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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 A \ PUBOG ' 2 ■ - . ,Y.09,,�w,., A, N ck �� 'P W Rio' s�f1'/ / / / / / /,• /: %/ter /L�� .� • 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