HomeMy WebLinkAboutSeattle King County GF-1228CITY OF AUBURN - AGREEMENT FOR SERVICES
THIS AGREEMENT made and entered into this 1 day of January ,
2012, by anu between the CITY OF AUBURN, a municipal corporation of the State of
Washington, hereafter referred to as "CITY", and Seattle King County: Mobile Medical
Program which is located at 401 Fifth Ave Suite 1000, Seattle WA 98104-1823, an agency of
a charter county government under the constitution 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 Seattle King County
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:
1. 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.
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City of Auburn Agreement: GF -1228, Seattle King County — Mobile Medical Program
January 1, 2012
Page 1 of 7
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.
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
a rees to pay the AGENCY up to $10,000. 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
City of Auburn Agreement: GF -1228, Seattle King County — Mobile Medical Program r
January 1, 2012
Page 2 of 7
causes of action of any kind or character whatsoever arising out of or relating to services
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,
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. It is further
specifically and expressly understood that the AGENCY's indemnification provided herein
constitutes the Agency's waiver of immunity under Industrial Insurance, Title 51 RCW, solely for
the purposes of this indemnification. This waiver has been mutually negotiated by the Parties.
The provisions of this section shall survive the expiration or termination of this Agreement.
VI. INDEPENDENT CONTRACTORIASSIGN M ENT
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.
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City of Auburn Agreement: GF -1228, Seattle King County — Mobile Medical Program
January 1, 2012
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VII. INSURANCE
The AGENCY shall include all volunteers, employees and agents under its policies
or shall furnish separate certificates and endorsements for each. All coverage's for volunteers
shall be subject to all the requirements stated herein. In lieu of the above insurance
requirements the AGENCY asserts that King County, a charter county government under the
constitution of the State of Washington maintains a fully funded Self -Insurance program as
defined in King County Code 4.12 for the protection and handling of the AGENCY's liabilities
including injuries to persons and damage to property.
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
any protected class status as defined by any national, state or local laws or ordinances
including but not limited to race, color, creed, religion, national origin, sex, sexual orientation,
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 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. ,
City of Auburn Agreement: GF -1228, Seattle King County — Mobile Medical Program
January 1, 2012
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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.
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.
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City of Auburn Agreement: GF -1228, Seattle King County — Mobile Medical Program
January 1, 2012
Page 5 of 7
F. Should it become necessary to enforce any term or obligationof 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 -1228, Seattle King County — Mobile Medical Program
January 1, 2012
Page 6 of 7
UBURN
PETER B. LEWIS
MAYOR
SEATTLE KING UNTY— MOBILE MEDICAL PROGRAM
BY:
TITLE:
STATE OF WASHINGTON )
)ss
COUNTY OF KING )
On this 17 t—F day of , 2012 before me, the undersigned, a
Not Public in and for the State of Washington, personally appeared
w '.S , to me known to be the �,z4,>dr_ &S
of�tle King County — Mobile Medical Program, 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.
date
IN WITNESS WHEREOF, 1 have hereunto set my hand and affixed my official seal the
rainnhnva cat fnrFh
"0* 1"M
%tis
4TARY PUB IC in and for the State of
Washington, residing in a
MY COMMISSION EXPIRES: �2ir..��C /& ?e)IA
City of Auburn Agreement: GF -1228, Seattle King County — Mobile Medical Program
January 1, 2012
Page 7 of 7
W J
Crry OF
WASHINGTON
HUMAN SERVICE AGREEMENT
2012 INVOICE FOR CONTRACTED SERVICES
To: CITY OF AUBURN, ATTN: COMMUNITY SERVICES
25 WEST MAIN STREET, AUBURN WA 98001
Agency: Seattle King County
401 FIFTH AVE
SEATTLE, WA 98104-1823
Program: Mobile Medical Program
Amount Requested: $ 2,500.00
EXHIBIT COVER PAGE
GF -1228
Contact, Title: John Gilvar, Program Mgr.
Phone: 206-369-3489
Email: john.gilvar@cingcounty.gov
Invoice for: ❑ V' Quarter, January to March — Due: April 15, 2012
❑ 2nd Quarter, April to June -- Due: July 15, 2012
❑ 3`d Quarter, July to September— Due: October 12, 2012
❑ e Quarter, October to December— Due: January 31, 2013
Attachments: ❑ Quarterly Service Report - Exhibit 1
❑ Quarterly Financial Report — Exhibit 2
❑ Demographic Report (2nd and 4h' Quarters only) — Exhibit 3
❑ Outcomes Report (4th Quarter only) — Exhibit 4
❑ Proof of Insurance (1" 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:
Signature
CITY OF AUBURN.
Contract Balance:
Date
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
Seattle King County
401 FIFTH AVE
SEATTLE, WA 98104-1823
Contact, Title: John Gilvar, Program Mgr.
Phone: 206-369-3489
Email: john.gilvar@kingcounty.gov
Are professional services (e.g., counseling, case management) provided as part of this
Agreement?
Contract Information
Contract Amount: $10,000
Program Name: Mobile Medical Program
Description of Service to be provided: Provides free healthcare to chronically homeless people livin
in South Kinq County. Services offered include dental, walk-in triage. medical treatment and mental
health care provided by physicians. There are medications dispensed on site. Both the medical and
dental vans attract numerous homeless people who are not otherwise receiving help with severe
illnesses. So far the dental van has not been able to keep up with the demand for service.
Reporting Information
Report for __._ 1St Qtr/Jan-Mar —2 nd Qtr/Apr-Jun —3 rd Qtr/Jul-Sep —4 th 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.
City Funding
Only
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
80
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.
2012 Exhibit 2
CITY OF AUBURN
2012 Quarterly Financial Report
Agency: Seattle King County Date:
Program: Mobile Medical Program
Report for _ 1- Qtr/Jan-Mar _ 2nd Qtr/Apr-Jun _ 3rd Qtr/Jul-Sep —4'h 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
$10,000.00
Requested
Reimbursement:
Detail as Applicable:
2612 Exhibit 3
CITY OF AUBURN
2012 Demographic Report
Agency: Seattle King County Date:
Program: Mobile Medical Program
Cate o
1 . 2nd 3M 4M Total YTD
Client.
Algona
Residence"
Auburn
Enumclaw
`List all clients
Federal Way
served in this
category.
In all other
categories list
Kent
Pacific
Unincorporated. King County
Auburn clients
Other:
only..
Unknown
TOTAL
Client
30% of median or below
Income
Level :.
50% of median or below
80% of median or below
Above 80% of median
Unknown
TOTAL
Client
Gender
Female
Male
Client .
0-4
Age
5-12
13-17
18-34
35-54
55-74
75+
Unknown
TOTAL
Ethnicity/
Cultural
Asian
Asian / White
Background
American Indian / Alaskan Native
American Indian /Alaskan Native & White
American Indian /Alaskan Native & Black
/African American
Black / African American
Black / African American & White
Hispanic / Latino
Native Hawaiian I Other Pacific Islander
Unknown / No Response
Condition
TOTAL
Disabling Condition
ESL
Limited English Speaking
Household
Female -Headed Household
Male -Headed Household
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CITY OF AUBURN - MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is an addendum to the agreement for services
between the City of Auburn and Seattle King County — Mobile Medical Program, the original of
which was executed on the 1 day of January , 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.
It is the goal of the City of Auburn to improve the living conditions of all Auburn
residents.
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 Agreement GF -1228, Seattle King County — Mobile Medical Program
January 1, 2012
Page 1 of 2
PETER B. LEWIS
MAYOR
ATTEST:
Danielle E. Daskam,
City Clerk
AP D
ffkt
gel B. Hei ,
City Attorney
SEATTLE KING COUNTY — MOBILE MEDICAL PROGRAM
BY: kln� ...
TITLE: c tjr- >
STATE OF WASHINGTON
)ss
COUNTY OF KING )
On this 170 day of W_ , 2012 before me, the undersigned, a
No P lic in and for thW State of Washi ton, personally appeared
to me known to be the A.
�� , _ C�/�
of Se ie Ki County — Mobile Medical Program, the non-profit corporatinh that executed the
within and fo egoing 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.
date
IN WITNESS WHEREOF,
City of Auburn A
January 1, 2012
Page 2of2
I have hereunto set my hand and affixed my official seal the
NOTARY�Zd
PUBLIC in /Aare State of
Washington, residing in a�2
MY COMMISSION EXPIRES:
GF -1228, Seattle King County — Mobile Medical Program