HomeMy WebLinkAboutChrist Community Free Clinic GF1017AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this ~ day of
Lai(' ~n , 2010, by and between 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 2010 term. This support is in
recognition of the fact that the demand for the services delivered by the AGENCY
continues to rise.
~
Agreement - GF - 1017, Christ Community Free Clinic
January 1, 2010
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, 2010.
III. TERM.
The term of this Agreement shall commence on January 1, 2010 and shall expire
on December 31, 2010.
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, 2010. 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 1017, Christ Community Free Clinic
January 1, 2010 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 $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 evenf 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 - 1017, Christ Community Free Clinic
January 1, 2010
Page 3 of 9
VII. INDEPENDENT CONTRACTORIASSIGNMENT.
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 1017, Christ Community Free Clinic
January 1, 2010
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 - 1017, Christ Community Free Clinic
January 1, 2010
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 1017, Christ Community Free Clinic
January 1, 2010
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 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.
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, 2010, describing the progress and activities performed for
the year 2010 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 - 1017, Christ Community Free Clinic
January 1, 2010
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 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 1017, Christ Community Free Clinic
January 1, 2010
Page 8 of 9
C O illBURN
~
PETER B. LEWIS
MAYOR'
ATTEST:
Danielle E. Daskam,
City Clerk
C~
APPR ED A O M:
Daniel B. Heid, ~
City Attorney
HRIST COMMUNITY FREE CLINIC
.J~
BY:
TITLE:
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this In il, day of m Clr' , 2010, before me, the undersigned, a
Notary Public in and for the State of Washington, personally appeared
V~fo, t nicr, G annon , to me known to be the 'eiei, . I0,'rpi,ftaV' of the
Chris ommunity 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 seal the date
hereinabove set
_r`(4V~•Q ~*i~"~!~~~,~,p'~i,
r0, F ~YV
~o
' U u ;r' 2✓''
NOTARY PUBLIC in and for the State of
Washington, residing in V_.v%4-
MY COMMISSION expires: 11
Agreement - GF - 1017, Christ Community Free Clinic
January 1, 2010
Page 9 of 9
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
Amount Requested: $ 5,000.00
Contact, Title: Virginia Gannon, Director
Phone: 253-736-2634
Email: vggannon66@comcast.net
Invoice for: ❑ 1S' Quarter, January to March - Due April 15, 2010
❑ 2"d Quarter, April to June - Due July 15, 2010
❑ 3rd Quarter, July to September- Due October 15, 2010
❑ 4tn Quarter (Final) October to December- Due January 31, 2011
Attachments: ❑ Quarterly Service Report
❑ Quarterly Financial Report
❑ Demographic Report (2"d and 4th Quarters only)
❑ Logic Model (15t Quarter only)
❑ Outcomes Report (4th Quarter only)
❑ Proof of Insurance (15t 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 CITY OF AUBURN USE ONLY:
Contract Amount: $20,000.00
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
2010 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 _ 1S' Qtr/Jan-Mar
2010 Service Units
-2"d Qtr/Apr-Jun _ 3`d Qtr/Jul-Sep _ 4th Qtr/Oct-Dec
City Funding
Onl
All Funding Sources
Actual Service
U
i
Service Unit Description:
Auburn Residents Only
Total Projected
Annual Units
Actual Units by Quarter
n
ts to Date,
all Fund
Sources
Service Unit/Performance Measure
240
15t
2"a
3ra
4cn
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
2010 Quarterly Financial Report
Agency: Christ Community Free Clinic Date:
Program: Community Health Clinic
Report for _ 1S' Qtr/Jan-Mar _ 2"d Qtr/Apr-Jun _ 3rd Qtr/Jul-Sep _ 4'h 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
2010 Demographic Report
Agency: Christ Community Free Clinic Date:
Program: Community Health Clinic
Cate o`
1
2"
3` ;
4
Total YTD'
Client '
AI ona
Residence**
Auburn
Black Diamond
""Lisf all clients '
gurien
served in this '
Covin ton
category.
U all other
Des Moines
categories list '
Enumclaw
Auburn clienis
Federal Wa
on/y.
Kent
Ma le Valle
Normand Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincor orated. Kin Count
Other:
Unknown
TOTAL
Clienf
30% of inedian or below
Income
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
Ethnicity/
Asian/Pacific Islander
Cultural
Black/African American
Background
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
2010 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.
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 Auburn and Christ Community Free Clinic, the original of which was
executed on the lb day of /N101,C''_j~1 , 2010. All other terms and conditions of
the agreement for services shall remain 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, 2008 and January, 2011.
II. The grant funds provided to the Agency during the 2010 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 - 1017 CHRIST COMMUNITY FREE CLINIC
January 1, 2010
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
390
350
298
Per 1000 adults ages 65+
Immunization
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 - 1017 CHRIST COMMUNITY FREE CLINIC
January 1, 2010
Page 2 of 3
R~' F BU
.
PETER B. LEWIS
MAYOR
A T T ST:
Danielle E. Daskam,
City Clerk
APP ED A FORM: .
~5aniel B. Heid,
City Attorney
HRIST COMMUNITY FREE CLINIC
~
BY: ~
TITLE:
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this I,,j+ day of r" , 2010, before me, the
undersigned, Notary Public in and for the State of Washington, personally a peared
yc~ o , to me known to be the ~[')c.e_c__ n, rte ~o c of
CHRI 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
seal the date 1~9"Nftoq set forth.
~y~P
' .j~
. y
iT FO~ A/r'~
y ~c~ _ . _ c~'n's $ : e.r
NOTARY PUBLIC in and for the State of
Washington, residing in '11-
' '~~MY COMMISSION expires:
t'~~~9~.1`~`
~~',~~~►,WASN~~.~.
Agreement GF -1017 CHRIST COMMUNITY FREE CLINIC
January 1, 2010
Page 3 of 3