HomeMy WebLinkAboutSeattle King County Mobile Medical Program GF1128
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AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this l day of
q 00, 2011, by and between the CITY OF AUBURN, a municipal
corporation of the State of Washington, hereafter referred to as "CITY", and Seattle King
County: Mobile Medical Program which is located at 401 Fifth Ave, Suite 1000, Seattle
WA 98104-1823, an agency of a charter county government under the constitution 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 Seattle King
County 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.
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January I, 2011
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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, 2011.
III. TERM
The term of this Agreement shall commence on January 1, 2011 and shall expire
on December 31; 2011.
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. 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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January I, 201 1
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C. As full and total payment for the services provided under this Agreement, the CITY
agrees to pay the AGENCY up to $10,000. 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.
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. It is further
specifically and expressly understood that the AGENCY's indemnification provided herein
constitutes the Agency's waiver of immunity under Industrial Insurance, Title 51 RCW,
Agreement - GF-1128, Seattle King County - Mobile Medical Program
January 1, 201 J
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solely for the purposes of this indemnification. This waiver has been mutually negotiated
by the Parties. The provisions of this section shall survive the expiration or termination of
this Agreement.
VI. 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.
VII. INSURANCE
The AGENCY shall include all volunteers, employees and agents under its policies
or shall furnish separate certificates and endorsements for each. All coverage's for
volunteers shall be subject to all the requirements stated herein. In lieu of the above
insurance requirements the AGENCY asserts that King County, a charter county
government under the constitution of the State of Washington maintains a fully funded
Self-Insurance program as defined in King County Code 4.12 for the protection and
handling of the AGENCY's liabilities including injuries to persons and damage to property.
VIII. 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 any protected class.status~as defined by any national, state or local laws or
ordinances including but not limited to race, color, creed, religion, national origin, sex,
sexual orientation, age, or the presence of any sensory, mental or physical handicap.
Agreement - GF-1128, Seattle King County - Mobile Medical Program
January I, 201 1
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IX. 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.
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.
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January 1,201 1
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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 OFRAGE LEFT INTENTIONALLY BLANK
Agreement - GF-1128, Seattle King County - Mobile Medical Program
January 1, 201 1
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(41T tOA URN
PETER' B. LEWIS
MAYOR
AP
Daniel B. Heid,
City Attorney
SEATTLE KING COUNTY: MOBILE MEDICAL PROGRAM
BY:
TITLE: l
APPROVED AS TO FORM:
Prosecuting Attorney
Agreement - GF-1128, Seattle King County - Mobile Medical Program
January 1, 201 1
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CITY OF
AD BURN
WASHINGTON
I
HUMAN SERVICE AGREEMENT
2011 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: Seattle King County
401 FIFTH AVE
SEATTLE, WA 98104-1823
Program: Mobile Medical Program Contact, Title: John Gilvar, Program Mgr.
Phone: 206-369-3489
Email: john.gilvar@kingcounty.gov
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.
❑ 3rd Quarter, July to September - Due: October 17, 2011
❑ 4`" Quarter, October to December - Due: January 31, 2012
Attachments: ❑ Quarterly Service Report i
❑ Quarterly Financial Report
❑ Demographic Report (2nd and 4th Quarters only)
❑ Outcomes Report (41"Quarter only)
❑ Proof of Insurance (1S` Quarter or if expired)
❑ Logic Model (1S` Quarter only)
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
HUMAN SERVICE AGREEMENT
2011 SCOPE OF SERVICES AND QUARTERLY SERVICE UNIT REPORT
Agency Information
Seattle King County
401 FIFTH AVE,
SEATTLE, WA 98104-1823
Contact, Title: John Gilvar, Program Mgr.
Phone: 206-369-3489
Email: john.gilvar@kingcounty.gov
Are professional services (e.g., counseling, case management) provided as part of this
Agreement?
Contract Information
Contract Amount: $10,000
Program,Name: Mobile Medical Program
Description of Service to be provided: Provides free healthcare to chronically homeless people living
in South King County. Services offered include dental, walk-in triage;'medical treatment and mental
healthcare provided by physicians. There are medications dispensed on site. Both the medicaland
dental vans attract numerous`horrieless'people who are not otherwise receiving help with severe
illnesses. So far the dental van has not been able to. keep up with the"demand for service.
Reporting information
Report for _ 1St Otr/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 80
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
2011 Quarterly Financial Report
Agency: Seattle King County Date:
Program: Mobile Medical Program
Report for 15' Qtr/Jan-Mar - 2nd Qtr/Apr-Jun _ 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 $1000.00
Requested
Reimbursement:
Detail as Applicable:
CITY OF AUBURN
2011 Demographic Report
Agency: Seattle King County Date:
Program: Mobile Medical Program
Category 1s 2" 3` 4 Total YTD
Client Algona
Residence** Auburn
Enumclaw
**List all clients Federal Way
served in this Kent
category.
Pacific
In all other
categories list Unincorporated. King County
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" Otr Due: Outcome identified, indicators „tiven, data collection method(s) explained
4"' Otr. Due: Outcome results
OUTCOME: (What change do you expect to see?)
MEASURABLE INDICATORS: (How vvill you kno-w 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.
F 1
CLTY OF AUBURN LOGIC MODEL REPORT,
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 Seattle King County - Mobile Medical Program, the original of
which was executed on the 1 day of QO\)a 2011. All other terms and
conditions of the, agreement for services shall remain in II 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.
11. 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.
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
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 - 1128, Seattle King County - Mobile Medical Program
January 1, 2011
Page 1 of 2
CIT.
PETER B. LEWIS
MAYOR
AT EST:
Danielle E. Daskam,
City Clerk
APP D FO
KeI B.` He16,-
City Attorney
SEATTLE KING COUNTY - MOBILE MEDICAL PROGRAM
o ,
BY:
TITLE:
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this r> . day of 2011, before me, the undersigned, a
Notary Publlii . in and for the State of . Washington, personally appeared
~jiG h~'UyS to me. known to be the Executive Director, of Seattle King
County - Mobile Medical Program, 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.
N TARY_:PUBLIC'in an_ for e Statep
s ~p?11A~ Washington, residing in - eILC
MY COMMISSION EXPIRES: 2P,14565-4 4, t
alp*
*2
OF
Agreement GF - 1128, Seattle King County - Mobile Medical Program
January 1, 2011
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