HomeMy WebLinkAboutValley Cities Counseling and Consultation GF1137
AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this day of
hoyu±M 2011, by and between the CITY OF AUBURN, a municipal
corporation of the State of Washington, hereafter referred to as "CITY", and VALLEY
CITIES COUNSELING AND CONSULTATION, which is located at 2704 1 Street NE.
Auburn, Washington 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 for victims of
domestic violence; 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:
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 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-1137, Valley Cities Counseling & Consultation: COD Treatment for Non Medicaid Clients
January 1, 2011
Page 1 of 9
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.
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-1137, Valley Cities Counseling & Consultation: COD Treatment for Non Medicaid Clients
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 insured 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-1137, Valley Cities Counseling & Consultation: COD Treatment for Non Medicaid Clients
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-1137, Valley Cities Counseling & Consultation: COD Treatment for Non Medicaid Clients
January 1, 2011
Page 7 of 9
- CITY 01~`AUBURN
PETER B. LEWIS
MAYOR
ATTEST:
/l a" I
Danielle E. Daskam,
City Clerk
APPR E OR
Da iel ,
City ttorney
VCC - VALLEY CITIES COUNSELING AND
CO SULTA N
BY:
V N\,
TITLE:
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this A~p 0 day of 2011, before the undersigned, a
Notary Public in and for the State of Washington, personally appeared
;Lp/L , to me known to be the ExecutivYpirector of VCC -Valley
Cities Counse ing 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 seal the date
hereinabove set forth.
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F11K !DISS :A7~A GT At ' S I"A1 Uh NOyi
RY PUBLIC in and for the State of
gton, residing in 4>= i
CONIMI,;Sjo\ Wa n
JUi\E 20, 2012 MY COMMISSION expires:
Agreement - GF-1137, Valley Cities Counseling & Consultation: GOD Treatment for Non Medicaid Clients
January 1, 2011
Page 9 of 9
CITY OF_ - -
A T T IwXH181T G~3iiR PACE
01137
l/- ~iJ_ BURN
WASHINGTON
HUMAN SERVICE AGREEMENT
2011 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: Valley Cities Counseling & Consultation
2704 'I' Street NE
Auburn, WA 98002
Program: COD Treatment for Non-Medicaid Clients Contact, Title: Beth Hammond, Program Mgr.
Phone: 253-661-6634 x147
Email: ehammonds@valleycities.org
Amount Requested: $ 2,500.00
Invoice for: ❑ 1St Quarter, January to March - Due: April 15, 2011
❑ 2nd Quarter, April to June - Due: July 15, 2011
❑ 3rd Quarter, July to September - Due: October 17, 2011
❑ 4th Quarter, October to December - Due: January 31, 2012
Attachments: ❑ Quarterly Service Report - Exhibit 1
❑ Quarterly Financial Report Exhibit 2
❑ Demographic Report (2nd and 4th 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 Terv plate
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 OFAUBURN 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
Valley Cities Counseling & Consultation
2704 T St NE
Auburn, WA 98002
Contact, Title: Beth Hammond, Program Mgr.
Phone: 253-661-6634 x147
Email: ehammonds@valleycities.org
Are professional services (e.g., counseling, case management) provided as part of this
Agreement?
Contract Information
Contract Amount: $10,000.00
Program Name: COD Treatment for Non-Medicaid Clients
Description of Service to be provided:
Reporting Information
Report for _ 1 St Qtr/Jan-Mar _ 2nd Qtr/Apr-Jun -3 d Qtr/Jul-Sep -4 1h Qtr/Oct-Dec
2011 Service Units
City Funding All Funding Sources
Only Actual Service
Service Unit Description: Total Units to Date
Auburn Residents Only Projected Actual Units by Quarter
Annual Units
Service Unit/Performance Measure 1St 2nd 3rd 4th
Unduplicated Number of Auburn 7
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.
2011 Exhibit 2
CITY OF AUBURN
2011 Quarterly Financial Report
Agency: Valley Cities Counseling & Consultation Date:
Program: COD Treatment for Non-Medicaid Clients
Report for _ 1st Qtr/Jan-Mar -2 nd Qtr/Apr-Jun -3 rd Qtr/Jul-Sep -4 1h 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: Valley Cities Counseling & Consultation Date:
Program: COD Treatment for Non-Medicaid Clients
Category 1s 2" 3` 4 Total YTD
Client Algona
Residence** Auburn
Black Diamond
**List all clients Burien
served in this Covington
category. Des Moines
In all other
categories list Enumclaw
Auburn clients Federal Way
only. Kent
Maple Valle
Normand Park
Pacific
Renton
SeaTac
Seattle
Tukwila
Unincorporated. Kin Count
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
Ethnicity/ Asian/Pacific Islander
Cultural Black/African American
Background Hispanic/Latino
Native American/ Alaskan Native
White/Caucasian
Other
Unknown
TOTAL
Condition Disabling Condition
ESL Limited English Speaking
Household Female-Headed Household
CITY OF AUBURN OUTCOMES REPORT- EXHIBIT4
Funder Reporting to: City of Auburn Reporting Period: to Date Form Completed:
Agency: Program:
Contact Person: E-mail: Phone:
V Qtr Due: Outcome identified, indicators given, data collection method(s) explained
4" 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.
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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 VALLEY CITIES COUNSELING & CONSULTATION, the
original of which was executed on .the I'C'Y day of ~J-ANUmM , 2011. .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.
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 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:
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.
I
i
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 programs by Auburn
f residents who have serious behavioral and health problems due to substance abuse and
II, 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
C~ 15%o within a three (3) year period.
Agreement GF - 1137, Valley Cities Counseling & Consultation, COD Treatment for Non-Medicaid Clients
January 1, 2011
Page 1 of 2
f
' CITY OF AUBURN
PETER B. LEWIS
MAYOR
ATTEST:
ji~
Danielle E. Daskam,
City Clerk
APP O D A T FO
D 'el B. Heid,
City Attorney
VALLEY CITIES COUNSELING AND CONSULTATION
BY: 161'\T
TITLE: O-STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this -2 9 day of 2011, befor e, the
undersigned a Nota Public in and for the State of Washington, pe7tive II 4ppeared
to me known to be the Exe Director of
VALLEY CITIES COUNSELING & 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
seal the date hereinabove set forth.
A. TORZA:
NOTA PUBLIC in and fpr , e State of
PUBLIC
STATE CF N':1,!f~f\GTON Washin ton, residing in LA~~ W~
i=XRiRES MY C MMISSION expires:
JU4E 20, 2012
Agreement GF - 1137, Valley Cities Counseling & Consultation, COD Treatment for Non-Medicaid Clients
January 1, 2011
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