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PSA Agreement with Maria Castillo - Youth Services go 13----a S 0 PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH, FLORIDA AND MARIA CASTILLO FOR YOUTH SERVICES RELATED TO THE CITY'S PARENT-CHILD HOME PROGRAM THIS AGREEMENT made and entered into this 1 st day of August, 2013, 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 MARIA CASTILLO, (hereinafter referred to as Contractor), whose address is 225 NE 160 St., North Miami, Florida 33162. 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. 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-MARIA CASTILLO Page 1 of 18 Parent-Child Home Program SECTION 2 SCOPE OF WORK (SERVICES) The Contractor will provide home-visiting services for up to fourteen (14) youth and their families in accordance with The Children's Trust Miami Beach Early Childhood Development Grant, dated August 1, 2013. 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, 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 home visits for up to fourteen (14) families with program-required supervision and training, at Thirty Dollars and Fifty Cents ($31.50) per home visit, for a maximum not to exceed Nineteen Thousand Five Hundred and Ninety Three Dollars ($19,593). 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 Nineteen Thousand Five Hundred and Ninety Three Dollars ($19,593). 3.2 INVOICING Contractor shall submit a biweekly invoice (every two weeks) and accompanying time sheets indicating hours worked which includes an itemized, detailed description of the Services, or portions thereof, provided and cost(s) for same. Invoices and supporting documentation shall be submitted to Maria Castillo, Division Director, Office of Community Services, 1700 Convention Center Drive, Miami Beach, Florida, 33139. 3.3 METHOD OF PAYMENT Payments shall be made within thirty (30) days of the date of invoice, in a manner satisfactory to and as approved and received by the City Manager and/or his designee, who shall be the Division Director, Office of Community Services. SECTION 4 City of Miami Beach-MARIA CASTILLO Page 2 of 18 Parent-Child Home Program i 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, 2014. 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, 2014. 4.5 INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City of Miami Beach and its officers, employees and agents, from and against any and all actions, claims, liabilities, losses, and expenses, including, but not limited to, attorneys' fees, for personal, economic or bodily injury, wrongful death, loss of or damage to property, at law or in equity, which may arise or be alleged to have arisen from the negligent acts, errors, omissions or other wrongful conduct of the Contractor, its employees, agents, sub-consultants, or any other person or entity acting under Consultant's control, in connection with the Contractor's performance of the Services pursuant to this Agreement; and to that extent, the Contractor shall pay all such claims and losses and shall pay all such costs and judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys' fees expended by the City in the defense of such claims and losses, including appeals. The Contractor's obligation under this Subsection shall not include the obligation to indemnify the City of Miami Beach and its officers, employees and agents, from and against any actions or claims which arise or are alleged to have i City of Miami Beach-MARIA CASTILLO Page 3 of 18 Parent-Child Home Program arisen from negligent acts or omissions or other wrongful conduct of the City and its officers, employees and agents. The parties each agree to give the other party prompt notice of any claim coming to its knowledge that in any way directly or indirectly affects the other party. 4.6 TERMINATION, SUSPENSION AND SANCTIONS 4.6.1 Termination for Cause If the Contractor shall fail to fulfill in a timely manner, or otherwise violate any of the covenants, agreements, or stipulations material to this Agreement, the City shall thereupon have the right to terminate the Services then remaining to be performed. Prior to exercising its option to terminate for cause, the City shall notify the Contractor of its violation of the particular terms of this Agreement and shall grant Contractor seven (7) days to cure such default. If such default remains uncured after seven (7) days, the City, upon three (3) days' notice to Contractor, may terminate this Agreement and the City shall be fully discharged from any and all liabilities, duties and terms arising out of/or by virtue of this Agreement. Notwithstanding the above, the Contractor shall not be relieved of liability to the City for damages sustained by the City by any breach of the Agreement by the Contractor. The City, at its sole option and discretion, shall additionally be entitled to bring any and all legal/equitable actions that it deems to be in its best interest in order to enforce the City's right and remedies against the defaulting party. The City shall be entitled to recover all costs of such actions, including reasonable attorneys' fees. To the extent allowed by law, the defaulting party waives its right to jury trial and its right to bring permissive counter claims against the City in any such action. 4.6.2 Termination for Convenience of City NOTWITHSTANDING SECTION 4.6.1, THE CITY MAY ALSO, FOR ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE THIS AGREEMENT AT ANY TIME DURING THE TERM HEREOF BY GIVING WRITTEN NOTICE TO CONSULTANT OF SUCH TERMINATION, WHICH SHALL BECOME EFFECTIVE SEVEN (7) DAYS FOLLOWING RECEIPT BY THE CONSULTANT OF THE WRITTEN TERMINATION NOTICE. IN THAT EVENT, ANY FINISHED OR UNFINISHED DOCUMENTS AND OTHER MATERIALS PREPARED AND OR OTHERWISE COMPILED BY CONSULTANT PURSUANT TO ITS PROVISION OF THE SERVICES CONTEMPLATED IN SECTION 2 AND IN EXHIBIT "A", SHALL BE PROMPTLY ASSEMBLED AND DELIVERED TO THE CITY, AT CONSULTANT'S SOLE COST AND EXPENSE. IF THE AGREEMENT IS TERMINATED BY THE CITY AS PROVIDED IN City of Miami Beach-MARIA CASTILLO Page 4 of 18 Parent-Child Home Program i THIS SUBSECTION, CONSULTANT SHALL BE PAID FOR ANY SERVICES SATISFACTORILY PERFORMED, AS DETERMINED BY THE CITY AT ITS SOLE DISCERTION, UP TO THE DATE OF TERMINATION; PROVIDED, HOWEVER, THAT AS A CONDITION PRECEDENT TO SUCH PAYMENT, CONSULTANT SHALL HAVE DELIVERED ANY AND ALL DOCUMENTS, MATERIALS, ETC, TO CITY, AS REQUIRED HEREIN. 4.6.3 Termination for Insolvency The City also reserves the right to terminate the remaining Services to be performed in the event the Contractor is placed either in voluntary or involuntary bankruptcy or makes an assignment for the benefit of creditors. In such event, the right and obligations for the parties shall be the same as provided for in Section 4.6.2. 4.6.4 Sanctions for Noncompliance with Nondiscrimination Provisions In the event of the Contractor's noncompliance with the nondiscrimination provisions of this Agreement, as applicable, the City shall impose such sanctions as the City or the State of Florida may determine to be appropriate, including but not limited to, withholding of payments to the Contractor under the Agreement until the Contractor complies and/or cancellation, termination or suspension of the Services and/or the Agreement. In the event the City cancels or terminates the Services and/or the Agreement pursuant to this Subsection the rights and obligations of the parties shall be the same as provided in Section 4.6.2. 4.7 CHANGES AND ADDITIONS Any changes and additions to the terms of this Agreement shall be by a written amendment, signed by the duly authorized representatives of the City and Contractor. No alteration, change, or modification of the terms of this Agreement shall be valid unless amended in writing, signed by the parties hereto, and approved by the City. 4.8 OWNERSHIP OF DOCUMENTS Any changes and additions to the terms of this Agreement shall be by a written amendment, signed by the duly authorized representatives of the City and Contractor. No alteration, change, or modification of the terms of this Agreement shall be valid unless amended in writing, signed by the parties hereto, and approved by the City. 4.9 ASSIGNMENT, TRANSFER OR SUBCONTRACTING City of Miami Beach-MARIA CASTILLO Page 5 of 18 Parent-Child Home Program 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. 4.10 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. 4.11 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. 4.12 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. 4.13 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 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-MARIA CASTILLO Page 6 of 18 Parent-Child Home Program i 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: Maria Castillo 225 NE 160 St. North Miami, FL 33162 (786) 975-7730 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 4.14 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. L 4.15 ENTIRETY OF AGREEMENT This writing and any exhibits and/or attachments incorporated (and/or otherwise referenced for incorporation) herein embody the entire Agreement and understanding between the parties hereto, and there are no other agreements and understandings, oral or written, with reference to the subject matter hereof that are not merged herein and superseded hereby. 4.16 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 City of Miami Beach-MARIA CASTILLO Page 7 of 18 Parent-Child Home Program 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-MARIA CASTILLO Page 8 of 18 Parent-Child Home Program 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 elerk Edward L. Tobin Vice-Mayor Date Date FOR CONTRA- ��RP • ..... ATTEST: \'' �/'?c By- By: .t Witness Signature Maria Castillo Witness Printed Name os N pv� Date Date APPROVED AS TO FORM & LANGUAGE & FOR CUTION f me Date City of Miami Beach-MARIA CASTILLO Page 9 of 18 Parent-Child Home Program EXHIBIT "A" "SCOPE OF SERVICES„ The Contractor agrees to provide the following services to youth enrolled in the City of Miami Beach Parent-Child Home Program: Service Documentation of Service Home visits 1. Completed Home Visit Report form for each completed visit. (Please see attached.) 2. Home Visit Attendance Sheet Screening — Developmental ASQ-3 Screening — Social Emotional ASQ-SE Home Safety Checklist The Children's Trust Home Safety Checklist Related Definitions: Home Visits — A Home Visit requires that Home Visitors visit the client's home at a time mutually agreed upon for the purpose of role-modeling the appropriate parent- child interaction as defined by the Parent-Child Home Program guidelines. The Home Visitor will bring the assigned toy or educational aid and spend a minimum of 30 minutes modeling appropriate parent-child interaction for the client. A Home Visit Report will be completed for each home visit and client will sign the Home Visit Attendance Sheet to confirm attendance and acknowledge receipt of materials. Supervision of Home Visitors — The Supervision of Home Visitors is required of all Home Visitors engaged in the provision of Home Visits to clients. The City of Miami Beach is responsible for meeting with each Home Visitor on a one-on-one basis at least two (2) times for each twenty-three (23) week program period. Supervision must be conducted by a person trained by the Parent-Child Home Program and must conform to Parent-Child Home Program guidelines for Home Visitor supervision. In addition, the City must provide group supervision for the Home Visitors for each of the twenty-three (23) program weeks. Ages and Stages Questionnaires (ASQ-3) — The ASQ-3 questionnaires are used to screen young children for developmental delays in the first five years of life. Home visitors are required to complete the questionnaire with the parent within two (2) months of program cycle commencement. Ages and Stages Questionnaires: Social-Emotional (ASQ-SE) — The ASQ-SE questionnaires assess young children's social-emotional development. Home visitors are required to complete the questionnaire with the parent within two (2) months of program cycle commencement. Evaluation of Child Behavior Traits (CBT) — The scale evaluates the socio- emotional status of children. During the program, ratings are based on the global evaluations of the home visitors who have observed the child in home visits. Home City of Miami Beach-MARIA CASTILLO Page 10 of 18 Parent-Child Home Program visitors are required to complete the scale at the beginning of the program year between the fourth and sixth visit and at the end of the program year. Evaluation of Parent and Child Together (PACT) — The scale was developed to evaluate the positive parent-child interaction behaviors of parent-child dyads. During the program, ratings are based on the global evaluations of the home visitors who have observed the parent and child together in a home visit. Home visitors are required to complete the scale at the beginning of the program year between the fourth and sixth visit and at the end of the program year. Home Literacy Activity Survey— This survey gathers information regarding literacy activities taking place in the client's home. Data will be reported in the beginning of the contract year (existing clients) or at the first home visit for (new clients) and every six months thereafter. The Children's Trust Home Safety Checklist — The checklist contains questions related to home safety within the client's home. The checklist will be completed by the home visitor within two months of program cycle commencement and every six months thereafter. Services will be deemed as provided when the following documentation is provided within the noted timeframes: Service Unit of Documentation Timeframe Submission Service Deadline Home visits 46 Home Home Visit 23-week 72 business hours Visits (two per Report form & program from provision of week) per Home Visit period service client Attendance Screening — 1 ASQ-3 Once per year. 5 business days Develop- Within 2 from provision of mental months of service program cycle commenceme nt Screening — 1 ASQ-SE Once per year. 5 business days Social Within 2 from provision of Emotional months of service program cycle commenceme nt Home Safety 2 The Children's Within 2 5 business days Checklist Trust Home months of from provision of Safety Checklist program cycle service commenceme nt and every 6 months City of Miami Beach-MARIA CASTILLO Page 11 of 18 Parent-Child Home Program thereafter. For each client, the following benchmarks must be met: Introduction Home Introduction visit with Program Coordinator Visit 1 S Home Visit Completion of Home Literacy Activity Survey 4 th Home Visit 5 th Home Visit CBT & PACT must be administered and submitted 6 th Home Visit Between 7 — 16 Completion of ASQ-3 & ASQ-SE Home Visit Completion of Home Safety Checklist 44 th Home Visit 45 Home Visit CBT & PACT must be administered and submitted Completion of Home Literacy Activity Survey 46 1h Home Visit Failure to meet contracted service units within the allocated timeframe may result in the City subsequently reducing the Contractor's service level and allocated funding accordingly. If the Contractor is unable to fulfill the contracted service level within the allocated timeframe for each service component, the City reserves the right to reduce service levels accordingly across the funded service spectrum. If the Contractor is unable to fulfill the contracted service level and the City subsequently reduces service and funding levels, the City reserves the right to select another vendor to fulfill the remaining service units. The City will select the alternate vendor at its sole discretion. Reporting Requirements The Contractor will provide the City with a reimbursement request utilizing the City's Reporting and Reimbursement Forms (attached) by the third (3rd) 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. Reports are due on the following dates: • Thursday, September 5, 2013 • Wednesday, March 5, 2014 • Thursday, October 3, 2013 • Thursday, April 3, 2014 • Tuesday, November 5, 2013 • Monday, May 5, 2014 • Wednesday, December 4, 2013 • Wednesday, June 4, 2014 • Friday, January 3, 2014 • Thursday, July 3, 2014 • Wednesday, February 5, 2014 • Tuesday, August 5, 2014 City of Miami Beach-MARIA CASTILLO Page 12 of 18 Parent-Child Home Program Monthly reports and reimbursement requests will be submitted via any of the following methods: • Electronic mail • Facsimile • Standard mail • Hand delivery Monthly reports will not be considered acceptable unless the following is met: • Forms are completely and accurately filled • Necessary back-up materials are included (client documentation, expense receipts, time logs, etc.) • Reports bear the signature of the person submitting the report on behalf of the Contractor The failure to submit required monthly reports and invoices in a timely manner for two consecutive months will result in the forfeiture of one (1%) percent of the combined billed total for the two months in question. These forfeited funds will be used exclusively for client incentive materials as approved by the Miami Beach Service Partnership Governing Board. These forfeited funds will be submitted to the City by the Contractor via check within 30 days. Partner Performance Ratings The Contractor agrees that its Partner Performance Rating, the score awarded for performance on the following measures, will be posted on the City's website: • Timely and accurate submission of monthly progress report • Timely and accurate submissions of monthly financial reports (reimbursement requests) • Delivery of contracted service units • Promotion of the Miami Beach Service Partnership • Attendance at Miami Beach Service Partnership Governing Board and related committee(s) meetings Ratings will be given for each performance measure based on the following: Performance Measure Rating Rationale & Score Timely and accurate submission of ➢ "0" for failing to submit on time monthly progress report ➢ "25" for submitting on time Timely and accurate submissions of ➢ "0" for failing to submit accurate report monthly financial reports (reimbursement with back-up material on time requests) ➢ "25" for submitting accurate report on time Delivery of contracted service units Possible score of 0 to 50 based upon completion of monthly projected service City of Miami Beach-MARIA CASTILLO Page 13 of 18 Parent-Child Home Program i units. Score is pro-rated if total projected service units are not met. Engagement Strategies The Contractor will adhere to the following engagement strategies in the delivery of services: • Advise the parents and/or guardians of the scheduled appointment as documented via the appointment card. • Refrigerator magnet with days and times of visits. Evaluation In the continuing effort to ensure programming excellence, clients will be provided with evaluation forms throughout programming to gauge their satisfaction with services provided. Monitoring & Performance Reviews The City of Miami Beach reserves the right to inspect, monitor and/or audit the Contractor to ensure contractual compliance. This includes, but is not limited to: • Review of on-site service delivery • Inspection and review of client, budgetary and employee files (for those employees providing services under this contract) The monitoring tool provided by The Children's Trust, "On-Site Monitoring Tool", will be used to guide inspections and monitoring visits. Monitoring must be completed within forty-five (45) days of service commencement. Employee File Review The following documentation must be included in the employee file for those employees providing services under this contract. The City of Miami Beach reserves the right to inspect client files with due notice (at least 48 hours in advance of planned site visit) to ensure adherence to contractual expectations as well as to ensure pre- screening prior to a monitoring visit by The Children's Trust. The following must be included in the employee files: • Employment Application • Evidence of degree/credentials • Job Description Signed by Employee • Evidence of Required Experience • Florida Background Criminal Screening • National FBI Background Criminal Screening (Level2) City of Miami Beach-MARIA CASTILLO Page 14 of 18 Parent-Child Home Program • Affidavit of Good Moral Character • Proof of Knowledge of Policies & Procedures • Confidentiality Agreement Re: Client Information Documentation of Agency Training/In-Service Training for Contracted Services Provided • 1-9 Verification on File Two Year Commitment Master Calendar The Contractor will notify the City of any client appointment or anticipated service delivery at least 72 hours in advance of the appointment or service delivery for inclusion in the Parent-Child Home Program Master Calendar. The Master Calendar will be updated daily. Training Requirements Frontline personnel will be required to receive supervision and complete the following trainings prior to service provision: Activity Requirements Party Responsible Home visits ❑ Program Overview & Engagement City of Miami Beach Training (City of Miami Beach) ❑ Domestic Violence & Child Abuse Barry University Training ❑ Child Development Training Barry University Supervision of Home ❑ Weekly Staff Meeting City of Miami Beach Visitors ❑ Individual Supervision (Twice City of Miami Beach annually) Home Safety ❑ Home Safety Training City of Miami Beach Checklist Supervision of Home Visitors Activity Frequency Party Reporting Responsible Tool Group Weekly City of Miami Sign-in Sheet Supervision Beach Individual Two (2) times each twenty- City of Miami PCHP Home Supervision three (23) week program , Beach Visit City of Miami Beach-MARIA CASTILLO Page 15 of 18 Parent-Child Home Program period Observation Checklist Home Visit Observation of two (2) Home City of Miami PCHP Home Monitoring Visits yearly (video or actual) Beach Visit Observation Checklist Client Termination Home visitors must notify Program Coordinator of client inactivity. If the home visitor has not been able to reach a client they must notify the Program Coordinator by the fourteenth (14) day. Home Visitors i Contractor will provide the City with following information for each home visitor: • Name • Address • Phone number • E-mail address • Days and times available for home visits • Number of hours they are able to commit Home Visitors are required to wear identification while conducting home visits Switchboard of Miami Registration Contractor agency will register with Switchboard of Miami to ensure that agency information is accurate and updated. This contractual obligation is directed by The Children's Trust. Agency registration can be done at the following website: www.switchboardmiami.org Additional Documentation The following documentation must be submitted with this executed agreement: • All required insurance certificates • Copy of current audit • Copy of required business licenses and permits i City of Miami Beach-MARIA CASTILLO Page 16 of 18 Parent-Child Home Program EXHIBIT "B" INVOICING The Contractor agrees to provide the invoicing and services documentation as indicated in the Monthly Invoice Report, as attached to this Exhibit, by the third (3�d) of the subsequent month. City of Miami Beach-MARIA CASTILLO Page 17 of 18 Parent-Child Home Program EXHIBIT 66C99 ATTACHMENTS The following documents are attached: • Home Visit Report form • Home Visit Attendance Sheet • Home Visit Observation Checklist • Evaluation of Child Behavior Traits • Evaluation of Parent and Child Together • Home Literacy Activity Survey • Home Safety Checklist City of Miami Beach-MARIA CASTILLO Page 18 of 18 Parent-Child Home Program I Office of Community Services/Grant Reimbursement Request Grant Name Funder Parent-Child Home Program The Children's Trust Contract Number Awarded Amount 1428-1090 Reporting Period Initials Expended Thus Far $ - Available Balance $This Request $ - Balance Remaining $ - Fiscal Summary Line Item Category Unit Cost #of Units Category Total Previous Requests Balance Available This Request 1. ____ ...........__ ___ ..._ ._._. Home Visits $ 31.50 $ - $ - $ - $ - 0 TOTALS $ - $ - $ - $Documentation - Not Documentation Submitted Submitted Service delivery documentation List of clients served and services provided Leverage/Match Staff Member Hourly Rate Hourly Benefits #of Hours Line Total $ - 0 $ - Space&Other in-Kind Value/Unit Cost Unit Quantity Line Total I certify that the information provided above is accurate to the best of my knowledge and that I have included all documentation required to ascertain the delivery of services as delineated in our contract with the City of Miami Beach. Signature of Authorized Agency Representative Date Date Received . Amount Authorized for Reimbursement HOME • 'D ;FCh #d's=Name . ,k U..I a Home Visitor's dame Pai :rc .atirtAdi�t herr+�sen ���Notesl�ond�rns. Have$there'bee��`an�r,signf�car���ohar� e���s��ce yout`t�1as��vts�t�:�l�sclude��famil�- z�� , change, �IlnessChospifCttlon,fob changes,.schoollchildcae charges;chrsc resderce,pane' number, schecuiin b k < Rate the agent's level of ver aC interaGt�on ittr tie child Ffi hfi lit rune k. t ❑ Almost none ❑ Small ❑ Moderate ❑ Large _.. ... y Rate the parent`s Level of e_neourager er�f sr p?ortr'4f the Child f-{Ig ❑ Almost none ❑ Small ❑ Moderate El Large ldentifj strengths of the"parertt/Gh ldlfac t l�r that�e �ob'senred dut in this v�s�fi and ar g as thaf yQU�rQuld. a r /�i>/'� `; {yam{ ;;�/e^�+ .��++.. S�X�� s�'2Y. ¢i � "a�Fp, ✓es W�� r �- � C� like fob\JLIS©n 3E1 r.f,LFtiir�r 7(�t7)�7 Y R . 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S= S= C 1= a a a 41 aJ a) a) Q1 a) aJ U >, a a'[' a t]J a1 N fa f6 ca fa ca �,.:, fa (a (a ra ca fa ca ° Ln L Agency: Contract Number: The ChildreKsTrust Client Name: Date: Home Literacy Activities* Please tell me how many times in the past week you or someone in your household have done any of the following: How many times in the past week have you or ENTER NUMBER OF someone in your household... TIMES PER WEEK 1 . Read to [CHILD]? 2. Told [CHILD] a story? 3. Taught [CHILD] letters, words, or numbers? *To be collected at Enrollment (First month of contract year for Carryover participants) and EVERY SIX (6) MONTHS thereafter. �%j Uri fret coalifi Miami The ChildredsTmst HOME SAFETY CHECKLIST Participant Name: ID: Date: Staff Name: -ghokes(Please citc Do you ever travel with a child in a car without a car seat or a Yes No booster seat? (1) 1 Too many I am going My child If the answer is Yes,why? (1) I don't people in the only a short complains have one car distance about it 2 Do older children and adults sometimes ride without using a Always Frequently Sometimes Never booster or seat belt in a car? (include back and front seats) (1) Airway Obstructer JSuffocoflco;strangulafton,choking) Answer choltes(Please circle one) 3 Does your baby sleep in a crib? (0) Yes No Does your baby ever sleep on a waterbed,adult bed, 4 Yes No beanbag chair or sofa? (1) Is the sleeping area kept simple-without soft blankets, 5 Yes No bumpers, pillows,and stuffed toys? (0) 6 Is your baby put to bed on his/her back to sleep? (1) Always Frequently Sometimes T Never Are there curtains or cords dangling or looped near the crib, Yes No playpen,or other areas of the house? (0) Which of the following objects might young children try to put in Pins Balloons Baggies $ their mouths that could cause them to choke I () Coins All of the above None of the above Do you ever get down on the floor of your house and look for 9 potential choking hazards (such as pins, balloons, Baggies, Always Frequently Sometimes Never coins)? (1) 10 Do you check your child's toys for small parts that can fit in their Always Frequently Sometimes Never mouth? (1) e utbokes(Please clmle dne.} Because drowning can happen in seconds,young children should not ever be alone in the water,but some parents have been tempted to "leave for a second" to answer a phone,a 11 doorbell or get something they forgot. What do you do to avoid leaving even for a second? (1) Home Visitor's rating of parent's response (Appropriate response: I don't ever leave my child in the tub alone no matter Very appropriate Somehow Not appropriate what) appropriate If there is a pool or a hot tub on your property, Is access limited 12 through gates, door alarms, door locks or door knob covers? (1) Yes No N/A If there is a fence or other barrier around the pool,are there 13 chairs or other items nearby a child can climb to get over the Yes No N/A fence? (0) (0) Indicates the item should ideally be answered based on the home visitors Observation. (1) Indicates the questions should be asked to the parent verbatim on an Interview format. h%jurg Free cocilifior, The ChildredsThist Miami fires sums Asir o �sPl + iicfe ae 14 When was the last time you checked if your smoke detector Last Last 6 months A year I can't works? (1) week month ago ago remember 15 When was the last time you changed the batteries in your Last Last 6 months A year I can't smoke detector? (1) week month ago ago remember Ask parent to demonstrate which stove burners are commonly 16 used and how pot handles are placed. Are pot handles turned Yes No toward the back of the stove? (0) Have you checked the temperature of the hot water where you Yes No live? (1) 17 What is the recommended temperature setting for water heaters to avoid water burns? (1) HV's rating of response (Appropriate response: 120 Fahrenheit) Very appropriate Somehow Not appropriate Appropriate Do you test the water prior to bathing the child? (1) Yes No 18 If yes, How do you check it? (1) Somehow HV's rating of response (Appropriate response:'use wrist/hand) Very appropriate Not appropriate _. .. Appropriate 19 Does anyone in the house ever fall asleep smoking? (1) Yes No >. a _k tar o ra b ect A� � (Ple st circle cane %. Is there a safe place (such as a crib, playpen,high chair, or 20 stationary activity center) to place the baby when he/she is not Yes No being held? (0) Are heavy urniture entertainment centers,cabinets on which 21 � ( Yes No kids can climb) braced securely? (0) 22 Stairways have gates (for infants and toddlers) and handrails (0) Yes No N/A 23 Do the high chair and sitting toys have a waist and a crotch Yes No N/A strap? (0) 24 Do you leave the baby alone on tables or beds,even for a brief Always Frequently Sometimes Never moment? (0) A4ftwq dices Please circle one) Are all medicines cleaning supplies,make-up,adult beverages 25 (alcohol and energy drinks),art supplies stored up high and out Yes No of reach of children or in a locked cabinet)? (0) 26 Are emergency numbers (i.e. Poison Control 1800-222-1222) Yes No posted on/by your phone? (0) Gun Safe*--frovenfion Education ONLY °r Ans o c -ces(Please circle one) Age-appropriate gun safety statistics and prevention education 27 were provided (including access,storage, locks,separate Yes No ammunition, etc.) from a ceAn v r Gen (Please circle one) 28 Do you check for/ask about safety hazards in homes of friends Always Frequently Sometimes Never or relatives where your child may play? (1) (0) Indicates the item should ideally be answered based on the home visitors Observation. (I) Indicates the questions should be asked to the parent verbatim on an Interview format.