HomeMy WebLinkAboutChrist Community Free Clinic GF0917-__C.r", . ff
AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this day of
2009, by and befinreen the CITY OF AUBURN, a municipal corporation of the State of
Washington, hereafter referred to as "CITY", and CHRIST COMMUNITY FREE CLINIC
which is located at 1 A Street S.E., Auburn, Washington 98001, 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 CHRIST COMMUNITY
FREE CLINIC, 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:
1. 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 - 0917, Christ Community Free Clinic
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 0917, Christ Community Free Clinic
January 1, 2009
Page 2 of 9
C. As fuil and total payment for the services provided under this Agreement, the CITY
agrees to pay the AGENCY the total amount of $20.000.00 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 CI'fY
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
shaN 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 - 0917, Christ Community Free Clinic
January l, 2009
Page 3 of 9
VI1. 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.
VI11. 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 0917, Christ Community Free Clinic
January l, 2009
Page 4 of 9
1) GENERAL LIABILITY COVERAGE:
The CITY, its elected and appointed officials, empioyees 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 i#.
(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 - 0917, Christ Community Free Clinic
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.
(fl 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.
A. 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, national origin, sex, age, or the presence of any sensory,
mental or physical handicap. The AGENCY is a faith based organization and as such
Section 702 of the Civil Rights Act of 1964 allows a faith based organization to use religion
as a factor in hiring potential employees. However, a faith based organizations shall not
discriminate against potential employees or in the provision of any services or programs
for all other protected classes as set forth in the Civil Rights Act of 1964.
B. Agency shall not use any funds paid under this Agreement to pay for any of the
following:
(i) Inherently religious activities such as, religious worship, instruction, or
proselytization; or
(ii) Equipment or supplies to be used for any of those activities.
Agreement - GF 0917, Christ Community Free Clinic
January 1, 2009
Page 6 of 9
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 pertormed 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.
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 pertormed 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.
Agreement - GF - 0917, Christ Community Free Clinic
January 1, 2009
Page 7 of 9
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.
F. Should it become necessary to enforce any term or obligation of this
Agreement, then all costs of enforcement inc{uding 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 0917, Christ Community Free Clinic
January 1, 2009
Page 8 of 9
I 2A72~~
PETER B. LE1MS
MAYOR
A7EST:
~ c.
Danielie E. Daskam,
City Clerk
APPF~V~ A~UFLIRM:
DahiCl'B. Heid,
City Attorney
CHRIST COMMUNITY FREE CLINIC
BY:
TITLE:
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this ~r~Z ~ fh day of , 2009, before me, the undersigned,
a Notary Pu lic in and for e State of Washin~on, person y, appeared
, , to me known to be the ,JcC' ' ~ n'1-41hL of
the ist Communi y Free Clinic, the non-proft 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 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.
L•
.~\gg1 `0'~''fwF`
~ _ ~O►A,Q~~~.,~ :
NOTARY PUBLIC and i the St te of
Washington, residing in
~ •
080G " MY COMMISSION expires: - -
~~i "~.h4~ 19_ ~ 1..~•~;~~.r~
WA
Agreement - GF - 0917, Christ Community Free Clinic
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: Christ Community Free Clinic
1 A Street NW
Auburn, WA 98001
Program: Community Health Clinic
COVER PAGE
Contact, Title: Virginia Gannon, Director
Phone: 253-736-2634
Email: vggannon66@comcast.net
Amount Requested: $ 5,000.00
Invoice for: ❑ 15' Quarter, January to March - Due April 15, 2009
Ll 2"d Quarter, April to June - Due July 15, 2009
❑ 3rd Quarter, July to September- Due October 15, 2009
❑ 4th Quarter (Final) October to December - Due January 31, 2010
Attachments: ❑ Quarterly Service Report
❑ Quarterly Financial Report
❑ Demographic Report (2"d and 4'h Quarters only)
❑ Logic Model (1St Quarter only)
❑ Outcomes Report (0 Quarter only)
❑ Proof of Insurance (1S' 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.
Signature of Authorized 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 C1TY OF AUBURN USE ONLY:
Contract Amount: $20,000.00
Payments Year to Date:
Payment this invoice: Contract Balance:
Authorized to Pay:
Signature Date
CITY OF AUBURN CpVIER PAGE - US7 BE SIGNED ABV~ SUBM1TTED ITH EAGH PAY ENT REQt1EST°
HUMAN SERVICE AGREEMENT
2009 SCOPE OF SERVICES AND QUARTERLY SERVICE UNIT REPORT
Agency Information
Christ Community Free Clinic
1 A Street NW
Auburn, WA 98001
Contact, Title: Virginia Gannon, Director
Phone: 253-736-2634
Email: vggannon66@comcast.net
Are professional services (e.g., counseling, case management) provided as part of this
Agreement?
Contract Information Contract Amount: $20,000
Program Name: Community Health Clinic
Description of Service to be provided:
Reporting Information
Report for _ 1St Qtr/Jan-Mar _ 2"d Qtr/Apr-Jun _ 3rd Qtr/Jul-Sep _ 4th Qtr/Oct-Dec
2009 Service Units
City Funding
Onl
All Funding Sources
Actual Service
U
it
t
D
t
Service Unit Description:
Auburn Residents Only
Total Projected
Annual Units
Actual Units by Quarter
n
s
o
a
e,
all Fund
Sources
Service Unit/Performance Measure
15t
2nd
3rd
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 Financiai Report
Agency: Christ Community Free Clinic Date:
Program: Community Health Clinic
Report for _ 1St Qtr/Jan-Mar _ 2"d Qtr/Apr-Jun _ 3rd 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
$20,000.00
Requested
Reimbursement:
Detail as Applicable:
CITY OF AUBURN
2009 Demographic Report
Agency: Christ Community Free Clinic Date:
Program: Community Health Clinic
; Ca O
1
` 2"
3
TOtal YTD
Gfient
AI ona
Resideace"*
Auburn
'
Black Diamond
""List all clients '
gurien
served in this
3[
Covin ton
G
2g4ry. ;
tn all other
Des Moines
categodes /ist
Enumclaw
AuburR c►ients :
Federal Wa
only-
Kent
'
Ma le Valle
'
Normand Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated. Kin Count
'
Other.
Unknown
TOTAL
Glierit
30% of inedian or below
Ineome '
50% of inedian or below
Level
80% of inedian or below
Above 80% of inedian
Unknown
TOTAL
Client
Female
Gender
Male
Client
0-4
Age '
5-12
13-17
18-34
35-54
55-74
75+
Unknown
TOTAL
E#hnicityt
Asian/Pacific Islander
Cultural
Black/African American
Backgrourtd '
Hispanic/Latino
'
Native American/ Alaskan Native
`
White/Caucasian
Other
Unknown
TOTAL
Condition
Disablin Condition
ESL '
Limited En lish S eakin
Household' '
Female-Headed Household
CITY OF AUBURN
2009 Outcomes Evaluation Format
Agency: Christ Community Free Clinic Date:
Program: Community Health Clinic
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 CHRIST
COMMUNITY FREE CLINIC 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. CHRIST COMMUNITY FREE CLINIC shall develop the following status report
components within the time frames established below:
1) 1 St Quarter
a) The outcome based results CHRIST COMMUNITY FREE CLINIC 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) 4th Quarter
a) Information collected;
b) Conclusions developed as a result of the information.
MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is an addendum to the agreement for services
between the City of ~urn and C rist Gommunity Free Clinic, the original of which was
executed on the day of , 2009. All other terms and conditions of
the agreement for services shall r° main in full force and effect except as specifically
amended by this Memorandum of Understanding.
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
■ 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.
Agreement GF - 0917 CHRIST COMMLJNITY FREE CLINIC
January l, 2009
Page 1 of 3
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 lmmunization
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 ] 000 females ages 15 - 17
Agreement GF - 0917 CHRIST COMMiJNITY FREE CLINIC
January 1, 2009
Page 2 of 3
BUR
F~;O F
PETER B. LEWIS
MAYOR
BY
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
TITLE: WL_d'~ '
CHRIST COMMUNITY FREE CLINIC
On this day of , 2009, before me, the.
undersigned a Nolary Public in and for the State of Washington, personally
re% cc~A V~ OG-cL 1+` rr✓1 , to me known to be the
u t of CHRIST COMMUNITY FREE CLINIC, 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 instrument on behalf of said non-
profit corporation.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my
official seak•'_ftta.hereinabove set forth.
~ ~Q~A4t.1' ~ ' Qi
~ V - -
the State qf
NOTARY PUBLIC in and f~'VX_UV0C_tu_LjWA
Washington, residing in MY COMMISSION expires:
Agreement GF - 0917 CHRIST COMMLTNITY FREE CLINIC
January 1, 2009
Page 3 of 3
ATTEST:
~
Danielle E. Daskam,
Citv Clerk