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PSA with Playing the Game of Life, Inc c�)013— ;2,Yi70 PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF MIAMI BEACH, FLORIDA AND PLAYING THE GAME OF LIFE, INC. FOR CHILD AND FAMILY SERVICES RELATED TO THE CITY'S SERVICE PARTNERSHIP INITIATIVE This AGREEMENT made and entered into this 1st day of August, 2013 (effective date: P9 day of J rW14k 1' 1204, 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 PLAYING THE GAME OF LIFE, INC., a non-profit Florida Corporation, (hereinafter referred to as Contractor), whose address is 7144 Byron Avenue, Miami Beach, Florida 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-Playing the Game of Life, Inc. Page 1 of 32 Miami Beach Service Partnership SECTION 2 SCOPE OF WORK (SERVICES) The Contractor will provide the following services in accordance with The Children's Trust Miami Beach Service Partnership Grant, dated August 1, 2013: • Care Coordination Assessment & Plan Development services for up to twenty (20) children and their families; • Care Coordination Plan Review services for up to twenty (20) children and their families; • Care Coordination Plan Check-In services for up to twenty (20) children and their families; • Eight (8) Flexible Care Coordination Plan Check-In services to be utilized in accordance with client Care Coordination Plans, as needed; and • Care Coordination Plan Close-Out services for up to twenty (20) children and their families. 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 Care Coordination Assessment & Plan Development services for up to twenty (20) children and their families at One Hundred Forty Four Dollars and Twenty Cents ($144.20) per each service, for a maximum not to exceed Two Thousand Eight Hundred Eighty-Four Dollars ($2,884); b) Provision of Care Coordination Plan Review services for up to twenty (20) children and their families at Seventy Eight Dollars and Seventy-Five Cents 78.75 per Care Coordination Plan Review, for a maximum not to exceed One Thousand Five Hundred Seventy-Five Dollars ($1,575); c) Provision of Care Coordination Plan Check-In services for up to twenty (20) children and their families, at Twenty-Seven Dollars and Eighty-One Cents ($27.81) per Care Coordination Plan Check-in for a maximum not to exceed Five Hundred Fifty-Six Dollars and Twenty Cents ($556.20); d) Provision of eight (8) Flexible Care Coordination Plan Check-In services to be utilized in accordance with client Care Coordination Plans at Twenty-Seven Dollars and Eighty-One Cents ($27.81) per each service for a maximum not to exceed Two Hundred Twenty-Two Dollars and Forty-Eight Cents ($222.48); and City of Miami Beach-Playing the Game of Life, Inc. Page 2 of 32 Miami Beach Service Partnership e) Provision of Care Coordination Plan Close-Out services for up to twenty (20) children and their families at One Hundred Three Dollars ($103) per each service for a maximum not to exceed Two Thousand Sixty Dollars ($2,060). 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 Seven Thousand Two Hundred Ninety-Seven Dollars and Sixty-Eight Cents ($7,297.68). 3.2 INVOICING Contractor shall submit monthly Reimbursement Requests, Monthly Service Summary Reports, and accompanying Monthly Client Status Lists, as set forth in Exhibit "B", which include an itemized, detailed description of the Services, or portions thereof, provided (including the names of the clients served) and cost(s) for same. Invoices and supporting documentation shall be submitted to Maria Ruiz, Division Director, Office of Community Services, 1700 Convention, Center Drive, Miami Beach, Florida, 33139. 3.3 METHOD OF PAYMENT Payments shall be made within thirty (30) days of the date of invoice, in a manner satisfactory to and as approved and received by the City Manager and/or his designee, who shall be the Division Director, Office of Community Services. 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 City of Miami Beach-Playing the Game of Life, Inc. Page 3 of 32 Miami Beach Service Partnership 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 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 City of Miami Beach-Playing the Game of Life, Inc. Page 4 of 32 Miami Beach Service Partnership 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 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 City of Miami Beach-Playing the Game of Life, Inc. Page 5 of 32 Miami Beach Service Partnership 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 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, at least once during the Contract period. 4.10 ACCESS TO RECORDS City of Miami Beach-Playing the Game of Life, Inc. Page 6 of 32 Miami Beach Service Partnership 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 DATA SECURITY OBLIGATION Contractor shall maintain an appropriate level of data security for the personally identifiable information (PII) Contractor is collecting or using in the performance of this Contract. PH is information that can uniquely identify, contact, or locate a single person or can be used with other sources to uniquely identify individuals. Contractor shall maintain and adhere to a written Data Security Policy that addresses requirements regarding the protection of PH from unauthorized access and protection against data breaches and ensures Contractor is in compliance with applicable federal and state standards with respect to transmission, receipt and storage of PH on Contractor's computing network and as paper records. This policy shall address the topics of computer passwords, screensavers that lock computers, securing physical facilities, storing data, data use, data confidentiality agreements, and staff training related to the policy. Additionally, Contractor is responsible for approving and tracking all Contractor employees who request system or information access and ensuring that user access has been removed from all terminated employees of Contractor. All employees and independent contractors performing work or duties related to this Contract will sign a Data Confidentiality Agreement prior to beginning work related to this Contract. 4.12 INSURANCE REQUIREMENTS 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. Comprehensive General Liability insurance, to include sexual molestation, in an amount not less than $500,000 combined single limit per occurrence and $1,000,000 aggregate in a policy year. Deductibles exceeding $1,000 are discouraged, unless Contractor can provide financial statements to support a higher deductible. The City of Miami Beach must be designated and shown as an additional insured and the certificate holder with respects to this coverage. The general liability policy must contain coverage for the following: City of Miami Beach-Playing the Game of Life, Inc. Page 7 of 32 Miami Beach Service Partnership a. Bodily Injury; b. Property Damage; c. No exclusions for Abuse, Molestation or Corporal Punishment; d. No endorsement for premises only operations. 2. Professional Liability insurance, with coverage amounts not less than $250,000 per claim and in the aggregate. Defense costs may be inside the limits of liability and the policy can be written on claims made form. The City of Miami Beach is not required to be named as an Additional Insured. Professional liability insurance is generally required when the scope of services uses professional services that require certification or license(s) to provide direct services to program participants. 3. Worker's Compensation Insurance covering all employees, non-incorporated independent contractors or consultants, and incorporated independent contractors or consultants that do not have worker's compensation coverage or a valid State of Florida exemption on file with the Department of Labor, as required by Florida Statutes, Chapter 440. In the event that the Contractor is no longer exempt from obtaining Worker's Compensation insurance, the Provider must notify the City of Miami Beach and provide the necessary certificate of insurance upon the termination of the exemption. The employer's liability portion will be $500,000/$500,000/$500,000 as a minimum. 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 sole) responsible for obtaining and submitting all insurance Y p 9 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. City of Miami Beach-Playing the Game of Life, Inc. Page 8 of 32 Miami Beach Service Partnership 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. 4.13 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. 4.14 SUB-CONTRACTORS The Contractor shall be liable for Contractor's services, responsibilities and liabilities under this Agreement, and the services, responsibilities and liabilities of sub-contractors, and any other person or entity acting under the direction or control of Contractor. When the term "Contractor" is used in this Agreement, it shall be deemed to include any sub-contractors and any other person or entity acting under the direction or control of Contractor. All sub-contractors must be approved, in writing by the City Manager, or his designee, prior to their engagement by Contractor (which approval, if granted at all, shall be at the Manager's sole discretion and judgment). 4.15 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. 4.16 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. City of Miami Beach-Playing the Game of Life, Inc. Page 9 of 32 Miami Beach Service Partnership 4.17 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. 4.18 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 or his/her designee. The Contractor's project manager shall be designated following execution of this Agreement by the parties and prior to commencement of the Services. All other notices and communications in writing required or permitted hereunder may be delivered personally to the representatives of the Contractor and the City listed below or may be mailed by registered mail. Until changed by notice in writing, all such notices and communications shall be addressed as follows: TO CONTRACTOR: Playing the Game of Life, Inc. Attn: Jeannette Egozi, Executive Director 7144 Byron Avenue, 2nd floor Miami Beach, Florida 33141 (305) 864-5237 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 4.19 LITIGATION JURISDICTION/VENUE City of Miami Beach-Playing the Game of Life, Inc. Page 10 of 32 Miami Beach Service Partnership 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. 4.20 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. 4.21 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. 4.22 BACKGROUND SCREENING In accordance with Sections 943.0542, 984.01, Chapter 430, 435, 402, 39.001, and 1012.465 Florida Statutes, as applicable, employees, volunteers and subcontracted personnel who work in direct contact with children or who come into direct contact with children must complete a satisfactory Level 2 background screening prior to commencing work pursuant to this Contract. For purposes of this section, the term "direct service provider" means a person 18 years of age or older, including a volunteer, who provides services to children, City of Miami Beach-Playing the Game of Life, Inc. Page 11 of 32 Miami Beach Service Partnership youth and their families. The term does not include volunteers who assist on an intermittent basis for less than 20 hours per month. Level 2 Background screenings must be completed through the Florida Department of Law Enforcement (FDLE) VECHS (Volunteer & Employee Criminal History System) Program. Satisfactory background screening documentation will be accepted for those agencies that already conduct business with either the Department of Children and Families (DCF) or the Department of Juvenile Justice (DJJ) or the Miami Dade County Public School System (MDCPS). A clearance letter from MDCPS Office of Employment Standards indicating the person has successfully completed a Level 2 screening will be accepted. If background screenings are completed with VECHS, then Provider shall complete Attachment E: "Affidavit for Level 2 Background Screenings" each for contract term. The Affidavit will cover employees, volunteers, and subcontractors performing services under this contract who are required to complete a Level 2 background screening as defined in this section. Provider shall keep Attachment E: "Affidavit for Level 2 Background Screenings" in Provider's personnel, volunteers, and sub-contractors files. Provider shall re-screen each employee, volunteer and/or subcontractor every five years. [REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK] City of Miami Beach-Playing the Game of Life, Inc. Page 12 of 32 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 4berk y 4' a Date Date FOR CONTRACTOR: PLAYING THE GAME OF LIFE, INC., A Florida corporation ATTEST: Y' B Title: T' le- r�S "C'e—✓ t ell 2 Print ame P nt Name P �i N 3 -21 Date Date Corporate Seal APPROVED AS TO FORM &LANGUAGE �,. &Fr)R EXECUTION "At t ey � Date y City of Miami Beach-Playing the Game of Life, Inc. Page 13 of 32 Miami Beach Service Partnership EXHIBIT "A99 "SCOPE OF SERVICES" The Contractor agrees to provide the following services to youth referred to the Success University program: §df , . . . Intake (Initial Assessment) 0 Completion and execution of the following documents: • The Children's Trust Adult Info Form • The Children's Trust Child Info Form f • The Children's Trust Photography/Video Release ► Form • Miami Beach Service Partnership Authorization for Release and Exchange of Information • Miami-Dade County Public Schools Consent Form for Mutual Exchange of Information • Miami Beach Service Partnership Attendance Form • Miami Beach Service Partnership Intake (Initial ) Assessment) Form j Review and inclusion of the following documents: ` • ISIS Parent Information j i • ISIS Student Information • ISIS Current School Year Attendance Records • ISIS Prior School Year Attendance Records i i • ISIS Current School Year Grade Report • ISIS Prior School Year Grade Report • ISIS Current School Year Disciplinary Referral i Report • ISIS Prior School Year Disciplinary Report i Issuance of appointment for the following: • Care Coordination Assessment & Plan Development i j Notification email, to be sent from Contractor to j City staff within 72 hours of service delivery. Care Coordination 1 20 Completion and execution of the following documents: Assessment & Plan ; Success University Assessment Form via Development Community OS; • Referral Form(s) with documentation of service j provided via Community OS software and referral authorizations containing original signatures; • Acknowledgement of Service Availability Form; • Attendance form signed by all attendees Issuance of appointment for the following: { I • Family Group Conferencin session inclusive of Y p 9 { documentation of attendees and transportation needs) ► City of Miami Beach-Playing the Game of Life, Inc. Page 14 of 32 Miami Beach Service Partnership Notification email, to be sent from Contractor to City staff within 72 hours of service delivery.. Family Group Conference I 0 Completion and execution of the following documents: • Family Group Conferencing Attendance Form • Family Group Conferencing Action Plan • Family Group Conferencing Confidentiality Agreement Review and inclusion of the following documents: j • Strengths & Concerns Form • Eco-Map Notification email, to be sent from Contractor to City staff within 72 hours of service delivery. Care Coordination Plan 20 Completion and execution of the following documents: Review • Care Coordination Plan, including client(s) and staff signatures with documentation of service provided via ' Community OS software • Care Coordination Plan Case Notes via Community OS software • Parental Stress Scale (PSS):pre-test • Strengths and Difficulties Questionnaire (SDQ): pre- test • For exactly two clients and their families: Adult I Adolescent Parenting Inventory (AAPI): Constructs B i through E:pre-test • Referral Form(s) with documentation of service i provided via Community OS software, if applicable Notification email, to be sent from Contractor to i I City staff within 72 hours of service delivery. Care Coordination Plan 20 Completion and execution of the following documents: Check-In • Updated Care Coordination Plan including staff signatures and client signatures, if applicable, with documentation of service provided via Community OS software I • Care Coordination Plan Case Notes via Community OS software • Referral Form(s) with documentation of service j provided via Community OS software, if applicable Notification email, to be sent from Contractor to City staff within 72 hours of service delivery. Flexible Care Coordination { 8 Completion and execution of the following documents: Plan Check-In Updated Care Coordination Plan including staff signatures and client signatures, if applicable, with documentation of service provided via Community OS software • Care Coordination Plan Case Notes via Community OS software • Referral Form(s) with documentation of service _ provided via Community OS software, if applicable City of Miami Beach-Playing the Game of Life, Inc. Page 15 of 32 Miami Beach Service Partnership Notification email, to be sent from Contractor to City staff within 72 hours of service delivery. j Care Coordination Plan 20 Completion and execution of the following documents: Close-Out • Updated Care Coordination Plan including client and staff signatures with documentation of service i provided via Community OS software • Care Coordination Plan Close-Out Case Notes via Community OS software • Referral Form(s) with documentation of service ' provided via Community OS software, if applicable • Program Evaluation Form completed by all clients • Parental Stress Scale (PSS):post-test 4 E • Strengths and Difficulties Questionnaire (SDQ): post-test j • For the two clients and their families completing the pre-test version of the same: Adult Adolescent j Parenting Inventory (AAPI): Constructs 8 through E: post-test ! I Notification email, to be sent from Contractor to City staff within 72 hours of service delivery.. j Related Definitions: Intake (Initial Assessment)— The Intake provides prospective clients with an overview of Success University and the benefits and expectations of program participation. Parental and client consents required for program participation are executed at this time, enabling the provision of further services. The Intake marks the initial consent for service and establishes the appointment for the completion of the Assessment. A list of forms associated with this service is delineated in Exhibit B. Additional information is provided in Exhibit D. Care Coordination Assessment & Plan Development—The Care Coordination Assessment & Plan Development ("Assessment") documents the natural supports and needs of the client and his/her family. The assessment forms must be completed accurately and completely and submitted to the City, where the client is assigned a number in The Children's Trust's data management system, SAMIS. Assessments must meet the following criteria: • Information collected is documented completely and accurately • Adherence to grammar and spelling rules for the English language • A sincere and thorough effort to understand the client, his/her family, and City of Miami Beach-Playing the Game of Life, Inc. Page 16 of 32 Miami Beach Service Partnership their respective strengths and needs • Effective engagement to ensure that the client and his/her family are informed regarding program services and expectations as well as the means/process by which to access additional services • Full, thorough, detailed explanation of the program, its timeline, what the client and his/her family can expect, and Care Coordination. • All client and family questions are answered completely • All client and family needs have been identified and subsequently addressed via Referral • The factors adversely impacting the primary concern (school attendance, risk of child maltreatment, or prevention of youth violence) have been identified and subsequently addressed via Referral • All Care Coordination goals, steps, and timelines are identified The Acknowledgement of Service Availability must be completed documenting that the client and his/her parent were asked if they needed any additional services beyond those offered. Assessments must be completed within thirty (30) days of referral. The Assessment also includes the issuance of an appointment for a Family Group Conference and the documentation of all invited participants for the conference. The appointment must be documented via Community OS software under the FGC tab. Contractor must make a good faith effort to invite as many participants to the FGC as possible. Additional information is provided in Exhibit D. Referrals — Referrals include the identification of a specific client need and the subsequent identification of a community-based resource and/or strategy to address the need. Referrals must be provided for all service needs recognized in the intake and assessment and for client-initiated requests — especially those that influence the primary concern (school attendance, risk of child maltreatment, or prevention of youth violence). Referrals must be issued with the following client-focused interests in mind: • Is the referral appropriate within the scope of Success University? • Does the referral specifically address the need identified? • Can the client access the services being sought via the referral, and did the Contractor give detailed instruction on how to do so? • Is the agency provided in the referral the most accessible, most appropriate provider for the services needed? • Is the referral culturally appropriate? • Does the client consent to receiving the referral? These referrals must be documented using the Miami Beach Service Partnership Referral Form and via Community OS software. A list and attached forms are found in Exhibit B. City of Miami Beach-Playing the Game of Life, Inc. Page 17 of 32 Miami Beach Service Partnership Additional information is provided in Exhibit D. Family Group Conference — The Family Group Conference expounds upon the information obtained via the Assessment process to focus the natural assets available in and around the child's support network to ensure school attendance, safe communities, supportive families, and personal success as defined by the client and his/her family and friends. The documentation, which is the product of the conference, must include the following at a minimum: • At least three (3) goals identified in the Action Plan • At least twelve (12) strengths have been identified for the child • At least three (3) strengths have been identified for the family Care Coordination Plan Review— The Care Coordination Plan outlines the specific strategies and steps to be taken by the child and his/her family members to address school attendance, the risk of child maltreatment, the prevention of youth violence, and personal and family stability. The plan identifies the issues to be addressed and the respective community-based agencies, natural supports, or general resources that will be harnessed in response. The Contractor will review and discuss with the clients each item listed on the Care Plan individually, and both parties will agree to its terms collectively. Shared decision-making is the crux of this document; as such, the Contractor and client may jointly request changes to the Care Plan, which subsequently must be approved by the City. The Care Coordination Plan Review is conducted in person with, at a minimum, the primary client and one parent or legal guardian present. The contact will document following minimum criteria: • Detailed review of the entire Care Coordination Plan • Progress on the Assessment Referrals is reviewed and documented • All client questions answered in detail • Detailed direction on how to access each item included on the Care Plan is provided (e.g., call for an appointment, address, public transit info, etc.) • The identification of any additional needs or issues were discussed and, when appropriate, referrals were subsequently issued • Outcome measurement tools are explained in detail to the client prior to their completion of the documents • Outcome measurement tools are completed clearly, accurately, and in their entirety A Care Coordination Plan Review is to take place within the following timeframe: • Within fourteen (14) days of the Assessment A list and attachment of appropriate forms are found in Exhibit D Care Coordination Plan Check-/n —A Care Coordination Plan Check-In provides an City of Miami Beach-Playing the Game of Life, Inc. Page 18 of 32 Miami Beach Service Partnership opportunity to monitor the client's progress towards the goals identified via the Care Coordination Plan as well as to identify any new concerns or issues that require action through referral. In addition, a status update on child attendance, risk of child maltreatment, and/or prevention of youth violence, must be included, as appropriate. A Care Coordination Plan Check-In is, at minimum, 45 minutes in length and is conducted in person or by phone. The contact will document following minimum criteria: • Progress on child attendance, risk of child maltreatment, and/or prevention of youth violence is reviewed and documented • Progress on the Care Coordination Plan is reviewed and documented • The identification of any additional needs or issues affecting school attendance, risk of maltreatment, or prevention of youth violence are discussed and, when appropriate, referrals are subsequently issued The Care Coordination Plan Check-In is to take place within the following timeframe: • Seven (7) to twenty-one (21) days of Care Coordination Plan Review A list and attachment of appropriate forms are found in Exhibit B. Flexible Care Coordination Plan Check-in — The Flexible Care Coordination Plan Check-In is identical to the Care Coordination Plan Check-In in scope and documentation. Care Coordination Plan Close-Out — The Care Coordination Plan Close-Out documents the client's successful completion of all items and strategies identified in P g the Care Plan. Conversely, to complete the Care Plan should trigger a referral Y� P gg to an alternate program or exploration of alternate educational options for the client. A Care Coordination Plan Close-Out is conducted in person with both the child/youth client and the client's parent/guardian. The contact will document following minimum criteria: • Progress on child attendance, risk of child maltreatment, and/or prevention of youth violence is reviewed and documented • Completion of the Care Coordination Plan is reviewed and documented • Completion of the Service Evaluation Form by every client • Completion of Attendance Form, signed by all attendees. • Outcome measurement tools are explained in detail to the client prior to their completion of the documents • Outcome measurement tools are completed clearly, accurately, and in their entirety Should the Contractor encounter challenges in meeting the below stated service deliverables within the required timeframes, the Contractor may request an extension. The approval and duration of all extensions are at the sole discretion of the City. City of Miami Beach-Playing the Game of Life, Inc. Page 19 of 32 Miami Beach Service Partnership Service Deliverables Services must be delivered as follows: Intake & Consent 1 for each of up to 0 School or Upon consent of i children/families Client Home client Care Coordination 1 for each of up to 20 Client Home All eligible --! Assessment & Plan children/families Assessments will be I Development completed within thirty (30) days of _ receipt of referral Care Coordination Plan 1 for each of up to 20 Client Home All eligible Care j Review children/families Coordination Plan Reviews will be completed within fourteen (14) days of completed Assessment Care Coordination Plan 1 for up to 20 Client Home All Care Check-in children/families Coordination Plan Check-Ins will be completed within seven (7) to twenty-one (21) days from Care Coordination Plan Review completion Flexible Care Up to 8 total Client Home Flexible Care Coordination Plan Coordination Plan Check-In Check-Ins will be i completed as triggered by client need. I Care Coordination Plan 1 for up to 20 Client Home All Care Close-Out children/families Coordination Plan j Close-Outs will be ` i completed within one hundred eighty (180) days of Assessment. Service Benchmarks Intake (Initial Assessment) - Completed documents as outlined above - Appointment for Assessment City of Miami Beach-Playing the Game of Life, Inc. Page 20 of 32 Miami Beach Service Partnership Care Coordination - Completed Assessment documents as outlined Assessment & Plan above Development - Targeted assessment of primary child concern (truancy, risk of child maltreatment, or youth violence) • Referrals Responding to all Service Needs • Appointment for Family Group Conference Family Group Conference • Family Group Conference documents as outlined above • Reflection of primary child concern in Action Plan (truancy, risk of child maltreatment, or youth violence) • At least three (3) goals identified in the Action Plan • At least twelve (12) strengths have been identified for the child • At least three (3) strengths have been identified for the family Care Coordination Plan - Care Coordination Plan Review documents as Review outlined above • Reflection of primary child concern as driving factor in Care Plan (truancy, risk of child maltreatment, or youth violence) - Deep understanding of the Care Plan by child and parent/guardian -Shared decision-making in Care Plan edit suggestions Care Coordination Plan - Deep understanding of the Care Plan by child and Check-In parent/guardian -Shared decision-making in Care Plan edit suggestions Flexible Care Coordination - Deep understanding of the Care Plan by child and Plan Check-In parent/guardian -Shared decision-making in Care Plan edit suggestions Care Coordination Close- - Care Plan showing at least 76% completion out • Program Evaluation Form completed by each client Service Documentation Services will be deemed as provided when the following documentation is provided within the noted timeframes: • on, Submissio' t - , e Care Coordination - Assessment Form; Three (3) business days Assessment & -Acknowledgement of Service from provision of Plan Development Availability Form; service j • Miami Beach Service Partnership Referral Form(s) i City of Miami Beach-Playing the Game of Life, Inc. Page 21 of 32 Miami Beach Service Partnership iNotification Email, including FGC ! nformation Referrals Miami Beach Service Partnership Three (3) business days Referral Form(s) signed by staff and from the identification of I receiving client(s). client need Care Coordination - Care Coordination Plan Form signed Three (3) business Plan Review i by staff and client(s) days from provision of • Updated Care Coordination Plan, with service changes as required • Related case notes, provided via Community OS I - Notification Email j - Additional Referrals, as required. I Care Coordination - Care Coordination Plan Form signed Three (3) business days Plan Check-In by staff and client(s) from provision of - Updated Care Coordination Plan, with service changes as required Related case notes, provided via Community OS ! • Notification Email • Additional Referrals, as required. Flexible Care ; • Care Coordination Plan Form signed Three (3) business days Coordination Plan by staff and client(s) from provision of ! Check-In • Updated Care Coordination Plan, with service I changes as required • Related case notes, provided via Community OS - Notification Email • Additional Referrals, as required Care Coordination ( - Care Coordination Plan Form signed Three (3) business days Close-Out b staff and clients from provision of Y O - i Updated Care Coordination Plan, with service changes as required - Related case notes, provided via Community OS • Service Evaluation Form • Notification Email • Additional Referrals, as required Penalties for Failure to Perform If the Contractor fails to submit required, accurate documentation in the timeframe allotted two times, the Contractor will forfeit one (1%) percent of the combined billed total for the months in which inaccuracies took place. If the Contractor fails to submit required, accurate documentation in the timeframe allotted three times within the contract period, the Contractor is subject to the cessation of any further client referrals but will be allowed to complete the service City of Miami Beach-Playing the Game of Life, Inc. Page 22 of 32 Miami Beach Service Partnership I units allotted to existing clients. The decision to cease additional referrals rests at the sole discretion of the City. "Required, accurate documentation" may refer to: • Monthly invoices • Monthly narratives • Monthly client lists • Monthly in-kind hours • Client assessments • Referral forms • Family Group Conference documents • Any documents associated with Care Coordination, including Care Plan Certification forms, Care Plan Contact forms, Care Plan Close Out forms, Attendance forms, Service Evaluation forms, and any other documentation related to this Contract. If any individual employed by or independently contracted with the Contractor fails to attend a scheduled client meeting without notifying the City of their impending absence more than once, the City reserves the right to remove that individual from the Contractor's staff roster for the purposes of this Contract. 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 Care Coordination services: • Advise the client and his/her parents and/or guardians of the scheduled appointment for Family Group Conference at the time of the Assessment. • Provide client and his/her parents and/or guardians information regarding the importance of adhering to school attendance policies, if applicable. • 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 or on behalf client via Community OS. Employee/ Contractor File Review City of Miami Beach-Playing the Game of Life, Inc. Page 23 of 32 Miami Beach Service Partnership The following documentation must be included in the employee/contractor file for those employees/contractors providing services under this contract. The following must be included in the employee files: C 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 • Documentation of attendance at one CCDH training • 1-9 Verification on File Monitoring visits will take place within forty-five (45) days of the commencement of services. The City will notify the Contractor a minimum of ten (10) business days notice prior to a monitoring visit. The City of Miami Beach reserves the right to inspdct employee/contractor files with due notice (at least forty-eight (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. 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. At a minimum, the Contractor must obtain evaluation forms from the primary child client and the parent/guardian. The evaluation forms will be provided by the City and must be administered at the following times: • Completion of Family Group Conference • Completion of Care Plan Close Out (program evaluation form) Reporting Requirements The Contractor will provide the City with a Monthly Progress Report and reimbursement request utilizing the City's Reporting and Reimbursement Forms (Exhibit C) by 5:00 PM on the third (3rd) of the following month. A client list detailing the dates, services provided, and clients receiving said services must be included. If City of Miami Beach-Playing the Game of Life, Inc. Page 24 of 32 Miami Beach Service Partnership in-kind hours are being submitted, back-up documentation stating the same must be included. In the event that the third of the month lands on a Saturday, Sunday or holiday, the report must be submitted the following business day. Monthly reports and reimbursement requests will be submitted via any of the following methods: • Electronic mail • Facsimile • Standard mail • Hand delivery Monthly reports will not be considered acceptable unless the following is met: • Forms are completely and accurately filled • Necessary back-up materials are included (client documentation, expense receipts, time logs, etc.) • Reports bear the signature of the person submitting the report on behalf of the Contractor The City will document Contractor service level data and monthly reports via Active Strategy software for inclusion in the monthly report to the Miami Beach Governing Board as well as the City's website. Governing Board Attendance The Contractor is required to have representation at each calendared Governing Board meeting. In the event you 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 for inclusion in the Success University Master Calendar that is distributed to all members of the Miami Beach Service Partnership via Community OS Software. The Master Calendar will be updated daily and distributed to the Partnership via 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. City of Miami Beach-Playing the Game of Life, Inc. Page 25 of 32 Miami Beach Service Partnership Memoranda of Understanding A Memorandum of Understanding (MOU) reflecting the terms of this agreement as well as commitment to the Miami Beach Service Partnership will be provided and updated as necessary. The MOU must be submitted to the City of Miami Beach prior to execution of the service contract and must be executed by the agency Executive Director or Board of Directors Chairperson. ' • • Rationale: : S, core Monitoring &.Performance Reviews The City of Miami Beach reserves the right to inspect, monitor and/or audit the Contractor to ensure.contractual compliance. This includes, but is not limited to: • Review of on-site service delivery • Inspection and review of client, budgetary and employee files (for those employees providing services under this'contract) The monitoring tool provided by The Children's Trust, Community and Neighborhood Services System of Care Programmatic Site Visit Form, will be used to guide inspections and monitoring visits. (Copy included herein.) Monitoring visits will take place within forty-five (45) days of the commencement of services. The City will notify the Contractor a minimum of ten (10) business days notice prior to a monitoring visit. 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 bi- annual basis: • 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: City of Miami Beach-Playing the Game of Life, Inc. Page 26 of 32 Miami Beach Service Partnership Timely and accurate submission of ➢ "0" for failing to submit on time monthly progress report _ ➢ 15" for submitting on time Timely and accurate submissions of ➢ "0" for failing to submit accurate monthly financial reports report with back-up material on time (reimbursement requests) ➢ 15" for submitting accurate report on time Delivery of contracted service units Possible score of 0 to 50 based upon completion of projected service units. I Score is calculated by dividing the completed number of service units by the total number of referred service units. ➢ For agencies providing Care Coordination, possible score of 0 to 40 for completion of projected service units ➢ For agencies providing Care Coordination, possible score of 0 to 10 for completion of Care Coordination plans. Score is calculated by dividing the completed number of Care Coordination plans by the total number of referred Care Coordination clients. Attendance at Miami Beach Service Possible score of 0 to 20: Partnership Governing Board and 10 Points for attendance at Governing related committee(s) meetings Board meetings; 10 points for Committee attendance (In the event that there are no committee meetings scheduled, the value for attendance at the Governing Board meeting will be 20.) Promotion & Public Relations Requirements The Contractor agrees to receive Success University Program Brochures and make them available to 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 City of Miami Beach-Playing the Game of Life, Inc.. Page 27 of 32 Miami Beach Service Partnership Personnel providing services under in this Contract will be required to complete the following trainings prior to service provision, as delineated below: Care Coordination Services: City ❑ Program Overview Training provided trainings ❑ Assessment & Referral Training ❑ Care Coordination Training ❑ Community OS Software Training ❑ Client Evaluation Survey Training Care Coordination Services: Additional ❑ Family Group Conference Audit required trainings ❑ CCDH Disability awareness training Family Group Conferencing Services ❑ Program Overview Training The total training time required under "Care Coordination Services: City provided trainings" is two business days. 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: Program Overview Training $150.00 Assessment & Referral Training $150.00 I Community OS Training _ $150.00 [Client Evaluation Survey Training $150.00 Care Coordination Training $150.00 The Contractor agrees to send at least one representative to attend a City-sponsored grant writing workshop by July 31, 2014. Alternately, the Contractor may submit documentation indicating at least one member of its staff has attended another Grant Writing training in the same period of time. The Contractor agrees to send its Miami Beach Service Partnership Governing Board representative to a City-sponsored board member refresher training at a minimum of once every two years. 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: City of Miami Beach-Playing the Game of Life, Inc. Page 28 of 32 Miami Beach Service Partnership • 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 [REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK] City of Miami Beach-Playing the Game of Life, Inc. Page 29 of 32 Miami Beach Service Partnership EXHIBIT "B" DOCUMENTATION The Contractor agrees to utilize the following forms to document the delivery of services with copies attached herein: • Consent Forms: • The Children's Trust Adult Info Form • The Children's Trust Child Info Form • The Children's Trust Photography/Video Release Form • Miami Beach Service Partnership Authorization for Release and Exchange of Information - Miami Dade County Public Schools Consent for Mutual Exchange of Information • Success University Enrollment Sign-In Sheet • Intake (Initial Assessment) Form • Assessment Form • Referral Form • Care Coordination Plan (Blueprint for Success) • Service Evaluation Form • Acknowledgement of Service Availability Form • Success University Attendance Form City of Miami Beach-Playing the Game of Life, Inc. Page 30 of 32 Miami Beach Service Partnership EXHIBIT 6699 INVOICING The Contractor agrees to provide the invoicing and services documentation as indicated utilizing the following forms attached herein: © Monthly Service Summary Report, and ® Monthly Reimbursement Request Monthly Client Status List City of Miami Beach-Playing the Game of Life, Inc. Page 31 of 32 Miami Beach Service Partnership r EXHIBIT "®" ATTACHMENTS The following reference documents are attached: 2013/14 Success University Client Path • 2013/14 Success University Provider Path FAQ Sheet TCT Core Contract City of Miami Beach-Playing the Game of Life, Inc. Page 32 of 32 Miami Beach Service Partnership