HomeMy WebLinkAboutSt Vincent De Paul GF1135
A3Ib.ll
AGREEMENT FOR SERVICES
THJS AGREEMENT made and entered into this day of
2011; by and between the CITY OF AUBURN, a municipal
corporation of the State of Washington, hereafter referred to as "CITY", and St. Vincent
De Paul which is located at PO Box 624, Auburn WA 98071-0624, 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 St. Vincent De
Paul 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 Exhibits 1 through 4, and incorporated herein by this
reference as if fully set forth, to Auburn residents during the 2011 term. This support is in
recognition. of the fact that the demand for the services delivered by the AGENCY
continues to rise.
Agreement - GF-1135, St. Vincent De Paul - Emergency Assistance
January 1, 2011
Page 1 of 9
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.
V. 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-1135, St. Vincent De Paul - Emergency Assistance
January 1, 2011
Page 3 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-1135, St. Vincent De Paul -Emergency Assistance
January 1, 2011
Page 5 of 9
X. TERMINATION OF AGREEMENT
This Agreement may be terminated by either party upon thirty (30) days written
notice should the. other party fail substantially to perform in accordance with its terms
through no fault of the other.
XI. GENERAL PROVISIONS
A. The AGENCY agrees to submit a report to the CITY no later than the last
quarterly invoice date, describing the progress and activities performed for
the previous year's 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-1135, St Vincent De Paul - Emergency Assistance
January 1, 2011
Page 7 of 9
CITY OF B RN
TER B. LEWIS
MAYOR
ATTEST:
Darnelle E. Daskam,
Cl
C*n
A DCST. VIN CENT DE PAUL
BY:
TITLE: `
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this ~L1 day of Air 2011, before me, the undersigned, a
Notary P~ubl' in and for the State of Washington, personally appeared
D w nkncac~P_ _ to me known to be the Executive Director of St. Vincent .de
Paul, 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 so "1'1111884,
51014
NOTARY y t 01 `
CA PUBLJC i 2 NOTARY PUBLIC in and for the State of
Washington, residing in
'0 S.
~~'••.9.re,2a~'~.••'~:~ MY COMMISSION expires: -
Agreement - GF-1135, St Vincent De Paul - Emergency Assistance
January 1, 2011
Page 9 of 9
CITY OFEXHIBIT COVER PAGE
WeN GF-1135
WASHINGTON
HUMAN SERVICE AGREEMENT
2011 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: St. Vincent De Paul
Site location: Mailing address:
171 AUBURN WAY N PO BOX 624
AUBURN, WA 98002-4333 AUBURN, WA 98071-0624
Program: Emergency Assistance Contact, Title: Mary Dorn, Project Mgr.
Phone: 253-804-4682
Email: med-34@comcast.net
Amount Requested: $ 2,500.00
Invoice for: ❑ 1s' Quarter, January to March - Due: April 15, 2011
❑ 2nd Quarter, April to June - Due: July 15, 2011
❑ 3`d Quarter, July to September - Due: October 17, 2011
❑ 0 Quarter, October to December - Due: January 31, 2012
Attachments: ❑ Quarterly Service Report - Exhibit 1
❑ Quarterly Financial Report - Exhibit 2
❑ Demographic Report (2"d and 4'h Quarters only) - Exhibit 3
❑ Outcomes Report (4th Quarter only) - Exhibit 4
❑ Proof of Insurance (1St Quarter or if expired)
❑ Logic Model (1St Quarter only) - Suggested Template
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: $10,000.00
Payments Year to Date:
Payment this invoice: Contract Balance:
Authorized to Pay:
Signature Date
CITY OF AUBURN
COVER PAGE - MUST BE SIGNED AND SUBMITTED WITH EACH PAYMENT REQUEST
2011 Exhibit 1
HUMAN SERVICE AGREEMENT
2011 SCOPE OF SERVICES AND QUARTERLY SERVICE UNIT REPORT
Agency Information
St. Vincent De Paul
Site location: Mailing address:
171 AUBURN WAY N PO BOX 624
AUBURN, WA 98002-4333 AUBURN, WA 98071-0624
Contact, Title: Mary Dorn, Project Mgr.
Phone: 253-804-4682
Email: med-34@comcast.net
Are professional services (e.g., counseling, case management) provided as part of this
Agreement?
Contract Information
Contract Amount: $10,000
Program Name: Emergency Assistance
Description of Service to be provided:
Reporting Information
Report for _ 1St Qtr/Jan-Mar -2 nd Qtr/Apr-Jun _ 3`d Qtr/Jul-Sep -4 th Qtr/Oct-Dec
2011 Service Units
City Funding All Funding Sources
Only
Total Actual Service
Service Unit Description: Projected Actual Units b Units to Date
Auburn Residents Only by Quarter
Annual Units
Service Unit/Performance Measure 1St 2"d 3rd 4th
Unduplicated Number of Auburn 257
Clients Served with Rent Assistance
Unduplicated Number of Auburn 267
Clients Served with Utility Assistance
Auburn clients served with Food 6,000
Assistance (not unduplicated)
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.
2011 Exhibit 2
CITY OF AUBURN
2011 Quarterly Financial Report
Agency: St. Vincent De Paul Date:
Program: Emergency Assistance
Report for -151 Qtr/Jan-Mar - 2nd Qtr/Apr-Jun -3 rd Qtr/Jul-Sep _ 4tr' Qtr/Oct-Dec
Cost Categories Budget This Cumulative Award
Award Request to date 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:
2011 Exhibit 3
CITY OF AUBURN
2011 Demographic Report
Agency: St. Vincent De Paul Date:
Program: Emergency Assistance
Category 15 2" 3` 4 Total YTD
Client Algona
Residence** Auburn
Enumclaw
**List all clients Federal Way
served in this Kent
category.
In all other Pacific
categories list Unincorporated. Kin Count
Auburn clients Other:
only. Unknown
TOTAL
Client 30% of median or below
Income 50% of median or below
Level 80% of median or below
Above 80% of median
Unknown
TOTAL
Client Female
Gender Male
Client 0-4
Age 5-12
13-17
18-34
35-54
55-74
75+
Unknown
TOTAL
Ethnicity/ Asian
Cultural Asian /White
Background American Indian /Alaskan Native
American Indian / Alaskan Native & White
American Indian /Alaskan Native & Black
/African American
Black / African American
Black / African American & White
Hispanic / Latino
Native Hawaiian / Other Pacific Islander
Unknown / No Response
TOTAL
Condition Disabling Condition
ESL Limited English Speaking
Household Female-Headed Household
Male-Headed Household
CITY OF AUBURN OUTCOMES REPORT- EXHI13IT4
Funder Reporting to: City of Auburn Reporting Period: to Date Form Completed:
Agency: Program:
E-mail: Phone:
Contact Person:
1St Qtr Due Outcome identified, indicators Given, data collection method(s) explained
4t" Qtr. Due: Outcome results
OUTCOME: (What change do you expect to see?)
MEASURABLE INDICATORS: (How will you know change has occurred?)
DATA COLLECTION METHOD(S):
OUTCOME RESULTS: (Narrative) highlight your data, include your interpretation of the data and attach any graphics if available.
CITY OF AUBURN LOGIC MODEL REPORT- Suggested Template
Funder Reporting to: City of Auburn Reporting Period: to Date Form Completed:
Agency: Program:
Contact Person: E-mail: Phone•
Program Evaluation Logic Model
PROCESS OUTCOME
RESOURCES ACTIVITIES OUTPUTS OUTCOMES GOAL
INDICATORS
CITY OF AUBURN - MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is an addendum to the agreement for services
between the City of Auburn and t. Vincent de Paul - E ergency Assistance, the original of
which was executed on the day of , 2011. All other terms and
zi~ conditions of the agreement for services shall r main in full force and effect except as
specifically amended by this Memorandum of Understanding.
1. It is the goal of the City of Auburn to improve the living conditions of all Auburn
residents.
II. The grant funds provided to the Agency during the 2011 year are provided with the
objective of achieving the results established by the City Council in the areas
of Abused and Neglected Children, Victims of Domestic and Sexual Assault,
Poverty Reduction, Substance Abuse and Health Fitness.
III. Agencies receiving funding from the City ou and agree o participate in
conceptual development of the One Stop Center
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.
Abused and Neglected Children: The City of Auburn will fund human service providers
that increase supportive services to children who are neglected and abused, specifically the
number of children who are victims of on-going and repeated neglect and abuse, within, the
city of Auburn by 15% over the next three (3) years.
Victims of Domestic and Sexual Assault: The City of Auburn will fund human service
providers that increase the number of Auburn residents, who are victims of domestic
violence, that- make the transition to a safe environment and self-determining lifestyle by
15% within the next three (3) years.
Poverty Reduction: The City of Auburn will fund human service providers who increase
the number of Auburn residents no longer living in poverty by 15% within the next three (3)
years.
Substance Abuse: The City of Auburn will fund human service providers to develop
strategies that increase the successful completion of treatment program's by Auburn
residents who have serious behavioral and health problems due to.substance abuse and
chemical dependency by 15% within a three (3) year period.
Physically and Mentally Fit: The City of Auburn will fund human service providers that
increase the availability, accessibility and use of health care to its low income residents by
15% within a three (3) year period.
Agreement GF - 1135, St. Vincent de Paul - Emergency Assistance
January 1, 2011
Page 1 of 2
AUBURN
PETER B. LEWIS
MAYOR
T:
kni
E. Daskam
City Clerk
:Di 0
B. Vee' Ci
ty Attorney
ST. VI ENT DE PAUL
BY:
TITLE:
STATE OF WASHINGTON )
COUNTY OF KING jss
}h
On this ' y day of _8;: \ , 2011, before me, the undersigned, a
N~2tary Public in and for the State of Washington, personal) a
~-}non`e , to me known to be the Executive Director of St. Vi ppentrde
Paul, 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 forth.
AQeZ
~~•''g10iv''• `'9
AA stn
_ ev NOTARY
Co. PUBS NOTARY PUBLIC in and for the State of
' O. Washington, residing in
s~9'18 MY COMMISSION expires: q-1
Agreement GF - 11351 St. Vincent de Paul - Emergency Assistance
January 1, 2011
Page 2 of 2