TERMINATION OF AGREEMENT.
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.
XII. GENERAL PROVISIONS.
A. The AGENCY agrees to submit a report to the CITY no later than
December 12, 2009, describing the progress and activities performed for
the year 2009 under its scope of services.
B. This Agreement shall be governed by the laws, regulations and ordinances
of the City of Auburn, the State of Washington, and County of King and
where applicable, Federal laws.
C. Agency agrees to conduct its activity in such a manner as to coincide with
the goals identified in the attached Memorandum of Understanding. The
Agency understands that the performance indicators established in the
Memorandum will be used by the City as a measurement tool in
determining if the goals have been achieved.
D. The CITY and the AGENCY respectively bind themselves, their
successors, volunteers, assigns and legal representatives to the other
party to this Agreement and with respect to all covenants to this
Agreement.
E. This Agreement represents the entire and integrated Agreement between
the CITY and the AGENCY and supersedes all prior negotiations. This
Agreement may be amended only by written instrument signed by both the
CITY and the AGENCY.
Agreement - GF - 0925, Griefworks
January 1, 2009
Page 7 of 9
F. Should it become necessary to enforce any term or obligation of this
Agreement, then all costs of enforcement including attorney's fees and
expenses and court costs shall be paid to the substantially prevailing party.
G. The AGENCY agrees to comply with all local, state and federal laws
applicable to its performance under this Agreement.
REMAINDER OF PAGE LEFT INTENTIONALLY BLANK
Agreement - GF 0925, Griefworks
January 1, 2009
Page 8 of 9
CIT A BURN
;
~
PETER B. LEWIS
MAYO R
ATTEST:
&Z~t~
Da ' Ile E. Daskam,
City Clerk
APPR TO FORM:
Daniel B. eid,
City Attorney
GRIEFWORKS
BY: 61"--
; `
TITLE: ze
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this day of a4A1L , 2009, before me, the undersigned, a
Notary Public in and for the State of Washington, personally appeared
rs`, to me known to be the _Executive Director of the Griefworks,
the non rofit corpor tion that executed the within and foregoing instrument, and acknowledged
said instrument to be the free and voluntary act and deed of said non-profit corporation for the uses
and purposes therein mentioned, and on oath stated that he/she is authorized to execute said
instrument on behalf of said non-profit corporation.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the date
hereinabove set forth.
. ,
{ .
,
.
.
,
NOTARY PUBLIC in and for the State of
Washington, residing inLf44A241_ VZ~
MY COMMISSION expires: ~9-19 -c;2e)1/
Agreement - GF - 0925, Griefworks
January 1, 2009
Page 9 of 9
CITY OF * ~ *
WASHINGTON
HUMAN SERVICE AGREEMENT
2009 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: MICHAEL HURSH, HUMAN SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: Griefworks
PO Box 912
Auburn, WA 98002
COVER PAGE
Program: Grief Talk Contact, Title: Daryl Thompson, Director
Phone: 253-333-9420
Email: Daryl@GriefWorks.org
Amount Requested:
Invoice for: ❑ 1 St Quarter, January to March - Due April 15, 2009
❑ 2`d Quarter, April to June - Due July 15, 2009
❑ 3`d Quarter, July to September - Due October 15, 2009
❑ 4tn Quarter (Final) October to December - Due January 31, 2010
Attachments: ❑ Quarterly Service Report
❑ Quarterly Financial Report
❑ Demographic Report (2nd and 4'" Quarters only)
❑ Logic Model (1st Quarter only)
❑ Outcomes Report (4th Quarter only)
❑ Proof of Insurance (1st Quarter and/or if expired since last reimbursement
request)
I certify to the best of my knowledge that this invoice and attachments reflect actual service provided to
Auburn residents.
m9yS
3g,t
Signature of Aufhorized Representative Date
The City of Auburn will issue payment upon this invoice within forty-five (45) business days of receipt. To
ensure prompt payment, please submit this form and all required attachments by the date listed above.
FOR C/TY OF AUBURN USE ONLY:
Contract Amount: $10,000.00
Payments Year to Date:
Payment this invoice:
Authorized to Pay:
Signature
CITY OF AUBURN
Contract Balance:
Date
COVER PAGE - MUST BE SIGNED AND SUBMITTED WITH EACH PAYMENT REQUEST
HUMAN SERVICE AGREEMENT
2009 SCOPE OF SERVICES AND QUARTERLY SERVICE UNIT REPORT
Agency Information
Griefworks
PO Box 912
Auburn, WA 98002
Contact, Title: Daryl Thompson, Director
Phone: 253-333-9420
Email: Daryl@GriefWorks.org
Are professional services (e.g., counseling, case management) provided as part of this
Agreement?
Contract Information
Contract Amount: $10,000
Program Name: Grief Talk
Description of Service to be provided:
Reporting Information
Report for _ 1t Qtr/Jan-Mar _
2nd Qtr/Apr-Jun _ 3rd Qtr/Jul-Sep
_ 4th Qtr/Oct-Dec
2009 Service Units
City Funding
Onl
All Funding Sources
Actual Service
Units to Date,
Service Unit Description:
Auburn Residents On/y
Total Projected
Actual Units by Quarter
all Fund
Sources
Annual Units
Service Unit/Performance Measure
1st
2nd
3`d
4m
Unduplicated Number of Auburn
Clients Served
Narrative: Please attach other relevant information, including current trends, program developments,
special events, publicity, community education, etc. If actual service units are lower than anticipated,
please explain.
CITY OF AUBURN
2009 Quarterly Financial Report
Agency: Griefworks
Program: Grief Talk
Report for _ 1" Qtr/Jan-Mar
Date:
_ 2"d Qtr/Apr-Jun _ 3ro Qtr/Jul-Sep _ 4th Qtr/Oct-Dec
Cost Categories
Budget
Award
This
Request
Cumulative
to date
Award
Balance
1
Personal/Agency Services
2
Office/Operating Supplies
3
Consultant or Purchased
Services
4
Direct Client Assistance
5
Communications
6
Travel & Training
7
Intra-Agency Support
8
Other per Detail
Grand Total
$10,000.00
Requested
Reimbursement:
Detail as Applicable:
CITY OF AUBURN
2009 Demographic Report
Agency: Griefworks
Program: Grief Talk
Date:
Black Diamond
Burien
Covington
Des Moines
Enumclaw
Federal Way
Kent
Maple Valiey
Normandy Park
Pacific
Renton
SeaTac
Seattie
Unknown
TOTAL
30% of inedian or below
50°/a of inedian or below
80% of inedian or below
Above 80°/a of inedian
TOTAL
Male
0-4
5-12
13-17
18-34
35-54
55-74
75+
Unknown
TOTAL
Asian/Pacific Islander
Black/African AmericE
Native American/ Alaskan Native
WhitelCaucasian
Other
TOTAL
Disabling Condition
Limited English Speaking
Female-Headed Household
CITY OF AUBURN
2009 Outcomes Evaluation Format
Agency: Griefworks Date:
Program: Grief Talk
1. Submission Dates.
This report shall be submitted with the first quarter invoice and again within sixty (60) days of
the end of the calendar year.
II. Contents.
A. The components of the evaluation will:
1) Identify both process and outcome portions of the services that GRIEFWORKS
proposes to provide the City of Auburn.
2) Show the relationship of program resources and activities to the expected results or
outcomes;
3) Help identify those questions the evaluation is to answer;
4) Provide a graphic summary of how program parts relate to the whole;
5) Make explicit the underlying theory of the program; and
6) Identify measurable categories in the program evaluation.
B. GRIEFWORKS shall develop the following status report components within the time
frames established below:
1) 1StQuarter
a) The outcome based results GRIEFWORKS expects to achieve;
b) An indicator to inform the City of Auburn that the anticipated change has or has
not occurred; and
c) The method for gathering information needed to indicate the outcomes that have
occurred.
d) Initial Collection and assessment of the information acquired to include
alterations in the anticipated outcomes or alterations in the methodology of
information gathering.
2) 4"' Quarter
a) Information collected;
b) Conclusions developed as a result of the information.
MEMORANDUM OF UNDERSTANDING
THIS AGREEMENT made and entered into this a~ day of 2009,
by and between the CITY OF AUBURN, a municipal corporation of the State of
Washington, hereafter referred to as "CITY", and GRIEFWORKS which is located at PO
Box 912. Auburn, WA 98071-0912, a non-profit corporation organized under the laws of
the State of Washington, hereafter referred to as "AGENCY."
1. It is the goal of the City of Auburn to increase the availability of healthcare to its
low income residents by 15% between January, 2007 and January, 2010.
II. The grant funds provided to the Agency during the 2009 year are
provided with the objective of achieving the result of increasing the
availability of healthcare to low income residents.
III. Agencies receiving funding from the City of Auburn agree to participate
in the conceptual development of the One Stop Center and to
collaborate with other agencies concerning the delivery of services to
clients when the Center is operational. The nature and extent of the
collaboration to be determined when the One Stop Center is operational.
IV. The City of Auburn will utilize the following performance measures in
evaluating the effectiveness of reaching this goal.
a. Performance Indicators
Agreement GF - 0925 Griefworks
January 1, 2009
Page 1 of 3
■ Auburn's children under the age of 19 will have access to healthcare.
■ Auburn babies and children are healthy and have adequate nutrition
and prenatal care.
■ The number of sites within Auburn where low income residents can
access healthcare will continue to increase.
■ Reduction in the number of emergency room visits
■ Better dissemination of information about the availability of health care
to low-income residents throughout the community.
Performance Indicators
2002
2004
Goal
Uninsured Adults
105
161
137
Per 1000 adults ages 18 - 24
Uninsured Children
78
40
34
Per 1000 children under 18 yrs.
Emergency Room Visits
13
13
11
Per 1000 adults ages 18 - 64
Unmet Medical Need
80
124
105
Per 1000 adults ages 18 - 64
Low Birth Weight
6
6
5
Per 100 births
No Flu & Pneumococcal Immunization
390
350
298
Per 1000 adults ages 65+
No Childhood Immunization
353
190
162
Per 1000 children under 3 years
Teen Pregnancy
23
21
18
Per 1000 females ages 15 - 17
Agreement GF - 0925 Griefworks
January l, 2009
Page 2 of 3
u
PETER B. LEWIS
MAYOR
~
ATT ST: ^
~
Danielle E. Daskam,
City Clerk
AP AS TO FORM:
Daniel B. Heid,
City Attorney
GRIEFWORKS
~
BY:
TITLE:
STATE OF WASHtNGTON )
)ss
COUNTY OF KING )
,
instrument on behalf of said non-profit corporation.
On this ~A- day of Loh-tz _ , 2009, before me, the
undersigned, a Notary Public in and for the State of Washington, personally
appeared :Dgh.ljL , to me known to be the Executive
Director of GRIE RKS, the non-profit corporation that executed the within
and foregoing instrument, and acknowledged said instrument to be the free and
voluntary act and deed of said non-profit corporation for the uses and purposes
therein mentioned and on oath stated that he/she is authorized to execute said
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my
official seal the date hereinabove set forth.
NOTARY PUBLIC in and for the State of
Washington, residing in L^IqAlt
MY COMMISSION expires:
Agreement GF - 0925 Griefworks
January 1, 2009
Page 3 of 3