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A: .16-11
* * Department of Administration
CITY OF IN Michael Hursh, Community Services Manager
"25 West Main Street
Auburn, WA 98001
WASHINGTON
Agreement for Human Service Activities
Costing $5,000 per year or less
This Agreement is made effective as of January 1, 2011, by and between CATHOLIC COMMUNITY
SERVICES: RITA'S HOUSE and the CITY OF AUBURN. In this Agreement, the party who is contracting to
receive services shall be referred to as "CITY", and the party who will be providing the services shall be referred
to as "AGENCY". The parties agree as follows:
1. DESCRIPTION OF SERVICES. Beginning on January 1, 2011, the AGENCY agrees to provide
transitional housing services for adult women in recovery for up to two years located in the City of Auburn.
Services will be delivered as per the attached Scope of Work.
2. PAYMENT. The CITY will pay a fee to the AGENCY for services provided in the amount of $5,000 per
year, paid in semi-annual installments of equal amounts, for services delivered as described in the attached Scope
of Work. This fee shall be payable in a lump sum upon receipt of an invoice from the AGENCY with appropriate
supporting documentation.
3. EXPENSE REIMBURSEMENT. The AGENCY shall pay all "but-of-pocket" expenses, and shall not be
entitled to reimbursement from the CITY except for specific services, items or activities listed in the Scope of
Services as reimbursable goods or services.
4. TERMITERMINATION. This Agreement is effective January 1, 2011, and expires December 31, 2011,
unless either party terminates the Agreement by notifying the other party in writing within seven (7) days of the
intent to terminate. The Agreement may be renewed for one year upon the mutual consent of both parties.
5. RELATIONSHIP OF PARTIES. It is understood by the parties that the AGENCY is an independent
contractor with respect to the City of Auburn, and not an employee of the CITY. The CITY will not provide
fringe benefits, including health insurance benefits, paid vacation, or any other employee benefit, for the benefit
of the AGENCY.
6. EMPLOYEES. The provisions of this Agreement shall also bind the AGENCY employees who perform
services for the CITY under this Agreement.
7. INDEMNIFICATION / HOLD HARMLESS. The AGENCY shall defend, indemnify and hold the City, its
officers, officials, employees and volunteers harmless from any and all claims, injuries, damages, losses or suits
including attorney fees, arising out of or resulting from the acts, errors or omissions of the AGENCY in
performance of this Agreement, except for injuries and damages caused by the sole negligence of the City. The
City of Auburn shall defend, indemnify and hold the AGENCY, its officers, officials, employees and volunteers
harmless from any and all claims, injuries, damages, losses or suits including attorney fees, arising out of or
resulting from the acts, errors or omissions of the City in performance of this Agreement, except for injuries and
damages caused by the sole negligence of the AGENCY.
8. INSURANCE. The AGENCY shall procure and maintain for the duration of the Agreement, insurance
against claims for injuries to persons or damage to property which may arise from or in connection with the
performance of the work hereunder by the AGENCY, its agents, representatives, or employees.
Page 1 of 4
AUBURN 1 MORE THAN YOU IMAGINED
A. Minimum Scope of Insurance, the AGENCY shall obtain insurance of the types described below:
I. Automobile Liability insurance covering all owned, non-owned, hired and leased vehicles.
Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute
form providing equivalent liability coverage. If necessary, the policy shall be endorsed to
provide contractual liability coverage.
2. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01
and shall cover liability arising from premises, operations, independent contractors and
personal injury and advertising injury. The City shall be named as an insured under the
AGENCY's Commercial General Liability insurance policy with respect to the work
performed for the City.
3. Workers' Compensation coverage as required by the Industrial Insurance laws of the State of
Washington.
4. Professional Liability insurance appropriate to the AGENCY profession.
B. Minimum Amounts of Insurance: The AGENCY shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined single limit for bodily injury and
property damage of $1,000,000 per accident.
2. Commercial General Liability insurance shall be written with limits no less than $1,000,000
each occurrence, $2,000,000 general aggregate.
3. Professional Liability insurance shall be written with limits no less than $1,000,000 per claim
and $1,000,000 policy aggregate limit.
C. Other Insurance Provisions: The insurance policies are to contain, or be endorsed to contain, the
following provisions for Automobile Liability, Professional Liability and Commercial General
Liability insurance:
I. The AGENCY's insurance coverage shall be primary insurance as respect the City. Any
insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess
of the AGENCY's insurance and shall not contribute with it.
2. The AGENCY's insurance shall be endorsed to state that coverage shall not be cancelled by
either party, except after thirty (30) days prior written notice by certified mail, return receipt
requested, has been given to the City.
D. Acceptability of Insurers: Insurance is to be placed with insurers with a current A.M. Best rating of
not less than A: VII.
E. Verification of Coverage: The AGENCY shall ftirnish the City with original certificates and a copy
of the amendatory endorsements, including but not necessarily limited to the additional insured
endorsement, evidencing the insurance requirements of the AGENCY before commencement of the
work.
9. ASSIGNMENT. The AGENCY obligations under this Agreement may not be assigned or transferred to any
other person, firm, or corporation without the prior written consent of the CITY.
10. NOTICES. All notices required or permitted under this Agreement shall be in writing and shall be deemed
delivered when delivered in person or deposited in the United States mail, postage prepaid, addressed as follows:
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IF for the CATHOLIC COMMUNITY IF for the CITY:
SERVICES: Rita's House Michael Hursh
Susan Vaughn, Executive Director Community Services Manager
Catholic Community Services 25 West Main Street
100-23 d Ave S Auburn, WA 98001
Seattle, WA 98144-2302
Such address may be changed from time to time by either party by providing written notice to the other in the
manner set forth above.
11. ENTIRE AGREEMENT. This Agreement contains the entire agreement of the parties and there are no
other promises or conditions in any other agreement whether oral or written. This Agreement supersedes any
prior written or oral agreements between the parties.
12. AMENDMENT. This Agreement may be modified or amended if the amendment is made in writing and is
signed by both parties.
13. SEVERABILITY. If any provision of this Agreement shall be held to be invalid or unenforceable for any
reason, the remaining provisions shall continue to be valid and enforceable. If a court finds that any provision of
this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and
enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.
14. WAIVER OF CONTRACTUAL RIGHT. The failure of either party to enforce any provision of this
Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and
compel strict compliance with every provision of this Agreement. ,
15. APPLICABLE LAW. This Agreement shall be governed by the laws of the State of Washington.
The undersigned have read the above statements, understand them and agree a ' e by t eir terms.
Signed: Signed:
Date: qDate: RECEIVED APR 18 2011
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Address: ' oo a3 rj Address: ZS W(25 u
Sea-W1 e, WA
Phone: (o~~~ 3a$- 5V N Phone: [2s3) $ I (P q
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HUMAN SERVICES AGREEMENT BETWEEN THE
CITY OF AUBURN & CATHOLIC COMMUNITY SERVICES: RITA'S HOUSE
Scope of Work
Services to include:
■ Provide transitional housing services for adult women in recovery for up to two years.
■ Services provided include: housing placement assistance, comprehensive case management and
follow up support for program graduates.
■ Housing to support individuals' transition from homeless to independent living within two years of
entering the program.
Reporting Requirements:
■ With each semi-annual request for reimbursement, CATHOLIC COMMUNITY SERVICES: RITA'S
HOUSE will provide a summary of the number of people served along with the number of
unduplicated clients who are Auburn residents.
■ At the end of each year, a brief report describing the past program, number of clients served along
with noteworthy accomplishments and/or challenges.
Additional Billable Services, Goods and/or Activities:
■ None
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CITY OF -.....sue
r M EXHIBIT COVER PAGE
_ GF-1108
WASHINGTON
HUMAN SERVICE AGREEMENT
2011 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: CCS - Catholic Community Services
Location Address (good for mailing):
32505 110th Ave SE
AUBURN, WA 98092
Program: Rita's House Contact, Title: Johanna Cherland, Program Mgr.
Phone: (253) 850-2507
Email: JohannaC@ccsww.org
Amount Requested: $ 1,250.00
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 (1St Qtr. identified and 4th Qtr. data due) - 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: $5.000.00
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
CCS - Catholic Community Services
Mailing address:
100 23`d AVE S
SEATTLE, WA 98144-2302
Contact, Title: Johanna Cherland, Program Mgr.
Phone: 253-850-2507
Email: JohannaC@ccsww.org
Are professional services (e.g., counseling, case management) provided as part of this
Agreement?
Contract Information
Contract Amount: $5,000
Program Name: Rita's House
Description of Service to be provided: Transitional housing services that include housing placement
assistance comprehensive case management and follow upsupport for program graduates
Reporting Information
Report for - 1St Qtr/Jan-Mar -2 nd Qtr/Apr-Jun -3 rd Qtr/Jul-Sep -4 th Qtr/Oct-Dec
2011 Service Units
ity Funding Only
Service Unit Description: Total Actual Service
Auburn Residents Only Projected Actual Units by Quarter Units to Date
Annual Units
Service Unit/Performance-Measure St 2nd 3rd 4th
Unduplicated Number of Auburn 3
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: CCS - Catholic Community Services Date:
Program: Rita's House
Report for -1st Qtr/Jan-Mar -2 nd Qtr/Apr-Jun 3rd Qtr/Jul-Sep -4 th 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 $5,000.00
Requested
Reimbursement:
Detail as Applicable:
2011 Exhibit 3
CITY OF AUBURN
2011 Demographic Report
Agency: CCS - Catholic Community Services Date:
Program: Rita's House
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- EXHIBIT4
Funder Reporting to: City of Auburn Reporting Period: to Date Form Completed:
Agency: Program:
Contact Person: E-mail: Phone:
I" Qtr Due: Outcome identified, indicators given, data collection method(s) explained
4'h Qtr. Due: Outcome results
OUTCOME: (What change do you expect to see?)
j 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