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Agreement w/ Ayuda, Inc. 77YS PROFESSIONAL SERVICES AGREEMENT BETWEEN THE* CITY OF MIAMIBEACH, FLORIDA AND AYUDA, INC. 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, Florida, 33139, and Ayuda, Inc., a Florida Corporation, (hereinafter referred to as Contractor), whose address is 7118 Byron Ave., Miami Beach Fl, 33141 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. City of Miami Beach - Ayuda, Inc Page 1 of 21 Miami Beach Service Partnership SECTION 2 . SCOPE OF WORK (SERVICES) The Contractor will provide intake and assessment services for up to thirty -two (32) youth and their families,. care plan contact services for up to thirty -two (32) youth and their families, and close out follow -up services for up to thirty -two (32) 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 1 " entitled "Scope of Services." The Contractor shall report to the City of Miami Beach, Neighborhood Services Department, Office of Community Services, Division Director. SECTION 3 COMPENSATION 3.1 FIXED FEE Contractor shall be compensated for the Services, as set forth in Section 2 and Exhibit "A", as follows: (a) Provision of intake and assessment services for up thirty -two (32) youth and their families at One Hundred Forty Dollars ($140) per each intake, for a maximum not to exceed Four Thousand Four Hundred Eighty Dollars ($4,480); (b) Provision of care plan contact services for up to thirty -two (32) youth and their families at Eighteen Dollars ($18) per each care plan contact for a maximum not to exceed Five Hundred Seventy Six Dollars ($576); (c) Provision of close out follow up services for up to thirty -two (32) youth and their families at One Hundred Dollars ($100) per each follow -up contact for a maximum not to exceed Three Thousand Two Hundred Dollars ($3,200). 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 Eight Thousand Two Hundred Fifty Six Dollars ($8,256). 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. City of Miami Beach - Ayuda, Inc Page 2 of 21 Miami Beach Service Partnership 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. 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, 2012. 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 City of Miami Beach - Ayuda, Inc Page 3 of 21 Miami Beach Service Partnership Agreement; and to that extent, the Contractor shall pay all such claims and losses and shall pay all such costs and„ judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the City in the defense of such claims and losses, including appeals. The Contractor's obligation under this Subsection shall not include the obligation to indemnify the City of Miami Beach and its officers, employees and agents, .from and 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) City of Miami Beach - Ayuda, Inc Page 4 of 21 Miami Beach Service Partnership -DAYS FOLLOWING RECEIPT BY THE CONSULTANT. OF THE . WRITTEN TERMINATION NOTICE. IN THAT EVENT, ANY FINISHED OR UNFINISHED DOCUMENTS AND OTHER. MATERIALS PREPARED AND OR OTHERWISE COMPILED BY CONSULTANT PURSUANT TO ITS PROVISION OF THE SERVICES CONTEMPLATED IN SECTION 2 AND IN EXHIBIT "A ", SHALL BE - PROMPTLY ASSEMBLED AND DELIVERED TO THE CITY, AT 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 City of Miami Beach - Ayuda, Inc Page 5 of 21 Miami Beach Service Partnership 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. 4.9 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 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. City of Miami Beach - Ayuda, Inc Page 6 of 21 Miami Beach Service Partnership All insurance required hereunder "must be furnished by insurance companies authorized to do business in the State of Florida. Original certificates of insurance for the above coverage must be submitted to the City's Risk Manager at the Office of the Risk Manager of the City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139. The Contractor is solely responsible for obtaining and submitting -all insurance. certificates for its sub - contractors. 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 fora 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 City of Miami Beach - Ayuda, Inc Page 7 of 21 Miami Beach Service Partnership Contractor (which approval, if granted at all, shall be at the Manager's sole discretion and judgment). 4.14 EQUAL. EMPLOYMENT OPPORTUNITY In connection with the performance of this Agreement, the Contractor shall not discriminate against any employee or applicant for employment. because of race, color, religion, ancestry, sex, age, and national origin, place of birth, marital status, or physical handicap. The Contractor shall take affirmative action to ensure that applicants are employed and that employees are treated during their 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. City of Miami Beach - Ayuda, Inc Page 8 of 21 Miami Beach Service Partnership -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: TO CONTRACTOR: Ayuda, l nc. Attn: Diana Susi, Executive Director 7118 Byron Ave. Miami Beach Fl, 33141 (305).864-6885 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. City of Miami Beach - Ayuda, Inc Page 9 of 21 Miami Beach Service Partnership 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 the City's liability for any cause of action for money damages due to an alleged breach by the City of this Agreement, so that its liability for any. such breach never exceeds the sum of $1,000. Contractor hereby. expresses its willingness to enter into this Agreement with Consultant's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of $1,000: Accordingly, and notwithstanding any other term or condition of this Agreement, Contractor hereby agrees that the City shall not be liable to the 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] r City of Miami Beach - Ayuda, Inc Page 10 of 21 Miami Beach Service Partnership IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by th appropriate officials, "as of. the date first entered.-above. FOR CITY: CITY OF MIAMI BEACH, FLORIDA ATTEST: City Clerk Mayor Date Date FOR CONTRACTOR Ayuda, Inc., A Florida Corporation ATTEST: By: By: Secretary President Print Name Print Name Date Date Corporate Seal City of Miami Beach - Ayuda, Inc Page 1 1 of 21- Miami Beach Service Partnership it EXHIBIT "A" "SCOPE OF SERVICES The Contractor agrees to provide the following services to youth referred to the Success University program: -of Service' D . o cumentation Intake &Assessment Completed Success University Intake & Assessment Form via Communiity OS with executed consents and releases containing original signatures (attached); Copy of completed Referral Form(s) (attached); Documentation of service provided on Community OS Software ------- ......... ....... ...... ___...._......._..__._.._....... ....... .._. ........... _.......__ ...... ............_.___..._._ ...... _;.....__......-.._._-..._.-.._..._..._.._.............._......_..__........-.-...._.-_....__._._._...._____..._........-. ............. ........... .___- .........:...._..._ -.._ _.__.-.____............ ._.._ .......... _...__... Care Plan 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 __ .. _.._._ __ __ __ _......_..__._.. _ _ _ .... _ .................... _ _ _._............._.....____.-.........__...__.__.__.- __........ ......... ..............__.___............. ......................... ............. .._ ................ . ...... _...._............................... .._._ ...... ............................... .__.......... ..- _____.___._.- ___. -.____ Close Out Follow -Up Contact Completed Close Out Follow -Up form including client signature (attached); Documentation of service provided on Commun ........ . ....... ........__.__._...........__. .............. _ ......... ...................... W____ ....... .__............ _ ..... _ _..__ ........ ._._.___.__._....__' Related Definitions: Intake & Assessment An intake and assessment documents the natural supports and needs of the client and his /her family. The intake and assessment form must be completed accurately and completely and submitted to the City via Community OS software. Notification of submission of intake and assessment must-be provided via email to the Program Coordinator. The client is assigned a number in The Children's Trust Data Tracker system by the City. Intakes must be completed within thirty (30) days of referral. 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 care plan contact are to: (a) review student absenteeism and encourage school attendance; (b) determine if referrals have been followed up on; (c) review, implement, and 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. Once 30 days have passed following the initial Intake & Assessment, the Care 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. 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 City of Miami Beach - Ayuda, Inc Page 12 of 21 Miami Beach Service Partnership the Miami Beach Service Partnership Referral Form (attached) with copies provided Ao the client and City, via Community OS. Close Out f=ollow -Up Contact The Close Out Follow -Up Contact is conducted in person with the client and the client's primary caregiver. In the event that numerous attempts to make in- person contact have failed, a phone contact may substitute for a face —to —face meeting, only. upon . documentation of multiple failed in person attempts. The contact will be no less than 30 minutes in duration and the document produced must be completed accurately and in its. entirety. Follow -up contacts must be. completed within ninety (90) days of intake but no earlier than forty -five (45) days after intake date. The Program Evaluation Form (in English or Spanish) (attached) must be completed by the client and his /her primary caregiver at the Close Out Follow -Up Contact. Services will be deemed as provided when the following documentation is provided within the noted timeframes: Documentation Submissio Intake & Assessment Intake & Assessment Form on ' 72 business hours from Community OS; Notification Email to provision of service Program Coordinator Care Plan Contact Case Note Form; Amended Care i 72 business hours from Plan, if triggered; Notification Email provision of service to Program Coordinator _ _ ........................................ .................................................... .........-- ... ................_.................................................................. ........._.........-- ......... ....... _.......... ._ ............................ ................. _._....._. ...... _....._......................................................................... .....- ...... _ ..... Referral Miami Beach Service Partnership 72 business hours from Referral Form (front and back, with the identification of separate back of referral form for client need each agency to which referrals are provided) Close Out Follow -Up Close Out Follow-Up Form; Program' 72 business hours from Contact Evaluation Form; Notification Email to provision of service Program Coordinator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... 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 Contractor via check within 30 days. Service Deliverables Intake & Assessment i 1 for each of up to 32 Client Home All eligible intakes will ....yo.uth ............. ......._and.......- ............ their...........................................................-.................... .........................be.... completed within ................................................................................................... ............................... .... .... .......................................: City of Miami Beach - Ayuda, Inc Page 13 of 21 Miami Beach Service Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................ .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . families thirty (30) days of receipt of appointment _ .. ......................_..............__.............._......__..__.... _._......_..._................. _ ................................ ........... .._.......__._ _ ..._.._..___............... ......__.............._..._.... _.._ .....__...... ..... ................._.........,........_...............__............................................._._._..__ .......... ....._....._..._._.._..: Care Plan Contact 1 for each of up to 32 1 Via Telephone or All Care Plan Contacts youth and their at Client Home will be completed families within thirty (30) days .................. ....... _ .......... _ ............. .:......... ..... .................. _......... ........................ ......_..._.._._..__ ...... _.........__... ._................... ......... . _.:...__....._._..._. ..... ... _..._.........:.... _._.__- ...._.................................. of Intake ....__............. .............. ..:.__.....__. ........_..._........... ._._..; Close Out Follow -Up 1 for each of up to 32 Client Home All close out follow -ups Contact, youth and their will be completed families within one hundred twenty 20 d Y( ) s of Y com letion 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 City of Miami Beach - Ayuda, Inc Page 14 of 21 Miami Beach Service Partnership 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 • 1 -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 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 5:00 PM on the third (3 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: City of Miami Beach - Ayuda, Inc Page 15 of 21 Miami Beach Service Partnership A Forms are completely and accurately filled. "N /A" and "no examples this month" are not acceptable responses on Monthly Reports • Necessary back -up materials are included (client documentation, monthly client list, 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 accurate required monthly reports and invoices in a timely manner will result in the forfeiture of one (1 %) percent 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 Contractor via check within 30 days. 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 for a 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. 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. 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 City of Miami Beach - Ayuda, Inc Page 16 of 21 Miami Beach Service Partnership updated as necessary. The MOU must be submitted to the City of Miami Beach prior to execution of the service contract. 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 Child ren's 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: PPer.f orm:ance • ' • : ;Score T " Timely and accurate submission of "0" for failing to submit on time month) ress report ➢ "15" for submitting on time _...Y.ro r ..P ............._g_ . . W . _ . _....... P... ........... ............. .. . .. .. . ..................... 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 t ime 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 Governing Board and related 10 Points for attendance at Governing c meetin Board meetings; 10 points for C City of Miami Beach - Ayuda, .Inc Page 17 of 21 . Miami Beach Service Partnership ................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................................... : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................................................. . ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . attendance (In the event that there are no committee meetings scheduled, the value for attendance at the Governing Board meetin will be 2 0 g 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. Training 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 ❑ Intake & Assessment Training ❑ Community OS Software Training El Client Evaluation Survey Training ❑ Care Coordination Training El 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:. Trainth' Program Overview Training $66.56 Intake & Assessment Training _.......__........__.._....._....._............_...._.__...______._ _........_. ._ ..._...__.__._ g ................_......_____.._...._:___.__.___.___.__._..__._...._........_.._._._.__- ____._____.___.__..__... - $_ 13............. 2 _ ... un Commit OS Training _..... ...... _......_...____.. Y. W..__....._..._._..._.___...._ ................_ J....__._____.. .._.... . ......:_.___.__.__.._._. _.__.. _. _.. $133.12 .. Client Evaluation Survey Trainin 9. i... ............................... $16.64 ............................................................. . ................................................ ................ ....................................................................... ............................... ............................................_._................................._ FGC Audit Tra ......_.___........._.......___ . Training _._.__..._..._.._ Follo U .. p g ` $66.56 The Contractor agrees to send at least one representative to attend a City- sponsored grant writing workshop by July 31, 2012. Switchboard of Miami Registration City of Miami Beach - Ayuda, Inc Page 18 of 21 Miami Beach Service Partnership 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: WVVw. switchboard miami: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 City of Miami Beach - Ayuda, Inc Page 19 of 21 Miami Beach Service Partnership 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. I ! City of Miami Beach - Ayuda, Inc Page 20 of 21 Miami Beach Service Partnership EXHIBIT 6VY ATTACHMENTS The following documents are attached: Referral Form (2 pages) • Care Plan - Contact Form (1 page) • Close Out Follow Up Form (2 pages) • Program Evaluation Forms (2 pages) • Monthly Progress Report (1 page)' • Monthly Invoice Form (1 page) Programmatic Sign -In Form (1 page) • Subcontractor Monitoring Tool (4 pages) City of Miami Beach - Ayuda, Inc Page 21 of 21 Miami Beach Service Partnership i PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH, FLORIDA AND ASPIRA OF FLORIDA, INC. FOR YOUTH SERVICES RELATED TO THE CITY'S SERVICE PARTNERSHIP INITIATIVE - THIS AGREEMENT made and entered into this 1st 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, Florida, 33139, and ASPIRA of Florida, Inc., a Florida Corporation, (hereinafter referred to as Contractor), whose address is 4100 NE 2nd Avenue Suite 302, Miami, FL 33137: 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. City of Miami Beach - Ayuda, Inc Page l of 21 Miami Beach Service Partnership SECTION 2 SCOPE OF WORK (SERVICES) The Contractor will provide intake and assessment services for up to thirty -two (32) youth and their families, care plan contact services for up to thirty -two (32) youth and their families, and close out follow -up services for up to thirty -two (32) 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- intake and assessment services for up to thirty -two (32) youth and their families at One Hundred Forty Dollars ($140) per each intake, for a maximum not to exceed Four Thousand Four Hundred Eighty Dollars ($4,480); (b) Provision of care plan contact services for up to thirty -two (32) youth and their families_ at Eighteen Dollars ($18) per each care plan contact for a maximum not to exceed Five Hundred Seventy Six Dollars ($576); (c) Provision of close out follow up services for up to thirty -two (32) youth and their families at One Hundred Dollars ($100) per each follow -up contact - for a maximum not to exceed Three Thousand Two Hundred Dollars ($3,200). 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 Eight Thousand Two Hundred Fifty Six Dollars ($8,256). 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. City of Miami Beach - Ayuda, Inc Page 2 of 21 Miami Beach Service Partnership 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. 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 2012. 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 City of Miami Beach - Ayuda, Inc Page 3 of 21 Miami Beach Service Partnership Agreement; and to that extent, the Contractor shall pay all such claims and Losses and shall pay all such costs and judgments which may issue from any .lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the City in the defense of such claims and losses, including appeals. The Contractor's obligation under this Subsection shall not include the obligation to indemnify the. City of Miami Beach and its officers, employees and agents, from and 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) City of Miami Beach - Ayuda, Inc Page 4 of 21 Miami Beach Service Partnership 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 'CO.MPILED BY CONSULTANT PURSUANT TO ITS PROVISION OF THE SERVICES CONTEMPLATED IN SECTION 2 AND IN EXHIBIT "A ", SHALL BE PROMPTLY ASSEMBLED AND DELIVERED TO THE CITY, AT CONSULTANT'S SOLE COST AND EXPENSE. IF 'THE AGREEMENT IS TERMINATED BY ,THE CITY AS PROVIDED IN THIS SUBSECTION, - CONSULTANT SHALL DE 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 City of Miami Beach - Ayuda, Inc Page 5 of 21 Miami Beach Service Partnership 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. 4.9 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 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. City of Miami Beach - Ayuda, Inc Page 6 of 21 Miami Beach Service Partnership All insurance required hereunder must be furnished by insurance companies authorized to do business in -the State of Florida. Original certificates of insurance for the above coverage must be submitted to the City's Risk Manager at the Office of the Risk Manager of the City of Miami , Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139. The Contractor is solely responsible for obtaining and submitting all insurance certificates for its sub- contractors. 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, O.Idwick, 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 City of Miami Beach - Ayuda, Inc Page 7 of 21 Miami Beach Service Partnership Contractor (which approval, if granted at all, shall be at the Manager's sole discretion and judgment). . 4.14 EQUAL EMPLOYMENT OPPORTUNITY In connection with the performance of this Agreement, the Contractor shall not discriminate against any employee or applicant for employment because of race, color, religion, ancestry, sex, age, and national origin, place of birth marital status, or physical handicap. The Contractor shall take affirmative action to ensure that applicants are employed. and that employees are treated during - their 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 -to -da activities shall be exchanged between a project r 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. City of Miami Beach - Ayuda, Inc Page 8 of 21 Miami Beach Service Partnership 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: TO CONTRACTOR: ASPIRA of Florida, Inc. Attn: Luis M. Artime,. President 4100 NE 2nd Avenue Suite 302. Miami, FL 33137 (305)576 -8494 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 JURISDICTIONIVENUE 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. City of Miami Beach- Ayuda, Inc Page 9 of 21 Miami Beach Service Partnership 1 4.20 LIMITATION OF CITY'S LIABILITY The City desires to enter into this Agreement only if in so doing the City can place a limit on the City's liability for any cause of action for money damages. due to an alleged breach by the :City of this Agreement, so that its. liability for any such. breach. never exceeds the sum of $1,000. Contractor hereby expresses its willingness to enter into this Agreement with Consultant's recovery from the City for any damage action for breach of contract to be limited to a maximum amount of $1,000. Accordingly, and notwithstanding any other term or condition of this Agreement, Contractor hereby agrees that the City shall not be liable to the 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] City of Miami Beach - Ayuda, Inc Page 10 of 21 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 OF MIAMI BEACH, FLORIDA ATTEST: By: City Clerk or Date Date FOR CONTRACTOR ASPIRA of Florida, Inc., A Florida Corporation ATTEST: �N cretary resident sv-S Print Name Print Name Date Dat APPROVED AS TO FORM & LANGUAGE Corporate Seal &' FOR EXECUTION 1c .. r' it ttorne Date : A 4� � •y � �,t k �,< ` C.iT -yof M arni B -- eac h - Ayuda, Inc Page 1 1 of 21 Midi Beat. h S rvice Partnership k Y EXHIBIT "A" "SCOPE OF SERVICES" The Contractor agrees to provide the following services to youth referred to the Success University program: Service �. Intake & Assessment Completed Success University Intake & Assessment Form via Communiity OS with executed consents and releases containing original signatures (attached); Copy of ` completed Referral Form(s), , (attached); Documentation of service provided on Community OS _....._.__.......__..__ __....__...__._.._..__......___ Software Care Plan Contact _.- _...... _ ....__.........__ Completed Care Plan __..._Contact_ ... ._ Form (attached), Documentation of service provided on Community OS Software; Amended Care Plan uploaded to Community _..._._ ................... __..._..........................._._._._..._.._._......__..._._....._.._.. .....:..........:..- .._OS.,__if tri. 0. 9. ered..._.__....___..............__..._._.._.__.........._..._....__..._._._.__.....___....._....__............................ ............................_.. Close Out ;Follow -Up Contact Completed Close Out Follow -Up form including client signature (attached); Documentation of service provided on Community OS software __._.....__....... . ......... .............._......_...-._...._........... _._......._............. ._............... ............ .._ .... ........... __.._..._...._...._..........................__.............. ....... ...... Y......................_......... W.................... ... ............. ........................ ......_.__...._.._...._.. __..... _. W ............. ......... ..__...__._..... ............ _ Related Definitions: Intake & Assessment — An intake and assessment documents the natural supports and needs of the client and his /her family. The intake and assessment form must be completed accurately and completely and submitted to the City via Community OS software. Notification of submission of intake and assessment must be provided via email to the Program Coordinator. The client is assigned a number in The Children's Trust Data Tracker system by the City. Intakes must be completed within thirty (30) days of referral. 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 care plan contact are to: (a) review student absenteeism and encourage school attendance; (b) determine if referrals have been followed up on; (c) review, implement, and 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 p rior to the Care Plan,- Contact. Once 30 days have passed following the initial Intake t t; 'ter & Assessment 4 Car&,Pian Contact will become the responsibility of the City and the Contractonwilf} n lqngerhave the opportunity to complete or bill for said contact. Referrals,—, Referrals include the identification of a specific client need fhe subsequent .°i,d.entification- ,..o.,f ;a-based resource to address - 'then` need rr Referrals must d be'. °provided- , f6r all service needs recognized in the idtake-. andy �a assessment or client- initiated requests. These referrals must be docume tedsinn City of Miami Beach - Ayuda, Inc Pagc jl ,'df 21 Miami Beach Service Partnership i the Miami Beach Service Partnership Referral Form (attached) with copies provided to the client and City; via Community OS. Close Out Follow -Up Contact —'The, Close Out Follow -Up Contact is conducted: in person with the client and the client's primary caregiver. In the event that numerous- attempts to make in- person. contact have failed,, a phone contact may substitute for 'a face—to—face meeting, only upon documentation of multiple failed, in person attempts. 7he..contact will be no less than 30 minutes in duration and the document produced must be completed accurately and in its entirety. Follow -up contacts must be completed within, ninety, (90) .days of intake but no earlier than forty -five (45) days after intake date. The Program Evaluation Form (in English or Spanish) (attached) must be completed by the client and his /her primary caregiver at the Close Out Follow-Up, Contact. Services will be deemed as provided when , the following documentation , is provided within the noted timeframes: D. Intake & Assessment Intake & Assessment Form on 72 business hours from Community OS; Notification Email to provision of service Program Co ordinator _ Care Plan Contact Case Note Form; Amended Care ' 72 business hours from Plan, if triggered Notification Email ' . provision of service to Program Coordinator ..................... .:....._..... ...._ .... .... Referral Miami Beach Service Partnership 72 business hours from Referral Form (front and back, with the identification of separate back of referral form' for client need each agency to which referrals are,{ p rovide d} Close Out Follow -Up C lose Out Follow -Up Form; Program 72 business hours from Contact Evaluation Form; Notification Email to provision of service Program 'Coordinator _ ....._ ................................................................................................................................................................................................................................................................................................................................................ ...,........................... .. ............................... ........... 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-Contractor via check within, 30 days_. Service Deliverables Intake & Assessment 1 for each of up to' 32 Client Home ''All eligible intakes will outh and their be com leted within ...... Y ......................................................................................................... ............................... ................................. .._............... ................ .... City of Miami Beach - Ayuda, Inc Page 13 of 21 Miami Beach Service Partnership ......................................... ............. .................................... ....................................... ........................................................... ................................................................................................................. ..................... ................................ ......................... ............................................. .......................................................... . families thirty (30) days of receipt of appointment .......... __._...__. ....... ... ._.__..__......... ..__.__.._.......__...._...__.. ................ ._. _ _...__. _...___.. _........_..__._.... r .. _ ...!......:..__.._....... .... ` Care Plan Contact 1 for each of up to 32 Via Telephone or All Care Plan Contacts youth and their at Client Home will be completed t families within thirty (30). days ... . ................... ............................... .. ..........._ _................ . of Intake Close Out Follow -Up 1 for each of up to 32 : Client Home All close out follow -ups Contact youth and their I will be completed families within one hundred twenty (120) days of completion 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 City of Miami Beach - Ayuda, Inc Page 14 of 21 Miami Beach Service Partnership 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 Ao 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 • 1 -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 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 5:00 PM on the third (3 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: City of Miami Beach - Ayuda, Inc Page 15 of 21 Miami Beach Service Partnership Forms are completely -and accurately filled. "N /A and "no examples this month" are not acceptable responses on Monthly Reports • Necessary back -up materials are included (client documentation, monthly client list, 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 accurate required monthly reports and invoices in a timely manner will result in the forfeiture of one (1 %) percent 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 Contractor via check within 30 days. 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 for a 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. 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. 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 City of Miami Beach - Ayuda, Inc Page 16 of 21 Miami Beach Service Partnership updated - as necessary. The MOU must be -submitted to the City of Miami Beach prior to execution of the service contract. 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 limitedao: • 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 comm'ittee(s) meetings Ratings will be given for each performance measure based on the following: - • • • : • . Timely and accurate submission of ➢ "0" for failing to- submit on time month) Progress report ➢ "15" for submitting on tune ....Y r s e .............. .. 9 .._ ........................... . _ ..._ . . _ . . 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 ti 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 unit Attendance at Miami Beach Service Possible score of 0 to 20 Partnership Governing Board and related 10 Points for attendance at Governing: com mittee(s ) -m eeting s _ Boa rd meetings; 10 poin f or Committee. City of Miami Beach Ayuda, Inc Page 17 of 21 Miami Beach Service Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... . ...................... . ....................................................... : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................................. . . . . . . : . . . . . . . . . ................... . ........................... . . . . . . . .......................... attendance (In the event that there are no committee meetings scheduled, the value for attendance at the Governing Board meetin will be 20.) J .................................................................................................................................................. ............................... 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. Training 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 ❑ Intake & Assessment Training. ❑ Community OS Software Training El Client Evaluation Survey Training ❑ Care Coordination Training ❑ 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- mem.ber prior to this contract's termination on a pro -rated basis as follows:. .9 T1 ........ . Program Overview Traini $66.56 Intake & Assessment Trainin E ._ ..........................._._..____ ....._.__.._.._.._.._._._....._ ..........__ _.....___......_.__....__.._....._.....:........ 9_.._.___.._...__.._..._._..__.._......_._........_.......... �..........................._.____..._.__._.._...._.._.._..._...........__._.....__.__.._.............._...._. _.............._..._..______._. $ 133.12 Community OS Training __......... _ .. __. ......_.........__..._._._.__._ ....... _y._.._._._ ......9 $133.12 Client Evaluation Survey . ...................I........... Training $16.64 '' ................ ............................................................................................................... 9................................................................................................................ ............................... . ................................................................................................... ............................... FGC Audit Training _...__.__... ..._._..._...._..___..._._.__.. E $66.56 ..._..._..._..._ .._._......_.__..__...._..__... _._.____.. ......_..__............________ ....__ _.___...._ __.._____.._._.___.___.._.___._ __.._.........__ Follow Up Trainin $66.56 The Contractor agrees to send at Feast one representative to attend a City- sponsored grant writing workshop by July 31, .2012. Switchboard of Miami Registration City of Miami Beach - Ayuda, Inc Page 18 of 21 Miami Beach Service Partnership Contractor agency will register with Switchboard of Miami to ensure that agency information is accurate and updated. This contractual obligation .is directed by - Th.e 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 City of Miami Beach - Ayuda, Inc Page 19 of 21 Miami Beach Service Partnership 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. I City of Miami Beach - Ayuda, Inc Page 20 of 21 Miami Beach Service Partnership EXHIBIT ATTACHMENTS The. following documents are attached; • Referral Form (2 pages) Care Plan Contact Form (1 page) • Close _ Out Follow Up. Form (2 pages) • Program Evaluation Forms (2 pages) ; Monthly Progress Report (1 page) Monthly Invoice Form (1 page) - Programmatic Sigh-in Form (1 page) Subcontractor Monitoring Tool .(4 pages) City of Miami. Beach - Ayuda, Inc Page 21 of 21 Miami Beach Service Partnership Data Tracker # Miami Beach Partnership Referral Form Client Information Name {Check here if client is a minor ❑) Place of Birth/ Date of Birth Social Security Legal Status El US Citizen ❑ US Resident ❑ Status Pendin Primary Language Race /Ethnicity English ❑ Spanish . ❑ Creole ❑ Other ❑ White, Non - Hispanic ❑ Hispanic ❑ Black, Non -His anic ❑ Other Address /Zip Code Home Telephone/ Work Telephone Marital Status Housing Status '❑ Single ❑ Divorced ❑ Domestic Partnership ❑ Own ❑ Rent ❑ - Live w /others ❑ Married ❑ Se crated ❑ Other ❑ Homeless ❑ Other Others in Household Household Income ❑ Child ❑ Adult ❑ Employment - $ ❑Child ❑ Adult ❑ SSA ❑ SS1 ❑ SSDI $ ❑ Child. ❑ :Adult ❑ Child Support $ ❑ Child ❑ Adult ❑ Pension $ ❑ Child ❑ Adult ❑ Other $ . El Child ❑ Adult ❑ Other $ For youth only — For youth only Current Grade Level Current School Q ' r11 El El ❑4 El El El ❑8. 9 ❑ 10 ❑ 1.1 E112 ❑ 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 El Yes - Amount.$ ❑ Pending Recipient ❑ No Current Service Current Service Needs Providers ❑ Child Care After Care. F 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 FI Douglas Gardens ❑ 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 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 Chil Care/Aftercare Services Other Services ❑Child ❑ Ayuda ($) C Care ' [I Alliance for GLBTQ Youth ❑ Medical . ❑ Miami Beach 1175 NE 125th St/1- 866 - 634 -8087 Aftercare El Ayuda ($) Services Community Health ❑ Aspira 4100 NE 2nd Ave. 305.576.8494 El Boys /Girls Club Center ❑ Ayuda 7144 Byron Ave. 305.864.6885 ❑ MB PAL ❑ Dental DI BCHC El Barry University - 305 - 899 -3742 El MB Recreation Services El Boys &Girls Club - 305'.673.7760 ij: ❑ Attached • • Brochure [:1 The Bridge 2810 N.W. South River Drive / 305 - 635 -8953 ❑ Clothing ❑ Neat Stuff ❑ Mental ❑ Douglas Gardens 'd ❑Dress for Success Health El JCS #1 ❑Central Intake 2500 NW 22 Ave. /305.638.6540 Counsel,ling Services ❑ Institute CFH ❑ CINS /FINS 1825 NW 167" St. Ste. 102 ❑ Youth ❑ Institute CFH / 305:474.1707/ 305.474.1738 R A ss i s t ance ❑ Community Action Agency #1 ❑ JCS #1 ❑ Rent ❑Stand Up ($) ❑CAA #1 6100 NW 7 Avenue/305.756.2830 Assistance ❑ CAA #2 ❑. Community Action Agency #2 ❑Barry University Edison /Little River 833 6th St 1s' Fl. 33139 /305 -672 -1705 _ ❑ ❑ GLBTQ; ❑ Allia nce for GLBTQ ❑ HAND ❑Culmer Service Center _ _ W 3 Av YOiath Youth; 1800 N e. 305 - 438 -4161 ❑ Adult � ❑Douglas Gardens � • - - 171 Dept. of Children &Families ❑ Detox ❑ JMH Crisis 945 Pennsylvania Avenue/305.535.5401 El JCS #1 ❑ Douglas Gardens CMHC Stand Up ($) El Addiction El Central Intake 1680 Meridian Ave. 305.531.5341 ❑ Institute CFH Services [ EHEAEP 395 NW 1 St 305.347.4685 - ❑ Edison /Little River Service Center ❑Family ❑ Ayuda (Parents: Now] ortati th Disabled ❑Miami - Dade 150 NW 79 Street/305.758.9662 JCS #1 E] Disable Immigrant Advoca C Elder Transit ❑ Fl y me r Stand Up ($) Bi scayne B 6 3000 Bi Bl vd ./305.573.110 573 110 ❑ Speech ❑ Playing the Game ❑ HAND 1(877) 994 -4357 ❑ L El Thera of Life $ Elder Program EHEAEP Institute for Child & Family Health 430 West 66 St. Hialeah /305- 558 -2480 El der Services ❑ Emergency ❑ Culmer Ctr. ❑ 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 s' St. #216/305.576.6550 ❑ LHANC — MB • - • • 171 JCS #2 2056 NE 155 St.305.947.8093 . ❑ LHANC - RT ❑Academic ❑ MBSH Library El JCS #3 Access /Referrals 305.576.6550 El MB - OCS Tutoring ❑MDC Libraries ❑ LHEAP 2902 NW 2 Ave. 305.438.8614 El Legal Services of Greater Miami [:1 UNIDAD ❑ Dial -A- Teacher . 3000 Biscayne Blvd./305.576.0080 Home ❑ MD ­Human _ _ . __6 6�1­ 7 z I Legal Aid Society 123 NW First Care Services ❑ Youth ❑ Ayuda �TAC!J Avenue, Suite 21.4 (305) 579 -5733 Em Assistanc Development ❑' °Aspira (Club] El Little Havana /Rebecca Towers ❑;JCS: #3 150 Alton Road/305.572.3736 L] Employment ❑CAA #2 ❑TACQLCY ❑ Miami Beach CDC (ADULT) El JCS #1 (FAST] 945 Pennsylvania Avenue /305.538.0090 Unidad El Miami Beach CHC #1 ❑MDC El Youth Co -Op Prevention 710 Alton Road/305.538.8835 ;­ : : 1­..1 ❑ Employment ❑CAA #2 ❑CINS %FINS M iami Beach -Community Serv El i - y es 1700 Convention Ctr. Dr. / 305 -673 -7491 (YOUTH) ❑ JCS #1 ❑Social/ ❑ Playing the ❑ Miami Beach - Homeless ❑ Teen Job Corps Emotional Dev. Game of Life {$) 55517 th St. / 305 - 604 -4663 El Unidad ❑Yo'uth El MB Police Athletic League ❑The Village 999 _ 11 Street/305.531.5636 • • • A Substance`Abuse South 1. ❑ Emergency El JCS #2 El Miami Beach — Recreation Internal 2100 Washington Avenue/305.673.7730 Food ❑ Univ St. Joseph's Church . d ir e ct . s El Miami - Dade Human Services ❑ St Patrick's Church 4500 Biscayne Blvd. /305.576.2511 ❑ 7 Habits ❑ Miami Beach - ❑ Food Stam s DCF Teens OCS El Miami Transit p ❑ 111 NW 1 st Street/305.770.3131. 07 Habits ❑ Miami Beach — [:1 Playing the Game of Life 7144 Byron El Discount El Miami Beach - Families OCS Ave. 2 nd Fl. 305 - 864 -5237 Food OCS ❑ Employment E:] Teen Job Corps El St. Joseph's Church • • Assistanc 8670 Byron Avenue/305.866.6567 El Emergency ❑ MB - Homeless ❑ Counseling ❑ Barry University [] St. Patrick's Church ❑ Shelter Transportation ❑ Miami Beach — 3716 Garden Avenue/305.531.1124 OCS ❑ Stand Up! 305 - 864 -5237 ❑ Affordable ❑ Miami Beach CDC Emergency El Miami Beach - ❑ Switchboard (305) 358 -4357 Housing Gap Services OCS ❑ TACOLCY 6161 NW 9th Avenue (305) 398 -1770 - Le gal Other Services ❑ Teen Job Corps 305.868.0635 Disability ❑ Legal Services ❑ UNIDAD 833 6 Street/305.532.5350 ❑Landlord/Tenant ❑ The Village 400 NE 31S St 305-573 - ElFamily Law El Legal Aid 3784 _ ❑ []Youth Immigration F] 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 • Care Plan Contact form Success University ' Case Worker: Partner Agency: Contact Date: EA( Data Tracker Date: Client Name 1= b: Mid Middi le L a, Client Address A i; I t. s e t r Zip C£€ Home Telephone Cellular Telephone E -Mail Address Contact Date Contact Location O Home 0 Other 0 Phone Contact Indicate Persons Present 0 Client 0 Mother/ Step - Mother 0 Father/ Step- Father 0 Other Females # 0 Other Males # Phone Call Log Date: Date: Date: Time: Time: Time: 0 Message 0 No Answer 0 Message O No Answer O Message 0 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 0 Family •Conferencing 0 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 Close Out Follow -Up Form Care Coordinator: Success University Partner Agency: Contact Date: z Data Tracker Date: Client Name # WST f d Client Address Apa _ ri ; r 0 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 0 Other Females # 0 Other Males # Phone Call Log Date: Date: Date: Time: Time: Time: 0 Message D No Answer O Message 0 No Answer 0 Message 0 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 affordabilit 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. 0 Intake & Assessment 7 Referral Services 0 Family Conferencing 0 Mental Health -0 7 Habits Teens /Families 0 Employment Services 0 MB Helpers Client/ Parent 0 Discount Food Program Success University Close Out Follow Up Form 1 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 famil Service Reminder Yes No Did you ensure that all contact information is accurate and up-to-date? 0 M Did you provide family with this month's Discount Food Program information? Did you remind client and parent of the importance of adhering to the Attendance Contract? 0 O Next Scheduled Encounter Indicate your next scheduled encounter with client and location. Date Time Location Purpose 0 Family Conferencing 0 No follow -up expected 0 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 Success University Close Out Follow Up Forme 2 Revised December 2011 SUCCESS Service Evaluation Form UNIVE.R.51TY zfft 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 advance for your feedback. Content NIA Poor Fair Good Excellent Objective and scope of services ❑ ❑ ❑ ❑ Organization of events and agency staff ❑ ❑ ❑ ❑ El Understandability of communications with staff ❑ ❑ ❑ ❑ ❑ Relevance of event /services to your objectives p ❑ ❑ p El 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 ❑ ❑ p ❑ p Please list an fur ther questions ou may have. What was best about the program? What aspect of the program did not meet your expectations? aw lf Ai: -{ ' UCS Formulario de evalu:acion de servicio UN Miami Beach Service Partnership Encuestador: Entrenamiento: Fecha: Lugar: Por favor tome un momento de su tiempo para evaluar el programs de Success Univeristy. Califique cada objetivo de inferior a excelente. La informacion recibida sera utilizada para mejorar los servicios ofrecidos De antemano muchas gracias por su opinion. -Contenido N/A Inferior Regular Bueno Excelente Objetivo y proposito del entrenamie.nto ❑ ❑ ❑ ❑ ❑ Organizacion del evento y.empleados de la agencia ❑ ❑ ❑ ❑ ❑ Comprension de la informacion comunicada por el ❑ ❑ ❑ ❑ p empleado Relevancia del evento /servicio a sus objetivos ❑ ❑ ❑ ❑ ❑ Instructor /a N/A Inferior Regular Bueno Excelente Presentacion de la informacion ❑ ❑ ❑ ❑ Participantes fueron alentados a participar ❑ ❑ ❑ ❑ ❑ Discusiones se manejaron apropiadamente ❑ ❑ ❑ ❑ ❑ Preguntas fueron respondidas satisfactoriamente ❑ ❑ ❑ ❑ El Experiencia en general N/A Inferior Regular Bueno Excelente Experiencia en general del servicio ofrecido ❑ ❑ ❑ ❑ 0 Por favor escriba cualquier pregunta que pueda tener sobre el programa. �,Que fue to mejor del programa? �,Que del programa no cumplio sus expectativas? 1 M Monthly Project Summary : Office of Community Services r o ® o Reportrn g * , ey =`Pro ect 2 Success Universit x Reporting Period ❑ November /11 ❑ December /11 ❑ January /12* ❑ February/1 /12 March /12 , z ry ❑ ❑April /12 ,..:_ . :.. El Ma /12 0 June /12 ❑July /12 Please provide a narrative summary for each section, as applicable. Seances Management (Please provide narrative regarding the, administration /delivery of services including robl"ems confronted in im lementation this ast month. ® o e o o e o o Clien Success S ory (Please include a(n) :example of clients) success indicating how services t were beneficial or made a meanin ful ini "'act. ` repare Pd By Signature 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 $ - Fiscal Summary Line Item Category Account # Category T,ot, Previous Requests Balance Available This Request Intake & Assessments ($140) $ $ - - Care Plan Contact ($1g) $ $ $ - $ - Close Out Follow -Up ($100) $ $ $ - $ - Family Group Conferencing ($175) - Employment Services ($9.86/$24.44) $ $ - $ - Mental Health Services ($195/$75) „ $ $ - $ _ $ $ - $ $. TOTALS $ $ $ - $ Documentation Checklist Not Documentation Submitted Submitted Service delivery documentation List of clients served and services provided Leverage /Match Staff Member k= Hourly Rate Hourly Benefits : '# of Hours Line Total ;. $ .0 $. J' $ $ : $ $ $ _. E Space & Other m K(nd Uaaue /Unit Cost : Unit Quantity Line Total v $ $ • • In-Kind $ - Total Leverage $ - 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 Date Received by City of Miami Beach Amount Authorized for Reimbursement ' N Q W A p p . U c� z o c . H c �U U _� LL -i U) a 4) o ........... X: CL Q): CD L 0 .2 0 u 0 L- CD o r- 0) " 0 ......... (n c Q CL U C R I M M O t11: O 3' ,�f � 'p Z N d � O >. w . ... . . . .. .. LL In E LE a) L- CD r O A (D 04 m / t C N' `o E.' 0. C v , . 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