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Amendment No. 1 to the Agreement with Teen Job Corps, Inc.
020 cS—fit 90230 AMENDMENT NO. 1 TO THE AGREEMENT, DATED FEBRUARY 26, 2016, BETWEEN THE CITY OF MIAMI BEACH, A FLORIDA MUNICIPAL CORPORATION, AND TEEN JOB CORPS, INC., A FLORIDA NOT FOR PROFIT CORPORATION (THE "AGREEMENT") This Amendment No. 1 ("Amendment")to the Agreement is entered into this (iay of kl J k 7 2016 ("Effective Date"), by and between the CITY OF MIAMI BEACH ("City") and TEEN JOB CORPS, INC., a not for profit corporation ("Provider"). WITNESSETH: WHEREAS, on July 8, 2015, the City Commission adopted Resolution No. 2015-29080, approving the City's One-Year Action Plan for Federal Funds for FY 2015/2016, which included funding to engage the Provider to provide youth employment opportunities to City of Miami Beach residents within the City limits; and WHEREAS, pursuant to the Agreement, the City agreed to provide Community Development Block Grant funds in the amount of$19,724.58 to the Provider; and WHEREAS,following an annual audit, the worker's compensation insurance rate for Teen Job Corps was recently reduced by $470.21 per year; and WHEREAS, the City desires to amend the Agreement, to allow the Provider to use the additional funds for program supplies. NOW, THEREFORE, in consideration of the mutual promises contained herein,the parties hereby agree to amend the Agreement, as follows: 1. The above recitals are true and correct and are incorporated as part of this Amendment. 2. Exhibit"C"to the Agreement entitled "Budget", is hereby deleted in its entirety and replaced with the attached Exhibit "C". 3. All other terms and conditions of the Agreement shall remain unchanged and in full force and effect. In the event there is a conflict between this Amendment and the Agreement,the provisions of this Amendment shall govern. IN WITNESS WHEREOF, the parties hereto have executed this Amendment No.1 to the Agreement as of the day and year first written above by their duly authorized representatives. TEEN JOB CORPS, INC. a Florida not-for-profit corporation ATT� S PP < a.„.i ,✓.,_J L�LAr'.L /A,,./.1,../A,./`Li 'rue .�s i di S gnature /, 11j A. ��APAai / Deborah Ruggiero, Executive Director . • ame Print Name and Title `..d .� 1 jj , BFq"° CITY OF MIAMI BEACH \• $ a Florida Municipal corporation =.INCORP ORATED: ATTplzi °� ,�QCH•26N'F, j Sign Signature % /� Rafael E. Granado, City Clerk Phili• .' , .. J or Print Name Print - Date APPROVED AS TO FORM & LANGUAGE & FOR EXECUTION E( 006‘,,.c--- (0 2v (L City Attorney ate 0.' F:\RHCD\$ALL\HSG-CD\CDBG\CDBG FY 2015 2016\Public Services\TEEN JOB CORP\CDBG TJC Amendment 1 to CONTRACT FY 1516.docx MIAMBEACH BUDGET CDBG FY 15/16 EXHIBIT"C" Project Budget Sub-Recipient: Teen Job Corps,Inc. Project: Youth Training and Employment Please list all items that will be reimbursed by the City of Miami Beach. Line Item Quantity Unit Cost Line Total Personnel(Employees Only)-List Position Title Salary Supervisor 165 $ 24.00 $ 3,960.00 Salary Youth -February-September 1221 $ 8.05 $ 9,829.05 FICA $ 13,789.05 7.65% $ 1,054.86 Unemployment $ 13,789.05 0.10% $ 13.79 Worker's Compensation $ 13,789.05 4.59% $ 632.92 Other Expenses Insurance 1 $ 1,970.00 $ 1,970.00 Accounting 1 $ 1,793.75 $ 1,793.75 Program Supplies 1 $ 470.21 $ 470.21 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ • $ - Project Total- $ 19,724.58 Budget Amendment Authorization Fund Source: CDBG I Fiscal Year: 15/16 I 0 MIAMI B EAC H Budget Amendment Authorization Sub-Recipient: Teen Job Corps Date of Request: 5/9/2016 Project: Youth Training and Employment Date of Review: 5/9/2016 Summary of Budget Changes Line Item/Funding Category Current Allocation Proposed Allocation Salary Supervisor $ 3,960.00 $ 3,960.00 Salary Yourh $ 9,829.05 $ 9,829.05 FICA $ 1,054.86 $ 1,054.86 Unemployment $ 13.79 $ 13.79 Worker's Compensation $ 1,103.12 $ 632.92 Insurance $ 1,970.00 $ 1,970.00 Accounting $ 1,793.75 $ 1,793.75 Program Supplies $ 470.21 Category Totals $ 19,724.58 $ 19,724.58 Summary of Proposed Changes Teen Job Corps is requesting a decrease on Worker's Compensation due to rate change of$470.21 and increase to Program Supplies for$470.21. Staff Recommendation Program Monitor: Omar Barrera Recommendation: Approved as Proposed Director: , Maria Ruiz Recommendation: .S 4 j j SS7io O Cd. Conditional Changes for Approval City Manager's Authorization L A endment Ap! roved El Amendment Denied �. Sell /14 Jimm . Moral s,City Manager Date Housing Division to riAt ONNENSC ASSOCLllO LY� ,AIM LM�[RN'RNINC ISSaCIA710N,INC. 2420 LARBDSONT AVE STE 200 WORKERS COMPENSATION ORLANDO FL 32814 AND EMPLOYERS LIABILITY POLICY TEEN JOB CORPS INC 7356 GARY AVE MIAMI BEACH FL 33141 INSURER: FLORIDA W.C. JUA Acknowledgement is hereby made that the change document designated below has been cancelled in accordance with your request. This acknowledgement is given only by the Company or Companies which issued the policy designated . below. POLICY NUMBER: (6FR13UB-2852C28-8-15) EFFECTIVE DATE: 12-18-15 CHANGE EFFECTIVE: 03-07-16 CHANGE NO.: 2 ISSUED: 03-11-16 ISSUE DATE: 05-04-16 PRODUCER&CODE OFFICE BLUE OCEAN INSURANCE INC 78CMB FLORIDA WC JUA 821 KF ST ASSIGN: FL WUNT5I95 Page 1 of 1 74 q FLORIDA WORKERS'COMPENSATION WORKERS COMPENSATION No JOINT UNDERWRITING ASSOCIATION,INC. AND EMPLOYERS LIABILITY POLICY ENDORSEMENT FWCJUA 04 05 POLICY NUMBER: (6FR13UB-2852C28-8-15) FWCJUA POLICY CHANGE NOTICE ENDORSEMENT INSURED'S NAME: TEEN JOB CORPS INC CHANGE EFFECTIVE DATE: 121815 THIS CHANGE IS ISSUED BY THE FWCJUA AND FORMS A PART OF THE POLICY. IT IS AGREED THAT THE POLICY IS AMENDED AS FOLLOWS: THE FOLLOWING CHECKED ITEM(S) IS CHANGED BY THE ATTACHED ENDORSEMENT(S) (see checked item(s) below): ❑Insured's Name (WC 89 06 01) :Item 3.B. Limits (WC 89 06 12) ['Policy Number(WC 89 06 02) ['Item 3.C. States (WC 89 06 13) ❑Effective Date (WC 89 06 03) El Item 3.D. Endorsement Numbers (WC 89 06 14) ❑Expiration Date (WC 89 06 04) El Item 4. *Class, Rate Other(WC 89 04 15) ❑Insured's Mailing Address (WC 89 06 05) ['Interim Adjustment of Premium (WC 89 04 16) ❑Experience Modification (WC 89 04 06) ❑Carrier Servicing Office (WC 89 06 17) ❑Producer's Name (WC 89 06 07) ❑Interstate/Intrastate Risk ID Number(WC 89 06 18) ❑Change in Workplace of Insured (WC 89 06 08) ❑Carrier Number(WC 89 06 19) ❑insured's Legal Status (WC 89 06 10) CI Issuing Agency/Producer Office Address (WC 89 06 25) ['Item 3.A. States (WC 89 06 11) ❑FL JUA"If Any" Policy Notice (FWCJUA 03 03) ETier and Premium Surcharge Notice(FWCJUA 04 02) THE FOLLOWING ENDORSEMENTS ARE DELETED: Reason for Change: ❑Insured/Producer's Request ©Audit ❑State Mandate ❑UTC-6 ❑Other ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. ADDITIONAL PREMIUM $ 769 RETURN PREMIUM $ NIL A revised schedule is attached for all premium bearing changes. DATE OF ISSUE: 05-04-16 KF CHANGE NO: 004 PAGE: 1 OF 1 POL. EFF. DATE: 12-18-15 POL. EXP. DATE: 121816 OFFICE: FLORIDA WC JUA 821 PRODUCER: BLUE OCEAN INSURANCE INC 78CNB DATE OF ISSUE: 05-04-16 F r1 A FLORIDA WORKERS COMPENSATION JOINT UNDERWRITING ASSOCIATION,INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (6FR13UB-2852C28-8-15) INSURER: FLORIDA W.C. JUA INSURED'S NAME: TEEN JOB CORPS INC PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 010731644 ENTITY CD 001 TEEN JOB CORPS INC 7356 GARY AVE MIAMI BEACH, FL 33141 SIC CODE: 0782 NAICS: 561730 LAWN MAINTENANCE - COMMERCIAL OR DOMESTIC & DRIVERS 9102 54181 4.59 2487 I EXPERIENCE MODIFICATION: NONE MODIFIED PREMIUM $ NONE TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 2487 EXPENSE CONSTANT(0900) 200 0.0200 TERRORISM (9740) 11 TIER 1 SURCHARGE 135 FWCJUA FLAT FEE(9601) 475 TOTAL ESTIMATED PREMIUM 3308 DEPOSIT AMOUNT DUE 3308 DATE OF ISSUE: 05-04-16 KF ST ASSIGN: FL Page 1 of 1 A FLORIDA WORKERS COMPENSATION JOINT UNDERWRITING ASSOCIATION.INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 89 04 15(00)— 001 POLICY NUMBER: (6FR13IIB-2852C28-8-15) POLICY INFORMATION PAGE ENDORSEMENT Item#4 is changed to the following: PREMIUM BASIS Total Estimated Rate Per Code Annual $100 of Estimated Classifications No. Remuneration Remuneration Annual Premium 9102 54181 4.5900 2487 Total Estimated Annual Premium $ Minimum Premium $ Deposit Premium $ ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. DATE OF ISSUE: 05-04-16 ST ASSIGN: FL F�jyl q FLORIDA WORKRS COMPENSATION JOINT U NDE RWRITING ASSOCIATION. INC. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 89 0614(00)— 001 POLICY NUMBER: (6FR13UB-2852C28-8-15) POLICY INFORMATION PAGE ENDORSEMENT Item 3.D. Endorsement numbers is changed to read: ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. DATE OF ISSUE: 05-04-16 ST ASSIGN: FL A ILORRN WORKERSCOARE1EA1EN JOINT UIOERWRRRIC ISSOCWION,INC. 2420 LAKEMONT AVENUE P.O.BOX 3556 ORLANDO, FL 32802-3556 Date of this Notice 05/05/16 Account No. 4046C8078 DIRECT INQUIRIES TO: TEEN JOB CORPS INC FvzCJUA 7356 GARY AVE P.O. BOX 3556 MIAMI BEACH FL 33141 ORLANDO FL 32802-3556 (800) 247-7218 Insuring Company: FLORIDA W.C.JUA REINSTATEMENT NOTICE We are pleased to tell you that your policy has been reinstated. POLICYHOLDER POLICY IDENTIFICATION NUMBER TEEN JOB CORPS INC 2852C288 UB TYPE OF INSURANCE POLICY PERIOD Workers Comp 12/18/15 To 12/18/16 We are pleased to inform you that the policy designated above, previously issued to you, remains in full force as of the original date of issue. The notice of cancellation originally sent to you is hereby withdrawn. Receipt of funds dishonored upon presentment is not a valid means of reinstatement. Reinstatement will only occur when all conditions have been met. If these conditions have not been met the reinstatement will be null and void. 648826R 2016126 8628 821 078CMB CLDRREIN