HomeMy WebLinkAboutValley Cities Counseling GF0515
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AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this / sr
day of
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JtI¥lJ
corporation of the State of Washington, hereafter referred to as "CITY", and VALLEY
, 2005, by and between the CITY OF AUBURN, a municipal
CITIES COUNSELING AND CONSULTATION which is located at 2704 I Street N.E..
Auburn. Washinqton 98002, 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 mental health counseling and therapy; and
WHEREAS, the CITY is interested in continuing support of Valley Cities
Counseling and Consultation, 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 2005 term. This support is in
recognition of the fact that the demand for the services delivered by the AGENCY
continues to rise.
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Agreement - GF-0515, Valley Cities Counseling, Survivor Support
March 1, 2005
Page 1 of8
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, 2005.
III. TERM.
The term of this Agreement shall commence on January 1, 2005 and shall expire
on December 31, 2005.
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 13, 2005. 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.
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Agreement- GF-0515, Valley Cities Counseling, Survivor Support
March 1. 2005
Page 2 of8
C. As full and total payment for the services provided under this Agreement, the
CITY aarees to Day the AGENCY the total amount of $12.000.00 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 governmentai or public
law is involved; and iff inal 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.
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Agreement - GF-0515, Valley Cities Counseling, Survivor Support
March 1, 2005
Page 3 of8
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:
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Agreement - GF-0515, Valley Cities Counseling, Survivor Support
March 1, 2005
Page 4 of8
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1) GENERAL LIABILITY COVERAGE:
The CITY, its elected and appointed officials, employees and agents are to be
covered as additional insureds as respects: Liability a rising 0 ut 0 f 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.
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Agreement - GF-0515, Valley Cities Counseling, Survivor Support
March 1, 2005
Page 5 of8
(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.
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Agreement- GF-0515, Valley Cities Counseling, Survivor Support
March 1, 2005
Page 6 of8
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 13, 2005, describing the progress and activities performed for
the year 2005 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. 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.
D. 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.
E. Should it become necessary to enforce any term or obligation of this
Agreement, then all costs of enforcement including attorneys fees and
expenses and court costs shall be paid to the substantially prevailing party.
F. The AGENCY agrees to comply with all local, state and federal laws
applicable to its performance under this Agreement.
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Agreement - GF-0515, Valley Cities Counseling, Survivor Support
March 1, 2005
Page 7 of8
~._--_.~--_.~,...
Gf~
PETER B. LEWIS
MAYOR
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....
¡ST:
'-úJlI tJjð-ð~
'Da . lie E. Daskam,
CityCI
VALLEY CITIES COUNSELING AND
CONSULTATION. ~~/7
By:;øJ:/ ~~
TITLE: ( £. 0
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this ~ day of ~ , 2005, before me, the undersigned, a
Public . and for the State of Washington, personally appeared
, to me known to be the Executive Director of Valley Cities
Counselin and Consultation, 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 seai the date
hereinabove set forth.
~qlL~ a. 0~
;;¿IS 1/ ~~ -:Or ~r- æ "'<~. ,.NI.
NOTARY PUBLIC in and f9[ the State of
Washington, residing in ,..lJ.Jtu..-
MY COMMISSION expires: II-I-r -oí
Agreement - GF-0515, Valley Cities Counseling, Survivor Support
March 1, 2005
Page 80f8
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E)(HIBIT 1, GF-0515
CITY OF AUBURN
HUMAN SERVICE AGREEMENT
2005 SCOPE OF SERVICES AND QUARTERLY SERVICE UNIT REPORT
Agency Information
Valley Cities Counseling & Consultation
2704 I Street N.E.
Auburn, WA 98002
253.876.3468
cmoose@valleycities.org
Contact:
Cheryl Moose
Title: CFO
Are professional services (e.g., counseling, case management) provided as part of this
Agreement? YES
Contract Information
Contract Amount:
12,000
Program Name: Survivor Support & Therapy Services
Description of Service to be provided: Comprehensive mentai health services to survivors lorimarilv
adults) of famiiv vioience and soecificallv to survivors of
childhood and aduit sexuai and/or ohvsical abUSE!
Reporting Information
Report for
1st Qtr/Jan-Mar
_ 2" Qtr/Apr-Jun
_ 3" Qtr/Jul-Sep
4th Qtr/Oct-Dec
2005 Service Units
City Funding All Funding Sources Açtual Service
Onlv Units to Date,
Service Unit Description; Total all Fund
Auburn Residents Only Projected Actual Units by Quarter Sources
Annual Units
Service Unit/Performance Measure 1't 2" 3"' 4th
Unduplicated Number of Auburn 137
Clients Served
Mentai Health Counseiing (Hours) 1,562
Narrative; Please attach other relevant information, including current trends, program developments,
special events, publicity, community education, etc. If actual service units are lower than "nticipated,
please explain.
'-~-_.-...-
EXHIBIT 2, GF-0515
CITY OF AUBURN
2005 Quarterly Financial Report
Agency: Valley Cities Counseling & Consultation
Program: Survivor Support & Therapy Services
Date:
Report for
1st Qtr/Jan-Mar
_ 2nd Qtr/Apr-Jun
_ 3'd Qtr/Jul-Sep
4th Qtr/Oct-Dec
Cost Categories Budget This Cumulative Award
Award Request to date Balance
1 Personnel/Agency Services 12,000
2 Office/Operating Supplies
3 Consultant or Purchased
Services
4 Direct Client Assistance
5 Communications
6 Travei & Training
7 Intra-Agency Support
8 Other per Detail
Grand Total 12,000
Requested
Reimbursement:
Detail as Applicable:
- -_....._..~.._.._---
EXHIBIT 3, GF-0515
CITY OF AUBURN
2005 Demographic Report
Agency:
Program:
Valley Cities Counseling & Consultation
Survivor Support & Therapy Services
Date:
Category 1"' 2" 3 4' I Total YTD I
Client Algona
Residence*· Auburn
Black Diamond
"'list all clients Burian
served in this Covington
category. Des Moines
In all other
categories list Enumclaw
Auburn clients Federal Way
only. Kent
Maple Vallev
Normandy Park
Pacific
Renton
SeaTae
Seattle
TUkwila
Unincor orated. Kina 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
Ethnicityl Asian/Pacific Islander
Cultural Black/African American
Background Hispanic/latino
Native Amerlcanl Alaskan Native
White/Caucasian
Other
Unknown
TOTAL
Condition Disabling Condition
ESL Limited Enalish Soeakina
Household Female-Headed Household
---- -_._------'-'--~-----.------.._~_.._--
COVER PAGE, GF-0515
CITY OF AUBURN
Outcomes Evaluation Format
Agency: Valley Cities Counseling & Consultation
Program: Survivor Support & Therapy Services
Date:
I. Submission Dates.
This report shall be submitted with the first quarter invoice and again within thirty (30) days
after the end of the calendar year.
II. Contents.
A. The components of the evaluation will:
1) Explain the underlying theory of the program and what it was designed to accomplish
in terms of outcomes and output goals..
2) Show the relationship of program resources and activities to the expecteid results or
outcomes;
3) Provide a logic model that relates outcomes to activities to projected outputs and the
resources required to generate those outputs.
B. Valley Cities shall develop the following status report components within the time frames
established below:
1) 151 Quarter 2005
a) The above logic model and explanation of the underlying theory of the program.
b) The method for gathering information needed to indicate the outcomes that have
occu rred.
c) Initial collection and assessment of the information for the first quarteir inciuding
alterations to the initial grant application and/or alterations in the methodology of
information gathering.
2) 41h Quarter 2005
a) Revise the logic model with actual outcomes achieved, activities performed,
outputs generated and resources spent.
b) Conclusions developed as a result of the information.
c) Completion of the Demographic Report represented in Exhibit 3.
COVER PAGE - MUST BE SIGNED AND SUBMITTED WITH EACH PAYMENT RE(~UEST
-_.._~~~~-
COVER PAGE, GF-0515
CITY OF AUBURN
HUMAN SERVICE AGREEMENT
2005 INVOICE FOR CONTRACTED SERVICES
To: City of Auburn, AUn: Bill Mandeville, Planning Department
25 West Main, Auburn, WA 98001
Agency: Valley Cities Counseling & Consultation
2704 J Street NE
Auburn, WA 98002
Date:
253.876.3.468
253-876<1422
cmoose@valleyclties.org
Contact: Cheryl Moose
Invoice for: 0 1st Quarter, January to March - Due April 15, 2005
o 2'd Quarter, April to June - Due July 15, 2005
o 3'" Quarter, July to September - Due October 15, 2005
o 4th Quarter (Preliminary, Cover sheet and Ex. B only) October to December - Due
December 13, 2005
o 4th Quarter (Final) October to December - Due January 31,2006
Amount Requested:
Required Attachment Checklist: _ Exhibit A - Quarterly Service Report
_ Exhibit B - Quarterly Financial Report
_ Exhibit C - Demographic Report (2'd and 4th Quarters only)
_ Logic Model/Outcomes Report (1't and 4th Quarters 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.
Date
The City of Auburn will issue payment upon this invoice within thirty (30) business days of receipt. To
ensure prompt payment, please submit this form and all required attachments by the date iisted above.
FOR CITY OF AUBURN USE ONL Y:
Contract Amount:
Payments Year to Date:
12,000
Date:
Date:
Date:
Date:
Contract Baiance:
Payment this invoice:
Authorized to Pay:
Signature
Date
COVER PAGE - MUST BE SIGNED AND SUBMITTED WITH EACH PAYMENT RECIUEST
-....----..-....-
EXHIBIT 1, GF-0515
CITY OF AUBURN
HUMAN SERVICE AGREEMENT
2005 SCOPE OF SERVICES AND QUARTERLY SERVICE UNIT REPORT
Agency Information
Valley Cities Counseling & Consultation
2704 I Street N.E.
Auburn, WA 98002
253.876,,1468
cmoose@valleycities.org
Contact:
Cheryl Moose
Title: CFO
Are professional services (e,g., counseling, case management) provided as part of this
Agreement? YES
Contract Information
Contract Amount:
12,000
Program Name: Survivor Support & Therapy Services
Description of Service to be provided: Comprehensive mental health services to survivors (primarilv
adults) of familv violence and specificallv to survivors of
childhood and adult sexuai and/or phvsical abUSE¡
Reporting Information
Report for
1 'I Qtr/Jan-Mar
_ 2"" Qtr/Apr-Jun
_ 3'd Qtr/Jul-Sep
4th Qtr/Oct-Dec
2005 Service Units
City Funding All Funding Sources A<:tual Service
Only Units to Date,
Service Unit Description: Total all Fund
Auburn Residents Only Projected Actual Units by Quarter Sources
Annual Units
Service Unit/Performance Measure 1" 2nd 3'" 41h
Unduplicated Number of Auburn 137
Clients Served
Mental Health Counseling (Hours) 1,562
Narrative: Please attach other relevant information, including current trends, program developments,
special events, publicity, community education, etc. If actual service units are lower than êlnticipated,
please explain,
_._.------_._~~_._-~.-
.-------------
EXHIBIT 2, GF-0515
CITY OF AUBURN
2005 Quarterly Financial Report
Agency: Valley Cities Counseling & Consultation
Program: Survivor Support & Therapy Services
Date:
Report for
1st Qtr/Jan-Mar
_ 2,d Qtr/Apr-Jun
_ 3"' Qtr/Jul-Sep
4th Qtr/Oct-Dec
Cost Categories Budget This Cumulative Award
Award Request to date Balance
1 Personnel/Agency Services 12,000
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 12,000
Requested
Reimbursement:
Detail as Applicable:
-_...--..-_~~..- -~-~
EXHIBIT 3, GF-0515
CITY OF AUBURN
2005 Demographic Report
Agency;
Program:
Valley Cities Counseling & Consultation
Survivor Support & Therapy Services
Date:
Category 1 2"· 3 4'" Total YTD
Client Alaona
Residence·· Auburn
Black Diamond
-·List all clients Burian
served In this Covinaton
category. Des Moines
In all other
categories list Enumclaw
Auburn clients Federal Wav
only, Kent
Maale Vallev
Narmandv Park
Pacific
Renton
SeaTae
Seattle
Tukwila
Unincorporated. KinQ 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
Ethnlcltyl Asian/Pacific Islander
Cultural Black/African American
Background HisoaniClLatino
Native American! Alaskan Native
White/Caucasian
Other
Unknown
TOTAL
Condition DisablinQ Condition
ESL Limited Enalish Soeakina
Household Female·Headed Household
_..._~_.__._~,-~~-
COVER PAGE, GF-0515
CITY OF AUBURN
Outcomes Evaluation Format
Agency: Valley Cities Counseling & Consultation
Program: Survivor Support & Therapy Services
Date:
I. Submission Dates,
This report shall be submitted with the first quarter invoice and again within thirty (30) days
after the end of the calendar year.
II, Contents.
A, The components of the evaluation will:
1) Explain the underlying theory of the program and what it was designed to accomplish
in terms of outcomes and output goals..
2) Show the relationship of program resources and activities to the expectE!d results or
outcomes;
3) Provide a logic model that relates outcomes to activities to projected outputs and the
resources required to generate those outputs.
B. Valley Cities shall develop the following status report components within the time frames
established below:
1) 1 st Quarter 2005
a) The above logic model and explanation of the underlying theory of the program,
b) The method for gathering information needed to indicate the outCOm<9S that have
occurred.
c) Initial collection and assessment of the information for the first quarte,r including
alterations to the initial grant application and/or alterations in the methodology of
information gathering,
2) 4th Quarter 2003
a) Revise the logic model with actual outcomes achieved, activities performed,
outputs generated and resources spent.
b) Conclusions developed as a result of the information.
c) Completion of the Demographic Report represented in Exhibit 3.
COVER PAGE - MUST BE SIGNED AND SUBMITTED WITH EACH PAYMENT RECIUEST
--_._-_...__._~-_.._~._~-------------
. ----,-.---------.---
COVE.R PAGE, GF-0515
CITY OF AUBURN
HUMAN SERVICE AGREEMENT
2005 INVOICE FOR CONTRACTED SERVICES
To: City of Auburn, Attn: Bill Mandeville, Planning Department
25 West Main, Auburn, WA 98001
Agency: Valley Cities Counseling & Consultation
2704 I Street NE
Auburn, WA 98002
Date:
253.876.:1468
253-876-:3422
cmoose@valleycities.org
Contact: Cheryl Moose
Invoice for: 0 1" Quarter, January to March - Due April 15, 2005
o 20d Quarter, April to June - Due July 15, 2005
o 3"' Quarter, July to September - Due October 15, 2005
o 41h Quarter (Preliminary, Cover sheet and Ex. B only) October to December - Due
December 13, 2005
o 41h Quarter (Final) October to December - Due January 31,2006
Amount Requested:
Required Attachment Checklist: _ Exhibit A - Quarterly Service Report
_ Exhibit B - Quarterly Financial Report
_ Exhibit C - Demographic Report (20d and 41h Quarters oniy)
_ Logic Model/Outcomes Report (1" and 41h Quarters only)
_ Proof of Insurance (1" quarter and/or if expired sinGe last
reimbursement request)
I certify to the best of my knowledge that this invoice and attachments reflect actual service provided to
Auburn residents.
Date
The City of Auburn will issue payment upon this invoice within thirty (30) business days of receipt. To
ensure prompt payment, please submit this form and all required attachments by the date listed above.
FOR CITY OF AUBURN USE ONL Y:
Contract Amount:
Payments Year to Date:
12,000
Date:
Date:
Date:
Date:
Contract Balance:
Payment this invoice:
Authorized to Pay:
Signature
Date
COVER PAGE - MUST BE SIGNED AND SUBMITTED WITH EACH PAYMENT REQUEST
-"-"-"'._-~.,._-~...-