HomeMy WebLinkAboutChrist Community Free Clinic - GF-1214 - Community Health ClinicCITY OF AUBURN - AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this '11- day of Ffrlyackv�
2012 by and between the CITY OF AUBURN, a municipal corporation of the State of
Washington, hereafter referred to as "CITY ", and CHRIST COMMUNITY FREE CLINIC which
is located at 1 A Street SE, Auburn, Washington 98001, 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 CHRIST COMMUNITY
FREE CLINIC, 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 Exhibit 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 -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 1 of 8
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 qprovided under this Agreement, the CITY
agrees to, pay the AGENCY, the.,totaI. amount-of $20',000.00.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
City of Auburn Agreement:,GF- 1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 2 of 8
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 'ads; .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.
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 Auburn Agreement: GF -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 3 of 8
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 or self 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 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.
City of Auburn Agreement: GF -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 4 of 8
(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 underits 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
A. 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, national origin, sex, age, or the presence of any sensory; mental or physical
handicap. The AGENCY is a faith based organization -and as such Section 702 of the Civil
Rights Act of 1964 allows a faith based organization to use religion as a factor in hiring potential
employees. However, a faith based organizations shall not discriminate against potential
City of Auburn Agreement: GF -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 5of8
employees or in the provision of any services or programs for all other protected classes as set
forth in the Civil Rights Act of 1964.
B. Agency shall not use any funds paid under this Agreement;to pay for any of the
following:
(i) Inherently religious activities such as, religious worship, instruction, or proselytization;
or (ii) Equipment or supplies to be used for any of those activities:
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.
City of Auburn Agreement: GF -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 6of8
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.
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 -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 7 of 8
ATTEST:
Da Ile E. Daskam,
City Clerk
APP
Daniel B. Hei. ,
City Attorney
PETER B. LEWIS
MAYOR
CHRIST COMMUNITY FREE CLINIC
BY:
TITLE: n�
STATE OF WASHINGTON )
)ss
COUNTY OF KING
On thi day of �� �r <<'�� , 20112 before me, the undersigned, a
N y Public in and for the St of Washington, personally appeared
���.� , to me known to be the Director dye ,.■.5u 67
o Christ Community Free Clinic, 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.
14{' v G• W AR
•a toTARy
• PUBLIC ;
Wfa9���1I44
A
NOTARY PUBLIC in and forth .State of
Washington, residing in
MY COMMISSION expires /
City of Auburn Agreement: GF -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 8 of 8
• CITY OF _,.r►'
WASHINGTON
HUMAN SERVICE AGREEMENT
2012 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: Christ Community Free Clinic
Site location: Mailing address:
1 A Street NW PO BOX 908
Auburn, WA 98001 Auburn, WA 98071
Program: Community Health Clinic
Amount Requested: $ 5,000.00
Invoice for:
Attachments:
EXHIBIT COVER PAGE
GF -1214
Contact, Title: Virginia Gannon, Executive Director
Phone: 253 - 736 -2634
Email: vggannon66 @comcast.net
❑ 1s1 Quarter, January to March — Due: April 15, 2012
❑ 2nd Quarter, April to June — Due: July 15, 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: $20,000.00
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 SERVICE AGREEMENT
2012 SCOPE OF SERVICES AND QUARTERLY SERVICE UNIT REPORT
Agency Information
Christ Community Free Clinic
Site location: Mailing address:
1 A Street NW ,PO BOX 908
Auburn, WA 98001 Auburn, WA 98071
Contact, Title: Virginia Gannon, Executive Director
Phone: 253- 736 -2634
Email: vggannon66 @comcast.net
Are professional services (e.g., counseling, case management) provided as part otthis
Agreement?
Contract Information
Contract Amount: $20,000
Program Name: Community Health, Clinic
Description of Service to be provided:
Reporting Information
Report for _ 1st Qtr /Jan -Mar
2012 Service Units
_ 2nd Qtr /Apr -Jun
_ 3rd Qtr /Jul -Sep-
4th Qtr /Oct -Dec
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.
1St
nd,
3rd
4th
Unduplicated Number of Auburn
Clients Served
250
'-
■■■
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
2012 Quarterly Financial Report
Agency: Christ Community Free Clinic
Program: Community Health Clinic
Report for _ 1st Qtr /Jan -Mar
_ 2 "d Qtr /Apr -Jun
Date:
2012 Exhibit 2
_ 3rd Qtr /Jul -Sep _ 4th Qtr /Oct -Dec
Requested
Reimbursement:
Detail as Applicable:
Cost Categories
Budget
Award
This
Request
Cumulative
to date
Award
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
$20,000.00
Requested
Reimbursement:
Detail as Applicable:
CITY OF AUBURN
2012 Demographic Report
Agency: Christ Community Free Clinic
Program: Community Health Clinic
Date:
2012 Exhibit 3
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.
AI•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. Count
-
-
-
--
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.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 I ortin ' to: Cit of Auburn
Re ortin ' Period:
to
Date Form Com s leted:
Agency:
Program:
Contact Person:
E -mail:
Phone:
CITY OF AUBURN
OUTCOMES REPORT - EXHIBIT4
1 ` Qtr Due: Outcome identified, indicators given, data collection method(s) explained
4th 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.
Funder Re . ortin . to: Cit of Auburn
Re ortin ' Period:
to
Date Form Com s leted:
Agency:
Program:
Contact Person:
E -mail: •
Phone:
CITY OF AUBURN
LOGIC MODEL REPORT - Suggested Template
Program Evaluation Logic Model
PROCESS
RESOURCES
ACTIVITIES
OUTPUTS
• OUTCOME
OUTCOMES
INDICATORS
GOAL
CITY OF AUBURN - MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is an addendum to the agreement for services
between the City of Auburn and Christ Community Free Clinic, the original of which was
executed on the 22-- day of feiova io..k , 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 Aubum Agreement: GF -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 1 of 2
tt
I■
t3
URN
ATTEST:
PETER B. LEWIS
MAYOR
Danielle E. Daskam,
City Clerk
Da el eid,
City Attorney
STATE OF WASHINGTON
COUNTY OF KING
:1
CHRIST COMMUNITY FREE CLINIC
BY: U�✓l nu�WJ• fl
TITLE: / 2hw
)ss
On this =7 day of , 2012, before me, the undersigned, a
Not Public in and for the Stag of Washington, personally appeared
1.5�� � 3 , to me known to be thee;; IfJ-r „—, of CHRIST
CMUNITY FREE CLINIC, 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 fort;)r,,,,,��,!
iiiii G..w
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NOTA-Y PUBLIC in and for the State
Washington, residing in
MY COMMISSION expires:
City of Aubum Agreement: GF -1214, Christ Community Free Clinic - Community Health Clinic
January 1, 2012
Page 2 of 2