HomeMy WebLinkAboutNeighborhood House GF-1224CITY OF
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WASHINGTON
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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 Neighborhood House -
Emergency Assistance Services and the 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 helping low income individuals and families with emergency rental and utility assistance,
eviction prevention and service referrals 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
City of Aubum Agreement GF -1224, Neighborhood House — Emergency Assistance
January 1, 2012
Page 1 of 4
connection with the performance of the work hereunder by the AGENCY, its agents, representatives, or '
employees.
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
City of Aubum Agreement GF -1224, Neighborhood House — Emergency Assistance
January 1, 2012
Page 2 of 4
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,
addressed as follows
IF for the NEIGHBORHOOD HOUSE
Mark ok4zg1<i , Executive Director
Neighborhood House
905 Spruce St., Suite 200
Seattle, WA 98104
IF for the CITY
Michael Hursh
City of Auburn
Community Services Manager
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
Agency
Signed,�(_::),A Signed
Printed OLau1&t / ) Printed
Title'
Title:
Ex e (,u ih ve- b i (ec'ro"
(/21 fz
Date: Date
Address Neighborhood House, Inc. Address 25 West Main Street
City of Auburn
utt 14,
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bmwtuvi Svxvioceo er-
Phone"
905 Spruce Street #200
Seattle, WA 98104
Zorn . (1/9/ y`t3 v
Auburn, WA 98001
Phone: (253) 876 -1964 (Community Services Line)
City of Aubum Agreement GF -1224, Neighborhood House — Emergency Assistance
January 1, 2012
Page 3 of 4
HUMAN SERVICES AGREEMENT BETWEEN THE
CITY OF AUBURN & NEIGHBORHOOD HOUSE - EMERGENCY ASSISTANCE SERVICES
Scope of Work
Services to include:
• Clients receive assessments from Helpline Coordinators to identify pressing needs and develop
action plans that respond to these needs
• Clients are given financial aid such as direct payments to landlords and utility providers to avoid
eviction and /or shut off
■ Other financial aid can consist of providing bus tickets, items for children and food
• Helpline Coordinators give general referrals to services that help resolve immediate crisis
Reporting Requirements:
• With each semi- annual request for reimbursement, Neighborhood House — Emergency
Assistance services will provide a summary of the number of people served along with the number
of unduplicated 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 -1224, Neighborhood House — Emergency Assistance
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, Neighborhood House — Emergency Assistance, the original of which was executed on the
•Z3 - day of \ ri ` , 2012 All other terms and conditions of the agreement for services shall
remain in full force aAd 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 dunng 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 _.
A -3 ti9TYA1 MAYR1M
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City of Aubum Agreement GF -1224, Neighborhood House — Emergency Assistance
January 1, 2012
Page 1 of 2
ATTEST.
CITY OF AUBU
Danielle E Daskam,
City Clerk
APPROVED AS T
RM
Daniel eid,
Cit = orney
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
PETER B LEWIS
MAYOR
Neighborhood /House
BY ' . l itAidV ( /%
TITLE
On this 13(A, day of i Yi t , 2012, before me, the undersigned, a Notary Public in
and for the State of Washington, personally appeared (1f14�r(� . Ok a. �-A,k c ,to me
rnh known to be
the ry,e ve, 0�rc t' . ,of Neighborhood,;House, 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
•
MIRYAM LAYTNER
NOTARY PUBLIC
STATE OF WASHINGTON
CO MISSION EXPIRES
-FEBRUARY 7 2016
)
NOTARY PUBLIC in and for the State -of
Washington, residing in 13c f leAnt?. I IiiA
My Commission Expires z /7/ 16-
City of Aubum Agreement GF -1224, Neighborhood House — Emergency Assistance
January 1, 2012
Page 2 of 2
CITY OF
UBURN
WASHINGTON
EXHIBIT COVER PAGE
GF -1224
HUMAN SERVICE AGREEMENT
2012 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency Neighborhood House
Site location:
1723 K STREET NE
AUBURN, WA 98002
Program Emergency Assistance
Amount Requested: $ 1,250.00
Invoice for:
Attachments:
Mailing address:
905 SPRUCE STREET, STE 200
SEATTLE, WA 98104
Contact, Title: Jay Kang, Program Mgr
Phone: (206) 461 -4522 x 202
Email: jayk @nhwa org
❑ 1st Quarter, January to March — Due Apnl 15, 2012
❑ 2 "d Quarter, April to June — Due July 15, 2012
❑ 3rd Quarter, July to September — Due October 17, 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 Authonzed 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
Authorized to Pay:
Signature
CITY OF AUBURN
Contract Balance
Date
2012 Exhibit 1
COVER PAGE — MUST BE SIGNED AND SUBMITTED WITH EACH PAYMENT
REQUEST
HUMAN SERVICE AGREEMENT
2012 SCOPE OF SERVICES AND QUARTERLY SERVICE UNIT REPORT
Agency Neighborhood House
Site location: Mailing address:
1723 K STREET NE 905 SPRUCE STREET, STE 200
AUBURN, WA 98002 SEATTLE, WA 98104
Contact, Title: Jay Kang, Program Mgr.
Phone: (206) 461 -4522 x 202
Email: jayk @nhwa org
Are professional services (e g , counseling, case management) provided as part of this Agreement?
Contract Information
Contract Amount. 5 000
Program Name. Auburn Family Support Program - Emergency Assistance
Description of Service to be provided helping low income individuals and families with emergency
rental and utility assistance, eviction prevention and service referrals
Reporting Information
Report for _ 1st Qtr /Jan -Mar _ 2nd Qtr /Apr -Jun _ 3rd Qtr /Jul -Sep _ 4th Qtr /Oct -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.
Cit of Auburn Fundin• Onl
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
50
■■■ ■
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 Neighborhood House
Program Emergency Assistance
Report for _ 1st Qtr /Jan -Mar
_ 2nd Qtr /Apr -Jun
Date
2012 Exhibit 2
_ 3`d Qtr /Jul -Sep _ 4th Qtr /Oct -Dec
Requested
Reimbursement
Detail as Applicable
Cost Categones
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
$5,000.00
Requested
Reimbursement
Detail as Applicable
CITY OF AUBURN
2012 Demographic Report
Agency Neighborhood House
Program Emergency Assistance
2012 Exhibit 3
Date
Cate • 0
1
2"'
3 '
4
Total YTD
Client
Residence"
**List all clients
served in this
category
In all other
categories list
Aubum clients
only
Client
Income
Level
AI•ona
-
-
-
--
Auburn
-
-
-
--
Enumclaw
-
-
-
--
Federal Wa
-
-
-
--
Kent
-
-
-
--
Pacific
Uninco •orated Kin. Coun
-
-
-
--
Other
Unknown
-
-
-
--
TOTAL
-
-
-
--
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
Condition
Asian
-
-
-
--
Asian / White
-
-
-
--
American Indian / Alaskan Native
-
-
-
--
American Indian / Alaskan Native & White
-
-
-
--
American Indian /Alaskan Native & Black
/ African American
_____
-
-
-
--
Black / African American
Black / African American & White
His • anic / Latino
-
-
-
--
Native Hawaiian / Other Pacific Islander
-
-
-
--
Unknown / No Res.onse
-
-
-
--
TOTAL
-
-
-
--
Disabim. Condition
-
-
-
--
ESL
Limited En•lish S•eakin•
-
-
-
--
Household
Female- Headed Household
-
-
-
--
Male- Headed Household
-
-
-
--
Funder Re s ortin to: Cit of Auburn
Re i ortin Period:
to
Date Form Com i leted:
Agency:
Program:
Contact Person:
E -mail:
Phone:
CITY OF AUBURN
OUTCOMES REPORT - EXHIBIT4
I 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.
CITY OF AUBURN
Funder Re ortin . to: Cit of Auburn
Re ortin . Period:
to
LOGIC MODEL REPORT - Suggested Template
Date Form Com 1 leted:
Agency:
Program:
Contact Person:
E -mail: -
Phone:
Program Evaluation Logic Model
PROCESS
RESOURCES
ACTIVITIES
OUTPUTS
OUTCOME
OUTCOMES
INDICATORS
GOAL
i
n
n
4
a'