HomeMy WebLinkAboutPediatric Interim Care Center GF-1226 - Interim Care of Drug Exposed InfantsCITY OF AUBURN - AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this 2:3_ day of rula_r
2012, by and between the CITY OF AUBURN, a municipal corporation of the State of
Washington, hereafter referred to as "CITY ", and Pediatric Interim Care Center which is
located at 328 4th Ave South, Kent WA 98032, 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 Pediatric Interim Care
Center 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:
I. 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 2012 term. This support is in recognition of
the fact that the demand for the services delivered by the AGENCY continues to rise.
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, 2012.
City of Auburn Agreement: GF -1226, Pediatric Interim Care Center - Interim Care of Drug - Exposed Infants
January 1, 2012
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III. TERM
The term of this Agreement shall commence. on January 1, 2012 and shall expire on
December 31, 2012.
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.
C. As full and total payment .for the :services .provided under this Agreement, the .CITY
agrees to pay the AGENCY the•total >amount,of $10;000 as-setforth 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
City of Auburn Agreement: GF -1226, Pediatric Interim Care Center - Interim Care of Drug - Exposed Infants
January 1, 2012
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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,
Toss 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.
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 procure and maintain for the duration of this Agreement insurance
against claims for injuries to persons or property which may arise from or in connection with
services provided by the AGENCY, it agents, employees or volunteers under this Agreement.
The AGENCY agrees to provide comprehensive general liability insurance and .shall maintain
liability limits of not less than ONE MILLION DOLLARS ($1,000,000) combined single limit
coverage per occurrence for bodily injury, personal injury and property damage. Where
City of Aubum Agreement: GF -1226, Pediatric Interim Care C enter - Interim Care of Drug - Exposed Infants
January 2012
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professional.services-are provided as part of the services rendered pursuant to this Agreement,
as shown in Exhibit 1, the AGENCY shall also provide and maintain professional liability
coverage including errors and omissions coverage in the minimum liability amount of ONE
MILLION DOLLARS ($1,000,000) combined single limit per occurrence for bodily injury,
personal injury and property damage.,Any deductibles orself.insured retentions in either policy
must be declared to and approved by the CITY. At the option of the CITY either: The insurer
shall reduce .or eliminate such deductibles or self insured retentions as respects the CITY, its
officials and employees; or, The AGENCY shall - procure. a bond guaranteeing payment of
losses and related investigations, claim administration and defense expenses. The policies are
to contain or be endorsed to contain the following provisions:
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 .ofAGENCY, 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.
City of Auburn Agreement GF -1226, Pediatric•Interim' Car e -Center Interim Care ofDrug- Exposed Infants
January 1, 2012
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(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.
(e) The AGENCY shall furnish the CITY with Certificates .of Insurance 'and with original
endorsements affecting coverage required by this clause. The : certificate and
endorsements for each insurance policy are to be signed by a person authorized by
that insurer to bind coverage on its behalf. The CITY reserves the .right to require
complete, certified copies of all required insurance policies at any time.
(f) The AGENCY shall include all volunteers; employees and agents under its policies or
shall furnish separate certificates and endorsements for each.' All'-coverages for
volunteers shall be subject to all the requirements stated herein.
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
race, color, creed, religion, national origin, sex, age, or the presence of any, sensory, mental or
physical handicap.
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
City of Auburn Agreement: GF -1226, Pediatric Interim Care Center - Interim Care of Drug- Exposed Infants
January 1, 2012
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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.
The CITY
volunteers,
Agreement
•
and the AGENCY respectively bind themselves, their successors,
assigns and legal representatives to -:the - othera7party` toe this
and with respect to all covenants to this Agreement,:
City of Auburn Agreement:_.GF -1226, Pediatric Interim Care Center= Interim Care of Drug - Exposed Infants
January 1, 2012
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ATTEST:
Danielle E. Daskam,
City Clerk
APPRO
Daniel :. Heid,
City Attorney
STATE OF WASHINGTON
PETER B. LEWIS
MAYOR
PEDIATRIC I T- TM CARE CE
TER
TITLE:
)ss
COUNTY OF KING
On this ' �3 day of T b ft,t a VLj , 2012, before me, the undersigned, a
Notary Public in and for the Stat of Washington, personally appeared
to me known to be the Kecif-�ive_ P; re c- r of
Pediatric Interim Care Center, 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.
• SStOk �'•��''.
AvaTA
B tAC. • o •
• e'a,C'F WA`s
NOTARY PUBLIC in and the Sta
Washington, residing in[►
MY COMMISSION expires: D09 / 3
0
City of Auburn Agreement: GF -1226, Pediatric Interim Care Center - Interim Care of Drug - Exposed Infants
January 1, 2012
Page 8 of 9
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 OF PAGE LEFT INTENTIONALLY BLANK
City of Auburn Agreement: GF -1226, Pediatric Interim Care Center - Interim Care of Drug- Exposed Infants
January 1, 2012
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„Av.-.1'°F
WASHINGTON
HUMAN SERVICE AGREEMENT
2012 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: Birth to Three Development Center
Site location: Mailing address:
35535 6th Place SW PO BOX 24269
Federal Way, WA 98023 Federal Way, WA 98093
Program: Family Services
Amount Requested: $ 2,500.00
Invoice for:
Attachments:
EXHIBIT COVER PAGE
GF -1207
Contact, Title: Maryanne Barnes, Program Mgr.
Phone: 253 - 874 -5445
Email: mbarnes @birthtothree.org
❑ 15t Quarter, January to March — Due: April 13, 2012
❑ 2nd Quarter, April to June — Due: July 13, 2012
❑
3rd Quarter, July to September — Due: October 12, 2012
❑ 4th Quarter, October to December — Due: January 31, 2013
❑ 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 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:
Authorized to Pay:
Contract Balance:
Signature Date
CITY OF AUBURN
COVER PAGE — MUST BE SIGNED AND SUBMITTED WITH EACH PAYMENT REQUEST
2012 Exhibit 1
HUMAN SERVICE.AGREEMENT
2012 SCOPE OF SERVICES AND QUARTERLY SERVICE UNITREPORT
Agency Information
Birth to Three Development Center
Site location: Mailing address:
35535 6th Place SW P,O.,BOX24269
Federal Way, WA 98023 Federal Way, WA 98093
Contact, Title: Maryanne Barnes, Program Mgr.
Phone: 253- 874 -5445
Email: mbarnes @birthtothree.org
Are professional services (e.g., counseling, case management) provided as part of this
Agreement?
Contract Information'
Contract Amount: $10,000
Program Name: Family Services
Description of Service to be provided:
Reporting ! Information
Report for _ 1St Qtr /Jan -Mar _ 2nd Qtr /Apr -Jun _ 3rd Qtr /Jul -Sep _ 4th Qtr /Oct -Dec f
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 Tower 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
1st
2nd
3rd
4th
Unduplicated Number of Auburn
Clients Served
75
■
■■�
Narrative: Please attach other relevant information, including current trends, program developments,
special events, publicity, community education, etc. If actual service units are Tower than anticipated,
please explain.
CITY OF AUBURN
2012 Quarterly Financial Report
Agency: Birth to Three Development Center
Program: Family Services
Report for _ 1st Qtr /Jan -Mar _ 2nd Qtr /Apr -Jun
Date:
2012 Exhibit 2
3rd Qtr /Jul -Sep _ 4th Qtr /Oct -Dec
Detail as Applicable:
Requested
Reimbursement:
T
Cost Categories
Budget
Award
This
Request
Cumulative -
to date
Award
'_ Balance
1
Personal /Agency Services
2
Office /Operating Supplies
3
Consultant or P urchased
Services
4
Direct Client Assistance
5
Communications
6
Travel & Training
7
Infra- Agency Support -
8
Other per Detail
Grand Total
$10,000.00
Detail as Applicable:
Requested
Reimbursement:
T
CITY OF AUBURN
2012 Demographic Report
Agency: Birth to Three Development Center
Program: Family Services
x:.iCate -(3.- _ , -.,:_ ; - - -a:�.. ;�ua �NF;�: --.—_ , .. =�:i1 -: ':. ,2< -- =a -'_p -•3 i-'.:� _�'� ,- 5 4".:11,1. c=* µ TritTotal,l(�TD`",
'Client,;. ~',y '3 AI•ona
Residence;' Auburn
`�- �- = :J : i Black Diamond - - - --
'�List all clients, ' Burien - - - --
served;m this . Covin•ton -- -- ategory_,,' Des Moines - - - --
Yn all!other` . --
'categories;'list ` Enumclaw
Ai burn,cl'ients Federal Wa - - - --
only. _ `' Kent - - - --
Normand Park - --
'� "i�; Pack
Renton
SeaTac - - --
Seattle
Tukwila --
r• Uninco .orated. Kin • Count 3
Other: - - - --
+,F -{C��' 4f•';- ,�;'r Unknown
-a•:: r''.. 'r r -r : " - TOTAL - -_-
Client 30% of median or below
Iricome''_,= -,'.;• 50% of median or below
80% of median or below - - - --
`�> Above 80% of median
Unknown - - - --
rst_ ,. TOTAL -- --
Client : Female - - - --
3
Gende� Male --
Age' 5 -12 - - - --
":;'` 13-17 - - - --
i 18-34
55 -74 - - - --
75+ - - - --
Unknown - - - --
-: TOTAL - - - --
Ethnicity/ Asian /Pacific Islander - - - --
Cultural �'> Black/African American
Background His • anic/Latino - - - --
Native American/ Alaskan Native - - - --
White /Caucasian - - - --
` Other - - - --
:, Unknown - - - --
- TOTAL - - - --
Condition Disablin• Condition
ESL Limited En•lish S•eakin• --
Household Female- Headed Household -- --
Funder Re ortin ' to: Ci of Auburn
Re ortin . Period:
Date Form Com leted:
Agency:
Program:
Contact Person:
E -mail:
Phone:
CITY OF AUBURN
OUTCOMES REPORT - ExHiair4
ISt {Qfr:Due�OutcomeC�identif ed + indicatorsiven�' data�collection�metliod (s)iexnlairied
4 Qtr Due fQutcome 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
Funder Reporting to: City of Auburn
Agency:
Reporting Period:
Program:
to
LOGIC MODEL REPORT - SuggestedTemplate
Date Form Completed:
Contact Person:
E -mail:
Phone:
Program Evaluation Logic Model
PROCESS
RESOURCES
ACTIVITIES
OUTPUTS
OUTCOME
OUTCOMES
INDICATORS
GOAL
Danielle E. Daskam,
City Clerk
APP RO
Davie B. Heid,
City Attorney
FO
STATE OF WASHINGTON
COUNTY OF KING
PETER B. LEWIS
MAYOR
THRE ' EVELOPMENT CEN+ER
TITLE: Executive Director
)ss
On this ?_3 day of ✓000 , 2012, before me, the undersigned, a
Notary Public in and for the State of Washington ,$ersonally appeared
to me known to be the Zak e M 3 DiredVv of Birth To Three Development
Center, 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.
NOTARY PUBLIC in andr the State
Washington, residing in
MY COMMISSION expires: C9 �J9 l3
City of Auburn Agreement: GF -1207, Birth to Three — Family Services
January 1, 2012
Page 2 of 2
CITY OF AUBURN - MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is an addendum to the agreement for
services between the City of Auburn and Birth to Three Development Center the original of
which was executed on the 2 3 day of fit t ru oo(1, 2012. All other terms and
conditions of the agreement for services shall remain in fGll force and effect except as
specifically amended by this Memorandum of Understanding.
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 provides 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 provid'ers'that
increase the availability, accessibility and use of health care to its low ineome,res(deott by :.
15% within a three (3) year period.
City of Aubum Agreement: GF -1207, Birth to Three — Family Services
January 1, 2012
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