So. Florida Center for Family Counselingaoo y= ~7aa
PROFESSIONAL SERVICES AGREEMENT
BETWEEN THE CITY OF MIAMI BEACH, FLORIDA
AND SOUTH FLORIDA CENTER FOR FAMILY COUNSELING
FOR YOUTH SERVICES
RELATED TO THE CITY'S SERVICE PARTNERSHIP INITIATIVE
THIS AGREEMENT made and entered into this 1st day of August, 2009, by and
between the CITY OF MIAMI BEACH, FLORIDA (hereinafter referred to as City),
having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida,
33139, and South Florida Center for Family Counseling, Inc., a Florida Corporation,
(hereinafter referred to as Contractor), whose address is 17801 NW 2nd Ave Suite 207
Miami, Florida 33169
SECTION 1
1.1 DEFINITIONS
Agreement: This Agreement between the City and Contractor, and any
exhibits and/or attachments hereto.
City Manager: The Chief Administrative Officer of the City.
Contractor: For the purposes of this Agreement, Contractor shall be
deemed to be an independent contractor, and not an agent
or employee of the City.
Services: All services, work and actions by the Contractor performed
pursuant to or undertaken under this Agreement, as
described in Section 2 and Exhibit "A" hereto.
Fee (Compensation): Amount paid to the Contractor to cover the costs of the
Services.
Risk Manager: The Risk Manager of the City, with offices at 1700
Convention Center Drive, Third Floor, Miami Beach, Florida
33139, telephone number (305) 673-7000, Ext. 6435, and
fax number (305) 673-7023.
1
SECTION 2
SCOPE OF WORK (SERVICES)
The Contractor will provide intake and assessment services for up to two hundred
fifty (250) youth and their families in accordance with The Children's Trust Miami
Beach Service Partnership Grant, dated August 1, 2009. The scope of work to be
performed by Contractor is further detailed in Exhibit "A," entitled "Scope of Services."
The Contractor shall report to the City of Miami Beach, Neighborhood Services
Department, Office of Community Services, Division Director.
SECTION 3
COMPENSATION
3.1 FIXED FEE
Contractor shall be compensated for the Services, as set forth in Section 2
and Exhibit "A", as follows: (a) Provision of intake and assessment services for up to
two hundred fifty (250) youth and their families at One Hundred Forty Dollars ($140)
per each intake, fora maximum not to exceed Thirty-Five Thousand Dollars
($35,000).
Contractor's compensation shall be further subject to and conditioned upon all
or any portion of the Services to be provided herein being allowable and within the
Scope of Services delineated in Exhibit "A".
Notwithstanding the preceding, Contractor's total compensation during the
term of this Agreement shall not exceed the maximum allowable sum of Thirty-Five
Thousand Dollars ($35,000).
3.2 INVOICING
Contractor shall submit monthly invoices, a Monthly Progress Report, and
accompanying Monthly Status Report, as set forth in Exhibit "B", which includes an
itemized, detailed description of the Services, or portions thereof, provided (including
the clients served) and cost(s) for same. Invoices and supporting documentation shall
be submitted to Maria Ruiz, Division Director, Office of Community Services, 1700
Convention Center Drive, Miami Beach, Florida, 33139.
3.3 METHOD OF PAYMENT
Payments shall be made within thirty (30) days of the date of invoice, in a
manner satisfactory to and as approved and received by the City Manager and/or his
designee, who shall be the Division Director, Office of Community Services.
2
SECTION 4
GENERAL PROVISIONS
4.1 RESPONSIBILITY OF THE CONTRACTOR
With respect to the performance of the Services, the Contractor shall exercise
that degree of skill, care, efficiency and diligence normally exercised by recognized
professionals with respect to the performance of comparable services. In its
performance of the Services, the Contractor shall comply with all applicable laws,
ordinances, and regulations of the City, Miami-Dade County, the State of Florida, and
the federal government, as applicable.
4.2 PUBLIC ENTITY CRIMES
A State of Florida Form PUR 7068, Sworn Statement under Section
287.133(3)(a) Florida Statute on Public Entity Crimes shall be filed with the City's
Procurement Division, prior to commencement of the Services herein.
4.3 DURATION AND EXTENT OF AGREEMENT (TERM)
The term of this Agreement shall commence upon execution of this Agreement
by all parties hereto, and shall terminate on July 31, 2010.
4.4 TIME OF COMPLETION
The Services to be rendered by the Contractor shall be commenced upon
receipt of a written Notice to Proceed from the City subsequent to execution of the
Agreement by the parties, and shall be completed no later than July 31, 2010.
4.5 INDEMNIFICATION
Contractor agrees to indemnify and hold harmless the City of Miami Beach and its
officers, employees and agents, from and against any and all actions, claims,
liabilities, losses, and expenses, including, but not limited to, attorneys' fees, for
personal, economic or bodily injury, wrongful death, loss of or damage to property, at
law or in equity, which may arise or be alleged to have arisen from the negligent acts,
errors, omissions or other wrongful conduct of the Contractor, its employees, agents,
sub-consultants, or any other person or entity acting under Consultant's control, in
connection with the Contractor's performance of the Services pursuant to this
Agreement; and to that extent, the Contractor shall pay all such claims and losses
and shall pay all such costs and judgments which may issue from any lawsuit arising
from such claims and losses, and shall pay all costs and attorneys' fees expended by
the City in the defense of such claims and losses, including appeals.
The Contractor's obligation under this Subsection shall not include the obligation to
indemnify the City of Miami Beach and its officers, employees and agents, from and
3
against any actions or claims which arise or are alleged to have arisen from negligent
acts or omissions or other wrongful conduct of the City and its officers, employees
and agents. The parties each agree to give the other party prompt notice of any
claim coming to its knowledge that in any way directly or indirectly affects the other
party.
4.6 TERMINATION, SUSPENSION AND SANCTIONS
4.6.1 Termination for Cause
If the Contractor shall fail to fulfill in a timely manner, or otherwise
violate any of the covenants, agreements, or stipulations material to this
Agreement, the City shall thereupon have the right to terminate the
Services then remaining to be performed. Prior to exercising its option
to terminate for cause, the City shall notify the Contractor of its violation
of .the particular terms of this Agreement and shall grant Contractor
seven (7) days to cure such default. If such default remains uncured
after seven (7) days, the City, upon three (3) days' notice to Contractor,
may terminate this Agreement and the City shall be fully discharged
from any and all liabilities, duties and terms arising out of/or by virtue of
this Agreement.
Notwithstanding the above, the Contractor shall not be relieved of
liability to the City for damages sustained by the City by any breach of
the Agreement by the Contractor. The City, at its sole option and
discretion, shall additionally be entitled to bring any and all
legal/equitable actions that it deems to be in its best interest in order to
enforce the City's right and remedies against the defaulting party. The
City shall be entitled to recover all costs of such actions, including
reasonable attorneys' fees. To the extent allowed by law, the defaulting
party waives its right to jury trial and its right to bring permissive counter
claims against the City in any such action.
4.6.2 Termination for Convenience of City
NOTWITHSTANDING SECTION 4.6.1, THE CITY MAY ALSO, FOR
ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE THIS
AGREEMENT AT ANY TIME DURING THE TERM HEREOF BY
GIVING WRITTEN NOTICE TO CONSULTANT OF SUCH
TERMINATION, WHICH SHALL BECOME EFFECTIVE SEVEN (7)
DAYS FOLLOWING RECEIPT BY THE CONSULTANT OF THE
WRITTEN TERMINATION NOTICE. IN THAT EVENT, ANY
FINISHED OR UNFINISHED DOCUMENTS AND OTHER
MATERIALS PREPARED AND OR OTHERWISE COMPILED BY
CONSULTANT PURSUANT TO ITS PROVISION OF THE SERVICES
CONTEMPLATED IN SECTION 2 AND IN EXHIBIT "A", SHALL BE
PROMPTLY ASSEMBLED AND DELIVERED TO THE CITY, AT
4
CONSULTANT'S SOLE COST AND EXPENSE. IF THE
AGREEMENT IS TERMINATED BY THE CITY AS PROVIDED IN
THIS SUBSECTION, CONSULTANT SHALL BE PAID FOR ANY
SERVICES SATISFACTORILY PERFORMED, AS DETERMINED BY
THE CITY AT ITS SOLE DISCERTION, UP TO THE DATE OF
TERMINATION; PROVIDED, HOWEVER, THAT AS A CONDITION
PRECEDENT TO SUCH PAYMENT, CONSULTANT SHALL HAVE
DELIVERED ANY AND ALL DOCUMENTS, MATERIALS, ETC, TO
CITY, AS REQUIRED HEREIN.
4.6.3 Termination for Insolvency
The City also reserves the right to terminate the remaining Services to
be performed in the event the Contractor is placed either in voluntary
or involuntary bankruptcy or makes an assignment for the benefit of
creditors. In such event, the right and obligations for the parties shall
be the same as provided for in Section 4.6.2.
4.6.4 Sanctions for Noncompliance with Nondiscrimination Provisions
In the event of the Contractor's noncompliance with the
nondiscrimination provisions of this Agreement, as applicable, the City
shall impose such sanctions as the City or the State of Florida may
determine to be appropriate, including but not limited to, withholding of
payments to the Contractor under the Agreement until the Contractor
complies and/or cancellation, termination or suspension of the
Services and/or the Agreement. In the event the City cancels or
terminates the Services and/or the Agreement pursuant to this
Subsection the rights and obligations of the parties shall be the same
as provided in Section 4.6.2.
4.7 CHANGES AND ADDITIONS
Any changes and additions to the terms of this Agreement shall be by a written
amendment, signed by the duly authorized representatives of the City and Contractor.
No alteration, change, or modification of the terms of this Agreement shall be valid
unless amended in writing, signed by the parties hereto, and approved by the City.
4.8 OWNERSHIP OF DOCUMENTS
Any changes and additions to the terms of this Agreement shall be by a
written amendment, .signed by the duly authorized representatives of the City and
Contractor. No alteration, change, or modification of the terms of this Agreement
shall be valid unless amended in writing, signed by the parties hereto, and
approved by the City.
5
4.9 AUDIT AND INSPECTIONS
Upon 24-hour's written notice, the City Manager (on behalf of the City) and/or
such authorized representatives as the City Manager may deem to act on the City's
behalf, may, during Contractor's normal business hours, audit, examine and make
audits of all contracts, invoices, materials, payrolls, records of personnel, conditions
of employment, and any and all other data and/or records and/or documents
relating to all matters covered by this Agreement. Contractor shall maintain any and
all such records, as necessary to document compliance with the provisions of this
Agreement.
4.10 ACCESS TO RECORDS
Contractor agrees to allow access during normal business hours to all
records including, without limitation, Contractor's financial records, to the City and/or
its authorized representatives, and agrees to provide such assistance as may be
necessary to facilitate audit by the City and/or its representatives, when and as the
City Manager, in his sole and reasonable discretion, may deem necessary to ensure
compliance with the provisions of this Agreement including, without limitation, as
they pertain to any financial audits (with applicable accounting and financial
standards). Contractor shall allow access during normal business hours to any and
all records, forms, files, and documents which have been generated in performance
of this Agreement, by the City and/or its authorized representatives.
4.11 INSURANCE REQUIREMENTS
The Contractor shall not commence any work and/or Services pursuant
to this Agreement until all insurance required under this Section has been obtained
and such insurance has been reviewed and approved by the City's Risk Manager.
Contractor shall maintain and carry in full force during the term of this Agreement the
following insurance:
1. Contractor General Liability, in the amount of $1,000,000.
2. Contractor Professional Liability, in the amount of $200,000.
3. Workers Compensation & Employers Liability, as required pursuant to Florida
Statutes.
All insurance required hereunder must be furnished by insurance companies
authorized to do business in the State of Florida.
Original certificates of insurance for the above coverage must be submitted to
the City's Risk Manager at the Office of the Risk Manager of the City of Miami Beach,
1700 Convention Center Drive, Miami Beach, Florida 33139.
The Contractor is solely responsible for obtaining and submitting all insurance
certificates for its sub-contractors.
6
All insurance policies must be issued by companies authorized to do business
under the laws of the State of Florida. The companies must be rated no less than
"B+" as to management and not less than "Class VI" as to strength by the latest
edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New
Jersey, or its equivalent.
Compliance with the foregoing requirements shall not relieve the Contractor of
the liabilities and obligations under this Section or under any other portion of this
Agreement, and the City shall have the right to obtain from the Contractor specimen
copies of the insurance policies in the event that submitted certificates of insurance
are inadequate to ascertain compliance with required overage.
All of Contractor's certificates, as required in this Section 4.11, shall contain
endorsements providing that written notice shall be given to the City at least thirty
(30) days prior to termination, cancellation or reduction in coverage in the policy.
The Contractor shall not commence any work and/or Services pursuant to this
Agreement until the City's Risk Manager has received, reviewed and approved, in
writing, certificates of insurance showing that the requirements of this Section (in its
entirety) have been met and provided for.
4.12 ASSIGNMENT, TRANSFER OR SUBCONTRACTING
The Contractor shall not subcontract, assign, or transfer any work under this
Agreement without the prior written consent of the City Manager which consent, if
granted at all, shall be at the Manager's sole and absolute discretion.
4.13 SUB-CONTRACTORS
The Contractor shall be liable for Contractor's services, responsibilities and
liabilities under this Agreement, and the services, responsibilities and liabilities of
sub-contractors, and any other person or entity acting under the direction or control
of Contractor. .When the term "Contractor" is used in this Agreement, it shall be
deemed to include any sub-contractors and any other person or entity acting under
the direction or control of Contractor. All sub-contractors must be approved, in
writing by the City Manager, or his designee, prior to their engagement by
Contractor (which approval, if granted at all, shall be at the Manager's sole
discretion and judgment).
4.14 EQUAL EMPLOYMENT OPPORTUNITY
In connection with the performance of this Agreement, the Contractor shall
not discriminate against any employee or applicant for employment because of
race, color, religion, ancestry, sex, age, and national origin, place of birth, marital
status, or physical handicap. The Contractor shall take affirmative action to ensure
that applicants are employed and that employees are treated during their
7
employment without regard to their race, color, religion, ancestry, sex, age, national
origin, place of birth, marital status, disability, or sexual orientation, as applicable.
4.15 NO CONFLICT OF INTEREST
The Contractor agrees to adhere to and be governed by the Metropolitan
Miami-Dade County Conflict of Interest Ordinance, as same may be amended from
time to time; and by City of Miami Beach Code, as same may be amended from
time to time.
The Contractor covenants that it presently has no interest and shall not
acquire any interest, direct or indirectly which should conflict in any manner or
degree with the performance of the Services. The Contractor further covenants that
in the performance of this Agreement, no person having any such interest shall
knowingly be employed by the Consultant. No member of or delegate to the
Congress of the United States shall be admitted to any share or part of this
Agreement or to any benefits arising there from.
4.16 PATENT RIGHTS: COPYRIGHTS: CONFIDENTIAL FINDINGS
Any patentable result arising out of this Agreement, as well as all information,
design specifications, processes, data and findings, shall be made available in
perpetuity to the City, for public use.
No reports, other documents, articles or devices produced in whole or in part
under this Agreement shall be the subject of any application for copyright or patent
by or on behalf of the Contractor or its employees or subcontractors.
4.17 NOTICES
All notices and communications relating to the day-to-day activities shall be
exchanged between a project manager appointed by the Contractor and the
program coordinator designated by the City Manager, who shall be Neighborhood
Services Department, Office of Community Services, Division Director. The
Contractor's project manager shall be designated following execution of this
Agreement by the parties and prior to commencement of the Services.
All other notices and communications in writing required or permitted
hereunder may be delivered personally to the representatives of the Contractor and
the City listed below or may be mailed by registered mail.
Until changed by notice in writing, all such notices and communications shall
be addressed as follows:
8
TO CONTRACTOR:
TO CITY:
South Florida Center for Family Counseling, Inc.
Attn: Mayra Matos, Executive Director
17801 NW 2nd Ave Suite 207
Miami, Florida 33169
305-651-3534
City of Miami Beach
Office of Community Services
Attn: Maria L. Ruiz, Director
1700 Convention Center Drive
Miami Beach, Florida 33139
(305) 673-7491
4.18 LITIGATION JURISDICTIONNENUE
This Agreement shall be governed by, and construed in accordance with, the
laws of the State of Florida, both substantive and remedial, without regard to
principles of conflict of laws. The exclusive venue for any litigation arising out of the
Agreement shall be Miami-Dade County, Florida, if in State court, and the U.S.
District Court, Southern District of Florida, if in federal court.
BY ENTERING INTO THIS AGREEMENT,
EXPRESSLY WAIVE ANY RIGHTS EITHER PARTY
JURY OR ANY CIVIL LITIGATION RELATED TO,
AGREEMENT.
4.19 ENTIRETY OF AGREEMENT
CONTRACTOR AND CITY
MAY HAVE TO A TRIAL BY
OR ARISING OUT OF, THIS
This writing and any exhibits and/or attachments incorporated (and/or
otherwise referenced for incorporation) herein embody the entire Agreement and
understanding between the parties hereto, and there are no other agreements and
understandings, oral or written, with reference to the subject matter hereof that are
not merged herein and superseded hereby.
4.20 LIMITATION OF CITY'S LIABILITY
The City desires to enter into this Agreement only if in so doing the City can
place a limit on the City's liability for any cause of action for money damages due to
an alleged breach by the City of this Agreement, so that its liability for any such
breach never exceeds the sum of $1,000. Contractor hereby expresses its
willingness to enter into this Agreement with Consultant's recovery from the City for
any damage action for breach of contract to be limited to a maximum amount of
$1,000.
Accordingly, and notwithstanding any other term or condition of this
Agreement, Contractor hereby agrees that the City shall not be liable to the
9
Contractor for damages in an amount in excess of $1,000 for any action or claim for
breach of contract arising out of the performance or non-performance of any
obligations imposed upon the City by this Agreement. Nothing contained in this
paragraph or elsewhere in this Agreement is in any way intended to be a waiver of
the limitation placed upon the City's liability as set forth in Section 768.28, Florida
Statutes.
[REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK]
10
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to
be executed by their appropriate officials, as of the date first entered above.
FOR CITY:
CITY OF MIAMI BEACH, FLORIDA
ATTEST:
d ~ ~/-~
City Clerk
FOR CONTRACTOR:
Mayor
South Florida
Counseling,
Corporation
ATTEST:
Center for Family
Inc., A Florida
By: ~, B C-- ---~
Secretary President
------- ~
~ oS S ~ S
Print Name
/hl9y~~ ~A"~.s
Print Name
Corporate Seal
APPROVED AS TO
FORM & LANGUAGE
t~ F~~ EXECUTION
a tk o°l
Date
11
EXHIBIT "A"
"SCOPE OF SERVICES"
The Contractor agrees to provide the following services to youth referred to the
Success University program:
Service Documentation of Service
Intake & Assessment :Completed Success University Intake & Assessment
Form (attached); Copy of completed Referral Form(s)
(attached); Documentation of service provided on
Community OS Software
Related Definitions:
Intake 8 Assessment - An intake and assessment documents the natural supports
and needs of the client and his/her family. The intake and assessment form must be
completed accurately and completely and submitted to the City, where the client is
assigned a number in The Children's Trust Data Tracker system.
Referrals -Referrals include the identification of a specific client need and the
subsequent identification of a community based resource to address the need.
Referrals must be provided for all service needs recognized in the intake and
assessment or client-initiated requests. These referrals must be documented using
the Miami Beach Service Partnership Referral Form with copies provided to the client
and City.
Services will be deemed as provided when the following documentation is provided
within the noted timeframes:
,.... .
` Service Documentation Submission Deadline
_..
Intake & Assessment :Intake & Assessment Form; j 72 business hours from
i
' _ _ _ _ _ _ _____FGC Invited Participants Form 3 provision of service __
Referrals _ ~~~ u ~ ~ "Services Referral Form 72 business hours from they
~ .identification of client need
:.......................................................................................................................................:..................................................................................................................................................................................................................................................................................................................................................:
Service Deliverables
Service Unit of Service Service Location Timeframe
Intake & Assessment 1 for each of up to Client Home All eligible intakes
250 youth ;will be completed
within thirty (30)
days of receipt of
a ointment
~_.___~_._________._ ~ _____._._._.__._ .____......________......_._._____._._._..._ __._._._._. ___1_._._._._._.___._._._ _.__.__~__._._.~____P_p____ _.___,
Failure to meet contracted service units within the allocated timeframe may result in
the City subsequently reducing the Contractor's service level and allocated funding
accordingly.
12
If the Contractor is unable to fulfill the contracted service level within the allocated
timeframe for each service component, the City reserves the right to reduce service
levels accordingly across the funded service spectrum.
If the Contractor is unable to fulfill the contracted service level and the City
subsequently reduces service and funding levels, the City reserves the right to select
another vendor to fulfill the remaining service units. The City will select the alternate
vendor at its sole discretion.
Reporting Requirements
The Contractor will provide the City with a Monthly Progress Report and
reimbursement request utilizing the City's Reporting and Reimbursement Forms
(attached) by the third (3~d) of the following month. In the event that the third of the
month lands on a Saturday, Sunday or holiday, the report must be submitted the
following business day.
Monthly reports and reimbursement requests will be submitted via any of the
following methods:
• Electronic mail
• .Facsimile
• Standard mail
• Hand delivery
Monthly reports will not be considered acceptable unless the following is met:
• Forms are completely and accurately filled
• Necessary back-up materials are included (client documentation, expense
receipts, time logs, etc.)
• Reports bear the signature of the person submitting the report on behalf of
the Contractor
The City will document Contractor service level data and monthly reports via Active
Strategy software for inclusion in the monthly report to the Miami Beach Governing
Board as well as the City's website.
The failure to submit required monthly reports and invoices in a timely manner for two
consecutive months will result in the forfeiture of one (1 %) percent of the combined
billed total for the two months in question. These forfeited funds will be used
exclusively for client incentive materials as approved by the Miami Beach Service
Partnership Governing Board. These forfeited funds will be submitted to the City by
the Contractor via check within 30 days.
13
Partner Performance Ratings
The Contractor agrees that its Partner Performance Rating, the score awarded for
performance on the following measures, will be posted on the City's website:
• Timely and accurate submission of monthly progress report
• Timely and accurate submissions of monthly financial reports (reimbursement
requests)
• Delivery of contracted service units
• Promotion of the Miami Beach Service Partnership
• Attendance at Miami Beach Service Partnership Governing Board and related
committee(s) meetings
Ratings will be given for each performance measure based on the following:
Performance Measure Ratin Rationale & Score
Timely and accurate submission of - "0" for failing to submit on time
3.monthlYprogress..re.po.rt ................
.
. "20"
fo
r
submittin
on
time
-
9
.
...
..................................................................
Timely and accurate submissions of _
_
_
_
......
...
.
_
.......................
- "0" for failing to submit accurate report
monthly financial reports (reimbursement :with back-up material on time
requests)
3 - "20" for submitting accurate report on
time
Delivery of contracted service units :Possible score of 0 to 20 based upon
completion of monthly projected service
units. Score is pro-rated if total projected
service units are not met.
Promotion of the Miami Beach Service :Possible score of 0 to 20:
Partnership - Contractor will promote Service
Partnership on its website, if applicable (5
points for inclusion on website)
- Contractor will display Service
:Partnership materials and/or poster in
service lobby. (5 points for inclusion in
lobby)
- Contractor will adhere to approved
j :commitments in Service Partnership
Marketing Plan (up to 10 points pro-rated
for artici anon on commitments
.....................P...........................P )
Attendance at Miami Beach Service ....
:Possible score of 0 to 20:
I Partnership Governing Board and related 10 Points for attendance at Governing
committee(s) meetings : Board meetings; 10 points for Committee
: attendance (In the event that there are no
committee meetings scheduled, the value
for attendance at the Governing Board
. _ ____._. __._ _ _ _. _._._._ ___..........____._. : meeting, will be 20
14
Web Promotion of Miami Beach Service Partnership
The Contractor is required to provide a link to the Miami Beach Service Partnership
web page on its organization's web site. In turn, the City of Miami Beach will provide
a link to the Contractor web page on its web site.
Memoranda of Understanding
A Memorandum of Understanding (MOU) reflecting the terms of this agreement as
well as commitment to the Miami Beach Service Partnership will be provided and
updated as necessary. The MOU must be submitted to the City of Miami Beach prior
to execution of the service contract.
Governing Board Attendance
The Contractor is required to have representation at each calendared Governing
Board meeting. If the Contractor fails to have representation at two meetings, the City
reserves the right to reduce contracted service levels at its sole discretion.
Engagement Strategies
The Contractor will adhere to the following engagement strategies in the delivery of
services:
• Advise the client and his/her parents and/or guardians of the scheduled
appointment for Family Group Conference.
• Provide client and his/her parents and/or guardians information regarding
tutoring and other available services.
Evaluation
In the continuing effort to ensure programming excellence, clients will be provided
with evaluation forms at the end of each programming component to gauge their
satisfaction with services provided. The evaluation forms will be provided by the City
and must be administered at the following time:
• Completion of Services Evaluation Form
15
Monitoring & PerFormance Reviews
The City of Miami Beach reserves the right to inspect, monitor and/or audit the
Contractor to ensure contractual compliance. This includes, but is not limited to:
• Review of on-site service delivery
• Inspection and review of client, budgetary and employee files (for those
employees providing services under this contract)
The monitoring tool provided by The Children's Trust, "Community and Neighborhood
Services System of Care Programmatic Site Visit Form", will be used to guide
inspections and monitoring visits. (Copy included herein.)
Employee File Review
The following documentation must be included in the employee file for those
employees providing services under this contract. The City of Miami Beach reserves
the right to inspect client files with due notice (at least 48 hours in advance of planned
site visit) to ensure adherence to contractual expectations as well as to ensure pre-
screening prior to a monitoring visit by The Children's Trust. The following must be
included in the employee files:
• Employment Application
• Evidence of degree/credentials
• Job Description Signed by Employee
• Evidence of Required Experience
• Florida Background Criminal Screening
• National FBI Background Criminal Screening (Level2)
• Affidavit of Good Moral Character
• Proof of Knowledge of Policies & Procedures
• Confidentiality Agreement Re: Client Information
• Documentation of Agency Training/In-Service Training
• I-9 Verification on File
Master Calendar
The Contractor will notify the City of any client appointment or anticipated service
delivery at least 72 hours in advance of the appointment or service delivery for
inclusion in the Success University Master Calendar that is distributed to all members
of the Miami Beach Service Partnership. The Master Calendar will be updated daily
and distributed to the Partnership as needed.
16
Training Requirements
Frontline personnel (those conducting trainings) will be required to complete the
following trainings prior to service provision:
Intake & Assessment Services ^ Program Overview Training
^ Intake & Assessment Training
^ Community OS Software Training
^ Client Evaluation Surve Trainin
While initial training expenses are covered by the City, the Contractor agrees to
reimburse the City for the early departure (termination) of any trained staff member
prior to this contract's termination on a pro-rated basis as follows:
Switchboard of Miami Registration
Contractor agency will register with Switchboard of Miami to ensure that agency
information is accurate and updated. This contractual obligation is directed by The
Children's Trust. Agency registration can be done at the following website:
www.switchboardmiami.org
Additional Documentation
The following documentation must be submitted with this executed agreement:
• All required insurance certificates
• Copy of current audit
• Copy of required business licenses and permits
• Copy of notice as recipient of funding from The Children's Trust
• Updated Memorandum Of Understanding (MOU) reflecting scope of services
and leverage associated with Success University
17
EXHIBIT "B"
INVOICING
The Contractor agrees to provide the invoicing and services documentation as
indicated in the Monthly Progress Report and Monthly Invoice Report, as attached to
this Exhibit, by the third (3~d) of the subsequent month.
18
EXHIBIT "C"
ATTACHMENTS
The following documents are attached:
• Intake & Assessment Form (10 pages)
• Referral Form (2 pages)
• Monthly Progress Report (1 page)
• Monthly Invoice Form (1 page)
• Status Report Form (2 pages)
• Services Evaluation Form (1 page)
• Programmatic Site Visit Form (9 pages)
19
CONTRACT NO. 903-109-1
BETWEEN THE CHILDREN'S TRUST
AND The City of Miami Beach
FOR Success University Service Partnership 2009-10
THIS CONTRACT, made and entered into by and between The Children's Trust whose address is 3150 S.W.
3`d Avenue, 8th Floor, Miami, Florida 33129 and The City of Miami Beach hereinafter referred to as the
"Provider" whose address is 555 17th Street, Miami Beach, FL. 33139 states the conditions and covenants for
the rendering of services to children and families (hereafter referred to as "Services") for The Children's Trust.
In consideration of the mutual covenants herein, The Children's Trust and the Provider (sometimes hereafter
referred to as "Parties") agree as follows:
A. EFFECTIVE TERM
The effective term of this Contract shall be from August 1, 2009 through July 31, 2010, subject to funding
availability and Provider's performance.
B. TERMS OF RENEWAL, if applicable
In the sole discretion of The Children's Trust, this Contract may be renewed twice and with the
acknowledgement of the Provider. Renewal may not exceed a term equal to the term of the initial contract,
for a total maximum of three (3) terms. In considering the exercise of any contract renewal, The Children's
Trust in its sole discretion will consider, but is not limited to, the following:
1. Provider meeting the performance requirements specified in this Contract.
2. Continued demonstrated and documented need for the services funded.
3. Program performance, fiscal performance and compliance by the Provider that is deemed satisfactory
in The Children's Trust's sole discretion.
4. The availability of funds from The Children's Trust. The Children's Trust is prohibited from creating
obligations in anticipation of budgeted revenues from one fiscal year to another without year to year
extension provisions in the contract.
5. If applicable, The Children's Trust in its sole discretion will initiate re-negotiation of this Contract
before the contract term expires.
C. SCOPE OF SERVICES
Provider agrees to render services in accordance with the Scope of Services, Attachment A, to this
Contract. Provider shall implement the Scope of Services, Attachment A, in a manner deemed
satisfactory to The Children's Trust. Any modification to the Scope of Services shall not be effective
until approved, in writing, by The Children's Trust and the Provider.
2. The Scope of Services' activities and performance measures, as well as other complete and accurate
data and programming information, will be used in the evaluation of the Provider's overall
pertormance.
3. Provider agrees that all funding provided by The Children's Trust, pursuant to this Contract will be
used exclusively for Services in and for the benefit of Miami-Dade County residents.
D. TOTAL FUNDING
Subject to the availability of funds, the maximum amount payable for Services rendered under this Contract
shall not exceed $400,000. The Parties agree that should available funding to The Children's Trust be
reduced, the amount payable under this Contract may be reduced at the sole option of The Children's Trust.
Provider agrees to adhere to the Budget and Method of Payment outlined in Attachment B to this Contract.
The City of Miami beach Page 1 of 34
Contract #903-109-1, Resolution 2009-90
E. FISCAL MANAGEMENT
1. Double Billing and Payments
Provider costs or earnings claimed under this Contract may not also be claimed under another contract
or grant from The Children's Trust or from any other agency. Any claim for double payment by
Provider shall be a material breach of this Contract.
2. No Supplanting of Existing Public Funds
The Children's Trust funding may not be used by any provider as a substitute for existing resources or
for resources that would otherwise be available for children's services, or to replace funding previously
provided by and currently available from local and state funding sources for the same purpose.
Government agencies must certify that they have maintained their previous funding level when
applying for additional funding from The Children's Trust. A violation of this section shall be
considered a material breach of this Contract.
3. Capital Equipment
Capital equipment is included in the definition of "property" under Florida Statutes, Chapter 274, and
Florida Administrative Code, Section 69I-73.001, and is defined for purposes of this Contract as
individual items with a value of $1,000 or greater which have a life expectancy of more than one year.
Capital equipment purchased with The Children's Trust funds by Provider become assets of The
Children's Trust; are intended for The Children's Trust funded programs; are owned by The Children's
Trust; and must be tagged at the time of purchase as an asset of The Children's Trust. The Children's
Trust will work with Provider to tag the asset and receive all information regarding the capital
equipment. Provider must maintain a record of any capital equipment purchased with funds provided
by The. Children's Trust. When Provider is no longer funded by The Children's Trust, the equipment will
be returned to The Children's Trust for use by another funded program unless it is fully depreciated.
Provider must initiate return of such capital equipment to The Children's Trust. Ownership of capital
equipment will be transferred to Provider and removed from The Children's Trust's fixed asset system
when the capital equipment is fully depreciated and in the possession of Provider.
4. Assignments and Subcontracts
Neither Provider nor The Children's Trust shall assign this Contract to another party. Provider shall not
subcontract any Services contemplated under this Contract without prior written approval of The
Children's Trust. Provider shall incorporate appropriate language form The Children's Trust contract
into its subcontracts and shall require that all subcontractors providing services shall be governed by
the terms and conditions of this contract. Provider shall submit a copy of said agreement to The
Children's Trust within 30 days of its execution. All sub-contracted providers must agree to be
monitored by or on behalf of The Children's Trust in the same manner as Provider under the terms of
this contract. Provider and Subcontractor must be qualified to do business in the state of Florida.
Provider shall be responsible for all services pertormed and all expenses incurred with this Contract,
including services provided and expenses incurred by any and all subcontractors. It is understood by
Provider that The Children's Trust shall not be liable to a subcontractor for any expenses or liabi-ities
incurred under any subcontract and Provider shall be solely liable under the subcontract. Provider
agrees, at Provider's sole expense, to hold harmless and defend The Children's Trust against any such
claims, demands or actions related to any subcontract.
In no event shall The Children's Trust directly provide funds to any subcontractor. All payments to any
authorized subcontractor shall be paid directly by Provider to the subcontractor.
5. Religious Purposes
Organizations and their faith-based community partners shall not use funds provided under this
Contract to support inherently religious activities, such as religious instruction, worship, or
proselytization.
6. Lobbying
The City of Miami beach Page 2 of 34
Contract #903-109-1, Resolution 2009-90
Provider shall not use any funds provided under this Contract or any other funds provided by The
Children's Trust for lobbying any federal, state or local government or legislators.
7. Adverse Action or Proceeding
Provider shall not utilize the funds provided under this Contract or any other funds provided by The
Children's Trust to retain any legal counsel for any action or proceeding against The Children's Trust or
any of its agents, employees or officials.
F. INDEMNIFICATION BY PROVIDER
1. Government Entity
Subject to the limitations and sovereign immunity provisions of Florida Statute, Sec. 768.28, Provider
shall indemnify and hold harmless The Children's Trust and its officers, employees, agents and
instrumentalities from any and all liability, losses or damages, including attorneys' fees and costs of
defense, which its officers, employees, agents or instrumentalities may incur as a result of claims,
demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or
resulting from the performance of this Contract by Provider or its employees, agents, servants,
partners, principals or subcontractors.
Subject to the limitations and sovereign immunity provisions of Florida Statutes, Sec. 768.28, Provider
shall pay all claims and losses in connection therewith and shall investigate and .defend all claims, suits
or actions of any kind or nature in the name of The Children's Trust, where applicable, including
appellate proceedings, and shall pay all costs, judgments, and reasonable attorney's fees which may
issue thereon.
2. All Other Providers
Provider shall indemnify and hold harmless The Children's Trust and its officers, employees, agents
and instrumentalities from any and all liability, losses or damages, including reasonable attorneys' fees
and costs of defense, which The Children's Trust or its officers, employees, agents or instrumentalities
may incur as a result of claims, demands, suits, causes of action or proceedings of any kind or nature
arising out of, relating to or resulting from the performance of this Contract by the Provider or its
employees, agents, servants, partners, principals or sub contractors, except to the extent arising from
The Children's Trust's willful or wanton acts or omissions, or those of its employees or principals.
To the extent arising from a liability that is covered by the foregoing indemnification, Provider shall
pay all claims and losses in connection therewith and shall investigate and defend all claims, suits or
actions of any kind or nature in the name of The Children's Trust, where applicable, including appellate
proceedings, and shall pay all costs, judgments, and reasonable attorney's fees which may issue
thereon. Provider expressly understands and agrees that any insurance protection required by this
Contract or otherwise provided by Provider shall in no way limit the responsibility to indemnify, keep
and save harmless and defend The Children's Trust or its officers, employees, agents as herein
provided.
The provisions of this section on indemnification shall survive the expiration or termination of this
Contract.
G. COPYRIGHTS AND RIGHT TO DATA/MATERIALS
Where activities supported by this Contract produce original writing, data, sound recordings, pictorial
reproductions, drawings or other graphic representations and works of similar nature, The Children's Trust
has a license to reasonably use, duplicate and disclose such materials in whole or in part in a manner
consistent with the purposes and terms of this Contract, and to have others acting on behalf of The Children's
Trust to do so, provided that such use does not compromise the validity of any copyright, trademark or
patent. If the data/materials so developed are subject to copyright, trademark or patent, legal title and every
right, interest, claim or demand of any kind in and to any patent, trademark or copyright, or application for
the same, will vest in the Provider or with any applicable third party who has licensed or otherwise permitted
the Provider to use the same. Provider agrees to allow The Children's Trust and others acting on behalf of
The Children's Trust to have reasonable use of the same consistent with the purposes and terms of this
Contract, at no cost to The Children's Trust, provided that such use does not compromise the validity of such
copyright, trademark or patent.
The City of Miami beach Page 3 of 34
Contract #903-109-1, Resolution 2009-90
H. OWNERSHIP AND LICENSING OF INTELLECTUAL PROPERTY
The Parties understand that this Contract is subject to the provisions, limitations and exceptions of Chapter
119, Florida Statutes, regarding public records. Accordingly to the extent permitted by Chapter 119, Florida
Statutes, the-Provider retains sole ownership of intellectual property developed under this Contract. It is the
responsibility of the Provider to pay all required licensing fees if intellectual property owned by other parties is
incorporated by the Provider into the services required under this Contract. Such licensing should be in the
exclusive name of the Provider. Payment for any such licensing fees or costs arising from the use of others`
intellectual property shall be at the expense of the Provider.
As applicable under Fla. Stat. Section 768.28, and to the extent permitted by and within the limitations of Fla.
Stat. Section 768.28, the Parties shall indemnify and hold each other harmless from liability of any nature or
kind, including costs and expenses for or on account of third party allegations that use of any intellectual
property owned by the third party and provided, manufactured or used by the indemnifying Party in the
performance of this Contract violates the intellectual property rights of that third party.
I. BREACH OF CONTRACT AND REMEDIES
1. Breach
A material breach by the Provider shall have occurred under this Contract if the Provider through
action or omission causes any of the following:
a. Fails to provide the Services outlined in the scope of services (Attachment A) within the effective
term of this Contract;
b. Fails to correct an imminent safety concern or take acceptable corrective action;
c. Ineffectively or improperly uses The Children's Trust funds allocated under this Contract;
d. Does not furnish the certificates of insurance required by this Contract or as determined by The
Children's Trust;
e. Does not meet or satisfy the conditions of award required by this Contract;
f. Fails to submit or submits incorrect or incomplete proof of expenditures to support disbursement
requests or advance funding disbursements, or fails to submit or submits incomplete or incorrect
detailed reports of requests for payment, expenditures or final expenditure reports;
g. Does not submit or submits incomplete or incorrect required reports pursuant to the scope of
Services in this Contract;
h. Refuses to allow The Children's Trust access to records or refuses to allow The Children's Trust to
monitor, evaluate and review the Provider's program, including required client data;
i. Fails to comply with child abuse and incident reporting requirements;
j. Attempts to meet its obligations under this Contract through fraud, misrepresentation or material
misstatement;
k. Fails to correct deficiencies found during a monitoring, evaluation or review within a specified
reasonable time;
I. Fails to meet the terms and conditions of any obligation or repayment schedule to The Children's
Trust or any of its agencies;
m. Fails to maintain the confidentiality of client files, pursuant to Florida and federal laws;
n. Fails to fulfill in a timely and proper manner any and all of its obligations, covenants, contracts and
stipulations in this Contract;
o. Fails to comply with Background Screening, as required under this Contract.
Waiver of breach of any provisions of this Contract shall not be deemed to be a waiver of any
other breach and shall not be construed to be a modification of the terms of this Contract.
2. Remedies
If the Provider breaches this Contract, and fails to cure such breach within thirty (30) days after
receiving written notice from The Children's Trust identifying the breach, The Children's Trust may
pursue any of the following remedies:
a. The Children's Trust may, at its sole discretion, enter into a written performance improvement
plan with the Provider to cure any breach of this Contract as may be permissible under state or
federal law (Attachment F, if applicable). Any such remedial plan shall be an addition to this
Contract and shall not affect or render void or voidable any other provision contained in this
Contract, costs, and any judgments entered by a court of appropriate jurisdiction.
The City of Miami beach Page 4 of 34
Contract #903-109-1, Resolution 2009-90
b. The Children's Trust may suspend payment in whole or in part under this Contract by providing
written notice to the Provider of such suspension and specifying the effective date thereof, at least
five business days before the effective date of suspension. On the effective date of suspension the
Provider may (but shall not be obligated to) continue to perform the services provided for in this
Contract, but the Provider shall promptly cease using The Children's Trust's logo and any other
reference to The Children's Trust in connection with such services. All payments to the Provider as
of effective date shall cease, except that The Children's Trust shall continue to review and pay
requests for payment for services that were performed and/or for deliverables that were
substantially completed at the sole discretion of The Children's Trust, prior to the effective date of
such suspension. • If paym~filts a~~Gspendi32f; The~hildren's Trust must specify in writing thy""
actions that must be taken by the Provider as a condition precedent to the resumption of
payments and shall specify a reasonable date for compliance. The Children's Trust may also
suspend any payments in whole or in part under any other contracts entered into between The
Children's Trust and the Provider by providing separate written notice to the Provider of each such
suspension and specifying the effective date thereof, which must be at least five business days
before the effective date of such suspension. In any event The Children's Trust shall continue to
review and pay requests for payment as provided for in such other contracts for services that were
performed and/or for deliverables that were substantially completed, at the sole discretion of The
Children's Trust, prior to the effective date of such suspension. The Provider shall be responsible
for all direct and indirect costs associated with such termination including reasonable attorney's
fees.
The Children's Trust may terminate this Contract by giving written notice to the Provider of such
termination and specifying the date thereof at least five (5) business days before the effective
date of termination. In the event of such termination, The Children's Trust may (a) request the
Provider to deliver to The Children's Trust clear and legible copies of all finished or unfinished
documents, studies, surveys, reports prepared and secured by the Provider with Trust funds under
this Contract subject to the rights of the Provider thereto as provided for in Paragraphs G and H
above; (b) seek reimbursement of any Trust funds which have been improperly paid to the
Provider under this Contract; (c) terminate further payment of Trust funds to the Provider under
this Contract, except that The Children's Trust shall continue to review and pay requests for
payment for services that were pertormed and/or deliverables that were substantially completed
at the sole discretion of The Children's Trust prior to the effective date of such termination; and/or
(d) terminate or cancel any other contracts entered into between The Children's Trust and the
Provider by providing separate written notice to the Provider of each such termination and
specifying the effective date thereof, which must be at least five business days before the effective
date of such termination, in which event The Children's Trust shall continue to review and pay
requests for payment as provided for in such other contracts for services that were performed
and/or for deliverables that were substantially completed at the sole discretion of The Children's
Trust prior to the effective date of such termination. The Provider shall be responsible for all direct
and indirect costs associated with such termination, including reasonable attorney's fees.
d. The Children's Trust may seek enforcement of this Contract including but not limited to filing an
action with a court of appropriate jurisdiction. The Provider shall be responsible for all direct and
indirect costs associated with such enforcement, including reasonable attorney's fees, costs, and
any judgments entered by a court of appropriate jurisdiction, including all direct and indirect costs
and reasonable attorneys' fees through conclusion of all appellate proceedings, and including any
final settlement.
e. The provisions of this Paragraph I shall survive the expiration or termination of this Contract.
J. INSURANCE REQUIREMENTS
Provider shall have their insurance agent(s) provide to The Children's Trust within 30 days of contract
execution, Certificates of Insurance or, as applicable, a letter of self-insurance indicating coverage applicable
to a Florida municipal corporation or written verification (binders) required under this section or as determined
by The Children's Trust, except as required by Florida law for government entities. It is the Provider's
responsibility to comply with this requirement. The Children's Trust shall be named as an additional insured
as their interest may appear on all applicable policies, and all applicable policies shall be maintained in full
force for the term of this contract. As a condition of the execution of the contract, The Children's Trust will
not disburse any funds until The Children's Trust is provided with the necessary Certificates of Insurance,
The City of Miami beach Page 5 of 34
Contract #903-109-1, Resolution 2009-90
letter of self-insurance or written verification (binders) and The Children's Trust has approved such
documents. The Children's Trust shall have the rights to review said certificates or letters and, if applicable,
reasonably require updating of types and amounts of coverage provided upon any renewal of this Contract.
Provider will carry insurance policies in the amounts and with the requirements indicated below:
1. Worker's Compensation Insurance for all employees and non-incorporated independent
contractors and non-incorporated consultants of the Provider, as required by Florida Statutes,
Ch^=r 440. The employer's liability portion will be $500,000/$500 000/$500,000 as a minimum.
2. Comprehensive General Liability insurance in an amount not less than $500,000 combined single limit
per occurrence and $1,000,000 aggregate in a policy year. Deductibles exceeding $1,000 are
discouraged, unless Provider can provide financials to support a higher deductible. The Children's
Trust must be designated and shown as an "Additional Insured as Their Interest May Appear" with
respects to this coverage. The general liability policy must contain coverage for the following:
a. Bodily Injury;
b. Property Damage;
c. No exclusions for Abuse, Molestation or Corporal Punishment;
d. No endorsement for premises only operations.
3. Automobile liability coverage for all owned and/or leased vehicles of the Provider and non-owned
coverage for their employees and/or sub-contractors transporting program participants. The
amount of coverage is $1,000,000 combined single limit per occurrence for bodily injury and property
damage. The Children's Trust must be designated and shown as an "Additional Insured as Their
Interest May Appear" with respects to this coverage. Coverage can be purchased as non-owned
without hired auto coverage, but rental cars can not be used in the course of the Provider's regular
operations. Rental cars may be used for travel to attend conferences outside the tri-county area.
4. Automobile liability coverage for all owned and/or leased vehicles of the Provider and non-owned
coverage for their employees and /or sub-contractors not transporting program participants. The
minimum amount of coverage is $300,000 combined single limit per occurrence for bodily injury and
property damage. The Children's Trust must be designated and shown as an "Additional Insured as
Their Interest May Appear" with respects to this coverage. Coverage can be purchased as non-owned
without hired auto coverage, but rental cars can not be used in the course of the Provider's regular
operations. Rental cars may be used for travel to attend conferences outside the tri-county area.
5. If applicable, Special Events Coverage, as determined by The Children's Trust. The liability coverage
will be the same as the coverage and limits required for comprehensive general liability and The
Children's Trust must be designated and shown as "Additional Insured as Their Interest May Appear."
Special Events policies are for short term functions and not meant to replace annual liability policies.
The coverage is for the day or days of the event and must provide coverage the day prior and the day
following the event.
If applicable, Professional Liability insurance, as determined by The Children's Trust, with coverage
amounts determined by The Children's Trust but not less than $250,000 per claim and in the
aggregate. Defense costs may be inside the limits of liability and the policy can be written on claims
made form. The Children's Trust is not required to be named as an Additional Insured.
If applicable, Proof of Property Coverage is required when the Provider has capital equipment paid for
by The Children's Trust and said capital equipment is under the care custody and control of the
Provider. The Children's Trust must be shown on the evidence of property coverage as a Loss Payee.
Certificate holder must read:
The Children's Trust
3150 SW 3~d Avenue, 8th Floor
Miami, Florida 33129
The City of Miami beach Page 6 of 34
Contract #903-109-1, Resolution 2009-90
Classification and Rating
All insurance policies required above shall be issued by companies authorized to do business under the laws of
the State of Florida, with the following qualifications:
The company must be rated no less than "B" as to management, and no less than "Class V" as
the financial strength, by the latest edition of Best's Insurance Guide, published by A.M. Best
Company, Oldwick, New Jersey, or its equivalent, subject to the reasonable approval of The
Children's Trust's Risk Management Division, or the company must hold a valid Florida Certificate
of Authority as shown in the latest "List of All Insurance Companies Authorized or Approved to Do
Business in Florida" issued by the State of Florida Department of Insurance and are members of
the Florida Guaranty Fund.
The Provider shall notify The Children's Trust, in writing, of any material changes in insurance coverage,
including, but not limited, to any renewals of existing insurance policies, not later than thirty (30) days prior
to the effective date except for ten (10) days for lack of payment changes.
In the event of any change in the Provider's Scope of Services, Attachment A, The Children's Trust may
increase, waive or modify, in writing any of the foregoing insurance requirements. Any request by a Provider
to decrease, waive or modify any of the foregoing insurance requirements shall be approved, in writing, by
The Children's Trust prior to any such decrease, waiver or modification.
In the event that an insurance policy is canceled during the effective period of this Contract, The Children's
Trust shall withhold all payments from the Provider until a new Certificate of Insurance or written verification
(binders) of insurance required under this section is submitted and approved by The Children's Trust. The
new insurance policy shall cover the time period commencing from the date of cancellation of the prior
insurance policy.
The Children's Trust may require the Provider to furnish additional and different insurance coverage, or both,
as may be required from time to time under applicable federal or state laws. Provision of insurance by
Provider, in no instance, shall be deemed to be a release, limitation, or waiver of any claim, cause of action or
assessment that The Children's Trust may have against the Provider for any liability of any nature related to
performance under this Contract or otherwise.
All insurance required hereunder may be maintained by the Provider pursuant to a master or blanket policy or
policies of insurance.
K. PROOF OF TAX STATUS
Provider is required to keep on file the following documentation for review by The Children's Trust.
• The Internal Revenue Service (I.R.S.) tax status determination letter;
^ The most recent (two years) I.R.S. form 990 or applicable tax return filing within six (6) months after
the Provider's fiscal year end or other appropriate filing period permitted by law;
• If required by applicable law to be filed by the Provider, IRS 941 -quarterly federal tax return reports
within thirty-five (35) calendar days after the quarter ends and if the 941 reflects a tax liability, proof
of payment must be submitted within sixty (60) calendar days after the quarter ends.
L. NOTICES
All notices pursuant to this Contract shall be in writing and sent by certified mail to the addresses for each
Party appearing on the first page of this Contract, and in the case of notices to The Children's Trust, marked
to the attention of its President and CEO. It is each Party's responsibility to advise the other Party in writing
of any changes in name, address and/or telephone number.
M. AUTONOMY
Both Parties agree that this Contract recognizes the autonomy of, and stipulates or implies no affiliation
between, the contracting parties. It is expressly understood and intended that Provider is only a recipient of
funding support and is not an agent or instrumentality of The Children's Trust, and that Provider's agents and
employees are not agents or employees of The Children's Trust.
The City of Miami beach Page 7 of 34
Contract #903-109-1, Resolution 2009-90
N. RECORDS, REPORTS, AUDITS AND MONITORING
1. Accounting records
Provider shall keep accounting records which conform to generally accepted accounting principles. All
such records will be retained by Provider for not less than five years beyond the last date that all
applicable terms of this Contract have been complied with and final payment has been received and
appropriate audits have been submitted to and accepted by the appropriate entity. However, if any audit,
claim, litigation, negotiation or other action involving this Contract or Modification hereto has commenced
before the expiration of the retention period, the records shall be retained until completion of the action
and resolution of all issues which arise from it or until the end of the regular retention period, which ever
is later.
2. Financial Audit and Program Specific Audit
Within 180 days of the close of its fiscal year, Provider agrees to submit to The Children's Trust an Annual
Financial Audit, performed by an independent certified audit firm who is registered to do business with the
Florida State Department of Business Regulation, of all its corporate activities and any accompanying
management letter(s) or report(s) on other matters related to internal control, for each year during which
this Contract remains in force and until all funds expended from this Contract have been audited. If no
management letter or report or other matters related to internal control is prepared by the independent
audit firm, Provider must confirm in writing to The Children's Trust that no such report was submitted to
the Provider. This audit shall be conducted in accordance with auditing standards generally accepted in
the United States of America and standards contained in the Government Auditing Standards issued by
the Comptroller General of the United States.
Providers that are required to have a single audit conducted under OMB Circular A-133, Audit of States,
Local Government and Non-Profit Organizations or the Florida Single Audit Act, Florida Statutes 215.97
agree to submit the schedule of expenditures pertaining to awards, summary schedule of prior audit
findings, applicable auditor's reports and the corrective action plan when the schedule of findings and
questioned costs prepared by the independent auditor discloses audit findings. In the event that the
independent auditor does not disclose audit findings, Provider shall written notification to The Children's
Trust that an audit of Provider was conducted in accordance with applicable laws and regulations and that
the findings and questioned costs disclosed no audit findings related to this Contract; and, that the
summary schedule of prior audit findings did not report on the status of any audit findings relating to
awards that The Children's Trust provided.
Within 180 days of the close of its fiscal year, a Provider who is contracted for a combined total of
$300,000 or more from The Children's Trust, from this or any other The Children's Trust contract(s),
related to the fiscal year under audit, agrees to have aerogram-specific audit relating to The Children's
Trust contract(s) in addition to the annual financial audit of the Provider's entire organization. This
program-specific audit is to encompass an audit of The Children's Trust contract(s) as specified in
Attachment D: Program Specific Audit Requirements.
A Provider that does not meet the program-specific audit threshold requirement of a combined total
contract amount of $300,000 or more from The Children's Trust will be exempt from the program-specific
audit requirement.
Audit extensions may be granted in writing by The Children's Trust, after proper approval has been
obtained from The Children's Trust's Finance Department, upon receipt in writing of such request with
appropriate justification by the Provider.
The financial audit and other financial information will be used in the evaluation of the Provider's
performance and the Provider's overall fiscal health soundness.
3. Access to records
Provider shall provide access to all records including subcontractor(s) which relate to this Contract at its
place of business during regular business hours. Provider agrees to provide such assistance as may be
necessary to facilitate their review or audit by The Children's Trust to insure compliance with applicable
accounting, financial, and programmatic standards. This would include access by The Children's Trust or
its designee, to Provider's independent auditor's working papers for complying with federal, state and
local requirements. The Children's Trust reserves the right to require Provider to submit to an audit by an
auditor of The Children's Trust's choosing at The Children's Trust's expense.
The City of Miami beach Page 8 of 34
Contract #903-109-1, Resolution 2009-90
4. Monitoring
Provider agrees to permit The Children's Trust personnel or contracted agents to perform random
scheduled and/or unscheduled monitorings, reviews, and evaluations of the program which is the subject
of this Contract, including any subcontracts under this Contract, using The Children's Trust approved
monitoring tools. The Children's Trust or contracted agents shall monitor both fiscal/administrative and
programmatic compliance with all the terms and conditions of the Contract. Provider shall permit The
Children's Trust or contracted agents to conduct site visits, client interviews, client assessment surveys,
fiscal/administrative review and other techniques deemed reasonably necessary in The Children's Trust's
sole discretion to fulfill the monitoring function. A report of monitoring findings will be delivered to
Provider and Provider will rectify all deficiencies cited within the period of time specified in the report.
5. Client Records
Pursuant to Florida Statute 119.071(5), The Children's Trust collects the social security numbers of child
participants of funded programs and services for the following purposes: (a) to research, track and
measure the impact of The Children's Trust funded programs and services in an effort to maintain and
improve such programs and services for the future (individual identifying information will not be
disclosed); (b) to identify and match individuals and data within and among various systems and other
agencies for research purposes. The Children's Trust does not collect social security numbers for adult
participants.
Provider shall maintain a separate file for each child/family served. This fife shall include all pertinent
information regarding program enrollment and participation. At a minimum, the file will contain
enrollment information (including parent registration consents and child demographics), service plans,
outcome measures (as set forth in Attachment A), and notes documenting referrals, special needs, or
incident reports. These files shall be subject to the audit and inspection requirements under this Contract,
subject to applicable confidentiality requirements. All such records will be retained by the Provider for not
less than five calendar years after the participant is no longer enrolled. Provider agrees to comply with all
applicable state and federal laws on privacy and confidentiality.
6. Internal Documentation/Records Retention
Provider agrees to maintain and provide for inspection to The Children's Trust, during regular business
hours the following as may be applicable, subject to applicable confidentiality requirements: (1) personnel
files of employees which include hiring records, background screening affidavits, job descriptions, and
evaluation procedures; (2) authorized time sheets, records, and attendance sheets to document the staff
time billed to provide Services pursuant to this Contract; (3) daily activity logs and monthly calendars of
the provision of Services pursuant to this. Contract; (4) training modules; (5) pre and post session
questionnaires; (6) all participant attendance records; (7) participant consent and information release
forms; (8) agency policies and procedures; and (9) such other information related to Service provision as
described in Attachment A; all upon request by The Children's Trust. Provider shall retain all records for
not less than five years beyond the last date that all applicable terms of this Contract have been complied
with and final payment has been received, and appropriate audits have been submitted to and accepted
by the appropriate entity.
7. Confidentiality
Provider and The Children's Trust understand that during the course of performing the Services
hereunder, each party may have access to certain confidential and proprietary information and materials
of the other party in order to further performance of the Services. The Parties shall protect confidential
information and comply with applicable federal and state laws on confidentiality to prevent unauthorized
use, dissemination or publication of confidential information as each party uses to protect its own
confidential information in a like manner. The Parties shall not disclose the confidential information to any
third party (except that such information may be disclosed to such Party's attorneys), or to any employee
of such Party who does not have a need to know such information, which need is related to performance
of a responsibility hereunder. However, this Contract imposes no obligation upon the Parties with respect
to confidential information which (a) was lawfully known to the receiving party before receipt from the
other, (b) is or becomes a matter of public knowledge through no fault of the receiving party, (c) is
rightfully received by the receiving party from a third party without restriction on disclosure, (d) is
independently developed by or for that party, (e) is disclosed under operation of law, (f) is disclosed by
the receiving party with the other party's prior written approval or (g) is subject to Chapter 119 of the
Florida Statutes or is otherwise required to be disclosed by law. The confidentiality provision of this
Contract shall remain in full force and effect after the termination of this Contract.
The City of Miami beach Page 9 of 34
Contract #903-109-1, Resolution 2009-90
8. Security Obligation
Provider shall maintain an appropriate level of data security for the information Provider is collecting or
using in the performance of this Contract. This includes, but is not limited to, approving and tracking all
Provider employees who request system or information access and ensuring that user access has been
removed from all terminated employees of Provider.
9. Withholding of payment
At the sole discretion of The Children's Trust, payment may be withheld for non-compliance of contractual
terms. The Children's Trust will provide payment upon satisfactory compliance of the contractual terms as
solely determined by The Children's Trust.
O. MODIFICATIONS
Any alterations, variations, modifications, extensions or waivers of provisions of this Contract including but not
limited to amount payable and effective term shall only be valid when they have been reduced to writing, duly
approved and signed by both Parties.
P. GOVERNING LAW & VENUE
This Contract shall be interpreted and construed in accordance with and governed by the laws of the State of
Florida without regard to its conflicts of laws provisions. Any controversies or legal problems arising out of the
terms of this Contract and any action involving the enforcement or interpretation of any rights hereunder shall
be submitted to the jurisdiction of the state courts of the Eleventh Judicial Circuit, in and for, Miami-Dade
County, Florida.
Q. EMPLOYEE BACKGROUND SCREENING
In accordance with Sections 943.0542, 984.01, Chapter 435, 402, 39.001, and 1012.465 Florida Statutes, as
applicable, employees, volunteers and subcontracted personnel who work in direct contact with children or
who come into direct contact with children must complete a satisfactory Level 2 background screening. Level
2 Background screenings must be completed through the Florida Department of Law Enforcement (FDLE)
VECHS (Volunteer & Employee Criminal History System) Program. Satisfactory background screening
documentation will be accepted for those agencies that already conduct business with either the Department
of Children and Families (DCF) or the Department of Juvenile Justice (D]J) or the Miami Dade County Public
School System (MDCPS). A clearance letter from MDCPS Office of Employment Standards indicating the
person has successfully completed a Level 2 screening will be accepted. An Attestation of Good Moral
Character must be completed annually for each employee, volunteer, and subcontracted personnel who work
in direct contact with children. The Provider shall re-screen each employee, volunteer and/or subcontractor
every five years. Provider shall keep Attachment E: Affidavit for Level 2 Background Screenings in the
Provider's personnel, volunteers, and/or sub-contractors files.
R. CHILDREN WITH DISABILITIES AND THEIR FAMILIES
Provider understands that The Children's Trust expects Provider to meet the federal standards under the
Americans with Disabilities Act. By policy of The Children's Trust, providers must also implement reasonable
programmatic accommodations to include children with disabilities and their families, whenever possible.
Notwithstanding anything to the contrary, the Provider shall not be required to make any alteration to any
public school building or other building or structure which is not owned by the Provider.
S. REGULATORY COMPLIANCE
1. Non-discrimination and Civil Rights
Provider shall not discriminate against an employee, volunteer, or client of the Provider on the basis of
race, color, gender, pregnancy, marital status, familial status, sexual orientation, religion, ancestry,
national origin, disability, or age, except that programs may target services for specific target groups
as may be defined in the competitive solicitation.
Provider shall demonstrate that it has standards, policies, and practices necessary to render services
in a manner that respects the worth of the individual and protects and preserves the dignity of people
of diverse cultures, classes, races, religions, sexual orientation, and ethnic backgrounds.
The City of Miami beach Page 10 of 34
Contract #903-109-1, Resolution 2009-90
Provider agrees to abide by Chapter 11A of the Code of Miami-Dade County ("County Code"), as
amended, which prohibits discrimination in employment, housing and public accommodations; Title VII
of the Civil Rights Act of 1968, as amended, which prohibits discrimination in employment and public
accommodation; the Age Discrimination Act of 1975, 42 U.S.C. Section 6101, as amended, which
prohibits discrimination in employment because of age; Section 504 of the Rehabilitation Act of 1973,
29 U.S.C. § 794, as amended, which prohibits discrimination on the basis of disability; and the
Americans with Disabilities Act, 42 U.S.C. §12101 et seq., which prohibits discrimination in
employment and public accommodations because of disability.
It is expressly understood that upon receipt of evidence of discrimination under any of these laws, The
Children's Trust shall have the right to terminate all or any portion of this Contract. If Provider or any
owner, subsidiary, or other firm affiliated with or related to Provider, is found by the responsible
enforcement agency or the courts to be in violation of these laws, said violation will be a material
breach of this Contract and The Children's Trust will conduct no further business with Provider.
2. Public Entities Crime Act
Provider will not violate the Public Entities Crimes Act (Section 287.133, Florida Statutes), which
essentially provides that a person or affiliate who is a Provider, consultant or other provider and who
has been placed on the convicted vendor list following a conviction for a Public Entity Crime may not
submit a bid on a contract to provide any goods or services to The Children's Trust, may not submit a
bid on a contract with The Children's Trust for the construction or repair of a public building or public
work, may not submit bids on leases of real property to The Children's Trust, may not be awarded or
perform work as a Provider supplier, sub Provider, or consultant under a contract with The Children's
Trust, and may not transact any business with The Children's Trust in excess of the threshold amount
provided in Section 287.017, Florida Statutes, for category two purchases for a period of thirty-six
(36) months from the date of being placed on the convicted vendor list. Violation of this section shall
result in cancellation of this Contract and recovery of all monies paid hereto, and may result in
debarment from The Children's Trust's competitive procurement activities.
3. Conflict of Interest
Provider represents that the execution of this Contract does not violate Miami Dade County's Conflict
of Interest and Code of Ethics Ordinance, www.miamidade.gov/ethics/library/Ethics-Brochure-
2005.pdf and Florida Statutes §112 as amended, which are incorporated herein by reference as if fully
set forth herein. Provider agrees to abide by and be governed by these conflict of interest provisions
throughout the course of this Contract and in connection with its obligations hereunder.
4. Compliance with Sarbanes-Oxley Act of 2002
Provider shall comply with the following provisions of the Sarbanes-Oxley Act of 2002:
• Provider agrees not to alter, cover up, falsify, or destroy any document that may be relevant
to an official investigation.
• Provider agrees not to punish whistleblowers or retaliate against any employee who reports
suspected cases of fraud or abuse.
5. Licensing
The Provider (and subcontractor, as applicable,) shall obtain and maintain in full force and effect
during the term of this Contract any and all licenses, certifications, approvals, insurances, permits and
accreditations, required by the State of Florida, Miami-Dade County, relevant municipalities, The
Children's Trust or the federal government.. The Provider must be qualified and registered to do
business in the State of Florida both prior to and during the contract term with The Children's Trust.
6. Incident Reporting
Provider shall immediately report knowledge or reasonable suspicion of abuse, neglect, or
abandonment of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide
toll-free telephone number (1-800-96-ABUSE). As required by Chapters 39 and 415, Florida Statutes,
this is binding upon both the Provider and its employees.
Provider shall complete an incident report in the event of any serious bodily injury to anyone within
the scope of this Contract or arising out of the pertormance of this Contract. Provider shall provide
written notification of the incident together with a copy of the incident report to The Children's Trust
within three (3) working days after Provider is informed of such incident. Provider shall provide
written notification to The Children's Trust, within seven (7) days, if any legal action which is filed as a
result of such an injury.
The City of Miami beach Page 11 of 34
Contract #903-109-1, Resolution 2009-90
7. Sexual Harassment
Provider shall complete an incident report in the event a client or employee makes an allegation of
sexual harassment, sexual misconduct or sexual assault by a Provider employee arising out of the
performance of this Contract and the Provider has knowledge thereof. Provider shall provide written
notification to The Children's Trust within three (3) business days after Provider is informed of such an
allegation. Provider shall provide written notification to The Children's Trust, within seven (7) business
days, if any legal action which is filed as a result of such an alleged incident.
8. Proof of Policies
Provider (and subcontractor, as applicable) shall keep on file copies of its policies including but not
limited to confidentiality, incident reporting, sexual harassment, non-discrimination, equal opportunity
and/or affirmative action, Americans with Disabilities Act, and drug-free workplace.
T. CONSENT
Provider must obtain parental/legal guardian consent for all minor participants and/or for adult participants in
the program for services; and to share information with The Children's Trust for monitoring and evaluation
purposes.
Provider will ask participants to sign a voluntary Consent to Photograph form. The form is available in English,
Spanish, and Creole and can be downloaded from www.thechildrenstrust.org. The signed consent form for
photography will be maintained at the program site with a copy filed in the participant's record. The consent
shall be part of the participants' registration form. Any refusal of consent must be properly documented and
signed by the parent or legal guardian on the consent form.
U. PROGRAMMATIC DATA REPORTING
Demographic and service information on program participants will be provided to The Children's Trust as part
of The Children's Trust's research mission. Provider agrees to comply and participate in any data collection
reporting, including participant data as required by The Children's Trust and described in Attachment C to
this contract, Programmatic Data and Reporting Requirements, subject to confidentiality requirements. In
addition, Provider agrees to furnish The Children's Trust with complete and accurate reports in the timeframe
and format to be reasonably specified by The Children's Trust, and as described in Attachment C.
Provider must participate and provide agency (agency profile) and site(s) information to Switchboard of Miami
2-1-1, The Children's Trust 24 hour helpline, as applicable and as defined in Attachment C: Programmatic
Data Reporting Requirements.
V. PUBLICITY
Provider agrees that activities, services and events funded by this Contract shall recognize The Children's
Trust as a funding source. Provider shall ensure that all publicity, public relations, advertisements and signs
within its control recognize The Children's Trust for the support of all contracted activities. The use of the
official Children's Trust logo is permissible.
Provider shall use its best efforts to ensure that all media representatives, when inquiring with the Provider
about the activities funded by this Contract, are informed that The Children's Trust is a funding source.
Provider shall, if it possesses the appropriate technology, provide a link between the website and The
Children's Trust's website.
W. PUBLICATIONS
Provider agrees to supply The Children's Trust, without charge, up to three copies of any publication
developed in connection with implementation of programs addressed by this Contract. Such publications will
state that the program is supported by The Children's Trust. Provider agrees that The Children's Trust will
have use of copyrighted materials developed under this Contract to the extent provided in, and subject to, the
provisions of Paragraphs G and H above.
To the extent permitted by the applicable journal or other publication source, Provider shall include The
Children's Trust logo and the following paragraph in all materials featuring programs funded by The Children's
Trust, including but not limited to newsletters, press releases, brochures, fliers, homepage of websites or any
other materials for dissemination to the media or general public:
The City of Miami beach Page 12 of 34
Contract #903-109-1, Resolution 2009-90
English:
The City of Miami Beach -Success University is funded by The Children's Trust. The
Children's Trust is a dedicated source of revenue established by voter referendum to
improve the lives of children and families in Miami-Dade County.
Spanish:
The City of Miami Beach -Success University esta financiado por EI Fidecomiso de los Ninos
(The Children's Trust). EI Fidecomiso de los Ninos es una fuente de financiacion, establecida
por referendum para mejorar las vidas de Winos y familias en el Condado de Miami-Dade.
Kreyol:
The City of Miami Beach -Success University finanse pa "The Children's Trust". Trust la, se
yon sous lajan ke gouvenman amerikin vote an referandom you ke' li investi byen Wan
pwogram kap ameliore la Vi Ti Moun ak fanmi yo Wan Myami Dade.
Note: In cases where funding by The Children's Trust represents only a percentage of the Provider's overall
funding, the above language can be altered to read "The (organization) is funded in part by The Children's
Trust..."
X. HEADINGS, USE OF SINGULAR AND GENDER
Paragraph headings are for convenience only and are not intended to expand or restrict the scope or
substance of the provisions of this Contract. Wherever used herein, the singular shall include the plural and
plural shall include the singular, and pronouns shall be read as masculine, feminine or neuter as the context
requires.
THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK
The City of Miami beach Page 13 of 34
Contract #903-109-1, Resolution 2009-90
Y. TOTALITY OF CONTRACT/SEVERABILITY OF PROVISIONS
This Contract with its attachments as referenced below contains all the terms and conditions agreed upon by
the parties:
Attachment A: Scope of Services
Attachment B: Fiscal Requirements, Budget and Method of Payment
Attachment C: Programmatic Data and Reporting Requirements
Attachment D: Program Specific Audit Requirements
Attachment E: Affidavit for Level 2 Background Screenings
Attachment F: Pertormance Improvement Plan, if applicable
No other contract, oral or otherwise, regarding the subject matter of this Contract shall be deemed to exist or
bind any of the parties hereto. If any provision of this Contract is held invalid or void, the remainder of this
Contract shall not be affected thereby if such remainder would then continue to conform to the terms and
requirements of applicable law.
The City of Miami Beach
MIAMI-DADE COUNTY, FLORIDA
By:
ign tur of A orized esent
j~ -
( Type or Print Name)
The Children's Trust
MIAMI-DADE CO TY LORIDA
by:
( S gn ur
Modesto E. Abety
l'r`-t ry`r`~~)t4-GLC
(Type or Print Title)
Date: ~ ~( ~ `~ `~
President and CEO
Date:
Approved as to form and legal sufficiency
~/~
County Attorney v
Date: ~d~ o~'q
7 ,
This contract is not valid until signed by both parties
THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK
APPROVED AS TO
FORM & LANGUAGE
t~ FOR EXECUTION
~ ti`10~
t Attorne Date
The City of Miami beach Page 14 of 34
Contract #903-109-1, Resolution 2009-90
ATTACHMENT A:
Scope of Services
The City of Miami beach Page 15 of 34
Contract #903-109-1, Resolution 2009-90
Attachment A
Scope of Services
Contract No. 903-109-1
Agency name: City of Miami Beach
Program name: Success University
1. Program Summary (Limit to 100 words):
Success University is an integrated service program that partners with community agencies to provide Miami
Beach youth at risk for truancy with personal and academic supports, while providing their families with
holistic, comprehensive services to ensure family stability and youth success. Success University utilizes the
principles of the 7 Habits of Highly Successfully People to create an operating platform that seeks to prepare
youth and families for personal success, positive cohesion and economic betterment. Service components
include: tutoring, family assessments, care plan coordination, Family Group Conferencing, and referrals to
community-based services. Success University will have ongoing interaction and efforts toward service
coordination with Eleventh Judicial Circuit Court (Truancy Court). Success University and the Youth
Empowerment Network will collaborate wherever possible to maximize existing capacity and resources.
2. Target Population (Include numbers in table and a narrative description of participant
characteristics, including ages, geography, disabilities, etc.):
Total number of unduplicated Total number- of participants
.participants .expected to receive expected to receive TYpe 2
intensive T_ype 1 services services (less than 3 intended
Po ulation _ '3+ intended contacts coritact~
Children/Youth
100 500
Parents/Primary Caregivers
100 500
Other populations
(e.g., staff professionals, general
ublic 0 120
- Children/Youth** -Participants attend Miami Beach Senior High School. Participants are aged
13 to 18 and predominantly have indicators showing them to be at-risk as demonstrated by school
absences, family stability, and economic/social attachment to community. Students are referred to
the program when reported school absences indicate they have missed 3 unexcused school days.
- Parents/Primary Caregivers** -Represent the parents and/or caregivers for the targeted
children/youth. These adults serve as head of household and/or live within the participants' home.
- Other Populations -Participants are encouraged to include friends, extended family, teachers
and others in addition to their family members when engaging in the Family Group Conferencing.
Services will be provided to everyone that resides in the home with the youth clients.
**There is the possibility that some youth and parents at Biscayne Elementary serviced under The
City of Miami Beach Youth Empowerment Network, will be referred for those unique supp/emental
services via Success University).
3. Program Schedule (Limit 50 words):
Success University provides after-school and evening programming beginning August 1, 2009 and continues
until July 31, 2010. Services will be provided after-school at Miami Beach Senior High School, evenings at
Biscayne Elementary and Miami Beach City Hall and evenings and weekends in the participants' homes.
4. Service Locations:
Provider Name Site Name Address ~ .City State ZIP Code.
Chokes Et AI, City Biscayne Elementary .800 - 77th Street Miami Beach Florida 33141
The City of Miami beach Page 16 of 34
Contract #903-109-1, Resolution 2009-90
of Miami Beach,
Teen Job Corps &
Unidad of Miami
Beach
City of Miami Miami Beach Senior 2231 Prairie Avenue Miami Beach Florida 33139
Beach, Teen Job High School
Cor s
City of Miami Miami Beach 1901 Convention Miami Beach Florida 33139
Beach Convention Center Center Drive
City of Miami Miami Beach 2100 Convention Miami Beach Florida 33139
Beach Botanical Gardens Center Drive
City of Miami Miami Beach City 1700 Convention Miami Beach Florida 33139
Beach Hall Center Drive
Unidad of Miami Miami Beach Career 833 6th St. Miami Beach Florida 33139
Beach Center
5. Service Delivery:
TYPE 1 ACTIVITIES (3 or more contacts with participants)
Activities/Service Name &
:Description (Include
frequency, length & duration
of sessions, as well as the
°inumber of Cycles expected to
be offered)' Provider Name
-
- Total #
unduplicated
participants to
be served
(specify if
children/youth,
..parents or
~- others Minimum #
participants
to be
erved
(guideline
is no less
than 85%
of totai Expected
Dosage:
Minimum # of
sessions a
participant will
complete
----- -
FCAT Preparation & General --
-
Studies Tutoring -Services will
be offered by Reading and Math
instructors after school, 2 hrs per
day, for 115 days prior FCAT.
Preference will be given to youth Contracted
participating in the Success Instructors 20 out of 115
University program. However, Supervised by the 100 youth 85 youth
other youth will be allowed to City of Miami sessions
participate. Attendance will be Beach
tracked for all youth
attending, but outcomes will
be documented solely for
those Success University
students.
Employment Services -
Services will be provided on an
ad hoc basis contingent upon
needs identified through care
plans and will be provided to .
youth whose legal status are
pending and would not be able to
be employed otherwise. Success
Teen Job Corps
25 youth
22 youth 40 out of 45
University will assist the students sessions
in obtaining Individual Taxpayer
Identification Numbers. Partner
Provider will supervise them at all
times and employ them for
activities such as beach clean-up,
waterwa restoration and
The City of Miami beach Page 17 of 34
Contract #903-109-1, Resolution 2009-90
assistance at local festivals.
Employment Services -
Services will be provided on an
ad hoc basis contingent upon
needs identified through care
plans and will be provided to
youth who are eligible for
employment. Students will meet
one on one with Job Developers,
who will provide: skills
and education assessments and
assistance with resume and cover Unidad of Miami
50 youth 43 youth 3 out of 3
letter preparation; appropriate Beach sessions
referrals to open positions of
employment in the following
stages: three (3) at initial client
meeting; two additional at first
follow-up meeting; two additional
at second follow-up meeting; and
job placement. Clients are
considered placed upon provision
of their first a check.
Care Coordination -Services
will be provided on an ad hoc
basis contingent upon needs
identified through care plans. South Florida
These various services, typically Center for Family
gap services for which no Counseling,
available, free remedy is found, Ayuda, Inc.,
will be sought by community- Unidad of Miami
based agencies within the
Partnership as well as the Beach &
Community 100 youth, 85 youth, 3 out of 3
community-at-large. If three or
Involvement 100 parents 85 parents sessions
more gap services are found, Specialist
Care Coordination will exist as a Supervised by the
Type 1 activity. If substantive City of Miami
changes are experienced by the Beach, among
youth and/or family after a care others
plan is established, a revised care
plan will be created to reflect
emer in needs.
TYPE 2 ACTIVITIES (less than 3 contacts with participants)
Activities/Service'Name &
Description
(Include'frequency,`length'&
duration of `sessions Provider Name Total # participants to
be served (specify if
children/youth,
parents or others) Total # of sessions
to be offered by
provider-across
cycles and sites
School/Parent/Provider
Meetings -These provide the City of Miami
initial contact for services and Beach & 700
attendance expectations. Prior to Community 500 youth, 500 (some clients may
meetings, youth/parents will Involvement parents experience 2
receive a letter requesting their Specialists meetings)
presence at a school meeting (contracted)
u on 3 unexcused absences. At
The City of Miami beach Page 18 of 34
Contract #903-109-1, Resolution 2009-90
this meeting, school and program
staff review with the child and
parent that the program goal is to
make sure that the youth attends
school regularly. If a parent is
unable or unwilling to attend the
school meeting, program staff will
visit the home to ensure that
initial consents are received for
subsequent program services that
are requested or required. If
deemed appropriate, ahome-
based assessment is then
scheduled. Subsequent school
meetings will be requested if a
youth experiences an additional 3
or more unexcused absences.
~
Assessments -Clients will
complete ahome-based
assessment to determine service
needs and natural assets. The
assessment will lead to the South Florida
creation of a care plan for those Center for Family 500 youth, 500
with 3 or more service needs as Counseling, Unidad parents 500
well as serve as the initial of Miami Beach,
engagement and planning session Ayuda, Inc.
for the subsequent Family Group
Conferencing session, if
applicable.
Family Conferencing (1 session
p/ client x 2 hours) -Family
Conferencing engages youth,
parents, siblings, friends,
teachers and others to identify
and qualify ways in which they
could support the youth's
personal goals including regular
school attendance. This process
has been successfully used by the
state's juvenile judicial system to
reduce recidivism and promote Choices Et AI, Inc., 400 youth, 400
positive behaviors. During the &Unidad of Miami parents & 120 other 400
conferences, priorities and values Beach family members
are defined and roles are ascribed
to attendees to ensure
achievement or support of
identified goals and values. The
resulting contract establishes the
framework upon which the youth
is expected to achieve required ',
school attendance as well as
address any other influencing
concerns.
The City of Miami beach Page 19 of 34
Contract #903-109-1, Resolution 2009-90
Care Coordination -Services
will be provided on an ad hoc
basis contingent upon needs
identified through care plans.
These various services, typically South Florida
gap services for which no Center for Family
available, free remedy is found
~ Counseling, Ayuda,
will be sought by community- Inc., Unidad of
based agencies within the Miami Beach &
Partnership as well as the Community 300 youth, 300 300
community-at-large. If less than Involvement parents
three gap services are found, Care Specialist
Coordination will exist as a Type 2 Supervised by the
activity. If substantive changes City of Miami
are experienced by the youth Beach, among
and/or family after a care plan is others
established, a revised care plan
will be created to reflect emerging
needs.
6. Performance Measure:
Provider shall measure outcome achievement and report on a basis as outlined in Attachment C of
this contract.
Service Provision Outcomes:
Outcomes
Outcome Indicators
Measurement Timing (when will
tools be
Associated "Activities
Tool
administered (from Service Delivery)*
Increase 75% of youth will ISIS School Prior school year School Meetings;
school experience a reduction Attendance (benchmark); Family Group
attendance in school absences Report Every 9 weeks; Conferencing
compared to prior (M-DCPS) End of school
school ear ear
Increase 65% of targeted ISIS Grade Prior school year Family Group
academic students will improve Report (benchmark); Conferencing; FCAT
achievement their cumulative grade (M-DCPS) Every 9 weeks; Preparation
point average. End of school
ear
Decrease 75% of youth will ISIS School Prior school year School Meetings;
disciplinary experience a reduction Disciplinary (benchmark); Family Group
referrals in disciplinary referrals Reports (M- Every 9 weeks; Conferencing
compared to prior DCPS) End of school
school ear ear
Partnership Outcomes:
Outcomes Outcome Indicators Measurement
Tool Timing (when will
tools, be
administered .Associated Activities
(from Service Delivery)*
Improved 100% of • Executed Upon execution • Intake & Assessment
systems of care Partnership MOUs of contracts
within City of members will have ^ Family Team
Miami Beach an executed Conferencing
Memoranda of ^ Adopted • Revised
Understanding Policies & December 2008 • 7 Habits of Highly
Procedures & Effective Families
The City of Miami beach Page 20 of 34
Contract #903-109-1, Resolution 2009-90
• A Governance Governance
Structure is Structure ^ Monthly ^ Care Coordination
established Governance
^ Governance Board meetings
Board meeting
• The Partnership will attendance
meet regularly to sheets
address collective ^ Monthly (using
concerns via its monthly
Governing Board ^ Partnership progress reports)
meetings Performance
Ratings
^ 100% of Partners (measuring
will receive a service levels,
Partnership partnership
Performance Rating participation,
of 80% or greater at etc.)
least 3 of 4 quarters
of o eratin ear
7. Staff Qualifications:
Provider represents that all persons delivering the Services required by this Contract have the
knowledge and skills, either by training, experience, education, or a combination thereof, to
adequately and competently perform the duties, obligations, and Services set forth in the Scope of
Services (Attachment A) and to provide and perform such Services to The Trust's satisfaction.
#!& 'Position Qualifications: Required, Duties
Status (specify staff, Education' &'Experience
FT/PT volunteer or
sub-contractor)
1 - FT Program Bachelor's or greater in Public Day-to-day program
Coordinator Administration or other related field supervision, contractor
and at least one year community supervision, and program
involvement experience. report preparation.
1 - FT Division Director Graduation from an accredited Oversee Service Partnership
college or university with a Bachelor's operations, preparation of
or Master's Degree with major course Service Partership reports,
work in public or business and supervision of Program
administration, social services or Coordinator
other related field. Experience can
substitute for education on a year-
for-year basis.
1 - PT Transportation Graduation with an Associate's Transportation of clients to
& Support I degree or equivalent in college Family Group Conferences,
credits with major course work in ordering and delivery of meals
Social Work, Business, Criminal for these events, supervision
Justice, Sociology or Psychology, with of attendees of these events
some experience working in social who are under the age of 5.
service,
youth program or related field
(Experience may substitute for
education on a year for year basis);
Valid driver's license.
The City of Miami beach Page 21 of 34
Contract #903-109-1, Resolution 2009-90
1 - PT Transportation Bachelor's Degree in Education, with Transportation of clients to
& Support II course work in Special Education, and Family Group Conferences,
some experience in teaching the ordering and delivery of meals
mentally and/or emotionally for these events, supervision
handicapped OR Associate Degree in of attendees of these events
a related field and experience in who are under the age of 5.
training or teaching the mentally
and/or emotionally handicapped OR
considerable related experience.
Experience must include
employability skills training and job
placement activities; experience can
substitute for education on a year-
for-year basis. Possession of a valid,
appropriate driver's license and an
acceptable driving record
8. Best practices
Provider shall perform its duties, obligations, and services under this Contract in a skillful and
respectful manner. The quality of Provider's performance and all interim and final product(s)
provided to or on behalf of The Trust shall be comparable to local, state and national best practice
standards.
Activit Name - -
'Related :Best Practice Model ''
Famil Trainin 7 Habits of Hi hl Effective Families
Youth Trainin 7 Habits of Hi hl Effective Teens
Famil Em owerment/Su ort Famil Team Conferencin
Care Coordination Western New York Model
The City of Miami beach Page 22 of 34
Contract #903-109-1, Resolution 2009-90
ATTACHMENT B
Fiscal Requirements, Budget
and Method of Payment
The City of Miami beach Page 23 of 34
Contract #903-109-1, Resolution 2009-90
ATTACHMENT B
FISCAL REQUIREMENTS, BUDGET and METHOD OF PAYMENT
Advance pavment reauests
The Children's Trust offers advance payments up to 15% of the total contract amount. Advance requests shall
be limited to governmental entities and not-for-profit corporations, in accordance with subsection 216.181
(16) (b), F.S. The advance request is to include the amount requested and the justification. Advance payment
requests must be submitted using the designated form and must be approved in writing by The Children's
Trust's Contract Manager and Chief Financial Officer or their designee(s).
Advanced funds if not used shall be invested by the Provider in an insured interest bearing account, in
accordance with subsection 216.181 (16) (b), F.S. Interest earned on advanced funds shall be returned to
The Children's Trust on a quarterly basis or applied against the amount of the contract owed by The Children's
Trust.
Advance pavment
Within 60 calendar days of receipt of an advance, Provider shall report the actual expenditures paid by or
charged to the advanced funds using the reporting "invoice" form provided by The Children's Trust. If the
invoice' amount is less than the amount advanced, The Children's Trust will deduct the difference from the
next a licable month)
pp y payment request. Provider may request, in writing, an extension of the repayment of
the advance. A fiscal need must be clearly demonstrated and substantiated by the Provider in order for an
extension request to be considered by The Children's Trust.
Budget revisions
Budget revision(s) require prior written approval from the Contract Manager and The Children's Trust's Chief
Financial Officer or their designee(s). Request for budget revisions must be submitted to the Contract
Manager using the appropriate form as determined by The Children's Trust. The Provider must request a
budget revision to add, delete, and/or modify any line item(s). Budget revisions can not be used to modify the
total contracted amount nor can they be used to modify the Scope of Services. No more than two (2) budget
revisions may be approved during the contract term. Budget revision requests must be submitted sixty (60)
days prior to the expiration of the Contract. Budget revisions will be incorporated into the Contract.
Indirect Administrative Costs
In no event shall The Children's Trust fund indirect administrative costs in excess of ten (10%) percent of the
total contract amount.
Cost Reimbursement Method of Payment
The parties agree that this is a cost reimbursement method of payment contract; the Provider shall be paid in
accordance with the approved budget and/or approved budget revision as set forth in this Attachment.
Invoice Requirements
The Provider shall submit an original request for payment, in the format prescribed by The Children's Trust
and in accordance with the approved budget or approved budget revision(s). The request for payment is due
on or before the fifteenth (15th) day of the month following the month in which expenditures were incurred
(exclusive of legal holidays or weekends). The Children's Trust agrees to reimburse Provider on a monthly
billing basis. The Children's Trust reserves the right to request any supporting documentation. A final request
for payment (last monthly invoice of the contract term) from the Provider will be accepted by The Children's
Trust up to forty-five (45) days after the expiration of this Contract. If Provider fails to comply, all rights to
payment shall be forfeited.
If The Children's Trust determines that Provider has been paid funds. not in accordance with this Contract, and
to which it is not entitled, Provider shall return such funds to The Children's Trust or submit appropriate
The City of Miami beach Page 24 of 34
Contract #903-109-1, Resolution 2009-90
documentation to support the payment. The Children's Trust shall have the sole discretion in determining if
Provider is entitled to such funds in accordance with this Contract and The Children's Trust's decision on this
matter shall be binding.
In the event that Provider, its independent auditor, or The Children's Trust discovers that an overpayment has
been made, Provider shall repay said overpayment within thirty (30) calendar days without prior notification
from The Children's Trust.
If the Provider fails to serve the number of participants and/or fails to utilize the funds in accordance with the
Contract, The Children's Trust may amend the Contract to reduce the amount of dollars. Any delay in
amendment by The Children's Trust is not deemed a waiver of The Children's Trust's right to amend or seek
reimbursement for under-serving participants in accordance with the Contract.
In order for a request for payment to be deemed proper as defined by the Florida Prompt Payment Act, all
requests for payment must comply with the requirements set forth in this Contract and must be submitted on
the forms as prescribed by The Children's Trust. Requests for payment and/or documentation returned to
Provider for corrections may be cause for delay in receipt of payment. Late submission may result in delay in
receipt of payment. The Children's Trust shall pay Provider within thirty (30) calendar days of receipt of
Provider's properly submitted Request for Payment and/or other required documentation.
The Children's Trust shall retain any payments due until all required reports or deliverables are submitted and
accepted by The Children's Trust.
Supporting Documentation Requirements
The Provider shall maintain original records documenting actual expenditures and services provided according
to the approved budget and scope of services as required.
Provider shall keep accurate and complete records of any fees collected, reimbursement, or compensation of
any kind received from any client or other third party, for any Service covered by this Contract, and shall
make all such records available to The Children's Trust upon request. Provider shall maintain a cost allocation
methodology that it uses to allocate its costs. Such methodology shall be made available to The Children's
Trust upon request.
The City of Miami beach Page 25 of 34
Contract #903-109-1, Resolution 2009-90
GENERAL INFORMATION
Organization Name
Agency Fiscal Year:
Program Titie:
AGENCY BUDGET
C~_of Miami Beach
Areas in Blue to be completed by the Agency
October 1 -September 30 (for example Jury 1 to June 30)
Success University Care_Coordination Pr~ram
Name of Source/
Agency Source of Funding Department of Matching
Program Budget
Agency Budget % of
A
Funds for the Program gency
Bud et Budget
Trust Amount Requested _ _ ____ _ $400,000.00 400,000.00 37.6%
Trust Other Funding _ _ ___ 205,520.54 19.3%
Miami-Dade Count Grants Local
_ 0 0%
Federal Grants ___ _
0 0%
State Grant
Foundations/Charitable Funds _ __ _-_ 16,156.00 1.5%
Cash/Fees/Other Revenue
_ _- 0.0%
- Cash
0.0%
- Pro ram Fees 0.0%
- CDS Subsidies for School-Aged children 0.0%
-Other
0.0%
In-Kind Contributions 90,722.25 0.0%
General Funds (Property Tax Revenue 441,561.00 41.5%
_-- -- - 0.0%
-
0.0%
Total Bud et 490 722.25 1 063 237.54 100.0°/a
26
Attachment B, Contract #903-109-1, Resolution #2009-90 Rev 6109
Enter Agency's Name
Program Budget
~onuacc
Period:
py~gu~r t X009 -lulu 31 2010
12
months
Areas in Blue to be completed by the Agency
PROGRAM BUDGET Success UNv. Success Univ.
Requested Funding Matching Funds Justification
SALARIES: % Amount % Amount
List Full-Time Employees
Annual
S
l
a
ary
P i i n 12 m h
~
Program Coordinator 44,417.62 100%
44,417.62 0°~', 0.00;$44,417.62 x 100% FTE for day-to-day program supervision, '~
' ', :contractor supervision and program report preparations. The
' Isalary is established by the City's wage studies and is
' commensurate with the City payscale for this job classification;
',[his will be paid on a bi-weekly basis. $1708.37 per pay period x ',
,26 pay periods (bi-weekly) =;44,417.62
----- --
Division Director 123,990.90
0% 0.00 2U%
.12,3990.90 x 20 /o for Service Partnershi o erations, preparation
24,798.18' ° p p
lof Service Partership reports, and supervision of Program
--
-- i '
--~ -_.. .._- . _r--- _ _.tCslxrdinator = 524.798.18
__.--- ---- '
__ 0.00 0.00' I
-- _ ~ _ ___ __ __
0.00
-- 0.00'1
-
~- ---- ---0.00 0.00! j
0.00 i 0.00
Full-Time Total
1.00 44,417. --- ----
24,798.18
List Part -Time/Seasonal Em to ees
P y
- ------- -- ----- ---- -
--
-
Jose Elvis Nunez/ Transportation & ~ _ -- ---
3,083.00 ~
- - --
0.00 Transportation of clients to Family Group Conferences as well as
~
Support I ordering and delivery of meals for these events. This will be paid
i,
I j
~
- jon a bi-weekly basis as services are rendered - 100 hours x
143n.A3 n/hnnr = S3.os3.
Maria Carmela Chiovaro/ Transportation 3,322.18 ' ITransportation of clients to Family Group Conferences as well as
0.00
& Support tl 1
' !ordering and delivery of meals for these events. This will be paid ;
'
' II
----_J
-l - -- ion a bi-weekly basis as services are rendered - 86 hours x $38.63
___!n/hour = 53.322.18.
-
0.00' 0.00
0.00, , 0.00!
_ --I
~ 0.00 i * --
I --- ----t
0.00 !
o.oo; ~ o.oo
o.oo
- ___
!~
o.oo'
--- o.o ~ o.oo ~ i
o.oo~
- -
' 1 0.00
--- ---
-
! o.oo ~ I o.oo' ;
Part-Time Total 0.00 6,405.18 0.00 0.00
TOTAL FTEslSALARIFS 1.00 ;50822.80 .20 ;24,798.18
FRINGE BENEFITS _ _____
Fica/Mica Ra[e: 7.65 % ~
3,887.94;
~ 3,016.52, Inc. Matching funds for 20% of Division Director's salary
W-Comp's Ra[e: 3.00% I ____
~
1,524.68 ---
- - ---------1
743.95,
Inc. Matching funds for 20% of Division Director's salary
Unempioy Rate: ' i 0.00. 0.00
Retirement Rate: 8.00% _! 4,065._82_:
- - _ _ 1 98.3.85 Inc. Matching funds for 20% of Division Director's salary
Other Specify & provide calculations r
L_
Health tns. Cost per Staff ;$282.86 3,394.321 1,099.75 Health Insurance contribution to Program Coordinator is $282.86 ~
~ i i per month. Grant funds are being requested for Program
Cooridnator position only. The City provides the health insurance
contribution for the remaining employees at the following match
bates: Transportation & Support I, City pays $282.86 per month /
160 working hours = $1.768 per hour x 100 hours of work within
I this scope =;176.80, Transportation & Support II, City pays i
: ~ ' $336.98 per month / 160 working hours = $2.106 per hour x 66 j
j ~ i hours of work within this scope =;181.12 Division Director, City ;
', pays $142.66 per pay period x 26 pay periods = $3,709.16
~ ~,
~ ~
i i annually x 20% leveraged =;741.83 =;1,099.75
!
Life Ins. Rate: !
r ~
I ! !
I Rate:
I ~ ~ ~ I '.
TOTAL FRINGE BENEFITS ;12,872.76 ;6,844.07 TCT Fringe is 25.3287107361263% of TCT Requested Salarie
OPERATING EXPENSES: Cost
Travel (other than participants) ~I i
Travel (participants) I S,SOO.OO
it
i
Meals (participants) i 5,676.00!!
i
i
(rent of a building) '.
s (e.g. telephone, janitorial services)
Transit cards to enable after-school participation for tutoring and
other services. Purchase of 200 Easy Cards for youth clients @ $2 !
i each = $400 + purchase of fares (200 youth clients at an average
of 27 uses each x;1 per fare) =;5,800 ~
i
Full meals are provided for Family Group Conferencing and any !
iother actwlty that is directly related to the program and takes I
place during dinner time. (400 Family Group Conferencing II
sessions x 3 participants each x $4.73 per person for the cost of ~..
jone dinner meal for each participant as per Trust guidelines and
federal reimbursement rates) _ $5676.00
59,080.OO~Use of office space m City Hali for Program Coordinator, 9" x il"
~. = 99 Sq. Ft. x $35 per Sq. Ft. as per July City Commission
meeting = $3,465 per month x 12 months = ;41,580.00 + Use
of Miami Beach Botanical Garden Center for Family Group
!Conferences in zip code 33139 at $350 per use x 50 uses (2
!families per use) = 517,500 = 59,080.00
27
Attachment B, Contract #903-109-7, Resolution #2009-90 Rev 6/09
Enter Agency's Name
Supplies -office (e.g. paper, printing, postage) I 1,887.24
Supplies -program (e.q. curricula, books, standardized
Educational Software
i
Non Capital Equipment (less than;1,000) (List each) 10,000.00
I
Capital Equipment (greater than;1,000) (List each)
Professional Services (List each)
Ayuda, Inc.
i 21,000.00
Choices Et AI, Inc,
i
I 43,750.00
South Florida Center for Family Counseling
' 35,000.00
Unidad of Miami Beach
i
i
I
Teen lob Corps 49,OOD.OO
i
I
5,333.20
I FCAT/Afterschool Tutoring 14,858.00
Community Involvement Specialists
i
I
~ -- -- 28,000.00
I
~
Program ttuaget
Flip charts for use in Family Group Conferencing sessions ($5 x
200 [1 for every 2 familles served]) _ $1,000 + Markers, pens,
copier paper, toner, etc. _ $887.24; =;1887.24
Acquisition, training and Implementation of Community OS for use
by all Partner agencies to enable case management via web
access. Software enables case progress review, case note
collection and intra-partner client consultations. First year cost
with training for ail staff Is expected not to exceed $10,000 and
will cost up to $3,000 in subsequent years. See attachment for ~
Community OS proposal as well as that of other software
companies which were considered ~
Provision of Initial home visits and completion of intake
documents. All partners providing this service are reimbursed at
the standard unit cost of $140 per family. This rate includes
consideration for: 90 minutes for conducting the intake
appointment Including completion of assessment forms; 30 ~
minutes for transportation to and from client home; and 30
minutes for office follow up Including distribution of referrals fora
total of approximately two and a half hours per intake. (150 x
$140 each) =;21,000
Provision of Family Group Conferencing facifltation and completed
family contracts. All partners providing this service are reimbursed ~
at the standard unit cost of;175 per family. This rate includes
consideration for: 3 hours spent wnducting the Family Group
Conference; 30 minutes for transportation to and from service
site; and 1 hour for office follow up and the development of family
contracts. (250 familles/sessions x $175 each) =;43,750
Provision of initial home visits and completion of intake
documents. All partners providing this service are reimbursed at
the standard unit cost of $140 per family. This rate includes
consideration for: 90 minutes for conducting the Intake
appointment including completion of assessment forms; 30
minutes for transportation to and from client home; and 30
minutes for office follow up including distribution of referrals, for a
total of approximately two and a half hours per Intake, (250 x
$140 each) =;35,000
Provision of initial home visits and completion of intake
documents. All partners providing this service are reimbursed at
the standard unit cost of $140 per family. This rate includes
consideration for: 90 minutes for conducting the Intake
appointment including completion of assessment forms; 30
minutes for transportation to and from client home; and 30
minutes for office follow up including distribution of referrals, for a
total of approximately two and a half hours per intake. (100 x
$140 each) =;14,000; + Provision of Family Group Conferencing
fadlitation and completed family contracts. All partners providing
this service are reimbursed at the standard unit cost of $175 per
family. This rate Includes consideration for: 3 hours spent ~
i
conducting the Family Group Conference; 30 minutes for
transportation to and from service site; and 1 hour for office
follow up and the development of family contracts. (150
familles/sessions x;175 each) =;26,250; + Provision of Job
Placement services for up to 50 eligible youth clients. (50 youth
clients x$175 each) =;8,750 =;49,000
Supervision and wages for 25 youth clients whose legal status is
pending and would not be able to be employed otherwise.
([Florida minimum wage + worker's comp + FICA =hourly rate]
$9.7928 per hour x 90 hours x 25 youth) =;22033.80 +
(Hourly cost for one supervisor at $24.44 x 135 hours) _
__ ;3299.40 =;25,333.20
FCAT preparation and general studies tutoring by certified
Instructors, which takes place at Miami Beach Senior High School.
($32.30 p/hour x 2 teachers x 2 hours p/day x 115 days) _
2 contracted Community Involvement Specialists (employed part-
time by Miami-Dade County Public Schools, one who works In AM
and one in PM) to serve as school representatives at all
designated client/famlly encounters. CIS will be based at the
school but will also be responsible for conducting home visits ',
when parents fail to attend scheduled school meetings. CIS will
also track dally client attendance and provide tracking data. They
will be paid on a bi-weekly basis as services are rendered. (7UU
meetings [500 targeted youth and 200 follow-up meetings] x;40
each) _ #28,000.
28
Attachment B, Contract #903-109-1, Resolution #2008-90 Rev 6/09
Enter Agency's Name
Other (List each) __ _
~~. Emergency Assistance
One-time Expenditure (List each)_
91,500.00'
i
I
i
TOTAL OPERATING EXPENSES: ;331,804.44
Administrative/Indirect Costs (Can
not exceed 30%) _...
Program-speclfic Audlt 1%, 4,500.00
TOTAL BUDGET ;400,000.00
TOTAL PROGRAM COST (REQUESTED FUNDING AND MATCH) must agree with Total
Program Budget on Agency Budget worksheet
Program Budget
,Emergency assistance based on service partnership assessment,
jand approval granted by the partnerships director, governance
Icommlttee, and Children's Trust staff. Assistance is limited to a
None-time allotment of $150 total per a participant. 400 youth
iclients + 210 parent guardian clients = 610 clients x 150 per
lclient =;91,500.
r ---- --- -- -l'.
1 . - -- --~- - - ---- -- -- -- ---!
Program-specific audit to be completed by independent
1;4,500 _. ______ ____
;90,722.25
$490,722.25
29
Attachment 8, Contract #903-109-1, Resolution #2009-90 Rev 6109
ATTACHMENT C
Programmatic Data and Reporting
Requirements
The City of Miami beach Page 30 of 34
Contract #903-109-1, Resolution 2009-90
ATTACHMENT C
Service Partnership
Programmatic Data and Reporting Requirements
Contract No. 903-109-1
Agency name: The City of Miami Beach
Program name: Success University
The Provider shall submit to The Children's Trust individual participant demographics, attendance, additional
output information, and outcome data, as noted in the Scope of Service (Attachment A). Reporting will include
direct submission of information into the electronic web-based reporting application (Data Tracker), as wel- as
standard paper reports, as noted below.
DEMOGRAPHICS ATTENDANCE & OTHER OUTPUTS (electronic reporting in Data Tracker; requires attendance
at training and user login)
Activities with 3 or more contacts with the same participant will enter:
Participant Demographics (including all the items noted below), shall be entered within seven (7) days
of entry into the program. All participant demographics shall be updated on an ongoing basis if and
when new information is collected.
Participant Attendance shall be entered by the fifteenth (15th) day of the month following the end of
each month, exclusive of legal holidays or weekends.
Activities with less than 3 contacts per participant:
Dates, number served, and locations (address and zip code) for each service activity delivered.
• Monthly updates on the status or percent achieved toward other products or materials noted in the
Scope of Service.
Demographics required for CHILD/YOUTH participants with 3 or more contacts:
Is participant a parent, child, or other?
Participant's Name (last, first, middle initial)
• Parent's Name (last, first, middle initial)
• Street Address, City, and Zip Code
• Gender (male, female)
• Date of Birth
• Race (American Indian/Alaska Native, Asian, Black/African American, Pacific Islander, White, Other)
Ethnicity (Hispanic, Haitian, Other)
• English Proficiency (yes/no)
Additional/Other language(s) spoken (English, Spanish, Haitian Creole, Other)
• Child's Social Security #
• Child's Miami-Dade County Public Schools ID Number
• Current Grade Level
Current School
Does child have a Health Insurance? (yes/no)
• Does child have a Disability? (yes/no)
Documentation of Disability (Individualized Family Service Plan, Individualized Education Plan, Section
504 Plan, Medical diagnosis, Other)
• If Disabled, what type? [Autism Spectrum Disorders, Chronic Medical Condition, Developmental Delay,
Emotional and/or Behavioral Disorder, Hearing Impairment (or deaf), Intellectual Disability (or mental
retardation), Learning Disability, Physical Disability, Speech/Language Impairment, Visual Impairment
(or blind), Other]
Is participant involved with the Dependency System (e.g., DCF, Our Kids, full case management
agencies, dependency and family courts) or Delinquency System (e.g., DJJ, Juvenile Services
Department, diversion/Civil Citation programs)] (Optional Field)
The City of Miami beach Page 31 of 34
Contract #903-109-1, Resolution 2009-90
Demoaraohics required for PARENT/CAREGIVER and OTHER.participants with 3 or more contacts:
• Is participant a parent, child, or other?
• Number of Children in their Care (for Parents/Caregivers only)
• Name of the Children in their Care (for Parents/Caregivers only)
• Date of Birth of the Children in their Care (for Parents/Caregivers only)
• Participant's Name (last, first, middle initial)
• Street Address, City, and Zip Code
• Gender (male, female)
• Date of Birth
• Race (American Indian/Alaska Native, Asian, Black/African American, Pacific Islander, White, Other)
• Ethnicity (Hispanic, Haitian, Other)
• English Proficiency (yes/no)
• Additional/Other language(s) spoken (English, Spanish, Haitian Creole, Other)
• Adult's Highest Grade Completed
• Is participant involved with the Dependency system (e.g., DCF, Our Kids, full case management
agencies, dependency and family courts) or Delinquency system (e.g., DJJ, Juvenile Services
Department, diversion/Civil Citation programs)] (Optional Field)
OUTCOMES & NARRATIVE REPORTS (Paper Reporting -Excel and Word Documents)
• Outcomes Measurement and Results (Excel spreadsheet reports customized for each
program/provider, based on current contract Scope of Service)-due monthly by the 15th of each
month for the previous month.
• Quarterly Program Narrative Report (using standard Word document format provided by The
Children's Trust) captures a BRIEF report of successes, challenges and supports needed-due
quarterly by the 15th of the month following the end of the quarter.
___
___ __
SCHEDULE OF REPORTS DEADLINES
- - _ __ _ _ .
Required Report Reporting Due Date
Frequency
~ r.--
Outcomes Measurement and Results ~ Monthly gy 15th of each month for the previous month
'~ (Excel)
i- - --- -------
Data Tracker Electronic Reporting of Monthly
'Demographics, Attendance, and other ', ~ By 15th of each month for the previous month
outputs ! ~, 'I
--
Quarterly Program Narrative Report Quarterly ' For August, September and October
(Word) DUE November 15, 2009
', For November, December and January -
DUE Febrary 15, 2010
__ _ _ ,
For February, March and April -
DUE May 15, 2010
J For May, June and July -
DUE August 15, 2010
The provider shall create and/or update annually their agency and program profiles and site(s) information in
the Community Resource Directory maintained by Switchboard of Miami to facilitate referrals to Children's
Trust-funded services. Provider shall maintain accurate information including adding or deleting sites.
Evidence that the profile(s) have been created or updated must be provided to the Contract Manager within
30 days of execution of this contract.
The City of Miami beach Page 32 of 34
Contract #903-109-1, Resolution 2009-90
Attachment D
Program Specific Audit Requirements
The Program Specific Audit is to encompass an audit of The Children's Trust contract(s) as follows:
• Submission of: (a) schedule of total expenditures, reflecting expenditures during the audit period for
each The Children's Trust contract by contract number; (b) If applicable, audit of attendance or other
applicable unit for contracts whereby the method of payment is the unit based method of payment as
specified in Attachment B; (c) summary of schedule of prior audit findings, (d) disclosure of any
significant finding(s) relating to The Children's Trust contract(s), (e) disclosure of all questioned costs
and liabilities due to The Children's Trust, with a reference to the contract number involved, and (f) a
recommendation for a corrective action plan. on any finding;
• Report whether the schedule of expenditure(s) is fairly stated;
• Provide notes to the schedule of expenditures that describe the significant accounting policies used in
preparing the schedule;
• Report whether contractual matching requirements were met, if applicable;
• Report whether the provider has internal controls in place to provide reasonable assurance of
compliance with The Children's Trust applicable contractual requirements and on the reliability of
financial operations.
• The auditor must include in their testing: testing of the budget versus the actual expenditure for
contracts reimbursed on the cost reimbursement payment method, testing for double billing i.e.
billing under The Children's Trust contract the same expenditure that is billed under another contract
and/or revenue source, testing for the supplanting of funds, testing of match requirements, if
applicable, and testing of attendance or other unit if the method of payment is other than a cost
reimbursement payment method.
The auditor's report(s) as to the program specific audit shall state that the audit was conducted in
accordance with the program specific audit requirements listed in The Children's Trust contract(s) and
include the following:
An opinion (or disclaimer of opinion) as to whether the financial statement(s) of the provider is presented
fairly in all material respects in conformity with the stated accounting policies;
An opinion (or disclaimer of opinion) as to whether the schedule of expenditures is presented fairly in all
material respects in conformity with the stated accounting policies;
A report on internal control related to The Children's Trust contract(s), which shall describe the scope of
testing of internal control and the results of the tests;
A report on compliance which includes an opinion (or disclaimer of opinion) as to whether the auditee
complied with laws, regulations, and the provisions of contract(s) with The Children's Trust which could
have a direct and material effect on the program; and
A schedule of findings and questioned costs for The Children's Trust contract(s) that includes a summary
of the auditor's results relative to The Children's Trust and findings and questioned costs.
The City of Miami beach Page 33 of 34
Contract #903-109-1, Resolution 2009-90
ATTACHMENT E
Affidavit for Level 2 Background Screenings
Affidavit Affirming Compliance with
Background Screening for Provider Personnel
and/or Volunteers, Subcontracted Personnel, as applicable
In accordance with Sections 943.0542, 984.01, Chapter 435, 402, 39.001, and 1012.465 Florida
Statutes, and pursuant to the requirements of Paragraph Q. Employee Background Screening of
this Contract, the undersigned affiant makes the following statement under oath, under penalty of
perjury, which is a first degree misdemeanor, punishable by a definite term of imprisonment not to
exceed one year and/or a fine not to exceed $1,000, pursuant to Sections 837.012 and 775.082,
Florida Statutes.
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
Before me, the undersigned authority, personally appeared (Agency CEO/Executive Director)
Authorized Provider Representative
of (Provider Name) ,who being by me first duly sworn, deposes and says:
Name of Contracted Provider
I swear and affirm that the above-named contracted Provider is compliant with the requirements
for personnel background screening detailed in Sections 943.0542, 984.01, Chapter 435, 402, 39.001,
and 1012.465 Florida Statutes, as applicable, for all personnel having direct contact with children.
(Signature of CEO/Exec Dir/HR Dir)
Date:
•
Sworn to and subscribed before me at Miami-Dade Coi'Snty, Florida this day of ,
2009 by
Who is personally known to me
Who produced identification:
Type of identification
Signature of Notary Public
State of Florida at Large
Print, type or stamp name of notary public
My Commission Expires:
The City of Miami beach Page 34 of 34
Contract #903-109-1, Resolution 2009-90
St:1CC[5S
u~?ivrRs~r~ Date of Assessment:
Data Tracker Date:
Success University Client Intake Data Tracker Client Number:
Client Profile
Client Name First Middle Last
Client Address Apartment Zip Code
Home Telephone Client Cellular Telephone E-Mail Address
Date of Birth City/State/Country of Birth
Social Security Number M-DCPS Student ID Number
Client Legal Status ^ tJS Citizen
^ US Resident
#
^ Other ^ Visitor's Visa
^ Student Visa
Sex ^ Male ^ Female ^ Trans ender
Race ^ Amer, ind~~n~ Alaska Native
^ BlcklAfrican American ^ Pacific Islander
^ ~Nhite ^ Other
Ethnicit ^ His anic ^ Haitian ^ Other
Preferred Language (Primary
Lan ua e S oken in Home ^English
^ S anish ^ Haitian Creole
^ Other S ecif
School Attended ^ Nautilus Middle ^ Miami Beach Senior Hi h School
Current Grade Level ^ 7 Grade ^ 9 Grade ^ 11' Grade
^ ~t~ {3rade ^ 10~r' Grade ^ 12`r' Grade
Community Service Hours Submitted to School as of Intake
Graduation Re uired -10
School Attendance M-DCPS rovided
( p ) ~, ir;r ~; _;l ;~.;1 ~'~'~~~,.
{aitrr~';"i~ Sctioo[ Year
GPA (M-DCPS provided) 3~I fCJf `~~:~11~,~1 'f`~~C C;.Irrent SCE?~(~1 Y~~Y
ESE Status (M-DCPS verified) ^ Specific Learning Disabled ^ Trainable Mentally Handicapped
^ Speech Impaired ^ Autistic
^ Emotionally Handicapped ^ Hospital/Hamebound
^ Educable Mentally Handicapped ^ DeaflHard of Hearing
^ Language Impaired ^Ortopedlc-Impaired
^ Gifted ^ Developmentally Delayed
^ Other Health Impaired ^ Visually Impaired
^ Several Mentall Handica ed ^ Profound Mental Handica
Is Child Disabled? ^ Yes ^ No
Disability Type ^ Autism ^ Hearing Impairment Physical Disability
^ Chranic Medical Cc~r~dition ^ Learning Disability ^ Visual Impairment
^ Emotional Disorder ^ Mental Retardation ^ Other (Specify)
^ Behavioral Disorder
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009
Time Start f 1
Parental/Guardian Profile
Mother's Name First Middle Last
Mother's Address If Different from Client Rpartn~ent # Zip Code
Home Telephone Mother's Cellular Telephone Mother's E-Mail Address
Date of Birth City/State/Country of Birth
Social Security Number Driver's License/State ID # Issuing State
Client Legal Status ^ US Citizen ^ Visitor's Visa
^ US Resident #
# ^ Student Visa
^ Other #
Preferred Language ^ English ^ Haitian Crease
Prima Lan ua e S oken in Home ^ S apish ^ Other {S eci
Preferred Days/Time for Contact ^ Sunday ^ Monday ^ Mornings Data Tracker #
^ Tuesday ^ Wednesday ^ Evenings
^ Thursday ^ FYiday ^ Afternoons
^ Saturda
Father's Name First Middle l..ast
Father's Address If Different from Client Apartment ~ Zip Code
Home Telephone Father's Cellular Telephone Father's E-Mail Address
Date of Birth City/State/Country of Birth
Social Security Number Driver's License/State ID # Issuing State
Client Legal Status ^ 1JS Citizen ^ Visitor's Visa
^ US resident #
# ^ Student Visa
^ Qther #
Preferred Language (Primary Language ^ English ^ Haitian Creole
Spoken in Home) ^ S apish ^ C}ther S ecif
Preferred Days/Time for Contact ^ Sunday ^ Monday ^ Mornings Data Tracker #
^ Tuesday ^ Wednesday ^ Evenings
^ Thursday ^ Friday ^ Afternoons
^ Sat~~rda
Guardian's Name First Middle Last
^ Step Parent ^ Foster Parent
^ Grand arent ^ Domestic Partner
Guardian's Address If Different from Client Apartment # ,Zip Code
Home Telephone Guardian's Cellular Telephone Guardian's E-Mail Address
Date of Birth City/State/Country of Birth
Social Security Number Driver's License/State ID # Issuing State
Client Legal Status US Citizen ^ Visitor's visa
^ US Resident #
# ^ Student Visa
^ C)ther /#
Preferred Language (Primary Language ^ English ^ Haitian Creoie
S oken in Home ^ S apish ^ Other {Sped }
Preferred Days/Time for Contact ^ Sunday ^ Monday ^ Mornings Data Tracker #
^ Tuesday ^ Wednesday ^ Evenings
^ Thursday ^ Friday ^ Afternoons
^ Saturda
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009
Time Start [ 1
Household Members' Profile
Additional Household Members Date of Birth Relation to Client Data Tracker #
^ Sh~i,^,g ^ Adult ^ Otiia;
Relative
^ Sibling ^ Adult ^ OthCCt
relatve
^ Sibkirtg ^ Adult ^ C7ther
relative
^ Sblir~g ^ Adu14 ^ Other
relative
^ Sibling ^ Adult ^ Other
it;l~tive:
^ Sibling ^ Ad~d1 ^ Other
Relay€ve
^ Sibling ^ Adt7fY. ^ {?Chr~:r
Reletive
^ Sib~ltlg ^ A6iUlC ^ ~Ch(?r
€'teletiv
^ S?b;irtg ^ Adult ^ C?ther
f'tclative
^ Shiirta ^ Adult ^ Qthar
IdcNative
Total # in Household ^ 1 ^ 2 ^ 3 ^ 4 ^ 5 ^ 8 ^ 7 ^ 8 ^
Housing Profile
Housin Unit ^ A artment ^ Sin le Home ^ Mobile Home ^ Other
Housing Type ^ Rent ^ Own ^ Other:
^ Lives wtother family
^ Lives w/friends
^ Other
# of Bedrooms ^ 1 ^ 2 ^ 3 ^ 4 ^ 5 ^ Elmore
Housing Adequacy Are there more than 2 peaple per bedroom? ^ Yes ^ No
Does housing meet safety requirements? ^ Yes ^ No
Has client moved more than twice in past 12 months? ^ Yes ^ No
C}oes client spend mare than 50°l0 of income on hcusing? ^ Ye5 ^ No
Is client at-risk of losing housing? (i.e. late in rent) ^ Yes ^ No
Household/Housing Narrative -
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009
Time Start f 1
Household Financial Profile
Income Profile
Parent/Guardian Em to ent .-
Em to er;
$
Parent/Guardian Emplo ent Emplo er: $
S ouse/Si nificant Other Earnin s mplo er: $
Parent SSA Benefits ^SSI ^ SSDI ^ SS trecsrementl $
S ouse/Si nificant SSA Benefits ^ S al ^ SSDi ^ ~~ {retirerrierrf} $
S ouse/Si nificant Other Pension Source: $
Client SSA Benefits ^SSI ^ Survivor's Benefits $
De endent SSI Benefits Dependent: $
De endent SSI Benefits Dependent: $
De endent SSI Benefits De endent; $
Dependent SSI Benefits Dependent; $
Household Food Stam Benefits of Persons Covered: $
Tem ore Aid for Need Families Dates of Expiration: $
General Public Assistance Source; Expiration: $
Child Su ort Dependent: $
Child Support Dependent: $
Child Su ort De endent; $
Alimon Scsurc: $
Alimon Source; $
Alimon Source; $
Investment Income Source: $
Investment Income Source: $
Other: Source: $
Other: Source: $
Other:
Monthl Household Income Total Source: $
$
Monthly Household Expenses
.-
Housing .- .-
Utilities ^ Electricit ^ Nature[ Gas $
Utilities ^ Telephone ^ Cellular $
Utilities ^ Cable ^ Satellite Service $
Utilities ^ Internet Provider $
Household Insurance ^ Renters ^ Pro ert Insurance $
Medical Insurance ^ ItdledicaidtMedicare ^ Private $
Medical Ex ense ^ Co- a ^ Prescription ^ Medical Care $
Food Ex ense $
Water/Sanitation $
Vehicle Loan/Lease Ex ense ^ {7wn ^ Lease $
Vehicle Insurance $
Vehicle O eratin Cost ^ Gasoline ^ R airs $
Trans ortation Ex ense ^ Public Transportation ^ School Trans ort $
Child Support/Alimon ^ Child Support ^ AI€mon $
Other: Source: $
Other: Source: $
Other:
Monthl Household Ex enses Source; $
$
** PLEASE NOTE: If household expenses exceed income, please review referral possibilities to address need.
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009
Time Start [ ~
Household Members Profile
Current Services Matrix
Indicate all services received/obtained by any members of the client's household.
-.
Day Care/ Childcare/
Adult Da Care ..
.-
Counseling Services
Disability Benefits
Educational Services
Elder Services
Employment Services
Food Stamps
Food Subsidy
Home Care Assistance
Housing Assistance
Legal Assistance
Medicaid
Medicare
Rehabilitation Services
Survivors Benefits SSA
TANF
Transportation Services
Unemployment
Compensation
Utility Assistance
Tutoring
Vocational Training
Other: Specify
Other: Specify
Other: Specify
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009
Time Start f 1
Household Health Profile
Adult Health Profile
Service Inquiry Mother/Female Guardian Father/Male Guardian Significant Other: (Name) Other: (Name)
When was your last Medical: Medical: Medical: Medical:
visit with a doctor? Dental: Dental: Dental: Dental:
E e: e: e: E e:
Other: Other: Other: Other:
Have you been ^ Yes ^ Yes ^ Yes ^ Yes
hospitalized in the past ^ No ^ No ^ No ^ No
12 months? ^ Don't Know ^ Don't Know ^ Don't Know ^ Don't Know
Do you currently have ^ Yes ^ Yes ^ Yes ^ Yes
any medical ^ Na ^ No ^ No ^ No
roblems? ^ Don't Know ^ Don't Know ^ Don't Know ^ Don't Know
Do you have any ^ Medicaid ^ Medicare ^ Medicaid ^ Medicare ^ Medicaid ^ Medicare ^ Medicaid Cl Med;care
medical insurance? ^ Private ^ Private ^ Private ^ Private
^ Other ^ Other ^ £}ther ^ Other
Have you been ^ Yes ^ Yes ^ Yes ^ Yes
diagnosed with a ^ No ^ Nc~ ^ No ^ No
mental illness? ^ Don't Know ^ Don't Know ^ Don't Know ^ Don't Know
Do you have a history ^ Yes ^ Yes ^ Yes ^ Yes
of alcohol or drug ^ No ^ No ^ No ^ No
abuse? ^ Don't Know ^ Dan't Know ^ Don't Know ^ Don't Know
Adult Health Profile Narrative -
Youth Health Profile
Service Inquiry Client: Child # 1: (Name) Child # 2: (Name) Child # 3: (Name)
Last visit with a doctor Medical: Medical: Medical: Medical:
Dental: Dental: Dental: Dental;
E e: E e: E e• E e:
Other: Other: Other: Other:
Has child been ^ Yes ^ Yes ^ Yes ^ yes
hospitalized in the past ^ No ^ No ^ No ^ No
12 months? ^ Don't Know ^ Don't Know ^ Don't Know
^ Don't Know
Does child currently ^ Yes ^ yes ^ Yes ^ Yes
have any medical ^ No ^No ^No ^No
roblems? ^ on't Know ^ Don't Know ^ Don't Know '
^ Dan t Know
y
Does child have an ^ Nted;caid
^ MedSCare ^ Medicaid ^ Medicare ^ Medicaid Medicare ^ Medicaid ^ Medicare
medical insurance? ^ Private ^ Private ^ Private ^ Private
^ Other ^ Other ^ Other ^ Other
Has child been ^ Yes ^ Yes ^ Yes ^ yes
diagnosed with a ^ Ncs ^ Na ^ No ^ No
mental illness? ^ Don't Know ^ Don't Know ^ Don't Know
^ Don't Know
Youth Health Profile Narrative -
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009
Time Start [ ~
Youth Risk Factor Profile
Factor Client: Child # 1: (Name) Child #2: (Name) Child # 3: (Name)
Child is performing ^ ~~s ^ if~a ^'~~s ^ Ir~1 ^ ~'~~ ^ P~}A ^ Yep ^ 3~IA
below school level ^ r~4 ^u~~r:z~~~~, ^PJ~ ^~_{,~_,~,.•,~~, ^ Na ^ unk.,u~~„ ^ No ^Llnkr,orir,
Child has been diagnosed ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
with a learning disability ^ Na ^unknown ^Na ^ Unknown ^ Na ^ unknawn ^ NA ^unknown
Child is having behavior ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
problems In school ^ Na ^llnknown ^NC3 ^unknown ^ NCf ^ unknawn ^ Na ^unknown
Child has a poor ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
attitude towards school ^ Na ^unknawn ^No ^unknown ^ No ^unknawn ^ Na ^unknawn
Child has been a ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
victim/witness Of domestic ^ Na ^unknown ^Na ^ unkno+.vn ^ NC1 ^unk„own ^ Na ^unknown
violence
Child has experienced ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
economic deprivation in ^ No ^unk€,awn ^Na ^ ur,knawr, ^ Na ^unknawn ^ Na ^ur,kr,awr,
the ast 12 months
Child lives in a single- ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ N/A ^ Yes ^ NIA
arent home ^ Na ^unknown ^Na ^unknown ^ Na ^ U„known ^ Na ^unk„awn
Child has sibling who ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
dr0 ed out of school ^ Nfl ^unknown ^Na ^ Unk„owrE ^ Na ^ U„known ^ Na ^Unknowr,
Child or sibling is ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
involved in a an ^ Nt3 ^unknown ^Na ^unknown ^ lsla ^unknown ^ Na ^unknawn
Client is exposed to ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NtA
drug use in home Or ^ NC} ^unknawn ^Na ^unknawn ^ Na ^unknown ^ Na ^unknawn
nei hborhood
Child has a parent or ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
caregiver who has ^ Na ^unknawn ^Na ^unknawn ^ Na ^ unknawr, ^ Na ^unknawn
been arrested
Child has access to ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
after-care services Or ^ No ^Ut,kr,c,wn ^NEf ^unknawn ^ Na ^unknawn ^ Na ^unknawn
adult su ervision
Child is experiencing ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
ne lect ^ Na ^unknown ^Na ^unknawn ^ No ^unknown ^ Na ^unknown
Child has been ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA ^ Yes ^ NIA
involved in the juvenile ^ Na ^urrkrnwn ^Ir? ^unknawn ^ No ^unknawn ^ Na ^unk„awn
'ustice s stem
Child has missed 10 or ^ 'r°~~ ^ ~fi~°~ ^ "~~~ ^ P~~~: ^ Ycs ^ ~fIA ^ ~'e~ ^ C~itA
more school da s ^ t~:~ ^~~,~~~~„~~.,,a ^~tc~ ^ G~;,~~,~,rt~ ^ t~~ onk„~~,
^
^ I'd0
^t3nknahn
Identified Risk Factors Narrative - (If "Yes" to any above, you must provide detail here)
If answer is "Yes" to shaded areas, a strategy must be identified in Care Coordination Plan.
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009 7
Time Start [ 1
Natural Support Map and Identified Participants for the FGC
Mother:
Father:
Guardian:
Extended Family Member(s):
Neighbor(s):
Friend/Classmate(s):
Teacher/Counselor(s):
Other(s) (Coach, Godparent, Religious
Leader, etc.):
FGC Appointment
Day of the Week•
Date•
Time•
Location•
Transportation:
Number of Invitees:
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009 g
Time Start [ 1
Referral Needs Profile
Housing Services
Client household in need of affordable housin (housing cost exceeds 50% of income) ^ Yes ^ No
Client household in need of rent assistance (3-da notice, eviction notice received) ^ Yes No
Client household in need of other housin (inadequate, unsafe, etc. ^ Yes ^ No
Financial Services
Client household in need of food assistance (inadequate food for family ^ Yes ^ No
Client household in need of clothin assistance (including school uniforms ^ Yes No
Client household in need of utilit assistance (late notice, final notice Yes ^ No
Client household in need of trans ortation assistance (bus tokens for school, work, etc.) Yes ^ No
Client household in need of em to ment referral (emplo ment for adults, outh) ^ Yes ^ No
Client household in need of and eli ible for entitlements (food stamps, TANF, etc.) ^ Yes No
If es to an above, lease indicate re ferral rovided:
Medical/Counseling Services
Client household in need of medical assistance (evaluation, intervention, etc. ^ Yes ^ No
Client household in need of mental health assistance (evaluation, intervention, etc,) ^ Yes ^ No
Client household in need of counselin services (individual, famil ,marriage, etc.) ^ Yes ^ No
Client household in need of 7 Habits Famil training (family cohesiveness) ^ Yes ^ No
Legal Services
Client household in need of immi ration services (residenc , as lum, etc.) ^ Yes ^ No
Client household in need child su ort enforcement services ^ Yes ^ No
Client household in need of landlord/tenant le al services (eviction) ^ Yes No
Miami Beach Service Partnership/Universal Intake Form -Revised August 2009 9
Time Start [ ~
Miami Beach Service Partnership
Authorization for Release and Exchange of Information
The purpose of this Authorization Form is to enable Miami Beach Service Partnership agencies to better
serve you and/or your children through coordinated service planning and delivery. Representatives of these
agencies may share information in order to arrange for the appropriate and prompt delivery of services as
planned. The following Partner agencies may provide you or your family services:
^ Aspira of Florida ^ Ayuda, Inc.
^ Choices et al, Inc. ^ Jewish Community Services
^ Miami Beach Community Health Center ^ Miami-Dade County Public Schools
^ Junior Achievement of Greater Miami ^ The Children's Trust
^ Teen Job Corps ^ Unidad/Hispanic Community Center
^ South Florida Center for Family Counseling ^ City of Miami Beach
Please indicate which information, if any, you do not want to be shared. Note that some agency
referrals require the prior release of information to determine eligibility. Please mark all appropriate.
^ Client Demographic Information ^ Education/Training/Skills Background
^ Employment Background & Information ^ Support Service Information ~;~~;~d;ngent;t;errients8cu~rentserv;ces>
^ Financial Eligibility Information ^ Housing Information
^ Medical Eligibility Information ^ Legal Background Screening Information
^ Services History Information ^ Other
Is there any agency that you do not want us to share your information with? ^ Yes ^ No
If yes, please list the agency/agencies below:
I understand that this release authorizes an exchange of information between Service Partnership agencies in order to
provide me and/or my child(ren) with the most complete and thorough services available. It does not authorize release
to any other person or agency except those agencies which are Partnership members or to those agencies to which I
am being referred for services.
Unless revoked in writing, this release shall remain in force for a period of 24 months from the date of authorization. My
signature below indicates that I have been informed of and understand the eligibility information provided within this
form and certify that it is true and correct and subject to verification. Any false or misleading responses or submissions
on my part may lead to the refusal of services.
Parent Signature
Date
Parent Name -Printed
Client Name
Intake Worker Signature
Date
Intake Worker Name -Printed
Agency Name
nniami t3each Service Partnership/Universal Intake Form -Revised August 2009
Time Start [ 1
10
Data Tracker #
Miami Beach Service Partnership
Client Information
Referral Form
Name (Check here if client is a minor ) Place of Birth/ Date of Birth
Social Security Legal Status
^ US Citizen ^ US Resi dent ^ Status Pendin
Primary Language Race/Ethnicity
^ English ^ Spanish ^ Creole ^ Other ^ White, Non-Hispanic ^ Hispanic
^ Black, Non-His anic ^ Other
Address/Zip Code Home Telephone/ Work Telephone
Marital Status Housing Status
^ Single ^ Divorced ^ DomesticPartnership ^ Own ^ Rent ^ Live w/others
^ Married ^ Se c rated ^ Other ^ Homeless ^ Other
Others in Household Household Income
^ Child ^ Adult ^ Employment - $
^ Child ^ Adult ^ SSA ^ SSI ^ SSDI $
^ Child ^ Adult ^ Child Support $
^ Child ^ Adult ^ Pension $
^ Child ^ Adult ^ Other $
^ Child ^ Adult ^ Other $
For youth only - For youth only -
Current Grade Level Current School
^K ^1^2 ^3 ^4 ^5 ^6 ^7 ^8
^ 9 ^ 10 ^ 11 ^ 12 ^ Biscayne Elementary ^ North Beach Elementary
^ Fienberg Fisher K-8 Center ^ Nautilus Middle
M-DCPS ID # ^ North Beach Elementary ^ Miami Beach Senior Hi h
Services History
Food Stamp
Reci lent ^ Yes
^ No ^ Pending Section 8
Reci lent ^ Yes
^ No ^ Pending
SSA Benefits Medicaid/Medicare ^ Yes ^ Pending
^ Yes -Amount $ ^Pendin Reci ient ^ No
Current Service Current Service Needs
Providers ^ Child Care After Care
^ Disability Benefits
^ ASPIRA ^ Lutheran Services ^ Disability Services
^ AYUDA ^ Miami Beach CHC ^ Educational Services
^ Boys & Girls Club ^ M-Dade Housing Authority ^ Employment Assistance
^ Catholic Charities ^ SSA ^ Food
^ CAA ^ So. FI. Ctr. Family Counseling ^ Housing Services
^ City of Miami Beach ^ Teen Job Corps ^ Legal Services
^ DCF ^ Veteran's Affairs ^ Medical Services
^ Douglas Gardens ^ Volunteers of America ^ Substance Abuse Services
^ HACOMB ^ UNIDAD ^ Youth Intervention Services
^ JCS ^ Other ^ Youth Prevention Services
^ Le al Services of Miami ^ Other ^ Other
I understand and have authorized this release and exchange of information between Service Partnership agencies in order to provide
me and/or my child(ren) with the most complete and thorough services available. The information I have provided is true and accurate
to the best of my knowledge.
Client Authorization
Staff Signature
Date
Miami Beach Service Partnership
Universal Referral Form -Revised August 2008
^ Child Care ^Ayuda, Inc.
^ Aftercare ^Ayuda, Inc.
^ Boys/Girls Club
^ MB PAL
^ MB Recreation
^ Clothing ^ Neat Stuff
^ Suited 4 Success
• •
^ Youth ^Ayuda, Inc.
^ JCS #1
^ MBCHC
^ GLBTOYouth ^ Alliance for
GLBTQ Youth
^ Adult ^ Douglas Gardens
^ JCS #1
^ Family ^Ayuda, Inc.
^ JCS #1
^ Referral ^Ayuda, Inc.
^ JCS #3
^ DHS Day Care
^ LHANC - MB
^ LHANC - RT
^ MB - OCS
^ UNIDAD
^ Home Care ^ MD -Human
Services
••
^ Child Care ^Ayuda, Inc.
^ Aftercare ^Ayuda, Inc.
^ Boys/Girls Club
^ MB PAL
^ MB Recreation
^ Employment ^ CAA #2
^ JCS #1
^ Unidad
^ Cash , ^Culmer Center
Assistance ^ Edison/Little River
•~•
^ Emergency ^ JCS #2
Food ^ St. Joseph's Church
^ St. Patrick's Church
^ Food Stamps ^ DCF
^ Discount Food ^ OCS
•
^ Emergency ^ MB -0CS
Shelter
^ Affordable ^MBCDC
Housing
^ Transitional ^ Douglas
Housin Gardens/Ma air
•
^ ^
^ Emergency ^ MB - OCS
Shelter
^ Affordable ^MBCDC
Housing
^ Transitional
LJ Disability L~ Legal Services
Benefits
^ Immigration ^ FIAC
Services ^UNIDAD
^ Landlord/Tenant ^ Legal Services
^ Medical ^MBCHC
Services
^ Dental ^MBCHC
Services ^UNIDAD
^ Mental ^ Douglas Gardens
Health ^ JCS #1
^ Rent ^ CAA #1
Assistance ^ MB - OCS
^ Edison/Little
River Center
• ~.
^ Detox. ^JMH Crisis
^ Addiction ^ Central
Services Intake
•.
^ Disabled ^ Transit
^ Veterans Agency
^ Elder
^ STS
^ Elder Program ^ EHEAEP
^ Emergency ^Culmer Ctr.
Help ^ Edison/Little
River Center
^ LHEAP
~- - ..
^ Academic ^Aspira
Tutoring ^Ayuda, Inc.
^ Boys/Girls Club
^ MB - OCS
^ Youth ^Aspira
Development ^Ayuda, Inc.
^ JCS #3
^ Employment ^ CAA #2
^ JCS #1
^ Teen Job Corps
^ Unidad
^ American Veterans' Food
6632 Collins Avenue/305.867.6060
^ Alliance for GLBTQ Youth
1175 NE 125th SU1-866-634-8087
^ Aspira
4100 NE 2nd Avenue/305.576.8494
^ Ayuda, Inc.
13899 Biscayne Blvd Suite 123
North Miami Beach/ 305.864.6885
^ Boys & Girls Club
1245 Michigan Avenue/305.673.7760
^ Central Intake
2500 NW 22nd Avenue/305.638.6540
^ Community Action Agency #1
6100 NW 7d' Avenue/305.756.2830
^ Community Action Agency #2
810 NW 28t" StreeU305.638.4672
^ Culmer Service Center
1600 NW 3'" Avenue/305.579.2820
^ Dept. of Children 8~ Families
945 Pennsylvania Avenuel305.535.5401
^ DHS/Adult Day Care
150 - 79`" StreeU305.571.4342
^ Douglas Gardens CMHC
701 Lincoln Road/305.531.5341
^ Douglas Gardens/Mayfair
1960 Park Avenue/305.531.5341
^ EHEAEP
395 NW 1~` StreeU305.347.4685
^ EdisoNLittle River Service Center
150 NW 79d' StreeU305.758.9662
^ Fla. Immigrant Advocacy Center
3000 Biscayne Blvd./305.573.1106
^ JMH Crisis Center
1611 NW 12`" Avenue/305.355.7377
^ Jewish Community Services #1
300 41 Street#216/305.576.6550
^ Jewish Community Services #2
2056 NE 155`" StreeU305.947.8093
^ Jewish Community Services #3
Access! Referral Services/305.576.6550
^ LHEAP
2902 NW 2"d Avenue/305.438.8614
^ Legal Services of Greater Miami
3000 Biscayne Blvd./305.576.0080
^ Little Havana/Miami Beach
533 Collins Avenue/305.532.8576
^ Little Havana/Rebecca Towers
150 Alton Road/305.572.3736
^ Miami Beach CDC
945 Pennsylvania Avenue/305.538.0090
^ Miami Beach CHC #1
710 Alton Road/305.538.8835
^ Miami Beach -Community Services
555 - 17d' StreeU305/6737491
^ MiamiBeach Police Athletic League
999 - 11`" StreeU305.531.5636
^ Miami Beach -Recreation
2100 Washington Avenue/305.673.7730
^ Miami-Dade Human Services
4500 Biscayne Blvd./305.576.2511
^ Miami-Dade Transit
111 NW 1~` StreeU305.770.3131
^ St. Joseph's Church
8670 Byron Avenuel305.866.6567
^ St. Patrick's Church
3716 Garden Avenue/305.531.1124
^ So. FI. Ctr. for Family Counseling
1031 Ives Dairy Rd., # 228/305.914.3789
^ Teen Job Corps 305.868.0635
^ Temple Beth Sholom
4144 Chase Avenue/305.538.7231
^ Unidad/Miami Beach HCC
833 6d' StreeU305.532.5350
^ Other
Miami Beach Service Partnership -Universal Referral Form Back -Revised August 2008
n
u
N V 0
Contract #;
Invoice Date:
Bill To:
Office of Community Services
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
I C E
r ~ ~- .
Subtotal
Please make sure to submit all contractually required documentation with invoice. (Performance
Balance Due
REMITTANCE
Date of Receipt:
Date ofApprova/:
Amount Due:
Amount Paid••
Primary Business Address Address 2 City, ST ZIP Code Country
Phone: (340) 555-0167 Fax: (340) 555-0168 E-mail: someone@example.com Web site: www.xyz.com
r~
u
Attachment Checklist
Invoice ^
Referral Status Report ^
Primary Business Address Address 2
Phone: (340)555-0167 Fax: (340)555-0168
N A R R A T I V E
Contract #;
Invoice Date:
Reporting
Month
City, ST ZIP Code Country
E-mail: someone@example.com Web site: www.xyz.com
v ~•
-a ~
o~
a o
N y
i °-
~
~
w. m
~ 3
is
U
C9
LL
d
Y
R
r
C
R
L
V
~
d d
Q
0 dd
~ a
R
o d
R
D
m
m
0
0
s
N
L_
r
N
{0
J
d
R
Z
C
d
V
ar
0
z
m
a
R
v
as
~
~,
3~
~
o
_~
0
LL 3
io C
L `~~-
d ~
d ~
w
~ N
O 3
+~+ ~
(a L
R
~~ L
Y.~
r~+
N
3
U
C
N
~ ~.
N O
t .~
w w
~
d
•
Q N
•
~ U
0. L
w
R
L
d
W
d
Service Evaluation Form
Intake Worker: Training: Intake & Assessment
Date: Location:
Please take a moment to evaluate today's service. Rate each item from poor to excellent. Your
information is used to better improve services. Thanks in advance for your feedback.
Content
Objective and scope of service
Organization of event and agency staff
Understandability of communications with staff
Relevance of event/service to your objectives
Intake Worker
Presentation of information
Participation by attendees encouraged
Discussions managed well
Questions responded to satisfactorily
N/A Poor Fair Good Excellent
^ ^ ^ ^ ^
^ ^ ^ ^ ^
^ ^ ^ ^ ^
^ ^ ^ ^ ^
N/A Poor Fair Good Excellent
^ ^ ^ ^ ^
^ ^ ^ ^ ^
^ ^ ^ ^ ^
^ ^ ^ ^ ^
Overall Experience
N/A Poor Fair Good Excellent
Overall experience ^ ^ ^ ^ ^
Please list any further questions you may have about Success University.
What was best about the service?
What as ect of the service did not meet our ex ectations?
a
a
c
c~
a
~~
c
~, ~ a~
~O E
`~ o
~ ~ a
~ L
d p~ L
~ ~ O >
• C
C v ~
~
~ ~ ~
L
u a..+
C
~ V U
C \ i0
i
+
+ N c0 ~' v
a o
n
L
~ ^
'v + a
~ f0
,~ c
a
c cn
-° v g c
o
.L ~,
~ ~'
o ,~
a
#
a
° ~
a
v ~ o
~
v v p o a ~ o U
~
~ ~
U \ ~
a\ ~
~
0~ ~ oL
0
U 0
U # U O # U
+~
N
+~
~v
+~
0
c
L
.~+
L
LL
U
C ~
w
O t
n
" a a
•; .U ~
~ ^
O o
v
= f!I ~ ~ ..
p O C
~ N
~
it
~0 ~
~ .. ~
~ N
~ >
~ ~ L
p ~ ~ Q
~ ~ ~ a ~ ~ a
4. fp U C N ~ O
a
L J O C ~ ~
b ~ .. '-~
' U vi Q
i
~ c_ -o
O U ~ U ~ C ~ C
L
4 C
v
o
~
o ~
'rn i
~ N
L
~i Q a N a m ~ U
L
3
V
3
L
L
w
C
w
OAS
01
C
._
C
10
a
fl.
L
C
dd
L
f0
a
c
v
E
0
U
v
.n
o v
Z 'Q
a
Q
0
z
N
~-'
a~ ~
E -a ~_ ~ ~
~ C C '~"'
~ C E
i~
7
~ (0
- p ~ p~
p ~p
L ~
~ ~
L
(0 U C
~
(A
d
a..,
~ Q1
~ p ~
~ C V
~ ~
f0 N
~
~ C
O .~~.+
C
~ ra`o
L L
' o.o
C V ~
~ w
y
I m
~ L
~ V ~_
L
~ co
C
+r d,.l
~ .~ C ~
O~
U
N ,
,,
L
N
V
C L
(!f p j
> ~
U
v ~ O O
~.d C N p ~
~ fL6 -p 01 C C ~ ~ ~ ~ C
IQ Q O N ~ O ~ ~ .
L -p ~ f0
,~~,
U ~ ;~
o a~ ~
~ ~
,~ ai
c ~
~- U ~
o w ~
l 'Nv
i N 'd
L U =p 'd U ~ fp ~ U
+r '
° ro ~
C Q ~ o
o
~ ~ ~ ~
v ~
V V O
E O
y C
a~ O
u ~ N
u~ ~ V
~ o ~
~
O a'd
~ .a
~ L o
L
- ~+
3 ~
v ~
o ~
c
o o
c~w ~
U
Q
cn o
a~
~ 0
a
O
O
N
,-.
a1
Q
LL
H
H
H
W
r
M
U
w
F-
Q
E
O
CC
a
W
Q
U
O
W
W
V
ra
W
0
Q
O
m
C7
N
W
Z
D
Z
4
N
Z
.0 'O
~ ~
~" U
O O
'O
~ ~
~ U
N N
fl. ~
0 C
U ~,,,
~ a
C O
~ Y
a~ ~
~o
L N
~ ~
U
U ~.., iC
f0 U y~
f0
G1 aL+ (0
~ c a
~ ~ U ~
'~v~~
~o~ a m
H
E
v
a
a~
u
ro
y
~ T
~
~ O
O
L
U 0
a~
a
V
V
f6
C
7
O ~
~C
C _~
+~ a
d' N
s;uawa~~nbaa
6urpaa~x3
s;uawa~~nba2/
6u~;aa~y
~l/nd
s;uawa~mbaa
wnw~uiw
6u~;aa~y
s;uawa~inba~
wnwruiw
hue;aaw ;ou/
a~qe;da~~eu/~
a~ge~~~dde;oN
O ~ ~ N
~ ~ C ~ ~ ~ C w
~ C
~ U L
\ U
~ (n ~
~ c c
p1 O
(A N ~ •
~
O a.., ~O
O
L f0 O '~ ~
L
O O O
~
O 'p ~` ~ ~ O ~~~
c
O O O
_
fa C U t ~ O = ~ -~ v
f0 .~ L
~~ aoia°~ ~~ '+~-,+ c a o Ecru >~
N~ ~ >. O
~ ~ ~
U ~ i N
~ ~° .U
O m N~ ~+ N
7
~ ~ +
C 'p N
i dl
~ ~
fC U O
f0 ~
O V
~ L O
~
C a..+ C
~
f0 ~ ~ ~..+ f0 .c O C (n w C
•~
~ p
~a C f
0
o o ~ ~-+
na> > O Q N N C N O~ O
c+~
~ c
t-v ~~o c~n~~
L V o.u ~~
~ ~ ~~a. ~c
c
i~
i O ~
~ N N N f0 O
U ~..+
i+
(n O
7 ~ C
f0 ~ (~ c t' N
L O
=
'L ~ L +.+
~ = (n O>
~~ N O ~ C Q J
O
,
a-'U
L• ~f0
~ ~ O
so
a~ ~
s ca Q~
o a~~~-L
~
pO ~
o ~~ ~ N o
0 o~
L ~~ O v O O H O
+ C (Il O O- ~ O
~ a (0 ~ O a
+
~ o ;~ ~o 0 7
-a ~
~ v~ aci~~ .~
~,~a O=~° o~
~ a ~•~ ov
C ~ ~ ~ O N .~ "0
~ ~ ~ N (/~
~ ~ i ~ c C O (0 U
~
a f0
L = Q ~
° c rn ~o
~ t
~'
~ d L
~ °~ (p f0 N L
~ •L
°
°' °' ~
or
v '
~ o
~ ~
o ~ a~ 3
ov a~
a
c~ a~ ,~ - vi
o~
N o~ e
~~oo .
°~
o cL°'c a~iL ~n.°-o aaoi
~ C7 a~ D Ea ~
Una ~..,Q(n_ ~ a a ~ ~ ~ Q N
N
0
0
N
G
L
~~
Q
~0
V
i
i.~
V
U
y
X41
H
O
G
3
O
'I
C
~~
V
W
++
v
L
Q
U
'a
C
N
d7
d
w
O
O
V
O
L
w
r
C
d
N
L
U
~o
.a
L
C
G1
U
s3uawannbab
bu~paa,~x3
s~uawaarnbab
6ui;aary ~(ryn~
s~uawaainba~
wnw~uiw
6ui;aa{y
s3uawa~inba~
wnwiu~w
bud;aaw you/
a~qe;da~~eun
a~ge~~/dde ~o/~
~
~
~
~ ~ ~
O
v
3 ~ ~ ~ ~ v
.
~ U O O U C
O^
~ O
~~
~ R
~ ~
.O ~
~ ° `0 ~ _ _o
4
~ ~~ ~ ~ ~~
o ~ v
L
~ C i
~ ~
0 ~
a"r L O
~0
~' 6 ~
f
=
o
~ (0 ~
~ VI
~ U
ii
^^4 to ~
V ~ ~
~ CC c
~
`
O~~'~ f0
'O ~~ L
p C
~ ~
~"O ~ ~
N L (O
U O ~0
~ ~ ~ ~
~
a a~
~ w
~' c
c ~ ~
° m '_ +-~
~ °
.~
O'
~o ~~ a
i ~° ~_
• ~ -v a~ °i v a~
L\ ~ ~ ~ O L
' ~ ~ O ~ ~
~v~ ~~' o ~ ~ a~~ a~
V~ V~ ~ O ~ L L C
~ C ~ O ~
3`O
~a~°i
~
f° t0
c O
o"
a~n
a
O ~
~
*~ ~~
~
O ~
v ~ ~~.+ O
+r v c
~ f wt w
~
~ ~ c -p 0 C to C
~ ~ .O '1,r ~ O ~ L ~
- f0 L f0
'~ (A
N m
N
~ a
i
U i
d
U
tit O =
oC ~o +~
~ f0
~ ++
~ O
I- 'a
O ~ U
a ~v f0
az f0
a
M
0
O
N
o~
3
a~
d
/'~
a
f0
a
s
3
v
R
C
0
v
i
M
...
V
d
a
F~-
d
++
m
U
~~
a~
L
.;
L
a
a~
,~
C
O
a
a~
it ~ .b
'~o
~ L
o ~c
L
y,. ~
~+~
a+ ±'
V
• .~
_
, •
0 ~ Q
c Q ~
a ~ ~,
o o Q ~
.U O ~ ~ ~ Q
O V
y
a
z cn p
j
° fi
.~ I ev
W
LL
a
a
c
d
0
U
~o
M
N
H
~ ,-,
c c c ~
~, '° o ,~
N 'v s ~ v
a ~ v ~ -a = u
~ ~ ~ ~ ~ o a
~ L ~ \ °-
a ~ ~ ~ o °- c '.~
~
~
U r~ ~ ~.
~ c c
c ~ ~ o 0 0
C
C ~ ~
~ Q C
L C ~..~
~ ~ ~ L ~ O O O
w L
~ ~
~. ~
~ t~ L
~ w
.C ~
N ~
(Q
a..i
~ ~ fd °~ a
~ v ~ ~
~ d te .L C U fn f0
~ C a
./
~ O U O N ~.
N ~ ~'' 0 a-' L ~, N (A
\ . ~ U O
O a_ ~ ~
~ c L
7
~'
L ~
Q
~
L
N
O N L O C R ~, (n
~ C
~ N O .a ;~ V N '
V E E~ c a c ~
(
~ n D ~ U a U ~v U cn
O~
O
0
N
o,
c
.
~
a
~ `
v
v ~,
c
~
~o a
Q N
N ~
.p O.
V1 (~j~ i
~ ~ N i
C
N
~ ~ v
~~E
o' o
~ ~ u
~
U ~
QJ
I , ~
~
V
O k
try N
~
~
L ~ i
_
~•`1
s;uawa~~nbab
6ulpaa~x3
s;uawa~inbab
6u~;aa{y ~~Ind
wnwiuiw
6u~;aaW
s;uawa~inbaa
wnw~u~w
6ui;aaw;ou/
~ a~qe;da~oeu/~
a~ge~~~dde ;o/~/
i~ Ip L
7 ~, O
~ ~
O O
cc
C
C IA ~
~ ~ ~
aJ
~
~
V ~
d ~
N
~ w
O O
i C
~
~
'~ O
~ ~
a~ ~
c O
a O
~ ',
~, ~ •c O O
f0 L ~ N Q1
• ~ ~'
~ O ~ •f0 ~ ~ C O
' O
O f0 w f0 O ~
' N
C O
(0
~.
O
O N
f0 E
C
~
+
~+ i
(UA
~
i O , O O. p ~ ~ ~ _
~ ~ .
•C
O
~ ~ '~ ,~ _
a o •~ o ~ N ~
~ . ` v
~ a~
~,
~
~
~ a
O x
O
-a
_
O
~
O
~
cn
~
O
~ o a v a ° ~ ~ ~ +~ .
Q v ° ~ c ,~
o o _
m +~ °'
aS ~
+~
C ro ~ a~ f0 ~ t w C •
~
~,
c
~
a
o
~
~
o
~
O i
Q
~ ~' ~ ~ ~ ~ o °• o
~ o ~ .
•
~ L L O +~+ f~ +~+ ~ ~ L N ~
Q a
+ O ~ ~ . ~
+
~ L ~ ~ V O U ~ Q
o ~ Q ~ U U
' L U a a a ~ ~ a ~ a s
rn
N
+.,
a~
0
U
1
n
tp
b
a
Mi
N
i
H
i
y ~ ', ~
~ovv~
~a`~
v
.~
0
v
4
O
U
N
a
~.
c
v
v
R
C
H
~.+
C
~o
Q.
...
u
a
H
w
3~
C
U
i
`b
ti ~
O U
O cij
~ aLi u
~ ~~~~
o
.
~
~
a~
~ 4
~
~ ~ ~
H ~ ~ .~
v ~ o ~
~ cu
n
~c
~
~
i
~
U t~p
Q C
o,
0
0
N
O~
d
.;
O~G
d
a
H
M
N
1
C
a~
O
V
~ ~
O o
~ 'i
~ v
C 4
Q) L
3
u
0
4
0
.Q
O
.~
L
O ..
4
~~
~~ o
+.~
V
a~
k
W
+^~
U
i.i
C
Q
U
~II
`..
Grl
C
m
c
U
Q
c~
W
f0
N
+~
c
O
O
U
0
Z
m
a~
w
O
O
Q
0
U
'~
O
a
Q
0
N
O
01 ~
C O
U
`~ i
~° a~
~ ~
ii
C
C
O
H
L
a
a~
d
O
a
W
a~
0
U
ICI
'~
t0
~'
M
N
H
m
.
~
r~
N
a~
O
a
W _
N
~
C
n
f0
c
~
~
o
~
O
~
=
c >
v
..
~
O
O
~
ci
~,
~
O
O
O
o-
~
o
o
O
C_
~ _
C
~~
+~
°~
U
41
~
~
o
+
U
~Q
a
Q N
N
i
~
f0
o
a
'a
~
~
O
L
~
°
U
N
'a
'>
w ~
+~
O
~
~
~
v
O
c
°_'
cA
C
.o-
~
~
o
r,
Q~
U
~
'L
a
x
~
_~
L
O
Q
°
V
N
~
'>
w O
L
U
_~
fa
O
'~
L
U
~
C
O
O
~
~
~
'i
o
~ f0
~
~_
~
U
~
c
O
L
rn
Y
U
f0
m
C
~
co
z L
GJ
~+
U
~
fd
U
~
O
~
'~
O
o
.~.+
f0
'a
~
Q ~
f0
N
N
"V
o
a
o
a~
Q1
'p
N
~
~
w
O
o
a N
U
~
i
~
a~
~
o
~
L'
~
~
~`-°
C
'O
~
0
U Q1
_
O
(0
i+
~
u
~
O
rn
fd
`~
O
C
`°
~
E
u
o
~
~
w
C
O
iC
N
~
rn
,'.,
O
O
N
3
W
N
W
Z
H
H
H
W
+~
~ ~
v
O~
0
U L
m
j U
p cLa
4 c
~ o
u
O
~
L ..
~
~ ~
~ ~
~
O
•> ~
~
a
O ~
~
~ ~ ~
+~~+ U co
~
`~
~ ~
~ L
Q~
~ ~ _ ~
ca
~ ~
~ ~
~ ~
~ cc
Q~ G
~ C ~ ~
~
U '~`'
~ ~ f0
•~ ~
~ O ~ O
~
ro U
~~ o
~ .C V
w O ~ ~"
o Q c
`
~~
L N ~
~
~ = f0
(~ ~ f0
~` C
~
~ L
Ol
,
(v
`•
•
a
L
~ 0 ~
_
~
d cn
J O
d
O
i
~a
y
N
~_
f
Vi O
W u.
U~
M F„~
N
W
W
H
o~
o `~
= U
~ ~
F-
Oa
mg
=g
ca a
zo
^~
Qa
W
a
~~
z~
~ LL
a
~f
Q W'
~ ~
cn
3
~
a
i
c
k
a~ ~
z
o
E w
y }
Of
.~
~
++
V
~..
~ ~
~
~
~
~
~
Q
= 4
~
y ,`
=
~ ~ Q Q
rn
N
f0
0
L
Q)
Q1
C
~
c
G
O
U
~
+.+
C
U O
'-+
rn