Choices Et Al, Inc.
PROFESSIONAL SERVICES AGREEMENT
BETWEEN THE CITY OF MIAMI BEACH, FLORIDA
AND CHOICES ET AL, INC.
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 CHOICES ET AL, INC, (hereinafter referred to as Contractor), whose
address is P. O. Box 695409, Miami, Florida, 33269.
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.
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SECTION 2
SCOPE OF WORK (SERVICES)
The Contractor will provide Family Group Conference 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 Family Group Conference services for up
to two hundred fifty (250) youth and their families at One Hundred Seventy-Five
Dollars ($175) per each Family Group Conference, for a maximum not to exceed
Forty Three Thousand Seven Hundred and Fifty Dollars ($43,750).
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 Forty Three
Thousand Seven Hundred Fifty Dollars ($43,750).
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.
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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
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indemnify the City of Miami Beach and its officers, employees and agents, from and
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
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PROMPTLY ASSEMBLED AND DELIVERED TO THE CITY, AT
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.
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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.
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The Contractor is solely responsible for obtaining and submitting all insurance
certificates for its sub-contractors.
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
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status, or physical handicap. The Contractor shall take affirmative action to ensure
that applicants are employed and that employees are treated during their
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:
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TO CONTRACTOR:
Choices Et AI, Inc.
Attn: Cheryl Polite-Eaford, Executive Director
P. O. Box 695409
Miami, Florida, 33269
(305) 332-2074
TO CITY:
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 PART
JURY OR ANY CIVIL LITIGATION RELATED TO,
AGREEMENT.
4.19 ENTIRETY OF AGREEMENT
CONTRACTOR AND CITY
Y 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.
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Accordingly, and notwithstanding any other term or condition of this
Agreement, Contractor hereby agrees that the City shall not be liable to the
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]
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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:
Y:
City Clerk
Mayor
FOR CONTRACTOR:
Choices Et AI, Inc., A Florida
Corporation
ATTEST:
By:
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Secretary
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APPROVED AS TO
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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
Family Group Conferencing :Completed Family Group Conferencing Contract Forms
_ (attached)
Related Definitions:
Family Group Conferencing -Family Group Conferencing, an engagement and
natural supports process, will involve the client, his/her family and any others
identified by the client, as directed by fidelity standards provided during training led by
Choices, Et AI. The Family Group Conference is documented by the full and accurate
completion of FGC Contract Forms, including the following: Eco-Map,
Strength/Concern Worksheet, Action Plan, and Sign-in sheet(s)
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 Family Group
Conference or client-initiated requests. These referrals must be documented using
the Miami Beach Service Partnership Referral Form with copies provided to the client
and the City.
Services will be deemed as provided when the following documentation is provided
within the noted timeframes:
.Service ~ Documentation Submission Deadline
Family Group Conference ;Family Group Conferencing 72 business hours from
Contract Forms rovision of service
Referrals Services Referral Form 72 business hours from
the identification of
__ _ _ _.___.._._.____._._._~___..._._.__,__...._._ ~ client need
Service Deliverables
_ _.
ervice _ i Unit of Service
Family Group Conference ~ 1u for each of up
to 250 families
Service Location
Biscayne Elementary
School; Miami Beach
City Hall; Miami Beach
Botanical Gardens;
Miami Beach
Convention Center
_ Timeframe _
All eligible Family
Group Conferences
will be completed
within thirty (30)
days of first
scheduled
appointment
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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.
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.
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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_
Timely and accurate submission of
monthl.Y.._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
Rating Rationale & Score
- "0" for failing to submit on time
_-... ``20"_for _submitting _o_n _time ....................................................
- "0" for failing to submit accurate report
with back-up material on time
- "20" for submitting accurate report on
time
....................................................................................................................................................................................................................................
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.
Possible score of 0 to 20:
- 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
commitments in Service Partnership
Marketing Plan (up to 10 points pro-rated
for participation on commitments)
Possible score of 0 to 20:
10 Points for attendance at Governing
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
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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:
• Identify referral needs during the Family Group Conference process and
subsequently provide client and City with copies of appropriate referrals.
• 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
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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
• Irispection 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.
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Training Requirements
Frontline personnel (those conducting trainings) will be required to complete the
following trainings prior to service provision:
Family Group Conferencing ^ Program Overview Training
^ Family Group Conference Booster
Training (for certified facilitators)
^ Community OS Software Training
^ Client Evaluation Survey Training
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
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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:
EXHIBIT "B"
INVOICING
The Contractor agrees to provide the invoicing and services documentation as
indicated in the Monthly Progress Report, Monthly Invoice Report, and Status Report
Form, as attached to this Exhibit, by the third (3rd) of the subsequent month.
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EXHIBIT "C"
ATTACHMENTS
The following documents are attached:
• Referral Form (2 pages)
• Family Group Conference Forms (10 pages)
• Monthly Progress Report (1 page)
• Monthly Invoice Form (1 page)
• Status Report Form (1 page)
• Services Evaluation Form (1 page)
• Programmatic Site Visit Form (9 pages)
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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 Resident ^ Status Pendin
Primary Language Race/Ethnicity
^ English ^ Spanish ^ Creole ^ Other ^ White, Non-His anic
p
^ Hispanic
^ Black, Non-His anic ^ Other
Address2ip Code Home Telephone/ Work Telephone
Marital Status Housing Status
^ Single
^ Married ^ Divorced
^ Se arated ^ Domestic Partnership
^ Other ^ Own ^ Rent
^ Homeless ^ Other ^ Live w/others
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
M-DCPS ID # ^ Fienberg Fisher K-8 Center
^ North Beach Elementary ^ Nautilus Middle
^ Miami Beach Senior Hi h
Services History
Food Stamp
Reci lent ^ Yes
^ No ^ Pending Section 8
Reci lent ^ Yes
^ No Pending
SSA Benefits
^ Yes -Amount $
^Pendin Medicaid/Medicare
Reci lent ^ Yes
^ No ^ Pending
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
^ Legal 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 andlor 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
^ GLBTQYouth ^ 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 -
Shelter
^ Affordable ^ MBCDC
Housing
^ Transitional ^ Douglas Gardens
^ Disability ^ Legal Services
Benefits
^ Immigration ^ FIAC
Services ^UNIDAD
^ Landlord/Tenant ^ Le al Services
^ Medical ^MBCHC
Services
^ Dental ^MBCHC
Services ^UNIDAD
^ Mental
Health ^ Douglas Gardens
^ 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
^ Emergency ^Culmer Ctr.
Help ^ Edison/Little
River Center
^ LHEAP
L__I Academic ^ Aspire
Tutoring ^Ayuda, Inc.
^ Boys/Girls Club
^ MB - OCS
^ Youth ^ Aspire
Development ^Ayuda, Inc.
^ JCS #3
^ Employment ^ CAA #2
^ JCS #1
^ Teen Job Corps
^ American Veterans' Food
6632 Collins Avenuel305.867.6060
^ Alliance for GLBTQ Youth
1175 NE 125th St/1-866-634-8087
^ Aspire
4100 NE 2nd Avenue/305.576.8494
^ Ayuda, Inc.
13899 Biscayne Blvd Suite 123
North Miami Beach/ 305.864.6885
^ Boys 8 Girls Club
1245 Michigan Avenue/305.673.7760
^ Central Intake
2500 NW 22nd Avenue/305.638.6540
^ Community Action Agency #1
6100 NW 7`" Avenue/305.756.2830
^ Community Action Agency #2
810 NW 28`" Street/305.638.4672
^ Culmer Service Center
1600 NW 3'd Avenue/305.579.2820
^ Dept. of Children & Families
945 Pennsylvania Avenue/305.535.5401
^ DHS/Adult Day Care
150 - 79`h Street/305.571.4342
^ Douglas Gardens CMHC
701 Lincoln Road/305.531.5341
^ Douglas Gardens/Mayfair
1960 Park Avenue/305.531.5341
^ EHEAEP
395 NW 1S1 Street/305.347.4685
^ EdisoNLittle River Service Center
150 NW 79`" Street/305.758.9662
^ 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`" Street/305.947.8093
^ 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 -17`" Street/305/6737491
^ 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 ~` Street/305.770.3131
^ St. Joseph's Church
8670 Byron Avenue/305.866.6567
^ 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' Street/305.532.5350
^ Other
Miami Beach Service Partnership -Universal Referral Form Back -Revised August 2008
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- - =Absent
Natural Support Map
O =Female
= Male
Q =Provider
Miami Beach Service Partnership Project
INVITED PARTICIPANTS OF THE FAMILY GROUP CONFERENCE (FGC)
Youth's Name: Student #:
Parent's/Guardian's Name:
Preferred Location, Date & Time of FGC:
Mother:
Father:
Guardian: ~
Care Giver:
____
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r _ _..._.~ _ .__.__._ ~ . ~ __ ~ _.__. ______ __ _ _ __ .~__._ ._ _.____..__ .._ _______.. ___ _______ ________.__ ~ _ _ _ __
xtended Family:
Extended Family:
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.........___~....__._.._.._.___.._____.__......_..__....._._..._....._._..___.r_._..__..__._...,_._,_,.._~.._.._____._____....____._. .........._.. ____._..,.._._...,~_......_._ ._.,........_______
" ~'""'"""""`""' Page 1 of 1
= Strong -
--~--~--~--~-- =Stressed
---------- =Weak
- - =Absent
Natural Support Map
O =Female
=Male
Q =Provider
Name T e of Su ort/Relatonsh s, ete.
T: CHOICES/MB2007trnoFrn ma n
Eco-map
An ecomap is structural assessment tool used to visualize family member's contact with the
larger systems. In our case, with the child(ren) it is used to illustrate the current
relationships and systems of support.
- In pictorial for, outlines relationships between individuals;
- The flow of resources and support (in & out) can be shown.
- Shows dynamics between the subject child and their family support system/agency
support, etc...
1. Solid lines ( )indicate strong relationships (the thicker the line the stronger the
tie);
2. Dotted lines (- - - - - -) indicate weak relationships;
3. Crossbars (--/--/--/--/-) on the line indicate stressful relationships;
4. Absence or distance of lines ( ; - )indicate no or distant connection;
S. Arrows signify energy or resource flow (~~);
6. O=female; ~ =male; Q=provider;
T/7A-CHOICES: MB2007tTmgEcomap
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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
r1
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Contract #;
Invoice Date;
Bill To:
Office of Community services
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
C E
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~.
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
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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 feedbacl~
Content
N/A Poor Fair Good Excellent
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
N/A Poor Fair Good Excellent
Presentation of information ^ ^ ^ ^ ^
Participation by attendees encouraged ^ ^ ^ ^ ^
Discussions managed well ^ ^ ^ ^ ^
Questions responded to satisfactorily ^ ^ ^ ^ ^
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 aspect of the service did not meet your expectations?
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