PSA with Allyn Bernstein -I -. s
PROFESSIONAL SERVICES AGREEMENT
BETWEEN THE CITY OF MIAMI BEACH, FLORIDA
AND ALLYN BERNSTEIN
FOR CHILD AND FAMILY SERVICES
RELATED TO THE CITY'S SERVICE PARTNERSHIP INITIATIVE
This Agreement is entered into on this 51'd day of ��r��r 201
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between ALLYN BERNSTEIN (Contractor), and the City of Miami Bach, Florida
(City), for a period of one year, with an effective starting date of 1.54 day of
40 u G r v 20-&and an end date of July 31, 2014 (the Term).
1. SCOPE OF WORKJSERVICES.
This Agreement is for the purpose of providing services related to the City's Success
University/Miami Beach Service Partnership initiative to the City's Real Estate,
Housing, & Community Development Department. Specifically, throughout the Term
of this Agreement, Contractor shall provide and/or perform the following minimum
services:
The Contractor will provide oversight of the Suspension Diversion activity and
School Liaison personnel in accordance with The Children's Trust Miami Beach
Service Partnership 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,
Neighborhood Services Department, Office of Community Services, Division Director.
2. FEE & COMPENSATION.
In consideration of the work and/or services to be provided pursuant to this
Agreement, the City agrees to pay Contractor a fee, in the not to exceed amount of
Nine Thousand Dollars ($9,000.00), which shall be paid as follows:
Compensation shall be issued at a rate of Seventy-Five Dollars ($75.00) per
each hour worked for up to one hundred twenty (120) hours, for a maximum not to
exceed Nine Thousand Dollars ($9,000.00).
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".
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Miami Beach Service Partnership
Notwithstanding the preceding, Contractor's total compensation during the
term of this Agreement shall not exceed the maximum allowable sum of Nine
Thousand Dollars ($9,000.00).
2.2 INVOICING
Contractor shall submit bi-weekly Time Sheets and Reimbursement Requests, as set
forth in Exhibit "B", which include an itemized, detailed description of the Services, or
portions thereof, provided (including the clients served) and cost(s) for same.
Invoices and supporting documentation shall be submitted to Maria Ruiz, Division
Director, Office of Community Services, 1700 Convention Center Drive, Miami
Beach, Florida, 33139.
2.3 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.
3. WORK SCHEDULE
During the Term of the Agreement, Contractor shall provide the work and/or services
in accordance with the following minimum work schedule:
Contractor is expected to work a minimum of eight (8) hours each week. Contractor
may schedule their work hours to their availability, upon approval by the City.
Contractor's work and/or services shall be overseen by the following City
Department/Individual: Maria Ruiz, Division Director, Office of Community Services,
1700 Convention Center Drive, Miami Beach, Florida, 33139.
4. TERMINATION
This Agreement may be terminated for convenience of either party, with or without
cause, by giving written notice to the other party of such termination, which shall
become effective upon fourteen (14) days following receipt by the other party of the
written termination notice. Upon termination in accordance with this paragraph, the
Contractor shall be paid a sum equal to all payments due to him/her up to the date of
termination; provided Contractor is satisfactorily continuing to satisfactorily perform all
work and/or services up to the date of termination. Thereafter, the City shall be fully
discharged from any further liabilities, duties, and terms arising out of, or by virtue of,
this Agreement.
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5. IDEMNIFICATION/HOLD HARMLESS
Contractor agrees to indemnify, defend, 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, attorney's 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
or omissions or other wrongful conduct of Contractor, and/or any and all
subcontractors, employees, agents, or any other person or entity acting under
Contractor's control, in connection with the Contractor's performance of the work
and/or services pursuant to this Agreement. Contractor shall pay all such claims and
losses and shall pay all costs and judgments which may arise from any lawsuit
arising from such claims and losses, and shall pay all costs and attorney's fees
expanded by the City in defense of such claims and losses, including appeals. The
parties agree that one percent (1%) of the total compensation to Contractor for
performance of the work and/or services under this Agreement is the specific
consideration from the City to Contractor for the Contractor's agreement to indemnify
and hold the City harmless, as provided herein. Contractor and the City hereby
agree and acknowledge that this indemnity provision is intended to and shall survive
the termination (or earlier expiration) of this Agreement.
6. LIMITATION OF LIABILITY
The City desires to enter into this Agreement only if in so doing the City can place a
limit on 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 the compensation/fee to be paid to Contractor pursuant to this
Agreement, less any amounts actually paid by the City as of the date of the alleged
breach. Contractor hereby expresses his willingness to enter into this Agreement
with Contractor's recovery from the City for any damage action for breach of contract
to be limited to a maximum amount equal to the compensation/fee to be paid to
Contractor pursuant to this Agreement, less any amounts actually paid by the City as
of the date of the alleged breach. Accordingly, and notwithstanding any other term or
condition of this Agreement, Contractor hereby agrees that the City shall not be liable
to Contractor for damages in the amount in excess of the compensation/fee to be
paid to Contractor pursuant to this Agreement, less any amounts actually paid by the
City as of the date of the alleged breach, 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 subparagraph or elsewhere in
this Agreement is in any way intended to be a waiver of the limitation placed upon
City's liability as set forth in Section 768.28, Florida Statutes.
7. NOTICES.
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Miami Beach Service Partnership
All 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, postage prepaid (or airmailed if addressed to an
address outside of the city of dispatch).
Until changed by notice in writing, all such notices and communications shall be
addressed as follows:
TO CONTRACTOR:
Allyn Bernstein
1551 Harbour Side Drive
Weston, FL 33326
954-817-7092
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
8. VENUE.
This Agreement shall be governed by, and construed in accordance with, the laws of
the State of Florida, both substantive and remedial, without regard to principles of
conflict of laws. The exclusive venue for any litigation arising out of this 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, CITY AND CONTRACTOR EXPRESSLY WAIVE ANY RIGHTS
EITHER PARTY MAY HAVE TO A TRIAL BY JURY OF ANY CIVIL LITIGATION
RELATED TO, OR ARISING OUT OF, THIS AGREEMENT.
9. DUTY OF CARE/COMPLIANCE WITH APPLICABLE LAWS.
With respect to the performance of the work and/or service contemplated herein,
Contractor shall exercise that degree of skill, care, efficiency and diligence normally
exercised by reasonable persons and/or recognized professionals with respect to
the performance of comparable work and/or services.
In its performance of the work and/or services, 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.
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The Contractor agrees to adhere to and be governed by the Miami-Dade County
Conflict of Interest Ordinance, as same may be amended from time to time; and by
any and all ethics/standards of conducts as referenced in Chapter 2 of the City of
Miami Beach Code (as may be amended from time to time).
Contractor covenants that it resent) has no interest and shall not acquire an
presently q Y
interest, direct or indirectly which should conflict in any manner or degree with the
performance of the work and/or services. Contractor further covenants that in the
performance of work and/or services under this Agreement, no person having any
such interest shall knowingly be employed by the Contractor. 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.
10. FLORIDA PUBLIC RECORDS LAW.
Contractor agrees to be in full compliance with Florida Statute 119.0701 including,
but not limited to, agreement to (a) Keep and maintain public records that
ordinarily and necessarily would be required by the public agency in order to
perform the services; (b) provide the public with access to public records on the
same terms and conditions that the public agency would provide the records and at
a cost that does not exceed the cost provided in this chapter or as otherwise
provided by law; (c) Ensure that public records that are exempt or confidential and
exempt from public records disclosure requirements are not disclosed except as
authorized by law; (d) Meet all requirements for retaining public records and
transfer, at no cost, to the public agency all public records in possession of the
contractor upon termination of the contract and destroy any duplicate public records
that are exempt or confidential and exempt from public records disclosure
requirements. All records stored electronically must be provided to the public
agency in a format that is compatible with the information technology systems of the
public agency.
11. ® NDERSHIP OF DOCUMENTS/PATENTS AND COPYWRIGHTS.
Any and all documents prepared by Contractor pursuant to this Agreement are
related exclusively to the work and/or services described herein, and are intended or
represented for ownership by the City. Any re-use distribution, or dissemination of
same by Contractor, other than to the City, shall first be approved in writing by the
City Manager, which approval, if granted at all, shall be at the City Manager's sole
and absolute discretion.
Any patentable and/or copyrightable result arising out of this Agreement, as well as
all information, specifications, processes, data and findings, shall be made available
to the City, in perpetuity, for public use.
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No reports, other documents, articles or devices produced in whole or in part under
this Agreement shall be the subject of any application for patent or copyright by or
on behalf of the Contractor (or its employees or sub-contractors, (if any) without the
prior written consent of the City Manager, which consent, if given at all, shall be at
the Manager's sole and absolute discretion.
12. NO ASSIGNMENTITRANSFER.
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13. LIABILITY FOR SUB-CONTRACTORS.
Contractor shall be liable for its work and/or services, responsibilities and liabilities
under this Agreement and the services, responsibilities and liabilities of any sub-
contractors (if any), and any other person or entity acting under the direction or
control of Contractor (if any). When the term "Contractor" is used in this
Agreement, it shall be deemed to include any sub-contractors (if any) and/or any
other person or entity acting under the direction or control of Contractor (if any). All
sub-contractors (if any) must be approved in writing by the City Manager prior to
their engagement by Contractor, which approval, if granted at all, shall be at the City
Manager's sole and absolute discretion.
14. INDEPENDENT CONTRACTOR/NO JOINT VENTURE.
THIS AGREEMENT SHALL NOT CONSTITUTE OR MAKE THE PARTIES A
PARTNERSHIP OR JOINT VENTURE. FOR THE PURPOSES OF THIS
AGREEMENT, THE CONTRACTOR SHALL BE DEEMED TO BE AN
INDEPENDENT CONTRACTOR, AND NOT AN AGENT OR EMPLOYEE OF THE
CITY, AND SHALL NOT ATTAIN ANY RIGHTS OR BENEFITS UNDER THE CIVIL
SERVICE OR PENSION ORDINANCE OF THE CITY, OR ANY RIGHT
GENERALLY AFFORDED CLASSIFIED OR UNCLASSIFIED EMPLOYEES
INCLUDING ANNUAL AND SICK DAY ACCRUAL. FURTHER, THE
CONTRACTOR SHALL NOT BE DEEMED ENTITLED TO FLORIDA WORKER'S
COMPENSATION BENEFITS AS AN EMPLOYEE OF THE CITY OR
ACCUMULATION OF SICK OR ANNUAL LEAVE.
15. WAIVER OF BREACH.
A party's failure to enforce any provision of this Agreement shall not be deemed a
waiver of such provision or modification of this Agreement. A party's waiver of any
breach of a provision of this Agreement shall not be deemed a waiver of any
subsequent breach and shall not be construed to be a modification of the terms of
this Agreement.
16. SEVERANCE.
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In the event this Agreement or a portion of this Agreement is found by a court of
competent jurisdiction to be invalid, the remaining provisions shall continue to be
effective unless City elects to terminate this Agreement.
17. JOINT PREPARATION.
The parties hereto acknowledge that they have sought and received whatever
competent advice and counsel as was necessary for them to form a full and complete
understanding of all rights and obligations herein and that the preparation of this
Agreement has been a joint effort of the parties, the language has been agreed to by
parties to express their mutual intent and the resulting document shall not, solely as a
matter of judicial construction, be construed more severely against one of the parties
than the other.
18. PURCHASE ORDER REQUIREMENT.
This agreement shall not be effective until executed by the parties hereto and until
the City has issued a Purchase Order for this agreement.
19. ENTIRE 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.
20. 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, 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
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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.
21. ACCESS TO RECORDS
Contractor agrees to allow access during normal business hours to all records
including, without limitation, Contractor's financial records, to the City and/or its
authorized representatives, and agrees to provide such assistance as may be
necessary to facilitate audit by the City and/or its representatives, when and as the
City Manager, in his sole and reasonable discretion, may deem necessary to ensure
compliance with the provisions of this Agreement including, without limitation, as
they pertain to any financial audits (with applicable accounting and financial
standards). Contractor shall allow access during normal business hours to any and
all records, forms, files, and documents which have been generated in performance
of this Agreement, by the City and/or its authorized representatives.
22. 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
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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.
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City of Miami Beach-Allyn Bernstein Page 9 of 18
Miami Beach Service Partnership
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed by
the respective officials thereunto duly authorized, this date and year first above written.
FOR CITY: CITY OF MIAMI BEACH, FLORIDA
ATTEST:
By: Z. _
City Clerk INCORP OWED:: i City Onager
FOR CONTRACTOR: 2 LLYN BERNSTEIN
WITNESS:
By:
Signature
Print Name
By: 9tLYA) v
Print Name/Title
Print Name
Approved: Approved as to form & language &
fo xecution.
Departmen ector -City Attorney Date
naA
Offic Budget and Performance Improvement
uman Resour
-, A
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EXHIBIT «A»
"SCOPE OF SERVICES"
The Contractor agrees to provide the following .services to youth referred to the
Success University program:
Service Uln its of Documentation of
Service
Suspension Diversion Per • Daily report of successes and challenges at program
Supervision diem activity
Recommendations for program improvement
• Recommendations for academic improvement
School Liaison 10 • Observation and review of each School Liaison, a
Supervision minimum of two times per individual
Recommendations for improved performance
Related Definitions:
Suspension Diversion Supervision — Supervision of the Suspension Diversion
activity includes oversight of the activity operations, transitions, and direct service
providers, as follows:
• Suspension Diversion Teacher
• Restorative Justice Facilitator
• Suspension Diversion schedule
School Liaison Supervision — The supervision of School Liaisons includes
observation of the services provided by each of the four (4) individuals working in this
capacity, a minimum of two sessions each. Activities taking place during the
observation shall include Recruitment services, Intake (Initial Assessment), and/or
Student Tracking & Follow-Up Services. The School Supervisor will check for
program fidelity, client engagement, and accurate record taking. The School
Supervisor will issue a report, to include notation of any areas of concern,
recommendations for improvement, and strengths.
Recruitment Services — Recruitment services encompasses the identification of
prospective clients, initial contact with prospective clients, and scheduling of Intake &
Enrollment meeting. Recruitment may involve prospective client home visits, done in
conjunction with a City employee. Recruitment may also include community outreach
efforts, obtaining potential client school records, communication with teachers and
school staff on behalf of the City and Success University program, composing
Connect Ed messages, sharing program information on school announcements, and
other activities which will increase enrollment in Success University.
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. Client eligibility must
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be determined during or before the Intake. The Intake must include the establishment
of an appointment for the client Care Coordination Assessment; if no appointment is
provided, the service will not be considered complete.
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.
Student Tracking & Follow--Up Services — This activity entails the weekly
submission of a database which reports on the client's attendance and disciplinary
referrals. Attendance & Behavior Tracking may also include satisfying requests for
reports on specific students, should additional information be required. Follow-up
services include ongoing relationship development with clients, as needed, and may
also include outreach to clients/parents with whom communication has become
challenging for other program staff.
Additional information is provided in Exhibit D.
Referrals — Referrals address 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 or 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.
Additional information is provided in Exhibit D.
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.
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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
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:
• 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.
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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)
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.
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.
Promotion & Public Relations Requirements
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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 promote the City's Success University program whenever
possible.
The Contractor agrees to attend the Miami Beach Service Partnership Governing
Board meetings, held monthly.
Training Requirements
Personnel providing services under in this Contract will be required to complete the
following trainin s prior to service provision, as delineated below:
School Liaison Services ❑ Program Overview Training
❑ Intake (Initial Assessment) Training
❑ Community OS Software Training
❑ Suspension Diversion Training
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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
• Referral Form
• Service Evaluation Form
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EXHIBIT 66C9!
INVOICING
The Contractor agrees to provide the invoicing and services documentation as
indicated utilizing the following forms attached herein:
• Time Sheet Form; and
• Reimbursement Request
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EXHIBIT 6613"
ATTACHMENTS
The following reference documents are attached:
• 2013/14 Success University Client Path
• 2013/14 Success University Provider Path
• FAQ Sheet
• TCT Core Contract
• Suspension Diversion Activity Procedures
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