Agreement w/ Geiry Sterling x014 -- o�77Ed
PROFESSIONAL SERVICES AGREEMENT
BETWEEN THE CITY OF MIAMI BEACH, FLORIDA
AND GEIRY STERLING
FOR YOUTH SERVICES
RELATED TO THE CITY'S SERVICE PARTNERSHIP INITIATIVE
THIS AGREEMENT made and entered into this 1 st day of November., 2011, 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, Florid
33139, and GEIRY STERLING, (hereinafter referred to as Contractor), whose address
is 2607 NW 10 Ave. #201 Miami FL 33127.
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 attendance tracking and truancy intervention services for
up to two hundred thirty (230) youth and their families in accordance with The
Children's - Trust Miami Beach Service Partnership Grant, dated November 1, 2011.
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 attendance tracking, initial written
communication, follow -up communication, school or home meeting, assistance in
development of Care Coordination Plan services, and Care Coordination Plan
Meeting sessions for up to two hundred thirty (230) youth and their families at
Nineteen Dollars and Forty -Four Cents ($19.44) per each hour worked for up to five
hundred forty (540) hours, for a maximum not to exceed Ten Thousand Four
Hundred Ninety -Seven Dollars and Sixty Cents ($10,497.60).
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 Ten
Thousand Four Hundred Ninety -Seven Dollars and Sixty Cents ($10,497.60).
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
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Miami Beach Service Partnership
designee, who shall be the Division 'Director, Office of Community Services.
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, 201
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, 2012.
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.
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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
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 Citv
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
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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
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 pa hereto, and approved by the C
-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
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shall be valid unless amended in writing, signed by the parties hereto, and
approved by the City.
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.
Contractor agrees to submit its agency financial audit to the City within 30
9 g Y Y
days of completion.
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.
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Miami Beach Service Partnership
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 331.39.
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 Vl" 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 sha11 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 1 shall contain
endorsements providing that written notice shall be given Ito the City at least thirty
(30) days prior to termination, cancellation or reduction in coverage i`n,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 fora
4.1 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 a_n
liabilities under this Agreement, and the services, responsibilities and Liabilities of
s ub - contractors, and any other person entity a ctin g under the dire ction or contr
of Contract&. Whenthe term "Contractor" -is used�iri Phis Agreement; it shall
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
. 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).
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Miami Beach Service Partnership
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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
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 he performance t pe ormanae 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 past of th,is .
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 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 per
hereunder may - be - delivered personally to the representatives of the Contractor and
the City listed below or may be mailed by registered mail.
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Miami Beach Service Partnership
Until changed by notice in writing, all such notices and communications shall
be addressed as follows:
TO CONTRACTOR:
Geiry'Sterling
2607 NW 10 Ave. #201
Miami, FL 33127
(786) 547 -8998
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 JURISDICTION/VENUE
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, CONTRACTOR AND CITY
EXPRESSLY WAIVE ANY RIGHTS EITHER PARTY MAY HAVE TO A TRIAL BY
JURY OR ANY CIVIL LITIGATION RELATED TO, OR ARISING OUT OF, THIS
AGREEMENT.
4.19 ENTIRETY OF AGREEMENT
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
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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
$1,00.0.
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.
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Miami Beach Service Partnership
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 O F MIAMI BEACH, FLORIDA
ATTEST.
Q
City Clerk May r
l
Date Date
FOR .CONTRACTOR
ATTEST:
B
WitAes Signatur
Geiry Sterling �.
Witness Prinfeb Name
Date Date
APPROVED AS TO
FORM & LANGUAGE
OR EXECUTION
. _. ity Atfdrn Date
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EXHIBIT " p"
"SCOPE OF SERVICES"
The Contractor agrees to provide the following services to youth referred_ to the
Success University program:
Client Identification & ` School Records from ISIS system
Recruitment
........................................ .. ........................................................................ ..................................................................... .......................................................................................... :..............:....................:................................................................................................... ........:... .....
......
Enrollment Meeting Programmatic Sign In Form ( attached ...: __.__ _.__...__:..__..._..._.... _.......
................. _..__ .
.__._....___ _.....
Assistance with completion of Care Coordination Plan (attached)
CareCoordination Pl ................ ...... ................_ ... -.................. _. ..___............:--- .- _- __..__ _ _ ..
..._..........._...___._.._.......................__._...-.._....- __ .......... -._ __ ............... _ __-_
....._.....-_._-_.__...._..._...__._..-.__..__-......_ _ _ _ _
.-_._-_-.._......._.._..--_..--.----_.._-_.-__....--
Ongoing communication with ' Care Plan Contact Form (attached)
parents and students
Caro ..__....._ ...... i ....................__-_..- __--- _.- _.__..._._..___......_, .......__.___..__..._......_....-_..........
....._. 9 ...
............ ...... ..... ...__-___.__........_...._...-. _- __..__.._.._._._._....._..... -...--.-.--_.-_..._._:._...____. ... _..._._..__.-__.-_-.__...___._..._ .......... ..._......__.._....:....:_. ....._._ ..... ._..._..._....._..
an Contact Completed Care Plan Contact Form (attached);
Documentation of service provided on Community OS
Software; Amended Care Plan uploaded to Community
OS if tri ered
._.__..-__-_._._.._.__ -__ 9. 9___.__..___._.._____....._.. ..._._-- ._._._W_..___- _.._ -__._ _._- _..__.- .._._._._........__.. -__ .. _...._._._. __._- .........._._._...._._.._.
Related Definitions:
Client Identification & Recruitment — Students attending Miami Beach Senior High
School are identified and recruited in accordance with the eligibility criteria deemed
by 'The Children's Trust. Documentation of client eligibility must be provided.
Recruitment is ongoing until the program is full. ISIS school records must include:.(a)
Parent Information Page; (b) Student Information Page; (c) Previous School Year
Absences; and (d) Current School Absences.
Enrollment Meeting — The Enrollment Meeting takes place at the client's school or
home and must be attended by the youth student, parent or guardian of the youth,
Community Involvement Specialist and one representative from the City of Miami
Beach. At the Enrollment Meeting, the Intake & Assessment service is scheduled, to
the family's convenience. The Enrollment Meeting is documented by the
Programmatic Sign -In Form
Care Plan Contact - The care plan contact service is conducted with the client and
his /her parent and can be done via phone call or in person. It is to take place
between seven (7) and thirty (30) days following the initial Intake & Assessment. The
°purposes :of ,the, "c4re�plah'. contact are to: (a) review student absenteeism and
encourage school atterida'nce; (b) determine if referrals have been followed up on; (c)
review, implement; a ° nd "amend the Care Plan as necessary; and (c) continue to assist
participants in meeting their overall goals. Care Plan will be posted on Community
OS within. three business days of receipt of intake; the Care Plan must be consulted
prior to the,Care Plan, Contact or 30 days have passed following the initial Intake
& Assessment, the are Plan Contact will become the responsibility of the City and
the Contractor will no longer have the opportunity to complete or bill for said contact.
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Miami Beach Service Partnership
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 (attached) with copies provided
to the client and City, via Community OS.
Services will be deemed as provided when the following documentation is provided
within the noted timeframes:
Client Identification ISIS school records: (a) Parent 48 business hours from
& Recruitment Information Page; (b) Student provision of service
Information Page;' (c) . Previous
School Year Absences; and (d)
_C Scho Yea Abse _
Enrollment Meeting M Programmatic Sign -in Form TCT 48, business hours from
Enrollment forms, Authorization & I provision of service
Release Form , _
F
> ................. ............................ ................_.............. _._... __....._ .: _._..._.... ... _.. _ _ _ _ .... a ....... .. 3
Assistance with I Care Plan Contact Form; Amended 72 business hours from
completion, of Care Care Plan, if triggered; Notification F the identification of
Email to Program Coordinator client need
n
Coordinatio Plan g .......................................................... .............................:.
.....
................................................................................... ..... ............................... . ry ..................... .....................,......... ..................
Ongoing Care Plan Contact Form; Amended 72 business hours from
- communication with Care Plan, if triggered; Notification 1 provision of service
parents and Email to Program Coordinator
students
...... ...... ....... _ .................. .............................. __ ....... .......... _ ...... ,............ .... _........ _ ....... .__._.............. ...._......... ......
Care Plan Contact Care Plan Contact Form; Amended = 72 business hours from
Care Plan, if triggered; Notification provision of service
Email to Pro gram Coo rdinat or
If the contractor fails to submit required, accurate service documentation in the
timeframe allotted more' than two times in a calendar month, the Contractor will .forfeit
two percent (2 %) of the combined billed total " for the month 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 Contractorvia check within 30 days.
Service Deliverables
Vn- - - • .
Client Identification & i 1 for each of up to School or Client ;Ongoing
Recruitment .230 youth clients Home
.......... .
........................ .........................
...._.
__._
Enrollment Meeting ° 1 for each of up to 1 School or Client Within 30 days of
230 youth clients Home identification of need
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Miami Beach Service Partnership
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................ : .............................................................. . .............................................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................
Assistance with 1 for each of up to Client Home Within 30 days of
completion of Care 204 youth clients E Intake & Assessment
Coordination Plan
........................ .. ..._...............................................
Ongoing Ongoing for up to By phone, email, Ongoing
communication with 230 youth clients and at school or at
parents and student ; the ir fa mi li es h ome
Care Plan Contact s 1 for each of up to Via Telephone or All Care Plan Contacts
204 youth and their at Client Home = will be completed
families within thirty (30) days
i of Intake
................................................ . ...................................................... : : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......................... ...............................
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.
Engagement Strategies
The Contractor will adhere to the following engagement strategies in the delivery of
services:
• Evaluate and discuss school attendance with both the youth client and his /her
primary caregiver at every encounter, be in via phone or in person.
• 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 the
importance of adhering to school attendance policies.
Provide client and his /her parents and /or guardians information regarding the
Care Coordination process and other available services.
• Reintroduce the services available through the Program at each client
interaction.
• Document every interaction with client via Community OS.
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
City of Miami Beach - GEIRY STERLING Page 14 of 20
Miami Beach. Service Partnership
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
-9 Verification on File
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 Close Out Follow Up Contact
Governing Board Attendance
The Contractor is required to have representation at- each calendared Governing
Board meeting. In the event that the designated representative cannot attend in
person, arrangements can be made fora telephonic connection.
If the Contractor fails to have representation at two meetings, the City reserves the
right to reduce contracted service levels at its sole discretion.
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 and will
create the event in the Success University Master Calendar on the Community OS
Software.
City of Miami Beach - GEIRY STERLING Page l 5 of 20
Miami Beach Service Partnership
The Contractor must provide its availability for intake services inclusive of the number
of staff members, the hours they are available and the languages they speak. This list
must be up -to -date at all times.
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, Subcontractor Monitoring Tool,
will be used to guide inspections and monitoring visits. (Copy included herein.)
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 on a
quarterly basis.. One final Partner Performance Rating will be
• Timely and accurate submission of monthly progress report
• Timely and accurate submissions of monthly financial reports (reimbursement
requests)
• Delivery of contracted service units (percentage of services completed out of
referrals provided)
• 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:
e • 0 E• 0 e 0
Timely and accurate submission of ➢ "0" for failing to submit on time
monthly ..........:.......::......:.........................:...... ............................... ➢.....��_15" for submitting on time
... .
........................................................................................................................... ...............................
Timely and accurate submissions of ➢ " 0" for failing to submit accurate report
monthly financial reports (reimbursement with back -up material on time
requests) ➢ "15" for submitting accurate report on
time
Delivery of contracted service units Possible score of 0 to 50 based upon
completion of projected service units.
Score is calculated by dividing the
completed number of service units by the
total number of referred service units.
........................................................................................................................................................................................................................................... ...............................
Attendance at Miami Beach Service Possible score of 0 to 20:
Partnership Governin Board and related 10 Points for attendance at Governin
City of Miami Beach - GEIRY STERLING Page 16 of 20
Miami Beach Service Partnership
.......................... . . . . . . . . . ............... . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................... . . . . . . . . . . . . . . . ........... : ....................... . ................ : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................... . . ... . ................................. : .................................................... . ..................................
. . . . . . . . . . .
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.)
Promotion & Public Relations Requirements
The Contractor agrees to receive Success University Program Brochures and make
them available to all clients during all in- person client interactions.. The Contractor
agrees to link its website to the City's Success University webpage. Such link .must
be in place prior to the execution of this contract.
The Contractor agrees to indicate its membership in the Partnership in all self-
produced marketing materials that are produced for the benefit of youth and families..
Train -ing Requirements
Frontline personnel (those conducting : trainings) . will be required to complete the
following trainings prior to service provision: .
Intake & Assessment, Care Plan Contact, ❑ Program Overview Training
& Close Out Follow Up Services Q Intake & Assessment Training
Community.OS Software Training
Client Evaluation :Survey Training
0 Care Coordination Training
Ej FGC Audit Training
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:
ir
bing
Program Overview Training _ $66.56
"_.
__. _.._. ......_..._... _.__. " _ _..:
e m
. -. _ ...........
_....._......
Intake &Assessent Training
$133.12
......................... ...... .......................... g ..:.................. ............................... _ .............................. . ......................... ............................... ......, ................................................................................. ...............................
Community OS Training $133.12
............ ........................................... .. ...... . ............. .................................... . ................... .......... ................................................................................................................................. ............................................................ .... ................ ..... .................................... ...............................
Client Evaluation Survey Training .... ...:...........:...._..._.._... _:._....:.......................:.. ...._.......................... _._ .. ---- - ------ ._... $16.64.
..........
...__ _ ...........................
FGC Audit Trainin _ �� $66.56
_ _..__
Follow Up Training $66.56
._.. . . " 9 _._...._ .............. _................_........ ..
The Contractor agrees to send at Feast one representative to attend a City - sponsored
grant writing workshop by July 31, 2012.
City of Miami Beach - GEIRY STERLING, Page 17 of 20
Miami Beach Service Partnership
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
i
City of Miami Beach - GEIRY STERLING Page 18 of 20
Miami Beach Service Partnership
Y
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 5:00 PM on the third (3 of the subsequent
month.
City of Miami Beach - GEIRY STERLING Page• 19 of 20
Miami Beach Service Partnership
e.
EXHIBIT LLC77
ATTACHMENTS
The following documents are attached:.
® Referral Form (2 pages)
® Care Plan Contact Form (1 page)
® Close Out Follow Up Form (2 pages)
o Program Evaluation Forms (2 pages)
® Monthly Progress Report (1 page)
Monthly Invoice Form (1 page)
Programmatic Sign -In Form (1 page)
0 Subcontractor Monitoring Tool (4 pages)
City of Miami Beach - GEIRY STERLING Page 20 of 20
Miami Beach Service Partnership
Data Tracker #
Miami Beach S hers Referral Form
Client Information
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- Hispanic ❑ Hispanic
❑ Non -His an,ic ❑ Other
Address /Zip Code Home Telephone/ Work Telephone
Marital Status Housing Status
❑ Single ❑ Divorced ❑ Domestic Partnership ❑ - Own ❑ Rent ❑ Live w /others
❑ Married - ❑ Se arated ❑ Other ❑ Homeless ❑ Other
Others in Household Household Income
❑ Child ❑ Adult ❑ Employment - $
❑ Child ❑ Adult ❑ SSA ❑ SSI ❑ SSDI $
❑ Child ❑ Adult ❑ Child Support $
❑ Child ❑ Adult F P ension $
❑ Child ❑ Adult ❑ Other $
Child ❑ Adult ❑ Other $
For youth only = For youth only
Current Grade Level Current School
❑K D ❑2 ❑3 ❑4 El El El 17718.
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 High
Services History
Food Stamp ❑ Yes ❑ Pending Section 8 ❑ Yes ❑ Pending
Recipient ❑ No Recipient ❑ No
SSA Benefits Medicaid /Medicare... ❑ Yes ❑ Pending
❑ Yes - Amount $ ❑ Pending Recipient ❑ No
Current Service Current Service Needs
Providers ❑ Child Care After Care
ASPIRA ❑ Lutheran Services ❑ Disability Benefits
❑ AYUDA ❑ Miami Beach CHC ❑- Disability Services
❑ Barry University ❑ M -Dade Housing Authority ❑ Educational Services
❑ Boys & Girls Club ❑ SSA ❑ Employment Assistance
Catholic Charities ❑ So. Fl. Ctr. Family Counseling ❑ Food
❑ CAA- ❑ Stand Up! For Those Can't ❑ Housing Services
❑ City of Miami Beach ❑ Switchboard of Miami ❑ Legal Services.
DCF ❑ Teen Job Corps ❑ Medical Services
❑ Douglas Gardens F Veteran's Affairs ❑ Mental Health Services
HACOMB ❑ Volunteers of America ❑ Substance. Abuse Services
❑ Institute for CFH ❑ 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 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 February 2011.
•
F Child ❑ Ayuda ($) - • '
Care [:1 Medical El Miami Beach El Alliance for GLBTQ Youth
1175 NE 125th St/1- 866 - 634 -8087
❑ Aftercare ❑ Ayuda ($) Services Community Health ❑ Aspira 4100 NE 2nd Ave. 305.576.8494
❑ Boys /Girls Club Center ❑ Ayuda 7144 Byron Ave. 305.864.6885
❑ MB PAL ❑:Dental ❑ MBCHC ❑ Barry University - 305- 899 -3742
❑ MB Recreation Services ❑ Attached ❑ Boys & Girls Club - 305.673.7760
• • Brochure ❑ The Bridge 2810 N.W. South River
❑ Clothing ❑Neat Stuff Drive / 305 ❑ Mental ❑Douglas Gardens 1771 Central Intake 2500 NW 22 "d Ave.
❑ Dress.for Success Health ❑ JCS #1 /305.638.6540
• ❑ Institute CFH ❑ GINS /FINS 1825 NW 167` St. Ste. 102:
❑ Youth ❑ Institute CFH / 305.474.1707/ 305.474.1738
❑ Community Action Agency #1
❑ JCS #1 ❑ Rent
❑Stand Up ($) ❑CAA #1 6100 NW 7` Avenue /305.756 :2830
Assistance ❑ CAA #2 ❑ Community Action Agency #2
❑Barry University ❑ Edison /Little River 833 6th St 1 Fl. 33139 /305 - 672 -1705
❑ GLBTQ ❑ Alliance for.GLBTQ ❑ HAND ❑ Culmer Service Center
Youth Youth • � •
1600 NW 3` Ave. 305 - 438 - 4161.
❑ Dept. of Children & Families
❑ Adult Douglas Gardens ❑ Detox El Crisis 945 Pennsylvania Ave'nue/305.535.5401
F JCS #1 El Douglas Gardens CMHC
El Stand Up ($) ❑ Addiction El Central Intake 1680 Meridian Ave. 305.531.5341.
El Institute CFH Services ❑ EHEAEP 395 NW 1 St 305.347.4685
El Edison /Little River Service Center
El family �❑ Ayuda (Parents Now] • • • 150 NW 79 Street/305.758.9662
F] JCS. #1 ❑ Disabled ❑ Miami -Dade
❑ Elder Transit El 3000 Immigrant Advocacy Center
❑ Stand Up ($) 3000 Biscayne Blvd./305.573.1106
❑ Speech El Playing the Game
HAND 1(877) 994 -4357
Therapy of Life ($) ❑ Elder Program ❑ EHEAEP ❑ Institute for Child & Family Health
❑ Emergency ❑Culmer Ctr. 430 West 66` St. Hialeah /305 -558 -2480
° - - ❑ JMH Crisis Center
❑ Referral ❑ JCS #3 Help ❑ Edison /Little River 1611 NW 12 Avenue/305.355.7377
❑ DHS Day Care ❑ LHEAP ❑ JCS #1 300 41 St. #216/305.576.6550
LHANC — MB , - - • ° F JCS #2 2056 NE 155 St.305.947.8093
❑ LHANC — RT ❑ Academic ❑ MBSH Library
JCS #3 Access /Referrals 305.576.6550
❑ MB - OCS Tutoring ❑ MDC Libraries
[:1 LHEAP 2902 NW 2 " 305.438.8614
❑ UNI � Dial - Teacher ❑Legal Services of Greater Miami
❑ 3000 Biscayne Blvd./305.576.0080
Home ❑ MD — Human ❑ Legal Aid Society 123 NW First
Care Services ❑ Youth ❑ Ayuda [TALL] Avenue, Suite 214 (305) 579 -5733
Development ❑ 'Aspira! (C /ub] ❑ Little Havana /Rebecca Towers
❑ JCS #3 150 Alton Road/305.572.3736
❑ Employment ❑ CAA #2 '❑TACO.LCY ❑ Miami Beach CDC
(ADULT) ❑ JCS #1 (F;4'ST] 945 Pennsylvania Avenue /305.538.0090
❑ Unidad ❑MDG - ❑ Miami Beach CHC #1
El Youth Co - Prevention , 710 Alton Road/305.538.8835
❑ Employment ❑ CAA #2 ❑ Miami Beach — Community Services
❑ .CINS /FINS" 1700 Convention Ctr. Dr. / 305 - 673 -7491
(YOUTH) ❑ JCS #1 ❑Social/ ❑ Playing the
y g El Miami Beach- Homeless
❑ Teen Job Corps Emotional Dev. Game of Life ($) 55517 1h St. / 305 -604 -4663
❑ Unidad ❑Youth ED MB Police Athletic League
❑The Village 999 _ 11` Street/305.531.5636
` Substance Abuse South
r_1 Emergency E:1 JCS #2 El Miami Beach - Recreation
Food ❑St. Joseph's Church 2100 Washington Avenue/305.673.7730
° ❑ Miami -Dade Human Services
❑St. Patrick's Church 4500 Biscayne Blvd./305.576.2511
p ❑ `DCF El Habits ❑ Miami Beach - ❑Miami -Dade Transit
❑Food Stam s � Teens OCS
111 NW 1 st StreeU305.770.3131
❑7. Habits 1:1 Miami Beach — El Playing the Game of Life 7144 Byron
❑ Discount ❑Miami Beach - Families OCS Ave. 2nd Fl. 305 - 864 -5237
Food OCS El Employment El Teen Job Corps El St. Joseph's Church
° • . 8670 Byron Avenue/305.866.6567
❑ Counseling ❑ Barry University ❑ St. Patrick Church
❑ Emergency ❑ MB — Homeless ❑
Shelter Transportation El Miami Beach — 3716 Garden Avenue/305.531.1124
OCS ❑ Stand Up! 305 - 864 -5237
❑ Affordable ❑ Miami Beach CDC ❑Emer- ❑ Switchboard 305 358 -4357
Housing Emergency ❑Miami Beach [:1 TACOLCY 6161 NW 9th Avenue (305)
Ga Services OCS 398 -1770
Teen Job Corps 305:868.0635
Disability ❑ Legal Services ❑ UNIDAD 833 6' Street/305.532.5350
❑Landlord/Tenant ❑ The Village 400 NE 31 St 305 -573-
❑Family Law ❑ Legal Aid 3784
❑ Immigration ❑ FIAC ❑Youth Co -op 7900 NW 27 Ave. 305 -693-
2060 or 305 - 643 -3300
❑ Other
Miami Beach Service Partnership - Universal Referral Form Back — Revised December 2011 2
T
Care Plan Contact Form
Success Universit y Case Worker:
_ Partner Agency;
Contact Date:
,= Data Tracker Date:
r
Client *Name _ "iris; " d d E u
Client Address Y.. 3� eni x'i ,
Home - Telephone Cellular Telephone E -Mail Address,
Contact Date Contact Location
0 Home 0 Other 0 Phone Contact
Indicate Persons Present 0 Client 0 Mother/ Step- Mother 0 Father/ Step- Father
O Other Females # 0 Other Males #
Phone Call Log Date: Date: Date:
Time: Timer Time:
71 Message 71 No Answer 77 Message 0 No Answer 0 Message O No Answer
Case Notes
Please provide an update on the status of referrals issued at-time of intake and progress on Care Plan.
Next Scheduled Encounter
Indicate your next scheduled encounter with client and location.
Date Time Location Purpose
Q Family Cbnferencing
O Follow -up Home Visit
0 No follow -up expected
The information I have provided is true and accurate to the best of my knowledge.
Client. Authorization Staff Signature Date
Success University Care Plan Contact Form 1
Revised December 2011
i.
Close Out Follow -Up Form Care Coordinator:
Success ' Partner Agency:
Contact Date:
Data Tracker Date:
�
/ ``• � ° f i s. f i c,.,Ck i it
fl
Client Name is -Irs<" 141iddIe L. t
t
Client Address �' na i����,r� n' :# Zir) �;�Fr C r,
Home Telephone Cellular Telephone E -Mail Address
Contact Date Contact Location
` O Home M Other O Phone Contact
Indicate Persons Present 0 Client 0 Mother/ Step- Mother ® Father/ Step - Father
O Other Females # D Other Males #
Phone Call Log Date: Date: Date:
Time: Time: Time:
O Message O No Answer O Message O No Answer O Message 171 No Answer
Referral Follow -up
Please indicate the service needs recognized in prior visits and their subsequent follow-u
Service Need Agency Referred Current Status
Current Home Status
Please provide an update on the client and family's status for each category below.
Housing
(Housing .situation
including affordability)
Financial
(Employment, living costs,
etc.)
Familial
(Family dynamics,
- - relationships, etc.)
Educational
(Academic progress,
school attendance, etc.)
Health
(Physical, mental and
dental
Success University Audit
Indicate the Success University components/services that have been accessed by client as of this contact.
1 C3 Intake & Assessment O Referral Services ® Family Conferencing 0 Mental Health
717 Habits Teens /Families ® Employment Services 71 MB Helpers Parent ® Discount Food Program
Success University Close Out Follow Up Form I
Revised December 2011
Truancy Reduction Update
Indicate the status of the client's truancy reduction goals. Reference the Care Coordination Plan and /or FGC
Attendance Contract
Additional Narrative /Observations
Indicate any additional comments including observations regarding the client and /or family.
New Needs Identified
Indicate any new needs that require referral services.
Need. Identified Referral Provided /Agency
Service Reminders -
Please ensure you review all of the items below with client and family.
Service Reminder Yes No
-Did you ensure that all contact information is accurate and up-to-date? 171 D
Did you provide family with this month's Discount Food Program information? D D
Did you remind client and parent of the importance of adhering to the Attendance Contract? O O
Next Scheduled Encounter
Indicate your next scheduled encounter with client and location.
Date Time Location Purpose
O Family Conferencing
® No follow -up expected
71 Other:
I understand and have authorized this release and exchange of information between Service Partnership agencies in order to
provide me and /or my children) 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
Success University Close Out Follow Up Form 2
Revised December 2011
SUCCHS Service Evaluation Form
UNIVER
*M. � a5 Miami Beach Service' Partnership
Intake Worker: Service /Training:
Date: Location:
Please take a moment to evaluate the Success University program. Rate each item from poor to
excellent. Your input is used to improve services. Thanks in advaizce for your feedback.
Content
N/A Poor Fair Good Excellent
Objective and scope of services ❑ ❑ ❑ Q ❑
Organization of events and agency staff ❑ ❑ ❑ ❑ ❑
.Understandability of communications with staff ❑ ❑ ❑ ❑ ❑
Relevance of event /services to your objectives ❑ ❑ ❑ ❑ ❑
Program Staff
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.
What was best about the program?
What aspect of the program did not mee you expectations?
sU 'CESS Formulario de evaluacion de servicio
UNIVERSITY
t =x5„A =rt3°R =0 ;5 Miami Beach Service Partnership
Encuestador: Entrenamiento:
Fecha: Lugar:
Por favor tome un momento de su tiempo para evaluar el programa de Success Univeristy.
Califique cada objetivo de .inferior a excelente. La informacion recibida sera utilizada para
mejorar los servicios ofrecidos. De awemauo muchas gracias por su ophdo'll.
Contenido
N/A, Inferior Regular Bueno Excelente
Objetivo y proposito del entrenamiento ❑ ❑ ❑ ❑ El
Organizacion del evento y empleados de la agencia ❑ ❑ ❑ ❑ ❑
Comprension de la informacion comunicada por el ❑ ❑ ❑ ❑ ❑
empleado
t
Relevancia del evento /servicio a sus objetivos ❑ ❑ ❑ ❑ ❑
Instructor /a
N/A Inferior Regular Bueno Excelente
Presentacion de'la informacion ❑. ❑ ❑ ❑ ❑
Participantes fueron alentados a participar ❑ ❑ Q ❑
Discusiones se manejaron apropiadamente ❑ ❑ ❑ ❑ ❑
Preguntas fueron respondidas satisfactoriamente ❑ ❑ ❑ ❑ ❑
Experiencia -en general
N/A Inferior Regular Bueno Excelente -
Experiencia en general del servicio ofrecido ❑ ❑ ❑ ❑ ❑
Por favor escriba cualquier pregunta que pueda tener sabre el programa.
�Que fue lo mejor del programa?
�Que aspecto del programa no cumplio sus expectativas?
i
M ]AAMBEA C H
Monthly Project Summary
Office of Community Services
Re po rti n g'..A ep'cy
Project Success Universit
Repoiing Period ❑November /11 ❑ December /11 ❑ January /12
❑ February /12 ❑ March /12 ❑ April /12
❑ May/1 2 ❑ June /12 ❑ July /12
Please provide a narrative summary for each section, as applicable.
Services Il�anaget�ent (Please provide narrative regarding the .1 very
of seNJges. includtn
roblems confronted lementation this a'st. month
iq
Cisent Success Story:(Please include a(n} example of clients uccess indicatin how services .were beneficial
or made_a meanm ful Impact
P repared By bignature Date
Office of Community Services /Grant Reimbursement Request
Grant Name Funder
Miami Beach Service Partnership /Success University The Children's Trust .
Contract Number Awarded Amount
1179 -1090 Resolution 2012 -06 $ -
Reporting Period
Initials
Expended Thus Far $ - Available Balance $ This Request $ -
Balance Remaining $ -
g ry Account;# Category Total Previous Requests Balance;Ava
Line ilable This- Request,
Item Cate o
'Intake & Assessments ($140) $ - $ $ - $
Care Plan Contact ($18) $ - $ - $ - $ _
Close Out Follow -Up ($100) $ - $ - $ - $ _
Family Group Conferencing ($175) $. - $ _ $ _
Employment Services ($9.86/$24.44) $ $ _ $ _
Mental Health Services ($195/$75) $ - $ - $
$ $ $
TOTALS $ $ - $ _ $
' Checklist
Not
Documentation Submitted Submitted
Service delivery documentation
List of clients served and services provided
Leverage /Match
Staff Member Hourly Rate Hourly Benefits .# of Hours Line:Total
T
Space .& Other in -Kind Value /Unit Cost Unit.Quantity Line Total
$' $
.. $ _
$ -
I certify that the information provided above is accurate to the best of my knowledge and that I have included all documentation required to ascertain the
delivery of services as delineated in our contract with the City of Miami Beach.
Signature of Authorized Agency Representative Date
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