HomeMy WebLinkAboutPregnancy Aid of Auburn - Crisis HelpCITY OF
WASHINGTON
Department of Administration
Michael Hursh, Community Services Manager
25 West Main Street
Auburn, WA 98001
CITY OF AUBURN AGREEMENT FOR HUMAN SERVICE ACTIVITIES
COSTING $5,000 PER YEAR OR LESS
This Agreement is made effective as of January 1, 2012, by and between Pregnancy Aid of Auburn —
Crisis Help and 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, 2012, The AGENCY agrees to provide
services to women and their children 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 "out-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. TERM/TERMINATION. This Agreement is effective January 1, 2012, and expires December 31,
2012, 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.
City of Aubum Agreement: GF -1227, Pregnancy Aid of Auburn — Crisis Help
January 1, 2012
Page 1 of 4
A. Minimum Scope of Insurance, the AGENCY shall obtain insurance of the types described
below:
1. 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:
1. 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 furnish 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,
City of Aubum Agreement: GF -1227, Pregnancy Aid of Auburn — Crisis Help
January 1, 2012
Page 2 of 4
4,
d
addressed as follows:
IF for PREGNANCY AID:
Elaine Prenovost
Pregnancy Aid of Auburn
517 F Street SE
Auburn, WA 98002
IF for the CITY:
Michael Hursh
Community Services Manager
City of Auburn
25 West Main Street
Auburn, WA 98001
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 to abide by their terms.
Signed:
Printed:
Agency City of Auburn
Title: Q _ ,C
a\\ T �D1�
Address: r r 3T 5t!
Date:
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4wco
Phone: 453_ mei,, j /'IL
Signed:
Printed:
Title:
Date:
Address: 25 West Main Street
Auburn, WA 98001
Phone: (253) 876 -1964 (Community Services Line)
City of Aubum Agreement: GF -1227, Pregnancy Aid of Auburn — Crisis Help
January 1, 2012
Page 3 of 4
HUMAN SERVICES AGREEMENT BETWEEN THE
CITY OF AUBURN & PREGNANCY AID - CRISIS HELP
Scope of Work
Services to include:
• Prepare and provide services to approximately 200 clients per month along with childcare' supplies
to at -risk women and children. Identify additional. needs and distribute accordingly; i.e. grooming
supplies, baby care items, etc. - Provide direct. supplies and financial assistance to identified clients
in need for items such as: cribs, diapers, clothing, food, etc.
■ Recruit volunteers, train them and acknowledge their contribution to the community.
• Maintain records of residents served, and the service provided.
• Retain the above records for three years and make them available for review upon request by they
City and /or its agents or representatives.
Requirements:
• With each semi - annual request for reimbursement, Pregnancy Aid of Auburn — Crisis Help will
provide a summary of the number of people served along with the number of 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
City of Aubum Agreement: GF -1227, Pregnancy Aid of Auburn — Crisis Help
January 1, 2012
Page 4.of 4
CITY OF AUBURN - MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is an addendum to the agreement for services between the City of
Auburn and Pregnancy Aid, the original of which was executed on the 4,' day of Nl rc,V∎
2012. 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.
I. 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 2012 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.
CITY OF AUBURN
City of Aubum Agreement: GF -1227, Pregnancy Aid of Auburn — Crisis Help
January 1, 2012
Page 1 of 2
ATTEST:
Danielle E. Daskam,
City Clerk
APPROVED AS TO FORM:
Daniel B. Heid,
City Attorney
STATE OF WASHINGTON )
)ss
COUNTY OF KINGG U ) I^
,
On this day of I1 arok 012 before me, the undersigned,' a Notary ry Public in
and for tb State of Washington, personally appeared e .GCc._ J . ?ftrjouos f ,'to me Know, to be
the rc ('Wm ( Ct,nc c r of Pregnancy Aid, the, non - profit=' corporation that executed 'the
within and for oing 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.
PETER B.
M OR
BY:
Pregnancy Aid
TITLE:
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the date
1. I
hereinabove set forth.
JONATHAN C.SADLER
NOTARY PUBLIC.
STATE OF WASHINGTON
MY COMMISSION EXPIRES
06 -11 -14
Isno-/1104.-, C. Sage.
TARY PUBLIC-in and for the State of
Washington, residing in _ ch./1 ✓r)
MY COMMISSION expires: 6 • /1. 47.OI `1 I
City of Aubum Agreement: GF -1227, Pregnancy Aid of Auburn — Crisis Help
January 1, 2012
Page 2 of 2
Y
• CITY OF
' at ibISU
WASHINGTON
„e#A
HUMAN SERVICE AGREEMENT
2012 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: Pregnancy Aid
517 F STREET SE
Auburn, WA 98002
Program: Crisis Help
Amount Requested: $ 2,500
Invoice for:
Attachments:
EXHIBIT COVER PAGE
GF -1127
Contact, Title: Rebecca Prenovost, Program Mgr.
Phone: (253) 939 -6676
Email: becksterp @comcast.net
❑ 1St and 2nd Quarters, January to June — Due: July 15, 2012
❑ 3rd and 4th Quarters, July to December — Due: January 31, 2012
❑ Quarterly Service Report (due semi - annually) - Exhibit 1
❑ Quarterly Financial Report (due semi - annually) — Exhibit 2
❑ Demographic Report (due semi - annually) — Exhibit 3 (Suggested)
❑ Proof of Insurance (1St Quarter or if expired)
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
2012 Exhibit 1
HUMAN SERVICEAGREEMENT
2012 SCOPE OF SERVICESAND QUARTERLY SERVICE UNIT REPORT
Agency Information
Pregnancy Aid
517 F STREET SE
Auburn, WA 98002
Contact, Title: Rebecca.(Becky) Prenovost, Program Mgr.
Phone: (253) 939 -6676
Email:
Are professional services.(e.g., counseling, case management) provided as part of this
Agreement? -
Contract Information
Contract Amount:
Program Name:
5 000
Crisis Help
Description of Service to be provided:
Reporting Information
Report for _ 1st /2nd Qtr /Jan -Jun _ 3rd /4t " .Qtr /Jul -Dec'
2012 Service Units,
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 Funding
Onl
All Funding Sources
Actual Service
Units to Date
Service Unit Description:
Auburn Residents Only
Total
, Projected
Annual'Units
Actual Units by,Quarter
Service Unit/Performance Measure
151
2 "d
3`d
4th
Unduplicated Number of Auburn
Clients Served
1 360
■■
®�
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.
.1
CITY OF AUBURN
2012 Quarterly Financial Report
• Agency: Pregnancy Aid
Program: '
Report for 1st12nd Qtr/Jan-Jun 3rdi4th Qtr/Jul-Dec
Date:
2012 Exhibit 2
Detail as Applicable:
Requested
Reimbursement:
Cost Categories
Budget
Award
This
Request
Cumulative
to date
Award
Balance
1
Persorial/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
Detail as Applicable:
Requested
Reimbursement:
CITY OF AUBURN
2012 Demographic Report
Agency: Pregnancy Aid
Program: Crisis Help
•
2012 Exhibit 3
Date:
Cate • o
1
2"'
3 ' 4 Total YTD
Client
Residence"
"List all clients
served in this
category.
In all other
categories list
Auburn clients
only.
Al.ona
-
-
- --
Auburn
-
-
- --
Black Diamond
-
-
- --
Burien
-
-
- --
Covin•ton
-
-
- --
Des Moines
-
-
- --
Enumclaw
-
-
- --
Federal Wa
-
-
- --
Kent
-
-
- --
Ma • le Valle
-
-
- --
Normand Park
-
-
- --
Pacific
-
-
- --
Renton
-
-
- --
SeaTac
-
-
- --
Seattle
•
-
- --
Tukwila
-
-
- --
Uninco •orated. Kin. Coun
-
-
- --
Other:
-
-
- --
Unknown
-
-
- --
TOTAL
-
-
- --
Client
Income
Level
30% of median or below
-
-
- --
50% of median or below
-
-
- --
80% of median or below
-
-
- --
Above 80% of median
-
-
- --
Unknown
-
-
- --
TOTAL
-
-
- --
Client
Gender
Female
-
-
- --
Male
-
-
- --
Client
Age
0-4
-
-
- --
5 -12
-
-
- --
13 -17
-
-
- --
18-34
-
-
- --
35-54
-
-
- --
55-74
-
-
- --
75+
-
-
- --
Unknown
-
-
- --
TOTAL
-
-
- --
Ethnicity/
Cultural
Background
Asian /Pacific Islander
-
-
- --
Black/African American
-
-
- --
His•aniclLatino
-
-
- --
Native American/ Alaskan Native
-
-
- --
White /Caucasian
-
-
- --
Other
-
-
- --
Unknown
-
-
- --
TOTAL
-
-
- --
Condition
Disablin• Condition
-
-
- --
ESL
Limited En•lish S•eakin•
-
-
- --
Household
Female- Headed Household
-
-
- --